Periodontal Probing

Periodontal probing is the measurement of the gum pockets for evaluating the periodontal disease status.  It is done with a periodontal probe which is a instrument with depth marking and it is inserted into the gum pocket to measure its depth.  The depth of the gum pocket corresponds to the loss of attachment of the gum tissue to the surface of tooth.  It indicates the periodontal disease status.

 

The loss of attachment occurs when there is inflammation of the gum tissue.  When there is a bone loss around a tooth, the periodontal probing can also indicate the amount of bone loss.  The amount of bone loss can also be confirmed by the bitewing radiographs.

For new patient who comes in for comprehensive exam, I would establish a baseline periodontal probing measurement and record those measurements in patient’s chart.  Each tooth is probed at six different site.  Three on the facial side of the tooth; another three on the lingual side of the tooth.  The recorded gum pocket depths are written on the periodontal chart.  The following is a periodontal chart:

Periodontal disease, gum treatment

Periodontal disease, gum treatment

 

The patient has only one missing teeth.  The teeth are numbered from 1 to 32.   There are three dates on the chart.  The initial baseline measurements show probing depth ranging from 1 to 5 mm.  Depth from 1 to 3mm is considered normal depth for typically healthy gum tissue.  Depth from 4 to 5 mm indicates some incipient periodontal problem.  From the initial measurements, it shows that the patient used to have incipient stage of periodontal disease.  Thus I perform the periodontal treatment called Scaling and Root Planing.

 

Then patient would come in for periodontal maintenace once every 3 months.  Subsequent visits I re-measure the gum pockets and the patient shows significant improvement in the health of gum tissue.  There are reduction of pocket depths.  In the most recent visit, patient has almost all of his teeth return to normal range.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Baby Bottle Syndrome

Nursing Bottle syndromeTooth decay in children and infants are often referred to as Baby Bottle Syndrome. It happens when sweetened liquid (such as juice, milk, and pacifiers dip into the sweetener) clings onto the teeth for prolonged period of time and bacteria lived off from these sugar and secrete acidic metabolic  byproducts that damage the tooth structure.

Many parents would allow the baby to sleep with the bottle of milk or juice.  Also, they would give the child pacifiers dip into sugar water.  These would promote tooth decay because during sleep, the salivary flow would decrease and there is not enough saliva to wash away these sugar from the teeth.

Baby teeth are important because they are needed to chew food for proper nutrition.  Also, they are important for speaking and smiling.  The baby teeth are there to serve as placeholders for adult teeth when the adult teeth starts to come in.  Without these baby teeth, the adult teeth would come in improper position and the adult teeth become crooked.  Decayed or damage teeth can affect development of speech learning.  Decayed teeth can also become painful.

There are many methods to avoid baby bottle syndrome:

1.  Use and teach proper oral hygiene to child. Use dampened cloth to wipe the baby teeth after ingestion of food, milk or sweetened liquids.

2.  Floss the baby teeth

3.  Clean and massage the gum area.

4.  Make sure your child has proper fluoride exposure such as fluoridated drinking water, fluoride-containing toothpaste, etc.  Also go to the dentist for checkup and to give your child fluoride treatment on teeth.

5.  Don’t let your child to sleep with bottle of milk or sweetened liquids.

6.  Don’t dip pacifiers into sugar water.

 

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Does “Root Canal” Hurt?

The short answer to the question “Does Root Canal Therapy Hurt” is absolutely No.  The procedure itself should not hurt if performed under anesthesia.  The patient may not be able to get numb for the procedure because of bacteria secreting toxins that changes the chemistry in the tissue that prevent the proper action from the anesthetics.

For a longer answer, we can look into what kind of discomfort might be experienced by the patient and the cause of those discomfort.  My goal of this article is to educate the public about this common dental emergency procedure and to help people to cope with the fear of going to the dentist.

There are two major sources of discomfort experienced by the patient during the root canal therapy procedure.  One kind of discomfort is of nervous origin.  It can be the pain/discomfort from not having enough anesthesia.  Another kind of discomfort comes from the physical distress from undergoing the procedure, such as from opening the jaw for an extended time, stretching of the cheek and retracting of the tongue.

