A Periodontist Can Contour Gum Tissues For A More Beautiful Smile

Posted on Nov 23, 2023 by William J. Claiborne, DDS MS

During the holidays, my wife and I attend gatherings where we occasionally meet new people. A common question, as applies to most of us, is “What do you do?” When I reply that I’m a periodontist, it is often met with a look of not knowing what a periodontist is but not wanting to appear as if that’s the case.

I’d like to explain what “we” are and, from a smile enhancement basis, what we can provide. I typically find that when I say “periodontal plastic surgery” it comes across as far more familiar than “performing gingivectomies.”

A periodontist is a dental specialist who has an advanced level of understanding when it comes to diseases of the oral tissues, reshaping of gum tissues and in the selection and placement of dental implants.

The American Academy of Periodontology defines a Periodontist as:

“A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. Periodontists are also experts in the treatment of oral inflammation. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and are also trained in performing cosmetic periodontal procedures.”

https://www.perio.org/consumer/what-is-a-periodontist

To reach this specialty begins with educational requirements that are extensive. First, there is completion of 4 years of college (for an undergraduate degree) followed by another 4 years in dental school (for a doctorate). To specialize in Periodontics, he or she must further their education for another 3-4 years before completing the stringent requirements for specialty certification in periodontics.

The gums are rather under-rated when it comes to the tremendous role they play in both oral health and even your overall health.

Think of the gum tissues as a protective blanket in the mouth. The gums cover over the structures that support teeth and house the tissues and bone that are vital to our health. For instance, look at the base of each tooth. You’ll see that gum tissues snugly wrap around the base of each tooth. This protective seal is what prevents bacterial penetration beneath the gum line.

When oral bacteria amass to an extent that cannot be controlled by oral hygiene measures at home, they cause inflammation in the gums. In turn, the gums loosen their tight grip around teeth, which allows entry of the now-potent bacteria. These infectious bacteria have been linked to a number of problems related to a long list of serious health problems.

Oral bacteria has been found to trigger or worsen systemic conditions, including atherosclerotic vascular (heart) disease, pulmonary (respiratory) disease, diabetes, pregnancy-related complications (including preterm births), osteoporosis (bone loss), and kidney disease. A shared trait between gum disease and these medical conditions is that they are chronic conditions that take a long time to develop.

https://www.agd.org/docs/default-source/self-instruction-(gendent)/gendent_nd17_aafp_kane.pdf

It is important to be familiar with the signs and symptoms of periodontal (gum) disease, which include:

• Red, swollen or tender gums
• Bleeding while brushing, flossing, or when eating certain foods
• Gums that pull away from the teeth (recede) or make the teeth appear longer than normal
• Loose or separating teeth
• Pus pockets that form between gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way teeth fit together when biting
• A change in the fit of partial dentures

If you have any of these, you are urged to seek a thorough periodontal evaluation as soon as possible. This disease will only worsen without treatment. Gum disease is the nation’s leading cause of adult tooth loss.

Healthy gum tissues do more than serve in a protective role. The appearance of a smile can be greatly affected by the shape and amount of gum tissues exposed when smiling.

When a smile shows too much or too little gum tissue bordering the tops of teeth, it moves the “smile line” out of balance. For example, in a beautiful smile, the arches of gum tissues visible in a full smile flow at a similar height. These gum arches are in a complimentary line to teeth, rather than at varying levels over teeth. When the gum lime is not evenly balanced, it causes a smile to have a jumbled look.

Crown lengthening is performed to reposition the gum tissues to enhance the appearance of a smile. In addition to creating a more appealing look, crown lengthening is also performed to restore the tight seal of protection around teeth. While you enjoy the beauty of your new smile, crown lengthening gives your oral health a boost at the same time.

When the height of gum tissues that show above all teeth in a smile is too high, it is referred to as a “gummy smile.” A gummy smile is not detrimental to your oral health. However, having one does affect the appearance of a smile based on balance. For some people, it makes them “hold back” on a full smile.

