Misconceptions Of Oral Health
Posted on Sep 14, 2021 by William J. Claiborne, DDS MS
As a periodontal dental specialist, I have advanced skills in the treatment of gum disease and dental implants. In my specialty, I see patients who have various issues related to oral health. Some of these can be resolved with minor treatment and others require more involved procedures.
In many cases, however, a factor in the severity of certain issues occur because it was assumed the problem would resolve itself. Some patients have also assumed that certain signs or symptoms were “normal”.
The health of the mouth is largely reliant on the condition of the gum tissues. This moist, soft covering of tissues is a protective blanket for the structures underneath. Gum tissues protect the structures that support natural teeth as well as their roots.
Yet, because the gums are not visible as are teeth, it is easy to “back burner” problems. Some of these problems DO resolve on their own. However, in too many cases, what is set aside eventually requires extensive treatment; treatment that may have easily been avoided with early care.
I’d like to address some of the more common issues I see that are misconceptions…
Assuming seeing blood in the sink when brushing teeth is normal: Srubbing teeth so rigorously that they bleed is not a sign of doing a good job. This action not only wears away precious tooth enamel, it wears away the gum tissues that wrap the base of teeth.
Gums that bleed when brushing are also a symptom of periodontal (gum) disease. In addition, gum disease can cause tenderness, swelling or frequent bad breath. Without treatment, gum disease will progress further. This is why it is the nation’s leading cause of adult tooth loss.
Protect tooth enamel and gum tissues by using a soft to medium bristled toothbrush and a non-abrasive toothpaste (never substances such as baking soda). Using a swirling motion (rather than going back-&-forth), avoid applying too much pressure. Make sure that the tips of the bristles are contacting the surfaces of teeth. Hint: If you notice your toothbrush’s bristles flay outward after a month or so of use, you’re pressing too hard.
Ignoring gum recession: The gums are designed to snugly wrap the base of each tooth, serving to seal out bacteria. Although the aging process and oral dryness can shrink gum tissues, a common cause of receded gums is gum disease.
Gum recession is what causes sensitivity to hot, cold or the bristles of a toothbrush. Oftentimes, a bite of ice cream can send a jolt of pain. Even without the sensitivity, recession can leave the darker tooth root areas exposed. This leaves the tooth vulnerable to damage by oral bacteria.
Ignoring frequent bad breath: Bad breath is typically a by-product of bacteria build up. Although certain medical conditions can contribute to bad breath, keeping oral bacteria levels under control will minimize the risk of having smelly breath odor.
Saliva is what controls a significant amount of oral bacteria. However, without regular brushing and flossing, bacteria can quickly exceed what saliva is able to manage.
This is why it is important to brush twice daily and floss daily. These small tasks help to control bacteria by removing the sticky buildup of plaque. If not removed, plaque hardens into what is known as tartar. Tartar is a destructive mass of bacteria that can no longer be brushed or flossed away.
Having gum depth measurements of four and over: During regular check-ups, hygienists check gum health by gently using a probe along the base of each tooth. This is done to indicate loosening of gum tissues on the front and back sides of teeth. A good check-up will have no depth measurement higher than a three.
If the depth measures a 4 or 5 (or higher), the gums are not sealing out oral bacteria sufficiently. This may be an indication of gum disease. The higher the number, the more advanced it is.
Assuming tooth loss is normal: Some people assume tooth loss is a natural part of the aging process. This is not accurate. Adults lose teeth due to accidents, decay or (most often) gum disease.
Occasionally, a tooth that needs crowning or filling is deemed a “problem” tooth. This causes some people to want the tooth removed rather than repaired. Yet, missing tooth roots in the jaw bone triggers a process of bone shrinkage. This is known as resorption.
Resorption occurs without the stimulating presence of the tooth root. As the bone declines in height and width, neighboring teeth can also be affected. Adjacent tooth roots in areas of insufficient bone structure are at a higher risk of cavities, gum disease, and tooth breaks or fractures. Statistics show that a tooth adjacent to a missing tooth is most likely the next to be lost.
When a tooth must be removed, we recommend replacing it with a dental implant. Because an implant is positioned in the bone, it helps halt bone loss and protect the well-being of neighboring teeth.
Not reacting to spots on the tongue, lips or inside the cheek: People occasionally develop canker sores inside the mouth. These can be caused by stress or having an acidic diet. Both should go away within ten days or so.
