Dental Questions: Why are x-rays so useful?

In modern dentistry, we take x-rays fairly frequently. The average patient will receive four "periodic" radiographs annually, and an entire "full mouth" set of images every five to seven years (depending on multiple factors). Why do we need so many pictures? As it turns out, x-rays are an invaluable tool in diagnosing, documenting and monitoring changes in dental diseases. Take a look!

Dental x-rays give a dentist much more information that simply "looking in the mouth." In regards to tooth decay, radiographs can show cavities forming in areas that are impossible to visualize, such as in-between two teeth. Furthermore, they give more information on the location and depth of decay, helping inform decisions on placing fillings versus crowns, the risk of nerve irritation and what materials to use to fill the tooth. In most instances, we will not perform a filling on a tooth without an acceptable x-ray of the effected area. Radiographs are also necessary in assessing gum disease and bone loss. They can document the amount and pattern of recession, helping make decisions on dental cleanings and possible periodontal surgeries. In severe circumstances, heavy tartar hidden beneath the gum line will be visible on radiographs as well. 

This image shows the progression of cavities, as seen on dental x-rays. In the last image, the decay has reached the tooth's nerve, necessitating a root canal

X-rays are also of great use in documenting and monitoring dental problems. Particularly in working with insurance companies, radiographs help demonstrate the necessity of certain procedures. This can improve the approval process and speed up reimbursements. Additionally, x-rays can help track the changes in dental conditions over time, aiding in decisions on treatment or continued monitoring. 

This image shows the progression of gum disease, as seen on an x-ray. The small white bumps that form on the sides of the teeth are tartar below the gumline. 

Radiographs are useful in visualizing much more than gum disease and tooth decay. Procedures like root canals, extractions and implants are impossible to perform without good radiographs. To learn more about the diagnostic tools we use in dentistry, please give our office a call. 

Deep Cleanings

If you're one of the millions of Americans with Periodontal Disease, there is a good chance you have either been offered or received a deep cleaning. You may also still be unclear on what this procedure can accomplish and why we do it. In this article, we hope to remove the mystery from this very beneficial treatment. 

For starters, periodontal disease refers to a state of gum health where the moucosal tissues and/or bone have shrunken away from the teeth. In most cases, this is due to accumulation of hard tartar around the necks of the teeth and down the roots. Patients are left with deep gum pockets that serve as protective space for more tartar to form. 

Healthy gum pockets range between 1-4 millimeters. With a toothbrush and floss, you can reliably clean to about three millimeters of depth. Beyond this, it takes a special set of skills and tools to get the teeth completely clean. If you have healthy gums or inflammation of the moucosal tissues only (gingivitis), a typical "prophy" dental cleaning will serve you well. However, generalized pockets of five millimeters or more will require a deep cleaning, also known as scaling and root planing. 

A quick infographic explaining the transition from healthy gums to disease. An important note- healthy gums can naturally have a pocket of 1-4mm. 

Scaling and root planing is a procedure that is administered to one quadrant of the mouth at a time, as opposed to the "whole mouth" approach of a normal cleaning. You may only have one or two quadrants of teeth that actually require a deep cleaning. To effectively provide this service, we need to numb your gums with some type of anesthesia. This may be in the form of a topical jelly or a traditional injection. We then use a combination of ultrasonic scalers and hand instruments to clean the teeth to the depths of their pockets, removing hard deposits and smoothing the tooth root surface. The ultimate goal of this treatment is to leave behind a healthy, bacteria-free root for new tissue to attach, thus creating a shallower pocket. 

Deep cleanings are ideally only administered once and followed with a tight recall cleaning schedule. However, this depends largely on you body's ability to heal and your own home hygiene practices. It is also important to understand the limitations of a deep cleaning. While you may have a decrease in pocket depth, new bone is impossible to reform without surgery. Additionally, no amount of cleaning will save teeth with severe periodontal damage. To fully appreciate what a deep cleaning can do for your mouth, a complete dental exam with x-rays is absolutely necessary. To schedule an appointment or find out more about the different types of dental cleanings, please give our office a call!

Examining the Anti-Flossing News

If you've been on the internet in the last month, chances are you've seen the AP article titled "Medical Benefits of Dental Floss Unproven." In this article, the author postulates that as the Department of Agriculture and Health and Human Services dropped flossing from its dietary recommendations, it comes to light that there is little to no scientific evidence that flossing is beneficial to oral health.

In dissecting this article, it is important to understand why dentists recommend flossing. The primary goal of flossing is to physically remove bacterial film (plaque) from the pockets between the gums and the teeth. As a secondary action, floss can dislodge food that gets stuck between teeth and help prevent decay. Floss cannot remove hard bacterial film (calculus/tartar) nor can it clean deep periodontal pockets. That being said, regular flossing will help prevent the development of these conditions to begin with. 

It becomes clear that the author of this story does not have a solid understanding of periodontal disease, oral health or scientific studies. One of the main points of the article is that there aren't any quality scientific papers that show the benefits of flossing. This fact more-so highlights the high costs and extreme difficulty in performing a study of this nature. Much of scientific research pivots on having reliable metrics and a large enough sample to get valuable data. Since flossing is so universally accepted in the dental community, securing the millions of dollars necessary to perform this study would be nearly impossible. 

Furthermore, the author argues that any evidence on flossing points to its benefits in reducing bleeding gums, removing plaque and stopping gingivitis. He seems to view these attributes in a vacuum, when in reality they are all part of the periodontal disease process. Plaque, when left undisturbed, eventually hardens into tartar. This then causes an inflammation of the gum tissue known as gingivitis. Gingivitis is responsible for the bloody, puffy and sensitive gums that many patients experience. With time, the inflammation spreads to the bone surrounding the teeth and causes it to recede creating deep pockets. At this point, the disease is called periodontitis. While it is true that floss will not reach the bottoms of these deep pockets, any reduction in bacterial load is beneficial and crucial to the treatment of periodontal disease.

The author is quick to note that "early gingivitis is a long way from severe periodontal disease" and that "severe periodontal disease may take five to 20 years to develop." What he fails to mention that slight or moderate periodontitis can develop much quicker (we usually see the first signs around age 30) and that the technical "severe" periodontal disease is a debilitating condition marked by loose teeth, chronic bad breath, pain and tooth loss. This is the exact same disease that started out as gingivitis. Why wouldn't you do everything in your power to mitigate this problem from the start? 

If you would like more reasons to keep flossing, just read any statements made by the ADA, the California Dental Association or the American Academy of Periodontology. The dental community shows unanimous support for the regular, daily use of dental floss. Furthermore, evidence shows that controlling periodontal disease is associated with less heart disease, better glucose control in diabetics and better outcomes in at-risk pregnancies. Flossing is an important part of your oral health home care! If you need any more information on the benefits of flossing or instructions on how to floss, feel free to contact our office!

Dental Questions: Why are my Gums Bleeding?

Sometimes gums will bleed for obvious reasons, like cuts from flossing or abrasion from brushing. Other times, the root cause is less clear. The most common reason for gums to bleed randomly is due to calculus or tartar build up beneath the gum surface. Our office often sees patients that haven’t had their teeth professionally cleaned in a number of years. The number one complaint of these patients is that their gums bleed when brushing, when touched, or even while they are sleeping. A professional cleaning from a hygienist or dentist will remove the tartar, allow gums to heal and end the bleeding. 

Another common complaint is that gums bleed upon flossing. Interestingly, this is generally caused by not flossing enough. We recommend flossing or using some sort of hygiene instrument below the tooth contact once a day. This will help keep the gum tissue healthy and free of any plaque or tartar build up.