Gingivitis

Gingivitis is an inflammation of the gingiva, or gums. It is characterized by tender, red, swollen gums that bleed easily and may cause bad breath (halitosis). Gingivitis can be treated by good dental hygiene, proper diet, and stopping smoking. Untreated gingivitis can lead to periodontitis.

Periodontitis

Periodontitis occurs when the gum tissues separate from the tooth and sulcus, forming periodontal pockets. Periodontitis is characterized by:

• Gum inflammation, with redness and bleeding
• Deep pockets (greater than 3 mm in depth) that form between the gum and the tooth
• Loose teeth, caused by loss of connective tissue structures and bone

There are different forms of periodontal disease. They include:
Chronic Periodontitis. Chronic periodontitis is the most common type of periodontitis. It can begin in adolescence but the disease usually does not become clinically significant until people reach their mid-30s.
Aggressive Periodontitis. Aggressive periodontitis is a subtype of chronic periodontitis that can occur as early as childhood. It can lead to severe bone loss by the time patients reach their early 20s.
Disease-Related Periodontitis. Periodontitis can also be associated with a number of systemic diseases, including type 1 diabetes, Down syndrome, AIDS, and several rare disorders of white blood cells.
Necrotizing Periodontal Disease. Necrotizing periodontal disease is an uncommon acute infection of the gum tissue. It is characterized by painful and bleeding gums, bad breath, and rapid onset of pain. If left untreated, necrotizing periodontal disease can spread throughout the facial areas (cheeks, jaw) and cause extensive damage. Necrotizing periodontal disease is usually associated with systemic health conditions such as AIDS or malnutrition.
 

Causes

 
Periodontal disease is caused by plaque, which is formed from harmful bacteria. The mouth is full of bacteria but they tend to be harmless varieties. Periodontal disease usually develops because of an increase in bacteria quantity in the oral cavity and a change in balance of bacterial types from harmless to disease-causing bacteria. These harmful bacteria increase in mass and thickness until they form a sticky film called plaque.
In healthy mouths, plaque actually provides some barrier against outside bacterial invasion. When it accumulates to excessive levels, however, bacterial plaque sticks to the surfaces of the teeth and adjacent gums and causes infection with subsequent swelling, redness, and warmth.
When plaque is allowed to remain in the periodontal area, it transforms into calculus (commonly known as tartar). This material has a rock-like consistency and grabs onto the tooth surface. Tartar is much more difficult to remove than plaque, which is a soft mass. Once tartar has formed, it must be professionally removed by a dental practitioner.
 

Risk Factors

 
Most American adults have some form of gum disease but are unaware of it. The main risk factors for periodontal disease include:

• Age
• Smoking or tobacco use
• Female hormonal changes
• Illnesses   such as diabetes or HIV/AIDS, and the medications used to treat some conditions
• Genetic factors

Age

Periodontitis typically occurs as people get older and is most common after age 35.

Lifestyle Factors

Smoking. Smoking is the major preventable risk factor for periodontal disease. Smoking can cause bone loss and gum recession even in the absence of periodontal disease. The risk of periodontal disease increases with the number of cigarettes smoked per day. Smoking cigars and pipes carries the same risks as smoking cigarettes.
Substance Abuse. Long-term abuse of alcohol and certain types of illegal drugs (amphetamines) can damage gums and teeth.
Diet. A healthy diet, including eating fruits and vegetables rich in vitamin C, is important for good oral health. Malnutrition is a risk factor for periodontal disease.
Stress. Psychological stress can cause the body to release inflammatory hormones that may trigger or worsen periodontal disease.

Female Hormones

Female hormones affect the gums, and women are particularly susceptible to periodontal problems. Hormone-influenced gingivitis appears in some adolescents, in some pregnant women, and is occasionally a side effect of birth control medication.
Menstruation. Gingivitis may flare up in some women a few days before they menstruate, when progesterone levels are high. Gum inflammation may also occur during ovulation. Progesterone dilates blood vessels causing inflammation, and blocks the repair of collagen, the structural protein that supports the gums.
Pregnancy. Hormonal changes during pregnancy can aggravate existing gingivitis, which typically worsens around the second month and reaches a peak in the eighth month. Any pregnancy-related gingivitis usually resolves within a few months of delivery. Because periodontal disease may increase the risk for low-weight infants and cause other complications, it is important for pregnant women to see a dentist.
Menopause.Estrogen deficiency after menopause reduces bone mineral density, which can lead to bone loss. Bone loss is associated with both periodontal disease and osteoporosis (loss of bone density). The hormonal changes associated with menopause can cause dry mouth, which can lead to tooth and gum problems.

