OH NO: Dr. Koshki just told me that I have gum disease…..

Symptoms of periodontal disease include red and swollen gums, persistent bad breath, and receding gums and loose teeth. Smoking, certain illnesses (such as diabetes), older age, and other factors increase the risk for periodontal disease. Without proper treatment, periodontal disease can lead to tooth loss.

Often called a deep cleaning, scaling and root planing is the first approach for treating periodontal disease. This procedure is a deep cleaning to remove bacterial plaque and calculus (tartar). Scaling involves scraping tartar from above and below the gum line. Root planing focuses on eliminating tartar and plaque below the gum and detoxifying the root surfaces where the disease occurs. Obtaining smooth roots and flushing out the pockets allows for healthy reattachment of the gums to the root surfaces. Dr. Koshki and his hygienists will reevaluate the success of this treatment in follow-up visits. If deep periodontal pockets and infection remain, periodontal surgery may be recommended. Dr. Koshki is one of the few dentists certified in the use of dental lasers for the treatment of gum disease. Dr. Koshki and his hygienists (also certified in the use of dental lasers) find that adding laser treatment to regular deep cleanings is the next step to helping you achieve excellent oral health. We are always glad to answer any questions you may have about your periodontal conditions and treatments in our office.

With all the threats to your oral health out there, it’s enough stress to make you bite your nails. But of the many nervous habits, biting your nails is one of the worst for your oral health! Next time you find yourself tempted to chew your nails sider the following:

1. Nail biting can wear down your teeth over time, causing enamel wear and uneven biting surfaces. Your teeth need a break between meals, but chewing your nails means they are essentially being used all day. This puts stress on your front teeth, which can cause them to become misaligned.
2. Nail biting is bad for your jaw. It can contribute to Temporomandibular (TM) disorder, which causes jaw pain, headaches, and locking and popping of the jaw. Additionally, according to the Academy of General Dentistry (AGD), people who bite their nails are at greater risk for bruxism, the unintentional grinding or clenching of the teeth, which brings its own negative effects.
3. Beyond the effects on your teeth and jaw, there are also sanitary concerns. Even if you’re a compulsive hand-washer, your hands are still one of the most germ-laden areas of your body, and your nails are doubly so. When you bite your nails, you are exposing yourself to illness causing germs that transfer from your hands to your mouth.
4. Need one more reason to stop biting your nails? Money.According to the AGD, people

who bite their nails pay an average of $4,000 in additional dental bills over their lifetime.

Can’t stop biting your nails? Ask your pharmacist to recommend special treatments to

apply to your nails which might help break your nail munching habit.

Just by looking at your tongue, Dr. Koshki can give a fair assessment of your health. So what do the various tongue colors mean?

• Red Tongue: A red tongue can mean that you are low on vitamin B12. Vitamin B12 is necessary for red blood cell production, which helps carry oxygen throughout the body and plays a vital role in maintaining brain function. If vitamin B12 levels stay low for too long, there’s a possibility for neurological problems to develop. Talk with your dentist about ways to improve your diet and prevent vitamin deficiencies from damaging your body.
• White Tongue: A white tongue can be a sign of bacterial or debris buildup on the surface of the tongue. This can be caused by mild dehydration, smoking, dry mouth, or illness. A white film on the tongue could be a sign of oral thrush, which is a type of yeast infection.
• Black Tongue: A black tongue could be caused by a variety of factors. A “black hairy tongue” is a harmless overgrowth on the tongue, usually when the papillae (tongue hair) traps bacteria and other tongue debris. A black tongue could also be a sign of improper oral hygiene, excessive use of tobacco, antibiotics, mouthwashes, or even Pepto-Bismol type stomach medications. These usually resolve itself on its own, but it black tongue lasts for longer than 10 days than you should consult Dr. Koshki.
• Yellow Tongue: A yellow tongue, similar to black tongue, can also be a sign that bacteria is trapped within the papillae. Simply improving oral hygiene can often return your tongue to its normal color.

If you think your tongue color is off, or you have additional symptoms like burning, swelling, change in taste or difficulty moving the tongue, make an appointment with Dr. Koshki as soon as possible.

Our office receives many inquiries regarding dental insurance.  My office manager (Vicki) and I have both been in the dental profession for over 25 years, and in that time we have seen tremendous changes in dental benefit coverage. When the first company offered dental insurance in 1950, the policy covered an individual for $1000 in benefits per year. Many people have a similar annual limit 65 years later! There is a lot of misinformation being disseminated about dental insurance, and I thought it would be a good idea to address some of these points:

Q:      Why doesn’t my insurance cover the procedures that Dr. Koshki tells me that I need, like a night guard or an implant?

A:      Dental insurance isn’t really insurance after all.  It is a pre-determined benefit which allows a reduction of fees (if within a PPO network), and a specified amount a year to be used to help cover the costs of dental care.  It is not based on individual needs or diagnosis. The insurance company never sees your health assessment, nor do they change benefits for individuals based on any criteria. All benefits are the same for all members of a group and are fixed and created to make fiscal sense to the employer or group offering the plan.

Q:      I don’t have insurance, what plan can you recommend for me as an individual?

A:      There is no individual policy that will pay well or give you comprehensive coverage. Any individual policy available will either be a simple discount plan (with extremely low reimbursements paid directly to you after you pay us in full), or the few PPO’s that exist for individuals have extensive limitations, exclusions, downgrades and significant waiting periods that devalue paying for any such policy.

Q:      What should I do then? Are you telling me I can’t get help to pay for my dental care?

A:      Unlike medical care, dental care is still affordable for most people. The important thing is to keep up with excellent home care (brushing and flossing, following instructions given by Dr. Koshki or his Hygienists). See us for preventive care at least twice a year, and barring emergencies, your expenses should not present a burden. If you need more extensive dental care, we have interest free financing for extended periods of time to help you budget.

Q:      My group dental policy booklet says that all procedures are covered at 100%, why do I still have to pay out of pocket when I see Dr. Koshki?

A:      The details of many plans are complex. Keep in mind that your insurance is a contract between you, your employer and the insurance company.  There are deductibles, exclusions, frequency limitations and downgrades that are ever changing. This office does everything it can to help understand your plan, but we cannot know every detail of your contract.   

Q:      I have double coverage, will all of my services be covered at 100%?

A:      There have been changes in “Coor­di­na­tion of Ben­e­fits” poli­cies that your insur­ance com­pa­nies may fol­low, and even though you have dou­ble cov­er­age, you may still need to pay out of pocket for some of your treat­ment charges.

Q:      Will you still see me if I have HMO plan?

A:      We will wel­come you as a patient and you will need to pay 100% out of pocket for all ser­vices provided.

Here at the office of Dr. Moeiz Koshki, you will be treated with the utmost respect and consideration. We provide all dental treatments with prevention at the forefront of care. We offer the same level of excellence regardless of any or no insurance involvement. 

From American Pregnancy Association, Dr. Koshki recommends this advice on an important topic:

Swollen gums, which may be sore and more susceptible to bleeding, are common during pregnancy. This inflammation of the gums is called gingivitis. Pregnancy gingivitis is caused by the hormonal changes that increase the blood flow to the gum tissue and cause your gums to be more sensitive, irritable and swollen.

The hormonal changes also hinder the body’s normal response to the bacteria which causes periodontal infections. This makes it easier for plaque to build up on your teeth and makes you more susceptible to gingivitis. The severity of pregnancy gingivitis usually increases in the second trimester.

What Can You Do To Manage Your Swollen Gums Better?

Good dental care is essential during pregnancy. You should brush your teeth at least twice a day and floss at least once a day. A soft toothbrush may cause less irritation to your gums. You should also keep your scheduled professional cleanings and discuss any problems with your dentist.

If gingivitis is left unchecked it may lead to a more serious form of gum disease called periodontitis. Periodontitis during pregnancy increases the chance of preterm birth. The good news is that with good oral hygiene and routine professional cleanings, there should be nothing for you to worry about.

Here are a few things that you can do to manage swollen gums and have healthier oral hygiene:

• Have at least one oral checkup with your dentist during pregnancy
• Use a daily or periodic warm salt water rinse (1 teaspoon to 1 cup)
• Brush your teeth twice per day, especially after vomiting from morning sickness
• Practice good nutrition

Your gums usually return to normal following the delivery of your baby. The bleeding and sensitivity should diminish. If swelling and irritation continue after delivery or get worse during your pregnancy, contact Dr. Koshki.

Abfraction lesions are small notches caused by stress (forces) on your teeth. Biting, chewing, clenching and grinding put pressure on your teeth. Over time, this pressure can cause cracks and splits in the outer layer of your teeth. This occurs in the thinnest part of your enamel, near the gumline. Grinding your teeth puts pressure on them over and over. For this reason, people who grind their teeth are more likely to get abfraction lesions.

Abfraction lesions are fairly common in adults. Older adults are especially likely to have them. They occur more often in the back teeth, called premolars and molars. But they can occur in the front teeth as well. They appear as crescent-shaped or wedge-shaped notches near the gumline.

Teeth with abfraction lesions are not more likely to decay, but they can get weaker over time. Weak teeth may be more likely to break.

Abfraction lesions don’t usually hurt. They affect the enamel, the outer layer of the tooth. In severe cases, the dentin and cementum layers of a tooth may become involved. Dentin is the layer below the enamel. Cementum covers the tooth root instead of enamel. Dentin may be exposed if a crack develops. In these cases, the tooth may become sensitive. Otherwise, the lesions do not cause symptoms. Dr. Koshki can see abfraction lesions during a regular dental exam. Abfraction lesions do not heal over time.

Abfraction lesions are caused by the uneven forces produced when you bite or grind your teeth. Therefore, you usually can’t prevent them. If you grind or clench your teeth, you can wear a night guard to reduce the pressure on your teeth.

Dr. Koshki can treat abfraction lesions by filling them. The process is often like filling a cavity. In other cases, the tooth does not need to be drilled first. The material also is similar to a tooth filling. Dr. Koshki always uses tooth colored filling material to treat abfraction fillings.

If you notice notching or wear on your teeth near the gums, you do not need to call Dr. Koshki right away. You can point them out at your next visit. You may want to come in sooner if the lesions are causing tooth sensitivity. Using special gels or pastes recommended by our office may also reduce sensitivity issues caused by abfractions.

Note: An abfraction lesion is not the same as a cracked tooth. A cracked tooth is much more serious. Deep cracks are likely to affect the inside of the tooth, the pulp. These cracks are painful. These teeth need to be treated right away.

Always feel free to ask Dr. Koshki about any concerns that you might have regarding abfractions or any other oral health issue.