Connections of Oral Wellness and Overall Health

Posted on Aug 08, 2024 by William J. Claiborne, DDS MS

Over the past few decades, an increased number of studies have pursued the many connections of periodontal (gum) disease and our overall health. With the findings, research has become more focused with links found between infectious oral bacteria and a growing list of serious health problems.

Periodontitis is the most severe form of periodontal disease. It is a severe form of gum infection that damages soft tissues and destroys the bone that supports teeth. This occurs when toxins produced by the bacteria in plaque irritate the gums.

These toxins activate a chronic inflammatory response in which the body, which turns on itself. This systemic inflammation leads to break down and destruction of tissues and bone that support the teeth.

The potent bacteria of gum disease are able to enter the bloodstream through tears in weakened tissues. It is now known that it can trigger inflammatory reactions that are related to the development of the conditions mentioned above. While it can activate the development of serious health problems far beyond the mouth, it can also worsen others already underway.

The initial stage of periodontal disease is gingivitis. This may have mild symptoms or even some deemed “normal.” These include areas where the gums are tender or seeing blood in the sink when brushing teeth. However, gingivitis, if not halted, can soon progress to periodontal disease.

Gum disease symptoms include:

• Gums that loosen from teeth (or “recede”)
• Red or swollen gums
• Gums that bleed when flossing or brushing
• Persistent bad breath 

• Teeth that may loosen or drift

Without treatment, gum disease worsens. Many people are unaware of the severity of damage capable by these infectious bacteria. Below are some of the correlations that may surprise you.

---

Using findings from previous research, studies have closely scrutinized two types of oral bacteria pathogens. Researchers found that one pathogen was far more prevalent in the saliva of participants who developed pancreatic cancer with a 59% increased risk of developing the deadly cancer. Just as alarming was that the second pathogen was shown to increase this risk by 50%.

---

The connections between periodontal disease and other diseases in the body also include a link between oral health and psoriasis. Psoriasis is a chronic disease that affects the skin. Its cause isn’t fully understood but seems to relate to the immune system turning on itself.

This condition causes the life cycle of skin cells to accelerate beyond normal. Cells build up rapidly on the skin’s surface, forming scales and red patches that are often itchy and sometimes painful.

In one study, researchers found that while “people with psoriatic arthritis had about the same rate of gum disease as those without joint inflammation, people with psoriatic arthritis were more likely to have severe gum problems.”

https://www.psoriasis.org/advance/prevention-tips-for-uveitis-stroke-and-gum-disease

Other studies have shown that people with periodontitis (advanced gum disease) are nearly 1.5 times more likely to develop psoriasis than people with healthy gums. Could one trigger the other, and vice versa?

Another study showed that 36% of people with psoriasis had one or more sites of bone loss measuring at least 3 millimeters (over a tenth of an inch). This was compared to 13% of people without psoriasis.

---

For people who have rheumatoid arthritis (RA), many are learning that research is noting close connections with arthritis and gum disease, too.

RA is a debilitating, painful disease that destroys joints. RA often emerges gradually, initially causing morning stiffness and weak, sore muscles. As inflammation from RA worsens, joints become swollen.  Joints become achy and stiff most often in the fingers, wrists, elbows, hips, knees, ankles, toes, and neck. Unfortunately, there is no cure for RA.

Apparently, gum disease and RA share a genetic similarity. The clinical makeup shows similar structures, primarily in pathogens that spark disease or illness. Research has found that the pathological process that occurs in both gum disease and RA are nearly identical.

Both conditions cause chronic inflammation in tissues that connect to bone with both diseases having a similar inflammatory trigger. Even more similar is the particular species of bacteria found in periodontally-diseased tissues when compared with tissues around arthritic joints. In one study, a particular pathogen associated with periodontal disease was found to activate the same destructive process of rheumatoid arthritis.

---

Another example of damage possible by the infectious bacteria of periodontal disease is coronary artery disease. The heart disease connection, as explained by Harvard Medical School’s newsletter, states:

“In people with periodontitis (erosion of tissue and bone that support the teeth), chewing and toothbrushing release bacteria into the bloodstream. Several species of bacteria that cause periodontitis have been found in the atherosclerotic plaque in arteries in the heart and elsewhere. This plaque can lead to heart attack.

