Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

What is a Periodontist ?

Many patients come for a routine dental visit and are then referred off to see a “periodontist“. Here I will answer what a periodontist does and you can then decide if you need one.

I am going to being with a few definitions to get us on the same page:

PERIODONTIUM: This refers to all the supporting structures that surround the teeth. The specific tissues that make up the periodontium are the alveolar bone, periodontal ligament, cementum and the gingiva (or gums).

PERIODONTICS: This is the study of the periodontium and the branch of dental specialty that treats diseases of the periodontium.

Therefore, a periodontist is a specialist dental practitioner who treats and manages diseases and conditions of the periodontium. Most often a patient requires the expertise of a periodontist when they suffer from periodontal disease. Anyone can develop periodontal disease. It is usually a slow process (but sometimes can be very acute & develop rapidly) of destruction that develops over time when the oral hygiene of the mouth is poor. Initially patients suffer with bleeding gums. People assume that this is normal and do not seek treatment. Bleeding gums then become a part of their daily life. The bleeding is caused from a chronic inflammation of the gums due to the presence of bacteria in dental plaque. This is known as gingivitis. The dental plaque present on the tooth surfaces will turn to calculus, a hard accretion that cannot be removed with a toothbrush. The gingivitis, if untreated, will turn into periodontal disease which causes the destruction of the alveolar bone that houses teeth. The result is loosening of the teeth and if untreated, eventual loss of the teeth. The primary role of a periodontist is to treat periodontal disease, by removing the calculus that has accumulated and reverse the chronic inflammatory process. The objective is to halt the destructive process of bone loss through a number of minor surgical and non surgical procedures.

In addition the treating periodontal disease, a periodontist may place dental implants, surgically extract problem teeth, place bone grafts and place gingival grafts.

In general, it is advisable to see your dentist for an assessment first before booking directly with a periodontist. An astute dentist will be able to assess the severity of any possible gum problems and refer you to a suitable periodontist if you need one.

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What is a nesbit denture?

A nesbit denture is used to replace a lost single tooth, on one side of the mouth. Often teeth which have had a root canal treatment many years prior, present to me with a recurrent abscess. The treatment options are limited and depend of the size of the abscess and the extent of damage. If patients live with type of condition for a long time is becomes chronic (occurs over a long period of time) and they do not notice the pain. This is coupled with resultant bone loss around the tooth root. In these cases tooth extraction is needed. Sometimes patients want to hold on to their teeth and it may be viable to refer to patient to a specialist to have an apicectomy procedure. This may prolong the lifespan of the tooth, however the abscess generally will recur a few years down the line and the tooth will need to be extracted.

When a single tooth has been extracted there are a few different options for replacing it. A dental bridge, a dental implant or a removable partial denture may be used. These patients may not be ready for implant placement if a large amount of bone loss occurred, or they may not want an implant. The solution to replacing a tooth temporarily or a removable long term option is a nesbit denture. Traditionally these appliances contained metal clasps. However the nesbit denture is constructed completely out of an acrylic vinyl material. It is light and if made properly has good retention capabilities. These are now commonly used as interim replacements while patients are waiting for implant restoration.  They do require a natural tooth posterior and anterior to the edentulous space and are not appropriate for “free end saddle” situations (patient has no posterior tooth to support the partial denture).

 

The procedure for making a nesbit denture is very simple and requires some dental impressions which are then sent to the laboratory. After a week or two most patients are comfortable and used to wearing their nesbit denture. The nesbit denture is a cost effective, quick solution to tooth replacement.

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