Gregory E. Oxford, DDS, MS, PhD  &  Isabell G. Oxford, DMD
100 Whetstone Place, Suite 308, St. Augustine, FL 32086  (904) 810-2345

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By Oxford Dental Associates
October 27, 2015
Category: Oral Health
Tags: gum disease  
GingivitisCouldBecomeaMoreSeriousFormofGumDisease

People with poor hygiene habits can develop a chronic form of periodontal (gum) disease known as gingivitis. Characterized by inflamed and bleeding gums, gingivitis is caused by an infection triggered by bacterial plaque, a thin film of food remnant built up on tooth surfaces.

This chronic form of gingivitis, though, can quickly escalate into more serious forms of gum disease that may lead to tooth and bone loss. One such condition is Acute Necrotizing Ulcerative Gingivitis (ANUG), also known as “trench mouth.” ANUG is a painful condition that can appear suddenly and result in extensive tissue damage and ulcerations, particularly in the papillae, the small, triangular bits of tissue between teeth. Persons with ANUG may also develop a foul breath and taste.

Gingivitis often develops into ANUG when certain mouth conditions exist: poor diet, smoking, which can dry the mouth and disrupt healthy bacterial flora, and increased stress or anxiety. If caught early, though, ANUG is highly treatable and reversible.

After determining you have ANUG and not another condition, our first step is to relieve the symptoms with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to manage pain and reduce swelling. We also prescribe a regimen of antibiotics like Amoxicillin (a proven antibiotic against the specific bacteria that cause ANUG). This should decrease the symptoms within 24 to 48 hours.

As the inflammation subsides we want to continue treatment by removing any plaque or calculus (hardened plaque deposits), especially in hard to reach places. This involves a technique known as scaling in which we used specialized hand tools or ultrasonic equipment to manually remove and flush away plaque and calculus.

The final step depends on you. To prevent reoccurrence, it’s important for you to consistently practice effective oral hygiene to remove plaque — brushing twice and flossing once each day, and visiting us at least twice a year for cleanings and checkups. Quitting tobacco and improving your diet will also reduce your risk for ANUG.

ANUG and any other form of gum disease can cause a lot of damage. But taking steps to care for your teeth will help keep this acute form of gingivitis from arising in the first place.

If you would like more information on gingivitis and other forms of gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Painful Gums in Teens & Adults.”

By Oxford Dental Associates
September 04, 2015
Category: Dental Procedures
Tags: gum disease  
DontDelayTreatmentofGumDisease

Periodontal (gum) disease is a bacterial infection, which if left untreated could cause gum recession, bone loss and eventually tooth loss. Caused mainly by plaque left on tooth surfaces from poor hygiene practices, the deeper the infection spreads below the gum line, the more difficult it is to treat.

One possible scenario involves parts of a tooth’s root structure known as furcations. These are branching forks formed during the early development of teeth with multiple roots where they take different paths from the base of the crown. As gum disease spreads around the root it may cause different degrees of bone loss at the point of the branch.

It’s imperative when treating gum disease to uncover and remove any bacterial plaque or calculus (hardened plaque deposits) found, including below the gum line. To address bacterial plaque at the root level, it’s important to first determine if bone loss has involved the furcations (where the roots separate, also referred to as a “furcation invasion”) and to what degree.

We usually classify this degree of involvement in three classes: Class I, the invasion has created a groove in the furcation, but minimal significant bone loss; Class II, the bone loss has extended into the furcation by at least two millimeters; or Class III, the bone loss extends completely from one end of the furcation to the other (or “through and through”).

Depending on the class, cleaning plaque and calculus from furcations and then maintaining them thereafter can be quite challenging. We may need to use specially shaped hand instruments known as scalers or curettes to reach and clean root surfaces, or ultrasonic scalers that use high-frequency vibrations and streaming water to loosen and flush away plaque debris. It may also prove helpful, though limited, to apply antimicrobials or antibiotics to the area to help limit the levels of bacteria.

Disease damage around furcations may also require surgical treatment to encourage new tissue and bone growth in the area. Surgery can also help make the area more accessible to future cleaning and maintenance, both for you and us. Renewed hygiene practices on your part and regular cleaning and checkups with us will help ensure that the situation involving your tooth roots can be kept under control and your tooth preserved for many years to come.

If you would like more information on treatments for gum disease, please contact us or schedule an appointment for a consultation.

By Oxford Dental Associates
July 06, 2015
Category: Oral Health
Tags: pregnancy   oral hygiene   gum disease  
BabyYourTeethandGumsDuringPregnancy

For a healthy pregnancy, it helps to have healthy teeth and gums. In fact, the American College of Obstetricians and Gynecologists (ACOG) encourages its members to advise expectant moms to see their dentist. But maintaining oral health can be more challenging when you’re expecting. For one thing, hormonal changes make you more susceptible to periodontal (gum) disease, which has been linked to “systemic” (general body) health problems including preterm labor and low birth weight.

