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Saving Smiles -- Saving Lives Richard H. Yamada, D.D.S.

Douglas V. Gorin, D.D.S.

R
ecent studies suggest that people with periodontal disease have nearly twice the risk of a fatal heart attack and The Periodontics Ltd. Richard F. Marinello, D.D.S.
three times the risk of stroke as those without periodontal disease. This may be because oral bacteria attach Mark A. Rosen, D.D.S.
to atherosclerotic plaques in arteries, thus contributing to their rupture and subsequent clot formation. Stephen P. Russo, D.M.D.
A two-year study of 144,000 insured patients by Aetna and the Columbia University College of Dental Medicine
released in March, 2006, found that earlier periodontal treatment reduced overall medical care costs by 16 percent for
coronary artery disease and 11 percent for cerebrovascular disease or stroke! PDL tm
Since periodontal disease is treatable and almost 100 percent preventable, our patients now have a vital, even poten-
tially life-saving reason -- beyond just a pretty smile and comfortable chewing -- to make sure they have healthy mouths.
Death from cardiovascular disease has become epidemic. Heart disease and stroke cause more than 50 percent of Periodontics Ltd., Periodontics, Orthodontics and Implant Dentistry Spring
all deaths in the United States. Thats almost one million deaths per year -- 335,000 sudden deaths -- one every two
minutes! Preventing many of these deaths is possible if we encourage our patients to follow these 6 Ds:
From Our Office Altered Passive Eruption --
1. Diagnose! ately. Early clot dissolving ther- 5. Develop a Doctor to Yours...
The most common major signal of apy can greatly reduce heart Relationship. Get annual phys- The Undiagnosed Condition
angina and possibly an impending and/or brain damage in some icals. Dont say: Im too busy, Ill Altered passive eruption is
heart attack is a feeling of pressure types of heart attacks. Balloon do it later. Take statins and characterized by excessive gingiva
epithelial attachment and the

T
in relation to the crown of the ooth eruption consists of an
under the sternum brought on by angioplasty of blocked heart aspirin if advised. A recent study active and a passive phase. cementoenamel junction (CEJ).
tooth. This condition may be local-
exercise and relieved by rest. attacks within 90 minutes will of 59,094 new statin users pub- ized or generalized, may exist in Active eruption is the In Stage 1, the teeth reach the
Sudden sweating, shortness of also greatly reduce heart dam- lished in the European Heart conjunction with or without peri- movement of the teeth in the direc- line of occlusion and the junction-
age. Journal documented a 30 to 40 odontal disease and should be tion of the occlusal plane, whereas al epithelium lies totally on the
breath and referred pain to the left
considered in planning for restora- passive eruption is related to the tooth enamel.
arm, lower jaw or other areas may percent reduction in heart attacks
tive, orthodontic and esthetic den- exposure of the teeth by apical In Stage 2, the epithelial attach-
occur. It is not a sharp pain over 4. Defibrillate immediately if after two years of statin use com- tistry. migration of the gingiva. ment rests partially on the enamel
the heart. unresponsive with no pulse. In pared to those who didnt take their While altered passive eruption Originally thought to be a nor- and partially on the cementum apical
cardiac arrest, the best chance of recommended dose of statins. The is usually diagnosed by clinical mal physiologic process, passive to the CEJ. The base of the sulcus is
American Heart Association rec- observation, this condition is often eruption can at times be consid- still on the enamel.
2. Dont Deny or Delay! survival occurs in the first three
overlooked or unrecognized.
Most of the time there are warning minutes. Survival drops ten per- ommends an optimum LDL of ered a pathologic process. In Stage 3, the entire junctional
Failure to recognize this condition Gottlieb et al divided passive epithelium lies totally on the
signs before a heart attack. (See cent per minute. It is 90 percent under 100. can result in compromised clinical
eruption into four stages based upon cementum with the base of the sul-
Diagnose.) Dont take the attitude: at one minute and 0 percent at ten outcomes.
the relationship between the cus at the CEJ.
minutes. Emergency Medical 6. Do Make Life Style Correct diagnosis of altered
Dont worry, honey, its only indi-
Changes Early to prevent heart passive eruption and proper thera-
gestion! Half of all heart attacks Response is unlikely to arrive in py will result in improved dental
attack! Twenty percent of adults Figure 1. This
occur in people with no risk fac- time. Train yourself and others care and esthetic results for our
age 30-34 already have advanced 16-year-old
tors; 70 percent occur when a how to use a defibrillator. Its patients. This issue of The
female exhibited
smaller non-occluding plaque rup- easy. Immediately after one plaque formation. The incidence of PerioDontaLetter will address
these considerations.
very short
tures and a clot forms. It Can shock, begin CPR. The new heart attacks can be reduced by clinical crowns
two-thirds with a low fat diet, As always, we welcome your
Happen to You! American Heart Association CPR questions and suggestions. as a result of
guidelines call for five cycles of weight control, exercise, not smok- altered passive
ing, moderate alcohol consumption eruption. (See
3. Do Call 911 with one or 30 hard and fast chest compres-
and blood pressure control. photos page 2)
more of the above signs and get sions first followed by two short
PDL tm

