FAQ

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Frequently Asked Questions

Yes, in most cases. As mentioned earlier, periodontitis is a chronic condition that is not cured but can be stabilized and maintained. Periodontists have a great track record when it comes to getting periodontal conditions under control. Once the initial treatment has been completed, maintenance care is essential for future good oral health.

Periodontitis often follows certain patterns. Pockets and bone loss usually begin in the maxillary (upper) molars, followed by the mandibular (lower) molars. In time, it will involve other teeth, as well.

Once formed, periodontal pockets do not get worse on a daily basis. Rather, pockets can remain stagnant for long periods of time, only to have short bursts of problems when they worsen, only to become stabilized again. We call this periodontal breakdown “episodic.”

Along the way, abscesses can occur, and pockets and bone loss can progress to the point that teeth need to be removed. Treatment retards and, in many instances, can even stop this progressive gum/bone deterioration.

Contact us today to request additional information or to make an appointment . Together, we will explore your options and help you get the confident smile you deserve without you having to pay an arm and a leg.

Besides helping us look good, teeth are important for a host of other reasons.

For one, strong firm teeth enable us to chew our food more comfortably. Properly masticated food makes for better digestion.

Everyone likes a healthy, bright smile. First impressions count. Besides making you look and feel good, teeth help us to speak clearly. People, who have had the misfortune of losing all their teeth and wearing dentures, can have difficulty speaking. They also cannot eat all the things they want, are often self-conscious about their “choppers,” complain that they cannot taste their food as well as they used to, and may even have trouble breathing when they sleep.

Those are enough reasons to keep our teeth, and the best way to start is with good oral hygiene.

Until recently, periodontitis was considered a localized problem with little or no effect on our overall health and well-being. Continuing research, however, has shown that periodontitis may have powerful and multiple influences on the onset and severity of many systemic conditions and diseases.

Periodontitis is a serious infection caused by plaque bacteria. Although much of the bacteria are confined to the pockets around the teeth, the micro-organisms that make up the plaque can invade the gum tissue and enter the bloodstream, circulating throughout the body.

Once inside, the bacteria are able to secrete destructive chemicals and virulence factors. These factors activate the body’s immune system to respond much in the same way as the body responds to infected cuts or illnesses like pneumonia – with inflammation, pain, and destruction of the tissues.

The presence of long-standing periodontitis can place you at an increased risk for cardiovascular disease, as well as premature, low birth weight babies. In addition, periodontitis is a serious threat to patients already affected by diabetes, respiratory diseases, and stroke.

Women, in particular, have special health needs during certain periods of their lives. These come during periods of maturity and change in their bodies: puberty, menstruation, pregnancy and menopause. What is not so widely known is that women’s oral health needs can also change during these times.

Heart Disease – is bacterial infection the cause?

Bacterial infection has long been recognized as a risk factor for cardiovascular disease, including heart disease and stroke.

More and more research is finding that the presence of periodontitis, a chronic bacterial infection, can place a person at increased risk for heart disease, and increase the likelihood of a fatal heart attack by nearly two times (Beck et al, Journal of Periodontology, 1996).

This connection has recently been featured in prominent news outlets like TIME Magazine (Health. July 19, 1999: Vol. 154, No. 3), USA Today (News. Tuesday, February 17, 1998), and Men’s Health/ABC News (Monday, December 20,1999).

How does this happen? First, periodontitis increases the incidence of bacteraemia (bacteria in the blood), which allows more bacteria to enter the bloodstream and accumulate along blood vessels and heart tissues. In fact, bacteria commonly associated with periodontitis have been cultured from plaques taken from heart attack victims (Zambon et al, Journal of Dental Research, 1997).

Certain oral bacteria are also able to bind to platelets when introduced into the bloodstream, which can increase the formation of clots and growths on arteries and heart tissues (Herzburg et al, Journal of Periodontology, 1996).

The most recent significant research centres on systemic increases in inflammation and a very important marker for inflammation, C-reactive protein. Periodontitis increases the levels of C-reactive protein in the blood 4 times and a recent study in the New England Journal of Medicine found that C-reactive protein is the single most significant marker for heart disease – even more than cholesterol levels.

