On Sunday, March 27th, at 5:30 p.m., WCBS-TV will be running their periodic American Health Front medical news program in which I will be featured along with 11 other health practitioners who will be discussing various health issues. In my portion of the short segment, I will be discussing the importance of prevention in periodontal disease in addition to all the current technology being employed.
I hope you will tune in and enjoy the short segment.
As always, your feedback will be appreciated.
Victor M. Sternberg, D.M.D.
Dental Office of:
Victor M. Sternberg, D.M.D., PC
Westchester Center of Periodontal and Implant Excellence
141 North State Road
Briarcliff Manor, NY 10510
If you’ve been a maintenance patient in our practice, you’ve probably noticed that during each visit we measure the pockets around your teeth and record six numbers per tooth. This gives us a baseline of how the gum is attached or unattached to the tooth. Interesting study done as reported by the Journal of Clinical Periodontics in 2004 and 2008, came up with startling statistics. There is a direct relationship between the depth of the pocket and the eventual possibility of losing your tooth due to periodontal disease. If a tooth had a pocket of 5 mm., it was 7.7 times more likely to be lost due to periodontal disease. If the tooth had a pocket of 6 mm., it was 11 times more likely to be lost. If the tooth pocket probed 7 mm., it was 64 times more likely to be lost. In addition, if there was bleeding noted when the pocket was probed, there is a 46 times likelihood there will be tooth loss due to periodontal disease.
Now these numbers are statistics and as we all know, statistics can be misused. However, it is indicative that the shallower the pocket around the tooth, the fewer bacteria can be harbored there, and the easier it is for the patient and the hygienist to remove the bacteria on a predictable basis. When pockets are present around your teeth, we remove all the plaque and tartar that accumulate and then attempt to reduce the pockets to a shallower level. Periodontal surgery is often suggested when we feel these pockets cannot be reduced by scaling nor maintained by frequent cleanings alone.
Knowing your pocket depth and having it monitored is similar to having your blood pressure checked regularly and dealing with it when it gets too high.
This measurement of pockets around teeth is probably the single most important dental evaluation that one can obtain as an adult during a dental checkup.
If you have questions about this, please feel free to visit our website
or speak to me personally by calling 914.762.1885 or by email at: firstname.lastname@example.org
Dr. Victor M. Sternberg
Written by Anni Perkowski, RDH
It has long been stated that if there is bleeding, there is calculus. When a patient presents with the same pocket or bleeding despite our scaling efforts, the disease rears itself as a truly frustrating venture. We are speaking of periodontal disease. It is frustrating for the patient with good homecare and recurrent disease. It is frustrating for the practitioner who is providing the best level of care and disease is still present. We have all experienced it and the subsequent question is "what else can I do?"
When you couple magnification along with visualization, a new level of care emerges. The Perioscope has shown us exactly what is present on the tooth root. For our existing patient, we are finding burnished bacteria, bacteria at the entrance of roots and at the base of the pocket, and lots of calculus at the margins of restorations. For the patient we are able to SEE the calculus being removed and have confidence that we are providing the highest level of care. Aftercare is rarely different from normal scaling and root planing procedures. NSAIDS are recommended on an as needed basis, excellent homecare is required for long-term success and supplemental antibiotics are sometimes needed. Our patients report little to no tenderness or sensitivity.
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There are many mouth rinses on the market today. They are advertised as being effective for reducing plaque and gingivitis and to maintain a healthy mouth. The sad news is that, essentially, all of them are not effective in making a meaningful difference in preventing dental disease.
The only over the counter rinse that has any effectiveness is Listerine. I have found that if it is used for a full minute twice a day, it can reduce soft plaque to some degree. However, its long-term effectiveness in reducing dental problems is very small unless combined with careful tooth brushing and cleaning with other devices between the teeth and at the gumline. Under those conditions, it can have a slight benefit.
The only mouthwash that is truly effective in reducing bacteria is one containing chlorhexadine, better known as Periogard or Periodex. This mouthwash is only available through a prescription and only used under the direction and care of your dentist. It can make a meaningful difference particularly for patients for whom plaque removal is difficult due to dexterity or areas that are difficult to reach.
