Cosmetic Tissue Recontouring

It is not uncommon for us to suggest to a patient who has absolutely no sign of periodontal (gum) disease to seriously consider having elective periodontal procedures performed. In these cases, the procedures are almost always needed to improve appearance. Sometimes they are suggested to promote future periodontal health or to attend to a potential problem that might develop.

When you smile or talk, your teeth are framed by your lips and the visible gum tissue. People looking at you notice your teeth. People notice missing teeth, tooth alignment, gum color, discolored fillings, silver fillings, toot color, and how much of your teeth actually show. If everything is integrated well and looks natural, people say you have a nice smile. If something does not look natural, it may be easy to define, such as crooked, stained or yellow teeth; periodontal disease shown by red-colored gum tissue; or discolored fillings. Or it may be something not as readily to determine. It’s just something that does not look right.

That “something” may be related to the teeth and gum architecture. The position of the gums where they meet the teeth is esthetically important. If your teeth look too short, there may be more gum tissue covering them than is considered attractive. You may show too much gum tissue when you smile. There may be a difference in height of the gum of one tooth versus an adjacent tooth or its partner on the other side of the mouth. This could be caused by recession from brushing too hard; gum disease; poor or defective restorations, especially crowns; or just a problem with the way the tooth erupted into place. All of these things can detract from your appearance.

Several different periodontal procedures, simple to accomplish, can correct most of these routine problems. Some involve removal of unwanted tissue; some involve grafting of tissue. Orthodontics might be helpful in some cases. The more expensive procedures will require referral to our specialists.

In one common type of cosmetic periodontal plastic surgery, the gum tissue is reshaped and recontoured without the use of sutures (stitches). This procedure is done in the office. One tooth or several teeth may benefit from treatment. Postoperative discomfort is usually minor. There may be tooth sensitivity when gum tissue is removed, but this usually disappears. The improvement generated by this type of procedure can be startling.

We will show you and describe in detail how you can benefit from cosmetic periodontal procedures. In many cases, the cosmetic periodontal surgery will complete the treatment you need. In some cases, it will be part of a larger treatment plan including crowns, veneers, or bonded restorations. 

If you have any questions about cosmetic tissue recontouring, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Nine Things You Should Know About Looking After Your Own Oral Health

The Dental Helpline takes more than 10,000 calls every year from those who have questions or concerns about their mouth and oral health.  The free-to-call helpline, run by the British Dental Health Foundation, has seen a steady upsurge in calls over the last two years and answers questions on a wealth of oral health related issues.

 

In a new three-part series, the charity has taken a look at some of the most frequently asked questions to the Dental Helpline, so that we can learn what it takes to keep our mouth healthy.

In the first part of the series the British Dental Health Foundation address some of the most common questions they get asked about what you can do to look after your own oral health.

There are many aspects to looking after our oral health and it can often be confusing what advice we should listen to and what to ignore. Looking after our mouth doesn't have to be difficult, expensive or time-consuming, in fact it can be very easy.

So to make things a little clearer here is some advice to help you keep your smile healthy:

1) How often should I visit the dentist?

How often you need to visit the dentist depends on your own oral health. You may need to visit at different intervals depending on aspects such as if you have any existing oral health problems, your age and other health issues.

As a rule of thumb you should visit the dentist as often as they recommend so discuss this with your dentist.

2) When is the best time to brush my teeth?

Did you know that there are times when you shouldn't brush your teeth? For example, you should not brush your tooth within an hour of eating or drinking anything acidic.

You should brush your teeth before you go to bed and at least one other time each day with a fluoride toothpaste.

3) What toothbrush should I be using?

Choosing the best toothbrush for you can be a potential minefield, everybody will have their own requirements. Adults should look to use a small to medium-sized brush head with soft to rounded nylon bristles and there are bushes which are specifically designed for children and the elderly.

Electric toothbrushes, those with the oscillating and rotating heads, can also be very effective and are helpful for people with mobility problems.

