Osseous Surgery

Indications

When periodontal (gum) disease progresses to a more advanced stage, it is common for the underlying supporting bone to become involved. First, the soft, periodontal tissue becomes infected and inflamed. When the inflammation increases, the bone reacts to the infection. Bone is destroyed, and it does not return. You will generally not feel the gums becoming infected or the bone disappearing. Unfortunately, it is painless. Generally, by the time pain is involved, the condition is quite serious.
Since periodontal disease is site-specific, the bone loss will not be uniform. Some teeth will show slight bone loss, some teeth will show more serious loss, and some teeth will exhibit no bone loss at all. The bone loss around a specific tooth or teeth may be regular or irregular in form. The bone loss may be vertical, horizontal, or both. If irregular, surgery to correct the bone loss will be needed. It is not possible at this time to reliably regenerate all lost bone. Once it is gone, it is gone. Research involving the possibility of periodontal bone regeneration has been underway for some time. But at this time, there are few ways to regrow periodontal supporting bone after it has dissolved from periodontal disease.

Treatment

Until fairly recently, the only method of correcting the irregular bone was to smooth off the high spots. The new bone height between teeth would be even at the level of the most severe bone loss. Although the problem was now corrected, other teeth might lose healthy bone in the leveling process. This could and would make those teeth less stable, an unavoidable and undesirable consequence. In some cases, the nature of the bone defect still dictates that this procedure be done.
A better approach is to augment or build up the irregular bone in locations where it has been lost. This is accomplished with the placement of natural or synthetic bone in a procedure known as grafting. Natural bone has been used for over 3 decades and there have been no reported immune system problems. There are also autografts that use your own bone. Allografts are synthetic or freeze-dried natural bone.
Preoperative radiographs, clinical examinations, and periodontal charting will give us an understanding of the type of osseous surgery that is necessary. However, the full extent of the problem may not be fully discovered until the area is exposed during surgery. Radiographs are a two-dimensional, black-and-white representation of a three-dimensional, full-color area. For this reason, treatment goals will remain the same, but the surgery method may be modified. Prognosis of the teeth needing surgery, options, and a best guess for treatment progress will be discussed prior to treatment.
To perform periodontal osseous surgery, a flap must be raised. (Please refer to the Periodontal Flap Procedures page.) A local anesthetic is used and postoperative discomfort is handled with medication. After this surgical procedure, sutures and a periodontal dressing are placed
Osseous surgery may be the only treatment that will successfully help to retain your teeth after severe periodontal disease has been present for some time. Keeping your own natural teeth is generally better than having dentures.
If you have any questions about periodontal osseous surgery, please feel free to ask us. 512.250.5012

Are Dental X-Rays Safe?

Two of the biggest fears when visiting the dentist are pain and radiation from dental X-rays. While sedation dentistry options have quelled many concerns over pain from dental procedures, dental X-ray radiation worries still tend to creep up from time to time. This post will discuss the some of the misconceptions about radiation from dental X-rays.

How Safe are Dental X-rays?

Very safe. Dental X-rays require very little exposure to radiation and the regularity for which dental X-rays are needed is so infrequent that the risk associated with dental X-rays is very, very small. How often X-rays are performed is determined by your individual risk factors for decay and gum disease. Even in extreme cases, you still won’t be exposed to as much radiation as people who live in high altitudes and experience natural radiation on a regular basis.

Dental X-ray’s Biggest Risk

The biggest risk surrounding dental X-rays is not getting them. Dental X-rays are performed to help determine hidden tooth decay and gum problems. The risk to these types of problems going undetected is much greater than the miniscule effects of an X-ray. The University of Maryland Medical Center reports that over 75% of adults in the United States have gum disease in some form, but only 60% are even aware that they have a problem.

X-ray Equipment Matters

At Silver Screen Dental we use that latest technology when it comes to our equipment. This enables us to have some of the lowest radiation X-ray equipment available. Technological advances have improved X-ray equipment tremendously over the years. With high-speed film and digital X-rays being used, a patient today will receive up to 80% less radiation exposure than older generation equipment.
Anyone who wants to ensure that they are as safe as possible when getting dental X-rays should make sure that the machines used are as advanced as possible.

