Hookah smoking is a popular activity for the young and old alike, and has even been gaining popularity in metropolitan city centers: hookah lounges are very popular among residents and college students. The Mediterranean past time of smoking fruit-flavored tobacco (known as shisha) out of a water bong is safer for the lungs than traditional cigarette smoke (as the smoke is filtered through water and ice chambers), but does this smoke harm the oral health as normal cigarette smoke does?
Hookah smoke is damaging to your teeth.
Unfortunately, there is no good news for Hookah smokers. Although the benefits to a water hookah’s filtration have been debated, hookah smoke contains the same toxins as cigarettes which can cause increased blood pressure and risk for heart attack, as well as impaired liver function. In addition to these detractors, hookah smoke is no healthier for your mouth than common cigarettes. Researchers from the Karolinska Institute in Stockholm studied 262 adults in Saudi Arabia (where hookah smoking is extremely common and culturally condoned) to test this hypothesis – the group was made up of both exclusively cigarette smokers and exclusively hookah smokers, as well as smokers who partook in both forms of smoking.
After an extended period of observation, 20% of the group was found to have signs of gum disease – 30% of hookah smokers and 24% of cigarette smokers were affected by these symptoms. While other factors like age and diet were taken into account, the study concluded that regular hookah smokers are five times more likely than non-smokers to develop gum disease, whereas cigarette smokers were 4 times more likely to develop gum disease. This information might actually suggest that hookah smoke is more dangerous than cigarettes to your oral health! The bottom line is that any form of smoke – whether it is from a cigarette or a water pipe – is harmful to your body and your mouth. Gum disease is only the beginning of long-term systemic problems that occur with smokers, and can lead to tooth deterioration, tooth loss and eventually oral cancer (which is usually detected late, quickly becoming deadly). Curbing your smoking habits and substituting them with healthier living patterns will help you in the long run.
Do you have a gummy smile? Do your teeth appear too small, or there is too much gum showing? Aesthetic crown lengthening is a procedure which could improve your smile if you selectively decide to change the proportion of your teeth and gum.
Before Lengthening:
After Lengthening:
Your teeth are secured to your jaw via root structures that extend from the teeth into jaw bone. This bone is protected by the gums, which extends down over the top of the tooth root structure. Excess gum tissue poses no health risk, but can be unsightly and make your teeth look tiny or not as harmony with your face. Aesthetic crown lengthening remedies this condition by trimming away excess gum (and in some cases bone), reducing the amount of display of gum and lengthening the visible crown of the tooth. Gingival (gum) contouring (like a gingival plasty or soft tissue crown lengthening) refers to trimming of the gum tissue only. Most crown lengthenings refer to the recontouring of both the gum and supporting bone (osseous crown lengthening), when there is more length of the tooth is desired.
Traditionally, crown lengthening is performed with scalpel and mechanical rotary tool which trim and flap open the gum also trim away some bone tissue. This mechanical force results unfavorable inflammatory response of the periodontal tissues and taking up to 8 weeks to heal. The tissue must fully heal before restorations can take place. This procedure is often daunting to many patients!
Thankfully, new technology in the laser dentistry field has made aesthetic crown lengthening much easier and less invasive. By using a small fiber optic tip, laser energy can be manipulated to trim or ablate away tissues , disturbing the surrounding environment much less than traditional mechanical rotary instruments. The less invasive procedure means less pain, quicker healing and less trauma. The body does not react violently to laser treatment as it does blunt mechanical treatment!and often time the restorative work can be initiate quickly or even at the same visit. In some cases, crown lengthening alone can get you desirable bigger smile,but often time , the restorative work like bonding, veneers or crowns are called for the needed improvement or protection on dental structure.
When gingival contouring or crown lengthening is performed – but left with a compromised biological width (2 to 3mm is necessary for safe formation of a protective zone from the gum border to the bone) - gum tissue will stay inflammed and grow back after several months. It is important to have an experienced dental professional for proper diagnosis before getting your gum trimmed. Find a dental professional who been properly trained using lasers for a more comfortable surgical experience (www. Laserdentistry.org). The design of the smile and the shaping of the gum line both need an aesthetic touch (apart from solid surgical technique), so it is equally important for the dental professional have aesthetic background to assure the best aesthetic result (www. aacd.com).
Laser Gum treatment is an exciting treatment modality for treating and managing gum disease. Laser dentistry has been around for two decades, it is very useful in many applications on soft or hard tissues: the focused energy allows for precision treatment while minimizing pain and recovery time. Although only 6 to 7% of dental practices utilize laser technology so far, you may benefit greatly from laser dentistry.
