Periodontitis

Periodontitis is inflammation and infection of the ligaments and bones that support the teeth.

Causes 

Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.

Symptoms 

• Breath odor
• Gums that appear bright red or red-purple
• Gums that appear shiny
• Gums that bleed easily (blood on toothbrush even with gentle brushing of the teeth)
• Gums that are tender when touched but are painless otherwise
• Loose teeth
• Swollen gums

Note: Early symptoms resemble gingivitis.

Exams and Tests 

Examination of the mouth and teeth by the dentist shows soft, swollen, red-purple gums. Deposits of plaque and calculus may be visible at the base of the teeth, with enlarged pockets in the gums. The gums are usually painless or mildly tender, unless a tooth abscess is also present. Teeth may be loose and gums may be receded.

Dental x-rays reveal the loss of supporting bone and may also show the presence of plaque deposits under the gums.

Treatment 

The goal of treatment is to reduce inflammation, eliminate pockets if present, and address any underlying causes. Rough surfaces of teeth or dental appliances should be repaired. General illness or other conditions should be treated.

It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. It is often recommended that patients with periodontitis have professional tooth cleaning more frequently than twice a year.

Surgery may be necessary. Deep pockets in the gums may need to be opened and cleaned. Loose teeth may need to be supported. Your dentist may need to remove a tooth or teeth so that the problem doesn't get worse and spread to nearby teeth.

Outlook (Prognosis) 

Some people find the removal of dental plaque from inflamed gums to be uncomfortable. Bleeding and tenderness of the gums should go away within 1 or 2 weeks of treatment. (Healthy gums are pink and firm in appearance.)

You need to follow careful oral hygiene for your entire life or the disorder may return.

Possible Complications 

• Infection or abscess of the soft tissue (facial cellulitis)
• Infection of the jaw bones (osteomyelitis)
• Return of periodontitis
• Tooth abscess
• Tooth loss
• Tooth flaring or shifting
• Trench mouth

If you have any questions, pleased call Dr. Todd Welch at West Tennessee Periodontics and Dental Implants at 731-215-2347.

Dental Implants

 I have partnered with Astra Tech dental implants for use in my practice. Astra Tech is an extremely reliable company with a stable background of 25 years in the industry.  This implant system allows for prosthetic flexibility to create very esthetic final restorations.  Astra Tech is also a leader in the implant industry with volumes of clinical documentation. I feel I am placing the best implant available, which will enable us as a team the ability to provide your patients with the easiest mode of restorability while not sacrificing implant predictability and integration. Astra Tech is a bone level implant, which allows for a broader range of restorative options.  The standard “stock” snap-cap abutment that I am sure you are familiar with will still be available with this system; however, Asta Tech also offers many ways to customize abutments such as utilizing the Atlantis abutment or a Zirconium abutment if the case calls for it.  These costs will not be passed on to your patients and I will always contact you so we can discuss which abutment you prefer or would like for the case.  Please contact Dr. Todd Welch at West Tennessee Periodontics and Dental Implants at 731-215-2347.

Laser Assisted New Attachment Procedure (LANAP)

How the LANAP Protocol Works:

First, the patient is profoundly anesthetized with local anesthetic. Next, the patient’s pocket depths are probed down to the level of intra-osseous defects (bone sounding). The thin optic fiber is placed parallel to the root surface.. The first pass with the laser, called laser troughing, is accomplished with the short duration pulse. The free running pulsed Nd:YAG laser is combined with systemic antibiotics to achieve the optimal reduction of microbiotic pathogens (antisepsis) within the periodontal sulcus and surrounding tissues. Perio pathogens and pathologic proteins are selectively destroyed by the laser’s light energy, providing an aseptic surgical environment that allows healing following the laser hemostasis step.

The technique uses selective photothermolysis to remove the diseased, infected and inflamed pocket epithelium while preserving healthy connective tissue, literally separating the tissue layers at the level of the reté pegs and ridges. The practitioner is able to achieve both precise tissue ablation and aseptic hemostasis by varying the laser’s energy density, pulse duration and rate of repetition. The laser assists in the destruction of perio pathogens while preserving the healthy tissue.

The tenacity of the calcified plaque and calculus adherent to the root surface is modified by the laser energy so its removal with an ultrasonic scaler is more easily accomplished.

At this point, a second pass with the laser is taken to finish debriding the pocket and achieve hemostasis with a thermal fibrin clot. Gingival tissue is compressed against the root surface as necessary to close the pocket and aid with formation and stabilization of the fibrin clot. No sutures or surgical glue is needed. Mobile teeth above class II mobility are splinted. Occlusal adjustments are performed to remove interferences, minimize trauma, and provide balance to long axis forces and are considered an essential component of the LANAP protocol.

Finally, post-operative instructions specific to the LANAP protocol, diet guidelines and oral hygiene instructions are explained and their importance is stressed, and continued periodontal maintenance is scheduled. Patients are monitored at one week, 30 days and then every 3 months for periodontal maintenance. No subsequent probing is performed for at least nine months to a year to allow sufficient healing time for the cementum-fiber PDL interface.

For more information please contact Dr. Todd Welch at West Tennessee Periodontics and Dental Implants at 731-215-2347

Eliminate Stress and Save Your Oral Health

Resolve To Eliminate Stress and Save Your Oral Health

The holidays are always stressful. They can be stressful emotionally, physically, and finan- cially. You can probably feel the stress taking its toll on your mind, body, and spirit. What you may not realize is that your everyday stress may be affecting your oral health.

