Thursday, July 31, 2014

Basics of Cosmetic Dentistry

The goal of cosmetic dentistry is to enhance, improve, or change the appearance of your teeth. In today's society, appearance is very important. While judgment based solely on appearance may be superficial and not reflective of who you really are, it can still affect how people think of you. When you talk, people focus on your face, your eyes, and teeth. People notice a natural looking mouth, teeth, and smile. An unsightly mouth due to visible cavities, defective fillings, gum disease, or crooked or misshapen teeth is noticed, too. People will often form opinions of you based on what they see.


You can get an objective look at how other people see you. Get about 18 inches away from a mirror. This is about as close as most people get to you when you speak with them. If you get any closer to the mirror, the light will not be right and you will not get a true picture of how your teeth look. Smile, talk, laugh, and observe which teeth are visible and what they look like. Then ask yourself, "If I could wave a magic wand over my teeth and change anything I don't like, what would I change?" Write it down, then read on.

Many people think of dentistry as fixing cavities, root canals, false teeth, caps, and gum disease. But you will be fascinated by what we can do to improve your appearance. Here is just a partial list of dental procedures that can improve the way your teeth look. Click on the yellow text to read more about each procedure.

- Replace discolored fillings in front teeth
- Whiten teeth to a lighter color
- Straighten crooked teeth with orthodontics or recontouring your natural enamel
- Close up spaces between teeth
- Porcelain or resin veneers to change the shape and alignment of teeth (bonding)
- Place tooth-colored fillings in back teeth (instead of silver/metal fillings)
- Porcelain or resin inlays or onlays for back teeth
- Cosmetic periodontal surgery to even out gum tissue that is crooked
- Restoration of worn and short teeth to their proper shape
- Fill in toothbrush abrasion notches
- Cover missing gum tissue due to recession with soft tissue grafts
- Replace missing teeth with bridges or implants
- Replace defective and unsightly crowns (caps)
- Cover stained root surfaces
- Remove stained fracture lines from enamel
- Restore chipped teeth (bonding)
- Make teeth appear longer
- Make teeth appear shorter

Costs for these cosmetic procedures vary according to the extent of treatment. Tell us how you wish your smile looked. Then we can tell you what we can do, how long it will take, and what it will cost. Most of the time, people are pleasantly surprised to find that the cost is not as much as they thought. If you have dental insurance, you may often find that some of the procedures are a part of your benefit package.

If you have any questions about improving your appearance by cosmetic dentistry, please feel free to call our office at 512-250-5012.

Wednesday, July 30, 2014

Sealants and Fluoride: Benefit to Adult Patients

Dental decay can develop at any time, regardless of a person's age. A change in diet, change in lifestyle, change in oral self-care habits, the use of prescription medications, or a change in systemic health due to the normal aging process can all affect the caries (decay) susceptibility. Few people remain completely free of decay. Proper oral self-care on your part and properly spaced dental hygiene prevention appointments will go a long way to reduce the opportunity to have new decay to begin.

As you age, it is possible that some of your gum tissue will recede, exposing the root surfaces of your teeth. This gum recession can occur from improper brushing (brushing too hard with a hard toothbrush) or as a result of past periodontal problems. The more a tooth and root are exposed, the greater is the surface area you will have to keep clean. Sometimes the teeth with exposed roots are very hard to keep clean. These roots may be sensitive to temperature changes and are often times uncomfortable to brush. Decreased salivary flow (dry mouth) helps to create a breeding ground for bacteria to accumulate on the enamel and especially on the root surface. And root decay usually progresses quite quickly!

Goal of Prevention
Your goal should be to keep the dentist from drilling your teeth. Any reasonable preventive measure that is available should be seriously considered. When the dentist drills, you lose. When the dentist does not drill, you win.
                                                         Dental Sealants
Please see our blog post on sealants. Although sealants are primarily designed for children, adults who have a history of active decay should consider having sealants placed on the posterior (back) teeth where indicated. We will tell you where it is possible to place the sealants. Even if you have not had a cavity for a long time, consider the application of a sealant as an inexpensive insurance policy for your teeth. Perhaps you would never get decay on the unsealed surfaces. But, just as you insure your home against destruction by fire, a sealant insures the tooth surface from decay. Preventive measures may allow you to avoid having your teeth drilled. You win! 

Topical Fluoride
For a similar reason, we advise the use of topical fluoride treatments for adults. The effectiveness of systemic and topical fluoride in preventing decay is well documented. When a cavity first starts, an application of fluoride might (depending on when it is used) reduce or eliminate the need for drilling.
Fluoride Varnish

An alternative to the fluoride treatment we can provide in our office is a daily rinse. If you can rinse with an over-the-counter mouth rinse containing fluoride every night as directed on the rinse label, you do not need the office topical fluoride treatment. If you cannot rinse daily as instructed, you will need the benefit from the strong office-applied topical fluoride treatment. Your oral health will benefit most from small increments of fluoride that are applied daily rather than one larger concentration every 6 months. However, only you know whether you will be faithful in your rinsing routine. When in doubt, let us do it here.

We stress prevention of dental disease above all else. Sealants and topical fluoride treatments are two of the more important preventive dental measures that we believe will significantly enhance your oral health.

Tuesday, July 29, 2014

Seal the Deal: Everything You Need To Know About Sealants

What are dental sealants?  

Dental sealants represent one of the greatest advances in modern dentistry. Unfortunately, too many children do not receive the protective benefits of dental sealants. Dental sealants are clear protective coatings that are easily applied; they cover the tooth surface, preventing bacteria and food particles from settling into the pits and fissures (grooves) of the teeth. It is a thin coat of plastic that is painted on the surface of teeth, usually the premolars and molars in order to prevent caries.

