Home Remedies to Prevent Gum Disease

Do it yourself home remedies and social media health hacks have become popular over the last few years. Gum disease is an infection of the bone and gum tissue surrounding the teeth due to the build up of bacteria contained in plaque and tartar. The bacteria can cause infections of the gums leading to loss of gum tissue and bone. Eventually you can develop loose teeth that may come out of your mouth. Seeing a periodontist regularly and getting professional cleanings is the best way to keep your gums healthy but these are home treatments you can perform to help save your teeth.

  1. Improve Oral Hygiene – Brushing, oral irrigators, and flossing your teeth at least twice a day can help remove plaque and bacteria from your mouth and reduce your risk of gum disease.
  2. Saltwater Rinse – Mix one teaspoon of salt in a cup of warm water and swish it around your mouth for 30 seconds. This can help reduce inflammation and irritation in the gums.
  3. Improve Your Gut Bacteria – Gut dysbiosis and leaky gut can have direct effects on your mouth. Using a probiotic, controlling GERD, and H. Pylori can help prevent gum problems.
  4. Eat Vitamin-Rich Foods – Eating foods high in vitamins B3, B6, B9, B12, A, C, and D can help improve gum health and reduce inflammation.
  5. Avoid Sugary Foods – Sugary foods can increase the risk of gum disease by promoting the growth of bacteria in the mouth.
  6. Quit Smoking and Vaping – Smoking and vaping are known to increase the risk of gum disease, so quitting can reduce your risk.
  7. Use an Electric Toothbrush – An electric toothbrush can help reduce plaque and bacteria by removing more plaque than a manual toothbrush.
  8. Use an Antiseptic Mouthwash – Using an antiseptic mouthwash can help reduce bacteria and reduce the risk of gum disease.
  9. Use Natural Remedies – Natural remedies such as tea tree oil, aloe vera, chamomile, and hydrogen peroxide can help reduce bacteria and inflammation in the gums.
  10. Visit the Periodontist Regularly – Regular visits to the periodontist can help diagnose and treat gum disease before it becomes severe.

If you are interested in more home remedies that you can do please contact us and schedule a consultation appointment.

What Are the Signs of Gum Disease?

Gum disease, which is also known as periodontal disease affects close to 50% of American adults and is caused by a combination of bacteria and how the body’s immune system reacts to that bacteria. Since everyone is different, bacteria accumulation from missing dental cleanings and/or bad home care can cause gum disease in some people and not others. Genetics play a large role in who develops gum disease. Some common signs include:

It's important to note that gum disease is often painless in its early stages, and oftentimes does not begin to hurt until it becomes acutely infected. See your periodontist to check for signs of gum disease so gum treatment can be provided before the disease gets worse.

Frequently asked questions by people who may have the signs of gum disease:

Can gum disease only affect my gums?

No, gum disease can also affect the bone and gum tissue that support your teeth. If left untreated, it can lead to tooth loss of both and cause the tooth to become loose.

Are bleeding gums always a sign of gum disease?

Bleeding gums can be a sign of gum disease, but they can also be caused by other factors such as trauma or brushing too hard or using a toothbrush with hard bristles. If you notice your gums are bleeding, it's important to see a dentist to determine the cause.

Can gum disease only occur in older people?

No, gum disease can occur in people of all ages. It is more common in older adults, but it can also affect younger people. Certain types of gum disease (most often genetically determined) can affect people in their teens and be very aggressive. Factors such as poor oral hygiene, smoking, genetics, and certain medical conditions can increase the risk of developing gum disease.

Can gum disease be reversed?

In its early stages, gum disease can be reversed with proper oral hygiene and professional dental cleanings. However, once the disease has progressed to a more advanced stage, it can only be reversed with surgical regenerative medicine. As with any disease, the earlier it is treated, the better the outcome for success.

If you notice signs of gum disease, please contact us to set up a consultation appointment

Bad Breath: Is It Coming From Your Gut?

Halitosis, also commonly known as “bad breath,” is a concern of many patients seeking help from the periodontist as bad breath is usually associated with oral conditions. Cavities, gum disease, dry mouth, tonsil stones, poor salivary flow, acidic oral environments, and the consumption of odorous foods can all be attributed to causing bad breath. The hygienist or dentist will typically tell a patient to brush, floss, rinse, and drink more water to combat this problem.

What if bad breath is not coming from your mouth?

In that case the dentist/hygienist may tell the patient there is nothing wrong. In some cases, a referral to an Ear nose and throat (ENT) or a Gastroenterologist is made. Although  oral conditions can contribute to about 60-70% of the etiology behind bad breath, the gut can play a major role (20-30%) behind a person’s bad breath. Most people who have bad breath from the digestive system describe a rotten egg/fish/meat smell due to the bacteria in the digestive system that break down food products into sulfa gases. Sulfur-digesting bacteria and other organisms in your digestive system utilize sulfur compounds within food, producing hydrogen sulfide, dimethyl sulfide, and methyl mercaptan as an end product. This can make your breath smell bad and give you chronic halitosis.

What are the top 5 digestive issues accounting for halitosis?

1. H. Pylori

H. Pylori is a type of bacteria that exists within your normal gut microbiota but, when out of balance, can cause duodenal and stomach ulcers.

2. GERD 

Gastroesophageal reflux disorder (GERD) is a very common digestive system disorder that can cause bad breath. GERD is caused by the failure of the muscular valve (sphincter) that separates the lower end of the esophagus from the stomach. When this valve becomes weak, it can allow stomach acid and contents up into your esophagus, causing GERD and sometimes, bad breath. H. Pylori can also cause and/or exacerbate GERD.

3. SIBO (Small Intestinal Bacterial Overgrowth)

Because the small intestine is designed for nutritional absorption and has less digestive enzymes than the stomach, bacterial overgrowth can occur in this organ. 80% of people with irritable bowel syndrome (IBS) also have Small Intestinal Bacterial Overgrowth SIBO and can develop SIBO after gastric infections. Gasses produced in SIBO are the major cause of complaint and may cause bad breath. 

4. Irritable bowel syndrome, Crohn's Disease, Celiac Disease

Irritable bowel syndrome (IBS) is a common disorder of the digestive system. Most commonly, patients suffer recurrent abdominal pain and altered bowel habits such as constipation, diarrhea or both. Both Crohn’s and celiac disease may limit digestion, providing more undigested food for sulfur-reducing bacteria to break down. This generates more hydrogen sulfide and can cause halitosis.

5. Digestive System Infection (Giardia)

A specific digestive system infection can cause bad breath. Giardiasis is a diarrheal disease caused by the parasite Giardia lamblia which can infect humans via food or water.  

Other gut problems causing breath issues:

 If you have a problem with bad breath please contact us for a consultation appointment.

What Is Gum Recession and How Is It Caused

Gum recession is a condition in which the gum tissue that surrounds the teeth pulls back or ‘recedes’ from the tooth, exposing more of the tooth and possibly the tooth's root. There are several factors that can cause gum recession, including:

  1. Brushing too hard or using a toothbrush with hard bristles.
  2. Periodontal disease: This bacterial infection can cause inflammation and damage to the gums and bone, leading to loss of tissue around the tooth.
  3. Clenching or grinding of teeth (bruxism): This can put excessive pressure on the teeth and gums, leading to recession.
  4. Genetics: Some people may be more prone to gum recession due to inherited traits such as inclined teeth, thin bone, thin tissue, and tissue loss.
  5. Hormonal changes: Hormonal fluctuations, such as those that occur during pregnancy, can make gums more susceptible to recession because hormones can cause an increase in the bacteria that lead to tissue loss.
  6. Tobacco use: Smoking or using smokeless tobacco can increase the risk of gum recession because the hot smoke can cause tissue damage and cause the body’s immune system to break down.
  7. Dental misalignment or bad bite: This can put uneven pressure on the teeth and gums, leading to recession.
  8. Bad Dental fillings, crowns, veneer: these trap bacteria that can cause gum recession.

It's important to maintain good oral hygiene, to visit the dentist for regular checkup and cleaning, to quit smoking and to address any underlying issues such as bruxism in order to prevent gum recession and other periodontal problems.

Top Questions Asked About Gum Recession

What are the symptoms of gum recession?

The most common symptom of gum recession is the roots showing, sensitive teeth, tooth pain, tooth discoloration, and cavities on the root.

Can gum recession be reversed?

In most cases, gum recession can be reversed with gum grafts. Surgical techniques have been developed such as the Pinhole Surgical Technique that make covering gum recession less invasive.

What is the treatment for gum recession?

Non surgical treatment for gum recession may include deep cleaning, administration of antibiotics, and/or gum surgery to cover exposed roots and thicken lost tissue.

How can I prevent gum recession?

Preventing gum recession can be accomplished with good oral hygiene, visiting the dentist regularly, quitting or not smoking/vaping, and fixing bad bites and/or crowded teeth.

Are there any home remedies for gum recession?

Home remedies for gum recession are using a soft bristled or sensitive tooth brush, using a toothpaste without detergents and abrasives, flossing/brushing regularly, and seeing your periodontist as directed.  

Does gum recession mean I have periodontal disease?

Gum recession can be a symptom of periodontal disease, but it can also be caused by other factors such as genetics or aggressive tooth brushing. It's important to visit your periodontist for a proper diagnosis and treatment advice.

Can gum recession affect my overall health?

Research has shown a link between gum disease and systemic health conditions such as diabetes, heart disease, and stroke. It's important to address gum recession in order to maintain overall health.

For more information, please contact us for a consultation appointment.

Unexpected Causes of Bad Breath

  1. Gastrointestinal disorders: Gastrointestinal problems such as gut dysbiosis, acid reflux, GERD, or H. Pylori (stomach ulcers) can cause bad breath.
  2. Sinus infections, Lung disorders, or other respiratory problems: Bacteria in the sinus, lungs, nasal passages, can produce post nasal drip that leak into the mouth and cause bad breath.
  3. Medications: Certain medications can cause dry mouth and saliva is important to maintain good breath.
  4. Dehydration: When the mouth is dry, it can't produce enough saliva to wash away bacteria and food particles, leading to bad breath. Saliva is also protective and fights bad breath odors.
  5. Food: In certain cultures foods like onion, garlic, and other spices are associated with bad breath.
  6. Fasting diets: Fat breakdown in rapid fashion can cause ketonic breath or ketones in the breath and that can cause bad breath.
  7. Autoimmune disorders such as sjogrens syndrome can lead to dry mouth and breakdown of immunity that can stop bacterial overgrowth.

Frequently Asked Questions About Bad Breath

How can I tell if I have bad breath? 

The most accurate way to test for bad breath is to go to a dentist specializing in bad breath and they will perform a gas chromatography test to measure the sulfur gasses in your breath. Another way to check for bad breath is to lick the back of your wrist (wrist lick test), let the saliva dry, and then smell it. A third way is to scrape the back of your tongue with a spoon and smell the residue.

How can I get rid of bad breath?

 Treatment for bad breath depends on the underlying cause. If the problem is coming from your mouth, you can see your periodontist for cleanings and customized antibiotics creams/rinses to remove the problem. If the problem is coming from your gut, the bacteria/acids in your digestive tract need to be fixed.

What can I do at home for bad breath?

Brushing and flossing regularly, using an appropriate mouthwash, scraping the back of the tongue can help remove bacteria and food particles that can cause bad breath, and using a xylitol mouth spray can increase saliva flow and freshen breath. Drinking water throughout the day can also help to keep the mouth hydrated and prevent dry mouth.

Can bad breath be caused by a medical condition?

Yes, bad breath can be caused by a variety of medical conditions including inflammatory bowel diseases, gut dysbiosis, leaky gut, gastric ulcers, SIBO, chronic sinus infections, postnasal drip, acid reflux, and certain lung and throat infections.

Is bad breath a sign of poor oral hygiene?

Bad breath can be caused by poor oral hygiene, but it can also be caused by a variety of other factors, including taking certain medications and having certain illnesses.

Can smoking or vaping cause bad breath?

Yes, smoking and/or vaping can cause bad breath, as well as other oral health problems such as stained teeth and an increased risk of gum disease.

Can bad breath be a sign of a more serious health problem?

In some cases, bad breath can be a sign of a more serious health problem, such as diabetes, inflammatory bowel problems, leaky gut, stomach/duodenal ulcers, kidney or liver disease, or certain types of cancer.

The Importance of ‘Near Me’ Mobile Searches for Periodontists

When you are marketing as a periodontist, it is vital to have your site optimized for mobile - especially since it is more common for your future patients to be searching for dental specialties using their smartphones rather than a computer. And, since mobile devices take the user’s location into account with each search - for example, Google Map results - “near me” searches looking for hyperlocal results happen all the time.

“Near Me” Searches are Common for Periodontists

Adding the qualifier “near me” to local searches has grown exponentially according to Think With Google in 2017. This rate of growth is much higher than those without the phrase. What does this tell us? When people are searching for periodontists, they want to see periodontists that are nearby their location.

Taking this a step further, Think With Google also has data suggesting that searches are getting even more specific, including “where to buy” and “on sale” in addition to “near me.” This sort of knowledge can be applied to your business, shaping how you handle local SEO for your practice.

Getting Hyperlocal with “Near Me”

There was a time when local results with a search would have left searchers with periodontists in their city or town. Now, the “near me” qualifier is getting hyperlocal – presenting results down to the neighborhood where the search is conducted.

For instance, the Nextdoor app has users enter their home addresses in order to gain access to the site. They are then connected with their neighborhood and everything in it. Users are asked to leave a recommendation and, when they search for a service, such as a periodontist, or ask for a recommendation, they are provided results that include hyperlocal businesses.

AdviceLocal set up a test account to search for a business located outside of the set neighborhood. Can you guess what happened? That’s right - they could not see the business, rather only businesses within the neighborhood.

It is anticipated that this is the direction hyperlocal searches are headed over the next several years. The news, food delivery apps, and more are set up in this manner - which is further evidence of the direction local SEO efforts need to be going. If you haven’t claimed your periodontist practice on Nextdoor yet, now is the time to do so. And, of course, stay in touch with new hyperlocal opportunities as they present themselves.

Hyperlocal with Facebook Neighborhoods

Facebook made an announcement in May 2021 that it is testing its new concept, Facebook Neighborhoods, in Canada.

The Facebook Neighborhoods idea seems rather similar to that of Nextdoor, allowing neighbors to connect and integrate popular features in their communities. For instance, residents will be able to vote for their favorite hyperlocal businesses, services, and places - and this includes periodontists.

It is likely that Facebook Neighborhoods will make its way into the U.S. And when it does, you will want to claim your business listing so that you may take advantage of all it has to offer you.

To learn more about the future of hyperlocal searches and how they relate to your periodontal practice, visit www.Dentalfone.com

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

Excess Sugar Consumption: Effect on the Body

While sugar may seem like a substance that is harmful only to your teeth, causing cavities and gum disease, excessive consumption can cause severe damage to both physical and mental health. What is less well known are the systemic effects of sugar and that excess consumption is one of the leading causes of rising obesity, cardiovascular disease, type 2 diabetes and other chronic disease with addiction rates similar to narcotics. Because addition of sugar to food substances are often unregulated, the amount of sugar intake can remain largely unknown.

Sugar addiction or sugar craving?

Studies suggest sugar addiction or ‘cravings’ are similar to those of cocaine as it can increase energy and result in a short-term euphoric feeling. Sugar addiction has been shown to have withdrawal and relapse rates comparable to those associated with narcotics and other illicit drugs. One difference between narcotics and sugars is that unlike narcotics, sugar can be ‘added’ and hidden in foods, even foods considered healthy. Processed foods like protein bars, sweetened beverages like energy drinks, ‘healthy’ cereals, juices, and yogurts can be loaded with sugars. According to the American Heart Association, the average recommended sugar intake for men is 36 grams/day for men and 25 grams/day for women. One cup of Dannon low fat yogurt, a food substance deemed ‘healthy’, has 34 grams of sugar alone. Because of these hidden sugars and a lack of nutrition education, it is estimated the average American consumes 71.14 grams of sugar a day accounting for up to 17% of total adult calorie intake.

