|
A Little Long In The
Tooth
by Dr. Pietrini
As
the aging process sets in, people are often teased about being a
little long in the tooth. This expression actually originated
with horse breeders. By checking the amount of gum recession
around a horse’s teeth, breeders are able to estimate the age of
the horse.
In a previous column, I wrote
about the treatment of the early stages of periodontal disease.
This month, I would like to discuss some of the surgical
services available for the treatment of more advanced cases of
gum disease. The goal of the dental team is to help the patient
maintain healthy attachment of the bone and periodontal tissues
surrounding the teeth. When periodontal surgery is necessary,
generally two conditions exist—the gums have receded and require
a soft tissue graft or deep pockets with accompanying bone loss
require that a surgical flap be reflected to gain better access
to the inflamed/infected tissues. To avoid early loss of teeth,
let me review some of the latest treatment options.
In the healthy mouth, two
types of tissue surround the teeth. The first is called
“attached gingival” a calloused tissue that form a barrier
around the teeth, which prevents bacteria-laden plaque from
penetrating between the teeth and gums and helps to avoid injury
caused by friction from foods and brushing. The second type of
tissue is mucosa, which is the more fragile tissue found in the
lip and cheek areas. When moderate to severe recession occurs, a
gingival graft may be indicated to replace the lost gingival. A
piece of tissue from the palate (roof-of-the-mouth) or from an
adjacent area is placed to cover the exposed root surfaces. The
palatal graft most commonly used is referred to as a “connective
tissue graft”. A small window is made into the palatal tissue.
The surgeon removes some of the underlying tissue and grafts it
to the area requiring coverage. With the use of local
anesthetic, these procedures are virtually painless. The
surgical sites heal in a few days with minimal discomfort.
When bone loss has occurred, a
bone graft may be necessary to help stabilize the teeth or to
enhance the placement of dental implants. Several choices of
materials and techniques are available:
·
Allografts—purified human cadaver bone
·
Alloplasts—synthetic materials that are used to
stimulate growth of new bone
·
Xenografts—purified animal tissue (more often used
in life-threatening situations such as heart valve replacement,
orthopedic reconstruction or severe burn cases)
·
Autografts—using the patient’s own tissues to
stimulate new bone growth
It appears that autografts are
the wave of the future. By utilizing the patient’s own growth
factors new bone can be regenerated. A small amount of the
patient’s blood is placed in a centrifuge to separate the
various components. The platelet rich plasma (PRP) containing
many growth factors has been shown to be important in soft and
hard tissue wound healing. The PRP is mixed with other materials
to create a gel, which can be placed into bony defects to
stimulate new bone growth.
The Jewel of Denial
by Dr. Dennis R. Pietrini
Throughout history, jewelry
has been used to adorn the mouth and its surrounding structures.
The ancient Mayans placed elaborate inlays in their teeth made
of beautiful gems and stones, such as turquoise and jade. For
centuries, tribes in Africa have pierced the lips, tongue,
cheeks and ears with bones or metal objects as part of their
religious rituals. Even in the 21st Century, young
girls in several areas of South America insert sharpened sticks
of bamboo or other woods into their cheeks and lips or file
their teeth into sharp points believing that they enhance their
beauty. In recent years, there has been a dramatic increase in
oral-facial piercings among American youth--a trend that can
lead to serious health consequences.
Tongue piercing is of
particular concern. Even if a dentist or physician performed
these procedures, there would be inherent health risks. Since
people with no medical or surgical training usually do the
piercings, serious complications are not uncommon. It is
unlikely that a sterile environment is maintained, which may
lead to severe infections or transmission of bloodborne
diseases, such as hepatitis. As I have mentioned in previous
articles, certain patients require pre-medication with
antibiotics prior to dental treatment to avoid subacute
bacterial endocarditis (SBE), a disease affecting the heart
valves.
Since the tongue is a
constantly moving structure, attempting the piercing can be
tricky, often leading to injury of nerves and blood vessels.
Prolonged, excessive bleeding may occur. Post-operative swelling
can inhibit swallowing or affect speech patterns. Severe
swelling can be serious enough to prohibit proper breathing.
The most common type of
jewelry used in tongue piercings is metal barbells. These
appliances are capable of causing damage to the teeth and gums
and interfere with normal oral function. Some patients have
allergic reactions to the metal in the barbells. Food and plaque
accumulate around the tongue and the appliance, which can cause
gum recession and decay. The constant trauma caused by the
jewelry striking the teeth may result in chipping and fracturing
of the enamel or damage to fillings and crowns. The jewelry can
stimulate the over production of saliva causing difficulty with
chewing, swallowing and speech. If the appliance were to loosen
or break, it could be accidentally swallowed.
For additional information on
a wide variety topics related to oral health visit the website
of the American Dental Association (ADA) at
www.ada.org. You can click on their interactive “ADA Dental
Minute” to view the short videos presented by oral health
professionals.
|