Decay on back teeth, premolars, and molars usually begins in the grooves and fissures that normally exist on the biting surfaces of the back teeth.  Dental sealants, available since the 1960s, are clear plastic coatings that can be placed on the biting and grinding surfaces of posterior teeth.  These sealants prevent the formation of decay on the treated surfaces.  Sealants can even be placed of teeth with small areas of decay known as incipient carious lesions.  The sealants will stop the customary progress of tooth destruction.  

It can remain on the tooth from 3 to more than 20 years, depending on the tooth, type of sealant used, and the eating habits of the patient.  It can only be placed on teeth that have not been previously restored.
It is well known that the use of fluoride increases the resistance of enamel to decay. Unfortunately, the pits and fissures of the teeth do not benefit from the effects of fluoride as greatly as smooth enamel surfaces do. Scientific studies have proved that properly placed dental sealants are 100% effective in protecting development of cavities in sealed tooth surfaces. 

Why sealants are necessary
The narrow width and uneven depth of pits and fissures make them ideal places for the accumulation of food and acid-producing bacteria. Saliva, which helps to remove food particles from other areas of the mouth, cannot clean deep pits and fissures. Pits and fissures on the teeth are so tiny that even a single toothbrush bristle is too large to enter for cleaning purposes. Another difficulty associated with deep pits and fissures is that the enamel that lies at the base of the fissures is thinner than the enamel around the rest of the tooth. This means that not only can deep narrow fissures make it more likely that tooth decay will occur, but any decay that does form will penetrate through the thin enamel and progress more quickly into the pulp.

We, at this office, are dedicated to the prevention of oral disease.  It is clear that if the initial decay is prevented from beginning or is small enough to use a sealant, there is a great savings in time, money, discomfort, and tooth structure.  Decayed teeth must have the decay removed by drilling, then they must be filled.  This drill and fill may have to be done several times over the patient's lifetime as the filling ages and needs replacement.  We strongly suggest that patients who have teeth that can be successfully protected with a sealant material consider having this procedure performed as soon as possible.

How sealants work
The sealant acts as a physical barrier that prevents decay. Small food particles and plaque (bacteria) cannot penetrate through or around a sealant. As long as the sealant remains intact, the tooth is protected. However, if part of the sealant or bond is broken, the sealant protection is lost. 

A study completed in 1991 found that one application of sealant reduced biting surface decay 52% over a 15-year period.  Another study, completed in 1990, showed that decay on biting surfaces could be reduced 95% over 10 years if 2% to 4% of the sealants were routinely repaired each year.  We expect sealants to last many years. After a sealant is applied it can last up to ten years, however regular check-ups are recommended since they can chip or wear off. Replacing or repairing sealants, as needed, on an ongoing basis will give the best protection. 

A sealant is not meant as a substitute for proper brushing and flossing habits. The effectiveness of the sealant is reduced if oral self-care is neglected. Also, cavities can still form on untreated surfaces. Therefore, a topical fluoride treatment remains an essential and necessary preventative aid.

Application of sealants
The sealant is placed on the tooth through a chemical/mechanical bonding procedure.  There is not drilling or local anesthesia required for the sealant application procedure.  It is entirely painless.

Problems with sealants
On occasion, teeth with very small initial carious lesions may be inadvertently sealed, or some bacteria may remain beneath the sealant. It was one believed that if this were to occur, decay would develop under the sealant. However, numerous studies have shown that this does not occur. Bacteria cannot survive beneath a properly placed sealant because the carbohydrates that they need to survive cannot reach them. Studies have shown that the number of bacteria in small, existing carious lesions that had been sealed actually decreased dramatically over time. The most important factor is that the sealant must be properly placed.

When sealants are used
Sealants are used primarily on children, but in certain circumstances, adults also can benefit from their use. Children and teenagers are the best candidates for sealants. Children are prone to caries from age 6-14 and applying a sealant as soon as a child’s permanent molars and premolars erupt can be a great way to protect your child from tooth decay. Some maxillary central and lateral incisors may have deep pits that could be protected by sealants. Sealants are indicated for teeth with deep pits and fissures, preferably in recently erupted teeth (i.e., within previous 4 years). Sealants should be used as part of a prevention program that includes the use of fluorides, dietary considerations, plaque control, and regular dental examinations.

We especially advise that children have the sealant applied to their teeth as soon as the teeth break through the gum and the biting surfaces of the teeth are no longer covered with gum tissue.  If the teeth cannot be totally isolated from the moisture in the mouth during the bonding process, it is likely that the sealant will not remain on the tooth for as long a period of time as expected.  The sealant is most often applied to permanent teeth, but sometimes a situation arises in which it would be beneficial to have the sealant applied to a primary tooth.

In both 1984 and 1994, sealants have been recommended by the U.S. Public Health Services and Surgeon General of the United States, among others. We know that sealants are one of the most important treatments available for prevention of dental decay.

If you have any questions about sealants, please feel free to ask us.

Monday, July 28, 2014

A World Record Case!

A team led by Dr. Vandana Thorawade at Sir J.J. Hospital in Mumbai, India spent 7 hours removing 232 teeth from 17-year-old's Ashik Gavai's molars. Doctors were stunned to find a world record of 232 teeth inside his mouth.

What was it?
A series of tests revealed there was an abnormal growth on the second molar on his lower right jaw. The 232 "teeth" varied in sizes - some were very tiny and some were the size of a large marble.  

