Below are some of the most frequently asked questions patients have about dentistry and oral health issues. If you have any other questions, or would like to schedule an appointment, we would love to hear from you.
Click on a question below to see the answer.
Do I need to be referred to see a Periodontist?
While many patients contact a Periodontist as a result of a referral by their dentist, many people are surprised to learn that periodontal offices work with patients having no current periodontal concerns as well. Routine cleanings for healthy gums are as much a part of what we do as treating advanced disease. A periodontal office is focused on the health of the gums and bone. Helping to prevent problems from occurring is as important as treating problems that already exist. The Periodontist and their staff have advanced training on how to keep the gums and bone healthy. Many of the procedures used to treat active disease, also apply to the maintenance of periodontal health and disease prevention.
Why was I referred to a Periodontist?
Your family dentist monitors and cares for all of your oral health care needs, including the gums and surrounding bone. If you have been diagnosed with a periodontal concern or if your dentist has recommended that you seek a periodontal consultation, they want to maximize your treatment options and care in a highly specialized segment of dentistry. Your family dentist feels you would benefit from the expertise of a periodontal specialty office. We will work in conjunction with your referring office to provide optimal periodontal care that coordinates with any other dental concerns being addressed by your family dentist.
What can I expect to happen at my first visit?
The initial visit involves coupling the available historical records from your previous dentists with the current clinical findings obtained in our office, to evaluate your current periodontal concern and develop treatment strategies that address your specific concern while still considering how this treatment fits with the rest of your dentition. We go to great lengths to obtain all relevant dental records and to obtain treatment objectives from our referring offices. We can then focus in on the specific concern and obtain the records necessary to assess the concern. This will always include a periodontal assessment of the affected area and can include additional X-rays to thoroughly assess the concern. We also understand that the teeth are part of the mouth and the mouth is part of the body, so we do whatever is necessary to make sure that the treatment needs coordinate with the entire dentition and the general health of the individual.
Why can't I get my teeth cleaned during the first visit?
A dental cleaning should be customized for the condition of the teeth and supporting periodontal structures. While we do provide routine cleaning services, we specialize in thorough and specialized dental cleanings that address the specific periodontal condition of the individual ranging from periodontal health to advanced disease. If we schedule a cleaning at the same appointment as the initial evaluation, we are really saying that everyone has the same concerns and therefore can receive the same treatment. Our office specializes in identifying the specific treatment needs of each individual and customizing treatment to meet those needs. If you were referred by your family dentist, they are asking for our professional assessment of your unique condition. If you have contacted us on your own, we need to determine your current periodontal status to be able to recommend and provide treatment that meets your needs. By taking the time to first evaluate your periodontal condition as it presents, we can tailor our treatment recommendations to your specific treatment needs and avoid unnecessary treatment that has little benefit to your dentition.
Why isn't my evaluation free?
The evaluation appointment is when Dr. LaBell first gets a chance to meet with you to discuss your specific concerns. From the first time you or a referring office contacts our office, we start gathering information regarding dentists that have treated you in the past; the treatment they have provided; any notes, records and X-rays that are relevant and the concern we are being asked to evaluate. We are then prepared to meet with you and feel we understand how the current concern developed, what treatment has been provided already and how this concern relates to the rest of your mouth and your general well-being. During the evaluation we examine your teeth and gums, record the appropriate measurements, insure that there is no other pathology that would be a concern to you or might affect the treatment we recommend, discuss our findings with you, make recommendations for treatment and answer your questions. After you leave, Dr. LaBell, reviews all the information and records, obtains any additional records that need to be tracked down after the appointment and summarizes his findings in a very detailed letter that goes back to your family dentist and any of your other medical professionals that need or would benefit from the information. He often makes phone calls and sends emails to your treating doctors relating the findings and discussing how this treatment fits in with all of your dental needs. Finally, as a courtesy to you, we file a claim with any dental insurance company you may have and duplicate and include all needed records from your visit. As you can see, there is a lot of work before and after you arrive as well as during the actual evaluation appointment that falls under this evaluation. A periodontal office could never invest the amount of time necessary to understand your periodontal concern, insure that treatment recommendations are appropriate and in line with your other dental and medical needs and provide this level of service if the evaluation were free.
What if I don't have dental insurance?