Your dentist will know exactly what you need and be able to help you make the right decision.

4) Which toothpaste is best for me?

There are many types of toothpaste on the market, choosing the best one for you can sometimes be confusing.

The most important thing is that your toothpaste contains the correct amount of fluoride, 1350 parts per million for children over three and adults,1000 parts per million under three. But you may have other specific needs due to tooth sensitivity, gum health or your age. Your dentist will be able to advise what is best for you based on your individual requirements.

5) How does my diet affect my oral health?

What you eat and drink can have a huge impact upon your oral health.

Sugary and acidic food can cause damage including tooth decay and dental erosion if you don't look after your oral health properly. Try to keep sugary foods or drinks just to mealtimes, limiting the amount of time your mouth is at risk. Each time you have sugar it takes your teeth an hour to recover from the acid attack caused.

A diet that is rich in vitamins, minerals and fresh fruit and vegetables can help to prevent gum disease so make sure you keep an eye on what you are eating.

6) How often should I clean between my teeth?

Ideally you should clean between your teeth at least once a day, only brushing your teeth cleans just two thirds of the tooth surface so you need to do a little extra to make sure you are reaching all of the tooth. Cleaning in between your teeth removes plaque and bits of food from areas a toothbrush simply can't reach.

You can clean between your teeth with an ‘interdental' brush or dental floss. You can also use dental tape which is thicker than floss and many people find easier to use. Your dental team can show you proper interdental cleaning techniques and products to ensure you're doing it effectively.

7) Should I use mouthwash?

Mouthwash offers many benefits to your oral health if used properly; some contain anti-bacterial ingredients which help reduce plaque and prevent gum disease. Some mouthwashes contain fluoride which is important in the helping to prevent tooth decay.

Do not use mouthwash too close to brushing your teeth as it can wash away the fluoride from brushing.

If you find that you have to keep using mouthwash to hide bad breath you should see your dentist. Persistent bad breath can be a sign of unhealthy teeth and gums or of poor general health.

8) How bad is smoking for my oral health?

Most people are very aware that smoking is bad for their health. It can cause huge medical problems and, in some cases, fatal diseases.

However, many people don't realize the full extent to which smoking damages their mouth, gums and teeth.

Smoking can lead to tooth staining, gum disease, tooth loss, and in more severe cases mouth cancer. Smokers lose more teeth than non smokers.

If you are a smoker it is likely that you will have to visit your dentist and hygienists more often to keep a close check on the health of your mouth.

9) Where can I find information about how to look after my oral health?

Your oral health does not stop the moment you step out of the dentist, be sure you understand what you can do every day to make sure you keep your oral health in tip top condition. Your dental team can offer guidance and support from many other services and can refer you if you need extra help.

 

British Dental Foundation
https://www.dentalhealth.org/news/details/903

 

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Scaling and Root Planing

What is scaling?
Scaling is a periodontal dental procedure in which plaque and calculus are removed from the tooth both above (supragingival) and below (subgingival) the gum (gingiva). 

What is root planing?
Root planing is a procedure in which diseased or altered portions of the root surface, the cementum, and dentin are removed and the resulting new surface is made smooth and clean. The more altered and damaged the root surface has been from calculus (tartar) accumulation, the more the need for root planing.

Why is it necessary?
The purpose of scaling and root planing is to remove all debris from the teeth. Any item that can cause inflammation of the gum tissue must be eliminated. The root surface must be made as smooth as possible. Irregularities in the root surface can contribute to gum inflammation. Irregularities are sites for bacteria and plaque buildup. The bacteria and the toxins they produce in the plaque are held against the tooth by the calculus. In this way, plaque and calculus on the teeth have been positively linked to gum disease.