Trust Your Dentist

In the end, your dentist should be your trusted advisor when it comes to any kind of concern relating to your dental needs.
Under the care of a highly qualified dentist, dental X-rays are nothing to be squeamish about. In fact, your decision to get a dental X-ray may be the most important step in ensuring your current and continued oral health.

Article from  http://www.silverscreendental.com/are-dental-x-rays-safe/

Gingivitis & Periodontitis

Gum disease, is the process that begins when bacterial growth in your mouth begins to lead to the corrosion of your teeth and gums. If left untreated, long-term effects include extensive gum deterioration, along with early tooth loss.

There are two stages in gum disease of which include: gingivitis (gum inflammation) followed by periodontitis (gum disease). Within the stages of gingivitis, the bacteria in hardened plaque pockets build up causing the gums to become irritated and swell. When brushing your gums may appear red or may bleed easily. Despite gum irritation, the roots of your teeth are still firmly in their place.

If left untreated, gingivitis can progress into periodontitis. During this process, the gums begin to pull away from the tooth creating pockets where bacteria can collect and spread. Toxins produced by the bacteria, along with enzymes present in your body’s natural defense of infections, begin to eat at the bone and tissue that anchor your tooth. As the process continues, the corrosion spreads and more gum tissue and bone are damaged. When this happens, teeth are no longer anchored in place, thus resulting in permanent tooth loss.
While tartar buildup is the leading cause of gum disease, there are additional contributing factors. Some of these include: illnesses that affect the immune system (HIV, diabetes), poor lifestyle habits such as smoking or a diet high in sugar, poor oral hygiene habits or a family history of periodontal disease.
Some symptoms of gum disease include:

• Gums that are susceptible to bleeding
• Red, swollen, or tender gums
• Persistent bad breath (halitosis)
• A receding gum line
• Loose or shifting teeth

Some progression of gum disease may be present in your gums despite not having any symptoms. This is a reason why regular dental check ups are important in the prevention and treatment of gum disease. Only a dentist or periodontist will be able to recognize symptoms of gum disease.
If you live in or around Austin and you suspect you may be in need of gum disease treatment or if you have any questions, contact us or fill out an appointment request form today to schedule a consultation with one of our periodontists. Our specialists are experts in evaluating your oral health and will advise you along the appropriate treatment process.

Why it is important to get a dental cleaning every 6 months?

Top 9 most common dental visits:

1. Bad Breath: Haltosis also known as bad breath is very common. According to dental studies, about 85% of people with persistent bad breath have a dental condition that is to blame. Gum disease, cavities, oral cancer, dry mouth and bacteria on the tongue are some of the dental problems that can cause bad breath.
2. Tooth Decay: Tooth decay is the process that results in a cavity (dental caries). It occurs when bacteria in your mouth make acids that eat away at a tooth. If not treated, tooth decay can cause pain, infection, and tooth loss.
3. Gum (periodontal) disease: Gum disease, is the process that begins when bacterial growth in your mouth begins to lead to the corrosion of your teeth and gums. If left untreated, long-term effects include extensive gum deterioration, along with early tooth loss.
4. Oral Cancer: Oral Cancer can occur in any part of the mouth; the lips, on the surface of the tongue, inside of the cheeks, in the tonsils, in the salivary glands, and the roof or bottom of the mouth. The Oral Cancer Foundation estimates that over 42,000 people are diagnosed with Oral Cancer every year and 8,000 die annually, that is roughly 1 person per hour in a 24 hour day.
5. Mouth Sores: Different types of sores can appear anywhere in the mouth. Some different types of mouth sores are Canker sore, cold sore, herpes simplex, stomatitis and thrush.
6. Tooth Erosion: Acid erosion, also known as dental erosion, is the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin.
7. Tooth Sensitivity: Often caused by eating or drinking something hot, cold, sweet or acidic. Under normal conditions, the underlying dentin of the tooth (the layer that immediately surrounds the nerve) is covered by the enamel in the tooth crown, and the gums that surround the tooth. Over time, the enamel covering can get thinner, thus providing less protection. The gums can also recede over time, exposing the underlying root surface dentin.
8. Toothache: A toothache refers to pain around the teeth or jaws primarily as a result of a dental condition. In most instances, toothaches are caused by tooth problems, such as a dental cavity, a cracked tooth, an exposed tooth root, or gum disease. However, disorders of the jaw joint (temporomandibular joint) can also cause pain that is referred to as "toothache." Moreover, sinus infection can mimic a toothache.
9. Unattractive Smile: Lots of people are unhappy with their smiles; due to yellowing of the teeth or missing teeth. Dentures, Implants, Veneers and teeth whitening are simple fixes to

