How does periodontal disease affect overall health.mp4

Nanomedicine
The field of "Nanomedicine" is the science and technology of diagnosing, treating, and preventing disease and traumatic injury, of relieving pain, and of preserving and improving human health, using nanoscale structured materials, biotechnology, and genetic engineering, and eventually complex machine systems and nonorobots. It was perceived as embracing five main subdisciplines that in many ways are overlapping by common technical issues

Nanodiagnostics
It is the use of nanodevices for the early disease identification or predisposition at cellular and molecular level. In in-vitro diagnostics, nanomedicine could increase the efficiency and reliability of the diagnostics using human fluids or tissues samples by using selective nanodevices, to make multiple analyses at subcellular scale, etc. In in vivo diagnostics, nanomedicine could develop devices able to work inside the human body in order to identify the early presence of a disease, to identify and quantify toxic molecules, tumor cells.

Regenerative medicine
It is an emerging multidisciplinary field to look for the reparation, improvement, and maintenance of cells, tissues, and organs by applying cell therapy and tissue engineering methods. With the help of nanotechnology it is possible to interact with cell components, to manipulate the cell proliferation and differentiation, and the production and organization of extracellular matrices.

Present day nanomedicine exploits carefully structured nanoparticles such as dendrimers, carbon fullerenes (buckyballs), and nanoshells to target specific tissues and organs. These nanoparticles may serve as diagnostic and therapeutic antiviral, antitumor, or anticancer agents. Years ahead, complex nanodevices and even nanorobots will be fabricated, first of biological materials but later using more durable materials such as diamond to achieve the most powerful results.

The human body is comprised of molecules, hence the availablity of molecular nanotechnology will permit dramatic progress to address medical problems and will use molecular knowledge to maintain and improve human health at the molecular scale.

Applications in medicine
Within 10-20 years it should become possible to construct machines on the micrometer scale made up of parts on the nanometer scale. Subassemblies of such devices may include such as useful robotic components as 100 nm manipulater arms, 10 nm sorting rotors for molecule by molecule reagent purification, and smooth super hard surfaces made of automically flawless diamond.

Nanocomputers would assume the important task of activating, controlling, and deactivating such nanomechanical devices. Nanocomputers would store and execute mission plans, receive and process external signals and stimuli, communicate with other nanocomputers or external control and monitoring devices, and possess contextual knowledge to ensure safe functioning of the nanomechanical devices. Such technology has enormous medical and dental implications.

Programmable nanorobotic devices would allow physicians to perform precise interventions at the cellular and molecular level. Medical nanorobots have been proposed for genotological applicatons in pharmaceuticals research clinical diagnosis, and in dentistry, and also mechanically reversing atherosclerosis, improving respiratory capacity, enabling near-instantaneous homeostasis, supplementing immune system, rewriting or replacing DNA sequences in cells, repairing brain damage, and resolving gross cellular insults whether caused by irreversible process or by cryogenic storage of biological tissues.

Feynman offered the first known proposal for a nanorobotic surgical procedure to cure heart disease,  "A friend of mine (Albert R. Hibbs) suggests a very interesting possibility for relatively small machines. He says that, although it is a very wild idea, it would be interesting in surgery if you could swallow the surgeon. You put the mechanical surgeon inside the blood vessel and it goes into the heart and looks around. It finds out which valve is the faulty and takes a little knife and slices it out, that we can manufacture an object that maneuvers at that level, other small machines might be permanently incorporated in the body to assist some inadequately functioning organs".

Many disease causing culprits such as bacteria and viruses are nanosize. So, it only makes sense that nanotechnology would offer us ways of fighting back. The ancient greeks used silver to promote healing and prevent infection, but the treatment took backseat when antibiotics came on the scene. Nycryst pharmaceuticals (Canada) revived and improved an old cure by coating a burn and wound bandage with nanosize silver particles that are more reactive than the bulk form of metal. They penetrate into skin and work steadily. As a result, burn victims can have their dressings changed just once a week.

Genomics and protomics research is already rapidly elucidating the molecular basis of many diseases. This has brought new opportunities to develop powerful diagnostic tools able to identify genetic predisposition to diseases. In the future, point of care diagnosis will be routinely used to identify those patients requiring preventive medication to select the most appropriate medication for individual patients, and to monitor response to treatment. Nanotechnology has a vital role to play in realizing cost-effective diagnostic tools.

Chris Backous developing Lab-on-Chip to give doctor immediate results from medical tests for cancer and viruses, it gets its information by analyzing the genetic material in individual cells. Advances in gene sequencing mean this can now be done quickly and sequencing with tiny samples of body fluids or tissues such as blood, bone marrow, or tumors. The device can also detect the BK virus, a sign of trouble in patients who have had kidney transplants. Ultimately (Pilarski thinks,) chip technology will be able to detect what kind of flu a person has, or, even if they have SARS or HIV.

Nanotechnology has the potential to offer invaluable advances such as use of nanocoatings to slow the release of asthma medication in the lungs, allowing people with asthma to experience longer periods of relief from symptoms after using inhalants. Thus, what nanotechnology tries to do is essentially make drug particles in such a way, that they don't dissolve that fast, done this with.

Nanosensors developed for military use in recognizing airborne rogue agents and chemical weapons to detect drugs and other substances in exhaled breath.  Basically, you can detect many drugs in breath, but the amount you detect in breath is going to be related to the amount that you take and also to whether it partitions well between the blood and the breath. Drug abuse like marijuna (and things like), concentration of alcohol, testing of athletes for banned substances, and individual's drug treatment programs are two areas long overdue for breath detection technologies. We see this in future totally replacing urine testing.

Currently, most legal and illegal drug overdoses have no specific way to be effectively neutralized, using nanoparticles as absorbents of toxic drugs, is another area of medical nanoscience that is rapidly gaining momentum. Goal is design nanostructures that effectively bind molecular entities, which currently don't have effective treatments. We are putting nanosponges into the blood stream and they are soaking up toxic drug molecules to reduce the free amount in the blood, in turn, causes a resolution of the toxicity that was there before you put the nanosponges into the blood.

French and Italian researchers have come up with a completely new approach to render anticancer and antiviral nucleoside analoges significantly more potent. By linking the nucleoside analoges to sequalene, a biochemical precursor to the whole family of steroids, the researchers observed the self-organization of amphiphilic molecules in water. These nanoassemblies exhibited superior anticancer activity in vitro in human cancer cells.

