Although we encourage patients year-round to protect themselves when participating in athletic activities, National Facial Protection Month in April allows us to focus more effort on promoting this message. This year, we’re shedding light on the complications caused by missing teeth.

NFPM is a cooperative effort by the American Academy of Pediatric Dentistry, the American Association of Orthodontists and the American Association of Oral and Maxillofacial Surgeons.

If you get hit in the mouth and lose a tooth, you may find yourself in need of a periodontist, Pennsylvania periodontist and tooth replacement expert Dr. David DiGiallorenzo says.

“First and foremost, we recommend that everyone invests in a quality mouth guard if they participate in sports or other activities where there is a possibility of getting hit in the mouth,” Dr. DiGiallorenzo says. “For those who have lost a tooth due to trauma- or decay, for that matter- we strive to educate them on the importance of replacing that tooth sooner rather than later.”

These are the reasons why:

• A missing tooth not only leaves a space in your smile, it leaves a space in your gum. When eating, the pressure will begin pushing the surrounding teeth into the space, and cause shifting.

• As teeth shift, they can begin to tilt, which can result in pressure on areas of the teeth that aren’t designed to withstand biting forces. This also can put increased pressure on gums and jawbone.

• Missing teeth change your facial profile and often make people look older because the teeth support the lips and cheeks. Missing teeth can leave a person with a “sunken” appearance.

• Teeth that are above or below the area of a missing tooth will begin to grow longer because there is no longer an opposite tooth to help hold it in place.

There are some quite realistic denture treatments available for people who are missing all or most of their teeth. But for those who are missing a single tooth or just a few teeth, dental implants could be an ideal option, says Dr. DiGiallorenzo, who also offers laser periodontal therapy in his practice to help those who suffer from periodontal disease avoid losing their teeth to the disease.

“If you are a candidate for dental implants, this is an excellent way to restore form and function after you’ve lost a tooth,” he says. “We can replace teeth in one visit- simply and painlessly.”

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Perhaps nowhere is that more evident than in X-ray technology, specifically Cone Beam Computer Tomography. Here in our practice, we have employed CBCT for 18 years to capture 3-D images of the teeth and jaws prior to performing dental implant and bone grafting procedures.

“Conventional 2-D imaging simply cannot accurately portray the anatomy the way CBCT can,” says Dr. David DiGiallorenzo, a Collegeville dental implants specialist.

An article written by Dr. W. Bruce Howerton for Osseonews explains that 2-D images “inherently exhibit magnification, distortion and overlap of anatomy.” That makes measuring or determining anatomical relationships inaccurate.

Cone Beam 3-D captures a vast amount of data and through a reconstruction process, it delivers images that have no magnification, distortion or anatomy overlap, Dr. Howerton wrote. That results in precise measurements and anatomical relationships.

CBCT Benefits in Implantology
CBCT paints an incredibly accurate picture of a patient’s anatomy, which gives us a crystal-clear view of the bone, teeth, tooth orientation, tooth and nerve relation, airways and sinuses. All of this is beneficial to know when we must determine the best placement of your dental implant. Having all of this information results in a significant reduction in the time it takes to surgically place the implant.

What does that mean for you, the patient? Less post-operative discomfort and swelling. The pre-surgical planning that CBCT provides also makes it possible for us to place porcelain crowns on your implants the same day they are placed.

“Our patients love this, because it means instant restoration of their smile, rather than having an implant and a space where their tooth used to be for several months before the crown can be placed,” Dr. DiGiallorenzo says.

Safety & CBCT
Even though CBCT is viewed by most as superior to 2-D radiography, there is a camp of opponents who claim that 3-D technology can be harmful.

“I don’t subscribe to that belief,” says Dr. DiGiallorenzo, an expert in periodontal disease treatment. He uses CBCT in his dental spa to assist in dental implant placement when patients have lost a tooth or teeth to periodontal disease.