What is saliva and what role does it play in oral health?

Saliva is produced in the salivary glands, 98% water, but contains many important substances, including Antibacterial Compounds, Mucus, Electrolytes and various enzymes.

Saliva plays an important role in oral health, without enough saliva, our teeth suffer tremendously. Not only does saliva make it easy to swallow and begin digesting food right in our mouths, but it has special neutralising, remineralising and antibacterial qualities. For instance, when plaque or acid attacks a tooth surface, calcium and phosphate in saliva can actually repair early damage. This can mean the difference between having normal healthy teeth or teeth that are decayed or eroded.

 

Saliva is created when you chew, the harder you chew, the more saliva is produced. Sucking on a hard candy or cough drop helps produce saliva, too.

The glands that make saliva are called salivary glands. Salivary glands sit inside each cheek at the bottom of the mouth near the front teeth by the jaw bone.  

There are six major salivary glands and hundreds of minor ones. Saliva moves through tubes called salivary ducts.
Normally, the body is always making saliva, up to 2 to 4 pints a day. Usually, the body makes the most saliva in the late afternoon. It makes the least amount at night.
But everyone is different. What doctors consider to be a normal amount of saliva varies quite a bit. That makes diagnosing saliva problems a bit of a challenge.

What causes too little saliva?

Medications and diseases affect how much saliva is produced. If not enough saliva is produced, the mouth can become dry, this condition is called dry mouth (xerostomia).

Dry mouth causes the gums, tongue, and other tissues in the mouth to become swollen. Germs thrive in this type of setting which leads to bad breath. Dry mouth also makes the mouth acceptable to developing rapid tooth decay and gum (periodontal) disease. That's because saliva helps clear food particles from the teeth, this also helps reduce the risk of cavities. Dry mouth also changes the taste buds. Dry mouth is common in older adults, although the reasons are unclear. Diseases that affect the whole body (systemic disorders), poor nutrition, and the use of certain drugs are thought to play a key role.

Too little saliva and dry mouth can be caused by:

• Certain diseases such as HIV/AIDS, Sjogren's syndrome, Diabetes and Parkinson's
• Blockage in one or more tubes that drain saliva (salivary duct obstruction)
• Chemotherapy and radiation therapy
• Dehydrarion
• "Fight or flight" stress response
• Structural problem with a salivary duct
• Smoking cigarettes

Hundreds of commonly used medicines are known to affect saliva flow and cause dry mouth, such as:

• Antihistamines
• Anxiety medicines
• Appetite suppressants
• Certain types of blood pressure drugs
• Diuretics (water pills)
• Most antidepressants
• Certain pain medicines (analgesics)

Always ask your health-care provider about side effects you might have when taking a medication.

Dental Implants 101

A simple tour through the treatment of choice with expert Dr. Misch-Dietsh.

    MIAMI BEACH, FL, June 14, 2013 /Dental PR News/ -- In the US alone 70 % of the population are missing at least one tooth.

There are different treatment options, yet the treatment of choice today are dental implants. While there are many advantages to this option, many people are unsure of what is involved, what they should expect and if they are a good candidate.

Prosthodontist and clinical professor of Oral Implantology at Temple University Dr. Misch-Dietsh sheds light into this process and helps simplify the steps involved.

"Dental implants are a man made replacement for the natural tooth root.