What does excess sugar consumption do to the body?

  • Obesity: fat diets trended in the early 2000’s but those diets replaced fat with sugar and sugar has been labeled as the number one reason why obesity rates have increased. Fat around organs have been associated with organ damage and failure.
  • Diabetes: Sugar overconsumption can spike insulin levels and drive insulin resistance. The risk for diabetes grows approximately 1.1% for every 150 calories of sugar consumed in 1 day. Diabetes is a risk factor for many diseases including periodontal disease.
  • Inflammation: high sugar consumption significantly increases pro-inflammatory cytokines and increases adipose tissue which further increases levels of inflammation.
  • Gut Dysbiosis: Studies have shown that diets high in sugar can trigger changes in gut microbiome favoring those associated with obese body types.
  • Depression: diets high in sugars and processed foods can cause neurotransmitter dysregulation increasing the risk of depression. Research has also found a correlation between excessive high fructose corn syrup consumption and an increased risk for Alzheimer’s disease and dementia.
  • Premature Aging: The shortening of telomeres is a natural process in aging which can be accelerated by a high intake of sugar. One study with 5,309 adult subjects showed that regular drinking of sugar-sweetened beverages was associated with shortened telomere length and premature cellular aging.

Curbing the Sugar Addiction/Craving

Dietary changes that directly limit sugar consumption and replace processed products with whole foods or ‘the single ingredient method’ is the best method.  Eating whole fruits, vegetables, high fiber foods, and grains instead of processed snacks with added sugars will help keep blood glucose levels stable throughout the day. Avoiding high-fructose corn syrup-containing items, added sugars & dyes, and cutting out refined carbohydrates can help decrease inflammation and balance hormone levels. Additionally, mindfulness techniques can be incorporated as a supportive measure; these can include post-meal walks, meditation, and non-distracted eating practices to slow down the speed of food consumption.

For more information on how sugar affects the oral cavity and the body, call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

How a Periodontist Can Help Treat Halitosis

Bad breath, also commonly known as “halitosis” is an odor that is associated with the mouth that 50% of Americans suffer from and increase in intensity as a person gets older. There are many causes of bad breath and the treatment for it depends upon the reason for the bad breath. A periodontist is a specialist in bone and gum disease and can help you treat your bad breath with a variety of treatments.

What are the current treatments available for bad breath?

The available methods of halitosis treatment can be divided into a physical reduction of bacteria, a chemical reduction of bacteria, masking the odor of bad breath, and chemical neutralization of bacterial odor. Determining the cause of bad breath is extremely important to determine if a dentist can treat your bad breath or a medical doctor referral is needed to treat medical issues which are causing your halitosis.

What are the dental treatments available to treat bad breath?

Fix all cavities, broken crowns, broken teeth, crowded teeth, partially impacted teeth, and/or other food trap areas.

Professional cleanings to remove bacteria and a consultation with a periodontist to see if deep cleanings are necessary.

Cleanings done between the teeth with piks, water piks, inter-dental flossers, floss and/or any other tool used to get between the teeth. Specialized anti-bacterial cream specific to the bacteria in your mouth can be used as well.

Customized anti-bacterial mouth rinse specific to the bacteria in your mouth can be used for 2-3 weeks to reduce bad bacteria. This is followed by another probiotic rinse for two weeks to rebuild the good bacteria in the mouth.

What can I do at home to treat bad breath?

Use Triclosan toothpaste, use of essential oils, consumption of probiotics with Lactobacillus salivarius.

Use take home trays to decrease bacteria and volatile sulfa-compounds that are the source of malodor. These customized trays are combined with hydrogen peroxide gel can be used 2-3 times a day and have the added side effect of tooth whitening.

Use Xylitol agents, Biotene rinses, and systemic drugs such as Evoxac/Sialagen to increase salivation if you have dry mouth.

Decrease the consumption of odorous foods such as garlic, onions, and other spices that embed themselves in the tongue and can have long lasting bad breath effects.

Quit smoking, avoid tobacco products and the usage of heavy alcohol.

What medical options treat bad breath?

Medications to reduce bad breath can include broad spectrum antibiotic coverage for pharyngitis and/or drugs such as proton pump inhibitors for GERD.  When H. pylori infections are observed, the therapy consists of the intake of omeprazole, amoxicillin and clarithromycin. Surgical intervention can include tonsillectomy/adenotonsillectomy, Sinus surgery, or liver/kidney transplantation.  In the endocrinological and metabolic disorders (Diabetes/Amino Acid disorders), the underlying diseases should be treated. 

What psychological options treat bad breath?

Patients suffering from perceived bad breath can have significantly elevated scores for obsessive-compulsive symptoms, depression, anxiety, phobic anxiety, and paranoid ideation compared with similar patients without halitosis. To treat delusional halitosis a multidisciplinary approach of health care practitioner, psychologists and psychiatrist are required.

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

What Causes Gum Recession?

Gum recession, loss of gum tissue around the root surface, is a disease that can be caused by many different factors. 84% of teenagers & adults suffer from gum recession which can result in long and ugly teeth, sensitive roots and ultimately tooth loss. Gum recession can be both an esthetic (cosmetic) problem as well as a functional problem. Without the good thick tissue protecting our teeth, the teeth can develop cavities and bone loss, ultimately leading to larger problems. When treated early gum recession can be an easy fix but if treated late, treatment can become much more complex and costly. The most common causes of gum recession are as follows.

Gum Infections

Oral bacteria can cause gum infections including gum diseases like gingivitis and periodontal disease. During these diseases, the gum and bone tissue can be lost which cause the gums around the teeth to recede. Patients can develop long looking teeth that can become loose. Common signs of gum disease include bleeding gums, loose teeth, increased spaces between teeth, gum loss around the teeth, bad breath, and red swollen gums.

Aggressive Oral hygiene (Tooth Brushing)

Gum tissue can be lost by an oral home care routine that is too aggressive. Most commonly, people will brush their gums and teeth with a toothbrush in a manner that is either too hard and/or with a toothbrush that is too hard. When the gums are over brushed or flossed, they can be traumatized, and the gum tissue can recede around the teeth.

How does genetics cause gum recession?

People can be born with thin gum tissue that is more likely to recede than other people with thicker gum tissue. There are two types of tissue in the mouth. One tissue called keratinized tissue which is hard and protective and not likely to recede. The other tissue is called non-keratinized tissue and this is the tissue that allows for movement and flexibility but is more likely to recede when traumatized. The less keratinized tissue volume and thickness an individual has, the more prone they are to recession. Gum grafting is a technique that increases the amount of keratinized tissue around teeth with recession or prevent recession from occurring in people with thin gum tissue.

How does orthodontic Movement (Braces) cause recession?

When a person gets either braces or clear aligners like Invisalign, teeth are moved into different positions in the jaw. Teeth are often moved in a direction to lessen the teeth crowding in the jaw. Teeth moved in this direction, which increases the room in the jaw for crowded teeth, may result in thinning of the bone around the teeth resulting in gum tooth recession. This recession can happen during the orthodontic movement or many years after completion. An Orthodontist will often send people with thin tissue to a Periodontist to evaluate the gum and bone around the teeth to be moved and see if gum grafting is needed to build up the gum tissue before orthodontics begin.

How does smoking & tobacco products cause gum recession?

Smoking, vaping, and chewing tobacco products can cause gum recession around teeth because of the chemicals in the tobacco products. The hot smoke from smoking can traumatize the tissue leading to gum tissue loss. Chewed tobacco can harm the gum tissue from both the chemicals in the tobacco as well as the friction from the material against the gums.

Bad Bite

Many dental studies have shown that people who have bad bites with teeth banging against each other can develop recession around their teeth. Typically, bad bites will quicken the amount of recession someone can develop, especially if they already have bacteria in their mouth that cause bone and gum tissue loss.

Teeth Grinding & Teeth Clenching

Like a bad bite, grinding your teeth or clenching them together can quicken the recession you can get when you have bacteria that causes gum and bone tissue loss in your mouth. People who grind their teeth can find ways to prevent damage to their teeth by using a night guard and/or botox treatment in the jaw.