Research is ongoing to shed more light on these mechanisms. The bottom line is that approximately 50% of the deaths in the United States are attributable to the complications of cardiovascular disease.

Treating your periodontitis not only saves your teeth, it also can reduce long-term risk for heart disease and ensure your good health.

Diabetes

Diabetes affects millions of people, and of these, perhaps only one-half are diagnosed. It is obvious that diabetes is a serious health problem.

For many years it has been known that patients with diabetes are more likely to have periodontitis than people without diabetes. In fact, periodontitis has been recognized as another complication of diabetes (Loë, Diabetes Care, 1993).

However, recent studies have found the opposite is also true: the presence of periodontitis can make it more difficult to control blood sugar levels in diabetics. Treatment of periodontitis has been shown to result in significantly reduced blood sugar levels (Grossi et al, Journal of Periodontology, 1996, 1997). Research is ongoing to confirm how this occurs.

What has been confirmed is that the presence of periodontitis causes the diabetic patient to have elevated blood glucose levels for extended periods of time. This puts diabetic patients at increased risk of other systemic complications such as kidney disease, heart disease, blindness, nerve disorders and impaired wound healing.

Pre-term Low Birth Weight Babies

Smoking, drug abuse, alcoholism, and hypertension are all confirmed risk factors that contribute to pre-term, low birth weight babies.

Recent scientific data shows that a new risk factor, periodontitis, can increase the risk of premature, low birth weight infants by SEVEN times – a risk greater than that posed by tobacco or alcohol (Offenbacher et al, Journal of Periodontology, 1996).

Follow-up studies at multiple Centres have reached similar conclusions (Jeffcoat et al, Journal of the American Dental Association, 2001). In fact, a recent study found that treatment of gum disease in pregnant women decreased the chances of a pre-term, low birth weight infant by FIVE times (Lopez et al, Journal of Periodontology, 2002).

The facts are indeed alarming: pre-term low birth weight babies (weight < 2500 grams at birth) are 40 times more likely to die, and are at increased risk for congenital deformities.

More research is necessary to define the underlying mechanisms by which periodontal infections can affect the unborn child. However, one thing is clear: if you are thinking about becoming pregnant or are at risk for periodontitis, the American Academy of Periodontology recommends that a periodontal examination be included as part of your prenatal care.

Respiratory Disease

Our immune system is a powerful, indispensable tool necessary to fight off infection. For a long time, scientists have known that smoking, the aging process, and other health problems that suppress or hinder the immune system place patients at risk for respiratory diseases like bronchitis, pneumonia, emphysema, and chronic obstructive pulmonary disease (COPD).

Recent studies point to periodontitis as a potential risk factor for the development of these respiratory diseases.

It is important to note that this area of research is ongoing but several facts have been established. The same bacteria that are associated with periodontitis can also cause pulmonary disease (Lorenz and Weiss, Western Journal of Medicine, 1994; Benkalaramain et al, Chest, 1994).

Therefore, it is possible that diseased gums act as a reservoir for potentially infectious respiratory bacteria (Dahlen and Wickstrom, Oral Microbiology and Immunology, 1995). In fact, a recently completed 25-year study found that patients with bone loss caused by periodontitis places patients at a significantly increased risk of COPD (Hayes et al, Annals of Periodontology 1998).

Your Bay Dental And Orthodontics dentist should be the first line of defence in treating your gum condition. Once he or she discovers that you have periodontitis, they should initiate a program to return your gums to good health.

Many dentists employ dental hygienists. Hygienists are specially trained to recognize and treat the early stages of periodontitis. (However, there are limits as to what hygienists can do for patients).

In advanced cases of periodontitis, improved oral home care and thorough dental cleanings are not enough. More has to be done to the pockets and bone.

Most people do not know what periodontitis is or even that the specialty of Periodontics exists. In a sentence, periodontists are charged with saving teeth. That is their mission and goal for all patients. They utilize many types and techniques of treatment to achieve this goal.

When teeth cannot be saved and need to be removed, they are often replaced with dental implants. These dental implants are as strong (actually they’re stronger) than natural teeth, and allow the patient to keep an intact set of teeth (dentition) without the need for removable bridges or dentures.

A variety of factors can affect periodontitis. Other factors can modify how your gums react to plaque or calculus, thereby altering your body’s response to the disease and affecting your overall health.

The worst offender is smoking. Study after study shows that in the face of an established periodontal condition, smokers have worse gums. Not only do they have deeper pockets and more bone loss, but also they do not heal as well as non-smokers do.

Many diseases affect the gums. The most notable is diabetes. Diabetics need to take good care of their teeth and gums because they are prone to more infections and greater problems than non-diabetics. Other diseases that cause suppression of your immune system (i.e. leukaemia, AIDS) may also affect the gums.

Though nearly ¾ of the world’s population has some form of periodontitis, a genetic predisposition is the single biggest determinant as to how serious each case gets. Some individuals are more prone to periodontitis than others. Some get a mild form, while others get a severe case.

Why? It is likely we inherit a genetic predisposition to periodontitis, and this influences how severely it will affect us.

Dentists have always known that stress affects the gums. As far back as World War I, the soldiers fighting in the trenches noted the influence of stress. Their gums became acutely infected to the point where the tips between the teeth, called papillae, eroded away, leaving disfiguring craters and loss of bone.

Teeth became loose, and in severe cases, needed removal. This so-called “trench mouth,” has the more formal name of “Acute Necrotizing Ulcerative Gingivitis”. ANUG is also known as Vincent’s Disease, and is a stress-related disease.

To a lesser extent, what we eat affects the gums. Individuals who are overweight and those consuming high amounts of carbohydrates (especially in sweets, cakes and sugared drinks) adversely affect their teeth and gums. Constant sucking on cough drops and hard sweets help the bacteria metabolise more quickly, and in greater numbers. This causes a greater risk for dental decay and more inflamed gums.

Regarding vitamins, Vitamin C or calcium supplements do not affect periodontitis, and taking these supplements will have no effect on periodontitis.

Medications affect the gums. Drug groups that concern periodontists are the calcium channel-blockers (used to treat certain heart conditions), Beta-blockers (used to treat high blood pressure and other heart conditions) and anti-epileptic medications. Though these medicines do not affect every person in the same way, and in fact, do not affect all who take them, sometimes they cause the gums to swell.

These gum swellings occur between the teeth, and make brushing and flossing difficult. In some instances, people need surgery to manage the swollen gums. If you take drugs in these categories and are experiencing swollen and bleeding gums, you may want to seek professional help.

Be aware of another common side effect of many medications: dry mouth. When the salivary flow decreases, you need better oral hygiene since decay and inflammation may increase. If you sense your mouth is dry, clean your mouth frequently, and rinse often with water.

Hormones also modify periodontitis. Although women in general tend to take better care of their teeth than men do, their oral health is not that much better. Why? Because periodic fluctuations in hormone levels during the different stages of a woman’s life can affect many different areas of the body, including the gingivae (the gums).

Recent studies have shown that 23% of women aged 30 to 54 have periodontitis and 44% of women aged 55 to 90 that still have their teeth also have periodontitis.

Puberty in women is marked by an increase in the level of sex hormones (progesterone, estrogen), which increase the level of blood flow to the gums, making them more sensitive to irritants like plaque or tartar. The gums may turn tender, red, and swollen during this time but these changes are usually temporary and diminish as a young woman gets older.

Pregnancy may bring certain gingival and periodontal changes for the expectant mother. During the second or third month of pregnancy, women may experience what is termed pregnancy gingivitis; a condition characterized by tender, swollen, bleeding gums. This condition, once present, may increase in severity through the eighth month of pregnancy, then begin to resolve.

In some cases, gums already sensitive and swollen due to pregnancy gingivitis can react strongly to irritants and form large lumps, called pregnancy tumours. These tumours are NOT cancerous and are generally painless. If these benign growths get in the way of chewing, or become unsightly they may need removal.

When a woman gives birth, most problems reverse themselves, and leave no lasting marks. In some cases, however, pregnant women (suffering from periodontitis) may find their condition is actually worse post-partum. Teeth may feel loose or spaces may be present between teeth that were not there before pregnancy.

When these symptoms occur, professional help is required. Women who use oral contraceptives may experience similar symptoms as pregnant women in the form of red, swollen, bleeding gums.

