Gum Disease Gingivitis Periodontitis

What is gum disease that you hear often in the news? You may have heard of the term gingivitis, but what is periodontitis? Are you at risk for it? What is the consequence of no treatment?

You can ask yourself some of these questions: When was the last time you were at a dentist? Do you notice that your gum bleeds when you brush or floss? Do you have problem with the floss shredding? Do you have unpleasant breath? Food trapped easily between your teeth? How about any tooth that is loose? Sensitive when you chew or experience cold temperature?

Those are some of the signs of gum disease, better known as periodontal disease. Here's a summary: 

Red, swollen, tender gums 

Gums that bleed easily 

Gums that have pulled away from the teeth 

Persistent bad breath or bad taste

Pus between your teeth and gums 

Permanent teeth that are loose or separating 

Sensitive when chewing hard chewy food 

Any change in the way your teeth fit together when you bite

Any change in the fit of your partial dentures 

You may have periodontal disease and have no warning signs. Gum disease may not cause any pain either. That is why it is important to visit your dentist regularly for comprehensive checkups and periodontal examination. Gum treatment options depend on the severity and its progression.  

Periodontal disease is classified into two major stages: gingivitis and periodontitis. 

Gingivitis is the early stage of gum disease, where there is an increased inflammation of the gum. The gum bleeds easily, can be swollen, and red due to increased vascularity of the tissues. When you touch the tissues, the blood vessels break and bleed. The inflammation is caused by build up of plaque, or a layer of bacteria. Over time, the plaque buildup hardens by a process known as calculus formation. Calculus creates a haven and matrix for faster bacteria colonization. Your body tries to protect against the bacteria by making more blood vessels and to remove the toxins produced by the bacteria. Gingivitis can be easily treated by professional cleaning, good oral hygiene with the use of anti-baterial mouth rinse, regular brushing and flossing to remove plaque buildup. In addition, removal of plaque buildup would also prevent cavities, especially those in between the contacts of teeth.

A periodontal abscess that caused 

a toothache, resulted from bone loss,

gum infection, swelling, bad taste.

Periodontitis, also known as pyorrhea, is the later stage of gum disease, combined with attachment breakdown and bone loss. The tooth root will separate from the bone. Left untreated, it can become too severe that the bone lost can not be replaced or rebuilt. Most people with periodontitis may not have any symptoms. On occasion, someone may have a periodontal abscess and dull toothache from advanced periodontal disease. Dr. Vuong recommends a full set of x-rays to show the bone level, and sometimes the amount of calculus buildup, or harden minerals could be seen on the radiographs. Visual exam may miss the early stages of periodontal disease. We determine the amount of periodontal pocket depths or amount of gum detachment from your teeth. We will provide the appropriate treatment recommendations, depending on the severity of the disease. The earlier gum disease is diagnosed and treated, the better the prognosis in saving your teeth.

Early periodontitis shows swollen, puffy, sensitive, easily bleeding red gums, and calculus (white hardened) buildup. 

This young patient had early gum disease. Notice the red puffy gum and black buildups along the gum line. Besides sensitivity to cold, the gum is very tender and sensitive, and bleeds readily when brushing or touching even gently. This patient has sought treatment at the appropriate time, and he will have a beautiful healthy smile in a short time. Had he waited too long, gum disease can become very advanced, as illustrated in the case below. 

For advanced gum disease, most often patients end up with all teeth removed and immediate dentures made, as illustrated in the case above.

Some factors increase the risk of developing periodontal disease (not in order of significance):

Tobacco smoking or chewing
Systemic wide diseases such as diabetes
Some medications such as steroids, anti-epilepsy drugs, cancer therapy drugs, calcium channel blockers, and oral contraceptives
Bridges and partials that no longer fit properly
Crooked teeth
Fillings or dental restorations that have become defective
Pregnancy and puberty
Genetic predisposition--research shows 30% of population is genetically susceptible
Stress, clenching, and grinding of teeth
Poor oral hygiene and lack of regular professional care

In this video, Whoopi Goldberg talks about her personal experience with periodontal disease, particularly about a severe periodontal abscess!

Advanced periodontitis that has been treated, 

well maintained, and stabilized.

This is a case that Dr. Vuong has treated for advanced periodontitis. The patient has been very diligent in maintaining plaque control, and keeping gums and teeth clean. Not all advanced periodontal disease will lead to dentures! Though bone has been lost, the gum tissue is very healthy and the teeth are strong! 

