PERIODONTAL HEALTH, GINGIVITIS, PERIODONTITIS AND SCALING AND ROOT PLANNING (DEEP CLEANINGS)

  An important part of having good oral health is to have healthy gums.  In general, patients are most concerned about their teeth and forget that their gums, are just as important as their pearly whites. Healthy gums protect your teeth from bacteria and keep the bone that supports them strong and sturdy.  There are millions of bacteria in our mouth and they use the ingredients in our saliva and in our diet to grow and form dental plaque.  It is a colorless, soft, sticky film of bacteria and sugars that constantly forms on your teeth, and grow, at and underneath your gum line. If undisturbed it can harden to form tartar (calculus). Dental plaque is the main cause of cavities and gum disease.  Everyone develops dental plaque.

  Many patients have been told that they suffer from gum disease which is also called periodontal disease. If this has happened to you, you are not alone, more than 75 % of all adults in the United States have some kind of gum disease.  Periodontal disease is made of many diseases and the two most common are gingivitis and periodontitis.  It is generally accepted that periodontal disease is primarily caused and made worse by the bacteria located in your dental plaque.  The disease can range from a localized simple gum inflammation to a more generalized inflammation involving the soft tissues and bone structure of several teeth.  Depending on how extensive and how long the inflammation has been ongoing, without treatment, you can lose some or all your teeth.

Gingivitis

   The most common and well-known form of gum disease is gingivitis. In this stage the bacteria in the plaque builds up, causing the gums to become, red, inflamed and to easily bleed. It is usually painless.  Although the gums are affected, the teeth are still firmly held in their bony sockets and no irreversible damage has occurred to the gums or bone. If you do not treat gingivitis it may progress to Periodontitis.

Periodontitis

Periodontitis is the second most well-known gum disease.   It is also thought of as a painless disease and the patient is usually not aware of its progression until major damage has occurred. In its early stages very few signs and symptoms are experienced. Some of these signs are occasional bleeding during brushing, bleeding during flossing, discoloration of the gingiva, usually in the areas in between the teeth (a darker red) and softening of the gum.

   Periodontitis usually begins when the gums become inflamed due to plaque buildup.  Once inflamed the gums begin pulling away from the teeth to form pockets which become infected with bacteria from the dental plaque. As the pockets become deeper, there will be a greater concentration of bacteria below the gum line that allows the progression and severity of this disease. It has been repeatedly shown that when the pockets become abnormally deep the patient cannot reach and clean the depth of these “deep pockets” and the body’s immune system will be activated.  The reaction between the toxins produced by the bacteria and the body’s immunological defense system will start to break down the bone and tissue that hold the teeth in place. If allowed to advance without treatment, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

   Periodontitis is treatable. Although factors such as smoking, heredity, medications and lowered immunity make you more susceptible to gum disease, the most common cause is long term poor oral hygiene and the lack of professional dental care.   Over time, poor oral hygiene and the lack of professional dental cleanings, allow periodontal pockets to form around the teeth and become worse.  Patients cannot reach the depth of these pockets to clean them and progression of the disease occurs. Daily brushing and flossing and regular professional cleanings can greatly reduce your chances of developing periodontitis and its progression. Unfortunately, if you have periodontal disease you cannot do it all at home.  You need professional care to monitor you and to treat you, especially during those times when the disease is more active. Whether your periodontal disease is stopped, slowed, or allowed to get worse depends on how well you care for your teeth and gums every day, and if you seek professional help by a dentist.

   In summary, It is important to understand that periodontitis is a silent disease. Those who suffer from it rarely experience pain, and may not even be aware that they have a problem. The early stages of gum disease have very few warning signs. Some of the early warnings to look for are bleeding while brushing, softening of the gums, and discoloration of the gums (darker red/irritated in appearance rather than a light, healthy pink). As the disease gets worse, more noticeable signs may become apparent such as inflamed swollen gums that are red and easily bleed, persistent bad breath that does not go away, gums that are tender to the touch, changes in the position of the teeth and pus between the teeth and/or at the margins of the gingiva. The treatment of periodontal disease is twofold and involves home care and the evaluation and treatment by a dental professional.