to an emergency room immedi- one-second breaths.

A Periodontal Practice Committed to Excellence 111 N. Wabash, Suite 919, Chicago, IL 60602 (312) 641-2572 A Periodontal Practice Committed to Excellence 111 N. Wabash, Suite 919, Chicago, IL 60602 (312) 641-2572
4711 Golf Rd, Skokie, IL 60076 (847) 675-7555 4711 Golf Rd, Skokie, IL 60076 (847) 675-7555
cedure, maintenance of the biolog-
ic width is essential.

Periodontal Treatment,
Esthetic Considerations
and Restorative
Requirements
Figure 5. Orthodontic therapy Figure 6. Two weeks post
Altered passive eruption should in altered passive eruption operatively, the teeth have a
Figure 2. Upon flap reflection, Figure 3. 3mm of bone was Figure 4. Two-weeks post be treated if periodontal disease is evi- creates a large gingival much more pleasing, natural
the anatomic crowns have just removed to create room for a operatively, the teeth have a dent or if there are restorative, ortho- appearance with short teeth. appearance and orthodontic
barely erupted through the normal biologic width attached pleasing cosmetic appearance dontic or esthetic considerations. movement is facilitated.
alveolar process. The bone is to the cementum and the gingi- and the dimensions of the Additionally, if excessive tissue
at the cemetoenamel junction val margins were repositioned clinical crowns are normal. following orthodontic therapy is
which prevents gingival apically with papilla retention. not resolved, gingival surgery is armamentarium for treating these The indications for surgical
attachment to the root surface. indicated. situations because it provides ade- intervention may include peri-
It is incumbent upon the quate tooth structure while simulta- odontal, restorative, orthodontic
orthodontist to recognize that neously assuring the integrity of or cosmetic issues and all of
Finally, in Stage 4, the epithelial short-looking tooth. Altered pas- Eruption does not cease when altered passive eruption will not the biologic width. these must be respectful of the
attachment lies totally on the sive eruption is a physiologic vari- teeth make occlusal contact with resolve itself and will require a When periodontal surgical pro- biologic width.
cementum, the base of the sulcus is ation with excess gingiva covering teeth in the opposing arch but con- corrective periodontal procedure. cedures are indicated to enhance We hope this discussion of
on the cementum, and a portion of the crown of the tooth. tinues throughout life. If the junc- The management of altered restorative dentistry, it is impera- altered passive eruption will help
the root may be clinically exposed. Normally, the CEJ lies just api- passive eruption may include peri- tive the surgeon and the restorative in the diagnosis and treatment of
tional epithelial tissues do not
Proliferation of the junctional cal to the gingival margin of the odontal surgery, crown lengthen- dentist have excellent communica- this often overlooked and unrec-
recede to the CEJ by adulthood,
anatomic crown. Sulcus depth usu- ing, and in selected cases, forced tion, to ensure the most favorable ognized condition.
epithelium onto the root is accompa- corrective measures may be
ally measures 1 to 3mm. In cases eruption. As always, we look forward
nied by degeneration of gingival and required to maintain health or clinical outcomes for their
of altered passive eruption, the CEJ As with all periodontal treatment, to collaborating with you in the
periodontal ligament fibers and their enhance esthetics. patients.
might be up to 10mm apical to the the initial phase involves a proper diagnosis and treatment planning
detachment from the tooth. It is cur- In summary, altered passive
gingival margin. diagnosis and control of etiology. of these interesting cases and
rently believed this degeneration is eruption may present as a non-
the result of chronic inflammation There may be no other clinical
The Biologic Width When periodontal surgical pro- thank you for the opportunity to
pathologic entity or as a pathologic participate in the care of your
and therefore represents a patholog- signs of disease such as bleeding cedures are indicated, the objective condition requiring various forms
upon probing, suppuration, inflam- Gargiulo et al established a def- is to apically position the soft tissue patients.
ic rather than a physiologic process. of more aggressive treatment.
mation or radiographic bone loss. inite dimensional relationship to the appropriate esthetic height
When passive eruption does not
In some cases, excess gingival between the crest of the alveolar while producing sufficient sound
progress past stage one or two, it is
tissue interferes with oral hygiene bone, connective tissue attachment, tooth structure so the biologic
referred to as altered or delayed. This
and contributes to plaque accumula- epithelial attachment and sulcus width will not be violated when
creates a clinical crown that appears
tion. Probing depth often reveals a depth. They called this relationship restorative procedures are imple-
short due to the presence of excess
deep sulcus associated with marginal the biologic width. mented.
gingiva which covers the enamel.
inflammation of the gingival tissues. Gargiulo found that the width Altered passive eruption can
Occurrence of altered passive
Restorations and orthodontic of the connective tissue attachment, cause anterior teeth to appear too
eruption is unpredictable, but the
appliances placed in or near the sul- however, remains fairly constant short and contribute to excessive
incidence in the general population
cus may contribute to an exaggerat- with a mean average of 1.07mm. gingival display.
is about 12 percent.
ed inflammatory response. In- The junctional epithelium normally When full exposure of the
creased probing depth may be the averages 0.97mm. The combined anatomic crown is achieved surgi-
Diagnosing Altered result of excessive soft tissue rather dimension of the connective tissue cally to eliminate excessive gingi- Figure 7. A gummy smile is Figure 8. Two weeks following
Passive Eruption than attachment loss. However, in attachment and the epithelial val display, there is a dramatic the result of altered passive osseous resection and apical
the periodontally susceptible attachment averages 2.04mm. improvement in esthetics. eruption. flap positioning, the smile
Clinically, the most obvious patient, attachment loss and bone When contemplating any surgi- Crown lengthening is an inte- is cosmetically pleasing.
sign of altered passive eruption is a resorption may occur as well. cal, restorative or orthodontic pro- gral component of the esthetic

