Gingival Hyperplasia

What is gingival hyperplasia?
Gingival hyperplasia is an increase in the size of the gum tissues caused by an increase in the number and normal arrangement of the cells. It is characterized by inflammation of the soft tissues surrounding the teeth. The gum tissues will appear shiny and swollen and dark red to bluish purple in color.

How can I get it?
The predisposing factors in this inflammation can include but are not limited to systemic factors (diabetes mellitus), antiepileptic medications (such as Dilantin, Mysoline, and Depakene), immunosuppressant drugs (cyclosporine), calcium channel blockers (Procardia, Calan, Cardizem, and Bayotensin), select other medications, hormonal changes associated with pregnancy, oral contraceptives, or the types of hormonal changes younger teenagers experience during puberty. We commonly see hyperplasia associated with pregnancy, oral contraception, and puberty.

These conditions do not necessarily cause the gums to become inflamed or enlarged, but rather in the presence of only slight amounts of plaque and/or calculus, the response of the gum tissues can be out of the ordinary. Hyperplasic gingivitis can also occur just because of a large presence of bacterial plaque without any of these factors being present.

Symptoms
If you have any of these predisposing factors or take certain drugs, there is a potential for gingival hyperplasia. Unfortunately, gum disease does not hurt until it is too late. If you have gingival hyperplasia, and if you are lucky, you will probably notice that your gums bleed when you brush and floss. Bleeding is always a sign of disease or infection.

Elimination and/or Prevention
To eliminate or prevent these problems, your oral self-care must be thorough. You must brush and floss and do whatever other oral self-care procedures you have been instructed to do every day. This may clear up the problem entirely. If not, you will need to adjust the interval between recare appointments with the dental hygienist. A time frame of 2, 3, or 4 months between cleanings, depending on the severity of the problem, will be more appropriate for prevention of hyperplasia. This will be necessary for as long as the predisposing factors exist. 

• If medication is the factor, you will have to see the hygienist at the interval recommended. 
• If you are pregnant, gingival hyperplasia could persist until the hormonal changes associated with pregnancy revert back to normal. Until then, you need to schedule your oral recare appointments with the dental hygienist as recommended. Similarly, if you take oral contraceptives and notice signs of recurring gum infections (bleeding when brushing and flossing), assuming that your oral self-care is thorough, a more regular recare schedule may be necessary.
• Gingival hyperplasia in young teens is generally seen where oral self-care is not adequate. A 3-month interval is best in this circumstance. Some teenagers have inadequate oral self-care habits. Junk food and sugar drinks (even juice) coupled with almost nonexistent brushing and flossing cause serious gum disease, bad breath, and decay. Generally, the hormonal change stabilizes and the acute problem resolves.

These recommendations are designed to prevent gum problems. Prevention is better and much less expensive than any cure. If you have dental insurance, it will probably not cover the additional necessary dental treatment. While you do need them to maintain your oral health, these situations are not considered unusual by the carrier and are not generally covered procedures.

If you have any questions about gingival hyperplasia, please feel free to ask us!

Uprighting Tilted Molars

One of the most common conditions in an adult who has experienced an early loss of an anterior molar or premolar is the drifting and tilting forward of first or second molars. This drifting or tilting will cause the teeth to move off their normal vertical and horizontal positions. Teeth move at a very slow pace, so it may take many years for this movement to become noticeable to you. 


How do teeth become tilted?
Teeth are normally held in position by the contact with the adjacent and opposing teeth. When this contact or occlusion is changed because of an extraction, the teeth will migrate toward the front of the mouth. Because of the forces of occlusion, they will begin to tilt and move into the space created by the extraction. 

Why this is bad for you?
Because of the change, the tooth that has moved will be more prone to having decay start between it and the one behind it. There will also be a tendency for an adverse change in the position of the bone and gum architecture, and the change is not for the better. Because of a change in the way food deflects off the tooth and different actions and forces on the root, pathologic periodontal pockets can and usually do develop. As one tooth begins to move, the other teeth around it begin to change position too. The closer they are to to the tooth next to the space, the more they move. Three, four, five, or more teeth can easily be affected.

