Author Archives: Piedm

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April Is Oral Cancer Awareness Month

What do you know about oral cancer? Because the disease has been closely linked with smoking and tobacco use in the past, nonsmokers often believe they aren’t at risk. However, the fastest growing segment of oral cancer patients today is young, healthy, nonsmoking individuals. 

Why, you may ask? The human papilloma virus (HPV) — one of the most common viruses in the United States — is the leading cause of oropharyngeal cancer. The CDC says that up to 80% of Americans will have HPV infections in their lifetime. Fortunately, the body’s immune system is usually able to clear these infections without noticeable symptoms.

Oral cancer appears as a growth or sore in or near the mouth that does not go away. The most common symptoms include

  • swelling, lumps, or rough red/white patches on the lips or inside the mouth
  • unexplained bleeding in the mouth
  • loss of feeling or pain/tenderness in the face, mouth, or neck
  • persistent sores on the face, mouth, or neck
  • a feeling that something is caught in the back of the throat
  • difficulty chewing, swallowing, speaking, or moving the jaw or tongue
  • hoarseness, chronic sore throat, or change in voice
  • ear pain
  • a change in the way your teeth or dentures fit together
  • dramatic weight loss

Though approximately 50,000 Americans will be diagnosed with oral cancer this year, awareness remains low. The disease can be life threatening if not diagnosed and treated early. If you notice a problem, please bring it to the attention of a medical or dental professional as soon as possible. 

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Orthodontics for Adult Patients

Contrary to common thought, malocclusion – or “bad bite” – is not just a problem facing children and adolescents. As many as three quarters of adults have some form of orthodontic problem like crowding or drifting teeth, and today about one out of every five orthodontic patients is an adult.

There are many reasons to consider orthodontic treatment as an adult. It is never too late to boost your self-confidence and even enhance your career opportunities with a great looking smile. Furthermore, straightening teeth can make chewing more comfortable and teeth easier to clean.

Are you a good candidate for orthodontic treatment?

Orthodontics involves moving teeth through bone to relocate them in better places for both appearance and function. The process actually removes bone in front of the moving teeth and lays new bone down behind as the result of light forces applied by either wires or appliances.

Periodontal health is an important factor when considering orthodontic treatment for older patients. Gum disease, which is more prevalent in adults than in adolescents, can lead to the loss of tooth-supporting bone.

Because orthodontic treatment can aggravate periodontal disease, it is essential to bring any existing periodontal disease under control before treatment begins. This does not mean, however, that people who have had periodontal disease treated and controlled cannot undergo orthodontic procedures. In fact, treatment is desirable because it moves teeth to positions that are more easily cleaned.

If you are an adult considering orthodontic treatment

  1. Work with your periodontist to understand any risks before starting treatment. Be sure to discuss the removal of unstable teeth and any future plans for dental implants.
  2. Do not start orthodontics until you have approval from your periodontist.
  3. Commit to more frequent supportive care from your periodontist during orthodontic treatment.
  4. Follow up with a comprehensive periodontal evaluation after orthodontic treatment to see if any new problems have developed.

The relationship between orthodontics and periodontal disease is complex. Be sure to consult both a periodontist and an orthodontist before beginning any course of treatment.

Dr. Bartruff Marks 11 Years of Private Practice

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September marks the eleventh anniversary of Piedmont Periodontics in Midtown Atlanta. As they say, time flies when you are doing work you love!

Dr. Bartruff moved to Atlanta in 2001 after earning a Degree of Dental Medicine (DMD) from Alabama at Birmingham and a Certificate in Periodontics from Louisiana State University School of Dentistry. After a few years of work experience, he opened the original location of Piedmont Periodontics in 2005.

In October of 2011, Dr. Bartruff and his team proudly opened a new, state-of-the-art office in the heart of Midtown at 222 12th Street, just off of Peachtree Street in the Lobby level of the LUXE condominium building. The new office is designed to create a relaxing environment for patients that reflects the team’s philosophy of considerate care.