Good oral hygiene at home is important to keep periodontal disease from becoming more serious or recurring. You may have had gum treatment in the past, but without regular maintenance, you may still have active gum disease. You don't have to lose teeth to periodontal disease! Brush regularly, clean between your teeth by flossing, eat a balanced diet, and schedule your regular dental visits for a lifetime of healthy smiles! 

Periodontal disease is serious, but don't let fear or embarrassment keep you away from seeking care. 

What Is Root Canal?

Many people have misleading information about root canal treatment or root canal therapy, sometimes simply called a "root canal." Root canal is the inner aspect of the tooth that contains nerve fibers and blood vessels in a system of canal spaces, together they provide normal sensation, vitality, support, and nourishment for that tooth. Root canal treatment is the treatment of the canal spaces, with the goal to alleviate pain, infection, and preserve and protect the tooth. What does it mean when you need a root canal? When do you need a root canal? Does it hurt? Is it a myth that root canals don't work? Is it better to take the tooth out instead of trying to save it with a root canal? These are the questions that you should ask your dentist.


A tooth usually needs a root canal when it is broken with nerve exposure (think trauma to the front tooth), extensive decay that goes into the nerve or pulp (too sensitive?), an abscess and/or swelling, toothache that doesn't go away with lingering pain and keeps you up at night, or sometimes a dead nerve that doesn't present with any symptom at all. A recent large and deep filling on a tooth close to the nerve that was sensitive to cold prior to the work and has gotten worse usually indicates the need for root canal therapy. On occasion, the new filling must be evaluated for other problems and root canal may be avoided. 

A parulus on a chronically infected tooth which

has had root canal treatment. 

One sign of a dead nerve may be a pimple on your gum (dentally known as a parulus, also known as gumboil). A parulus may indicate a need for root canal therapy, but it may also be caused by a periodontally abscessed tooth, which may not need root canal therapy. Sometimes you may notice a bad taste, or a bleeding point along your gum that doesn't quite heal. A parulus is the drainage point of pus buildup of an abscessed tooth. Drainage may or may not be present. This is a serious condition and should be addressed as soon as possible to prevent severe flare up and swelling all of a sudden without any warning. Further, chronic swelling and resolution (recurrence of drainage and healing) can cause further damage to the bone support and result in tooth loss.

A deep cavity causing a lot of pain which 

needed root canal therapy to save it. 

This tooth had recurrent decay or cavity under the existing filling which was done by another dentist many years ago (black arrow). The decay was very advanced and had already reached the nerve (white arrow), and was painful to the patient. The nerve had died over a period of time. In order to save the tooth, root canal therapy was needed and we could keep the tooth root. You can compare how deep the cavity on this tooth with the other one, which could be treated simply with a new filling.

Dr. Vuong corrected a faulty filling that caused food trap, sensitivity, and gum bleeding. 

Each tooth is different, and the complexity of the canal systems may make the treatment of infected nerve a challenge. Some teeth should best treated by a root canal specialist called an endodontist. 

"Does it hurt?" You will be numbed before the procedure is started. It should not hurt. On contrary, root canal is one of the treatments for a toothache (besides pulling that tooth out) and it should resolve the pain that you have presented. Pain can be managed by adequate anesthesia, pain medication, and/or antibiotics. Each person as well as each situation is different. It should not hurt (didn't I just say that?). Dr. Vuong will discuss with you and provide appropriate recommendations. 

"I've heard that root canals don't work." There could be many reasons for failures of teeth that have been treated. Some canals may not have been adequately cleaned out, located, or the infection has recurred. The tooth may be fractured making it not savable. Some patients may fail to return for the follow up appointment to complete the procedure, rendering the re-infection too severe to treat. The good news is that many of these previously treated teeth can be re-treated by a well trained dentist or specialist. Dr. Vuong can discuss with you the prognosis, benefit, and risk of the procedure. 

Dr. Vuong uses specialized root canal instrumentation, such as digital x-ray, apex locator (an electronic instrument to determine appropriate lengths of the canals), magnification, and rotary files to clean and shape the canals. Dr. Vuong also uses a rubber dam to cover your mouth opening for safety and to keep the tooth away from bacteria in your saliva contaminating the canals. The purpose of the root canal is to kill off and clean out the bacteria inside your canal system, so you don't want them to be contaminated. That is why it is important for you to return to the dentist to have the tooth built up and crowned as soon as possible. Root canal treated tooth can become more brittle and prone to fracture. A crown helps protecting it and increases the longevity of the tooth.

