All about gum disease

Gum disease -- also known as periodontal disease -- is an infection of the tissues that surround and support your teeth.  Periodontal disease is caused by plaque, the sticky bacterial film that constantly forms on the tooth surface.  Because gum disease is usually painless, it often goes unnoticed and therefore untreated.  There is extensive ongoing research regarding the link between periodontal disease and systemic diseases such as diabetes and heart disease, and it has long been a well known fact that the mouth is a window into the body; many systemic diseases such as diabetes, Sjogren's Syndrome, and HIV first become apparent in the mouth.

In its advanced form, gum disease is referred to as periodontitis which causes rapid loss of tissue and bone surrounding the teeth and eventually leads to tooth loss.  Chronic periodontitis is the most common form of gum disease and can occur at any age, affecting over 45% of adults over the age of 30 in the US.

Some warning signs of periodontal disease include:

• Red, swollen, and tender gums that easily bleed
• Loose or "flapping" gums that have pulled away from the teeth
• Persistent bad breath or bad taste
• Loosening or separation of the teeth

Risk factors for the development of gum disease include:

• Poor oral hygiene
• Genetics
• Smoking
• Pregnancy
• Crowded teeth that are difficult to clean and floss
• Diabetes
• Medications including steroids, some calcium channel blocks, and oral contraceptives

It is possible to have gum disease with no warning signs, so regular dental check-ups and periodontal examinations are very important.  In its early stages, gingivitis can be reversed and usually eliminated with a professional dental cleaning followed by a diligent oral hygiene regimen.  Treatment for advanced periodontal disease depends on the level of progression, and can range of non-surgical treatments such as Laser Assisted Periodontal Therapy, to periodontal surgery.  

The good news is that periodontal disease is generally avoidable, and in most cases treatable with good oral hygiene and regular dental visits.

What is Laser Tooth Whitening?

Tooth whitening is the most requested cosmetic dental procedure in the US and our NYC patients are no exception -- especially around the holidays! When selecting a whitening system for our patients, as with everything else in our practice we spent the time, did our research and found the very best -- exceptional results in the least amount of time with the least amount of discomfort.  We proudly offer a laser whitening system that is an easy choice to brighten the smiles of our patients.

Any of our patients (and staff members) who have tried our laser whitening system have loved it, even the skeptics who had experienced sensitivity with other systems and swore they would never whiten their teeth again.  We invite you to give it a try; we promise you'll be pleased!

Below are some of the benefits of laser whitening as compared to other popular systems such as Zoom:

• A proprietary hydrogen peroxide-based gel is applied to the teeth which contains a pigment that is activated by the laser, and absorbs the laser's energy, allowing for the amount of energy to be adjusted, thus substantially decreasing and in most cases completely eliminating post-whitening sensitivity aka "zingers"
• No prolonged exposure to UV light -- the laser is directed only at the gel for a total of 6 minutes (in 2 minute increments), as opposed to a minimum of 45 minutes of UV light exposure with other systems
• The whitening procedure can be completed in just 20 minutes, a HUGE time saver as compared to systems such as Zoom which require at least a full hour and usually more
• Results are noticeable immediately after the procedure, and there is no "waiting time" to allow for the whitening gel to work

Do you need to have your wisdom teeth removed?

Many of us have had our wisdom teeth removed, usually in our late teens or early twenties, but not necessarily everyone needs them out.  While dentists often have varying opinions on wisdom tooth extraction, we like to take the most conservative approach, which is to say if it's not broken (or unhealthy), don't fix it!  Here are some general guidelines to help make an educated decision about when wisdom teeth should be extracted:

DO consult a dentist about extracting your wisdom teeth if:

• You are experiencing chronic pain in the area of your wisdom teeth
• You have a sensation of a bad taste/breath coming from the area of your wisdom teeth
• Pus, swollen gums, or ulcers on your cheek exist around a wisdom tooth
• You have pain or difficulty opening your mouth
• You have an earache or swollen glands

Your dentist may advise NOT to remove your wisdom teeth if they are:

• Healthy and cavity-free
• Grown in completely, meaning there was enough space for them in your jaw and they are not pushing against the teeth in front of them
• Positioned correctly and able to come together properly with their opposing teeth
• Properly cleanable as a part of your daily oral hygiene routine, meaning you can brush and floss all the way back there

When in doubt, always consult your dentist because if left untreated, infected wisdom teeth can become a serious and painful problem, sometimes needing emergency extraction.

