Mouth Sores – What Is Harmless & What To Watch Closely

Posted on Nov 04, 2021 by William J. Claiborne, DDS MS

As the holiday season approaches, our risk for illness goes up. Our chances for picking up colds or the flu increases, which is worrisome on its own. Add that to already-high concerns surrounding exposure to COVID, and we’re all taking added precautions to protect our health.

As in any year, colder months mean we’re more confined to the indoors and in closer proximity to others. With heightened potential for illness, the holidays simply create more stress to our lives. Stress is a contributor to our health as it compromises the immune system. This, in turn, lowers our resistance to fight off illness.

After the holiday mingling constraints endured in 2020, people are trying to take added precautions in 2021 so our “togetherness” is not overshadowed with worries about exposure to illness. To bolster our resistance, many people have had their Covid booster and flu vaccines, practice frequent hand washing, take vitamin supplements such as C, and are trying to stay active physically inside and out-of-doors.

Certainly, we applaud the health safety efforts taken by our Northwest NC population. As an Asheville periodontist, just a added tip for your overall health and well-being: Don’t forget to monitor the inside of your mouth while being committed to the other health measures you’re taking. You may be surprised at what your mouth reveals.

In busy times of year like the holiday season, we see a greater number of individuals who develop canker and cold sores.  As stress goes up, your likelihood of getting a cold or canker sore increases as well.

The difference between Canker and Cold sores is:

Canker Sores
These are small ulcers that typically have a white or gray base and red border. Unlike cold sores, canker sores appear inside the mouth and are not contagious. The exact cause of canker sores is uncertain but fatigue, stress or allergies can increase the likelihood of a canker sore. Some experts suspect immune system problems, bacteria or viruses can also spurn eruption. A cut caused by biting the tongue or inside of the cheek as well as hot foods or beverages may contribute to canker sore development. Canker sores usually heal on their own in a week or two. Over-the-counter topical anesthetics, steroid preparations,  and antimicrobial mouth rinses can provide temporary relief. As a holistic method, you may try swishing with plain, sugar-free yogurt for a minute or so. This helps to restore a healthy bacteria balance in the mouth while soothing discomfort.

Cold Sores
These are also referred to as fever blisters or Herpes simplex and are located around the lips, under the nose or on the chin. Caused by herpes virus type 1, cold sores are very contagious. These are clusters of fluid-filled blisters that often erupt since are they are most commonly found around the edge of the lips. Cold sores are Herpes lesions that may follow a fever, sunburn, skin abrasions or emotional upset. Because cold sore blisters are on the outside of the mouth, they can be embarrassing and uncomfortable. Although they usually heal in a week, over-the-counter topical anesthetics may speed the process while providing some relief. In our office, we can use a dental laser to hasten healing, often within a couple of days. If occurrences are frequent, ask about prescription drugs that can help reduce the duration of these viral infections.

Other issues your mouth’s interior can reveal include:

White Coating On Tongue
The tiny, bumpy protrusions on the tongue’s surface are papillae. Papillae are our source for taste and touch, allowing for feeling food’s form and texture. Saliva and food residue can become embedded in the grooves between the papillae, especially on the back portion of the tongue. This can create areas for rapid bacterial growth. As bacteria accumulate, a whitish film coats the tongue, which leads to bad breath. Let your white tongue be a warning sign of too much bacteria and take measures to manage it before cavities and gum disease develop. It’s important to keep the mouth moist since a dry mouth provides a breeding ground for bacteria reproduction. Drying sources, in addition to age, include smoking, alcohol consumption, caffeinated foods and beverages, and many prescription and OTC medications. Uproot bacteria in the tongue daily by brushing the tongue with your toothbrush after brushing teeth. Some toothbrushes have a tongue scraper on the back side of the bristles or you may want to purchase a tongue scraper. These are flexible strips you use to scrape over the tongue’s surface in a back to front motion.

Cheek Biting
Cheek biting can occur from a minor accident, such as during a fall. It can also occur from careless chewing or talking while eating. Cheek bites can occur more frequently due to a bite that is misaligned. A disparity in the bite can disrupt the harmonious congruency of upper and lower teeth while chewing and speaking. Cheek biting can be a symptom of bite misalignment. Other signs may indicate temporomandibular joint (or TMJ) disorders, which often result from a misaligned bite. Thus, cheek biting can be related. Too, TMJ disorders can cause night-time clenching or grinding of teeth. During these actions, you may be unknowingly biting the inside of your cheek while asleep. Cheek biting can cause inflammation at the location of the bite and can also result in canker sores. Chronic cheek biting can result in redness, painful sores, and tears in the mouth’s inner lining. Repeated bites can cause the oral tissues to become thick, scarred, and paler in the affected area. This surface can prompt the individual to continue biting in an attempt to create a smooth surface. If cheek biting has become habitual, there may be an emotional cause, such as  stress, anxiety, depression, or even genetics. This should be discussed with your primary care physician.

