Periodontist Archives - Atlanta Dental Implants

Will I Need Bone Grafting for Dental Implants?

Posted on February 14, 2024 by AllSmiles.

I think I will need bone grafting for dental implants. I lost most of Although my family dentist says he can do the implants, I am not confident that he has enough experience. I am not comfortable. How will a dentist determine if I am a candidate for bone grafting? Thank you. Rochelle

Rochelle,

Thank you for your inquiry. Your decision to get dental implants will improve your oral health. You are wise to be cautious when choosing an implant dentist.

Will You Need Bone Grafting for Dental Implants?

You will need bone grafting for dental implants if your teeth have been missing for years and you do not have enough bone volume to support implants. Your dentist must take a CT scan to measure your bone volume.

What Is Dental Implant Bone Grafting?

Dental implant bone grafting is a procedure that builds up jawbone volume. When your teeth are missing, your body takes minerals from your jawbone in those areas and uses them elsewhere. As your jawbone shrinks, it will become challenging to support dental implants.

Whether you need implants to replace individual teeth or to support a denture, bone grafting may be required to give implants enough support. The bone grafts need to heal before your dentist places implants.

Bone sources for dental implant grafting

Bone grafting for dental implants can come from your bone—perhaps your hip or below your knee. Other bone sources included a tissue bank or artificial bone.

Are You a Candidate for Dental Implant Bone Grafting?

A dental implant with components labeled - crown, abutment, implant screw

Schedule a consultation with a periodontist for bone grafting

An implant dentist must take x-rays and a CT scan to reveal your oral anatomy, bone volume, and bone health. But you are probably a candidate for implant bone grafting if the following is true:

Good oral health
Good overall health, including free of gum disease
A non-smoker

Consult a Periodontist

Schedule a consultation with two periodontists—specialists with years of post-graduate training in gum disease and dental implants. You can prepare questions and take notes to compare the specialists’ qualifications and whether you liked their interaction with you.

Best wishes.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Two of My Five Dental Implants Failed

Posted on June 30, 2023 by AllSmiles.

After five months of struggling, two of my five dental implants failed. After my two-month checkup, my dentist said that two implants did not have enough bone to survive. He recommended removing the implants and waiting a few months before a bone graft procedure. I let my dentist remove the implants but have not returned to the office because I need time to think. I know I cannot leave spaces between my teeth too long, but who can I trust? I had no problem seeing a dentist before this episode, but now I am anxious. Did the implants fail because I didn’t have enough bone volume, or was there another problem? Thank you. Shem from Thousand Oaks, CA

Shem,

We are sorry about your frustrating experience.

A periodontist (teeth, gums, and implant specialist) takes a 3-D CT scan before developing a dental implant treatment plan. The 3-D CT scan shows whether you have enough bone volume for implants and require removal.

Did Your Dental Implants Fail Due to Low Bone Volume?

The only way to identify the cause of your dental implant failure is to get a second opinion and a 3-D CT scan. A periodontist must complete these steps:

Scan your mouth using 3-D cone beam imaging
Determine whether your dentist placed implants in areas of low bone volume
Explain whether you need bone grafting for new dental implants

Whom Can You Trust to Resolve Failed Dental Implants?

You can trust periodontists because they have two to three years of specialized dental implant planning and placement training. They are trained to successfully plan for and place dental implants.

According to an article in the Journal of Applied Oral Science, an implant dentist should tailor your treatment plan according to all relevant variables when a dental implant fails.

Your anxiety is understandable. Although you may not have required sedation during past appointments, it can help you relax during treatment. Without treatment, your oral health will decline as missing teeth cause jawbone shrinkage and misalignment.

How to find a periodontist

Schedule a consultation with a periodontist (gum, teeth, and implant specialist) for dental implant failure

Before selecting a periodontist to resolve the failure of your two dental implants, we encourage you to consider the following suggestions:

Look for two or three providers in your area.
Schedule consultations.
Take notes and compare their credentials and how they will tailor your treatment plan.

