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Dentists who specialize in periodontics are referred to as periodontist. Imagine shiny, white healthy teeth, lying lose in your mouth… not a good imagination indeed. Well that is however, possible; when? Your teeth are supported in the mouth by the bone and the overlying gum. To sum up, the health of your teeth to some extent depends on the health of your gums. Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontalliterally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care. Top Periodontal treatment is necessary when various conditions affect the health of your gums and the regions of your jawbone which hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak; they also spoil your smile. Gum Care at Global Dental Care Professionals at Global Dental Care are trained in the prevention, diagnosis and treatment of gum diseases, hypothesize that this inflammatory response to bacteria in the mouth is the cause behind the periodontal-systemic health link. Preventive Approach This is an approach that we apply to all our patients; this is basically employs plaque and calculus removal through scaling. The scaling is done with the ultrasonic scalers that which ensures complete plaque and calculus removal, with patient comfort. Curative Approach Employed for those patients with advanced form of gum diseases, these measures may be either deep scaling, root planning or in very advanced disease where the bone is involved it may be a gum surgery. Whatever the approach may be we ensure: Complete health of your gums and supporting structure, to the utmost degree. Ensure the safety After care, for a continued safety of teeth supporting structure. Recall Recall appointments are of great importance after any treatment. It is important to check for healing of tissues, alteration in the patient’s suggested habits and their willingness to maintain their oral hygiene. By maintaining periodontal health, the life quality of these patients may be raised Top First Visit What Will Happen at My First Visit? Your first visit will be a thorough evaluation followed by a discussion of our findings. So that we can properly prepare you, we typically do not schedule initial exams and treatment on the same day; we want to make sure you have all the information you need, and that all of your questions are answered prior to any treatment being provided. Preparation for your First Visit Please complete your patient registration form and bring it with you to your first appointment or you may fill it out online patient registration form. It is important that you list any medications, allergies or other pertinent information that could affect your dental care. Please Note: All patients under the age of 18 must be accompanied by a parent or guardian at the consultation appointment. Please notify the office if you have a medical condition or concern prior to surgery (e.g. artificial heart valves or joints, heart murmurs requiring pre- medication, severe diabetes, or hypertension.) We will complete an in depth medical and dental health history and a thorough examination to measure for bone loss, loose teeth, bite, oral cancer screening, TMJ and other signs of periodontal disease. Will it Hurt? We will be as gentle as possible. The periodontal exam can be completed with little or no discomfort. Do I Need X-Rays? We will need current periodontal x-rays in order to see disease not otherwise visible. If your referring dentist has taken x-rays, you may request that they be forwarded to us. What Will it Cost? Since all patients are different, your Periodontist must complete your examination before establishing your treatment plan and the fee for care. The fee for periodontal treatment can vary considerably depending on the type of problems and the complexity and length of treatment. An approximate fee can usually be determined at the initial visit; but on occasion, some initial treatment or further diagnostics must be completed before the final treatment plan can be established. Our philosophy of practice is to treat as conservatively as possible to attain treatment goals. Will I Need Surgery? Not everyone needs periodontal surgery. If treated early, gum disease can be controlled without surgery. We will make recommendations based on your individual situation. Our philosophy of practice is to treat as conservatively as possible to attain treatment goals. Can My Teeth Be Saved? The recent advances in periodontal treatment allow us to successfully treat most teeth. What if I don't Have Gum Treatment? Periodontal disease is a progressive, painless infection. Delay may lead to further bone loss and more expense. If your teeth are lost, dentures are never as effective as your own teeth. We are available to respond to your concerns and encourage you to ask questions at any time. We are looking forward to seeing you soon! Top Prevention of Gum Diseases Adults past the age of 35 lose more teeth to gum diseases than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and Periodontal Diseases is by good tooth brushing and flossing techniques, performed daily, and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress. Oral Hygiene To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A frequent professional cleaning as recommended by your dentist is necessary to remove calculus from places your toothbrush and floss may have missed. Brushing Begin with the right equipment – a soft bristled toothbrush that allows you to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one. A worn-out brush won’t clean your teeth properly. While brushing the outside surfaces of your teeth, position the brush at a 45- degree angle to where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort. When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth. To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don't forget to gently