We all know that dentistry can do amazing things these days to give you the smile you've always dreamed of. With the latest cosmetic and restorative dental techniques, it is possible to achieve amazingly natural-looking results. But how do we map out the best route to a better smile? And how do we know that the results will hold up over time?
Every individual has a unique set of conditions in his or her mouth and it is our job to figure out how you have come to your present state, dentally speaking. We need to correct or at least manage any factors that could risk the success of your treatment. These risk factors fall into four basic categories:
Periodontal Risk — This involves the condition of the structures that support your teeth, including your gum and bone tissue. It's important to establish good periodontal health before we perform any restorative or cosmetic procedures.
Biomechanical Risk — This has to do with the structural integrity of your teeth. We will look at whether any tooth structure has been lost due to decay, and take steps to reduce your susceptibility to decay if necessary.
Functional Risk — This relates to your bite: how your teeth, muscles and jaw joints are functioning. For example, do you have excessive tooth wear or joint pain? If so, you are at a higher risk in this category and we need to figure out why.
Aesthetic Risk — This is the most subjective of the categories as beauty is in the eye of the beholder. Still, if you display a lot of your teeth and gums when you smile, any issues you have (gum recession, for example) will be that much more visible and affect your smile more. We will have to take this into account when we plan your treatment.
Only when we have determined how best to minimize your risk in all four of these categories can we restore or enhance your smile in a way that will not only look great but also last as long as possible.
“Smile, and the world smiles with you,” the old saying goes. For people who are afraid to smile because they don't like how their smile looks, the twenty-first century offers a myriad of solutions. Smiling shows your teeth in their various shapes, colors, and sizes, your gums and gum line, your tooth alignment, spacing, and bite all in relation to the rest of your face. Any of these can now be improved.
Through the knowledge, skills, and combined experience of our dental team, it is now possible to make teeth whiter, brighter, and more evenly aligned, to alter tooth shape and size, and to make the teeth and gum line more proportionally balanced. Here are some options for cosmetic dentistry:
- Polish. Remove unwanted stains on outside tooth surfaces by having your teeth polished.
- Teeth Whitening. If teeth are stained or have just lost their luster, whitening is a safe and effective way to lighten a smile.
- Porcelain veneers. Applying a thin layer of dental porcelain restorative material to replace stained or damaged tooth enamel can truly change a smile.
- Porcelain crowns. If teeth are damaged by decay or trauma, porcelain crowns can replace the parts of the teeth that show above the gum line.
- Orthodontics. For teeth that are not in their correct and functional position, a variety of orthodontic techniques can be used including traditional braces, clear aligners and moreÃ¢Â€Â”to improve crooked teeth or a malaligned bite.
- Dental implants. Nothing ruins a smile more than missing teeth. Entire teeth can be replaced, including the roots and the crowns, using dental implants. These are exact replicas of the natural teeth and can be made to match their neighbors exactly.
Considering the costs, many people view replacing a back tooth as less important than a more visible front tooth. They’re rarely seen, so who will notice?
You might, eventually. A missing back tooth can set off a chain reaction of problems that can affect your overall dental health. Besides playing an important role in chewing food, back teeth also redistribute most of the chewing force away from the front teeth. Their absence can also affect the bite: adjacent teeth to the missing one will tend to migrate toward the open space, causing them to tip and rotate into an improper position. This can cause an increase in tooth mobility, excessive wear and erosion, and endanger their survival in the long run.
To avoid these and other problems you should consider some form of replacement. Most dentists prefer a dental implant for its life-like appearance and durability, and because its titanium post has a natural affinity with bone. Bone cells will grow around and permanently adhere to the implant, which may stop and even reverse bone loss in some cases.
Implants, though, require a certain amount of bone structure initially to anchor and position properly. If you have inadequate bone and don’t want to bone graft the area, the next best option is a fixed bridge, in which the missing tooth is replaced with an artificial crown known as a pontic. The pontic is fused between two support crowns that are permanently affixed to the natural teeth on either side of the missing tooth (also known as abutments). While fixed bridges restore function and inhibit tooth migration, they require the natural tooth supporting the bridge to be reduced to accommodate the crowns placed on them. This permanently alters them and places them at higher risk for future nerve damage, gum disease and decay.