What are your options to fix it?
Since this is not normally a stable or good situation, we advise that you consider having it corrected. 

One tooth:
The easiest solution when there is one tooth missing and only one tooth that has moved forward and tilted is to orthodontically upright the malpositioned tooth. This can often be done in a matter of several months. Once the tooth has been moved back into position, you must stabilize it so that it will not drift back into the space again. If the tooth can be moved forward so that it is in contact with the more anterior tooth, stabilization might include some type of night retainer for several months. If there is a space anterior to the moved tooth, that is, if the tooth was moved backward in the uprighting process, you should consider replacing the missing tooth with a conventional fixed bridge, a bonded bridge, an implant, or a removable partial denture. All of these options should be considered and the choice should be made before the orthodontic treatment begins.

More than one tooth:

Conventional Bridge

If more than one tooth has moved, the orthodontic correction will become more complicated and involve more time and more teeth. Some teeth may be moved forward, and some, backward. Opposing teeth may have extruded into the space and need to be intruded back into the socket. As with the movement of only one tooth, the final prosthetic plan must be determined before any work begins. Stabilization and restoration must be begun as soon as possible after the teeth have been correctly moved, or they will move again.

How do you prevent it?
Prevention is the best treatment. Dentists recommend saving teeth. If you have had a tooth removed, get it replaced as soon as possible, thus preventing future improper movement and misalignment. But if you are unlucky enough to have had a back tooth removed at an early age and the teeth are beginning to move, consider orthodontics to upright and reposition the teeth. If you do not, you can expect future problems with decay and your periodontal supporting tissues. Continued movement may even cause the loss of more teeth!

If you have any questions about uprighting teeth, please feel free to ask us!

Sour Candies

In the past 20 years, candies marketed to children have increasingly been of a “fruity” or “sour” variety.

• Sour candies are very acidic, with a low pH level (Acid Levels in Sour Candies).
• Some candies are so acidic it can actually burn gums and cheeks.
• Acid weakens and wears away tooth enamel.
• Teeth without protective enamel are prone to tooth decay.
• Each acid attack lasts about 20 minutes.
• Holding the acid in your mouth by prolonged candy sucking or chewing continues the acid attack.

Research Supports the Theory of Dental Erosion

Research on the harmful effects of acidic food and beverages and dental erosion is well documented in scientific literature. Minnesota dentists Dr. Robyn Loewen and Dr. Robert Marolt, in conjunction with Dr. John Ruby (University of Alabama-Birmingham School of Dentistry), have compiled this substantial evidence into an article titled “Pucker Up: The Effects of Sour Candy on Your Patients’ Oral Health,” published in the Minnesota Dental Association’s Northwest Dentistry Journal (March-April 2008).

The findings are informational and highly useful for both dental professionals and the general public.

How Tooth Erosion Happens

• Sensitivity occurs when tooth enamel wears away. You may feel a twinge of pain when consuming hot, cold, or sweet foods and drinks.
• Discoloration is visible as a slight yellow appearance on the tooth surface.
• Transparency of the front teeth appears along the biting edges.
• Rounding of teeth occurs along the surfaces and edges of the teeth.
• Cracks and roughness appear along the edges of the teeth.
• Dents (known as cupping) develop on the chewing surfaces of the teeth. At this severe stage, fillings may actually appear to rise up.
• Tooth decay is caused by loss of the protective outermost layer of enamel.

View a Chart Showing the Acid Levels in Popular Sour Candies (.pdf)

What You Can Do To Protect Your Teeth Now:

1. Reduce or eliminate consumption of sour candies.
2. Don’t suck or chew sour candies for long periods of time.
3. If you do eat a sour candy, swish your mouth with water, drink milk, or eat cheese afterwards to neutralize the acids.
4. Chew sugar-free gum to produce saliva which protects tooth enamel.
5. After eating sour candy or other acidic foods or drinks, wait one hour before brushing teeth.  Brushing right away increase the harmful effects of acid on teeth.
6. Ask your dentist about ways to reduce sensitivity or minimize enamel loss if erosion has begun.
7. Use fluoride toothpaste and a soft toothbrush to protect your teeth.

http://scheumanndental.com/hard-facts-about-sour-candies/

You Know You've Got A Good Toothbrush When...

