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Edward Gottesman
Periodontist in New York City
Periodontist in New York City


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What are "periodontal" pockets?

Periodontal pockets develop when the gum tissue begins to pull away from the top of the tooth’s crown. These structures usually form as a result of the inflammation associated with periodontitis, a more advanced stage of gum disease.

Generally, when the pocket is at least 4 millimeters deep, some treatment for periodontal disease is warranted. If the issue is not addressed promptly, the pockets will continue to collect more oral bacteria and become bigger. At those more advanced stages of gum disease, effective treatment becomes more invasive.

To avoid gum surgery, patients should consult with a periodontist for treatment as soon as their general dentist identifies symptoms of gum disease, like periodontal pockets. There are several non-surgical interventions that a periodontist can use to reduce the size of pockets, such as root planing and scaling.

With this procedure, the periodontist removes plaque and tartar (which contain oral bacteria that cause the inflammation of gum disease) from the surface of the teeth below the gumline, as well as in any pockets that have formed. An ultrasonic scaler can be used for this procedure for maximum patient comfort. 

Some patients may also receive adjunctive antibiotic therapy as a follow-up to root planing and scaling in order to further reduce the presence of the oral bacteria that cause gum disease. The antibiotics may be taken in pill form or in a powder or gel that can be placed directly in the pockets.

After receiving treatment for gum disease, it is important for patients to take adequate preventive measures to reduce their risk of a relapse. Ongoing monitoring by a periodontist is essential, as is a thorough home oral hygiene routine.

Patients should work with a periodontist who demonstrates a commitment to ongoing education in the field to remain informed on the latest developments in interventions and preventive techniques. This will ultimately benefit the patient in the long-term maintenance of gum health.

If you notice signs of gum disease, like periodontal pockets, schedule a consultation with our skilled team of periodontists to learn more about your treatment options. Call 212-756-8890 for more information.
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Restoring your Oral Health after an Eating Disorder

Eating disorders have negative effects on many aspects of a patient’s mental and physical health. The patient’s oral health can be adversely affected by conditions like bulimia and anorexia, which can wreak havoc on the smile.

Patients who have successfully overcome an eating disorder can work with a periodontist to undo the damage done to their smiles as a result of those conditions.

Purging, an activity common for people with bulimia and anorexia, causes significant wear and tear on the teeth. Frequent exposure to stomach acids erodes the enamel, weakening the teeth to the point that the mere act of chewing can be a challenge.
In such cases, cosmetic dental surgery can help to restore a smile’s appearance and improve the teeth’s functionality.

For example, teeth that have gradually worn away can appear unusually short. Crown lengthening, in which a small amount of gum tissue is removed to expose more of the tooth’s enamel, can bring the appearance of the smile into the proper proportions.

When performing the crown lengthening procedure, the periodontist will use gentle techniques to remove and re-contour the gum tissue. In turn, the teeth will appear longer—or in the case of patient with tooth erosion, a normal size.

Crown lengthening is an outpatient procedure that takes just a few hours, a minimal investment to get back your beautiful smile. Many patients will be able to tolerate the procedure with just a local anesthetic.

In addition to crown lengthening, many patients also work with a prosthodontist to get restorations like crowns or onlays to strengthen their compromised teeth. The prosthodontist and the periodontist often collaborate in developing the overall treatment plan.

Just as it is possible to recover psychologically and physically from an eating disorder, you can heal your smile as well. To learn more about a patient named Allison and her real-life experience with these procedures, you can watch this video.

Contact our office to learn more about these interventions if you feel that you could benefit from cosmetic dental surgery to restore your smile as an important component of your eating disorder recovery.
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Study Shows Implant Success Rate is Highest When Performed by a Specialist

Even the most routine dental procedure can take an unexpected turn. Plans for placing a simple filling in a tooth can easily evolve into an emergency root canal procedure if there is deep decay. A tooth that is slated for a root canal procedure might need to be extracted if there is a fractured root or if the root canal procedure fails.

A general dentist is well-prepared for virtually any change of plans that may occur in the dental chair. Dentists have the training and experience to provide patients with comprehensive oral health care, enabling them to transition from fillings to root canals—many are even equipped to perform more advanced procedures such as tooth extractions and the placement of dental implants. However, as your treatment needs become more complex, your general dentist may choose to collaborate with a dental specialist such as a periodontist to ensure that each phase of your treatment is performed as flawlessly as possible.

This type of joint collaboration is made possible by the mutual respect, trust, and strong partnership that exist between the general dentist and the periodontist. For example, if a dental implant is needed to replace a missing tooth or a tooth that is to be extracted, your general dentist may opt to refer you to a periodontist with extensive dental implant experience rather than performing the implant surgery in the dental office.

