While the term “plastic surgery” might bring to mind face lifts or tummy tucks, not all procedures in this particular surgical field are strictly cosmetic. Some can make a big difference in a person’s health.
One example is periodontal plastic surgery, which corrects gum tissue loss around the teeth. Although these procedures can indeed improve appearance, they more importantly help save teeth.
Gum loss is most often a consequence of periodontal (gum) disease, a bacterial infection arising from a thin film of food particles on the teeth called dental plaque. As the disease weakens the gums’ attachment to teeth, they shrink back or recede, exposing the area around the roots. Without the protective cover the gums provide the roots, they become more susceptible to decay.
In milder cases of gum recession, treating the infection often results in the gums regaining their normal attachment to teeth. But with more advanced recession, natural gum healing may not be enough to reverse it. For such situations grafting donor tissue to the recessed area can help stimulate new tissue growth.
While gum tissue grafts can come from an animal or other human, the most likely source is from the person themselves. In one type of procedure, free gingival grafting, the surgeon locates and completely removes (or “frees”) a thin layer of skin resembling gum tissue, typically from the roof of the mouth, shapes it and then transplants it by suturing it to the recession site. Both donor and recipient sites heal at about the same rate in two to three weeks.
Another technique is known as connective tissue grafting. In this procedure the surgeon partially removes the donor tissue from its site while leaving a portion containing blood vessels intact. The palatal tissue is still used and transported to fit beneath the tissue that’s still attached to the blood supply. This connective tissue graft is then positioned and sutured to the recipient site while still maintaining its blood supply connection at the donor site. Maintaining this connection facilitates healing and increases the chances the graft will “take” and become firmly attached to the new site.
Grafting procedures require advanced techniques and skills. But with them we may be able to restore gum attachment to teeth with an impact on appearance and dental health that’s well worth the effort.
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 “Periodontal Plastic Surgery.”
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.”
There are a variety of methods for treating periodontal (gum) disease depending on its severity — from routine office cleanings to periodontal surgery. But the goal behind all of them remains the same: remove bacterial plaque and calculus (tartar), the root cause for gum disease, from all tooth and gum surfaces.
The traditional method for doing this is called scaling in which we use special hand instruments (scalers) to mechanically remove plaque and calculus. Scaling and a similar procedure called root planing (the root surfaces are “planed” smooth of plaque to aid tissue reattachment) require quite a bit of skill and experience. They're also time-consuming: full treatment can take several sessions, depending on how extensive the infection has spread.
In recent years, we've also seen a new method emerge for removing plaque: lasers. Commonly used in other aspects of healthcare, lasers utilize a focused beam of light to destroy and remove diseased or unhealthy tissue while, according to studies and firsthand accounts, minimizing healthy tissue destruction to a better degree than traditional techniques. Procedure and healing times are likewise reduced.
Because of these beneficial characteristics, we are seeing their use in gum disease treatment, especially for removing diseased and inflamed tissues below the gum line and decreasing sub-gingival (“below the gums”) bacteria.
Dentists who have used lasers in this way do report less tissue damage, bleeding and post-treatment discomfort than traditional treatments. But because research is just beginning, there's not enough evidence to say laser treatment is preferably better than conventional treatment for gum disease.
At this point, lasers can be an effective addition to conventional gum disease treatment for certain people, especially those in the early stages of the disease. As we continue to study this technology, though, the day may come when lasers are the preferred way to stop gum disease from ruining your dental health.
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 “Lasers Versus Traditional Cleanings for Treating Gum Disease.”
In the quest for the ideal diet, people often stress over one particular food group: carbohydrates. And for good reason—some carbohydrates have been linked to chronic inflammation, a contributing factor in many diseases. One such condition in particular, periodontal (gum) disease, could permanently damage your dental health.
But before you throw all the carbs out of your diet, let’s take a closer look at them. Not all carbs are the same or contribute to inflammation to the same degree.
Carbohydrates are organic compounds existing in living tissues. In foods, the most prevalent of these are sugars and starches that break down during digestion into the simple sugar glucose, which the cells in an organism use for energy.
But not all carb-based foods digest at the same rate, measured along a scale called the glycemic index. High glycemic foods like sugar, baked goods or potatoes digest quickly and can rapidly increase the glucose levels in the blood (blood sugar). This sudden glucose spike then triggers an insulin surge from the pancreas to restore the level to normal. This process in turn can cause inflammation.
