Dental Implants

A dental implant is an artificial tooth root placed into the jaw to hold a replacement tooth. Dental implants look and feel like natural teeth, and with proper care, they can be a long-term solution to tooth replacement. 

Advantages of Dental Implants 

Appearance: The replacement teeth that dental implants are built to hold will appear identical to your surrounding teeth. No one will know you have a replacement tooth. 

Periodontists: The Dental Implant Experts

As specialists in treating gum tissue and the underlying bone in the mouth, periodontists are uniquely qualified to place and maintain dental implants. Periodontists receive three additional years of training after dental school to master the surgical skills needed to provide predictable and successful dental implant treatment. 

Reliability: The success rates of dental implants are highly predictable. When placed by a periodontist and with diligent at-home maintenance, a dental implant can last for many years. 

Confidence: Because they are secured into the jaw, dental implants function like natural teeth, allowing you to confidently smile, speak, and eat. 

Comfort: Dental implants fuse into your jawbone, becoming permanent. Unlike dentures, they will stay comfortably in place and do not require messy adhesives. 

Improved Oral Health: Because the adjacent teeth are not affected by dental implants, your long-term oral health is not compromised. 

Dental Implant Treatment 

Your periodontist, in collaboration with your general dentist, will develop a treatment plan unique to your specific needs. The dental implant, often a small titanium post, is first placed into the jawbone where the missing tooth is. Your jawbone will grow around the dental implant through a process called osseointegration. Once the jawbone has fused with the dental implant, an abutment, which attaches to the replacement tooth, will be placed. Typically, the replacement tooth is affixed by a general or restorative dentist. The entire dental implant process—including extraction, integration of the implant, and periods of healing—can take up to several months depending on your treatment plan. 

Dental Implant Care 

Because dental implants look and function like natural teeth, they require the same care. The American Academy of Periodontology (AAP) recommends brushing twice a day, flossing at least once a day, and receiving regular check-ups including an annual comprehensive periodontal evaluation.

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The American Academy of Periodontology provides this information as a public service, and it should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Visit perio.org for more information on periodontal disease. © 2018 American Academy of Periodontology

Your Smile & Gums

A smile is one of the most universally recognizable expressions. Smiling can demonstrate a person’s happiness, confidence, attractiveness, sociability, and sincerity. However, the effects of gum disease or other oral tissue disorders cannot only be dangerous to your health and well-being but can also have the potential to ruin your smile. Luckily, periodontists are the experts in treating the tissues around the teeth. They have the know-how to treat the effects of gum disease or other oral tissue disorders and help improve your smile. There are a variety of periodontal cosmetic procedures that can improve and enhance the overall artwork of your smile. 

Missing Teeth 

Gum disease is one of the leading causes of tooth loss in adults. In the past, the only options for disguising tooth loss were dentures and bridges. Nowadays, dental implants are a more natural looking option because implants look and feel just like real teeth. They also allow the patient to speak and eat with comfort and confidence. During this procedure, a dental implant is attached to the root and after a healing period, an artificial tooth is attached. The result is a permanent replacement tooth that blends right in with the rest. 

Root Coverage

Smile for Happy Gums

A recent study published in the Journal of Periodontology found evidence that periodontal, or gum, disease may negatively affect an individual’s smiling patterns and deter someone from displaying positive emotions through a smile.1 So maintain good oral health by brushing and flossing daily and give your gums something to smile about.

Gum recession as a result of gum disease causes the tooth root to become exposed, which can make teeth look long and can prematurely age a person. In fact, the phrase “long in the tooth”, used to describe the elderly, is derived from this very reason. A periodontist can fix this problem with a procedure called root coverage. During this procedure, tissue from the mouth’s palate, or other synthetic materials, are used to facilitate coverage of the exposed root. 

Gummy Smile

Periodontists also have the ability to fix a “gummy smile” when a person’s teeth appear too short. The teeth may actually be the proper length, but they’re covered with too much gum tissue. Your periodontist can correct this by performing a procedure called crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. Think of it like pushing back the cuticles on a fingernail. The outcome is longer looking teeth and a winning smile. Your gums are an important part of your smile. They frame the teeth and play an integral role in the overall aesthetics of your everyday appearance. While taking care of them by brushing and flossing daily is the best way to maintain a healthy mouth, talk to your periodontist about the procedures available to maximize the potential of your smile. 

