Posts for: November, 2018
When we refer to periodontal (gum) disease, we’re actually talking about a family of progressive, infectious diseases that attack the gums and other tissues attached to the teeth. Caused primarily by bacterial plaque left on tooth surfaces from inefficient oral hygiene, gum disease can ultimately lead to tooth loss.
There’s only one way to stop the infection and restore health to diseased tissues — remove all of the offending plaque and calculus (hardened plaque deposits) possible from tooth and gum surfaces, including below the gum line at the roots. The basic tools for this task are specialized hand instruments called scalers or ultrasonic equipment that vibrates plaque loose. A series of cleaning sessions using these tools could stop the infection and promote healing if followed with a consistent, efficient daily hygiene habit.
There are times, however, when the infection has progressed so deeply below the gum line or into the tissues that it requires other procedures to remove the plaque and infected tissue. One such situation is the formation of an abscess within the gum tissues, a pus-filled sac that has developed in response to infection. After administering local anesthesia, the abscess must be treated to remove the cause and allow the infectious fluid to drain. The area is then thoroughly flushed with saline or an antibacterial solution.
The gum tissues are not completely attached to the tooth surface for a small distance creating a space. These spaces are called periodontal pockets when they are inflamed and continue to deepen as the disease progresses. These inflamed and sometimes pus-filled pockets form when tissues damaged by the infection detach from the teeth. If the pockets are located near the gum line, it may be possible to clean out the infectious material using scaling techniques. If, however, they’re located four or more millimeters below the gum line a technique known as root planing may be needed, where plaque and calculus are shaved or “planed” from the root surface. As the disease progresses and the pockets deepen, it may also be necessary for surgical intervention to gain access to the tooth roots.
To stop gum disease and promote soft tissue healing, we should use any or all treatment tools at our disposal to reach even the most difficult places for removing plaque and calculus. The end result — a saved tooth — is well worth the effort.
If you would like more information on treating periodontal 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 “Treating Difficult Areas of Periodontal Disease.”
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”
Recently, a number of new filling materials that mimic tooth color have come into popular use and, so far, have proven more durable than past versions. Even so, the traditional metal-based dental amalgam remains a viable choice, especially for less visible back teeth and their higher biting forces.
Used for more than a century, dental amalgam is a metal alloy composed of silver, mercury, tin and copper. The mixture is carefully proportioned so that potentially hazardous mercury is kept to a minimum and bonded with the other metals. Amalgam in its initial form is quite pliable so that it can be molded into the tooth structure under repair. Afterward it sets hard to form a durable filling that can withstand the daily force generated when we bite and chew food.
Besides durability, dental amalgam rarely causes an allergic reaction in a patient, and it’s easy for trained dentists to apply. On the downside, however, it can cause temporary temperature sensitivity in the tooth just after filling, and the tooth itself may require some removal of healthy structure to help keep the filling in place. And from an aesthetic point of view, its metallic appearance is considered unattractive especially for front teeth.
The presence of mercury in amalgam has also raised concerns over the years. “Free” mercury — atoms that escape through vapor emitted by the metal — can enter the bloodstream and potentially harm the nervous system. But after extensive study and research, U.S. and international health bodies including the American Dental Association have concluded any free mercury released during chewing is extremely low and well below any harmful levels. These studies have also found no ill effects in either children or adults with dental amalgam fillings.
Deciding on the type of filling material to use — dental amalgam or a newer composite resin, resin ionomer or glass ionomer — depends on a number of factors including the location of the teeth to be filled, the extent of decay and your personal preferences. Taking these into account, we’ll be happy to discuss which type of filling will suit you best for repairing decayed teeth.
If you would like more information on filling material options including dental amalgam, 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 “Silver Fillings — Safe or Unsafe?”