Posts for: September, 2014
You may not realize it, but the simple act of eating can generate a tremendous amount of force on teeth and jaws. Fortunately, your teeth can absorb much of this biting force — but within limits. If the force exceeds normal limits on a continual basis, you may begin to notice aching teeth or sore jaws, and we may begin to notice unusual tooth wear during your dental checkups.
The most common cause for this is a chronic habit of grinding or clenching the teeth, also known as bruxism. It can manifest itself by teeth grinding against each other, teeth pressing against soft tissue (as with thumb-sucking) or biting or chewing on hard objects such as pencils or nails. We commonly see bruxism with patients who are experiencing excessive stress, sleep-related problems or as a result of lifestyle habits such as smoking or excessive alcohol consumption. You may not even be consciously aware of it as in the case of bruxism that occurs while you sleep, but your sore jaws in the morning (as well as your sleeping partner’s complaints of noise) may be evidence of it.
Treatment involves a two-part approach. First, we want to relieve the pain symptoms and stop the damage. To relieve pain we’ll often prescribe mild, anti-inflammatory or muscle-relaxant drugs, or perhaps medication to help you sleep better. We may also design a bite guard for wear on your upper teeth at night: the lower teeth will tend to glide or skate on the wear-resistant plastic and prevents them from placing excessive forces on your teeth.
The other part is to address the underlying cause for long-term results. If the habit arises from severe stress or other lifestyle issues, we may recommend biofeedback therapy or psychotherapy to improve your coping mechanisms. If an abnormality like a bad bite (malocclusion) is an underlying factor, we may recommend a minor bite adjustment by reshaping the teeth to lessen the bite impact.
The right course of action depends on a thorough dental examination to determine the exact nature of your clenching or grinding habit. From there we can discuss your options on how to relieve the soreness and pain, as well as prevent problems in the future.
If you would like more information on bruxism and its effects, 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 “Stress & Tooth Habits.”
A dental implant can permanently restore the form and function of a missing natural tooth. But there’s an important prerequisite for this smile-transforming therapy — you must have enough bone remaining at the implant site to securely anchor the implant and ensure proper crown placement for the most natural looking result.
Patients who don’t meet this prerequisite may need to consider other restorative options. In some cases, however, we may be able to encourage sufficient bone growth to support an implantation through a technique called bone grafting.
Bone grafting involves opening the gum tissues at the intended implant site to expose the underlying bone. We then place the grafting material (usually a processed material) around the bone, sometimes with collagen membranes that serve as subterranean band-aids to guide bone growth. In most cases, the graft is actually a scaffold for the natural bone to grow upon; the natural bone will eventually replace the graft material. The procedure is normally performed with local anesthesia to minimize discomfort.
While bone grafting is a fairly routine procedure, it shouldn’t be undertaken unless there’s a firm prognosis it can successfully support a future implant. We must therefore determine if anything else in your oral health would disqualify you as an implant candidate, even if sufficient bone existed or not. We must also determine if there’s enough remaining bone currently at the site to even attach a bone graft.
Once we’re satisfied that bone grafting would be both possible and helpful, we must then consider what type of grafting material to use. If we’re only replacing one tooth we may choose to use an autograft, bone material taken from another area of your own body. Although autografts have advantages because of their regeneration ability, it does involve creating another surgical site within the body. In most cases we may use processed materials, for example allografts, material that originates from another human being; xenografts, taken from another species of animal; or synthetic (man-made) materials. Regardless of the source, these materials are first processed to be safe for human use.
If successful, the regeneration process will result in enough new bone structure to make dental implants a reality. Your mouth will be healthier — and your resulting smile will be more beautiful than ever.
If you would like more information on bone grafting, 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 “Can Dentists Rebuild Bone?”
While dental implants are considered the gold standard for tooth replacement, removable dentures are still a viable choice, especially for patients with edentulism (complete tooth loss). Removable dentures have also undergone considerable advancement to improve their function, appearance and longevity.
But even with these advancements, dentures still require a fair amount of skill, experience and — of utmost importance — a sense of art. If you’re considering this option, long-term success depends on a careful process of construction, fit adjustment and regular checkups to maintain that fit.
Our first step is to determine exact tooth placement on each denture. Using facial features (or photos before tooth loss) we establish placement landmarks so that corresponding upper and lower teeth align properly. We also consider tooth size, their orientation in relation to the lip, and the needed space to leave between the upper and lower teeth when they are at rest. We make these determinations based on accepted standards of beauty, but also taking into account your particular comfort level with any features that might alter your appearance.
The denture’s gums must also look realistic when you smile, especially if your upper lip rises above the teeth to expose more gum tissue. We also want to match the color and texture of your natural gums, as well as incorporate palatal rugae, the little ridges behind the upper front teeth that aid with speech and chewing food.
When we first place the new dentures in your mouth, we may need to adjust them for balance between the upper and lower sets when they come together. An imbalanced fit could have an adverse effect on your ability to bite, chew and speak normally.
