Diagnosing Periodontal Disease: How Dentists Do It

An accurate diagnosis of the patient’s periodontal condition is of paramount importance in the subsequent management of the disease.

It is the first step towards the development of an appropriate treatment plan that when implemented, will lead to the resolution of the infection and restoration of the patient’s periodontal health.

In this article, we will give you an overview on how dentists accurately diagnose your periodontal problem.

Medical and Dental History

The first most important thing in coming up with an accurate diagnosis is obtaining detailed information regarding the patient’s medical and dental history.

According to studies, periodontal disease affects and can be affected by a variety of systemic diseases and conditions. These include diabetes, heart disease, pregnancy, chronic stress, and smoking to name a few.

Dental history, on the other hand, will give your dentist an idea as to what must have contributed to the periodontal problem, how it will progress, and which of the treatment options may or may not suit the patient.

Gum Tissue Inflammation

After history-taking, your dentist will now rely on visual examination of your overall oral condition. This method will only assess whether or not the gum tissue is inflamed.

This assessment is done by examining the color (coral pink, red, or red-purple); consistency (firm or soft); and texture (stippled or smooth) of the gum tissue.

A healthy gum tissue is coral pink, firm, and stippled, while an inflamed one is red, soft, and smooth. Your dentist will inspect the gum tissue on the cheek side and tongue side of every tooth and compare it to what healthy gums should look like.

Plaque and Calcular Deposits

Periodontal disease is mainly caused by accumulation of plaque in the gum line and in-between teeth. Plaque contains bacteria that can induce host response, resulting to the inflammation of the gum tissue. If left for a long time, it will eventually harden, forming what is known as calculus (a.k.a. tartar).

Calculus has a rough surface that further facilitates plaque accumulation. Plaque and calcular deposits can be detected via visual examination or through the use of plaque disclosing agents. Disclosing agents contain dye which is absorbed by plaque, allowing them to be more easily seen by the dentist.

Periodontal Disease

Bleeding on Probing (BOP) and Periodontal Pocket Depth (PPD)

Bleeding on probing and measuring periodontal pocket depths provide a more objective and detailed assessment of the patient’s existing periodontal condition.

BOP confirms the presence of inflammation, while PPD determines the extent of destruction. Both are measured using a special instrument called periodontal probe, which has millimeter calibrations.

To measure PPD, your dentist will insert the probe into the groove between the gum tissue and the tooth. Normal PPD is 1-3mm, while more than 5mm is indicative of periodontitis.

Tooth Mobility

If periodontitis is suspected, your dentist will also assess the mobility of the involved teeth.

Mobility is usually a sign of bone loss. It is evaluated by pushing the tooth between two fingers or instrument handles and observing any movement.

This movement may be slight or severe (almost as though the tooth will pop out of its socket) depending on the amount and extent of bone loss.

Bone Loss

Periodontal disease that has been left untreated for a very long time results to bone loss, which your dentist can detect by taking dental x-rays.

Some dentist would take x-rays of the involved teeth only, while others prefer a full mouth series.

A full mouth series is a set of 18 x-rays that covers the entire dentition. It is recommended for cases where periodontitis seems to involve almost all of the patient’s teeth.

Understanding Periodontal Diseases

Periodontal disease comprises a number of oral health problems that affect the supporting structures of the teeth. These structures include the gums, periodontal ligament, and alveolar bone.

The periodontal ligament is the tissue that attaches the tooth to the alveolar bone, while the alveolar bone is the bone that makes up the tooth socket.

Periodontal disease is among the most widespread oral diseases worldwide, and it has to be taken seriously because it affects not just the oral health, but general health as well.

In this article, we will discuss some forms of periodontal disease, along with the recommended treatment for each.

Gingivitis

Gingivitis is the early and most common form of periodontal disease. It pertains to the inflammation of the gum tissue, and is characterized by the presence of red and swollen gums that bleeds easily upon manipulation (i.e. brushing, using toothpicks, etc.).

It is often caused by plaque buildup which is a result of poor oral hygiene. Gingivitis is reversible; it will resolve by practicing good oral hygiene and going to your dentist regularly for professional cleaning.

Good oral hygiene means brushing properly at least twice a day, flossing, and using an alcohol-free mouthwash.