Laurie B Gower, PhD, has been researching bone formation and structure at the nanoscale level. She is examining biomimetic methods of constructing a synthetic bone graft substitute with a nanostructured architecture that matches natural bone so that it would be accepted by the body and guide the cells toward the mending of damaged bones. Biomineralization refers to minerals that are formed biologically, which have very different properties than geological minerals or lab-formed crystals. The crystal properties found in bone are manipulated at nanoscale and are imbedded within collagen fibers to create an interpenetrating organic-inorganic composite with unique mechanical properties. She foresees numerous implications of the material in the future of osteology.

Hichan Fenniri, a chemistry professor, tried to make artificial joints act more like natural ones. Fenniri has made a nanotube coating for titanium hip or knee, is very good mimic of collagen, as a result of coating attracts and attaches more bone cells, osteoblasts, which help in bone growth quickly than uncoated hip or knee.

There is ongoing attempts to build 'medical microrobots' for in vivo medical use.  In 2002, Ishiyama et al ,  at Tohku University developed tiny magnetically driven spinning screws intended to swim along veins and carry drugs to infected tissues or even to burrow into tumors and kill them with heat. In 2005, Brad Nelson's  team reported the fabrication of a microscopic robot, small enough (approximately 200 µm) to be injected into the body through a syringe. They hope that this device or its descendants might someday be used to deliver drugs or perform minimally invasive eye surgery. Gorden's group at the University of Manitoba has also proposed magnetically controlled 'cytobots' and 'karyobots' for performing wireless intracellular and intranuclear surgery.

'Respirocytes', the first theoreotical design study of a complete medical nanorobot ever published in peer-reviewed journal described a hypothetical artificial mechanical red blood cell or 'respirocyte' made of 18 billion precisely arranged structural atoms. The respirocyte is a bloodborne spherical 1 µm diamondedoid 1000 atmosphere pressure vessel with reversible molecule selective surface pumps powered by endogenous serum glucose. This nanorobot would deliver 236 times more oxygen to body tissues per unit volume than natural red cells and would manage carbonic acidity, controlled by gas concentration sensors and an onboard nanocomputer.

Nanorobotic microbivores
Artificial phagocytes called microbivores could patrol the bloodstream, seeking out and digesting unwanted pathogens including bacteria, viruses, or fungi. Microbivores would achieve complete clearance of even the most severe septicemic infections in hours or less. The nanorobots do not increase the risk of sepsis or septic shock because the pathogens are completely digested into harmless sugars, amino acids, and the like, which are the only effluents from the nanorobot.

Surgical nanorobotics
A surgical nanorobot, programmed or guided by a human surgeon, could act as a semiautonomous on site surgeon inside the human body, when introduced into the body through vascular system or cavities. Such a device could perform various functions such as searching for pathology and then diagnosing and correcting lesions by nanomanipulation, coordinated by an onboard computer while maintaining contact with the supervising surgeon via coded ultrasound signals.

The earliest forms of cellular nanosurgery are already being explored today. For example, rapidly vibrating (100 Hz) micropipette with a <1 µm tip diameter has been used to completely cut dentrites from single neurons without damaging cell viability.  Axotomy of roundworm neurons was performed by femtosecond laser surgery, after which the axons functionally regenerated. Femtolaser acts like a pair of nanoscissors by vaporizing tissue locally while leaving adjacent tissue unharmed. Femtolaser surgery has performed the individual chromosomes.

Nanogenerators'
They could make new class of self-powered implantable medical devices, sensors, and portable electronics, by converting mechanical energy from body movement, muscle stretching, or water flow into electricity.

Nanogenerators produce electric current by bending and then releasing zinc oxide nanowires, which are both piezoelectric and semiconducting. Nanowires can be grown on polymer-based films, use of flexible polymer substrates could one day allow portable devices to be powered by movement of their users.
"Our bodies are good at converting chemical energy from glucose into the mechanical energy of our muscles," Wang (faculty at Peking University and National Center for Nanoscience and Technology of China) explained "these nanogenerators can take mechanical energy and convert it to electrical energy for powering devices inside the body. This could open up tremendous possibilities for self-powered implantable medical devices."

Future impact of nanotechnology on medicine and dentistry

Nanodentistry will make possible the maintenance of comprehensive oral health by employing nanomaterials, biotechnology, including tissue engineering, and ultimately, dental nanorobotics. New potential treatment opportunities in dentistry may include, local anesthesia, dentition renaturalization, permanent hypersensitivity cure, complete orthodontic realignments during a single office visit, covalently bonded diamondised enamel, and continuous oral health maintenance using mechanical dentifrobots.

When the first micro-size dental nanorobots can be constructed, dental nanorobots might use specific motility mechanisms to crawl or swim through human tissue with navigational precision, acquire energy, sense, and manipulate their surroundings, achieve safe cytopenetration and use any of the multitude techniques to monitor, interrupt, or alter nerve impulse traffic in individual nerve cells in real time.

These nanorobot functions may be controlled by an onboard nanocomputer that executes preprogrammed instructions in response to local sensor stimuli. Alternatively, the dentist may issue strategic instructions by transmitting orders directly to in vivo nanorobots via acoustic signals or other means.

Inducing anesthesia
One of the most common procedure in dental practice, to make oral anesthesia, dental professionals will instill a colloidal suspension containing millions of active analgesic micron-sized dental nanorobot 'particles' on the patient's gingivae. After contacting the surface of the crown or mucosa, the ambulating nanorobots reach the dentin by migrating into the gingival sulcus and passing painlessly through the lamina propria or the 1-3-micron thick layer of loose tissue at the cementodentinal junction. On reaching dentin, the nanorobots enter dentinal tubules holes that are 1-4 microns in diameter and proceed toward the pulp, guided by a combination of chemical gradients, temperature differentials, and even positional navigation, all under the control of the onboard nanocomputer as directed by the dentist.

There are many pathways to choose from, near to CEJ, midway between junction and pulp, and near to pulp. Tubules diameter increases as it nears the pulp, which may facilitate nanorobot movement, although circumpulpal tubule openings vary in numbers and size (tubules number density 22,000 mm DEJ, 37,000 mm square midway, ans 48000 mm square near to pulp). Tubules branching patterns, between primary and irregular secondary dentin, regular secondary dentin in young and old teeth (sclerosing) may present a significant challenge to navigation.

The presence of natural cells that are constantly in motion around and inside the teeth including human gingival and pulpal fibroblasts, cementoblasts of the CDJ, bacteria inside dentinal tubules, odontoblasts near the pulp dentin border, and lymphocytes within the pulp or lamina propria suggested that such journey should be feasible by cell-sized nanorobots of similar mobility.

Once installed in the pulp and having established control over nerve impulse traffic, the analgesic dental nanorobots may be commanded by the dentist to shut down all sensitivity in any particular tooth that requires treatment. When on the hand-held controller display, the selected tooth immediately becomes numb. After the oral procedures completed, the dentist orders the nanorobots to restore all sensation, to relinguish control of nerve traffic and to engress, followed by aspiration. Nanorobotic analgesics offer greater patient comfort and reduced anxiety, no needles, greater selectivity, and controllability of the analgesic effect, fast and completely reversible switchable action and avoidance of most side effects and complications.