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1 R Patel, -P Richards, -M Inglehart. Periodontal Health, Quality of Life, and Smiling Patterns – An Exploration. Journal of Periodontology. 2008, Vol. 79, No. 2, Pages 224-231 YOUR GUMS AND YOUR SMILE The American Academy of Periodontology Patient Page is a public service of the AAP and should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Call 1-800-FLOSS-EM for a free brochure on periodontal disease. 
 

Inflammation & Periodontal Disease

Most people know that maintaining healthy teeth and gums is a necessary step in achieving overall well-being. In fact, now not only dentists encourage brushing and flossing, but many physicians also promote oral hygiene as a way to help keep the rest of the body healthy. Several research studies have suggested that gum disease may be associated with other health issues, including heart disease, stroke, and diabetes. And with more and more research reinforcing the connection between periodontal and systemic health, scientists are beginning to understand why these connections exist. One theory points to chronic inflammation as the culprit. Inflammation is the body’s natural response to harm, such as an injury or infection.

For many years, dentists believed that gum disease developed as a result of a bacterial infection caused by the build-up of plaque between the teeth and under the gums. While plaque build-up is still a factor in the development and progression of gum disease, researchers now suspect that the more severe symptoms, namely swollen, bleeding gums; recession around the gum line, and loss of the bone that holds the teeth in place, may actually be caused by the chronic inflammatory response to the bacterial infection, rather than the bacteria itself.

What is Inflammation?

Inflammation is the body’s instinctive reaction to fight off infection, guard against injury or shield against irritation. Acute cases of inflammation are easily identifiable, and are often characterized by swelling, redness, heat and pain around the affected area. While acute inflammation initially intends to heal the body, over time, if left untreated, it can lead to chronic inflammation. Chronic inflammation can lead to dysfunction or destruction of the infected tissues, and potentially more severe health complications.

Scientists hypothesize that the chronic inflammatory response mechanism may be the reason behind the periodontal-systemic health link. Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, kidney disease and even certain forms of cancer, suggesting that chronic inflammation itself may be the basis for the connection.

More research is needed to pinpoint the precise biological mechanisms responsible for the relationship between gum disease and other disease states. However, since previous findings have indicated that gum disease sufferers are at a higher risk for other diseases, it is critical to maintain periodontal health in an effort to achieve overall health. Dentists recommend daily oral care, including regular brushing and flossing, and routine visits to the dentist to avoid gum disease. If gum disease develops, consultation with a dental professional such as a periodontist can lead to effective treatment.

More Tips to Keep Your Teeth & Gums Healthy

Most people recognize how important it is to keep your teeth and gums healthy, but over time, different lifestyle factors can negatively impact your periodontal health. To help maintain healthy teeth and gums, keep these tips in mind: 

Strive to be stress-free

Minimize the stress in your life. Research has shown that people who are having a difficult time coping with stress can neglect their oral hygiene (1). Additionally, researchers have also associated the hormone cortisol with periodontal disease. Chronic stress has been shown to increase levels of cortisol, and these increased levels can be a factor in developing periodontal disease. 

Genetics can affect your oral health, too!

Family history may make a difference in your overall health, including periodontal disease. Periodontal Disease multifactorial, which means you can be susceptible due to genetics as well as environmental factors such as diet and smoking. Your genes play a major role in the onset and severity of periodontal disease.

Kick the tobacco habit

Tobacco use is one of the most significant risk factors in the development and progression of periodontal disease. Tobacco’s negative effects on oral health are well documented. Most people that have recurrent periodontal disease are smokers, and smoking is also associated with complications after oral surgery. 

Drink alcohol in moderation

Drinking the occasional glass of red wine has been shown to have positive effects on the body; however, heavy drinking can negatively impact your oral health. Alcohol can irritate your gums, tongue, and other oral tissues. It can also contribute to poor healing after surgery and can halt your oral hygiene routine. In addition, heavy drinkers often suffer from tooth decay as a result of the increased exposure to sugars and acids that are often found in alcoholic drinks(2). 