This can be corrected with a gingivectomy. To begin, we numb the gum tissues and carefully trim the excess. As a Periodontist, I take specific measures to ensure a natural looking arch remains over the teeth while preserving the natural points that ‘dip’ between each tooth.

A gingivectomy is performed in our Asheville periodontal office with a dental laser. This provides patients with a number of advantages: (1) enhanced comfort; (2) precision lines; (3) minimal or no bleeding; and, (4) faster healing time.

In our Asheville NC periodontal office, we use the highly-advanced LANAP with PerioLase MVP 7 Laser-Assisted Attachment Procedure. This is an advanced protocol that efficiently and effectively treats advanced gum disease (periodontitis) with the added advantages of a dental laser. It is a non-surgical alternative for patients with moderate to severe periodontal disease, causes very little discomfort and has a quick recovery time. It has also been found to stimulate bone regrowth in damaged areas.

In some cases, the crown lengthening procedure can save a tooth from removal. Typically, when a tooth fractures or breaks at the gum line, it must be removed since there is not enough tooth structure to support a crown. However, a crown lengthening procedure may be able to expose more of the tooth’s structure, essentially saving the natural tooth.

For those who have avoided gum treatment due to dental fear, we offer several sedation options, including oral and IV sedation. Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward.

I.V. sedation (also known as “twilight sleep”) places the patient in a deeper sleep state and erases memory of the procedure. Here, anesthesia is overseen by a medical doctor (MD) who is a board certified Anesthesiologist. With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

We help patients understand that their fears and concerns are not unusual. The doctors and staff of our Asheville periodontal dental office respect each patient and provide gentle, compassionate care – at every appointment.

We believe you’ll find no better periodontal dental environment in western NC. Whatever your need for the treatment of gum disease, recontouring of gum tissues, or in the placement of dental implants, call 828-274-9440 to learn more or to schedule a consultation appointment. New patients are always welcome and a referral is not required.

Know How Oral Bacteria Form & Cause Damage

Posted on Nov 07, 2023 by William J. Claiborne, DDS MS

Often, once people understand how something breaks down, they are able to watch for telltale signs or take preventive measures. For example, when the grooves in a vehicle’s tires become more shallow, it’s obvious they need to make arrangements for new tires.

This is true, also, for your oral health. Knowing concerning oral signs and symptoms can help you prevent cavities, periodontal (gum) disease and tooth loss.

Oral bacteria exists in every mouth; some of it is “good” bacteria. The good bacteria are even helpful to the digestive system. However, harmful bacteria can run rampant if not kept under control.

The average mouth houses around 20 billion (that’s billion with a “b”), consisting of about 700 different types. Bacteria breed very quickly. The numbers can grow amazingly fast and their buildup produces a bacterial film that coats the teeth and gums. This is known as plaque.

Plaque is the sticky coating in your mouth, most obvious when you first wake up. When plaque is not removed regularly (through thorough brushing), the bacteria attack tooth enamel. Results include bad breath, yellowed teeth, cavities and tender gums.

Plaque formation actually begins as you chew carbohydrates, which seems to be prevalent in most of the foods we eat in today’s diet. As carbohydrates blend with saliva and existing bacteria in the mouth, an acid is created.

Plaque that is allowed to remain on teeth for about 48 hours hardens. This is known as tartar, which is a mass of bacteria that forms between and at the base of teeth.

Once in this hardened form, removal can only occur with special tools used by your dentist or dental hygienist. This is what your hygienist is scraping off during cleanings. Without tartar being removed, it causes the gums to swell, feel tender and may bleed when brushing. This is typically the initial stage of gum disease, known as gingivitis.

However, for people who brush twice a day and still have tartar formation between dental hygiene appointments, there are factors that may be contributing. Some of these are not common knowledge, which is important to know in your prevention goals. These include:

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Having “dry mouth”: There are a number of reasons that some people suffer with a drier mouth than others. Unfortunately, those who have insufficient saliva flow (which continually helps to cleanse the mouth) are more susceptible to tooth decay from plaque and tartar.