Tooth repair

Nanorobotic manufacture and installation of a biologically autologous whole replacement tooth that includes both mineral and cellular components, that is, 'complete dentition replacement therapy' should become feasible within the time and economic constraints of a typical office visit through the use of an affordable desktop manufacturing facility, which would fabricate the new tooth in the dentist's office.

Chen et al took advantage of these latest developments in the area of nanotechnology to simulate the natural biomineralization process to create the hardest tissue in the human body, dental enamel, by using highly organized microarchitectural units of nanorod-like calcium hydroxyapatite crystals arranged roughly parallel to each other.

Dentin hypersensitivity
Natural hypersensitive teeth have eight times higher surface density of dentinal tubules and diameter with twice as large than nonsensitive teeth. Reconstructive dental nanorobots, using native biological materials, could selectively and precisely occlude specific tubules within minutes, offering patients a quick and permanent cure.

Tooth repositioning
Orthodontic nanorobots could directly manipulate the periodontal tissues, allowing rapid and painless tooth straightening, rotating and vertical repositioning within minutes to hours.

Tooth renaturalization
This procedure may become popular, providing perfect treatment methods for esthetic dentistry. This trend may begin with patients who desire to have their (1) old dental amalgams excavated and their teeth remanufactured with native biological materials, and (2) full coronal renaturalization procedures in which all fillings, crowns, and other 20 ^th century modifications to the visible dentition are removed with the affected teeth remanufactured to become indistinguishable from original teeth.

Dental durability and cosmetics
Durability and appearance of tooth may be improved by replacing upper enamel layers with covalently bonded artificial materials such as sapphire or diamond, which have 20-100 times the hardness and failure strength of natural enamel or contemporary ceramic veneers and good biocompatibility. Pure sapphire and diamond are brittle and prone to fracture, can be made more fracture resistant as part of a nanostructured composite material that possibly includes embedded carbon nanotubes.

Nanorobotic dentifrice (dentifrobots) delivered by mouthwash or toothpaste could patrol all supragingival and subgingival surfaces at least once a day metabolizing trapped organic mater into harmless and odorless vapors and performing continous calculus debridement.

Properly configured dentifrobots could identify and destroy pathogenic bacteria residing in the plaque and elsewhere, while allowing the 500 species of harmless oral microflora to flourish in a healthy ecosystem. Dentifrobots also would provide a continous barriers to halitosis, since bacterial putrification is the central metabolic process involved in oral malodor. With this kind of daily dental care available from an early age, conventional tooth decay and gingival deseases will disappear into the annals of medical history.

Potential benefits of nanotechnology are its ability to exploit the atomic or molecular properties of materials and the development of newer materials with better properties. Nanoproducts can be made by: building-up particles by combining atomic elements and using equipments to create mechanical nanoscale objects.

Nanotechnology has improved the properties of various kinds of fibers.  Polymer nanofibers with diameters in the nanometer range, possess a larger surface area per unit mass and permit an easier addition of surface functionalities compared to polymer microfibers.  Polymer nanofiber materials have been studied as drug delivery systems, scaffolds for tissue engineering and filters. Carbon fibers with nanometer diamensions showed a selective increase in osteoblast adhesion necessary for successful orthopedic/dental implant applications due to a high degree of nanometer surface roughness.

Nonagglomerated discrete nanoparticles are homogenously manufactured in resins or coatings to produce nanocomposites. The nanofiller used include an aluminosilicate powder having a mean particles size of about 80 nm and 1:4 M ratio of alumina to silica. Advantages - superior hardness, flexible strength, modulus of elasticity, translucency and esthetic appeal, excellent color density, high polish, and polish retention, and excellent handling properties.  (Filtek O supreme Univrasl Restorative Pure Nano O).

Heliometer, microfilled composite resin, a close examination of this composite suggests that a form of nanotechnology was in use years ago, yet never recognized.

Nanosolutions produce unique and dispersible nanoparticles that can be added to various solvents, paints, and polymers in which they are dispersed homogenously. Nanotechnology in bonding agents ensures homogeneity and so the operator can now be totally confident that the adhesive is perfectly mixed every time.
Nanofillers are integrated in the vinylsiloxanes, producing a unique addition siloxane impression material. Better flow, improved hydrophilic properties, hence fewer voids at margin and better model pouring, enhanced detail precision

Your child's milk tooth can save her life

IANS Mar 30, 2012, 01.43PM IST
 
Is your child about to lose her milk tooth? Instead of throwing it away, you can now opt to use it to harvest stem cells in a dental stem cell bank for future use in the face of serious ailments. Now that's a tooth fairy story coming to life.
Still relatively new in India, dental stem cell banking is fast gaining popularity as a more viable option over umbilical cord blood banking.                                                                                                                        

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Stem cell therapy

Stem cell therapy involves a kind of intervention strategy in which healthy, new cells are introduced into a damaged tissue to treat a disease or an injury.
"The umbilical cord is a good source for blood-related cells, or hemaotopoietic cells, which can be used for blood-related diseases, like leukaemia (blood cancer). Having said that, blood-related disorders constitute only four percent of all diseases," Shailesh Gadre, founder and managing director of the company Stemade Biotech, said.
"For the rest of the 96 percent tissue-related diseases, the tooth is a good source of mesenchymal (tissue-related) stem cells. These cells have potential application in all other tissues of the body, for instance, the brain, in case of diseases like Alzheimer's and Parkinson's; the eye (corneal reconstruction), liver (cirrhosis), pancreas ( diabetes), bone (fractures, reconstruction), skin and the like," he said.
Mesenchymal cells can also be used to regenerate cardiac cells.
Dental stem cell banking also has an advantage when it comes to the process of obtaining stem cells.
"Obtaining stem cells from the tooth is a non-invasive procedure that requires no surgery, with little or no pain. A child, in the age group of 5-12, is any way going to lose his milk tooth. So when it's a little shaky, it can be collected with hardly any discomfort," Savita Menon, a pedodontist, said.
"Moreover, in a number of cases, when an adolescent needs braces, the doctor recommends that his pre-molars be removed. These can also be used as a source for stem cells. And over and above that, an adult's wisdom tooth can also be used for the same purpose," Gadre added.
Therefore, unlike umbilical cord blood banking which gives one just one chance - during birth - the window of opportunity in dental stem cell banking is much bigger.
"Of course, age is still a big factor," added Menon. "A child's milk tooth has more potency than a wisdom tooth. The ability of a young one's cells to multiply is twice as higher as anyone else."
Pankaj Kala is one of those who opted for dental stem cell banking for his child.
"I lost my mother to cardiac arrest when she was just 45. She was also a diabetic. After that I decided that I will do everything possible to protect my family from harm. I missed the opportunity of umbilical cord blood banking in the case of my daughter when she was born; so when she was six, we went for dental stem cell banking," Kala, who is in the jewellery business in Mumbai, said.
"It's been two years now and I have decided to go for the procedure for the second child too. Even my wife will go for stem cell banking using her wisdom tooth. In my case, however, it will be difficult since I had gone for root canal treatment in my wisdom tooth and therefore it's not healthy," he added.