It has been diagnosed as Complex Composite Odontoma, or a benign tumor of the tooth. The tumor fosters a slow-growth tumor inside the jaw capable of birthing additional teeth-like structures. This can cause some difficulties eating, swallowing, and can lead to a swelling on the patient's face. Dr. Sunanda Dhiware-Palwanker, the head of the hospital's dental department, stated that it most likely began its formation in Ashik's younger age, probably in his post-baby teeth years.

Are the structures really teeth?
Whether they should be called teeth or teeth-like structures are still to be determined.

The controversy
Some claim the condition is rare, while others claim that the structures were "wrongly" called teeth. A normal adult mouth cannot hold more than 34 teeth.

Dr. Sunanda Dhiware-Palwanker stated that Ashik will lead an absolutely normal and healthy life after the ejection of so many teeth. Following the procedure, he now has 28 teeth.

Here is another study published on the condition of Complex Composite Odontoma -

Friday, July 25, 2014


Why Would I Need It?
Most dental problems involving an infected tooth root are solved by a root canal. Although endodontic treatment has an extremely high rate of success, it is not 100% effective. Some teeth may not respond as expected to the root canal therapy. Sometimes, it is clear from the beginning that the root canal is not working as planned. Other times, it may be years later that the need for other treatment arises.

Typical reasons for an apicoectomy may include re-infection of the root canal site with signs like pain in the tooth, tenderness or swollen gums that occurs after a root canal.

The first and most desirable method of solving the problem is to re-treat the root canal at one or more roots. In other words, the root canal treatment is redone in a method similar to the original therapy. If it is possible to re-treat the root canal with this nonsurgical approach, this is best.

What Is It?
If not, a different form of treatment, an apicoectomy (root end surgery), must be considered. An apicoectomy is an oral surgery procedure that removes the tip of a tooth root to save the tooth from being pulled out. Keeping your teeth intact is the dentist's mission.

Teeth are held in place by tooth roots. The tips of each root, called the apex, serve as an entrance for nerves and blood vessels into the tooth. During an apicoectomy, the apex is removed, almost with the infected tissue, and then sealed with a tooth filling. 

What Can Be Corrected With An Apico
  • teeth that have narrow, curved roots
  • "blockages" of the canal
  • root resorption
  • persistent infection
  • fractures
  • a wide open apex
  • associated cysts
Reasons Not To Perform The Apico
  • surgical inaccessibility
  • poor or lack of bone support
  • short roots
  • vertical fracture of the root.
The Procedure 
1. The root or roots that are to receive the apicoectomy are measured with radiographs, and the approximate location of the root tip is estimated.
2. The area to be treated is anesthetized with a local anesthetic.
3. An incision of the gum is made over the root tip area and the gum is moved to the side. Access is made through the bone, and the tip or apex of the root can then usually be seen through this "window" in the bone. 4. The infection is visualized and cleaned out.
5. The tip of the root is usually removed, and a sealing filling is placed in the remaining tip opening.
6. The tissue is then sutured back into place.

Done with a surgical microscope, this procedure is also known as endodontic microsurgery and usually takes between 30 to 90 minutes, depending on the tooth's location and complexity of the root structure.

Who Performs The Procedure
Though general dentists can do an apicoectomy, most are performed by endodontists, or root canal experts.

What To Expect After The Procedure
The tooth does not lose significant stability from this procedure. There is no pain during the surgery. Postoperative discomfort will be eliminated with anti-inflammatory and analgesic medication. There is usually some slight swelling of the surgical site. The swelling is temporary and will disappear after a few days. When the "apico" is begun and the tooth can actually be seen, another type of problem may be noted. A fractured root may be the problem, and an apico would not work and the tooth would have to be removed. This procedure can be completed by a general dentist, but it is most often referred to an endodontist (root canal specialist) for evaluation and treatment.

Recovery Tips
  • Apply a cold compress to the area for 10 to 12 hours after the surgery
  • Avoid any strenuous activities and make sure to get enough rest
  • Take over-the-counter pain medication to manage any discomfort
  • Allow your tooth and the gums around it to rest while it heals. Avoid eating crunch or hard foods, as well as brushing the affected area and rinsing too vigorously 
If you have any questions about apicoectomy, please feel free to ask us.

Thursday, July 24, 2014

Sensitive Teeth

Teeth can become sensitive for many reasons. Sometimes, the sensitivity is an indication of a potentially serious problem. Other times, the dentally related problem may be small but the effects (the sensitivity) are extremely aggravating. 

What do we mean when we say "sensitive teeth?"
Twinges of pain or discomfort in our teeth in certain situations such as drinking or eating cold things, drinking or eating hot things, eating sweets, and touching the teeth with other teeth or the tongue. Your symptoms will involve reactions to temperature or pressure. Sensitivity to cold drinks or foods is the most common symptom. 

Two types of sensitivity:

1. Dentinal sensitivity
When the dentin (middle layer) of a tooth is exposed. Normally, dentin is covered by enamel. Dentin becomes exposed when the outer protective layers of enamel wear away. Dentin contains tiny openings called tubules. Inside each tubule lies a nerve branch that comes from the tooth's pulp (the nerve center of the tooth). When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches, causing sensitivity.