Periodontitis

Periodontitis is the more advanced form of periodontal disease that develops when gingivitis is left untreated for a very long time.

It occurs when plaque accumulates deep below the gum line, resulting to the destruction of the periodontal ligament and bone.

It is characterized by the bone destruction and separation of the gums from the teeth (forming what is known as periodontal pocket) in addition to the classic signs of gingivitis. Gum recession and loosening of the affected teeth are also common.

Periodontitis may be classified into two main types: CHRONIC and AGGRESSIVE periodontitis.

Chronic periodontitis, the more common of the two, is often seen in older patients. The destruction of the supporting tissues of the teeth happens very slowly, although there may also be periods of rapid destruction.

Aggressive periodontitis, on the other hand, is the less common but more destructive form. It affects younger patients.

In this type of periodontitis, redness and swelling of the gums is not obvious, but the destruction underneath is occurring very rapidly. If left untreated, both forms result to tooth loss.

Unlike gingivitis, periodontitis is irreversible. The bone lost cannot be brought back, but the periodontal ligament tissue can reattach the tooth back to its supporting bone.

This is possible through periodontal therapy in the form of scaling and root planing, which is more popularly known as deep cleaning.

Scaling and root planing is a more intensive form of treatment that involves the removal not just of plaque deposits, but of diseased tooth root structure as well. Root planning, in particular, results to a tooth root surface that is glassy smooth. This glassy smooth surface facilitates reattachment.

Scaling and root planing may be done through surgical and non-surgical means, with the latter being considered first. Surgical root planing is only considered when its non-surgical counterpart proves to be ineffective.

Necrotizing periodontal disease

Like periodontitis, necrotizing periodontal disease involves the destruction and subsequent necrosis (a.k.a. tissue death) of the gums, periodontal ligament, and bone.

It often affects individuals who are malnourished, diabetic, chronic smokers, and immunocompromised (ex. HIV-positive). This form of periodontal disease is extremely rare, and management involves consultation with a medical doctor before rendering treatment.

Treatment involves scaling and root planing along with prescription of antibiotics and medicated mouthrinse.

Periodontitis as manifestation of systemic diseases

This form of periodontitis, as the name suggests, is brought about by systemic diseases.

These include diabetes, respiratory disorders, and heart disease. Depending of the underlying disease, it may exhibit signs of chronic or aggressive periodontitis.

To treat this type of periodontal disease, the medical condition must be addressed first. Once the medical disease is controlled, your dentist will now be able to treat the periodontal disease with the same treatments used for chronic and aggressive periodontitis.

Your Kid’s First Dental Visit: What to Expect

First-time parents often have this question about their kid’s oral health: “When should my kid’s first dental visit be?”

According to the American Academy of Pediatric Dentists, it should be as soon as the kid turns one, or earlier if he or she is at high risk for tooth decay.

Some parents would find that age too early, so they tend to plan the dental visit when their kids are much older.

But one year old is actually the right time if you want to avoid future dental problems. In fact, some dentist would advocate bringing your kid to the dentist as soon as his or her very first primary tooth erupts.

But in case you are wondering how this visit will go about, here’s a short list of what to expect during your kid’s first dental visit.

Initial consultation

First dental visits, especially for kids, are always about consultations first. In this consultation, the general or pediatric dentist will teach the parent on how to properly care for a kid’s mouth in order to avoid dental problems.

The parent will also be instructed about proper diet, prevention of oral habits (i.e. grinding, thumbsucking) if any, prevention of accidents that could damage the kid’s teeth, and what would happen in the coming months as the kid continues to grow.

Clinical examination

Along with the initial consultation, the dentist may also conduct a comprehensive oral and dental examination to determine what treatment – preventive or curative – does the kid need.

The dentist and the parent will be in knee-to-knee position with each other. The kid will sit on the parent’s lap, and then lay down with his or her head on the dentist’s lap. This position allows both the dentist and the parent to see the kid’s mouth clearly.

The kid, on the other hand, will be facing his or her parent and can look up to the dentist at the same time.

Cleaning and fluoride application

First dental visit is mostly for consultation (and sometimes clinical examination) due to one important reason: the dentist wouldn’t want to scare the kid by doing routine dental work right away.

As much as possible, no procedures should be performed because they want this first dental visit to be as comfortable and relaxing as possible.

However, in kids who are highly susceptible to decay, immediate cleaning and topical fluoride application may sometimes be necessary.

This is totally fine because they are not as invasive and “scary” as doing restorations and extractions.

Scheduling of follow-up visits

After consultation, your dentist formulates a treatment plan and schedules your kid’s future dental visits.

The interval of this visits is anywhere from weeks to months, depending on your kid’s treatment needs. The schedule your dentist will provide you must be followed thoroughly because they are sequenced accordingly.

Many dental problems can be treated or prevented more easily if they are detected early.

To do that, one must make it habit to start visiting the dentist even at an early age. Educate your kid early on about the importance oral and dental health, so he or she will be encouraged to go to the dentist more often.

Find a general or pediatric dentist that you trust and feel comfortable enough to ask any questions that you may have regarding your kid’s oral and dental health.

Why Your Child’s Primary Teeth is More Important Than You Think

Primary teeth, otherwise known as the deciduous teeth or baby teeth, are the first set of teeth that develops in the mouth.

They start erupting at around 4-6 months after birth and are completed at age 2-3. There are a total of 20 primary teeth.

At age 6-7, they begin to shed off one by one to give way to the new set of teeth, called the permanent teeth.

When you think about it, if these teeth will be lost anyway, then why go all the trouble of fixing, saving, and preserving them?

Well, even though they will eventually be replaced, the primary teeth serve many purposes – in fact, they have the same function as the permanent teeth.

But to convince you more, here is a list of specific reasons that will tell you just how important these little pearly whites are.

They help kids speak more clearly

The first primary teeth to erupt in children’s mouth are the lower and upper incisors.

These teeth, and all the primary teeth in general, are crucial for speech development because they provide contact points for the tongue.

These contact points allow for certain sounds to be articulated properly when speaking. Learning to speak properly is very important for cognitive and social development.

If any of the primary teeth goes missing for whatever reason, speech impediment results.

They help kids chew properly and more efficiently

Again, the primary teeth have the same function as the permanent teeth especially when it comes to chewing food.

Like your permanent teeth, each primary tooth serves its own purpose. For instance, both primary and permanent incisors are for incising and tearing food, while the primary and permanent molars are for crushing.

We often see kids whose teeth are so badly-broken down that they find it so difficult to chew. Aside from the pain caused by the decay, they also suffer from not being able to enjoy their food.

This hinders them from getting proper nutrition which, in turn, results in failure to thrive.

They boost self-confidence

Another important purpose of healthy primary teeth is for social interactions. Having a perfect set of teeth makes you feel more confident about how you look, right? The same goes for a kid who has a healthy set of primary teeth.

Children, even the very young ones, can easily differentiate a perfect smile from an ugly one. Taking good care of your kid’s primary teeth helps prevent bad breath, promote healthy smiles, and make social interactions much more pleasant for him or her.

They maintain jaw space for the erupting permanent teeth

Sound primary teeth have certain width that allow them to maintain space for the future permanent teeth. Each primary tooth holds the space for their permanent successor, and they won’t let go until these successors are ready to come out.

Early loss of these primary teeth – particularly the molars – causes the remaining ones to drift into the space left by the missing tooth. This results to the entrapment or impaction of the permanent teeth. Trapped or impacted permanent teeth may or may not erupt.

If they erupt, it would be a partial eruption only and the tooth won’t be on its proper location. It would in front of or at the back of the existing teeth. Regaining lost space is possible through orthodontic treatment, but it can be difficult and expensive.

If a primary tooth cannot be saved and there’s no other choice but to get rid of it, there is still a way to keep the space open through the use of “space maintainer.”

A space maintainer is an orthodontic appliance consisting of a wire loop soldered to a metal band. The metal band is cemented on the tooth, while the wire loop extends across the gap and rests on the tooth on the other side of the gap.

The wire loop preserves the space left by the missing tooth by preventing the movement of the tooth on which the metal band is attached.

They preserve the health of the erupting permanent teeth

Early childhood caries is a severe form of tooth decay that affects children aged 0-4. If left untreated, the decay can affect the deeper parts of the tooth and eventually the underlying permanent teeth. This leads to the decay of the permanent teeth even before they erupt.

To avoid this, the decayed primary tooth may have to be removed. But this must be followed by the installation of a space maintainer to preserve the space.

Whenever possible, saving a primary tooth is must for the reasons stated above. For more information, consult your general dentist or if possible, your pediatric dentist as soon as your kid’s primary teeth erupt.

A pediatric dentist is someone who specializes in the diagnosis and treatment of dental issues not just of young children, but of adolescents as well.

Why Dentists Recommend Sedation Dentistry

Most patients cower in fear upon knowing that they need to go to their dentist, causing them to skip any treatment they badly need.

With sedation dentistry, you won’t think twice about seeing your dentist anymore, as this technique will ensure that your every appointment will be pleasant, comfortable, and pain-free.

But of course, these are not the only benefits of the technique. There’s a whole lot more – and that’s what we will tackle in this article.

It allows patients to survive lengthy appointments

Aside from ensuring a pleasant dental visit, one more very important benefit of sedation dentistry is it allows for a lengthy procedure to be carried out without the patient getting too tired.

More often than not, dentists worry about their patient feeling exhausted, so they tend to work faster and sacrifice the quality of their work.

Among the drugs that will be used for sedation are muscle relaxants. These drugs help relax the jaw muscles to the point of paralyzing them.

This enables patients to keep their mouth open for hours without causing jaw soreness after. Healing time will also be faster. Sedation dentistry is therefore ideal for complex procedures like root canal treatment and implant surgery, which require more than one lengthy appointment.

It controls the patient’s gag reflex

Another useful benefit of sedation dentistry is the control of gag reflex, which allows the dentist to work more efficiently and provide better results.

Gagging is often triggered by anxiety, and sedating the patient can effectively manage this problem.

If you are one of those who feel that strong urge to vomit whenever the dentist operates on your mouth, sedatives can help you get rid of that feeling.

It will also allow your dentist to concentrate more because he or she won’t have to worry about gagging or any other unnecessary patient movements.

It is best used for children, mentally-challenged, and disabled patients

While sedation dentistry is indicated for anyone, it is best used in children and patients with mental issues.

These patients are often the most uncooperative, requiring the dentist to seek additional help from his or her staff while doing the treatment.

Using sedatives makes cooperation from these patients a whole lot better, enabling the dentist to perform the entire treatment alone.

In disabled patients, cooperation is not really much of a problem, but they may produce sudden movements that can sometimes make it difficult for the dentist to carry out the treatment.

The muscle relaxants used for the technique can be of great help in such case.

It provides little or no memory of treatment

Having little or no memory of the treatment will help you make less fearful of it. Should you remember something, it will only be a couple of minutes of the procedure and not its entirety.

This is particularly beneficial when undergoing traumatic procedures like gum surgery, wisdom tooth surgery, or multiple extractions.

It creates an overall stress-free experience for both the patient and the dentist

For most patients, sedation dentistry provides them with stress-free experience.

It gives them the opportunity to maintain and improve their oral health, as they won’t have to be afraid about going to the dentist anymore. Sedation dentistry allows the patient to be comfortable while receiving treatment, while the dentist will be able to work more efficiently to provide great results.

A Guide to Sedation Dentistry

If you or someone you know suffer from dental anxiety and often don’t want to go to the dentist to get the treatment they need, the sedation dentistry might be the answer you’re looking for.

Find out what sedation dentistry is, and how it can help those who suffer from dental phobia receive dental care in a worry-free, comfortable manner.

What is Sedation Dentistry?

Sedation dentistry refers to the method of administering a sedative or a combination of sedative drugs to a patient who shiver with extreme dental fear and anxiety.

It allows any procedure, especially the more extensive ones, to be completed without causing distress to both the patient and the dentist.

What drugs are used in sedation dentistry?

As the name suggests, the drugs used in sedation dentistry are sedatives.

These sedatives work by depressing the area of the brain associated with consciousness. Sedative drugs include anti-anxiety drugs (ex. diazepam and midazolam), barbiturates, opioid analgesics, and anesthetics.

The most commonly used sedative is nitrous oxide, also known as laughing gas, which also acts as an analgesic.

How are these drugs administered?

Sedatives are administered mainly through inhalation or intravenous (IV) injection. Oral route may also be done in patients who require moderate sedation. All three are proven to be safe and effective.

