The Purpose of Sedation Dentistry

As your Pittsburgh periodontist, we at the Silberg Center for Dental Science want our services to be convenient and comfortable. We’ll always do our best to meet your needs, provide amenities, and talk to you about your procedures. But we understand that sometimes you need more than just reassurances, which is why we offer sedation dentistry.

Sedation has benefits for both you and us which help the procedure go more smoothly. First and most obviously, dental sedation can greatly reduce the discomfort that comes with some restorative procedures. It helps you to stay still and relaxed, so that the dental work is more precise and efficient. It can also soothe the anxiety some people experience in association with dental procedures, so that they feel at ease and have access to the care they need. We are happy to provide dental sedation wherever it’s called for. For your convenience, we offer both anesthesia and nitrous oxide.

Anesthesia can be either local or general. A local anesthetic causes numbness in that specific location, while you remain awake and alert. A general anesthetic puts you to sleep so you’re unaware of the procedure. Both will wear off after a few hours. When you come to our office, we’ll consult with you about your dental and medical history to make sure that you don’t have any unexpected reactions to these medications. In this way, we make sure that these options are safe for you.

Nitrous oxide, also known as “laughing gas” is a sedative that is inhaled throughout your procedure in a carefully adjusted dosage. Depending upon the person, nitrous oxide makes patients feel peaceful, giggly, or sleepy, all of which mean a relief from anxiety. The sedation wears off almost immediately after you stop receiving the gas, leaving no lasting effects, which makes it ideal for patients who will drive to and from their appointments or who don’t need general anesthesia.

If you’re concerned about your upcoming procedure, contact our office today. Your Pittsburgh periodontist, Dr. Silberg, will be happy to discuss your options with you and help you see how sedation dentistry can give you the comfortable care you deserve.

Virtual Dental Implant Planning

The dental field is always growing. As technology becomes more accessible and applicable, we are able to find new uses and benefits in many areas of life. Advances in medical technology have had a profound impact on dentistry and the methods we use to analyze, diagnose, and treat our patients. In particular, these advances have enabled more effective and positive outcomes for implant dentistry. Pittsburgh periodontist Dr. Silberg stays up to date on the applications of new dental technology, and chooses the best and most advanced procedures to benefit his patients.

In the past, there was much more guesswork in dental implant surgery. Dental impressions and the experience of the dentist ensured that dental implants would usually fit pretty well after some adjustment. But with the advancement of digital imaging and 3-D modeling, we can create an exact replica of your mouth, teeth, gums and tongue. From specific areas (such as where a tooth is missing) to entire mouth shapes, this new technology has improved dentistry drastically, and taken out virtually all the guesswork. Using state of the art equipment, we can obtain images of your mouth that are so accurate that we could navigate even the minutest of details with a few strokes of a keyboard. Because of this, the dental implants our Pittsburgh office provides are some of the best—and most easily placed—in the history of modern dentistry.

With virtual dental implant planning, preparing for the procedure and actually placing the implants is greatly simplified, meaning you spend less time in the chair. Using digital imaging, we can print surgical guides that are actually used in the procedure, ensuring that the implants are placed in the exact spot with the greatest bone strength, and with the highest chances of success. With the guidance of computer imaging, the dental implant process is simpler and more effective than ever.

Dr. Silberg is experienced in the use of virtual dental implant planning. Our patients love the simplicity it brings and the accuracy it provides. Make an appointment today and see for yourself how our tech-savvy approach to dentistry can improve your smile.

Teeth Grinding and Receding Gums

Bruxism is the clinical term for grinding your teeth while you sleep, a condition that can be as damaging to your smile as it is to your partner’s rest. Teeth grinding has a myriad of different causes, including genetics, abnormal stress levels, or sleep disorders. However, the result is the same—damaged teeth, oral lacerations, and neck and jaw fatigue that can cause pain and even dislocation or joint disorders. People who suffer from bruxism typically grind their teeth whenever they are sleeping deeply, which is one reason why tooth grinding isn’t typically diagnosed until people have suffered with it for awhile. Many aren’t aware of their teeth grinding at first; some people don’t even know that they grind their teeth until they wake up with a chipped or cracked tooth.  

