3470 Blazer Pkwy
Suite 110
Lexington, KY 40509
(859) 264-9493
(859) 264-8323


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3470 Blazer Pkwy
Suite 110
Lexington, KY 40509
(859) 264-9493

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Patient Education


Frequently Asked Questions

Daily Dental Care

Brushing Guidelines

No brush of any size, shape, or gimmick is effective if it is incorrectly positioned in the mouth. The brush should be placed where the gum meets the tooth, with bristles resting along each tooth at a 45-degree angle and then the tongue scrubbed for a total of about 30 seconds. One should rinse the toothbrush thoroughly and then tap it on the edge of the sink at least five times to get rid of debris. If brushing after each meal is not an option, rinsing the mouth with water after eating can reduce bacteria by 30%. Flossing should finish the process. A mouthwash may also be used.

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Correct tooth brushing and flossing should be everyone's defense against periodontal disease. For individuals with average dexterity, a 4- or 5-rowed, soft, nylon-bristled toothbrush is sufficient. A vast assortment of brushes of varying sizes and shapes are available, and each manufacturer makes its claim for the benefits of a particular brush. People should look for the American Dental Association (ADA) seal on both electric and regular brushes. Electric toothbrushes, particularly those with a stationary grip and revolving tufts of bristles, can be advantageous for some people with physical disabilities. Electric toothbrushes with heads that move back and forth up to 4,200 times a minute have been found to remove significantly more plaque than ordinary brushes. The most important factor in buying any toothbrush -- electric or manual -- is to choose one with a soft head. Soft bristles get into crevices easier and do not irritate the gums.

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Good toothpaste helps, but no toothpaste can be delivered past 3 millimeters below the gum line, where periodontitis is taking place. Toothpastes are a combination of abrasives, binders, colors, detergents, flavors, fluoride, humectants, preservatives, and sweeteners (usually saccharin). Commercial toothpastes deliver fluoride to the tooth, remove stains, and increase the appeal of tooth brushing with sweetness and various flavors. All brands should show ADA approval. Stannous fluoride gel toothpastes do not reduce plaque, but they have some effect against the bacteria that cause it and slightly reduce gingivitis.

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Mouthwashes that are considered plaque fighters are prescription-only chlorhexidine Peridex, PerioGard and Listerine, which is available over the counter. Chlorhexidine has a bitter taste as well as a tendency to give teeth a stained appearance; it reduces plaque by 55% and gingivitis by 30% to 45%.

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Dental Floss

The use of dental floss, either waxed or unwaxed, is extremely important in cleaning between the teeth where the toothbrush bristles cannot reach. In spite of this, nearly two thirds of people do not floss. To floss correctly, one should break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger. Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth. When it reaches the gum line, the floss should be curved around each tooth and slid gently back and forth against the gum. Finally, rub gently up and down against the tooth. Repeat with each tooth, including the outside of the back teeth.

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Periodontal Disease

What is Periodontal Disease?

Periodontal disease refers to a group of problems that arise in the gum sulcus, usually because of an increase in quantity and change in the type of bacteria. These diseases are generally divided into two groups: gingivitis, which causes lesions, or wounds, that affect the gums; and periodontitis, which damages the bone and connective tissue that support the teeth.

The most common of the periodontal diseases, gingivitis is an inflammation of the gingiva, or gums. It occurs when the bacteria, which exist normally in the oral cavity, proliferate, increasing in mass and thickness until they form plaque. Plaque adheres to the surfaces of the teeth and adjacent gingiva and causes cellular injury, with subsequent swelling, redness, and heat.

Ordinary Gingivitis
A number of different forms of gingivitis exist. By far the most common is ordinary gingivitis, characterized by tender, red, swollen gums that bleed easily and may be responsible for bad breath (halitosis). Treatment is very effective if initiated early in the course of gingivitis; without good management, however, the problem can progress.

Periodontitis is characterized by the loss of the connective tissue structures and bone and by the presence of inflammation. Periodontal pockets greater than 4 millimeters in depth form between the gum and the tooth. Gingivitis precedes periodontitis, although it doesn't always lead to this more severe condition; in fact, some experts believe it is an entirely different disease. Adult periodontitis may begin in adolescence as a slowly progressing disease that becomes clinically significant in the mid-30's and continues throughout life. Some experts question whether it is a chronic unrelenting condition but suggest instead that it waxes and wanes depending on the response of the immune system in fighting the bacteria causing this disease.

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What Causes Periodontal Disease?

Periodontal disease is marked by inflammatory lesions, or wounds, caused by plaque microorganisms that overgrow to form a mass in the crevice where the gum meets the tooth. Lack of oral hygiene encourages plaque formation. Poorly contoured restorations (fillings or crowns) that provide traps for debris and plaque can also contribute to its formation. When these bacterial strains adhere to gum tissue, they form plaque. When plaque is allowed to remain in the oral cavity, it reforms into calculus (commonly known as tartar). This material has a rock-like consistency and adheres tenaciously to the tooth surface. The color and hardness vary depending on the age of the material and extrinsic factors, such as tobacco use. It is much more difficult to remove than the earlier version of plaque, which is a soft mass.

The bacteria that form plaque and tartar release toxins. In people with severe periodontal disease, these toxins are very active in the mouth. The immune system, then, that help protect the body from disease can, when overactive, be responsible for local destruction leading to periodontitis.

Smoking can cause bone loss and gum recession even in the absence of periodontal disease. A number of studies indicate that smoking increases inflammation by triggering an over-active response of the immune system. It is particularly harmful to young smokers who have early onset periodontitis. Quitting decreases the severity and prevalence of periodontal disease.

Certain disorders render patients more sensitive to the inflammatory process, including diabetes, Down's Syndrome, and AIDS.

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What are the Symptoms of Periodontal Disease?

Bleeding of the gums, even during brushing, is a sign of inflammation and the major marker of periodontal disease in all categories. The symptoms progress over time. Initially, the gums are red and swollen as in gingivitis. As the disease advances the gums recede, and supporting structure of bone is lost. Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures. Debris and bacteria can cause a bad taste in the mouth and persistent bad breath. Pain is usually not a symptom, which partly explains why the disease may become advanced before treatment is sought and why some patients avoid treatment even after periodontitis is diagnosed.

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Who gets Periodontal Disease?

Children and Adolescents
Gingivitis, in varying degrees, is nearly a universal finding in children and adolescents. In general, young children are at low risk for the two primary bacterial culprits. In rare cases, children and adolescents are subject to destructive forms of the disease. Surveys show that periodontal disease occurs in less than 1% of 14- to 17-year olds and about 3.6% of adults ages 18 to 34.

Over half of American adults have gingivitis surrounding three to four teeth and 30% have significant periodontal disease surrounding an average of three to four teeth. Ironically, as people keep more of their teeth longer, gum disease and cavities in the elderly increase. In a study of people over 70 years old, 86% had at least moderate periodontitis and over a quarter of them have lost their teeth.

Female Hormones
Female hormones affect the gums, and women are particularly susceptible to periodontal problems. About three-quarters of periodontal office visits are made by women, even though women tend to take better care of their teeth then men do. Gingivitis may flare up in some women a few days before they menstruate when progesterone levels are high. Progesterone dilates blood vessels causing inflammation, and blocks the repair of collagen, the structural protein that supports the gums. Pregnancy also increases the risk for periodontal disease. and sensations (e.g., salty, spicy, acidic, burning) in the mouth.

Family Factors
Periodontal disease often occurs in members of the same family; both genetics and other factors appear to be responsible. Studies have found that children of parents with periodontitis were 12 times more likely to have the bacteria thought to be responsible for causing plaque and, eventually, periodontal disease. Up to 30% of the population may have some genetic susceptibility to periodontal disease.

Smokers face an increased risk for periodontal disease, and in one study over 40% of smokers lost their teeth by the end of their lives.

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How Serious Is Periodontal Disease?

Tooth Loss
The ultimate outcome of uncontrolled periodontal disease is tooth loss. As the destructive factors cause the breakdown of bone and connective tissue, there remains no anchor for the teeth.

Bad Breath
A much less severe, but nevertheless distressing, problem caused by periodontal disease is bad breath, although coatings on the tongue may contribute more to bad breath than even periodontal disease.

Heart Disease and Stroke
Studies are finding an association between periodontal disease and heart disease. In one study, men with extensive gum disease (bleeding from every tooth) had over a fourfold greater risk for heart disease than men without periodontal disease. The study also reported an association between stroke and gum disease. Experts believe that in people with periodontitis, normal oral activities, including brushing and chewing, can cause tiny injuries that release bacteria into the blood stream. The bacteria that cause periodontitis may stimulate factors that cause blood clots and other proteins that contribute to a higher risk for heart disease and stroke. In rare cases, periodontal bacteria can cause an infection in the lining or valves of the heart called infective endocarditis. The condition is more likely to occur in valves that are already injured or abnormal.

Affect on Diabetes
Diabetes and periodontal disease appear to actually worsen each other. For example, studies indicate that diabetes can increase bone loss. And, on the other hand, another recent study indicated that periodontal disease might actually accelerate diabetes. In the study, treating periodontal disease reduced the need for insulin.

