Periodontal diseases (also known as gum diseases) are infections of the gum and bone that hold teeth in place. The good news is that periodontal diseases often can be treated in the early stages with scaling and root planing.
They often are painless, and you may not be aware that you have a problem until your gums and the supporting bone are seriously damaged.
During a checkup, the dentist examines your gums for periodontal problems. An instrument called a periodontal probe is used to gently measure the depth of the spaces between your teeth and gums.
At the edge of the gumline, healthy gum tissue forms a very shallow, V-shaped groove (called the sulcus) between the tooth and gums. The normal sulcus depth should be 3 millimeters or less. With periodontal diseases, the sulcus develops into a deeper pocket that collects more plaque bacteria and is difficult to keep clean.
If gum disease is diagnosed, your dentist may provide treatment, or you may be referred to a periodontist, a dentist who specializes in the diagnosis, prevention and treatment of periodontal diseases. Treatment often depends on how far the condition has progressed and how well your body responds to therapy.
PREVENTION AND TREATMENT
Prevention includes a good daily oral hygiene routine. Brushing twice a day with fluoride toothpaste and cleaning between teeth once a day with floss or another interdental cleaner help prevent plaque from forming. Regular dental checkups and cleanings are important.
Scaling and root planing is a method of treating periodontal disease when pockets are greater than 3 mm. Scaling is used to remove plaque and tartar beneath the gumline. A local anesthetic may be given to reduce any discomfort. Using an instrument called a small scaler or an ultrasonic cleaner, the dentist carefully removes plaque and tartar down to the bottom of each periodontal pocket. The tooth’s root surfaces then are smoothed or planed. This allows the gum tissue to heal. It also makes it more difficult for plaque to accumulate along the root surfaces.
Your dentist may recommend, prescribe and administer medications to help control infection and pain or to facilitate healing.
At a follow-up appointment, the dentist checks how the gums have healed and how the periodontal pockets have decreased. When pockets greater than 3 mm persist after treatment, additional measures may be needed.
You’ll be given instructions on how to care for your healing teeth and gums. Maintaining good oral hygiene and continued, sometimes lifelong, follow-up by your dentist are essential to help prevent periodontal disease from becoming more serious or recurring.
Root Canal Treatment
Getting To the Root
THE GOAL: PRESERVING THE TOOTH
In the past, injured or diseased teeth frequently had to be removed. Today, they often can be saved through endodontic treatment. Also known as a root canal treatment, this procedure may be performed by a general dentist or a specialist called an endodontist. More than one office visit usually is required.
A root canal treatment generally involves the removal and replacement of a tooth’s pulp.
The pulp is soft tissue containing blood vessels, nerves and connective tissue. It is found in a canal that runs through the center of the hard tissue on the inside of the tooth (the dentin). The pulp extends from the pulp chamber in the crown down through the root canal to the tip of the root in the jawbone. A tooth has only one pulp chamber but may have more than one root and several root canals.
If pulp becomes damaged through injury or disease and cannot repair itself, bacteria and their products can leak into the pulp and cause the pulp to die. If a root canal procedure is not performed, an abscess can form at the tip of the root and cause considerable pain. Even if there is no pain, the bone anchoring the tooth in the jaw can be damaged. Without treatment, the tooth may have to be extracted.
WHAT TO EXPECT
Here is what you can expect when you schedule a root canal treatment.
On the initial visit:
An opening is made through the crown of the tooth. The pulp is removed, and then the root is cleaned and shaped. Medication may be added to the pulp chamber and root canal(s) to help eliminate bacteria. A temporary filling is placed in the crown opening to keep saliva out. Antibiotics may be prescribed if an infection is present and has spread beyond the end of the root(s).
On the next visit:
The temporary filling is removed.The root canal is filled and permanently sealed (A metal or plastic rod or post may be placed in the root canal for structural support).If an endodontist performs the procedure, he or she usually will send you back to your general dentist for preparation of a crown to be placed on the tooth. Crowns are made from a variety of materials, depending on the location of the tooth, the color of the tooth and the amount of natural tooth remaining.