  • Inadvertent notching of the tooth surface and/or recession of the gum tissue (exposing the root surface of the tooth) caused by improper brushing: either brushing too hard, brushing with a toothbrush that is too hard, or using an improper brushing technique, which will wear away the enamel layer. This sensitivity can range from mild to extreme; the degree of sensitivity does not appear to be related to the size of the root exposure or notch.
  • Poor oral hygiene, allowing tartar to build up at the gum line
  • Untreated cavities
  • An old filling with a crack or leak
  • Receding gums that expose the tooth's roots, often caused by periodontal disease
  • Gum surgery that exposes the tooth's roots
  • Tooth whitening in people who have tooth roots that already are exposed
  • Frequently eating acidic foods or drinking acidic liquids 
  • Purposeful repositioning of the gum tissue during gum surgery can also lead to tooth sensitivity. While recession from brushing is slow, gum recession following gum repositioning occurs very quickly. The portion of the tooth once covered with gum and bone may now be exposed.  Root sensitivity in these instances can be quite severe and immediate. It can sometimes last four months or years if not treated.
2. Pulpal sensitivity
The reaction of the tooth's pulp. The pulp is a mass of blood vessels and nerves in the center of each tooth. Pulpal sensitivity affects only a single tooth.
  • Decay or infection. When a tooth is decayed, temperature changes and sweets will make it sensitive. The solution can be as simple as removing the decay and placing an appropriate restoration.
  • A recent filling. A tooth may be sensitive to cold for several weeks after you get a filling. The metals in amalgam (silver) conduct the cold very well, transmitting it to the pulp. Bonded (tooth-colored) fillings require etching the tooth with acid before the filling is placed. In some cases, this etching removes enough enamel to make the tooth sensitive. If a filling is defective or failing, leakage around the filling may cause the tooth to become sensitive. The solution can be as simple as removing the defective filling and placing an appropriate restoration.
  • Excessive pressure from clenching or grinding
  • A cracked or broken tooth. If the tooth is fractured, you may be sensitive to temperature changes or when chewing food. This fracture condition may be hard to diagnose. If you think you might have this type of sensitivity, read our blog post on "cracked tooth syndrome."
  • A tooth can become sensitive after it has been prepared (drilled) for a restoration (filling). You may have been anesthetized during the procedure, so you did not feel any discomfort when the nerve in the tooth reacted to the heat generated by the drill. The closer the drill comes to the nerve, the more likely it is to cause a sensitivity problem. The high-speed rotation of the bur in the drill generates heat, and the response of the nerve to heat is inflammation. This inflammation is felt by you as a "sensitivity."  If the decay, fracture, or drilling was not too deep, this sensitivity will decrease over time. A week to a month or two is not an unusual length of time for the sensitivity to disappear. A good sign is the continued decrease of sensitivity.  However, if the occlusion (bite) is off after the restoration has been placed, the tooth may either become sensitive or may stay sensitive. Once the bite is adjusted, though, the sensitivity should disappear.
  • A dying nerve. This can be the result of a deep cavity. Commonly, the sensitive tooth holds an old large filling. The nerve may be damaged during drilling and the nerve has been dying gradually ever since. If this is the problem, the tooth will need endodontic treatment (root canal treatment).
See this post about the 10 biggest causes of tooth sensitivity.

How will the doctor diagnose sensitivity?
Your dentist will look at your dental history and will examine your mouth. You also will need x-rays to show if there is decay or a problem with the nerve. The dentist will ask about your oral habits. Grinding or clenching your teeth can contribute to sensitivity. Your dentist also will look for decay, deep fillings, and exposed root surfaces. During the consultation, your dentist uses an instrument called a spray gun to dispense air across every area of each tooth in order to locate the sensitivity. He or she may use an explorer - a metal instrument with a sharp point - to test teeth for sensitivity.
How will it be treated?
  • Your dentist or dental hygienist will clean your teeth. If your teeth are too sensitive to be cleaned, your dentist may use a local anesthetic or nitrous oxide before the cleaning. 
  • If there is a notch in the tooth or the shape of the defect is appropriate, the defect is restored (filled in) with a bonded material. This can give immediate relief -- sometimes partially, sometimes fully. 
  • When there is no defect to be restored, the exposed and sensitive root surfaces are covered with a dentin-bonding or other material. This material is invisible and has very little thickness, so you do not notice any change in the appearance of the tooth; but it works. It may have to be reapplied after several months because the bonding material has worn away by tooth-brushing.
  • If you have pulpal sensitivity and the tooth's nerve is damaged or dying, you will need a root canal. Your dentist will remove the nerve and place a non-reactive substance in the space where the nerve was. The tooth will no longer have a continuous barrier of enamel to protect it. Therefore, it will be restored with either a composite filling or a crown.
  • Your dentist may apply a fluoride varnish to protect your teeth. This temporarily reduces sensitivity and strengthens your teeth.
  • Using fluoride toothpastes and fluoride mouth rinses are home will help to reduce sensitivity. You can also buy toothpastes just for sensitive teeth. You should choose a fluoride mouth rinse that uses neutral sodium fluoride.
How can I prevent it?
If you have any questions about tooth sensitivity, please feel free to call our office for a consultation at (512) 250 - 5012.

Wednesday, July 23, 2014

Dental Injection

The amount of discomfort caused by any one dental injection can vary significantly. And even though so many patients are focused on the fact that a needle is involved, most of the pain from a dental injection is not related to the needle itself. Instead, it has to do with the location and type of tissue in which the shot is given.

Why is it not the needle's fault?
The needle initially does prick as it first enters the skin, but this only lasts for a split second. Once the needle is in position, the dentist does not move it around, so what would cause a further pricking sensation?