The truth is, any time X-ray imaging is used on a patient, there is an increased lifetime risk of cancer, according to an article written by Dr. Ed Lin in the September 2011 issue of Orthotown.
But putting this into perspective is important.

We are exposed to radiation every day. It’s in the sun that shines on us and in the air we breathe. When comparing CBCT to a traditional medical CT scan (or CAT scan), CBCT is a smaller unit that focuses the radiographic exam- a single pass around the patient- and creates less radiation exposure. CT scans make several passes over the area to generate the imagery needed to create a 3-D scan, which exposes patients to higher radiation levels. Some CBCT units have reduced the radiation exposed to a fraction of the amount of traditional CT.

“The CBCT is highly precise, it scans only the small area we need scanned, and it does so in just one pass,” Dr. DiGiallorenzo says. “There are studies that show CBCT exposure equals about 11 days of natural radiation exposure.”

Overall, we believe the vast benefits of the CBCT far outweigh any perceived risks. The picture it paints of a patient’s anatomy has resulted in hundreds of successful dental implants in our practice.

“We believe in using any and every tool at our disposal to create an ideal treatment experience for our patients that results in creating a beautiful smile that will last a lifetime,” Dr. DiGiallorenzo says.

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Obesity is linked to cancer, heart attack, diabetes, hypertension, arthritis, Polycystic Ovary Syndrome, and thyroid conditions, among other health problems. Now several studies performed within the past couple of years suggest you can add periodontal disease to that list, says Dr. David DiGiallorenzo, a Williamsport, Collegeville and Philadelphia dental implants specialist who offers a variety of periodontal-related services in his practice.

The gum disease-obesity connection may be a result of insulin resistance that regulates the relationship between the two, according to an article posted on Colgate.com, which cites an issue of Grand Rounds in Oral and Systemic Medicine. People with above-normal body mass indices also produce a higher level of inflammatory proteins, which could be another contributing factor.
“Obviously, there’s no revelation here that people who are obese need to lose weight to be healthier,” Dr. DiGiallorenzo says. “But these studies show more evidence that there is a whole-body connection to oral health. Our systems work hand-in-hand and when we don’t take proper care of one part of our body, the results are likely to show in other areas of our body.”

Periodontal disease affects the tissue that supports and anchors your teeth. It causes swelling, redness, tenderness, bleeding and receding gums, and persistent bad breath, to name a few of the signs. Often, patients with the disease require laser periodontal therapy to treat it appropriately.
A study shared at the 87th General Session of the International Association for Dental Research included data gathered from almost 37,000 men, which showed those who had a BMI of more than 30 were 29 percent more likely to develop periodontitis, or inflammation around the teeth, according to the American Dental Association.

In a second study presented at the session, Harvard University and University of Puerto Rico researchers gathered information from 146 Puerto Rican males and females including weight, height, waist measurements, probing depth and attachment loss to assess the relationship between periodontal disease and excess fat. Researchers determined that elderly men and women with a higher-than-normal waist to hip ratio have “significantly higher incidences” of periodontitis.

Studies dating back as far as 2003 have shown a connection between periodontal disease and obesity. A study published in the Journal of Periodontology in May 2003 stated there was a connection between increased risk of periodontal disease and obesity in a younger population, and obesity could be a risk factor for periodontal disease.

Obesity is becoming an epidemic, Dr. DiGiallorenzo says. Information released by the Centers for Disease Control and Prevention show that adult obesity rates doubled between 1980 and 2000. During that same timeframe, childhood obesity rates also have doubled, and they have tripled among adolescents.
Obesity-related health costs have grown from an estimated $52 billion in 1995 to approximately $75 billion in 2003, according to the CDC. Among children and adolescents, yearly obesity-related and overweight-related hospital costs have more than tripled in the past 20 years. They were $35 million between 1979 and 1981 and $127 million in 1997-99.