On the other end of the glycemic index are complex or unrefined carbohydrates that digest much more slowly, and don’t quickly elevate blood sugar like simple carbs. In fact, nutritional studies consistently show carbohydrates in most vegetables, greens, beans or whole grains may actually decrease inflammation.
Inflammation is also a primary factor in gum disease, caused by a bacterial infection in the gums. Chronic inflammation damages the gums’ attachment with the teeth and can contribute to eventual tooth loss. And if your body already has an overactive inflammatory response due to your diet, you could be even more susceptible to gum disease.
A change in your diet in relation to carbs could help reduce this risk. Eat less sugar, white flour, rice and potatoes and more complex carbs like fresh vegetables and fruits. For even more protection include foods rich in Omega-3 fatty acids (like certain fish and nuts) and less Omega 6 foods (fried food or pastries, or chips, for example). And don’t forget your antioxidants, vitamins and minerals.
Eating fewer simple carbs and more complex carbs will help reduce inflammation in the body. And that’s a good thing for your gums.
If you would like more information on how diet affects dental health, 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 “Carbohydrates Linked to Gum Disease.”
Although it’s a natural part of dental development, teething is no picnic for your baby. This process in which each of their twenty primary teeth gradually erupt through the gums usually begins around their sixth to ninth month and may not end until around age three.
These periodic tooth eruptions can cause your baby to bite, gnaw, drool or rub their ears. Teething can also disrupt sleeping patterns, decrease appetite and cause gum swelling and pain that can turn your otherwise happy baby into an unhappy one.
Managing these teething episodes is one of the most common topics parents bring up with their dentists. Since teething is supposed to happen, there’s no need for medical intervention unless the child is also experiencing diarrhea, rashes, fever or prolonged irritability associated with teething episodes. In most cases, the best you can do is to make your child more comfortable. Here are a few things to help you do just that.
Provide cold items for gnawing. Rubber teething rings, wet wash cloths or pacifiers that have been chilled can give your child something to gnaw on and ease the pressure of sore gums while the chilled temperatures help numb pain. Be sure, though, that the items aren’t frozen because extremely cold temperatures can burn the skin.
Gum massage. You can massage your child’s gums with one of your fingers during a teething episode to counteract the throbbing pressure coming from the erupting tooth. Just be sure your finger is clean and don’t use any numbing agents unless advised by your dentist or pediatrician.
OTC medication. You can ease mild to moderate teething pain with over-the-counter pain relievers like acetaminophen or ibuprofen in dosages appropriate for your child’s age. But don’t apply rubbing alcohol to the gums or massage in any pain reliever—both practices can burn the skin. And, as mentioned before, only apply numbing agents like Benzocaine with the advice and supervision of a healthcare professional.
Besides these practices, be sure to keep up regular dental checkups to monitor the teething process and ensure all is going normally. And remember: though it may seem harrowing at times, the teething process won’t last forever.
If you would like more information on easing the effects of teething, 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 “Teething Troubles: How to Help Keep Your Baby Comfortable.”
Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand.Â Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.
Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.
A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.
Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.
If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.
If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”
We breathe every moment of every day and we’re hardly aware of it most of the time. But if you take the time to focus, you’ll find two possible pathways for your breath: through the nose or through the mouth.
While either pathway provides the air exchange needed to live, nose breathing offers better health benefits. Air passes through the nasal passages, which filter out many harmful particles and allergens. The mucous membranes in the nose also humidify the air and help produce heart-friendly nitric oxide.
Nose breathing also plays a role in your child’s facial and jaw development: the tongue rests on the roof of the mouth (the palate) and becomes a kind of mold around which the developing upper jaw can form. With chronic mouth breathing, however, the tongue rests just behind the lower teeth, depriving the upper jaw of its normal support. This could result in the development of a poor bite (malocclusion).
To avoid this and other undesirable outcomes, you should have your child examined if you notice them breathing mostly through the mouth, particularly at rest. Since chronic mouth breathing usually occurs because of an anatomical obstruction making nose breathing more difficult, it’s usually best to see a physician or an ear, nose and throat (ENT) specialist first for evaluation and treatment.
It’s also a good idea to obtain an orthodontic evaluation of any effects on their bite development, such as the upper jaw growing too narrowly. If caught early enough, an orthodontist can correct this with a palatal expander, a device that exerts gradual outward pressure on the jaw and stimulating it to grow wider.
