University research has shown that plaque must be eliminated in order to successfully treat periodontal disease. An added advantage to lowered amounts of plaque in the mouth is that the incidence of dental caries can be markedly reduced

Plaque is a clear or white sticky film that adheres to the surfaces of the teeth, gum tissues, dental restorations and even the tongue. It sticks so firmly to these areas that it cannot be simply washed or even rinsed off, but must be physically removed by either a toothbrush, dental floss or devices used by your dentist or hygienist to clean your mouth. Plaque is made up of food and bacteria which can, when they are present in great enough numbers, cause not only periodontal disease, but dental decay. When plaque is hardened by the chemicals in your saliva, it forms tartar. The bacteria within the tartar cause periodontal disease.

No. The make-up of plaque can vary from person to person, depending upon what type of bacteria they have in their mouth and which area of the mouth is being examined. There is also a difference between individuals in the rate at which plaque forms, with some persons able to show significant accumulations of plaque several hours after a cleaning. Because plaque can form so quickly, it is important that you brush your teeth twice daily and floss at the end of each day.

The most common warning sign occurs when the edge of the gum tissue adjacent to the teeth becomes red and swollen. These gums often bleed when touched with a finger or brushed with a toothbrush. NORMAL GUMS SHOULD NOT BLEED WHEN BRUSHED. The earliest stage of gum infection is known as gingivitis. This is a reversible condition which, in its earliest stages, can be treated by the patient by brushing and flossing. If this condition is left untreated, the infection which starts on the surface of the gum can work its way down through the gum and eventually infect the underlying bone. When this infection begins to destroy bone, we now have what is known as periodontitis. Periodontal disease is present when there is a loss of attachment between the gums and the teeth and a loss of bone which supports the teeth. These teeth may become loose and may eventually have to be removed.

The formation of plaque starts on the surface of the gums and the teeth. When plaque does begin to collect beneath the gum line it is quickly acted upon by the chemicals in your saliva and hardens to form tartar. The tartar found below the gum line is usually extremely tenacious and may be very difficult to remove. This tartar is extremely dangerous because it is made up of millions of bacteria which are now in direct contact with the gum tissues

Yes. Some people never seem to form tartar despite the fact that they do little or nothing to clean their mouths. Others who try very hard to clean their mouths often still must deal with large accumulations of tartar. Although it is extremely important that patients do everything in their power to reduce the amount of plaque, and therefore the amount of tartar in their mouths, we cannot ignore the fact that the chemistry of a persons saliva is an extremely important factor in determining the rate of tartar formation.

Since we know that the removal of plaque and tartar is the most successful way to minimize or prevent periodontal disease, and since we understand that both plaque and tartar form at different rates in different people, the frequency of their removal is best determined by the dentist or periodontist who is treating you.

Recent advances in DNA labeling show that bacteria of the same genetic makeup are frequently found in married couples, or couples who have spent many years in cohabitation. Since these bacteria are identical from a DNA point of view, it can be assumed that they have been transmitted from person to person. Our office offers a free periodontal screening to the spouse of patients of record in order to determine whether or not they have or are at risk for developing periodontal disease.

Although there is no definitive proof that periodontal disease is a genetically transmitted disease, recent advances in DNA testing show promise in determining an individual's susceptibility to developing gum disease.

Why can't we treat periodontal disease with antibiotics alone as we do other infections in the body?

The mouth is one of only two places in the body which is not sterile when it is healthy. We require many different types of bacteria to help us digest our food. The long term use of antibiotics which would be necessary to constantly control the bacteria which cause periodontal disease would certainly have side effects which would be worse than the disease itself. There is always the danger of a patient becoming resistant to a particular antibiotic so that this antibiotic could not be used to fight a potentially life threatening disease itself. Any attempt at the long term use of antibiotics could greatly upset the bacterial makeup of the mouth, causing secondary types of infections such as those resulting in fungal infections.

Does stress affect oral health?

Although stress, either physical or emotional, does not cause periodontal disease, it acts as aggravating factor by chemically lowering the body's resistance to infection in general. Proof of this lies in the fact that people are more prone to colds when they are stressed.

Does smoking influence periodontal health?

Statistically, not only do smokers have a greater prevalence and severity of periodontal disease, but usually have a poorer response to treatment. Although the exact mechanism of how smoking effects periodontal health has not been established, it is generally thought that nicotine in smoke causes narrowing of blood vessels thereby decreasing blood flow to infected areas which in itself decreases the body's ability to heal. There is evidence that smoking negatively influences the success rate of dental implants.

Dental implants are metal pins which replace missing teeth. They are usually made of titanium which is a metal that is compatible with human tissues. Implants have been used for many years without any serious side effects. They can be used in both the upper and lower jaws.

What do dental implants replace?

Dental implants can replace single or multiple missing teeth, existing removable partial dentures, and full dentures whether they be in the upper or lower arches.

How do I determine if I'm a candidate for dental implants?

The amount and quality of bone remaining is most accurately determined by a clinical examination accompanied by x-rays. A dental CAT scan is most often used in order to accurately determine the anatomy of the jawbone. The dental CAT scan also provides information on the position of the sinuses in the upper jaw and the nerves in the lower jaw.

What are the alternatives if there is bone loss due to periodontal disease?

If your jawbone does not contain the necessary amount of bone to hold an implant, a bone graft and tissue regeneration can be done. A bone graft increases the height or width of the jawbone. An artificial membrane may be placed along the bone edge to ensure proper healing. This process is known as guided tissue regeneration.

If there is not enough bone to support an implant in the area of the sinuses what can be done?

A sinus graft can be performed in which bone is actually placed into the sinus in such a way to form new bone that is able to adequately support dental implants. This procedure is often called a sinus graft, and has become very common and predictable.

Are implants prone to infections?

Although infections rarely occur, they are possible. With careful placement of implants and proper postoperative care on the part of the surgeon and the patient, infections have become extremely rare.

How long must I wait to know if an implant has been successful?

Although the healing period varies from patient to patient, the general protocol indicates that implants placed in the upper jaw take between 6-7 months to mesh with the bone. While implants placed in the lower jaw may heal in only 3-4 months. There may be certain circumstances that may prolong the healing process such as bone augmentation, or the placing of bone in the sinus cavity which require a longer period of time before the implant can be deemed to have been successful.

How do we know that an implant has been successful?

After waiting an appropriate amount of time following the placement of the implants, x-rays are taken to indicate whether or not there has been an apparent "take" of the titanium implant. At this time, a rather simple surgical procedure is performed. Since the implant has been buried within the bone and below the gum tissue, it is now time to expose the implant in order to have the healing post extend above the gum line. Once this procedure is completed your restorative dentist will eventually place the caps which will now become your new teeth.

Can an implant be rejected?

Implants are not rejected in the true medical sense of the word. We know that soft tissue transplants such as hearts or kidneys can be rejected by the body because the donor's tissue may not be perfectly compatible with the recipient. In the case of dental implants, since the titanium is bio-compatible, implants are not "rejected" by the body, but are most frequently lost either because of an infection or overloading. If a failing implant is caught early, steps can be taken to save the implant by a variety of methods.

If an implant fails, can it be replaced?

In almost every instance an implant that has failed can be replaced. The failed implant fixture is usually removed, the area is cleansed, and allowed to heal for approximately 3-4 months. A new implant can then be placed in the same area. It is interesting to note that our experience has been that even in those rare instances where implants have failed, when a new implant is inserted into the same site they have usually been successful.

What is the success rate of the implants?

Implants placed in the upper jaw have a success rate of 86-90%, while implants placed in the lower jaw have a greater rate of 92-98%.

There are no guarantees that can be given by the dentist, nor should any be expected by the patient for any dental procedure, and the same is true for the placement of dental implants. Our experience has shown that when a case is carefully planned and executed by the dental team, that is the surgeon, the restorative dentist, and the patient, the placement of implants has become a routine and a successful way to replace missing teeth.
 

A laser is an instrument which produces a very narrow, intense beam of light energy which may or may not be visible to the human eye.

How does the laser work?

The intense beam of light is produced by the laser, and has the ability to either remove or vaporize soft tissue (gums) or hard tissues (teeth).

What are the advantages of a laser over the traditional scalpel when doing surgery?

In most instances a laser removes gum tissue without any bleeding. The intense power of the light beam sterilizes as it works, and because blood vessels and nerve endings are sealed by the beam, there is virtually no pain or swelling postoperatively.

Will a laser incision leave a scar in the mouth?

No. The nature of the laser's interaction with soft tissues and the moist environment of the mouth avert scarring.

How can I be sure that my dentist is competent to use a laser?

Ask questions of your dentist as to the amount and location of his/her training. It is generally agreed that either university training or that provided by the Academy of Laser Dentistry is the standard by which laser education is measured.

If you have any questions about lasers, you can contact our office at (914) 946-1923, or visit the web site of the Academy of Laser Dentistry at www.laserdentistry. org.

Periodontal maintenance therapy is a series of regularly scheduled appointments during which a patient's mouth is cleaned and is evaluated for any early signs of recurrent periodontal disease. Not only is the cleanliness of the mouth checked, but the patient's bite, as well as the possible formation of new pockets are evaluated. Most periodontists agree that the most effective maintenance interval is approximately 3-4 months, but this can vary from patient to patient, depending upon the quality of their home care and the tendency to form both plaque and tartar.

Why is periodontal maintenance therapy important?

Daily oral hygiene will not always insure that plaque will not return to damage the gums and bone. Even with the most effective brushing and flossing, plaque can and does find its way into areas which are difficult to clean. Since this can happen in a relatively short period of time, perhaps as quickly as 2 months, it is recommended that most patients schedule maintenance treatment every 3-4 months.

Who should perform periodontal maintenance?

The responsibility of maintenance therapy remains with your dentist and your periodontist. Most dentists and periodontists use highly trained dental hygienists to initiate the maintenance recall visit by eliminating as much superficial and deep deposits as possible. The ultimate responsibility for the thoroughness of the maintenance visit lies with the dentist or periodontist who supervises this work.

What does a periodontal maintenance visit usually consist of?

The oral tissues will be examined for any abnormal changes such as inflammation of the gum tissues or possibly the presence of growths. Your oral hygiene will be evaluated with suggestions being made on how to improve it if necessary.Pockets will be measured, and any significant changes will be noted. Your teeth will be cleaned to remove plaque and tartar. If x-rays are necessary to confirm clinical findings, they will be taken at that time. We suggest that a complete series of radiographs be taken every 3 years. Your bite will be evaluated to make sure that your teeth fit together properly, and that as many teeth as possible hit at the same time when you chew.

Any changes in your physical health will be discussed. The periodontist will make any appropriate recommendations for correcting or improving any conditions noted during the examination.

How does my general dentist get involved with my periodontal treatment?

Your dentist, periodontist, dental hygienist and you form a team whose goal is not only to return your mouth to optimum health, but to help you maintain that result. In order to accomplish this, a maintenance schedule should be established. It is also essential that you visit your general dentist periodically so that he/she may check your mouth for dental decay or to replace restorations which have become worn or unserviceable. Since there is always the possibility that you may have other dental needs which require the services of a different specialist, these referrals, whenever possible, should be made by your general dentist. He/she is the captain of the dental team, and retains primary responsibility for your general dental health.