Unfortunately, the damage caused by bruxism doesn’t stop with the teeth. Teeth grinding can also cause severe gum recession because of the pressure put on the gums by the motion. Tooth grinding can also make the teeth loose in their sockets, creating deep gingival pockets where bacteria can collect. These bacteria can cause the gums to pull back even farther from the teeth, exposing the delicate dental root.  

Treatment Options

Fortunately, there is a lot your Pittsburgh periodontist can do to help you with bruxism and subsequent gum recession. Here are some of the treatments periodontists in Pittsburgh might recommend:

Treatments for Bruxism

Treatment for bruxism typically includes wearing a customized mouthguard designed to keep your teeth apart as you sleep. There are a large variety of mouthguards available on today’s market, allowing our clinicians to cater your treatment specifically for your teeth, any allergies, and your personal preferences. Mouthguards can give your teeth and gums a chance to recover from previous bruxism damage, while preventing future problems.

Treatments for Gum Recession

  • Gum Grafting: Traditional gum grafting involves harvesting tissue from elsewhere in the mouth to graft into the recessed area of the gums. Traditional gum grafting is effective and time-tested.
  • The Pinhole Surgical Technique™: The Pinhole Surgical Technique™ can alleviate gum recession without the negative side effects of traditional surgery. During the Pinhole Surgical Technique™, a small incision about the size of a pinhole is made above the recessed area. Next, special tools are used to gently push the gum tissue downwards, and tiny collagen strips are used to hold the tissue in place. The treatment is effective immediately and requires a very simple recovery.

For more information about treating gum recession and bruxism, contact the Silberg Center for Dental Science.

How to Prevent Toothbrush Abrasion

The importance of frequent brushing and flossing is common knowledge. Using the proper techniques, teeth and gums can remain healthy, strong and beautiful. But it may come as a surprise to you that we have also seen patients who damage their teeth and gums by overdoing their dental hygiene routine.

Although the teeth seem very solid, they can only handle so much. Between the acids naturally found in the saliva and the pressures of biting and chewing, they take quite a beating each day. When the daily dental care ritual is harsh as well, it can really add up, causing damage to the teeth and the gum tissue which can contribute to gum disease. Pittsburgh periodontist Dr. Silberg wants to ensure that you avoid these costly problems and maintain the health of your teeth and gums.

Toothbrush abrasion is the damage that is caused by the hard scrubbing of the teeth and gums. It can compromise the integrity of your enamel, resulting (ironically) in a greater susceptibility to cavities, and in receding gums. This can result in discoloration of the teeth, and teeth which appear overly long.

In order to avoid toothbrush abrasion, it is important to use proper brushing technique. The first step would be choosing a toothbrush with softer bristles. Dental plaque is soft and requires no more pressure to remove than wiping the surface with a soft cloth. Because of the many contours and crevices of the teeth, we use bristles in order to help us reach every surface of each tooth–but they shouldn’t be any harder than necessary.

When brushing, you should use small, circular motions, rather than straight side-to-side or up-and-down motions, making sure to apply just enough pressure to gently clean the teeth. If the bristles of your toothbrush are splaying outward, (and especially if your toothbrush has a frayed appearance after being used for a few weeks or months), you are pushing too hard. While you are brushing, point the bristles at a 45 degree angle toward your gums so that the soft tissue is cleaned and strengthened as well. It is good to brush for about two minutes to be sure you cover all of the surfaces, but not much longer. Even with proper technique, brushing for long periods of time can also cause toothbrush abrasion.

To keep your teeth and gums healthy and strong, visit your Pittsburgh periodontist, Dr. Silberg, regularly. Together we can ensure that you receive the best care possible for your beautiful smile. Make an appointment today!

Dry Mouth and Periodontal Disease

Dry mouth, also known as xerostomia, significantly increases your risk for developing periodontal disease. We at the Silberg Center for Dental Science are here to help you understand dry mouth and the role it plays in gum disease. We’ll do everything we can to treat dry mouth and ultimately prevent periodontal disease, helping you to maintain a healthy, beautiful smile.

What is the link between dry mouth and periodontal disease?

