Archive for the 'Gum Disease' category

Are Oral Piercings a Costly Fashion Statement?

Feb 02 2010 Published by Dr. Toback under Gum Disease

It has been reported over the past five years, that individuals with oral piercings may be at risk for acute gum disease problems.  Typically, gum disease is diagnosed in adults over the age of 35, and is the leading cause of tooth loss in the United States.  However, younger patients with oral piercings put themselves at risk for gum recession, bone loss around teeth, and ultimately tooth loss.

tongue ring periodontal treatmentWe have seen young patients in our practice over the past several years, who have had dramatic gum defects, bone loss and tooth mobility associated with oral piercings.  These problems are localized to areas in close proximity to the jewelry.  These patients have no other signs of gum disease in other sites, and they would not normally be classified as high risk for gum disease.  Clearly, there is a detrimental affect of the oral piercing to the supporting tissues of the teeth.

Tongue piercings are a common culprit and most frequently affect the lower front teeth.  The tongue-ring will cause trauma to the gum tissue while eating and speaking.  In addition, many individuals with tongue rings develop a tongue thrusting habit that causes hitting of the ring against the lower teeth and gum tissues.  This trauma allows the bacteria within the oral cavity to infiltrate the tissues and create an acute inflammatory condition.  Ultimately, infection ensues and will cause irreversible bone loss which could result in eventual tooth loss.

tongue ring gum surgeryOverall the general public has not been well informed of these risks.  Most patients who present to our practice with piercing related periodontal disease, are completely unaware of the risks associated with this fashion trend.  Fortunately, most patients when faced with the possibility of losing their front teeth at a young age, decide to discontinue the use of oral jewelry.  Some patients have been told that if the jewelry is made of plastic instead of metal, that the risk of damage is eliminated.  Figures 1 & 2 show a plastic style tongue ring that a patient was using recently until diagnosed with rapid onset recession (stripping of the gum tissue away from the teeth).  Use of plastic jewelry definitely does not eliminate the risk of damage.

bone loss caused by tongue piercingFigure 3 depicts the inflamed and infected gums of another patient following use of a tongue ring.  I have included a surgical photo demonstrating the incredible destruction of the supporting bone.  This patient was facing imminent loss of at least one tooth prior to treatment.  Bone and tissue grafting helped recover some of the lost bone.  With suspension of use of the tongue ring, this patient will have a fairly good prognosis.  Others who are diagnosed later may not be as fortunate and will lose their teeth.

If you wear oral piercing jewelry, you should seek a periodontal screening examination to assess whether you have experienced any of these problems.  If a family member or friend wears an oral piercing, please share this information and you may save someone you care about from disastrous fashion fallout.

This article first appeared in the 2010 February / March edition of the The New London Women’s Journal

No responses yet

Laser Gum Surgery: A New Option For Treating Gum Disease

Jul 07 2009 Published by Dr. Toback under Gum Disease, Laser Gum Surgery

Lasers have revolutionized medicine and surgery over the past twenty years, and lasers have now added to the treatment choices for one of the most common dental problems facing adults.  Gum disease (periodontal disease) affects as much as 80% of the population and is the leading cause of tooth loss.  Gum disease results in destruction of the bone that supports the teeth when left untreated.  In addition, we reviewed in the last Women’s Journal, the relationship between periodontal disease and systemic disease.  We know that it is critically important to overall health, to properly diagnose and treat periodontal disease.  Unfortunately, many patients avoid treatment when the periodontist begins discussing gum surgery.

Gum disease (periodontal disease) is caused by plaque deposits on the teeth that harbor bacteria which infect the gums.  As this chronic infection progresses silently, bone is destroyed around the teeth resulting in gaps or “pockets” beneath the gum tissue.  These pockets are difficult to clean with brushing and flossing.  Bacterial debris accumulates further as the disease advances.  Gum surgery is the conventional form of treatment, and has evolved over the past fifty years.  All traditional forms of gum surgery have required incisions and suturing of the gums.

The NdYAG Laser Was FDA Approved in 2004. Lasers have been available in many forms for over twenty years.  However, in 2004 a specialized laser called the NdYAG was FDA approved for the treatment of periodontal disease.  Although lasers can be used for several purposes in dentistry, the NdYAG is the only laser indicated for targeting the causative agents of periodontal disease.  This laser, when applied within a very specific treatment protocol called LANAP, has the potential for restoring health to the gum tissues.  Many patients prefer this approach when compared to traditional incisional surgery, because the “minimally invasive” nature of laser therapy leads to less swelling and discomfort, and speedy recovery times.

How the Laser Works

The NdYAG laser targets inflamed tissue and the bacteria associated with gum disease.  A tiny fiber with a diameter the size of approximately three human hairs, is placed below the gum line and into the pockets.  The laser fiber is moved back and forth within the pocket, killing bacteria and removing the inflamed tissue.  Once the teeth are thoroughly cleaned, the fiber is once again inserted within the pocket and initiates a specialized clot to form between the gum tissue and the tooth root.  No incisions are made with the laser approach.  This leads to a speedy recovery with minimal post operative discomfort.  In addition, laser periodontal therapy results in less gum recession following treatment.  Patients appreciate this as they experience less tooth sensitivity when compared to those with incisional approaches.