Women taking oral contraceptives should be aware that medications sometimes used to treat periodontitis (i.e. antibiotics) could decrease the efficacy of their contraceptive medication. Be sure to ask your dentist, periodontist, or pharmacist before taking any prescribed medication while on oral contraceptive therapy.

To a lesser extent, some women notice that their gums get puffy and bleed with the slightest touch right before their menstrual cycle begins. These symptoms disappear a few days after menses has started. Women on hormone replacement therapy can also observe subtle changes in their gums.

Oral changes in menopausal or post-menopausal women may include dry mouth, pain and burning sensations in the gums, cheeks or tongue, or altered taste. In addition, conditions where the gums peel off and leave a raw bleeding surface (termed desquamative gingivitis) are more prevalent in menopausal or post-menopausal women.

The main cause of periodontitis is plaque that constantly forms and accumulates in our mouth. Plaque is an often-colourless mass of bacteria that sticks to teeth, crowns and bridges, and other tissues in the mouth. Plaque irritates the gums, i.e. causes an infection.

If not removed daily, plaque becomes the hard material known as tartar or calculus. Brushing and flossing alone cannot remove calculus. A hygienist, dentist or periodontist must remove it manually to stop it becoming worse.

With time, plaque and its by-products destroy the tissues that attach the gums to the teeth. The gums “pull away” from the teeth and pockets begin to form between the teeth and gums.

Plaque and calculus continues to fill these pockets. Unfortunately for us, the mouth is a perfect incubator. It is warm, dark, and moist, with tons of “food” for the bacteria to metabolise. The net result is that the bacterial plaque thrives, matures and eventually destroys the jawbone supporting the teeth.

Bacteria in plaque initiate the early changes to the gums. As the plaque matures on the teeth, the disease becomes more established to the point where it becomes irreversible.

Sometimes it is necessary to build up the jawbone before, or at the same time as implant placement. The procedure of building up the bone is known as Bone Grafting or Bone Augmentation.

Bone grafting is a very common procedure in dentistry and it is often used for dental implants and in periodontal procedures around natural teeth.

To do bone grafting, we need a source of bone. The bone that we use can be one of three types. The best bone is your own bone. This bone can be taken from other areas of the mouth or collected in our suction apparatus as we prepare the sites for dental implants.

Occasionally this bone is taken from areas outside the mouth, such as the hip. When bone is taken from the hip, it is usually done in the hospital by an orthopaedic surgeon and transferred to the dentist doing the implant procedure in the operating theatre.

Another very common source of bone is bone taken from cadavers. This bone is harvested under very strict supervision at several bone banks around the world and it is used in many dental and medical procedures. There has never been a case of a transmitted disease with this type of bone. It is very safe and very useful in our work to help patients.

A third type of bone used is taken from a bovine source, and again treated to eliminate any possibility of disease transmission or allergic reactions. In our practice we prefer to use human bone, preferably your own.

In the past patients had to go without wearing their dentures for at least two weeks after implant placement. Over the years, this has been modified considerably and in most situations, patients leave the office wearing their teeth the day the implants are placed.

In more and more cases we are able to provide temporary crowns, bridges or dentures on the implants immediately after placement with excellent success rates! Only in very rare cases may it be recommended that a patient go without his or her denture for a short period of time.

Every patient and procedure is evaluated separately and you will be informed of the type of temporary prosthesis that will be used in your case.

Occasionally dental implants fail or, as some people say, they are rejected. In most instances, they can be replaced with another implant, usually of a slightly larger size. Failure rates should be about 1-2%. Each year we place and restore approximately 200 implants and each year 1 or 2 of them fail. Failures are considered no more than a temporary setback that can lengthen the total treatment time.

The question is really who should you see about getting missing teeth replaced? Before implants, you went to either your general dentist or, if you wanted a specialist, to a prosthodontist.

It’s the same today. If you want to replace missing teeth, talk to the people who do that job and they will be glad to discuss the use of dental implants in that process. If you decide that dental implants are for you, then your general dentist can either place the implants for you or refer you to a qualified periodontist or oral surgeon for that phase of the treatment.

Unfortunately, there are dentists out there who, after only a week or two of training, call themselves “Implantologists” or say that they are specialists in Implantology or “Board Certified” in Implantology. While there are people and organizations that would like the general public to believe that there is such a thing as a dental specialty of Implant Dentistry, there is NO SUCH THING!