When a patient suffers from chronic dry mouth, they often experience thirst, a dry and raw tongue, bad breath, or a burning sensation in the mouth, especially on the tongue. Dry mouth is also problematic because it can lead to gum disease, because your mouth needs saliva to wash away food and bacteria from your teeth. When bacteria isn’t washed away, it can lead to gingivitis, the first phase of gum disease, which is characterized by decay, pain, and inflammation. As the infection progresses, it creeps down below your gum line, making the disease more difficult to treat and more dangerous for your teeth.

What treatment options are available for dry mouth?

Treating dry mouth is an easy and simple process. First, limiting the amount of sugar and caffeine that you consume, and avoiding tobacco products altogether, can help regulate your saliva production. Try to drink more water and breathe through  your nose. It can also help to sleep with a humidifier and to pay careful attention to your oral hygiene regimen. We can also talk to you about your medical history and what medications you are on in order to understand what might be causing your dry mouth condition. Adjusting these medication may help reduce dry mouth.  There are certain products that you can use to increase saliva production as well.

Treating dry mouth is important because it lowers your risk of gum disease.  If you are looking for dry mouth or gum disease treatment in Pittsburgh, come and see us today.

The Dental Implant Process

If you’ve experienced tooth loss, chances are you’ve thought about restoring your smile with dental implants. Dental implants are the healthiest, longest-lasting way to replace missing teeth, whether you need a single tooth or a whole row. They look and feel completely natural, and with proper care they can last a lifetime. But receiving implants can be a long journey. Read on to learn about the process.

  1. Evaluation: Before placing your implants, Dr. Silberg will conduct a thorough examination.  This examination consists of taking x-rays, which allow the dentist to see beyond your teeth themselves to the bone structure that would support an implant; assessing the depth of your jawbone as well as the position of other facial structures, like the sinuses, to determine how and where to place implants; and checking for gum disease or taking dental impressions to evaluate your bite.
  2. Preparatory procedures: In some cases, the evaluation will reveal that it is not safe to place implants right away. For example, because tooth loss can lead to the disintegration of supporting bone in the jaw, some patients may not have sufficient bone remaining in their jaw to stabilize an implant. In this case, bone grafts must first be performed in order to add mass to the jawbone. These grafts can take months to heal before the implant can be placed. In other cases, the sinuses may be too close to the upper teeth, and a sinus lift will be necessary to make room for the implant.
  3. Placing the post: This is the first stage of the actual surgery. The post is a titanium screw-like device that replaces the root of the tooth. It is placed completely under the gum, which protects the post from force while it heals.
  4. Adding the abutment: After the post has had time to bond completely with the bone, the top of the post is exposed and connected with an abutment. The abutment is the mechanism that links the post to the crown. After this, the gum is given time to heal around the abutment.
  5. Finishing with a crown: The final step in the implant process is placing the crown, the replacement tooth that is custom made to precisely match your natural teeth. The crown attaches securely to the abutment, and with proper care, it never needs to be replaced.

Looking for top-quality implant dentistry in Pittsburgh, PA? Schedule a consultation at the Silberg Center for Dental Science to find out if implants are right for you.

Flossing Doesn’t Work – Or Does It?

In Response To The Associated Press News:

Medical Benefits of Dental Floss Unproven

Yes, flossing works.

Yes, flossing works.

A few days ago, the Los Angeles Time picked up an article from the Associated Press entitled: “Haven’t flossed lately? Don’t feel too bad: Evidence for the benefits of flossing is ‘weak, very unreliable'” As a dentist, periodontist, and health professional I felt compelled to write a response and share it here, on our blog, as well as via e-mail with patients and colleagues.

There is little “high quality” evidence for most of what’s done in medicine or dentistry.  Indeed, when “evidence based decision making” became a big deal starting in the late 1990s, many people twisted it to mean that a “lack of evidence” is somehow proof that the procedure in question doesn’t work.  Indeed, one sees this sort of misleading rhetoric all the time in other areas, especially in politics, sex and religion”.  And to be sure… there is plenty of politics in healthcare, sex and religion. The media thrives on misconstruing the facts and creating rhetoric.