PerioDontaLetter, Spring
cedure, maintenance of the biolog-
ic width is essential.

Periodontal Treatment,
Esthetic Considerations
and Restorative
Requirements
Figure 5. Orthodontic therapy Figure 6. Two weeks post
Altered passive eruption should in altered passive eruption operatively, the teeth have a
Figure 2. Upon flap reflection, Figure 3. 3mm of bone was Figure 4. Two-weeks post be treated if periodontal disease is evi- creates a large gingival much more pleasing, natural
the anatomic crowns have just removed to create room for a operatively, the teeth have a dent or if there are restorative, ortho- appearance with short teeth. appearance and orthodontic
barely erupted through the normal biologic width attached pleasing cosmetic appearance dontic or esthetic considerations. movement is facilitated.
alveolar process. The bone is to the cementum and the gingi- and the dimensions of the Additionally, if excessive tissue
at the cemetoenamel junction val margins were repositioned clinical crowns are normal. following orthodontic therapy is
which prevents gingival apically with papilla retention. not resolved, gingival surgery is armamentarium for treating these The indications for surgical
attachment to the root surface. indicated. situations because it provides ade- intervention may include peri-
It is incumbent upon the quate tooth structure while simulta- odontal, restorative, orthodontic
orthodontist to recognize that neously assuring the integrity of or cosmetic issues and all of
Finally, in Stage 4, the epithelial short-looking tooth. Altered pas- Eruption does not cease when altered passive eruption will not the biologic width. these must be respectful of the
attachment lies totally on the sive eruption is a physiologic vari- teeth make occlusal contact with resolve itself and will require a When periodontal surgical pro- biologic width.
cementum, the base of the sulcus is ation with excess gingiva covering teeth in the opposing arch but con- corrective periodontal procedure. cedures are indicated to enhance We hope this discussion of
on the cementum, and a portion of the crown of the tooth. tinues throughout life. If the junc- The management of altered restorative dentistry, it is impera- altered passive eruption will help
the root may be clinically exposed. Normally, the CEJ lies just api- passive eruption may include peri- tive the surgeon and the restorative in the diagnosis and treatment of
tional epithelial tissues do not
Proliferation of the junctional cal to the gingival margin of the odontal surgery, crown lengthen- dentist have excellent communica- this often overlooked and unrec-
recede to the CEJ by adulthood,
anatomic crown. Sulcus depth usu- ing, and in selected cases, forced tion, to ensure the most favorable ognized condition.
epithelium onto the root is accompa- corrective measures may be
ally measures 1 to 3mm. In cases eruption. As always, we look forward
nied by degeneration of gingival and required to maintain health or clinical outcomes for their
of altered passive eruption, the CEJ As with all periodontal treatment, to collaborating with you in the
periodontal ligament fibers and their enhance esthetics. patients.
might be up to 10mm apical to the the initial phase involves a proper diagnosis and treatment planning
detachment from the tooth. It is cur- In summary, altered passive
gingival margin. diagnosis and control of etiology. of these interesting cases and
rently believed this degeneration is eruption may present as a non-
the result of chronic inflammation There may be no other clinical
The Biologic Width When periodontal surgical pro- thank you for the opportunity to
pathologic entity or as a pathologic participate in the care of your
and therefore represents a patholog- signs of disease such as bleeding cedures are indicated, the objective condition requiring various forms
upon probing, suppuration, inflam- Gargiulo et al established a def- is to apically position the soft tissue patients.
ic rather than a physiologic process. of more aggressive treatment.
mation or radiographic bone loss. inite dimensional relationship to the appropriate esthetic height