Genetic Factors

Periodontal disease often occurs in members of the same family. Genetic factors play a role in making some people more susceptible to periodontal disease.

Medical Conditions Associated with Periodontal Disease

Diabetes. There is a strong association between diabetes (both type 1 and 2) and periodontal disease. Diabetes causes changes in blood vessels, and high levels of specific inflammatory chemicals such as interleukins, that significantly increase the chances of developing periodontal disease.
Heart Disease. Periodontal disease and heart disease share common risk factors (smoking, older age, diabetes) but it is not yet clear if having one condition increases the risk for developing the other (see Complications section of this report).
Other Medical Conditions. A number of medical conditions can increase the risk of developing gingivitis and periodontal disease. They include conditions that affect the immune system such as HIV/AIDS, leukemia, and possibly autoimmune disorders (Crohn’s disease, multiple sclerosis, rheumatoid arthritis, lupus erythematosus).
Prescription Medications. Gingival overgrowth can be a side effect of many   drugs including certain types of oral contraceptives, antidepressants, and heart medications. Any drug that has a side effect of dry mouth can increase the risk for gum disease.
If you take a bisphosphonate drug such as alendronate (Fosamax, generic) discuss with your dentist any potential risks from dental procedures (such as extractions and implants) that involve the jawbone. Oral bisphosphanates, which are used to treat osteoporosis, have in rare cases caused osteonecrosis (bone destruction) of the jaw. (Intravenous bisphosphantes, which are used in cancer treatment, are more likely to cause osteonecrosis.) Your dentist or oral surgeon may need to take special precautions when performing dental surgery. In any case, be sure to inform your dentist of all medications you are taking.

Oral Health Risk Factors

Oral Hygiene. Lack of oral hygiene, such as not brushing or flossing regularly, encourages bacterial buildup and plaque formation.
Poorly Contoured Restorations. Poorly contoured restorations (fillings or crowns) that provide traps for debris and plaque can also contribute to periodontitis.
Tooth Structure . Abnormal tooth structure can increase the risk of periodontal disease.
Wisdom Teeth. Wisdom teeth, also called third molars, can be a major breeding ground for the bacteria that cause periodontal disease. Periodontitis can occur in wisdom teeth that have broken through the gum as well as teeth that are impacted (buried). Adolescents and young adults with wisdom teeth should have a dentist check for signs of periodontal disease.
 

Complications

Effect on Heart Disease

Cardiologists and periodontists currently encourage each other to monitor both conditions in their patients. Periodontists recommend that patients who have periodontal disease and at least one risk factor for heart disease have an annual medical exam to check their heart health. Cardiologists suggest that patients with atherosclerosis and heart disease have regular periodontal exams.

Effect on Diabetes

Diabetes is not only a risk factor for periodontal disease. Periodontal disease itself can worsen diabetes and make it more difficult to control blood sugar.

Effect on Respiratory Disease

Bacteria that reproduce in the mouth can also be carried into the airways in the throat and lungs, increasing the risks for respiratory diseases such as pneumonia and worsening chronic lung conditions, such as emphysema.

NON-SURGICAL PERIODONTAL TREATMENT

PERIODONTAL POCKET REDUCTION PROCEDURES

ARE YOU A CANDIDATE FOR DENTAL IMPLANTS?

The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.
Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own. The dentist and periodontist will work together to make your dreams come true.

WHAT IS A DENTAL IMPLANT PROCEDURE LIKE?

This procedure is a team effort between you, your dentist and the periodontist. The periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs.

• Replacing a Single Tooth   If you are missing a single tooth, one implant and a crown can replace it.
• Replacing Several Teeth   If you are missing several teeth, implant-supported bridges can replace them.
• Replacing All of Your Teeth   If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them.
• Sinus Augmentation   A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.
• Ridge Modification   Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

WHAT CAN I EXPECT AFTER RECEIVING A DENTAL IMPLANT?

