Dental Disease And Ridge Augmentation
Whether a tooth has been lost to periodontal disease, tooth decay, or trauma, one may be left with a cleft, an indentation, or uneven gum margins. This happens because after a tooth is removed, the bone that was encasing it disintegrates and the gum around it collapses. If this occurs in the front of the mouth, it can result in an esthetic problem. No matter how well designed the replacement teeth are, they may appear to be too long and unattractive. To have a pleasing smile, the shape, color, and texture of the gums is just as important as that of the teeth they frame.
Ridge augmentation is a cosmetic periodontal procedure that may include gum and/or bone grafting. A dentist will determine which option is better suited to a patient's esthetic needs. Regardless of what treatment method a dentist chooses, ridge augmentation is a very predictable procedure with long-lasting results.
What to Expect from Periodontal Ridge Augmentation
Ridge augmentation is a surgical procedure that is done in the dentist's office with local anesthesia (lidocaine). Stitches (sutures) are placed to aid in healing. Post-surgical discomfort can last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after oral surgery. The dentist will provide special instructions related to diet, exercise and medications.
To ensure more esthetic results, ridge augmentation procedures should always be done before new crowns are made. Although a temporary (provisional) tooth replacement can be made at the time of tooth loss, the final restoration should not be fabricated until after six to eight weeks of gum healing.
Alternatives periodontal treatments
It is possible to help prevent collapse of the gum tissue by doing a bone grafting procedure or by placing an implant at the time of extraction. Although sometimes it may still be necessary to do further periodontal plastic surgery procedures, these treatments can help maintain the space that was previously occupied by the tooth and prevent bone loss. If this was not feasible, ridge augmentation can be done to improve esthetics after tooth extraction.
Ridge augmentation should be considered as part of an individual's cosmetic dentistry options when there are uneven gum contours, clefts, or indentations on the gums. The most beautiful teeth will not look natural if the gum surrounding them is not cosmetically pleasing. Talk to a dentist about esthetic concerns and the possibility of incorporating cosmetic periodontal procedures as part of a "smile lift."
By Laura Minsk, DMD
Smoking and Gum Disease
The systemic risks of tobacco use are well known. Tobacco use can increase the risk for cancer, lung disease, and heart disease. But whether you smoke, dip, or chew tobacco, it also affects the oral cavity in a variety of ways. It contributes to oral cancer, stains the teeth, and contributes to tartar deposits, bad breath, and a loss of taste and smell.
Tobacco use causes inflammation of the soft tissues of the mouth, ulcers, recession, and other oral lesions. Tobacco users are two times more likely to develop periodontitis, and ten times more likely to develop acute necrotizing ulcerative gingivitis (ANUG). They also are more likely to lose teeth than those who don't smoke. Smoking is the number one most significant risk factor in the development and progression of periodontal disease.
Tobacco smoking causes periodontal bone loss that is not related to the amount of gum inflammation or plaque accumulation. Although the periodontal disease may be advanced, the classical signs of gum inflammation (redness, bleeding gums, etc.) are not usually as evident in tobacco smokers. Thus, prevention and early detection are more difficult.
Tobacco smoking has a direct effect on the oral tissues and it can alter the immune response. Although smokers do benefit from periodontal treatment, the healing is often delayed and the results are less predictable. In addition, the success rates of periodontal and implant treatment are reduced in people who use tobacco products. The amount of complications is related to the amount of daily tobacco exposure, and the number of years the person has been exposed.
The use of tobacco products can increase the risk of periodontal disease:
1. It weakens the immune system: Tobacco products suppress the body's ability to fight infection. Carbon monoxide (a major byproduct of cigarette smoke) reduces oxygen concentration and inhibits the movement of white blood cells. This reduces the capacity of the white blood cells to fight bacteria (including the bacteria that cause periodontal disease), and delays healing.
2. It masks signs of infection: Tobacco reduces the ability of blood vessels to carry infection fighting cells, nutrients, and oxygen to the tissues. As a result, the typical signs of periodontal disease (redness, swelling, and bleeding of the gums) are masked. People who smoke may have periodontal disease that is harder to diagnose.
3. It increases calculus formation: Smoking can cause more calculus (tartar) accumulation that if not removed promptly can lead to more plaque build-up and periodontal disease.
4. It reduces healing: Nicotine and other chemicals can be absorbed directly by the root surfaces of the teeth and reduce the ability of cells to reattach to the root surface during healing.
Besides the obvious health benefits of discontinuing tobacco use, quitting can also reduce the risk of oral cancer and the detrimental effects of tobacco on the gums and bone that support the teeth. In addition, another incentive to stop smoking is that former smokers respond similarly to never smokers to periodontal treatment.
Because there is a physical and psychological addiction to tobacco, quitting can be very difficult. But millions of Americans quit smoking every year. There are aids available that reduce the craving for tobacco. These include the use of systemic medications, the nicotine patch, the nicotine gum, the nicotine inhaler, and the nasal spray. See your dentist or physician for aid in stopping tobacco use.
By Laura Minsk, DMD