Stock up on healthy foods

You know that a healthy diet is important for your overall health, but it’s also very important for your oral health! A good diet will help your immune system be at its best to help fight infections, including periodontal disease. In addition to eating a wellbalanced, nutritious diet, research has shown that both yogurt(3) and green tea(4) may add an extra boost to your periodontal health. 

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1. Peruzzo, DC et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007 Aug;78(8):1491-504. 
2. Cury PR et al. Hydrocortisone Affects the Expression of Matrix Metalloproteinases (MMP-1, -2, -3, -7, and -11) and Tissue Inhibitor of Matrix Metalloproteinases (TIMP-1) in Human Gingival Fibroblasts. J Periodontol. 2007 Jul;78(7):1309-15. 
3. Shimazaki Y et al. Intake of Dairy Products and Periodontal Disease: The Hisayama Study. J Periodontol. 2008 Jan;79 (1):131-7. 
4. Kushiyama M et al. Relationship Between Intake of Green Tea and Periodontal Disease. J Periodontol. 2009 Mar;80(3): 372-7. 

There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Visit perio.org to assess your risk and for more information on periodontal disease.

Maintaining Oral Health During Cancer Treatment

Cancer therapy can cause oral complications that compromise periodontal health, so a visit to your periodontist is important to help keep your gums healthy during this difficult time.

Oral Complications

Common side effects of cancer treatments such as chemotherapy, radiation to the head and neck, and bone marrow transplantation can negatively impact your overall health and quality of life. Radiation and chemotherapy kill cancer cells, but they can also hurt normal cells. Complications vary for every person, but common complications include: 

• Inflamed gums and mouth ulcers 
• Dry mouth
• Difficulty speaking, chewing, and swallowing 
• Erosion of tooth enamel
• Loss of taste 
• Jaw stiffness 
• Delayed healing

Pretreatment Evaluation and Daily Oral Hygiene Routine

Before beginning your cancer treatment, an oral evaluation by a periodontist is important. Identifying and correcting potential problems in your mouth may prevent them from intensifying or interfering with your cancer treatment. In addition to pretreatment care, your periodontist will probably recommend a daily oral hygiene routine. This routine will provide comfort, reduce the risk of infection, and minimize the effects of the complications caused by the cancer treatment.

Special Considerations

Oral Cancer

According to the Centers for Disease Control (CDC), more than 30,000 Americans are diagnosed with mouth and throat cancers each year. Oral cancer can affect any area of the oral cavity including the lips, gum tissues, check lining, and the hard or soft palate. As with many forms of cancer, early detection can improve the chances of successful treatment. By taking a few minutes to examine your entire mouth, you’re taking an active role in detecting signs of oral cancer early. To minimize the risk of developing oral cancer, avoid all forms of tobacco and heavy use of alcohol.

Even though pretreatment and daily oral hygiene can go a long way toward keeping your mouth healthy and comfortable during cancer treatment, sometimes it is hard to keep the negative effects at bay. Chemotherapy and radiation can decrease your salivary secretion causing excessive dryness in the mouth, and a dry mouth can increase your susceptibility to infection. Therefore, it is important to keep your mouth moist by sipping cool water, melting ice chips in your mouth, chewing sugarless gum, applying lip balm to your lips, and using a humidifier in your bedroom to reduce oral dryness at night. If a dry mouth or vomiting is a side effect of your cancer treatment, then it is important to protect your enamel (the outer surface of the tooth). Your periodontist can prescribe fluoride trays, which will prevent the tooth enamel wearing away as a result of vomiting or increased oral bacteria from dry mouth. You may also want to consider asking your oncologist to prescribe anti-nausea medication during your cancer therapy to treat nausea and vomiting. The relationship with your periodontist is as important after your cancer therapy as it is before and during your treatments. This continued relationship will help you maintain a comfortable, confident smile for years.

Brush & Floss for Healthy Gums!

