Dr. Randy Nolf, Periodontist and Implants

There is now treatment to restore the airway so CPAP or oral jaw positioning appliances can be discontinued at treatment completion. I just had my own home sleep test screening done and found out I’m likely going to be diagnosed as severe sleep apnea when I see a sleep medicine physician (ASAP). It explains a lot. I may need a CPAP for a time but I will be treating myself with oral appliance therapy to recover lost arch volume and restore airway volume. I expect the CPAP and... appliances to be a temporary part of treatment. I will be treating myself and providing evaluation and treatment in conjunction with sleep physicians for patients.

https://youtu.be/U64z9HgAZdo

I posted this recently but it deserves more attention. The article was written to dentists in the UK in part about responsibility of diagnosing gum disease including the serious liability of not accurately diagnosing. More importantly it signals a change from expert professional opinion to an objective, repeatable scoring system that give Doctor, patient and insurance easy to understand numbers. Numbers produced by computer using clinical data collected at every dental check up enable precise tracking of improvement or decline in patient health. The insurance company and employer who pays for it will also be able to see population health for their insured groups.

Brilliant. Coming soon to patients in the US.

Continuing with the tissue graft theme I want to make it clear that grafting is not only done after recession has occurred. A tooth or group of teeth may be missing the normal zone of dense "leathery" gum tissue without having had any recession. That area is at increased risk of recession. There's a few ways to approach this situation. 1. simply do a graft before damage or recession happens. 2. wait for recession and repair it. Sometimes it's not possible to fully reverse the recession if it has gone too far. 3. graft areas without protective tissue when procedures like crowns or braces are planned. Examples of recession after a crown was placed. Hind sight is 20/20 and there can be other factors causing recession but one very important consideration is the quality of the gum tissue.

The picture is an example of a healed graft. Like the teeth of the previous posts the gum tissue was receding. With a simple procedure called a tissue graft the gum can be re built with dense tissue resistant to recession. While there are many techniques for doing a graft the main considerations are root coverage to repair recession or simply stabilize the recession at the same level preventing it from getting worse. Then a second consideration is where the donor material... comes from. 2 main choices exist, one is a thin piece of a patients own tissue usually taken from along the inside of the upper teeth or freeze dried donor tissue very similar to that used for medical skin grafts. The freeze dried donor materials add cost to the procedure but eliminate the need for a donor site along the inside of the upper teeth. I use palate-preserving freeze dried donor material in my practice especially for larger procedures. See more

Don't let a minor problem become a major tooth-threatening condition. The person on the left has a minor problem, almost undetectable yet it's very predictable it will become like the condition on the right. In both cases the "leathery" type gum tissue is missing over the central incisor. The dense gum tissue is intended to resist the forces of brushing, chewing and the pull of the muscles. The left one shows a muscle attachment (fold in the tissue) pulling on the edge of the gum. In both cases the treatment is minor procedure called a tissue graft used to rebuild a zone of dense protective "leathery" gum tissue. The difference is that the left one is a simpler procedure, very predictable. I'll post more about grafts, the procedure and expected out comes. Feel free to share this.

Gum recession affects 50% of all patients. More as we age but it's present even in young people. The 2 main considerations are 'health' and 'cosmetics'. The health concern is that you may lose the tooth if the recession advances. The cosmetic concern is that you don't like the appearance and you become unhappy with your smile. If you detect recession be proactive, ask your dentist or hygienist to explain the risk. Or call my office for a consultation, a referral from your dentist is not required. Just remember to ask specifically for Dr. Nolf when making the appointment.

Happy New Year today is the second day of 2017. I will be writing weekly about dental and oral health topics to keep my patients and friends informed. Please "like" my page.

http://youtu.be/IcCUKQhXjuE