Preventive tips for children...................

Infants

Infants should be seen by our office after the first six months of age, and at least by the child's first birthday. By this time, the baby's first teeth, or primary teeth, are beginning to erupt and it is a critical time to spot any problems before they become big concerns.

Conditions like gum irritation and thumb-sucking could create problems later on. Babies who suck their thumbs may be setting the stage for malformed teeth and bite relationships.

Another problem that can be spotted early is a condition called "baby bottle tooth decay," which is caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby's mouth.

If left untreated, this can lead to premature decay of your baby's future primary teeth, which can later hamper the proper formation of permanent teeth.

One of the best ways to avoid baby bottle tooth decay is to not allow your baby to nurse on a bottle while going to sleep. Avoid dipping pacifiers in sweet substances such as honey, because this only encourages early decay in the baby's mouth. Encouraging your young child to drink from a cup as early as possible will also help stave off the problems associated with baby bottle tooth decay.

Teething, Pacifiers and Thumb-Sucking

Teething is a sign that your child's gums are sore. This is perfectly normal. You can help relieve this by allowing the baby to suck on a teething ring, or gently rubbing your baby's gums with the back of a small spoon, a piece of wet gauze, or even your finger.

For babies under the age of 4, teething rings and pacifiers can be safely used to facilitate the child's oral needs for relieving gum pain and for suckling. After the age of 4, pacifiers are generally discouraged because they may interfere with the development of your child's teeth.

Moreover, thumb-sucking should be strongly discouraged because it can lead to malformed teeth that become crooked and crowded.

Primary and Permanent Teeth

Every child grows 20 primary teeth, usually by the age of 3. These teeth are gradually replaced by the age of 12 or so with a full set of 28 permanent teeth, and later on, four molars called "wisdom teeth."

It is essential that a child's primary teeth are healthy, because their development sets the stage for permanent teeth. If primary teeth become diseased or do not grow in properly, chances are greater that their permanent replacements will suffer the same fate. For example, poorly formed primary teeth that don't erupt properly could crowd out spaces reserved for other teeth. Space maintainers can sometimes be used to correct this condition, if it is spotted early enough.

Brushing

Babies' gums and teeth can be gently cleaned with special infant toothbrushes that fit over your finger. Water is suitable in lieu of toothpaste (because the baby may swallow the toothpaste). Parents are advised to avoid fluoride toothpastes on children under the age of 2.

Primary teeth can be cleansed with child-sized, soft-bristled toothbrushes. Remember to use small portions of toothpaste (a pea-sized portion is suitable), and teach your child to spit out, not swallow, the toothpaste when finished.

Fluoride

Fluoride is generally present in most public drinking water systems. If you are unsure about your community's water and its fluoride content, or learn that it has an unacceptable level of fluoride in it, there are fluoride supplements your dentist can prescribe. Your child may not be getting enough fluoride just by using fluoride toothpaste.

Toothaches

Toothaches can be common in young children. Sometimes, toothaches are caused by erupting teeth, but they also could indicate a serious problem.

You can safely relieve a small child's toothache without the aid of medication by rinsing the mouth with a solution of warm water and table salt. If the pain doesn't subside, acetaminophen may be used. If such medications don't help, contact your dentist immediately.

Injuries

You can help your child prevent oral injuries by closely supervising him during play and not allowing the child to put foreign objects in the mouth.

For younger children involved in physical activities and sports, mouth guards are strongly encouraged, and can prevent a whole host of injuries to the teeth, gums, lips and other oral structures.

Mouth guards are generally small plastic appliances that safely fit around your child's teeth. Many mouth guards are soft and pliable when opened, and mold to the child's teeth when first inserted.

If the tooth has been knocked out, try to place the tooth back in its socket while waiting to see our office. Remember to hold the dislocated tooth by the crown-not the root. If you cannot relocate the tooth, place it in a container of cold milk, saline or the victim's own saliva. Place the tooth in the solution.

First, rinse the mouth of any blood or other debris and place a cold cloth or compress on the cheek near the injury. This will keep down swelling.

For a fractured tooth, it is best to rinse with warm water and again, apply a cold pack or compress. Ibuprofen may be used to help keep down swelling.

If the tooth fracture is minor, the tooth can be sanded or if necessary, restored by the dentist if the pulp is not severely damaged.

If a child's primary tooth has been loosened by an injury or an emerging permanent tooth, try getting the child to gently bite down on an apple or piece of caramel; in some cases, the tooth will easily separate from the gum.

Irritation caused by retainers or braces can sometimes be relieved by placing a tiny piece of cotton or gauze on the tip of the wire or other protruding object. If an injury occurs from a piece of the retainer or braces lodging into a soft tissue, contact our office immediately and avoid dislodging it yourself.

Sealants

Sealants fill in the little ridges on the chewing part of your teeth to protect and seal the tooth from food and plaque. The application is easy to apply and typically last for several years.

Women's Teeth

Women have special needs when it comes to their oral health. That's because the physical changes they undergo through life-things like menstruation, pregnancy and childbirth, breast-feeding and menopause-cause many changes in the body, some harmful to teeth and gums.

Lesions and ulcers, dry sockets, as well as swollen gums, can sometimes occur during surges in a woman's hormone levels. These periods would be a prime time to visit the dentist. Birth control pills have been shown to increase the risk of gingivitis, and hormone replacement therapy has been shown to cause bleeding and swollen gums. Gum disease can also present a higher risk for premature births.

Some research has shown that women may be more likely to develop dry mouth, eating disorders, jaw problems such as temporomandibular joint disorders, and facial pain-all of which can be difficult from a physical and emotional standpoint.

Taking care of your oral health is essential, and can go a long way to helping you face the physical changes in your body over the years.

Tooth Care.....................

Nutrition and Your Teeth

 It has long been known that good nutrition and a well-balanced diet is one of the best defenses for your oral health. Providing your body with the right amounts of vitamins and minerals helps your teeth and gums-as well as your immune system-stay strong and ward off infection, decay and disease.