Periodontal disease in particular is a fantastic candidate for laser treatment. The nature of periodontitis (gum disease) involves bacterial growth which affects the supporting structures of the teeth, destroying attachment tissues which create deep periodontal pockets that are not easily cleanable (causing the gum disease to progress). Gum tissue responds very well to laser energy, which removes diseased linings in the periodontal pocket and also kills the bacteria. The laser-tissue interaction is thermal, controlled energy from the selected tip of the laser fiber will evaporate the inflamed unhealthy lining tissue ; its rising temperature will also kill any pathogen present in the tissue. The clean and less traumatic site becomes more efficient and comfortable for your healing. Other benefits of laser treatment include biostimulation (photo-biomodulation) on the cellular level , which energizes damaged cells through light receptors , allowing tissue to heal promptly!
The laser gum treatment is usually administered in conjunction with traditional scaling and root planning (SRP) services, performed with ultrasonic or hand instruments that remove toxic calculus from the root surface. Unlike more traditional methods which use a scaler to scrape away diseased tissue, the laser approach treats the diseased tissues with electromagnetic energy to ablate diseased tissues non-evasively, followed by irrigation with antiseptic solution (chlorhexidine) to flush away and clean the periodontal pockets. For more severe cases, localized placement of certain antibiotic agents (like Arestin minocycline hydrochloride) inside the treated periodontal pocket can assure a complication-free healing process without systemic effects. Low level laser therapy can also be applied to decrease post-operative discomfort and promote healing through photo-biomodulation.
Laser gum treatment has provided tremendous patient benefits as I have witnessed since it has been incorporated into my practice since 1997, but this treatment modality has raised some eyebrows in the periodontal community. It is difficult to establish a parameter with energy and expect to have consistent result on different subjects; there are too many variables from the color, texture, composition and condition of the tissues, whether the origin of the cause has been managed and how the different laser energy is handled by various operators. There are studies which have proven different results, and over-promising commercials also exist which have discouraged development of laser gum treatment.
When properly conducted, laser gum treatment provides a cleaner and more comfortable site for healing. The predictability of tissue regeneration, however, is too complicated for a blog discussion! I do recommend you go to a reliable, non-biased source like The Academy of Laser Dentistry to learn more about the benefits of laser treatment or referrals of certified laser dentists.
I looked at Jenny, as I have with many similar pretty young ladies, and really felt for her.
“Jenny, you will be fine – you are here to make sure you can have a healthy and beautiful smile. It is challenging, but work with me – together we can get your mouth back in shape.” And we did.
Jenny is not alone. Among the susceptible figure-conscious young female group, eating disorders are quite common, and teeth erosion is a side effect of the acidic oral environment resulting from either purging or a poor diet.
Eating disorders, including bulimia (binge eating followed by self-induced vomiting), anorexia and poor dieting habits carry side effects which are detrimental to your bodily and mental well being – they can also rot your teeth. Studies have shown that up to 2.1% of males and 7.3% of females purge (self-induced vomiting) at least once a week, and the numbers are even higher for adolescents.
Tooth surface loss from erosion caused by chemicals such as dietary, gastric or environmental acids typically wear away tooth enamel, which leads to sensitive teeth, caries or gum disease. If untreated, these effects can exacerbate leading to teeth grinding and gastric reflux disease. Soft tissue lesions, malnutrition, a suppressed immune system, low self-esteem, an addictive personality (smoking, drinking or drugs), peptic ulcers and esophagitis are common among people who suffer from bulimia and anorexia. Oral damage from such disorders can include a severe breakdown of the teeth or their supporting structures which can affect the facial muscular system, negatively affecting your daily quality of life; the effort to restore a damaged mouth can become extremely challenging and costly.
Treatment of the problem, besides education and being supportive to the person suffering from the disorder, involves precise dental management; controlling the oral environment, drinking water or healthier juice instead of diet soda, eating healthier (as opposed to binge eating and purging) are all part of the solution. Getting prescription strength fluoride from your dentist to harden and desensitize your teeth and maintaining your oral hygiene by brushing and flossing at least twice a day is also crucial. if you regurgitate or vomit, rinse your mouth out right away. Adding baking soda to your brushing can also neutralize the acidic environment.
Regarding dental treatment, additive compositebonding to cover exposed dentin or to replace lost tooth surface is a possibility. Getting a custom-fitted night guard to prevent further loss of tooth structure from bruxism and maybe veneers or crowns to restore your mouth to ideal health are other possibilities. Of course, a professional assessment would be the first step of the process. The earlier you start treating the problem the better. A healthy mouth is essential for a healthy life.