When passive eruption does not
In some cases, excess gingival between the crest of the alveolar while producing sufficient sound
progress past stage one or two, it is
tissue interferes with oral hygiene bone, connective tissue attachment, tooth structure so the biologic
referred to as altered or delayed. This
and contributes to plaque accumula- epithelial attachment and sulcus width will not be violated when
creates a clinical crown that appears
tion. Probing depth often reveals a depth. They called this relationship restorative procedures are imple-
short due to the presence of excess
deep sulcus associated with marginal the biologic width. mented.
gingiva which covers the enamel.
inflammation of the gingival tissues. Gargiulo found that the width Altered passive eruption can
Occurrence of altered passive
Restorations and orthodontic of the connective tissue attachment, cause anterior teeth to appear too
eruption is unpredictable, but the
appliances placed in or near the sul- however, remains fairly constant short and contribute to excessive
incidence in the general population
cus may contribute to an exaggerat- with a mean average of 1.07mm. gingival display.
is about 12 percent.
ed inflammatory response. In- The junctional epithelium normally When full exposure of the
creased probing depth may be the averages 0.97mm. The combined anatomic crown is achieved surgi-
Diagnosing Altered result of excessive soft tissue rather dimension of the connective tissue cally to eliminate excessive gingi- Figure 7. A gummy smile is Figure 8. Two weeks following
Passive Eruption than attachment loss. However, in attachment and the epithelial val display, there is a dramatic the result of altered passive osseous resection and apical
the periodontally susceptible attachment averages 2.04mm. improvement in esthetics. eruption. flap positioning, the smile
Clinically, the most obvious patient, attachment loss and bone When contemplating any surgi- Crown lengthening is an inte- is cosmetically pleasing.
sign of altered passive eruption is a resorption may occur as well. cal, restorative or orthodontic pro- gral component of the esthetic

PerioDontaLetter, Spring
Saving Smiles -- Saving Lives Richard H. Yamada, D.D.S.
Douglas V. Gorin, D.D.S.

R
ecent studies suggest that people with periodontal disease have nearly twice the risk of a fatal heart attack and The Periodontics Ltd. Richard F. Marinello, D.D.S.
three times the risk of stroke as those without periodontal disease. This may be because oral bacteria attach Mark A. Rosen, D.D.S.
to atherosclerotic plaques in arteries, thus contributing to their rupture and subsequent clot formation. Stephen P. Russo, D.M.D.
A two-year study of 144,000 insured patients by Aetna and the Columbia University College of Dental Medicine
released in March, 2006, found that earlier periodontal treatment reduced overall medical care costs by 16 percent for
coronary artery disease and 11 percent for cerebrovascular disease or stroke! PDL tm
Since periodontal disease is treatable and almost 100 percent preventable, our patients now have a vital, even poten-
tially life-saving reason -- beyond just a pretty smile and comfortable chewing -- to make sure they have healthy mouths.
Death from cardiovascular disease has become epidemic. Heart disease and stroke cause more than 50 percent of Periodontics Ltd., Periodontics, Orthodontics and Implant Dentistry Spring
all deaths in the United States. Thats almost one million deaths per year -- 335,000 sudden deaths -- one every two
minutes! Preventing many of these deaths is possible if we encourage our patients to follow these 6 Ds:
From Our Office Altered Passive Eruption --
1. Diagnose! ately. Early clot dissolving ther- 5. Develop a Doctor to Yours...
The most common major signal of apy can greatly reduce heart Relationship. Get annual phys- The Undiagnosed Condition
angina and possibly an impending and/or brain damage in some icals. Dont say: Im too busy, Ill Altered passive eruption is
heart attack is a feeling of pressure types of heart attacks. Balloon do it later. Take statins and characterized by excessive gingiva
epithelial attachment and the

