Periodontal disease may start in the gums’ superficial layers, but it’s not likely to stay there. As the disease moves deeper it can wreak havoc on tooth roots and bone as well as gum tissue attachments. Teeth with multiple roots are in particular peril because of the “forks” called furcations that form where the roots separate from each other. Infected furcations can be very difficult to treat.
We primarily treat gum disease by removing its main source, a thin film of bacteria and food particles called dental plaque that builds up on teeth. To remove it we most often use special hand tools or ultrasonic equipment to vibrate it loose. As the plaque and tartar diminish, the infection begins to wane.
But we can’t be completely successful in stopping the disease if any lingering plaque deposits remain. This especially includes furcations where the infection can cause significant damage to the roots. Although cleaning furcations of plaque can be difficult, it’s not impossible with the aforementioned tools and antimicrobial substances to disinfect the area.
The real problem, though, is access—effectively getting to the furcations to treat them. We may need to perform a surgical procedure called flap surgery where we create a hinged flap in the gum tissue to move it aside and access the root area beneath. Afterward we replace the flap and suture the tissue back in place.
In some cases, the infection may have already caused significant damage to the tissue and underlying bone. We may therefore need to graft gum or bone tissues to these damaged areas to stimulate re-growth. We may also need to surgically reshape the gum attachments around a tooth to make it easier in the future to access and clean the area.
These additional treatments around furcations can be very involved and labor-intensive. That’s why the best outcomes occur if we’re able to start treatment in the early stages of an infection. So, if you notice red, swollen or bleeding gums contact your dentist as soon as possible. Treating gum disease as early as possible will help ensure your tooth roots won’t suffer extensive damage.
If you would like more information on 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? Branching Tooth Roots can be Periodontal Nightmares.”
Overbites, underbites, crossbites—these are just a few of the possible malocclusions (poor bites) you or a family member might be experiencing. But no matter which one, any malocclusion can cause problems.
Besides an unattractive smile, a malocclusion makes it more difficult to chew and to keep the teeth and gums clean of disease-causing bacterial plaque. Thus correcting a malocclusion improves dental health; a more attractive smile is an added bonus.
This art of correction—moving teeth back to the positions where they belong—is the focus of a dental specialty called orthodontics. And, as it has been for several decades, the workhorse for achieving this correction is traditional braces.
Braces are an assembly of metal brackets affixed to the teeth through which the orthodontist laces a metal wire. The wire is anchored in some way (commonly to the back teeth) and then tightened to apply pressure against the teeth. Over time this constant and targeted pressure gradually moves the teeth to their new desired positions.
The reason why this procedure works is because teeth can and do move naturally. Although it may seem like they’re rigidly set within the jawbone, teeth are actually held in place by an elastic tissue network known as the periodontal ligament. The ligament lies between the tooth and bone and keeps the tooth secure through tiny fibers attached to both it and the bone. But the ligament also allows teeth to continually make micro-movements in response to changes in chewing or other environmental factors.
In a sense, braces harness this tooth-moving capability like a sail captures the wind propelling a sailboat. With the constant gentle pressure from the wires regularly adjusted by the orthodontist, the periodontal ligament does the rest. If all goes according to plan, in time the teeth will move to new positions and correct the malocclusion.
In a way, braces are the original “smile makeover”—once crooked teeth can become straight and more visually appealing. More importantly, though, correcting a poor bite improves how the mouth works, especially while eating, and keeping things clean. A straighter smile isn’t just more attractive—it’s healthier.
If you would like more information on correcting misaligned teeth, 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 “Moving Teeth with Orthodontics.”
While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.
“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.
Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.
Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).
For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.
Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.
If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”
Cancer treatment can be an all-out battle with intense side effects for your entire body. One particular area that can suffer is your mouth.
Chemotherapy and radiation target and destroy cancer cells, which can lead to non-cancerous cells caught in the crossfire and also destroyed. The salivary glands in the mouth are prone to such damage, which could greatly impact your ability to ward off dental disease.
Saliva, what salivary glands produce, plays a major role in oral health. The bodily fluid disseminates antibodies throughout the mouth that fight disease-causing bacteria. It also neutralizes acid, which can erode tooth enamel, and helps restore lost minerals to the enamel.
If the salivary glands become damaged, however, they may produce less saliva and create a condition called xerostomia or “dry mouth.” This is a common occurrence for cancer patients, which can rob them of saliva’s benefits and make them more susceptible to tooth decay or periodontal (gum) disease. The end result could be tooth loss.
There are things you and your dentist can do to prevent this. First, have a complete dental checkup before undergoing cancer treatment. If at all possible have any necessary dental work undertaken (with adequate recovery time afterward) before beginning chemo or radiation. Your dentist and oncologist (cancer specialist) may need to coordinate any planned dental work.
You should also practice daily oral hygiene with brushing and flossing, along with keeping up your regular dental cleanings. This will prevent the buildup on teeth of bacterial plaque, which in turn will reduce your chances for dental disease. Your dentist may also prescribe antibacterial as well as fluoride mouth rinses to help limit the growth of oral bacteria.
To minimize dry mouth, increase your water consumption as much as possible. You may also use saliva boosters like xylitol, an alcohol-based sweetener found in many gums or mints that promotes salivation (it also deters oral bacterial growth).
And don’t forget to maintain a healthy diet, which will not only benefit your stamina during cancer treatment but can also help you maintain better dental health. Providing good care for your mouth during this trying time will help ensure your teeth and gums stay as healthy as possible.
If you would like more information on oral 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 “Oral Health During Cancer Treatment.”
Thanks to treatments like chemotherapy and radiation, your chances of surviving cancer are greater than ever. These treatments, however, often produce unwelcome side effects. Treating throat or oral cancer, for example, could damage your mouth's salivary glands or bone.
Saliva is essential to oral health, providing antibodies to curb the growth of disease-causing bacteria and neutralizing acid, which can erode enamel. But salivary glands damaged during cancer treatment may not be able to produce enough saliva. The resulting “dry mouth” creates an environment conducive to bacterial growth and elevated acid levels.
You can help reduce the effects of dry mouth during your treatment (and after, if the damage is permanent) by drinking more water or by using substances that stimulate saliva. Cutting back on acidic foods and beverages will also help lower your mouth's acidity. And be sure to keep up daily oral hygiene and regular dental visits.
The more ominous threat to oral health during cancer treatment, though, is osteoradionecrosis. This occurs when radiation targets specific areas of bone. The bone can lose blood supply and living cellular tissue, which inhibit its ability to heal or replenish itself. If this occurs in the jawbone of teeth that may be lost, the bone tissue could be adversely affected during healing.
Depending on your treatment needs, your risk for osteoradionecrosis might be unavoidable if teeth are to be lost. It's important we discuss that risk because it could impact future dental treatment. In the worst case, before cancer treatment, we may not be able to save affected teeth and your restorative options might be limited.
If your risk of osteoradionecrosis is minimal, though, we may be able to restore any resulting damaged or missing teeth with a wide range of options like dental implants or crowns before or after your cancer treatment.
As with other aspects of health, taking care of your teeth and gums while undergoing cancer treatment can be challenging; some problems may be unavoidable. But with a proper dental treatment plan during and after chemotherapy and radiation, we can minimize those problems and help to eventually restore your smile.
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