Dr Bartruff’s excellent reputation has led to him becoming a preferred periodontist among many of Atlanta’s most prestigious dentists. Both referring dental partners and long term patients share confidence in Dr. Bartruffs periodontal skills and expertise.

Chronic Bad Breath and Periodontal Disease

Believe it or not, Americans spend more than $1 billion a year to fight bad breath. Unfortunately, over the counter treatments like toothpaste and mouthwash only mask the odor.

So what causes bad breath?
Chronic bad breath (halitosis) does not originate in the stomach. In most cases bad breath is caused by leftover food that collects bacteria on the teeth, surface of the tongue, below the gum line, between the teeth and other hard to reach areas. Naturally occurring anaerobic bacteria feed on this oral debris and produce foul-smelling volatile sulfur compounds (VSC) as a by-product.

While everyone has some level of VSC in their mouth, they cannot be detected by the nose at low levels. Saliva plays a key role in fighting chronic halitosis by flushing away debris. The dryer your mouth and the thicker your saliva, the less rinsing that takes place. Lower oxygen levels create environment in which the bacteria that produce sulfur compounds thrive.

Other major contributors to bad breath can include

  • oral stagnation from mouth breathing and/or snoring
  • alcohols that dry oral tissue
  • medications for high blood pressure, depression, and antihistamines
  • general dehydration
  • stress
  • proteins, acidic foods, and dairy products
  • genetics that determine the shape of your tongue

Fighting Bad Breath
Regular professional cleanings in conjunction with daily brushing and flossing normally take care of unpleasant breath. If bad breath persists, make extra effort to remove bacteria that accumulates in the cracks and crevices of your tongue.

Use a metal or plastic tongue scraper to gently scrape from the back of the tongue to the front or wrap a soft cotton washcloth around a finger and gently wipe from the back to the tip. Be sure to clean the back of your tongue where the most bacteria accumulates.

If bad breath continues, consider altering your diet or medications. Note that sudden bad breath can also be a sign that you have a health problem, such as a respiratory tract infection, chronic sinusitis, or postnasal drip.

If you suffer from chronic halitosis, you are not alone — over forty-million Americans have persistent bad breath. Regular professional cleanings combined with a robust daily oral care routine should significantly ease the burden.

 

Tissue Regeneration: Allograft vs. Free Gingival Grafts

Periodontal disease often destroys the bone and tissue that support teeth. Gum recession can make eating hot and cold foods uncomfortable and alter the aesthetic appearance of a smile.

Today’s sophisticated tissue regeneration techniques allow periodontists to reconstruct and regenerate lost and destroyed gingival tissues. The main goal is to cover an exposed root or to thicken the existing gum tissue and prevent further tissue loss.

Periodontists often use a free gingival graft to increase the thickness existing gum tissue. A small layer of tissue is removed from the palate of the patient’s mouth and stitched into place at the site of gum recession. Both sites heal in a very predictable, uneventful manner in two or three weeks.

When treating a larger area or root exposure, periodontists may recommend an allograft to create new gum tissue. With this option, tissue is surgically transplanted from one person to another. The science is not new — allografts have been used successfully for more than 150 years. In face, approximately one million allografts are transplanted each year in the United States alone.

Whether your doctor recommends a free gingival grafts or an allograft, the result will be new zones of gum tissue covering formerly exposed roots. Patients are often surprised by the relatively painless recovery process after either of these procedure.

When considering a tissue grafting for medical or cosmetic purposes, it is important to speak with a specialist to determine the best treatment method. Call 404-815-4800 today to schedule a consultation with Dr. Bartruff.

The Importance of Implant Maintenance

The American Dental Association (ADA) recommends a daily routine of brushing and flossing to maintain a healthy mouth and body. Proper care of dental implants is just as important as cleaning natural teeth since both depend on healthy surrounding tissues for support.

Plaque collects on implant crowns just like natural teeth, and must be removed on a daily basis at home through brushing and flossing. Without daily cleaning, peri-implantitis can cause inflammation around the implant and lead to bone loss. Because implants attach to surrounding bone and gums differently than natural teeth, peri-implantitis infections can rapidly lead to the loss of the affected implant.

