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

Healthy Gums Advantageous To A Healthier YOU!

Posted on Apr 22, 2024 by William J. Claiborne, DDS MS

Periodontal (gum) disease and subsequent tooth loss has damaging effects to an individual, far beyond the mouth. When this was suspected decades ago, it prompted national agencies to track the oral health of the U.S. population. Using this extensive data, studies have revealed some interesting statistics, including how various age groups fare when it comes to oral wellness.

The following is mostly information pulled from the National Institutes of Health’s (NIH) “Oral Health In America” report. Released in December 2021, the findings were the culmination of years of research assembled by more than 400 contributors.

On a positive note, the percentage of Americans who have experienced tooth loss has declined since the 1970’s. As of 2016, complete tooth loss has fallen by more than 75% for adults between the ages of 65 – 75 years. Unfortunately, there is not good news when it comes to tooth decay – for nearly any adult age group.

For adults between the ages of 20 – 64, cavities have affected 90% and gum disease exists for nearly 50% of adults aged 45 – 64 years. This should be a concern for every American. This is because research has determined that the bacteria of periodontitis (advanced gum disease) can trigger or worsen a long list of serious health problems.

The list includes:
• Stroke
• Coronary Artery Disease
• Arthritis
• Diabetes
• Preterm & low birth weight babies
• Some Cancers (including oral and pancreatic)
• Alzheimer’s disease
• Impotency, Erectile Dysfunction (ED)
• Prostatitis (elevated PSA levels)

In addition to poor oral hygiene routines at home and avoiding regular dental cleanings and exams, high-risk behaviors (such as use of tobacco, opioids, and alcohol) accentuate the risks of gum disease.

Although gum disease can begin 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

While the report found that there are stark differences in adult groups who had less access to having regular oral health care, disparities also stem from underlying economic, demographic, and societal inequities.

Below are some of the oral health variations pertaining to certain groups.

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ADOLESCENTS
During the past 20 years, the percentage of adolescents (ages 12 − 19) having at least one molar with a sealant applied has nearly tripled, from 18% to 48%. That’s a good thing. Even so, there has been no decline in untreated tooth decay in adolescents since the last surgeon general’s report twenty years ago.

High caries (cavities in teeth) experienced in early childhood is the strongest indicator of caries problems that will be experienced in adolescence and adulthood. This means that when the factors contributing to developing cavities in childhood persist, the incidence of caries affecting permanent teeth will continue to increase during adolescence. Likewise, misalignment of teeth that exist or develop during adolescence can substantially impact eating, speech, gum health, and even psycho-social development. (Imagine a teen with teeth so mispositioned that they are ridiculed by peers.)

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OLDER AMERICANS
There is good news for our older population (Americans over the age of 65). Their overall oral health has significantly improved over the past two decades with fewer teeth being extracted. Additionally, the proportion of the population with edentulism (no remaining natural teeth) is at an all-time low.

The not-so-great news… tooth loss remains a problem for older adults. Today, 1 in 6 Americans have no remaining natural teeth. At this rate, by the year 2030 (just 6 years from now), the 65-&-over age group without teeth will increase to 1 in 5.

For adults over the age of 75, the challenges are even greater. Over 54% have fewer than 21 remaining teeth with the number increasing to 80% for those living in poverty. With age also comes the increased prevalence of systemic diseases that may impact the mouth, making older adults more susceptible to oral health issues. (This includes heart disease, diabetes, arthritis, etc.)

Fortunately, things are moving in a positive direction for older adults, with more keeping their teeth than any previous generation. This has largely been the result of having increased attention on the benefits of prevention and improvements in treatments for gum disease and cavities, along with a decrease in the rate of smoking. (About 8 of every 100 adults – 8.3% – of adults 65 years and older were reported to smoke in 2023.)

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WOMEN
Women have unique oral health concerns due to changing hormone levels based on menstrual cycles, pregnancy, and menopause. These fluctuations can raise the risk of oral problems that effect teeth or gums. Health issues, such as diabetes, can also affect the oral health of females.

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To keep your teeth healthy, it is important to remove dental plaque. This is a sticky, colorless film of bacteria that coats teeth and gums. Plaque buildup can cause tooth decay and gum disease.