What is the procedure like?
Depending on the severity of your particular periodontal problem, scaling and root planing may be the definitive treatment and no further procedures will be required. In many cases scaling and root planing are only a necessary part of the overall therapy. It is a demanding procedure. It requires much more time than the familiar adult prophylaxis (cleaning). It is usually done in multiple appointments, treating a quarter, half mouth, or your full mouth at each appointment. In this office we find that most patients are most comfortable if the area to be treated during the root planing procedure is anesthetized with a local anesthetic.

Recare
The scaling and root planing may have to be repeated in the future. It is customary to place the patient on a 3- to 4-month hygiene recare schedule. Scientific evidence clearly shows that for individuals who have demonstrated a predisposition to periodontal disease, an interval of 6 months is too long. We will determine the appropriate interval for you. As your situation changes, there may be changes in the length of these intervals as well.

What happens after treatment?
Other than the teeth being somewhat sensitive after the scaling and root planing procedure, there is little postoperative discomfort. The sensitivity will diminish with time. If you have been diagnosed as having severe periodontal infection, the sensitivity may remain for quite some time and further procedures may be needed to eliminate sensitivity. Although many procedures in dentistry can be considered elective, we consider scaling and root planing to be a necessity for your dental health.

Post-procedure Tips:

• If therapeutic prophylaxis has been completed because your gingival (gum) tissue showed signs of infection and inflammation, and if you had significant calculus (tartar) buildup:

• You may notice that your teeth feel different where the calculus was removed. The soft tissues may be sensitive or sore for approximately one day as they begin to heal. You may find that taking an over-the-counter pain reliever (aspirin, ibuprofen, etc.) will help during this 24-hour period. You may also rinse your mouth every few hours with warm salt water. Make sure that you brush and floss your teeth during this time period as you have been instructed. be gentle, because the brushed areas may be sore, but be thorough! You do not want to have the periodontal infection begin again.
• If scaling and root planing, or other more involved periodontal procedures has been completed:

• You can expected your gingival (gum) tissues to be quite sore. This is normal when the gum tissues have been infected and inflamed for some time. The more severely they have been affected, the more discomfort you can expect. This soreness should go away very quickly. You may rinse with warm salt water every few hours until the soreness is gone.
• If scaling and root planing has been completed:

• You may also notice that the teeth have become sensitive to temperature changes after the scaling and root planing. This sensation frequently occurs when the surfaces of the roots of your teeth have been cleaned. Removal of the debris covering the roots and attached to the roots leaves the roots open to temperature stimulus. If the problem persists, please let us know.
• When you examine your gums closely in a mirror, you will also observe that the color, texture, and position of your periodontal tissues will undergo a change as the healing takes place. The swollen, reddened gum tissue will shrink, become more firm, and return to a healthy pink color. Watch for these welcome signs of improvement and be encouraged by the healing process.
• Please do not forget to brush, floss, and use other periodontal cleaning aids as you have been taught. It is important that you begin establishing proper oral self-care habits immediately. If you find that the recently treated areas are sensitive to the brushing and flossing, be gentle - but be thorough! With proper technique you cannot damage the teeth or gingival tissues.
• Brush after ever meal with a fluoride-containing toothpaste. Rinse with a fluoride-containing mouthrinse once each day.

Preventing Recurrence
Once scaling and root planing has been completed, it is most important for you to practice the brushing and flossing techniques in which you will be instructed. If we have recommended any additional periodontal aids, you must use them, too. Your cooperation is vital if the procedures are to be successful. To remain disease-free, you will need to remain constant in your oral self-care regimen.

If you have any questions about scaling and root planing, please feel free schedule a comprehensive dental exam with our office at 512-250-5012.

Sealants and Fluoride: Benefit to Adult Patients

Dental decay can develop at any time, regardless of a person's age. A change in diet, change in lifestyle, change in oral self-care habits, the use of prescription medications, or a change in systemic health due to the normal aging process can all affect the caries (decay) susceptibility. Few people remain completely free of decay. Proper oral self-care on your part and properly spaced dental hygiene prevention appointments will go a long way to reduce the opportunity to have new decay to begin.

