Posts for category: Dental Procedures
Primary (baby) teeth might not last long, but their impact can last a lifetime. Their first set of teeth not only allows young children to eat solid foods, but also guide permanent teeth to form and erupt in the proper position.
Unfortunately, primary teeth aren't immune to tooth decay. If the decay is extensive, the tooth may not last as long as it should. Its absence will increase the chances the permanent teeth won't come in correctly, which could create a poor bite (malocclusion) that's costly to correct.
If a primary tooth is already missing, we can try to prevent a malocclusion by installing a “space appliance.” This keeps nearby teeth from drifting into the empty space intended for the permanent tooth. The best approach, though, is to try to save a primary tooth from premature loss.
We can often do this in much the same way as we would with a permanent tooth — by removing decayed material and filling the prepared space. We can also perform preventive applications like topical fluoride or sealants that strengthen or protect the tooth.
It becomes more complicated, though, if the pulp, the interior of the tooth, becomes decayed. The preferred treatment for this in a permanent adult tooth is a root canal treatment. But with a primary tooth we must also consider the permanent tooth forming below it in the jaw and its proximity to the primary tooth. We need to adapt our treatment for the least likely damage to the permanent tooth.
For example, it may be best to remove as much decayed structure as possible without entering the pulp and then apply an antibacterial agent to the area, a procedure known as an indirect pulp treatment. We might also remove only parts of the pulp, if we determine the rest of the pulp tissue appears healthy. We would then dress the wound and seal the tooth from further infection.
Whatever procedure we use will depend on the extent of decay. As we said before, our number one concern is the permanent tooth beneath the primary. By focusing on the health of both we can help make sure the permanent one comes in the right way.
If you would like more information on caring for children's primary 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 “Root Canal Treatment for Children's Teeth.”
Although usually an orderly process, some permanent teeth don't come in as they should. In fact, they may not come in at all and remain hidden in the gum — a situation called impaction. This creates multiple problems for function, health and, in the case of front canines, appearance.
Canines are the longer and more pointed teeth on each side of the front-most incisors. They help tear and cut food during chewing, a function impaction eliminates. Besides a higher risk for developing abscesses (isolated areas of infection) and cysts, they can also put pressure on neighboring teeth and damage their roots or cause them to erupt abnormally.
Dentists often remove impacted wisdom and other back teeth to lessen these potential problems. Removing canines, though, has additional considerations: besides compromising ideal chewing function, missing canines often create an unattractive smile.
But before considering removal, there's another technique we might be able to use to save the canines and actually draw them down through the gums to their correct position. It's usually part of an overall orthodontic plan to correct a poor bite (malocclusion).
After pinpointing their exact position with x-rays or CT scanning, a surgeon surgically exposes the impacted canines' crowns through the gums. They then bond small brackets to the crowns and attach a small gold chain to each bracket. They fasten the other end of the chains to orthodontic hardware that exerts downward pressure on the impacted teeth. Over several months this pressure can help move the teeth into their normal positions.
Unfortunately, this technique isn't always advisable: one or more of the impacted teeth may be in a difficult position to attempt it. It's usually best in these situations to remove the teeth, usually sooner rather than later for the sake of neighboring teeth.
Fortunately, with today's advanced restorative techniques, we can eventually replace the canines with dental implants, although that's best undertaken after the patient enters adulthood. In the meantime, we can utilize orthodontic means to preserve the open space and provide a temporary restorative solution.
Whatever route taken, these teeth don't have to become a source of problems, especially for your appearance. Whether through orthodontics or restorative dentistry, impacted canines don't have to ruin your smile.
If you would like more information on various orthodontic procedures, 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 “Exposing Impacted Canines.”
For over three decades, veneers have helped mask dental imperfections like chipping, staining or gaps and improve the appearance of millions of teeth. As the name implies, this thin layer of porcelain covers a tooth's visible surface and accurately mimics the texture, color and translucence of natural teeth.
Veneers could be just the solution you need for a more attractive smile. But before you begin treatment, be sure you have these 3 essentials in place to ensure a successful outcome.
True expectations. While the transformation of a tooth's appearance with a veneer can be astounding, veneers in general do have their limitations. You need an adequate amount of the tooth's structure present for a veneer to properly adhere — if not, you may need to consider a porcelain crown instead. Likewise, gaps and other misalignments may be too great for a veneer to cover: in that case, you should consider orthodontics. A thorough examination beforehand will determine if veneers are the best option for you.