“This is alarming information,” Dr. DiGiallorenzo says a Philadelphia periodontist. “We need to stop this runaway train.”
It begins with you. Make a decision today to eat healthier, exercise more and take better care of yourself.
“This is the time of year when resolutions are made,” says Dr. DiGiallorenzo, who also performs crown lengthening procedures in his office. “Perhaps it’s time to add weight loss to your list and stick to that goal. You’re gums- as well as the rest of your body- just might thank you.”

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Dr. David DiGiallorenzo, a Williamsport and Collegeville, dental implants expert, purchased a Quantumwave Laser to use in a variety of applications. This cold wave laser can be used to treat facial pain and pain in the temporomandibular joint.

The term “cold laser” refers to low level laser therapy, according to the American Cancer Society.

The Quantumwave Laser also has been shown to accelerate healing in extraction bone and soft tissue procedures, as well as in dental implant and other periodontal procedures.

“I will use the laser for treating chronic head and neck pain, neuromuscular spasms, and TMJpain,” Dr. DiGiallorenzo says. “It also accelerates bone and soft tissue healing during and after tooth extraction procedures, bone grafts, soft tissue grafts and dental implants placement.”

But the benefits extend beyond the dental setting. The laser commonly is used in spa settings for facial rejuvenation and removing fine lines and wrinkles. It will be used for myriad rejuvenation treatments in Dr. DiGiallorenzo’s wellness center.

“Although we got it primarily for periodontal and other dental treatment services, we fully anticipate that patients will be interested in the anti-aging benefits of the laser,” says Dr. DiGiallorenzo, who offers a variety of treatment options for periodontal disease.

Dr. DiGiallorenso purchased the laser in December.

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The truth is, study after study continues to confirm that as goes the mouth, so goes the entire body. This knowledge has prompted us to constantly consider the bigger picture when it comes to treatment. That is why we introduced detoxification and biostimulation therapy to the gum disease treatment regimen.

Gum Disease- Symptoms & Causes
Before we get into how we treat gum disease, let’s share some information on what causes the disease, as well as its symptoms.
Gum disease- also known as periodontal disease – can be caused by smoking and using other tobacco products. It also can be hereditary, brought on by diabetes, or caused by certain medications or poor oral hygiene, says Dr. David DiGiallorenzo, a provider of affordable dental implant procedures.

• Signs of gum disease include:
• Tooth sensitivity
• Receding gums
• Red, swollen gums
• Moving/shifting of the teeth
• Loose teeth
• Pus between gums and teeth
• Tooth loss
• Bad breath
• Bleeding gums

If left untreated, the side effects of gum disease can become more serious and lead to malaise- a general feeling of discomfort or illness- digestive disorders and hyper-inflammatory response, says Dr. DiGiallorenzo who also is an expert in the placement of titanium dental implants.

Non-Surgical Treatment
When it comes to treating gum disease, we believe in taking the least invasive, most pain-free approach- LANAP, which stands for laser-assisted new attachment procedure. This procedure provides an alternative to traditional gum surgery that involves a scalpel and sutures.

“Rather than cutting and suturing, which results in pain and tenderness afterward, we use a laser to gently glide between the teeth and gums to remove diseased tissue,” says Dr. DiGiallorenzo. “This means less pain, a less-intrusive procedure and a speedy recovery process.”

When recommending LANAP, Dr. DiGiallorenzo also recommends a full body bio detoxification prior to and during the procedure, he says. The body is full of toxins, so taking measures to remove them prior to the procedure helps prepare the body. Undergoing detoxification during the procedure helps ensure that all of the diseased portions of the gum and related toxins as a result of the disease removal are promptly flushed from the body.

We also prescribe biostimulation therapy following LANAP. It is a treatment designed to promote gum tissue repair and rejuvenation by stimulating the body’s electrical healing system.

Untreated gum disease has been linked to more serious systemic problems including heart attack and stroke. We believe that by utilizing detoxification processes and biostimulation therapy when treating gum disease, we are taking extra measures to ensure toxic materials are flushed from the body before they can contribute to such serious health conditions.