Before you even move to open your tube of toothpaste, the quality of your tooth-brushing session has already been determined. We’re talking, of course, about your toothbrush.

How is your toothbrush, and is it working as hard at keeping your teeth clean as you are? Here are a few ways to tell.

A toothbrush is good when:

• It’s comfortable. Don’t worry about fancy add-ons—buy what you like and what feels right.
• It has soft bristles. Ask your dentist and hygienist about this one, but the ADA recommends that most people use soft-bristled brushes to avoid damaging their teeth and gums.
• It’s (relatively) new. When was the last time you switched out your toothbrush? Three months is about the right time to switch out, and sooner if you notice any discoloration or fraying of the bristles.
• It’s clean and dry. This is very, very important! Wet, un-rinsed toothbrushes can harbor bacteria that can actually make your mouth less clean when you brush.   
• Power brushes have been proven to be superior to manual brushes due to the amount of strokes/minute but even power brush heads need to be replaced. 3 months is a good rule of thumb for any brush you choose.

Go give yours a look and see if it measures up!

http://www.brightnow.com/our-blog/you-know-you%E2%80%99ve-got-good-toothbrush-when%E2%80%A6

Furcation Involvement

What is the furca?
The roots of the teeth are covered and surrounded by bone and gum tissues when they are in their normal state and have been disease-free. Only the crown portion is visible. Some teeth toward the back portion of your mouth have two or three roots extending into the jaw bone from the crowns of the tooth. This "V-shaped" area where the tooth branches or forks into two or three roots is called the furcation or furca. The furca is also covered with bone and is attached to the tooth by periodontal ligament fibers.

Normal amount of bone and gum vs. loss of bone
As long as a furcation of a multirooted tooth is covered with the normal amount of bone and gum, everything is fine and the furca holds no exceptional interest for the dentist or dental hygienist. When there is an alteration in the density of the furca bone, or it actually starts to resorb (disappear due to some type of dental pathology), the furca area becomes important and interesting. Continued loss of bone would lead to loss of the tooth.

The loss of the bone in the furca area could be related to periodontal disease (gum disease). The periodontal pathology in the furca could be part of a localized problem - only present at that one site - or a sign that there is a more widespread problem that needs attention. The breakdown of bone in the furcation could also indicate that the nerve inside the tooth is dying, and the tooth will need a root canal (endodontic treatment). 



Treatment
If the breakdown is specific to the site on that one tooth, treatment would be localized. The type of therapy recommended would depend on the severity of the breakdown. Minimal disease might be treated by a dental prophylaxis (cleaning) and reinforcement of personal oral self-care. Treatment of a more extensive breakdown could involve aggressive periodontal procedures including but not limited to periodontal surgery and bone augmentation. You may be referred to a periodontist for these procedures.

If the furca breakdown is a sign of more widespread periodontal disease, the whole mouth will be evaluated and specific treatment recommendations will be made.

There are many very small nerves that exit through various portions of the tooth, and a localized furcation problem could indicate that the nerve in a tooth is dead or dying and the tooth may require a root canal.

Cleaning
You may think that teeth are difficult to floss and brush when tooth alignment and gum position are ideal. When there is bone loss in a furca, daily oral self-care becomes more complicated. A furca is a difficult area to clean - the more bone loss, the more difficult. In extreme cases, there is no bone or gum left in the furca, and a patient could actually place an interdental cleaning aid completely between the roots of a two-rooted tooth. For a three-rooted tooth with a furcation involvement, the cleaning process is even more of a problem.

You have been diagnosed with a furcation involvement problem. After careful examination, a treatment recommendation will be made. Our recommendation will be based on not only treating your furcation problem but also preventing further exposure of the furcation area.

If you have any questions about a furcation involvement, please feel free to ask us.  

Enamel Dysplasia

What is Enamel Dysplasia?
Enamel, the first word in the title, is probably familiar to you as the hard outer covering of the tooth crown. The second word, dysplasia, is probably less familiar. Enamel dysplasia is a dental term that discusses a number of dental problems, both cosmetic and structural. The condition may affect only the tooth surface and appear as small pits in the enamel or as a gross malformation of the enamel and shape of the tooth. Enamel dysplasia can range from slight to severe with all grades in between.