Mouth Trauma

Trauma or a direct blow to the gums can cause recession by ulcerating the gum tissue or having the gum tissue peel away from the tooth. If the tooth is healthy and is not suffering from gum disease already, the gum tissue can grow back to normal levels after it heals from the trauma. If the gums do not grow back in 3-6 months, the gums may need to have soft tissue grafting to bring them back to normal levels.

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

How to Choose the Best Periodontist in NYC

Are you searching for a periodontist in New York, NY?

While dentists provide general care for the whole mouth, a periodontist focuses specifically on gum and bone health, the tissues that hold the teeth in the jaw. Your dentist can help monitor your gum health and even treat many gum conditions, but may recommend that you see a periodontist if you have any severe or chronic issues with your gums and teeth, such as bleeding gums, gum recession, bad breath, loose teeth, gum disease, or other gum issues. When it comes time to see a periodontist, how will you know which one to choose? With so many in NYC, you need to look for certain qualities that make the best periodontist stand out from the rest.

Qualities to Look For in a Periodontist

  1. Education. Of course you’ll want to be sure the periodontist you choose has not only completed the necessary undergraduate and dental degrees, but has also completed a residency in periodontology at an American Dental Association-accredited institution. Periodontology is a concentration within the medical dentistry or dental surgery field. A periodontist must complete all of the above to earn that title.
  2. Experience. In addition to education, you should look for a periodontist with plenty of experience in the field of periodontology, not just in dentistry alone. If a periodontist is new to the field, they should be working alongside a more experienced periodontist in order to learn and gain quality experience.
  3. Membership with Dental Associations and Societies. While it is not a requirement for a periodontist to be a member of any associations and societies, one who is a member of organizations such as the American Academy of Periodontology has proven that they are willing to go above and beyond with their practice and their professional development. Certifications such as this require extra written and oral exams and must be renewed periodically, which ensures that all qualifying periodontists are keeping up to date with current best practices.
  4. Handles Complex Cases. Not all periodontists offer the same services. Look for a periodontist who routinely handles complex conditions and procedures. Even if your current needs are relatively simple, you could experience changes that require more in-depth procedures. If this occurs, you will be glad you chose a periodontist from the beginning who could handle all periodontal conditions, no matter their complexity.
  5. Teaches. A truly excellent periodontist is also a teacher. Experience and knowledge should be used to the fullest to educate other periodontists and dentists on best practices and techniques. There’s no greater vote of confidence than when someone excels at their field to the extent that they are asked to teach others how to do the same.
  6. Uses Cutting Edge Technology. Advancements in technology have revolutionized periodontology, making procedures faster and less invasive for the comfort and convenience of the patient. Look for a periodontist who uses the latest technology in their practice for diagnosis and treatment.
  7. Has published in Dental Journals- Top periodontists in their field publish in journals and have performed research that is shared with other colleagues. When your periodontist not only is in clinical practice but academic research, they stand out from the rest of the field.

Dr. Scott H. Froum Embodies All of These Qualities and More

When it comes to excellence in the field of periodontology, Dr. Scott Froum checks all of these boxes and more. He completed his Bachelor of Arts at Amherst College and received his Dental Doctorate and Periodontal Certificate from the SUNY Stony Brook Dental School. Dr. Froum has multiple decades of experience in the dental and periodontal fields, specializing in periodontology and implant dentistry. He is currently a clinical professor in the post-graduate department of Periodontics at SUNY Stony Brook School of Dental Medicine.

In addition to being a diplomate of the American Academy of Periodontology, he serves as the chief editor of the Perio-Implant Advisory Journal and has been written in numerous textbooks on Periodontics and Implantology.  He lectures extensively on the national and international level.

Dr. Froum has handled and continues to handle many complex cases ranging from bone regeneration procedures to save teeth, to treating Implant Complications to gum grafting to crown lengthening and many other services. A complete range of periodontal, implant, and cosmetic procedures as well as preventive dentistry are all offered through Dr. Froum’s practice. State-of-the-art technology is implemented in every aspect of patient care to provide the highest quality service.

To choose one of the best periodontists in the field. Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

What Causes a Gummy Smile

The gummy smile is when the gums enlarge and can be caused by three main reasons (1) bacteria causing inflammation, (2) medication, and (3) systemic disease. Most of the treatment involves either gum cleanings or surgical intervention in the form of crown lengthening.


How does bacteria cause a gummy smile?


One reason by people develop gummy smiles is inflammation and bleeding of the gums caused by bacteria. Gum disease (gingivitis and periodontitis) can result in gum tissue swelling, overgrowing, and starting to bleed. Braces and other orthodontic appliances can trap food and if proper oral hygiene is not done, can result in gum overgrowth (Figure 1). The first step is to start performing good oral hygiene and get dental cleanings. In many instances, surgical removal of excess gingival tissue may be needed which can be accomplished quickly and efficiently with a dental laser (figure 2).


image

Gummy smile caused by a combination of poor oral hygiene and orthodontics increasing bacterial accumulation leading to gum overgrowth

Picture of a gummy smile correction after removal of excess gum tissue with a dental laser


What medications cause a gummy smile?


The following classes of drugs have been associated with gum overgrowth and a gummy smile.

  • Antiseizure (phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone)
  • Blood pressure (calcium channel blockers such as nifedipine, amlodipine, and verapamil)
  • Immunosuppressant (cyclosporine)
  • Amphetamines (cocaine, Ritalin, methamphetamine)

Treatment may not be needed, and this condition may resolve by itself if the drug causing the problem is discontinued or another drug is substituted. Bacteria caused by poor oral hygiene can make drug induced gummy smiles worse so frequent dental cleanings may be needed.  If these methods do not work surgical treatment may be necessary.


What conditions or diseases cause a gummy smile?


  • Hormonal changes associated with pregnancy or puberty
  • Diseases requiring hormone replacement therapy
  • Vitamin deficiencies (mostly vitamin C and vitamin Bs)
  • Benign neoplasms
  • Leukemias, malignant neoplasms/carcinomas, as well as many forms of granulomatous diseases

Treatment of gingival enlargement


Correction of the gummy smile is dependent on the reason for the gum overgrowth. If the gummy smile is caused by medication, stopping the drug and proper home care will usually resolve the problem. When caused by a disease, treatment of the disease usually will result in resolution. Hormonal fluctuations caused by pregnancy and puberty are often unavoidable, and gum overgrowth can often be minimized with excellent home care and dental cleaning visits. When these noninvasive modalities do not result in resolution of the gummy smile surgical treatment can remove the excess gum tissue.

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

Diseases That Affect the Tongue


How does the healthy tongue look?


The tongue should be a pinkish to reddish in color on the top of the tongue and should be pink with bluish hue on the underside as some veins may be seen.  The tongue should have a rough top surface due to the taste buds and the underside of the tongue should be smooth.  There should be no hairs, furrows, or ulcerations.  The tongue should fit comfortably in the mouth with the tip against the teeth.


What can cause a tongue to look smooth and shiny?


If the tongue is not smooth because of rubbing against the teeth, crowns, implants or a denture than nutritional deficiency may be the culprit. Vitamin deficiency, especially vitamin B12 deficiency (pernicious anemia), can be the cause. Other deficiencies that can contribute include vitamin B3, B6, B9, and iron.


What causes the tongue to look white?


  • Oral candidiasis (thrush), is an infection of a fungus called Candida albicans that can make the tooth look white and furry. Immunosuppression such as (HIV), diabetes, denture use without teeth cleaning, and/or antibiotic use (usually over long-term periods).
  • Oral lichen planus is an autoimmune disease that has a white lace-like pattern called reticular lichen planus.
  • Geographic tongue is a non-cancerous problem with painless patches on the tongue that can appear, disappear, and then reappear in a different area. This is seen in 1%–3% of the population. Recent evidence, however, suggests that geographic tongue may be linked with a Vitamin B3 deficiency and inflammation of the intestine or leaky gut.
  • Vitamin Deficiency in Vitamin A, Vitamin B2, B3, B6, B9, and B12

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White tongue: Candida albicans fungal infection sometimes referred to as thrush


What causes the tongue to look red?