“Oral bacteria could also harm blood vessels or cause blood clots by releasing toxins that resemble proteins found in artery walls or the bloodstream. The immune system’s response to these toxins could harm vessel walls or make blood clot more easily. It is also possible that inflammation in the mouth revs up inflammation throughout the body, including in the arteries, where it can lead to heart attack and stroke.”

http://www.health.harvard.edu/press_releases/heart-disease-oral-health

---

And the list goes on, even including connections between periodontal disease and erectile dysfunction (ED). For men in the 40 – 70 age group, ED affects over 40% with nearly 70% of men at age 70 affected.

https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/erectile-dysfunction/

One study of 162 males ages 30 to 40 by Turkish researchers, 82 of the participants had normal erection function while 80 who complained of ED, nearly half. Some men in both groups had chronic periodontitis, but the condition was more than twice as prevalent in the ED group.

In another study, 80 male participants who had severe gum disease were more than twice as likely to suffer from erectile dysfunction. This was true even after adjustments were made for other issues that could distort the findings.

---

Gum disease affects nearly 47% of American adults. It will worsen without treatment and, to no surprise, is the nation’s leading cause of adult tooth loss. As an Asheville periodontal specialist, I have an up-close view of the damaging effects of gum disease.

If you are experiencing signs of gum disease, start with a thorough periodontal examination. Call 828-274-9440 or ask our friendly staff about beginning with a consultation.

If dental fears have caused you to delay or avoid having regular dental care, many treatments can include oral or I.V. sedation (sleep dentistry, or “twilight sleep”).

And, if financial constraints are an obstacle in receiving treatment, we offer several payment plans. Most are interest-free with no down payment required (for qualified individuals). Feel free to ask about these during your consultation.

The “Risk vs. Reward” of Oral Health

Posted on Jun 25, 2024 by William J. Claiborne, DDS MS

Risk versus reward.

This is a phrase that’s often associated with decision-making, such as stock market investments. While certain strategies can increase the potential for “reward,” there is still an element of “risk” in losing part or all of the investment.

As a periodontist in Asheville, I see this in how it relates to decisions in dentistry. This is the case in replacing lost teeth. As a periodontal specialist, I place many dental implants in patients who’ve lost teeth that likely could have been kept had the patient made different decisions.

I also see this is in the decision of patients to have a crown (“cap”) placed on teeth. When a dentist recommends a crown, it is typically to keep the existing tooth structure intact and protected. So, when a tooth that’s been filled and needs yet another filling, the dentist may advise crowning the tooth instead. This preserves the remaining structure by avoiding the “risk” of tooth from breaking off.

Or, when a tooth shows signs of fracture(s), crowning may prevent the tooth from the need for removal. This is because a tooth that eventually breaks below the gum line can no longer be saved. Once removed, tooth replacement brings on an entirely new set of decisions, and costs.

Your general dentist’s goal, like yours, is to help you achieve and maintain a healthy smile. He or she wants you to keep your natural teeth or, if tooth loss does occur, replace them in a way that supports your overall oral health. A periodontist can be a strong team player in this goal.

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease and in the placement of dental implants. A periodontist is also a specialist in reshaping gum tissues, for reasons that may include esthetics as well as maintaining oral wellness.

I place many dental implants and am a proponent of them as a superior tooth replacement option. However, as ideal as an implant is, there is nothing as good for your oral health as natural teeth. This is why it’s so important to keep them. This may, for certain teeth, require the placement of a crown.

A periodontist may be involved in certain aspects of treatment to optimize a patient’s results and success level while minimizing discomfort. For instance, a periodontist may work with your general dentist to help save a tooth from removal when a tooth has broken close to the gum line. This is accomplished through crown lengthening procedures where gum tissues are removed to expose more of the tooth. This may be able to make sufficient tooth structure available to support a crown.

Crown lengthening is also beneficial in sealing gum tissues surrounding a tooth at its base. By securing the tissue around the tooth or crown, bacterial entry is avoided and the risk for periodontal (gum) disease decreased. This is especially beneficial in cases where gum tissues have receded, exposing sensitive tooth root sections that are easily affected by oral bacteria.

In some cases, gum tissue height can be corrected by careful removal in a procedure known as a gingivectomy. To enhance the appearance of a smile with an esthetically-pleasing smile line, combined with the placement of crowns, the tooth-to-gum ratio is rebalanced.

