Gum Disease and Heart Disease

It is becoming more and more apparent that there’s is a link between gum disease and heart disease. The link appears to have to do with inflammation. Chronic diseases such as diabetes, cardiovascular disease, Alzheimer’s disease and periodontal (gum) disease all have an inflammatory component. The general feeling at this time is that inflammatory components of gum disease can worsen plaque buildup in the arteries leading to the heart. The plaque buildup narrows the inside of those arteries, thus, restricting the blood flow.

Another theory is that bacteria that is present in periodontal (gum) pockets gets into the blood stream and attaches to the coronary arterial plaques. This theory says that that could contribute to clot formation. Studies have shown that people with periodontal disease are more than twice as likely to have coronary artery disease.

Even though theses theories haven’t been thoroughly proven, it is still a good idea to make sure that you are free of gum disease. A thorough periodontal exam by a dentist is necessary to be certain that gum disease is not present. This is because symptoms are not usually present until the later stages of the disease when irreversible bone damage occurs and the teeth start loosening.

3D Dental X-Rays

3D Cone Beam X-RayWe now have a piece of “Star Wars” technology at our disposal. 3D x-rays are now readily available to dentists. Called cone beam tomography, one can see jaw structures, tooth relationships and root canal anatomy. They are becoming the standard of care for implant surgery since it shows the relationship between the available bone and major structures such as nerves and sinuses. It’s indispensable for making sure that a dental implant does not impinge on the nerve that controls the lower lip. It can also help find some hidden bone around the sinuses allowing for placement without doing expensive bone grafts. In orthodontics, the relationship between the upper and lower jaw in conjunction with the rest of the skull can be determined readily with these x-rays. The3D view can aid a dentist in search for an elusive root canal or an extremely curved root.

Although the amount of radiation needed to produce these x-rays is reasonably minimal, the general feeling at this time is to not make them a routine procedure, especially in children who will probably be exposed to multiple sources of radiation throughout their lifetime.


Risks of Tooth Bleaching

Teeth bleaching has become a very popular way of lightening one’s teeth. It is a great technique that can be done minimally invasive and for low cost. As with any dental procedure, it does come with some minor risks. The most common one is tooth hypersensitivity, in other words, that next cold drink could shoot you through the roof. We use an at-home bleaching technique which greatly lessens the sensitivity. The bleaching agent that we use has potassium nitrate in it which which significantly reduces the problems with cold food and drink. You can also use a toothpaste that is specifically made for hypersensitive teeth, such as Sensodyne.

Before Bleaching

Before Bleaching

After Bleaching

After Bleaching

Scanning electron microscope studies have shown no appreciable damage to the tooth enamel, however, there can be some roughening of composite resins which are used for the tooth colored fillings. It’s not significant enough to avoid bleaching altogether, although you may need to be prepared to have any large fillings in your front teeth replaced since they probably won’t match after the bleaching is done.

Contact with the gums can cause some irritation, especially with the stronger concentrations of bleaching agent. Make sure that the tray that holds the bleach has been properly contoured so as to not cover the gums and wipe any excess gel off the gums.

Teeth Grinding

Worn Teeth From Night Grinding

Damage Due To Night Grinding

Damage Restored With Beautiful Porcelain Crowns

Damage Restored With Beautiful Porcelain Crowns






Teeth grinding is a very common problem. It’s not unusual for someone to not be aware that they are even doing it. It is more common at night since during the day, most people can catch themselves in the act. Stress is the most common reason for grinding. While sleeping (called nocturnal bruxism), it becomes an outlet for the normal stresses involved in everyday life. Another cause can be an uneven bite and the body’s reaction to try to even it out by subconsciously gnashing the teeth together in an attempt to even everything out.

Untreated teeth grinding can cause pain in the jaw joint (temperomandibular joint) and the surrounding muscles. It can also lead to premature extreme tooth wear necessitating major dental reconstruction.
To counter the problem, if the grinding is present during the daytime, I tell my patients to try to catch themselves doing it. If they find that they are clenching, then they should have “lips together, teeth apart”. This has been very successful for many of my patients. However, most of the grinding problems occur at night. In that case, it is best to build a nightguard, a plastic mouthpiece, to help prevent any further damage from occurring.