Saliva protects teeth and gums by helping to manage the growth of harmful bacteria while maintaining a neutral pH in the mouth. This slows microbial growth and keeps bacteria from sticking to teeth.

Other contributors to dry mouth include aging, caffeine (including coffee, tea, sodas, and chocolate), smoking, and a wide range of medications (such as antidepressants, decongestants and diuretics).

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Poor oral hygiene: Since the pandemic, normal routines have been uprooted for many people as they have adjusted their “ready for the day” tasks to more casual timetables. Unfortunately, this seems to have left the habitual brushing and flossing times to days where oral hygiene has dropped out of the twice-a-day routine.

A March 2023 poll (conducted on behalf of CeraVe) included 2,000 men between the ages of 18 – 42. They found that only 54% brush their teeth daily (with one-third admitting to only once a day when they do brush). To no surprise, a recent report by the Centers for Disease Control & Prevention reveals that nearly 26% of ages 20 – 44 have untreated dental caries.

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Frequent snacking: Every time you eat or drink, an acid attack begins in the mouth. This acid flows in with saliva to begin the initial stage of digestion. However, this acid is very potent, enough to even soften tooth enamel. So, every time you take a bite of a cookie, acid flows into the mouth and remains there for about 20-30 minutes. When the mouth endures frequent acid attacks from snacking between meals, the damage to precious tooth enamel will catch up to you in the form of cavities.

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In addition to the harm that oral bacteria can cause teeth, the gum tissues – essentially the protective coating to the vital structures that support teeth – endure the rigors of bacterial overload. Eventually, this catches up to most people in the form of:

• Gingivitis – As the initial stage of gum disease, inflammation is triggered by plaque buildup at the gum line. When daily brushing and flossing fail to thoroughly remove plaque, toxins form that cause irritation to the gum tissues. Once symptoms emerge, they may include seeing blood in the sink when brushing or having sore, swollen gums.

• Periodontitis – As the disease advances, the bone structures and fibers that support teeth are damaged by the destruction of infectious oral bacteria. At this stage, pockets form below the gum line, filling with bacteria-laden plaque.

• Advanced Periodontitis – In the advanced stage of gum disease, fibers and bone supporting natural teeth are destroyed. This can cause teeth to shift or loosen, requiring aggressive treatment to prevent tooth loss. Eventually, some teeth may require removal.

Proactive measures NOW can help you avoid costly repairs to teeth, tooth replacement or the treatment process to rid periodontal disease. Start now with:

  –  Brush twice daily, floss every day and maintain regular dental check-ups. Thorough at-home oral care and regular dental check-ups can help you avoid problems from occurring in the first place.

  –  Delay brushing after eating or drinking. Wait 20-30 minutes to allow the acid attack in your mouth to subside. Remember, this acid can soften tooth enamel. The abrasiveness of a tooth brush or tooth paste can wear away precious tooth enamel.

  –  Swish with water. Enjoy a cup of coffee or glass of wine but try to alter these with a glass of water, allowing it to wash over teeth before swallowing. Or, swish with water.

  –  Eat sweets only with meals. Rather than forgo a sweet indulgence as a snack, enjoy your favorites as dessert following your meal since your mouth is already enduring an acid attack. This merely prolongs an acid attack rather than trigger a new one.

A healthy mouth is important for your overall health, as research has shown. We now know that the inflammatory bacteria of periodontal (gum) disease are able to enter the bloodstream through tears in weakened gum tissues. Numerous studies have found this bacteria can trigger harmful reactions.

For example, the bacteria can cause inflammation that sets into motion risks factors connected to arthritis and diabetes. Some cancers have also been correlated to this bacteria. Heart disease, stroke and high blood pressure have been as well. Alzheimer’s is also being studied along these lines.

While there is no clear pathway to verify gum disease bacteria are the “cause” of these serious conditions, research has continually shown they are linked, which can greatly increase one’s potential for having these problems develop (or worsen).

If you haven’t been fully committed to your oral health, there is no better time to begin than the present. Start with a thorough periodontal examination by calling 828-274-9440.

