Dental Implants

Once upon a time, there were only two options that dentistry could offer to replace missing teeth. Option one, the removable partial denture which is exactly what the name implies, and therein lies its limitation. The partial is inconvenient because it must be removed from the mouth for cleaning. Often loose, it can trap food and become annoying and embarrassing. The second option, the fixed bridge, involves the preparation, or cutting down, of adjacent teeth and construction of two or more crowns basically hooked together by the replacement tooth or teeth. This is a cemented restoration, which never comes out, has no wires, and closely mimics natural teeth in look, feel, and function. Its limitations are that adjacent teeth have to be disturbed and that a bridge cannot be used if the patient has no back tooth on which to attach the restoration.
Sometime in the 1960’s, a group of dentists that were considered radical thinkers at the time began to experiment with placing pieces of metal into the bone of the upper and lower jaws and attaching false teeth to them, a science we now call implantology.
By now, the use of the dental implant is a well respected and successful therapy that is part of every dentist’s list of alternative treatments for patients with missing teeth.
Today’s implants are for the most part made with surgical grade titanium, placed within the bone and left for a period of time, usually three to six months, for the bone to integrate or fuse to the newly inserted implant. Many options are then open to the dentist and patient. In simple situations, a false tooth can be screwed directly onto the implant head, or an “abutment” that resembles a metal jacket can be screwed onto the implant, and the false tooth in the form of a crown can be cemented to the precision piece. Implants can be used to replace a single missing tooth, or can be placed in multiples to replace multiple missing teeth similar to the bridge mentioned above. Often they are used to secure a loose denture, sometimes even adapting and using the old denture. The dental implant has certainly added a new dimension in the versatility of treatment planning for the modern dentist.
Missing teeth can hamper one’s quality of life from the standpoint of esthetics, comfort, and ability to chew and digest food. Dental implants are another option you and your dentist can explore to help solve the dental challenges you may be facing.

"Piercing the Human Mouth"

Oral piercing has seen a traumatic increase in recent years. The lips, cheeks, and the tongue are popular sites for oral piercing. There are several potential health hazards related to this practice. Perforation of the blood vessels of the tongue can cause bleeding and hematoma formations. Frequently swelling in the mouth develops after tongue piercing.
A major possible consequence of oral piercing is the compromise of the airway from trauma, tongue swelling, or obstruction by the jewelry in the mouth. Securing or providing an adequate airway or even endotracheal intubation can be challenging when a patient has a tongue barbell. If in an emergency the jewelry in the mouth is not able to be removed easily or expeditiously, emergency physicians and dentist must try and ensure that the jewelry is not loosened and aspirated or swallowed. It would always be indicated protocol to remove oral and nasal jewelry for non-emergency surgical procedures.
Chipping, cracking, or splitting teeth are the most common dental problem related to barbells in the tongue. When beaded jewelry is in the mouth it is possible for the jewelry to become trapped between teeth. The mouth has millions of bacteria present at all times and the risk of infection is obviously high. It would be recommend to use oral rinses like Listerine to reduce the bacteria amounts found in the mouth, and thus reduce the chance of oral infection. There have been reported cases of rapidly spreading oral cellulitis (Ludwig’s Angina) as a complication of tongue piercing. This cellulitis can impact a person extremely quickly, sometimes a matter of hours, and can lead to life threatening complications such as maintaining an adequate airway due to the enormous swelling in the throat area.
The information offered above describes the reasons for caution to be used when having oral piercing done in your mouth. Please contact your dental professional and explore the pro’s and con’s to oral piercing.

Dental Examinations

Without getting into a lot of technical detail, a radiograph is a special kind of picture taken of hard structures, such as bone or teeth, which demonstrates the density of the subject of the picture. The more dense the matter shown, the lighter the image will appear on the x-ray or radiograph. Conversely, the less dense the subject, the darker that part of the radiograph will appear. Caries, fractures of the bone or tooth, and many tumors of the bone are less dense than healthy tissues, and the darker on the radiograph.

There are three types of radiographs used in dentistry:

1. Panoramic - This type of radiograph is taken by a machine that rotates around the head while projecting the radiograph beam onto a long film, which is also rotating in a canister. The result is a picture of the entire lower face from the eye sockets to the chin. This type of radiograph is excellent for detecting tumors and irregularities of the maxillary sinuses and upper and lower jaws, including fractures, as well as offering the best view of the position of the third molars (wisdom teeth). In most cases, the detail of the remaining teeth themselves is not adequate for diagnostic purposes.

2. Periapicals – Literally meaning “around the roots” of the teeth, this film shows the roots and bone around 2-4 teeth per film, and has excellent detail for diagnosing abscessed teeth, bone and tooth fractures, and bone loss due to advanced periodontal disease.

3. Bitewings – Either two or four films, this set of radiographs is taken specifically to detect caries (decay) that occurs between the teeth. Bitewings plus 14 periapical images constitute a “Full Mouth Series” of radiographs.

For a complete dental examination adequate to diagnose a patient’s dental problems and potential future problems, all the above mentioned radiographs are necessary. The panoramic in most cases, does not provide sufficient detail to diagnose decay or bone loss due to periodontal (gum) disease. Conversely, the periapicals and bitewings do not expose areas of the jaws where tumors and fractures of the bone typically occur. Be advised that your dental insurance company may not agree that all types are necessary.

The frequency of prescribed radiographs is based upon the dentist’s assessment of your individual needs, including whether you are a new patient, adult, child, and pregnant females. Many dental offices are now using the new technology of digital radiography. Much like a digital camera, there is no film. Instead, a sensor is used to capture the image. Directly connected to the computer, the sensor transfers the image into the computer data bank to be retrieved whenever needed. The image can be made larger, smaller, darker, lighter-changed in many ways to enhance diagnostic ability. In communicating with specialists or other dental offices, the image can be electronically transferred or emailed in seconds. An advantage for the patient is that less radiation is required to create the image.

A planned course of treatment is only as good as the information obtained in the diagnostic examination. Caries between the teeth, root fractures, bone loss caused by gum disease, fractures of the bone and many cancerous and non-cancerous tumors of the bone would be impossible to diagnose without the use of dental radiographs.

"Cracked Teeth"

A very common occurrence is to have a crack in a tooth. The teeth most likely to suffer from cracking are these that have been heavily filled during the life of the tooth. The cavity which causes the need for the filling also causes a weakening of the remaining tooth structure. Like all materials, teeth are subject to stress fatigue. After many bites on the tooth (stress cycles) a hairline fracture can develop, usually at the bottom corner of the cavity. A person that is predisposed to clench or grind their teeth due to life stress will have a much higher likelihood of creating stress cracks in their teeth, even in teeth that have never had a filling.
Once cracks are created in the enamel of the tooth, it hurts to bite because of the flexing of the enamel crack. As the tooth flexes microscopically, the nerve located deep in the interior of the tooth is stimulated via very small tubes situated in the inner core of the tooth, below the enamel. These small tubes run down to the nerve and fluid in the tubes runs down to the nerve creating pressure – which you feel as a sharp pain. The nerve in the tooth is aggravated by the crack and by bacteria being pumped into it via the small tubes. The nerve then becomes inflamed because of the toxins in bacteria. A classic symptom of nerve inflammation is hot and cold sensitivity.
If nothing is done, the crack continues to slowly propagate (spread) like a crack in the windshield of your car. Sometimes the crack goes off to the side of the tooth and a fragment of the tooth breaks off. The crack can also go deep into the root and at times right into the tooth nerve. It is hard to predict the course of the untreated cracked tooth, but usually it is a slow downhill slide as the crack deepens. It is not a good idea to leave a cracked tooth untreated, because a small crack can be corrected effectively, but a bigger one can lead to root canal treatment or extraction of the tooth should the crack split the tooth root completely.
Unless the crack is immobilized and splinted together, the tooth is very likely to deteriorate. Although various methods have been employed in an attempt to stick the crack together, chewing forces are extremely powerful and these patch-up solutions are fairly unpredictable and ineffective. The only effective solution is to bind the whole tooth together with a "cap" or crown, so that any chewing force moves the tooth as a whole, rather than splitting it apart.
Those of you in your adult years who have had a lot of dental work done over your lifetime have a much higher risk of suffering from cracked tooth syndrome. If you are noticing hot & cold sensitivity or pain when biting on firm foods, seek help from your dental professionals and they will evaluate your condition and recommend solutions.

"You Mean I Have Another Cavity"

Person after person resists going to their dentist out of avoidance to learn of just how healthy or unhealthy their mouths are. The frustration for a very large percentage of the public is trying their best to take care of their dental health daily and yet at their dental check-up they learn once again that they have a cavity.
Why is it that people can work consistently and intently on caring for their dental hygiene and still have damage to their teeth? Tooth healthiness or wellness can be envisioned as a "Three Legged Stool". Each leg of the stool is a variable, which must be considered in order to keep teeth healthy and sound.
The first leg of the stool is what we inherit when we are born, our dental genes. This is the variable we have no control over. Yet, heredity is the least important variable that influences tooth health long-term. Even though we do not have control of our heredity, this variable can be compensated for with effort toward the other two variables.
The second leg of our dental tooth stool is oral hygiene. It depends on how effective we are at properly cleaning every surface of every tooth multiple times a day. Almost every person who enters a dental office is using a toothbrush everyday. Yet, 90% or more have never been taught how to be the most effective with using dental hygiene tools (toothbrush, floss, perio-aids, etc).
The last leg of our stool (and by far the greatest influence) is nutrition. Most people believe sugars we eat or drink cause cavities. Yet, the sugars are only the food & energy source for bugs (bacteria), which live in all human mouths. The oral bugs use sugars (solid or liquid form) as food, covert it to energy and then release waste product into our mouths. This waste from the bugs is the real culprit to tooth enamel since it is a potent ACID. These acids dissolve the calcium out of our teeth leaving a damaged hole or cavity.
Our strong recommendation to our patients is to look closely at the amount and frequency of solid or liquid sugar intake they have daily. It is not just candy and cookies, but also soft drinks, power drinks, gum, mints, coffee and tea with sugar, etc. The less sugar we give the bugs the lower the acid levels will be and the less likely you and/or your children will have tooth damage.
See your dentist today and learn more of the nutrition tooth relationship.

Amalgam vs. Composite Fillings – Which is Best?

For well over a hundred years, dentists have "filled" teeth with dental amalgam. Basically, dental amalgam consists mostly of silver with trace amounts of copper and tin mixed with virtually pure mercury to produce a putty-like mass, which hardens in about an hour. In my grandfather’s day, this was mixed with a mortar and pestle, but now there is a machine specially made to mix these components together. The resulting "filling" is very hard, but is colored silver to black, which makes it cosmetically questionable in today’s esthetically-conscious market.
About fifty-years ago, composite resin filling material burst upon the market. Basically a very high-grade, specialized plastic, composite was originally two pastes mixed together to then set or harden within a few minutes. This means that they set only on an exposure to a very intense blue light, giving the dentist almost unlimited time to shape or contour the filling. Today’s composites are extremely varied as to strength and polish-ability reflecting the requirements called for in different parts of your mouth. Teeth are etched with a mild acid, producing microscopic grooves in the enamel. Composite is then bonded into the individual teeth and, when properly done, is almost impossible to separate from the tooth without the proper dental equipment. Best of all, they are tooth-colored, with hundreds of shades available to match any particular tooth producing a very life-like result.
For many years, the dental community has been split on the appropriateness of using dental amalgam in humans. Many accusations have been leveled at amalgam, including suggestions that mercury leaking from the restorations causes everything from Multiple Sclerosis to Autism. Many studies have been done over the years and results have been produced to support every possible position. This continues to be a hot topic in dentistry. However, the American Dental Association has continued to endorse the use of dental amalgam without reservation.
Composite resin is slightly more expensive than amalgam, due to the fact that it is somewhat more labor intensive and the materials are more expensive. Nevertheless, most patients today opt for composite for esthetic reasons. This certainly seems to be the direction operative dentistry is going. Millions of dollars each year are invested in research related to making composites stronger, more beautiful, and longer lasting. Amalgam is what it always has been and probably always will be: a utility dental material with limited application.

Dental Sealants

Sealants are a safe, painless, and low cost way to help protect you child’s back teeth from decay. Sealants have been used on children’s teeth for more than 30 years. A thin, plastic, tooth-colored or clear coating (sealant) is bonded to the chewing surfaces of the teeth (usually molars & premolars). This forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the tooth. The chewing surfaces of the back tooth have tiny grooves that form as each tooth develops. This is where most decay occurs in children. That is because the bristles of a toothbrush can’t get down into the grooves to remove the food and bacteria that get trapped there.
Usually, the back teeth (molars & premolars) are sealed. Fluoride in toothpaste and fluoride treatments in your dental office help protect the smooth surfaces on the front teeth and on the sides of the back teeth. But only sealants can keep food and bacteria from getting into the grooves on the chewing surfaces of the back teeth. Sealants should be applied as soon as the first permanent molars (6 year molars) erupt. This occurs between 5-7 years of age. The second molars (12 year molars) and the premolars should be sealed as soon as they erupt, between 11-14 years of age. That’s because the greatest chance of decay occurs during the first year after the teeth erupt. However, it’s never too late to apply sealants, as long as teeth are free of decay and fillings the teeth can be sealed.

Many ask about sealing baby teeth. The baby molars often don’t need to be sealed. However, your dentist may recommend sealing the baby molars if there is a high risk of decay. Since baby teeth are “space holders” losing baby molars due to decay can cause crowding when the permanent teeth come in.

Sealants can last for 3-5 years. If they chip or come off, they can easily be replaced, any problems can be detected and corrected at your child’s regular dental checkup. As long as the sealants are in place, decay is less likely to develop in the grooves. Parents can help the sealants last by encouraging your child not to chew on ice cubes and/or hard sticky candy. Your dentist will look at the sealants at each regular dental checkup.

Parents should seek the advice of their dental professionals for the best possible preventive dental care for their children. Helping your children grow to their adult years with the least amount of dental damage is the ultimate goal of your dental team.