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What exactly is preventive dentistry and why is it important in maintenance of our overall health?

Preventive Dentistry – The aspects of dentistry concerned with the teeth, oral cavity, and associated structures, including early detection,  prevention of disease, diagnosis, treatment of oral tissues, and restoration of defective or missing tissue.

“The body is like a piano, and hap­pi­ness is like music. It is need­ful to have the instru­ment in good order”

- Henry Beecher Ward

Dentistry as a whole focuses on prevention and treatment of dental disease. Preventive dentistry includes both at home and in office dental care. At home dental care includes maintaining a healthy dental hygiene regimen in between dental visits, trying to eat healthier meals and snacks, cessation of harmful habits such as smoking, and managing health issues. In office dental care includes regular dental examinations along with professional cleanings, oral cancer screenings, updated health history, fluoride treatments, dental sealants, and other required dental restorations. Home care and in office care work hand in hand to keep our teeth healthy, strong, and free from dental disease.

Unfortunately, many of us tend to neglect our dental care in one way or another. This could mean not following up with care recommended by your dentist or just not brushing and flossing properly (or even regularly). Tooth decay left untreated or undetected, can lead to more serious dental treatment being needed or even to loss of teeth. Periodontal disease can and will progress if not treated in its earliest stages. Periodontal disease can also lead to serious health issues such as heart disease or stroke, and recent studies link poor oral hygiene to pancreatic cancer. Preventive dentistry is an integral part to protecting not just our teeth but also our general health. Preventive dentistry acts as health guard.

What is Included In Preventive Dentistry?

-Dental Hygiene. This might very well be one of the most important things you can do to maintain both your dental health as well as general health. Numerous studies have shown that the build up of plaque, tartar, and bacteria in periodontal disease has been linked to heart disease, strokes, cancer, and even alzheimer’s disease. Flossing and brushing is an integral part of guarding against tooth decay and periodontal disease but it also acts as a protector for your heart and vascular systems. Without a proper dental hygiene regimen plaque and tartar will quickly form leading to tooth decay and periodontal disease.

-Dental X-Rays. Routine x-rays are an important part of preventive dentistry. X-rays can detect tooth decay, bone loss, some tumors (oral cancer), cysts, poor bone quality, and bone infections which in their earliest forms would not be detectable using a visual examination alone.

-Fluoride Treatment. Fluoride is a mineral that plays an important part in preventative dentistry by strengthening teeth and preventing tooth decay. For those with a history of tooth decay your dentist may recommend the use of a fluoride mouth rinse, or prescription fluoride products between dental visits.

-Nutritional Counseling. Most people do not realize how important a balanced diet is to their dental health. Foods and drinks containing sugar quickly begin to attack the teeth after entering the mouth. Most dentists recommend avoiding soft drinks or sugary foods as often as possible. If you choose to eat or drink these sweets, brush and rinse your teeth as soon as possible following ingestion of these items. Keep snacking to a minimum, try to eat well balanced meals, and you will find that your healthier choices will affect your dental health in a positive way.

-Cessation of Habits. Many harmful habits can be eliminated with help from your dentist. Nail biting, tooth grinding and clenching can be kept under control with dental appliances. Smoking can be stopped with prescription drugs such as chantix, nicotine patches, and counseling, Drug use may be addressed and a rehab program suggested.

-Dental Sealants. A dental sealant is a thin plastic-like coating that is applied over back teeth. Sealants are placed in areas of grooves and ridges where plaque can hide and the toothbrush can’t reach as easily. Covering up the grooves helps to prevent tooth decay. Dental sealants are most often applied as preventive dentistry for children but can also be used for adults.

-Oral Cancer Screening. Early diagnosis of oral cancers give patients the best chance for survival in the long term. Find a dentist who uses the Velscope early detection oral cancer screening system to ensure you are being checked regularly. The best defense against oral cancer is an early diagnosis. The mortality rate of oral cancer increases dramatically if not detected in its earliest stages.

Preventive Dentistry Conclusion

Considering that oral health is linked to overall health, preventive dentistry is important to your overall well being.  Oral diseases can interfere with eating, speaking, daily activities and even self esteem. Preventive dentistry can lead to less extensive (and less expensive!) treatment for any dental conditions that may develop, and help you keep your natural teeth for a lifetime.

Many believe that periodontal disease is a disease that is solely based on genetics. My grandparents had dentures, my parents had dentures, so will I. The truth is, that genetics plays a role, but is not a sentence for dentures. There are risks and limitations in the progression of periodontal disease… Can each patient limit the risks of developing full blown progressive periodontal disease?….The answer is a resounding…YES! It takes a good oral hygiene regimen, knowledge of the current state of your condition, and frequent professional cleaning to keep our mouths in a healthy, disease-free state.

Risk Factors Of Periodontal Disease

Patient Caused Risk Factors

-Poor Oral Hygiene – This is an obvious one that each individual can control. Brushing, flossing, rinsing, and seeking regular dental care are essential steps to remain periodontal disease free and avoid progression beyond gingivitis.

-Age - Research has shown that older people have the highest rates of periodontal disease. The research shows that over 70% of Americans 65 and older have periodontitis.

-Smoking Or Tobacco UseTobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

-Poor nutrition- Eating an unhealthy diet will not supply you with the essential vitamins and minerals necessary for tissue healing and repair.

-Anatomy - The local anatomic risk factors for periodontal disease include:,

1. Furcation anatomy. These are the spaces between roots of molars.  In many instances, the entrance of  such furcations are restricted enough to limit access for proper hygiene maintenance. Risk factors for periodontal disease are classified according to their involvement in tooth furcations. A Grade I CEP presents with minimal projection of enamel toward the entrance of the furaction. A Grade II CEP approximates the entrance of the furcation, and the tip of a Grade Ill CEP is well within the furcation.

2. Common anatomic deformities. These interfere with a patient’s ability to effectively remove plaque biofilm which are one of the risk factors for periodontal disease. An example are Cervical enamel projections (CEP). CEPs are tooth developmental deformities of the CEJ found on molars.

4. Palato-gingival grooves (PGG). POGs are tooth developmental deformities of maxillary central and lateral incisors. They begin in lingual pits and extend vertically onto root surfaces. PGGs could, on rare occasions, extend to the root apex. PGGs are commonly associated risk factors for periodontal disease with increased gingival inflammation, plaque accumulation, and probing depth.

5. Open contacts, loss of interdental papilla, and food impaction. Open contacts between teeth may allow for easy food impaction. Food impaction is defined as the forceful wedging of food between teeth. Loss of the pointed papilla between teeth leaves another area for food impaction.

-Medications - Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can have an affect on your oral health, causing dry mouth, inflammation and gum tissue overgrowth. It is important to tell your dentist the medications you might be on so they can tailor a treatment schedule for your needs.

-Other Disease - These include cardiovascular disease, diabetes, and rheumatoid arthritis.  These diseases can interfere with the inflammatory process, causing healing problems, and may worsen the condition of the gums.

-Poor Nutrition – A diet without all the essential nutrients for our bodies to function can compromise our immune systems, decrease healing ability, and make tissue weaker and easier to breakdown. This will make it harder to fight off infection. Since, periodontal disease essentially begins as an infection, this lack of nutrition can make the periodontal disease develop and progress faster than it normally would. Studies have also linked obesity with an increased risk of periodontal disease.

Dentist Caused Risk Factors

-Overhanging dental restorations – A poorly completed dental restoration typically has dental material overhanging the tooth. This creates an issue keeping the area clean and also creates an area for food and bacteria to build up. These overhangs can be irritating to the tissues and retain plaque and food more easily.

-Violation of the “biologic width” –  is the height between the deepest point of the gum pocket and the bone. This distance is important to consider when fabricating any dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. These consequences include bone and tissue recession.

-Open contacts and food impaction - If a dentist places a new dental restoration and does not create the proper tight contact between adjacent teeth, that area becomes a food and plaque trap. It will necessitate improved dental hygiene in that area to keep it clean. More often than not, food and debris will accumulate creating a localized area of periodontal disease.

-Occlusal trauma – If a new restoration is not properly set in alignment with the other teeth, a patient can create damage to the tooth as well as the surrounding tissue just from the act of chewing. The bite should always be checked and adjusted after dental work to prevent trauma to an individual tooth.

Periodontal Disease Conclusion

Luckily, with the exception of the anatomy we are born with, all of these periodontal disease risk factors can be overcome. The first step is to practice good oral hygiene by brushing, flossing, and using an antibacterial mouthrinse. The second step is to choose a well qualified dentist and keep a regular schedule to help give you the best fighting chance at preventing,  treating and stabilizing periodontal disease.

Peri-implantitis - is a destructive  process affecting the gums and bone surrounding dental implants. The various periodontal bacteria found surrounding failing dental implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.

Peri-implantitis is a unique complication when dealing with dental implants. Dental implants have a very high success rate but do fail for various reasons. These can include failure to integrate with bone, poor oral hygiene by patient, rejection by the body, trauma, or peri-implantitis. Peri-implantitis becomes a factor in patients with poor oral hygiene, diabetes, smoking, and when there is residual cement stuck to the implant surface.  Peri-implantitis will cause the destruction of bone and gum tissue exposing part of the dental implant to the outside. This will cause the possibility for the dental implant to become less stable and cause the patient to lose the implant and restoration if not treated in a timely manner.

How Is It Diagnosed?

A dentist will use x-rays and measuring instruments to determine the level of the bone surrounding the dental implant. If it is found there is some level of bone loss beyond normal surrounding the dental implant, then the diagnosis becomes that of peri-implantitis. It is normal to see some minor bone loss 1-2 years out following placement of the dental implants. It should be no more than 1-1.5 mm in the first year and no more than 0.2 mm in each subsequent year. As stated earlier peri-implantitis of a  dental implant that goes undiagnosed will lead to complete failure and have to be removed.

Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms are:

- Color changes of the gum tissue around the implant.

- Bleeding during brushing, probing or measuring.

- Increased pocket depth around the implant.

- Pus drainage from around the dental implant.

- Thinning of the tissue causing transparency around the implant..

- Progressive loss of bone height around the implant.

-X-rays showing loss of bone around the implant.

Peri-Implantitis Treatment Options

The course and success of treatment revolves around when the peri-implantitis is diagnosed. If the initial bone loss is limited there will be a higher chance of success in saving the dental implant. However, the later treatment begins the lower the chance of saving the dental implants. There are various methods used to treat peri-implantitis. All have varying degrees of success. These include the following:

-Mechanical Debridement (professional cleaning using instruments). A patient with dental implants must follow normal treatment schedules to maintain his/her dental implants. This includes regular dental visits. At these visits radiographs will be taken to ensure the dental implant and surrounding tissues are in a  healthy state. At these visits the patient will also undergo a professional cleaning for the dental implants and/or natural teeth. Dental implants require special tools for cleanings. The standard dental implant instruments used for cleaning include plastic, graphite, or gold tipped instruments. Ultrasonic tips may be used. The goal in cleaning the implant is to remove debris and bacteria without damaging the exterior coating of the dental implant.

-Perioscope. A microscope guided cleaning deep below the tissues to remove debris and otherwise  undetectable cement residue.

-Localized Drug Delivery. Since dental implants by nature have rough surfaces (to allow better integration with surrounding bone), removing infection tends to be quite a challenge using just hand instruments. It is recommended that a chemical anti microbial agent be used along side hand instrumentation. Recent studies have shown the combination of hand instruments and chemical agents have proven effective in eliminating peri-implantitis in its earliest stages. Drugs used can include chlorhexidine rinse, oral antibiotics such as tetracycline, minocycline, doxycycline hyclate, or Arestin, an antibiotic placed directly into the pocket.

-Bone regrowth factors. Emdogain can be placed along with bone grafting material to help stimulate new bone growth.

Conclusion

The primary goal once peri-implantitis has been diagnosed is to stop the disease process from progressing. If untreated, it will ultimately lead to loss of the dental implants. The #1 goal should be to see your dentist regularly to avoid the complication of peri-implantitis. It is important to note any signs that may be occurring so you can be proactive about your dental health.

Gingivitis is simply inflammation of the gum tissue in the mouth. It is a reversible, non-destructive form of periodontal disease. While there are many causes of gingivitis, the

Gingivitis Marielaina Perrone DDS

Gingivitis Can be Prevented!

number one cause is poor dental hygiene.

Gingivitis can arise as -a side effect to medication, surges in hormones, mouth breathing, dry mouth,poor nutrition, disease state, tobacco use, or poor oral hygiene. When hygiene is insufficient, bacteria in dental plaque release acids that stimulate the inflammatory response by the body. This in turn cause the gums to appear puffy, red, and bleed easily upon brushing. It takes some work to restore the gums back to a healthy state. Frequent professional cleaning along with regular tooth brushing and flossing can help to remove plaque and keep it from building up on the teeth and gums.

Signs Of Gingivitis

-swollen, shiny, and tender gums

-blood on toothbrush while brushing

- pink toothpaste when spitting out

-pus around teeth

-bad breath

-gum redness

-visible tartar deposits

-bad taste in mouth

-gums bleed easily

-gum ulcers

Other Causes Of Gingivitis

-Medications. Many prescription and over-the-counter medications come with the side effect causing dry mouth or xerostomia, and sometimes gum overgrowth. Saliva is important to help keep your teeth clean by controlling the growth of bacteria as well as maintaining a neutral environment to prevent tooth decay. That means that the less saliva you have, the greater your risk for gingivitis (and tooth decay!). Many common medications including antidepressants, blood pressure meds,  asthma inhalers, and cold medications can reduce the amount of saliva in your mouth. Seizure medications, and some blood pressure medications can cause the gum tissue to grow. This extra tissue, makes it more difficult to keep clean. It is important you always read the side effects for any medications you are taking to ensure you take the proper steps like drinking more water and brushing more often following meals.

-Infection/ Disease: Various types of viral infections or fungal infections can cause periodontal disease. Oral Thrush is an example. Thrush occurs when a type of fungus that occurs normally in the mouth gets out of control and forms lesions that can infect the tongue and gums. Also, an infection caused by the herpes virus can cause

Gingivitis Marielaina Perrone DDS

periodontal disease. It is important to get these infections under control as soon as possible as they are quite treatable in most cases. There are also other diseases that can effect the oral tissue, such as oral cancer, and diabetes.

-Nutrition: If you follow a fad diet or a diet that is severely lacking in calcium and vitamins B and C, you may be at increased risk for periodontal disease.

-Mouth Breathing: leaving the mouth open to breathe while awake or sleeping, dries the mouth substantially. Oral dryness  allows gingivitis to occur more readily.making healing more difficult

-Tobacco use: Smoking directly effects the gums by decreasing blood circulation and thereby increasing inflammation. Smokeless tobacco cause irritation in direct response to the product eroding the tissue.

-Hormone surges: Hormonal imbalance during puberty, menstruation, pregnancy, and menopause can cause gingivitis. The drastic hormone changes allow gum tissues to become inflamed quite readily.

Possible Complications From Gingivitis

In most cases, if gingivitis is properly treated and the patient follows good dental hygiene there will be no complications. However, if left untreated, gingivitis can worsen and develop into a more advanced version of periodontal disease called periodontitis. This form of periodontal disease is quite destructive and will cause loss of bone and eventually loss of teeth.

Possible complications from gingivitis can include:

-Abscess in the gum tissues.

-Abscess in the jaw bones.

-Infection in the jaw bone or gum tissues.

-increased susceptibility to heart disease.

-Loss of esthetic gum contours. The points of gum tissue between the teeth disappear, leaving behind a “black triangle”. Red, jelly-roll margins at the gum line of the tooth. Pink stippling disappears.

-Periodontitis.

-Recurrent gingivitis.

-Trench mouth, or ANUG.  Ulcerations of the gums caused by bacterial infection.

Gingivitis can cause damage in other areas of the body if allowed to remain untreated. The bacteria from the gums can enter the bloodstream and cause infections elsewhere. Periodontal disease has been linked to heart disease, stroke and erectile dysfunction. It may also cause the delivery of premature infants as well as low birth weight infants to gingivitis-infected mothers. Those with diabetes may have problems controlling blood sugar levels if they also suffer from gingivitis.

Prevention of Gingivitis

Gingivitis may be prevented or cured by following some simple preventative measures:

-Brush teeth, gum line, and tongue daily. Teeth should be brushed at least twice a day. Both morning and night and after meals when possible.Gingivitis Marielaina Perrone DDS

-Use a soft bristled toothbrush, which is less likely to damage teeth or gums. Replace toothbrush every three months or sooner if needed.

-Use a fluoride toothpaste.

- Do not snack in the middle of the night. Chew gum after daytime snacks.

-Floss at least once a day.

-Rinse with an effective mouthwash, such as listerine.

-Visit the dentist at least once every six months for cleaning and examination to keep gingivitis away.

-Avoid sugary foods, tobacco and drinking excessive amounts of alcohol.

Conclusion

Gingivitis is very treatable. The first step, is understanding what is making it occur. Following a regular dental hygiene regimen will keep gingivitis at bay and not allow it to progress to periodontal disease. A few minutes a day is all it takes to maintain a healthy teeth and gums. Remember to visit your dentist regularly for dental examinations and professional cleanings to avoid the onset of gingivitis.