If dental fears have caused you to delay or avoid regular dental care, consider beginning with a consultation. This occurs in a comfortable, private room that is removed from the clinical side of the office. Too, many treatments can include oral or IV sedation (sleep dentistry, or “twilight sleep”).

And, if budget constraints are an obstacle, we offer several payment plans. Most are interest-free with no down payment required (for qualified individuals). Feel free to ask about these during your consultation.

Sources:

www.todaysrdh.com/

perio.org

It’s Flu Season – Why You Should Keep Your Oral Health In Tip-Top Shape.

Posted on Oct 16, 2023 by William J. Claiborne, DDS MS

It’s cold and flu season. Now having weathered the worst pandemic Americans have ever experienced, a new emphasis has taken hold for the need to have flu vaccines and the latest Covid booster.

Vaccines, of course, do not fully eliminate the potential to acquire these health conditions. While they lower the chances of their development, the immune system still relies on our own actions. This includes taking measures to avoid their development in the first place, such as frequent handwashing, eating a healthy diet, mask-wearing in crowds for vulnerable populations, etc.

We learned much about the immune system during the Covid pandemic. And, the need for keeping oral health in good condition became more clear than ever.

During the worst of the outbreak, a 2020 study found that individuals with gum disease who contracted COVID-19 were 9 times more likely to die. And, the study showed that COVID patients who already had periodontitis (the advanced form of gum disease) were 3 times more likely to end up in intensive care or on a ventilator.

Evidence shows, too, that avoiding dental care may actually increase the potential to contract the virus. And, poor oral health can increase its severity, and even fatality rates.
https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13435

This is not only a concern for U.S. citizens, it’s a worldwide wake-up call. About 50% of the world’s population over the age of 30 suffer from periodontitis. Americans aren’t in much better shape – with over 47% having some form of gum disease.

Because gum disease can begin without obvious symptoms, or be present without having pain, it can be easily ignored. This allows the disease to progress further.

This is why dental care is deemed by Congress as “essential healthcare,” as it supports the need for preventive measures for gum disease and tooth loss. As a periodontist, I believe it is also important that Americans understand the signs and symptoms of gum disease as well as the overall health risks it brings.

Although gum disease can exist without obvious indication (typically in the early stage known as gingivitis), warning signs of gum disease usually begin with swollen and tender gums that bleed easily when brushing teeth.

As it worsens, the healthy pink hue of gums darkens to more of a red or purple color and breath odor is persistently bad. The gums begin to loosen their strong grip around the base of teeth, allowing infectious bacteria to reach bone structures that support tooth roots. In advanced stages, pus pockets form near the base of some teeth and gum tissues become spongy in texture.

The bacteria of periodontal disease don’t just damage oral health. This is where there is so much concern throughout the healthcare fields.

Through weakened oral tissues, the bacteria can enter the bloodstream and trigger inflammatory reactions. These reactions can worsen some serious health conditions and even activate others. Research has found correlations between these bacteria and heart disease, stroke, diabetes, arthritis, some cancers (including pancreatic), preterm babies, erectile dysfunction, and Alzheimer’s disease.

With such serious correlations, it should be common knowledge that oral wellness is a necessary part of maintaining good overall health. However, this isn’t necessarily the case. A report commissioned by Delta Dental Plans Association recently revealed concerning information regarding age groups and perceptions of oral health.

With over 1,000 online participants, 87% listed their priority for maintaining proper oral care was to save money or avoid unexpected expenses. Two-thirds of the group listed their commitment to at-home dental hygiene being to avoid tooth decay and gum disease. Yet, only 79% of adults stated they brushed their teeth twice a day with only 33% claiming to floss daily.

In reviewing age groups, the report found that baby boomers (those born between 1946 – 1964) understand there is a strong link between their oral and overall health but are less aware than other generations about the connection between poor dental health and chronic diseases (such as arthritis and diabetes).