A red tongue can be a sign of a vitamin deficiency (B2, B6, B9, B12) Iron deficiency, protein deficiency such as Kawasaki disease, or a strep infection (scarlet fever). Red ulcerations of the tongue can be signs of cell changes and red ulcerations lasting more than 2 weeks should be biopsied.


What causes the tongue to look black?


A black tongue is usually a harmless condition that can be caused by chlorohexidine rinses (Peridex), medications, smoking, antibiotic use, poor oral hygiene, soft diet, or dry mouth. The cause of black tongue is thought to be a change in the normal bacteria in the mouth after antibiotic treatment or use of products that contain bismuth (sulfa), such as Pepto-Bismol.


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Black, hairy tongue from poor oral hygiene and smoking


What causes a change in taste?


  • Medications usually cause a metallic taste, and these are associated with some forms of antibiotics; chlorhexidine rinses; antihistamines; antifungals; antipsychotics; blood pressure, diabetes, seizure, and Parkinson’s disease medications; among others.
  • Covid-19 has been associated with changes in taste because due to the SARS CoV-2 virus affects the ACE-2 receptors in the tongue and nose.
  • Dry Mouth caused by colds or flu, smoking, and nutritional deficiencies (Vitamin B12, Vitamin C, and Zinc).

What causes the tongue to have ulcers?


Tongue ulcers that do not heal or regress in 10–14 days should be of concern and either biopsied or referred to a specialist.

  • Canker sores (aphthous ulcer)is a painful form of ulceration frequently encountered. The ulcer appears in one of several patterns: minor (small that heal within 14 days), major (large and may scar when they heal), or herpetiform (multiple pinpoints that can combined into 1 large ulcer).
  • Recurrent canker sores occur in some systemic illnesses, including Crohn’s disease, celiac disease, Behcet’s syndrome, pemphigus, herpes simplex, histoplasmosis, and reactive arthritis (Reiter’s syndrome).

Minor canker sore white in appearance with a red border frequently found on the lateral border of the tongue


Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

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Saving a Tooth with a Maxillary Root Amputation


What is maxillary molar root amputation?


Maxillary root amputation is a surgical treatment that removes one of the roots of a maxillary tooth while leaving the crown and remaining roots intact.  Root amputation treatment is used to save teeth with bone loss, have failing or failed root canals, or have a root that is fractured and are supposed to be taken out. Using this technique to save compromised upper molar teeth with root amputation can often be successful but the technique is sensitive and complex.


When is a maxillary molar root amputation a good idea?


  1. There is enough bone support around the remaining roots
  2. The periodontist performing the procedure is experienced in this specific type of treatment
  3. The root canal on the tooth (if the tooth has a root canal) is in good shape
  4. A tooth crown can be placed on the tooth in proper function and bite
  5. Routine dental cleanings and good home hygiene can be performed

X-ray of a upper molar tooth with a root amputation that allowed the patient to keep the tooth and avoid a sinus lift and dental implant


What is the success rate of maxillary molar root amputation?


Prognosis for molar teeth with root amputation is good, provided case selection and treatment is performed properly as stated above. One 15-year study showed long term success rates to be the same between molars with maxillary root amputation as compared with dental implants. Another 10 year long term study showed that teeth that had bone loss and were planned to be extracted, showed excellent success and function over the time period of the entire study. In addition, patients were able to avoid taking out the teeth, having to perform sinus lifts, and place dental implants when maxillary molar root resection was performed. Finally, this treatment on average is about 25% of the cost when comparing the alternative of taking out the tooth, placing a bone graft, performing a sinus lift, and placing dental implants to replace the teeth that were extracted.


Who is a candidate for maxillary molar root amputation?


Patients that are not eligible for dental implant therapy due to medical history, smoking, financial limitations, and/or who do not want dental implants or sinus lifts may be eligible for this type of procedure. Long term success rates are similar when comparing this type of tooth saving procedure to dental implant therapy.

To find out more about maxillary molar root resection and if it is the right treatment for you, call 212-751-8530 to schedule a consultation with Dr. Froum or contact us today.


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What is Crown Lengthening and When Do I Need It?

 If you have been told by your dentist that in order to complete your crown or filling you need crown lengthening, you may have questions as to what it is and why you need it. This quick article will address those questions.


What Is Crown Lengthening?


Crown lengthening is a procedure that is designed to be either what in dental terms is known as functional or esthetic.

Functional crown lengthening is a surgical procedure used to create space between the end of the crown or filling and the bone holding your tooth in the mouth. This surgical procedure can be performed with dental instruments or dental lasers which make it fast and painless. This space is necessary for the gums to ‘breathe’ and be healthy. This space, which is about 2-3millimeters in length, can’t have dental filling material or the tooth crown placed into it or the body will react to it. The body may ‘reject’ the dental filling or crown by the gums becoming inflamed, swollen, red, and start to bleed. Functional crown lengthening is also needed when the tooth is broken down or has cavities in it or near the gum line. There must be enough tooth left above the gums to put a crown or dental filling into the tooth. If the tooth is broken down, functional crown lengthening is a surgical procedure that will remove enough of the bone and gum to allow for a long-lasting tooth crown or filling.


What is Esthetic Crown Lengthening?


Esthetic crown lengthening is a surgical procedure used to reshape the gums or remove excess tissue to correct a gummy smile. When you grow, the jaw can grow and the gums can move around the teeth unevenly. This can lead to some of the gums being asymmetrical and look uneven. Esthetic crown lengthening often uses a dental laser to shape the gum tissue around the teeth in a non-invasive manner that makes them look even. Esthetic crown lengthening is also used to remove excess gum in cases when patients smile and show too much gum (figure 1). Lasers can be used to reduce the gum tissue and make the teeth look longer so more teeth show when you smile (figure 2). Esthetic crown lengthening is also used before someone gets veneers or crowns so these restorations appear more cosmetic and natural.


Crown Lengthening - Excess Gum Tissue and Uneven Gums

Figure 1. Patient with excess gum tissue and uneven gums before esthetic crown lengthening


Figure 2. Patient after esthetic crown lengthening and cosmetic dentistry



Crown lengthening Procedure Explained


Crown lengthening is a very common procedure and is usually quick and painless. The procedure can be performed with local anesthesia and when using a laser, often does not require stitches. In cases of functional crown lengthening, the dentist can put a temporary crown on the teeth and then the periodontist will use that as a marker for how much bone and/or gum tissue needs to be removed to make the tooth crown long-lasting. In cases of esthetic crown lengthening, a wax model or digital model can be used to guide the periodontist on how to shape the gums or correct the gummy smile. In many instances the time of the procedure can be 30-60 minutes and the healing time is usually a few days. Over the counter pain relief is usually sufficient to control any discomfort and the periodontist may give you a prescribed mouth rinse to keep the area clean.  In some instances, glue stitches can be used, or a surgical dressing can be applied.  You may feel tooth sensitivity after the procedure and a desensitizing gel or toothpaste can be used.

The gums usually take 4-6 weeks to fully heal before the tooth crowns, veneers, or dental fillings can be done. If you are not getting any dental restoration on the teeth and the procedure was performed to correct a gummy smile or reshape the gums, full healing should be around 2-3 months for the gums to fully settle into position.  Crown lengthening is one of the quickest and painless surgical procedures that can be performed with great results and success. Contact your periodontist today to find out more about this treatment.

Why Am I Bleeding After My Tooth Was Removed?

How much bleeding is normal after tooth extraction?



A little oozing is normal after a tooth is removed and this can happen for 24-48 hours, especially if the tooth was difficult to remove and the tooth had to be removed in pieces. Broken down teeth, broken down root canal teeth, teeth with multiple roots on them, teeth that are fused to the bone, and teeth that are underneath the gums can typically require surgery to take them out and the bleeding can be more due to the increased difficulty in tooth extraction. A call to the dentist office that performed the tooth removal should be made if the bleeding you have is filling your mouth with blood, lasts more than 3 days, or is causing you to become faint.