As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply!
After treatment, your periodontist will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.

One out of every two American adults aged 30 and over has periodontal disease, according to recent findings from the Centers for Disease Control and Prevention (CDC). A study titledPrevalence of Periodontitis in Adults in the United States: 2009 and 2010estimates that 47.2 percent, or 64.7 million American adults, have mild, moderate or severe periodontitis, the more advanced form of periodontal disease. In adults 65 and older, prevalence rates increase to 70.1 percent. This study is published in the Journal of Dental Research, the official publication of the International and American Associations for Dental Research.
Periodontal disease is a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth, according to theAmerican Academy of Periodontology (AAP). If left untreated, periodontal disease can lead to tooth loss. Research has also shown that periodontal disease is associated with other chronic inflammatory diseases, such as diabetes and cardiovascular disease. The AAP has worked closely with CDC since 2003 on periodontal disease surveillance.
The findings are based on data collected as part of CDC’s 2009-2010 National Health and Nutrition Examination Survey (NHANES), designed to assess the health and nutritional status of adults and children in the United States. The 2009-2010 NHANES included for the first time a full-mouth periodontal examination to assess for mild, moderate, or severe periodontitis, making it the most comprehensive survey of periodontal health ever conducted in the U.S. Researchers measured periodontitis because it is the most destructive form of periodontal disease. Gingivitis, the earliest stage of periodontal disease, was not assessed.
Previous NHANES relied on partial mouth periodontal examinations and may have missed disease in teeth that were not examined. Since periodontal disease is not evenly distributed in the mouth, estimates based on partial mouth examinations may have underestimated actual prevalence rates in the U.S. population by as much as 50 percent.
“This is the most accurate picture of periodontal disease in the U.S. adult population we have ever had,” said Pamela McClain, DDS, President of the American Academy of Periodontology and a practicing periodontist in Aurora, Colorado. “For the first time, we now have a precise measure of the prevalence of periodontal disease, and can better understand the true severity and extent of periodontal disease in our country. The AAP values its collaboration with CDC to better understand the burden of periodontal disease in Americans.”
The findings also indicate disparities among certain segments of the U.S. population. Periodontal disease is higher in men than women (56.4 percent vs. 38.4 percent) and is highest in Mexican-Americans (66.7 percent) compared to other races. Other segments with high prevalence rates include current smokers (64.2 percent); those living below the federal poverty level (65.4 percent); and those with less than a high school education (66.9 percent).
According to Paul Eke, MPH, PhD, lead author and CDC epidemiologist, the findings may drive public health policy. “We have demonstrated a high burden of periodontal disease in the adult U.S. population, especially among adults 65 and older. Periodontal disease is associated with age, and as Americans live longer and retain more of their natural teeth, periodontal disease may take on more prominence in the oral health of the U.S adult population. Maintaining good periodontal health is important to the overall health and well-being of our aging population. Our findings support a need for public health programs to improve the oral health of adults.”
Co-author Robert Genco, DDS, PhD, Distinguished Professor at The State University of New York at Buffalo and Past President of the American Association for Dental Research (AADR) and the International Association for Dental Research (IADR), believes these findings elevate periodontal disease as a public health concern. “We now know that periodontal disease is one of the most prevalent non-communicable chronic diseases in our population, similar to cardiovascular disease and diabetes.”
Dr. McClain noted that these findings support the need for comprehensive periodontal evaluations annually. “To really know if you have periodontal disease, a dental professional must examine each tooth above and below the gum line. A visual examination alone, even by the most qualified dentist, is not enough. These findings suggest that many more people have periodontal disease than previously thought, so it is more important than ever to receive a comprehensive periodontal evaluation from your dental professional every year.”
Surveillance of periodontal disease in U.S. adults will continue through the 2014 NHANES to include more racial and ethnic segments of the population. Both CDC and AAP support additional efforts to continue to understand periodontal disease prevalence trends. This data will guide public health policy decisions including appropriate prevention and treatment recommendations.