Dental insurance is not a requirement for periodontal care. Every individual that contacts our office undergoes the same thorough evaluation and we provide the same level of service whether dental insurance benefits are available or not. Dental Insurance is a helpful asset, but these days, we recommend that you think of it as a type of financial aid, rather than something that will cover all your dental expenses. Dental insurance companies have always set their own fee schedules and then reimbursed only a proportion of those fees as benefits, regardless of the true costs of treatment. The truth is that most insurance companies are still using annual limits on dental benefits that were established at least 20 years ago with no adjustment for the increased costs of dental care over the years. We are happy to file claims with any dental insurance company, but our treatment recommendations and level of service are the same with or without dental insurance.
Do you accept my dental insurance?
Our office files and follows up with claims for every commercial dental insurance company. We have filed our fees with Washington Dental Service and have been approved as a premier provider, which also includes the nationwide Delta Dental companies. While we are proud to be part of this premier network, we are not a preferred provider for any dental insurance company. This means that while we accept their dental insurance, we are not under contract to work under their restricted fee schedule. We believe it is our responsibility to evaluate each patient and recommend treatment based on clinical findings rather than limiting treatment to what can be provided under a contracted fee structure. Our objective is to be unbiased in our treatment recommendations, which we believe offers you the best that today's periodontal care has to offer. We will of course, do everything in our power to help you obtain all the benefits your dental insurance has promised you.
What is the financial policy of the office?
Our office takes pride in offering many financial options for our patients. Of course we accept cash and checks as you might expect, but we also accept the following credit cards:
- Discover Card
We also work with CareCredit to offer many financing options including several that are interest free.
Will my health records be kept private?
Of course they will. We have gone to great lengths to insure that we gather only the information necessary to provide periodontal care, communicate with your other health care professionals, manage your account and file your insurance. Every new patient is asked about their desire for leaving messages, where to contact them and who they are comfortable with knowing that they are a patient in our office. We use the latest computer hardware and software to protect against unauthorized access to your dental and financial records. We back up our data nightly and we assess our security protocols continuously. We will never release your information to anyone or any agency not intimately involved in your periodontal care.
How do I know the office is kept clean (infection control)?
The moment you set foot in our office, it is evident that we maintain the highest level of cleanliness and infection control. We believe that a neat and organized office helps promote cleanliness. Our reception room is kept organized, clean and neat. Our operatories are cleaned and disinfected after every patient using the latest products and following the latest guidelines. They are left clean and ready even when not in use. Infection control takes top priority in our office. Our instruments are disposable whenever practical, and steam sterilized under high pressure using an autoclave when they are not disposable. We follow a strict protocol for cleanliness and sterilization following what is known as universal precautions. These precautions state that the instruments from every patient and every visit are handled identically as if there were a highly communicable disease. You can take comfort that your health takes top priority in our office and every instrument is spotlessly clean and sterile.
What if I have to cancel an appointment?
We operate on a reserved appointment policy. We find that by reserving time specifically for you we can be fully prepared for your appointment and insure that your treatment occurs as expected and within the time we discussed. If an emergency comes up or unexpected circumstances arise we ask that you give us the same courtesy we provide you so we have ample time to offer your reserved appointment to another patient that may be waiting to see us. We ask for 48 hours notice of a scheduling change for cleanings, evaluations, suture removals and post-operative checks and 7 days notice of a scheduling change for a surgical procedure. We go to great lengths to make sure we have gathered all necessary information, ordered all necessary materials, consulted with all involved professionals and set up for the planned procedure, so last minute changes become very costly to our office. We make every attempt to accommodate your scheduling changes, but we do reserve the right to assess a fee for our expenses if you find it necessary to cancel an appointment on short notice.
Where is the office located?
Our office is located just off the main thoroughfare in downtown Woodinville. We are located just west of Molbaks on 135th Ave. NE. Our physical address is 17320 135th Ave. NE, Suite B, Woodinville, WA 98072.
How often should I brush and floss?
Brushing and flossing help control the plaque and bacteria that cause periodontal disease. These bacteria multiply continuously and accumulate daily. Brush your teeth at least twice a day (especially before going to bed at night). Electric toothbrushes are recommended as they are easy to use and can remove plaque effectively. Flossing should occur at least daily. While most people object to flossing, it is still the best way to clean between the teeth and under the gum line.