Dr. Vuong treated this tooth with root canal therapy because it was hurting, and made a crown to protect it. 

"Is it better to take the tooth out?" Once the tooth is gone, it is gone forever, there's no second chance. Root canal therapy is the best way to save the tooth which may otherwise cost more to replace later on. You can keep the roots of the teeth; the infected inside contents of the root is removed and cleaned out. Root canals have over 90% of success when done properly, when the tooth is restored to its original function. In cases where the tooth is severely broken, or despite all efforts, the tooth is not savable, then it should be removed. That missing tooth can be replaced with a bridge, implant, or removable partial.

Dentures and Partial Dentures

A denture is a custom made removable or fixed dental appliance for missing teeth.  Generally, it is considered a dental prosthesis, the same as a dental crown or bridge, and is a very important appliance to restore function, looks, and comfort.  It has many different varieties, from very basic acrylic and plastic teeth, with reinforced metal framework, to high grade porcelain teeth on precision milled titanium framework, fixed (or screwed in) and supported by dental implants.  

A removal partial denture for missing
front teeth and back tooth

A denture is designed specifically for you, and only you can wear it.  A denture is not neccesarily a replacement for your missing teeth, but a solution to your missing teeth.  Dr. Vuong takes the proper steps and time to make your dentures so that they would fit the best and most comfortably for you.   Together with the dental technician, we will work closely with you to select the color of your teeth and design the dentures, so that we can enhance your smile.  We will also keep in mind to restore your bite to its youthful appearance.

There are two types of dentures, called complete or partial dentures. A complete denture is made when all of your teeth are missing or need to be removed, while a partial denture is made when we can keep some of your teeth. The proper term for a dental bridge is Fixed Partial Denture, since it replaces one or more missing teeth, and is cemented onto remaining teeth.  A removable partial denture, however, requires that you take it in and out to clean.  As mentioned above, a complete denture can also be fixed or cemented.  We want to maintain your remaining teeth for as long as possible. Natural teeth are always better than denture teeth. Your natural teeth not only help keep your dentures stable, but also preserve your bone level.

A removable partial denture replaces many missing back teeth.

Temporary partial dentures can be made when a patient needs a quick turn around time and fast inexpensive solution to a cosmetic concern.  Or when a few teeth need to be removed, a temporary partial denture is needed during healing time.  While there are existing conditions such as cavities, gum disease, or other more pressing situations that can not be met, or when on-going extensive treatment is needed and planned, temporary partial dentures play an important role.  

For example, in the case on the left, gum treatment is needed.  Perhaps this patient will want to have braces to correct his overbite and crowding, or he may want implants to replace these missing teeth.  A bridge could be another option.  We made a temporary partial denture to replace the missing teeth until definitive treatment can be done.  Temporary partial dentures do not fit as well as or as comfortable as the final definitive partial denture that you see above.

When you and Dr. Vuong have determined that all of your teeth need to be removed due to extensive decay or bone loss from gum disease, a special type of denture called an immediate complete denture is made.  Most of the back teeth will be removed first, except the front teeth, and then a denture is made.  Once we have the denture ready, we set up an appointment especially reserved for you to remove the remaining teeth and your denture is delivered.  With this approach, you will never walk out of the office without teeth!

Immediate denture replaces all bad teeth at time of taking them out

Immediate denture is sometimes called a healing, temporary, or transitional denture, as that is its role.  Most of the time, after removal of teeth and delivery of the immediate dentures, your gum tissues will continue to heal and shrink, making your dentures loose, and become uncomfortable.  The teeth may have to be ground down to correct your bite, and you will have to learn to adapt with your new denture.  It is a normal process of immediate dentures.  Sometimes, you will prefer to have a new one made, usually within 6 months to a year, to improve the setup position or color of the teeth.  We will offer to reline your dentures to make them fit more comfortably for you during that time period of healing.

Sometimes a few front teeth need to be removed, an immediate partial denture can be made before removing bad teeth.  It is still considered a temporary partial denture.  That way, the patient walks out of the office with teeth and a new beautiful smile on the day of surgery. 

