Don’t Let Misaligned Teeth Lead To Tooth Loss.

Posted on Feb 25, 2019 by William J. Claiborne, DDS MS

As a periodontist, I have specialized skills in treating all stages of gum disease (known as periodontal disease, or simply “perio” by some). I also have advanced training in the diagnosis and placement of dental implants.

Although my specialty does not cover the advanced training an orthodontist has in bite alignment, my dental education absolutely covered the benefits of having proper “occlusion.” It also covered the repercussions of NOT having a bite that is properly balanced.

Just as an orthodontist can spot telltale signs of gum inflammation, I (along with general dentists and most dental specialists) can see indications of teeth that are not working in unison — even at times when these teeth appear to be “straight.”

While the nation’s number one cause of adult tooth loss is gum disease, having a misaligned bite function (or “malocclusion”) can lead to tooth loss in ways you may not have realized.

For example, during chewing, the upper teeth and lower teeth are designed to work harmoniously together to grind food down for swallowing and digesting. When an upper tooth does not interact smoothly with one below it (or vice versa), a tooth can become chipped, broken or fractured.

When damage to a tooth occurs, it must be quickly repaired before oral bacteria can penetrate tooth structures. Without the protection of enamel, oral bacteria can cause tooth decay and gum disease.

A fracture in a tooth can expand over time, leading to a crack that loosens an entire segment of a tooth. These areas must also be repaired before the tooth is subjected to oral bacteria. This typically requires a crown (or “cap”) that is placed over the top portion of the tooth.

However, a crack in a tooth that extends into the gum tissues typically means the tooth must be removed. If a portion of the tooth breaks “just below” the gum tissue, the tooth can sometimes be saved by a procedure we do called a “crown lengthening.” This is often known as a gingivectomy and is performed to remove excess gum tissues.

A gingivectomy procedure exposes more of the natural tooth so a crown can be placed over the tooth to preserve its remaining structure. (For people who have a “gummy smile,” this is performed, also, to reduce the amount of gum tissue that arches over teeth most visible in a smile.)

Another hazard of bite misalignment relates to dental implants. The overall success rate of dental implants is very high, nearly 98 percent by some estimates (when properly selected, placed and maintained). However, when a newly-placed implant is subjected to the grinding forces of TMJ disorders, its risks for success are much lower.

People are often surprised to learn that they clench and/or grind their teeth at night – primarily due to bite misalignment. When a bite is “off,” the jaw joints can become strained and inflamed. During sleep, the upper and lower jaws go on a subconscious quest of sorts, searching to find a comfortable position that eliminates the strain.

The forces behind some clenching are enough to crack open a walnut. Imagine a newly placed implant that is dependent upon the jaw bones to “heal” it into this firm foundation. When the area of bone around an implant is subjected to night after night of disruption, the implant is against the odds of becoming fully embedded in supporting bone.

Here’s an example: Let’s say you use a screwdriver to firmly anchor a screw into a solid block of wood. However, every day, you use a pair of pliers to grasp the screw head and wriggle it back and forth. Obviously, it wouldn’t take long for the wood surrounding the length of the screw to wear down from the friction of the screw’s motion, even slight as it may seem. Eventually, the screw could be easily moved back and forth and would no longer serve as a dependable base of support.

It’s not unusual for more than one dental specialist to work with another to provide a patient with the combined skills needed in particular cases. I frequently work with other dental specialists and general dentists in a “team treatment” capacity in order to give patients optimal outcomes.

When we place an implant, our goal is for each patient to enjoy its benefits for the remainder of their life. Bite misalignment can jeopardize this. And, if you have all your natural teeth now, be sure to protect them by keeping your gums healthy and ensuring your bite is as well.

After all, every dental professional is on your team when it comes to enjoying confident smiles for a lifetime!

If you’ve noticed indications of gum disease (tender gums that bleed when brushing, for example) or have experienced tooth loss (or fear you are facing it), take charge of your smile now. Call 828-274-9440 to schedule a thorough examination.

Ways To Have A Successful Outcome With Dental Implants

Posted on Jul 16, 2018 by William J. Claiborne, DDS MS

For many individuals who wish to replace one or more missing teeth, dental implants have become the leading preference. Dental implants restore the look, feel, and function like that of natural teeth. They also help to prevent bone shrinkage that occurs when tooth roots are no longer present in the jaw bone.

A periodontist has advanced training in the diagnosis and placement of dental implants. He or she can help you enjoy a higher potential for dental implant treatment that lasts your lifetime. There are a number of reasons you should strongly consider having a periodontal specialist involved in your treatment.