These two analogies went through my mind while I was writing my last blog on gum disease, feeling the overwhelming impact of our falling economy!
It might seem like common sense that stress can take a toll on our health, but often we don’t think about what specific implications stress can have. Only weeks ago, Mahesh Verma, principal of the Maulana Azad Institute of Dental Sciences said “Growing economic stress among people has a deep damaging impact on teeth and heart. Recent studies have found that financial stress is one of the major cause of increasing dental problems.”
The damage begins when chemical triggers block your immune function, inhibiting your body’s natural defense mechanisms and deplete your teeth supporting bones of calcium and other necessities in order to maintain blood mineral levels. These triggers, brought on by stress (such as an economic recession), can worsen over time and indeed cause gum disease, in addition to a host of other medical maladies! The stress can also lead to poor diet and lifestyle habits (smoking, drinking), further damaging your health.
let’s hope today’s economical crunch has less impact on tomorrow’s public health!
Take home message: besides stress management, take charge of your own dental health, spend the full (read: required!) two minutes on oral hygiene brushing and flossing your teeth. Eat healthy, think positive and get ready for a better tomorrow.
Gum disease is silent – it creeps up on you slowly, gives no symptoms apart from little signs, and does not hurt – by the time you feel something, it could be very bad news!
Gingivitis, the first stage of gum disease causing inflammation around the gums affects over 50% of America’s population! See blood when rinsing your mouth after brushing? If so, you’ve got gingivitis. Bacterial biofilms, also known as plaque, as well as tartar adhere to tooth surfaces throughout the day. These bacterial substances build up in the small gaps between your teeth and produce toxins that cause the periodontal tissues like the gum and supporting bone to inflame. Over the years, this inflammation can cause deep pockets between the teeth and gums and loss of bone around the teeth, which is when gingivitis progresses to periodontitis. Gingivitis is reversible, but periodontitis can only be managed after treatment. Early detection, treatment and prevention is the key to save your teeth!
The loss of bone around the teeth can cause serious structure issues within the jaw; eventually leading to tooth loss. The signs of gum disease include red and swollen gums, blood appearing when brushing or flossing, mouth sores, bad breath, loose teeth and gum recession.
The causes of gum disease, besides the bacterial factors, are systemic and host resistance which needs to be revealed, such as stress, medication, hormonal changes, illness, bad habits (smoking, poor hygiene, poor diet), genetic history, etc… There are different approaches to treat the disease.
The mouth-body connection has been a hot topic for the past decade. We have learned about the association of gum disease with other chronic inflammatory conditions, such as diabetes, cardiovascular disease and alzheimer’s disease. Believe it or not, gum disease can even cause your physical health to deteriorate into a stroke, endangering a pregnancy.
So be kind to yourself! Treat those bleeding gums! Cosult with your dental professional. Treatments provided from a dental professional include cleaning up the “bad stuff” through deep scaling, root planning, laser gum treatment, medication applied locally or systemically, home care education and home care programs. Please take action to treat bleeding gums!
“Does it hurt? How long will it last? How long will it take? How much does it cost?”
These are common questions from patients looking for cosmetic dentistry.
If you’re interested in cosmetic dentistry to get yourself a winning smile, whether the problem is mis-alignment, cracked or chipping teeth, unsightly spacing, uneven or dark colored dentition, uneven or too much (or not enough) smile showing, or even gum erosion, the eternal question always arises: What would be the best solution?
In the past, crowns were the primary choice for masking tooth problems, but since the late 1980s, cosmetic dentistry has offered both bonding and veneers to improve your smile. This leads to the eternal question: “Bonding or veneers?”
Dental bonding involves the application of a durable composite material directly to the surface of the tooth, by your dentist, which is then sculpted and artistically shaped to the exact look the patient desires, to blend naturally and seamlessly with the patient’s existing teeth. A laser (or high intensity light) is then used to cure the composite material, hardening and reinforcing it to the surface of the tooth. This bonding technique has many applications, not only for aesthetic uses but also for prosthodontics and pediatric dentistry. The advantages to dental bonding are a quick treatment time (can be completed in one office visit after a consultation), and a relatively low cost per tooth when compared with porcelain veneers. Durability of bonding will be affected by the oral environment. Since composite bonding is a mixture of quartz particle (70% – 80% filled) and resin, discoloration and breakage is inevitable if your mouth has a high acidic pH value (if you are a soda drinker, lemon lover or candy sucker), if the bonding was not supported by a solid tooth structure, or if you are a night grinder.