Best wishes for a smooth resolution and recovery.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

My Tooth Fell Out, and Now I Have a Hole Left

Posted on January 31, 2023 by AllSmiles.

My tooth fell out, and now I have a hole. I’m not surprised because when I saw a dentist last year, they said my periodontal pockets were deeper than ever. I went to two or three deep cleanings but stopped due to anxiety and out-of-pocket concerns. The tooth fell out two days ago, and I saved it, but I suppose it’s too late for a dentist to put it back in. I don’t know what to ask, but other teeth are loose, too. Maybe I need to figure out a way to follow through with the deep cleanings. Thanks. Matt for Jacksonville, FL

Matt,

Thank you for contacting Pumphrey Periodontics in Atlanta. We understand the challenges of dental anxiety and how it can interfere with getting the care you need.

What Can You Do If a Tooth Fell Out and Left a Hole?

If a tooth fell out and left a hole, you should schedule an appointment with a periodontist for an exam and x-rays. Although you saved the tooth, it is too late for a dentist to put it back in its socket. When a tooth falls out of its socket, you need immediately follow these steps:

Pick it up by the crown.
Rinse the tooth with water without patting or touching it.
Put it back in place and hold it in place.
See a dentist within 30 minutes.

If you have loose teeth and deep periodontal pockets, you will need a periodontist’s help before seeking a tooth replacement option.

What Are Periodontal Pockets?

Periodontal pockets are spaces between your teeth and gums below your gumline. Ordinarily, your gums and bone should support your teeth snuggly.

Periodontal pockets form for these reasons:

You have untreated gum disease.
The infection destroys gum tissue and bone that should fit snugly around your teeth.
Missing tissue and bone leave spaces or pockets.

How Will a Periodontist Treat the Pockets?

A periodontist will close the pockets or spaces between your teeth and gums with these steps:

Folds back the gum tissue next to each tooth
Remove the bacteria from your gums and bone
Smooth tooth roots and irregular surfaces of the bone
Secure the gum tissue

The American Academy of Periodontology confirms that periodontal pockets will deepen and damage bone and tissue without treatment, leading to tooth loss.

Schedule a Consultation and Discuss Your Anxiety

A periodontist can restore your oral health and help save your teeth. We encourage you to consult with a periodontist to discuss a treatment plan. Talk to the specialist about your anxiety and learn about sedation options to relax you. A representative at the dental office can explain options for payment plans and financing to make your dental care affordable.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

Why Do I Have White Spots on My Gums?

Posted on August 9, 2022 by AllSmiles.

I noticed a patchy white spot on my lower left gums last month, but I didn’t think anything of it. When I see minor issues in my mouth or on my skin, I do not pay much attention to them unless I have symptoms with them. I forgot about the white spot. This morning while flossing, I noticed five or six white spots on my lower gums. I didn’t memorize the location of the first spot I saw last month, so I don’t know if it went away or if it’s one of the five or six. Now, I am concerned and wondering why I have the spots. What causes white spots on the gums? – Thanks in advance. Devon from Fort Wayne, IN

Devon,

Thank you for contacting Dr. Pumphrey’s office with your question. Dr. Pumphrey would need to complete an exam to determine the cause of the white spots on your gums, but we will provide general information.

Why Do You Have White Spots on Your Gums?

The cause of white spots on your gums can be one of several conditions, including canker sores, oral thrush, gingival reactive keratotic lesions, leukoplakia, or oral lichen planus. We will explain each of these conditions.

1. Canker Sores

Canker sores are small, raised ulcers on the inside of your mouth. They are benign and non-contagious. Although canker sores most often appear on the inside of the lip, they can cause white spots on your gums.

What causes canker sores?

Canker sore causes include:

Stress
Acidic foods
Injury
Dental appliances, such as braces or dentures that do not fit well
Nonsteroidal anti-inflammatory drugs, including ibuprofen

2. Gingival Reactive Keratotic Lesions

Gingival reactive keratotic lesions are white spots on oral tissue that can be benign or dysplastic, containing abnormal cells that may become cancerous.