The nervous pain is due to the problem of patient not being able to get enough anesthesia from the injected anesthetics.  There are many possibilities of why patient cannot get numb.  It can be due to the anesthetics not penetrating to the location where the nerve is located or there is not enough anesthetics to sufficiently numb the nerve.  This usually can be easily corrected by letting the dentist to readjust the site of injection so that the anesthetics can get to the right place or, if there is not enough anesthetics, dentist can give additional anesthetics to the area.  However, there are times that the patient might still not be able to get numb even after the dentist does the necessary steps of injecting the anesthetics.  The chemistry of the body tissue might have changed due to the presence of bacteria when the patient is having dental infection.  Sometimes the infection might affect only one smallest part of the nerve within the tooth and the dentist won’t be able to find out until the tooth has been worked on in the middle of the treatment.  Most of the time, the tooth can be anesthetized if the dentist administers additional anesthetics, but in some rare instances if the patient still cannot get numb, the dentist might tell the patient to come back after a week of taking the antibiotics.

During the root canal therapy procedure, the patient might have physical distress from the technical aspect of the procedure.  The patient’s jaw might get tired from opening wide for extended time.  Or patient might have discomfort from having the cheek stretched.  Most of this is due to the technical aspect of the root canal therapy.  The patient might need to open for extended time because root canal therapy consists of multiple steps which requires the most concentration from the dentist and it takes time to thorough treat the infection within the infected nerve canal in the tooth.  Sometimes if the patient cannot open wide enough, it might add difficulty for the dentist to be able to see and reach the nerve canals in the tooth.  And also, sometimes the patient would express their distress in their body movement.  So even though we cannot change the technical aspect of the procedure and we cannot change how wide the patient can open their mouth, we can educate patient about the procedure and let them more tolerable to the procedure.  A calm patient will definitely contribute to the outcome of the root canal therapy.

In summary, the root canal therapy is not a painful procedure.  Under proper anesthesia and proper physical coping, the patient should have a pleasant experience of undergoing the dental procedure.  The fear of going to the dentist is due to the lack of understanding of the dental problems and the dental procedures.  I hope people to find that the root canal therapy is not “scary” so they can get the necessary dental treatment to save their teeth.

 

Written by Daniel Tee, DDS, MS

Practicing Emergency Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Oral Health Affects Systemic Health

Proper oral hygiene does not only prevent cavities; proper oral hygiene can benefit your overall systemic health.

Research shows that oral health is closely related to the systemic health.  For example, periodontitis affects other vital organs in the body and contributes to diseases, like the cardiovascular disease, diabetes, breathing problems, osteoporosis, arthritis, etc.  From a research conducted by University of North Caroline, researchers show that patients with periodontitis are more likely to die from heart attack than those patients without periodontitis.  Also, the patients with periodontitis would be more likely to die from stroke than those patients without periodontitis.

Periodontitis is one of the most common infection in the world.  Our mouth is a entry way for bacteria.  Bacteria in the mouth can cause infection to the gum.  They can also travel through the blood stream and infect other vital organs, such as the heart, in the body.

Periodontitis can affect the diabetes status.  With proper treatment of periodontitis, it can help decrease the diabetic index.

For good overall heatlh, oral hygiene plays a vital role.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Missing Posterior Molar Teeth Can Start Series of Dental Problems

It is common that people have one or two missing teeth and sometimes people would ignore restoring those missing posterior molar teeth, because people would think it is at the back and nobody can see their missing teeth.  Also, people chose not to restore them because of cost of replacing them and they believe they are chewing fine with their remaining teeth.

Tooth Split

Tooth split due to excessive biting pressure. The patient has missing posterior molar teeth and mainly use the small premolars to chew.  Excessive biting pressure cause the premolar to fracture.

However, posterior teeth are especially important for chewing.  Lack of posterior molar teeth can dramatically decrease a person’s chewing efficiency.  Also the lack of posterior molar teeth can put additional stress on the rest of remaining other teeth.  I will show a photo of a patient who recenlty come to my office.  She has missing posterior molar teeth on both side of her mouth.  She mainly only chew with the premolars and anterior teeth which are relatively small and are not designed to handle the stress in chewing and grinding food.  Thus, with times, the right upper premolar tooth becomes fractured.  The photo shows that the tooth has a fracture line down thru the mid-section of the tooth.  Upon clinical examination, the fracture actually goes deep down to the mid root and this tooth cannot be repaired and needs to be extracted.

Another problem with missing teeth is that the teeth around the missing tooth area would start to shift in position.  The other teeth may collapse into the empty space.  The bite will be in disharmony and excessive wear and tear will happen to the other teeth.  Opposing teeth would start to come down and eventually they would touch the gum.  The opposing teeth will be affected and may have the risk of losing them, in addition to the already missing teeth.

Teeth Collapse

Upper teeth start to drift downward and eventually would come out of the bone socket.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.