Oral Cancer
It is important to pay close attention to any change to oral tissue that does not heal within 10-14 days. When oral tissue does not repair on its own in a week or so, it should be examined by your dentist or periodontist without delay. Some of these spots can be a symptom of oral cancer.
Oral cancer has one of the worst survival rates of all cancers. Because symptoms can mimic a bite on the inside of your cheek, more obvious symptoms often do not emerge until the cancer has reached advanced stages. Of those who acquire oral cancer, only 57% are estimated to still be alive 5 years later. Know the signs of oral cancer, which include:

• white or red patch of tissue
• unusual lesion in the mouth
• difficulty or discomfort when swallowing
• persistent sore throat or feeling something is stuck in the throat
• a lump or mass inside the mouth or neck
• wart-like mass
• numbness in the mouth or face

Lesions or discolorations that are early warning signs are not always visible, particularly in the back portion of the mouth. Because symptoms emerge slowly, the delay in early diagnosis and treatment can have deadly consequences. This reinforces the need to maintain regular oral hygiene exams and cleanings every six months. During these times, unusual changes in the mouth can be noted and, if concerning, further steps can be taken. Remember, never wait until your next dental check-up appointment to have anything unusual examined.

Bleeding Gums
Contrary to what some people believe, having gums bleed at any time is not normal. Seeing blood in the sink when you brush is not a sign you’re doing a good job. It’s a sign that the gum tissues are either being scrubbed too harshly or the gum tissues are infected by accumulated oral bacteria. If you notice bleeding – at all – take extra measures to maintain excellent oral hygiene at home. This includes twice daily brushing, daily flossing, using an oral rinse, keeping the mouth moist (ideally by drinking plain water), and limiting sugar. If bleeding continues for more than a couple of days, make a dental appointment. You may have developed Gingivitis, which is an early stage of gum disease. Halting this in its tracks early can save you greatly in treatment time and expenses.

The interior of your mouth can be a great indicator of your health in other areas. Just be sure to look inside and stay proactive on steps needed to keep the interior “in the pink”. Again, if an unusual spot or sore is still present after two weeks, call 828-274-9440 immediately for an appointment.

Contour of Gum Tissues Is Important To A Smile’s Appearance

Posted on Oct 28, 2021 by William J. Claiborne, DDS MS

When people think of their smile, they tend to think primarily of their teeth. Certainly, having white, straight teeth are a major part of a smile’s appearance. In today’s cosmetic dentistry, porcelain veneers and crowns give an exceptionally natural appearance with excellent longevity and durability. However, the gum line that borders teeth can greatly affect a smile’s appearance, perhaps more than you’ve considered.

People with unflattering smile traits tend to “hold back” when smiling. They may smile with lips only or hold a hand in front of their mouths. Some men even admit to growing a mustache that extends down over the top lip to hide the teeth visible in a smile.

In addition to placing dental implants and treating all stages of gum disease, a Periodontist specializes in the treatment of the soft tissues of the mouth. As an expert in oral tissues, my advanced training enables me to contour gum tissues to provide a natural appearance and healthy seals around the base of teeth.

For several reasons, gum tissues can pull away from the base of teeth. This can occur from gum tissues becoming drier with age or over-zealous tooth brushing. Gums can also loosen their grip around teeth when teeth tilt out of their proper positions.

When the tight seal around the base of teeth is compromised, the tooth becomes more vulnerable to oral bacteria. Darker, sensitive tooth root segments may be exposed. This not only causes sensitivity, these areas become susceptible to bacterial penetration. As an entry point for oral bacteria, the tooth roots and bones that support teeth are more vulnerable to damage as well.

In cases when a tooth breaks near the gum line, a procedure known as crown lengthening may be able to expose enough of the tooth structure so a crown can be placed. This means the natural tooth can be saved rather than require removal. Once a natural tooth is removed, it brings with it a long list of decisions and associated costs.

Although protecting and saving teeth is the priority, gum contouring procedures, such as crown lengthening are also performed to enhance the appearance of a smile. Gum re-contouring is typically referred to as a “gingivectomy”. It is performed to remove the excess gum tissue that arches over the teeth most visible in a smile.

For example, for people who have a “gummy smile,” too much gum tissue is visible above upper teeth in a full smile. A periodontist can use his or her specialized skills to reshape the tissues to provide a more balanced smile line.

In this, crowns are typically placed in addition to having the gum height adjusted. The result? A smile is greatly improved when the gum line is contoured to blend attractively with gum tissue bordering neighboring teeth.

