What Causes Pericoronitis?

Pericoronitis usually develops when the wisdom teeth only partially erupt (break through the gum). This allows an opening for bacteria to enter around the tooth and cause an infection. In cases of pericoronitis, food or plaque (a bacterial film that remains on teeth after eating) may get caught underneath a flap of gum around the tooth. If it remains there, it can irritate the gum and lead to pericoronitis. If the pericoronitis is severe, the swelling and infection may extend beyond the jaw to the cheeks and neck.

What Are the Symptoms of Pericoronitis?

Symptoms of pericoronitis include:

• Pain
• Infection
• Swelling in the gum tissue (caused by an accumulation of fluid)
• A "bad taste" in the mouth (caused by pus leaking from the gums)
• Swelling of the lymph nodes in the neck
• Difficulty opening the mouth

How Is Pericoronitis Treated?

If the pericoronitis is limited to the tooth (for example, if the pain and swelling has not spread), treat it by rinsing your mouth with warm salt water. You should also make sure that the gum flap has no food trapped under it.

If your tooth, jaw, and cheek are swollen and painful, see your dentist right away. He or she can treat the infection with antibiotics (usually penicillin, unless you are allergic). You can also take pain relievers such as aspirin, acetaminophen, or ibuprofen. The dentist may also prescribe a pain medication.

If the pain and inflammation are severe, or if the pericoronitis recurs, oral surgery to have the gum flap or wisdom tooth removed may be necessary. Your dentist can make the appropriate referral to the oral and maxillofacial surgeon. A low-level laser can be used to reduce pain and inflammation associated with pericoronitis.

The Massachusetts Dental Society (MDS) is happy to offer members the Leadership Institute Program as a means to cultivate future leaders and broaden our volunteer base with leaders who can propel the MDS into the future.

Participating dentists will acquire important leadership skills that will prepare them to:

• Think outside of the box on programs and activities
• Run effective meetings
• Motivate and inspire others to participate
• Understand and articulate to others the major legislative issues impacting the dental profession

The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole. Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue - sometimes long before a patient knows anything is wrong. There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications.

    Such findings are fueling a push for dentists to play a greater role in patients' overall health. It's an opportunity to tell a patient, 'You know, I am concerned. I think you really need to see a primary care provider,' so you are moving in the direction of better health. Some of the most distinctive problems come from uncontrolled diabetes. The gum tissue has a glistening shiny look where it meets the teeth. It bleeds easily and pulls away from the bone. An estimated six million Americans have diabetes but don't know it - and several studies suggest that dentists could help alert them. It's not just that the same lifestyle habits contribute to both gum disease and high blood sugar; the two conditions exacerbate each other. Inflammation from infected gums makes it more difficult for people with diabetes to control their blood sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.

    There is also growing evidence that the link between periodontal disease and cardiovascular problems is not a coincidence either. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease. Oral bacteria has been found in the plaques that block arteries. Bacteria from the mouth can travel through the bloodstream and cause problems, elsewhere, which is why people contemplatng elective surgery are advised to have any needed dental work performed first.

    Many medications, from antidepressants to chemotherapy drugs can cause dry mouth, which can cause cavities to skyrocket, since saliva typically acts as a protective coating for teeth. The Centers for Disease Control and Prevention recommends that dentists offer HIV testing, because some of the first symptoms appear in the mouth., including fungal infections and lesions. Dentists can do the HIV test with a simple mouth swab and get test results in 20 minutes.

Professional tooth whitening from a dentist is always recommended. Your dentist will check for gum diseases, as well as loose fillings. She will be able to fit you for trays as well. In addition, she can monitor your teeth's response to the product - especially the reaction to your gums. A combination of in-office and at-home dentist prescribed whitening treatment will give you faster and longer-lasting results.  It can provide maximum whitening with minimal effort and time while ensuring safety and effectiveness.

My sincere suggestion to patients is to seek out a more individualized perio treatment from your dentist based on your own unique periodontal issues. Disregard what your insurance is willing to pay. You may spend more or less initially, but in the long run you will save more money.

To summarize, if you take one message home after reading this, please remember one thing: Gum disease is like cancer. In the earliest form (Gingivitis) it is curable. After that, it’s only possible to achieve remission. Let your dentist help you to prevent gingivitis - so the next time your dentist asks you to come for a cleaning appointment that may be sooner than six months, don't give her grief!

This also has helped the patient to floss more easily. This naturally leads to more improved periodontal condition due to less accumulation of tartar and less likelihood of recession of gums.

