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Laser Gum Surgery - No incisions. No sutures. No fear. (6-15-2014)

Laser Gum Surgery

No incisions. No sutures. No fear. (article published in the Aberdeen American News and Senior Living Magazine)

Periodontal disease, also known as gum disease, is an inflammatory disease that affects the gums, bone and other supporting structures of the teeth. It is generally caused by plaque, a colorless film of bacteria that forms on teeth. If not removed daily, the toxins produced by the bacteria in the plaque result in an infection that will irritate the gums and cause them to become red and irritated, resulting in gingivitis, an early form of gum disease. With time, the plaque can spread and grow beneath the gum line, resulting in a chronic inflammatory response that breaks down the tissues and bone that support the teeth. Eventually, a number of symptoms can develop: 1) gums that bleed, or become tender, when you brush or floss, 2) receding gums, 3) chronic bad breath, 4) teeth that become loose or change position, and 5) pain and sensitivity when chewing. It untreated, tooth loss occurs. Worse, gum disease has also been found to be a significant risk factor for a number of serious and debilitating medical conditions, including heart disease, stroke, diabetes and rheumatoid arthritis.

To treat this disease, the plaque that has accumulated under the gums needs to be removed to stop the infection, allowing the gums to once again become healthy. Depending on the severity of the condition, a number of treatment options are available. In its early stages, gum disease may be managed with conservative methods, such as better oral hygiene, more frequent cleanings, or a nonsurgical cleaning of the roots of the teeth, a procedure known as scaling and root planing.

In more severe cases, surgical treatment involving incisions and suturing of the gum tissue surrounding the teeth are necessary to remove the plaque and diseased gum tissue. Bone grafting may also be recommended to restore, or regenerate, some of the bone that has been destroyed by the infection. Though very effective, traditional surgical methods generally result in recession of the gum tissue surrounding the teeth, producing teeth that have exposed roots which are, many times, cold sensitive and are noticeable when talking and smiling. Gaps can also form between teeth leading to annoying food impaction and cosmetic concerns.

Fortunately, a patented FDA approved laser gum treatment has been developed to achieve the benefits of surgical treatment while preventing much of the unpleasant side effects. The technique is called “laser assisted new attachment procedure” (LANAP). It uses an Nd:YAG pulsed laser to remove the diseased gum tissue without the need for incisions and suturing. Amazingly, the healthy gum tissue is minimally affected, so much less recession occurs. Cold food and beverages can be enjoyed afterwards and cosmetics are preserved when smiling. Much
less pain, bleeding and swelling is experienced immediately following the procedure, so most people resume their normal activities the next day. Research has found this technique to be as effective as traditional surgery and may also lead to regeneration of bone around the teeth, without the need for bone grafting.

Diabetes Mellitus and your Dental Health by Dr. Kassube (09-19-2013)

Diabetes Mellitus and your Dental Health

By Dr. Thomas Kassube

Diabetes Mellitus affects almost 10 percent of adult Americans. Approximately 35-40 percent of this group has diabetes and don't know it. Both incidence and prevalence are increasing each year.

The two main types of diabetes are classified primarily on the basis of their underlying physiology. Type 1 diabetes constitutes about 5-10 percent of all cases in the United States. There is destruction of insulin-producing cells of the pancreas leading to total loss of insulin secretion. Someone with type 1 diabetes must take insulin to remain alive therefore “insulin-dependent.”

Type 2 diabetes constitutes about 85-90 percent of all cases. With type 2 there is insulin resistance rather than total absence of insulin production. These patients may remain undiagnosed for years because hyperglycemia appears gradually and often without symptoms.

Periodontal disease is a chronic inflammatory disease caused by oral bacteria. Over 50 percent of the United States population has periodontal disease and the severity increases with age.

Scientific research strongly suggests that diabetes is a risk factor for periodontal disease. Inflammation plays an obvious role in periodontal disease and inflammation is also a major component of diabetic complications.

Conversely, periodontal disease may also be a risk factor for worsening glycemic control in patients with diabetes and may increase the risk of diabetic complications.

What should a diabetic do for optimal oral health?

  • Keep blood glucose under control
  • Brush teeth often and floss daily.
  • Regular dental checkups and professional cleanings
  • Don't smoke
  • Give your dentist name of health care provider
  • Do not skip meals or medications

Consult your dentist right away if you have:

Red, sore, swollen gums

  • Bleeding gums
  • Loose teeth
  • Bad breath
  • Bad taste
  • Dry mouth
Dr. Kassube's article published (09-25-2012)

Dr. Kassube's article published in the Aberdeen American News

The following article on dental implants written by Dr. Thomas Kassube was printed on Sunday, July 29, 2012 and discusses the options for tooth replacement. Click here to see full copy of the article.

Dental Implants

Nothing can replace a set of healthy natural teeth.  If disease or trauma results in tooth loss, it's nice to know that there are options for tooth replacement.  Generally speaking, options fall into three categories:

  1. Fixed Bridges 
  2. Removable partial denture 
  3. Implants

The most advanced method available today is dental implants.  Implants may replace a single tooth, several teeth or support complete dentures.  You can think of an implant as being a "metal root."  These titanium posts are surgically placed into the jawbone. 

The surgical procedure is generally accomplished with local anesthesia.  Tylenol or Ibuprofen is recommended for the mild post operative discomfort.

Typically three to six months of healing is necessary for the implant to integrate to bone.  They then become sturdy anchors for the replacement tooth or teeth.
 
Not everyone is a good candidate for implants.  There must be adequate bone structure to support the implant.  Sometimes bone grafting is necessary prior to implant placement.
 
Certain systemic conditions such as poorly controlled diabetes or leukemia would interfere with healing.  People who have been taking bisphosphonates (Fosamax) long term for osteoporosis may not be good candidates. Tobacco use also delays healing.

Careful oral hygiene is critical for the success of the implant.  Time must be spent to thoroughly clean around the implant.  If not, gum disease will damage and weaken the bone that's needed to support the implant.

Dental implants are considered the standard of care for tooth replacement in modern dentistry.  Consult with your dentist about options best for you.

Midwest Periodontics
Dr. Thomas Kassube

Periodontal Health and overall health by Dr. Kassube (8-22-2010)

The Mouth and Body Connection

Periodontal disease linked to host of other medical problems

By Dr. Kassube, Midwest Periodontics, Printed August 22, 2010 in the Aberdeen (SD) American News' Annual Healthcare Resource & Medical Guide. Click here to see a full copy of the article (page 19).

During the late 1800’s there was a popular theory called Focal Infection.  Experts of that time were convinced that a focus of infection could arise somewhere in the body and cause problems elsewhere.  There were a number of ailments that were blamed on dental infections, for example, ulcers, arthritis, and appendicitis.  A Physician may have accurately diagnosed a case of appendicitis and then recommended that all teeth be removed.  Many people had their teeth therapeutically removed hoping to avoid some of those systemic maladies.

Into the early and mid 1900’s the focal infection theory fell out of favor.  For many years periodontal disease was considered to be more of a localized infection.  However, with sophisticated research and clinical trials, the pendulum is now swinging back.

Periodontal disease is an infection.  The primary cause is dental plaque, which is bacteria.  There is a common misconception that the cause is food.  If we never ate another meal, the mouth would still be loaded with bacteria.  The oral cavity, being warm and moist, is ideal for bacterial growth.

The problem is that there are over 400 kinds of bacteria in the oral cavity.  Many are normal flora that a healthy immune system will keep in check.  If the dental plaque is not brushed and flossed away properly, it will advance beneath the gum line and create pockets of infection around the teeth.  The bacteria is now much more destructive with the ability to destroy bone and loosen teeth.

An early stage of periodontal disease is gingivitis, which means inflammation of the gum tissue.  Signs and symptoms include redness, swelling and bleeding.  Absence of bleeding does not necessarily mean absence of disease.  In more advanced cases of periodontal disease, there may not be any bleeding at all, as the disease activity is no longer on the surface.

With periodontal disease, heavy loads of destructive bacteria may be in close proximity to the gum tissue’s blood supply.  Simple tasks such as tooth picking or chewing coarse foods may allow this bacteria to have access to the blood stream.  The periodontal causing bacteria is now circulating throughout the entire body.

We have known for many years that poorly controlled diabetics tend to have worse periodontal problems.  The condition is now considered to be more bidirectional.  Periodontal disease can also have an affect on diabetes control. A group of insulin dependent diabetics with periodontal disease were followed in a research study.  Those who had the periodontal disease treated needed less insulin and had more stable blood sugar readings than the control group.

Other studies have concluded that people with active periodontal disease are more likely to have cardiovascular disease.  Periodontal disease does not cause someone to have a heart attack but in may be as much of a contributing factor as smoking,, cholesterol, and high blood pressure.

In another study, people diagnosed with acute cerebrovascular ischemia or stroke, were found more likely to have an oral infection when compared to those in the control group.

Research studies have also shown that pregnant women with periodontal disease are more likely to have a premature low birth weight baby compared to women with healthy gum tissue.

Clearly, periodontal disease is far from being just an oral health problem and can adversely affect conditions outside the mouth.  Brushing, flossing, and regular professional cleanings are necessary for dental health.  As we are learning more and more, dental health is also important for systemic (overall) health.

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