SELECTION OF IMPLANTS – Dental implants come in a wide array of shapes and sizes. Each system is designed to accommodate certain needs and preferences. For example, some implants are designed to support a full arch of teeth while others can be placed in areas where a great deal of bone loss has occurred. The selection of the implant type that is appropriate for your needs and goals requires a unique understanding of all implant types. That is, a periodontist can select the type that will work best for you rather than go with the one or two in which they have received training.

PLACEMENT OF IMPLANTS – In addition to selecting the best type for your needs, proper placement of implants has a great deal to do with having a successful outcome. When an implant that is too long, for instance, is placed in bone that is too shallow, it can have future repercussions that may require its removal. This could occur when a lower implant is placed too close to a nerve that runs horizontal through the jaw bone (mandible). Or, when an upper implant is placed in shallow bone, it can work its way into the sinus cavity. A periodontal specialist considers intricate factors that can effect your potential for success.

STRUCTURAL ISSUES – In addition to the factors involved with bone loss, other issues can ‘make or break’ having a successful treatment outcome with dental implants. For example, for people who have bite misalignment or TMJ disorders, they may be grinding or clenching their teeth during sleep – often unknowingly. Telltale signs of ‘bruxing’ including remaining, natural teeth that are chipped or worn. These forces have been measured to that enough to crack a walnut! When dental implants endure these forces, especially during their ‘healing’ phase, there is greater risk for implant failure. A periodontist considers these issues prior to your treatment, helping you to bypass problems that can result in eventual removal.

INDIVIDUALIZED TREATMENT CONSIDERATIONS – Our goal is to help you get the most from your dental implants. When there are individual habits or preferences that can complicate success, we work with each patient to help them enjoy their dental implants for a lifetime. For smokers, we advise ways to support saliva flow and minimize oral bacteria levels. For people who take certain medications that can interfere with oral moisture, we recommend methods to keep the mouth properly hydrated. And so on. We want to make sure your care is individualized so your potential for implant success is high!

Unfortunately, I have seen a number of patients over the years who have had implants that were improperly placed or chosen. It is a significant loss for the patient when they have to have these implants removed and start all over. Like any procedure, you want your treatment time and investment to be successful and a pleasant experience. We do, too!

If you’ve considered dental implants to replace missing teeth, let’s discuss how a periodontal dental office can enhance your potential to enjoy confident smiles and chewing comfort for your lifetime! Call 828-274-9440 to schedule an appointment.

Is Insurance Coverage Ruling Decisions For A Confident Smile?

Posted on May 22, 2018 by William J. Claiborne, DDS MS

I think we’d all agree that having insurance coverage today is necessary, albeit rather costly. For those who shell out hundreds of dollars each month (or more, based on deductibles and dependents), it can be an investment that gives peace of mind and strains our budgets at the same time. I have friends who pay MORE for health insurance coverage than their monthly home mortgage. Ouch!

Regardless of the type of insurance coverage you have, using its benefits to the max is a yearly goal. Some people have Health Savings Accounts (HSA) to help buffer certain non-covered, health-related expenses. However, because of the monthly costs, it is to no surprise that we monitor treatment accepted to keep our out-of-pocket within covered levels.

Dental insurance was developed to give people some help for typical annual expenses. For many, this includes twice-a-year dental exams and cleanings. Some policies include assistance for an annual crown or filling, and some coverage for periodontal (gum) therapy to treat gum disease. Higher end policies may cover portions of orthodontic treatment (braces) or oral appliances to treat TMJ (jaw joint) disorder.

For smile-conscious individuals, these benefits sound terrific. For an affordable monthly fee, the annual costs for dental care are more budget friendly. But, are they smile friendly?

The ‘catch’ for policy holders occurs in what these for-profit insurance companies deem coverage-worthy. What is appropriate for a patient’s long term oral health versus what is approved for coverage may be very different. This has become a real dilemma for many dentists and dental specialists.

For example, when I consult with a patient who is missing several teeth, I recommend dental implants. My recommendation is based upon what will provide the patient with a lifelong solution for missing teeth as well as other benefits.

I look at a dental implant as the ideal in tooth replacement, since it is held in the jaw bone just as natural tooth roots. An implant restores the dependable foundation necessary for biting and chewing, enabling the patient to eat a healthy diet and chew foods comfortably, which supports the digestive system and overall health.

Yet, dental implants are a more expensive option (initially) than crown-&-bridge combinations, dentures, or partials. So, guess what is often deemed as ‘elective’ by insurance companies? Right! But, is protecting your overall health and smiling confidence elective to YOU?

What it comes down to is, essentially, how we perceive insurance coverage. While major medical insurance gives us peace of mind should we experience a health challenge that would otherwise drain us financially, most dental insurance coverages are different.