To begin, we numb the gum tissues and carefully trim the excess. As a Periodontist, I take specific measures to ensure a natural looking arch remains over the teeth while preserving the natural points that ‘dip’ between each tooth.

A gingivectomy performed with a dental laser provides our Asheville periodontal office patients with a number of advantages: (1) enhanced comfort; (2) precision lines; (3) minimal or no bleeding; and, (4) faster healing time.

It’s normal to experience some tenderness or swelling after the procedure. However, most patients do fine by applying an ice pack off and on for the first day. In most cases, over-the-counter pain medications are sufficient, however, we make prescription strength options available to ensure comfort during the healing process. Many patients tell us they needed no medication at all.

Healing time depends on each individual and can vary from a few days to a few weeks. The dental laser we use helps to reduce the amount of time needed for healing. For patients who smoke, healing times are longer due to smoking’s drying effect on gum tissues.

Most gingivectomies are followed by porcelain veneers or crowns to give a beautiful, even smile line.

For those who have avoided gum recontouring due to dental fear, we offer several sedation options, including oral and 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.

IV sedation (also known as ‘twilight sleep’) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety. In our Asheville office, anesthesia is overseen by a medical doctor (MD) who is a board certified Anesthesiologist.

With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment. We help patients understand that their fears and concerns are not unusual. Our doctors and staff respect each patient and provide gentle, compassionate care – at every appointment.

Treatment fees depend on the extent of the condition and whether crowns or veneers will be applied following treatment. In either case, beautiful results can occur, helping the individual who once ‘held back’ on smiling confidently.

A healthy smile is a benefit to our overall health. An attractive, confident smile is also an asset when it comes to self-image, helping us to feel good from the inside out! Call 828-274-9440 for a consultation to discuss a gingivectomy and what may be recommended for your specific needs.

 

 

How The Contours of Your Gums Can Enhance Smile’s Appearance

Posted on Aug 10, 2021 by William J. Claiborne, DDS MS

I remember the home of a beloved Great Aunt, whom I visited often growing up. One of the things that made her home so “homey” were the displays of bric-a-brac. As a youngster, I didn’t term her arrangements of china tea sets and Hummel figurines as bric-a-brac (they were “knick knacks,” to me). However, I found myself being drawn to her displays on shelves, in curios, and on tables moreso as I grew older.

To me, what was impressive about these groupings was how balanced they were. The china tea pots were centered, surrounded by carefully spaced cups and saucers. Hummel children were in playful arrays to appear as a happenstance assembly of friends.

As a Periodontist, I am now far more appreciative of how my Aunt kept such proper balance to these displays. Everything seemed so coordinated, harmonized.

As a specialist in the treatment of all stages of periodontal (gum) disease and the placement of dental implants, I am also the expert when it comes to the contours of gum tissues surrounding teeth. The gums are important to the health of your teeth as well as the appearance of a smile.

When it comes to protecting teeth, think of the gum tissues as a protective blanket. The gums cover over the under-structures of the mouth’s interior (oral cavity). If you’ll look at the base of each tooth, you’ll see that the gum tissues snugly wrap the base of each tooth. This protective seal is what prevents bacterial penetration below the gum line.

When gum tissues loosen their grip around teeth, the leading cause is gum disease. Gum disease weakens oral tissues and causes them to become inflamed. As the gums loosen, bacteria is able to work their way into the structures that support natural teeth (including bone).

When bacteria reach this level of oral structures, ridding it involves a more involved procedure than what a mere dental cleaning can combat. As it progresses, the gums become spongy and pus pockets form. Teeth loosen and may need removal. Gum disease is the leading cause of adult tooth loss.

Yet, gum tissues not only serve as a protective element of your mouth. The appearance of a smile can be greatly affected by the shape and amount of gum tissues exposed when smiling.

Balance is an element of beauty, according to studies. We are drawn to it. According to Penn State’s “Science in Our World: Certainty and Controversy”,

“Studies show that symmetrical faces are preferred and more attractive to others than people who have asymmetrical faces. Similarly shaped eyes and eyebrows, sides of the nose mouth can all fall into the symmetrical category.”

They shared findings of one study, performed over the course of two decades, that had men and women rank the attractiveness of people in photos. The study revealed:

“Men and women both overwhelmingly chose the most symmetric face. This test was an observational study, so it was only as clear and truthful as the participants of the study were. There wouldn’t really be a way to make this sort of study an experimental test, so as far as attraction goes, studies must rely on the opinions of the participants. However, the majority of the participants chose the most symmetrical faces as the most attractive ones, so it is easily said that it is true, symmetry equals attractiveness.”

http://www.livescience.com/7023-rules-attraction-game-love.html

Although “beauty is in the eye of the beholder,” symmetry seems to be a component of what humans define as beautiful and what we’re drawn to (although inner beauty is an important factor in what keeps us connected to an individual).