T
in relation to the crown of the ooth eruption consists of an
under the sternum brought on by angioplasty of blocked heart aspirin if advised. A recent study active and a passive phase. cementoenamel junction (CEJ).
tooth. This condition may be local-
exercise and relieved by rest. attacks within 90 minutes will of 59,094 new statin users pub- ized or generalized, may exist in Active eruption is the In Stage 1, the teeth reach the
Sudden sweating, shortness of also greatly reduce heart dam- lished in the European Heart conjunction with or without peri- movement of the teeth in the direc- line of occlusion and the junction-
age. Journal documented a 30 to 40 odontal disease and should be tion of the occlusal plane, whereas al epithelium lies totally on the
breath and referred pain to the left
considered in planning for restora- passive eruption is related to the tooth enamel.
arm, lower jaw or other areas may percent reduction in heart attacks
tive, orthodontic and esthetic den- exposure of the teeth by apical In Stage 2, the epithelial attach-
occur. It is not a sharp pain over 4. Defibrillate immediately if after two years of statin use com- tistry. migration of the gingiva. ment rests partially on the enamel
the heart. unresponsive with no pulse. In pared to those who didnt take their While altered passive eruption Originally thought to be a nor- and partially on the cementum apical
cardiac arrest, the best chance of recommended dose of statins. The is usually diagnosed by clinical mal physiologic process, passive to the CEJ. The base of the sulcus is
American Heart Association rec- observation, this condition is often eruption can at times be consid- still on the enamel.
2. Dont Deny or Delay! survival occurs in the first three
overlooked or unrecognized.
Most of the time there are warning minutes. Survival drops ten per- ommends an optimum LDL of ered a pathologic process. In Stage 3, the entire junctional
Failure to recognize this condition Gottlieb et al divided passive epithelium lies totally on the
signs before a heart attack. (See cent per minute. It is 90 percent under 100. can result in compromised clinical
eruption into four stages based upon cementum with the base of the sul-
Diagnose.) Dont take the attitude: at one minute and 0 percent at ten outcomes.
the relationship between the cus at the CEJ.
minutes. Emergency Medical 6. Do Make Life Style Correct diagnosis of altered
Dont worry, honey, its only indi-
Changes Early to prevent heart passive eruption and proper thera-
gestion! Half of all heart attacks Response is unlikely to arrive in py will result in improved dental
attack! Twenty percent of adults Figure 1. This
occur in people with no risk fac- time. Train yourself and others care and esthetic results for our
age 30-34 already have advanced 16-year-old
tors; 70 percent occur when a how to use a defibrillator. Its patients. This issue of The
female exhibited
smaller non-occluding plaque rup- easy. Immediately after one plaque formation. The incidence of PerioDontaLetter will address
these considerations.
very short
tures and a clot forms. It Can shock, begin CPR. The new heart attacks can be reduced by clinical crowns
two-thirds with a low fat diet, As always, we welcome your
Happen to You! American Heart Association CPR questions and suggestions. as a result of
guidelines call for five cycles of weight control, exercise, not smok- altered passive
ing, moderate alcohol consumption eruption. (See
3. Do Call 911 with one or 30 hard and fast chest compres-
and blood pressure control. photos page 2)
more of the above signs and get sions first followed by two short
PDL tm

to an emergency room immedi- one-second breaths.

A Periodontal Practice Committed to Excellence 111 N. Wabash, Suite 919, Chicago, IL 60602 (312) 641-2572 A Periodontal Practice Committed to Excellence 111 N. Wabash, Suite 919, Chicago, IL 60602 (312) 641-2572
4711 Golf Rd, Skokie, IL 60076 (847) 675-7555 4711 Golf Rd, Skokie, IL 60076 (847) 675-7555