brush the surrounding gum tissue. Next you will clean the biting surfaces of your teeth. To do this use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing If you have any pain while brushing or have any questions about how to brush properly, please be sure to call the office. Top How to Floss Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice. Start with a piece of floss (waxed is easier) about 18" long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand. To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gum line then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section. To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower. When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop. Caring for Sensitive Teeth Sometimes after dental treatment, teeth are sensitive to hot and cold. This should not last long, but only if the mouth is kept clean. If the mouth is not kept clean the sensitivity will remain and could become more severe. If your teeth are especially sensitive consult with your doctor. They may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth. Top Choosing Oral Hygiene Products There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients. Automatic and "high-tech" electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with electric toothbrushes called Sonicare and Oral B Plaque Remover. Some toothbrushes have a rubber tip on the handle, this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with your doctor. Fluoride toothpastes and mouth rinses if used in conjunction with brushing and flossing can reduce tooth decay as much as 40%. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gum line so these products have not been proven to reduce the early stage of gum disease. Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing. Your periodontist is the best person to help you select the right products that are best for you. Professional Cleaning Daily brushing and flossing will keep dental calculus to a minimum, but a professional cleaning will remove calculus in places your toothbrush and floss have missed. Visit your periodontist, as he or she is an important part of your program to prevent gum disease. Keep your teeth for your lifetime. Top Gum/Periodontal Diseases Periodontal diseases are infections of the gums, which 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, which 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% of Indians by age 45. Gingivitis The culprit for most of the cases of gingivitis or Periodontitis is Dental Plaque. Plaque is a sticky colourless “bio-film”, composed of different types of bacteria that adhere to your teeth at and below the gum line. It constantly forms on your teeth within minutes after cleaning. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance know as calculus. This cannot be removed without professional cleaning.Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorder and heart diseases. Periodontitis Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Top Aggressive Periodontitis A form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation. Chronic Periodontitis A form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva. It is recognized as the most frequently occurring form of periodontitis. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur. Bone Loss in Periodontal pocket Top Periodontitis as a Manifestation of Systemic Diseases Periodontitis, often with onset at a young age, associated with one of several systemic diseases, such as diabetes. Necrotizing Periodontal Diseases An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Diagnosis Sometimes the only way to detect periodontal disease is through a periodontal evaluation. This may be especially important in the following situations: If you Notice any Symptoms of Periodontal Disease, Including: gums that bleed easily, such as during brushing or flossing red, swollen or tender gums gums that have pulled away from the teeth persistent bad breath pus between the teeth and gums loose or separating teeth a change in the way your teeth fit together when you bite Periodontal Abscess If you Have a Family Member with Periodontal Disease Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member. If you Have Heart Disease, Diabetes, Respiratory Disease or Osteoporosis Ongoing research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed. Top Other Important Factors Affecting the Health of your Gums Include: Periodontal Diseases and Tobacco Diabetes and Oral Health Women and Periodontal Health Genetics Stress Clenching and grinding teeth Medication Poor nutrition Periodontal Diseases and Tobacco You are probably familiar with the links between tobacco use and lung disease, cancer and heart disease. Current studies have now linked periodontal disease with tobacco usage. These cases may be even more severe than those of non-users of tobacco. There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth as well as greater loss of the bone and fibers that hold teeth in your mouth. In addition, your chance of developing oral cancer increases with the use of smokeless tobacco. Chemicals in tobacco such as nicotine and tar, slow down healing and the predictability of success following periodontal treatment. Problems Caused by Tobacco Include Lung disease, heart disease, cancer, mouth sores, gum recession, loss of bone and teeth, bad breath, tooth staining, less success with periodontal treatment and with dental implants. Quitting tobacco will reduce the chance of developing the above problems. For more information go to www.tii.org.in Diabetes and Oral Health Individuals suffering from diabetes, especially uncontrolled diabetics, have a higher risk of developing bacterial infections of the mouth. These infections may impair your ability to process insulin, resulting in greater difficulty with controlling your diabetes. Periodontal diseases will be more