Harmful acids and bacteria in your mouth are left behind from eating foods high in sugar and carbohydrates. These include carbonated beverages, some kinds of fruit juices, and many kinds of starch foods like pasta, bread and cereal.

Children's Nutrition and Teeth

Good eating habits that begin in early childhood can go a long way to ensuring a lifetime of good oral health.

Children should eat foods rich in calcium and other kinds of minerals, as well as a healthy balance of the essential food groups like vegetables, fruits, dairy products, poultry and meat. Fluoride supplements may be helpful if you live in a community without fluoridated water, but consult with our office first. (Be aware that sugars are even found in some kinds of condiments, as well as fruits and even milk.)

Allowing your children to eat excessive amounts of junk food (starches and sugars)-including potato chips, cookies, crackers, soda, even artificial fruit rollups and granola bars-only places them at risk for serious oral health problems, including obesity, osteoporosis and diabetes. The carbonation found in soda, for example, can actually erode tooth enamel. Encourage your child to use a straw when drinking soda; this will help keep at least some of the carbonated beverage away from the teeth.

Adult Nutrition and Teeth

There's no discounting the importance of continuing a healthy balanced diet throughout your adult life.

Five Ways to Help Promote Healthy Teeth and Gums...................

• Eat and drink up. It is well known that eating a balanced diet leads to proper nutrition and helps keep the body running effectively. Studies published in the Journal of Periodontology (JOP) have also shown that certain foods can promote teeth and gum health. Foods containing omega-3, calcium, vitamin D and even honey have all been shown to reduce the incidence or severity of periodontal disease.
• Hit the gym. Frequent exercise is a recognized way to avoid being overweight, and it may ultimately reduce your risk of periodontal disease. In a study published in the Journal of Periodontology, researchers found that subjects who maintained a healthy weight and had high levels of physical fitness had a lower incidence of severe periodontitis than those that did not exercise.
• Stress less. Stress can lead to a variety of health complications, including periodontal disease. Research published in the JOP showed a relationship between stress and periodontal disease. Increased levels of cortisol, which the body releases when experiencing stress, can intensify the destruction of the gums and bone due to periodontal disease. In addition, another JOP study indicated that people experiencing stress are more likely to neglect their oral hygiene.
• Kick the habit. Smoking is not only a leading cause of respiratory and cardiovascular disease in the United States, it is also a major risk factor for periodontal disease. Several research studies have shown that smoking not only increases the chance of developing periodontal disease, but it can also affect the success of treatments for existing periodontal disease.
• See the doctor. Regular check-ups by a physician can help with early diagnosis of several health issues, including periodontal disease. A large body of research associates gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis. Therefore, by screening for systemic disease early and receiving any needed treatment, you may also benefit your periodontal health.

Dr. McClain stresses that while these tips may contribute to healthy teeth and gums, the benefit of routine oral care cannot be discounted. “Taking good care of your periodontal health starts with daily tooth brushing and flossing. You should also expect to get a comprehensive periodontal evaluation, or CPE, every year,” she advises. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, can conduct a comprehensive exam to assess your periodontal health.

More Americans use the ER for dental care: study

A new study released today from the Pew Center on the States finds that more Americans are getting their dental care at the hospital emergency room.

A new study released today from the Pew Center on the States finds that more Americans are getting their dental care at the hospital emergency room.
The number of ER visits nationwide for dental problems increased 16 percent from 2006 to 2009, the report said. In some states, the rise was more dramatic. ER visits for dental-related problems have jumped nearly 60 percent over the past four years in South Carolina, Pew researchers found. And in Tennessee, hospitals treat five times as many patients for dental problems as for burns.
Using emergency rooms for dental care "is incredibly expensive and incredibly inefficient," Dr. Frank Catalanotto, a professor at the University of Florida's College of Dentistry who reviewed the report, told the Associated Press. Preventive dental care such as routine teeth cleaning can cost $50 to $100, compared with $1,000 for emergency room treatment of cavities and infections, Catalanotto said.
What’s more, ER physicians and nurses are not dentists, so the services they can provide are generally limited to pain relief and fighting infections, the AP reported. When patients’ dental problems persist, they return to the ER for additional expensive stop-gap treatments. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips, Pew found.
"It's the wrong service, in the wrong setting, at the wrong time," Shelly Gehshan, director of Pew's children's dental campaign, told the AP.
In many cases, patients skip regular checkups at a dentist’s office because their community has a shortage of dentists, especially those willing to treat Medicaid patients, Pew said.
The Pew report suggested a few state policy changes that could improve access to dental care, including providing incentives for pediatricians to offer basic dental services and encouraging more dentists to participate in Medicaid by keeping reimbursement rates high enough to cover the actual cost of care

sedative dentistry.........

IV (Intravenous) Sedation

Intravenous Conscious Sedation (aka “IV sedation”) is when a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment.

What does it feel like? Will I be asleep?

A lot of dental offices and practices use terms such as “sleep dentistry” or “twilight sleep” when talking about IV sedation. This is confusing, because it suggests that IV sedation involves being put to sleep. These terms are more descriptive of deep sedation. Deep sedation isn’t commonly used (in the U.K. at least), and is classified as general anaesthesia (even though sedation occurs on a continuum).
In reality, you remain conscious during conscious IV sedation. You will also be able to understand and respond to requests from your dentist.
However, you may not remember much (or anything at all) about what went on because of two things:

1. IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on
2. the drugs used for IV sedation produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. As a result, time will appear to pass very quickly and you will not recall much of what happened. Many people remember nothing at all. So it may, indeed, appear as if you were “asleep” during the procedure.

First-hand accounts of IV sedation

“Basically, its just a tiny pinch in the back of the hand and in goes the ‘stuff’. Nothing happens for several seconds and then you begin to feel light-headed (a little drunk) for a few moments, which is not unpleasant. Then instantly several hours have magically passed and everything has been done. Its like the flick of a switch which turns your brain off for an hour or two. You feel fairly dopey and woozy afterwards where you may want to go and sleep it off.”

“Well, I DID IT !!!!!!!! … As I sat in the chair, I could feel my heart racing and remember telling the dentist that I needed to do this… I didn’t feel the IV being inserted, and as he was topping up the sedation level, he gave me the local injections, now this should be freaking me out, but honestly, I only felt a scratch!! and me being needle phobic too! And just to quell any fears about infection being present throughout extraction: The infection i’ve had on and off for months now came back with a vengeance last night, and I NEVER felt it being extracted. Next thing I knew I was in the little recovery room with my partner.”

“I had iv sedation last Friday and remember nothing about what happened. It was called ‘Twillight Sleep’. If i had known how well it worked i would have had it years ago! Felt absolutely fine afterwards although i am told i was quite confused! You need someone to accompany you and bring you home afterwards.”

“i had iv sedation back in june, got 2 rotten and abcessed teeth extracted and a filling to a front tooth – remember nothing at all from the iv going in, to being aware i was in my husbands car asking for some water and telling him how i felt nothing ”

“IV sedation is the best!! I would not hesitate to use it again if I needed to. They numb your hand first, then they put the IV in and before you know it you are off to sleepyland. I really don’t remember too much, just bits and pieces of conversations.”

“I had IV sedation when I got my wisdom teeth surgically removed yesterday. Let me tell you, it was AMAZING. Cannot put it in better words. All I remember is the doctor putting the sedative in the IV, feeling COMPLETELY relaxed, and still in control of everything, and closed my eyes and before I could reach 8 counting backwards, I was peacefully asleep. I woke literally 2 seconds later with no pain at all! I didn’t believe the doctor when he said it was all over.”

Is it still necessary to be numbed with local anaesthetic? Will my dentist numb my gums before or after I’m sedated?

The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added, see below for more info), but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.
If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (i. e. until you’re numb) before starting on any procedure.

“But how does the dentist know whether I’m numb?”
“You check the local anesthetic has worked by asking the patient. Just coz they’re sedated doesn’t mean they can’t answer you… in fact they better be able to answer or they ain’t sedated, they’re anaesthetised! If they’re not numb enough they’ll soon tell you. But they won’t remember telling you of course because of the amnesia effect…” (answer courtesy of Gordon Laurie, BDS – yet again!)

How is IV sedation given?

“Intravenous” means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand. This needle is wrapped up with a soft plastic tube. It makes the entry into the vein, then is slid out leaving the soft plastic tube in place. The drugs are put in through that tube (which is correctly referred to as an “indwelling catheter”, but more commonly known by the tradename of Venflon). The tube stays in place throughout the procedure.
The venflon to the right is a pinkie, which is one size bigger than the blue one that’s usually used for IV sedation in dentistry.
Throughout the procedure, your pulse and oxygen levels are measured using a “pulse oximeter”. This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you’re getting too low on oxygen, although if your dentist and the nurses are paying attention they should see it way before the machine does . Blood pressure before and after the procedure should be checked with a blood pressure measuring machine (a tongue-twister called “sphygmomanometer”, which for obvious reasons is referred to as “sphyg”).

But I’m terrified of all needles, not just dental injections!

You can get Ametop numbing cream to make the site where the needle goes profoundly numb:

“AMETOP numbing cream. I have a mortal fear of needles, and I find injections unbearable. Every injection I’ve had in my life has been intolerable. However, my dentist managed to get the IV in without me even noticing. I actually just turned round and it was in. The stuff is that good. I did not even feel any pressure. You can get a tube of it from your pharmacist for a few pounds, and it needs to stay in the fridge. If you need proof, buy two tubes, and use one a couple of days before your operation, just to reassure yourself how deeply numb it makes you.”

Ask your dentist or oral surgeon where the venflon will be going beforehand, and try it out! If you cannot get hold of Ametop, try EMLA cream.
You may also be offered laughing gas to enable you to accept the IV sedation.

What drugs are used? Are there different types of IV sedation?

Good question!! The most commonly used drugs for IV sedation are benzodiazepines, or “benzos” for short. These are anti-anxiety sedative drugs. In the UK, a benzodiazepine is almost always the only drug used for IV sedation (although I have heard of fentanyl being used as well). However, the situation is different in the U.S. First of all, regardless of location, what are the drugs which can be used for IV sedation?
1) Anti-anxiety sedatives (benzodiazepines): Midazolam and Diazepam
Mostly the drug used for IV sedation is a short acting benzodiazepine, or “benzo” for short. This is an anti-anxiety sedative. IV administered benzos have 3 main effects: they reduce anxiety/relax you, they make you sleepy, and they produce partial or total amnesia (i. e. make you forget what happened during some or, less frequently, all of the procedure). Total amnesia is more common with midazolam compared to diazepam.
By far the most commonly used drug for IV sedation is Midazolam, but occasionally Diazepam can be used.
Midazolam is the first choice because of its relatively short duration of action (meaning that it’ll be out of your system faster). Valium is (marginally) cheaper but longer acting and a bit “harder” on the veins, so you may feel a burning sensation on your arm/hand when the drug first enters. Local anaesthetic solution can be mixed in with Diazepam to make things more comfortable. The latest IV Diazepam is an emulsion which is claimed to be easier on the veins.
The drug is put into the vein at the rate of 1mg per minute for Diazepam or 1 mg every 2 minutes (followed by an extra 2 minutes to evaluate the effect) for Midazolam (because Midazolam is stronger in terms of the dose needed to achieve sedation). Because there are differences between individuals in how much of the drug you need to be sedated, your response to the drug is monitored. Once the desired level of sedation is achieved, the drug is stopped.
The Venflon is left in place during the procedure so that the sedation can either be topped up or so that the reversal agent for benzos (Flumazenil) can be put in in the unlikely event of an emergency.
2) Opioids
Opioids (strong pain-killers) can be used as an add-on to either benzodiazepines or barbiturates.
At first glance, the use of opioids seems appealing, because of the pain-killing factor. In reality, this usually only comes into play for post-treatment pain, because local anaesthesia will take care of any pain during treatment. However, should the local anesthetic effect begin to lessen, an opioid will help to alter the experience of pain.
What is often done instead is give a long-acting local anaesthetic where post-op pain is expected. When you take opioids, even terrible pain becomes tolerable – you can still feel the pain, but somehow you don’t care. Also, where barbiturates are used (see below), an opioid must be added to counteract their pain-threshold-lowering properties.
The addition of an opioid may also be desirable if a benzo has been administered to its maximum recommended dose yet the patient remains unsedated (which is more likely if you’ve been using benzodiazepines for years and have become tolerant to them). In this case, adding an opioid may provide the desired sedation. Alternatively, propofol (see below) may be used.
Opioids which may be used for IV sedation include:

• Meperidine (Demerol)
• Morphine
• Butorphanol (Stadol)
• Nalbuphine (Nubain)
• Fentanyl (Sublimaze)
• Pentazocine (Talwin)