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How Can Periodontal Disease Be Prevented?

Dental Examinations
Periodontitis is a silent disease; individuals rarely experience pain and may not be aware of the problem. A periodontal examination by a general dentist once or twice a year should reveal any incipient or progressive problems. A full mouth series of x-rays is advised every two to three years. This will alert the dentist to early bone loss and other disorders of the oral cavity. The dentist will identify any areas where deep pocketing has occurred, where the health of the gingiva appears compromised, and where there is undue mobility of teeth. It is the general dentist's responsibility to identify periodontal disease and inform the patient. If the condition is severe, the dentist may want to refer the patient to a Periodontist.

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The Adjustable PM Positioner

What causes snoring and sleep apnea?

Snoring and sleep apnea can stem from a variety of causes.  Usually, there is a decrease in the size of the airway opening, which restricts the amount of air going into and out the lungs.  There are definitive studies that show a direct relationship between heart disease and obstructive sleep apnea.  Whatever the cause, the results are always disruptive for the sufferer and nearly as disturbing and frightening for the apnea patient’s family members.

Our goal at Dr. Robert Loy's practice is to be an alternative treatment resource for patients with medically diagnosed obstructive sleep apnea. We use FDA approved oral appliances designed to help keep the airway open during sleep.

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Who needs the oral appliance?

Oral appliances are indicated for medically diagnosed sleep apnea. Many of the patients we see are those with issues regarding CPAP intolerance or compliance.  Additionally,the sleep physician may recommend an oral appliance as a first choice for mild to moderate sleep apnea.

Loud snoring that bothers others' sleep is also an indication for an oral appliance.  Without a medically diagnosed condition, medical insurance is unlikely to provide benefits, but the appliances are quite useful in reducing snoring.

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How does the appliance work to help manage snoring/sleep apnea?

An oral appliance is a plastic device worn over the upper and lower teeth, similar to an orthodontic retainer or mouth guard. Worn during sleep, oral appliances prevent the soft tissues of the throat from collapsing and obstructing the airway. The appliance moves the lower jaw slightly forward bringing the base of the tongue with it, opening the airway to allow improved breathing, reduced snoring and fewer apneas during sleep.

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What percentage of people find the appliance to be effective?

We have found that if someone has a problem that involves snoring only, oral appliance therapy is approximately 85% effective.

When treating apnea, oral appliances are 65-70% effective, depending on the severity of the apnea, the appliance tends to be more effective for mild to moderate obstructive sleep apnea than for severe.

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Are there any side effects?

There are several temporary side effects that are usually most noticeable during the initial week or so.  We make the first follow-up appointment at 1-2 weeks from initial delivery to address these issues early.

A feeling of tightness or tension in the jaw muscles. Sore Teeth.

Excess Saliva, especially at first.

Temporary change of feel of your bite when the appliance is first removed in the morning. We include 90 days of follow-up in our treatment plan to adjust anything about the appliance that is needed to get to that goal.

Published Research looking at long term side effects shows:

  • No change in the shape of the jaws.
  • No irreversible stretching of muscles, ligaments or tendons.
  • No individual tooth movements (making teeth crooked)

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What is the process?

  1. An initial consultation
  2. Comprehensive clinical evaluation, including two diagnostic X-Rays and intra-oral photos. We use appliances that are custom-made for each patient�s situation and are adjustable, allowing us to achieve the best jaw position for maximum effect with optimal comfort
  3. Making, adjusting, and placing the appliance
  4. Follow-ups, 1-2 weeks, 6 months and one year
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How long does it take to adapt to the appliance?  Will it hurt my teeth?

95% of patients will adapt to the appliance within 2-7 days. It takes a few days to get used to having a device in your mouth during sleep. We tell our patients to expect some initial tooth and/or muscle soreness, not lasting more than an hour after awakening. First follow-up visits are within 1-2 weeks, sooner if needed, to immediately address any discomfort issues. The appliances are easily adjustable for your comfort

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How long do these appliances last?

We are telling our patients 3-5 years, although we expect many will last much longer. Patients with heavy bruxing (tooth-grinding) activity may wear them out somewhat faster.

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Does my insurance cover appliance treatment?

Most insurance contracts have coverage for treatment of obstructive sleep apnea with an oral appliance. Most do not have coverage for treatment of snoring only. Coverage is usually through medical insurance, not dental insurance. We encourage you to call and check with your insurance company. We will be happy to send information to your insurance company regarding your situation to request a determination of benefits.

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