Periodontal (gum) disease often involves more than gum inflammation. The real danger is what this bacterial infection may be doing to tissues beneath the gum line—including tooth roots and supporting bone.
Gum disease can do extensive damage to the forked areas where the roots separate from the main tooth body. If one of these areas, known as a furcation, becomes infected, the associated bone may begin to diminish. And you may not even know it's happening.
Fortunately, we may be able to detect a furcation involvement using x-rays and tactile (touch) probing. The findings from our examination will not only verify a furcation involvement exists, but also how extensive it is according to a formal classification system that dentists use for planning further treatment.
A Class I involvement under this system signifies the beginning of bone loss, usually a slight groove in the bone. Class II signifies two or more millimeters of bone loss. Class III, also called a “through and through,” represents bone loss that extends from one side of the root to the other.
The class of involvement will guide how we treat it. Obviously, the lower the class, the less extensive that treatment will be. That's why regular dental checkups or appointments at the first sign of gum problems are a must.
The first-line treatment for furcation involvements is much the same as for gum disease in general: We manually remove bacterial plaque, the main source of infection, from the root surfaces using hand instruments and ultrasonic equipment. This is often followed by localized antibiotics to further disinfect the area and stymie the further growth of the furcation involvement.
We also want to foster the regrowth of lost tissue, if at all possible. Classes II and III involvements may present a challenge in this regard, ultimately requiring grafting surgery to stimulate tissue regeneration.
The best approach by far is to prevent gum disease, the ultimate cause for a furcation involvement. You can reduce your chances of gum disease by brushing and flossing daily to remove disease-causing plaque. Regular dental cleanings and checkups, at least every six months, help round out this prevention strategy.
A furcation involvement could ultimately endanger a tooth's survival. We can stop that from happening—but we'll have to act promptly to achieve the best results.
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?”
You have a winning smile except for one small flaw — one of your front teeth is chipped. In functional terms the defect is insignificant: your tooth is healthy and can still do its job. But with regard to your smile that chip is like a smudge on a masterpiece painting: it stands out — and not in a good way.
The good news is you have options to repair the chip and vastly improve your appearance. One option is to bond a custom porcelain veneer to the outside of the tooth to cover the chip. But that would also mean removing a slight bit of tooth enamel so the veneer won't appear too bulky. Although not as much as with a crown, the alteration still permanently affects the tooth — it will always require a restoration of some kind.
There's another choice that doesn't involve removing any of your enamel: composite resin. This treatment is a mixture of materials with a glass-like binder in liquid form that we apply to a tooth in successive coats. As we build up the layers we can match the tooth's shape, texture and various shades of its natural color. We're able to fill in the defect and make the tooth appear as natural as possible.
Unlike porcelain restorations, composite resins don't require a dental lab or a period of weeks to prepare. We can transform your simile in our office in as little as one visit.
Composite resin isn't the answer for every tooth defect. Teeth that have become worn, fractured or have undergone a root canal treatment are best treated with a porcelain restoration such as a veneer or crown. But where the defect is relatively minor, composite resin may be the answer.
To learn if you can benefit from a composite resin restoration, you'll need to undergo a dental exam. If we determine you're a candidate, we can use this state-of-the-art dental material to make your teeth look flawless.
If you would like more information on composite resins, 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 “Artistic Repair of Front Teeth with Composite Resin.”
Pregnancy is an exciting time in a woman’s life — but it can also generate a lot of questions about both the mother’s and the baby’s health. The realm of dental care is no exception.
Here are a few of the questions we frequently hear from expectant mothers, along with our answers.
Does the baby’s tooth calcium come from my teeth?
This question is frequently asked by mothers who may have had dental issues and are worried they’ll pass on these problems to their baby. Simply put, no — a baby developing in the womb derives minerals like calcium for their teeth and bones from the mother’s diet, not her teeth. What an expectant mother can do is be sure to eat a healthy, balanced diet rich in nutrients and minerals like calcium.
Am I at heightened risk for dental disease during pregnancy?
Pregnancy does cause significant increases in your body’s hormones, particularly estrogen. This can cause changes in the gum tissue’s blood vessels that may make you more susceptible to periodontal (gum) disease (commonly called “pregnancy gingivitis”). It’s also possible later in pregnancy to develop non-cancerous overgrowths of gum tissues called “pregnancy tumors.” The heightened risk for gum disease during pregnancy calls for increased vigilance in monitoring gum health.
What should I do to take care of my teeth?
It’s important to brush your teeth thoroughly twice a day with ADA-approved fluoridated toothpaste to remove plaque, a thin layer of bacteria and food remnants that adhere to teeth. You should also floss daily and consider using an anti-plaque/anti-gingivitis mouthrinse. And, of course, you should see us for regular office cleanings and checkups, or if you notice swollen, tender or bleeding gums, or other abnormalities.
