Steven R. Uretsky, DMD
Scaling and Root Planing
When periodontal disease is diagnosed early this nonsurgical therapy can by the only treatment you need. This involves the removal of plaque and tarter from the teeth and slightly below the gum line. The objective is to smooth the root surfaces so the gums can heal and reattach to the teeth without the underlying bacteria.
Pocket Reduction Therapy
In progressive gum disease a pocket forms between the teeth and gum collar. The pocket and bacteria then advances under the gum tissue to damage the supporting tissues resulting in bone loss. If this goes too far the teeth will need extracted.
To prevent further damage the pocket must be eliminated. This is done by removing the existing tarter and treating the underlying supporting areas. The outcome is that the gums will then be secure around the teeth. After our therapy, when you place a toothbrush and floss it will actually to remove the bacterial plaque giving you healthy non-bleeding gums and fresh breathe.
This is a necessary procedure when gums have pulled away from teeth, causing deep pockets. It is usually performed before gum disease can progress and damage the underlying supporting bone. I often do this in coordination with an orthodontist allowing the teeth to be moved into their final position as well as enhancing a smile.
This procedure is done with Novocain and involves reshaping loose, and diseased gum tissue around the teeth. After healing aesthetic results can be dramatic.
Normally the frenum blends into the gum tissue well above the level of the teeth. There are times however where the frenum is attached between the two upper or lower front incisor teeth.
For children the frenum can also be attached in such a way that the baby teeth can not erupt into the mouth. If this is the case, then you will notice the abnormal frenum sooner. A high frenum can also impede speech. For the orthodontic patient a higher frenum can also prevent the completion of therapy as the spaces can not be closed.
For adults high attached frenum can be subject to food trauma. This is usually evident with sharp edged chips or hard crusts. A frenectomy alleviates this constant and often painful trauma.
A frenectomy is a quick surgical procedure using Novocain that removes or loosens this band of muscle tissue.
The typical things my patients notice are a wish to enhance their smile by covering one or more of the roots that now look long as well as cringing because the exposed roots are sensitive to hot or cold liquids. Patients have also mentioned their dentist or orthodontist is noticing more root cavities at their visits.
Gums can receded for a variety of possible reasons , including aggressive tooth brushing, gum disease, lip piercings to name a few. An orthodontist may notice recession a result of how your teeth erupted into you jaw making thin tissue susceptible to trauma. I will identify these causes so once the recession is fixed you will be aware and be able to prevent the recurrence of the problem.
In a healthy mouth, teeth are surrounded by two types of tissue. Gingiva (gum) tissue is light pink and thick. This tissue forms a tight seal around the teeth and makes a barrier against the bacteria that can penetrate to the bone. This tissue is important because it prevents trauma from food when eating, brushing and cavities. The second is mucosa which is the reddish tissue. It does not seal tightly and is easily penetrable to bacteria.
When recession occurs, the body has no natural defense against the bacterial penetration and trauma. Advanced recession can often result in root sensitivity, poor appearance (long tooth look), root decay and root gouging.
A gingival graft solves these problems. A thin piece of tissue is taken from the roof of the mouth and transplanted to the affected area to act as the needed barrier. In other cases a donated tissue called an Allograft can be utilized providing the same results. I will discuss which is a better option for you.
This is a comfortable procedure that utilizes local anesthetic (the Novocain you would get for fillings) and takes 30 to 60 minutes.
The gingival graft is lasting and predictable resulting in a stable and esthetically healthy band of attached tissue.
When teeth are decayed or broken below the gum line the options are few, either extract the tooth or do this elongation procedure. As the name suggests, I use Novocain and adjust the gum and bone levels to expose more of the tooth surface so the dentist can see the cavity or broken tooth and restore it with a cosmetic filling or a crown.