What causes excessive bleeding after tooth extraction?


Certain types of medical problems can cause clotting disorders and make someone prone to bleeding issues. Diseases like Hemophilia, von Willebrand’s disease, liver dysfunction, certain types of cancer, and other disorders involving the blood clotting cascade can cause someone to be more likely to bleed after tooth extraction. People on aspirin, Coumadin, Xarelto, Plavix, Lixiana, Pradaxa, and Eliquis are also more likely to bleed after tooth removal. Other medications that can cause bleeding are antidepressants, antipsychotics, corticosteroids, oral contraceptives, and tamoxifen. Supplements known to cause bleeding include garlic, ginseng, ginger, ginko biloba, donq qua, and feverfew. Other things that can cause bleeding after tooth removal include smoking, drinking alcohol, strenuous exercise, vigorous rinsing, and eating hard foods.


What can someone do to try and stop the bleeding after tooth removal?


If you are experiencing heavier than normal bleeding the first step to try and stop the bleeding is put gauze in your mouth and bite down on it for an extended period of time (20-30 minutes). If the bleeding continues wrap a warm tea bag around gauze and bite down on it in the same fashion as the tannic acid in the tea have clotting properties.  Do not smoke, drink alcohol, rinse for 24 hours after tooth removal, eat hard foods, or perform vigorous exercise to prevent the blood clot from dissolving and bleeding to occur. Bleeding can also occur the following morning after extraction as your tongue can disturb the clot and you can wake up in the morning with blood in your mouth. It is not uncommon for people who take anticoagulation medication to wake up with a jelly clot or a ‘liver clot’ in their mouth in the area of the removed tooth. This jelly clot needs to be wiped away and the whole process of biting down on gauze to stop the new bleeding will have to begin.


What can be done in the dental office to try and stop the bleeding?


If the bleeding after tooth removal is uncontrolled and filling your mouth with blood or it has lasted for more than 48 hours, a return to the dental office may be advised. Procedures that can be performed are removal of the bad clot by suction and saline irrigation of the tooth extraction area. The area can be cleaned and then packed with material that help stop bleeding. The area will then be stitched in a way that can assist gum tissue closure and stop bleeding. There are also ‘glue stitches’ available that can further help bleeding to stop. Lasers can also be used to cauterize the area and stop the bleeding.

Bone Grafts to Save Your Teeth

Why would your teeth need a dental bone graft?


Teeth can lose bone and gum tissue when a person has gum disease otherwise known as periodontal disease. Certain bacteria around the teeth will cause your body to activate the cells in the body that cause inflammation which can then lead to bone loss around the teeth. When bone is lost, the teeth can become loose, look long, begin to shift, and eventually may need to be taken out. A dental bone graft can be used to replace the missing bone and help the teeth become strong and firm. By using a bone graft you can regenerate lost bone and reverse the damage caused by periodontal disease. This type of procedure is performed by a periodontist that specializes in saving bone and gum tissue.


What kinds of dental bone grafts are available?


  • Autografts: Dental bone grafts can be taken from your own bone in a different part of the mouth or body (called the donor site) and added to the teeth with lost bone support (called the recipient site). This type of bone graft is called an autograft and is the best type of graft since it contains cells (osteoblasts) that can turn on your body’s bone making properties.
  • Allografts: Another type of dental bone graft is taken from a cadaver, and this is known as an allograft. Allografts also can have cells that turn on your body’s bone making properties but usually to a lesser degree. These grafts have an advantage as they can be used without having to take bone from another part of the body and are available in greater quantities.
  • Xenografts: Dental bone grafts can be taken from animals (usually pig or cow) and these grafts are known as xenografts. Xenograft bone has a structure that resembles human bone and acts like a scaffold that supports the gum and bone until your body breaks it down and builds its own bone around the scaffold. The advantage of this bone graft is that some people do not like the thought of using another human’s body parts.
  • Alloplasts: The last type of dental bone graft is a synthetic graft known as alloplast. Alloplast grafts are taken from a variety of sources but are usually manmade in nature. These grafts are purely a scaffold and do not turn on the body’s bone making properties. The advantage of these grafts are that some people do not want grafts from humans or animals but something that is synthetic.

How are teeth saved with dental bone grafts?


Dental bone grafts can be added to teeth suffering from periodontal disease with lost bone and gum tissue during a surgical treatment. The teeth will be anesthetized with local anesthesia and the gums can be elevated to expose the area of lost bone. After the bacteria is removed with dental instruments and on many occasions dental lasers, the dental bone graft is added to the area and the gums are replaced. The dental bone grafts can be combined with growth factors that help the person heal faster as well. The bone grafts will then begin to heal for a period of 3-6 months and start to solidify. Once the bone grafts solidify, the teeth will become stronger and lost biting power can be restored. This type of treatment is performed by a periodontist that studies for 3-4 years after graduating from dental school in order to learn how to perform these procedures.

What Causes Bad Breath and How Can It Be Treated?

Bad breath, also commonly known as “halitosis” is an odor that is associated with the mouth that 50% of Americans suffer from and increase in intensity as a person ages. There are many causes of bad breath and the treatment for it depends upon the reason for the bad breath. This article will briefly describe the causes of bad breath, how it can be discovered, and how it can be treated.


What are the Causes of Bad Breath?


Morning breath (physiologic halitosis) is caused by a slow down of saliva in the mouth while a person sleeps. Because the food particles are not moved around the mouth by saliva during the night, bacteria can accumulate in the tissues of the mouth (especially the tongue) and cause odors.

Bad Breath originating in the mouth

  1. Gum disease and bone loss
  2. Dental implant gum disease and bone disease
  3. Tooth Problems such as cavities, broken teeth, fractured teeth, bad fillings
  4. Gum abscesses, ulcers, and sores in the mouth
  5. Dry Mouth Problems

Bad Breath from medical problems

  1. Gastrointestinal disorders
  2. Respiratory disorders
  3. Immunocompromised
  4. Autoimmune disorders
  5. Liver failure, renal failure
  6. Hormone fluctuation, menstruation
  7. Metabolic disorders

Bad breath that a person thinks is present but is not

“Delusional halitosis” is a psychological condition in which a subject believes that their breath odor is offensive even though it is not present


How Can Bad Breath Be Detected?


  1. A smell test is when a person the exhales air out of the mouth and then out of the nose and compares the two. Bad breath from the mouth but not from the nose is likely to be from the mouth or the throat. Bad breath from the nose alone is likely to come from the sinus or nasal area.
  2. A lick test is when a person licks their wrist and lets it dry for 10 seconds and then smells for odor. Tongue scrapings form a tongue scraper can also be smelled.
  3. Floss can also be used and then smelled for bad breath
  4. Gas chromatography also called a hallimeter measures sulfur-containing compounds and is a very accurate test to see if a person’s breath has odorous gases
  5. DNA PCR test is a salivary test that measures for the presence of DNA from bacteria known to cause bad breath

What are the Current Treatments Available for Bad Breath?


The available methods of halitosis treatment can be divided into a physical reduction of bacteria, a chemical reduction of bacteria, masking the odor of bad breath, and chemical neutralization of bacterial odor. Determining the cause of bad breath is extremely important in order to determine if a medical doctor referral is needed in order to treat medical issues in addition to dental issues.

