Frequently Asked Questions
1. What is a periodontist?

Every licensed dentist has completed college as well as four years of advanced training in dental school. What dental students are taught is carefully prescribed and enforced by the Commission on Dental Accreditation (CODA). CODA is a part of the American Dental Association but answers solely to the U.S. Department of Education. The commission takes its job seriously; you can be assured that a graduate of an accredited dental school in the U.S. has been given a solid educational foundation upon which to build, with life-long learning, the skills to care for patients.

Some dentists choose to pursue specialty training. For a periodontist this means three additional years of full time training.

Periodontists spend their three extra years of training learning to be surgeons. This training focuses on the diagnosis and treatment of periodontal disease (gum disease), periodontal plastic surgery (rebuilding receded gum and bone on the roots of teeth) and the surgical management of dental implants (rebuilding damaged and lost gum and bone and the actual placement of dental implants). We build on this foundation with a life time of continuing education and we limit our practices to these and related skills.


2. Why choose a specialist?

Choosing the right health care professional to take care of you is both important and potentially confusing. After all, everyone wants the most qualified individual to treat us or a family member. Determining who is most qualified is where the confusion can occur.

After graduation from dental school some doctors pursue specialty training, such as in periodontics. Becoming a periodontist requires three additional years of full time training. These training standards are also enforced by CODA. If a student fails to meet the standards they cannot call themselves a periodontist.

Periodontists spend their three extra years of training learning to be surgeons. This training focuses on the diagnosis and treatment of periodontal disease (gum disease), periodontal plastic surgery (rebuilding receded gum and bone on the roots of teeth) and the surgical management of dental implants. We build on this foundation with a life time of continuing education and we limit our practices to these and related skills.

So, what is special about a specialist? For the periodontist it is two things: three additional years of full time, formal training as surgeons and the fact that we limit our practice to these special skills. In other words this is all we do, all day long, every day of our professional career. That focus gives the periodontist a depth and breadth of experience in these areas which is unmatched in dentistry. That is what makes the periodontist the expert in the diagnosis and treatment of periodontal disease and periodontal plastic surgery and what insures great expertise in the surgical management of dental implants.

Many dentists treat periodontal disease and place dental implants. Only the periodontist has the additional formal training and limits his practice to these areas.

The choice is yours.


3. How long will my dental implant last?

The short answer is “as long as you take care of it”. Implants, being made of an alloy of titanium, cannot get cavities. They can, however, develop gum disease just like teeth. Called peri-implantitis this infection, which starts in the gums and, if untreated, spreads to the jaw bone, can cause enough damage that your implant can be lost. The process is just like gum disease in natural teeth although studies suggest it progresses faster than in natural teeth.

The good news is you can prevent this infection the same way you keep your natural teeth healthy; you brush and floss them carefully every day and see your dentist and dental hygienist for regular professional cleanings. This also allows your dentist and hygienist to spot problems early and take care of them easily, just like with teeth. If you want your dental implants, and your teeth, to last a lifetime remember: clean them well every day and have professional cleanings and check-ups 2-3 times every year.


4. Are implants as good as natural teeth?

In a word, no. As we tell patients every day, nothing is better than a healthy natural tooth. Our number one goal is to help every patient keep their natural teeth for a lifetime. Unfortunately that is not always possible. And dental implants provide a wonderful alternative to partials and bridges when it becomes necessary to replace a lost tooth. They are the closest thing dentistry has to a natural tooth.


5. When my treatment is complete do I go back to my dentist or will you be treating me from now on?

You absolutely will be returning to your dentist! As specialists we work with our dental colleagues, and their patients, to provide services that may be outside the training of our colleagues but is our day-to-day work. That is the beauty of collaborative dental care. Everyone brings to the table their best skills and experience to provide our patients the best care we can. It is great fun being part of such a team effort and I can assure you the patient is the winner, getting the best each of us has to offer.

Ultimately the patient returns to the dentist for dental cleanings, examinations and restorative care. For many of our patients with periodontal disease, which has a tendency to recur, we continue to see the patients, in conjunction with the dentist, on an alternating basis. How often they are seen (3-4 times per year is common, with the appointments alternating between the periodontist and dentist) depends on the severity of the disease and the risk factors which may lead to a new periodontal infection. We work with each patient, and their dentist, to create a maintenance schedule which minimizes the possibility of recurring infection.


