Soft Tissue Grafting

Soft Tissue Grafting

When people hear ‘grafting’, many things spring to mind—most of them quite scary, and few of them accurate.

With education being at the core of Dr. Caudry’s practice, we thought it best to take some time to educate you and the rest of our readers on the world of gum grafting. By the time you’re done reading this your understanding of periodontal surgery will have deepened, your misconceptions will have withered away, and your faith in Dr. Caudry and co. will have strengthened.

Before we explore periodontal surgery, let’s first look at why someone requires such a surgery.

When Your Gums Recede

Gum recession is a widespread condition that many people live with, without even realizing it!

Gum recession refers to the fading away of the gum tissue that surrounds the teeth. The gum tissue may look like it has been pulled back rather than having faded. This will sometimes give people the impression that you have ‘long’ teeth. Those teeth of yours aren’t any longer than before, it’s just that more of the tooth’s root is exposed than usual.

Gum recession has other drawbacks beyond slightly changing the look of your smile. Gums can recede to the point where the root of the tooth is exposed. When that happens, there are greater risks than just seeming like you have long teeth. When a tooth’s root is exposed it can be extremely sensitive to hot and cold foods as well as sugar. The more a tooth is exposed, the more chances there are for unwanted bacteria buildup. If you’re not proactive about tooth care, that bacteria could affect the surrounding tissue and lead to many problems.

Gum recession, if left untreated, can also lead to loosening of your teeth. If unwanted bacteria or periodontal disease is left untreated, gum pockets deepen, and teeth become loose.

What Causes Gum Recession?

Your gums may begin to recede for a variety of reasons.

For some, the cause—ironically—is brushing too hard. You might think there is no such thing as brushing too hard but think again. Aggressive or incorrect brushing can cause a tooth’s enamel to wear away and the gums to recede.

Overall poor dental care is another cause. Failing to floss, brush your teeth, or use antibacterial mouthwash can lead to a variety of problems. While all these things are important, what’s equally important is that you perform each task properly. Improper flossing can do as much harm as good.

Smoking, as we all know, is responsible for many problems. The use of cigarettes and other tobacco products often lead to the development of plaque which can lead to gum recession.

How to Fight Gum Recession

When your gums have receded to the point that you have developed swollen gums, loose teeth, big cavities or chronic bad breath, it is time to do something about the problem. If you were to visit your local dentist, they would inform you of your receding gums. Before long you might just find yourself speaking to a certified periodontist about soft tissue grafting.

What Is Soft Tissue Grafting?

Soft tissue grafting is a minimally invasive procedure performed to combat gum recession. The main goal of soft tissue grafting is to either thicken the existing gum tissue or cover the exposed root in order to prevent further loss of gum tissue. The tissue used for the graft is usually taken from the roof of your mouth and stitched to the gum tissue surrounding the root. Though this might sound gruesome, it is painless, minimally invasive, and holds few risks for the patient.

The Benefits of Soft Tissue Grafting

There are many benefits to be had with soft tissue grafting. Some of these include:

  • Comfort: Gum grafts can eliminate much of the pain and discomfort caused by gum recession. With the exposed root covered, hot and cold foods can once again be enjoyed. What’s more, the health of the gum area improves dramatically!
  • Appearance: Though it is often recommended by periodontists for issues related to gum recession, you may also seek it out to improve your smile. Because soft tissue grafting is all about repairing the gum line, it will inadvertently make your teeth have the appearance of being smaller.
  • Improved Health: The problems associated with gum recession (such as periodontal disease) can destroy your teeth and gum tissue rapidly. Gum grafts and a combination of proper dental care can put a stop to tissue loss, bone loss, and further issues.

The Connective Tissue Graft

There are several types of soft tissue grafts. One is the connective-tissue graft. By far the most common graft method, this one is used to treat root exposure. During this procedure, an incision is made into the roof of the patient’s mouth. A piece of tissue (known as subepithelial connective tissue) is removed from underneath the incision and stitched onto the exposed root’s surrounding gum tissue.