What causes gingival reactive keratotic lesions?

Heat and chemicals may irritate gum tissue and cause lesions, including:

Tobacco use
Heavy alcohol consumption
Reaction to toothpaste or dental cleaning gels, powders, or liquids

3. Leukoplakia

Leukoplakia is thick white patches inside your mouth on your gums, sides of your cheeks, the bottom of your mouth, or tongue. The patches are generally not painful. An October 2020 article in the Journal of the National Cancer Institute says oral leukoplakia is the most common oral precancerous lesion.

What causes leukoplakia?

Although the exact cause of leukoplakia is unknown, common oral tissue irritants that can lead to the condition include:

Smoking
Chewing tobacco, paan, or betel nuts
Excessive alcohol consumption

4. Oral lichen planus

Oral lichen planus is a chronic inflammatory, an autoimmune condition that causes your body to attack your oral tissue. White patches of raised tissue can appear almost anywhere in your mouth, including your gums, inner lip tissue, tongue, insides of your cheeks, and palate. The lesions require regular monitoring by your periodontist for early detection of cancerous cells.

What causes oral lichen planus?

The exact cause of oral lichen planus is unknown, but these factors may trigger it:

Certain medications
Oral injury
Reaction to dental chemicals or materials and resulting infection

5. Oral thrush

Oral thrush is an infection that causes white, raised lesions on your tongue and the insides of your cheeks. Sometimes, it spreads to your gums or the roof of your mouth. The condition is benign but contagious if you are exposed to the saliva of someone who has oral thrush.

What causes oral thrush?

An overgrowth of the Candida fungus causes oral thrush. Factors that lead to Candida overgrowth include:

Illness
Stress
Medications

What Is the Treatment for White Spots on Your Gums?

The treatment for white spots on your gums depends on their cause. Rather than schedule an appointment with your medical doctor or general dentist, schedule an exam with a periodontist (a gum specialist with three years of advanced training) for an accurate diagnosis. Your periodontist may biopsy your oral tissue as part of the diagnosis. Afterward, they will explain your treatment options. Avoid guessing at the cause of your condition and treating it yourself, which can delay proper care and make things worse.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Deep Cleaning is Too Painful

Posted on November 9, 2021 by writeradmin.

My teeth have never hurt until I had a deep cleaning done two years ago. They are sensitive and painful all the time and the cleaning appointment itself is agony. I regret doing it. I’ve tried to go back just for a regular cleaning, but my teeth just hurt too much. What do I do?

Claire

Dear Claire,

I am sorry that you are in so much pain. Your deep cleaning should have been done under a local anesthetic so I’m not certain why it was so painful. I believe I have a solution for you, but first I want to make certain you understand why the deep cleaning was necessary. In general, if a dentist is recommending a deep cleaning, it is because the patient has advanced gum disease and they are trying to get it under control before you start losing your teeth.

When periodontitis (gum disease) is left untreated, your teeth will eventually just fall right out of your mouth. Being proactive now can prevent that. If a gum infection is very active, it can lead to post-operative pain. To help with this, your dentist can provide a course of antibiotics for you during the duration of your treatments.

Now for the solution. I want you to go to a periodontist. They are gum specialists. Look for one who also offers dental sedation. This will allow you to have a pain-free appointment. Let the periodontist know ahead of time what happened during and after your last deep cleaning so he or she can be prepared and take steps to make things better for you.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Gum Disease Following Dental Crowns

Posted on August 5, 2021 by writeradmin.

I have always had very healthy teeth and gums. A few months ago I had a bicycle accident that led to my two front teeth getting chipped. My dentist said the repair would require dental crowns. By the time my regular check-up came in, I had gum disease. I’ve never had anything close to gum disease before. They felt I’d been babying my teeth since the accident, but that is not true. I pointed out to my hygienist that sometimes food gets stuck at the top of my crowns, between that and my gums. She said that is normal. I just have a hard time thinking I suddenly forgot how to care for my teeth.