A literature review published in the August issue of the Journal of Periodontology (JOP) saw a strong relationship between stress and periodontal diseases; 57% of the studies included in the review showed a positive relationship between periodontal diseases and psychological factors such as stress, distress, anxiety, depres- sion and loneliness.

While more research is needed to explain the specific role stress plays in gum disease, it is speculated that the hormone cortisol may play a role. When experiencing stress, the body releases increased amounts of cortisol, which can be harmful to the gums and surrounding bone tissue. This damage can eventually cause bone loss which leads tooth loss.

People with high stress levels are also more likely to increase their use of drugs or alcohol which can undermine oral health. Stress can also cause an individual to be less attentive to their oral hygiene. Exercise, a balanced diet and a positive mental attitude are all ways to help reduce stress and ultimately help promote periodontal health.

So this holiday season, don’t let the stress of life take a toll on your oral health. Having a healthy mouth can mean having a healthy body and that is a resolution everyone should make. Dr. Todd Welch. Jackson, TN 731-215-2347

Targeting Tobacco Use

You are probably aware of the devastating effects that smoking and tobacco use can have on your heart, lungs, and other organs. However, you might not be familiar with the whole other “mouthful” of problems caused by tobacco use. For example, tobacco use is a significant risk factor in the development and progression of periodontal disease, which is a major cause of tooth loss in adults. The sooner you take aim at your tobacco use and quit, the closer you will be to healthy teeth and gums!

Tobacco users are more likely to have calculus, dental plaque that hardens on your teeth and can only be removed during professional cleanings. If this calculus is not removed and it remains below the gum line, the bacteria in the calculus will infect the gums causing redness and swelling, otherwise known as inflammation. This inflammation damages the tissues that support the teeth, including the bone. When this happens, the gums can separate from the teeth, forming pockets. Tobacco users often have deeper pockets than people who do not use tobacco. These pockets can then fill with more bacteria, which leads to more inflammation. If the infected pockets are left untreated, the gums may shrink away from the teeth, making teeth appear longer and possibly causing them to become loose and fall out.

The detection of periodontal disease is often more difficult in tobacco users. This is because the nicotine and other chemicals found in tobacco products can hide the symptoms commonly associated with periodontal disease, such as bleeding

gums. Since the detection of periodontal disease in tobacco users can be difficult, necessary treatment is sometimes delayed.

Treating periodontal disease in tobacco users can be a difficult task, but not an impossible one. Smoking and tobacco use reduces the delivery of oxygen and nutrients to the gingival tissues, weakening the body’s defense mechanisms. This can slow down the healing process and make periodontal treatment results less predictable. For example, dental implants that are placed in a tobacco user’s mouth fail more often than they would in a patient who does not use tobacco. Additionally, the actual treatment of periodontal disease can vary widely depending on how far the disease has progressed. If caught in the early stages, simple non- surgical periodontal therapy may be used.

Because the treatment of periodontal diseases can be more difficult in tobacco users, your periodontist will urge you to quit your tobacco use. Quitting seems to gradually erase the harmful effects of tobacco use on periodontal health. One study showed that 11 years after quitting, a former smoker’s likelihood of developing periodontal diseases was not much different from one who had never smoked. And with the increasing amount of research indicating that periodontal health may be related to overall health, reducing your risk of periodontal disease is more important than ever. Start taking aim at quitting your tobacco use today and move one step closer to a lifetime of periodontal health and happy smiles! Please contact Dr. Todd Welch at West Tennessee Periodontics and Dental Implants at 731-215-2347 for more information.

Gum disease and cardiovascular disease

Gum disease and cardiovascular disease are both major public health issues that impact a large number of Americans every day. While these two diseases impact separate areas of the body, research indicates that periodontal disease and cardiovascular disease are connected; having one disease may actually increase your risk of developing the other.

Inflammation’s Role

Periodontal disease and cardiovascular disease are both considered chronic inflammatory conditions. Inflammation is the body’s instinctive reaction to fight off infection. Inflammation is initially good for your body because it helps in the healing process. However, chronic and prolonged inflammation can lead to severe health complications. Researchers believe that inflammation provides the basis for the connection between gum disease and heart disease1. And now, periodontists and those who treat cardiovascular disease are working together to provide the best care to patients.

The Perio-Cardio Connection

In July 2009, a consensus paper2 was published in both the Journal of Periodontology and The American Journal of Cardiology. The paper was jointly developed by periodontists and cardiologists. Periodontists are dentists with advanced training in the treatment

and prevention of periodontal disease, and cardiologists are doctors who specialize in treating diseases of the heart. The paper summarizes the evidence that links periodontal disease and cardiovascular disease, and provides clinical recommendations for periodontists and cardiologists to use in managing their patients living with, or at risk for, either disease.

What does this Mean for You?

You might be surprised when your periodontist now asks even more questions about your medical history, especially questions about your family history of heart disease and any behaviors that may affect your heart health such as smoking. Your cardiologist may start to ask you about your dental history and might even look in your mouth to evaluate your teeth and gums! These new recommendations are intended to help periodontists and cardiologists better manage your risk factors for future disease progression, and ensure your well- being. Hopefully by working together with your periodontist to ensure healthy teeth and gums, you will also ensure a healthy heart throughout your entire life. If you have any questions about this please contact Dr. Todd Welch at 731-215-2347 at his Jackson, TN office or visit www.wtnperio.com