Porcelain veneers are fabricated in the laboratory. They are 100% filled with hard mineral particles, and are fired at a high temperature with a vacuum (to procure the best physical properties to sustain the veneer’s strength in the harsh oral environment). Compared to bonding, there is more procedural work involved with porcelain veneers. There are different techniques to fabricate the veneer pieces (which call for different methods of preparation for the tooth); the pressing technique produces a stronger veneer, but requires 0.8mm thickness of the veneer. The porcelain powder build-up technique can produce super thin veneers (0.3mm), which produces a very conservative look on your tooth structure, while at the same time keeping a natural silhouette. The veneer piece lays on top of the tooth structure and is similar to a press-on nail. They chemically adhere to the tooth with bonding composite cement; since porcelain is acid resistant and stronger in physical properties than composite material, this restoration provides long-term service. When getting the veneers, the first visit consists of preparation and imprints f the teeth (which might involve anesthetic). After this, you will leave the office with temporary veneers which look like natural teeth. A wafer-thin veneer is then crafted out of porcelain which is seamlessly cemented to the front side of the tooth on the second visit. In addition to straightening teeth, porcelain veneers can close gaps between teeth, whiten teeth that do not respond well to bleaching, and can also be used to protect damaged tooth surfaces. The advantages to porcelain veneers over bonding is that veneers are much longer lasting (and stronger) than composite bonding material.
Whether you decide to invest in dental bonding or porcelain veneers, make sure you have all work done at a reputable dentist, preferably at a practice which has its own in-house ceramic lab. When ceramic work is done by an in-house lab with an in-house ceramist, any changes that need to be made to the length or color of the veneers can be done without requiring an additional office visit. Remember, the result of the cosmetic procedures are truly varied depending on the ability of the dentist, ceramist, your clinical situation and the communication between all parties involved. Do your research!
Both bonding and veneers are additive procedures, depending on the position, alignment and shape of your teeth, which is the foundation for any new restorations. This foundation will need to be in the right fundamental situation to receive restorations to result in a fabulous smile. In other words, sometimes, you do not need to do much to your own teeth before applying cosmetic restorations. It might be necessary to reduce or modify the tooth structure before anything can be added onto it to make it look perfect.
There is some risk involved with cosmetic bonding or veneers, so be cautious with any cosmetic procedure. A comprehensive evaluation of your present dental condition is absolutely necessary as a first step; blue prints of your teeth and of your prospective dental project are needed to establish clear verbal communication between all parties involved (including you), including possible mock-up or wax-up models to preview possible changes, which could avoid costly mistakes.
Do your homework: finding the right dental professional, discussing every aspect of your dental needs, understanding the pros and cons of each procedure, and making an educated decision will ensure you get the smile you’ve always wanted.
When I examine a patient’s mouth, I often inform them “You have been grinding your teeth at night! If you’re grinding at night as well, please take a vacation – doctor’s orders!” We laugh, then get serious about what was just said. Common responses from patients include:
“How do you know that I grind my teeth?”
“Why do I grind my teeth?”
“I sleep with my mouth open; I do not grind my teeth!”
“Yes, I know, but I do not want to wear a night guard!”
Let’s have a discussion.
Teeth grinding is a multifactorial phenomenon, it can originate from bite problems, posture problems, stress, diet or even certain oral medications. You may experience one or multiple symptoms of night grinding, including sensitive teeth, receding gums, teeth chipping, teeth movement, flat teeth, broken teeth, damaged dental restorations (such as fillings), and even headaches and a sore jaw .
Usually, during the day, there is space between your upper and lower teeth – the teeth are not in contact, they come in contact only when they are being used to chew food. Eating food exerts approximately 5 – 10 pounds per square inch of loading force. This is normal and will not create wear and tear issues in the tooth structure. At night however, during sleep, facial muscle contractions (like the Masseter muscle) generate a much greater force, anywhere from 300 to 500 or even up to 1000 pounds per square inch of force! This is very powerful, and very destructive.
So how do we fix the problem? Management of night grinding can be approached from several angles. By wearing a night guard, immediate protection is provided when sleeping. The design of the night guard can be as simple as a thin coat of silicon rubber material which is custom-molded to fit over your teeth, or can be highly specialized to help realign your jaw when made from acrylic. Ask your dentist about this.
Grinding your teeth at night (bruxism) occurs during the REM (Rapid Eye Movement) cycle of sleep, for light sleepers. If restful sleep can be induced, the REM cycle of sleep can be reduced, contributing to a more peaceful night for your mind and also your body (including your facial muscular system). This means less grinding!
Achieving restful sleep can be tricky, there are many techniques: meditation to clear your mind in preperation for a restful night of sleep, deep and slow breathing, and cutting out sugar and caffeine in the PM hours will all be helpful.
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After Lengthening:
