Posts for: August, 2021
Tooth loss is often the unfortunate conclusion to a case of untreated periodontal (gum) disease—incentive enough to try either to prevent it or aggressively treat an infection should it occur. In either case, the objective is the same: to remove all plaque from dental surfaces.
Dental plaque (and its hardened form, tartar) is a thin buildup of bacteria and food particles on tooth surfaces. It's a ready food source for sustaining the bacteria that cause gum disease. Removing it can prevent an infection or “starve” one that has already begun.
Your first line of prevention is brushing and flossing your teeth daily to remove any accumulated plaque. Next in line are dental cleanings at least twice a year: This removes plaque and tartar that may have survived your daily hygiene.
Plaque removal is also necessary to stop an infection should it occur. Think of it as a more intense dental cleaning: We use many of the same tools and techniques, including scalers (or curettes) or ultrasonic devices to loosen plaque that is then flushed away. But we must often go deeper, to find and remove plaque deposits below the gums and around tooth roots.
This can be challenging, especially if the infection has already caused damage to these areas. For example, the junctures where tooth roots separate from the main body of the tooth, called furcations, are especially vulnerable to disease.
The results of infection around furcations (known as furcation involvements or furcation invasions) can weaken the tooth's stability. These involvements can begin as a slight groove and ultimately progress to an actual hole that passes from one end to the other (“through and through”).
To stop or attempt to reverse this damage, we must access the roots, sometimes surgically. Once we reach the area, we must remove any plaque deposits and try to stimulate regrowth of gum tissue and attachments around the tooth, as well as new bone to fill in the damage caused by the furcation involvement.
Extensive and aggressive treatment when a furcation involvement occurs—and the earlier, the better—can help save an affected tooth. But the best strategy is preventing gum disease altogether with dedicated oral hygiene and regular dental visits.
If you would like more information on preventing and treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “What are Furcations?”
Although Santa Claus has Christmas and the Easter Bunny has Easter, neither of these mythical characters has a day just for them (unless you count the Feast of Saint Nicholas in early December). Not so the Tooth Fairy: According to NationalToday.com, August 22nd is National Tooth Fairy Day, in celebration of this favorite sprite of children.
And, there's good reason for the love—he (or she, if you prefer) comes bearing gifts. Well, not technically a gift: the deal is a tooth in exchange for a treat. Now, what the Tooth Fairy does with all the millions of teeth obtained, no one knows. But that he/she has a huge potential supply is undeniable.
The teeth sought are a specific kind—primary ("baby") teeth that start showing up on the jaw a few months after birth and then gradually fall out by adolescence. Kids have around twenty of these teeth for the potential under-the-pillow exchange.
Here's how it happens: The roots slowly begin to dissolve and the gum tissues holding the tooth in place detach. The sure sign this is occurring is the tooth's noticeable looseness. The process continues naturally, and with no help from us, until the tooth falls out.
But children especially can grow impatient—a wiggly tooth becomes annoying, not to mention all that "earning potential" just hanging there. And so, there's an understandable urge to help it along. But some methods for doing so are problematic—tying a string to the tooth and yanking, for example. Trying to remove a tooth not quite ready can result in excessive bleeding or damage to the tooth socket.
Depending on a tooth's degree of looseness, there is a way to take it out safely. You can do this by draping a piece of gauze pad over the tooth and grasping it firmly between your fingers. Then, gently give the tooth a gentle downward pinch or squeeze. If it's loose enough, it should come out. If not, simply wait another day or two and try again.
A tooth ready to come out doesn't normally bleed much. If it does, have the child bite down on a clean piece of gauze or a wet tea bag for a few minutes until the bleeding stops. They might also eat softer foods for a few days to avoid a resumption of bleeding.
Of course, the tooth inevitably comes out whether you help it along or not. In the event it does away from home, make up some kind of small container your child can carry with them to secure the lost tooth. It's a fun project—and we wouldn't want to lose the opportunity for that profitable encounter with You-Know-Who.
The worst outcome of periodontal (gum) disease is tooth loss—but it isn't the only form of misery you might suffer. One of the more troublesome results associated with gum disease is gum recession.
Normal gum tissue covers teeth from just above the visible crown to the roots, providing protection against bacteria and oral acid similar to the enamel on the crown. But advanced gum disease can weaken these tissues, causing them to pull away or recede from the teeth.
Not only can this diminish your smile appearance, but the exposed areas are more susceptible to further disease and painful sensitivity. And it certainly can accelerate tooth loss.
But there are some things we can do to reduce the harm caused by gum recession. If we're able to diagnose and treat a gum infection early while the gums have only mildly receded, the tissues could stabilize and not get worse.
The chances for natural regrowth are unlikely, especially the more extensive the recession. In such cases, the gums may need some assistance via plastic periodontal surgery. Surgeons reconstruct gum tissues by grafting like tissues to the area of recession. These grafts serve as a scaffold for new tissues to gradually grow upon.
There are two general types of grafting procedures. One is called free gingival grafting. The surgeon completely removes a thin layer of skin from elsewhere in the mouth (such as the palate), then shapes and attaches it to the recession site. Both the donor and recession sites heal at approximately the same rate, usually within 14-21 days. This procedure replaces missing gum tissue, but doesn't cover exposed tooth roots to any great extent.
In cases of root exposure, dentists usually prefer another type of procedure, known as connective tissue grafting. The donor tissue is usually taken again from the palate, but the design of the surgery is different. A flap of tissue at the recipient site is opened so that after the connective tissue from the palate is placed at the recipient site to cover the exposed roots, the flap of tissue covers the graft to provide blood circulation to the graft as it heals.
Both kinds of procedures, particularly the latter, require detailed precision by a skilled and experienced surgeon. Although they can successfully reverse gum recession, it's much better to avoid a gum infection in the first place with daily oral hygiene and regular dental care.
If you would like more information on treating gum recession, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal Plastic Surgery.”