What is gum disease and how can I tell if I have it?

Gum disease ( periodontal disease) is a bacterial infection that occurs below the gum line and is caused by specific bacteria. If we do not brush and floss effectively and/or frequently enough the bacteria accumulate along the gum line. As the bacteria accumulate they cause the gum tissue to become inflamed. This condition is known as gingivitis and is the non-destructive form of gum disease. If untreated, gingivitis may progress to periodontitis, the destructive form of gum disease. This causes the gums to recede and the bone around the roots of the teeth to begin to dissolve away. If this condition persists patients will be susceptible to gum abscesses, loose teeth and may eventually lose teeth.

Gum disease is known as the silent tooth killer. It has been reported that eight out of ten adults in America have some degree of gum disease and only one in four of those with gum disease realize they have a problem. Your dentist or dental hygienist can and should perform a very simple gum examination at each check-up appointment to determine if you have gum disease. A very small measuring device is gently inserted between the gum tissue and the tooth at six points around each tooth. The measurements will tell if your gums are swollen or have receded. The main indicator of active gum disease is bleeding during the examination. Simply put, if your gums bleed you have gum disease. Other information such as measurements and tooth mobility will assist the dentist in determining if you have gingivitis or periodontitis and what treatment will be necessary to help heal your gums. You may only need a cleaning or you may need more extensive treatment followed with a maintenance program to keep your gums healthy.

The key to beating gum disease is early detection followed by the necessary treatment. Good oral hygiene and a good maintenance program is critical is preventing the return of gum disease. With a little time and effort each day and routine help from your hygienist gum disease is often very manageable.

How do you treat gum disease?

Treatment for gum disease depends on what type and what extent of gum disease a patient has. There are two types of gum disease. Gingivitis, the non-destructive type of gum disease, usually only requires a thorough cleaning. More severe cases of gingivitis may include heavy calcified plaque build-up requiring debridement prior to the cleaning. Treatment may require two appointments. Periodontitis, the destructive type of gum disease, is classified into four different stages; early, moderate, advanced and rapidly progressive. The initial therapy for periodontitis consists of scaling and root planing. The early and moderate stages are usually successfully treated this way followed by routine periodontal cleanings. Advanced and rapidly progressive stages may require surgical intervention as well. Each case is evaluated and treated on an individual basis.

Are x-rays necessary?

Dental x-rays are one of our best diagnostic tools and are absolutely critical in assisting the dentist in making accurate diagnoses. They are used to detect decay between teeth, evaluate bone loss around teeth, identify pathological entities such as cysts and tumors and much more. By detecting dental problems early your dentist can offer more conservative treatment avoiding more aggressive and usually much more expensive treatment. Modern technology has also made dental x-rays very safe.

How can fluoride help my teeth?

Fluoride is a naturally occurring element. It has been proven that routine application of fluoride helps re-mineralization of enamel preventing tooth decay. Both children and adults benefit from fluoride use. Many children do not have good oral hygiene habits and tend to eat excessive amounts of sugar. These situations leave children much more prone to tooth decay. Because many adults do not have good oral hygiene habits and eat excessive amounts of sugar they are also prone to tooth decay. Adults are also prone to develop gum disease leaving the root surfaces very susceptible to decay. Routine fluoride use is probably the single most important measure we have to prevent tooth decay.

Can I get a cavity under a crown?

Decay can occur anywhere the tooth is exposed to the environment of the oral cavity. The area of the tooth where the crown stops and the tooth starts can become decayed if good oral hygiene is not maintained. However, if you brush and floss regularly and have your teeth cleaned and checked regularly a crowned tooth is no more prone to decay than any other tooth.

Why fill a baby tooth? Can't we just have it pulled?

Children usually keep their front baby teeth until the ages of six to twelve and their back baby teeth until the ages of nine to twelve. Baby teeth are very important to the child's self-esteem, speech, smile and they also hold a space for the adult teeth to erupt into. Early removal of a baby tooth may lead to serious orthodontic problems. Baby teeth should only be extracted when it is time to do so or when they cannot be restored.

Should I replace all of my mercury fillings with white ones?