One of the easiest ways to help prevent gum disease is to brush and floss every day, so, therefore, it is very important to know the correct way to take care of your teeth and gums. It does not matter if you brush first or floss first, as long as you do both (twice a day!). Equipment The most commonly used toothbrush is the manual toothbrush.

Another option is the electric toothbrush, which uses electrical power to move the brush head. The resulting vibrations that are created gently clean the teeth. It is important to always choose a soft brush head when using either a manual or electric toothbrush and to replace the toothbrush when the bristles begin to bend (or every two to three months).

According to a recent study in the Journal of Periodontology(1), all dental flosses are equally effective. This means that it does not matter which type of floss you choose to use. There are many different varieties of floss, including waxed, unwaxed, flavored, and shred-resistant, so there is a type of floss out there for everyone!

How to Brush

Position the toothbrush at a 45-degree angle where your gums and teeth meet. While applying slight pressure, gently move the brush in a circular motion using short strokes. Use this method to clean the front of your teeth, then move to the back of your teeth, then the biting surfaces, and then your tongue, using the same gentle movements. Be sure you are constantly moving the brush head to avoid damaging your gums!

How to Floss

Using about 18 inches of floss, wrap the floss around your middle finger. Wrap the rest around your other middle finger, leaving 2-3 inches of floss between your fingers. While tightly holding the floss between your thumbs, insert it between two teeth. Curve the floss into a “C” shape against the tooth, and gently slide it up and down. Then, with the floss still in between the two teeth, switch the “C” shape against the adjacent tooth, and repeat the sliding motion. Move to the next tooth over, and repeat the process, unwrapping fresh floss from your middle finger as you go. For more information on brushing and flossing techniques or to learn other ways to prevent gum disease, make an appointment!

Don’t Forget your Checkup!

Daily brushing and flossing are some of the best ways to help prevent gum disease because it keeps the formation of bacteria-rich plaque to a minimum. However, you should be sure to visit a dental health professional, such as a periodontist, at least twice a year to have your teeth professionally cleaned and to screen for signs of periodontal disease. Money may be tight in the current economy, but preventing gum disease can be less expensive than treating gum disease. Additionally, research(2) has found that people with gum disease can have higher health care costs than people without gum disease! Take the time now to regularly brush and floss to help prevent gum disease and avoid higher health care costs! 

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(1) G Terézhalmy, R Bartizek, A Biesbrock. Plaque- Removal Efficacy of Four Types of Dental Floss. Journal of Periodontology. February 2008, Vol. 79, No. 2, Pages 245-251
(2)R Ide, T Hoshuyama, K Takahashi. The Effect of Periodontal Disease on Medical and Dental Costs in a Middle-Aged Japanese Population: A Longitudinal Worksite Study. Journal of Periodontology. November 2007, Vol. 78, No. 11, Pages 2120-2126 Brush and Floss for Healthy Gums!

The American Academy of Periodontology Patient Page is a public service of the AAP and should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Call 1-800-FLOSS-EM or visit perio.org for more information on periodontal disease.

A Lifetime of Healthy Teeth & Gums

Special Concerns for Women

Women who are menopausal or post-menopausal may experience changes in their mouth including dry mouth, pain or burning sensations in the gum tissue, and altered taste due to hormonal changes. Additionally, menopausal women should be concerned about osteoporosis, which can lead to tooth loss if the density of the bone that supports the teeth has decreased. Talk to your doctor about hormone replacement therapy or estrogen supplements, which may help symptoms of menopause.

People are now living longer and healthier lives, and older adults are more likely than ever before to keep their teeth for a lifetime. However, research has shown that older people also have the highest rates of periodontal disease. In fact, at least half of people over age 55 have some form of periodontal disease, and almost one out of four people over 65 have lost all their teeth.

No matter what your age, it is important to keep your teeth and gums healthy. If you’ve succeeded in avoiding periodontal disease as you age, it is especially important to continue to maintain your oral care routine. Be sure to brush and floss daily, and see a dental professional, such as a periodontist, regularly.