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Diabetes can be a predictor of gum disease, says Dr. David DiGiallorenzo, a Williamsport, Collegeville and Philadelphia periodontist. We offer a variety of gum disease treatments at our practice locations, and many of our patients who are battling gum disease also are diabetics. For that reason, we are offering information this month on the diabetes/gum disease connection.

Patients with diabetes are more prone to developing periodontal disease, and the reason likely has to do with the fact that diabetics are more susceptible to contracting infections. Diabetics also have a higher tooth loss index and greater susceptibility to periodontal disease.
“Diabetes has been shown to reduce the immune response, leaving sufferers prone to a variety of susceptible illnesses and degenerative processes,” says Dr. DiGiallorenzo, who also offers Teeth in a Day and implant dentures.

Consequently, glycemic management becomes crucial to successful healing in dental implant and LANAP patients. LANAP- which stands for laser assisted new attachment procedure- is a no cut, no sew, virtually painless treatment for gum disease.

A super-developed diet and nutritional protocol to supplement and detoxify the body of harmful toxins is crucial in cases such as these, Dr. DiGiallorenzo says.
A raging gum infection could cause an unstable glycemic index if you are a diabetic patient, which leaves your body in an energy-depleted state. Infections in the oral arena are prevalent and quiescent, so you may not realize you have an infection.

Dr. DiGiallorenzo uses 3D imaging, nutritional detoxification, laser biostimulation, risk factor modification and LANAP therapy to effectively manage his diabetic patients.

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“The fact is that several studies have shown- and I agree with them- that some dental materials used in procedures as significant as placing a tooth implant and as simple as filling a cavity can be toxic,” says Dr. David DiGiallorenzo, a Williamsport, Collegeville and Philadelphia  periodontist. “I want to help educate patients on this fact and give them enough information to make an educated decision for themselves.”

Many of the dental materials used can be toxic to your health. As well, they can facilitate metal toxicity and harbor potential bacterial pathogens, creating inflammation and long-term problems.

Dental amalgam is one material on Dr. DiGiallorenzo’s list of toxic materials that he recommends patients avoid. Amalgam is made by combining metals including mercury and an alloy powder that consists of silver, copper and tin, according to information published by the Dental Board of California.

Information posted on Mercola.com says the U.S. Food and Drug Administration has admitted that fillings containing mercury can create health issues for women who are pregnant, their fetuses and children.

The primary cause of mercury exposure in Americans is through dental amalgams, according to the Mercola website. One amalgam filling releases up to 15 micrograms of mercury daily. The average person has eight amalgam fillings and could absorb as much as 120 micrograms of mercury each day. As a comparison, dining on seafood that contains mercury exposes a person to just 2.3 micrograms per day.

“Metal dental implants can be another source of toxicity,” says Dr. DiGiallorenzo, who also provides periodontal dental services including metal-free dental implants and periodontal laser surgery.

Biocompatible Materials
Rather than simply accept that many dental materials are toxic, we counsel our patients on the choice of biocompatible materials, Dr. DiGiallorenzo says.

Composite fillings are a great alternative to mercury fillings, he says. And there are metal-free dental implant alternatives, too.

Dr. DiGiallorenzo’s practice was selected in 2009 by Swiss biotechnology company Z-Systems to be the first in the the United States to offer their metal-free implants. These implants are made of zirconium. Studies have shown that patients’ soft tissue and hard tissue responds well to this type of implant, he says.

“Besides being toxic, some patients are allergic to various metals used in dental restorations,” Dr. DiGiallorenzo says. “Metal-free options make it possible for those patients to receive natural-looking, healthy restorations without all of the negative side effects that may accompany metal restorations.”

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The wellness center, located at 184 W. Main St. in Collegeville, is scheduled to open Jan. 1.  Services offered will include medical facials, organic dermal fillers, acupuncture, cranial-sacral therapy, massage, heavy metal detox, infrared sauna, massage therapy, reflexology and reiki.