Your dental hygienist also has an important role to play in keeping dental implants infection-free. Since implants are made of materials that are very different from natural teeth, routine professional cleaning is vital. Your hygienist will be able to select the right instruments for removing both soft (plaque or food) or hard (tartar) debris based on the type of surface in your mouth.

Despite special cleaning challenges, implants are highly successful. Studies indicate long-term success rates well over 95%. Proper cleaning and prevention of peri-implant disease is an important part of success.

Self-Funded vs. Employer-Provided Dental Insurance

by Sam Morgan, Practice Administrator

The world of insurance is ever changing. Even those of us who work in the medical field can find it hard to understand and work through insurance on a daily basis.

The New Year has come and open enrollment season is over so, you either have the dental insurance you had last year or you have something new. Either way, you may find yourself asking the question, why doesn’t or why didn’t my insurance cover that procedure?

First, you need to ask yourself one question: Is this a self-funded policy or is this a policy provided through you or your spouse/significant others employer? 

If you answered that you have a self-funded policy you need to review three big items in your policy: 

  1. Covered Services
    Almost every self-funded policy is going to have substantial LIMITATIONS on covered services. Most of them only cover dental diagnostics and preventative care. If you have or are looking to a plan like this to pay for implants, gum grafts or deep cleanings, you are probably going to find that these are NOT covered services.
  2. Waiting Periods
    Almost all of these policies have 6–12 month waiting periods for anything more than dental diagnostics and preventative care. While they may cover implants, deep cleanings or gum grafts, they are not going to cover any of that until you have paid into the policy for at least 6–12 months.
  3. Annual Maximum and Deductible
    You need to make sure you understand what your annual maximum is for your covered period. Once you understand, you will be able to assess whether or not it is a good decision for you to carry a dental benefits/insurance policy. If what you are paying is almost equal to what you COULD get back from your plan each year, you may want to consider dropping the plan and simply putting that money aside for a rainy day.

If you have a policy issued through an employer, you need to understand that your EMPLOYER has pre-negotiated rates and terms for the policies available to you — and ultimately your EMPLOYER controls what your plan covers. Look into the following points to get more clarity: 

  1. Frequency
    How often can you have a procedure? This is common with cleanings, deep cleanings and the placement of a prosthesis.
  2. Missing Tooth Clause
    A missing tooth clause is a stipulation in a policy that will only allow coverage for an implant if the tooth is extracted under that plan. So, if you had a tooth extracted prior to your current insurance contract, your new carrier may not cover the implant procedure.
  3. History
    Your dental history can work for or against you when get a new carrier. Carriers can decided whether or not they want to pull information about previous procedures when making the decision to pay or deny a claim.
    For example, to get a periodontic maintenance procedure covered, you have to have documentation of a previous periodontal surgery from your previous carrier. Or let’s say you want to have an implant placed with a policy that only allows the placement of 1 prosthesis every 5 years. If you have had a crown placed on that same tooth under another plan in the last 5 years, your carrier may not pay for the new implant because they picked up the history from your previous carrier.

Regardless of whether you have a self-funded plan or an employer provided plan, review all these points and apply them to your situation. Never be afraid to ask questions of your provider (Dentist), the Carrier (Insurance Company) or your HR Department at your employer, and always ask for a pre-authorization for costly procedures if time permits.

Am I a Candidate for Dental Implants?

Dental implants are increasingly the solution of choice for adults of all ages. If you can have routine dental treatment, you are generally a good candidate for dental implants.

If you answer yes to the following questions, implants could improve your quality of life.

Are you currently wearing dentures?
Implants can replace dentures or stabilize and secure the denture to make it more comfortable.

Do you have bone loss?
Bone loss is common in people who have lost teeth or had periodontal disease. Implants can help preserve facial structure and prevent the bone deterioration that occurs when teeth are missing.

Have you been diagnosed with gum disease?
Success rates remain high for implants in patients who have lost their teeth due to periodontal disease.