The higher abrasivity of tooth whitening toothpastes is the main cause of side effects that arise from their use. Normal toothpastes recommended for everyday use have an Enamel Abrasion Value of 40-90, while the whitening toothpastes have a value higher than 100 and in some extreme cases over 250. Their abrasive action can reduce staining and yellowing of teeth but it can also damage the tooth enamel and cause tooth sensitivity. The Consumer Affairs website has several complaints from people using such whitening toothpastes:

I recently purchased Creast Pro-Health toothpaste about a month ago. Shortly after my mouth became dry at night, gums bleeding and receding, teeth very sore, blisters in mouth, and skin peeling off the inside of my cheeks. I finally thought to see if there were any complaints with this toothpaste.

If you would like to use these whitening toothpastes, pay attention to the way you brush your teeth. Brushing incorrectly or too vigorously can lead to irreversible loss of tooth enamel. The damage can be much worse if you use a very abrasive whitening toothpaste. Finally, do not use a whitening toothpaste more often than it is recommended by the manufacturer, under the impression that quicker results could be achieved. The enamel loss caused by over-brushing could lead to severe tooth sensitivity or even tooth decay and tooth loss. Be especially careful if you already have a problem of sensitive teeth.

Before you start using any whitening product you should have a thorough examination by your dentist. Your dentist will need to make sure that your teeth and gums are healthy before you start.

I am glad to know Dr. Meena and would like to share my case. I know Dr. Meena since early 2009 when I first went to her clinic in Worcester for a check-up. The reason for my visit was to take her opinion after being a victim of an improperly fitted bridge for my upper right premolar and canines.I had no problem with my teeth until I ...met with a car accident in 1997 when my right mandible was fractured. Also, I lost my upper two incisors. My mandible was immobilized for 4 weeks (during which I survived on liquid diet) and the fracture was healed. Later, my broken incisors were root canal treated and replaced with a new bridge. During all these years, I got a couple of replacement bridges after the previous ones were worn out.

Meanwhile, my sinusitis problem was complicated, probably by these treatments and ended up in a tooth abscess of one of the neighboring canine tooth. This was diagnosed when I went to India (Hyderabad, my home town) for a visit. Although, they diagnosed the tooth abscess, the dentist I saw in Hyderabad did a sloppy job while taking the measurements for my new bridge, which I needed after extracting the abscessed tooth. As a result the bridge loosened day after day and came out completely by the time I returned back to Worcester. I was so fortunate that I could see Dr. Meena who identified and fixed the problem. Till today, I had no hint of any issues with the bridge. I am very thankful to Dr. Meena and her skillful approach to address my case. My sincere recommendation and reference to all is to go visit Dr. Meena, my favorite dentist, if have any dental problem.

Unfortunately, no one whitening system works equally well for all people. Some folks need the outside and inside (buccal and lingual) parts of their teeth to be whitened. For other people, going to bed with the whitening product inserted in their mouth may be more effective. Some may need only 30 minutes per day for 10 days for their teeth to be pearly white. Disposable take-home trays may be a good choice for such people. These trays are typically preloaded with the whitening product and inserted into the mouth. The thin membrane adheres to your teeth and remains securely in place for the 30-60 minute wear time. The bottom line is that one needs their teeth to be properly evaluated by a good dentist to determine which system would be the best option.

Research has shown that the most effective and long-lasting whitening system is the take-home whitening kit. Over the counter whitening gels may harm the gums, if used incorrectly. In comparison with whitening strips, the take-home trays require far less dexterity. The trays are easy to put in, cover much more of the tooth than whitening strips, and are easy to wear. However, if you have extremely yellow teeth, you're better off going with a professional solution.

OK, what is the treatment? This involves periodontal or deep cleaning. Scaling coupled with root planing is used to remove plaque and tartar beneath the gum lines. A local anesthetic is given to reduce any discomfort. A scaler or an ultrasonic cleaner is used to carefully remove plaque and tartar down to the bottom of each periodontal pocket. Root surfaces are then smoothed or planed. This helps pockets to shrink. This procedure also makes it difficult for plaque to accumulate along the root surfaces. Once treatment is completed, regular dental cleanings are required every three months so that the pockets can be maintained.

1. Yearly Maximum
The yearly maximum is the most money that the dental insurance plan will pay for your dental work within one full year. This amount varies by insurance company, but the average is around $1,000 per year, per person. The yearly maximum usually renews every year (on January 1 if your plan is on a calendar year). If you have unused benefits, most plans will not allow rollover.

