Periodontal Services

If your dentist has concerns that you may have a form of periodontal disease, he or she may refer you to Dr. Morarend for an evaluation for periodontal services. During your periodontal exam, the spaces between the teeth and the gums will be measured, any looseness of the teeth will be assessed, and your x-rays will be evaluated to determine the strength of the bone supporting the teeth.

Treatment of periodontal disease varies depending on the level of periodontal disease and is aimed at the least invasive and most cost-effective option. Most often, periodontal disease is treated non-surgically through Scaling and Root Planing, commonly referred to as a “Deep Cleaning.” During the deep cleaning, plaque and calculus (tartar) are removed from the root surfaces of the teeth below the gumline, beyond where you are able to clean with a toothbrush and deeper than what is possible with a regular dental cleaning. Occasionally, antibiotics may also be used depending on the individual situation.

Periodontal services may be recommended in the case of gum recession. Gum recession is a common condition in which the gum tissue wears away or moves away from the neck of the tooth exposing a portion of the root of the tooth.  Recession can be caused by a number of contributing factors including periodontal disease, aggressive tooth brushing, and genetics.  Not all gum tissue recession is problematic, however, in many cases, it can lead to a higher risk for cavities, tooth sensitivity, and in severe cases, tooth loss.

Gum tissue grafting is performed to cover exposed root surfaces, and to increase the thickness of gum tissue to prevent further recession and tooth loss.  Grafting is also often performed before, during, or after orthodontics (braces) for patients with thin gum tissue, as movement of the teeth can lead to recession.  In addition, grafting may be performed for aesthetic reasons to cover root surfaces and prevent the appearance of “long” teeth leading to a healthier and younger looking smile.

Pocket reduction is performed to clean the root surfaces of the teeth below the gum line. When periodontal disease is present, the supporting tissue and bone around the tooth is destroyed, forming pockets around the tooth that become deeper over time, allowing a greater chance for bacteria to thrive. During a pocket reduction procedure, Dr. Morarend will remove the disease-causing bacteria, and in some cases, smooth the irregular surfaces of the damaged bone in which bacteria can hide, in order to halt the progression of periodontal disease and maintain overall oral health.

Aesthetic crown lengthening is usually performed to correct a gummy smile. In some cases, the teeth look short and stubby and partly covered by gum tissue due to either genetics or gingivitis. Periodontal services can correct this cosmetic issue. Dr. Morarend performs this procedure to expose more of the patient’s teeth. In gum reduction surgery, the excess gum tissue is removed to reshape the outline of the gums. The tooth is then more exposed creating a fuller, more attractive smile. The same procedure can also be done create a more aesthetic gum line for dental crowns and other restorative procedures.

Periodonal services can also address gaps that form by missing teeth. These gaps can cause periodontal disease and infections that may affect a person’s ability to eat or speak. It is very important to fill in any gaps to prevent the adjacent and opposing set of teeth from shifting positions or causing further damage to the mouth. Gaps are also not very attractive, and therefore artificial teeth act as a restorative and cosmetic dental procedure. With today’s advancements in dentistry, your tooth implant will look and feel extremely natural, and most patients forget the tooth was replaced.

Dental implants are fused to the bone and offer more stability than traditional bridges and dentures. During the procedure, the implant will be inserted into the jaw to replace the tooth root. After the implant heals, your general dentist or prosthodontist will make you a crown to fit over the dental implant that looks like a natural tooth.

Many patients sense greater security with artificial teeth than other procedures because they are secured into the jaw. In order to qualify for this procedure, you must have a set of healthy gums and enough bone to support the implant.

In addition to their many aesthetic advantages, dental implants offer a number of benefits for your oral health. Artificial teeth allow for the replacement of one or more teeth without affecting the bordering teeth. Additionally, implants can support a bridge and eliminate the need for removable partial dentures. Because dental implants are easier to brush and keep clean than dentures or bridges, they may reduce your risk of developing gum disease in the future. Finally, these can help preserve the integrity of your mouth and face by supporting gum and jawbone structure.

Another important component of our periodontal services is one where grafting thickens the jawbone to allow for the successful placement of dental implants. Bone grafts can also help elevate the sinus floor, fill defects in the jawbone, and restore lost bone around teeth from periodontal disease. In most cases, a small opening is made in the jawbone and then packed with an artificial bone grafting material. Sutures are placed, and restorative treatments are performed once healing is complete.