Another bite problem associated with chronic mouth breathing is misalignment of the jaws when closed. An orthodontist can address this with a set of removable plates worn in the mouth. As the jaws work the angled plates force the lower jaw forward, thus encouraging it to grow in the direction that best aligns with the upper jaw.
Any efforts to correct a child’s breathing habits can pay great dividends in their overall health. It could likewise head off possible bite problems that can be both extensive and costly to treat in the future.
If your smile is, to put it mildly, “unattractive,” you may think only extensive and expensive dental work can change it. But depending on your teeth’s actual condition, you might be able to obtain a new smile with a less-invasive option: porcelain veneers.
As their name implies, veneers are thin layers of dental porcelain bonded to the front of teeth to cover imperfections. They’re custom designed and manufactured by a dental technician to match the natural color, shape and size of the teeth they’re covering and to blend with neighboring teeth.
Veneers are quite effective for heavily stained, chipped or moderately misaligned teeth that are otherwise healthy. They can even be used to address slight gaps between teeth and restore worn teeth to make them appear larger and more youthful.
Overall, they’re less invasive than other dental restorations. That said, though, most veneers will still require some alteration of the affected teeth. This is because although quite thin they can still appear bulky after they’re bonded to the teeth. We can minimize this by removing a small amount of a tooth’s outer enamel. While this alteration is modest compared to other restorations, it’s nonetheless permanent– your teeth will require some form of restoration from then on.
Veneers also require special consideration while biting. You’ll need to exercise care and avoid biting hard items like candies (or using your teeth as tools) or the veneer could break. Similarly if you have a teeth grinding habit, you may want to consider having a custom guard created that you wear at night to prevent solid contact between your teeth. The excessive force generated while grinding or clenching teeth could also shatter veneers.
Veneers may not be the answer in all cosmetic dental situations, such as extensive disfigurements or bite problems. To know for sure if your particular dental condition could benefit, see your dentist for a complete dental examination and discuss whether obtaining veneers is a viable option for you. If so, you may be able to gain a much more attractive smile from this less invasive but no less effective option.
If you would like more information on porcelain veneers and other dental restorations, 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 “Porcelain Veneers: Strength & Beauty as Never Before.”
National Fresh Breath Day is celebrated in August, but who doesn’t want fresh breath every day? Everyone has bad breath once in a while, so here are some tips to fight it.
1. Step up your oral hygiene routine.
Good oral hygiene is the first line of defense against bad breath. Brush your teeth morning and night and floss daily to remove much of the tiny food debris and plaque (colonies of oral bacteria) that can cause bad breath.
2. Don’t neglect your tongue.
A coated tongue can be a source of bad breath, so brush your tongue as well as your teeth or use a tongue scraper, which can be purchased in the oral health aisle of your local pharmacy.
3. Clean around your braces.
If you have braces, use an interdental brush or a water flosser to free trapped food particles.
4. Pay attention to your oral appliances.
If you wear dentures, be sure to clean them thoroughly every day, and brush your gums and the inside of your mouth as well. Bridgework also needs special attention: Clean carefully around the bridge and under the false tooth, as food can get stuck there.
5. Tackle dry mouth.
Dry mouth, a major cause of bad breath, can result from numerous medications, salivary gland problems, or breathing through the mouth instead of the nose due to sinus problems, sleep apnea, or other conditions. If your mouth is chronically dry, chew sugarless gum to stimulate saliva production, or ask about an over-the-counter or prescription saliva substitute.
6. Avoid extreme dieting.
Weight loss diets that advocate a stringent reduction in carbohydrates can lead to “keto breath.” This foul-smelling breath happens when the body burns fat instead of glucose for fuel.
7. Quit smoking.
In addition to smelling like cigarettes, people who smoke have less—as well as lower quality—saliva, which contributes to bad breath and poor oral health. If you need help quitting, talk with us or call (800) QUIT-NOW.
8. Be aware that some foods and beverages can leave stinky breath.
These include garlic, onions, strong spices, coffee, alcohol, cheese, and canned fish.
9. Keep up with regular dental visits.
Professional dental cleanings are necessary to get rid of hardened plaque (tartar) that can’t be removed by your brushing and flossing routine at home. We also check for gum disease, another cause of bad breath.
10. See your doctor.
Certain medical conditions like acid reflux, diabetes, and respiratory infections can cause bad breath. If you have an untreated health condition, make an appointment with your medical doctor.
If you are concerned about bad breath, please contact our office or schedule a consultation. You can learn more in the Dear Doctor magazine article “Bad Breath: More Than Just Embarrassing.”
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