Dentures are very durable appliances and will last many years, but over time may have to be remade, repaired, or re-adjusted due to normal wear.  Even though you don't have any teeth remaining, you should see a dentist periodically to check for other problems with your bite, rocking dentures, and also for cancer screening.

There is another type of complete denture called implant supported overdenture. This type of denture uses implants and attachments as anchors to make your denture fit more tightly into your jawbone.  The denture will snap into place.  If you have found that you need to use adhesive or glue to hold your dentures in place, implant overdentures would be a solution for you!  Not only will they boost your self confidence, knowing that your dentures will be not fall out in public, overdentures can greatly improve the way you speak and chew.

Don't hesitate to ask Dr. Vuong for more options, depending on your needs and circumstances.

3 Steps To A Healthy and Beautiful Smile!

Have you always wanted a Healthy and Beautiful Smile? Now you can! Do you know that beautiful lips frame the smile, healthy gums support the teeth on a great foundation, beautiful straight white teeth give it a nice sparkle, and fresh breath makes it more attractive? Here are some simple steps that you can apply to give you the confidence to smile BIG! 

1. Healthy Lips, Gum, Clean Teeth, and Fresh Breath

Lips should be protected from sun and harsh weather damage. They should be conditioned with moisturizer to protect them from drying, chapping, and peeling. To achieve healthy gums, brush and floss daily to remove bacterial plaque to prevent gingivitis, periodontitis, and bad breath. Brushing the tongue is also recommended. Consider and limit your diet high in refined sugars. Drink plenty of water; watch out for sugar containing and carbonated beverages. Regular dental cleanings and checkups give your smile its best chance in maintaining optimum health. Problems caught in the early stages can be quickly treated or prevented. Cavities can contribute to bad breath, so get those taken care of as soon as possible. Clean, healthy teeth, and gums are the foundation to a beautiful smile! 

2. Straight Teeth 

Many people think that braces are mainly for kids and take 2-4 years to complete. Not anymore! Now, there is a choice! Dr. Vuong can straighten your smile in an average time of six months with our new 6 Month Braces. Ask us about this new treatment option that many of our patients are very excited about! 

3. Stunning White Teeth 

Teeth can be whitened with our Custom Take Home Whitening System that has been proven to lighten your teeth in 2 weeks, without the need for a "laser" light. The light has been clinically proven to be unnecessary. For even better result, close professional guidance can enhance the typical result that most patients are happy with! 

If you have missing teeth, or badly decayed teeth that are holding back your smiles, give us a call. There are options and solutions. We can help!

Removable Partial Denture For Missing Teeth

This patient came to Dr. Vuong not happy with the appearance of her current partial denture. It was also not fitting well, neither was it esthetically pleasing. She also had a lower partial denture which didn't fit at all and was painful when worn.  It was rocking during chewing. The bite was off.  For these reasons, she wasn't wearing the lower partial denture. She wanted new teeth so she could look and chew better!

There are many treatment options for missing teeth for a case such as this, from fixed partial dentures such as porcelain-fused-to-metal bridges, zirconia-framework fixed bridges, multiple implants to replace many of the missing teeth, precision attachment removable partial dentures, or traditional metal framework removable partial dentures. The final decision is usually made by the patient, guided by the outcomes that both the patient and the dentist want to achieve.

This patient elected to have new removable partial dentures made.  We treated a few large cavities.  While this case has room for esthetic improvements, it is okay with this patient.  We worked with many limiting factors due to budget constraints. We had to use metal frameworks for rigidity and support of many missing teeth. We did two front crowns and made rest seats in them (places for partial framework to hook onto). We could have made crowns for her back teeth to bring out the arch for a more beautiful and wider smile.  Her bite was another complicated factor. Nevertheless, we achieved the result we both wanted!  You can see noticeable major improvements! Most importantly, the patient can now eat her favorite food without the partial dentures falling up and down or moving! :) 

Less lower teeth showing makes for a more pleasing smile... :) 

Many who have to wear partial dentures don't like metal hooks to show when they smile. They may have the entire partial denture made in plastic, which looks great but they can not eat and chew variety of food with it. In cases where the entire removable partial can not be made with the flexible plastic material, a metal framework is needed for rigidity and support so that it can take the work load when you chew. Here we could see that the metal hooks were needed, but we incorporated the plastic esthetic design into the framework so that it blends right in with the gum tissue color. There are many other advanced options, known generally as precision attachment partial dentures, however, the combination of metal framework and esthetic hooks is a very popular option for many of our patients.

