Posts for: September, 2015
Periodontal (gum) disease is a bacterial infection, which if left untreated could cause gum recession, bone loss and eventually tooth loss. Caused mainly by plaque left on tooth surfaces from poor hygiene practices, the deeper the infection spreads below the gum line, the more difficult it is to treat.
One possible scenario involves parts of a tooth’s root structure known as furcations. These are branching forks formed during the early development of teeth with multiple roots where they take different paths from the base of the crown. As gum disease spreads around the root it may cause different degrees of bone loss at the point of the branch.
It’s imperative when treating gum disease to uncover and remove any bacterial plaque or calculus (hardened plaque deposits) found, including below the gum line. To address bacterial plaque at the root level, it’s important to first determine if bone loss has involved the furcations (where the roots separate, also referred to as a “furcation invasion”) and to what degree.
We usually classify this degree of involvement in three classes: Class I, the invasion has created a groove in the furcation, but minimal significant bone loss; Class II, the bone loss has extended into the furcation by at least two millimeters; or Class III, the bone loss extends completely from one end of the furcation to the other (or “through and through”).
Depending on the class, cleaning plaque and calculus from furcations and then maintaining them thereafter can be quite challenging. We may need to use specially shaped hand instruments known as scalers or curettes to reach and clean root surfaces, or ultrasonic scalers that use high-frequency vibrations and streaming water to loosen and flush away plaque debris. It may also prove helpful, though limited, to apply antimicrobials or antibiotics to the area to help limit the levels of bacteria.
Disease damage around furcations may also require surgical treatment to encourage new tissue and bone growth in the area. Surgery can also help make the area more accessible to future cleaning and maintenance, both for you and us. Renewed hygiene practices on your part and regular cleaning and checkups with us will help ensure that the situation involving your tooth roots can be kept under control and your tooth preserved for many years to come.
Professional basketball player Lamar Odom is sometimes known as “the candyman” because of his notorious fondness for sweets. But when his sweet tooth finally caught up with him — in the form of a mouthful of decayed teeth — the six-foot-ten-inch, 230-pound hoops star admitted that he had been avoiding treatment… because he was afraid of going to the dentist!
It took two Kardashians (Khloe and Kim) and a painful toothache to finally persuade Odom to sit in the chair. Once he did, it was found that he needed a root canal, a wisdom tooth extraction, and several fillings. Yet the fretful forward sailed through the whole set of procedures in a single visit, and walked out with a big smile afterward. How did his dentists make that happen?
Put it down to the “magic” of sedation dentistry. With anxiety-relieving medications that can be delivered orally (in pill form or by gas) or intravenously (into the bloodstream), the techniques of sedation dentistry can help even the most fearful patients get the dental care they need. That’s good news for about 50 percent of the population, who admit they’re at least somewhat afraid of the dentist — and even better for the 15 percent who avoid dental care completely due to their fear.
Dentists have a number of ways to ease apprehensive patients through a dental visit. An oral anti-anxiety drug can be given in pill form about an hour beforehand. Nitrous oxide (sometimes called “laughing gas”), which is administered by a mask placed over the mouth or nose, may also be used to relieve anxiety. The calming effects of these medications help make any nervousness melt away — and in many circumstances, mild sedation is all that’s needed to ease the fear.
For lengthier or more complex procedures, intravenous (IV) sedation may be recommended. Unlike deeper (unconscious) sedation, IV sedation doesn’t cause “sleep.” Instead, it puts you in a comfortable semi-awake state, where you can still breathe on your own and respond to stimuli… but without feeling any anxiety. And when the procedure is over, you probably won’t have any memory of it at all.
IV sedation can be administered by dentists who are specially trained and equipped with the proper safety equipment. While sedation is being provided, you will be monitored at all times by a dedicated staff member; when it’s over, you will rest for a while as the medication quickly wears off. Then (as is the case with oral sedation), you’ll need another person to give you a ride home.
Does sedation dentistry really work? Lamar Odom thinks so. “I feel so much better,” he said when his 7-hour procedure was over. “I feel like I accomplished something.”
Somewhere between bites during a recent meal, the inside of your cheek found itself in the way of your teeth. You winced with pain at the resulting bite, and while it was sore for a day or two it seemed to heal over. Now, though, you’re noticing this same area of your cheek gets in the way of your teeth a lot more often, with more bites and sores.
What’s likely happened is that you have developed a traumatic fibroma. When the soft tissues of the inner cheek, lips or tongue heal after being injured, a small bit of fibrous tissue composed of the protein collagen forms like a callous over the bite wound to protect it after it heals. If, however, the process is interrupted by another bite, the fibrous tissue that subsequently forms may be thicker and thus more raised on the surface of the skin. This higher profile makes it more likely the site will be involved in repeated episodes of biting.
If the fibroma continues to be a problem, it can be solved with a simple surgical procedure. A surgically-trained dentist or oral surgeon will remove portions of the fibroma (usually with local anesthesia) to flatten the skin profile, and then close the resulting wound with a couple of stitches unless a laser was used. Any discomfort after the procedure can usually be managed with a mild anti-inflammatory drug like aspirin or ibuprofen, and the site should heal in just a few days to a week.
Although the vast majority of fibromas aren’t dangerous, it’s routine practice to have the excised tissue biopsied for abnormalities. More than likely the fibroma tissue will be normal; but by having the fibroma removed and examined, you’ll gain peace of mind about your oral health. In the process, you’ll also eliminate a bothersome and painful problem.
If you would like more information on mouth sores, 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 “Common Lumps and Bumps in the Mouth.”