That said, Tim Iafolla’s comments (from NIH) in the LA Times article are both troublesome and perplexing.  My guess is that he was quoted only in part — because even when there is very little evidence from what are considered to be weak studies, many procedures are recommended based on cost versus risk and in consideration of perceived benefits. It is fascinating how few “experts” seem to intuitively understand that every decision we make in life, from how we perform oral hygiene to changing lanes on the highway are most often considered in cost/benefit terms. Flossing studies? Who is going to pay for a study to follow 500 patients for 10 years? We learned in the 1960’s that a buildup of plaque bacteria, now called biofilms, causes bleeding gums and gum disease. We proved that removing said plaque allows the gums to heal. We have very strong medical evidence that inflammation anywhere in the body is bad and affects the entire system negatively. While some patients that are resistant to gum disease may not get much benefit from flossing, it helps many people quite a bit. And, truth be told, floss is not a goal it is a tool and other tools can be used besides floss to remove plaque. The idea is to remove the bacteria that cause infalmmation to a low level to prevent disease. This needs to be done between the teeth and floss is one tool that accomplishes that goal.

So yes, it is true, we don’t have high-quality evidence for flossing but that doesn’t mean it isn’t useful (just like we don’t have high-quality evidence that jumping off the US Steel Building is likely to be fatal).  And in light of the low costs of flossing and its potential benefits, is it not better to over-recommend flossing to reduce inflammation and disease than to under-recommend it?

But in a larger sense, this sort of near sighted thinking regarding evidence can easily spin out of control.  An LA Times author seeks to write a compelling article questioning and criticizing a long accepted practice. Kudos to him or her, that’s how one gets ahead in journalism-sometimes truth be damned.  But I can’t tell you how many times I hear otherwise smart folks condemn certain approaches in medicine, dentistry, life, etc. because supportive evidence is weak or not there at all.  Often this is done with a bit of ignorant intellectual arrogance that shouts: “I’m using evidence-based criteria here!”  Sorry Dr. knows it all… this is a fallacy that’s based on the all too frequent failure to only understand evidence-based decision making on the most superficial level.  Yet this foolishness seems increasingly widespread, all pivoting off the same and increasingly popular shallow thinking about what evidence (and lack of evidence) means and doesn’t mean.

So this is the most important thing to remember: A lack of high quality evidence is not proof that there is no benefitThe lack of evidence does not prove that something does not work or is not effective. Thus, the lack of evidence only means that there is a lack of evidence.  And, because most of the time high-quality evidence has never been sought, the journalist that seeks to sensationalize and write a high profile story that garners national attention will get just that-a lot of attention even if the story is biased and untrue.


May The Floss Be With You

Dr. Mark Silberg

When Gum Disease Comes Back

Gum disease can be treated in a number of ways depending on its severity. For mild cases, nonsurgical treatments like scaling or planing may be used, sometimes in combination with antibiotics. In more advanced cases, you might have to undergo a surgery like pocket reduction surgery (which allows the dentist to scale and plane root material covered by gums) or receive grafts to replace gum tissue or bone that have been destroyed by disease.

While gum disease is treatable, it isn’t completely curable. Without vigilance on the part of the patient, including good oral hygiene practices, it can easily come back.

After receiving treatment for periodontal disease at the Silberg Center, Dr. Silberg will teach you how to and help you keep the disease at bay. Periodontal disease is caused by a buildup of plaque on the teeth and gums, and no matter how diligent you are about cleaning your teeth, plaque will continue to accumulate after your periodontal treatment. Periodontal disease can come back as soon as two to four months after your treatment. That’s why maintenance therapy is important.

During maintenance therapy, which may last for several months after your treatment, you will need to have your teeth checked periodically for plaque buildup and other hidden problems. Maintenance visits may also involve measuring the pockets around your teeth, taking x-rays to examine the condition of the bone beneath your teeth, and assessing of your oral hygiene habits. Your general dentist and Dr. Silberg will work together to determine how often you should have maintenance visits.

Of course, Dr. Silberg and your dentist will do all they can during maintenance therapy to prevent your gum disease from recurring. However, the most important factor in determining whether your gum disease will return or not is you. Brushing your teeth multiple times per day and flossing daily are essential. Your maintenance visits will support and reinforce these good habits.

If your gum disease recurs—and goes unnoticed—you may require more extensive, expensive, or invasive treatments in the future. However, keeping your natural teeth clean, healthy, and functional will allow you to speak, eat, and smile comfortably. If you think you may have gum disease or you’re concerned that your gum disease may be returning after treatment, visit the Pittsburgh periodontist you can trust with your smile, Dr. Mark Silberg. Contact us to schedule an appointment today.