You should also receive a comprehensive periodontal exam each year. This will ensure that your oral health (and possibly even your overall health) stays at its best. If you have dexterity problems or a physical disability and are finding it difficult to properly brush or floss your teeth, your dentist or periodontist can suggest options such as an electric toothbrush or floss holder.

Research has shown that periodontal disease is a chronic inflammatory disease that may put you at a higher risk for other diseases including cardiovascular disease, diabetes, and Alzheimer’s disease. During your regular visits with your dentist or periodontist, be sure to let him or her know if you have any of these medical conditions or if you have a family history of disease. Likewise, if you have been diagnosed with periodontal disease, it’s a good idea to share this information with your physician to ensure that you’re receiving appropriate care. You should also tell your dentist or periodontist about any medications you are taking, because many medications can impact your oral health and therefore affect your dental treatment. Hundreds of common medications - including antihistamines and high blood pressure medications - can cause side effects such as soft tissue changes, taste changes, and gum overgrowth. Another possible side effect of some medications is dry mouth, a condition that leaves the mouth without enough saliva to wash away food from your teeth. This may leave you more susceptible to tooth decay and periodontal disease, and can cause sore throat, problems with speaking, and difficulty swallowing.

Maintaining your oral health should be a priority at any age. As you get older, be sure to continue to take care of your teeth and gums to ensure that they’ll stay healthy and strong for life!

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The American Academy of Periodontology Patient Page is a public service of the AAP and should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Visit perio.org to assess your risk and for more information on periodontal disease. 

Periodontal Plastic Surgery & Cosmetic Treatments

Just as cosmetic surgery can help people improve their looks, several periodontal plastic surgery procedures are available to help enhance the aesthetics of your smile. The following are some common treatments.

Dental Implants

A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants are the answer for many people with missing or damaged teeth, and they are a long-term solution that look, feel, and function just like natural teeth.

Root Coverage

Root coverage procedures are often used to treat gums that have receded to the point that the roots of a tooth are exposed. During a root coverage procedure, your periodontist will take gum tissue from the roof of your mouth (known as the palate) to cover roots, develop gum tissue where needed, or make dental implants look more natural. In some cases, this procedure can cover exposed roots to protect them from decay or to prepare your teeth for orthodontic treatment.

Ridge Augmentation

Ridge augmentation procedures are often performed to correct irregularities in the gums and jaw after a tooth extraction. A periodontist may also perform a ridge augmentation to prevent the jawbone from collapsing after a tooth extraction. A ridge augmentation may be needed to allow the placement of a properly sized dental implant.

Pocket-Depth Reduction

Bone and gum tissue should fit snugly around the teeth. In cases of advanced periodontal disease, deep pockets can form in the spaces between the gum and tooth, providing a space for additional bacteria to fester and possibly cause further damage to gum tissue and bone. During a pocket depth reduction, a periodontist clears the pockets of any bacteria and infection and retightens the gum tissue around the tooth.

Crown Lengthening

Crown lengthening is a procedure where excess gum tissue is removed to expose more of the “crown,” the white enamel-covered part of the tooth. This procedure is performed on patients who have a “gummy smile” in which the teeth appear too short or the gum line seems uneven. The procedure, which can be administered to one tooth or to enhance your entire smile, reshapes excess gum and bone tissues to expose more of the natural tooth.

Combination Procedures

Sometimes, you may need a few of these procedures to build the framework for your perfect smile. Often, periodontal plastic surgery is used to lay the foundation for further cosmetic enhancements, such as orthodontic devices and veneers. A combination of periodontal procedures can result in a beautiful new smile and improved periodontal health. 

Dental Anxiety

Your periodontist may recommend conscious sedation to ensure that you are comfortable and relaxed during your procedure. Conscious sedation uses medications that leave you conscious and pleasantly relaxed, yet free of fear, anxiety, and apprehension about undergoing dental treatment. It is different than general anesthesia (a controlled and reversible unconscious state in which you are unable to sense any pain), and it does not carry inherent risks. Ask your periodontist for more information about conscious sedation. Reducing Dental Anxiety

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The American Academy of Periodontology provides this information as a public service, and it should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Visit perio.org for more information on periodontal disease.