A study which was recently published in the prestigious Journal of the American Dental Association explores the long-term benefits that can be seen when a general dentist recruits the services of a periodontist on your behalf for the placement of dental implants. For the purposes of the study, 922 dental implants and patients were observed for signs of success or failure three to five years after initial placement. After allowing for common causes of implant failure such as bone loss and inflammation, the researchers suggested that the survival and success rates for implants that were placed in general dental offices were lower than the statistics for implants that were placed in specialty settings such as periodontal and oral surgery offices.Your general dentist is committed to providing you with optimal tooth replacement solutions, which often includes the expertise of a seasoned dental implant provider like a periodontist. From the partnership between the two professionals, your chances for a predictable and successful implant will increase significantly. View the JADA article here.

To learn more about how your general dentist and your periodontist can work together to provide you with the most ideal dental implant treatment, call 212-756-8890 to schedule a consultation today.
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Can gum disease treatment also improve the health of my arteries?

Heart health may be the furthest thing from your mind when you are scheduling an appointment with your periodontist, but effective treatment for gum disease can benefit your arteries, too.
Furthermore, this type of gum disease treatment doesn’t even need to involve surgery.

In a study of Aboriginal Australians with gum disease, a single non-invasive intervention for that condition was correlated with reduced thickening of the wall of the carotid artery a year later. The effects were similar to those that might be seen with a 30 percent decline in LDL cholesterol (often referred to as the “bad” cholesterol).

The inflammation associated with gum disease, which is caused by oral bacteria, is similar to inflammation in other tissues throughout the human body. When similar inflammation occurs in the artery walls, they can thicken, potentially contributing to serious health issues like heart attacks and stroke.

Gum disease treatment becomes necessary when signs of periodontal disease, like bleeding or swollen gums or pockets between the gums and the teeth are evident. The condition is progressive, so the interventions for earlier stages of gum disease tend to be less invasive.
For example, gingivitis—the mildest form of gum disease—can be addressed with a thorough dental cleaning around the gum line. When pockets of minimal depth are present, a root planing and scaling in which the pockets are cleared of bacteria and reduced in size, can be effective.

The most advanced form of gum disease, periodontitis, may require a surgical treatment, such as gum grafting to repair receded gums.
The goal of gum disease treatment is to eliminate the bacteria that are causing the inflammation. As these bacteria can travel throughout the body, it makes sense that effective gum disease treatment can also correlate with systemic effects, as it did in the aforementioned study of Aboriginal Australians. Other research has suggested similar results in other groups at risk for both oral health problems and heart disease.

Getting effective treatment when you first notice signs of gum disease won’t benefit just your oral health. Your cardiovascular system can get a boost, too. Discuss this benefit of periodontal treatment during your next appointment. Call 212-756-8890 to schedule your visit.

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3D Imaging Technology Can Enhance Patient Care

When it comes to gum disease treatment, the placing of dental implants, and many other dental procedures, 3D imaging technology assists your periodontist in providing accurate diagnoses and treatments. While X-rays are still very important diagnostic tools, 3D imaging provides an even deeper look at the condition of tissues beneath the surface in panoramic and cephalometric views.

What is 3D imaging?

A scanner that gathers images with cone beam computed tomography (CBCT) produces three-dimensional imaging. Cone beam imaging refers to X-ray emissions that radiate in the shape of a cone to capture a 3D image. This technology produces realistic and detailed imaging that shows both hard, mineralized tissues like teeth and bone along with soft structures like the gums.

Why is 3D imaging used?

Cone beam imaging is often reserved for complex treatment such as periodontal therapy or procedures involving the placement of dental implants. Allowing our team to view the entire oral cavity in deeper detail, 3D imaging also assists a periodontist when monitoring a patient’s progress during treatment. For example, when dental implants are placed, the bone should fuse around the implant by a natural process called osseointegration. 3D imaging can reveal how the jawbone is responding to the implantation process over time along with determining the best areas of the jaw to place implants.

Are there other benefits associated with 3D imaging technology?

Yes, an additional benefit to 3D technology is that the images produced by the CBCT scanner are digital. Instead of the need for developing images using radiographic film, images are sent to a high-resolution monitor. Because these digital representations are viewable on a computer screen, our team can zoom in and out on images and easily transfer images to other medical and dental professionals—especially when our periodontist is working in conjunction with an orthodontist or general dentist.

We offer many technologies to help enhance patient treatment along with comprehensive oral health services including gum grafting, laser-assisted periodontal therapy, and dental stem cell banking. To schedule an appointment with our experienced and skilled periodontists, contact our practice today.