As you age, it is possible that some of your gum tissue will recede, exposing the root surfaces of your teeth. This gum recession can occur from improper brushing (brushing too hard with a hard toothbrush) or as a result of past periodontal problems. The more a tooth and root are exposed, the greater is the surface area you will have to keep clean. Sometimes the teeth with exposed roots are very hard to keep clean. These roots may be sensitive to temperature changes and are often times uncomfortable to brush. Decreased salivary flow (dry mouth) helps to create a breeding ground for bacteria to accumulate on the enamel and especially on the root surface. And root decay usually progresses quite quickly!

Goal of Prevention
Your goal should be to keep the dentist from drilling your teeth. Any reasonable preventive measure that is available should be seriously considered. When the dentist drills, you lose. When the dentist does not drill, you win.

                               
                                                         Dental Sealants

Please see our blog post on sealants. Although sealants are primarily designed for children, adults who have a history of active decay should consider having sealants placed on the posterior (back) teeth where indicated. We will tell you where it is possible to place the sealants. Even if you have not had a cavity for a long time, consider the application of a sealant as an inexpensive insurance policy for your teeth. Perhaps you would never get decay on the unsealed surfaces. But, just as you insure your home against destruction by fire, a sealant insures the tooth surface from decay. Preventive measures may allow you to avoid having your teeth drilled. You win! 

Topical Fluoride
For a similar reason, we advise the use of topical fluoride treatments for adults. The effectiveness of systemic and topical fluoride in preventing decay is well documented. When a cavity first starts, an application of fluoride might (depending on when it is used) reduce or eliminate the need for drilling.

Fluoride Varnish

An alternative to the fluoride treatment we can provide in our office is a daily rinse. If you can rinse with an over-the-counter mouth rinse containing fluoride every night as directed on the rinse label, you do not need the office topical fluoride treatment. If you cannot rinse daily as instructed, you will need the benefit from the strong office-applied topical fluoride treatment. Your oral health will benefit most from small increments of fluoride that are applied daily rather than one larger concentration every 6 months. However, only you know whether you will be faithful in your rinsing routine. When in doubt, let us do it here.

We stress prevention of dental disease above all else. Sealants and topical fluoride treatments are two of the more important preventive dental measures that we believe will significantly enhance your oral health.

Implants: Procedural Overview

Compared to a routine dental filling or crown (cap), replacement of a missing tooth or teeth with implants is a more complicated and lengthy process. It will take several phases. A periodontist or an oral surgeon will place the implant surgically. Then we will place the tooth or visible portion.

Phase One
The specialist evaluates the position, suitability, and strength of the bone that will surround the implant. This information determines the length and width of the implants and how many implants will be necessary to replace the missing teeth. Impressions of all your teeth will be taken for study models in order to design the shape of the tooth or teeth to be implanted. A surgical guide will be made to indicate to the surgeon where the implants should be placed.  

Phase Two
Surgical procedure is done to place the implant in the bone. A local anesthetic is given, and the gum tissue is lifted to expose the implant site. The implant is placed into the bone and the gum is closed over it. You will not see the implant while integration with the bone takes place. The integration takes 4 to 6 months. After this time, the site is opened again and a healing collar will be threaded into the implant. This will guide the tissue into a shape that is needed for the future crown(s). The time that the healing collar needs to be in place will vary from person to person, but will be at least several weeks.

Phase Three
Once the tissue shape is sufficient, specific attachments and components will be fitted to the implant. The implant components are similar in function to the wall or plaster anchors used to hang pictures on drywall. The healing collar is removed. Implants transfer copings, analogs, and other items are used to take an impression of the site. The healing collar is then put back on. The impressions and implant components are sent to the laboratory for fabrication of implant posts and temporary acrylic crowns.