When a smile shows too much or too little gum tissue bordering the tops of teeth, it moves the smile line out of balance. For example, in a “beautiful” smile, the arches of gum tissues visible in a full smile are at a similar level. The amount of gum arches are in a complimentary line to teeth, rather than an amount that draws the eye. Too much gum tissue showing is referred to as a “gummy smile.”

A gummy smile is not an unattractive feature. Having one does, however, alter the appearance of a smile based on balance. For example, a diastema is a wide space between the two front teeth. It is often a hereditary trait. Although it is not unattractive feature, the eye seems drawn to that one spot rather than seeing the smile, as a whole, as a complement to other facial features. The individual may have beautiful lips or eyes, but the gap between the teeth is what is noticed as being “off.”

Quite frankly, some people are perfectly comfortable with having a gummy smile or a diastema. For them, it’s part of their personality or signature look. After all, what would Lauren Hutton, the famous model of the 70’s, have been without her diastema?

For other people, these features cause shyness, insecurity or a feeling of awkwardness. Some people try to smile with lips only. Others try to conceal a full smile with a hand. “Holding back” on a smile is a shame, especially since smiling is a proven asset to our frame of mind.

The act of smiling causes the brain to release chemicals known as endorphins. These trigger somewhat of a natural high, creating a happier mood. This has been shown to be true even when faking a smile.

Additionally, people who smile often are deemed happier, more confident and even younger. In smiling, the facial muscles pull upward and smooth out the skin to give the face a bit of a lift. Free of charge!

Another distortion in a balanced smile can be an uneven line of gum tissues, where there is more gum showing on some teeth than others. This up-and-down line of gum tissues creates a jumbled look. Again, the appeal of balance is disrupted.

In these cases, a “crown lengthening“ procedure is often advised. This is a simple procedure that alters the height of the gum tissues prior to placement of a crown (‘cap’). Not only does this provide a more flattering smile line, it protects the teeth involved while enhancing the tooth’s shape.

Another issue that impacts both appearance and the health of a tooth is gum recession. When the gums recede from the base of teeth, more sensitive and vulnerable areas of the tooth’s root are exposed. Exposure can lead to sensitivity and higher risk for bacterial penetration.

The procedure for most gum recontouring is known as a Gingivectomy. In this, our Asheville Periodontal dental office uses a dental laser. Gingivectomy is the most common procedure performed with a laser, which is used to precisely contour gingiva (gum tissue) for restorative, cosmetic, and periodontal needs.

The laser promotes rapid healing and reduces discomfort post-operatively with periodontal packing or sutures rarely needed. In the hands of a skilled periodontal specialist, laser technology also minimizes penetration depths. For minor procedures, lasers can sometimes require little or no anesthetic.

For more involved gum contouring, our Asheville periodontal office offers both oral and I.V. 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 places the patient in a deeper sleep state, also erasing memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety. In our office, this is overseen by Dr. Brad Stone, a Medical Doctor (MD) who is a board certified Anesthesiologist & Pediatric Anesthesiologist.

With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

The health and appearance of your smile are important. It is proven that good oral health is a supportive component to your overall health. It is also shown that the appearance of a smile can add positively to an individual’s perception of “self”.

If you’re interested in improvements in the health and appearance of your smile, let’s discuss the possibilities during a consultation appointment. Call 828-274-9440. A referral is not always needed.

 

Keep The Mouth Moist To Minimize Bacterial Growth

Posted on Jul 22, 2021 by William J. Claiborne, DDS MS

When you think of an environment of a warm, dark, moist space, it would seem to be a perfect breeding ground for bacteria growth. For homeowners, the worry over this is often how easily mold forms in such places.

According to FEMA (Federal Emergency Management Agency), molds are microscopic organisms that thrive anywhere there is a moist environment. Growth can start on a damp surface within 24 to 48 hours.

Molds digest organic material, eventually destroying the material they grow on, and then spread to destroy adjacent organic material. (https://www.fema.gov/pdf/rebuild/recover/fema_mold_brochure_english.pdf)

As an Asheville periodontist, I can’t help but think of the similarities to the mouth. Bacteria in the mouth, when not removed, can multiply and form the sticky film that coats teeth and gums. This is known as plaque.

Like molds, plaque must to be removed to prevent its spread and destructive nature. This is what your twice-daily brushing and flossing regimen is intended to do. When plaque remains in the mouth for roughly 48 hours, it hardens onto teeth. This is tartar and typically forms between teeth or in chunks at the base of teeth.

Essentially, tartar is a hardened mass of bacteria. Like mold, tartar continues to grow if not removed. And, like mold, tartar can cause damage to what it is growing on and spread to surrounding structures.