3) Barbiturates
Barbiturates (sleep-inducing drugs) are not used for conscious sedation in the U.K., and have gone out of fashion in the U.S. The only barbiturate which is still occasionally used is called Pentobarbital Sodium (tradename: Nembutal).
In the absence of a trained anesthesiologist, barbiturates are pretty dangerous to use, for a number of reasons: it’s very easy to have the patient slip into general anaesthesia by mistake, where breathing and heart rate are dangerously lowered and coma and death can follow. Worse still, unlike for benzos, there’s no reversal agent. Barbiturates have only one advantage over benzos, and that is that they can be used to provide very long periods of conscious sedation. If pentobarbital is used, it’s in combination with opioids (see above), because barbiturates have the effect of lowering a person’s pain threshold.
4) Propofol
Some anaesthetists use Propofol instead of benzodiazepines. The advantage of this is the very rapid recovery time, less than 5 minutes. The drug must be continuously administered, so the drug is pumped in using an electric infusion pump, the dose rate is set by the anaesthetist. Propofol is not a common sedative agent because it’s very easy to tip over into GA (General Anaesthesia) with it, where reflexes such as breathing are lost. It can be useful you have developed a high tolerance to benzodiazepines because you’ve been hitting them hard for years. Propofol is classed as a GA drug and in the U.K. can only be administered in a hospital setting (although a few private dental clinics meet the standard of a hospital setting, and offer it as well).
Anything else? And why so many different drugs?
There are quite a few other drugs that can be used for IV sedation. But in practical terms, most of the time a single benzodiazepine, usually midazolam, is used. This is especially true in the UK, where polydrug use is discouraged (even though it is not illegal). A typical IV session takes up to 1 1/2 hours. If it takes longer, it’s done in multiple visits, or depending on the case, under General Anaesthesia.
In the U.S., the situation is slightly more complex. Polydrug use is much more common, possibly because IV sedation is taught at a high level. This encourages the use of polypharmacy (multiple drugs). Also, there appears to be a liking for long IV sessions, which require the use of polypharmacy. Long IV sessions may be driven by consumer demand, or maybe it’s a training issue.
Many IV specialists in the United States are opposed to the use of opioids for sedation, but there is a habit of using them ingrained in most practitioners. However, things appear to be changing as new dentists are coming through.
The general consensus among the leading experts in the field of dental sedation today is: the fewer medications are used, the safer the treatment tends to be (and the easier it is to track any potential problems). Usually, this means one medication only. Midazolam tends to be the drug of choice.

Is it safe? Are there any contraindications?

IV sedation is extremely safe when carried out under the supervision of a specially-trained dentist. Purely statistically speaking, it’s even safer than local anaesthetic on its own!
However, contraindications include

• pregnancy
• known allergy to benzodiazepines
• alcohol intoxication
• CNS depression, and
• some instances of glaucoma.

Cautions (relative contraindications) include psychosis, impaired lung or kidney or liver function, advanced age, and sleep apnea. Many people who have sleep apnea haven’t been officially diagnosed – if you are overweight and you snore, do mention this.
Heart disease is generally not a contraindication.
If you have been taking benzodiazepines for many years, your tolerance may be very high – so let your dentist know that you’ve been taking them!
The Dental Sedation Teachers Group uses the following classification for making the decision if and where conscious sedation should be provided:

• I – Normal, healthy patient
• II – A Patient with mild systemic disease, e.g. well controlled diabetes or epilepsy, mild asthma
• III – A patient with severe systemic disease limiting activity but not incapacitating, e. g. epilepsy with frequent fitting, uncontrolled high blood pressure, recent heart attack
• IV – A patient (usually hospitalised or bedridden) with incapacitating disease that is a constant threat to life
• V – A patient who is expected to die within 24 hours with or without treatment

source: American Society of Anaesthesiology Classification of Physical Status (ASA)
If you are in category I or II, then you can normally be treated in a general practice.
If you are in category III, it is best to be treated in an environment where more experienced support is available (a hospital-based clinic or a sedation clinic where medical support is available).

What are the main advantages of IV sedation?

• IV sedation tends to be the method of choice if you don’t want to be aware of the procedure – you “don’t want to know”. The alternative in the U.S. is oral sedation using Halcion, but oral sedation is not as reliably effective as IV sedation.
• The onset of action is very rapid, and drug dosage and level of sedation can be tailored to meet the individual’s needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and highly reliable.
• The maximum level of sedation which can be reached with IV is deeper than with oral or inhalation sedation.
• Benzodiazepines produce amnesia for the procedure.
• The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging. However, if minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.
• Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.

Are there any disadvantages?

• It is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood).
• While IV sedation is desired precisely because of the amnesia effect (i. e. forgetting what happened while under the influence of the drug/s), there can be a downside to this: if you can’t remember that the procedure wasn’t uncomfortable or threatening, you cannot unlearn your fears. However, it depends on the precise nature of your phobia and the underlying causes to which extent this may be a problem. Some people would voice a concern that some patients can’t be “weaned off” IV sedation, as dental anxiety tends to returns to baseline levels. As a result, people who rely on IV sedation may be less likely to seek regular dental care. Other people would argue that this is not a concern if IV sedation is readily available to people.
• Some dentists may resort to IV sedation too quickly, without exploring alternative options such as iatrosedation and psychological techniques in enough detail first. Sedation should not be used as a substitute for these techniques, but as an additional tool if other techniques alone don’t work, or if it is a potentially traumatic procedure.
• Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.
• You should want to be sedated. If, for any reason, you’re unwilling to “let go”, for example because you’re terrified of not being in control, it will be more difficult to be successfully sedated.
• Cost is another disadvantage – IV sedation is more expensive than other sedation options.

Can I take valium tablets or other benzodiazepines beforehand?

Yes. You must let your dentist know about it though (unless your dentist has prescribed them and knows already). It’s best to do this before you turn up on the day, because you’re likely to forget to mention it.

What about eating and drinking before sedation?

Some dentists in the U.K. prefer to have people have a light meal about an hour before they come in (this is for conscious sedation using midazolam), but it may depend on the drugs used for the IV. In the U.S., the standard advice appears to be no eating or drinking for 8 hours beforehand. Where a GA drug like propofol or ketamine or a barbiturate is used, there is a danger that a person who regurgitates food while anesthetized could get food or liquid into their lungs.

After IV Sedation:

1. Have your escort take you home and rest for the remainder of the day.
2. Have an adult stay with you until you’re fully alert.
3. Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.
4. Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e. g. liquids and toast.
5. If you experience nausea, lie down for a while or drink a glass of coke.
6. Don’t drink alcohol or take medications for the rest of the day unless you’ve contacted your dentist first.
7. Take medications as directed by your dentist.
8. If you have any unusual problems, call your dentist.

Protecting Children's Oral Health

Gingivitis (the first stage of periodontal disease) is nearly universal in children and adolescents. Gum diseases in children      Signs of gum disease Adolescent oral care Advice for parents

Many people think of periodontal disease as an adult problem. However, studies indicate that nearly all children and adolescents have gingivitis, the first stage of periodontal disease. Advanced forms of periodontal disease are more rare in children than adults, but can occur.