Should I take prenatal fluoride supplements?
This sounds appealing as a way to give your baby a head start on strong tooth development. Studies on its effectiveness, however, remain slim and somewhat inconclusive — we simply don’t have enough data to make a recommendation. What does have a solid research record is the application of fluoride to teeth in young children just after they appear in the mouth — studies involving over a thousand teeth have shown 99% cavity-free results using topical fluoride applications with sealants.
If you would like more information on dental care during pregnancy, 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 “Expectant Mothers.”
This year's Carol Burnett Award, presented at the Golden Globes, goes to Ellen DeGeneres for her “outstanding contributions to the television medium on or off the screen.” This is the latest in a long list of honors for the comedienne, talk show host and activist that includes Emmys, Grammys and Teen Choice Awards. And one not quite as well-known: a 2004 “Flossy” award.
DeGeneres received this honor from the National Flossing Council in recognition of her passionate promotion of oral hygiene, particularly flossing. She wrote about its virtues in her 2003 book, The Funny Thing Is…., saying, among other things, “Don't even think for a second that you can get away with not flossing.”
DeGeneres's motivational cheerleading for flossing is helpful and necessary because, well, many of us just don't like doing it. It requires more manual dexterity than its more popular sibling, brushing. And the tendency for the floss to gunk up with plaque residue for some is simply unpleasant.
Mainly, though, many folks think brushing is enough. Not so fast, according to dental professionals. While brushing removes disease-causing bacterial plaque from broad tooth surfaces, it can't effectively get into the spaces between teeth. It takes flossing to clear plaque from these more difficult areas.
But don't fret: There are ways to make flossing an easier—and more pleasant—task.
Ask us for help. As we said before, flossing does take some hand dexterity and coordination to perform. You may also wonder if you're doing it effectively. We can provide training and tips on how to be a more effective flosser at your next visit.
Practice, practice, practice. You probably think nothing of riding a bicycle, and yet it probably took you weeks or months as a kid to become proficient. Similarly, your first attempts at flossing might feel awkward, but you'll improve with practice, so don't give up.
Brush before you floss. Most people floss before brushing, but if you tend to encounter a lot of soft plaque debris that makes flossing “icky” for you, then try brushing first to clear a good portion of it out of the way before you floss. Just be aware, most professionals believe that flossing first is better because it loosens up debris between teeth so the bubbles from the toothpaste can carry it away. But any flossing is better than no flossing!
Try flossing tools. For some people, floss picks, small pre-threaded tools you can use with one hand, seem easier to maneuver than regular floss thread. If you have issues with manual dexterity, an oral irrigator can make the task easier: This handheld device uses a stream of pressurized water to loosen and flush away plaque between teeth.
So, follow Ellen DeGeneres's advice she gave Tulane University graduates during a commencement speech: “Remember to exfoliate, moisturize, exercise…and floss.” The latter, along with brushing, will certainly help keep your teeth and gums healthy.
Every year 150,000 people, mostly women over age 50, find out they have a painful condition called trigeminal neuralgia. For many it begins as an occasional twinge along the face that steadily worsens until the simple act of chewing or speaking, or even a light touch, sets off excruciating pain.
The source of the pain is the pair of trigeminal nerves that course along each side of the face. Each nerve has three separate branches that provide sensation to the upper, middle and lower areas of the face and jaw.
The problem arises when areas of the myelin sheath, a fatty, insulating covering on nerves, becomes damaged, often because of an artery or vein pressing against it. As a result, the nerve can become hypersensitive to stimuli and transmit pain at even the slightest trigger. It may also fail to stop transmitting even after the stimulation that caused it is over.
Although the condition may not always be curable, there are various ways to effectively manage it. The most conservative way is with medications that block the nerve from transmitting pain signals to the brain, coupled with drugs that help stabilize the nerve and decrease abnormal firing.
If medication isn't enough to relieve symptoms, there may be some benefit from more invasive treatments. One technique is to insert a thin needle into the nerve to selectively damage nerve fibers to prevent them from firing. Another microsurgical procedure attempts to relocate the nerve away from a blood vessel that may be compressing it.
The latter procedure has some higher risks such as facial numbness or decreased hearing, and is often better suited for younger patients. Older patients may benefit more from the needle insertion procedure previously mentioned or a directed beam of high-dose radiation to alter the nerve.
To learn the best options for you, you should first undergo a neurological exam to verify you have trigeminal neuralgia and to rule out other causes. From there, you and your doctor can decide the best course of treatment for your age and individual condition.
Trigeminal neuralgia can be an unpleasant experience. But there are tried and true ways to minimize its effect on your life.
If you would like more information on trigeminal neuralgia, 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 “Trigeminal Neuralgia.”
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