“There is a connection between oral health and overall health, and there is a variety of ways in addition to traditional medical care to address each of these areas,” says Dr. DiGiallorenzo, one of the Pennsylvania periodontists who is a  metal-free implant dentist and offers laser periodontal treatment for patients with gum disease.  “This wellness center will offer a variety of therapies to improve one’s well-being.”

Because periodontal disease is a chronic inflammatory disease, many of our patients are at risk for other complications such as cardiovascular disease. Patients with diabetes, obesity, high blood pressure and high cholesterol are at risk for periodontal disease and tooth loss.

“Oral health and systemic health are so crucial for optimal health, and we take a whole-body approach to periodontics,” the dentistry professional says. “Offering ways to reduce stress, detoxify the body, and feel and look better has a positive effect on one’s state of being.”

The wellness center also will offer infrared sauna and chelation for heavy metal detoxification. Since many patients go through full oral detoxification, it is an ideal time to balance the system and cleanse all organs’ systems. Heavy metals are present in almost everyone’s bodies due to eating non-organic foods, smoking, cooking in aluminum cookware or foil, or due to amalgam fillings in dental restorations, according to the Natural News website.

Detoxification is recommended during dental reconstruction to remove metals from the gastrointestinal tract and balance the body, Dr. DiGiallorenzo says. Cosmetic services offered that the center include medical facials and peels and cutting edge organic dermal fillers by a leading plastic surgeon. Nutrition,herbal medicine and supplementation will be a large component of the wellness center.

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The IAOMT is a network of professionals in dental, medical and research fields who work to increase scientific biocompatibility standards in dentistry practice by making information from the latest interdisciplinary research available.

Dr. DiGiallorenzo’s discussion covered a great deal of information, ranging from the science and history of metal allergies, how those allergies are diagnosed, and how zirconium implants can be used effectively in patients with metal allergies.

Dentistry experts estimate that about 1 in 30 people are hypersensitive to one or more metals used in fillings or dental implants, according to the MELISA Foundation website.

“More dentists and periodontists are seeking to learn about metal-free options when it comes to dental implants because some patients have metal allergies and won’t tolerate implants made from titanium,” says Dr. DiGiallorenzo, a dental implants and laser periodontal therapy expert. “Zirconium dental implants are a viable option for those patients.”

Properly using metal-free implants is dependent upon accurate diagnosis of metal allergies, Dr. DiGiallorenzo explained at the conference. He says that is accomplished using the MELISA allergy blood test or Clifford Materials Reactivity Testing.

The MELISA test gauges a person’s metal hypersensitivity to help determine whether they might tolerate the materials routinely used in implants and other dental restorations, according to the MELISA Foundation.

CMRT is a laboratory screening process that periodontists and dentists can use to assist in identifying a patient’s sensitivity problems to a variety of chemical groups and families of compounds, according to the Clifford Consulting and Research site.

Although he speaks frequently on the topic of metal-free dental implants, Dr. DiGiallorenzo is an advocate of early diagnosis and treatment of periodontal disease to prevent tooth loss. The expert in periodontal treatment uses a periodontal laser surgery procedure known as LANAP- laser-assisted new attachment procedure- to quickly and painlessly treat many cases of periodontal disease. However, when tooth loss occurs, he considers the potential for metal sensitivities prior to placing an implant, he says.

Dr. DiGiallorenzo will speak again on the topic in Washington D.C. On Nov. 4. On Nov. 13 in Miami, he will speak at an American Academy of Periodontology conference on accelerated aesthetic implant protocols replacing #8, the advent of the anodized pink implant, and its relation to biology, form and function.

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What begins as a cosmetic inconvenience can advance into the realm of a serious health issue if left untreated. As many as 12 percent of adults suffer from gum recession, which frequently isn’t noticed until it reaches an advanced stage, according to WebMD (http://www.webmd.com/oral-health/gum-tissue-graft-surgery).
A periodontics procedure known as gum grafting can replace the lost gum tissue to improve your oral health and restore your smile, says Philadelphia dental implants and gum grafting expert Dr. David DiGiallorenzo.