Even teeth that already have fillings are at risk for tooth decay. Plaque can build up underneath a chipped filling and cause new decay. And if there are areas in your mouth where your gums have pulled away from the teeth (known as receded gums or gum recession), the exposed tooth roots can decay as well.

It’s important – for all ages – to be committed to their oral hygiene time at the sink, at least twice a day. Devoting these minutes to the care of your teeth and gums will pay off in future years, helping to minimize costs for dental repairs and time in treatment. And, when early ages get into the habit of an oral care routine at home, they are more likely to carry that into adulthood.

Here are some easy brushing tips:

• Use fluoride toothpaste, which is an ingredient of many products. Fluoride protects teeth from cavities, helping to strengthen the tooth’s hard outer surface – the enamel.
• Angle the bristles toward the gumline so they can sweep away bacteria between the gums and teeth.
• Brush gently using small, circular motions. Do not scrub hard back and forth, which can wear down tender gum tissues and wear away tooth enamel.
• Brush all sides of each tooth and the tops (where debris and bacteria can hide within grooves).
• Brush your tongue, especially towards the back where the majority of bacteria embed. Swish well with water at least twice afterwards.

Cleaning between teeth to remove plaque is also part of a good oral hygiene routine. If plaque is not removed, some of it can harden below the gum line and irritate the gums. The gums become red, swollen, and may bleed easily. These are signs of gingivitis. Gingivitis caused by plaque buildup is a mild form of gum disease, and you can usually reverse it with daily brushing and flossing.

If plaque stays on your teeth for too long, it can harden. This hardened plaque is called calculus, or tartar. The only way to remove tartar is to have your teeth cleaned by a dentist or dental hygienist. If the tartar is not removed, the gingivitis can get worse and lead to more severe gum (periodontal) disease. In advanced stages, gum disease causes sore, bleeding gums; painful chewing problems; loose teeth; and even tooth loss.

Here are some additional ways to keep a healthy smile with practical measures.

• Floss to remove plaque, and food particles, from between your teeth.
•  Visit the dentist for routine check-ups and professional cleaning. If you are at a high risk for tooth decay (for example, if you have a dry mouth because of medicines you take), your dentist or dental hygienist may give you a fluoride treatment, such as a varnish or foam during the office visit.
• Drink fluoridated water. Drinking water with the right amount of fluoride protects your teeth throughout the day.
• Don’t smoke. Smoking increases your chance of gum disease. If you smoke and want to quit, there are many resources to help you: FDA’s Center for Tobacco Products, CDC’s Quit Smoking website, and the BeTobaccoFree.gov website.
• If you are planning to become pregnant, have a dental checkup. Because of hormonal changes, pregnant women may develop gingivitis and experience gums that are swollen and bleed easily. During pregnancy, it is especially important to practice good oral hygiene to maintain the health of your gums.
• Eat a diet that is low in sweets and sugary drinks.

A periodontal specialist is your best advocate in restoring or maintaining healthy gums. In addition to the skills in treating all stages of gum disease (from gingivitis to periodontitis), a periodontist specializes in the selection and placement of dental implants.

If you have signs or symptoms that may be indicative of gum disease, please know this disease will only worsen without treatment. Call 828-274-9440 to schedule an appointment or ask to begin with a consultation.

If dental fear is a concern, we can discuss oral or IV sedation options. These are administered safely with skilled staff members who use advanced safety equipment throughout your care.

Additionally, if you’ve delayed care due to cost, we office several payment plans that many patients find helpful. These plans can break costs into monthly payments, often with no down payment required.

Sources:

https://www.nidcr.nih.gov/news-events/nidcr-news/2023/report-reveals-striking-differences-oral-health-care-across-us

https://www.nidcr.nih.gov/health-info/oral-hygiene

https://www.nidcr.nih.gov/research/oralhealthinamerica/section-2b-summary

https://www.nidcr.nih.gov/research/oralhealthinamerica/section-3b-summary

https://www.nidcr.nih.gov/research/oralhealthinamerica/section-3a-summary

https://www.womenshealth.gov/a-z-topics/oral-health

https://www.nidcr.nih.gov/

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm