Family & Cosmetic Dental Care in a Relaxed Environment.

Exceptional Dentistry Las Vegas and Henderson NV Since 1999.

Dental Implants, Teeth Whitening, Porcelain Veneers, &
Botox Cosmetic.

Call Today For Consultation!

Email Us
Directions

Dry socket (also called alveolar osteitis) is an extremely painful dental condition that can occur after removal (extraction) of a permanent adult tooth.

Having a tooth removed is generally not something anyone looks forward to. Most people understand there will be some level of discomfort following the procedure.  Many are given a prescription for pain medication before leaving their dentist. Most people in fact do not even need to get the prescription filled. However, when a patient experiences what is called a dry socket the pain can become quite intense and linger for days.

Very few people are affected by dry socket. The development of Dry socket after a tooth extraction occurs in only about 2-3% of patients. For those who experience dry socket it can be a very scary experience. Fortunately dry socket is treatable.

A dry socket occurs when the blood clot at the site of the tooth extraction has never fully formed, has broken free, or has dissolved before the wound has had a chance to fully heal. The blood clot is the protective layer for the underlying bone and nerves, it begins the process of healing so that gum tissue and bone can refill the area. When the clot is gone the bone and nerves are now exposed to the outside air, food, fluid, and anything else that enters the mouth. This can lead to a dry socket with sharp, aching pain that can last for 5-6 days, and in the case of a patient taking fosamax type drugs the pain can last for weeks.

A dry socket is considered the most common complication following tooth extractions. It happens more frequently with extraction of impacted wisdom teeth, in patients with poor blood flow to the socket, (smokers, patients taking fosamax), delayed healing (diabetics ).  The pain begins to build and develop about 2-4 days following the procedure.

Signs and Symptoms of Dry Socket

Signs and symptoms of dry socket may include:

-Sharp, aching pain within 2-4 days after a tooth removal.

explanation of dry socket

Graphic explanation of dry socket…image courtesy of Dental Care Matters

-Partial or total loss of the blood clot at the tooth extraction site. You would be able to visually notice a deep hole or space where tooth used to be, that weeps fluid when pressed vs a blood clot overlaying the site.

-Bone that is visible upon visual examination in the socket

-Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction

-Abnormally bad breath or a foul odor emanating from your mouth. This will coincide with having a bad taste in your mouth as well.

-If you have swollen lymph nodes around your jaw or neck, this is a sign of infection and you need to be seen by your dentist immediately.

Over the counter medications by themselves will not control the symptoms. Your dentist or oral surgeon will need to begin treatments to lessen pain and allow for healing to take place.

Treatment of Dry Socket

Taking a nonsteroidal anti inflammatory drug (NSAID – aspirin or ibuprofen) can help to ease the pain but probably will not be enough to take it away completely. When the pain persists you should call your dentist immediately. The dentist may prescribe you a stronger pain medication to allow the pain to subside for you or give you anesthesia in the office to relieve some of the symptoms for a little while anyway.

paste for dry socket

Paste for Dry Socket

What will your dentist need to do for the dry socket? Your dentist will need to numb and clean the tooth socket. This will allow for  removal of any debris from the space where the tooth once was, and allow for rebleeding into the site. The dentist may then fill the socket with a medicated dressing or a special paste to promote healing and soothe the symptoms. Patients with dry socket dressings generally need to come back to be seen by the dentist every day until the pain subsides. The dressing needs to be changed daily. Warm cloth on the outside of the face also helps promote blood flow.

An antibiotic may also be prescribed at this point to prevent an infection from forming. At home care will include rinsing with salt water and being careful what you eat and how you eat it, ( avoiding the side where the dry socket is ).

The site will usually heal completely following treatment in 1-2 weeks.

Who is most likely to get a Dry Socket?

Some patients will be more likely than others to get a dry socket after a tooth extraction. These include the following:

Smokers. Patients who smoke have twice the chance of developing dry socket over those who do not. Smoking also is believed to slow the healing process.

Poor Oral Hygiene. Those with poor oral hygiene will have an increased risk due to the amount of bacteria in the mouth. Will be difficult to maintain a sterile field when removing tooth.

Having wisdom teeth (3rd molars) extracted. Increased trauma to area during procedure is one of the indicators for increasing the possibility for the development of dry socket. 3rd molars tend to be more difficult to remove especially if they are fully or partially impacted.

Previous history of dry socket. If you have had dry socket previously, you are more likely to develop it after another extraction.

Use of birth control pills. Contraceptives which contain estrogen effect the blood clotting system of the body. So we see an increased incidence in dry socket in patients on oral contraceptives.

Rinsing and spitting a lot or smoking after having a tooth extracted also can increase your risk of getting dry socket. These activities will increase chances of the blood clot becoming dislodged.

