We most often associate plastic surgery with cosmetic enhancements to our outer appearance. While this is their primary purpose, some forms of reconstructive surgery restore lost function and health as well as improve appearance. A classic example is cosmetic periodontal (gum) surgery that restores receded gum tissues that have exposed more of the tooth than is visually appealing.
Gum recession occurs primarily because of excessive brushing (too hard or for too long) or because of periodontal (gum) disease, a bacterial infection that ultimately causes gum tissue to detach and pull away from the teeth. Gum recession not only affects the appearance of the teeth, it can expose the tooth’s root surface to further infection and decay. Without treatment, the disease could progress causing further damage with the potential for the tooth to be eventually lost.
In conjunction with plaque removal to stop gum disease and possibly other treatments like orthodontics to correct misaligned teeth, cosmetic gum surgery is used to rejuvenate lost gum tissues around teeth through tissue grafting. In these procedures, a combination of surgical approaches and/or grafting materials are attached to the area of recession to stimulate the remaining tissue to grow upon the graft and eventually replace it.
Donor grafts can originate from three sources: from the patient (an autograft); another person (an allograft); or another animal species, usually a cow (a xenograft). Tissues from outside the patient are thoroughly treated to remove all cellular material and bacteria to eliminate any possibility of host rejection or disease transmission.
Depending on the nature of the gum recession and tooth condition, the procedure can take different forms. It could involve completely detaching the graft tissue from the host site and re-attaching it to the recipient site. But if more of the tooth root is exposed, the surgeon may cover the graft with tissue adjacent to the host site to supply blood to the graft, and affix the loosened pedicle to the graft site. While any technique requires advanced training and experience, the latter procedure involves microsurgical techniques that require the highest levels of technical skill and art.
Cosmetic gum surgery can result in healthier gum tissues and teeth that are less susceptible to infection and loss. No less important, though, these procedures can return a more natural look to your teeth and gums — and a more pleasing smile.
If you would like more information on gum tissue reconstruction, 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 “Periodontal Plastic Surgery.”
On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.
“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”
Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.
Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.
A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.
Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.
So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.
If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”
It takes only a few days of inadequate oral hygiene for bacterial plaque to trigger the periodontal (gum) disease gingivitis. Though sometimes subtle, there are signs to watch for like inflamed, reddened or bleeding gums.
Untreated gingivitis can develop into more advanced forms of gum disease that infect deeper levels of the gums and supporting bone and ultimately cause bone and tooth loss. Fortunately, though, prompt treatment by a dentist removing plaque from teeth and gums, along with you reinstituting daily brushing and flossing, can stop gingivitis and help restore health to your gums.
If you’re under acute stress or anxiety, however, basic gingivitis can develop into something much more serious and painful, a condition called Acute Necrotizing Ulcerative Gingivitis (ANUG). It’s also known as “trench mouth” from its common occurrence among World War I soldiers experiencing stressful periods in front line trenches without the means for proper oral hygiene.
ANUG develops from a “perfect storm” of conditions: besides anxiety and deficient hygiene practices, ANUG has a high occurrence risk in people who smoke (which dries the mouth and changes the normal populations of oral bacteria) or have issues with general health or nutrition.
In contrast to many cases of basic gingivitis, ANUG can produce highly noticeable symptoms. The gum tissues begin to die and become ulcerative and yellowish in appearance. This can create very bad breath and taste along with extreme gum pain.
The good news is ANUG can be treated and completely reversed if caught early. In addition to plaque removal, the dentist or periodontist (a specialist in the treatment of gum disease) may prescribe antibiotics along with an antibacterial mouthrinse to reduce bacteria levels in the mouth. A person with ANUG may also need pain relief, usually with over-the-counter drugs like aspirin or ibuprofen.
It’s important that you seek treatment as soon as possible if you suspect you have ANUG or any gum disease. It’s possible to lose tissue, particularly the papillae (the small triangle of tissue between teeth), which can have an adverse effect on your appearance. You can also reduce your risk by quitting smoking, addressing any stress issues, and practicing diligent, daily oral hygiene and visiting your dentist for cleanings and checkups twice a year or more if needed.
If you would like more information on the signs and treatments for gum disease, 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 “Painful Gums in Teens & Adults.”
One of the most effective techniques for saving decayed or injured teeth is the root canal treatment. Yet when many people hear they need it, they become nervous at the prospect.
Much of this stems from a common misunderstanding that undergoing a root canal is painful. It’s not — today’s anesthetics are quite effective in numbing pain during a procedure, and mild pain relievers like ibuprofen are usually sufficient to manage any discomfort afterwards.
In fact, a root canal treatment relieves pain caused by decay within a tooth. As decay progresses, it can enter the interior known as the pulp, which contains bundles of nerves and blood vessels. It attacks these nerves causing pain and infection. If the infection progresses through passageways known as root canals that are in the roots of the tooth, the pain can intensify. More important, the tooth is in danger of loss as the root and connective tissues that hold the tooth in place are injured from the spreading infection.
During a root canal treatment, we access the pulp by drilling a small access hole, usually in the biting surface or in the rear of a front tooth. Once we enter the pulp chamber we remove all the contaminated tissue. Once thoroughly cleansed, we fill the empty chamber and canals with a special filling (usually gutta percha) to prevent future infection. The access hole is then sealed and at a subsequent visit we strongly recommend placing a permanent crown to provide further protection from damage to the tooth.
Root canal treatments are quite common. All general dentists have been trained in endodontic treatment and can perform most types of procedures. More difficult cases (like a complex root canal network that may be hard to access) may require the services of an endodontist, a specialist in root canals. Endodontists use advanced techniques and specialized microscopic equipment to treat complicated situations.
It’s actually good news if we recommend you undergo a root canal treatment — it means your tooth has a good chance of survival once it’s disinfected and the decay is removed. But don’t delay: the sooner we can treat your tooth, the better your chances of a healthy outcome.
If you would like more information on root canal treatment, 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 Concerns about Root Canal Treatment.”
There’s more to teeth than meets the eye. Hidden beneath the visible crown are the tooth’s roots set within the jawbone, secured and protected by the gums from bacteria and infection. But if the gums shrink back (recede), the roots become exposed and susceptible to disease, especially at the points where multiple roots branch from each other, areas called furcations.
It all begins with periodontal (gum) disease caused by built-up bacterial plaque from insufficient brushing and flossing. The infection triggers inflammation that over time weakens gum tissues. They begin to detach from the teeth, which can eventually lead to gum recession and root exposure.
This also causes bone loss, especially at the furcations. We can detect any loss (known as a furcation invasion) and how far along it may be with x-ray imaging or by manually probing with an instrument called a periodontal probe.
There are three general classes measuring furcation invasions. In the earliest, Class I, we can feel the invasion as a slight groove; in Class II, it increases to two or more millimeters across. In Class III the bone loss extends from one side of the root all the way to the other (a “through and through”).
At this stage a patient is in danger of losing the tooth, so we’ll have to act promptly. This means first removing accumulated dental plaque and calculus (tartar) to stop the infection and allow the gums to heal. With severe damage, we may need to assist healing with bone and gum tissue grafting, in which we place donor grafts to serve as scaffolding for the appropriate tissue to grow upon.
You can help prevent this situation by practicing effective daily hygiene and visiting your dentist for thorough cleanings at least twice a year (or more if recommended). And at the first signs of a gum infection—swollen, reddened or bleeding gums—make an appointment as soon as possible to have it checked. The sooner we can detect and treat gum disease, the less likely a furcation invasion or worse will be in your future.
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