Unlike the natural tooth it replaces, a dental implant is impervious to decay. But don’t think that means you can relax your oral hygiene habits — even though the implant itself can’t be infected, the surrounding gum tissues and bone can. And if they’re not properly cared for you might eventually lose the implant.

In fact, implants may be more susceptible to problems from impacted food that becomes wedged between the gums and teeth than their natural counterparts. Natural teeth are connected to the jaw by way of a resilient, elastic tissue known as the periodontal ligament: the ligament resides in the space between the tooth root and the bone and attaches to both through tiny fibers. The bone and ligament are protected by an attachment of gum tissue that covers all of the surrounding bone and attaches to the root surface. The outer gum tissue surface is covered by a protein called keratin that makes it resistant to wear.

On the other hand, these periodontal ligament fibers don’t exist when implants are present as the implant is fastened directly to the bone. Because it doesn’t have this ligament attachment, and the gum tissues around can’t attach to the implant as with natural teeth, it may be more vulnerable to bacteria or trauma caused by food impaction. So, cleaning and caring for dental implants is just as important, if not more so than with natural teeth.

If the gums around an implant become infected and inflamed it could lead to peri-implantitis, a condition that can destroy the bone attachment between the implant and the bone. In other words, the loss of bone support can weaken the integration of the implant with the bone. As more and more attachment is lost, the implant can loosen and eventually be lost.

The best way to avoid this is with consistent daily hygiene and regular dental checkups. And, if you notice any signs of swelling or redness of the gums around an implant, contact us as soon as possible. The sooner we begin treatment to alleviate the infection, the less danger there will be of losing your implant.

If you would like more information on how to care for dental implants and other restorations, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Infections around Implants.”

If you ever get out of the habit of daily brushing and flossing, you’re setting yourself up for dental disease. Neglecting oral hygiene allows bacterial plaque to build up on tooth surfaces, which can give rise to aggressive gum infections known collectively as periodontal (gum) disease.

Gum disease may first manifest itself as gingivitis, an inflammation of the outer gum tissues around teeth. Resuming hygiene habits could help reduce the infection if it’s detected early enough. If the infection has spread deeper below the gum line, though, brushing and flossing won’t be able to reach and remove the offending plaque — you’ll need our help with that.

The objective of any such treatment is the same as your daily brushing and flossing — remove plaque as well as hardened deposits (calculus) that cause disease. The most basic technique is called scaling in which we use specialized hand instruments (scalers) or ultrasonic equipment to loosen and remove the plaque and calculus from all tooth and gum surfaces.

For deeper plaque, we may need to use a technique called root planing. As its name implies, we use equipment similar to scalers to shave or “plane” plaque, calculus, bacteria or other toxins from the roots that have become ingrained in their surfaces.

These procedures are often carried out with local anesthesia to ensure patient comfort and allow us to be as meticulous as possible with plaque and calculus removal. It’s imperative that we remove as much plaque and calculus as possible, and which often involves more than one session. This is because as the gum tissues become less inflamed it allows us to access more plaque-infested areas during subsequent sessions.

Hopefully, these techniques will arrest the infection and restore good health to gum tissues. It’s then important for you to recommit and follow through on a renewed daily hygiene regimen to reduce the chances of re-infection that could lead to more serious problems and potential tooth loss.

If you would like more information on treating periodontal (gum) disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Planing.”

For a healthy pregnancy, it helps to have healthy teeth and gums. In fact, the American College of Obstetricians and Gynecologists (ACOG) encourages its members to advise expectant moms to see their dentist. But maintaining oral health can be more challenging when you’re expecting. For one thing, hormonal changes make you more susceptible to periodontal (gum) disease, which has been linked to “systemic” (general body) health problems including preterm labor and low birth weight.

Periodontal (gum) disease results from the buildup of bacterial plaque on tooth surfaces in the absence of good oral hygiene. It typically starts as gingivitis — inflammation and redness around the gum margins and bleeding when brushing and flossing. If the infection progresses, it can attack the structures supporting the teeth (gums, ligaments, and bone) and may eventually result in tooth loss. And if the infection enters the bloodstream, it can pose health risks elsewhere in the body. Studies suggest that oral bacteria and their byproducts are able to cross the placenta and trigger an inflammatory response in the mother, which may in turn induce early labor.