How often should I have my teeth examined and cleaned?
If you know that your teeth, gums and bone are healthy, you should have your teeth checked and cleaned at least twice a year. For our patients with periodontal disease or other periodontal concerns, we go to great lengths to recommend an interval for cleanings and evaluations tailored specifically to your unique concerns. Periodontal disease is a chronic condition that responds well to regular maintenance appointments so we work hard to determine the best interval to meet your specific needs.
Why do my teeth need to be cleaned at a periodontal office?
A Periodontist is the specialist for the gums and bone. Periodontal Disease (Gum Disease) is a chronic (long-term) disease caused by bacteria that damage the gums and bone, leading to tooth loss. While your family dentist is very good at caring for the overall health of your gums and bone, the periodontal office treats patients with all stages of periodontal disease all day long. In the periodontal office, a patient with bone loss, gum recession, bleeding gums and loose teeth, is a normal occurrence. The hygienists in the periodontal office have honed their skills to be highly effective at cleaning teeth so that the destructive bacteria that cause the disease are thoroughly removed and the gums and bone get a chance to heal. The staff is highly educated on the factors that contribute to the disease and know the best methods for cleaning your teeth professionally and keeping them clean at home. Because we have the support of your family dentist in finding and treating decay and restorative concerns, we can focus our attention and the entire appointment on providing the care your gums and bone need to get healthy and stay healthy.
How do I know if I have gum disease?
Your family dentist, dental hygienist or Periodontist is in the best position to determine if you have periodontal disease (gum disease), but there are many signs and symptoms that you can identify that suggest that you may have gum disease. The following signs are suggestive of periodontal disease (gum disease):
- Red, puffy or bleeding gums
- Sore teeth or gums during brushing
- Bad odor or taste
- White or brown stain, or obvious tartar around your gumline
- Loose teeth
- Spaces taht are getting bigger between your teeth
- Receeding gums
If you have any of these findings or if you have been told by your family dentist that you have periodontal pockets, furcation involvements, gum recession, minimal attached gingiva or mobile teeth, you should should contact a periodontist to have a comprehensive periodontal evaluation.
If my teeth and gums don't hurt, how can I have a problem?
Bone loss is not usually a painful condition. The bacteria that cause the bone loss are often normal inhabitants of the mouth. When they accumulate in higher proportions, they get under the gums and cause bone loss. If the bone loss becomes so severe that the bacteria get trapped deep under the gums, they can multiply to the point that they create pressure and then pain can occur. Teeth can also get so loose that they become painful. Unfortunately, by the time these things occur, the disease is in its advanced stages and can usually only be managed by removing the painful tooth. Your family dentist or a Periodontist, takes measurements of your gums and bone at every cleaning appointment to determine the health of your gums. They use this information to identify the disease at an earlier stage when treatment is possible and more likely to get things under control.
Does gum disease affect my general health?
Yes. There are more and more studies identifying the links between gum disease and other medical conditions. The bacteria that cause bone loss have been known for many years. These same bacteria are known to play a role in many medical conditions. Recent research has now begun to unravel the link between gum disease and other medical conditions. Presently there is a link between gum disease and the following medical conditions:
- Heart Disease
- Respiratory Disease like pneumonia
- Premature low birth weight babies
What is Periodontal Initial Therapy?
Periodontal Initial Therapy is what many offices refer to as nonsurgical periodontal therapy. Initial therapy is the treatment that a periodontal office or family dental office undertakes to halt the progression of gum disease. It usually involves a dental cleaning that has been tailored to your specific needs. This can often be referred to as a deep cleaning, but more accurately is called scaling and root planing. This cleaning uses a local anesthetic to allow a dental hygienist to go deep below your gums and remove the disease causing bacteria and the plaque and tartar accumulations that are causing bone loss in your mouth. While the cleaning is often emphasized during initial therapy, the treatment can involve other modalities aimed at controlling disease, like permanent or temporary restorations, emergency root canals, removal of hopeless teeth, treatment of oral lesions (sores)and elimination of destructive habits like smoking, smokeless tobacco use, excessive intake of sodas, and reduction of sweets. The goal of initial therapy is to halt the progression of dental disease so that treatment can move into the reconstructive phase where damaged teeth can be restored with crowns or missing teeth can be replaced with bridges, dental implants or removable appliances.
