September is National Gum Care Month. Did you know that advanced periodontal disease is the number one cause of tooth loss among adults? Periodontal disease refers to any disease that affects the structures that hold the teeth in place, including gums, ligaments and bone. In its earliest stage, called gingivitis, the gums become inflamed. When it progresses to periodontitis, both soft and hard tissues that hold the teeth in place are affected, threatening the integrity of the teeth. Some people are more susceptible to periodontal disease than others. Here are some common risk factors:
Poor oral hygiene. Plaque buildup is the primary cause of gum disease. When life gets busy, we may be less diligent about our oral care. This allows bacteria in the mouth to form a biofilm (plaque), which causes inflammation of the gums.
Heredity: Some people are genetically more predisposed to gum disease. Look at your family history. Have any of your relatives had gum disease or lost their teeth?
Pregnancy. Gums are sensitive to hormone fluctuations, and it is not uncommon for pregnant women to experience an inflammation of the gums known as “pregnancy gingivitis.” Gingivitis — characterized by red, swollen gums that bleed easily — is the beginning stage of gum disease.
Age: The chance of developing gum disease increases with age. Over 70% of Americans 65 and older have periodontitis, an advanced form of gum disease, according to the U.S. Centers for Disease Control and Prevention. This may be influenced by other diseases, medications that cause dry mouth, or other causes of plaque buildup.
Diet: Eating too many simple carbohydrates (those found in sugar, white bread, white rice and mashed potatoes, for example) is linked to chronic inflammation in the body, which increases the risk of gum disease.
Smoking: Smoking is a significant risk factor for the development and progression of gum disease. Since nicotine constricts blood vessels, smokers may not see the typical symptoms such as red, puffy, bleeding gums, so the disease may cause damage before smokers realize there is a problem with their gums.
Diabetes: Uncontrolled diabetes puts you at higher risk of periodontal disease. Not only can diabetes make gum disease worse, gum disease can make diabetes symptoms worse.
Our aim is not to scare you but to help you become aware of factors that can increase your risk of gum disease. Many of these factors are not under your control. However, you can do your part to prevent gum disease by staying on top of the things you can control. Let us know about any new medications you are taking, eat a balanced diet rich in complex carbohydrates and other nutrients and, if relevant, manage your diabetes and explore programs that will help you quit smoking.
Fortunately, good oral hygiene and regular professional cleanings can turn early gum disease around, so if you have any of the risk factors that contribute to periodontal disease, be extra diligent about your oral hygiene routine. And make sure you come in for regular dental checkups and cleanings. If you show signs of gum disease, we may recommend that you come in for more frequent cleanings.
In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?
“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.
How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.
With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.
In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.
While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.
Which method is best for you? Don’t try using paranormal powers to find out: Come in and talk to us. If you would like more information about tooth replacement, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Crowns & Bridgework,” and “Dental Implants.”
Accidents happen, especially to teenagers involved with sports or similar activities. In an instant they can lose one or more teeth and permanently alter their smile.
Fortunately we can restore a teenager’s lost teeth, but often not immediately as a permanent restoration with a dental implant requires maturity of their jaw structure. Our focus then turns to the age of the patient and the condition of the underlying bone. A future dental implant, your best choice for tooth replacement, depends on bone for support, but also the age of the patient as it relates to jaw development.
There are a couple of ways an accidental tooth loss can harm supporting bone: first and foremost, the impact of the accident itself can damage the bony socket. To find out for sure we may need to perform a cone beam scan, a type of x-ray that allows us to view the area three-dimensionally. If we do find damage, we can attempt to repair the socket through bone grafting.
Bone can also suffer from the long-term absence of a tooth. Bone has a growth cycle in which older cells dissolve and new ones form to take their place. The force generated by teeth when we eat or chew helps stimulate this growth. Without stimulation, as with a missing tooth, the bone may not grow at a healthy rate. In time, it could lose some of its volume and density and not be able to support an implant.
Installing an implant right after tooth loss could help avoid this situation. Bone has a natural affinity with the titanium post imbedded in the jaw and will naturally grow and adhere to it. But we can’t place an implant with a teenager. This is because the jaw is still developing so an implant would gradually become misaligned as the jaw grows. It’s best to install an implant later after full jaw development in early adulthood.
Today, we can place a bone graft in the empty socket right after tooth loss. The graft serves as a scaffold for bone cells to grow on and will help keep the bone volume at a healthy level until we can install an implant.