SCALING AND ROOT PLANNING

   To determine whether you have periodontitis and how severe it is we will review your medical history to evaluate any risk factors such as smoking, medications and systemic diseases.  X-rays will be taken to look for the presence of calculus, faulty fillings and bone loss. We will examine your mouth to look for the presence of plaque and calculus buildup, check your gingival health for color, contour, consistency, bleeding on probing, presence of suppuration and the presence of gingival recession. We will also examine your teeth for abnormal mobility.  Most importantly, the pocket depth formed between your gums and teeth will be measured by a periodontal probe which is a little ruler that tells us how deep the pockets are around each tooth. There are six sites around each tooth that we routinely measure every year and are recorded; it is a painless procedure and no anesthesia is needed and it is done during your cleaning appointments.

   The results of the periodontal probing is very important to us and gives us an accurate picture of the health of your gums. We do not only take into account our immediate probing results but we compare them to past years results to see if the probing depths are better, the same, or worse. It forms a history of your periodontal health and enables us to detect a problem at an early stage when it is treatable with better brushing and flossing and other non-intrusive procedures. By monitoring the recordings against each other, our dentists and hygienists at our dental office are able to make sure no areas become progressively worse, or note improvement where treatment has occurred. In those situations where our periodontal exam discovers that some pocket depths are worsening and home care has not improved them we believe in early treatment and intervention and may recommend scaling and root planning.

   Scaling and root planning is one of the most effective way to treat periodontal disease before it becomes severe. This is   performed after a thorough examination of the mouth and radiographic confirmation.  Ideally, normal healthy pockets will be no more than 3 millimeters. If the pockets depths reach 5 mm or greater and are located in multiple sites we will usually recommend the treatment of scaling and root planning; especially if probing results show a progression of the disease for the worse as compared to previous probings. Occasionally even an isolated 5 mm reading deserves a site-specific scaling. However, treatments are always custom for each patient and their specific clinical situations.

   Scaling and root planning is one procedure but is compose of two parts. The scaling part involves removing plaque and tartar from the surface of the teeth above and below the gumline making sure to clean all the way down to the bottom of the pocket. We will do this using either with ultrasonic instruments or manual scaling instruments or a combination of both. The other part of scaling and root planning is the root planning part which involves using scaling instruments to smooth the surface of the root of each of the teeth treated so the gum can reattach properly. We usually perform scaling and root planning in two visits dividing the mouth in two halves but on occasion we will divide the mouth into four quadrants either because of medical needs, patient’s wishes or other circumstances.  Often the affected area is localized and treatment is very limited and we will only need to treat a couple of affected teeth. Six weeks after the scaling and root planning, the gums are once again examined to ensure that healing is occurring.  Patients that have scaling and root planning’s are usually placed on a 3-4 month recall until long term gingival health has been established but recall are always determined on an individual basis.

   We believe in early intervention and prevention. By recording periodontal measurements at regular recall appointments, we can detect small problems before they turn into large ones. We will work together to help you identify where these periodontal pockets are, how you can help and what we can do to help them heal. If you’re looking for a dentist, please feel free to call and schedule an appointment.

   Periodically, there are news stories claiming to demonstrate an association between periodontal disease and one or more forms of cardiovascular disease. However, both periodontal disease and cardiovascular disease are complex conditions that share common risk factors and saying that two conditions are associated is not the same as saying that one causes the other.  The current position of the American Heart Association and the American Dental Association is that while periodontal disease and heart health have an association, additional research is needed to establish whether one causes the other.