There are organizations that give credentials and awards to dentists that make it look like these dentists are highly trained implant specialists, but these credentials are not recognised by the General Dental Council. It is considered illegal to advertise these credentials.

The specialty areas of dentistry that are most aligned with dental implants are Periodontics, Prosthodontics and Oral and Maxillo-facial Surgery.
Our suggestion is to check on the qualifications of a dentist before allowing him or her to treat you.

The actual procedure to surgically place a dental implant is done under local anaesthesia and is generally not at all painful. Most of our patients report that the implant placement was less traumatic than the extraction of the tooth, and that they only took painkillers for 1-2 days after the procedure.

When the anaesthesia wears off about three or four hours later, you might expect some discomfort. The level of discomfort is quite different from patient to patient, but most patients do not have significant problems.

Some patients do have varying degrees of pain or discomfort, which may last for several days. Pain medication is prescribed which usually alleviates this discomfort. Patients generally prefer a soft diet for the healing period following surgery.

Swelling and bruising may also develop, depending on the amount and positions of the implants placed.

For more complex treatments or if you are very anxious, we offer intravenous conscious sedation. A qualified anaesthetist will administer a mild sedative, which will keep you calm and relaxed for the duration of the procedure.

Conscious sedation is very safe (much safer that general anaesthesia) and does not leave you feeling awful for days after the procedure!

Anyone who is in reasonable health and wants missing teeth replaced. You must have enough bone in the area of the missing teeth to provide for the anchorage of the implants.

Some people are missing all their teeth and most of those are excellent candidates for dental implants, but today, we use implants to replace small bridges, removable partial dentures and even missing single teeth.

In the past we had to wait three months in the lower jaw and six months in the upper jaw before placing any load on implants. In recent years, however, there has been a movement within the profession to speed up this process.

Today, with better techniques and implant surfaces, it is possible to shorten the healing time. In a large proportion of cases we can even load implants right away!

Nevertheless, one thing to keep in mind with implant therapy is to “respect nature”. It is important that neither the patient nor the implant provider attempt to rush the treatment or try to advance the various stages faster than the time required for complete healing and maturation of bone and soft-tissues.

Treatment duration also depends on the complexity of the treatment. Initially there is a treatment planning stage. Then there may be some time spent on preparatory procedures as improving gum health, removing any hopeless teeth and growing bone.

This may take anything from a few weeks to many months. After the implants are placed they are left to settle in place from six weeks to six months. The final fitting of crowns or bridges or the attaching of dentures to the implants takes a month or two. The time depends on your individual situation.

The success rate in our practice for the past five years has been 99+% for all implants placed.

Although it is impossible to give an absolute guarantee, our aim is that your implants should last you the rest of your lifetime. With the proper home care and professional maintenance, there is every reason to believe that they will.

Nutrition, oral hygiene, genetics, diseases (such as diabetes), and smoking have an effect on the long-term survival of dental implants. Implant success also depends very much on where the implants are placed (bone quality and quantity) and what they will be called upon to do.

The best-case scenario is the placement of implants in the front portion of the lower jaw. Here success can be as high as 98-100%. In other areas of the mouth, success rates can be slightly lower, but these are improving with new materials and techniques, and are approaching 100%.

This depends on the type of bite you have, the position of your teeth and the condition of both your teeth and gums. For instance if you have active gum disease, it is important this is brought under control before having a brace. Essentially adults can be treated at any age as long as the gums and bone holding the teeth are healthy.

Contact us today to request additional information about braces for adults or to arrange an initial consultation.

We offer professional interest free and low cost payment plans . Now you can have what you want in the most affordable manner possible.

Please ask us for full details of the payment plans.

Contact us today to request additional information or to arrange an initial consultation.

You will need to contact the practice for an emergency appointment for the brace to be repaired. Repeated breakages slow down the treatment and increase the overall treatment time. As a rule, every time the brace is broken 1-2 months is added to the normal treatment time of 6 – 24 months. If you repeatedly break the brace, treatment may be stopped, leaving your teeth in a worse position than when you started.

Problems with tooth brushing or tooth decay may have to be dealt with prior to commencement of the treatment.

