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PeriodontalSurgeryAllowsustoAccessDeepSurfacesforPlaqueRemoval

All treatments for periodontal (gum) disease focus on one goal — to remove any bacterial plaque and calculus (hardened plaque deposits) that are at the heart of the infection. Plaque is a thin surface film of food particles and bacteria that cause gum disease.

Plaque builds up on tooth surfaces due to inadequate oral hygiene. And as the disease progresses brushing and flossing won’t be enough — you’ll need our services and specialized equipment to fully remove the plaque and calculus. The basic technique is called scaling in which we remove plaque and calculus manually from tooth surfaces above and just a few millimeters below the gum line.

As the disease develops, though, the slight natural gap between teeth and gums may begin to increase to form voids known as periodontal pockets. Filled with infection, these pockets can extend below the gum line onto the roots of the tooth. If the pocket extends more than 4 millimeters, basic scaling may not be able to remove all of the plaque and calculus.

Periodontists (dentists who specialize in the treatment and care of gum tissues) can perform a surgical method to access these deeper areas. Known as flap surgery, this procedure aims not only to reach and disinfect periodontal pockets and root surfaces, but also repair damaged gum tissue and create a better environment for future hygiene and treatment.

As the name implies, we create an opening in the gum tissue with one side remaining attached to the gum structure — much like the flap of a paper envelope. Through this opening we’re able to reach areas to remove plaque and calculus, as well as install both bone grafts to regenerate lost bone and growth factors to stimulate tissue growth. Once finished, we stitch the flap back into place with sutures and, in many cases, place a moldable dressing to protect and hold the flap secure while the incision heals.

This relatively minor procedure can be performed with local anesthesia and requires only a few days of recuperation. The results, though, can provide long-term benefits — reduced infection, better bone and gum health, and a more conducive environment for future maintenance of health — that could save your teeth and your smile for many years to come.

If you would like more information on treatments for gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal Flap Surgery.”

FifthHarmonysCamilaCabelloChipsaToothbutConcertStillWorthIt

Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand. Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.

Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.

A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.

Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.

If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.

If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”

GoodBoneHealthEssentialforObtainingTeethinOneDayImplants

You've seen ads for “Teeth in One Day” that promise immediate implant placement at the same time you have the problem tooth removed. But this presumes the gums and underlying bone are healthy and able to support and protect the implant. If that's not the case, it may be ill-advised to place an implant on the same day.

Even with immediate placement, there will be a small degree of bone and gum opening or space around the implant after it's placed into the socket. This can often be remedied by placing a bone graft and sometimes a gum graft when we install the implant. It's also possible for natural healing to gradually fill in the space, but we'll need to monitor the site carefully for several weeks.

On the other hand, if we detect significant bone loss (or strongly suspect it will occur), immediate placement may not be an option — there's not enough bone or it's too weak to support an implant. In this case, it's necessary to wait on placement and focus on improving the bone health and quantity, beginning when we remove the old tooth and place a bone graft.

After completing the extraction, we typically place a bone graft in the empty socket. The graft will become a “scaffold” for new bone cells to grow upon. We may then allow about two to four months for new bone to partially replenish the area and then place the implant. The bone will continue to regenerate as it grows and attaches to the titanium implant to create a solid attachment.

If the site, however, still appears fragile even after partial bone growth, we may opt to wait another two to four months before attempting placement. From a long-term perspective, this is the best scenario for ensuring a durable foundation for the implant. It also allows for a socket severely compromised by disease to heal more thoroughly.

To determine which of these placement scenarios is best for you, we'll first need to conduct a thorough dental examination. From there we'll be in a better position to discuss the right implant timeline for your situation. Our main goal is to ensure we can securely place your implant in just the right position to achieve the most successful and attractive result.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implant Timelines for Replacing Missing Teeth.”