What is causing the pain?
The bulk of the discomfort that a patient experiences during an injection has to do with the act of placing a quantity of liquid (the anesthetic) into soft tissues. Shots in different locations have varying potential to hurt. It is the act of dispensing the anesthetic liquid into tissue that is painful.

Shots that are less likely to hurt:
Loose tissue: In some locations, the tissue receiving the injection is comparatively "loose," thus making it easy for the injected anesthetic solution to find a space to occupy.
  • In locations where the tissue is relatively loose and flabby, the anesthetic solution will flow into the tissue easily and you probably will not feel the injection process much at all. Shots given on the cheek side of a person's upper molars, and probably even this bicuspids, involve this type of tissue and are often remarkably painless.
Shots that are more likely to hurt:
Dense tissue: In other areas, the construction of the tissue will be dense and tight. The anesthetic solution is injected, and it must forcibly make its own space - this is what pinches so much.
  • In situations where the soft tissue receiving the injection is relatively tight and dense, the anesthetic liquid must force its way in. This type of instance is where you are likely to feel discomfort. As an example, injections given directly into the type of tight gum tissue that surrounds a person's teeth and covers over their palate are likely to pinch.
Will my shots hurt?
Ask your dentists what to expect with any specific injection. You may be pleasantly surprised to learn what they have to say.

What can I do to ease the pain?
Give your dentist some cooperation with the injection process. The more you cooperate with your dentist, the more pleasant the experience will be.
  • The more you rush your dentist, the more likely it is to hurt: One factor associated with ease with which the anesthetic solution can enter into soft tissue has to do with the rate at which it is injected. The slower the rate, the less potential there is for discomfort.
  • Be a cooperative patient: If you are an uncooperative patient, your dentist's natural instinct will be to speed up the injection process so it is finished more quickly. That is the exact opposite of what you want.
  • Help your dentist be on-target, the first time: When a dentist performs a dental injection, they must place the anesthetic in the proper location. This takes a little concentration. If the dentist is focused on your behavior, as opposed to just performing the injection, it will increase the likelihood that the injection will be off-target and additional shots will be required. 
  • If you want it to hurt, it will: Some people place themselves in a position of creating a self-fulfilling prophecy. They expect the injection to hurt and therefore do not give the process a chance, thus making a guaranteed unpleasant experience. 
If you have apprehensions about injections, let your dentist know in advance. They can address your concerns and take steps to make the process as pleasant for you as possible.

Friday, July 18, 2014

Implants: Procedural Overview

Compared to a routine dental filling or crown (cap), replacement of a missing tooth or teeth with implants is a more complicated and lengthy process. It will take several phases. A periodontist or an oral surgeon will place the implant surgically. Then we will place the tooth or visible portion.

Phase One
The specialist evaluates the position, suitability, and strength of the bone that will surround the implant. This information determines the length and width of the implants and how many implants will be necessary to replace the missing teeth. Impressions of all your teeth will be taken for study models in order to design the shape of the tooth or teeth to be implanted. A surgical guide will be made to indicate to the surgeon where the implants should be placed.  

Phase Two
Surgical procedure is done to place the implant in the bone. A local anesthetic is given, and the gum tissue is lifted to expose the implant site. The implant is placed into the bone and the gum is closed over it. You will not see the implant while integration with the bone takes place. The integration takes 4 to 6 months. After this time, the site is opened again and a healing collar will be threaded into the implant. This will guide the tissue into a shape that is needed for the future crown(s). The time that the healing collar needs to be in place will vary from person to person, but will be at least several weeks.

Phase Three
Once the tissue shape is sufficient, specific attachments and components will be fitted to the implant. The implant components are similar in function to the wall or plaster anchors used to hang pictures on drywall. The healing collar is removed. Implants transfer copings, analogs, and other items are used to take an impression of the site. The healing collar is then put back on. The impressions and implant components are sent to the laboratory for fabrication of implant posts and temporary acrylic crowns.

When the temporary crown or bridge is returned from the laboratory, the healing collar is removed and the implant attachments are fasted to the implant. The temporary crowns are then seated and adjusted. They will be held in place by temporary cement or with screws, depending on your certain situation. We will explain the advantages and disadvantages of each in your particular case at the time you decide to have the implant

Temporary crowns are placed because the bone that supports and surrounds the implant must be given the opportunity to be put into function gradually. Implant techniques dictate that the implants be slowly brought into biting function. This means you will be returning several times to have more acrylic added to the temporary crown. After the implant and temporary crown have been in biting function for a few months, the final crown(s) will be fabricated and cemented or screwed into place.

Maintaining All Your Teeth
To keep your implants and your natural teeth healthy and functional for the longest time possible, clean the implant and your other teeth daily, as instructed. You will also need to come in for dental hygiene recare appointments at a 3- to 4-month interval. You have invested time and money in these state-of-the-art tooth replacements. Maintaining them as instructed will give you the best chance of success.

We feel that the benefits of replacing teeth with implant-supported crowns and bridges far outweigh the inconvenience of the long start to finish time. This is especially true when the teeth on either side of the implant are sound, unfilled teeth that would not otherwise require dental treatment. Implants help you preserve your nature tooth structure.

If you have any questions about dental implants, please feel free to ask us.

Thursday, July 17, 2014

A Beginner's Basics to Braces

How can orthodontics help you?
If your teeth are in poor alignment, you could be facing a functional or cosmetic problem. Orthodontics (braces) can eliminate that problem for you. One of the first things people notice about you is your smile and how your teeth look. You don't have to be a dentist to notice poorly positioned, crooked teeth. In today's culture, crooked teeth are not regarded as attractive or desirable. Most people, when asked, say that they would like to have straight teeth. Straight, white teeth are the cosmetic dental improvements patients most request.

