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The Practice SF Blog | News and perspective on periodontal healthcare and implant dentistry
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FDA Approved Laser Therapy Video (LANAP)

Want to know more about Laser Therapy?
Watch our 2 mn presentation.

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Photo of PerioLase MVP 7

Dr. Conte and Dr. Guglielmoni now delivering laser treatment

Laser Periodontal Therapy™ is the FDA-cleared and patented laser gum therapy that greatly reduces the pain and recovery time associated with traditional gum surgery. Dr. Conte and Dr. Guglielmoni of The Practice SF are the first periodontists in San Francisco to be fully trained and licensed to perform this breakthrough therapy.

The PerioLase® MVP-7 is the first-ever digital dental laser in the United States marketplace, and The Practice SF is using the technology for Laser Assisted New Attachment Procedure (LANAP). The laser energy selectively removes diseased or infected pocket epithelium from the underlying connective tissue. Because the treatment spares healthy connective tissue, healing and regeneration of the tissue around the teeth is enhanced. The PerioLase® MVP-7 is the first and only laser to receive FDA clearance for the LANAP protocol, which has been clinically shown to reduce inflammation and infection around teeth and promote a healthy environment for the natural healing of wounds.


“The PerioLase is 21st century digital technology,” said Dr. Guglielmoni. “We recognized it as an important step in moving away from conventional treatments that involve the cutting away of gums.”

“PerioLase is the most advanced laser on the market today,” added Dr. Conte. “It has seven different pulse durations and operates at a wavelength that kills bacteria associated with periodontal disease. We feel it is an essential weapon in the fight against gum disease.”


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Important periodontal research for closing your dental year

The American Academy of Periodontology circulated a good recap of recent research about oral health and its connection to systemic health.  These points are good to know, and we share them below.

“Research has shown that there may be an association between periodontal disease and other chronic inflammatory conditions, such as cardiovascular disease and diabetes, among others. Scientists believe that inflammation may be the cause behind the link between periodontal disease and other chronic conditions. Inflammation, the body’s reaction to fight off infection, guard against injury, or shield against irritation, initially intends to have a protective effect. Untreated chronic inflammation, on the other hand, can lead to the destruction of affected tissues, which can lead to more serious health conditions.

If you think or know you have one of the inflammatory conditions listed below, it is important to talk with both your physician and a dental health professional, such as a periodontist, to help reduce your risk of further disease progression. Dental professionals and medical professionals will often work together to manage their patients living with, or at risk for, the following diseases:

  • Cardiovascular disease (CVD) is one of the leading killers of men and women each year. Research has shown that inflammation is a major risk factor for developing CVD, and that people with periodontal disease may have an increased risk for CVD. Though more research is needed to better understand the connection between periodontal disease and CVD, don’t be surprised if your periodontist asks you about your heart health or if your cardiologist or physician asks you about your periodontal health.
  • Periodontal disease can be a complication of diabetes. Researchers have found that people with poorly controlled Type 2 diabetes are more likely to develop periodontal disease. However, the risk isn’t just one way; people with periodontal disease may find it more difficult to control their blood sugar levels, which can increase the risk for diabetic complications. If you are living with diabetes, it is crucial that you pay close attention to your periodontal health.
  • Studies have shown that women with periodontal disease may be at an increased risk of pregnancy complications, such as delivering a preterm or low birth weight baby. More research is needed to determine the exact relationship, but expectant mothers should consider having a periodontal evaluation to ensure that their periodontal health is at its best.
  • Research has suggested that bacteria found in the mouth can be drawn into the respiratory tract and cause an inflammatory response in the lungs, commonly known as pneumonia. In addition, periodontal disease may also worsen existing chronic lung conditions. Anyone with lung or respiratory problems should consider a complete oral health examination to determine if gum disease is present.
  • Since periodontal disease has been shown to have a connection with other chronic diseases, you should try to keep your teeth and gums healthy. First, be sure to brush your teeth at least twice each day and floss your teeth at least once each day. Additionally, you should receive a comprehensive periodontal exam each year from your general dentist or your periodontist. Doing so can help ensure that your periodontal health is at its best, which can help keep your entire body healthy.
  • According to a 2010 study by the American Academy of Periodontology (AAP) and the Centers for Disease Control (CDC), the prevalence of periodontal disease in the United States may have been underestimated by as much as 50 percent. This means that more Americans may have periodontal disease than previously thought, and therefore may be more susceptible to other chronic inflammatory diseases such as CVD, diabetes, and respiratory diseases. If you think you may have periodontal disease, talk to a periodontist for more information.”

© The American Academy of Periodontology.  The American Academy of Periodontology (AAP) is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. The current membership includes periodontists and general dentists from all 50 states as well as around the world.

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Last minute stocking stuffers you can find in the drugstore

If you need some more ideas for what to put in those stockings, and you don’t want to brave the department stores, here are a few things you can pick up at your neighborhood pharmacy.

  • Toothpaste!  Spring for the good stuff — sensitive or whitening or specially-flavored
  • Floss!  Try the coated king
  • Toothbrush!  Go for the softest bristles
  • Whitening rinse!  Pick up the ones that double as a bacterial wash

Think about it:  wouldn’t it be great if we didn’t have to buy this equipment ourselves?  So give a great gift with benefits that last and keep your friends and family on the path to wellness.

And have yourself some wonderful holidays.  All the best from your friends at The Practice SF.