This is what is often referred to as a “gummy smile.” Crown lengthening is a common method that teams your general dentist with a periodontist to create a smile that looks natural and is beautifully flattering.

Another look at the risk-reward consideration, the “risk” of not caring properly for oral health can easily upend the “reward” of having a healthy smile. Regular dental check-ups and a thorough at-home oral hygiene regimen can prevent the development of cavities and periodontal disease.

When oral bacteria levels in the mouth are not managed, the teeth and gums pay the price, often through the need for costly treatment that may have been prevented. Periodontal disease is the nation’s leading cause of adult tooth loss.

Research has also found that the inflammatory bacteria of gum disease can enter the bloodstream, triggering or worsening a long list of serious health problems. These include heart disease, stroke, high blood pressure, diabetes, arthritis, memory loss, some cancers, impotency and Alzheimer’s disease.

Although gum disease can exist without obvious signs or symptoms, the most commonly noticed are:

• Red, swollen or tender gums
• Seeing blood in the sink when brushing
• Receded gums
• Loose or separating teeth
• Pus pockets on gum tissues
• Sores in the mouth
• Persistent bad breath

As a periodontist in Asheville, we want everyone to know the benefits of a healthy, confident smile. Maintaining healthy gums and keeping your natural teeth is important to every individual.

If your gum health needs improvement or there are signs of gum disease, we can structure a program that restores healthy gums and helps you maintain your oral health between visits.

For those who have already experienced tooth loss, we are happy to discuss the process to replace them with dental implants. These are the closest thing to the natural teeth you had and will restore stability and dependable biting and chewing. Too, dental implants are designed to last a lifetime, making them an excellent investment.

With proper measures, you can enjoy healthy gums and natural teeth throughout your lifetime. Call 828-274-9440 to schedule a periodontal examination or ask for a consultation to get to know us. A referral to our office is not required.

If dental fear or anxiety has kept you from receiving regular dental care, please ask us about oral or I.V. sedation (“twilight sleep”). Both are administered safely with patient comfort always a priority.

Females & Males – Oral Health Differences

Posted on Jun 05, 2024 by William J. Claiborne, DDS MS

As a periodontist, I have an intense understanding of how oral health impacts the overall health of both males and females. However, my specialized skills also allow me to understand the unique factors that affect the oral health of our female patients.

As a result of hormonal fluctuations, females can face particular challenges when it comes to oral wellness. For example, pregnancy gingivitis is not uncommon in women during pregnancy. If not treated and resolved, however, it can develop into periodontitis (advanced periodontal disease) and subsequent tooth loss.

A good illustration of how women face unique oral health challenges was noted in findings shared recently on Fox News. (https://www.foxnews.com/health/women-experience-dental-health-issues-men-experts-say-heres-what-do-about)

Using a pH meter, the pH levels in saliva were tested on multiple people over the course of many years. The researchers found the pH of women’s saliva was frequently 5.5 or 6 – a lower saliva flow rate than men.

Saliva’s ideal pH rate is between 7 and 7.4. If the pH of saliva constantly drops below 5.5, the tooth enamel gets demineralized, which means it will be more prone to tooth decay. Because the aging process causes a lower flow of saliva, a drier mouth weakens teeth due to the slower remineralization or buffering capacity.

Below are some of the different phases of life that can be accompanied by various challenges to a female’s oral health:

Puberty: Estrogen and progesterone hormones produced during puberty increase blood flow to the gums. This changes how the gums respond to plaque, the sticky film of bacteria in the mouth. With this may be gums that bleed when brushing and become red, tender, and swollen.

Menstruation: The menstrual cycle causes hormonal changes that cause some women to experience symptoms such as swollen gums that turn bright red, canker sores, or gums that bleed easily. Referred to as menstruation gingivitis, this usually occurs just prior to the onset of the period and resolves in a day or so.

Oral Contraceptives: Taking birth control pills that contain progesterone cause some women to have gum tissue inflammation. This occurs from heightened sensitivity to the toxins produced from the overload of bacteria that form plaque. While many women have less gum reactions after the first few months, some medications can lower the effectiveness of oral contraceptives. This reinforces the need to keep your dentist updated on all medicines you take.

