Frequently Asked Questions
If the below does not address your specific questions, please contact our helpful and knowledgable reception staff at (650) 571-1900
Dr. John believes in the minimally invasive approach to soft tissue grafting. The tissues are reflexed just enough with microblades to place the graft. The most common soft tissue graft that Dr. John does is the Connective Tissue Graft using the patient’s own tissue. However, if Dr. John feels that the Allograft will give the same results as the Autograft, he will often times recommend the Allograft to spare his patient’s the additional trauma of having the palate as a secondary surgical site. Dr. John will only recommend an Allograft from one of two extremely reputable companies. Dr. John has had years of experience using and perfecting the use of the Allodermal grafts.
Auto Grafts: This type of tissue comes from your own mouth. The sides of the roof of your mouth (adjacent to the molar and bicuspid areas) is the most common donor site. For the Free Gingival Graft, the graft is taken from the top 2mm surface of the roof of the mouth. For the Connective Tissue Graft, the graft is taken from just underneath the surface of the palate. The wound is usually smaller and heals faster than the Free Gingival Graft. Both donor sites are sutured.
Allo and Xeno grafts: The Allograft is tissue that is donated from another person. The allografts used for soft tissue grafting are a dermal matrix, collagen, that has all cellular components removed and ‘sterilized’ using a number of various techniques. The Xenograft is tissue taken from an animal, usually a cow, that has all the cellular components removed and ‘sterilized’ using a number of various techniques. Both of these grafts are very safe. Because the cellular components are removed, typical donor tissue rejection is not seen in these grafts.
The main goal in sift tissue grafting for recession is to thicken the soft tissue covering the tooth to prevent further recession. The secondary goal in soft tissue grafting is to attempt coverage of the root that has previously been exposed by the recession. Unfortunately, total root coverage is not always possible. Dr. John should be able to give you a pretty good estimate as to how much root coverage you can expect after the grafting.
Gum or gingival recession is the movement of the gums resulting in exposure of the root surface of the tooth/teeth. The primary factor in the development and progression of recession is due to the minimal thickness of the gums and bone surrounding the teeth and/or position of the tooth in the jaw bone. Other factors that may affect recession are too aggressive tooth brushing, too hard of a tooth brush and grinding and/or bruxing your teeth.
Periodontal disease is the progressive breakdown of the supporting structures of the teeth. The primary cause of periodontal disease is a combination of plaque and calculus. Plaque is bacteria that form on the teeth. Calculus is the hard stuff that forms on the teeth. Calculus requires the attention of the dentist or hygienist to remove. Whereas plaque, can usually be removed by the patient. The areas the patient can’t quite get to to remove, then that’s when we get involved with the cleaning and removing of the plaque and bacteria. If left alone, or untreated, or if we don’t remove it, then unfortunately, the plaque and bacteria will create a chronic inflammatory process, which results in the continued progression of bone loss around the teeth and ultimately tooth loss.
We use a number of techniques to go ahead and diagnose periodontal disease. The primary tool that we use in diagnosing periodontal disease is the periodontal probe. It’s a small measuring tool that we place between the gum and the tooth, to see how deep the pockets or the gap is. Normally, zero to three millimeters is considered healthy. Four millimeters is on the borderline. Five millimeters and above is potentially considered to be diseased. In addition to going ahead and looking at the pockets, we also look for other signs, for instance, bleeding. If there’s bleeding on probing or spontaneous bleeding, we look at if there’s any infection or pus that happens to be formed around the gum line area, and we look at plaque control. If there’s a lot of plaque build-up around the teeth, then there’s a more likely chance of developing a problem or a disease process. In addition, we look at x-rays. X-rays are very important in the diagnosis of periodontal disease. A lot of times, people think x-rays are just kind of a formality or a luxury. But x-rays actually are a very, very integral part in the detection of periodontal disease.
Toothpastes are actually detergents. A detergent is designed to loosen up the plaque, making it easier to remove from the teeth. So that’s pretty much all that a toothpaste does, is it helps to remove the plaque and bacteria. By loosening the plaque, making it easy to remove, means there’s going to be less plaque buildup, and hopefully, less bleeding gums. All toothpastes have the ability to go ahead and break up the plaque and bacteria, and aid in the reduction of bleeding gums. There’s some toothpastes that have other components associated with them, which are also designed to help reduce the amount of bacteria. Fluoride was in toothpaste, which helps kill the bacteria, but also helps to strengthen the tooth at the same time. While toothpastes are beneficial, there really isn’t necessarily one toothpaste that is greatly beneficial over another one. What we tend to find, is that certain people would respond better to one toothpaste than others do. Why? I couldn’t really tell you and I don’t know. There are also some people out there that feel that you shouldn’t use any toothpaste, just brush with a dry toothbrush or a damp toothbrush. Most of the time, it’s very patient selective… I should say, individualized for each patient, and that’s how we choose whether or not to recommend a toothpaste or not.
Interviewer: And toothpastes that advertised to strengthen enamel, do you know if they actually do that?
Dr. John: Yes, most of those toothpastes are designed to strengthen the enamel.
Interviewer: And fluoride, is that a component of detergent?
Dr. John: I feel that fluoride is very beneficial in toothpaste, some individuals don’t. It’s just more a matter of my opinion.
Interviewer: And what about mouthwash that’s advertised for the reduction of gingivitis or plaque, etcetera?
Dr. John: Most of mouthwashes, again, are alcohol-based or detergent based, mostly designed to flush out the bacteria. So as you brush your teeth, loosen the plaque, it’s mostly designed to kind of flush them out. Do they have any therapeutic benefits? There are some mouthwashes out there that do. But as for, again, each patient may show the benefits with the mouthwashes, other patients don’t.
What are some of the treatments that my dentist or periodontist might recommend for periodontal disease?
There are different types of periodontal diseases. Some of which are very minor, such as gingivitis. Which all it means is just an inflamed gum. Others involve break down of the bone support and a little bit more advanced from potential loss of the tooth. The treatment therapy is usually started off as being simple. Keep it simple and then proceed from there. The first therapy you wanna do is optimal oral hygiene. Brushing, flossing, tooth picking. So the first phase of treating periodontal disease is making sure the patient is doing a great job and optimizing cleaning their teeth. Once we’ve done that, the next step would be to go ahead and remove any sort of plaque or calculus by the doctor. Common procedure in more advanced periodontal treatment is root planing, or deep cleaning. It involves a little bit deeper type of a cleaning underneath the gum to make sure there aren’t any plaque or calculus. After the deep cleaning, we give about three or four weeks of healing.
Make sure that the body’s able to respond to that type of therapy, we then do what’s called a re-evaluation. Re-evaluation is where we probe around the tooth just like we did in the initial examination. What we’re looking for is decreased bleeding, decreased irritation, and decrease in the pockets. If we don’t happen to see a decrease in each of those, then we try to determine how come, or why that they didn’t end up responding. If they didn’t end up responding because there’s calculus remaining or if there is, we can’t get the calculus, then we go into what’s called phase two, a more advanced therapy. Phase two therapy could include periodontal surgery, could involve laser therapy, or a number of other different types of treatments.
So with periodontal disease, per se, or bone loss, again it depends, we start off easy and then the therapies get advanced from there. The other thing that we need to look at, is potential of medical influence. There are patients who are diabetic, patients who smoke, or patients that take medications that will influence a periodontal disease. So a part of the overall treatment is making sure that these patients are looked at, and evaluated, and see if they have other contributing factors, which could be creating a problem to their disease process.
Yes. We think of periodontal disease as a plaque related irritation of the gums and potential bone loss. We also take care of what’s called gingival recession, where the gums are starting to recede away from the tooth. This is not necessarily related towards periodontal disease, but more or less a tooth position problem, or how thin or how thick the gums are. The problem with recession, is that sometimes, if you allow recession to progress, it can ultimately lead in to cavities, decrease in ability to clean them efficiently, and even potential tooth loss. We tend to recommend to do what’s called soft tissue grafting on those types of situations. There are a couple different ways of doing soft tissue grafting, one of which utilizes your own tissue, and some of which utilizes what we call a donor tissue, or collagen types of… Donor type of tissues.
Pain is associated with pressure due to an infection or nerve trauma. You can have a progressing problem that needs attention that has not created pressure and/or nerve trauma. Many times pain is associated with a condition that is advanced. Do not wait until it hurts!
We use the most advanced techniques in pain management.
Post treatment pain is different for each type of procedure and different for every patient. Dr. John will let you know what to expect before and after the treatment and will prescribe any pain medication to help reduce the post op discomfort.
There are times that a condition has numerous options on how to treat it. Dr. John will go over all of your options and discuss the pro’s and con’s of each.
The biggest concern of not having the recommended treatment done is possible worsening of your condition and tooth/teeth loss. If a condition advances, the treatment recommended may no longer work and a more aggressive treatment may be necessary.
This question is more individually and condition based. “Periodontal disease” is not “treated”, it is controlled. Every day you clean your teeth, you are treating/controlling your periodontal condition. Most periodontal conditions are maintained with regular cleaning by you and regular maintenance cleanings by your dental therapist. There are also systemic and environmental factors that can affect the stability of your condition.
Why do some hygienist use hand instruments and some use an ultrasonic scaler and what is the difference?
Some dental hygienist prefer to use hand instruments and some an ultrasonic scaler. Most will use both during your appointment. Both techniques work very well. Usually the instrument used is what the therapist was trained with and feels most comfortable with.
If I am having my teeth cleaned regularly, why do I sometimes need to have some root planing, laser therapy and/or periodontal surgery done?
A typical periodontal maintenance (cleaning) involves a scaling both above and below the gums. Some individuals develop more and/or harder calculus below the gums than what a hygienist can remove in a standard cleaning appointment. These areas may require more time and/or more aggressive therapy to remove the calculus and possibly repair any damage.
The recommended frequency of your cleanings is based on your periodontal condition. Twice a year cleanings are usually enough for the average individual who does not have a periodontal condition. Just because your insurance will only pay for 2 cleanings a year does not mean that this is best for you.
There are hundreds of dental plans out there. It is impossible for us to be familiar with every plan. If you give us your current insurance information 5 business days prior to your appointment, we will do our best to research your plans benefits and remaining funds to give you as close as possible estimate on what your insurance company should pay and your co-payment. Please remember that while you may have insurance, you are ultimately responsible for final payment for the treatment. Please see our section on Insurance for more information.
There are times that we can get booked up fairly far in advance. We do get cancellations. If you wish to get in sooner, let us know and we will put you on our cancellation call list. Chances are very good that we will be able to get your in sooner.
We require a 3 day notice if you need to cancel an appointment or there may be a cancellation fee. We understand that illness and emergencies come up.
We have payment options available. The payment options need to be worked out before that day of your appointment. Your quoted estimated co-payment is due the day of the appointment.