When the temporary crown or bridge is returned from the laboratory, the healing collar is removed and the implant attachments are fasted to the implant. The temporary crowns are then seated and adjusted. They will be held in place by temporary cement or with screws, depending on your certain situation. We will explain the advantages and disadvantages of each in your particular case at the time you decide to have the implant

Temporary crowns are placed because the bone that supports and surrounds the implant must be given the opportunity to be put into function gradually. Implant techniques dictate that the implants be slowly brought into biting function. This means you will be returning several times to have more acrylic added to the temporary crown. After the implant and temporary crown have been in biting function for a few months, the final crown(s) will be fabricated and cemented or screwed into place.

Maintaining All Your Teeth
To keep your implants and your natural teeth healthy and functional for the longest time possible, clean the implant and your other teeth daily, as instructed. You will also need to come in for dental hygiene recare appointments at a 3- to 4-month interval. You have invested time and money in these state-of-the-art tooth replacements. Maintaining them as instructed will give you the best chance of success.

We feel that the benefits of replacing teeth with implant-supported crowns and bridges far outweigh the inconvenience of the long start to finish time. This is especially true when the teeth on either side of the implant are sound, unfilled teeth that would not otherwise require dental treatment. Implants help you preserve your nature tooth structure.

If you have any questions about dental implants, please feel free to ask us.

Classification of Periodontal Disease

Any periodontal disease is undesirable and, if left untreated or ignored, can lead to a number of serious dental problems. If you wish to maintain your teeth and gums (gingiva) in a healthy and disease-free state, it is important that you brush properly and use dental floss daily. Do these procedures as we have instructed. Return for continuing dental hygiene care at the time intervals that we have recommended. These time intervals for your cleaning appointments have been established specifically for your existing dental condition. The intervals can and will fluctuate according to your ability to take care of your teeth and gums. A periodontal infection is site-specific and episodic in its nature. Any delay in your office-related routine dental hygiene recare appointments could prove detrimental to your oral health. 

What is periodontal disease? Periodontal disease is an infectious process classified according to how much damage has been done to the structures surrounding the teeth, namely the gingiva (gums) and bone. It is an infection in your mouth. The better you clean your teeth to remove all the plaque bacteria, the less likely you will be to develop periodontal disease. A previous blog post details how the disease progresses and how to solve it.

The following is a brief overview of the American Academy of Periodontology's classification of the types of periodontal disease.

Type 1 - Gingival Disease: An inflammation or lesion of the gum characterized by changes of color, gingival form, position, surface appearance, and presence of bleeding and/or pus.


Type 2 - Chronic Periodontitis: An inflammation of the supporting structures of the teeth associated with plaque and calculus; the rate of progression is affected by local, systemic, or environmental factors. It can be further classified as localized or generalized.




 

Type 3 - Aggressive Periodontitis: Characterized by a rapid rate of periodontal disease progression in an otherwise healthy individual in the absence of large accumulations of plaque and/or calculus. It can be further classified as localized or generalized.








Type 4 - Periodontitis as a Manifestation of Systemic Disease: Periodontitis associated with blood or genetic disorders.






Type 5 - Necrotizing Periodontal Disease: Ulcerated and necrotic gums between the teeth and at the tooth margins. It can be further classified as necrotizing ulcerative gingivitis or necrotizing ulcerative periodontitis.

Type 6 - Abscesses of the Periodontium: A localized pus-forming infection of the periodontal tissue.







Type 7 - Periodontitis Associated with Endodontic Lesions: Localized deep periodontal pocket extending to the tip of the root of the tooth involving pulp death.

Type 8 - Developmental or Acquired Deformities and Conditions: Gingival disease or periodontitis started by localized tooth-related factors that modify or predispose to plaque accumulation or prevention of effective oral hygiene measures.

Due to the nature of the disease, most classifications will involve both a generalized and a localized diagnosis. 

See this previous blog post for early detection signs of periodontal disease.

If you have any questions about the classification of your periodontal disease, please feel free to ask us.