By Paul Schoenbaum, DDS
July 04, 2017
Category: Oral Health
AnyTimeAnyPlaceCamNewtonsGuidetoFlossing

When is the best time to floss your teeth: Morning? Bedtime? How about: whenever and wherever the moment feels right?

For Cam Newton, award-winning NFL quarterback for the Carolina Panthers, the answer is clearly the latter. During the third quarter of the 2016 season-opener between his team and the Denver Broncos, TV cameras focused on Newton as he sat on the bench. The 2015 MVP was clearly seen stretching a string of dental floss between his index fingers and taking care of some dental hygiene business… and thereby creating a minor storm on the internet.

Inappropriate? We don't think so. As dentists, we're always happy when someone comes along to remind people how important it is to floss. And when that person has a million-dollar smile like Cam Newton's — so much the better.

Of course, there has been a lot of discussion lately about flossing. News outlets have gleefully reported that there's a lack of hard evidence at present to show that flossing is effective. But we would like to point out that, as the saying goes, “Absence of evidence is not evidence of absence.” There are a number of reasons why health care organizations like the American Dental Association (ADA) still firmly recommend daily flossing. Here are a few:

  • It's well established that when plaque is allowed to build up on teeth, tooth decay and gum disease are bound to follow.
  • A tooth brush does a good job of cleaning most tooth surfaces, but it can't reach into spaces between teeth.
  • Cleaning between teeth (interdental cleaning) has been shown to remove plaque and food debris from these hard-to-reach spaces.
  • Dental floss isn't the only method for interdental cleaning… but it is recognized by dentists as the best way, and is an excellent method for doing this at home — or anywhere else!

Whether you use dental floss or another type of interdental cleaner is up to you. But the ADA stands by its recommendations for maintaining good oral health: Brush twice a day for two minutes with fluoride toothpaste; visit your dentist regularly for professional cleanings and checkups; and clean between teeth once a day with an interdental cleaner like floss. It doesn't matter if you do it in your own home, or on the sidelines of an NFL game… as long as you do it!

If you would like more information about flossing and oral hygiene, contact us or schedule an appointment for a consultation.

By Paul Schoenbaum, DDS
June 19, 2017
Category: Oral Health
3DentalSignsofanEatingDisorder

Sometimes dental conditions point to health problems beyond the teeth and gums. An astute dentist may even be able to discern that a person’s oral problems actually arise from issues with their emotional well-being.  In fact, a visit to the dentist could uncover the presence of two of the most prominent eating disorders, bulimia nervosa or anorexia nervosa.

Here are 3 signs dentists look for that may indicate an eating disorder.

Dental Erosion. Ninety percent of patients with bulimia and twenty percent with anorexia have some form of enamel erosion. This occurs because stomach acid — which can soften and erode enamel — enters the mouth during self-induced vomiting (purging), a prominent behavior with bulimics and somewhat with anorexics. This erosion looks different from other causes because the tongue rests against the back of the bottom teeth during vomiting, shielding them from much of the stomach acid. As a result, erosion is usually more severe on the upper front teeth, particularly on the tongue side and biting edges.

Enlarged Salivary Glands. A person induces vomiting during purging by using their fingers or other objects. This irritates soft tissues in the back of the throat like the salivary glands and causes them to swell. A dentist or hygienist may notice redness on the inside of the throat or puffiness on the outside of the face just below the ears.

Over-Aggressive Brushing. Bulimics are acutely aware of their appearance and often practice diligent hygiene habits. This includes brushing the teeth, especially after a purging episode. In doing so they may become too aggressive and, coupled with brushing right after purging when the minerals in enamel are softened, cause even greater erosion.

Uncovering a family member’s eating disorder can be stressful for all involved. In the long run, it’s best to seek out professional help and guidance — a good place to start is the National Eating Disorders Association (www.nationaleatingdisorders.org). While you’re seeking help, you can also minimize dental damage by encouraging the person to rinse with water (or a little baking soda) after purging to neutralize any acid in the mouth, as well as avoid brushing for an hour.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”





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