6. I’m not in pain. Why did my dentist send me here?

Pain is not a common symptom of periodontal disease. And that is not so unusual. High blood pressure and type II diabetes are two other examples of common diseases which cause little or no pain until they become extremely serious.

The fact is that pain, in this instance, is not a good indicator of severity. And like most problems, the sooner it is diagnosed and treated the less damage is done and the easier (and often less expensive) the treatment.


7. Do you offer sedation?

Absolutely! While many of the services we provide are done only with local anesthetic (numbing) a number of our patients prefer something to help with the anxiety they feel at the dentist. Sedation fills the bill.

There are basically three types of sedation offered in our office: nitrous oxide (laughing gas), oral moderate sedation and intravenous moderate sedation. Here are the differences.

With nitrous oxide the patient simply breathes a combination of nitrous and oxygen. The level of nitrous oxide is adjusted for each patient to provide relaxation and anxiety relief. With nitrous the effect goes away after it is discontinued (you will be given pure oxygen for 5-10 minutes to insure that the effect has passed) and then you may drive home or return to work.

With oral moderate sedation the patient fills a prescription we provide and brings it to the office. We have the patient take the medication here, while in the chair and while being monitored. Typically within an hour or so the medication has relaxed the patient and the procedure can begin. You must have someone staying with you in our office ready to drive you home as soon as your treatment is complete.

With intravenous moderate sedation a small IV line is established in a vein on the back of the hand and the medication is administered. This route of administration allows a more precise level of sedation as the effects are quickly seen. Should additional sedation be needed during treatment it is easily administered through the same IV line. You must have someone staying with you in our office ready to drive you home as soon as your treatment is complete.

Just a couple of additional points. Moderate sedation is quite safe. You are awake and your protective reflexes (coughing, etc.) are intact. Your blood pressure and the oxygen levels in your blood are constantly monitored. The sedation is not a substitute for local anesthesia (numbing). We will make sure you are numb and comfortable before we ever begin. The sedation simply helps alleviate the anxiety some people feel at the dentist’s office.

Whether or not you are sedated is always your choice to make.


8. How much pain am I going to be in after surgery?

Discomfort after dental work depends primarily on two things: the work that was done and the patient herself.

People perceive pain differently. Part of our examination, when we are getting to know our patients, is to ask about this. Most people have an idea of their level of tolerance for discomfort and we try to provide medication appropriately.

The other factor is just what work, and how much work, is done. For a small number of our procedures it is necessary to provide our patients with both an anti-inflammatory drug (such as Motrin or Alleve) and a narcotic. For many of our patients the anti-inflammatories are all that is needed for comfort. We always try to provide adequate medication for comfort and are always available by phone should more be required. Every patient having surgery is given our office number, which is answered 24/7, and our cell phone numbers. Should the need for additional medication arise (or simply a question, for that matter) your doctor will always be available.


9. When can I have my teeth cleaned again?

This will depend on what type of treatment you need. For many of our procedures there is adequate time for complete healing between one six month dental visit and the next. For others, such as surgery to eliminate the infection of periodontal disease and repair of the damage the infection has caused, the treatment and follow-up time can be from 6-12 months. During that time you will be followed closely here, with cleanings and maintenance performed to ensure maximum healing and regeneration of bone and gum after surgery is complete. Your dentist will always be kept up to date on your progress and you will be back in their office just as soon as possible.


10. Will I be able to eat after my surgery?

Of course! Good nutrition is essential for good healing. Some limitations, however, will apply to your diet after some types of treatment.

Certain types of treatment are vulnerable to damage, especially in the first few weeks after surgery. Gum grafts for recession, bone grafts to rebuild places for implants to be placed, and surgery to eliminate periodontal disease and regenerate the bone and tissues lost to the infection, have to be treated carefully in the days and first few weeks after surgery. With each procedure we have a specific set of written post-operative instructions which are reviewed with and given to each patient before they leave our office. The doctors are always available to answer questions in the evenings and on weekends about these matters. You may be asked to alter your diet and your brushing and flossing routine for a period of time. Rest assured that we only ask you to do these things to ensure the best possible outcome for your treatment. Our goal is first to make you healthy and then to work with you and your dentist to keep you healthy!

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Dr. Steven Daniel is Board Certified by the American Board of Periodontology. 

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