Online Dental Education Library
Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.
Periodontal Disease
When to See a Periodontist
Periodontal treatment may be sought in several ways. Your general dentist or a hygienist may recommend a consultation with a periodontist if they find signs of periodontal disease through the course of a checkup or other dental care appointment. You may also decide to see a periodontist on your own, as a referral is not necessary to be seen at our office.
In fact, if you experience any of these symptoms, we encourage you to schedule an appointment at our office without delay:
- Unexplained bleeding while performing regular cleaning or consuming food is the most common sign of a periodontal infection.
- Ongoing halitosis (bad breath), which continues despite rigorous oral cleaning, can point to periodontitis, gingivitis or the beginnings of a gum infection.
- Longer-looking and loose-feeling teeth can indicate recession of the gums and/or bone loss as a result of periodontal disease.
Patients with heart disease, diabetes, osteopenia or osteoporosis are often diagnosed with correlating periodontal infections. The bacterial infection can spread through the blood stream, affecting other areas of the body.
- Bleeding while brushing or eating normal foods
- Bad breath
- Loose teeth and gum recession
- Related health concerns
What is Periodontal Disease?
Periodontal disease is a chronic infection of the periodontal or gum tissue. This infection is caused by the presence of a bacterial film, which is called dental plaque, that forms on the teeth surfaces. Bacteria that found in dental plaque produce toxins which irritate the gums. They may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss. With periodontal disease, bleeding, redness and swelling do not have to be present. Further, pain is usually not associated with periodontal disease. This disease damages the teeth, gum and jawbone of more than 80% of Americans by age 45. Each case is looked at individually, because in addition to plaque there are co-factors such as genetics, smoking, and overall health, which contribute to disease severity. Once periodontal disease is detected, our goal as therapists is to provide information and treatment necessary to control/ or arrest the active infection, and help keep the disease in an inactive or controlled state.
However, don’t be fooled!
With periodontal disease, bleeding, redness and swelling do not have to be present. The periodontal disease symptoms of inflammation may only be evident with sub gingival probing. Further, pain is usually not associated with periodontal disease.
Dentistry is an art as well as a science; dental crowns offer a perfect example of this. A dental crown or “cap” is a covering that fits over a damaged, decayed or unattractive tooth. It can even replace a tooth entirely as part of dental bridgework.
A crown completely covers a tooth above the gum line. This is in contrast to a dental veneer, which only covers a tooth's front surface and needs natural tooth structure to support it. Therefore, if a tooth is missing a significant amount of structure above the gum line, a crown would be the restoration of choice.
Crowns strengthen damaged teeth, allowing them to function normally again. When crafted from today's high-tech porcelains (dental ceramics), crowns are virtually indistinguishable from natural teeth. They can even be designed to improve upon a tooth's original appearance.
There are other materials besides porcelain that we can use to make dental crowns, depending on what qualities are most important. For durability, cast gold can't be beat. However, this is not always the most aesthetic choice — especially towards the front of the mouth. Other possibilities include porcelain-fused-to-metal crowns (PFM), which have a metal interior for strength and a porcelain exterior for a more natural appearance, and all-porcelain crowns with zirconia, representing the strongest ceramic. We would be happy to discuss the pros and cons of these various options with you.
Crowning or Capping a Tooth
Crowning or capping a tooth will usually take two to three visits. At the first visit, your tooth is prepared to receive its new crown. First, it is shaped to fit inside the new covering. This will involve some drilling to give the tooth a uniform shape. The tooth and the surrounding area will be numbed beforehand. If there is very little tooth structure left to begin with, the tooth may have to be built up with filling material, rather than filed down, to support the crown.
After the tooth is prepared, impressions of your teeth are taken, either digitally or with reliable, putty-like impression materials, and sent to the dental laboratory. There, the impressions will be used to make models of your teeth for the creation of a crown. The models will serve as guides to the highly skilled lab technicians, who will ensure that your new crown is designed to enhance your smile and function well within your bite.
Before you leave the office, a temporary crown will be attached to your tooth to protect it until the permanent crown is ready. At the second visit, your permanent crown will be attached to your tooth with either a resin that hardens when exposed to a special light source, or a type of permanent cement.
Creating a Bridge
Crowns can also be used to create a lifelike replacement for a missing tooth. This is done with bridgework, which spans the space of the missing tooth and requires at least three crowns. Two of those crowns will be placed over healthy teeth on either side of the missing tooth; these healthy teeth are referred to as abutment teeth. The two crowned abutment teeth become supports for a third crown placed in between them; that third crown is referred to as a pontic. If more than one tooth is missing, more crowns will be needed to bridge the gap in between the abutment teeth.
The number of abutment teeth necessary to replace missing teeth is influenced by the number of missing teeth, the size and length of the abutment tooth roots, the amount of bone support each abutment tooth has, as well as where in the mouth the missing tooth is located. For example, if you have three missing teeth, four abutment teeth may be necessary, thereby creating a seven-tooth bridge. Engineering and designing of the bridge requires an understanding of how to replace teeth, as well as the biology of the supporting gum and bone tissue.
Caring for Your Crowns & Bridgework
Crowns and bridgework require the same conscientious care as your natural teeth. Be sure to brush and floss between all of your teeth — restored and natural — every day to reduce the buildup of dental plaque. When you have crowns, it is even more important to maintain your regular schedule of cleanings at the dental office. Avoid using your teeth as tools (to open packages, for example). If you have a grinding habit, wearing a nightguard would be a good idea to protect your teeth and your investment.
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