Archives for January 2018

The Three Levels of Sedation Dentistry

Posted on January 28, 2018 by AllSmiles.

My mother is in her late 60s and is very fearful of the dentist, but she has some work she absolutely needs to have done soon. Her dentist told her that provides three levels of sedation dentistry and that she doesn’t need to fear or worry. I’m trying to help her understand exactly what she can expect, but I don’t know enough to really give a clear explanation. Can you explain what those three levels entail and what she can expect?

Craig, Atlanta

Hi Craig,

Sedation dentistry is a great way to help people overcome their anxiety, so they can receive the dental care they need. If your mother has ever had a traumatic experience at the dentist, or if she is one of the people who have a hard time getting numb with novocaine, sedation can probably help. Let’s take a look at the three levels of sedation your dentist talked about.

Sedation Level I: Nitrous Oxide

You have probably heard of the phrase “laughing gas,” but you may not know that it refers to nitrous oxide. This is a sedative gas that is breathed in through your nose while the dentist is working on your teeth. You can see an example of this nose mask in the image above: it covers just the nose, leaving the mouth free for the procedure. The gas produces a mildly euphoric state that can help you relax completely while remaining awake and aware. And for many patients who have a harder time getting completely numb, it can increase the effectiveness of novocaine, making dental care a much less frightening experience. And once the procedure is done and the nitrous oxide stops flowing, your mom will be ready to go about her daily life activities, including driving, because there are no after-effects of the gas.

Sedation Level II: Oral Sedation

There are people for whom nitrous doesn’t work, so the second level of sedation is offered. This is called oral sedation. If your mom is really scared, her dentist can give her a pill to take about a half hour before her appointment. This will require that she has someone to drive her to and from her office visit because she will be in too relaxed a state to drive. This pill will help reduce anxiety and produce a deeper feeling of relaxation. Again, even though the patient will feel very calm, she will be completely awake and aware of what is going on, but may not remember the procedure afterward.

Sedation Level III: IV Sedation

Finally, for people who experience a sense of extreme anxiety or fear, intravenous or IV sedation is available. This kind of sedative will place the patient in a very dreamy state, in which she won’t really care about what is taking place around her. While she will be awake enough to respond to requests from the dentist, she will likely not remember the procedure at all afterward. And this level will again require that someone drive her to and from her appointment because the effects can last for a while.

Whatever level of sedation your mom eventually chooses, you can help her understand that she is not likely to have another traumatic experience. Perhaps she can look forward to a lifetime of great dental care from here on.

Good luck to you and your mom in finding the dental health to improve your life.

This Blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta, Georgia.

Can the Pinhole Surgical Technique permanently reverse gum recession?

Posted on January 15, 2018 by AllSmiles.

Hi and thanks for your thoughtful postings. I was told I was a good candidate for pinhole gum surgery, but I am worried that the effects of the treatment will not be lasting. I want to treat my gum disease and recession permanently, and not have to come back over and over again.

Christopher, Atlanta, Georgia

Hello Christopher,

The Chao Pinhole Surgical Technique® can permanently treat gum recession. Furthermore, it can do so without the scalpels, sutures, and gum grafts that used to be necessary. Let’s first take a look at gum disease and its treatment. Then we can examine the role of the pinhole surgical technique in permanently treating gum recession.

Gum Disease Causes Gum Recession

It’s very important to understand the underlying causes of gum recession, because without proper treatment and maintenance, it will likely come back. Until you have resolved the periodontal or gum disease that causes gum recession, it is not a good idea to treat the recession itself.

Gum or periodontal disease is a chronic inflammatory disease that can be successfully treated but not cured. It begins with irritation of the gums by plaque that has not been removed with frequent brushing, flossing, and professional dental cleanings. The plaque hardens into tartar, and it irritates the gums, which can lead to infections, or simply progress unnoticed until it is very advanced.

In the early stages, the gums can become inflamed or infected, and as it progresses, the inflammation spreads to the bone structures that support the teeth, leading to gum recession and bone loss. The diagram on the right shows this progression from a healthy tooth with full gum and bone support on the left to a diseased tooth on the right where the gum has receded, along with the bone.

Treating Gum Disease First

The gum disease needs to be treated first. This can usually be accomplished with non-surgical gum treatment involving scaling and root planing. This procedure will remove the pockets of inflammation and infection and prepare the teeth for regular periodontal maintenance.

Periodontal maintenance requires that you return for professional periodontal check-ups and cleanings about four times a year. In addition, you will need to be rigorous in your dental hygiene, brushing and flossing after every meal to make sure that new plaque does not accumulate into tarter and start the cycle over again.