Sometimes after teeth are extracted, people lose bone in the posterior upper jaw below the sinus. This results in limited available bone for placement of dental implants as a means of tooth replacement.
In order to now place dental implants in the back of the upper jaw, a bone graft procedure called a “sinus lift” or “sinus elevation” is necessary. These procedures can be performed concurrently with the placement of dental implants or, in some cases, may need to be performed a few months in advance of placing dental implants. This all depends on the amount whatever little bone is still available under the sinus.
There is a procedure called a 3D cone beam CAT scan which can determine how much bone exists in the area of the sinus. Then, dental implant placement can be planned in conjunction with the placement of dental implants or in advance.
The type of bone that is used in such grafts is cow bone. This bone is 100% safe as it is harvested from cows that are raised specifically for the purposes of these bone grafts and are fed and treated appropriately. There is no evidence in the scientific literature of any risks of disease transmission to humans from such treatment.
The sinus lift/elevation procedure has benefited millions of people world wide in the past 40 years since it was developed. This allows people to enjoy the function and comfort of dental implant supported fixed non-removal prosthetics for life.

When you break a tooth, you may notice a gum boil (looks like a pimple on the gum). This is an indication that something is wrong with the bone and roots of the tooth. Most likely, the tooth has a root canal and even a post inside which could have led to a tooth crack over time. This most likely means that the tooth has to be pulled out and replaced with a dental implant either right away or over a 4-6 months period of time.
If the tooth to be pulled out is a single rooted tooth (incisor, cuspid, premolar) then an implant can be placed right away into the socket. If on the other hand the tooth is an upper or lower molar, then the tooth is extracted and bone grafted immediately. An implant may not be possible right away because the configuration of the socket left behind most likely cannot accommodate the shape of a dental implant. Therefore, often times, the tooth is extracted, bone grafted, allowed to heal for 4-6 months and then a dental implant is placed. Following three months of healing, the crown or bridge can be placed.
For any questions, please call our office 416-225-9910.

One of the most common treatments we perform in the office is tooth extraction, bone regeneration and dental implants. The reason this procedure needs to be performed has to do with the fact that when teeth break beyond the point of repair, they must be removed. In order to replace teeth, patients have the following options:
1. No tooth replacement
2. Dental bridge
3. Partial or full denture
4. Dental implant(s)
 
The first option is a poor one because if you do not replace missing teeth, you risk tooth shifting and over-eruption by other teeth in the opposite jaw. This can lead to alterations and changes in your bite which can lead to life-long pain and discomfort (e.g.. headaches, jaw pain, and more broken teeth).
The second option is old technology and results in destroying adjacent teeth. When you lose a tooth, if you have teeth on either side of the space, a dentist can cut down these teeth (permanently destroying these teeth) and placed a bridge in the space to replace the missing tooth or teeth. However, these bridges are relatively short term and no dentist can assure you use of such a bridge for more then 7 to 10 years. Often times, the teeth that hold these bridges undergo the tooth decay process which lead to more treatment like root canals and more root fillings. So crown and bridge treatment can actually lead to more tooth compromise and more tooth destruction in the long-term. Even though dental insurance companies are happy to cover such treatment, these are your teeth being destroyed. So proceeding with this treatment JUST BECAUSE dental insurance may cover it is extremely short sighted and can lead to more tooth loss in the upcoming few years.
The third option, a partial or full denture, can be cheap but extremely uncomfortable. Dentures can loosen and fall out of you mouth when you laugh, you can get food stuck between the denture and your gums leading to extreme pain and they can smell really awful when food is stuck under them and not cleaned out multiple times per day.
So the best option in today’s modern world where people want to look, feel, and smell their best, is the dental implant. A dental implant is a titanium alloy post which is gently inserted into the jaw bone, hence, replacing the ROOT of the tooth. A couple months later, once the implant has integrated with your own bone, a dental crown or CAP is screwed into the implant. It’s that simple. It doesn’t hurt. It’s a little more expensive then a bridge, but in the long term, it will likely last for the rest of your life whereas a bridge you will replace multiple times throughout your life and potentially lose the bridge teeth as well.
Dental Implants are long lasting, easily cleanable, and relatively inexpensive dental treatment options that should last a lifetime. They replace teeth to the extent that they look almost identical to the teeth being replaced (assuming you treat the problem in time and don’t allow your bone to degenerate too long).
I always tell my patients that if a tooth is cracked and you are experiencing an early abscess (gum boil), then you should have the tooth extracted as soon as possible because otherwise you risk losing more bone and requiring bone grafting PRIOR to dental implant placement. When you have an abscess, you lose bone. When you lose bone, it becomes more challenging to place an implant. Therefore, if you wait a long time before dealing with an infection (abscess), the tooth will be extracted and then, instead of placing the dental implant right away into the tooth socket, you will need to spend thousands of dollars on a bone graft PRIOR to placing the dental implant a few months later (usually four months later). People who wait too long end up spending A LOT more money then those who address the problem right away.
An extraction and dental implant with a final crown three months later should cost around $4500-5000. However, if wait too long with an infection and you end up requiring bone grafting BEFORE the dental implant, this could increase the cost of your treatment by $1800 to $5000 per tooth. Why wait? If you have a tooth infection or pain or gum boil, give us a call for a consultation and let us tell you what is the best course of action. You can call Dr. Veisman at 416-225-9910 for a consultation.