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Five best practices for the dental hygienist maintaining implant patients

The role of the dental hygienist is critical in implant maintenance, and in our office, we’ve created a hygienist protocol around five best practices.
  1. The patient interview.  The dental hygienist always begins the exam by asking the patient several questions:  “How does the implant feel?  Do you notice any bleeding or pus when you brush your teeth?  Do you have any bad taste around the implant?  Do you have any pain?”.  We ask open-ended questions about pain or mobility to get as specific a description as possible from the patient.  This helps later during the doctor’s exam.
  2. Tissue evaluation.  The hygienist evaluates the tissue surrounding the implant for color, tone, texture, inflammation, redness, bleeding, mobility and exudate (pus).  We evaluate any exudate through palpation (massaging the tissue gently).  The peri-implant pocket depth is assessed by gentle probing; the probing must be done with a light hand.
  3. Scaling. Implants surrounded by healthy tissue don’t require scaling, but a light polish using a fine polishing paste and rubber cup is appropriate.  We avoid medium and coarse grades of paste.  Where the tissue is unhealthy (deep pocket depth with bleeding or exudate), we use a cavitron tip, especially designed for implant maintenance, on low power.  It has a soft-tip plastic sleeve that will not scratch the surface of the implant.  After the polish, we use an irrigating syringe with chlorhexidine gluconate (Peridex) or Super Floss soaked in chlorhexidine around the implant.  Betadyne can also be used as an irrigant in patients who are not allergic to iodine.
  4. Home care instructions.  Our hygienists always review the steps of implant care with the patient.  Our view is that implants need to be maintained aggressively, and we remind patients at every visit.  Daily flossing is essential along with twice daily brushing.  At The Practice SF, we recommend waxed or Glide Floss, Soft Picks, Sulcabrush, End Tuft Brush, Go-Betweens, Super Floss and soft-bristled toothbrushes.  (Electric or sonic toothbrushes are OK only a week or two after the implant is restored.)
  5. Documentation.  We believe that detailed notes are as important as detailed questions and examination technique — not just for the current appointment but so that our periodontal team has a baseline of conditions and symptoms to measure in subsequent appointments.  Also, taking the time to address even the slightest symptoms with the patient during the appointment can minimize potential future problems.  Finally, patients know when you’re paying attention, and they appreciate it.  This is important to the referring dentist as well.
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Tips for your teeth at Thanksgiving — and always

Thanksgiving is a moment for gratitude, so as we gather around the table, The Practice SF is thankful for all the new technologies we have for treating patients and helping them stay well.

There are two technologies, however, that are especially appropriate to visit during this important holiday.  And they’re the standby technologies.  Food and hygiene.

We came across a blog post from fellow dental professionals that does a great job of reminding us that we can use Thanksgiving as the starting point for healthy menus to enjoy year-round.  The Richmond  Smile Center Blog tells us why pumpkin, sweet potatoes, cranberries, green beans and cheese are health boosters.

And there’s no time like this season to make ourselves feel good about how we take of ourselves.  Our friends at Delta Dental share suggestions for how to manage the impact of all the sweets we’ll be enjoying during the holidays.  You may be surprised at what you read.

This season, we’re recommending that patients put themselves on the path to a healthy mouth by adopting healthy habits now.  No need to wait for the new year.

Happy Thanksgiving!

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Have you visited our Facebook page yet?

We’re populating our Facebook page with articles and notes.  Join us there, too, and keep us posted on what’s new with you.

For patients and referring doctors, we’d enjoy talking with you on Facebook.

See you there.

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How to smile

We decided to do a little surfing today and see what’s on the Internet about smiling.  One of the things we found made us very happy:  WikiHow puts mouth hygiene as the sixth element of learning how to smile.  Keep up the good work!

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Watch out for those giant burgers

Back in July, there were a number of press reports about this news out of Taiwan: “giant” hamburgers were causing jaw injuries, and Taiwanese dentists were getting concerned.

Apparently, the dentists noticed an increase in cases of temporomandibular dysfunction (TMJ), and the common cause seemed to be eight-centimeter-tall burgers being served in Taiwan’s fast food restaurants.  TMJ is a serious jaw condition that often requires treatment and physical muscular rehab.

So should we really be on the lookout for giant burgers?  Yes!  Always chop your food down to size.  Anyway, it looks better to your dining companions.


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Four things to know about menopause and periodontal disease

The Cleveland Clinic Journal of Medicine reports that after menopause, women become more prone to developing periodontal disease.  It’s another byproduct of estrogen deficiency, which can cause bone loss and inflammation.

Here is what The Practice SF takes away from this important research:

  1. Physicians and gynecologists should incorporate dental and periodontal questions into their examinations of patients.  Teeth and gum issues are major signposts of systemic problems and opportunities.  Doctors should ask their patients if they are brushing at least twice a day and flossing once a day – and whether patients are experiencing pain, sensitivity and bleeding in their gums.
  2. Women who are evaluating hormone therapy should consider that one of its benefits – protection against bone loss – extends to the bone in the jaw.  Bone loss in the jaw can contribute to periodontal disease.
  3. While osteoporosis drugs have been linked to a few cases of alveolar bone necrosis ( death of bone in the jaw) after extractions or bone surgery, studies indicate that there is little risk and more benefit to this drug therapy when evaluating its impact  on the bone. There is a  bone turnover test that can evaluate the risk for this problem.
  4. Regular dental checkups – not just excellent oral hygiene practices at home – are critically important because they serve as another preventive action.
For Jane Q. Citizen: if your doctor is not asking you questions about your oral health, bring it up in your next examination. Tell your doctors that you want periodontal status to be an aspect of your annual physicals and gynecological exams.
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