The Role of the Pinhole Surgical Technique

Once the underlying gum disease has been successfully treated and you are maintaining your dental health with regular periodontal visits and cleanings, the pinhole surgical technique, or PST, can offer a permanent solution to your gum recession.

In contrast to traditional gum surgery, where gum grafts were taken from your soft palate and surgically implanted over the exposed tooth roots, the PST uses a small pinhole opening in the gums along with special instruments to loosen and reposition the soft tissues over the teeth. The technique is much less time consuming, it requires much less time to heal, and patients are often amazed when they see how much more attractive their smiles are.

In finding a dentist or periodontist to help you alleviate the causes and symptoms of gum disease, don’t be afraid to ask a lot of questions and research different professionals. The PST is currently only taught by Dr. John Chao of California, the inventor of the technique, and your professional should be a certified pinhole technique practitioner.

Good luck to you in attaining the healthy, beautiful smile you deserve.

This Blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta, Georgia.

Why didn’t my dentist tell me about facial collapse?

Posted on January 4, 2018 by AllSmiles.

About 10 years ago, I was having a lot of trouble with my teeth. My dentist said I had periodontal disease and recommended that I have my teeth removed so he could fit me with dentures. I wanted to stop hurting and going to the dentist all the time, so I got the dentures. That same dentist always worked with me until recently, when I took my daughter’s advice to see a new dentist. Now I find out I have lost a lot of bone and I want to know why my first dentist didn’t tell me about facial collapse, what it is, and if I can prevent further bone loss.

Judy, Tallahassee, Florida

Hi Judy,

It’s unfortunate that you are just now finding out about facial collapse. Hopefully they are fewer and fewer, but there are some dentists who not only aggressively sell their patients on dentures, but also fail to fully inform them about the problems with dentures and especially about the bone loss that leads to facial collapse. But further bone loss can be prevented with dental implants. And with bone grafting, the effects of the bone loss you have already suffered can, to a large extent, be reversed. Let’s take a look at what facial collapse is, and then we can explain your options for treatment at this point.

What is Facial Collapse?

We tend to think of our teeth as just the visible crowns that appear above the gum line, when, in fact, our tooth roots are integral to our dental and overall health. The roots not only attach the teeth to the jawbone, they also keep the jawbone in place. In fact, as soon as we lose a tooth, the body interprets the loss to mean that we no longer need the bone that used to support that tooth. So it begins to “resorb” the bone-building minerals from that part of the jaw, because there is always a need for those minerals elsewhere in the body.

When we lose most or all of our teeth, this process of resorption proceeds quickly at first and then slows down, and over the course of just ten to twenty years, we can begin to see the signs of facial collapse. The illustration to the right shows four jawbones. The first one still has a full set of lower teeth, and you can see that the jawbone is still present and healthy. In the second jawbone, there has been some vertical bone lost. And finally, in the last two, so much bone has been lost that it would be impossible to even support dentures.

The corresponding appearance that accompanies facial collapse is the kind of sunken-in appearance with strong vertical lines around the mouth that we associate with old age.

Because you have been without your teeth for about ten years, it is likely that your new dentist can take remedial measures to prevent the bone loss from progressing further, and there may even be a chance of reversing what you have already lost with bone grafting and dental implants.

Preventing and Treating Facial Collapse

Because dentures only replace the visible parts of our teeth, they can never prevent bone loss. But dental implants are actually tooth root forms onto which dental crowns are fixed, effectively replacing both the tooth root and the visible part of the tooth. These tooth root forms are placed into the jaw bone during a surgical procedure.

As you heal from the surgery, a process that is the reverse of resorption takes place. It is called osseointegration, and it means that the body brings more bone-building minerals to the site of the implanted root and surrounds it with new bone. By the time you are fully healed, your jawbone will have fully integrated the implant, so that it ultimately becomes part of the bone. The resulting structure is strong enough to receive a crown and to withstand the pressures of chewing.

And if you no longer have enough bone left to support an implant, bone grafting can be used to reverse the bone loss process. Bone grafting can sound like a difficult procedure, but it is actually a minimally invasive surgery during which safe and effective grafting materials are placed. Your body responds to the implanted material by regenerating tissue, and will actually replace the graft with your own bone-building minerals.

The Role of Implant-Supported Dentures

Finally, you do not need to replace every single tooth with a bone graft and dental implant to have a great outcome. Implant-supported dentures are held in place with six to eight dental implants, and they can not only solve many of the problems many people experience with removable dentures, they can also prevent further bone loss.

Your next step should be to talk over your treatment options with your dentist, and if you do not feel that he or she is really comfortable discussing dental implants, bone grafting, and implant-supported dentures, don’t hesitate to do more research. You will eventually find the right dentist to provide you with the kind of outcome you are looking for.

Good luck to you!

This Blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta, Georgia.