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Restorative dentistry. What is full mouth reconstruction?

Posted on December 2, 2017 by AllSmiles.

Can you tell me what is involved in full mouth reconstruction? I don’t want to go into the details, but I am in need of complex restorative dentistry, and I just want to get an idea of what I am looking at.

Samuel, Mississippi

Hi there, Samuel.

It’s difficult to tell exactly what may be involved in full mouth reconstruction without more details about your situation. But we can give you an overview of the various procedures that may be used in restoring the entire mouth to health.

Full Mouth Reconstruction Basics

In general, full mouth reconstruction, restoration, or rehabilitation (FMR) describes a situation in which all or most of the teeth need some kind of treatment. There are a variety of things that could be wrong, from extensive tooth decay or wear to broken or missing teeth, and the exact nature of the problems will determine the kinds of treatment needed. The most common FMRs involve crowns, bridges, and porcelain veneers.

Here is an example of a patient who needed FMR. His teeth were severely worn, and some of them were missing, as you can see in the photo to the left. To the right, the same patient has received his porcelain crowns and bridges. As you can see, FMR can literally change a person’s life. Having to live with an unhealthy looking mouth can cause a lot of shame, and the outcome can supply self-confidence and esteem while making chewing much easier.

FMR may sound very daunting, but it is usually completed in just two appointments. During the first one, the teeth are prepared to receive restorations. If there are older restorations, they are removed along with any decay. The dentist will then take impressions of the healthy tooth structure that remains and create a set of temporary teeth for you to wear home while you are waiting for the final restorations. Then during the second appointment, the restorations are bonded in place.

While any general dentist should be able to do a fine job of restoring teeth, a qualified and experienced cosmetic dentist will be interested in more than just restoring function. When it comes to the teeth, appearance and aesthetics are as important to most people as health, and only a well-trained cosmetic dentist will be able to provide you with a truly aesthetic outcome.

Good luck to you in seeking and finding dental health.

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

Aesthetic Ridge Expansion and Dental Implants

Posted on November 4, 2017 by AllSmiles.

I’m finally getting around to dealing with the tooth I lost about seven years ago. I was working two jobs to support my kids when it got knocked out during a pick-up hockey game, and there have always been too many things that had to come first. Well, my kids are all off to school, and I’m working with a dentist to get a dental implant. Now, I’ve been watching that spot in my gums sink ever since I lost that tooth, so I know something was going on, but my dentist is suggesting something called aesthetic ridge expansion. I listened when he was describing why it is needed, but I don’t really get it. Can you explain?

Gary, in Michigan

This is a great topic, Gary. Aesthetic ridge expansion isn’t on a lot of people’s radar, but it’s fairly common to need it when a tooth has been missing for a number of years.

The first thing that happens when we lose a tooth is that the body senses that it is gone. It immediately responds by beginning to absorb or resorb the minerals in the jawbone that once supported the tooth. This process progresses quite rapidly just after the tooth loss, and then slows. And as you say, you can see the result: the spot where the tooth once was has sunken in due to this bone loss.

During aesthetic ridge expansion, a bone graft will be placed under the gum line to bring it back up and into alignment with the rest of your gums. As it heals, the body will bring more bone building minerals back to the site, so the grafting material will actually integrate with your jawbone and become a part of it. Then when the dental implant is placed, the same process will integrate the implant and make it part of your jaw. The result is a very stable foundation and a gum line that will look as natural as it does around all the rest of your teeth.

I understand your reasons for not doing something about your tooth earlier, but it’s important to replace a lost tooth as soon as possible with a bridge, an implant, or another solution. That way the surrounding teeth will not move into the empty space, which can affect the bite and cause other problems.

Best of luck to you.

This Blog is brought to you by Atlanta periodontist David Pumphrey of Pumphrey Periodontics.

Periodontal cleanings and maintenance.

Posted on October 27, 2017 by AllSmiles.

I recently found out that I have gum disease. I guess it’s pretty advanced from what my dentist said. She’s sending me to a periodontist who she says has all the latest equipment and practices with a gentle touch. I’m worried, not so much by the diagnosis or the immediate treatment, but by what she said about periodontal disease not being curable. She kind of explained what she meant, but I’m wondering if you can clear this up for me. I’ll be able to keep my teeth, won’t I?

Richard S. in Tennessee

Hello Richard,

It is true that periodontal disease is never really cured, but it is possible to control it and prevent further damage to the teeth and their supporting structures with regular periodontal cleanings and maintenance.

diagram-of-periodontal-cleaning-maintenance It sounds like your dentist has referred you to a good periodontist where your gum disease can be fully diagnosed and treated. What she may have been referring to in terms of advanced technology is the perioscope. This is an instrument that will enable the periodontist to see below the gumline to evaluate exactly how much damage has occurred and to plan for a full cleaning. It makes diagnosis and treatment much easier on the patient that it ever was in the past, so you can hopefully rest easy there. Take a look at the illustration to the right, and you’ll see how much of the tarter, plaque, and damage in periodontal disease happens below the gum line. This is where the cleanings will also take place.

