Posts for: October, 2013

By Dr. Manson
October 30, 2013
Category: Oral Health
FiveFactsaboutGumDisease

The ailment we commonly called gum disease is actually series of related diseases, all of which involve the tissues that surround the teeth. It's sometimes thought of as a “silent” malady, because its symptoms — bad breath, soreness, or bleeding of the gums — may be masked by other conditions. Or, they may simply be disregarded.

But don't ignore these symptoms! Left untreated, periodontitis can have serious health consequences. Here are five things you should know about this disease.

Gum disease is a chronic inflammatory disease.

That means it's a disease related to a natural response of the body's immune system (inflammation), and it develops over time (chronic). Gingivitis, an inflammation of the gums, may be the first step in the disease's progression. Left untreated, it can be followed by destruction of the periodontal ligament (which helps hold the tooth in place), loss of the supporting bone, and ultimately tooth loss. But it doesn't stop there.

The effects of gum disease aren't confined to the mouth.

In fact, recent research has suggested a connection between periodontal disease and chronic diseases in the whole body. There is evidence that severe periodontal disease is linked to an increased risk of cardiovascular diseases (like heart attack and stroke), pregnancy complications, and other conditions. It is also believed to have an adverse effect on blood-sugar control in diabetics.

Gum disease is caused by the bacteria in dental plaque.

Oral bacteria tend to build up in a colony of living organisms called a biofilm. Of the many types of bacteria that live in the mouth, only a relatively few are harmful. When oral biofilms are not regularly disturbed by brushing and flossing, the disease-causing types tend to predominate. Once it gains a foothold, treating gum disease can become more difficult.

Prevention is the best defense.

Good personal oral hygiene, carried out on a daily basis, is probably the best defense against many forms of periodontal disease. Proper brushing and flossing is effective in disrupting the growth of dental plaques. Lifestyle changes — like quitting smoking and reducing stress — are also associated with lessening your chance of developing the disease. Genetics also seems to play a part, so those with a family history of periodontitis should pay special attention to preventive measures.

Prompt, effective treatment is critical.

Bleeding of the gums is never a normal occurrence. But sometimes this (and other symptoms of gum disease) may be overlooked. During routine dental checkups, we can detect the early signs of periodontal disease. We can then recommend an appropriate treatment, from routine scaling and root planing (a cleaning of the teeth) to other therapies. So, besides brushing and flossing regularly, don't neglect regular examinations — they're the best way to stop this disease before it becomes more serious.

If you have concerns about gum disease, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Understanding Gum (Periodontal) Disease” and “Warning Signs of Periodontal (Gum) Disease.”


ToothPainDuringPressureChangesCouldBeWarningofaBiggerProblem

People who fly or scuba dive know firsthand how changes in atmospheric pressure can affect the body: as minor as a popping in the ears, or as life-threatening as decompression sickness. Pressure changes can also cause pain and discomfort in your teeth and sinuses — in fact, severe pain could be a sign of a bigger problem.

Barotrauma (baro – “pressure;” trauma – “injury”), also known as a “squeeze,” occurs when the unequal air pressures outside and inside the body attempt to equalize. Many of the body's organs and structures are filled with air within rigid walls; the force created by equalization presses against these walls and associated nerves, which in turn causes the pain.

The sinus cavities and the middle ear spaces are especially sensitive. Each of these has small openings that help with pressure equalization. However, they can become swollen or blocked with mucous (as when you have a head cold), which slows equalization and contributes to the pain.

It's also possible to experience tooth pain during pressure change. This is because the back teeth in the upper jaw share the same nerve pathways as the upper jaw sinuses — pain originating from the sinuses can be felt in the teeth, and vice-versa. In fact, it's because of this shared pathway that pressure changes can amplify pain from a tooth with a deeper problem, such as a crack, fracture or a defect in dental work.

Besides problems with your teeth, the severe pain could also be related to temporo-mandibular joint dysfunction (TMD), which is pain or discomfort in the small joint that connects your lower jaw to your skull. There are a number of causes for this, but a common one for scuba divers is an ill-fitted regulator mouthpiece that they are biting down on too hard while diving. A custom-fitted mouthpiece could help alleviate the problem.

If you've been experiencing tooth pain during pressure change events, you should see us for an examination before you fly or dive again. There might be more to your pain — and correcting these underlying problems could save you extreme discomfort in the future.

If you would like more information on the effects of atmospheric pressure changes on teeth, 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 “Pressure Changes Can Cause Tooth & Sinus Pain.”


By Dr. Manson
October 14, 2013
Category: Oral Health
Tags: dental injuries  
GivingaKnockedOutToothaSecondChance

It can happen in an instant — your child takes a hard hit to the mouth while playing football, basketball or some other contact sport. Suddenly, he or she faces the severest of dental injuries: a knocked out tooth.

There's both good and bad news about this situation. First, the good news: the knocked out tooth can be reinserted into its socket and take root again. The bad news, though, is that the tooth has only the slimmest of chances for long-term survival — and those chances diminish drastically if the reinsertion doesn't take place within the first five minutes of the injury.