Braces may also be suggested to correct a specific dental problem that only affects one or several teeth. This is not a cosmetic tooth repositioning, but rather a functional tooth movement. Occasionally, in order to properly finish an orthodontic case, the orthodontist may ask the dentist to adjust the enamel of some teeth or bond a resin to some teeth to improve the occlusion (bite alignment) or to enhance cosmetics. This will be discussed with you as soon as it becomes apparent.

When should you see an orthodontist?
The need for orthodontics is best discovered when you are young. A dentist will have a good indication of whether or not your teeth will be straight when he sees you as a child 6 to 8 years of age. Most treatment would not begin until a patient is 8 years old, although in some cases, orthodontics can be started earlier.

It is easier to direct the movement of teeth in a child. Early tooth guidance is a very important phase of orthodontic care, which can take place even though all the permanent teeth are not yet in place. Certain problems are much easier to correct at this stage of a "mixed dentition" of baby and permanent teeth. An average case can last from 18 to 24 months.

While orthodontic therapy is admittedly easier in the child patient, you are never too old to begin orthodontics. The number of adults seeking orthodontic treatment has risen dramatically during the past decade. As long as you have healthy bone support for your teeth, you can have orthodontic therapy. Most adult cases take 18 to 24 months to complete.
What are retainers?
Once braces are removed, it is usually necessary to wear a retainer. After your braces come off, your orthodontist will make a mold of your mouth and produce a set of retainers. This retainer will maintain the new tooth alignment until the teeth have had a chance to become firmly set in their new positions. This retainer may be either removable or fixed in place. Aside from a permanent bonded retainer, there are two other types that most people get.

A Hawley Retainer is made of acrylic and metal. The acrylic goes behind your teeth and up against your upper palate; the metal is in front of your teeth. This is the most reliable refinements that still need to be done to your teeth.

Orthodontic Toothbrush
An Essix Retainer is clear plastic and looks like an Invisalign aligner tray. Many people want this type of retainer, but it has its disadvantages. Many orthodontists feel that because it covers the biting surface of your teeth, they do not "settle" properly after treatment. For this reason, sometimes orthodontists give a patient both types of retainers: an Essix Retainer to wear during the day when they are people-facing, and a Hawley Retainer to wear at night when they are home sleeping.

No matter what type of retainer you get, the most important thing is to wear it exactly as the orthodontist tells you. Most people need to wear their retainers 24/7 for at least 6 months, then switch to wearing it only at night when sleeping. 

How do I keep clean teeth with braces on?
While orthodontic treatment is in the active phase, that is, while the braces are on your teeth, you must be very diligent about keeping your teeth clean. This will be more difficult than and somewhat different from cleaning your teeth without braces. You will be instructed in the use of any cleaning aids needed. These may include dental floss threaders, orthodontic toothbrushes, an oral irrigator to flush out debris, proper brushing habits, fluoride mouth-rinses, and periodontal aids. You must follow your proper oral self-care routine each night to prevent decay, decalcification of the teeth, and gum disease. You also should not use a whitening toothpaste when you have braces. It could cause you to have "two tone" teeth after the brackets are removed. Another thing to remember is that although a device like a Waterpik is great for gum stimulation and dislodging food, it is not a substitute for flossing. You still need to floss daily.

Wednesday, July 16, 2014

How Do Dentists Fix A Chipped Tooth

Composite bondingIf you have chipped your tooth, do not worry - you can get your chipped tooth fixed to look brand new by cosmetic dental procedures. A dentist who is trained in cosmetic and restorative procedures will make it look life-like and aesthetic, that you yourself couldn't tell a difference.

A chipped tooth generally means that a small flake of your tooth surface is chipped off. Usually, it is the front tooth (these are used more to open bottles and bite on hard things). You can get a chipped tooth corrected easily and pain-free by a sitting in a single procedure called composite bonding. There are a few other procedures to correct a chipped tooth, but composite bonding is the most efficient, easy, aesthetic, and cost effective.

What is composite bonding?
Composite bonding is dental restorative procedure to restore the aesthetic and function of a tooth which may have broken due to any trauma or decay.

What is composite?
Composite is a mixture of different materials that are combined together to enhance and complement each other's properties. Composite is primarily made up of synthetic resins, filler particles, shade producing agents, chemical initiators and inhibitors, and much more.
Composite comes in a kit, and there are 3 main components of the composite kit.
1. Adhesive
2. Etchant
3. Composite Syringes

Composite is packed in a syringe-like tube and comes out in a semi-solid form. This semi-solid paste-like substance is used to build up the chipped portion of the tooth.

Method of Composite Bonding to Fixed a Chipped Tooth
1. Tooth is cleaned with prophylaxis paste
2. Chipped area and sharp margin is slightly smoothened
3. Chipped area is treated with an etchant (blue-colored gel)
4. Tooth surface is blotted and a layer of adhesive is applied (bonds the composite with tooth). A blue-colored light will be shown over the tooth surface from a curing light equipment (it cures the adhesive layer) 
5. Composite is applied layer by layer and cured by the blue-colored light
6. Proper tooth anatomy is restored in the chipped area by incremental buildup of the composite
7. Composite is polished
8. A mirror will be given to you to see the work

Time and Cost
The procedure takes about 45 minutes, depending on difficulty level. The cost may be anywhere between $150 to $500. The cost may go on the higher side depending upon the status and skill of the dentist.