Again, ask our office to discuss whether you are a candidate for this product.
Changing toothbrushes, whether it is the head of an electric Sonicare brush or a manual toothbrush, is vitally important. The effectiveness of the brush is directly dependent upon the firmness of the bristles. As the bristles become softer, frayed, and bent, they are unable to penetrate between the teeth or under the gumline.
As a rule, we change the heads of the sonicare brushes every three months and discard our manual brushes every month. If you rigorously brush with a manual brush twice a day, the bristles should begin to deteriorate in about one month. Irrespective of which brush you use, even though I have found that the sonicare is more effective than a manual brush, it is essential that the focus of tooth cleaning and plaque removal be directed at the gumline and between the teeth. These are the areas where the bacteria accumulate first.
Almost all periodontal disease and dental decay begins between the teeth and at the gumline. Brushing alone, no matter how effective, can only remove 80-90% of the bacteria that accumulate. Additional devices such as floss, toothpicks, where accessible, and a water irrigator are necessary. These devices, when used in conjunction with careful brushing, can remove up to 90-95% of the bacteria rendering the mouth healthy enough to be maintained for a long period of time.
If you are not comfortable or clear on how to use the different devices, please share the information with our staff. We will be more than happy to help you master this vital technique.
Medical research is confirming what has been suspected for the last decade; there is a relationship between periodontal disease and coronary heart disease. The recent study from the University of Colorado Medical School reports that there is a clear association between bone loss due to periodontal disease and coronary artery disease. The conclusion of the study was that there is a significant, positive correlation that exists between the actively occurring bone loss and coronary artery disease. Implications are that the inflammation in the mouth associated with periodontal bone loss and periodontal disease seems to be directly, or indirectly affecting the development of plaque along the coronary arteries leading to coronary heart disease. In both patients with periodontal disease and those with heart disease, there are often elevated levels of a protein associated with inflammation in the body. How this elevated level connects periodontal disease and heart disease is still in the study stage. This study and a recent one out of the Middle East, showed that the more severe the periodontal disease, the higher the level of coronary artery disease in patients studied. These studies are in a long line of information that is coming forward that relates inflammation in the body and especially in the mouth, and changes in the blood vessels, involving heart disease.
Another study appearing in the Journal of Periodontology compared patients who had regular periodontal maintenance to those who were erratically seen in a periodontal practice of over a three (3) year period. The conclusion of the study of those seen on a regular basis had a significant lower progression of periodontal disease and tooth loss compared to those not seen on a regular basis. This study involved over 300 patients and is an affirmation of what has been observed in many periodontal practices over the last fifty years.
Within my practice, I have observed that patients who are maintained regularly in a pre-determined interval, have had significantly less bone and tooth loss than patients who have been seen irregularly or not at all.
These series of studies provide a motivator to take good care of your mouth!
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As a continued commitment to our patients, I believe my staff should continue learning new information and clinical skills. This was recently embodied when I sponsored my Dental Hygienist to attend a seminar given by a leader in the field, Mrs. Anna Pattison, R.D.H., M.S.
It was reinforced that a proper early diagnosis is critical for correct care. With 75-80 percent of the population having some form of periodontal disease (gingivitis, periodontitis), dental providers need to commit to spending time collecting the data crucial for a correct diagnosis and definitive treatment. This includes taking the necessary and timely digital x-rays, periodontal charting (primarily measuring the space between the gum tissue and the tooth) and recording bleeding. With the use of a periodontal microscope, it has been confirmed that if there is bleeding then there is bacterial calculus on the tooth-100 percent of the time! The patient must also be educated in and commit to home care practices that work for them. Periodontal disease is a bacterial infection and your homecare is a prescription that must be adhered to.
This seminar confirmed all of the practices employed here at The Westchester Center for Periodontal and Implant Excellence. From employing Dental Hygienists who have additional certifications to administer local infiltration anesthesia (Novocain) to utilizing bacterial cultures and targeted antibiotics to advanced instrumentation techniques, we are dedicated to providing you with the best proven periodontal care.
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