Pregnancy: With each trimester of pregnancy, hormonal levels can change. Pregnancy also causes increased progesterone levels, which can increase the risk for plaque formation. This can lead to pregnancy gingivitis, particularly during the second to eighth month of pregnancy. This condition causes the gum tissues to become swollen and bleed easily. Gingivitis is the first stage of gum disease, which is why it is important to have gingivitis fully resolved to prevent its further progress. Because studies have found that gum disease can increase the risk for preterm and low birth weight babies, obstetricians are urging their pregnant patients to be particularly diligent in maintaining good oral health.

Menopause: With age, a variety of changes can take place in our mouths for both males and females. A particular challenge is the decrease in saliva flow, leaving the mouth is less moist. Additionally, the side effects of certain medications can pose challenges to keeping the gums healthy. Without adequate saliva flow to keep the mouth cleansed and efficient in neutralizing the acids from plaque, the risk for gum disease is greater for females in menopausal years. Declining estrogen levels also place women at greater risk for bone loss or osteoporosis as well as inflamed gum tissues around the teeth (called periodontitis). When there is bone loss of the jaw, it can result in tooth loss. Receding gums are a sign of this bone loss since more of the tooth surface is expose to the causes of tooth decay.

Researchers in Romania studied the gender differences in oral health. Through an online survey of 600 adults, the study assessed attitudes, behaviors, and educational understanding related to oral health and dental services.

The results show that women have more positive attitudes towards dental services with higher oral health values, better self-care behaviors, and have higher oral health literacy than men.

While the study indicated that oral care attitudes and behaviors of men had different influencing factors, women were primarily influenced by their level of oral health literacy. The study also noted that differences in oral health attitudes and values for both genders can be based upon education.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604615/

This is a good reason to stay on top of how intricately your oral health is to your overall health. Because the bacteria of periodontitis can penetrate the bloodstream through weak gum tissues, it has been correlated to a long list of serious health problems.

Research has found that periodontal bacteria can trigger the development or worsen the likelihood of heart disease, stroke, some cancers (including pancreatic and lung
cancer), preterm babies, diabetes, arthritis, erectile dysfunction, Alzheimer’s disease and more.

Although gum disease can exist without obvious signs or symptoms, the most commonly noticed are:

• Red, swollen or tender gums
• Seeing blood in the sink when brushing
• Receded gums
• Loose or separating teeth
• Pus pockets on gum tissues
• Sores in the mouth
• Persistent bad breath

In our Asheville periodontal dental office, patients can begin with a private consultation. We are always happy to discuss oral health options with new patients. A referral is not needed.

Call 828-274-9440 to schedule.

What Can A Periodontist Do For You?

Posted on May 13, 2024 by William J. Claiborne, DDS MS

In meeting someone for the first time, a common question is “What do you do?” Telling them that I am a periodontist often gets followed by another question: “What does a periodontist do?” The long version, according to the American Academy of Periodontology, is:

“A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. Periodontists are also experts in the treatment of oral inflammation. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and are also trained in performing cosmetic periodontal procedures.”

Choosing this dental specialty is achieved by an understanding that it will require many years of education. A periodontist begins by completing 4 years of college (undergraduate training) followed by another 4 years in dental school to earn a doctorate. The periodontal specialty then requires another 3-4 years before completing the stringent requirements for a specialty certification in periodontics.

What can all of this in-depth education and advanced skill level do for you?

Let’s begin with the diagnosis and treatment of all stages of periodontal (gum) disease. According to the Centers of Disease Control & Prevention (CDC), it is estimated that over 47% of Americans have some level of gum disease, which is also the leading cause of tooth loss. That’s nearly half of our population.

In addition to a healthy smile, the health of your gums can impact your overall health. By keeping the bacteria of advanced gum disease, known as periodontitis, you lower your risks of a long list of serious health problems that have been shown connected to gum disease bacteria. These include heart disease, stroke, diabetes, arthritis, Alzheimer’s disease, some cancers, preterm babies, and erectile dysfunction (ED).

A periodontal specialist is also a leading choice in the selection and placement of dental implants. With specialized skills, a periodontist is especially respectful to oral tissues as sensitive layers that have an important role in the appearance of a smile and the health of teeth. Utilizing these skills, a periodontist can help to minimize incisions while effectively treating each area in the mouth.