What is pocket reduction surgery?
When gum disease has progressed to the point that bone is lost or damaged, pocket reduction surgery may be recommended. This is a surgical procedure that allows the Periodontist to get under the gums and repair the damage caused by the disease. The procedure pulls back the gums to allow the Periodontist to clean the teeth for the first time where tartar can be visualized on the root surface. Infected gum tissue is removed and the bone is reshaped to create the best contour for the gums and to provide the needed access for optimal oral hygiene and oral health.
Will bone grow back?
Bone will not usually grow back on its own. The bacteria causing bone loss get deep under the gums and penetrate into the gum tissue and leave deposits on and in the root surfaces. This prevents the bone from growing back. If the bone loss occurs in a very specific way, we can sometimes help it grow back using Guided Tissue Regeneration.
What is Guided Tissue Regeneration?
Guided Tissue Regeneration is a procedure aimed at repairing (regenerating) bone that has been lost usually to periodontal (gum) disease. When bone loss occurs in a very specific way, bone particles can be placed into the bone defect and a small, resorbable membrane used to cover the bone and block the gums from re-entering the defect. With time, the bone particles mature and promote growth of your own bone and the membrane breaks down and resorbs. The new bone matures and strengthens the involved tooth.
What can I do about my receding gums?
Gum recession is very common and can occur at almost any age. The first thing to do about gum recession is to have it evaluated by a Periodontist to determine if it should be treated and what may be causing it. In many cases, if gum recession is treated early it is possible to completely reverse the recession and protect the bone. In essence the damage is completely repairable when identified early. If the gum recession is allowed to progress to the point that the bone is damaged or all of the thicker gum tissue is lost, treatment requires multiple steps and many times results in a compromised outcome. If you think you have receding gums or have been told by your dentist or hygienist that your gums are receding you should contact a Periodontist to have it evaluated as soon as possible.
What is a free gingival graft?
A free gingival graft is probably the most common grafting procedure performed by a Periodontist. The procedure involves borrowing a piece of thicker gum tissue from a donor site in the mouth and placing it on a tooth that has thin or receding gums. The gum tissue very often is obtained from the roof of the mouth, but sometimes can be obtained from the outside of other teeth with excess gum tissue and more recently can be purchased commercially (Alloderm®). The procedure is used to create a better quality and thickness of gums around a tooth that is at high risk of developing gum recession or where gum recession is likely to progress due to very thin fragile gums. It is also commonly needed before teeth are moved orthodontically to strengthen the gums and reduce the chance of gum recession during the tooth movement.
What is a connective tissue graft?
A connective tissue graft is similar to a free gingival graft in that it borrows a piece of gum tissue from another donor site in the mouth, and uses it to cover exposed root surfaces on the teeth in some cases eliminating the need for a permanent filling. While the appearance of the graft after healing is highly esthetic, the procedure is recommended to protect the soft root surfaces from decay, thicken the gums where they are at risk of receding, shorten the teeth in preparation for new crowns or restorations and protect sensitive roots. This procedure places the donor tissue under the existing gums and can also be completed with commercially available Alloderm®
What is Alloderm®?
AlloDerm in technical terms is an acellular dermal matrix derived from donated human skin that undergoes a multi-step proprietary process that removes both the epidermis and the cells that can lead to tissue rejection. More simply put, it is donated human skin that has been treated to remove the cells that cause rejection. It was introduced in 1994 to our medical colleagues to treat burn victims and it is now widely used in many medical procedures. The procurement and processing of the material is strictly controlled for safety. Details on the process and more information on Alloderm® can be found at www.biohorizons.com/alloderm.aspx
What can I do about my short teeth or gummy smile?
It is important to determine the reason for the short teeth or gummy smile, but in many cases, the teeth can be lengthened or some of the excess gum tissue can be removed to expose the full tooth using an esthetic crown lengthening procedure. This is often done to improve your smile, but sometimes the excess gum tissue can hide periodontal pockets that lead to bone loss. A periodontist can determine the reason for the short teeth or excess gums and determine if you have periodontal pockets. They can also recommend treatment options to make your teeth longer or reduce the amount of gums that show in your smile.
What is a gingivectomy?