TLC for Your Oral Environment

Brushing twice daily with fluoride toothpaste and flossing or using another interdental cleaner at least once daily is your first-line defense again bacteria buildup. Professional cleanings are also important to remove hardened plaque (calculus) that brushing and flossing may miss. And regular checkups can catch problems early to avoid or minimize adverse effects. Periodontal disease and tooth decay aren’t always painful or the pain may subside, so you won’t always know there’s a problem.

Dental emergencies such as cavities, root canals and tooth fractures should be treated promptly to address pain and infection, thereby reducing stress to the developing fetus. Of course, if you know you need a cavity filled or a root canal prior to becoming pregnant, that’s the optimal time to get treated!

If you would like more information about dental care during pregnancy, please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “Pregnancy and Oral Health.”

If you're one of the millions of people wearing an oral appliance, you already know how important it is to your dental health. Whatever the purpose—replacing teeth, stopping teeth grinding or guarding against injury—you want to get the most and longest service from it. That means showing your appliance some tender loving care on a regular basis.

It doesn't require a lot of time and effort to clean and maintain your oral appliance. But there are some pitfalls that could lead to greater wear and tear and just outright damage. Here are 3 things you should be on the alert for to keep your appliance doing its job for you.

Be careful how you clean it. Your appliance might resemble natural oral tissue, but it's not—so don't use toothpaste. Toothpaste contains abrasives, which are fine for tooth enamel but damaging to materials in your appliance. Instead, use dish detergent, hand soap or a specialized cleaner. Don't use hot or boiling water, which could soften any plastic and distort the appliance's mouth fit. Nix the bleach too, which can fade colored portions of the appliance that mimic gum tissue.

Don't wear them 24/7 unless your dentist advises. Depending on the type and function of your appliance, you shouldn't wear them around the clock unless your dentist advises otherwise. Dentures are usually removed at night while you sleep to help prevent bacterial growth. Keeping them out at night -and keeping them clean—will help lower your risk of dental disease. One caveat, though: there are some concerns today about the effect of keeping dentures out of the mouth at night on sleep apnea. It's a good idea, then, to discuss the issue with your dentist regarding taking dentures out at night.

Prevent accidental drops on hard surfaces. Chewing forces are considerable, but your appliance is designed to take it. The same can't be said, though, if they accidentally fall on a hard surface—the fall could crack or break them. To protect against this, be sure to put a soft towel or cloth in your sink basin while you're cleaning your appliance. And don't place it on a night stand or low surface where it could be knocked off accidentally by a child, a pet or you. A sudden accident like this could be costly.

If you would like more information on extending the life of your oral appliance, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “10 Tips for Cleaning Your Oral Appliance.”

Implant-supported fixed bridges are growing in popularity because they offer superior support to traditional bridges or dentures. They can also improve bone health thanks to the affinity between bone cells and the implants' titanium posts.

Even so, you'll still need to stay alert to the threat of periodontal (gum) disease. This bacterial infection usually triggered by dental plaque could ultimately infect the underlying bone and cause it to deteriorate. As a result the implants could loosen and cause you to lose your bridgework.

To avoid this you'll need to be as diligent with removing plaque from around your implants as you would with natural teeth. The best means for doing this is to floss around each implant post between the bridgework and the natural gums.

This type of flossing is quite different than with natural teeth where you work the floss in between each tooth. With your bridgework you'll need to thread the floss between it and the gums with the help of a floss threader, a small handheld device with a loop on one end and a stiff flat edge on the other.

To use it you'll first pull off about 18" of dental floss and thread it through the loop. You'll then gently work the sharper end between the gums and bridge from the cheek side toward the tongue. Once through to the tongue side, you'll hold one end of the floss and pull the floss threader away with the other until the floss is now underneath the bridge.

You'll then loop each end of the floss around your fingers on each hand and work the floss up and down the sides of the nearest tooth or implant. You'll then release one hand from the floss and pull the floss out from beneath the bridge. Rethread it in the threader and move to the next section of the bridge and clean those implants.

You can also use other methods like specialized floss with stiffened ends for threading, an oral irrigator (or "water flosser") that emits a pressurized spray of water to loosen plaque, or an interproximal brush that can reach into narrow spaces. If you choose an interproximal brush, however, be sure it's not made with metal wire, which can scratch the implant and create microscopic crevices for plaque.

Use the method you and your dentist think best to keep your implants plaque-free. Doing so will help reduce your risk of a gum infection that could endanger your implant-supported bridgework.

If you would like more information on implant-supported bridges, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Hygiene for Fixed Bridgework.”