severe than those of a non-diabetic and treatment more difficult. However, well- controlled diabetics have a lower incidence of cavities. Steps to prevent periodontal disease include daily brushing and flossing to remove plaque from your teeth and gums, regular dental visits for professional cleaning and regular periodontal evaluation. Your health professional must also be told of your history and the current status of your condition. And finally, you can help resist periodontal infection by maintaining control of your blood sugar levels. Top Women and Periodontal Health Throughout a woman’s life, hormonal changes affect tissue throughout the body. Fluctuations in levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral health. As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies. Puberty During puberty, there is increased production of sex hormones. These higher levels increase gum sensitivity and lead to greater irritations from plaque and food particles. The gums can become swollen, turn red and feel tender. Menstruation Similar symptoms occasionally appear several days before menstruation. There can be bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek. The symptoms clear up once the period has started. As the amount of sex hormones decrease, so do these problems. Pregnancy Your gums and teeth are also affected during pregnancy. Between the second and eighth month, your gums may also swell, bleed and become red or tender. Large lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal, but usually disappear after pregnancy. Periodontal health should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby’s health at risk. The best way to prevent periodontal infections is to begin with healthy gums and continue to maintain your oral health with proper home care and careful periodontal monitoring. Top Oral Contraceptives Swelling, bleeding and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones. You must mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate risk of drug interactions, such as antibiotics with oral contraceptives – where the effectiveness of the contraceptive can be lessened. Menopause Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include feeling pain and burning in your gum tissue and salty, peppery or sour tastes. Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also saliva substitutes to treat the effects of “dry mouth.” Top Genetics Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime. Stress As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases. Medications Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider. Top Clenching or Grinding Your Teeth Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you're taking a test or solving a problem at work? Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed. Poor Nutrition As you may already know, a diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums. Other Systemic Diseases Diseases that interfere with the body's immune system may worsen the condition of the gums. Top Treatment of Periodontal Disease We provide a variety of non-surgical and surgical services. We pride ourselves on the fact that we are conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary. Many times, the early stages of periodontal disease are best treated with non- surgical periodontal therapy. Even in severe cases, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery. If you're diagnosed with periodontal disease, non-surgical and surgical periodontal therapies may be indicated. Periodontal health should be achieved in the least invasive manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as systemic antibiotics and local delivery of antimicrobials, as needed on a case-by-case basis. Non-surgical therapy is indicated when you have been diagnosed with gingivitis and mild forms of periodontitis. This therapy is also performed in moderate to severe cases of periodontitis to slow the disease progression and to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgical therapy. Non Surgical Treatment Scaling and Root Planing Systemic Antibiotics Local Delivery of Antimicrobials Top Surgical Treatment If you're diagnosed with periodontal disease, we may recommend periodontal surgery. Periodontal surgery is necessary when it is determined that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonlyprescribed: Pocket Reduction Procedures Regenerative Procedures Crown Lengthening Soft Tissue Grafts If you've already lost a tooth to periodontal disease, you may be interested in dental implants– the permanent tooth replacement option. Scaling and Root Planning 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, We may recommend the use of a laser to remove diseased tissue in the gum pocket, eliminate bacteria and stimulate healing cells. When deep pockets between teeth and gums are present, it is difficult for us 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. Top Local Delivery of Antibiotics It is a well-established fact that periodontal diseases are bacterial infections. It is also known that tetracyclines (a type of antibiotic) are very effective in killing the bacteria responsible for some periodontal diseases. For those patients who did not respond well to traditional therapy (scaling and surgery), antibiotics were occasionally used to assist in controlling the disease. This meant taking pills every day for prolonged periods of time, sometimes years. There are a number of problems associated with this. Long- term use of antibiotics can lead to bacteria that become resistant to the antibiotics rendering them ineffective not only to treating periodontal disease but to other infections as well. Tetracyclines also increase your sensitivity to the sun and can lead to severe sunburn. This led to the development of a way to deliver the tetracycline to the periodontal pocket without having to take pills. The first local delivery system was a thin fiber that was wrapped around the root of the tooth. It delivered tetracycline to the affected pocket and had to be removed. Newer methods of local delivery have been developed and the most current delivery system is one that dissolves on its own. Although the local delivery of antibiotics can be an effective adjunct to the treatment of periodontal disease, it is by no means a stand- alone treatment and is not for everyone. We will evaluate you at your initial appointment to determine if you are a candidate for this adjunctive therapy. Top Pocket Reduction The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth. Many factors can cause periodontal disease or influence its progression. Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, too much bone is lost, and the teeth need to be extracted. A pocket reduction procedure may be recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth - and decreases your chances of serious health problems associated with periodontal disease. Top Procedure During this procedure, we will fold back the gum tissue and remove the disease causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone. Benefits Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth and decrease the chance of serious health problems associated with periodontal disease. Top Cosmetic These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures. Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure, crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile. Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession and protect the roots from decay and eventual loss. Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, an appearance of a general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth. Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more esthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth. Top Crown Lengthening This periodontal procedure is designed to expose more tooth structure prior to restorative and cosmetic dentistry and/or to improve the esthetics of your gum line. A frequently asked question is whether we can change the esthetics of a gummy smile because the teeth appear somewhat short. Your teeth can actually be of proper length and just covered with excessive gum tissue. In such circumstances, an esthetic crown lengthening procedure will correct this by exposing the shape of your natural teeth. Esthetic crown lengthening can also be done to single teeth to even your gum line and create a pleasing smile. If your teeth are decayed, fractured at or below the gum line or have insufficient tooth structure for a new crown retention, a crown lengthening procedure may be recommended to enable your dentist to perform a restorative and/or cosmetic dental procedure. Crown lengthening (or crown exposure) is required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not accessible. It is also usually too close to the bone or below the bone. This procedure create a new gum-to-tooth relationship. This allows your dentist to reach the edge of the restoration, ensuring a proper fit of your restoration to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease. Procedure During this procedure, excess gum and bone tissue is reshaped to expose more of your natural teeth, which can significantly enhance periodontal health. Benefits Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence. Crown Lengthening procedure can be effectively done with lasers. Top Guided Tissue Regeneration Traditionally, eliminating the gum pockets by trimming away the infected gum tissue and re-contouring the uneven bone tissue treats gum disease. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today. Guided Tissue Bone Regeneration "regenerates" the previously lost gum and bone tissue. Most techniques utilize membranes, which are inserted over the bone defects. Some of these membranes are bio- absorbable and some require removal. Other regenerative procedures involve the use of bioactive gels. Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted. Regenerative procedures are recommended when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue. Procedure During this procedure, we will fold back the gum tissue and removes the disease- causing bacteria. Membranes (filters), bone grafts and/or tissue- stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue. There are many options to enhance support for your teeth and to restore your bone to a healthy level. Top Soft Tissue Grafts Periodontal procedures are available to stop further dental problems and gum recession, and/or to improve the esthetics of your gum line. Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you're not bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids. Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment we can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss. Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. Procedure During this procedure, gum tissue is taken from the palate or another donor source to cover the exposed root. A recipient site is prepared in the affected areas. The graft is then gently adapted and sutured into the recipient site to either cover exposed root surfaces and/or to create a wide band of protective gum tissue. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity. Benefits A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile Top Ridge Preservation When a tooth is removed or lost to gum disease, supportive bone is lost with it. Maintenance of bone is essential to support gum tissue for cosmetic restoration or allow for an environment that will support a dental implant. Careful management of the extraction site after tooth removal prevents unsightly bone loss and can provide a better cosmetic outcome for tooth replacement. At the time of tooth loss a bone graft is placed in the socket to promote bone healing and an ideal clinical outcome. Bone Grafting Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance. Major Bone Grafting Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration. Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of he defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay Top Sinus Lift Procedure The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone. There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone. The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures. If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed. Ridge Expansion In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant. Top Osseous Surgery Traditionally, gum disease is treated by eliminating the gum pockets. The infected gum tissue is trimmed away, and uneven bone tissue re-contoured. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today to treat specific types of bony defects Frenectomy A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. A lack of attached gingiva, in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a Frenectomy. Often a Gingival Graft is added to re-establish an adequate amount of attached gingiva. When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve success of the final orthodontic result. Top Laser Periodontics Crown Lengthening: Dental lasers can reshape gum tissue (soft tissue laser) and bone (hard tissue laser) to expose healthier tooth structure. Referred to as crown lengthening, such reshaping provides a stronger foundation for the placement of restorations. Gummy Smile: : Dental lasers can reshape gum tissue to expose healthy tooth structure and improve the appearance of a gummy smile. Muscle Attachment (Frenula): A laser frenectomy is an ideal treatment option for children who are tongue tied (restricted or tight frenulum) and babies unable to breast feed adequately due to limited tongue movement. A laser frenectomy may also help to eliminate speech impediments. Top Patients Role & Follow Up Visits No matter how successful the periodontal treatment has been, ultimately you are most important in maintaining periodontal health. For maximum results, the patient must accept this role as a "co-therapist". You must take "ownership" in achieving long-term success. The first responsibility is to eliminate factors that increase susceptibility to periodontal disease. Some of these include smoking, diabetes and excessive use of alcohol. Secondly, it is important to maintain daily plaque control. This is achieved through brushing and using other homecare aids such as floss, interdental brushes and rubber tips. Most periodontal disease begins between the teeth, therefore, we will recommend hygiene aids for your oral hygiene routine. Lastly, you are responsible for scheduling regular periodontal maintenance. The frequency of these visits will be determined by the level of your periodontal health. Most patients with moderate to advanced cases or patients who may be susceptible to periodontal disease should have periodontal maintenance appointments every three to four months for their lifetime. Maintaining this schedule is very important to controlling periodontal disease. Top Oral Health & more Oral Health & Heart Don’t Let a Dirty Mouth Pollute Your Clean Heart taking care of your oral health will give you a winning smile and may also be heart healthy. Do you find this far-fetched to believe? It’s true...A dirty mouth is like a factory dumping into a river. Using this analogy, the bacteria from your mouth is the sewage that can seep into your bloodstream, or in this case the river causing it to become polluted. Your bloodstreamcarries bacteria from the mouth and may cause the arteries of the heart to become polluted with periodontal bacteria. This can bring about inflammation of the arteries and possibly increase your risk of having a heart attack. Periodontal researchers are racing to find out more about exactlyhow periodontal disease may affect heart disease. Recent issues of the Journal of Periodontology published findings about thistopic. Following is a brief overviewof these studies providing a pulse on the connection: Levels of Oral Bacteria May Increase Risk for Heart Attacks Two studies in the May 2005 issue furthered researchers’ understanding about the potential link between the periodontal bacteria found in the mouth and heart disease.In one study, researchers found that the total number of periodontal bacteria was higher inindividuals that suffered from a heart attack. In the second study, DNA of periodontal bacteria from the mouth was found in the plaque of the heart’s arteries. Researchers believe these findings may help confirm what they have long known - if there is a sterile pathway, such as a bloodstream near an infected area, the bacteria can travel to other parts of the body and cause harm. Although more research needs tobe done, periodontists are advising people to maintain good oral health. Top Deep Periodontal Pockets Increase Risk for Electrocardiographic Abnormalities In another study suggesting a relationship between periodontitis and cardiovascular disease, researchers found that people with deep periodontal pockets had an increased risk for Electrocardiographic (ECG) abnormalities. People with severe attachment loss also had a significant risk for ECG abnormalities. Periodontitis is a chronic inflammatory bacterial infection. Past studies reported that when periodontitis is present, it elevates levels of other inflammatory substances such as C-reactive protein (CRP), interleukin-6 and neutrophils. This suggests that when these inflammatory substances are elevated, the risk of a cardiac event is also elevated. Additional studies are required in order to examine the degree of cardiovascular risk from periodontitis compared with other risk factors. Because problematic ECG results are a widely appreciated risk factor for cardiovascular disease, it could be valuable to know if periodontal