So you lost your teeth and you are stuck wearing a denture. Now what are your options?
Well, if you are missing, say, all your upper or lower teeth, you basically have THREE options:
Option 1- An REMOVABLE acrylic denture that clicks into three to four dental implants
Option 2- A FIXED acrylic denture that is screwed permanently into four to six dental implants
Option 3- A FIXED Porcelain bridge that is screwed permanently into six to eight dental implants
Which option is best? That depends on:
A. Your budget (financial capability or limitations)
B. Your anatomical and physical constitution (how much bone you have left in your jaw)
C. How much time you are ready to spend in the dental chair
D. How ready and prepared you are emotionally and psychologically to move forward with one of the treatment options noted above
 
Let’s discuss each of the options above one by one.
 
Option 1-Removalbe acrylic denture
Advantages: Relatively inexpensive , needs 2 to 4 dental implants,quick to complete treatment, requires minimal bone, can eat most things like steak, corn on the cob, apples and bite into bagels
Disadvantages: Must be taken out daily to clean, needs a couple connection parts to be replaced every year (associated with some minimal cost), does have a little movement
Cost: $10,000 to $15,000
Time to completion: 3-4 months
Pain/Recovery: Minimal
Option 2- Fixed Acrylic denture
Advantages: Fixed so you never take it out; comfortable (never moves around in your mouth), very esthetic, requires 5-6 dental implants
Disadvantages: More expensive then the removable version, may take longer to complete treatment
Cost: $25,000 to $40,000 depending on whether you are treated by a General Dentist or Prosthodontist
Time to Completion: 5-6 months
Pain/Recovery: Minimal
Option 3-Fixed Porcelain Bridge
Advantages: VERY cosmetic, very strong, generally has the best long term prognosis and longevity of the three options-REMEMBER! YOU GET WHAT YOU PAY FOR!
Disadvantages: Most expensive of the three options, takes longer to complete treatment
Cost: $50,000 per jaw (so full mouth rehab with 8 dental implants in top jaw and 8 dental implant in lower jaw can cost over $100,000)
Time to completion: 5-6 months
Pain/Recovery: Minimal
So, these are your options. Remember NOT to shop around for best price. Meet as many surgeons as you need until you find the one you are MOST comfortable with and the one that has the best credentials. You can also ask to speak to previous patients who have had the treatment you are interested in and ask the patients any questions you may have until you are 100% comfortable to proceed. If you can’t afford to go ahead with any treatment right away, you are better off waiting and saving up rather then proceeding with an unqualified surgeon where you don’t feel right. Just wait, save and do it right the first time. There is an old saying “People who pay for quality only cry ONCE!. “
 

Treating gum disease is important because there are various complications which can arise throughout the body if this disease is left untreated. There is a strong relationship between gum disease and:
1. Low-weight pre-term babies
2. Diabetes
3. Heart disease and stroke
4. Alzheimer’s
5. Arthritis
6. Lung disease
By seeing a specialist in gum disease called a PERIODONTIST and getting treatment, you lower your risk of developing any of the above mentioned diseases in addition to helping keep your teeth for life. As well, by seeing a periodontist, you will be tested for other diseases which can manifest in the gums such as LEUKEMIA. Periodontists can check for oral cancer, such s MELANOMA, which can also show up on the gum tissues.
If you have bad breath, bleeding gums, loose or migrating teeth, call us today at 416-225-9910. Let us help you keep or improve your oral and overall health.