Periodontal (gum) disease results from the buildup of bacterial plaque on tooth surfaces in the absence of good oral hygiene. It typically starts as gingivitis — inflammation and redness around the gum margins and bleeding when brushing and flossing. If the infection progresses, it can attack the structures supporting the teeth (gums, ligaments, and bone) and may eventually result in tooth loss. And if the infection enters the bloodstream, it can pose health risks elsewhere in the body. Studies suggest that oral bacteria and their byproducts are able to cross the placenta and trigger an inflammatory response in the mother, which may in turn induce early labor.

TLC for Your Oral Environment

Brushing twice daily with fluoride toothpaste and flossing or using another interdental cleaner at least once daily is your first-line defense again bacteria buildup. Professional cleanings are also important to remove hardened plaque (calculus) that brushing and flossing may miss. And regular checkups can catch problems early to avoid or minimize adverse effects. Periodontal disease and tooth decay aren’t always painful or the pain may subside, so you won’t always know there’s a problem.

Dental emergencies such as cavities, root canals and tooth fractures should be treated promptly to address pain and infection, thereby reducing stress to the developing fetus. Of course, if you know you need a cavity filled or a root canal prior to becoming pregnant, that’s the optimal time to get treated!

If you would like more information about dental care during pregnancy, please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “Pregnancy and Oral Health.”

By Oxford Dental Associates
February 12, 2015
Category: Oral Health
GumDiseaseAreyouatRisk

Did you know that roughly 75% of Americans suffer from some sort of gum disease? Gum disease (also known as periodontal disease) refers to the progressive loss of attachment between the fibers that connect the bone and gum tissues to the teeth, and the consequential loss of the tooth-supporting bone itself.

As you get older, your chances for developing gum disease increase significantly. Here are a few other factors that might put you at a higher risk for developing gum disease:

  • Family History. 30% of the population may be genetically susceptible to gum disease. Luckily, there are new tests that can assess if you are at risk. However, even with good oral hygiene, studies have shown that genetically susceptible individuals may be 6 times more likely to develop gum disease.
  • Tobacco. Smokers are four times more likely to develop periodontal disease. Smokers have more disease-causing biofilm bacteria and collect it more quickly. They also lose more attachment between the teeth and gums, which leads to more loss of bone that supports the teeth.
  • Bleeding Gums. Some people mistakenly think that it is normal for their gums to bleed when they brush. In fact, this is an indication that you are not brushing and flossing effectively and a common symptom of gum disease. Pregnant women are also more likely to have bleeding gums, because elevated hormone levels may cause gum tissues to be more responsive to bacterial biofilm, thus bleeding more easily. That is why we recommend that pregnant women have regular cleanings at three to four month intervals.

We often refer to gum disease as silent, because symptoms may not appear until the disease has advanced. For this reason, you should conduct a self-assessment to identify if you are at risk.

  • Have your gums receded and/or do your teeth appear longer?
  • Are any of your teeth feeling or getting loose?
  • Do your gums appear red or swollen?
  • Have you recently had a tooth or teeth extracted because they were loose?

If you answered “yes” to any of these questions, then you may be at risk for gum disease. You should make an appointment with our office so that we can conduct a thorough examination and prescribe treatment, if necessary.

If you would like more information about gum disease, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Assessing Risk for Gum Disease.”

By Oxford Dental Associates
August 06, 2013
Category: Oral Health
Tags: gum disease   diabetes  
TakingaCoordinatedApproachtoTreatingDiabetesandPeriodontalDisease

Diabetes and periodontal (gum) disease are two types of inflammatory conditions that have more in common than was once thought. There is strong evidence to show that each of these diseases is a risk factor for the development and growth of the other. Studies have also found that treating one condition successfully may have a positive impact on the treatment of the other.

From the Greek meaning “to pass through the urine,” diabetes mellitus causes an abnormal rise in blood glucose level that can't be adequately controlled by insulin, the body's primary hormone for that task. Either the pancreas can't produce an adequate supply of insulin (as with Type 1 diabetes) or there is resistance to the hormone's effects (as with Type 2 and gestational/pregnancy diabetes). If you are a diabetic patient, you face many difficult issues with your health: your body develops an altered response to inflammation that may severely inhibit wound healing. You also may become more prone to chronic cardiovascular disease.

Periodontal (gum) disease describes a group of diseases caused by dental plaque, a whitish film that contains infection-causing bacteria. As infection rises within the gum tissues, the auto-immune system of the body responds to this threat and inflammation results. If the person is also a diabetic, this response may be impaired and may have a direct effect on how severe the periodontal disease progresses.

Periodontal disease can also affect your blood glucose level, if you are a diabetic. A number of studies have demonstrated that diabetic patients who have improved control of their periodontal disease through better oral hygiene and dental treatments have shown improvement in their blood sugar levels. There's even some evidence that effective periodontal treatment that reduces inflammation may improve the body's sensitivity to insulin. Likewise, bringing diabetes under control with supplemental insulin or positive lifestyle changes can help lessen the likelihood and severity of periodontal disease.

To sum it up, if you have been diagnosed with some form of diabetes, taking care of your teeth and gum tissues can have a positive impact on your diabetes. Likewise, making healthy changes in your lifestyle to bring your diabetes under control can reduce your risk for periodontal disease.

If you would like more information about periodontal disease and its effect along with diabetes, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Diabetes and Periodontal Disease.”