Any spot or change inside the mouth or throat that does not resolve on its own within two weeks should be seen immediately. This may be a sign of oral cancer and may appear as a red or white spot. Or, it may cause hoarseness or difficulty swallowing. If caught early, oral cancer can be successfully treated. Acting promptly is highly important as it can lead to disfiguring treatment and be even deadly.
Assuming oral health is contained in the mouth: It has been shown that having good oral health is an advantage to having good overall health. The potent bacteria of gum disease can enter the bloodstream and cause inflammatory reactions elsewhere in the body. Research has correlated a number of serious health problems with the infectious bacteria of gum disease. These include heart disease, stroke, some cancers, Alzheimer’s disease and arthritis.
As an Asheville periodontist, I believe that adults can improve their oral health by being informed patients and committed to having a healthy smile.
A good resource on maintaining good oral health is the web site of the American Academy of Periodontology: www.perio.org (go to Patient Resources). Or, call our Asheville periodontal dental office at 828-274-9440.
Be “Sweet” To Your Smile By Monitoring Sugar Intake
Posted on Aug 31, 2021 by William J. Claiborne, DDS MS
If Americans truly calculated the amount of sugar they’ve consumed at the end of each day, I believe most would be shocked. Even unintentionally, sugar intake can easily reach levels that are far beyond what is assumed.
For example, in a 2015 Washington Post article, it was reported that 25 percent of catsup is sugar. Alarmingly, one tablespoon has four grams of sugar, which is more sugar than a typical chocolate chip cookie.
The World Health Organization (WHO) recommends a maximum of no more than 10 teaspoons of free sugars per day. Regardless of age, the WHO advises keeping daily sugar consumption to less than 10 percent of calories “to reduce the risk of unhealthy weight gain and dental caries.”
However, our goal in limiting sugar is often sabotaged by hidden sugars.
Sugar comes in far more forms than just the white or brown bags of granular “cane sugar” we purchase in the grocery store. If you read the list of ingredients in foods and beverages, you may be surprised at how many forms of sugar are concealed with different names. At this time, there are more than sixty.
Here’s how to catch some of them:
Added sugar may be listed as syrup (examples are corn syrup or rice syrup) or anything with an ingredient that ends in “ose” (such as fructose, sucrose, maltose, dextrose). Other examples of added sugar include fruit nectars, juice concentrates, honey, agave and molasses.
Ideally, the WHO urges an intake of no more than 6 teaspoons (or less than 5 percent) of sugars per day to “provide additional health benefits.” This is an ambitious goal for Americans who have become literally addicted to sugar.
In a study of lab rats who were provided with a diet of food and intermittent supplies of sugar water, the results showed indications of addiction and symptoms of withdrawal. https://www.sciencedirect.com/science/article/abs/pii/S0149763407000589?via%3Dihub
The study spurned on a succession of additional studies. In one, it was noted that sugar “lights up” the same area of the brain as cocaine.
As a periodontist, I’m especially concerned about sugar intake to the detriment of oral health. Sugar lowers the natural pH levels in saliva and triggers a process that is the beginning of tooth demineralization. Demineralization describes the process where the enamel and tooth structures are dissolved.
Although sugar is not a healthy food choice for any part of the body, it is important to remember that it is the mouth that is the entry point for what we eat or drink. Thus, the destructive nature of sugar begins by causing an imbalance in the mouth through altering the healthy formulation of saliva.
For a minute, think of the foods you consumed yesterday. Coffee with sweetened creamer? Toast with jam? Sweet tea with lunch? A candy bar and cola as a mid-afternoon snack? Catsup over your fries at dinner, followed by a bowl of ice-cream?
When we are conscious of just how much sugar is being consumed over the course of a day, it becomes easier to make better choices. As we taper down little by little, it actually helps us to “wean” off the dependency of sugar so it doesn’t feel like deprivation.
As an Asheville Periodontist, I see patients every day who have periodontal disease, cavities and missing teeth that can be attributed to diet, smoking and insufficient oral hygiene. Many face involved treatment decisions that can be costly and take months to accomplish.
Although we pride ourselves on providing our patients with a comfortab
le experience backed by advanced skills and technology, so much of our treatment can be prevented with easy proactive measures. Eating a healthy diet, keeping the mouth moist, brushing and flossing, and seeing a dentist regularly are all practical ways to keep a healthy, confident smile.
Yet, “we don’t know what we don’t know.” Because our population is largely unaware of the extent of sugars in many foods and beverages, it is easy to consume far more than is realized.
Take charge of your oral health by reading food labels, meal planning that limits sugars, and being highly committed to your oral hygiene routine at home. A few tips for a healthy mouth between dental check-ups are:
• Brush twice a day (at least) for two minutes each time. Use a fluoride toothpaste with a soft to medium bristle toothbrush.
