AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Education/Credentials BA
DMD
Awards and Honors National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude
Question QUESTION: I am a 32 year old woman. When i was 14, I had corrective jaw surgery for a
severe underbite - bone was taken out of my lower jaw and bone was added
below my nose. I had five years of braces.
I have had teeth move position and gum recession occur in the last five years.
i am now living in France and have not found a dentist that seems thorough
enough so I am already looking into to finding a ADA member periodontist.
I floss, waterpick, and use an electric toothbrush daily. I am a major tooth
grinder and have been wearing some kind of night guard for six years.
Is the surgery I had a factor in my gum loss? It seems to be becoming
severe. I am very worried about bone loss and eventualy tooth loss, to say
nothing of the cosmetic aspects.
I am also in recovery from drug and alcohol abuse, so unfortunately had a
few years where I was very hard on my body and dental hygeine was not a
priority, although I have not lost any teeth due to my addiction. The last
dental exam I had I was told I had good hygeine but the dentist I was did not
take the measurement between my teeth and gums.
Any information you have is appreciated and any suggestions for what I
should do next is appreciated. Thank you for your time.
ANSWER: Maria - After the actual surgery and the braces, the excess pressure on the teeth, especially with braces can produce early periodontal problems. Many orthodontists are not totally aware of the potential and actually never look for an incipient problem. Once the periodontal problem begins at an earlier age, the areas are more prone to developing a recurrent problem in the future. It sounds like you are adamant about keeping your mouth clean, but you may need the assistance of a periodontist to help you. You are correct to look for one as soon as possible.
Another approach you can add to your cleansing techniques is to use Listerine (only that mouth rinse). Use it after you brush in the morning and at night before bed. Brush your teeth, floss and water pick and then rinse for 30 seconds with 1/2 capful. The Listerine will kill off bacteria in the mouth that produces the periodontal problem.
I wish you well and hope you find a periodontist soon. If you have additional questions, feel free to contact me again.
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QUESTION: Thank you for your helpful and quick reply. I will add Listerine to my hygeine
routine.
I have large black triangles (where gum used to be I assume) around several
of my front bottom and top teeth. Are there procedures to graft to areas with
such large loss? This is both a cosmetic and structural concern. I dont want
to lose my teeth.
Also, as a teeth grinder I wear a night guard of hard plastic. It seems to make
me bite down on my front teeth and I am experiencing soreness and have
continuous open cracks in the corners of my mouth. Does this sound like an
effective night guard? I also have one of soft plastic that gave me more
soreness on my molars and jaw muscles. Is this preferable to the hard plastic
one?
Is there any way to bring back lost tissue once it is gone?
I realize there is only so much you can answer via email. I sincerely thank you
for your time.
Answer Maria - The loss of tissue and bone can be corrected. You can have bone grafting to replace lost bone and they can take gum grafts from elsewhere in your mouth to replace the tissue loss.
As far as the night guard you are using, it should always be made of hard acrylic material. If you are feeling excess pressure from the guard on the front teeth, it needs to be adjusted. I hope the dentist who fabricated it knows how to properly adjust it - many dentists who make them don't know how to adjust them.
So you definitely have hope, but you need to see a periodontal specialist (periodontist) for the grafting and replacement of lost bone and gum tissue. You need a knowledgeable dentist for the adjustment of the night guard.
I wish you well and hope everything works out well for you. If you ever have any more questions, I am available.