A gingivectomy is where some of the gum tissue around the neck of the tooth is trimmed away to expose more of the tooth. When first described it was used for reducing the periodontal pockets associated with gum disease. Today, it is used primarily to remove excess gum tissue as part of esthetic crown lengthening or if the gums begin to grow over orthodontic brackets making it difficult to change the wires.
What is esthetic crown lengthening?
Esthetic crown lengthening is a procedure used to uncover more of the tooth when teeth appear very short detracting from your smile or when you have a gummy smile. It creates the optimal tooth length for a beautiful smile and establishes the proper relationship for the gumline on each of your front teeth. Esthetic Crown Lengthening may be indicated if new restorations are planned on the teeth visible in your smile, or if you just want to have the optimal tooth proportions on the teeth you see when you smile.
What is functional crown lengthening?
Functional Crown Lengthening is often requested to get access to a fractured area or decay that extends under the gums. The procedure will reposition the gumline to give your restoring dentist the ability to repair the tooth and at the same time create a healthy restorative environment for your tooth.
What are my options for replacing my missing teeth?
There are essentially three options for replacing missing teeth. These are a dental implant, a fixed bridge or a removable appliance. The location and number of missing teeth and the health of the adjacent teeth will determine which of these options are available for your situation and which option is best.
What is a dental implant?
A dental implant is a screw usually made of titanium that takes the place of the root where a tooth has been removed or is missing. The dental implant is placed into the bone, usually with very little discomfort during or after the procedure. After it has had time to heal the dental implant can be used to support a crown, a fixed bridge or a removable appliance. In some cases they can be used first to help an orthodontist move your teeth and then to support a crown replacing a missing tooth.
Can a dental implant be placed at the same appointment as a tooth extraction?
In some cases it is possible to place a dental implant into an extraction site, but each situation is unique. If a tooth was badly infected, severe bone loss occurred, the roots of the tooth are in a bad position or the hole is just too big, it is usually necessary to let the bone heal and then place the implant exactly where it will look and work the best to support the planned restoration. If you have an implant surgeon evaluate your tooth before it is removed, they can help determine if an implant can be placed back into the extraction site during the same appointment the tooth is removed. If possible, this combination of procedures can significantly reduce the time it takes to get your replacement tooth. Your restoring dentist and implant surgeon will work together to determine the best option for your situation.
Why do I need to wait so long before I get a tooth on my dental implant?
Dental implants go through a process called osseointegration. When the dental implant is first placed into the bone it is held in place by the tightness of the threads in the bone. Since bone is a living tissue, it responds to the pressure from these threads. If there is too much pressure like sometimes occurs when a crown is placed on the implant the same day, the bone will loosen around the implant and the implant will become loose where it is of no use. If the implant is given time to heal without excessive pressure, the bone will heal to the implant (osseointegrate) to the point the implant cannot be removed and can now support the planned restoration. This process takes approximately 3-4 months, but when complete, you have a strong implant that is expected to last for many years to come.
If I am missing a tooth or need to extract a tooth, how do I know if I am a candidate for a dental implant?
While your family dentist can help make this determination, it is often useful to contact a Periodontist or an Oral Surgeon (Implant Surgeons) before any treatment is completed. Dental Implants require healthy, strong bone in appropriate quantities, density and locations to support the implant. The way a tooth is removed and the procedures undertaken at the time of tooth removal, can have a large effect on the amount and location of the bone in the healed ridge after the tooth has been removed. To protect and preserve the bone, a tooth must be removed as gently as possible, which often requires separating it into smaller portions. A socket preservation procedure will often be recommended where the bone is thin to increase the odds that the bone heals adequately to support a dental implant. Without this procedure in areas where bone is thin, the healed bone is usually too narrow to accommodate a dental implant and a ridge augmentation procedure becomes necessary extending treatment time and expense. It is sometimes possible to combine necessary procedures like a sinus lift, a ridge augmentation or even the dental implant placement with the needed tooth removal, which can decrease treatment time, promote a better or more esthetic healing result and decrease costs associated with the dental implant. An implant surgeon will evaluate the condition of the tooth along with the surrounding gums and bone before the tooth is removed and then work with your family or restoring dentist to determine the best way to remove the tooth and the type and order of procedures necessary to get the best outcome.
What is socket preservation?