2. Deductible
The deductible is the amount of money that you must pay to your dentist out of pocket before your insurance company will pay for any services. This fee varies from one plan to another and could be higher if you choose an out-of-network dentist. However, the average deductible for a dental insurance plan is usually around $50 per year. Your deductible also starts again when your plan rolls over for next year.

3. Premiums
If you are paying your dental insurance premiums every month, you should be using your benefits. Even if you don't need any dental treatment, you should always have your regular dental cleanings to help prevent and detect any early signs of cavities, gum disease, oral cancer and other dental problems.

4. Fee Increases
Another reason to use your benefits before the end of the year are possible fee increases. Some dentists raise their rates at the beginning of the year due to the increased cost of living, materials and equipment. A fee increase can also make your copay higher.

5. Dental Problems Can Worsen
By delaying dental treatment, you are risking more extensive and expensive treatment down the road. What may be a simple cavity now, could turn into a root canal later. Call our office and schedule an appointment to use those benefits.

I always thought I would get my bottom teeth fixed "eventually" but never got around to it. My teeth are very tight and shred through dental floss, even the shred-proof kind. It was an annoyance, but not a big deal because most people don't look at your bottom teeth. However, I was starting to have some other problems, and found out that by straightening my teeth I could clean them more easily and prevent further problems down the road. I work long hours and have a very busy schedule, so the thought of braces just sounded too inconvenient, not to mention painful. Starting Invisalign has allowed me to take care of my health while not interfering with my other responsibilities.
Some tips from me:

- Starting Invisalign: If you can, pick a time when you're less busy to start. It's easier to get used to the aligners if you can relax and take your time. The aligners can cause some soreness, but it isn't too bad and goes away after the first couple of days. Learning to pop the trays in and out is tricky at first, but I got the hang of it quickly. You will feel some tightness when you switch trays, but just for a day or two. I like to switch them at night to sleep through some of this.
- Cleaning: I carry a travel toothbrush and toothpaste with me, and a special opaque water bottle (full of mouthwash) on my desk at work to keep my aligners clean when I'm out and about. I use denture cleaning tablets when I'm at home. Taking out your aligners in public is a personal preference. I still don't like to but will discreetly if I have to. I've talked to others who have no problems with this. You'll find what works for you.
- Keeping track of your aligners: I wear eyeglasses, and think of my aligners in the same way. I always make sure to have them with or near me when I'm not wearing them. It's easy to lose track of the case(s) but I try to keep a backup small ziploc bag in my purse or something with me just in case. You will be warned when you start not to wrap them in a napkin because they are easy to throw away accidentally. I didn't believe this at first, but it's true! When I'm in a pinch and absolutely have to do this, I will wrap them and put them in my pocket or purse which helps.
- Paying for Invisalign: I was able to use a payment plan and my employer's flexible health spending account (FSA) to make paying for Invisalign easier. Check with your health insurance and employer to see what your options are.
- "Good" side effects: Since you can't eat while wearing the aligners, it makes it easier to drink more water and pass up on food you shouldn't be eating anyway. It makes you think about what's worth taking them out for. If you bite your nails, you can't do that when wearing the aligners. It does make it harder if you ever "bite" open a bag of chips etc. but so far it hasn't been a big problem for me.

October 4th is Invisalign Day at our practice. I will be providing free consultations to answer your questions about Invisalign treatment. If you have ever wondered if Invisalign is right for you, make an appointment for this special event. Along with the free consultation and free teeth whitening with Invisalign treatment, you will also receive $250 off your Invisalign treatment.

If you want to straighten your teeth without the traditional metallic smile than Invisalign braces may be for you. Invisalign is an orthodontic treatment that straightens your teeth with a series of aligners or plastic molds. Wear each aligner until the progression is finished and your teeth are straighter. Invisalign braces are great because they are hardly noticeable when you wear them and they are removable. Invisalign isn't for everyone, but there are significant benefits to straightening your teeth with invisible braces.

For more information about Invisalign please visit this useful web site.

A recent article in The Fiscal Times can be added to the long list of evidence that decreasing access to dental care only drives up costs in the long run:

When parents don't take their children for routine checkups and diagnostic tests, the risks of tooth decay and hospitalization rise. "The use of ambulatory surgery for dental problems is among the top five reasons for [same-day] surgery in kids under five," says Dr. James J. Crall, child advocate at the American Academy of Pediatric Dentistry.