An artisan team. Every veneer is custom made to match an individual patient's tooth shape and color, handcrafted by a skilled dental technician. There's also an art to the dentist preparing the tooth beforehand and then properly positioning the veneer for bonding to achieve the most attractive result. Be sure, then, that your veneer "team" comes highly recommended by others.
The best materials. The first porcelains were powdered glass ceramics mixed with water to form a paste. Technicians shaped the paste in successive layers and as it oven-cured it took on the beautiful translucence of natural teeth. Unfortunately, this type of porcelain could be brittle and prone to shattering when subjected to heavy biting forces. In recent years, though, we've begun to use ceramics reinforced with other materials like Leucite for added strength. Today, the materials dentists use have much better durability.
If you would like more information on porcelain veneers, 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 “Porcelain Veneers.”
Digital computer technology has made a big impact on cosmetic dentistry. We can now simulate on a monitor display of your face how your new smile will appear after dental work, thanks to a graphics program specifically designed for cosmetic dentistry.
While that's an amazing development, we can also take it a step further by creating the look of a new smile on your actual teeth during an office visit. We call it a “trial smile.”
To create a trial smile, we begin with composite resin, a tooth-colored bonding material, and fashion it into temporary veneers or crowns that we then temporarily place over your teeth. This gives us the chance to see what your new smile will look like in all three spatial dimensions (rather than the two-dimensional view on a computer monitor) and while your face is in motion as you talk and smile. This can give us a great deal more detail to help better evaluate your proposed look.
A trial smile also helps us in planning your new look. Like you, we want the best result possible: a trial smile allows us to see how your jaw movement interacts with your updated look and if everything works together as it should. It will also give us a better idea how much tooth structure we'll need to remove to accommodate your permanent veneers or crowns — the less, of course, the better.
Although you won't be able to take your trial smile with you when you leave, we can take a photograph you can review later, as well as show friends and family for their opinion. Trial smiles do add some cost to treatment, but the proportion of expense to the benefit of actually viewing your smile in this fashion is well worth it. It's one more way we can ensure your final new smile meets your expectations.
If you would like more information on “trial smiles,” 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 “Testing Your Smile Makeover.”
Not long ago, the most affordable option for total tooth loss was a removable denture. Dentures, prosthetic (false) teeth set in gum-colored acrylic plastic bases, can effectively restore function and appearance. But the appliance continues to have one major drawback: it can accelerate bone loss in the jaw.
Like other living tissues, older bone cells die and become absorbed into the body (resorption). Normally they're replaced by newer cells. The forces generated when we chew our food travel through the teeth to stimulate this new growth. This stimulus ends when we lose our teeth, and so cell replacement can slow to an abnormal rate. Eventually, this causes bone loss.
Removable dentures can't provide this stimulation. In fact, the pressure generated as they compress the gums' bony ridges can even accelerate bone loss. That's why over time a denture's fit can become loose and uncomfortable — the bone has shrunk and no longer matches the contours of the dentures.
In recent years, though, a new development has been able to provide greater support to dentures while at the same time slowing or even stopping bone loss. We can now support dentures with dental implants.
Implants are best known as individual tooth replacements: a titanium metal post replaces the root, while a life-like porcelain crown attaches to the post to replace the visible tooth. In addition to providing a longer-lasting alternative to removable dentures, implants provide a very important health benefit: they improve bone density because they mimic the function of natural teeth. Bone cells are naturally attracted to the titanium; they adhere to the titanium post and are stimulated to grow through the action of chewing, increasing bone density and securing the implant's hold in the jaw.
Using the same technology we can support removable dentures, or even full fixed bridges. Rather than rest directly on the bony ridges, a denture can make a secure connection through a coupling system with just a few strategically placed implants. We can also permanently attach a full bridge by fastening it to a few implants with screws.
Not only do we eliminate the pressure from dentures compressing the gums and bone tissue, we can actually stimulate bone growth with the implants. Although more costly upfront than traditional dentures, unlike traditional dentures which must be replaced every five to seven years, long-lasting implants may be more cost-effective over the long-run.
If you would like more information on implant-supported tooth replacement, 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 “New Teeth in One Day.”