Types of periodontal diseases in children

Chronic gingivitis is common in children. It usually causes gum tissue to swell, turn red and bleed easily. Gingivitis is both preventable and treatable with a regular routine of brushing, flossing and professional dental care. However, left untreated, it can eventually advance to more serious forms of periodontal disease.
Aggressive periodontitis can affect young people who are otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.
Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.
Periodontitis associated with systemic disease occurs in children and adolescents as it does in adults. Conditions that make children more susceptible to periodontal disease include:

• Type I diabetes
• Down syndrome
• Kindler syndrome
• Papillon-Lefevre syndrome

For example, in a survey of 263 Type I diabetics, 11 to 18 years of age, 10 percent had overt periodontitis.

Signs of periodontal disease

Four basic signs will alert you to periodontal disease in your child:

Bleeding Bleeding gums during tooth brushing, flossing or any other time	Puffiness Swollen and bright red gums	Recession Gums that have receded away from the teeth, sometimes exposing the roots
Bad breath Constant bad breath that does not clear up with brushing and flossing

Periodontal Disease Runs in the Family

Periodontal disease may be passed from parents to children and between couples. Researchers suggest that the bacteria which causes periodontal disease may be passed from one person to another though saliva. This means that the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
Genetics may also play a major role in the onset and severity of periodontal disease. Researchers found that Up to 30% of the population may be genetically susceptible to developing severe periodontal disease. Therefore, if one family member has periodontal disease, it is a good idea for all family members to see a dental professional for a periodontal disease screening.

Adolescence and oral care

Evidence shows that periodontal disease may increase during adolescence due to lack of motivation to practice oral hygiene. Children who maintain good oral health habits up until the teen years are more likely to continue brushing and flossing than children who were not taught proper oral care.
Hormonal changes related to puberty can put teens at greater risk for getting periodontal disease. During puberty, an increased level of sex hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.
As a teen progresses through puberty, the tendency for the gums to swell in response to irritants will lessen. However, during puberty, it is very important to follow a good at-home oral hygiene regimen, including regular brushing and flossing, and regular dental care. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.

Advice for parents

Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important that children receive a periodontal examination as part of their routine dental visits. Be aware that if your child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy.
Many medications can dry out the mouth or pose other threats to oral health. Be sure to tell your dental professional about any medications your family members are taking.
Monitor your family to see if anyone has the habit of teeth grinding. Grinding can increase the risk of developing periodontal disease, in addition to causing cracked or chipped teeth. Dentists can make custom-fitted night bite guards to prevent teeth grinding at night.
Researchers suggest periodontal disease can pass through saliva. This means that the common contact of saliva in families may put children and couples at risk for contracting the periodontal disease of another family member. If one family member has periodontal disease, all family members should see a dental professional for a periodontal evaluation.
The most important preventive step against periodontal disease is to establish good oral health habits with your child. There are basic preventive steps to help your child maintain good oral health:

• Establish good oral health habits early. When your child is 12 months old, you can begin using toothpaste when brushing his or her teeth. However, only use a pea-sized portion on the brush and press it into the bristles so your child won't eat it. And, when the gaps between your child's teeth close, it's important to start flossing.
• Serve as a good role model by practicing good oral health care habits yourself.
• Schedule regular dental visits for family checkups, periodontal evaluations and cleanings.
• Check your child's mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.

If your child currently has poor oral health habits, work with your child to change these now. It's much easier to modify these habits in a child than in an adult. Since your child models behavior after you, it follows that you should serve as a positive role model in your oral hygiene habits. A healthy smile, good breath and strong teeth all contribute to a young person's sense of personal appearance, as well as confidence and self-esteem.

Periodontal Plastic Procedures-Gummy smile........................

Periodontal plastic procedures can improve your smile and boost your confidence if you have any of these problems.           Gummy Smile/Uneven Gum Line       Long Teeth/Exposed Roots Missing Teeth Indentations in Gums/Jawbone

First impressions are everything! So why not make a good first impression when you meet someone, go on a job interview or a first date by dazzling him or her with your "Hollywood smile." Whatever the reason, periodontal plastic procedures can help you "knock the socks off" of anyone by giving you a perfect smile and boosting your confidence so you can be at your best.

Before After "After periodontal plastic surgery, everyone told me I was more approachable. I now have an inner confidence that everyone can see through my smile." –Deborah Wolf, Bellevue, WA

Cosmetic surgery has become more popular than ever before especially now that more Americans are living longer and aging more gracefully with the help of plastic surgery. Periodontal plastic surgery has also felt this trend as it has experienced a significant shift toward cosmetic-related surgery to help make smiles last a lifetime.
A recent poll of 253 consumers conducted by the American Academy of Periodontology found the following:

• 50 percent consider the smile the first facial feature they notice
• 80 percent are not happy with their smile
• Respondents were seven times more likely to have periodontal, smile enhancement procedures, than face-lifts
• Smile enhancement procedures outnumbered eyelid surgeries five to one

Gummy Smile or Uneven Gum Line

Do you feel your teeth look too short and your smile is too gummy or your gums cover too much of some teeth while leaving the others the right length? If so crown lengthening might be the solution for you. During this procedure, excess gum tissue is removed to expose more of the crown of the tooth. Then your gumline is sculpted to give your new smile just the right look.

Before crown lengthening 18 months after crown lengthening 4 years after crown lengthening

Long Teeth/Exposed Roots

Do you feel you look older than you really are? Sometimes gum recession causes the tooth root to become exposed, which makes your teeth look long and can make you look older than you are. This recession can happen as a result of a variety of causes, including periodontal diseases. Whatever the reason, exposed roots are unappealing and can leave you at risk of developing cavities on your tooth root. Soft tissue grafts and other root coverage procedures are designed to cover exposed roots, to reduce further gum recession and to protect vulnerable roots from decay.

Before root coverage After root coverage

Missing Teeth

Are you starting to look like your grandmother because missing teeth are causing unappealing gaps in your smile? If, so dental implants might be the answer for you. Dental implants are a more natural looking option compared to dentures or bridges because implants look and feel just like your own teeth. They also allow you to speak and eat with comfort and confidence.
During this procedure, an artificial tooth root is placed into your jaw, and after a healing period, an artificial tooth is attached to the root.

• More about dental implants

Before dental implant After dental implant

Indentations in the Gums and Jawbone

Tooth loss can cause an indentation in the gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indention unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth. Ridge augmentation can fill in this defect recapturing the natural contour of the gums and jaw. A new tooth can then be created that is natural looking, easy to clean and beautiful.

Before ridge augmentation After ridge augmentation

Combination Procedures

Oftentimes, periodontists may use several different types of procedures to build a framework for your perfect smile.

Before resective and restorative procedures	After resective and restorative procedures