Timing is everything in restoring a teenager’s accidental tooth loss. But with coordination and care for the supporting bone, a teenager can eventually enter their adult years with their smile intact.
If you would like more information on restoring your teenager’s smile after tooth loss, 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 “Dental Implants for Teenagers.”
Have you started orthodontic treatment recently? Are you having a little trouble getting used to your braces? If so, you are not alone: Everybody goes through an adjustment period during which they momentarily wonder if they’ll really ever get used to this. Don’t worry — you will! And we’ve never heard anyone say, on the day their braces come off and their new smile is revealed, that they aren’t glad they went the distance. Just ask Houston Rockets all-star center Dwight Howard, who discussed his own orthodontic treatment in a recent interview.
“I’m sure I was no different than anyone else who has ever had braces,” he told Mediaplanet. “At first I hated them so much… That changed once I got used to them and I actually grew to love them.” What’s Howard’s advice? “Do exactly what your orthodontist says and know that the outcome is well worth it in the end.” We couldn’t agree more! Here are some tips for wearing braces comfortably:
- Hard & Chewy Foods: If you love fresh fruits and vegetables, that’s great; there’s no reason to give them up, just the really hard ones. You don’t want to bite into an apple or carrot or any other hard foods like bagels and pizza that have any “size” to them. Small pieces may be ok as long as they can’t bend your wires. Chewy, sticky candy should really be avoided completely. Same with soda, sports drinks and so-called energy drinks because they contain acids that promote tooth decay and can cause a lot of damage around the braces.
- Effective Oral Hygiene: Keeping your teeth clean is more important than ever, but also more challenging than ever. It’s easy for food to get stuck under wires and around brackets, but failing to remove it can cause tooth decay, gum irritation and soreness. Therefore, the cleaner your teeth and your braces are, the healthier you will be. Use interdental cleaning brushes and/or a floss-threader to get behind your wires. A mouthrinse can also help strengthen teeth and keep bacteria in check. If you have any questions about how to clean between your teeth, please ask for a demonstration at your next visit.
- Pain Relief: Some soreness at the beginning of orthodontic treatment is normal. To relieve it, you can use an over-the-counter pain reliever and/or a warm washcloth or heating pad placed on the outside of the jaw. If brackets or wires are rubbing against the inside of your cheeks or lips, try applying wax to these areas of your braces. If this does not offer enough relief, we may be able to trim the end of a poking wire. Call us if you need help with this.
Our goal is to make your orthodontic treatment as comfortable as possible on the way to achieving your all-star smile. If you have questions about adjusting to braces, contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Caring for Teeth During Orthodontic Treatment.”
There are a number of ways to improve unsightly teeth. You can, of course, replace them with dental implants — but not if they're still viable. You can crown them: however, you'll have to significantly reduce their structure for the crowns to fit over them.
There is another less invasive option for teeth with mild to moderate imperfections — you can cover them with porcelain veneers. As the name implies, a veneer is a thin covering of dental porcelain bonded to the outside surface of a tooth. They literally put a “new face” on chipped, stained or slightly gapped teeth.
You'll first need a dental examination to ensure your teeth are reasonably healthy and that you don't have any significant dental problems that could interfere with the veneers. We can then design your veneers' shape and color to achieve the look you desire. We can also create a temporary “trial smile” with acrylic replicas of your proposed veneers to give you a realistic impression of your future smile.
The next step is the possibility the teeth need to be prepared for the veneers. Although quite thin, veneers can still make the teeth look larger or bulky. To compensate, we remove some of the tooth enamel. Although much less than for a crown, this alteration is still permanent: your teeth will need some form of restoration from now on. There are also “no-prep” veneers, which require no tooth surface reduction.Â Ask us if this is an option.
We then make an impression of the teeth, which with other information will guide a technician at a dental laboratory to manually create your new veneers. This can take several weeks and requires a high degree of artistry to produce a custom product that will match your teeth.
Once they've arrived, we'll use a permanent bonding process to precisely attach them to your teeth.Â It will then be up to you to care for your veneers, especially not biting down on anything hard that could chip or crack them. You should also maintain regular dental visits and proper oral hygiene to keep your smile as bright and attractive as possible.
Although small in size, veneers can make a big impression. They can restore the smile you once had — or give you the look you've always wanted.
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: Strength & Beauty as Never Before.”
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