If your tooth has a large amount of tooth structure loss, then your dentist may suggest veneers or crowns for proper strength and buildup.

Fixed and Removable Orthodontics

The traditional and stereotypical movie, television, and commercial vision of orthodontic treatment is one of yards of metal wire tied down to teeth so covered with silver bands and brackets that the whites of the teeth are barely visible. With today's advanced dental technology, this picture is far from accurate.

Tooth Alignment:
Changes in tooth alignment can be accomplished in several different ways. When appropriate, upper and lower arch expanders can be used to increase the curvature of the tooth-bearing supporting structures. These expanders are usually cemented into place and are not able to be removed by the patient. The expanders are often a prelude to fixed metal bands. They can be cemented to the teeth as well as longitudinal arch wires and springs and still be used to move teeth.

The look:
Some time ago, the desire of patients to show less metal resulted in the development of bonded tooth-colored and clear brackets (as opposed to the metal bands that completely surround a tooth). These brackets cover only about 25% of the tooth surface and are bonded into place. The trade-off with the more esthetic bonded brackets is a higher percentage of dislodgement of the bracket, requiring additional office visits for repair and replacement. The wires and springs are changed periodically to accomplish the various stages of movement. The metal components stay in place until the tooth movement is finished. Some dental conditions mandate the use of this traditional orthodontic process.

Tooth-colored Braces
It is not always necessary to use fixed devices to move teeth. Less aggressive tooth movement can additionally be done with patient-removable appliances. Some are made of a gum-colored pink acrylic material with metal wires and springs embedded in them. These are worn by the patient except when he or she is eating, brushing, and flossing. The metal and plastic appliances do not show as much metal so they are somewhat more acceptable. The trade-off with removable appliances is that they only work when they are in the patient's mouth, making proper patient compliance a big issue. If you do not wear them, the teeth will not move as planned. The metal and plastic appliances are used in what is called minor tooth movement. Many orthodontic cases are not appropriate for removable appliance therapy.

Several years ago, a new type of removable appliance therapy was developed and patented. Align Technology has a product called Invisalign. Clear, thin plastic aligners (positioners) are sequentially placed to move the teeth in a precise fashion. The aligners are left in the mouth as much as possible and removed only for eating, drinking, and cleaning the teeth. Again, if you do not wear them, the teeth will not move. The aligners are almost invisible when in place and are extraordinarily acceptable esthetically. They are indicated for adults and patients older than 14 years who have all permanent teeth in including fully erupted second molars. They can be used to treat simple to fairly extensive misalignment problems. Most cases are completed in about 12 months. Research is still in progress to determine the limits of this process.

The doctor who will be performing the orthodontic treatment will take these different modalities into consideration and develop a treatment plan best suited to your needs. Age of the patient, number of teeth involved, and extent of movement are primary factors in the decision-making process. Please be sure to ask why or why not one technique rather than another was suggested.

If you have any questions about your orthodontic treatment, please feel free to ask us.

Tuesday, July 15, 2014

Prevention of Decay

What is dental decay, and how do dentists fix it?
Dental caries (decay) is a bacterial infection, first of the enamel, then of the dentin of the tooth. The tradition in dentistry has been to surgically remove the diseased portion of the tooth by "drilling" out the decay and then filling the resulting hole in the tooth with some inert material. As most adults know, this procedure will be performed over and over again when new decay begins or when the filling (often silver) breaks or the tooth fractures.

Click here to learn about decay in young children.

Why should I practice prevention?
Would it not be better to eliminate the cause of the infection and thus not be forced to have big holes drilled in the teeth? We believe the bacterial cause of the infection should be addressed.

How do I prevent dental decay?
There are several positive steps that you can take to reduce your risk of dental decay. 

A. At the dentist's office
1. First, all the active decay in your mouth should be treated immediately. 

2. Next, all teeth that would benefit from sealants should be treated. 
  • Why? This will prevent bacteria from reaching into the pits, fissures, and grooves that normally exist on the occlusal (biting) surfaces of teeth. Any stray bacteria that may still be in the sealed area are effectively cut off from their source of food and become inactive. Although sealants are most effective on teeth that have not been previously restored, they can be successfully placed on teeth filled with bonded fillings.
3. The infection can be treated with antimicrobials. 

4. We believe that the use of a fluoridated mouthrinse twice daily or use of a prescription fluoridated dentifrice as directed provides a great advantage. 
5. We may also prescribe a chlorhexidine mouthrinse, an antimicrobial oral rinse that has a great effect on Streptococcus mutans.

B. In your daily life
6. Your diet and oral self-care are important in dental decay prevention. When you eat junk food and drink sugary liquids, your teeth are more prone to decay. The more frequently you snack, the more prone your teeth will be to decay. 

7. If your brushing and flossing are not effective, your teeth will be more prone to decay. When you can't brush after a meal, at least rinse your mouth with water within 15 minutes to dilute the acids forming from the ingested food or drink. 

8. If you have a diminished salivary flow, take frequent sips of water during the day to help dilute the acids produced by the bacteria.

What if decay keeps coming back?
If you have a continuing problem with active decay, we recommend more frequent preventive recare appointments. It has been repeatedly shown that patients who have good oral self-care and maintain a recare interval of 3 to 4 months have many fewer dentally related (cavities or gum disease) problems.

Present-day dental suggestions are based on proven scientific information. You might need to have your teeth cleaned by the hygienist twice each year, or you may need to be seen more frequently. 

For certain individuals, we also suggest testing the oral bacterial levels to determine the magnitude and presence of a Streptococcus mutans infection and to determine your risk level for future dental disease.