The Free Gingival Graft

Like the connective-tissue graft, the free gingival graft requires tissue from the roof of the mouth. However, this tissue doesn’t come from underneath the top layer of skin. Instead, the tissue comes from the top layer of flesh itself. This method is most often used when an individual’s gum tissue is very thin and only needs to be thickened.

The Pedicle Graft

With this approach, the periodontist creates a flap of tissue near the recessed area and uses that flap to cover it. For this procedure to be successful the patient needs plenty of healthy gum tissue surrounding the recessed area.

Recovery from Soft Tissue Graft

Before you are sent home, your dentist will give you specific instructions to ensure your gums heal correctly. You’ll be asked not to floss or brush the repaired area, and you’ll likely be given a special mouth wash to help fight plaque buildup. For a week or two following the procedure, you should expect to maintain a diet of soft and cool foods such as eggs, yogurt, pasta, and well-prepared vegetables.


Sensitive Teeth — A Sensitive Issue

Is enjoying ice cream or sipping hot coffee sometimes painful to you? What about brushing or flossing your teeth?  If so, you may have sensitive teeth.

 

Possible causes of sensitive teeth

  • Tooth decay (cavities)
  • Fractured teeth
  • Worn fillings
  • Gum disease
  • Worn tooth enamel
  • Recession
  • Exposed tooth roots

 

A tooth is made of layers; at the centre are nerves and blood vessels.  These are protected by an outer layer of strong enamel in the crown (above the gums).  The root is protected by the gums and a tooth layer called cementum.  The bulk of a tooth is the middle layer called dentin.  Dentin is less dense than enamel and cementum, and contains microscopic tubules (small hollow canals). When the protective covering of enamel or cementum or gums are lost, the dentin tubules are exposed and can transmit heat, cold, acid and sugar to the nerves and cells on the inside.  Dentin can be exposed when gums recede or enamel is worn or fractured off.

 

Sensitive teeth can be treated.  The type of treatment depends on the cause of the sensitivity.  Your dentist may suggest one of a variety of treatments:

  • Desensitizing toothpaste: Some toothpastes are designed to decrease sensitivity and contain compounds that help block transmission of sensations through dentin tubules.  These usually require several applications before relief is experienced.  Different toothpastes have different compounds, so one may work better for you than other.
  • Fluoride gel: Topical application of fluoride strengthens tooth enamel and reduced transmission of sensations. This can be done in-office or with special take-home treatments.
  • Crown, Inlay, bonding: These techniques can be used by your dentists to restore tooth structure lost from decay, wear or chipping.
  • Surgical gum graft: If recession has occurred, and gum tissue has been lost, surgery can be done to recover this soft tissue protection of the root, and reduce sensitivity.
  • Root canal: Severe and persistent sensitivity often cannot be treated by other means; your dentist may recommend treating the tooth with a root canal to eliminate the problem.

 

Proper oral hygiene is the key to preventing sensitive-tooth pain.  Ask your Dentist or Periodontist if you have any questions about your daily oral hygiene routine or concerns about tooth sensitivity.


Peri-Implantitis — Risk Factors, Diagnosis and Treatment

Peri-implantitis is an inflammatory process that involves progressive bone loss and suppuration affecting the soft tissue and bone surrounding an implant. It is associated with a bacterial infection that, unless treated, leads to the eventual loss of the implant.

 

What Causes Peri-implantitis?

Peri-implantitis is a result of a variety of patient and treatment conditions that collectively lead to bacterial colonization. These include those associated with the patient’s presenting medical condition, the implant itself, the restoration and the maintenance of good oral health.

 

How is Peri-implantitis Diagnosed?

Patient Symptoms may include pain, mobility of the implant and a bad taste. It is important to note that in most cases there may be no symptoms noticed by the patient.

Signs observed by the dentist or hygienist include suppuration and profuse bleeding around the implant, progressive bone loss and increasing probing depths (see images A & B).

 

How is Peri-implantitis Treated?