Socket preservation is a procedure that helps to keep all the bone around a tooth that is being removed. When a tooth is extracted, the bone around the tooth immediately begins to resorb. This resorption causes the jawbone to get narrower and shrink away from where the biting surface of the tooth was. This shrinkage often results in the healed jawbone being too small to accommodate even a very small implant. This can mean that a dental implant can not be used to replace the tooth that was removed or that additional bone building procedures are will be necessary. It is always a good idea to let an implant surgeon evaluate a tooth that needs to be removed before it is removed. They can determine if a socket preservation would help preserve your bone so more involved and costly procedures are not necessary later. The procedure does not guarantee that bone building procedures will not be necessary, especially if the tooth was badly infected or caused a lot of damage to the bone, but it does significantly reduce the chance.
What is a sinus lift?
If a tooth has been missing for a few years or if there was a lot of infection or bone loss when the tooth was removed, the healed ridge after tooth extraction can often be very narrow. This can make implant placement impossible and significantly detract from the appearance of a restored dental implant or even a fixed bridge. A ridge augmentation builds out the healed ridge with bone if an implant is planned or with bone and/or gums if a fixed bridge is planned. When healed, this replaces some of the bone that was lost and provides the support needed for a strong dental implant or fixed bridge and helps support the gums so the replacement tooth looks normal.
Why is a dental implant a superior choice to a dental bridge?
Dental implants do not require any modification to the adjacent teeth. A dental bridge requires that the teeth on each side of a missing tooth, be ground down to make room for a crown supporting the missing tooth to be placed. In some cases the teeth that are ground down had no previous restorations or dental problems. Because the dental implant goes into the bone where the tooth is missing, the adjacent teeth are left untouched with the dental implant. A dental bridge also connects several teeth together making daily flossing much more difficult. The most common reason a bridge fails is because bacteria get under the bridge where they are hard to clean and one of the supporting teeth gets decay and fails. A dental implant supports a crown, just like a tooth, so brushing and flossing are just like your normal teeth. A dental implant is usually titanium and supports a gold or porcelain tooth, so there is no possibility of decay. Because a dental implant actually goes into the bone, it keeps the bone strong with the daily exercise it receives during chewing. Finally, a dental implant is naturally accepted by the body and has the best chance of lasting many years into the future.
What is a fiberotomy?
A fiberotomy is a minor procedure to release some of the gum fibers around your tooth after it has been moved by an orthodontist. When a tooth is rotated into proper position, it stretches some of the gum fibers attached to it. When the braces are removed, these fibers contract and pull the tooth back into the position it held before the braces. A fiberotomy makes a small, nonvisible incision between the tooth and gum so the tension in these fibers is released and the gum can reattach to the tooth in the new position with no tension. This significantly reduces the chance the tooth will begin to rotate back to where it was before the orthodontic treatment.
What is a surgical tooth exposure?
In some cases a tooth will not erupt from under the gums into the mouth. This most often occurs with upper canine teeth, but can occur with any tooth. A surgical tooth exposure is where a surgeon lifts the gum to get access to the unerupted tooth and often puts an orthodontic bracket on the tooth so an orthodontist can pull it into proper position. The position of the tooth and the manner that the procedure is completed can affect how easy the tooth can be moved and the health of the gums when the tooth is in place. The Periodontist works with the orthodontist to determine the best method to expose the tooth creating the best periodontal health after the tooth has been moved into position.
What is a temporary anchorage device (TAD) or miniscrew?
TADs or miniscrews are small temporary screws that are placed into the jaw to help the orthodontist move teeth. There are certain types of tooth movement that are difficult to achieve or take a lot of time. A TAD can be used as an anchor to allow the orthodontist to move the tooth easier and/or faster into position. In some cases, they can allow the orthodontist to move teeth in the back of the mouth without needing brackets and wires in the front until later. This can reduce the amount of time the brackets and wires are visible in the front. When the TAD is no longer needed, it can be easily removed. These same miniscrews are sometimes used when all the teeth need to be extracted to support replacement teeth while permanent dental implants are healing.
Where can I find additional information (links)?
There are so many places to find information on periodontal topics, gum disease and dental implants. A few good places to start are listed below:
- American Academy of Periodontology www.perio.org
- American Dental Association www.ada.org
- Washington State Dental Association www.wsda.org
- Seattle-King County Dental Society www.skcds.org