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Injuries to our teeth and gums can have harmful effects on the bone tissue and structures that support them. In turn, this damage can impact both the appearance and the health of our smiles. One of the ways we can protect our dental health and restore our smiles is with a technique called bone grafting, available at our Livingston office.

What is Bone Grafting?

Bone grafting is a type of periodontal surgery. Bone tissue for grafting may be taken from your own body, or a graft material composed of donor tissue or synthetic substitutes can be used. This kind of graft will be absorbed gradually by the body as your own new, healthy bone tissue replaces it.

If you decide a bone graft is your best option, we will discuss the options for grafting with you beforehand, and use imaging to map out the area of bone loss and to create the best individual treatment plan for you. After anesthesia, an incision will be made in the gum tissue to reveal the damaged bone. Grafting material will be shaped and secured to the affected area, and sutures are generally used to close the incision. We will give you careful instructions for after care and follow-up visits. The time it takes for you to heal completely will depend on the type and size of the graft.

Why Consider a Bone Graft?

The bone structure that supports our teeth can be compromised in a number of ways. Dr. Rothstein might recommend a bone graft as your best option for treating many conditions which have both medical and cosmetic impacts.

• Tooth Loss Can Cause Bone Loss

The bone tissue which supports our teeth needs the stimulation of biting and chewing to stay healthy. Without that stimulation, the bone area under the missing tooth gradually shrinks. The bone tissue is resorbed into the body, which, in a relatively short amount of time, can lead to a noticeable sunken spot where the tooth used to be. A dental implant will provide the tissue stimulation that a natural tooth would, and will prevent future bone loss in the jaw. But if too much bone tissue has already been lost, you might need surgical bone grafting to achieve the right bone area and density to hold an implant.

• Gum Disease

As gum disease progresses, the gums pull away from the teeth, leaving the bone and connective tissue exposed to infection and bacteria. Infection and the body’s own response to bacteria can cause deterioration in the bone structure supporting the teeth, leading to loose teeth, a change in your normal bite, or even tooth loss. Bone loss cannot be reversed, but a graft can replace lost bone and allow healthy tissue to regenerate.

• Other Uses

Bone grafting can also be used to correct deformities in the jawbone, as part of nerve repositioning, to restore bone after trauma or long-term denture wear, and for other restorative and cosmetic uses.

Dr. Rothstein will recommend bone graft surgery when it will provide the best possible outcome for your individual needs. Because this is surgery, we are here to answer any questions you might have about the process and how we can provide the most skillful, gentlest, and least invasive treatment available. Above all, we want not only to protect your smile now, but to restore the strength and function of the bones which make it possible—for a lifetime of future smiles.

Have you been having trouble getting a good night’s rest?

Sometimes the reason for a poor night’s sleep is obvious. A midnight horror movie. A bedtime espresso. That anchovy and pineapple pizza you had for dinner. Not much we can do about these problems.

Sometimes, though, the cause of your sleep difficulties is dental in origin, and that is something Dr. Rothstein can help with.

Teeth grinding, or bruxism, is a very common dental problem. When people with this condition sleep, their jaws clench and their teeth grind against each other throughout the night. When to suspect you might suffer from bruxism?

• You wake with a sore jaw, or you hear pops or clicks when you move your jaw
• You suffer from frequent headaches or facial pain
• Your teeth are chipped, cracked, flattened, worn down, or sensitive
• You wake up tired, because grinding affects the quality of your sleep
• Partners, siblings, or roommates complain about nocturnal grinding noises affecting the quality of their

Pain and fatigue are unpleasant enough, but there are additional serious consequences for those who suffer from bruxism. Our jaws are extremely powerful, and clenching and grinding can put hundreds of pounds on pressure on teeth and jaws over hours of sleep. These forces can lead to:

• Damaged teeth. Cracked, chipped, and worn down teeth can mean veneers, crowns, and root canals. Seriously compromised or broken teeth might need to be extracted.
• Damaged dental work. Bruxism can lead to fractured veneers and damaged fillings and crowns. If the damage is too serious for repair, replacement might be necessary.
• Damaged jaw joints. Severe cases of bruxism can lead to injury to the temporomandibular joint, or TMJ, the complex hinge that allows our jaws to move up and down, back and forth, and side to side.

Why are periodontists concerned about bruxism? Because tooth grinding, over time, can also cause problems for your gums. Grinding your teeth doesn’t cause periodontitis, or advanced gum disease, but it can make the effects of the disease worse.

Periodontitis, left untreated, breaks down the bones and ligaments which support our teeth and hold them firmly in place. The extreme forces generated by tooth grinding put even greater pressure on these already compromised support structures, which can accelerate their breakdown.

While tooth, jaw and periodontal damage can be treated with restorations, or root canals, or implants, or surgical procedures, prevention is clearly a much better option for a healthy smile. And one of the simplest and most effective treatments for preventing the damage caused by bruxism is a night guard.

Night guards fit over the affected teeth to prevent them from touching directly, saving tooth and enamel from injury and wear. Not only do night guards prevent contact, they spread the biting forces of the jaw over the surface of the guard to greatly reduce their impact. And because they also stop the jaw muscles from clenching tightly, there’s no excess stress placed on the temporomandibular joint.

While over-the-counter products are available, a dental professional is the best person to see for the most effective night guard. A custom night guard is designed to fit your individual teeth and mouth perfectly. Impressions or 3D scans are taken in our Livingston office, and a guard is fabricated with the precise shape, strength, and thickness you need to protect your teeth. And, as a bonus, custom night guards offer the most comfortable fit for the most comfortable night’s sleep.

Scary movies, late night caffeinating, creative food combinations—not much we can do about those! But if you’re suffering lost sleep and painful mornings because of tooth grinding, give your dentist a call. In many cases, a night guard just might be the key to sweet dreams.

Sometimes people feel a tiny bit nervous when they sit in the dental chair. And sometimes it’s more than a tiny bit. If your anxiety over dental procedures is leading you to postpone scaling and root planing to treat your periodontitis, if the fear of oral surgery outweighs regenerating lost bone tissue or a gum graft, if dreading an implant procedure means you would rather live with tooth loss than give our Livingston office a call, give us a call! Sedation dentistry might be just the procedure you need to make dental anxiety a thing of the past.

Depending on your preferences, there are several levels of sedation Dr. Rothstein can provide to make your visit more comfortable.

• Minimal Sedation—this type of sedation leaves you calm and conscious, and you respond normally to verbal directions.
• Moderate Sedation—sometimes called “conscious sedation,” this option will leave you awake, relaxed and able to follow directions, but you will probably have little memory of the procedure afterward.
• Deep Sedation—a deeper level of sedation where you cannot be roused easily or respond to instructions. It is unlikely you will remember much or any of the dental treatment.

Our office is trained to administer and monitor all these forms of sedation. Because sedation in all its varieties is a regular part of our practice, we have the medical knowledge and skill to provide you with a safe and comfortable dental experience.

And we will prepare you with all the information you need to decide on any dental treatment, including sedation. We will describe the procedure in detail, and discuss any possible risks. If you have any health conditions or take any medications that might interfere with sedation, we can discuss your options with you and your doctor to make sure you are a good candidate. We will explain any preparations you should take, and let you know if there is a window of recovery time needed in our office while the sedation wears off.

Don’t let yourself suffer dental pain or discomfort because you suffer from dental anxiety! Please call us to discuss your sedation options. Whether you choose oral, inhaled, or IV sedation, we are trained to administer your treatment gently and safely. Above all, we want to help you keep your smile the heathiest it can be, and that only happens with proper dental care. Let us work with you to make that care as comfortable and stress-free as possible.

Dr. Rothstein and our team at A R Periodontics understand that many of our patients have a fear of dentistry. You may be concerned about experiencing pain from sensitive teeth or routine procedures. General anxiety is also common. Do not put off visiting our Livingston office; we offer various types of sedation to take the pain and fear out of your dental procedure.

Nitrous Oxide Sedation

For many patients, nitrous oxide, combined with local anesthetics, will both provide pain relief and reduce anxiety. Nitrous oxide is beneficial because the dosage can be regulated during treatment and patients are normally capable of driving shortly after the procedure is completed.

Oral or Injected Sedation

With oral sedation, you may be given a pill or liquid to consume several hours before your procedure. You will not be able to drive yourself to the appointment. An oral liquid is often given to children before any shots or intravenous anesthesia. An intramuscular injection may be given at the office that provides relaxation benefits for 20 to 30 minutes.

Nitrous Oxide with an Oral Sedative

If you experience higher levels of anxiety, an oral or injected sedative can be offered before nitrous oxide is started. This is also effective for reducing anxiety regarding the injection of local anesthetics. A liquid medication followed by nitrous oxide is beneficial for children. This combination can produce a deep sedation level.

General Anesthesia

This type of anesthesia can be offered as an inhaled gas or intravenous liquid. If no oral sedative is given before the general anesthesia is administered, you should wake up quickly after your procedure is complete. An injection, pill, or liquid medication can be offered to reduce anxiety before intravenous sedation begins. Intravenous sedation can also be used at moderate-to-deep sedation levels without complete loss of consciousness.

Do not hesitate to ask Dr. Rothstein about receiving sedation or pain prevention when you visit. We will be glad to explain the options we have available and answer all your questions to ensure that your exam is pleasant for you.