Depending on how advanced your gum disease is, it may take one or several cleanings to completely remove all the bacteria, plaque, and tartar to give you a fresh start. And here is the good news. If you don’t lose any teeth with this initial treatment, you can keep them. But you’ll have to adjust to a new kind of normal. Instead of going to see the dentist every six months, you’ll need to follow a very strict protocol at home and have regular cleanings by a highly trained hygienist four times a year.

If you would like to find out more about what your initial treatment may involve, click here to read Pumphrey Periodontics’ Non-Surgical Gum Treatment page.

Good luck to you in restoring your full dental health.

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

What is cosmetic gum surgery?

Posted on October 16, 2017 by AllSmiles.

I’ve heard a lot about cosmetic dentistry, and how porcelain veneers and crowns can make smiles more beautiful, but when I went in for a smile makeover, my cosmetic dentist said I would need cosmetic gum surgery for my makeover to be really great. Can you tell me more about what it is and why I might need it?

Carol, Florida

Hi Carol,

This is a great question because it doesn’t get asked that often. Cosmetic gum surgery is often needed to restore the beauty and balance of the gums after treatment for advanced periodontal disease. And sometimes it is undertaken as part of the smile makeover process even when there is no gum disease present.

Sometimes periodontal disease will respond to non-invasive treatments, but when it is very far advanced, it may require gum surgery. As you can see in the illustration to the left, when plaque and tartar build up under the gums, they break down the tooth’s supporting structures, affecting both the soft tissues and the bone. This in itself can cause recessed gums, exposed tooth roots, and characteristic black triangles between the teeth. Gum surgery may be required, first of all, to completely remove plaque, bacteria, and damaged tissues. And even though this leaves healthy teeth and gums, sometimes the results are not very aesthetic. In these cases, cosmetic gum surgery can cover exposed roots, fill in gaps, and bring a more uniform and natural look to your smile.

And if you are working with a well-qualified cosmetic dentist, he or she will pay close attention to the contour of the gums and how it is contributing to or distracting from the beauty of your smile. If the gums don’t show enough of your teeth or if they are very uneven, they can make some teeth look longer and some shorter. When dentists talk about “gummy smiles” they are referring to teeth that are out of proportion with predominant gums, making the teeth look smaller or shorter.

So it sounds as though you are probably on the right track with your cosmetic dentist. It is a good sign that the appearance of the gums is playing a role in your smile makeover. And there’s more good news. Cosmetic gum surgery is often accomplished with a high-tech device like a laser or electrosugery instrument. This means the gum tissue can be trimmed and contoured with minimal discomfort. In addition, this type of procedure heals quite rapidly.

If you would like to learn more about this topic, click here to read Pumphrey Periodontics’ Periodontal Plastic Surgery page.

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

Welcome to our new Website!

Posted on October 10, 2017 by AllSmiles.

We hope our new website will help our patients more easily understand the comprehensive nature of the services we offer.

Our new homepage emphasizes the fact that with advanced training and technology, periodontal and dental implant procedures are much easier on the patient than they have ever been.

And our new smile gallery highlights the beauty of our work.

We’d like to thank Infinity Dental Web for creating our new design and expanding on our content.

We hope you enjoy the new experience, and we’d love to hear your feedback.

This blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta.

Is bone grafting dangerous? It sounds terrible!

Posted on October 5, 2017 by AllSmiles.

I’m facing bone grafting, and I think it sounds like a terrible ordeal to go through. I have three missing teeth on the lower left side of my mouth, and my dentist wants to to do a bone graft before he places dental implants. I had a bridge there for a lot of years, but it finally broke, and after what I learned about implants, I decided to go that way.

My dentist said I lost bone from my jaw while I had the bridge there and that bone grafting will make that part of my jawbone strong enough to support the implants. But bone grafting just seems like it would be too much for me. My wife laughs at me because I’m so afraid, and I think I could handle the implant surgery, just not the bone grafting part.

John in Georgia

Hello John,

It can be scary to approach a procedure when it sounds strange and unfamiliar. Once you understand more about bone grafting, you’ll probably feel as comfortable with the procedure as you seem to feel with the surgery to place the dental implants.

Let’s start by talking about what a bone graft is, and then we can explore some facts that could make it even easier for you to face. It’s true that we lose bone density when we lose a tooth. Without the tooth root there to signal the body that the the jawbone is needed to support that particular tooth, the body absorbs, or resorbs, as the process is called, the minerals for use elsewhere in the body. So it’s no surprise that you have had some bone loss if you’ve been without those three teeth for many years. The good news it that with bone grafting and dental implants, your bone loss will not grow worse over the years.