If you have any questions about the prevention of dental decay, please feel free to ask us.

Monday, July 14, 2014


Reasons for Recommending Tooth Extraction
Teeth may need to be extracted for several reasons, including but not limited to:
  • severe periodontal disease
  • irreversible damage to the nerve tissue inside the tooth (and the patient decides against saving the tooth)
  • failed endodontic therapy
  • extreme fracture or decay of the tooth structure
  • improper positioning of the tooth or for orthodontic purposes
To a great extent, the reason for the extraction will influence the amount of discomfort you might experience subsequent to the procedure. When the tooth is to be extracted for periodontal reasons, there will be reduced bone support for the tooth and the tooth might be removed more easily than if there were full bone support. In this case, there might be lessened discomfort following the extraction.

The Procedure
1. Numb the tooth: Your dentist will need to anesthetize (numb up) both your tooth and the bone and gum tissue that surround it. This is done as an injection.

2. Extraction: The root portion of a tooth is firmly encased in bone (its socket), and tightly held in place by a ligament. During the extraction process, the dentist needs to both "expand the socket" (widen and enlarge it) and separate the tooth from its ligament, to the point where the tooth is loose and free to come out.
  • What does it mean to "expand" a tooth's socket? If you have ever tried to remove a tent stake that has been driven deeply into the ground, you know that you can't just pull the stake straight up. Instead, you first have to rock the stake back and forth, widening the hole in which it is lodged. Once the hole has been enlarged enough, the stake will come out easily.
  • How does the dentist expand the jaw bone? The bone inside the jaw is spongy. When a dentist applies firm pressure to a tooth (forcing it against the side of its socket), the bone will compress. After repeated application of pressure, from many different angles, the entire socket gradually becomes expanded. At some point, enough space will have been created (and the ligament separated from the tooth enough) that the tooth will come out.
3. Closing the extraction site: Once your tooth has been removed, your dentist will begin the process of closing your extraction site. This may include:
  • Removing infected or pathologic tissue by curetting (scraping) the walls of the tooth socket
  • Using finger pressure to re-compress the "expanded" socket
  • Rounding off sharp bone edges
  • Evaluating the tooth socket for sinus complications (upper back teeth)
  • Washing out ("irrigating") the socket, so to remove any loose bone or tooth fragments that remain
  • Placing stitches (usually only after surgical extractions).
  • Placing folded gauze over your extraction site and then having you bite down on it so to create firm pressure
The Tools
1. Dental Elevators: During the extraction process, a dentist will usually use an elevator first. These instruments are designed to be wedged in the ligament space between the tooth and its surrounding bone. As the elevator is forced and twisted, the tooth is pressed and rocked against the bone. This helps to expand the socket. It also helps to separate the tooth from its ligament. As this work is continued, the tooth will become more and more mobile. In some cases, the elevator may be able to shove the tooth on out. If not, the dentist will switch to the use of extraction forceps and remove the tooth with them.

2. Extraction Forceps: A dentist will usually keep a number of different extraction forceps on hand. Each one will have a design that's been specially made to grasp a certain type of tooth. When they're used, the dentist will grasp the tooth with the forceps and them firmly and deliberately rock it back and forth as much as it will. Because the bone that surrounds the tooth is compressible, the socket will expand. In addition to a rocking motion, a dentist will also rotate the tooth back and forth. This twisting action helps to rip and tear the tooth from the ligament that binds it in place. At some point, the socket will be enlarged enough, and the ligament torn enough, that the tooth can be easily removed.

What will I feel?
1. Pressure
2. You should not feel any pain 
3. Expect to hear startling extraction noises: These are often just routine

Following the Extraction
We will tell you the reason for the extraction and let you know what to expect following the procedure. Please follow the instructions given to you. If antibiotics are prescribed, take them until the prescription is completely finished. If pain medication is prescribed, take it only if necessary. If the medication prescribed contains a narcotic component, such as codeine, do not drive a motor vehicle or operate machinery that could prove dangerous to yourself or others. Expect some bleeding to occur from the extraction site for the first 24 hours. Remember, there is now a hole in your jaw from which the tooth has been removed, and the hole can be quite large. Some bleeding is to be expected.
  • Do not spit, rinse, or smoke for 24 hours
  • Do not drink through a straw for 24 hours
  • It would be a good idea not to brush near the extraction site for a day or two
  • When you brush and floss the area, be gentle!
  • For 24 hours after the extraction, try to chew food away from the extraction site
  • Some slight swelling in the area is to be expected, especially if the extraction was difficult
  • If sutures are placed, return to have them removed
  • If medication has been prescribed for possible post extraction discomfort, take it as directed
  • If prescription medication has NOT been given, you may take your usual over-the-counter pain reliever, as directed
 Please notify us if:
  • There is extended bleeding from the extraction site. Slight bleeding for several hours is normal.
  • Anything other than slight swelling occurs.
  • Discomfort continues for more than 24 hours, especially if it is not relieved by over-the-counter pain relievers.
Some infrequent complications of routine oral surgical procedures include (but are not limited to):
  • fracture of adjacent teeth or restorations (which of course would mean that these affected areas must be restored to normal function after the healing of the extraction site)
  • separated root tips or root fragments
  • temporary or permanent nerve damage to the area, resulting in anesthesia or paresthesia (numbness)
  • incomplete healing, resulting in severe pain - a "dry socket"
  • fracture of the surrounding bone
If you have any questions about reasons for dental extraction, please feel free to ask us.