This increase in costs when early treatment is denied is not limited to children. Oral health services provided to adults through MassHealth reduce costs to the state by preventing costly emergency services and decreasing the severity of other chronic diseases. A Kaiser study found the 2002 elimination of dental services merely shifted the cost of care to other parts of the health care system.

As more and more research emerges demonstrating the ineffectiveness of eliminating programs such as MassHealth aduled dental benefits, we must increase the urgency with which we deliver this message to decision makers in the Commonwealth of Massachusetts.

Vizilite is a simple device that uses a unique chemically engineered light source. This device improves the identification, evaluation and monitoring of oral mucosal abnormalities in patients.

More than 25% of oral cancers are discovered in patients with no lifestyle risk factors. This means that vizilite exams should be performed on all adult patients (age 18 or older):

• Increased risk: 18 -39 years.
• High risk: 40 and older - tobacco users
• Highest risk: 40 and older with tobacco and chronic alcohol use and patients with a history of oral cancer.

When detected early, oral cancer is curable in 90% of the cases and patients can live a healthy life. Yet a majority of early lesions are not detected by an unaided visual examination. Early detection tools such as mammograms and PSA tests have greatly reduced death rates for breast and prostrate cancers.

A great article on the nationwide Medicaid cuts in dental coverage for adults in the New York Times. One piece of good news - starting in January, Massachusetts Medicaid will pay for fillings — but only for those in the front of the mouth.  "The dental benefits issue came to the forefront recently here in Massachusetts, a state known for generous Medicaid benefits. Under budgetary pressures, the state stopped paying private Medicaid providers for fillings, root canals, crowns and dentures in July 2010. But it recently decided to restore part of that coverage. Starting in January, Massachusetts Medicaid will pay for fillings — but only for those in the front of the mouth. The reasoning was that healthy front teeth were more important for getting and keeping jobs."

Another sobering piece of statistics: "Pew Center estimated that preventable dental problems were the primary diagnosis in 830,590 emergency room visits in 2009 — up 16 percent from 2006.“It’s penny-wise and pound-foolish,” said Shelly Gehshan, the director of the Pew Children’s Dental Campaign. “Rather than an $80 extraction or a $300 filling, states are spending much more on emergency room visits that can’t fix the problem.”

In the final analysis, I concur with Dr. Michael Wasserman, the president-elect of the Massachusetts Dental Society, who said that he was disappointed Massachusetts did not restore full coverage but that even a partial restoration was extraordinary in these fiscal times.

Here are some 'Before' and Áfter' pictures of a patient on whom Dr. Downs performed the Full Arch Reconstruction in the seminar at Utah. As the pictures show, today's modern dentistry can work wonders for the esthetics which in turn boosts the patient's confidence. Unbelievable transformation!

The Pew Center recently released a report on dental sealants across the country, grading each state (and D.C.) on its performance in providing sealants. The grades failed to impress: only 5 states (Alaska, Maine, New Hampshire, North Dakota, and Wisconsin) received the top grade of an “A,” and 20 states received either a “D” or an “F.”

The center awarded its highest grades to states which provided dental sealants in over 75% of high-risk schools with minimal restrictions. Forty states, as well as Washington, D.C., were unable to confirm that 50% of children had received sealants – a minimum standard set by the federally sponsored Healthy People program. 

Massachusetts received a “B” under the metric. Although over 50% of high-risk schools in the state now have sealant programs, the state has not yet reached the 75% standard, and some unnecessary restrictions still remain in place.

This is an important reminder that we have a way to go before we can declare victory on dental disease. We have solutions to prevent this disease; yet more than one in four MA children enters school with a history of dental decay. By approaching this issue with community and state-wide solutions – providing access to screenings, fluoride, and of course sealants (which can reduce tooth decay more than 70 percent (PDF))– we can eliminate dental disease and give our children the healthy childhood that they deserve.

The local media has covered my acceptance into the Massachusetts Dental Society Leadership Institute quite extensively. 

• The local Hopkinton newspaper has an article titled, "Local Worcester Dentist Accepted into Training Program". It goes on to report that the two-year program provides Dr. Meena Yegneswaran the tools and training to become civic leaders on local, state or national levels. When the training is complete, participants take part in a year long ad hoc committee focused on issues affecting dentistry.  

• The Worcester Telegram and Gazette has a similar article on my acceptance into the Leadership Institute.