If you answer yes to any of the following questions, you should schedule a complimentary consultation with a periodontist to discuss your treatment options.

Do you have existing medical conditions including chronic diseases like diabetes or high blood pressure?
Although precautions must be taken for certain conditions, chronic disease does not automatically make you ineligible for dental implants.

Do you smoke?
Although smoking lowers the success rate of implants, it doesn’t eliminate the possibility.

Are you a child?
Generally children are not eligible for dental implants until their jaw growth is complete. However, in some cases a dental implant may be part of a child’s orthodontic treatment plan.

When considering a dental implant, it is important to consult a specialist to determine if you are a candidate. Periodontists have additional training to help them understand the implications of both anatomy and medical history on implant success rate.  

Why Dental Implants Are Worth the Investment

Whether you have lost a tooth (or several) as the result of an injury or periodontal disease, missing teeth can be both embarrassing and inconvenient. Dental implants provide a foundation for replacement teeth that look, feel and function like natural teeth.

If you are missing teeth and your gums and jaw are healthy, you may benefit from dental implants. Composed of titanium metal that “fuses” with the jawbone through a process called osseointegration, implants are surgically placed into the jawbone then topped with natural white crowns. Two or more implants can easily serve as a base of support for several replacement teeth. 

Because the dental implant fuses with the jawbone, the procedure actually helps prevent gum and bone deterioration, jawbone recession, and facial collapse. Better yet, dental implants can last for 20 years or more with proper oral hygiene. 

Though implants cost more upfront and may not be covered by insurance, patients avoid the cost of possibly having to replace a prothetic device like dentures or a bridge once, twice or more over the course of a lifetime. In addition, patients may avoid both the pain and cost of future dental work on adjacent teeth. Studies show a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture within five to seven years of treatment.

With nearly 50 years of clinical research an overall success rate around 98%, dental implants are frequently the best treatment option for replacing missing teeth. They are changing the way people live by helping them rediscover the comfort and confidence to eat, speak, laugh and enjoy life. 

Periodontal Disease and Long Term Care

by Sam Morgan, Practice Administrator

Recently, I had a patient that had been in for a consultation over one year ago call to schedule his procedure. The patient had been diagnosed with progressive Periodontal Disease and severe bone loss. Since the patient was already missing several teeth, the doctor recommended a more aggressive treatment plan that included Osseous Procedure and then, after a period of healing, the placement of Implants.

Much to my amazement, the patient only had interest in placing the implants. I explained that the doctor would not place implants with out a healthy environment that would support osseointegration, giving the patient and his implants the chance for success. As I discussed the situation with the patient in more detail, he explained to me all of the research he had done on the recommended Osseous Procedure. He was concerned because there was no guarantee of success.

My response was that he was absolutely correct, but I took it one step further. I explained to the patient that he has Periodontal Disease and that there is no “cure” for the disease. I compared Periodontal Disease to Heart Disease, Diabetes, HIV or a diagnosed Mental Disease. There is no “cure” for any of these, only the ability to manage or attempt to manage the disease. Every human being is unique and the circumstances surrounding Periodontal Disease for that individual will more than likely be different from another individual. It could be genetic, it could be caused from poor hygiene, or it could be linked to another disease such as Diabetes.

I also explained that usually, we see a patient for a procedure like Osseous and then we see them 2-4 times per year for Periodontal Maintenance Procedures. A strong majority of our patients who maintain a strong regimen between our office and their primary dentist don’t revisit more drastic procedures. A person who has been diagnosed with Periodontal Disease is really no different than an individual who has had a heart attack and now has must visit their cardiologist for testing and monitoring on a routine basis.

Unfortunately, I believe this patient — like many others — will let fear keep him from receiving the care he so desperately needs to keep his mouth healthy and keep his teeth. We believe in preventative care and the least invasive treatment for any patient. Our ultimate goal is to help our patients keep their teeth and keep them as comfortable as possible while providing the care needed.

If you have been told you have Periodontal Disease or you suspect you may have symptoms, seek a professional to help you understand your options and what the future may look like for you and your teeth.