Dental insurance, for the most part with most policies, is set up to provide ‘support’ in maintaining a healthy mouth. For people who already have good oral health and are able to tend to it sufficiently between regular dental checkups, this is fine. However, for most American adults, tooth repair, tooth loss and gum problems are a fact of life, particularly as we age.

For most of us, the decisions we make today will affect us in the years to come. When it comes to your oral health, don’t let your long-term oral wellness, the longevity of your teeth, the comfort of eating, or the confidence of smiling and laughter be dictated by what insurance coverage allows.

If you trust your dentist and others involved to help guide you towards good oral health and maintaining your smile, consider the recommendations made and ask questions. Be an informed consumer. But, most importantly, be sure to make decisions that are in your best interests rather than that which a for-profit insurance company deems worthy for your smile.

You may be interested that the five largest insurance companies in the U.S. (Aetna, Anthem, Cigna, Humana, United Health Group) enjoyed $4.5 billion in NET earnings in just the first quarter of 2017. That’s BILLION, with a B! ( And, that’s just a 3-month period!

Healthcare is a dilemma our nation will struggle with for years to come. In the meantime, put YOUR needs first and take charge of YOUR well-being by finding dental caregivers you feel will guide you best to a lifetime of confident, comfortable, and healthy smiles – for a lifetime!

If you don’t have regular dental care and would like recommendations, feel free to contact us at 828-274-9440. We work with exceptional general dentists in Western North Carolina and will be proud to connect you. Or, feel free to begin with a thorough periodontal exam here. We will make recommendations based upon your unique needs and goals.

Proper Bite Alignment Necessary To Support Oral Health & Implant Success

Posted on Mar 27, 2018 by William J. Claiborne, DDS MS

As a Periodontist, I specialize in treating all stages of gum disease and perform a number of procedures that involve the gum tissues (including crown lengthening and repair of ‘gummy smiles‘). My specialty also includes advanced training in the diagnosis and placement of dental implants.

So, why would I be so concerned with bite alignment?

In my profession, I work with a number of general dentists and dental specialists. Together, we create a ‘team treatment’ approach designed to fulfill each patient’s unique oral wellness needs. While I do not provide orthodontic realignment services or claim to specialize in that area, I do understand the need for having properly aligned teeth.

I see a lot in an adult’s mouth that isn’t necessarily obvious to the patient, yet has a tremendous impact on overall oral health, especially in their potential to AVOID problems.

First, the position of the teeth is more important than how they come together and create an attractive smile. Teeth that become crowded or crooked tend to form tight angles that make it difficult for a toothbrush to get into.

These nooks can easily become breeding grounds for oral bacteria. The accumulation of oral bacteria can lead to the formation of cavities and the development of gum disease.

Example of gum recession

Also, know that each tooth helps to support neighboring teeth, providing an abutment to keep other teeth in their positions. This is why it is so important to replace a missing tooth.

Without it, the teeth on either side can tilt out of their proper positions. Additionally, the tooth above (or below) can grow longer. These abnormal positions of teeth can contribute to a number of issues.

When a bite is misaligned, gum recession can occur. This is due to the unnatural pull of the gums around the base of teeth. Without this tight seal, oral bacteria can more easily penetrate below the surface of the gum line. Bacteria that reaches tender tooth root segments can create decay and periodontal disease.

Another problem with improperly aligned teeth has to do with dental implants. A ‘bad bite’ can lead to problems that include night-time clenching and grinding. A dental implant is placed in the jaw bone, the same sturdy foundation as natural tooth roots enjoy. However, a newly placed implant can be put at dire risk when surrounding teeth are interfering.

A dental implant is placed in the jaw bone, which serves as a replacement tooth root. During the first 3 – 6 months, the bone is growing around it, securing it in place. It is during this time that an implant is most vulnerable to the forces that clenching and grinding exert.

However, all teeth are at risk when clenching and grinding occur – not just those attached to an implanted post. ‘Bruxing’ (as it is known) can lead to chipped, broken and fractured teeth. It can also transfer stress and strain to facial, neck and shoulder muscles.

A number of people who have frequent headaches and migraines are surprised to discover the originating source is actually their TMJ (jaw joints). This typically occurs when a bite is misaligned. This can lead to a domino effect that reaches these joints. As a matter of fact, ear ringing, dizziness and difficulty opening the mouth fully are common symptoms of TMJ disorders that people are often unaware.

So, as a periodontist, I see how bite misalignment can cause the gums to recede and also how the potential for implant success can be affected. Simply, a correct bite is necessary for good oral health. Having it can help you avoid a long list of problems.

If gum tenderness or bleeding gums seems to occur in the area of crooked teeth, then let’s evaluate the issue. Or, if you’re considering dental implants but suspect you clench or grind your teeth, we’ll discuss ways you can achieve your smile goals and protect your investment.

Call 828-274-9440 to schedule a consultation.


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