Who Can Benefit From Laser Therapy

Patients who have put off gum surgery due to anxiety or concern about the procedure, should consider a laser approach.  Remember that periodontal disease will progress when left untreated.  In addition, patients with very sensitive teeth could benefit from laser approaches due to decreased root exposure following surgery.  Other appropriate candidates are patients with medical conditions that could complicate incisional surgery.  The non-invasive nature of the laser offers an alternative to patients who may have health concerns.

Is Laser Gum Surgery The Best Option For You?

As with all treatments, there are specific indications for different therapies.  While laser therapy is appropriate for many patients, incisional surgery may still be the treatment of choice for other patients, especially where bone regeneration with grafting technologies is desired.  A comprehensive examination with a periodontal specialist is the first step in determining which treatment approach is best for each individual situation.

This article first appeared in the 2009 July / August edition of the The New London Women’s Journal

No responses yet

Gum Disease And Your Health: Mind-Body Connection

May 05 2009 Published by Dr. Toback under General Health, Gum Disease

The medical and dental community would never have imagined thirty years ago that we would be discussing gum disease and cardiovascular disease in the same sentence.  The belief at that time was that tooth and gum problems were exclusively dental issues, and this led to many people not realizing the importance of oral health.  The past decade has produced an impressive array of research that has changed the way we view the relationship between gum disease and overall health.  It is clear that daily brushing and flossing must be a part of a program to maintain favorable overall health.

Research has shown a strong association between periodontal disease (gum disease) and major medical conditions such as heart disease, stroke, diabetes, respiratory disease and pregnancy complications (pre-term low birth weight).  Let us start by reviewing the definition of periodontal (gum) disease.

What Is Gum Disease?

Gum disease (periodontal disease) is caused by plaque deposits on the teeth that harbor bacteria which infect the gums.  The gums may become swollen and bleed while brushing.  As the disease progresses, the infection becomes more serious causing a separation of the teeth and gums which is termed a “pocket”.  The infection can become severe causing dramatic bone loss and ultimately, loss of the teeth.  Individuals with the highest risk for gum disease are smokers, diabetics, or those with a family history of gum disease.

Gum Disease In Women

Hormonal fluctuations have also been linked to the inflammatory findings in gum disease.  This is of particular relevance to women since hormonal impact can be seen during puberty, menstruation, pregnancy and menopause.  These all represent higher risk times for women, and can promote pronounced gum inflammation.  It has been estimated that approximately 25 percent of women between 30 and 54 have active bone loss associated with gum disease.  This figure increases to almost 50 percent for women who are over 55.

For many years, dental professionals believed that periodontal disease was solely the result of a bacterial infection caused by a buildup of plaque between the teeth and under the gums.  However, this could not explain the varying levels of bone loss reaction to the plaque accumulation.  This led to research that identified the body’s response, or what we term “the host response” as a critical key to the cause of gum disease.  Shortly thereafter, new research began to link gum disease to a variety of health conditions.

Heart Disease And  Stroke

Researchers have found that people with gum disease are almost twice as likely to suffer coronary artery disease than those without gum disease.  This in turn, may increase the chance of a heart attack.  Other studies have demonstrated a relationship between periodontal disease and stroke.  One study showed that individuals diagnosed with acute cerebrovascular ischemia (stroke) are more likely to have an underlying oral infection than those without stroke.

One theory that explains these findings is that oral bacteria may enter the bloodstream and attach to the fatty plaques within the walls of heart vessels.  The bacteria could then cause injury to the vessels which results in clot formation.  These clots can obstruct normal blood flow to vital organs, thus causing heart attack or stroke.  Another theory points to the inflammatory process resulting from gum disease, which may contribute to swelling of the arteries.  Regardless of the theories, it appears clear from the studies that the long term effects of gum disease, such as extended bacterial exposure and the resulting inflammatory response may be a critical risk factor for cardiovascular disease.

Diabetes

It has long been known that diabetes is a major risk factor for gum disease.  Diabetics are at significantly higher risk for experiencing bone loss related to gum disease, when compared to non-diabetics.  Diabetics with poor control are at the highest risk.  However, recent research suggests that the relationship may go both ways.  Gum disease can increase blood sugar levels, making it difficult to achieve diabetic control and increasing the risks of diabetic complications.  Studies have shown that when diabetics treat their gum disease, their blood sugar levels will improve.  One study suggests that gum disease may induce diabetes in borderline patients.

Pregnancy Complications

Studies have shown a relationship between periodontal disease and preterm, low birth weight babies. Pregnant women with periodontal disease may be seven times more likely to have a baby that’s born too early and too small. A cellular chemical called prostaglandin, is produced in the inflammatory cycle of periodontal disease.  Prostoglandin is also known as a potent inducer of labor.  Pregnant women should be screened for active gum disease and treated appropriately to improve oral health during pregnancy and reduce the risks of early labor.

Conclusions

It should not surprise us that a long-standing, chronic oral infection, such as gum disease, should have such a widespread impact on the overall health of the human body.  The research is now defining these relationships, and new associations are being identified each year.  Proper screening and diagnosis of gum disease is the first step to health, and your family dentist is an appropriate starting point.  If you are found to have gum problems, you may be referred to a periodontal specialist.  If you suspect that you have gum disease, or you are in a high-risk category (smokers, diabetes, family history), you may wish to seek a gum disease screening by a periodontal specialist.

This article first appeared in the 2009 May / June edition of the The New London Women’s Journal

No responses yet