Discuss with your dentist which option is best for you.
When a Filling Needs To Be Replaced
A dental filling (also called a “dental restoration”) is intended to replace tooth structure lost to decay. Dental fillings may last many years; however, eventually, all fillings need to be replaced. Constant assault from eating and drinking, or stress from clenching or grinding, eventually may cause a dental filling to fail.
Bacteria cause tooth decay. Fillings that have worn away, chipped, cracked or fallen out may leave gaps between the tooth and the filling that can provide an entry point for bacteria. Bacteria are abundant in the mouth and are commonly found in saliva and in dental plaque (a thin film that forms on teeth and gums). If the seal between the tooth and the filling breaks down, food particles and decay-causing bacteria can work their way between the worn filling and the tooth. These bacteria cannot be removed easily with a toothbrush or other means, and decay may develop along the edge of the filling or underneath it. Decay that is undiagnosed and untreated can progress to infect the dental pulp (which contains the tooth’s nerve and blood supply), which often results in the need for root canal (endodontic) treatment or, possibly, loss of the tooth.
Regular dental examinations are important because problems with existing fillings generally can be detected in the early stage. Although you may not be able to tell that your filling is worn, your dentist can identify any weaknesses in it during a regular checkup.
During the examination, the dentist determines if the existing fillings are intact or if any have cracked or worn away. He or she uses an instrument called an explorer to gently detect any worn spots around the filling’s edge. This instrument will help your dentist determine if the dental filling is sealed to the tooth, or if it is sufficiently worn and needs replacement. Dental radiographs (“X-rays”) may be taken to help detect decay under existing dental fillings or between teeth, neither of which can be seen simply by looking at the tooth. If the dentist finds evidence that a filling has failed or detects decay on the radiograph, the dental filling should be replaced promptly. Don’t wait until the tooth hurts or a crack appears in the filling of the tooth.
Early detection and treatment can minimize the need for extensive and costly procedures.
CHOICES FOR NEW FILLINGS
Advances in dental materials and techniques offer new ways to create more pleasing, natural- looking smiles. Researchers are continuing their often decades-long work in developing materials, such as ceramic and plastic compounds, that mimic the appearance of natural teeth. There are several types of tooth-colored materials that can be used to repair damaged or decayed teeth.
Several factors influence the performance, durability, longevity and expense of dental fillings. These factors include:
- the components in the filling material;
- where and how the filling is placed;
- the chewing load that the tooth must bear;
- and the length and number of visits needed to prepare and adjust the restored tooth.
TALK TO YOUR DENTIST
The ultimate decision about what to use is best determined by the patient in consultation with the dentist. Before your treatment begins, discuss the options.
Protecting Teeth with Mouthguards
Knowing how to prevent injuries is important if you participate in organized sports or other recreational activities. When it comes to protecting your mouth, a mouthguard is an essential piece of athletic gear that should be part of an athlete’s standard equipment from an early age. In fact, an athlete is 60 times more likely to suffer harm to the teeth when not wearing a mouthguard. Mouthguards help buffer an impact or blow that otherwise could cause broken teeth, jaw injuries or cuts to the lip, tongue or face. Mouthguards also may reduce the rate and severity of concussions.
Mouthguards are used most commonly in contact sports, such as boxing, football, hockey and lacrosse, but findings show that even in noncontact sports like basketball, gymnastics or skateboarding, mouthguards help prevent mouth and jaw injuries.
There are three types of mouthguards:
- the ready-made, or stock, mouthguard;
- the mouth-formed “boil-and-bite” mouthguard;
- and the custom mouthguard made by a dentist.
Choose a mouthguard that is:
- resilient and tear-resistant;
- fits properly and is comfortable;
- is easy to clean;
- does not restrict speech or breathing.