The bone used in the grafting procedure can sometimes be taken from your own jaw, and it can also be obtained from a tissue bank, but the most important point to remember is that the grafting materials that are used these days a safe and effective.

The procedure, as rough as it may sound, is minimally invasive. That’s because advanced technology enables something called guided tissue regeneration. This happens because your body recognizes the grafting material as natural bone, and during the healing process, it will bring more bone-building minerals to the site and actually replace the graft with your own bone materials.

And finally, you may not have heard about sedation dentistry. Something as simple as nitrous oxide works to help many patients relax and experience less stress, but if you are really fearful, a good sedation dentist can make sure that you don’t remember your procedure. With the right kind of sedation, you can be aware enough to respond to requests during treatment, but the whole process can be forgotten.

This log is brought to you by David Pumphrey of Pumphrey Periodontics in Atlanta.

Thrush or oral yeast infection

Posted on September 15, 2017 by AllSmiles.

About a month ago, I had an infection in my gums around two lower front teeth. I went to the dentist, and she told me it wasn’t serious. She examined my teeth and took x-rays, and then she told her hygienist to be extra careful with my cleaning.

For follow-up care, she recommended that I rinse my mouth with hydrogen peroxide twice a day, and let her know if it didn’t clear up. I’ve been following her advice, and the infection has cleared up just fine, but I’ve been in pain for about a week now. My mouth and cheeks and gums feel sore, and there are white patches on my cheeks and tongue.

When I showed my girlfriend last night, she said she thought it was an oral yeast infection and she mentioned something about thrush. I’ve never heard of a yeast infection in your mouth, and I thought a thrush was some kind of bird! Can you help me?

Joshua T., Atlanta

Hi there Joshua,
Absolutely! We can clear things up for you, both literally and figuratively. While a thrush is indeed a kind of song bird, thrush is also the term for an oral yeast infection, often called candidiasis. And as you have noted, it can be quite painful.

Basically, we have a number of species of small organisms living in our mouths all the time. Bacteria are one type, and Candida Albicans, a type of yeast, is another. Normally, the bacteria will keep the yeast in balance, but if something disrupts that balance, an overgrowth of yeast will result.

More than likely, your instructions for using the hydrogen peroxide rinse included a two-week cutoff, and you may have just missed this detail. While the rinse is great for short-term use, killing many strains of bacteria, it is so good at its job that after about two weeks, it will kill off too many bacteria, leaving the yeast to proliferate and cause problems.

You can make sure by scraping away one of those white patches. If you have thrush, you’ll be able to rub it off and the tissue underneath will be red and inflamed. Your dentist will most likely help you resolve your infection with the help of an anti-fungal agent, such as Nystatin. And you don’t have to worry in the meantime, because this type of infection is not contagious.

Thrush, the oral yeast infection

A thrush, the songbird.

The illustrations to the left and the right will enable you to see what an oral yeast infection looks like. More importantly, they will provide a clear distinction between thrush and a thrush and hopefully brighten up your day while you are calling your dentist. The photo on the left shows the characteristic white patches of oral candidiasis, while the one on the right shows the characteristic spotted breast and belly of the songbird.

There are certain populations that are more susceptible to these types of infections. Infants have not yet established the full spectrum of oral bacteria. Undernourished people often lack essential nutrients, leading to thrush. Denture wearers who do not take their dentures out can unintentionally foster yeast growth beneath the dental appliances. And finally, people with compromised immune systems are usually more susceptible.

You can find out more about different types of oral infections on Pumphrey Periodontics’ Gum Disease page.

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

What’s that gritty yellow stuff around my teeth? Dental tartar buildup.

Posted on September 4, 2017 by AllSmiles.

I grew up in a family that, I guess, didn’t really pay too much attention to teeth. I just found out I have to floss and brush my teeth, so I started flossing about a month ago. I have noticed that when I am flossing, sometimes pieces of my teeth seem to crack off. My teeth are nice and white and smooth except nearer the gums, where they’re yellower and not so smooth. It’s these lower parts of the teeth that sometimes crack off when I am flossing. My teeth don’t hurt when this happens, and I don’t have any other pain. Do you think I need to go to the dentist?

Jolene, Atlanta

Hi there Jolene,
Yes. You do need to see a dentist, and it would be a good idea to go as soon as you can. You don’t need an emergency appointment, but I would try to get an appointment as quickly as you can. What you are describing as the lower parts of your teeth is actually dental tartar that has built up.

When we eat, food particles and sugars mix with saliva and create a sticky substance called plaque that clings to our teeth. When we don’t brush and floss regularly, this plaque can harden into tartar, which can only be completely removed by a dental hygienist during a dental cleaning.

