Thursday, June 25, 2015

It's Not Just a Cleaning

People often wonder why their "cleaning" is not a "cleaning". I had patient come in recently that was visibly upset about this. 

How do we differentiate between a regular cleaning and a deep cleaning? I've written a couple of blogs previously on this topic. Click here for a link to a previous blog explaining the differences in more detail. 

Basically, the main difference is the depth of the pockets and the presence of calculus (tartar) that has accumulated below and at the level of the gums.

A pocket is a term that describes the space between the highest point of the gums and the lowest point of attachment. We consider normal pocket depth to be 3 millimeters or less. 

Calculus is the hardened and mineralized plaque and debris that has formed on the teeth. This is not much different from the hard water deposits you get in a bathtub. Some people accumulate it faster than others depending on the mineral content in their saliva.

Is there a potential problem when a "cleaning" is performed on a person that requires a "deep cleaning"? Absolutely! 

The problem here is that if only the visible surfaces of the teeth are cleaned, then the gums will heal at only the most superficial levels. This will in turn cause the gingiva to pretty much tighten at the most superficial areas. However, debris will remain in the pocket and act as a foreign body that can cause anaerobic bacteria to thrive. When our immune system is overwhelmed, a periodontal abscess will develop. This is considered a dental emergency.

If you are wondering what type of cleaning you require, speak with your dentist. He or she would be happy to discuss it with you.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, June 17, 2015

Got Bleeding Gums?

In Latin, the word gingi- means gums and the word -itis means inflammation. Therefore, the word gingivitis means inflammation of the gums. In the picture above, this is fairly obvious and can be recognized with an untrained eye. All cases are not quite so obvious.

There are numerous reasons why gums can become inflamed. The primary reason is from debris (plaque) that forms at the gum line. The gums become inflamed when we fail to remove debris during our routine oral hygiene. If you don't remove the debris, it will become inflamed and tender. In addition, there will also be some bleeding. I've heard many people state that they don't brush or floss at the gumline because it hurts and bleeds. Healthy gums do not hurt and bleed. If you have areas that hurt or bleed, the last thing you want to do is to avoid removing the debris. It must be removed. It's not much different than having a splinter in your finger. If you leave it, it will become inflamed and tender. If left for an extended period, it may become infected.

Other causes of gingivitis:
  • Calculus (Tartar)
  • Certain Hormones
  • Certain Drugs
  • Foriegn Bodies
  • Crowded/Crooked Teeth

Calculus is plaque that has mineralized. It becomes hard and attaches to the tooth surfaces. This is a bigger problem than plaque.

Women undergo many hormonal changes during pregancy. The gums become enlarged and will therefore create more difficulty in removing debris during routine oral hygiene.

Certain drugs like Dilantin (anti-epileptic medication), will cause gingival hyperplasia which means the gums will grow. Again, this makes hygiene much more challenging.

Foreign bodies also cause inflammation. The most common one that I've seen are popcorn kernel husks. They notoriously get stuck between the tooth and gums. They can be difficult to remove at home.

Crowded/crooked teeth are more difficult to keep clean. There is an increased risk of developing gingivitis.

Healthy gums should have a coral pink appearance and should not bleed readily. In addition, the texture should be stippled. In other words, it should have a texture similar to an orange. When they get somewhat glossy, it's because the gums are edematous (puffy from excess fluid). This is an early warning sign. Some may ask what the big deal is with swollen and bloody gums. Well, there are oral and systemic complications.

Orally, if the inflammation is chronic it will lead to periodontitis. Even if the teeth are in good shape, there is an increased risk of tooth loss. Systemically, this can lead to cardiovascular sequelae which I have written about before.

The best thing anyone can do for their oral health is to meticulously brush and floss. I prefer electric toothbrushes over manual ones because the plaque is removed more thoroughly. It is also much gentler on the gums. Some people can be too aggressive with a manual toothbrush. Your dentist or hygienist can demonstrate proper flossing and brushing techniques.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, June 3, 2015

Cheap Dentures

The title could be $199 Dentures or $299 Dentures or Same Day Dentures. It doesn't matter. The point I'm going to make is about super cheap same day dentures (and other options). 

There are many types of dentures. In general there are pre-made dentures and custom made dentures.

Cheap same day dentures:

One advantage of cheap same day dentures is obviously the price. Another advantage is same day service. Other than that, there are no other advantages. 

There are several significant disadvantages with cheap same day dentures. 
  • The fit is very poor. This in of itself presents other issues such as having a loose denture and a more rapid loss of jaw bone. The loss of bone then exacerbates the poor fit and looseness of the denture.
  • The aesthetics are very poor. You don't want to have ugly dentures that can be spotted a mile away. This is a common issue with prefabricated dentures.
  • The function is very poor. If the dentures aren't fitting well, then the dentures will not function the way they are supposed to.
For some people, this may be the only feasible option.

If you are looking for a better option, consider a custom made or implant supported denture.

Custom made dentures:

These dentures are significantly better. The fit, aesthetics and function are greatly improved.

The disadvantage with these is obviously that they cost more and often require multiple dental appointments before you get to take them home.

Implant supported dentures:

I would hate to wear a denture. They will never be as good as real teeth. But, if you find yourself in a position to have to wear one, this is the best denture you can get.

With these dentures, you won't have to have an excessive amount of acrylic in your mouth. Your mouth will therefore not be crammed with a foreign material. You will also be able to taste, feel the textures and temperatures of your foods. In addition, you won't have to worry about the dentures flopping around or even falling out at the most embarrassing and inopportune times.

The biggest drawback to these dentures of course is the cost. These are significantly more costly than cheap same day dentures or conventional custom dentures. 

One other disadvantage is that the entire process may take multiple visits and take several months or more.


Now that you know that there are several options, you can discuss with your dentist your particular circumstances and choose an option that best suits your needs.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit