Periodontal Specialists – Dr. Herbert Veisman
At the Periodontal Specialists, we work collaboratively with your dentist and consultatively with you to formulate the optimal treatment plan that will ensure your best chance for success.
Gum disease is often silent, meaning symptoms may not appear until an advanced stage of the disease.
Warning signs of Gum Disease:
- Red, swollen or tender gums or other pain in your mouth
- Bleeding while brushing, flossing, or eating hard food
- Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
- Loose or separating teeth
- Pus between your gums and teeth
- Sores in your mouth
- Persistent bad breath
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
SINGLE TOOTH DENTAL IMPLANTS
What are the advantages of a single-tooth implant over a bridge?
A dental implant provides several advantages over other tooth replacement options. In addition to looking and functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that adjacent teeth be ground down to support the cemented bridge.
Because a dental implant will replace your tooth root, the bone is better preserved. With a bridge, some of the bone that previously surrounded the tooth begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, a single implant can be more esthetic and easier to keep clean than a bridge. Gums can recede around a bridge, leaving a visible defect when the metal base or collar of the bridge becomes exposed. Resorbed bone beneath the bridge can lead to an unattractive smile. And, the cement holding the bridge in place can wash out, allowing bacteria to decay the teeth that anchor the bridge.
How will the implant be placed?
First, the implant, which looks like a screw or cylinder, is placed into your jaw. Over the next two to six months, the implant and the bone are allowed to bond together to form an anchor for your artificial tooth. During this time, a temporary tooth replacement option can be worn over the implant site.
Often, a second step of the procedure is necessary to uncover the implant and attach an extension. This temporary healing cap completes the foundation on which your new tooth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.
Finally, a replacement tooth called a crown will be created for you by your dentist and attached to a small metal post, called an abutment. After a short time, you will experience restored confidence in your smile and your ability to chew and speak. Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.
Every case is different, and some of these steps can be combined when conditions permit. Your dental professional will work with you to determine the best treatment plan.
How to Pick a Top Periodontist
When you have moderate-to-severe gum disease, you need a top periodontist to help restore your mouth to good health. Periodontitis can be difficult to control, and sometimes, the most a dentist can hope for is to slow the progression of the disease. But the best periodontists can often stop periodontitis and reverse some of the damage that’s already been done to your gums and jaw. Here are some areas you can ask prospective providers about to help you identify the right periodontist for your treatment.
Education and Board Certification
Periodontists are specialists who have gone through several years of advanced training in an ADA-accredited periodontology program after completing four years of general dental training. The national board that certifies periodontists is the American Board of Periodontology (ABP). A good periodontist will always keep up with the recertification process and renew their status with the ABP every six years. A top periodontist will go above and beyond the minimum requirements for recertification by pursuing additional education in the latest periodontic disease prevention, treatment and restoration options. They may also be an active member of the American Academy of Periodontologists – a professional organization for dentists who limit their practice to periodontics and related specialties.
Length of time in practice is another factor to consider in choosing a provider to treat your gum disease. There are many excellent periodontists who have just begun their own practice after completing the certification process. These new graduates are likely to be up to date on the most modern treatment protocols. However, they may lack experience with non-standard or more complex cases. You’ll also have a more difficult time finding reviews online from satisfied (or dissatisfied) patients regarding the standard of care at a new practice.
On the other hand, a periodontist who has been in business a long time but doesn’t keep up with all the latest advances may not offer top-of-the-line treatment either. Your best bet is to find a top periodontist who has been in practice for many years but who also places a high priority on continuing education and research. Some of the most respected specialists will be those who have participated in and published recent peer-reviewed journal articles on periodontics.
Even within the field of periodontistry, there are many areas of additional specialization. Some practitioners focus on treating gum disease using mostly non-surgical interventions. Others have experience with complex and lengthy procedures such as gum grafting or bone regeneration along with the placement of dental implants. There are also periodontists who crossover into the field of cosmetic dentistry by performing gum revision and contouring to create a more even and attractive smile for patients who don’t necessarily have any gum disease. The top periodontist for your procedure is the one who has the best track record for treatment success with cases like yours.
This is something you can only assess during an in-person consultation. Periodontal disease is often a condition that takes many sessions to effectively treat. You could be seeing this specialist for many, many years for ongoing maintenance. The periodontist and his or her staff members need to be emotionally supportive so you stay on track with treatment. If you dread visiting the periodontist because you feel like you aren’t being shown compassion or respect, you are likely to stop going. A top periodontist will take time to fully explain both the recommended treatment plan and the rationale behind it. The staff should make every effort to ease any anxiety you feel and encourage you in following your at-home oral hygiene plan to ensure the success of your treatment.
Your general dentist may be able to refer you to a top periodontist who has a history of providing top-notch patient care. Since your periodontist will need to communicate well with your general dentist about your treatment, choosing a specialist your general dentist trusts is often a good option. However, also understand that some general dentists will refer you to a periodontist because they are golf buddies, friends from school or simply conveniently located in the same building. These are not good enough reasons to go that particular periodontist. This is why today, it’s “buyer beware” and you should do your homework and research the internet to help you find the best specialist for you.
Surprisingly enough, there is very LITTLE pain IF ANY after dental implant surgery. Dental implant surgery is very gentle surgery performed at low drill speed with copious irrigation to keep the bone cool and prevent it from burning from the heat. An implant surgery for a single implant should take no longer then 10 to 15 minutes. As such, the surgical site is open for a minimal amount of time. As well, a good surgeon will use anesthesia and give you three drugs through the IV: 1. Anti-inflmmatory 2. Anti-biotic 3. Sedative. This way, you will have very little swelling, consequently, very little if any pain. Anti-inflammatory prevents swelling which in turn prevents pain. Same for the anti-biotic.
Sometimes a crown or a filling is placed a little too high and can cause someone to grind their teeth. This can also result in tooth sensitivity and headaches. Bite or occlusal adjustment will assist in ensuring that the bite is correct and teeth interdigitate appropriately.
Many patients ask if dental insurance will cover their necessary dental and periodontal treatment. The answer is: IT DEPENDS!
Most insurance policies have a standard maximum annual allowable expense of $1500 to $2000. In addition, each procedure will be covered anywhere from 50 to 100% of the estimated amount. For example, if you require a couple of gum grafts on two different teeth (say, one in your top jaw, and one in your bottom jaw), then the estimate for the treatment might be $2800 ($1400 per graft). However, if your annual maximum is $1500 and each procedure is covered at 50%, then your total reimbursement per graft will be $700, or a total of $1400 for both. Since the total estimate is for $2800, you will receive $1400 from the insurance company you will have to pay the additional $1400 out of pocket.
It is important to understand that in Ontario (and most Canadian provinces) it is illegal for a dentist to write off the difference between the total estimate fee and the amount to be reimbursed by your insurance company. Also, it is illegal and fraudulent to send a CLAIM to an insurance company for treatment that has not already been completed.
In most cases, if you need to have a tooth extracted, a dental implant usually can be placed right away, and at time, a cap (crown) or bridge can be placed on the same day (depending on how strong you jaw bone is).
Teeth need to be extracted if you have advanced gum disease, trauma (ie. accident), broken tooth beyond repair, failed root canal or abscess (infection). If the infection is too complex, then the tooth will be extracted but a bone graft needs to be completed first. Then, after four months, a dental implant can then be placed. The crown (cap) can then be placed either on the same day or two to three months later (depending on bone strength).
The Dental Implant protocol is:
1. Extraction of hopeless tooth-Immediate dental implant if no infection in socket
2. Extraction of hopeless tooth-Bone graft first-Wait four months-dental implant-Wait three months-Cap (crown)
For more information, call our office at 416-225-9910
Who gets gum disease?
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
Symptoms of gum disease include:
- Bad breath that won’t go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
- Receding gums or longer appearing teeth
Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. At your dental visit the dentist or hygienist should:
- Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
- Examine your gums and note any signs of inflammation.
- Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
PREVENTING PERIODONTAL DISEASE
Periodontal disease, also known as gum disease, is caused when bacteria in plaque (a sticky, colorless film that forms in the mouth) builds up between the gums and teeth. When the bacteria begin to grow, the gums surrounding the tooth can become inflamed.
If left untreated, this inflammation can cause the gums and supporting bone structure to deteriorate. This can lead to gum recession or even tooth loss. In addition, research has shown that gum disease may be associated with other diseases, such as diabetes and heart disease.
Luckily, periodontal disease can be preventable. Adding these habits to your daily routine can help.
Brush your teeth. Brushing after meals helps remove food debris and plaque trapped between your teeth and gums. Don’t forget to include your tongue, bacteria loves to hide there.
Floss. Flossing at least once a day helps remove food particles and plaque between teeth and along the gum line that your toothbrush can’t quite reach.
Swish with mouthwash. Using a mouthwash can help reduce plaque and can remove remaining food particles that brushing and flossing missed.
Know your risk. Age, smoking, diet and genetics can all increase your risk for periodontal disease. If you are at increased risk, be sure to talk with your dental professional.
See a periodontist. Get an annual comprehensive periodontal evaluation (CPE) from a dental professional. A CPE looks at your teeth, plaque level, gums, bite, bone structure and other risk factors for periodontal disease. Identifying symptoms of gum disease early is key to protecting your teeth and gums.