Lisa

Dear Lisa,

I don’t like it when a dentist deflects from a flaw in their work and blames the results on the patients. Having a space at the top of your dental crowns like that is very likely the cause of your gum disease. What you have are called open margins and not only is it not normal, it can lead to decay and gum disease, as you have unfortunately experienced. The best thing for you to do is get a refund on these dental crowns because they are going to have to be re-done. If he or she thinks inferior crowns are normal, you definitely don’t want them to be the ones to replace them.

Go ahead and look for a periodontist. They are gum specialists and can treat your gum disease and replace your dental crowns to proper form and function. Don’t put this off because untreated gum disease can lead to bone loss of the tooth. In its most advanced stages people can start losing their teeth.

If your dentist does not want to refund your money, it will be helpful to have a periodontist look at the crowns. If open margins are the problem, having him on your side, will help you secure your refund.

Best of luck moving forward.
This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.
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Should I Get This Root Canal Treatment?

Posted on June 5, 2021 by writeradmin.

I am in a pickle and not sure what to do. I had some trauma to a tooth about five years ago. The tooth is beginning to turn dark, though there is still feeling in the tooth and it is considered viable. At the moment, the dentist is saying that a root canal treatment is optional, but there is a faint, possible horizontal fracture. I have a choice between doing the root canal or cosmetics. What is the way for me to proceed?

Angie

Dear Angie,

I am puzzled by his statement that a root canal treatment is optional at this point. Either it is needed or it isn’t. Is the tooth infected? Then you need a root canal treatment. If the tooth isn’t infected, then you will not need it. Simple. Your dentist leaving you wondering gives me pause that you may need a different dentist.

About this possible horizontal fracture. If that is true, then a root canal would be problematic, as it could cause leaking. I would really like you to get a second opinion on this whole situation. I haven’t examined you or seen x-rays so it would be hard for me to do that for you.

A tooth can turn dark simply from trauma to the mouth, which you have experienced. The treatment for that, if the tooth is otherwise fine, is to do cosmetics. However, be careful who you get to do this. Cosmetic dentistry is not a recognized specialty, nor is it taught in dental school. You will want to seek out a dentist who invested a lot of time in post-doctoral training in cosmetic procedures.

The two cosmetic options in your case would be either dental bonding or a porcelain veneer. A veneer is more expensive, but will last longer. Before making a final decision, get that second opinion to know whether or not your tooth is actually fractured and if there is an infection.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Can a Root Canal Treatment Whiten a Tooth

Posted on May 5, 2021 by writeradmin.

My son has a tooth where the nerve has died due to trauma. As a result, the tooth is turning slightly gray. My dentist is suggesting a Gentle Wave Root Canal Treatment which he says will whiten the tooth. I am a tad skeptical of this and wonder if it is better if we just get a dental crown to make the tooth look whiter. I have always been told that a root canal treatment will darken a tooth, not lighten it. Am I misunderstanding something?

Claudia

Dear Claudia,

The GentleWave system is fairly new but it has received great reviews in all the dental literature I have read. While a traditional root canal treatment uses files to clean things out, GentleWave uses sodium hypochlorite that has been activated using sonic energy to soften the tissue. While that ingredient is often used in laundry detergent, its whitening effects would be minimal.

There is a method to keeping a tooth whiter after a root canal treatment. One of the things that causes the dark color is the left over root canal filling material. Here is what I suggest to get the tooth its whitest. First, Make sure the dentist removed all the material from inside the tooth. Really clean it out. Then, if you want to do some internal bleaching, that is okay too.

Once that it done, your dentist should place a white fiberglass post and fill the area with composite filling. This will keep the tooth from turning darker for a much longer period of time.

