PERIODONTAL SERVICES

Single Tooth Extraction
People are sometimes anxious when they have a tooth removed, and fear of the unknown is usually the cause of this anxiety. We’d like you to know about the steps we take when we extract a tooth, as well as what we do to ensure that you’re comfortable – before, during and after the procedure.

Multiple Teeth Extraction
If more than one tooth have to be extracted, many patients prefer to have them removed during the same dental visit, by a multiple tooth extractions procedure. They want to save the time of many dental visits, but the main reason usually is that they want to feel the discomfort just once.
Not everyone is eligible for multiple tooth extractions. The patient must have a good medical health to withstand the increased stress of the multiple extractions. Multiple tooth extractions are usually done for patients who have extensive and severe periodontal disease. In severe periodontitis cases the bone loss is so extensive that the jaw bone cannot support the teeth, which become loose. Except of the increased tooth mobility, continuous gum inflammation and dental infections may put in risk the overall health of the patient.
Preparation for full dentures is another reason that multiple tooth extractions are performed. Some of the patients, usually for economic reasons, may choose the solution of full dentures instead of other alternative treatments

About tooth anatomy and the tooth extraction process
The roots of your teeth are encased in sockets in your jawbone, and are held in their sockets by ligaments. When we extract a tooth, we need to expand the tooth socket and disconnect the tooth from the ligament that holds it in place.

When Are Tooth Extractions Needed?
There are a number of situations that indicate to us that we need to extract your tooth. Perhaps the tooth is badly decayed and cannot be saved, or the gums surrounding it have advanced periodontal disease (gum disease) so there’s no longer enough bone and connective tissue to hold the tooth in your jaw. Other teeth need to be removed because they aren’t positioned correctly in the mouth and there is no other solution, as is the case when wisdom teeth are impacted.

The Extraction Process
Before we begin the extraction, we’ll use anesthetic to numb the tooth and surrounding area. Once you’re completely numb, we’ll use instruments called “elevators” or forceps to remove your tooth. Elevators are placed next to your tooth and are used to gently roll the tooth out of its socket. Forceps are used to carefully grip the tooth. As we remove your tooth, you’ll feel pressure, but not pain. If you do feel any discomfort beyond just a sensation of pressure, be sure to let us know. We’ll stop immediately and give you more anesthetic.
Sometimes, if the tooth’s roots are curved or are tightly held in its socket, we might need to cut the tooth into sections and remove the sections one at a time. This is a very common practice that can reduce the amount of time and effort needed to remove a tightly held tooth.

Periodontal Diagnosis & Treatment Planning

Medical History
Dr. Wood will first take a medical history to reveal any past or present periodontal problems, any underlying diseases that might be contributing to the problem, and any medications the patient is taking. After noting the general state of oral hygiene, the dentist may ask about the quality of home dental care.

Physical Examination
Inspection of the Gum Area. The dentist inspects the color and shape of gingival tissue on the cheek (buccal) side and the tongue (lingual) side of every tooth and compares these qualities to the healthy ideal. Redness, puffiness, and bleeding upon probing indicate inflammation. If the gum formation between teeth is blunt and not pointed, acute necrotizing periodontal disease may be indicated.
Periodontal Screening and Recording (PSR). PSR is a painless procedure used to measure and determine the severity of periodontal disease:

• Dr. Wood uses a mirror and a periodontal probe, a fine instrument calibrated in millimeters (mm), which is used to measure pocket depth.
• The probe is held along the length of the tooth with the tip placed in the pocket. The tip of the probe will then touch the point where the connective tissue attaches to the tooth.
• Dr. Wood will “walk” the probe to six specified points on each tooth, three on the buccal (cheek) and three on the lingual (tongue) sides. Dr. Wood measures the depth of the probe at each point.
• Pocket depths greater than 3 mm indicate disease.

These measurements help determine the condition of the connective tissue and amount of gingival overgrowth or recession.
Testing Tooth Movement. Tooth mobility is determined by pushing each tooth between two instrument handles and observing any movement. Mobility is a strong indicator of bone support loss.

X-rays. X-rays are taken to show any loss of bone structure supporting the teeth.

Pocket-Reduction Therapy

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming “pockets” around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.
Your periodontist has measured the depth of your pocket(s). A pocket reduction procedure has been recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
What are the benefits of this procedure?
Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it’s important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.

Periodontal Regeneration

The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth. However, many factors can cause periodontal disease or influence its progression.
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, too much bone is lost, and the teeth need to be extracted.
Dr. Wood will recommended a regenerative procedure if the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage your body’s natural ability to regenerate bone and tissue.
As you can see, there are many options to enhance support for your teeth and to restore your bone to a healthy level. Your periodontist will discuss your best options with you.
What are the benefits of this procedure?
Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you’ll increase the chances of keeping your natural teeth – and decrease the chances of serious health problems associated with periodontal disease.

Tooth Exposure

An impacted tooth simply means that it is “stuck” and cannot erupt into function.  Patients frequently develop problems with impacted third molar (wisdom) teeth.  These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems (see “Impacted wisdom teeth” under Procedures).  Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems.  The maxillary cuspid (upper eye tooth) is the second most common tooth to become impacted.  The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”.  The cuspid teeth are very strong biting teeth which have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.
Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place.  They usually come into place around age 13 and cause any space left between the upper front teeth to close tight together.  If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch.  The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth.  60% of these impacted eye teeth are located on the palatal (roof of the mouth) side of the dental arch.  The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

Oral Cancer Exam
Oral cancer is a pathologic process, which begins by producing no symptoms making it hard to recognize without an exam. There are many types of oral cancer, including teratoma, adenocarcinoma and melanoma. The most common form of oral cancer is malignant squamous cell carcinoma, which typically originates in the lip and mouth tissue. There are many other places in which oral cancers occur, including: the tongue, salivary glands, throat, gums, and face.

The oral cancer examination is completely painless. Dr. Wood will look for abnormalities and feel the face, glands, and neck for unusual bumps. Lasers may be used to highlight pathologic changes, and can “look” below the surface for spots and legions invisible to the naked eye. Some of the signs that will be investigated are red patches and sores. Red patches on the floor of the mouth, or the front of the tongue, and bleeding sores which fail to heal easier, can be indicative of cancerous changes. Leukoplakia is a hardened white or gray, slightly raised lesion that can appear inside the mouth, and may be cancerous. Signs of these will be examined as well. Finally, soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathologic signs, and will be examined.

If abnormalities, lesions, lumps, or leukoplakia are apparent, we will implement a treatment plan that is right for you. Treatment options vary according to the precise diagnosis, but may include: excision, radiation therapy, and chemotherapy.

It is also important to note that over 75% of oral cancers are linked with avoidable behaviors such as smoking, tobacco use, and excessive alcohol consumption. We can provide you with literature and options about quitting dangerous behaviors such as tobacco use.