Your dentist can make a custom mouthguard for you or your child that is comfortable and offers superior protection. Because treating a sports-related dental injury can be costly, a custom mouthguard is a worthwhile investment. While custom mouthguards are considered by many to be the most protective option, patients for whom a custom mouthguard is not feasible (for example, because of cost) should discuss other types of mouthguards with their dentist.
TAKE CARE OF THE MOUTHGUARD
Patients need to take care of their mouthguards by doing the following:
- rinse before and after each use or brush with a toothbrush and toothpaste;
- occasionally clean the mouthguard in cool, soapy water and rinse thoroughly;
- transport the mouthguard in a sturdy container that has vents;
- make sure not to leave the mouthguard in the sun or in hot water;
- check for wear and replace the mouthguard when necessary.
GET THE MOST FROM A MOUTHGUARD
To get the best service from a mouthguard you should:
- not wear removable appliances, such as retainers, with a mouthguard;
- wear a custom-fitted mouthguard if you wear braces or have a protruding jaw, receding chin or cleft palate;
- not chew on or cut pieces off your mouthguard;
- wear the mouthguard during practice sessions as well as during games;
- schedule regular dental checkups and visit your dentist before each playing season;
- bring your mouthguard to each dental visit.
Missing a Tooth?
There are plenty of reasons to replace a missing tooth. A gap between your teeth, if obvious when you smile or speak, is a cosmetic concern. Depending on their location, some missing teeth may affect your speech. A missing molar might not be noticeable when you talk or smile, but its absence can affect chewing.
When a tooth is missing, the biting force on the remaining teeth begins to change. As the bite changes to compensate for the lost tooth, there is a risk of extra pressure on and discomfort in the jaw joints. If a missing tooth is not replaced, the surrounding teeth can shift. Harmful plaque and tartar can collect in new hard-to-reach places created by the shifting teeth.
Over time, this may lead to tooth decay and periodontal disease.
WHAT IS A DENTAL IMPLANT?
A dental implant is one option for replacing a tooth. Implants are manufactured devices that are placed surgically in the upper or lower jaw, where they function as anchors for replacement teeth. Implants are made of titanium and other materials that are compatible with the human body.
An implant looks and feels like a natural tooth. It fits securely when you chew and speak. A single-tooth implant is a free-standing unit and does not involve treatment to the adjacent teeth. With a dental implant, the surrounding teeth can remain untouched if they are healthy, and their strength and integrity may be maintained.
The implant can stabilize your bite and help prevent problems with the jaw.
WHAT HAPPENS DURING THE IMPLANT PROCESS?
Treatment generally is a three-part process that takes several months. Your dentist may provide the treatment, or you may be referred to a specialist —such as a periodontist, a prosthodontist or an oral and maxillofacial surgeon—for all or part of the treatment.
In the first step, the dentist surgically places the implant in the jaw, with the top of the implant slightly above the top of the bone. A screw is inserted into the implant to prevent gum tissue and other debris from entering. The gum then is secured over the implant, where it will remain covered for approximately three to six months while the implant fuses with the bone, a process called “osseointegration”. There may be some swelling and/or tenderness for a few days after the surgery, so pain medication usually is prescribed to alleviate the discomfort. A diet of soft foods, cold foods and warm soup often is recommended during the healing process.
In the second step, the implant is uncovered and the dentist attaches an extension, called a “post,” to the implant. The gum tissue is allowed to heal around the post. Once healing is complete, the implant and post will serve as the foundation for the new tooth.
In the final step, the dentist makes a custom artificial tooth, called a “dental crown”, of a size, shape, color and fit that will blend with the other teeth. Once completed, the crown is attached to the implant post.
AM I A CANDIDATE FOR IMPLANTS?
If you are missing a tooth but you are in good general health, with healthy gums and a jawbone that can support an implant, implant treatment may be an option for you. (However, keep in mind that in many cases, third molars—called “wisdom teeth”—do not require replacement.) Health is more a factor than is your age. For example, chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery. And if you use tobacco, you are at greater risk of experiencing gum disease, which can weaken the bone and tissues needed to support the implant.