Your dentures should have a good, comfortable fit. Over time, however, you will encounter some degree of bone loss because you no longer have your natural teeth to stimulate bone growth and absorb the forces created during function when your teeth contact. This and other factors may cause your dentures to become loose and uncomfortable to wear. For that reason, it's important for you to visit us regularly to maintain that good fit and check the health of underlying tissues and bone.
Careful planning and denture construction help ensure your new dentures successfully restore form and function to your mouth. Regular monitoring will also ensure they continue to serve you well for as long as possible.
If you would like more information on removable dentures, 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 “Removable Full Dentures.”
Do you have silver dental fillings that you wish you didn't have? Wouldn't it be nice if no one could look in your mouth and see how many cavities you had as a kid? Tooth-colored fillings may offer a solution to the problem of too much metal in your mouth. How much do you really know about non-metallic tooth-colored fillings? Take our quiz and find out.
True or false: Tooth-colored fillings are a radical new technology.
False. A variety of dental porcelains and composite resins have been successfully used in tooth restoration for many years. These materials have been designed to mimic the properties of the two major components of teeth: the hard outer enamel, and the bone-like inner dentin. Our increasing understanding of tooth structure and composition has led to better and more natural-looking filling substances.
True or false: Teeth must remain rigid under the pressure of the bite.
False. At one time, metal amalgam (silver) fillings were preferred because of their extreme hardness. But we now know that the crowns of our teeth actually flex under the forces of the bite. This discovery has spurred the development of new methods and materials to stabilize the restored tooth and reduce the incidence of premature failure.
True or false: It's usually more complicated to put in a tooth-colored filling than a metal one.
False. Regardless of which material is used, the basic process of filling a tooth is the same. The dentist prepares the tooth for treatment, removes decay, and places a filling directly into the tooth. If the filling is moderately deep, a tooth-colored filling may be set in several layers which are successively “cured” or hardened. More extensive restorations may require more than one visit, but the natural-looking results generally justify the extra time.
True or false: Regular metal fillings make the tooth structure stronger.
False. Properly securing an amalgam filling may require the tooth to be “undercut,” meaning that a greater amount of healthy tooth material must be removed. This can weaken the tooth structure, eventually leading it to chip and crack. Non-metallic fillings don't require undercutting, so more tooth structure is left intact. This more conservative treatment can result in a stronger, longer-lasting restoration.
True or false: Non-metallic (tooth-colored) fillings are safer than silver fillings.
False. While each method has advantages and disadvantages, and may not be an appropriate treatment in every situation, both methods have been deemed safe and effective by major U.S. and international science and health organizations. While there have been recent concerns about mercury in amalgam fillings, there is presently no reason to believe that it presents any cause for concern.
If you would like more information about tooth-colored fillings, 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 “The Natural Beauty of Tooth-Colored Fillings.”
Treating periodontal (gum) disease is rather straightforward: remove the bacterial plaque that causes the disease. The techniques to accomplish this are varied, depending on how far the disease has advanced with an individual patient.
Plaque is a thin film of bacteria and food particles that build up on tooth surfaces due to inadequate oral hygiene. The bacteria that grow there can cause an infection that inflames and damages the gum and supporting bone tissues to the point they begin to lose their attachment to the teeth and form spaces known as periodontal pockets. In time, plaque becomes calcified due to the minerals in saliva, forming calculus or tartar. As the disease advances, it can ultimately cause tooth loss.
The most common technique for interrupting this progression of disease is known as scaling. Using hand instruments and/or an ultrasonic device, we remove as much plaque and calculus as we can detect on the outer surfaces of the teeth and gum tissues. Scaling, however, won’t address the plaque and calculus that has accumulated at the tooth root level, especially where pocket formation has taken place. This is where root planing may be necessary.
As the name implies, we use this procedure to literally “plane” plaque and calculus from the roots, a similar concept to removing thin layers of wood from a board. If necessary, we will first numb the affected area so that we can perform the procedure in a meticulous manner without causing discomfort. It’s essential we remove every bit of plaque and calculus that we can, especially where it has become lodged deep at the base of the pockets.
It’s common to start with ultrasonic therapy, using vibration to loosen the plaque while flushing the pockets with water. We then switch to delicate hand instruments known as curettes to physically remove any remaining plaque and calculus. An experienced touch helps us determine when the root surfaces have been properly cleaned; we can also “read the gum tissues,” as they will slightly change color as the offending plaque and calculus deposits are removed. As the gum tissues heal and become less inflamed, they return to a healthy pink color and the pocket depths generally become smaller as the inflammation leaves the area.
While a good portion of the treatment requires our professional skills, equipment and expertise, the bedrock for renewed periodontal health is effective daily oral hygiene on your part. Working together we can preserve the progress already made, while continuing to progress in restoring your oral health.
If you would like more information on root planing and other periodontal disease treatments, 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 “Root Planing.”