How do you know if you have periodontal (gum) disease? Sometimes your gums will tell you—when they’re red, swollen or bleed easily.
But your gums can also look and feel healthy while a gum infection still brews below the gum line. In this case, a regular dental visit could make the difference. Even without overt signs of infection, we may be able to detect gum disease with a slender metal instrument called a periodontal probe.
Gum disease is a bacterial infection that most of the time arises from dental plaque. This thin film of bacteria and food particles accumulates on tooth surfaces, especially because of poor or non-existent oral hygiene. A continuing infection can weaken gum tissues and cause them to pull away or detach from the teeth.
Normally, there’s a slight gap between the gums and teeth. But as the infected gums pull away, the gaps grow larger and deeper, forming what are known as periodontal pockets. They become filled with infection that soon spreads to the root and bone and increases the risk of tooth loss.
These pockets, though, could be the means for detecting a gum infection with the help of the periodontal probe. During a dental exam we gently insert the probe, which has millimeter depth markings etched on it, between a tooth and its adjacent gums. While a depth of 1 to 3 mm is normal, a probe measurement of 4 to 5 mm could be a sign of an early stage infection. A reading of 7 to 10 mm, on the other hand, may indicate more advanced disease.
Along with other factors, periodontal probing can be quite useful identifying both the presence and extent of a gum infection and then how to treat it. The goal of any treatment is to remove plaque and tartar (calculus) deposits that sustain the infection. But probing, along with other diagnostic methods like x-rays, could point to deeper infection below the gum line that require more extensive methods, including surgery, sometimes to access and remove the disease.
Achieving the best treatment outcome with gum disease often depends on finding the infection early. Periodontal probing helps to make that discovery more likely.
Osteoporosis is a major health condition affecting millions of people, mostly women over 50. The disease weakens bone strength to the point that a minor fall or even coughing can result in broken bones. And, in an effort to treat it, some patients might find themselves at higher risk of complications during invasive dental procedures.
Over the years a number of drugs have been used to slow the disease’s progression and help the bone resist fracturing. Two of the most common kinds are bisphosphonates (Fosamax) and RANKL inhibitors (Prolia). They work by eliminating certain bone cells called osteoclasts, which normally break down and eliminate older bone cells to make way for newer cells created by osteoblasts.
By reducing the osteoclast cells, older bone cells live longer, which can reduce the weakening of the bone short-term. But these older cells, which normally wouldn’t survive as long, tend to become brittle and fragile after a few years of taking these drugs.
This may even cause the bone itself to begin dying, a relatively rare condition called osteonecrosis. Besides the femur in the leg, the bone most susceptible to osteonecrosis is the jawbone. This could create complications during oral procedures like jaw surgery or tooth extractions.
For this reason, doctors recommend reevaluating the need for these types of medications after 3-5 years. Dentists further recommend, in conjunction with the physician treating osteoporosis, that a patient take a “drug holiday” from either of these two medications for several months before and after any planned oral surgery or invasive dental procedure.
If you have osteoporosis, you may also want to consider alternatives to bisphosphonates and RANKL inhibitors. New drugs like raloxifene (which may also decrease the risk of breast cancer) and teriparatide work differently than the two more common drugs and may avoid their side effects. Taking supplements of Vitamin D and calcium may also improve bone health. If your physician still recommends bisphosphonates, you might discuss newer versions of the drugs that pose less risk of osteonecrosis.
Managing osteoporosis is often a balancing act between alleviating symptoms of the disease and protecting other aspects of your health. Finding that balance may help you avoid future problems, especially to your dental health.
If you would like more information on osteoporosis and dental care, 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 “Osteoporosis Drugs & Dental Treatment.”
Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.
Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.
Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”
Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.
There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.
So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.
Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”
If you have questions about cosmetic dentistry, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Magic of Orthodontics.”
Bonjour! Hola! Shalom! December is National Learn a Foreign Language Month, and learning to say “Hello” in different tongues is a good place to start. You could then move on to another set of wonderful words like sonrisa, lächeln and sourire, the Spanish, German and French words for “smile.”
But then again, smiling itself doesn’t need a translation—it’s common to every culture on earth. It’s one of our best assets for interacting with people, both at home and abroad. So, make sure your smile is the best it can be by taking care of the “stars of the show”: your teeth and gums.
Here are a few tips for keeping your teeth and gums healthy and your “international” smile attractive.
Brush and floss daily. It takes just 5 minutes a day to perform one of the most important things you can do for your long-term oral health. Brushing and flossing clean away dental plaque, a sticky bacterial film that causes tooth decay and gum disease. A daily oral hygiene practice helps keep your teeth shiny and clean and your gums a healthy shade of pink.
Get regular dental cleanings. Even the most diligent hygiene habit may not clear away all plaque deposits, which can then harden into a calcified form called calculus. Also known as tartar, calculus is an ideal haven for disease-causing bacteria—and it can’t be removed by brushing and flossing alone. Dental cleanings at least twice a year remove stubborn plaque and calculus, further reducing your disease risk.
Don’t ignore dental problems. While your dentist will check your mouth for disease during your regular cleanings, you should also be on the lookout for signs of problems between visits. Watch for odd spots on the teeth and swollen, reddened or bleeding gums. If you see any abnormalities like these, don’t ignore it; make an exam appointment as soon as possible. The sooner we identify and begin treating a potential dental issue, the less your oral health—and your smile—will suffer.
Consider cosmetic improvements. Keeping teeth clean and healthy is one thing, but what can you do about existing dental blemishes that detract from your smile? Fortunately, there are numerous ways to cosmetically enhance teeth and gums, and many are quite affordable. Teeth whitening can brighten up yellow, dingy teeth; bonding can repair minor chips and other tooth defects; and veneers and other restorations can mask tooth chips, stains or misalignments.
Like the ability to speak another language, a confident, joyful smile can open doors to new cultures, places and friends. Let us partner with you to make your smile as attractive as possible.
If you would like more information about improving and maintaining your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “10 Tips for Daily Oral Care at Home.”
You may think all crowns are alike—but there can be a world of difference between one crown and another. Getting the crown your dentist recommends and one that's satisfactory to you will depend on a number of factors, including what you'll ultimately have to pay.
Here are 3 things you need to know about crowns before undergoing a crown restoration.
Different materials. Although porcelain is the most life-like material used, earlier types of this glass-based material weren't strong enough to withstand biting forces, especially in back teeth. Years ago, all-metal crowns were most often used until the development of a hybrid porcelain crown with an inner metal substructure for strength. In recent years stronger all-porcelain crowns have risen in popularity. The material type that works best often depends on the tooth to be crowned—all-porcelain may work for a visible front incisor, but a porcelain-metal hybrid might be needed for a back molar.
Level of artistry. While new computer manufacturing systems allow dentists to produce patient crowns in-office, most still require the services and skills of a dental lab technician. The cost difference between crowns usually occurs at this juncture: the more life-like and customized the crown, the more artistry and time required by a technician to produce it. This can increase the cost of the crown.
Limited choices. While you and your dentist want your crown choice to be as individualized and life-like as possible, your dental insurance may limit your options. Many policies only provide benefits for the most basic crown restoration—enough to regain functionality and have an acceptable, but not always the most aesthetic, appearance. To get a higher quality of crown you may have to supplement what your policy and deductible will cover.
Deciding which crown is best will depend on where it will be needed, the level of attractiveness you desire and your insurance and financial comfort level. And your dentist can certainly help guide you to a crown choice that's right for you.
If you would like more information on restorative crown choices, 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 “Porcelain Dental Crowns.”
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