This depends on why you would want to have them replaced. If you want your teeth to look nicer or if your mercury fillings are wearing down I do recommend white (composite resin) fillings over silver fillings in most instances. However, if you are hoping to prevent or cure any ailment you should know that there is no scientific evidence at this time to suggest that removing silver fillings will help prevent, alleviate or cure any medical problems. You have the right to have silver fillings replaced if you choose to do so; just don't expect anything other than a nicer whiter smile.

Do the white fillings last as long or longer than the mercury fillings?

White (composite resin) fillings offer advantages that mercury fillings do not offer. Obviously white fillings have more cosmetic value than mercury fillings. Other advantages offered by white fillings are that they cause less stress on the teeth. Mercury fillings are metal fillings. They expand and contract when we eat hot and cold foods and liquids. This expansion stresses the teeth causing the tooth to fracture. Many times this will lead to the need for a crown. Mercury fillings are packed into the tooth and are mechanically held in place. This does not help strengthen the tooth. White (composite) fillings actually bond to the tooth and can strengthen the tooth. How long a filling lasts depends on many different factors. I would advise that you consider how the filling affects the tooth rather than how long it will last. Replacing a filling is more conservative and much less expensive than having a tooth crowned.

Do we sterilize our instruments?

All instruments used in our office that can be sterilized are sterilized in an autoclave sterilizing unit or a cold sterilization solution. If it cannot be sterilized an instrument is used only one time on one patient and is then disposed of properly. After each use instruments are cleaned in an ultrasonic cleaner, thoroughly rinsed, packed into a sterilization packet and autoclave sterilized. Instruments that cannot be autoclave sterilized are handled in the same manner but are placed in a cold sterilization solution approved by the American Dental Association, the FDA and the CDC. Our autoclave sterilization units are monitored regularly to assure its effectiveness. Test strips are sent to a microbiology laboratory on a regular basis to assure that the sterilization units are working properly. To prevent the spread of disease we use disposable products as much a possible. Disposable products in our office are used one time only on one patient and are then disposed of properly. We adhere to all health codes and OSHA regulations to insure that all patients in our office are safe from the spread of disease. If you visit our office we will be happy to show you our sterilization room and demonstrate the methods we use.

Why do I need a root canal if my tooth is not hurting? Do root canals hurt?

Root canals like all other dental procedures are performed for specific reasons. Reasons for doing root canals can be infections, fractures or broken teeth, etc. In some instances when a tooth becomes infected the nerve in the tooth may die preventing the tooth from hurting. Even though the tooth may not hurt the infection can get worse and cause very serious problems such as erosion of bone around the root tip and may even spread to other teeth. Tooth infections can also spread to the blood stream or abscess so severely they can obstruct a patient's airflow. Before antibiotics were widely used it was not uncommon for patients to die from abscessed teeth.

Most of us have heard horror stories about how painful root canals are. The fact is that root canals are usually not painful at all. When a patient experiences pain with a root canal it is usually because their tooth is severely infected, they are already in a lot of pain, the infection prevents the anesthetic from working well and they associate this with having a root canal. The pain is from the infection not the procedure. Unless your tooth is severely abscessed you can be confident that you will not experience a lot of pain. If your tooth is severely abscessed you should be on antibiotics for at least a few days before the root canal is performed.

How many appointments does it take to have a root canal?

Evidence supports performing root canals in one appointment if conditions are favorable. However, if there is infection or uncontrollable bleeding it may best to reappoint and complete the root canal at a later time.

Why does my tooth need to be crowned following a root canal?

Root canal therapy consist of removing the nerve, vein and artery from the root canal system of the tooth. Removing the blood supply from the tooth causes the tooth to become dehydrated. Over time this leaves the tooth brittle and susceptible to fracture and may result in tooth loss. Crowning a tooth following root canal therapy is considered standard of care.

What is Standard of Care?

When a patient seeks care for a problem there is a standard or specific treatment for that problem. Therefore, as a patient, if you seek care you have the right to expect that the health care provider will know and provide you with that care. Standard of care is the usual care needed for a specific problem.