Following the removal of a tooth it is very important to follow all instructions given to you by your dentist. If you are unsure of anything you must ask or call back. At first sign of pain or discomfort call your dentist to be sure it is not something more serious. As always, maintain a regular schedule visiting your dentist, as well as keeping an open communication with your dentist. This will make you feel comfortable asking questions and knowing you are getting the proper information to care for your oral health.



Periodontal disease (or commonly called gum disease) is a very serious and chronic dental infection of the periodontal tissues that can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports your teeth. This dental infection disease begins when bacteria and plaque form a sticky bio film on your teeth and causes inflammation of the periodontal tissue.  Periodontal disease will continue a downward progression if this is not resolved by maintaining proper dental care and hygiene. Periodontal disease is the leading cause of tooth loss in adults. Scientific studies show that somewhere between 75% and 95% of all adults are suffering from some stage of periodontal disease.

Periodontal disease and tooth decay (cavities) are caused by different types of bacteria, and are considered to be two separate and distinct conditions, however, you can suffer from both issues. Poor oral hygiene promotes the risk of both cavities and periodontal disease. Swollen and receding gums open up the more vulnerable areas of the tooth…The root areas, which, are not protected by enamel and can break down quickly to form root decay.  On the flip side, in patients with significant tooth decay, the broken down teeth allow for food trap areas which keep periodontal tissue chronically inflamed.

Gingivitis

Periodontitis

Stages of Periodontal Disease

The earliest stage of periodontal disease is gingivitis (or simply inflammation of the gum tissues). This is the most mild form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During the earliest of stages the periodontal disease process it can be reversed thru proper brushing, flossing and professional dental care to remove the excess bacterial plaque. If the required oral hygiene does not occur, the periodontal disease then progresses  to the next stage. The majority of people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated by a dental professional. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as raging hormones can make you more prone to inflammation. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions.

Periodontitis

As the periodontal disease progresses it is now becoming harder to treat and control. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other daily functions.

Advanced Periodontitis

As the periodontal disease process advances further, the fibers and bone that provide support for the teeth are broken down and  destroyed. At least half (50%) of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly even tooth removal.

How Do I Know If I Have Periodontal Disease?

Periodontal disease can happen to a person of any age. It is most common among adults. Remember, if periodontal disease is detected in its earliest stages it can be reversed so it is important to see your dentist right away if you notice any of the following symptoms:

-Gums that are red, puffy or inflamed, or tender.

Periodontitis

X-Ray showing Periodontal Disease Progression

-Gums that bleed easily during routine brushing or flossing.

-Teeth that appear longer due to recession of gum tissue.

-Changes in the way your teeth fit together when you bite or chew.

-Pus coming from between your teeth and gums

-Bad breath odor or bad taste in your mouth.

Treatment of Periodontal Disease

Periodontal Disease

Arestin use in Periodontal Disease

The earliest stages of periodontal disease are reversible. This is accomplished thru proper brushing, flossing, and maintaining a regular schedule with your dentist. A professional cleaning by your dentist or hygienist is the only way to remove plaque and tartar especially below the gum line. The hygienist will clean (also called scaling) your teeth to remove the tartar and plaque buildup from above and below the gum line. If the periodontal disease condition worsens, then a root planing procedure may be necessary. Root planing helps smooth irregularities on the roots to make it more difficult for plaque to deposit and stick there. Also makes it easier for you to keep your teeth clean at home. Treatment may also include use of antibiotics.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery. This surgical intervention may include:

-Pocket Reduction Surgery (also called Flap surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.

Soft tissue grafts. Gum tissue is often lost as part of the periodontal disease process making your teeth appear longer than normal. You may need to have damaged tissue replaced to return your cosmetic appearance back to normal. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.

Bone graft. This procedure is needed when periodontitis has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.

-Antibiotics and medicaments – A wide array of antibacterial rinses(Peridex), antibiotics taken in pill form, (Periostat) or localized placement directly into the affected pockets(Arestin), can aide in and promote healing of the affected gum tissue.

-Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

-Enamel matrix derivative application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

To ensure a successful result following periodontal therapy, patient cooperation in maintaining excellent oral hygiene is essential. More frequent professional cleanings can help reduce the likelihood of the periodontal disease ever returning.

By scheduling regular checkups, early stage periodontal disease can be treated before it leads to a much more serious condition. If your periodontal disease is more advanced, treatment in the dental office will be required. Periodontal disease can be managed and controlled for most patients. Following a regular routine of brushing, flossing, and seeing your dentist should be enough for most to keep periodontal disease at bay.




