Urban on Today’s Dentistry/What is Laser Gum Sugery? Lanap! No Cutting, No Stitches!

Your dentist has determined that you have moderate to advanced periodontal disease. What happens now?

The term disease refers to a negative or reversing force that impairs normal function. Invading organisms or internal factors such as autoimmune factors can cause this tearing apart of our normal states of health.

Periodontal disease turns out to be a very complicated process that can vary greatly from one person to the next. Basically, dentists are now aware that there are over two dozen different bacteria that can team up in different numbers and infect the gum tissues that normally form little tight collars around the teeth. The bacterial invasion will creep down past these collars and onto the roots. The body will fight back with its immune system and the gums will bleed. Prolonged exposure will result in gum recession, bleeding, swelling, pus, bone loss and eventually tooth loss.

Treatment of periodontal disease is also a complicated process. We must remove the invading bacteria, cleanse the root surfaces, and maintain the healing site until gums are fully restored to normal health. In moderate to advanced conditions this has traditionally been done with surgical techniques involving cutting the gums, exposing the roots, removal of hardened bacterial, reshaping the supporting bone, and stitching everything back together.

I believe this is pretty common knowledge and perhaps this has made people fearful of the periodontal “solution”. Remember, periodontal disease does not hurt until the teeth become very loose and have to be extracted. Now we have a technique that should remove the fear of treating periodontal disease.

LANAP (Laser-assisted new attachment procedure) is a minimally invasive procedure that avoids the cutting and stitching associated with periodontal surgery. The technique removes the bacteria, cleanses the roots, and stimulates new gum and bone growth around infected teeth without the post-operative discomfort associated with traditional surgery. It is performed in one or two phases with just local numbing agents.

Simply put the laser is attracted to dark matter (bacteria and calculus) that is residing in the gums and in the surface of the tooth. Diseased tissue around the tooth is vaporized so the doctor can peer under the gums with magnification. Hardened calculus deposits are removed and the laser again is used to develop a clot that forms a seal like an “O ring” around the neck of the tooth leaving the remaining tissues intact and untouched. Healing and regeneration in an undisturbed sterile environment will then begin. Teeth are slightly adjusted so they hit together in balanced harmony.

Dr. Eric Johnson, who recently joined my staff and is trained and licensed with the perio laser, has performed this procedure for several years. He has performed it on many of my patients and I have seen some astounding results. In addition to the regeneration of bone growth, patients heal very fast. There is very little bleeding, no stitches needed and they can resume their normal activities with little or no down time. It is exciting to see a procedure that can stop the ravages of periodontal disease without having to resort to periodontal surgery. The cost is less that two implants with crowns or about the same for extractions and dentures. The result is that you may continue to have your own teeth serve you for years to come.

Don’t let fear make you wait before it is too late. Check the alternatives before your teeth are hopeless.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Your Medications and Dentistry

When you visit your dentist you have to fill out a health questionnaire and current medications list. It seems redundant and seemingly remote that medications should interfere with your dental visit. Why is this important?

My intention with this article is not to list all the drug interactions with dental disease and dental restorations. I intend to list the most common problems and consequences and to let you know that you should tell your dentist and hygienist your most current medical status.

Xerostomia or dry mouth occurs when the salivary output becomes diminished, usually through age or side effects of medications. Dry mouth can become especially uncomfortable when a removable bridge or denture has to be worn. If dry mouth can be tied to a new prescription then the prescription can be changed. If this is impossible then extra effort is made to enhance salivary output by using over-the-counter salivary stimulants or chewing gums. The Biotene company has many products that fit this description. Chewing gums with Xylitol help prevent the high incidence of decay in people with dry mouth.

Cardiac and hypertension medications present different problems. Your dentist should know if there is a need to limit the use of a local anesthetic that contains a vasopressor. Vasopressors are commonly used with anesthetics let the numb effect linger longer. Sedation may be necessary for more lengthy dental visits or for those who are anxious.

Warfarin or Coumadin is given for people who need anti-clotting medication to prevent thrombosis. Current thinking is that there is little (short of a lot of dental surgery) that is done in the dental office that would require cessation of this medication several days prior to dental work. Oral surgery may require going off the medication. This should be done with the advice of the cardiologist.

Antihypertensive drug therapy can lead to a dry sore mouth or lichenoid infection. These conditions can be treated, but dentists should be aware of the cause.

Diabetes treatment consists of maintaining metabolic control of blood glucose levels. Oral complications include poor response to the bacteria that cause periodontal disease., candidiasis (fungus infection), poor wound healing, dry mouth and increased decay at the gum line. Your dentist should know if you are a controlled diabetic.

Allergies to drugs are also common. If you suspect that an allergic reaction to medication has occurred in your life, let your dentist know. For instance there are many other antibiotics that can be administered for those who are allergic to penicillin. If you have aspirin or anti-inflammatory NSAID sensitivity, make your dental office aware.

Your dentist may have to contact your physician before dental work is initiated. Make sure you have all the necessary phone numbers available. Your dental office is there to help you have a problem free visit.
For answers to your dental questions, contact

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today's Dentistry/What is a Root Canal?

I sure get a little nervous when my doctor combines treatments and canals in the same sentence. Justifiably my patients react the same way when I recommend a root canal treatment.

When it becomes impossible to restore a severely decayed or fractured tooth merely with a filling or crown I have to recommend root canal therapy or extraction. I still get people fidgeting and wincing at the thought.

The vast majority of root canal treatments are successful and are provided with minimal discomfort. Just like the TV news and printed newspapers we only hear about tragic events, crumbling economies and horrible acts done by man. In other words no news is good news. So the uneventful successful root canal fillings go by unnoticed.

There are a few failures. It ranges between 2% to 5%. Some teeth are just untreatable or not worth the time and expense due to predictable unfavorable outcomes.

Root canal myths abound. Root canal treatments remove the roots, pulling a tooth is better than a root canal filling, pregnant women can’t have root canals, root canals cause illness, and if it doesn’t hurt don’t fix it with a root canal. These are just myths. Let me explain.

Anatomically, the teeth are formed with a hard outer enamel shell covering a less dense dentin core. This core protects the pulp of the tooth which has a nerve and blood supply. When trauma or bacterial invasion penetrates through the enamel and into the dentin core the living tissues of the pulp will die off leaking out into the bone through the end of the root and causing an abscess to form.

Pain may not be present when the dentist examines the x-rays and finds a latent abscess or dead tooth. The tooth is best treated before a severely painful infection develops. Infections will compromise pain control and the outcome of the treatment. Do not delay.

Root canal fillings obliterate the space that was once occupied by the nerve. It takes a lot of clinical know-how and patience to place these fillings. Once placed the fillings need protection from the mouth fluids with a restoration like a crown or sealed filling.

Root canal fillings can be placed during pregnancy without any special precautions. Also, there is no evidence to suggest that root canal treatments will develop into an illness. Save your teeth if you can. In the long run it is far easier the alternatives.

Do all crowns need root canal fillings first? No. Only about 20% of crowned teeth will need root canal fillings later on in normal situations. Do most root canal fillings need crowns? Yes. Root canal filled teeth become brittle and may fracture later so they require full coverage of the chewing surface. Once properly restored the tooth should perform like a normal tooth for a long time.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com