DENTAL IMPLANTS FOR MISSING TEETH

   Dental implants are a common and effective way to replace missing teeth and are designed to feel, look and function like natural teeth. They are an excellent long-term option for restoring your smile. They have been successfully used in dentistry for over 30 years and research studies have clearly established their safety and effectiveness. Dental implants are made of titanium which is compatible with the human body. The implants themselves are tiny titanium posts, surgically placed in the upper or lower jawbone where teeth are missing. The bone fuses with the titanium posts, creating a strong anchor and sturdy foundation for the replacement of a tooth or several teeth. Implant crowns and implant dentures come very close to feel and function like real teeth and are usually considered the best option for patients missing one, several or all their teeth.

Implants for Missing Teeth

   At one time, a dental bridge was your only choice when you were missing a tooth and wanted to replace it with something permanent.  To fabricate this dental bridge the neighboring teeth on either side of the missing teeth would need to be reduced in size and its shape changed forever. Now with predictable dental implants we can replace the missing tooth without touching the adjacent teeth. It is the standard by which other tooth replacement options are judged and when indicated it is truly the best option.  However, there are situations where a dental bridge should be considered.  For example, if the adjacent teeth have large fillings and will need crowns in the future, a dental bridge is a viable option.  Another instance is, when a tooth has been lost for a long time and multiple surgical procedures are needed before an implant can be placed.  In this situation, the patient may choose not to proceed with an implant and a bridge may be indicated.  The advantages and disadvantages of both procedures will be discussed with our patients before any treatment is started.

Implant Supported Dentures and Partials

    Alternative options to complete and removable partial dentures are those that are supported by dental implants. They have been repeatedly shown to improve the patients comfort, satisfaction and quality of life.  You will find that implant supported complete or removable partial dentures will be more stable, easier to eat and speak with, and you will not have to worry about the prosthesis becoming loose. The overall size of the prosthesis is also much smaller and they will generally feel and function like natural teeth. These implant supported prostheses are generally thought of as the best option if you are missing several or all your teeth.

   There are different types of implant supported dentures and partials. An implant prosthesis can either be screw retained where you will never remove the prosthesis, or removable where the prosthesis has special attachments in the tissue side of the denture that snap on to their corresponding part on the implant. The latter can be taken in and out by the patient. In either case, you will find that you will be able to eat foods you could not eat before, be more comfortable, and speak easier.  The stability of either of these implant prostheses will be much greater than a conventionally prosthesis.

   If you are self-conscious because you have missing teeth, wear dentures or partials that are uncomfortable, or you simply do not want to have good tooth structure removed to make a bridge, speak to us to see if dental implants are an option for you. Dental Implant treatment can take longer and cost more than other replacement options but generally are a good value because they can last a lifetime.

   Our dentists are highly trained and have extensive experience in both placing and restoring dental implants.  Not all patients are good candidates for dental implants, but our dentists are here to help you decide if dental implants are a good option for you. Schedule an implant consultation to find out more.

COMPLETE DENTURES AND REMOVABLE PARTIAL DENTURES

COMPLETE DENTURES.

   If you’re struggling with extensive tooth loss, complete dentures can provide reliable, affordable coverage.  Complete dentures can be either conventional or immediate. A conventional complete denture is made of a pink or gum-colored acrylic base in which the teeth are set.  It is placed in the patient’s mouth after the teeth have been removed and the tissues have had time to heal. The gums, palate, lips, cheek and other mouth muscles help support this type of denture.

   If a patient is anxious about being in public without teeth after removal of teeth, an immediate denture is a complete denture that is inserted on the same day as tooth removal. These dentures are made in the lab before the remaining teeth are removed. Once your teeth are removed, the denture is placed in position. Immediate dentures allow the patient to go home with a denture instead of being toothless.  Once healing is complete, the dentures may need to be adjusted or relined. Sometimes a new denture may need to be made if the changes during the healing phase are substantial.

REMOVABLE PARTIAL DENTURES

    Removable partial dentures can replace one or more natural teeth that are missing in the upper or lower jaw. They can be taken in and out of the mouth and consist of a pink gum colored denture base with one or more replacement teeth attached that match the color and shape of your natural teeth. There are different types of Removable Partial Dentures.

   Flexible Partial: These partials are stain- and odor-resistant, very thin, and made of a strong nylon type material.  Although these dentures are more esthetic than cast metal partial dentures, if a tooth falls off or the denture breaks the denture will most likely need to be replaced.  

   Cast Metal Partial Denture: The cast metal partial denture is stronger, less bulky and offers a great fit. This partial has a metal framework to which is attached a gum colored denture base which hold the replacement teeth. It is usually not as cosmetic as the Flexible Partial but offers the advantage of reparability and usually maintain their fit better over time.

   Acrylic Partial Denture: Acrylic partial dentures have an acrylic base into which the denture teeth are set. It is attached to your natural teeth with small wire clasps but does not have a metal substructure.

   Complete dentures and removable partials can be combined with dental implants for support and stability. Studies have repeatedly shown that the use of dental implants can alleviate some of the problems associated with partials and dentures and substantiality improve the quality of life and will provide outstanding comfort and satisfaction to the patient.  However, we also offer the effective, time tested treatment alternatives, dentures and removable partial dentures, to patients where implants supported dentures and partials are not feasible or desirable because of emotional or financial limitations. For those that want them we create high-quality, secure fit dentures and removable partials dentures and we will work with each patient to make them fit and feel natural and comfortable.

CROWNS AND DENTAL BRIDGES

CROWNS 

   Crowns may be needed for several reasons but one of the major reason are when teeth become weak due to loss of tooth structure and the health of the tooth is threatened. By placing a crown on a weak tooth, it can withstand chewing and grinding forces so it does not break beyond repair and must be extracted.  Teeth can become weak because they have large fillings or break while eating, biting or grinding.  A crown may also be needed when the tooth has an internal hairline fracture and hurts while biting. This stops the hairline fracture from progressing. Dental crowns, when indicated, are sometimes the best option to extend the life of a tooth for years to come.

   A dental crown is a hollow tooth-shaped “cap” that is placed over the tooth to restore its shape, size, strength, and function.  It covers the complete tooth and reinforces the tooth that has lost a significant amount of its structure. A crown also channels the biting forces outward not internally dispersing the forces to the perimeter of the tooth and away from its center greatly reducing the chances of a fracture.  The procedure for a dental crown normally takes two separate visits. During the first appointment, the tooth is prepared and a provisional crown is placed and an impression of the tooth is sent to the lab so the permanent crown can be fabricated.

   At the second appointment, the provisional crown is removed, and the new, permanent crown is cemented onto the tooth with a special dental resin cement. Your new crown will function and feel like a natural tooth and provide years of worry-free service.

   In some cases, while a crown is one option, there can be others. You might decide for a filling instead, but keep in mind that a filling does not prevent you from needing a crown later on and large fillings do not give you the same kind of protection as crowns do.  Chewing and grinding forces in the mouth can cause an unprotected tooth to break or allowing a hairline fracture to progress causing the loss of the tooth due to irreparable damage.  

DENTAL BRIDGES

   When one or more teeth are missing, one way to replace them is with a traditional dental bridge. It is cemented permanently and cannot be removed. A dental bridge is anchored by neighboring teeth. The teeth on either side of the gap are prepared as crowns to serve as abutments (anchors) to hold the pontic (replacement tooth) in place.

   If there is a missing tooth without neighboring teeth on one side, another type of dental bridge that can be made is a cantilever bridge. It involves attaching the pontic to one or more adjacent teeth with one or two abutments (crowns). If a patient does not want to prepare the adjacent teeth a bonded dental bridge also known as a Maryland bridge can be made.  It is often used in the front part of the mouth. It is essentially a pontic with two “wings” that are either made of metal or tooth-colored ceramic and are bonded to the posterior side of the adjacent teeth.  Some important criteria’s have to be met so that Cantilever and Maryland bridges will be successful and secure over a long period of time.

   At our dental practice, we will evaluate and discuss all options with you before recommending a crown or a dental bridge. We considered you to be a partner in your dental health and we will take the time to explain the pros and cons of your treatment options.

   Today, restorative treatment and cosmetic improvements can become one and the same with metal-free restorative all-ceramic dental crowns, for repairing tooth damage. These materials are natural looking,  durable, and very comfortable within the mouth. Their biocompatible nature is also safer for patients who have had sensitivities and allergies to dental metals in the past.

INVISALIGN®

   Dr.  Aaron Delgado is a certified Invisalign provider. Invisalign is the clear alternative to traditional braces.  It is a great choice for patients who are seeking a more discreet orthodontic treatment option. Invisalign treatment uses a series of custom-made, virtually invisible, removable, and comfortable, thin plastic aligners that allow the patient to smile during treatment without seeing the wires and metal brackets of conventional braces. All the patient has to do is wear each aligner for a certain amount of time (usually a couple of weeks) before switching to the next in the set, creating gradual, beautiful improvements in their smile over a period of months. Invisalign clear aligners are made with 3D computer imaging technology and have been proven to be as effective as traditional braces. We invite you to call us for more information and to schedule your complimentary consultation with Dr. Aaron Delgado and our dental team today.

EMERGENCY DENTAL CARE

   If you are experiencing a dental emergency, call our practice as soon as possible. There is no need for a patient to suffer from a persistent toothache without relief.  During your appointment, we will identify the cause of pain and recommend the appropriate treatment. Our concern is to relieve your pain, help you feel comfortable and improve your oral health.

   Please call us at (305) 274-6114 and we will accommodate you as soon as possible.

PEDIATRIC DENTISTRY

   At our practice, we enjoy seeing and providing dental services for patients of all ages including young children, teenagers and everyone in-between. We are a family practice who have been treating patients of all ages for over 25 years.  We have seen patients grow from childhood to adulthood and take pride in having taught them how to maintain their teeth for life. We focus on providing a positive dental experience and on prevention and our team members will go out of their way to be as friendly and kind to gain your child’s trust.  We encourage parents to form a partnership with us and be involved in all aspects of their child’s dental treatment.  Parents are welcome to be in the examination room during cleanings and procedures.

   Our goal is to help children develop proper dental habits so they can enjoy a lifetime of excellent dental health. Early on, our young patients are taught proper brushing and flossing techniques and positive reinforcement is used to teach them to develop a daily routine. During their appointments, we carefully note any development concerns so they can be addressed as early as possible. Our in-office services include dental cleanings, topical fluorides, dental sealants, tooth-colored fillings, baby root canals, extractions, space maintainers, and more. Having good dental experiences as children can influence the way a patient will take care of their teeth throughout their lives and influence if they will visit a dentist regularly later in adulthood.

ENDODONTIC TREATMENT (ROOT CANAL THERAPY)

   With proper dental care your teeth can last a lifetime, however, there are instances where teeth and the surrounding areas can become infected.  Some examples include teeth that have been treated with large fillings, have extensively broken, or have fractured/cracked internally due to grinding (also called bruxism).  When this happens, inflammation can develop and the excessive pressure inside the tooth may overcomes its ability to heal. This causes the death of living tissue within the tooth (pulp) leading to an infection. Other times, bacteria can enter the inside of a tooth through deep cavities, broken teeth, or deep periodontal pockets and an infection develops. In these situations, root canal therapy is indicated.

   Pain is not always diagnostic of the need of root canal therapy.  Occasionally teeth can become infected without symptoms and are only diagnosed during routine exams and x-rays. In other occasions, an infected tooth or a tooth with irreversible nerve inflammation can have one or several signs and symptoms such as facial swelling, parulis (gumboil), spontaneous or constant pain, pressure, pain on biting and sensitivity to heat and/or cold that lingers. Root canal therapy alleviates the pain and eliminates the infection from the tooth so it does not have to be extracted. The therapy consists of removing the infected pulp, carefully cleaning and disinfecting the inside of the tooth, and filling and sealing this space with a material called gutta-percha. Afterwards, the tooth will often need a crown to protect it from breaking. If the infected pulp is not removed the tooth can be a source of an infection that can spread to other areas of the mouth and body, and in severe cases can become a life-threatening problem. Root canal therapy is covered by most dental insurances.

   Dental technology and techniques have evolved considerably over the last decade and root canals are not always a complex procedure. Over the last 25 years, we have performed hundreds of root canals and we are highly experienced in this procedure. After root canal treatment, our patients often comment on how easy and comfortable their experience was. Your comfort is our top priorities, and we will take every precaution to make sure that your treatment is stress-free and painless. Our staff and dentists are committed to doing everything we can to save your damaged teeth.

COSMETIC DENTISTRY

   The term “Cosmetic Dentistry” refers to several cosmetic dental treatments designed to enhance the smile and correct cosmetic and structural imperfections of the teeth. Cosmetic dental procedures include Porcelain Veneers, Composite Veneers, and Teeth Whitening. At our office, patients can choose from a variety of cosmetic procedures that restore the health, beauty and vitality of their smile.  Often times, multiple imperfections can be addressed at once. It is said that cosmetic dentistry does much more than improve smiles, it can change lives.

   A bright, beautiful smile is one of the first things people notice about you. If you have teeth that are stained, damaged, or otherwise imperfect, our office can make dramatic cosmetic improvements. We will work together to formulate a personalized plan that takes your budget, level of time commitment, and personal goals into account. Spending a few hours with us, can transform your smile, can help your self-esteem and can reduce self-consciousness, and can create for you a whole new outlook on your life.

   If you are unhappy with your smile it is easy to do something about it, better sooner than later, so you can enjoy your smile longer. Make an appointment with us so that we can implement an appropriate course of action.

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While routine brushing and flossing is necessary to have healthy teeth and gums visiting the dentist every six months is essential. The American Dental Association recommends that you visit your dentist every six months to ensure your teeth stay healthy and your smile stays beautiful. Routine dental exams will often avoid problems before they start. During the check up appointment several things will be done.

A Thorough Cleaning

Checkups almost always include a complete cleaning, either from your dentist or a dental hygienist. Using special instruments, a dental hygienist will scrape below the gum line, removing built-up plaque and tartar that can cause gum disease, cavities, bad breath and other dental problems. The hygienist will also polish, floss your teeth and review and discuss oral hygiene instructions custom to your needs

A full examination

  During  the dental exam, we will ask you about any health problems and medications you are taking and discuss how they may be affecting your oral health. We will  check the surfaces of your teeth to determine if you have any cavities and will determine the quality of your existing fillings. We will also do a periodontal exam which includes periodontal probing to make sure your gums adhere tightly to your teeth, and no periodontal disease or bone loss may be occurring. We will also evaluate your overall dental health and oral hygiene. If we finds a cavity or gum disease, we will speak to you about changing your brushing or flossing habits and/or techniques. In severe cases, we may recommend other dental treatments. If your teeth and gums appear to be healthy, we will recommend that you continue your brushing and flossing routine as usual.

X-rays

X-rays are usually taken once per year and are limited to those areas that are difficult to check with just a clinical examination. Our dental practice uses modern Digital X-rays which emit very little radiation. X rays help your dentist find and treat dental problems early which will save you money, discomfort and time.  X Rays can detect damage to teeth and gums that aren’t visible during a routine checkup. X-rays can help us determine the presence or degree of gum disease, cavities, abscesses and many abnormal growths, such as cysts and tumors, and also impacted teeth or supernumerary teeth that have not yet fully developed. As a precaution, we will always have you wear a lead apron when having an X-ray and, if you are pregnant, we will not take X-rays unless it is an emergency situation. Always inform us if you are pregnant.

Always remember that prevention is the key and remember that both home care and professional dental care are part of that prevention.