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Love The Gums You’re WIth

AAP launches “Love The Gums You’re With” to raise national consumer awareness about periodontal disease
To elevate the critical role of periodontists and to educate consumers on the importance of maintaining a healthy relationship with their gums, the American Academy of Periodontology (AAP) has launched “Love The Gums You’re With” – a national public relations campaign featuring relationship expert and host of ABC’s “The Bachelor” Chris Harrison. This campaign provides an exciting opportunity to support our AAP members and raise awareness of periodontal disease.

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The American Association of Oral and Maxillofacial Surgeons (AAOMS) has released a Position Paper recommending the change in the nomenclature of “bisphosphonate-related osteonecrosis of the jaw (BRONJ)” to the more accurate term “medication-related osteonecrosis of the jaw (MRONJ)” and provided recommendations regarding risk/benefit analysis of medications and treatment guidance to clinicians.

The stated purpose of this updated position paper is to provide: risk estimates of developing MRONJ, comparisons of the risks and benefits of medications related to osteonecrosis of the jaw (ONJ) in order to facilitate medical decision-making for the treating physician, dentist, dental specialist, and patients. Additionally the paper will provide guidance to surgeons regarding: the differential diagnosis of MRONJ in patients with a history of exposure to antiresorptive and/or antiangiogenic agents and MRONJ prevention measures and management strategies for patients with MRONJ based on the disease stage.

Download the Position Paper
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How many teeth are involved in the crown lengthening procedure?

crown lengthening ManhattanTo prepare the teeth for healthy and well-proportioned dental restorations or crowns, the procedure known as crown lengthening is occasionally required. Crown lengthening is performed to ensure that the edge of a crown or filling does not extend too deep beneath the gumline where it would not be readily accessible. It is unhealthy for the edge of any restoration to be located too close to the bone level or too far below the gumline.

With crown lengthening, we are able to adjust the height of the gum and bone around a single tooth or multiple teeth to ensure a proper fit and an attractive appearance. The procedure increases the amount of tooth structure that is visible above the gums. This enables the dentist to create a more ideal restoration and it also enables the patient to properly clean all surfaces of the teeth, reducing the risk for cavities or gum disease.

Quite often, crown lengthening is performed to improve the cosmetic relationship between the gums and teeth, rather than in preparation for a dental restoration. For a patient who exhibits a “gummy smile” or a smile in which the teeth appear small in relation to the bulky nature of the gums, the tissue around multiple teeth can be recontoured and gently reshaped. The gumline across multiple teeth can be altered in this way to bring more balance and proportion to the smile.

The number of teeth that will be involved in the crown lengthening procedure will be dictated by the goals of the dentist, periodontist, and the patient. For a dental restoration, this may involve only a single tooth; to improve a gummy smile, this may involve a series of teeth. The procedure can be performed in a specific location within the mouth or in the case of smile makeover the entire smile line can be treated.

Crown lengthening provides many functional and cosmetic benefits. Ask our skilled team of periodontists for more information on the procedure. Contact our office to schedule your professional consultation today.

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Harvesting Dental Stem Cells for Future Use

We often hear that the mouth is the window to the rest of the body. We sometimes hear that the mouth is a mirror of our general health. These statements suggest that the conditions inside of the mouth can provide clues about the health of the entire body. Your periodontist would agree, since many health conditions can be identified based upon the way that they impact your mouth and your smile, both positively and negatively.

However, the mouth can also be viewed as much more than a window or a mirror—it’s a treasure chest! Inside the mouth, there are precious findings that are of significant value to the rest of your body.

The presence of the stem cells that can be found inside of healthy teeth is one example of the treasures that the mouth can provide. Stem cells are being used to promote the regeneration and healing of the human body, and stem cell research has enhanced our ability to treat serious health conditions like Parkinson’s disease and Leukemia. It has been shown that the very best stem cells are those that have been harvested from your own body, and the most powerful stem cells are those that are found inside of your own teeth!

Of course, you wouldn’t wait until you are stricken with an illness to pull your healthy teeth just to access your vital stem cells. But, it is possible for your periodontist to harvest or save the stem cells from the healthy teeth that are removed from your mouth during your lifetime. Just think about the times when healthy teeth must be extracted:

Wisdom teeth
Naturally exfoliated baby teeth
Broken teeth

Teeth that are removed to make space for braces
The vital cells that are found within these teeth can be banked or preserved for future use. Plus, the stem cells from the teeth are typically easier to access than the cells that are collected from the umbilical cord or from bone marrow.

Find out more by making plans to discuss stem cell harvesting with our skilled periodontal team today. Call 212-756-8890 to schedule your informative consultation.

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