Dental Treatment

Mechanical removal of plaque and bacteria is the first step in the control of bad breath. This includes:

  1. Fix all cavities, broken crowns, broken teeth, crowded teeth, partially impacted teeth, and/or other food trap areas
  2. Professional cleanings to remove bacteria and possible a consultation with a periodontist to see if deeper cleanings are necessary
  3. Tongue scrapers
  4. Cleaning between the teeth with piks, water piks, inter-dental flossers, floss and/or any other tool used to get between the teeth. A compounded anti-bacterial cream can be used as well.
  5. An anti-bacterial mouth rinse can be used for 2-3 weeks to reduce bad bacteria. This is followed by another probiotic rinse for two weeks to rebuild the good bacteria in the mouth
  6. Triclosan toothpaste, use of essential oils, consumption of probiotics withLactobacillus salivarius
  7. Use of take home trays to decrease bacteria and volatile sulfa-compounds that are the source of malodor. These customized trays are combined with hydrogen peroxide gel can be used 2-3 times a day and have the added side effect of tooth whitening
  8. Xylitol agents, Biotene rinses, and systemic drugs such as Evoxac/Sialagen can increase salivation.
  9. Decreasing intake of odorous foods such as garlic, onions, and other spices that embed themselves in the tongue and can have long lasting bad breath effects
  10. Quitting smoking, avoidance of tobacco products and usage of heavy alcohol also helps to avoid bad breath

Medical Treatment

  1. Medications to reduce bad breath can include broad spectrum antibiotic coverage for pharyngitis and/or drugs such as proton pump inhibitors for GERD. When  pylori infections are observed, the therapy consists of the intake of omeprazole, amoxicillin and clarithromycin.
  2. Surgical intervention can include tonsillectomy/adenotonsillectomy, Sinus surgery, or liver/kidney transplantation. In the endocrinological and metabolic disorders (Diabetes/Amino Acid disorders), the underlying diseases should be treated.

Psychological

Patients suffering from perceived bad breath can have significantly elevated scores for obsessive-compulsive symptoms, depression, anxiety, phobic anxiety, and paranoid ideation compared with similar patients without halitosis.  To treat delusional halitosis a multidisciplinary approach of health care practitioner, psychologists and psychiatrist are required.

Are There Differences Between Teeth and Dental Implants?

Although dental implants have high success rates in the mouth and are a great option to replace missing teeth they are not without problems. This article will address structural differences between teeth and dental implants and how that can affect their long-term stability.


Do Bone and Gum Attach Differently to a Tooth vs a Dental Implant?


Natural teeth have more fibers that help it to attach to the bone and gum as compared to a dental implant. In addition, the fibers are oriented in a way that make them stronger than the fibers that attach a dental implant to the bone and gums.  Because of this the likelihood of tissue breakdown when faced with a bacterial challenge is more likely with dental implants. Seeing a periodontist to get professional cleanings and good home hygiene is very important for people with dental implants to avoid bone and gum tissue breakdown.


Tissue Around Dental Implants Are More Likely to Become Inflamed


When bacteria contaminate a dental implant not only is the tissue around dental implants weaker but the inflammatory response a person mounts to the bacteria is much greater. Dental implants will develop gum disease and peri-implantitis much faster and more severe than natural teeth. The immune system has a much greater reaction to contaminated implants than contaminated teeth and gum and bone tissue can break down in a faster period of time. It therefore becomes very important to see a periodontist and get treatment early when you have an implant infection.


Is the Healing Ability of Teeth Different Than Dental Implants After Treatment?


The blood supply around dental implants is less than that of natural teeth. Due to the decreased blood supply around implants compared with teeth, the healing after nonsurgical and/or surgical therapy is slower. Tissue repair around diseased implants is not as predictable as it is around teeth and more growth factors, proteins, and/or stem cells may need to be added when repairing diseased implants.


Natural Tooth Roots Can Handle Bite Stress Better Than Dental Implants


Teeth have a shock absorber in the form of a ligament (called the periodontal ligament) that acts as a suspension system, transferring forces from your bite to the surrounding bone in a distributed fashion. Implants do not have a periodontal ligament so forces are transferred to parts of the implant itself and pinpoint areas on the bone. Implants, therefore, are more likely to have mechanical breakdown such as dental implant screw loosening, fracture, and bone loss. Any type of excessive bite stress, chewing on ice, chewing on pencils, teeth grinding, or teeth clenching can be much more damaging to a dental implant than a natural tooth.


Bacteria Attach to the Dental Implant Stronger Than a Tooth Root


Because the surface of a dental implant is rough and porous bacterial contamination of the implant body versus the root surface is higher.  Removing the bacteria once it contaminates a dental implant is much harder when compared to a tooth. A periodontist may use a laser or other instruments to remove the bacteria around a dental implant prior to rebuilding the damaged bone and gum tissue.  In addition, recent studies have shown that the surface of the dental implant can breakdown and corrode leading to bleeding, swelling, and pain. Removal of these breakdown particles are also very important prior to attempting to rebuild any lost bone or gum tissue.

Why Do I Have Dental Implant Pain?

Even though dental implants are very successful, they can have problems and fail. Dental implants can become problematic after they are placed and before the tooth crown is put on, this is known as early complications. Dental implants can also have problems after the tooth crown is put on and that is known as late complications. The course of action need to address the pain depends on why you are having pain and diagnosing the problem. This article will focus on factors that can elicit pain post dental implant placement.


Can My Dental Implant Become Infected?


Dental implants can develop gum and bone disease very similar to your natural teeth since the bacteria that damage teeth are the same that damage dental implants. In dental terms it is known as peri-implant mucosisitis or implant gingivitis where the gum tissue around the implant can start to bleed, become red, become swollen, ulcerate, and/or start to pus. Bone can also be affected and start to dissolve around the dental implant and this is known as peri-implantitis or implant bone and gum loss. When this type of infection occurs around your implant you can also develop pain and throbbing in the jaw. Consultation with a periodontist is advised to treat this type of dental implant infection.


The Implant Was Placed to Close to the Nerve


The inferior alveolar nerve (IAN) is a nerve in your lower jaw that provides sensation to your lower teeth and when it branches off towards the front of your chin it becomes the mental nerve which provides sensation to your chin and lip. Everyone’s nerve length and position can be different. If a dental implant is placed too close to these nerves, they can either compress the nerve or traumatize the nerve leading to pain. The first step to take of this happens is to take an x-ray called a cone beam cat scan or CBCT to find out the location of the implant as it relates to the nerve. Depending on what the CBCT says treatment can include steroids and anti-inflammatory medications if the implant is not close to the nerve. Removal of the dental implant should occur if the implant was placed too close or into this nerve.


Can Lack of Gum Tissue Around the Dental Implant Cause Pain?


There are two types of tissue in the mouth. Some tissue is non-keratinized such as the mucosa on the inside cheeks of your mouth and this is a very moveable flexible tissue. The other tissue is called keratinized tissue and this is the harder tissue (similar to your fingernails) and it is a protective tissue that can withstand pressure. In some people there is not enough keratinized strong tissue around the dental implant that may cause them to have pain when performing things like eating, brushing, or any pressure that touches the tissue around the dental implant. In dental terms this is known as a lack of keratinized tissue. Ways to correct this problem would be to see a periodontist and discuss enhancing the tissue around the dental implant with a gum graft.



A Weak Bond Between the Dental Implant and the Bone


When a dental implant is placed into the bone, the bone binds to the surface of the dental implant. The amount and the strength of this bone binding is called bone to implant contact in dental terms or BIC. Even though the bone can appear that it is completely surrounding the dental implant on a standard two-dimensional x-ray, there may be poor bone quality and strength of that binding. If the bone is not bound well to the dental implant, a person can have pain when the implant is used. Many times, the dentist will look at the x-ray and think nothing is wrong since the bone looks normal. There is a machine that uses resonance frequency analysis and can measure the strength of the bone to implant bone giving a digital read out when measuring. If that bond strength is low, the implant may need to be removed.


Predisposing Risk Factors Toward Postoperative Dental Pain


Certain risk factors can exist within the medical/genetic makeup of a person that may predispose you to persistent pain post implant therapy. These risk factors include fibromyalgia, temporomandibular disorders, visceral pain hypersensitivity disorders, chronic pain, depression/anxiety, etc. All of these factors can result in pain with unknown etiology. This type of pain is usually placed under the umbrella of “peripheral painful traumatic trigeminal neuropathy” (PPTTN). A referral to a neurologist or pain specialist is recommended in these cases.

Why Did My Dental Implant Fall Out?

One of the more frustrating problems in dentistry is when you think your dental implant that was placed has fallen out. Although many studies have shown that dental implants have a greater than a 90% survival rate over a 10-year period, problems do occur, and implants fail and/or fall out of the mouth.  Please continue to read this article to find out what dental implant parts can fall out of the mouth and what can be done to treat this problem.


What Are the Parts of a Dental Implant?