Overcoming Dental Phobia

iStock_000060650738_XXXLarge_CompressedOdontophobia, or the fear of dentists, is common in adults. Millions of Americans suffer from some form of odontophobia. While few people look forward to visiting the dentist, those who suffer from the worst anxiety would rather suffer extreme pain than go in for a visit, even if that meant taking the pain away. The fear of the dentist can have many causes, but the most common catalysts are a traumatic experience as a child, fear of loud noises, fear of pain, and the feeling of lacking control when in the dentist’s chair.

If you are one of the many who avoid the dentist out of anxiety, or if you’ve found dental visits a distressing experience until now, we can help. Pittsburgh periodontist Dr. Silberg and his staff are trained to help even the most anxious patient overcome their fear. Read on to learn a few of the things that we can do to help accommodate your particular needs.

Explaining Procedures

We try to explain everything that will happen before it does to help patients feel comfortable with their procedures. Don’t be afraid to ask questions, as knowledge truly is power. If you know what to expect, you will be less afraid of it.

Establishing a Safeword

When you first sit in the chair, we will establish a signal or a word that means “Stop.” Common signals include raising a hand, tapping the chair repeatedly, or making a certain sound–things you can do even when you can’t speak. That way, you have control over your dental visit.

Allowing Comforting Objects or People

We encourage our patients to bring something or someone that will help them remain calm during their visit. Many patients bring a friend or relative, especially to their first visit to help them until they are more comfortable with Dr. Silberg.

Seeking Distractions

A similar strategy to the previous one, this idea relies on being too busy to focus on the dental procedure. You can distract yourself by listening to music, watching a movie, or doing something else to keep yourself busy. Find something to do that will keep your mind occupied so that you don’t succumb to your anxiety. As much as possible, we’ll accommodate your need for a distraction.
Dental care can be frightening, but it will improve your life and your health. If you have any questions or concerns about your dental phobia, please contact us!

Options for Dental Implants

Options for Dental ImplantsAt The Silberg Center For Dental Science, we are on a mission to help people find a better solution for missing teeth. Dental implants are a permanent tooth replacement that will keep you comfortable when you eat, smile, or laugh. As part of our mission, we want to educate you about all your implant options. What’s best for you will depend on the details of your dental health; but we can at least give you an idea of what possibilities there are for dental implants in Pittsburgh.

Traditional dental implants for single teeth

Generally, getting implants takes multiple visits. On the first visit we will give you an exam, ask about your dental history, take impressions of your teeth, and discuss your treatment options. Usually, the root portion of your implant is placed during your next visit, topped with temporary crowns until the root fully fuses with your jaw bone. Sometimes a visit is needed to secure an abutment, or connector, to the implant. This abutment in turn connects to your permanent crown. There are also implants in which the post and abutment are one piece, placed at the same time.

Traditional implants for fixed bridges

Even with traditional implants, there are many possible variations. If you are missing multiple teeth, you’ll have the option of choosing individual implants for each missing tooth or getting a single implant which will support a dental bridge. This is the less expensive option, and while it is not as close an imitation of your natural mouth structure, it is still an excellent choice for function and aesthetics.

Immediate Load Dental Implants

Immediate load dental implants are also known as same day implants. If you have strong enough natural bone, you can have an implant complete with temporary crown placed during a single visit; you’ll come back just once to receive your permanent crown, individually crafted to fit your mouth.

Mini Implants

For a less invasive option, talk with us about mini implants, which are smaller in diameter than traditional implants. We consider using mini implants when there is a need to secure a complete lower or loose denture. It is also an option for patients that can’t receive traditional implants.  

Subperiosteal Implants

If there isn’t enough jawbone to secure traditional implants and a bone graft is not an option, we offer subperiosteal implants. These implants are not secured in the bone, but are placed below your gumline and sit on top of the bone. While we’d prefer traditional implants where possible, these can be an excellent second choice.

Remember, the best option for you will depend upon the health and shape of your mouth. If you are looking in Pittsburgh for dental implants, please contact us today to learn more about your choices. We’ll answer your questions and help determine the treatment option that fits your situation.