One final option is a removable partial denture (RPD). Although RPDs restore function and improve appearance, their movement within the mouth may place additional stress on the teeth that hold them in place. This movement over time could damage or loosen them.
We can discuss which option is best for you after a complete dental exam. The important thing, though, is to replace the back tooth as soon as possible — doing nothing could cost you much more in the long run.
If you would like more information on 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 “Replacing Back Teeth.”
While tooth decay and periodontal (gum) disease destroy more teeth than any other causes, both of these diseases are largely preventable with proper oral hygiene and dental treatment. It’s more than possible, then, to enjoy a lifetime of healthy, disease-free teeth.
But even with healthy teeth, the effects of aging will cause tooth wear over time. And although we can’t prevent the aging process from occurring altogether, there are steps we can take not to accelerate the process.
Most tissues, including bone and teeth, have a growth cycle in which older cells are broken down (known as catabolism), removed and replaced by newer cells (anabolism). As we develop during childhood, the growth phase exceeds breakdown; when we reach adulthood, the two phases come into equilibrium. But as we age, breakdown will gradually overtake growth. This aging effect results in, among other outcomes, tooth wear.
“Normal” wear appears to be greatest — and most visible — along the biting surfaces of the teeth. The forces generated when we bite or chew causes enamel to erode over time. Unfortunately, you can accelerate this process through bad oral habits: clenching or grinding teeth, often times at night while you sleep, as well as habitually chewing on hard objects like nails or pencils.
Normal forces generated when we bite or chew are actually beneficial for dental health — they help stimulate bone growth. But when they exceed their normal range as when we clench or grind our teeth, they can increase tooth wear and cause other problems such as diminished function or changes in appearance, such as a shortened facial height.
To slow the rate of wear, it’s important to modify any behaviors that may be contributing to it. In many cases an occlusal night guard worn while you sleep helps prevent teeth clenching. You may also need assistance with stress management, a major trigger for these kinds of habits, through biofeedback therapy or counseling.
If you’ve already encountered excessive wear, bonding techniques using colored composite resin, veneers or crowns that attach directly to the teeth can restore lost function and rejuvenate the appearance and color of your teeth. We can perform a “smile analysis” to determine if one of these techniques is right for you to help you regain a more youthful and attractive smile.
If you would like more information on aging and tooth wear, 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 “How and Why Teeth Wear.”
Daily personal care is essential for optimal oral health. Brushing and flossing in particular keep bacteria and acid, the main causes of dental disease, at manageable levels. But to gain the most benefit from your personal care, you need to perform these tasks effectively with the proper techniques and equipment.
For most people brushing begins with a soft-bristled, multi-tufted toothbrush with fluoride toothpaste that helps strengthen enamel. You should hold the brush at a slight angle and brush with a gentle motion to remove plaque, the main cause of gum disease and tooth decay — if you’re too aggressive by brushing too hard or too long, you could damage the gums. You should brush no more than twice a day for two minutes, and at least thirty minutes to an hour after eating to allow saliva time to neutralize any remaining acid and help restore minerals to enamel.
Although some people find flossing difficult to perform, it remains an important component of daily care. Flossing once a day removes plaque from between teeth where a brush can’t reach. If you need help with your technique using string floss, we’ll be glad to provide instruction at your next visit. If you have bridges, braces or other dental restorations or appliances that make string flossing difficult, you might consider other options like floss threaders or a water flosser.
There are also dietary and lifestyle choices you can make to enhance your daily care: limit sugary or acidic foods to mealtime and avoid between meal snacks to reduce bacteria and acid in the mouth; drink water to keep your mouth moist, which will inhibit plaque buildup; and stop tobacco use, excessive alcohol consumption and chewing habits like clenching or biting on hard objects. Above all, be sure to visit us at least twice a year for cleanings and checkups, or when you notice abnormalities like bleeding gums, pain or sores.
Keeping your teeth and gums healthy can be done, but it requires a daily care commitment. Performing these hygiene habits in an effective manner will help preserve your teeth for a lifetime.
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