Outside of the five-minute window, it's almost inevitable that the tooth root won't reattach properly with the tiny fibers of the periodontal ligament, the sling-like tissue that normally holds the tooth in place to the jawbone. Instead, the root may fuse directly with the bone rather than via the ligament, forming what is called ankylosis. This will ultimately cause the root to melt away, a process known as resorption, and result in loss of the tooth.

Of course, the resorption process will vary with each individual — for some, tooth loss may occur in just a few years, while for others the process could linger for decades. The best estimate would be four to seven years, but only if the tooth receives a root canal treatment to remove any dead tissue from the tooth pulp and seal it from possible infection. Over time the tooth may darken significantly and require whitening treatment. Because the tooth may be fused directly to the jawbone it can't grow normally as its neighbor teeth will and thus may appear uneven in the smile line. From a cosmetic point of view, it may be best at that time to remove the tooth and replace it with an implant or other cosmetic solution.

In many ways the longevity of the tooth post-injury really depends on time — the time it takes to reinsert the knocked out tooth into its socket. The quicker you take action, the better the chances the tooth will survive.

If you would like more information on treating a knocked out tooth, 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 “Knocked Out Tooth: How Long Will a Tooth Last After Replantation?


ThreeReasonstoStraightenyourTeeth

If you've lived for many years with crooked teeth, you may think that your teeth will be this way forever. Believe it or not, one out of every five orthodontic patients is an adult and 75% of adults have some form of malocclusion. You're never too old to improve your smile, and here a few reasons why you should consider orthodontic treatment:

  • Self-Esteem: An attractive smile contributes to your confidence and self-image, and this is important at any age. Research has shown that, logically, the better you feel about your looks, the better you feel about yourself. You might not realize it, but those crooked teeth can cause you to be self-conscious, thus smiling and talking less. Studies have even demonstrated that orthodontic treatments can enhance your career opportunities.
  • Longevity: Though you can always expect a certain amount of wear and tear to your teeth from aging, properly aligned teeth will function better over time. If you are prone to gum disease, your problems can worsen with poorly aligned teeth. Not only is it more difficult to clean around crooked teeth, but we often see gum recession around poorly positioned or crowded teeth.
  • Options: If you choose to explore orthodontic treatment, you will see that much has changed since you were a teenager. Instead of traditional metal braces, we can sometimes use clear or colorless braces that are less noticeable. Some braces can even be attached to the back of your teeth. You may also be a candidate for clear orthodontic aligners, which use a sequence of clear, removable and custom-fitted trays to gradually straighten your teeth.

If you're considering orthodontic treatment, you should schedule an appointment with our office, so that we can conduct a thorough examination, discuss your options and recommend a course of treatment. We'll also make sure that your teeth and gums are healthy, an important requirement to successfully straighten your teeth.

If you would like more information about adult orthodontics, please contact us for a consultation. You can also learn more by reading the Dear Doctor magazine article “Orthodontics for the Older Adult.”


RootPlaningRemovesDangerousPlaqueandTartarYourToothBrushCant

While periodontal disease can take on a variety of forms, most are caused by a thin layer of bacterial plaque called biofilm. This layer of plaque will form every 8-12 hours and sticks like glue to your teeth near the gum line. With time, tartar formation occurs at and below the gum line.

If left unchecked, biofilm can give rise to a very unhealthy progression. It first triggers an infection that leads to painful inflammation, progressive bone loss and the gum tissue losing attachment with a tooth. Void spaces (or pockets) form where the gum and bone tissue once adhered; infectious plaque and tartar moves into these pockets and advances deeper to the root. Overcome by disease, the tooth is in danger of being lost.

It's imperative then to remove as much of this entrenched plaque and tartar as possible. Renewed oral hygiene is not enough — removing plaque and tartar from the root surfaces requires a treatment known as root planing.

Root planing is a meticulous, labor-intensive process. We first clear away larger portions of plaque around the teeth and gums with hand instruments or an ultrasonic device and then flush out the pockets with water. After administering a local anesthetic for pain, we would then turn to a number of small hand instruments known as curettes to probe and scrape away as much remaining plaque below the gum line as we can get to.

Root planing requires experience and a good sense of touch to work in areas that can't be clearly seen. Observing the gum line, though, can give us a good indication of progress as these tissues will actually change color once the biofilm and tartar deposits have been removed.

Being so deeply entrenched, not all the deposits might be removed during one session. However, as plaque and tartar are removed, the gum tissues will begin to heal and become less inflamed. This will make it easier to remove plaque in subsequent sessions.

Root planing takes time, but the effort is well worth it. In the short term you'll notice less inflammation and pain around your teeth and gums. In the long-term, it just may save your teeth.

If you would like more information on root planing and periodontal 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 “Root Planing.”




Contact Us

Steven B. Manson, DDS, FAGD

Long Island City, NY General Dentist
36-01 31st Street
Astoria, NY 11106
(718) 729-8383
Manhattan, NY General Dentist
136 East 57th Street
         Suite 1604
New York, NY 10022