• Floss your teeth every day before your brush to dislodge food particles caught between teeth. If flossing is difficult for you, try one of the water flossers. These are affordable and as effective as manual flossing.
• Brush your tongue after your teeth to unroot embedded bacteria, especially reaching the back area of the tongue (where most bacteria are embedded).
• Use an oral rinse that replenishes moisture twice a day (or as directed). These are available at most drug stores.
• Chew sugarless gum, preferably a brand that contains Xylitol. Xylitol looks and tastes like sugar, yet has 40 percent fewer calories.
• Drink plenty of water throughout the day. Be aware that beverages such as most coffee, tea and colas contain caffeine are drying to the mouth. Many medications also have the side effect of oral dryness – another good reason to stay hydrated.
Also, be aware of the signs and symptoms of gum disease. Sore, tender, bleeding, swollen or red gums are all warning signs. With prompt measures, we can greatly minimize treatment needs to rid your mouth of this dangerous bacteria that has been associated with a number of serious health problems (including stroke and some cancers).
If you haven’t seen your general dentist on a regular basis, call 828-274-9440. Our Asheville periodontal office can help to restore your mouth to a healthy state with the most conservative, yet effective, treatment possible.
How The Contours of Your Gums Can Enhance Smile’s Appearance
Posted on Aug 10, 2021 by William J. Claiborne, DDS MS
I remember the home of a beloved Great Aunt, whom I visited often growing up. One of the things that made her home so “homey” were the displays of bric-a-brac. As a youngster, I didn’t term her arrangements of china tea sets and Hummel figurines as bric-a-brac (they were “knick knacks,” to me). However, I found myself being drawn to her displays on shelves, in curios, and on tables moreso as I grew older.
To me, what was impressive about these groupings was how balanced they were. The china tea pots were centered, surrounded by carefully spaced cups and saucers. Hummel children were in playful arrays to appear as a happenstance assembly of friends.
As a Periodontist, I am now far more appreciative of how my Aunt kept such proper balance to these displays. Everything seemed so coordinated, harmonized.
As a specialist in the treatment of all stages of periodontal (gum) disease and the placement of dental implants, I am also the expert when it comes to the contours of gum tissues surrounding teeth. The gums are important to the health of your teeth as well as the appearance of a smile.
When it comes to protecting teeth, think of the gum tissues as a protective blanket. The gums cover over the under-structures of the mouth’s interior (oral cavity). If you’ll look at the base of each tooth, you’ll see that the gum tissues snugly wrap the base of each tooth. This protective seal is what prevents bacterial penetration below the gum line.
When gum tissues loosen their grip around teeth, the leading cause is gum disease. Gum disease weakens oral tissues and causes them to become inflamed. As the gums loosen, bacteria is able to work their way into the structures that support natural teeth (including bone).
When bacteria reach this level of oral structures, ridding it involves a more involved procedure than what a mere dental cleaning can combat. As it progresses, the gums become spongy and pus pockets form. Teeth loosen and may need removal. Gum disease is the leading cause of adult tooth loss.
Yet, gum tissues not only serve as a protective element of your mouth. The appearance of a smile can be greatly affected by the shape and amount of gum tissues exposed when smiling.
Balance is an element of beauty, according to studies. We are drawn to it. According to Penn State’s “Science in Our World: Certainty and Controversy”,
“Studies show that symmetrical faces are preferred and more attractive to others than people who have asymmetrical faces. Similarly shaped eyes and eyebrows, sides of the nose mouth can all fall into the symmetrical category.”
They shared findings of one study, performed over the course of two decades, that had men and women rank the attractiveness of people in photos. The study revealed:
“Men and women both overwhelmingly chose the most symmetric face. This test was an observational study, so it was only as clear and truthful as the participants of the study were. There wouldn’t really be a way to make this sort of study an experimental test, so as far as attraction goes, studies must rely on the opinions of the participants. However, the majority of the participants chose the most symmetrical faces as the most attractive ones, so it is easily said that it is true, symmetry equals attractiveness.”
Although “beauty is in the eye of the beholder,” symmetry seems to be a component of what humans define as beautiful and what we’re drawn to (although inner beauty is an important factor in what keeps us connected to an individual).
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 are at a similar level. The amount of gum arches are in a complimentary line to teeth, rather than an amount that draws the eye. Too much gum tissue showing is referred to as a “gummy smile.”