Periodontal services can also include this procedure, which is usually performed prior to the placement of dental implants. The success of an implant is highly dependent on the quantity and quality of the jawbone to which it will be attached. If the jawbone has receded, a sinus augmentation can slightly elevate the sinus floor to allow new bone to form. Generally, a small incision is made and the underlying space is packed with grafting material. The incision is sutured closed, and the implant will be placed once healing has occurred.

Functional crown lengthening is performed when the tooth is too short for crown placement, or cavities extend deep into the tissue. The goal is to expose more tooth structure in order to retain a crown and improve the health and longevity of the gum tissue restoration.

Periodonal services can also treat deformities in the jawbone. Ridge modification procedures are used to treat deformities in the jawbone which have occurred due to periodontal disease, trauma, or birth defects. During the ridge modification procedure, Dr. Morarend gently pulls the gum away from the bone to fully expose the defect. The defect is then filled with bone graft material and sutured closed. When healing occurs, the cosmetic appearance of the jaw is much improved and implants can be successfully placed where necessary.

Occasionally teeth do not erupt as they typically should and are “stuck” below the gums; periodontal services can address this issue as well. This can occur with any tooth, but is common with upper canine or “eye” teeth. When teeth are impacted, your orthodontist will refer you for a minor surgical procedure in which the gum tissue is lifted to expose the tooth. During the procedure, Dr. Morarend may bond a bracket or gold chain that will allow your orthodontist to pull the tooth into position.

Sedation is a process to establish a relaxed, easy, and calm state through the use of sedative medications. For your comfort, during periodontal services, these medications can be administered in pill form, inhaled through the nose (nitrous oxide), or injection intravenously (IV). In this sleepy state, patients can still respond if requested, but it can feel as though treatment is completed very quickly (oral or nitrous oxide) or patients may have little or no memory of the procedure (intravenous).  This is called conscious sedation for that reason and is very safe in the outpatient setting when administered by Dr. Morarend. You may not always be asleep, but you will be comfortable, calm, and relaxed.  Many times, oral anti-anxiety medications are combined with nitrous oxide or intravenous routes.

We are happy to offer sedation to nearly all our patients in one form or another. Intravenous medications may be limited to healthy patients with more severe dental anxiety. Depending on patient preference, planned procedures, or cost, one form of sedation may be preferable to the others. Oral and IV sedation both require an escort/driver to and from the office. With IV sedation, you must also not have anything to eat or drink for six hours prior to your dental appointment.  A consultation prior to the date of treatment is required to allow Dr. Morarend to review your health history and determine which type of sedation is best for you.

With IV sedation, a thin needle will be placed in a vein and all medications will be introduced through the tubing. The goal is to provide a safe level of disassociation of the patient’s awareness from the procedure being performed  It is desirable to use the smallest amount of medication possible to achieve comfort while maintaining safety during and after the procedure. Dr. Morarend has had training in sedation, maintains certification in Basic Life Support (BLS) as well as Advanced Cardiac Life Support (ACLS) as mandated by the Iowa Dental Board. A bi-annual sedation permit is granted by the Board, and an on-site inspection is completed to assure the safety of the facility and equipment.

Nitrous oxide is a sweet smelling, non-irritating, colorless gas which is inhaled through the nose.  It was developed by a dentist long ago and has been used with extreme safety for 175 years. It is a very effective means of relieving mild-to-moderate levels of anxiety and even an exaggerated gag reflex. You likely will not fall asleep but will have drowsiness, possibly experience euphoric feelings, feel a whole-body comfort, and feel like treatment went more quickly than it actually did.  The amount given can be modified throughout the procedure and tailored minute-by-minute for each patient. Afterward, the effects are removed within five minutes and you can drive yourself.  It is extremely safe for adults and children.

The levels of sedation used include:

• Minimal sedation — you are awake but relaxed.
• Moderate sedation (formerly called “conscious sedation”) — you may slur your words when speaking and not remember much of the procedure.

The following types of sedation are used in dentistry:

• Inhaled minimal sedation.
• Oral sedation.
• IV moderate sedation.

Description credit: WebMd.com