Gum Grafting

Gum Graft








Gum recession is a very common problem. It can cause cold sensitivity on the exposed roots. In severe cases, it can lead to bone loss causing the tooth to loosen and eventually loss of the entire tooth. The recession can be caused by improper tooth brushing, thin gum tissue, abnormal muscle pull, or trauma. The good news is that we now have surgical techniques that will allow the gum to be rebuilt close to the original level. The procedure involves harvesting a piece of gum tissue from the roof of the mouth, stripping the top layer of gum tissue in the affected area, then suturing the new piece in place. After a few weeks of healing, the tissue looks almost as good as the original. Aftercare is extremely important to keep the problem from recurring. Very careful use of a toothbrush in the area is a must.

The procedure is usually performed by a periodontist, a specialist in treating the gums. If you going to have this procedure done, ask the surgeon to make a surgical stent to cover the roof of your mouth. This area can be extremely painful if left exposed. The feedback that I have had from my patients is that they have been extremely grateful that the roof of their mouth was covered. This made their healing time much more uneventful.

Mercury in Dental Fillings

Drops of mercuryThe element mercury in its pure form is toxic to humans. The good news is that when it is combined with silver into a compound called amalgam, it becomes inert. That makes it safe for using for dental filings. Using over 100 years of data, the American Dental Association has determined that it is safe for use. In fact, it is considered unethical for a dentist to recommend removing “mercury” fillings for health reasons. If a dentist tells you that you need all of your “poisonous” fillings replaced, it’s time to run out the door.

The newer tooth colored fillings are approved for use in back teeth. Although they don’t last as long as the silver fillings, they are still a very reasonable alternative to the metal ones and they look great. The cost of amalgam fillings is about 20% less than tooth-colored. At Gangwisch Dental Group, we normally use the composite (tooth-colored) materials, however, we will place the amalgam ones upon request.

Panoramic X-Rays

Panoramic X-Ray MachinePantomographic radiographs, panoramic x-rays for short, show a picture of the entire upper and lower jaws and the surrounding structures. They are an excellent tool for your dentist to find dental diseases in there early stages. One can see tumors while they are small and have caused minimal damage. Removal at that stage can be less debilitating, and, if cancerous, can greatly increase the survival rate. One can see impacted wisdom teeth and their relationship to major structures such as nerves and sinuses. They are great for an orthodontist to check root alignment and blunting of the roots The detail is not enough to spot cavities in their early stages. It is also not generally used to diagnose gum disease since the closeup x-rays give better detail.

The amount of radiation is about the equivalent of a chest x-ray. It is not recommended on a routine basis, except for every third year. It can be an excellent screening tool to see things that don’t normally show up on the routine x-rays such as failing root canals, root fractures, or cysts. The use of panoramic x-rays can help keep costs of dental treatment down due to being able to catch things in their early stages and can also save lives.

Alternatives for Porcelain Veneers

Invisalign aligners - Invisible Braces

Invisalign® Aligner

Porcelain laminate veneers are a fantastic way to create an utterly dazzling smile. Since a small amount of tooth structure generally must be removed, it is not a reverisable procedure. If the teeth themselves look good, and the cosmetic concern is the alignment, then there are other alternatives available to get a great smile. Invisible braces (for example, Invisalign®) are now available for many types of alignment problems. This way, the teeth can be straightened in such a way that there will be no changes in the front of the tooth surface. Therefore, it is a reversible procedure. Many a beautiful smile has been created by simple straightening and bleaching.

The pros of the invisible braces approach are cost and reversibility. Fees tend to be about 60% less than porcelain laminates. The cons of invisible braces are retention and inability to mask stains. Once invisible braces have been completed, the teeth must be retained in their position by wearing a retainer each and every night. It’s not as daunting a task as it sounds, but it still requires one to put the retainer in every night. If the teeth are stained in such a way that they cannot be adequately improved by bleaching alone, then porcelain laminates are usually the better alternative.

Gum Disease and Diabetes

There is a connection between periodontal (gum) disease and controlling a diabetic’s blood sugar. A 1997 study of Pima Indians found that when gum disease was eradicated in diabetics, their blood sugar management improved. It is much easier for gum disease to gain a foothold because diabetics are more prone to infection. Thus, the two diseases feed off each other.

It has been found that diabetics who have gum disease are more prone to high blood sugar levels. Due to the fact that this relationship exists, it becomes extremely important for a diabetic to perform very meticulous home care. They should get regular dental examinations at least twice a year along with a thorough professional cleaning. Some diabetics require even more frequent cleanings, maybe up to 4 times per year, accompanied occasionally by scaling and root planing (a very deep cleaning usually done with a local anesthetic). This can be very helpful in managing blood sugar levels in a diabetic.