I do not recommend you get a dental crown for the purposes of making a tooth look whiter. In may opinion, that is an overtreatment as it removes healthy tooth structure. If it becomes necessary to make a cosmetic adjustment, I would suggest a porcelain veneer, but you will want to go to a dentist with advanced cosmetic training for that.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Crowns Gave Me Dry Mouth

Posted on February 24, 2021 by writeradmin.

My dentist told me that my bite needed to be opened up and crowned all the teeth to do that. Aside from the unbelievable cost of this procedure, the dry mouth that resulted from it has been complete agony for me. I think it is because it is hard to close my mouth now. Please tell me you have some advice for me that can help.

Melissa

Dear Melissa,

When a dentist crowns all the teeth, it is called a full mouth reconstruction. This is actually one of the most advanced procedures in dentistry. When done correctly, it can be very helpful for patients with debilitating TMJ Disorder or other significant bite issues. Unfortunately, I believe your dentist was in over his or her head.

He seems to have opened your bite up too much by making your teeth so tall that you can no longer properly close your mouth. We call this lip incompetence and it is serious. The dry mouth you are experiencing can actually destroy the health of your teeth and gums. In addition, your bite being open too far, will lead to jaw pain at some point as well.

Let’s focus on the teeth and gums. When your mouth is dry that means you are not able to retain enough saliva. Most patients do not realize that our saliva is one of our best weapons against tooth decay and gum disease. This is because it contains bacteria-fighting minerals. Without that, you will see an increase in cavities and gum disease. In my mind, your dentist thinking this is an acceptable condition to leave your teeth is malpractice.

This needs to be redone completely. I would ask for a refund. He or she may press back against that. If that happens, it will be helpful to have a second opinion on your side. Mine will not count because I have not examined you. I am simply going based on your description. You will need to have a dentist examine you. When you do, make sure it is someone with experience in full-mouth reconstructions. Call their office and ask how many they’ve done. Another important thing will be to make it a blind second opinion. That means you don’t tell them who the dentist was that did the work. The dental world is a small one. If it turns out they are friends, you don’t want him in an awkward situation. Just tell the second opinion dentist what is going on and ask what their advice is. If it is similar to mine, they can help you secure that refund so you can get this done well and not have your teeth and gums at risk.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Is Palladium in Crowns Toxic?

Posted on January 16, 2021 by writeradmin.

My periodontist also does cosmetic work. We’d been working on getting my gums healthy and once that happened, I wanted to place two teeth with crowns to make them look better. I did teeth whitening and then had the crowns made. I later discovered they are 40% palladium. They look good, but I’m a bit concerned about the toxicity of those. Should I switch them out for zirconia crowns?

Lauren

Dear Lauren,

I am glad that you love the appearance of your crowns. I also love the fact that you were able to get your gum disease under control. Many patients find they feel better in general when their gums are healthy. Few people realize the impact oral health has on their general health. Way to go!

I try to stay on top of metal sensitivity and toxicity issues because there are patients who deal with some pretty severe allergies. When you mentioned palladium toxicity it threw me because I’d never heard of it. After doing some research I see two things that could have led to this idea.

First, is the Iron Man series. Tony Stark, a weapons manufacturer, has an arc reactor with a palladium core that is slowly poisoning his blood. However, despite the fictional tale, palladium is a noble metal and quite biocompatible as a member of the platinum family. There are compounds, such as palladium chloride, which has some toxicity, but you aren’t dealing with the compound. Your crown will only have the pure metal.

The second thing I found is a natural health website with a load of misinformation. As for the palladium, they called it a heavy metal with high toxicity — False! It is a precious metal, without toxicity. So, why the bad information? On that same website I found that for a mere $325.00 they will do a hair mineral analysis for you and tell you if you are dealing with toxicity. How nice of them.
The phrase “follow the money” is well known for a reason.

Even though palladium is biocompatible, can you have an allergy to it? It would be rare, but not impossible. However, you would have allergy symptoms. I would not recommend switching out a crown you are not allergic to and risk getting a different crown that you could be allergic to.

Bottom line: You’re safe.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.