The first step in formulating any treatment plan is to gather data for a proper diagnosis. This requires us to complete a periodontal exam and review your radiographs (x-rays). Usually this can be done in about 30-45 minutes. An extra-oral and intra-oral exam will be conducted, including an oral cancer screening and intra-oral photographs. Reviewing your previous medical and dental history will also give us clues to help determine the best plan of action.
Close-up photographs of your mouth will help capture the state of your dentition, including fillings, position of your teeth, the color of your gums and more! Throughout treatment, we take photographs to document and share with you the progress of your care and see changes as they occur.
Your Friendly Dental Hygienist
Regular professional dental hygiene visits are an important part of maintaining your beautiful and healthy smile. No matter how often or how well you brush and floss, there will be small bits of food left behind. Only a hygienist can reach and remove those deep remaining deposits known as "calculus" or "tartar" (hardened calcium and food deposits) from under your gums.
During your hygiene appointment, the hygienist will perform a cleaning (also known as scaling and root-planing) and tooth polishing to remove debri, plaque and stain. The health of your gums will also be checked to determine the best preventive care maintenance plan. Bleeding or inflamed gums may indicate that you have gingivitis or periodontitis (bone loss around the teeth) which may require additional procedures such as osseous flap debridement.
Depending on the health of your gums and teeth, we may recommend that you have hygiene visits every 6 to 9 months, or more frequently at every 3 to 4 months. We may even ask you to alternate hygiene visits between your regular dentist and our office. Most importantly, your regular daily home care together with routine dental hygiene visits is the key to prevention of gum disease and dental decay.
Replacing single teeth with implants is the closest option we have to nature. It eliminates the need to prepare adjacent teeth, allows you to floss normally and transfers your biting pressure directly to the bone, just like a natural tooth.
If you are missing several adjacent teeth, implants can be placed either individually (separate teeth), joined together (splinted) or placed apart and bridged together. The choice will depend on individual factors related to your bite.
Removable over-dentures utilize 2 to 4 implants to help retain a partial or complete denture. Only a few implants can be life-changing, helping to improve comfort, stability and giving you the security you need to feel confident eating and smiling.
For denture-wearers who prefer never to remove their dentures again, fixed options are available using 4 to 6 implants. A denture-like prosthesis is made to anchor to these implants, which provide a strong and firm base comparable to natural teeth.
Thin receding gums can lead to further loss of support around teeth. Grafting procedures allow us to transform and strengthen the gum around your teeth, forming more resilient margins that improve stability.
Esthetic concerns may also be addressed with gingival grafting. Root surfaces can be covered with gum tissue to improve both the appearance and length of the teeth and cover areas that may be sensitive.
Gingival recontouring can be performed to idealize the symmetry, shape and length of the teeth prior to new crowns or veneers, helping to make your smile look as perfect as possible.
Although you may think of a periodontist as a "gum doctor", we are primarily concerned with the bone around your teeth. Without bone support, your teeth loosen and fall out. There are numerous situations where your gum treatment would require modification to the bone around your teeth (either addition or removal) to optimize the health and long-term maintenance of the area. The following procedures involve some hard-tissue (bone) modification:
Osseous flap surgery is a procedure that we use to alter the contours of the gum tissue and bone surrounding your teeth. During the procedure, we access areas that cannot normally be cleaned during your regular hygiene visits. This helps us remove tough to reach deposits (calculus or tartar) that irritate your gums and bone. We are able to minimize gum pockets, improve access for hygiene maintenance and help reduce the inflammation that can cause future bone loss. Irregularities in the bone are usually smoothened out and flattened, resulting in gum tissue that is tighter around your teeth but resulting in more tooth exposure. In some cases, areas of irregular bone can receive bone grafting to try and regrow the lost bone in a process known as guided tissue regeneration.
When teeth are removed, your body will naturally begin to resorb (shrink away) the bone in the area. This may result in bone that is too thin to allow adequate support for implants. Socket bone grafting is a procedure that adds bone directly at the time of tooth removal to help minimize bone resorption. The best time to bone graft is before the bone is lost in the first place, at the time of the tooth extraction. However, if teeth are already missing and the ridge has already resorbed, a ridge bone grafting procedure can allow us to regain some of the thickness to allow implants to be placed.
The nasal sinuses are large air-filled chambers located above the back teeth (within the bone of your upper jaws) that connect with your nasal passages. These spaces may enlarge as we age and reduce the amount of bone height available above the back upper teeth. In these cases, if you lose upper back teeth and wish to place implants, there may not be enough bone available. A sinus bone graft procedure allows us to add additional bone to the sinus and regain enough bone height to place implants.
A tooth may require a filling or crown that extends close to or beneath the gum-line. Your dentist may ask us to expose more of the tooth to allow them to properly access below the gum to repair it. When we expose your tooth, we make the top of the tooth longer (the part visible in your mouth). In functional crown-lengthening, we expose your tooth primarily to allow optimal access and repair for restorative procedures (fillings, crowns). When teeth need to be lengthened for cosmetic reasons, if it involves bone removal as well, it is called esthetic crown-lengthening. If only soft-tissue (gum) needs to be removed, it is known as an esthetic gingivectomy.
Periodontal disease destroys the bone around your teeth in an irregular pattern (bone loss defects). This results in spots where deeper gum pockets trap food, create more inflammation, and feed a vicious-circle of irreversible destruction, ultimately ending with loss of teeth. Usually we manage this with an osseous flap surgery procedure, used to access the bone around your teeth in order to clean and smoothen the irregularities and tighten the gums. Sometimes during this procedure we encounter a bone loss pattern that allows the possibility of repair to the bone. Using the same principles as for when we perform socket/ridge bone grafting, we can try to regenerate bone in these defects, ideally restoring what was lost by disease.
Your dental health can be impacted by general health issues and the environment. The most common factors we see that affect periodontal disease include diabetes, smoking, hormonal changes (puberty, pregnancy), certain medications, dry mouth and auto-immune conditions. Genetic factors also make a big impact on your overall susceptibility to periodontal disease.
We try to identify and work with you to reduce the impact of these other factors to improve treatment outcomes and minimize further progression of disease.
We are pleased to help you in the case of a dental emergency. Whether you are experiencing dental pain, have broken a tooth or have a sore mouth, our office can see you for an assessment and emergency treatment. Please feel free to call us and we will try to schedule an appointment within a short time frame. Depending on the type of emergency, we may even be able to provide advice over the phone to help you in the meantime.
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