A gummy smile is not an unattractive feature. Having one does, however, alter the appearance of a smile based on balance. For example, a diastema is a wide space between the two front teeth. It is often a hereditary trait. Although it is not unattractive feature, the eye seems drawn to that one spot rather than seeing the smile, as a whole, as a complement to other facial features. The individual may have beautiful lips or eyes, but the gap between the teeth is what is noticed as being “off.”
Quite frankly, some people are perfectly comfortable with having a gummy smile or a diastema. For them, it’s part of their personality or signature look. After all, what would Lauren Hutton, the famous model of the 70’s, have been without her diastema?
For other people, these features cause shyness, insecurity or a feeling of awkwardness. Some people try to smile with lips only. Others try to conceal a full smile with a hand. “Holding back” on a smile is a shame, especially since smiling is a proven asset to our frame of mind.
The act of smiling causes the brain to release chemicals known as endorphins. These trigger somewhat of a natural high, creating a happier mood. This has been shown to be true even when faking a smile.
Additionally, people who smile often are deemed happier, more confident and even younger. In smiling, the facial muscles pull upward and smooth out the skin to give the face a bit of a lift. Free of charge!
Another distortion in a balanced smile can be an uneven line of gum tissues, where there is more gum showing on some teeth than others. This up-and-down line of gum tissues creates a jumbled look. Again, the appeal of balance is disrupted.
In these cases, a “crown lengthening“ procedure is often advised. This is a simple procedure that alters the height of the gum tissues prior to placement of a crown (‘cap’). Not only does this provide a more flattering smile line, it protects the teeth involved while enhancing the tooth’s shape.
Another issue that impacts both appearance and the health of a tooth is gum recession. When the gums recede from the base of teeth, more sensitive and vulnerable areas of the tooth’s root are exposed. Exposure can lead to sensitivity and higher risk for bacterial penetration.
The procedure for most gum recontouring is known as a Gingivectomy. In this, our Asheville Periodontal dental office uses a dental laser. Gingivectomy is the most common procedure performed with a laser, which is used to precisely contour gingiva (gum tissue) for restorative, cosmetic, and periodontal needs.
The laser promotes rapid healing and reduces discomfort post-operatively with periodontal packing or sutures rarely needed. In the hands of a skilled periodontal specialist, laser technology also minimizes penetration depths. For minor procedures, lasers can sometimes require little or no anesthetic.
For more involved gum contouring, our Asheville periodontal office offers both oral and I.V. 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 places the patient in a deeper sleep state, also erasing memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety. In our office, this is overseen by Dr. Brad Stone, a Medical Doctor (MD) who is a board certified Anesthesiologist & Pediatric Anesthesiologist.
With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.
The health and appearance of your smile are important. It is proven that good oral health is a supportive component to your overall health. It is also shown that the appearance of a smile can add positively to an individual’s perception of “self”.
If you’re interested in improvements in the health and appearance of your smile, let’s discuss the possibilities during a consultation appointment. Call 828-274-9440. A referral is not always needed.
Why You’re Losing Teeth (and how to halt the process)
Posted on Jul 29, 2021 by William J. Claiborne, DDS MS
The inevitable. Murphy’s law. Sooner or later.
It is to no surprise that life throws us occasional curves, some being out of the blue and others being somewhat predictable. As an Asheville Periodontal Specialist, one that comes to mind is the path to losing teeth.
Losing natural teeth is a challenge to both oral and overall health. And, there’s nothing that will definitively replace natural teeth once they’re extracted (although dental implants come pretty close!). Keeping natural teeth and gums healthy is the best way to support your health as you age.
According to a 2017 article published by Dentistry Today that shared recent study findings:
“people who had lost 5 or more teeth by the age of 65 years were more likely to suffer from cardiovascular disease, diabetes, and osteoporosis, all of which could severely limit life expectancy. Many of these illnesses previously have been linked to a person’s quality of life and socioeconomic status. The study concludes that the number of teeth in aging humans can affect longevity and life expectancy.”
Of course, no one wants to lose a natural tooth. Yet, many people assume that tooth loss is simply a natural part of the aging process. It’s not.
Through the years, certainly, accidents, injuries, decay, gum disease and deep fractures in teeth can result in loss of teeth. Regardless of how committed some people are to their oral hygiene regimen at home and regular dental check-ups, unexpected occurrences can lead to the need for an extraction.
However, the people who are committed to their oral health are far less likely to endure the undesirable outcome of tooth removal. The measures are simple and take very little time.
• Brush your teeth at least twice a day, for a minimum of two minutes each time.