It is important you brush your teeth well, three times per day and use fluoride toothpaste. A fluoride mouth rinse should also be used last thing at night, after tooth brushing, to further protect teeth. Failure to keep your teeth and brace clean will lead to permanent scarring of your teeth.

Many orthodontic treatments, especially for crowding or protruding teethare traditionally treated by the extraction of permanent teeth. Our philosophy is non extration wherever possible. With current advances in technology such as the Damon self ligating brace – the number of teeth that need to be taken out have been dramatically cut.

After school appointments are very few in number and their appointments will usually be in school time. Do remember that you will only be attending once a month and appointments do not last long. We try to vary appointment times to cause minimum disruption to schooling. If this is a problem, we suggest you schedule your visits into free periods or sport.

In order to be fair to all concerned, we do not allow advanced block booking. We are sorry if this sounds unduly severe in this age of “customer care” but you wouldn’t believe what a difficult problem this is.

Instant Orthodontics is not orthodontics at all in that you define orthodontics as moving teeth to straighten them. Instant Orthodontics is performed by non orthodontists. They leave the roots of crooked teeth crooked and place crowns or veneers on the top half of the tooth to make it look straight.

In the December 2006 Journal of the American Dental Association, Dr. Gordon Christensen wrote: “Even the most conservative ceramic veneer placement procedures remove some tooth structure, during either initial tooth preparation or finishing procedures. Ceramic veneers have a finite life expectancy.”

“Veneers placed on a young adult will require replacement several times during life, each time requiring the removal of more tooth structure and potentially causing damage to pulp and/or supporting structures…..the orthodontically treated patient retains his or her own tooth structure and tooth anatomy, which can serve for as long as a lifetime.”

Teeth and sometimes faces are permanently changed by orthodontic treatment; therefore, it is very important that the treatment be conducted properly. A licensed orthodontic specialist is a expert at moving teeth, helping jaws develop properly and working with you to help make sure the teeth stay in their new positions. Remember that most orthodontic insurance plans pay for braces only once in a lifetime. Have a orthodontic specialist do it right that one time!

That depends a lot on you and how bad your bite is to begin with. Complex/severe bad bites take longer. The national average is 27 months. The better you are at following your orthodontist’s instructions and taking care of your braces, the sooner your teeth will improve. Remember that no one else can wear your braces for you!

Yes, the teeth will move in different directions as the teeth are straightening out. You may see a space between your two front teeth that was never there before or teeth that seemed perfectly straight before the braces were placed may not seem as straight. Be patient and things will start to improve. That space will close and those teeth will line up as treatment continues.

Braces use steady, gentle pressure over time to move teeth into their proper positions. They don’t look like they’re doing much just sitting there. but in fact, every moment or your orthodontic treatment, there’s something happening in your mouth. Something good for you.

The brackets we place on your teeth and the main arch wire that connects them, are the two main components. The bracket is a piece of specially shaped metal or ceramic that we affix to each tooth. Then we bend the arch wire to reflect your ‘ideal” bite-what we want you to look like after treatment.

The wire threads through the brackets and, as the wire tries to return to its original shape, it applies pressure to actually move your teeth. Picture your tooth resting in your jaw bone. With pressure on one side from the arch wire, the bone on the other side gives way. The tooth moves. New bone grows in behind.

It may look like nothing is happening but we’re making a new smile here. Thanks to new materials and procedures, all this happens much quicker than ever before. It’s kind of an engineering feat.

Poorly arranged teeth can break easily and can trap food particles that cause tooth decay and gum disease. Researchers at the Baylor College of Dentistry, found that malocclusions (a poor fit (alignment) of the teeth and jaws) interfere with the chewing ability to break down foods which affects digestion and overall health. Finally, poorly arranged teeth detract from your smile which is one of the more important features contributing to facial beauty. You only have one chance to make that first impression!

Just as we inherit eye color from our parents, mouth and jaw features are also inherited. Local factors such as finger sucking, pacifier sucking, high cavity rate, gum disease, trauma and premature loss of baby teeth can also contribute to a bad bite. One out of every five school age children have a severe bite problem so it is not surprising that so many people need braces.

An orthodontist is a dentist who specializes in the correction of misaligned teeth and jaws with braces, retainers, or other dental appliances.