Anterior Implant Case

This is a great case- This is a young woman that came in that had an infection on one of her front teeth- This shows a great before, during and after the case-

Beautiful results with final implant crown
Restorative work by Dr. Greta Richter

Pregnancy and Gum Disease

Being a periodontist and a new mom, I fully understand the risks and the actual symptoms that go along with pregnancy and gum disease.  The hormones that are associated with pregnancy can cause your gums to get swollen and to bleed more than normal. This is triggered even further by bacterial plaque or tartar, thus good oral hygiene and seeing your dentist regularly is important- Usually getting a cleaning once a trimester is ideal for optimal oral health.

It is ideal to leave dental treatment until the 3rd trimester, but if emergency treatment is needed than it is recommended to have the mom wear a double layer of the lead shield when radiographs or X-rays are needed.  Specific antibiotics like penicillins and clindamycins are safe but certain antibiotics like Tetracycline is contraindicated in pregnancy women.  

In some cases, the pregnancy hormone, progesterone can cause an increase in swelling and bleeding in the gums severe enough that a "Pregnancy tumor" can form. This usually manifests as a localized swelling that is very red and inflamed with lots of vasculature. This can form in the front of the mouth or in the back of the mouth. This sometimes goes away on its own, but sometimes, it needs to be removed surgically. See a periodontist immediately if you suspect you have one.

When is it time to see a periodontist?

When is it time to see a periodontist?
Many of my patients that come in to see me, have periodontal disease that is diagnosed and seen by their general dentist; however there are a certain population that are at a higher risk of getting gum disease than others. Sometimes, dentists overlook the health of the gums and bone so many patients now are very proactive about their health and see me as a self referral. Here are a couple of reasons to come see a periodontist.
1. SMOKING- If you are a smoker either currently or in the past, there is a high chance that you have bacteria that is harboring in the pockets of your gums. This can eventually cause bone loss and the loosening of your teeth. Smoking actually causes a change in the immune reaction to bacteria, thus your immune system can not fight the bacteria as well as a non smoker. It also causes vasoconstriction of your blood vessels and your bone really survives via the blood. Thus if there is less blood flow, there is more chance of bone loss around the teeth.
Typically, I see more severe bone loss in the front teeth because when you smoke, the smoke blows more concentrated in the front teeth. This causes bone loss as well as gum recession. The literature shows that smokers also have a higher risk of oral cancer and gingival recession.

2. DIABETES- Patients with diabetes (especially uncontrolled diabetics) have a higher risk of getting gum disease than those with controlled or non diabetics. This is due to the immune response to the bacteria in the mouth, causing more inflammation and bone loss around teeth. Diabetics are also much more prone to infections in general.

3. PREGNANCY- For those women that are pregnant, it is really important to make sure your gum health is in check. Due to the rising hormones during pregnancy, any increase in bacteria or plaque that forms on your teeth can cause bleeding and swollen gums. This can exaserbate into a more severe gum disease that research has shown can affect the well being of the baby (including pre-clampsia and pre term babies). It is really important to get your gums checked and keep up with good oral hygiene at home.

4. BAD BREATH- Bad breath typically stems from only 2 things: Bacteria in the mouth and gums and the Gastrointestinal tract. Many times, gum pockets can form around your teeth which are warm, dark places for bacteria to live and hide. These gum pockets are really hard to keep clean at home so occasionally, you will need a deep cleaning to get this bacteria out. Typically, a regular cleaning that you get every 3 to 6 months cleans above the gum tissue, but a deep cleaning goes under the gums and cleans the baceria out from under the gums.

5. GUM RECESSION- Gum recession is found in my rigourous tooth brushers. This can cause root exposure and thus sensitivity of the teeth.

Oral Cancer

Oral Cancer- So, I saw a young patient the other day as a referral from a General Dentist, with swelling around a tooth on the lower jaw. What was unusual about this swelling was that this tooth had swelling around the front and the area near the tongue. It also did not go down after debridement of the soft tissue that the general dentist performed a few days before. The swelling persisted and got slightly bigger. I took a sample of the tissue and realized that the tissue did not bleed on the inside of the epithelial layer. The area was a whitish tissue with areas that seemed abnormal. The answer came back from pathology: Squamous Cell Carcinoma- a malignant oral cancer that was invasive.

This patient was a young 21 year old female. She had no significant medical history.

This news was devastating to me.

I had to break this news to her and her family.

I quickly called the physician referral line at Memorial Sloan Kettering to get her an appointment with the Head and Neck Surgery Department. They asked for her primary medical insurance: "She doesn't have Primary Medical Insurance."

This was even more devastating.... I didn't know what she was going to do. I knew this treatment will cost an amount that could bankrupt her and her family. Pre-existing condition= she will never have insurance that will cover this.

She will see the docs tomorrow so I will get an update- My prayers and hopes are with my patient.

Gum Grafting

Receeding gums is a problem that occurs in patient young and older. There are a couple of contributing factors that causes gum recession:

1. Toothbrush abrasion- the use of a Medium or coarse bristles with rigorous brushing motion can cause gum recession and tooth abrasion as well
2. Post orthodontic treatment- some patients can get this after braces 
3. Abnormal bite- abnormal forces can cause tooth abfraction and gum recession
4. Smoking- patients that smoke have a higher risk of gum recession

The treatment includes:

1. Connective tissue grafting- taking the underlayer of tissue from the roof of the mouth, leaving the top epithelial layer on- this option has the best esthetic result
2. Free Gingival graft- taking both the epithelial layer and connective tissue layer- this is indicated when there is NO keratinized tissue remaining
3. Soft tissue allograft- Donated tissue from a cadaver- this prevents a secondary surgical site but can be more costly financially
4. Use of Emdogain- porcine enamel- helps healing and root coverage- an additional cost, but has superior results

 This is a mirror image of the sites that required soft tissue grafting

This is the healing after a connective tissue graft done on the 3 teeth at the same time

Welcome!

Hi! I'd like to introduce myself- I'm Nancy S. Kim DDS.  I'm a dentist, well, more like a specialized dentist. I'm a periodontist which is a dentist that specializes in the health of the gums and the underlying bone in your mouth! I mostly do specialized surgeries like gum grafting, bone grafting and dental implants.

I grew up in Baltimore, Maryland where I was lucky enough to have attended an all girls school, Bryn Mawr School for middle and high school.  I'm an alum of Johns Hopkins University where I played Division I Women's Lacrosse- So you may see me occasionally post some things about JHU Lacrosse- Go HOP!

I then went to University of Maryland, Baltimore College of Dental Surgery- the FIRST Dental school in the world!! Yup, currently the home of The National History of Dentistry where George Washington's denture rest :)  After I got my DDS, I moved to the big city of New York and did a GPR at New York Presbyterian Hospital, Weill Cornell Medical Center. I LOVED this program. I learned so much and began to encounter the real deal in on call emergency dental work... I also spent 4 months as Memorial Sloan Kettering Cancer Center where I learned Dental Oncology and treatment with treatment manifestations.... I'll probably blog more about that too...

Then I spent 3 years at New York University where I did my post graduate surgical residency in Periodontics and Dental Implantology. I became Board Certified in Periodontics in 2008 which was a great accomplishment for me personally and professionally.

My hope with this Blog is to give you the trends and interesting topics that I encounter in the dental world. Not only cases, but issues in the news that constantly come out.

I will love to hear what you have to say about some of my posts.

I have private practice in Manhattan on 61st street and Park Avenue
Please feel free to contact me anytime:

115 East 61st Street, 14th Floor
New York, New York 10065
(212) 838-7219
www.nycperioimplants.com