How it Works
If it is determined that you need a gum graft, this procedure can be done in our office. Depending on the location of your receding gums, periodontist Dr. DiGiallorenzo may use hard or soft tissue for the grafts. The hard tissue is known as keratinized gingiva and its function is to protect your teeth’s roots. Gingiva mucosa is the soft, flexible tissue. The soft tissue is the first to go during gum recession, and it makes your teeth look longer because it exposes more of the enamel.

“This is yet another reason to stay on top of your routine dental checkups,” Dr. DiGiallorenzo says. “If caught early, we can do a soft tissue graft to restore your gumline. It’s less invasive and offers a quicker healing time.”
Gums grafts today are generally quick, minimally invasive and painless.  And whole areas of the mouth can be accomplished, he says.
The graft helps stunt further recession, according to the Mayo Clinic website. It often is used on patients with thin gums who require extra tissue to enlarge their gums, the WebMD site states.

The connective graft is the most frequently used method of correcting root exposure, according to DiGiallorenzo. It still uses tissue from the roof of your mouth. However, once the flap is made in the palate, Dr. DiGiallorenzo removes tissue- called subepithelial connective tissue- located beneath the flap and sutures that to the exposed root areas of your teeth.

Often, gum grafting can be accomplished without the need to obtain tissue from the roof of your mouth.  Our office draws a bit of blood from the patient, and utilizes a terrific technique called PRGF, which utilizes the body’s proteins to stimulate repair and healing, says Dr. DiGiallorenzo.  In addition, we routinely use lasers to biostimulate the site for optimal healing, and we also implement nutritional protocols.

After the Graft
Following your gum graft procedure, we advise you to avoid flossing or brushing near the graft until the area has had time to heal. We also prescribe a rinse that fights against plaque as you heal.

In addition to your oral hygiene habits, your diet must change a bit while you heal. We recommend a diet of eggs, pastas, yogurt, well-cooked vegetables and other soft foods.

An Ounce of Prevention
“We understand that most people don’t enjoy dental procedures and want to avoid them if at all possible,” says Dr. DiGiallorenzo, who also is a denture implants expert.

The good news is that steps can be taken to help keep periodontal disease at bay. If you smoke or use other tobacco products, stop. We offer smoking cessation assistance through our office. Floss daily and brush your teeth for at least two minutes. And don’t forget to brush your tongue. Keep up to date with your dental exams and cleanings.

“In the event that you are diagnosed with periodontal disease, remember that the earlier it is caught, the better,” Dr. DiGiallorenzo says. “If caught early enough, gum grafting can be avoided. We have a procedure we can perform that is a no-cut, no-suture, virtually pain-free method of combatting the harmful effects of periodontal disease.”

Known as LANAP, which stands for laser-assisted new attachment procedure, this procedure uses a laser to lightly pass between your gumline and teeth to remove diseased tissue, seal the gum and leave healthy tissue behind.

Learn More
If you would like to learn more about gum grafting or LANAP, or you want to schedule a consultation with Dr. David Digiallorenzo, please call (610) 409-6064 in Collegeville; (570) 322-4741 in Williamsport; or visit his Web site: www.perioimplants.us.

About Dr. David Digiallorenzo
Dr. David Digiallorenzo, or “Dr. D,” graduated from Temple University School of Dentistry in 1993 and completed a specialty in periodontics and dental implantology from the University of Pennsylvania in 1995.

He is an associate clinical professor at the University of Pennsylvania in the Department of Periodontics. He teaches nationally and internationally and is a regular contributor to dental literature.

Dr. D’s private practice in suburban Philadelphia concentrates on periodontics, dental implantology, advanced reconstructive case management and TMJ treatment. It is a unique dental spa with two full-time massage therapists that specialize in reflexology, reiki, massage, aromatherapy and homeopathy. This combination creates a relaxed, optimal healing response.
Dr. D has two office locations: 184 W. Main St., Ste. 200, in Collegeville, PA; and 121 E. Fourth St. in Williamsport, PA.

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