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What causes periodontium diseases?

The key starting moment in the periodontium disease development is the formation of calculus consisting of food debris. Calculus provides favorable conditions for the development of microorganisms, which facilitate not only the decay of tooth enamel, but also the gradual corruption of the connection between teeth and gums. When that happens, the so-called gingival pockets are formed, which are, basically, "slits" between gums and teeth.

Gingival pockets provide favorable conditions for trapping food particles that nurture even more rapid reproduction of microorganisms. This is often accompanied by the inflammation of gums manifested through the swelling, painfulness and bleeding of the gums, as well as the appearance of bad breath. As inflammation progresses, the gums get thinner, the gingival pockets get larger and the neck of tooth gets exposed. Unprotected by the enamel the neck of tooth becomes extremely sensitive to external influence, such as cold, hot, sour and sweet food. Calculus may form on the neck of tooth.

Gradually, the chronic microbial inflammation spreads deeper and deeper and gets onto the tooth roots and into root sockets. As a result of changes due to inflammatory processes the former healthy periodontium tissues are substituted by connective tissue, which causes a considerable reduction in local blood circulation. Consequently, due to low circulation the nutrition of the gums and tooth tissues is significantly impaired causing the structural disruption and slow atrophy of periodontium tissues. As gums get thinner, the teeth start getting loose and fall off.


How safe and efficient is the chemical tooth whitening?

Many of our clients turn to us with questions about safety and efficiency of chemical tooth whitening. Recently, the attitudes towards whitening started to change drastically. A series of studies were performed to investigate the effect of various teeth whitening formulas on teeth susceptibility to caries. In one group the teeth were treated with gels containing 10%, 20% carbamide peroxide, as well as a gel containing 35% hydrogen peroxide intended for in-office whitening. In the other group the teeth were treated with whitening gels with the same concentrations of carbamide peroxide, yet additionally containing sodium fluoride and potassium nitrate. The experiment proved that the use of all bleaching gels does not increase teeth susceptibility to caries, and the use of gels containing NaF and KNO3 leads to the reduction of caries incidence. In other words, such bleaching systems act as caries prevention! Sodium fluoride serves as remineralizing agent that strengthens the enamel. The role of potassium nitrate is to desensitize, i.e. reduce the sensitivity of the teeth.

Thus, the following conclusions can be made:

  • Undoubtedly, gels with 10-20% of carbamide peroxide containing NaF and KNO3 can be recommended as the safest and most efficient ones. Using such gels ensures maximum esthetic effect at minimum risk.
  • "The golden standard of bleaching was and is the take-home bleaching with custom-fit trays. Today this type of bleaching is unrivalled in performance, bio-tolerance and stability of results (bleached teeth can stay like that for many years)", - said the inventor of bleaching gels, president of Ultradent Products Inc., Dan Fischer, DDS.

Besides that the custom-made whitening trays may be used for remineralization and fluorination of teeth, treatment of dental hyperesthesia, periodontium tissue therapy.

Concerning the highly concentrated gels. They are certainly necessary for endodontic bleaching, for the bleaching of strong local discolorations that lie predominantly in near-surface areas.

When choosing the method of bleaching, one should always remember about the principle of the lowest invasiveness: prolonged interaction with the gel of smaller concentration is more efficient, safe and predictable than a short-term whitening with highly-concentrated gels. This is caused by the process of bleaching the tooth tissue. The gel's active ingredient penetrates the tooth tissue, where under the influence of heat and more alkaline medium it decomposes and atomic oxygen is released. In its turn, oxygen reacts with the color-forming organic substances, breaks their ties with the enamel and dentine and thus facilitates their quick break-down and excretion from the tooth tissues. Prismatic structure of enamel and tubular structure of dentine considerably slows down the process of penetration of peroxide and the released atomic oxygen into the tooth tissues. In other words, it takes quite a considerable amount of time for the bleaching agent to get to the colored deep dentine layers. Such therapy can be ensured only by using at-home or in-office bleaching with the help of custom-made trays.

Laser whitening is based on using highly concentrated peroxide gels, in which the process of hydrogen peroxide decomposition is dramatically accelerated by illumination with highly intensive light, whereas it is of absolutely no difference, whether the gel is activated by coherent or incoherent radiation. That means that LED light curing unit available at practically every clinic today can be used for quick in-office bleaching with light-activated gels to gain virtually the same efficiency. One can achieve the same results by using chemically activated peroxide gels.

So, what method of bleaching to choose?

  1. Laser (light) bleaching is considerably more chemically invasive, and therefore more risky, because here it goes about high concentrations of hydrogen peroxide and about its very quick decomposition.
  2. During such a procedure the near-surface areas of tooth tissues are intensively bleached, as the short time this procedure takes is not enough for atomic oxygen to penetrate the deeper layers of enamel and dentine. At the same time the tooth becomes highly dehydrated, which can hardly be classified as a positive factor.
  3. Instantaneous bleaching effect widely advertised as a characteristic of laser bleaching is caused by a combined effect of two factors – the bleaching of near-surface areas and increasing the whiteness of teeth as a result of dehydration. The latter effect is reversible, and the later return to darker shades after laser bleaching will be much more expressed, than in the case of at-home whitening with custom-made trays.
  4. Laser bleaching machine is quite expensive, which, naturally, increases the bleaching procedure cost for the patient.

You can make your own conclusions from the above-given information.


Tips for Parents

Is it necessary to brush small children's teeth?

By 2.5 years of age all the appropriate teeth already appear. The tighter they are pressed together, the higher the probability of caries development. The saliva that contains the substances neutralizing the pathogenic bacteria fails to wash the teeth on all sides, therefore the plaque from the enamel has to be removed with the help of a tooth brush. It is necessary to start teaching the child to brush teeth since the age of 2 and not to delay the acquaintance with the tooth brush until the child is 4 or 5.

Why fill baby teeth?

It is quite obligatory to treat milk teeth. The health of permanent teeth depends on their condition. Whatever happens to the baby tooth cannot but influence the development of the permanent tooth. If the caries is not treated, pulpitis can develop followed by periodontitis, which is a serious threat to the germ of the permanent tooth. Besides that, untreated teeth are an ever-thriving source of infection.

Are there nerves in milk teeth?

Yes, there are nerves. It is just that for some children the teeth deteriorate so fast that the pain does not have the time to appear. So, in some way, having the pain is actually good. It sends the signal: time to visit the doctor!

After the tooth crown emerges above the gum, it continues to accumulate salts, and the root continues to grow. When it is done growing the tooth has a period of physiological rest that lasts for 3 years. This time is the most opportune for dental treatment: there is no risk of damaging something.

Is it necessary to visit an orthodontist with milk teeth?

Today 60% of children have some sort of orthodontic pathology. In most cases it goes about narrow jaws. Normally, there are only 20 milk teeth, and there should be 28 or 32 permanent teeth, which are bigger and wider at that. That means that the jaw needs to grow both in width and in height. That is why an orthodontist must see how the jaw of the kid develops in advance. He will also check the correctness of the bite. The bite of a pre-school child can be corrected with the help of plastic plates. Adolescent and adult bite requires the bracket system. It is quite obligatory to see an orthodontist.

Anyway, one must see a dentist twice a year, regardless of whether the child has or has not any dental problems.