Those listed in the Generation Z group (born between 1997 – 2012) showed less commitment to their oral health as the “boomers,” but were more focused on eco-friendly and nontraditional oral care products. Only 76% of Generation Z agreed that oral health is closely connected to overall health.

https://www.deltadental.com/content/dam/ddpa/us/en/state-of-america%27s-oral-health-and-wellness-report/DDPA_State%20of%20Oral%20Health%20Report_2023-Release_FINAL.pdfse-you

If you wear dentures or partials, keeping them clean is an important measure to take to avoid getting sick. Why?

One study (published in the Journal of The American Dental Association) assessed bacteria levels of the porous material that make up the gum base of dentures and partials. In the mouth, it becomes coated with a sticky bacteria known as biofilm.

One study found that wearing dentures while sleeping doubles the risk of pneumonia in elderly adults. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541085/)

It has also been found that this biofilm can harbor MRSA or bacteria that is resistant to antibiotics. It was also found that the bacteria in the biofilm doesn’t just stay in the mouth. It can be inhaled into the lungs where infections become much more difficult to treat. (https://www.nbcnews.com/healthmain/dirty-dentures-dangerous-mrsa-may-be-lurking-dentists-say-662637)

Regardless of age, Americans must maintain a healthy smile in order to support their immune systems. Research shows that oral bacteria are also connected to gut health, so keeping bacteria levels in the mouth in check can go a long way in healthy benefits far beyond the mouth.

For those who have avoided regular dental care due to dental fear or anxiety, we offer several comfort options, including oral and IV sedation.

Oral sedation is a pill that helps patients relax.  I.V. sedation (also known as ‘twilight sleep’) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety with patients closely monitored with advanced safety equipment throughout treatment.

Call 828-274-9440 to arrange an examination appointment or to learn more about our Asheville periodontal dental office.

 

A “Lecture-Free” Look At Cigarettes & Your Smile

Posted on Oct 11, 2023 by William J. Claiborne, DDS MS

In this article, I’m going to address cigarette smoking as it affects oral health. This is not intended to lecture or chastise an adult for making a choice to smoke or those caught up in the addictive grip of nicotine. My goal is to relay factual information regarding oral health for smokers so they can better protect their smiles.

Because I’m a native North Carolinian, I’ll begin by sharing some information on our State, as provided by 2018 stats from the CDC (Centers for Disease Control & Prevention).

In 2018, the percentage of adults in North Carolina who smoked was reported as 17.4% (of every 100 adults). The CDC shared findings of all states, with smoking ranged from nearly 9 of every 100 adults in Utah (9.0%) to 25 of every 100 adults in West Virginia (25.2%).

They also shared that cigarette smoking was lowest among those with a graduate degree (3.2%) and highest for those who had only achieved a GED certificate (30.7%). Those with a high school diploma showed a lower percentage of nearly half of the GED level adults at 17.1%.

As an Asheville periodontal dental specialist, smoking is a particular concern since many people are unaware of the oral health risks. While many smokers are familiar with the risks smoking poses related to cancer and other diseases, smoking is also terribly harmful to your smile.

For instance, smokers have a greater risk of periodontal (gum) disease. The drying effect that smoking has on the soft tissues in the mouth offers an ideal breeding ground for oral bacteria. This enables easier entry of oral bacteria into the structures that support tooth roots.

According to the Centers for Disease Control & Prevention (CDC), a smoker has twice the risk for gum disease compared to that of a nonsmoker.

As oral bacteria thrive and reproduce in the mouth, gum tissues become tender and inflamed. These are signs of gingivitis, the beginning stage of gum disease.

Gum disease at this stage can cause persistent bad breath, swollen gums and gums that bleed easily when brushing. As it progresses, gum tissues turn red or purple from inflammation. Pus pockets may form at the base of some teeth. This advanced stage is known as periodontitis.

Eventually, the infectious bacteria penetrate below the gum line and attack supporting bone and the tissues surrounding tooth roots. This can cause teeth to loosen and eventually require removal. Gum disease is the nation’s leading cause of adult tooth loss.

Losing teeth is detrimental to your overall health and not a normal part of the aging process. Studies have shown that people who wear dentures die an average of ten years earlier than those who keep their natural teeth.