Bad breath...and what to do about it

Oh halitosis...we've all had to deal with bad breath at some point. Your mouth is far from sterile, with over 700 different strains of bacteria having been detected in the oral cavity, though thankfully most of us only host a fraction of them!  Many factors such as diet and oral hygiene affect breath, but in the end your breath is largely dependent on the specific variety of bacteria that reside in your mouth.  The anaerobic bacteria in the mouth excrete volatile sulfur compounds that are responsible for the rotten sulfuric odor.  The more anaerobic bacteria you have, the more likely you are to suffer from halitosis.  Therefore for some patients, even with a strict oral hygiene regimen it's difficult to keep the bacteria under control.  If this is the case, an antimicrobial mouthrinse can be prescribed for you which can help tremendously.

You breathe [out] what you eat, and high protein foods as well as foods and drinks that are acidic such as coffee tend to worsen your breath.  In contrast, green tea is a natural fighter of halitosis due to its antibacterial properties.  Of course, oral hygiene is incredibly important and brushing and flossing at least 2x/day is recommended.  Also, brushing the tongue is key since it's a prime location for bacteria to settle in. 

In some cases, chronic halitosis can have systemic causes.  Sinus infections, diabetes, liver and kidney disease, and certain cancers can all cause chronic bad breath.  Like any other chronic condition, chronic halitosis should not be ignored as it can be a symptom of a larger whole-body problem.

Which toothbrush is best?

One of the most common questions patients ask is what kind of toothbrush we recommend, manual or electric?  The truth is, it's really not the toothbrush that does the cleaning, it's the brushing technique. Though electric toothbrushes can be helpful in instances such as arthritis in the hand, arm, or shoulder, a manual toothbrush can do the job equally well.  

Whether your preference is electric or manual, here are a few tips on how to get your pearly whites the cleanest they can be:

• Always choose a soft-bristled brush; medium or hard bristles may damage your gums.
• Brush at least 2x a day, 3x if you can.
• Brush for approximately 2 minutes.
• Don't push too hard! Use a gentle touch.
• Angle your toothbrush bristles at 45 degrees to your gums, and make short up and down strokes such that you lightly feel the bristles at your gumline, and sweep over your teeth.
• Brush outer and inner tooth surfaces; if you have trouble reaching those back teeth, try closing your mouth a little, this will allow some space for the toothbrush to get between your cheeks and teeth.
• Pay attention to your toothpaste, many whitening or tartar control products are abrasive and can wear away tooth enamel over time.

When a toothache is not a toothache...

Especially during Winter months, we often have emergency patients who visit us complaining of a sudden onset of pain in their upper teeth.  It's almost always on one side, and they usually can't pinpoint which tooth is hurting, but are convinced that something is terribly wrong.  Though sometimes a tooth is indeed the culprit, sinus infections can oftentimes be mistaken for toothaches, as they present with similar symptoms.  Below are a few tips to help distinguish between the two: 

Symptoms common to both:

• Generalized pain and throbbing of upper teeth
• Pain when chewing
• Pain when lying on your back

Symptoms more unique to toothaches:

• Lingering sharp pain to cold/sweet/chewing
• Spontaneous pain that wakes you up at night
• Pain that can be localized to a single tooth
• Visible facial swelling, or swelling of the gums above a single tooth

Symptoms more unique to sinus infections:

• Pain is more dull and feels like severe pressure
• Leaning forward increases the pain/sense of pressure
• Jumping (especially when landing) causes severe pain
• Pain behind eyes and around temples

In rare cases, due to the proximity of the upper teeth to the maxillary sinuses, an abscessed tooth may only present with sinus infection-type symptoms.  If you've had relapses of sinus infections in a short timespan and have been treated by a physician, it might not be your sinuses -- your tooth may be the actual culprit, so make an appointment with your dentist!