What causes it?
The causes of the dysplasia are numerous, but occur during a critical stage of enamel/tooth formation. Fever, illness, medication, change in nutrition, or prescription medication have all been cited as causes.

Is the tooth weaker?
Rarely do these conditions make the tooth weaker or more prone to decay. Teeth with dysplasia are not "soft." In fact, many times these affect teeth exhibit less incidence of decay than teeth that have normal shape, color, contour, and texture!
  
How do you correct it?
Everyone agrees that enamel dysplasia is unsightly and correction of the problem is needed. The solution depends on the type of defect and the extent to which the teeth are involved. 

If the blemish is superficial: many times it can be polished off the tooth, and  it never returns. This is done either with a drill or with special polishing compounds, or both. Sometimes a whitening agent is also used. Local anesthetic is not required because there is no pain involved. A restoration (filling) is not necessary to correct a superficial dysplasia.

When the defect is deeper in the tooth: the defect may have to be mechanically removed (drilled) and a bonded, tooth-colored restoration will be placed. Sometimes an injection of a local anesthetic is needed to correct a deeper defect. The filling should last for many years before it needs to be replaced. The color match is usually perfect.

Smoothing the enamel defect or replacing the area with a small filling is often all that is needed. When the defect is more severe, however, reconstruction of the tooth with bonded onlays or crowns is necessary. We will tell you what is indicated after examining your mouth and determining the extent of your problem.

Enamel Decalcification
There is one type of white spot or line that forms on a tooth that is not really a dysplasia of the enamel but it looks like one. This appears as a white line along the gumline and is caused by a decalcification of the enamel because of plaque or debris sitting on the tooth. In short, the area is not being brushed properly and a cavity has started to form. When a patient has orthodontic braces, cleaning the space between the orthodontic band and the gumline can be a problem. Proper oral self-care is a must for patients undergoing orthodontic therapy.

Treatment, other than some treatment with topical fluoride, may not be necessary if the enamel decalcification is discovered in the early stage. When the white line is soft or the decalcification has invaded the underlying dentin, drilling and restoration will be needed.

If you have any questions about enamel dysplasia, please feel free to ask us. 

How Does A Dentist Drill Work?

Today, dentists are dependent on the drill handpiece. If the drill is running smoothly, then the practice is running smoothly.

What is it?
The drill is a sophisticated device which runs on electric motor or air pressure. The most common type is the air driven handpiece. It runs with the help of compressed air which helps in rotating the turbine, ultimately rotating the bur.

Dentist Drill (Air Driven) Consists of 2 Main Parts:
1. The body or shell through which air and water are supplied
2. The turbine which revolves the bur

Dental Handpiece

The body or shell can be made up of brass, stainless steel, or titanium. Brass is cheaper, but it is less strong and more corrosive. Steel is strong by costly. Titanium is the least corrosive, most strong, and the most costly.

The body can be further divided into head and outer sheath. The head holds the turbine and the outer sheath forms the handle and holds the inlets of air and water supply.

Interior Cross Section of Drill

Rusting of the inner surface of the head can be seen in handpieces due to repeated sterilization

Turbine is the heart of the drill. It is a kind of precision component which converts the air pressure in mechanical energy of rotation. Turbine rotates around an axis on which a bur or drill bit is fixed. As the turbine rotates, the bur will rotate. The turbine has small fin-like structures attached around its axis to catch the air resistance and convert it into rotatory motion.

How does the dental drill work?

Turbine inside head

1. Dentist presses a foot pad. The foot pad is a switch to turn the drill on and off.
2. When the foot pad is pressed, compressed air is released and enters the drill through the air inlet pipe which is attached to the drill at the back end, i.e. coupling
3. Compressed air reaches the head part of the handpiece in a small chamber which houses the air turbine
4. In attempt to escape, this compressed air rotates the turbine
5. Through various minute attachments, there is a facility to attach a bur to this turbine
6. When the turbine rotates, the bur also rotates
7. This bur is used for drilling and cutting tooth structures