Periodontics
Dr. Michael J. Wiener
Periodontist
A periodontist is a dentist who specializes in preventing, diagnosing, and treating gum disease. They also help you manage signs of advancing gum problems like oral inflammation.
Periodontal diseases are infections of the gums that gradually destroy the support of your natural teeth. Dental plaque is the primary cause of gum disease in genetically-susceptible individuals. Bacteria found in plaque produce toxins or poisons that irritate the gums. They may cause them to turn red, swell, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
However, don’t be fooled. With periodontal disease, bleeding, redness, and swelling do not have to be present. Further, pain is usually not associated with periodontal disease. This disease damages the teeth, gum, and jawbone of more than 80 percent of Americans by age 45.
Dental implants are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The implants themselves are tiny titanium posts that are placed into the jawbone where teeth are missing. The bone bonds with the titanium, creating a strong foundation for artificial teeth. In addition, implants can help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.
Dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh, and enjoy life.
A periodontist has received extensive training in Implantology. Through continuing education, is abreast of the most current information on implant dentistry.
Evaluation
If like many others, you feel implant dentistry is the choice for you, we ask that you undergo a dental/radiographic examination and health history. During these consultation visits, your doctor will address your specific needs and considerations. Your questions and concerns are important to us and our team will work with you very closely to help make your procedure a success.
We will also discuss fees and insurance at this time. There are many types of insurance plans, and coverage for implants is varied. We will be happy to assist you in obtaining any benefits to which you may be entitled.
Procedures
Dental implants are metal anchors that act as tooth root substitutes. They are surgically placed into the jawbone. Small posts are attached to the implant to provide stable anchors in the gums for replacement teeth.
For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. Healing time following surgery varies from person to person and is based on a variety of factors that include the hardness of bone. In some cases, implants may be restored immediately after they are placed.
For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time, your restorative dentist designs the final bridgework or denture that will ultimately improve both function and aesthetics.
After the implant has bonded to the jawbone, the second phase begins. will uncover the implants and attach a small healing collar. After two weeks your general dentist will be able to start making your new teeth. An impression must be taken. Then posts or attachments can be connected to the implants. The teeth replacements are then made over the posts or attachments. The entire procedure usually takes six to eight months. Most patients do not experience any disruption in their daily life.
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an option.
When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.
In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance of the gum and tooth. When significant, gum recession can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.
The gingival graft procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth.
The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line.
The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is difficult for to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.
Bite Adjustment
A bite is considered to be healthy when all or most of the teeth are present and not destroyed by normal daily usage.
It is destructive when teeth show wear, looseness or when TMJ (jaw joint) damage is seen. Bite therapy helps restore a bite that can function without damage and destruction. The therapy may include:
- Reshaping the biting surfaces of the teeth and eliminating spots of excessive pressures where the teeth are brought into contact. This is done by carefully dividing bite pressures evenly across all of the teeth.
- Bite splint therapy using a custom-fitted and adjusted plastic bite guard to keep the teeth apart, day, night, or both.
- Braces to reposition mal-aligned or drifted teeth.
- Replacement of old, worn out, or damaged fillings.
- Reconstruction of badly worn and damaged teeth.
What are common signs and symptoms of periodontal disease?
Periodontal disease is often silent, meaning symptoms – particularly pain – may not appear until an advanced stage of the disease. However, you should still be on the lookout for the signs and symptoms, which include:
- Red, swollen or tender gums or other pain in your mouth
- Bleeding while brushing, flossing, or when eating certain foods
- Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
- Loose or separating teeth
- Pus between your gums and teeth
- Sores in your mouth
- Persistent bad breath
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
If you notice any of these symptoms, be sure to contact your dentist or periodontist right away!
What is the difference between plaque and calculus?
Plaque is the sticky, colorless film that constantly forms on your teeth. Bacteria live in plaque and secrete acids that cause tooth decay and irritate gum tissue. This irritation causes an inflammatory reaction by your body that can eventually lead to gingivitis and periodontal disease. If plaque is not removed regularly by tooth brushing and flossing, it hardens to create calculus (also known as tartar). Calculus cannot be removed with a toothbrush; only a dental professional can remove it during an oral cleaning. To keep plaque and calculus under control, it is essential to brush your teeth twice every day, floss at least once every day, and see your dental professional for regular cleanings.
Can children be at risk for developing periodontal disease?
Periodontal disease is rarely found in children, and only sometimes found in adolescents. However, children should still learn the importance of keeping their teeth and gums healthy to prevent periodontal disease in the future. Children should brush their teeth twice a day and learn how to floss properly- if children learn how to floss at an early age, they will be more likely to make it a lifetime habit. These two simple acts will help protect their teeth and gums from periodontal disease.
As a parent, you should also be aware of the warning signs of periodontal disease, which include red, swollen, bleeding gums or bad breath that won’t go away. If your child develops any of these symptoms, tell your dental professional right away. It’s also a good idea to ensure your dental professional knows your complete family history, as genetics can play an important role in the early development of periodontal disease.
What can I do at home to prevent periodontal disease?
The best way to prevent periodontal disease is to take good care of your teeth and gums at home. This includes brushing your teeth after every meal and before bedtime, flossing at least once each day, and seeing your dentist or periodontist for regular exams twice a year. Spending a few minutes a day on preventative measures may save you the time and money of treating periodontal disease!
I was recently diagnosed with periodontal disease. How often should I see my periodontist for an examination?
Regular examinations are very important to keep track of the present status of your disease and any disease progression over time. Your periodontist will work with you to create a maintenance schedule depending on how advanced your periodontal disease is at that time. Based on many variable factors such as your overall health, the severity of bone loss, and risk factors such as smoking and genetics, your periodontist will constantly tailor your care so your periodontal disease does not progress further. He or she may recommend exams every six months for mild periodontal disease, or every few months for more advanced stages.
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