Posts for: June, 2017
During your lifetime you’ll eat thousands of meals — and generate a lot of force from chewing over the years. But thanks to a support system of gum tissues and bone, your teeth can normally handle it.
What your teeth can’t handle, though, are higher than normal chewing forces on a continual basis. This can happen if you grind your teeth, which can produce 20-30 times the normal force. The habit often arises in adults because of high stress and often occurs during sleep.
These abnormal forces can stretch the periodontal ligaments that hold teeth in place, cause the teeth to become loose and at increased risk for loss. The best treatment strategy is to reduce clenching with, for example, muscle relaxants or anti-inflammatory drugs or lower the effects with a mouth guard that won’t allow the teeth to make solid contact during clenching.
Your teeth can also become loose even with normal chewing forces if you have advanced periodontal (gum) disease. Gum disease arises from dental plaque, a thin film of bacteria and food particles left on teeth due to poor oral hygiene. As it builds up, it causes inflammation of the gum tissues resulting in bone loss and causing the gums to detach from the teeth, increasing pocket depth.
Our first step in this case is to treat the gum disease by removing plaque and calculus (tartar) from all tooth and gum surfaces. This includes infected areas below the gum line and around the roots, a circumstance that could require surgical access.
As treatment progresses in either of these scenarios the gum tissues heal and often regain their attachment to the teeth. But that can take time, so we may need to stabilize any loose teeth in the short term. The most common way is to splint them to other secure teeth. This is done by using a clear acrylic bonding material to join the loose teeth together with a strip of metal or other rigid material (like joining pickets in a fence).
When symptoms arise, quick action is the key to preventing lost teeth. If you notice swollen, painful or bleeding gums or especially loose teeth, don’t delay — contact us so we can begin treatment as soon as possible.
If you would like more information on the causes and treatments for loose teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Loose Teeth.”
“To gain something, sometimes you have to give up something else.”
No, that isn't the latest viral meme on the Internet. It's actually a practical consideration that could arise in orthodontics.
In this case, the “something” to gain is a straighter, more attractive smile; the “something” you may have to part with is a few teeth. This may be necessary if there are too many teeth on a dental arch for its capacity, a situation called crowding. A lack of space is the main reason teeth come in misaligned.
Before we can correct this, we'll need to free up space to allow for tooth movement by removing one or more of the existing teeth. The ideal candidates are those that are near to the teeth we wish to move but not highly visible. The first bicuspids are the most frequent choices for removal: they're located behind the cuspids or eyeteeth (the pointed teeth right under the eyes).
Ideally, we'll remove the target teeth some time before we apply braces to give the gums a chance to heal. At the same time we want to preserve the bone that once supported the teeth we've extracted. This is because when we chew the forces generated by the teeth stimulates bone replacement growth. When a tooth is no longer there the supporting bone doesn't receive this stimulation and may ultimately reduce in volume.
We may try to prevent this by placing a bone graft in the empty socket immediately after removing the tooth. The graft serves as a scaffold to encourage new bone to grow. Hopefully when we're ready to apply braces, the bone will be strong and healthy to handle the movement of the teeth.
As the teeth move under the influence of braces, they'll begin to fill up the space created by tooth removal. Once it's completed, the extracted teeth won't be missed — the other teeth now straightened will completely fill out the smile.
The different steps in this process must be carefully planned and executed precisely, and it will take months or even years to complete. In the end, though, this complicated bite problem can be corrected and replaced with an attractive, straight smile.
If you would like more information on correcting a poor bite, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Removal for Orthodontic Reasons.”
“Redesigning” a smile is a lot like remodeling a house: the technicalities of construction must blend seamlessly with what is perceived as elegant and beautiful. The first aspect — the proper materials and techniques to achieve a sound restoration — is absolutely crucial. But the aesthetic is just as important for assuring the final restoration evokes beauty and style.
Balancing these two aspects of a smile makeover requires thoughtful intent and planning. What may be pleasing aesthetically may not be technically feasible; but what may be technically sound may not have that sought-after “curb appeal.”
You and your dentist must work together to achieve the successful blending of these two aspects. That’s why it’s important for you to have full confidence in your dentist: that he or she is both technically skilled and experienced in cosmetic procedures and artistically aware of what will look best aesthetically.
The first step in your makeover is a thorough dental examination to determine the overall state of your oral health. With this “bigger picture,” your dentist will have a better understanding of what’s possible and practical for you and your situation. The exam may also reveal problems that should be treated first before any cosmetic work.
From there, you must communicate clearly to your dentist what you perceive as wrong with your smile and what you would like to have changed. While there are general principles of beauty best followed, your dental work could hypothetically take different paths depending on your desires and expectations. You might prefer a more “sexy” look or one that’s “sophisticated.” Or perhaps you only want subtle changes that still retain features expressing your individuality.
Ultimately, though, your expectations must line up with reality. Much like your house contractor, your dentist will advise you on what’s both practical and possible. And with their experience in smile enhancement, they can also help you determine what will look most attractive given your facial structure and features.
With this preliminary planning, you can be confident as the work proceeds that the end of the project will be both exciting and satisfying. And just as with your newly renovated home, you’ll be more than happy to share your smile with others.
If you would like more information on enhancing your smile through cosmetic dentistry, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Beautiful Smiles by Design.”
What do dentures, retainers and nightguards have in common? Along with orthodontic aligners and athletic mouthguards, they’re all types of removable dental appliances. They also share another commonality: each one depends on the wearer caring for it to ensure its longevity.
The most important thing you can do for your appliance is to clean it regularly. Don’t use toothpaste, though, even with dentures: while your natural tooth enamel can handle the abrasive particles in toothpaste, your appliance’s materials may not. Toothpaste can create tiny scratches that can harbor disease-causing bacteria. Instead, use liquid dish detergent or hand soap with warm water.
Although boiling water may disinfect your appliance, it’s not advisable to use. Even hot water can distort plastic components and warp the appliance’s fit in your mouth. Likewise, don’t use bleach, which can fade the plastic color used to resemble gum tissue and break down the material’s composition. When you clean your appliance, use a brush — but not the one you use for your natural teeth. Use a soft toothbrush, a nail brush or a specialized brush for appliances like dentures.
You should also protect your appliance from damage. Some appliances like dentures have parts that can break if they’re dropped on a hard surface — like the porcelain in your sink. To prevent this, place a towel in the sink to cushion the appliance if it accidentally slips from your hand during cleaning. And when the appliance isn’t in your mouth, don’t keep it on a low table or night stand where small children or pets can easily get their hands (or paws) on it.
And one more thing: don’t wear your denture appliance around the clock — take it out, for instance, while you sleep. Leaving dentures in interferes with the acid-neutralizing and antibacterial function of your mouth’s saliva, which could increase your risk of disease (and bad breath).
Appliances can be an expensive investment in your dental health. By following these guidelines you’ll help protect that investment for years to come.
If you would like more information on caring for your dental appliance, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “10 Tips for Cleaning Your Oral Appliance.”
Porcelain veneers are positive proof that unattractive teeth don't always require an intensive restoration to regain their beauty. These thin layers of translucent porcelain — custom-designed and color-matched to blend with your other teeth — are permanently bonded to the visible side of your front teeth.
Although they can't remedy every tooth defect, they're well suited for mild to moderate disfigurements like chipping, staining or gaps. There are now two types of porcelain veneers: the traditional veneer and the “no-prep” veneer.
The standard veneers require some tooth structure removal, referred to as “tooth preparation.” This is because although they're a millimeter or less in thickness, they can still appear bulky if bonded to an unprepared tooth. To accommodate their width, it's necessary to remove some of the tooth enamel. This permanently alters the tooth so that it will need some form of restoration from that time on.
In recent years, however, other veneer options have emerged that reduces — or even eliminates — this tooth alteration. No-prep veneers are so thin they can be applied to a tooth with virtually no preparation. A more common option, minimal-prep, requires only a minor reshaping with an abrasive tool to ensure the fitted veneer looks as natural as possible. Because of their thinness, these veneers also don't have to fit under the gum line like standard veneers.
To obtain no- or minimal-prep veneers, your tooth enamel needs to be in good, healthy shape. They're also best suited for people with small or worn teeth, narrow smiles (the side teeth can't be seen from the front), or slightly stained or misshapen teeth.
Because there's little invasiveness, these low preparation veneers won't typically create tooth sensitivity and they can often be applied without any form of anesthesia. And because tooth structure isn't removed, they can be “uninstalled” to return to your natural look. Of course, that's not always an easy process since the bonding between veneer and the enamel is quite strong, although today's lasers can be used to detach the veneer quite easily.
If you'd like to consider these minimally invasive veneers, talk with your dentist. If you're a good candidate, you may be able to gain a new smile without much change to your natural teeth.
If you would like more information on how veneers can change your smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “No-Prep Porcelain Veneers.”