When it comes to the selection of the implant system best for you, our speciality also understands the complete spectrum of all implant types. Some implant systems offer a non-removable (“fixed”) option with others functioning with removable teeth.

Proper selection of your dental implants can also help to keep treatment fees to a minimum. This is because some implants can support more than one tooth and others are designed to support a full arch of replacement teeth. Because treatment fees are based on the number of implants required, your tooth replacement goals may be within a more manageable budget with fewer implants needed to accomplish your goals.

Reshaping gum tissues is also part of our specialized skills. The gum tissues are designed to provide a tight seal around the base of teeth and block bacterial entry to the sensitive tooth root area. When oral bacteria are able to penetrate beneath the gum line, they can cause inflammation to tender gums and attack the structures that support natural teeth.

In a procedure known as a gingivectomy, we are able to reposition or graft gum tissues over the area of recession to restore a healthy seal and protect the tooth structures below the surface.

In some cases, we are also able to save a natural tooth when the tooth breaks near the gum line. In a procedure known as  crown lengthening, a periodontist can sometimes expose enough of the tooth structure for the placement of a crown. By preventing the need for the tooth’s removal, the patient is able to avoid the extensive costs and potential upkeep of replacing it.

When it comes to a smile’s appearance, a periodontist is also the go-to. In smiles that have an uneven line of gum tissues, meaning that some teeth have more gum showing than others. This up-and-down line of gum tissue creates a jumbled look. Crown lengthening can alter the height of these tissues prior to placement of a crown (‘cap’) to provide a more flattering smile line.

Another benefit of the skills of gum recontouring  are the correction of a “gummy smile.” In this, the patient has too much gum tissue bordering the tops of teeth, making the smile line unbalanced. Using the gingivectomy procedure, a periodontist can lower the height of gum tissues, which is generally followed by placement of crowns.

Here, our Western North Carolina periodontal dental office features some of the most advanced technology in dentistry. Many of these features are not available in other dental offices elsewhere. Some of these include:

LANAP With PerioLase MVP 7 (Laser-Assisted New Attachment Procedure) – an advanced protocol that efficiently and effectively treats advanced gum disease with the added advantages of a dental laser. This offers a non-surgical alternative for patients with moderate to severe periodontal disease. LANAP treatment has also been found to stimulate bone regrowth in damaged areas.

3-D Cone Beam Imaging – used for diagnoses and treatment planning, giving clear views of the upper and lower jaw, used for intricate review of sagittal, axial, and coronal planes, locating and tracking nerve canals optimizes implant placement.

CareStream Cone Beam Computer Tomography Imaging – provides enhanced tomography that interacts with 3D imaging for exceptional detail and range.

CS 3600 Intraoral Scanner – This scanner quickly and comfortably captures digital impressions without the need for bulky, goopy trays! Through this process, we are able to create precision models or appliances (crowns, inlays, onlays, bridges, orthodontic appliances and aligners, custom abutments). The scanner can also reach difficult–to–access areas in the patient’s mouth for superior results with improved patient comfort.

Computerized Dental Implant Placement – allows for pre-surgical positioning of dental implants using a 3D model of the patient’s jaw. Once the implant type is selected, a template is developed for optimal treatment success, even for complex cases.

Sedation Dentistry – When dental fear or anxiety causes people to delay or avoid having dental treatment, we offer oral or IV sedation. Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward. I.V. sedation (also known as “twilight sleep”) places the patient in a deeper sleep state and erases memory of the procedure.

Through our extensive menu of treatments offered, it’s easy to see that our main goal is to provide patients with a comfortable and positive experience within our specialized skills. We believe this helps patients truly appreciate the advantages of a healthy smile and understand how our involvement can create a healthier, more confident individual.

I also feel it’s important that people are aware of the signs and symptoms of periodontal disease, which are:

• Red, swollen or tender gums
• Seeing blood in the sink when brushing
• Receded gums
• Loose or separating teeth
• Pus pockets on gum tissues
• Sores in the mouth
• Persistent bad breath

If any of these are present, please know that the condition will only worsen without treatment. And, early treatment can minimize treatment needs and costs.

Call 828-274-9440 if you have questions or wish to arrange a consultation discuss your individual needs (or those of a smile you love!). Our Asheville periodontal dental office staff will be happy to help you!

https://www.perio.org/consumer/what-is-a-periodontist