Denture wearers also have higher incidences of pneumonia, and worse. A 2015 report by NBC News shared findings surrounding dentures and MRSA biofilm. The report included a dental specialist’s warning that, “Concern about biofilms on dentures is growing as researchers continue to identify links between oral bacteria and heart disease, chronic obstructive pulmonary disease or COPD, and respiratory diseases, including aspiration pneumonia.”

Many smokers are aware that they have stained teeth and more-frequent bad breath than non-smokers. They also have slower healing periods after procedures such as extractions, gum treatment and oral surgery.

Although a hygienist may go slowly and gently, dental cleanings are typically less comfortable for smokers. This is because smoking causes a greater buildup of plaque. With gum tissues already tender from the bacterial irritation of plaque, removing buildup from between and around the base of teeth adds to the discomfort of inflamed tissues.

According to the American Dental Association (ADA), smoking increases the risks of oral cancer, lesions inside the mouth, enamel erosion and tooth loss in addition to periodontal (gum) disease.

If you vape, remember that nicotine in any form is a hazardous force in the mouth. And the vapor itself is not safe for oral health.

Vaping (using e-cigarettes) delivers nicotine through an inhaled mist. Although the vapor is generally not labeled as “dangerous,” one study of some e-cigarette products found the vapor contains known carcinogens and toxic chemicals, including, propylene or polyethylene glycol, glycerin, and additives. And, its nicotine is no less harmful to the user as that delivered via cigarette smoke.

Unfortunately, many cigarette users switch to vaping based on the perception that “e-cigs” are a safer alternative. For those hoping to wean themselves off cigarettes through this switch, very few achieve that goal as a result.

A 2018 report by the National Academy of Sciences, Engineering, and Medicine concluded there was “evidence that e-cigarette use increases the frequency and intensity of cigarette smoking in the future.”

Although the focus in this article is meant to be on oral health, allow me to reiterate some of the benefits of “kicking the habit” …

• Smokers have a decreased life expectancy of an average of 10–15 years compared to non-smokers.


• Smoking is linked to nearly a third of all cancer diseases and deaths.


• Pregnant women who smoke have a higher risk for first-trimester spontaneous abortion, preterm births, low birth weight babies and sudden infant death syndrome (SIDS).


• Women who smoke are at risk for early menopause while men who smoke are more at risk for impotency.


• People who breathe in your “second hand” smoke (what you exhale) are subjected to over 50 known carcinogens and other harmful chemicals.

For those who are able to give up smoking, the effort is well worth it. The positive effects can be felt almost immediately. In about 48 hours, damaged nerve endings begin to restore. The sense of smell and taste begin to return to normal.

“Quitters” also notice their breathing is easier in about 3 days and they have fuller air intake. Oral health improves within 2 weeks as blood circulation in the gums and teeth returns to nearly that of non-smokers. Heart attack risk also declines with blood flow greatly improving. Activities are easier and the constant smokers cough is gone.

In our Asheville periodontal office, our goal – for every patient – is to help each achieve optimal oral health and a smile he or she is proud to share. For those who smoke, we make individualized recommendations so the potential for achieving this is favorable.

If tooth loss has already occurred, we are specialists in the treatment of all stages of gum disease and in the diagnosis and placement of dental implants. We will be happy to discuss the dental implant system that may be best for your needs.

Or, if dental fear or anxiety have kept you from receiving regular dental care, ask us about oral or IV sedation (“twilight sleep”). These sedatives are delivered by an MD of anesthesia for your optimal safety and comfort. And, in all procedures, we make patient comfort a high priority.

Call 828-274-9440 to schedule an examination.

Sources:

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm#:~:text=This%20means%20an%20estimated%2028.3,with%20a%20smoking%2Drelated%20disease.&text=Current%20smoking%20has%20declined%20from,every%20100%20adults)%20in%202021.

https://www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum-disease.html

https://www.sciencedaily.com/releases/2016/11/161116101821.htm

https://www.nbcnews.com/healthmain/dirty-dentures-dangerous-mrsa-may-be-lurking-dentists-say-662637

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm