Periodontal Disease

Periodontal Disease

The most common cause of loose and sensitive teeth is periodontal disease. Periodontal disease includes gingivitis (inflammation of the gums) and periodontitis (inflammation of the periodontium). The periodontium is the structure that surrounds the teeth and holds them in their sockets. Periodontal disease is an infection that can cause teeth to become loose and eventually lost.

Periodontal disease is most often caused by bacterial plaque that surrounds teeth. Bacterial plaque is a sticky film that continues to form around teeth. If it isn’t removed constantly, it can continually build up and form calculus (calculus is just a hardened form of bacterial plaque). There are a number of other causes of periodontal disease.

Causes of Periodontal Disease

• Smoking: smoking causes shrinkage of some blood vessels, hence the periodontium is affected by not having enough blood flow and oxygen. Smokers tend to lose teeth more than non-smokers, because of periodontal disease.
• Hormones: gum tissue are sometimes affected by hormonal changes, for example during pregnancy or menopause
• Genetics: some individuals are more prone to periodontal disease, despite proper oral hygiene practices, because of genetic factors. Early diagnosis and treatment may help to save teeth in such individuals.
• Diabetes: diabetics have a higher risk of developing infections, including periodontal disease. Healing is also slower with diabetes, making periodontal disease a greater concern with respect to oral health. Diabetes, though not the only reason, may be a cause of necrosis (tissue death due to lack of blood and oxygen).
• Poor Nutrition: a diet that is low in necessary nutrients affects the body, including the oral cavity. Periodontal disease is a distinct infection that may worsen with poor nutrition.

Treatment of Periodontal Disease

In many cases, an individual may have had long standing or severe periodontal disease, and some teeth (in other cases, all of the teeth) cannot be saved. In these cases, extractions may be the only viable option, with replacement of the missing teeth with implants, bridges or dentures. Other treatment options are available for treating periodontal disease, each option depending on individual cases/.

• Scaling and root planning: this involves professional cleaning of plaque and calculus from root surfaces and periodontal pockets. This is the most common method used to treat periodontal disease.
• Periodontal surgery: if the tissues around the teeth are determined to be unhealthy, periodontal surgery (there are more than one types) may be necessary to treat the periodontal disease. Periodontal surgery can help to improve function.
• Cosmetic methods: this can be done to improve a patient’s appearance, smile and function, if for example a lot of roots are exposed by the periodontal disease.

Each individual’s case of periodontal disease is different, so the necessary treatment may be different for each patient. An individual with a diagnosis of periodontal disease, especially long standing or advanced, can be treated by a periodontist (a dentist with specialized training in diagnosing, preventing and treating periodontal disease). You can be referred to a periodontist by a general dentist, or be treated by a general dentist. Please be pro-active in a consulting with your dentist for a comprehensive evaluation, diagnosis and treatment.

We hope this helps!

Help, My Root Canal Failed

Question:

Question 1:

Why do root canal treatments fail?… What will be the solution to save the tooth again? [Are there] any good options?
Please share the good thoughts.

Question 2:

If root canal treatment failed – what will be next option to save the tooth?

Answer:

Today we had two similar questions from readers so we will address both.

Root canal treatments do not have a 100% success rate.  The success rate actually varies between 68% -95% depending on several factors involved including the presence of bacteria, the vitality of the tooth, etc.  A root canal treatment is just an alternative method to save a tooth when its pulp has become infected with bacteria.

Why do root canals fail?

They can fail for several reasons.  Some include:

• Bacteria left in the canal
• A “leaky” filling
  • This leaves pathways for bacteria to reinfect the tooth
• Missed canals
  • Sometimes teeth have extra or sneaky canals that aren’t easily found on an xray.  If the canal is missed during root canal treatment, there is a possibility of failure
• Systemic conditions
  • Other illnesses such as diabetes or complicated medical conditions can affect the success rate of treatment
• The tooth is fractured or have a crack

What’s the next step after root canals fail?

The reason of failure will determine the next step in treating a failed root canal.  Here are some options:

• Re-treatment
  • This includes removing the old root canal material in the canals (gutta percha), recleaning the inside of the tooth, disinfecting the inside again, and placing new material
• Apicoectomy
  • This is a dental surgery that involves removing just the tip of the root.
• Extraction+ replacement
  • If all else fails, the tooth can be removed and replaced with an alternative including a bridge, implant, or removable appliance.

Root canal treatments are a great way to treat a seriously infected tooth.  Unfortunately, some fail and other treatment modalities have to be introduced.  We hope this information helps in your understanding for treatment failures and alternatives.

Good luck,

SaveMySmile Team

Good luck!

One tooth is longer than the others

Question:

Hello, I have a tooth on my lower level that … stands taller than the other lower teeth.  This is very obvious…at all times…when I’m talking.  It makes me very self-conscious.  I’m not interested in braces but I am interested in lowering that tooth’s visibility.  Is it possible to file a tooth down shorter?  I am interested so that this tooth can be the same visible height as the other lower teeth.  It would help me to feel more comfortable smiling, talking and just living day to day.  I am a single mother and do not have the funds to do much for myself, which is why I’m looking for a “simple” solution which does not require a huge financial commitment.  Please reply.  I can’t tell you how much this affects my day to day life.

Answer:

Thanks for submitting your question with us.  And we completely understand the huge link between teeth and self-confidence.  First we will explain exactly what’s going on in your mouth, and then we will examine several options for its correction.

Teeth Move Throughout Life

Throughout life, teeth continually grow and move.  For instance, if you have a missing tooth, notice that over time the tooth adjacent to it will slowly drift into that open space.  From what you are describing, it looks like that tooth in the back of your mouth does not have a tooth above it (opposing it) and that is why the tooth continues to erupt, or “grow taller.”  Until there is a tooth, or prosthetic device (partial denture, implant, etc.) placed above it to oppose it, the tooth will continue to erupt.

How to Fix the High Tooth

So, what are some immediate and cost effective options:

• Have the tooth adjusted – To answer your specific question, yes, you can have the tooth filed down.  However, keep in mind the anatomy of a tooth (please see our article here on tooth anatomy for more details).  The dentist can take away tooth structure (in dental terms, adjust the occlusion) so that the tooth can appear more in line with the surrounding teeth.  This is the most cost effective option.  However, there is a drawback.  There is only so much tooth structure that the dentist can take away before encroaching upon the dental pulp.  Once near the pulp, the health of the tooth will be jeopardized.  Also, as stated before, the tooth in question will continue to gradually grow taller if there is not a tooth opposing it.
• Have a crown placed on the tooth – This option involves a little more money.  But with this option, the dentist will reduce the tooth so that it is aligned with the surrounding teeth, and then place a crown over the tooth so that the tooth will no longer continue to erupt.

Several other options include extraction and replacement with an implant, or extraction and replacement with a cantilever bridge, or even extraction and partial denture.

The best treatment really depends on how much the tooth has erupted.

We hope this advice helps and good luck,

Save My Smile Team.

Types of Dentures

Question:

What are distant dentures?

Answer:

Not exactly sure of what you mean by distant dentures, however you could be referring to either immediate dentures or overdentures.  Either way, we will provide a thorough definition of each.

Immediate dentures are delivered the SAME day that your teeth are extracted (pulled) by the dentist.  The great thing is that you won’t have to suffer through a period of going without teeth.  However, the bad thing is that once your teeth are pulled, and as the bone heals, the dentures may not fit the same in a couple of months.  The bone underneath will shrink and the dentures will become too big, thus causing them to rock in your mouth or not fit properly.  When this occurs, you will have to visit your dentist for a reline (adding more material to the inside of your denture) or for a completely new set.

Overdentures can be implant retained, or retained by natural teeth.  If implant retained, the dentist will insert a minimum of 2 implants into your bone, and the denture will be designed around the implants so as to ensure a better fit.  For natural teeth, the concept is the same.  The advantage of overdenture is that in the long-run you won’t lose as much bone and overall the dentures will fit better.

Hope these tips help out and good luck,

SaveMySmile Team

My root canal failed!

Question:

I had a root canal done and it abscessed. I haven’t got it finished all the way yet. Can I safely pull the tooth, and be done with it.

Answer:

Now before you think about pulling the tooth, let’s think about some other factors that will come into play down the road.  Once that tooth is gone, the tooth behind it and the tooth across from it (in the opposite jaw) will begin to slowly drift into the open space.  This will cause the other teeth to drift also, resulting in open spaces amongst your teeth.  You will eventually have to replace the space with either a bridge, implant, or partial denture which are all pretty costly.

Root canal procedures don’t have a 100% success rate, sometimes they do fail.  However, retreatment is always an option and definitely cheaper as compared to some of your other options.  Being that your procedure wasn’t finished, the pathway for bacteria wasn’t completely blocked meaning it had an opportunity to repopulate or wasn’t completely removed.

If would be best, in the long run, if you were to return to have the procedure completed or retreated.  Yea, it may be cheaper and easier to pull the tooth now, but believe us, you may regret this decision down the road.

Good luck with your decision,

SaveMySmile Team