February is National Children's Dental Month

February is the National Children's Dental Health Month! Have you considered the importance of a dental exam for your child before kindergarten enrollment? It is recommended that children visit a dentist before 1 year old or as soon as teeth are coming in. Although Dr. Vuong likes to see children starting at age 3 and up, we love kids and would be happy to make accommodations for your child's first dental visit! We can make that visit fun and memorable!

Do Cavities Have Holes In Them?

What is a cavity? What does it look like? Is it supposed to hurt? What happens when your tooth has big hole in it? 

Although this young person hasn't been to the dentist in 5-7 years, overall she has good teeth, healthy gums, and no pain at all. However, can you point out to me which teeth have cavities? Do you think these need to be treated as soon as possible? How deep do you think they are? Do you think there are cavities in between teeth as well? What would happen if this patient delays treatment?

Do all cavities have holes in them? It's okay for you to guess. Dentists are not guessing which of your teeth has a cavity or caries when they tell you that you have a cavity. It takes many years of reading X-rays, looking for signs of a cavity, and past experiences to diagnose them properly. When diagnosed, treatment should be done as soon as possible to receive the best prognosis and saving more of your tooth! You will be glad you did!

Cavities, sometimes called tooth decay, or caries, develop from breakdown of your enamel and soon the softer dentin layer of your teeth. Most of us blame cavities on eating too much sugars and candies, but it's only half true. Bacteria, normally present in your mouth environment, are the ones that feed on sugars and carbohydrates, and make acid as their waste product. The acid not only irritates your gums, causes gum bleeding, it also breaks down your teeth. Not all cavities have "holes" in them. You may have a cavity or decay under your existing fillings, or crowns. White fillings can turn black from recurrent decay or failure in bonding as they get older and stressed from daily use. Some older fillings break because they have decay underneath. When you can actually see a hole in your tooth, the decay is too big and you need to have that treated as soon as you can to prevent more damage. When your cavities are too big, you may not be able to do a filling anymore, you may need a root canal (when the cavity is too close to the nerve), a large buildup, and/or a crown. 

So could you point out which teeth have cavities here? We just finished the treatment for this patient. We will have taken out the wisdom teeth that had cavities in them. See the new photos. 

Close up view of the finished new white fillings.

Here's a picture of a very deep cavity in a molar. It doesn't really have a hole in it for you to feel that it is there. Though this patient is not aware of it because it is not sensitive or hurting yet, it is very advanced and even involves the contact areas between teeth that can be detected on X-rays called the Bitewing X-rays. Treating a cavity as soon as possible can prevent the need for root canal as the deeper cavity reaches close to the nerve inside. Flossing will prevent future problems in the restorations or fillings and ensure they will last much longer. 

Here I was using a different camera, and I have increased the contrast setting in these images to show the failed white filling that had significant amount of decay or softness underneath once the existing filling was removed. You can also see the crack line in the third image. The dark dentin was good tooth structure so that was not removed. We masked the darkness and filled the rest of the cavity, checked the bite, and made sure that all the margin was sealed tight. Failing filling or restoration treated early, more often than not, can prevent the need for root canal, which many people dread. Though this cavity was significantly much deeper, the patient reported no sensitivity. He was quite pleased to see that they all blended in nicely without the dark lines. No root canal! 

This series of pictures shows what appeared to be a small cavity turned out to be very deep! These types of cavities are often missed during the exam when the grooves are not cleaned out, or the criteria used by one dentist are different from another. Some dentists may not consider this a cavity that needs treatment yet. To make matters more complicated, when a dentist diagnoses a cavity, patients may hesitate to get the treatment right away, and over time have forgotten that they ever have a cavity. 

As you can see, when these grooves are opened, the cavity looks very bad. By first opening the grooves, and using a slow speed handpiece and round bur (a safer way to remove the softer decay tooth than a high speed drill), Dr. Vuong cleaned out and checked for any remaining decay. Once cleaned out, a new filling can be done and verified that all the margins are sealed properly. When the bite is checked and proper steps are observed, this patient should experience little or any post-operative sensitivity at all. 

As shown in the examples above, the sooner the cavities are treated, the better it is, and you may avoid pain, sensitivity, or even root canal treatment.