• Floss daily.
• Avoid snacking and limit sugar.
• Drink plenty of water.
• See your dentist twice a year for exams and cleanings.
• Don’t smoke.
Although smoking cessation is a tough task for most people, the other items listed above require just minutes a day and cost very little. What they help you accomplish is PREVENTION. Rather than have problems treated, many instances surrounding tooth loss could have been prevented.
It is far less costly and time consuming to be attentive to your oral health than deal with the repercussions of insufficient oral upkeep. Losing a tooth will require a lifelong commitment, regardless of how it is replaced. And, replacing teeth is absolutely necessary.
When a tooth is lost, whether it can be seen in a smile or not, it no longer supports the surrounding teeth. The tooth above (or below) can elongate. Neighboring teeth can tilt or turn since they lack the bolstering affect provided by the now-missing tooth.
These factors can lead to chipped, fractured or broken teeth. They can also be an issue in bite misalignment. A misaligned bite can cause stress or strain on the temporomandibular joints (TMJ). The results can be frequent headaches, sore jaw joints, ear ringing, dizziness, and difficulty opening the mouth fully.
Another problem lies in the absence of the missing tooth’s roots. When these roots are missing, there is a lack of stimulation and nourishment to the jaw bone in this area. Without this, the bone begins to shrink, or resorb. Bone mass decline affects the stability of the adjacent teeth. It is known that the next tooth to be lost will most likely be one bordering a missing one.
The path to tooth loss, other than accident or injury, is actually a pretty predictable one. For people who take their oral hygiene lightly, it’s not a matter of “if” but “when”. Bacteria buildup in the mouth should be removed regularly, which is why twice-daily brushing is advised. If not thoroughly removed, their growth runs rampant.
Saliva flow helps in moving some bacteria out of the oral cavity. However, as people age, saliva flow decreases. Add to that the many elements that are drying to oral tissues: caffeine (including coffee, tea and colas), many medications, snoring, and some health conditions.
Oral bacteria that accumulate in the mouth for more than 48 hours first create a sticky film that coats the teeth and gums. This is plaque. If not removed through brushing and flossing, plaque transforms into hardened masses on the base of (or between) some teeth. This is tartar, which can no longer be brushed or flossed away.
As tartar spreads, the gums become inflamed. This causes gingivitis – the first stage of gum disease. Gingivitis causes the gums to become tender, swell, and sometimes bleed when brushing. Breath odor can become frequently bad.
If not resolved quickly, gingivitis can progress into full-blown gum disease. At this stage, the gums are red, inflamed, tender, bleed easily and breath odor is bad, even shortly after brushing.
As gum disease worsens, gums loosen their strong seal around the base of teeth. This allows entry of these infectious bacteria below the gum line. The structures that support natural teeth (including bone) are attacked, which can cause some teeth to loosen.
The advanced stage of gum disease is periodontitis. This means that gum tissues are red, spongy, have pockets of pus, bleed even when eating, and breath odor is putrid. To add insult to injury, this devastation doesn’t remain only in the mouth. Through tears in diseased gum tissues, the inflammatory bacteria of gum disease can enter the bloodstream.
This bacteria has been linked to serious, even life-threatening, health problems, as severe as stroke, heart disease, some cancers and Alzheimer’s disease. It can cause inflammatory triggers that worsen diabetes and prostatitis and cause preterm births.
Obviously, it’s important to keep your teeth and gums healthy. And, if tooth loss does occur, consider replacing it/them with dental implants. As an Asheville periodontist, one of my areas of advanced skill is in dental implant diagnosis and placement.
Dental implants are the closest thing to the look, feel and function of natural teeth. They restore dependable biting and chewing, without the need to be removed for cleaning. Best of all, confidence in smiling and laughing returns.
We frequently see Western NC adults who feared they would lose teeth due to periodontal disease and/or had already lost one or more natural teeth. Through our advanced skills and computerized technology, we are often able to fully restore people to excellent oral health and halt the progression of tooth loss.
If you have avoided seeing a dentist because of fear or anxiety, please know that we provide our patients with an environment of respect and comfort. We offer I.V. sedation (‘twilight sleep’) as well as oral sedation to create a totally relaxed state throughout treatment.
If cost is a concern, we also have payment plans that can help you achieve the smile you desire while making monthly payments that fit your budget.
Why allow tooth loss to happen? It CAN and SHOULD be prevented and we can help you regardless of your current oral condition. Call 828-274-9440 to request a consultation appointment. This will take place in a private consultation room where your questions will be answered thoroughly.