The implant is inserted into the bone and allows a person to return to non removable teeth."

Misch-Dietsh, who has worked as a Prostodontist for 24 years, explains that the material used is Titanium, which is bio compatible and is traditionally used for various implants in the body. It has been safely used since the 1960s due to its reliable reaction with the body.

The first step in considering dental implants is a thorough evaluation, which includes the patient's medical history and dental examination complete with X-rays ect. Only THEN the treatment is decided with pros and cons of different strategies. "A very strong evaluation before starting treatment is essential and consists of a full intro and extra oral exam and evaluation of the patients needs and desires." Misch-Dietsh explains that her office uses the Cone beam computerized imaging program to get the most detailed view. "This is basically the Rolls Royce of imaging. Here we look for possible bone atrophy to make sure we have enough bone volume and quality to ensure adequate support."

Some of the relative factors in deciding if a patient is a good candidate are age, state of the gums and bone structure, as well as the overall health of the patient. "For example I just finished working with a lovely 89 year old lady with great success, so age is not a critical factor."

In fact, many elderly people choose dental implants to improve quality of life, not just esthetics. Dr. Misch explains that tooth loss can often impede speech, the ability to chew and causes many self esteem issues.

Osteoporosis is another relative contra indication. Significant bone loss might require an additional step before the implants can be inserted. In this case Bone grafting is used to rebuild a more favorable structure.

Smoking has been recognized as a major obstacle for dental implants, causing inflammation in the mouth and periodontal disease. However, if the person quits, these effects are fully reversibly and after a short waiting period we can proceed with the procedure.

"One critical factor to maintaining dental implants is proper care," explains Dr. Misch-Ditsh.

Many people think that because the implant itself is not affected by bacteria they can loosen dental hygiene. As she points out, quite the opposite is the case. "The soft tissue (gums) around the implant are not as resistant, and less able to fight bacteria. There is a need for a serious regiment! When you brush, you disturb the plaque and it can't stick. Here it helps to have the proper tools such as an electric or ultra sonic toothbrush, small brushes for the spaces and of course dental floss."

She explains that around the implant the tissue is very weak, because there are not as many fibers as in a natural tooth structure. If you don' t give it the right defense, you open the road for infection to go to the bone and further propel bone loss.

So what makes for a good implant?

According to Dr. Misch-Ditsh at the heart of it is sound engineering. She explains that Prosthodontics uses many of the principles of mechanical engineering and is in fact Bio mechanical engineering. "For example if there are not enough beams, the construction will not hold and that is the same principle for dental implants. We treat patients to provide a predictable, long-term satisfactory result that will enhance their quality of life. It is key not to present them with an under engineered plan, just because it is cheaper and faster. What is needed is a treatment that is predictable long-term, not a quick fix."

Dr. Misch-Dietsh, who is also an associate editor of the official publication of the International Congress of Oral Implantologists Implant Dentistry, feels that in order to provide the most adequate care one needs to stay current with the most updated technology and developments. "You find a lot of borderline and not predictable treatment plans out there, and its important to base treatment on sound principles."

Many patients considering the pros and cons are trying to evaluate if this type of treatment would fit their needs and budget. Of course the apparent disadvantage is the high cost and the time needed. However, from the moment you are going to loose a tooth or have lost several teeth, the road leads down hill, and the only way to intervene are dental implants.

Only implants will maintain the bone and enhance the long-term survival of the neighboring teeth. What many patients fail to consider is that once a tooth has been lost, the bone starts deteriorating and the neighboring teeth are in danger of being lost as well. Dr. Misch-Dietsh points out that if you look at it short term, cost is high, but after a certain number of years it will be the more cost effective choice, because it will ensure the health of the neighboring teeth that would otherwise require treatment.

According to Dr. Misch-Dietsh' s experience little can offset the superior feeling of having what feels like one' s own teeth. With this comes the ease of chewing function, speech, health and maintenance of the bone and of course the confidence of a beautiful smile. "I don't have one patient who had the treatment and regretted it. It is a long term investment that has become the treatment of choice!"

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