Non-surgical therapy is not supported by the literature.

Surgical treatment:

- Open flap debridement to gain access, disinfect, and re-prepare the exposed surface of the implant.

- Open flap debridement and disinfection with bone regeneration (see images C, D & E).

NB: Laser therapy has been proposed for both surgical and non-surgical therapies, however, there is no scientific evidence for its efficacy above traditional treatment

 

Major Risk Factors of Peri-implantitis

 

Patient Factors:

- Poorly controlled diabetes

- Smoking

- Untreated Periodontics

- Poor oral hygiene, and non-compliance with a maintenance program

 

Implant/Prosthesis Factors:

- Uncleansable prosthesis

- Excess cement

- Loose/ill-fitting or broken components


Herbal Medications

Herbal medications are very popular. According to North American surveys 30-40% of the population report using herbal medications or similar alternative treatments.

 

Why does my dentist care about herbal medications?

Herbal medications can put you at risk because they interact with important medications we use in dentistry.

 

  • Acacia – can decrease the absorption of Amoxicillin, and therefore alter the effectiveness of this antibiotic
  • John’s Wort & Valerian – can increase the effects medications such as Codeine, benzodiazepines (Lorazepam), or sedative agents used in our office during sleep dentistry.

 

Other medications alter normal functions in your body:

  • Ginkgo, ginseng, green tea, garlic (starting with the letter ‘G’) – these all affect your body’s ability to stop bleeding. This is very important in surgery and relevant to your body’s ability to heal.

 

For these reason we may recommend you stop taking some of your herbal medications prior to treatment to prevent possible complications.

 

“Drug interactions with herbal medications can put you at risk”

 “Report any medications, including herbal medications, to your dentist.”


Legalization of Marijuana — What Dental Patients Need To Know

The Cannabis Act will likely become law in 2018. This means that in addition the existing program for medical marijuana, the recreational use of marijuana will be legal for adults 18 years and older. What does this mean for your oral health?

 

 

Oral adverse effects of Marijuana

Studies have shown that using cannabis can have a number of adverse effects on your oral health.

  • Xerostomia (dry mouth)
  • Dental caries (cavities/tooth decay)
  • Periodontal disease
  • Soft tissue problems (stomatitis, leukoedema, and leukoplakia)
  • Oral cancer
  • Infections
  • Drug interactions:
    • Increased drowsiness if combined with drugs such as codeine and antidepressants (increased drowsiness)
    • Increased bleeding with aspirin, NSAIDs, blood thinners, antiplatelet drugs
    • May influence sugar levels, so caution is advised in patients taking diabetes medications
    • Other possible interactions with: sedatives, CNS depressants, pain relievers, analgesics, corticosteroids.

Little is known of the potential risks of treating patients who use cannabis, including patients who have active cannabis in their body at the time of treatment. Some possible issues include increased heart rate and changes in blood pressure. Cannabis may also lead to fainting spells. For these reasons caution is advised in using cannabis to manage stress or anxiety associated with your dental appointment.

 

Approved Medial uses

Currently there are two synthetic cannabinoid-based medications available in Canada: 1) Nabilone, an antiemetic used to treat nausea and vomiting associated with chemotherapy. 2) Nabiximols used to relieve pain. Physicians may authorize the use of cannabis oils and marijuana for patients with specific medical conditions, such as cancer, HIV/AIDS, MS, or other chronic diseases, when conventional medical treatments are unsuccessful.

 

Why don’t we know more?

There is limited research on the therapeutic effects of cannabis because it is considered as Schedule II drug under the Canadian Controlled Drugs and Substances Act. This is why many physicians and researchers advocate for a change in the schedule.

 

Your advocate in the future

With these impending legal changes, what we know about the potential medical applications and consequences of using cannabis will increase dramatically. Deciphering this information is not always easy. Dr. Caudry is here for you. With her experience and background in scientific research, Dr. Caudry can help advise you on the latest information as it becomes available to ensure you understand any health and dental risks.