Inhalation sedation is more commonly performed, especially since most patients faint at the sight of needles. It is a mild form of sedation that makes use of nitrous oxide.

Intravenous sedation, on the other hand, is a more advanced technique that is otherwise known by the names Sleep Dentistry or Twilight Sedation.

In this method, a combination of drugs – usually stronger ones – are administered using a small needle inserted into the vein of the arm. This combination usually consists of an anti-anxiety drug, a barbiturate, and an opined.

Regardless of the route, local anesthetics will still be used to induce numbness at the surgical site. The anesthetic is given through injections, usually after administering the sedatives so the patient won’t remember or feel the needle being inserted through the skin.

Will I be asleep while on sedatives?

The level of sedation ranges from mild to deep, depending on the extent of the procedure and your level of fear or anxiety.

Mild sedation will only make you feel drowsy, while deep sedation causes you to fall asleep and place you in dream-like state. In moderate sedation, you are awake enough to respond to purposeful stimulation.

How does sedation dentistry differ from general anesthesia?

Sedation dentistry, particularly IV sedation, will put you in a relaxed state which may cause you to fall in deep sleep during the entire procedure just like in general anesthesia.

The main difference, however, is that you are still in control of your breathing while sedated.

In general anesthesia, your body won’t be able to control itself so you have to rely on equipment’s to do the breathing for you.

Given this, general anesthesia must be done in a hospital setting, whereas sedation dentistry may be performed in a dental clinic.

Both sedation and general anesthesia, nonetheless, will leave you will very little or no memory of the procedure. It would feel as though the entire treatment took a few minutes only when in fact it was a couple of hours.

Is sedation dentistry safe?

Sedation dentistry is generally safe particularly if done by a trained professional.

Inhalation sedation may be done by your dentist, but intravenous sedation must be performed only by those who have a special training for it.

Discuss with your dentist the possible risks, especially if you have any obstructive systemic conditions.

How much does sedation dentistry cost?

The cost depends on how extensive the treatment will be and what type of sedation it requires.

During your initial appointment, your dentist will examine your mouth and formulate a treatment plan accordingly. The best method of sedation will be identified based on what treatment you need.

The dental staff will also provide you with an estimate cost. Your insurance plan may cover some of the total cost.

There are insurance companies who cover all costs (sedation plus the actual procedure) if the entire process is completed in a single appointment. If it is not covered or you don’t have an insurance plan, you dentist may come up with payment schemes that suits you.

What to Look for In Your Teeth Whitening Products

Even if your oral hygiene is near-perfect, you’re probably still wondering why your teeth is as not as white as you want them to be.

Truth is, there are lot of factors that contribute to the yellowing of our teeth, and some of them there’s nothing we can really do about.

Of course, you can opt to avail of the whitening treatment offered by your dentist as long as you have the time and money.

For those who can’t afford it, or simply are just too busy for a dental appointment, there are teeth whitening products you can use at the comfort of your own home.

But before you pick up that toothpaste that promises to restore your picture-worthy pearly whites, make sure you know how to pick the right products.

Not all whitening products are created equal – it’s the active ingredients that spell the difference on which ones will work and which ones won’t. Find out more about these ingredients in this article.

Hydrogen Peroxide

Peroxide is a staple in almost all teeth whitening products. Two types of peroxide exist – hydrogen peroxide and carbamide peroxide.

Hydrogen peroxide is more commonly used, but both work the same way. Basically, the peroxide breaks down to release oxygen into the enamel and whitens it. Hydrogen peroxide exerts most of its whitening power within 60 minutes.

Whitening products contain hydrogen peroxide in varying concentrations; the higher the concentration, the faster and more dramatic the effect. However, it may also result to sensitivity which, albeit temporary, can be very uncomfortable.

Lower concentrations produce less sensitivity, but the teeth won’t whiten as quickly. Single-use products tend to have high concentration of hydrogen peroxide, while everyday products like toothpastes contain less.

If used properly and in the right concentration, hydrogen peroxide should not cause any significant adverse effects on the teeth.

Carbamide Peroxide

Carbamide peroxide is a combination of hydrogen peroxide and aqueous solution of urea.

It breaks down to produce hydrogen peroxide which, in turn, produces the whitening effect.The effect takes longer to be seen, but it is longer-lasting than that of hydrogen peroxide by about six hours.

That’s because carbamide peroxide is more stable and the active oxygen that gives the whitening effect is released more slowly.

But end results are just the same after 12 weeks of use. Like hydrogen peroxide, carbamide peroxide also comes in different concentrations. These concentrations vary for 10-20% for home use products, and as much as 35% for professional products.

These numbers are higher than what you would find on hydrogen peroxide products because carbamide peroxide is only converted to the more active form.

For instance, a product containing 10% carbamide peroxide has about 3% hydrogen peroxide in it. It also applies that the higher the concentration of carbamide peroxide (hence, hydrogen peroxide), the greater the whitening effect and the adverse effects. Furthermore, products with carbamide peroxide have longer shelf-life.

Baking Soda

Baking soda is a common household item that you can use to whiten your teeth. More and more whitening toothpastes now are adding baking soda as one of the main components.

It does an excellent job of removing surface stains through its abrasiveness. But like the peroxides, it should be used with caution because it can damage the tooth enamel.

Take note that baking soda is effective for enamel stains only – if the stains are located deeper or inside the tooth, this agent won’t produce any effect.

Conclusion

Brushing your teeth everyday to make them whiter makes sense, but it would be better if you use products that are actually meant for such purpose. By knowing what to look for in your whitening products, you can have that picture perfect white smile as soon as possible.

Wisdom Tooth Surgery – What to Expect After?

One of the reasons that makes going to the dentist a dreadful thought is tooth extraction. And we’re only talking about a simple extraction procedure here.

What if what it is your wisdom tooth that has to be extracted? As you might probably know, it is a way more extensive procedure because it involves a lot of pretty complicated steps.

But you don’t have to worry about undergoing it if you know what to expect after the operation and what you can do about it.

Bleeding

Bleeding is a common complication of any type of surgery, including simple extraction and wisdom tooth surgery.

Some bleeding may occur for up to a few minutes after surgery, but it’s nothing that cannot be stopped by applying pressure on the surgical area.

Do this by biting firmly on a piece of gauze for half an hour at least to allow for the formation of a blood clot that will plug the tooth socket.

Apply a new piece of gauze as needed. If the bleeding becomes profuse and persistent, you must contact your dentist immediately.

Aside from pressure application, you will also be given other instructions to keep bleeding to minimum. Basically, any activity that generates negative pressure like smoking, spitting, and using straws should be avoided.

Negative pressure creates a suction effect that can dislodge the clot and start bleeding again. It is also advised to refrain from doing any activity that causes blood pressure to rise.

You will also be instructed to be on a soft, cold diet for the first 24 hours. Cold promotes narrowing of the blood vessels on the extraction site, thereby preventing further bleeding.

Pain and Discomfort

You may also start to feel pain and some other discomfort a couple of hours after the operation, as anesthesia start wears off.

The degree of discomfort depends on your tolerance and the extent of the surgery. Needless to say, in a more extensive and traumatic surgery, the discomfort will be greater.

It will be mild to moderate in nature, but painkillers such as ibuprofen and mefenamic acid should be enough to get rid of them, otherwise, contact your dentist for further instructions because you might be experiencing the so-called dry socket.

With regards to your oral hygiene, you can avoid further discomfort by not brushing the area for the first 24 hours. You can clean it by rinsing it with a warm saline solution or an alcohol-free mouthwash. After a day, you should be able to go back to your normal oral hygiene routine.

Swelling

Swelling is another definite complication of surgery, and it will greatest for 48 to 72 hours after the operation.

To minimize swelling during this period, you may apply cold compress on intermittently on the area. Cold relieves swelling by causing the blood vessels to constrict.

Also, be sure to keep your head slightly above the heart level when lying down.

Infection

Infection should not be much of a problem if the operation is completed in the fastest possible time, although antibiotics may be given prior to and after the operation.

One way to determine if infection has occurred is the presence of foul odor. To combat infection, take your antibiotics exactly as prescribed by your dentist. Typically, you have to be on antibiotics thrice a day for seven to ten days.

Follow-up visits

After your surgery, you will be asked to come back to your dentist’s clinic for a follow-up visit, the purpose of which is to monitor healing. This follow-up visit should be done a week after the operation, or earlier if the depending on the complications you are experiencing.