Moderate Dental Tartar

Dental Tartar Buildup

These illustrations will help you better understand tartar. On the left is a drawing of a moderate amount of tarter on the teeth. The dental hygienist scrapes this away with special instruments to leave the enamel clean. The photo to the right shows a more severe buildup of tartar. It may look familiar to you.

Even though you don’t have any other type of dental pain, the tartar that has built up on the lower parts of your teeth may have already caused a certain level of gum disease. If it is not removed, it can lead to other, more serious problems. You didn’t say how old you are, but tarter starts to build up when we are in our twenties.

It sounds like you haven’t had much education regarding the care of your teeth, but once your dentist has resolved this issue, you should plan on returning every six months. That way, as problems arise, they will be found quickly and treated early, when treatment is most effective and inexpensive.

Don’t feel bad, though. The good news is that once you have your teeth checked by a dentist and the tartar is removed, you don’t ever have to have yellow tartar in your mouth again. And you may be amazed by how beautiful your smile is when the cleaning reveals your “real” teeth!

Find out more about how lack of dental hygiene contributes to periodontal disease by reading Pumphrey Periodontals’ page entitled Bleeding Gums.

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

Putting my teeth back in with crazy glue

Posted on August 5, 2017 by iowasmiles.

“Bout 3 months ago my teeth just starting falling out root and all the whole tooth. I been using crazy glue but it is starting to mess up the inside of my mouth and it hurts all the time the crazy glue is killing me cause when I’m inhaling it but I have to leave the house and I want let people see me with out teeth but I only go out when I have to I have no life I stay home out the times I don’t date I want go out with friends please help me.”
– (we’re not posting a name with this question)

Unfortunately, we don’t think we have a good answer for this poor woman. There is an answer, but we don’t think she’s going to like it. We’re writing this blog post because we think it’s interesting what she has tried to do.

First we want to comment on the severity of her gum disease and the hopelessness of trying to get these teeth to stay in, even with crazy glue or superglue. We have seen gum disease so bad that the teeth fall out spontaneously, and to be that bad the teeth already have to be dangling somewhat from the root. Here is a photograph of the teeth of a patient with advanced periodontal disease. As bad as this is, it’s not nearly the stage of periodontitis that this woman is experiencing.

Photograph courtesy of Dr. David Mastro, Roswell, GA

This patient’s lower four incisors are getting close to being loose enough to fall out, but they’re not that bad yet. Imagine a little more of the root showing–this is what this woman had.

Putting them back in with crazy glue or superglue? These glues have cyanoacryate, which is is an excellent soft tissue adhesive, but it would only hold for a day or two, maximum, we’re imagining from our experience with it. And the teeth would still flop around.

Our guess is that it’s been a number of years since this woman visited a dentist.

She needs a dentist badly now, and our guess is that none of the teeth are saveable at this point. She needs removable dentures or dental implants.

I’m facing gum surgery, and I’m terrified.

Posted on August 4, 2017 by AllSmiles.

My parents both had gum disease, so I know what it looks like. I’ve been afraid to go to the dentist for many years, but I know if I do, they’re going to operate because I have the family problem. My mom had gum surgery when I was young, and I remember how painful it was. She was in pain for days. Now I’m facing the same thing. Aren’t there better painkillers now?

Theresa V.
Atlanta

Hi Theresa,
It sounds like your mom had a very bad experience with both gum disease and gum surgery, and that may have contributed to your being afraid and avoiding the dentist. That’s unfortunate, but there’s a very bright side here. Your fear may have kept you away, but during your absence, there have been a lot of advances in the way gum disease is diagnosed and treated. None of them include the kind of pain your mom experienced.

It can be hard to overcome long-lasting fear, but you may be pleasantly surprised. Instead of assuming you need gum surgery, if you allow a qualified periodontist to examine your teeth, you may find out that your dental condition is easily treatable without surgery.

Healthy Gums vs. Periodontal Disease

Let’s break things down a little here. Sometimes straightforward information can be the best prescription for fear and avoidance. To begin with, periodontal disease is caused by plaque and tartar that attach to the tooth root below the gumline where brushing and flossing can’t reach. These pockets of plaque and tartar cause inflammation, which damages the bone structure that keeps our teeth stable. The drawing above shows this process.

Even diagnosing the extent of the inflammation and damage used to be fairly difficult. But a new, high-tech camera, called a perioscope, now allows the periodontist to see how far the damage extends. In addition, the laser technology that uses both heat and water to eliminate pain now enables non-surgical gum treatment to smooth the tooth root and remove bacterial toxins. This procedure is called scaling and root planing, and it does not require incisions, sutures, or a long healing process. In essence, it is a deep cleaning that can be accomplished in one or more appointments, leaving healthy tissue intact.

Here’s hoping you find a solution to your fear and your dental condition soon!

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