There are many parts to a dental implant. There is the implant screw that binds to your bone in a process called osseointegration. When a dental implant is placed, the implant screw binds to the bone over the period of weeks to months. The implant can be placed under the gums at the time of the surgery and a cover screw is placed over the implant. The implant can also be left exposed and have a healing cap that is placed at the time of surgery, this part sticks out of the gums while the gums heal. Once the implant surgeon determines the implant to be ready for a dental crown, a post, called an abutment, is screwed into the implant. A dental crown is then placed over the implant.


Identify What Part of The Implant Fell Out


It can be confusing as to what part of the dental implant fell out and you can call a dental office stating ‘my implant fell out’ when it was not the dental implant screw but another part. One good way to help the dental office identify the implant part is to take a picture of the piece that fell out of your mouth and either text it to the office or do a teledental consultation. Many times, a healing cap or cover screw can fall out and it is confused for a dental implant screw. Placing the cover screw or healing cap back onto the implant usually is a simple procedure. If the dental abutment or crown has fallen off, the implant dentist must first evaluate the implant part to see if there is any damage to the material. The dental implant screw that remains in the bone must also be evaluated to see if there is any damage to the screw part as well. Then an evaluation of why the part fell out will take place and adjustments can be made. Once again, placing the implant abutment or implant crown back into the mouth is usually not a difficult procedure if all implant parts are intact.


What Can be Done if the Dental Implant Screw Falls Out?


On rare occasions, the dental implant screw itself can fall out. There are a variety of reasons as to why this happens including:

  • Bacterial infection
  • Trauma
  • Dental implant material fatigue/fracture
  • Heavy bite force putting too much stress on the dental implant
  • Loss of bone and/or gum tissue
  • Dental implant that has never bound to bone properly

Depending on why the implant fell out, treatment can consist of rinsing with an antibiotic rinse, taking antibiotics, and keeping the area clean. A visit to the dentist should occur shortly after the dental implant screw has fallen out. An evaluation by the dentist should include an x-ray and a possible determination as to why the dental implant screw fell out. If the implant is being replaced, addition of bone and/or gum tissue may be needed to support a new dental implant.  Other possible replacement options for a lost dental implant include a fixed tooth supported bridge or a removable denture. You should discuss with your implant dentist what the best option is for you after determining why your dental implant screw fell out.

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

Common Myths About Gum Disease

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After


What are Common Myths About Gum Disease?


Gum disease is a serious condition that can have very bad effects on your oral health and your overall health. Keep reading to learn the truth about some of the biggest myths about periodontal disease so you and your periodontist can work together to prevent it:


Flossing Does Not Do Much to Prevent Gum Disease


A lot of people neglect flossing because they do not believe that it does much for their oral health. Flossing or water irrigation is one of the most important aspects of an oral hygiene routine and it can greatly affect the condition of your teeth and gums. Brushing your teeth only removes a certain amount of food and plaque that develops in your mouth. Flossing or water irrigating helps you reach the food and bacteria that are hiding in between your teeth and in your gums. If you do not reach these areas, you might start to get an infection or inflammation at the gum line, which can eventually cause gum disease. You can ask your dentist for some tips on flossing and water irrigation that will help you do it as effectively as possible. The studies show that water flossing or flossing before you brush can be helpful since it will clear the food particles in between your teeth and the helpful products in toothpaste will now be able to reach your teeth.


Gum Disease Is Only Caused by Poor Oral Hygiene


Although a good oral hygiene routine can significantly decrease the risk for gum disease it is not the only factor that can cause it.

  • Smoking
  • Diabetes
  • Obesity
  • Stress
  • Medications that suppress the immune system
  • Genetics

These are some of the risk factors and risk modifiers that have been linked to the development of gum disease. Because of the fluctuation in hormone levels pregnant women can also have a higher risk for developing gum problems. It is important to schedule regular appointments with your dentist to ensure that your teeth and gums are clean and healthy. If family members have lost their teeth or have gum disease, get an oral exam by a periodontist to make sure you are not at risk.


Bleeding Gums Are Not a Big Deal


If you notice any bleeding, swelling, or redness in your gums, it is very important to schedule an appointment with your periodontist. These can all be side effects of gingivitis, which is the first stage of gum disease. With the proper treatment, gingivitis can be reversed and not lead to a more serious condition called periodontitis. Gingivitis is caused by bacteria that infect your gums and cause them to bleed. These same bacteria can also lead to bone and gum loss around your teeth if left and can become periodontitis. Periodontitis is the loss of gum and bone tissue that surround the teeth. These bacteria can also get into your blood stream and have been linked to other diseases such as heart problems, lung problems, Parkinson’s disease, diabetes, dementia, increase the risk of certain types of cancer, and premature-low birth weight babies. If your gums bleed when you brush or floss, are sensitive, or hurt when you eat, visit your periodontist as soon as possible to get the treatment you need to avoid further problems. Early detection and treatment is the key to a healthy life style.

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.

Bleeding After a Dental Crown

Why Do My Gums Bleed After a Dental Crown Has Been Placed?


Gum bleeding after you get a dental crown or veneer placed can be a frustrating problem and can lead to gingivitis and periodontal disease if left untreated. Keep reading to learn why this can occur and some of the options available so you and your periodontist can work together to treat this problem:


Do Dental Cements Cause Gum Bleeding?


Dental crowns and veneers are usually placed onto your teeth with different types of dental cement. These cements have different viscosity and sometimes they can flow into the gums and cause irritation and bleeding. These cements can also attract bacteria that will stick to the cement and cause bleeding. If left for a longer period of time, these bacteria can cause the breakdown of bone and gum tissue leading to periodontal disease. If you have bleeding gums after a dental crown or veneer is placed, go to the dentist to get it checked. The dentist can take an x-ray of the area and see if the cement is there. Unfortunately, some dental cements will not show up on an x-ray even if it is in the gum tissue so the dentist will have to use dental instruments to check for the cements. If the cement is present, it can often be removed with a scaler during a gum cleaning or deep gum cleaning. If the bleeding continues after the cleaning, referral to a periodontist may be needed in order to fully remove the cement.


The Dental Crown was Placed too Far into the Gums


There is a space that exists between the tip of the gums and the bone surrounding the tooth that is filled with fibers that attach the gums to the tooth. This space is intended to not have any dental crown or veneers placed into them. A dentist will sometimes place a crown into this area by accident or as a way of hiding the metal at the base of the crown.

If this occurs it is known as “violation of the biologic width” and is a dental term used to signify sinking of the crown into that particular gum space. The body can react to this violation with:

  • Inflamed gums
  • sore gums
  • bad breath
  • gum bleeding

If left unchecked bone and gum tissue around the crown or veneer can start to become damaged. The first line of treatment usually involves seeing a dentist to try and clean around the crown or veneer to stop the bleeding. If this gum bleeding continues, then removing the crowns and referral to a periodontist for crown lengthening evaluation may be necessary.


How Does an Unpolished Dental Crown or Veneer lead to Gum Bleeding?


Another reason gum bleeding can occur after the placement of a dental crown or veneer is that the edge of the crown where the crown meets the gum is rough. Rough areas of crowns can attract bacteria which can cause the gums to become red, swollen, and sore. Once again if left unchecked, this can lead to destruction of bone and gum tissue as well as bad breath. The treatment for a rough dental crown is the smoothing out of the crown with dental instruments designed to polish the crown margin.


Lack of Flossing or Water Flossing Around the Dental Crown or Veneer


Oral hygiene is extremely important after a dental crown or veneer is placed. Often it is not enough to just brush your teeth twice a day when someone gets a crown. Flossing or water flossing is required in order to remove the bacteria that can gather around a crown. Dental crowns or veneers have microscopic spaces where the crowns first meet the tooth. These spaces are too hard to see but not too hard for bacteria to get into them and cause bleeding gums. Removal of this bacteria can be accomplished by good habits such as flossing, interdental cleaning, water flossing, and tooth brushing. If your gums continue to bleed after getting a dental crown and oral hygiene is not helping, referral to a periodontist may be required.

Call 212-751-8530 today to schedule a consultation with Dr. Froum or request an appointment.