The #1 goal of periodontal disease treatment is to allow for re formation of and re attachment of the periodontal tissues. The best way (and least invasive) is via regeneration or regrowth. There have been various products come to market over the years that have been considered the next immediate fix in regenerative periodontal therapy. Very few have ever seen the real world clinical results of emdogain. Emdogain is made up of various biological proteins and growth factors that have been scientifically proven (thru clinical research and trials) to regrow periodontal tissue, connective tissue, and bone. Emdogain has been shown to be quite stable and predictable for Periodontal  regeneration of lost periodontal tissues.

How Does Emdogain Work?

Emdogain achieves its clinical results by tricking the body into forming new bone, cementum, and attachment fibers. Emdogain’s secret weapon is in its enamel matrix proteins (also called amelogenins) taken from developing teeth in pigs. Luckily, humans do not recognize these proteins as foreign, as they are similarly found in all mammals. There is also a 0 (zero) chance of transmission of any disease by the proteins. During tooth development, these proteins are secreted onto the root surface that is developing preceding the formation of tooth attachment. Luckily for us, this also occurs when the proteins are placed on the root surface of a tooth that has lost bone and attachment from periodontal disease.

Periodontal regeneration

Emdogain

By reintroducing enamel matrix proteins, you are triggering a biologic response from the body to do what it did naturally during your earliest of development. Enamel matrix proteins are only in the body for a short window of time during human development.When applied to the root surface of teeth, these proteins group and form into an insoluble matrix layer that promotes the attachment of mesenchymal cells. These cells produce new matrix components and growth factors that participate in the regain of tooth attachment. Epithelial cell growth is also inhibited by emdogain. This allows for proper tissue and bone reformation to take place without interference.

Treatment

Periodontal regeneration

Radiograph showing bone level before and after emdogain.

Once your dentist has diagnosed, the presence of periodontal disease. Emdogain will be discussed as the least invasive and most effective way to restore the area back to its natural cosmetic appearance. The area in question is generally referred to as a defect. That term is used because there is a periodontal pocket present where the bone and soft tissue has moved away from attaching to the tooth. This is caused by the periodontal disease process. After the defect has been  exposed so the dentist has full visualization of the area. The area is cleaned and debrided of any inflammation and/or diseased tissue or hard tartar deposits. Emdogain is used to help the tissues repair themselves. Emdogain comes as a premixed gel in a syringe. The material is inserted into the defect area. The area is closed and patient can then go about their normal lives. Obviously, the area might be a little tender and patient should avoid flossing and chewing on that side for a few days to allow proper healing time and no disturbance of emdogain as it does its work.

Post Treatment

In the following two weeks, about 75% of the tooth surface where the defect was present will be covered withPeriodontal Regneration the newly developing tooth tissues. The attachment and supporting  structures begin to reattach to the tooth to aid in keeping the tooth stable and healthy. These new tissues will take about one year to complete the maturation process. For this reason, the area where Emodgain is used, should not be periodontally probed (by your dentist or hygienist) for a period of about 6 months. Emdogain can also be used with soft tissue defects.

Emdogain is not ideal for every defect. Your dentist 89014 will be able to describe to you if emdogain is right for your particular case.

 



A gingival graft is the name given for any of a number of surgical periodontal procedures whose goal is to cover an area of exposed tooth root surface with grafted oral tissue from another source. Other names for this procedure are gum graft or periodontal cosmetic surgery. Gum recession is a process in which the margin of gingival tissue that surrounds the teeth wears away in a direction toward the end of the root, exposing more of the tooth. This can cause damage to supporting bone. It is a common dental problem (Studies have shown about 75% of americans have some form of periodontal disease) that often goes unnoticed until it becomes more severe.

Most people are not even aware that their gum tissue has receded since it is such a slow,gradual process. However, over time, an exposed tooth root can not only look ugly, but it can also cause tooth sensitivity. Tooth loss can occur eventually if the gingival tissue is not restored. To repair the damage and prevent further dental problems, a gingival graft may be needed. There are a few goals the dentist and patient are looking for when recommending or performing this surgery. They include:

1)Prevention of further root exposure.

2)To decrease or eliminate tooth sensitivity by covering the root area that was previously uncovered.

Gingival Graft

Gingival Graft – Before and After

3)Decrease the possible incidence of root caries as the root is no longer exposed.

4)Improved aesthetics. This is especially true of teeth that are shown during smiling.

A gingival graft is very effective in solving the problem at hand but there is no guarantee that gum problems won’t develop again. However, with regular dental checkups and careful at home maintenance, serious damage requiring further surgery can be prevented. Other ways to prevent periodontal disease include:

*Brush your teeth twice a day with a fluoride toothpaste. I recommend an electric toothbrush like the Rotadent.

*Floss daily.

*Maintain the schedule recommended by your dentist in regards to hygiene appointments. Usually a 6month recall schedule is the norm but it can more often depending on your situation. Ask your dentist what the best schedule is for you.

*Eat a well balanced and healthy diet.

*Do not smoke.