What do "periodontal pockets" mean?

When dentist's refer to "periodontal pockets" they are referring to measurements of teeth's gingival crevices of more than 3 mm. Commonly dentists and periodontists become concerned when measuring pockets that are 5 mm or more since these are thought to be more likely to develop further breakdown that can result in loss of bone supporting teeth.

Pocket measurements of three mm or less are thought to be OK and are considered normal. In fact a more significant finding is 'bleeding on probing' since this indicates the presence of inflammation. Inflammation is a more predictable predictor of either gingivitis or active periodontal disease. In fact pockets of any depth may or may not exhibit bleeding on probing.

The goal of most periodontal therapy is to try to cause pocket shrinkage, institute frequent recall schedule and coach the patient in methods of keeping their mouth cleaner at home, Using good brushing techniques, interproximal cleaning and possibly the use a water pik. The first two help remove plaque from the surfaces of the teeth and the latter is a help in causing fluid exchange of the sulcular fluid. Sulcular fluid, especially in periodontal pockets can be 'seeded' with harmful bacteria 'floating in solution' and these may in part be responsible for the inflammation found in pockets. The water pik, although not very good at removing plaque adhering to tooth surfaces can be effective at removing contaminated sulcular fluid and can help eliminate inflammation in pockets deeper than 3 mm.

Can crowns look like real teeth?

In the photo adjacent photo, the left central incisor is a all porcelain bonded crown.

As this photo shows, crowns can be extremely natural looking and porcelain bonded crowns are probably the most aesthetic. They are are often used to restore anterior teeth since their degree of translucency can approach that of a natural tooth. Lava or Procera crowns are 'metal free' and can also look extremely real, but are more sturdy than bonded porcelain crowns.

Dentists can send high quality close up photographs of a patients teeth to the laboratory to help a ceramicist customize a patients crown and sometimes dentists can even have the patient visit their dental laboratory and the ceramicist can custom stain a crown with the patient present. After being custom stained the crown can be tried in or held close to the mouth to check how well it matches adjacent teeth and the patient may have the opportunity to preview it before going back to their dentist to have the crown cemented.

What are custom wax ups used for?

When a dentist would like to preview changes needed he can take some study impressions and take photos and a bite registration. When the impressions are poured up in stone, the models can be mounted on an articulator and sent along with the photographs to a dental laboratory for a custom wax up treatment. The dentist can ask the lab to make the proposed changes so that both he and the patient can preview a possible rendition of a the final result.

If the proposal meets with the dentist's and patient's approval, the wax up can be used to help generate temporary restorations that will serve a dress rehearsal for the final result. This can be helpful since the mounted models do not show the position of the lips in relation to the proposed dental restorations.

Usually it when contemplating a make over, generating a "dress rehearsal version of a smile" can be helpful so that the results can be previewed in the mouth prior to instructing a ceramicist on how to make the final restorations appear.

What does staging dental treatments refer to and how do you plan it?

Staging dental treatments refers to a way of managing complex or expensive dentistry so that it is spread out over time. This can be necessary either 1) due to plans that involve multiple specialists and their treatments or 2) due to a number needed dental procedures that a patient can not afford to do in one calendar year.

The first instance is common when dealing with complex restorative treatment plans that may involve multiple specialty treatments such as orthodontics, endodontics, periodontics and/ or oral surgery in conjunction with restorative dentistry. In this case the restorative dentist after consultation with his specialist must often decide on an order of treatments and coordinate them so that the plans are delivered in a way that results in the best treatment outcome.

In the second instance, patients often present with simple treatment plans that involve multiple procedures that can not be afforded by the patient all at once. In this case the dentist can plan a series of treatments, including interim treatments, that prevent dental problems from worsening while waiting for a definitive restorative treatment to be delivered. For example in the case where a patient might present with a number of cavities some of which may result in teeth needing a root canals and a post and crowns, a dentist might take care of excavation of decay, and performing root canals one year and contemplate making posts and crowns at a later point when the patients finance allow. This would be preferable to just fixing one tooth at a time. If a patients finances are exhausted by definitively restoring one tooth than they often do not have the funds to take care of the other cavities that are present. This can result in untreated conditions worsening and in further dental expenses that might have been avoided by the proper staging of dental treatments. I have written an article on this subject on my website which can be viewed by clicking on http://www.lspindeldds.com/staging_dental_treatments2

What are the effects of Bulimia on a person's teeth?

Bulimics can experience acid erosion due to the acidic environment that their habit creates in the mouth. This often leads to thinning and stripping off of their of their teeth's enamel. This is more prevalent on the lingual or palatal aspect of their teeth since that is the surface of the teeth that is bathed in acid from their repeated regurgitation of meals. Some patients notice that their teeth are becoming thin and more translucent toward the edges.

People suffering from bulimia can also experience an inceased incidence of tooth decay due to the acidic breakdown and demineralization of the enamel. Often the fillings that I place to repair their decay are glass ionomer based, since they offer a high release of fluoride to help prevent recurrent decay of these restorations.

Do mouth washes that claim to whiten really work?

If they have hydrogen peroxide as an active ingredient then they can whiten your teeth. Recently several of my patients have come in and had whiter teeth and when asked about it they explained that they had been using a whitening mouth wash. These are being sold over the counter by several manufacturers and apparently do work.

These mouth rinses may have side effects. One of my patients who had been using one came in and his outer layer of his gingiva was 'sloughing off'. He had no apparent inflammation, just a layer of tissue that could be peeled off with a dental instrument. He had no bleeding when I removed the layer and his gums looked healthy underneath. When I asked him about it , he reported that he had noticed it as well, but though it was a residue from the mouth rinse. I asked him to stop using his rinse.