Implants: Options

Twenty-five years ago, if someone described how missing teeth could be replaced with implants, it might have been called a miracle. Ten years ago, the use of dental implants to replace missing teeth might have been called astounding. Today, implant procedures are called routine. We would like you to have a basic understanding of what implants are, what can be expected from them, and what limitations they might have in your specific area of need.

A dental implant is a synthetic metallic root substitute that is placed or implanted in the jaw bone. It can be used to replace a single missing tooth, provide an abutment (anchor or retainer), replace several missing teeth, or provide added retention to a removable dental appliance such as a full denture. In fact, if you are missing all of your natural teeth, it is possible to have maxillary (upper) and mandibular (lower) fixed replacements. The replacements do not come out and you cannot remove them yourself.

Two separate events are needed when replacing a missing tooth with an implant. First, is the surgical phase in which the implant is placed. In the second phase the replacement teeth are constructed and fixed into proper position.

The implant placement procedure involves making a small incision in the gum area where the implant is to be placed, preparing a site in the underlying bone, inserting the implant into the prepared site, and closing the tissue over the implant with several sutures. This area is left undisturbed, usually for 4 to 6 months. More healing time may vary due to the density of your bone. The lower jaw is composed of bone that is more dense than that of the upper jaw. This healing time allows for the slow integration of the implant within your jaw. The implant is held in place by the bone.

After the healing and integration of the implant, the placement site is exposed by reopening the gum. A post will then be fastened to the implant by cement or with internal threads. The crown, bridge, or other type of replacement will be attached to this post. Some dentists prefer to do all phases of the implant procedure themselves, but many choose to perform either the surgical or prosthetic (the actual construction of the replacement device) only. If this is the case, you will be referred to a periodontist or oral surgeon who will perform the surgical portion of the implant placement.

Implants are very successful. Maxillary and mandibular implants are more than 90% successful. Lower implants have a somewhat higher success rate than upper implants. Occasionally, implants fail, but it is not common. Chances of an implant failure, many times, can be determined during or after the surgical phase before the replacement tooth or teeth are constructed.

*Smokers take note:  There is a heightened risk of dental implant failure among smokers - as much as 20% greater failure rate!

We will discuss with you the requirements and options for your particular situation. There are usually several possibilities for effectively replacing missing teeth. It is important to decide on the design of the implant-retained replacement prior to the actual implant surgical procedure. Position and alignment of the replacement teeth need to be carefully considered before determining the location of the implant.

If you have any questions about implants, please feel free to call Omni Dental Group.

North location on Hymeadow Drive: (512) 250-5012
Central location on Jollyville Road: (512) 346-8424
South location on William Cannon Drive: (512) 445-5811

Scaling and Root Planing: Reevaluation

The goal of scaling and root planing is to remove all plaque, toxins, and calculus both above and below the gumline. After healing has occurred, the tissues will shrink, and a reevaluation of the condition of the gum and supporting structures will reveal any areas that may need re-treatment. Your oral self-care habits will be reevaluated at the same time and any revisions to our recommendations will be made. We will be polishing your teeth at this appointment. As you will recall, we did not polish your teeth during the root planing and scaling appointments. Although the polishing can, in theory, be done then, we believe that allowing tissues proper time to heal will allow us to make the best reevaluation of our treatment and oral self-care recommendations. That is why there is a time period of several weeks between the root planing and scaling appointment and this prophylaxis and evaluation. Once all tissues have responded and the goals of scaling and root planing are met, a recare interval will be established for you.

At the recare appointment, we will once again be evaluating your oral self-care to determine whether we need to recommend different procedures to keep your oral health at its best. We will reexamine your periodontal tissues for evidence of healing by remeasuring the probing depths around each tooth. Any areas of bleeding will be noted and treated; your teeth will then be polished and a topical fluoride treatment will be applied.

Topical fluoride provides a bacteriostatic action to the oral bacteria during treatment and for several hours afterward. It appears to be harder for the bacteria that cause gum disease to multiply and cause problems when topical fluoride is used.

If the goals of scaling and root planing have not been met, we will either re-treat those areas that have reinfected or refer you to a periodontist for specific periodontal surgery. The periodontal surgery will correct some of the hard (bone) and soft tissue defects that were caused by the periodontal infection.

At this time we may also consider using one or more of the newer nonsurgical therapies available for localized sites that have not healed as much as we would like. The site-specific therapy may be recommended for the first time or as a re-treatment. We will then monitor the results to determine whether a referral to a periodontist is appropriate.

A final word about how often you should have your teeth cleaned:  modern dentistry considers a patient who has had gum disease to be always recovering, never completely "cured." If you do not take care of your teeth and gums, the problem can come back again. It is in the best interest of your oral health to have your teeth examined and cleaned at an interval of 3 to 4 months in most cases, not every 6 months as you have heard for years.

If you have any questions about the prophylaxis and reevaluation appointment, please call Omni Dental Group at (512) 250-5012.

How Can I Keep My Mouth Healthy?: Oral Health for Children

Children's teeth begin forming before birth. As early as 4 months, the first primary, or baby teeth, erupt through the gums. All 20 of the primary teeth usually appear by age 3, although their pace and order of eruption varies.

Permanent teeth begin appearing around age 6. This process will continue until approximately age 21.

Oral Health for Children

To help ensure oral health and a lifetime of good oral care habits:

• Limit children's sugar intake
• Make sure children get enough fluoride, either through drinking water or as a treatment at the dentist's office
• Teach children how to brush and floss correctly
• Supervise brushing sessions and help with flossing, which can be a challenge for small hands

Major Obstacles to Children's Oral Health

Babies

"Baby bottle tooth decay"

• Wipe gums with gauze or a clean washcloth and water after feeding. When teeth appear, brush daily with a pea-sized amount of fluoride toothpaste.
• Put child to bed with a bottle of water, not milk or juice

Thumb sucking

• Not a concern until about 4 years of age or when permanent teeth appear; after this time, it could cause dental changes

White spots on teeth

• As soon as the first tooth appears (at about 6 months), begin cleaning child's teeth daily and schedule a dental appointment

Toddlers

Fear of the dentist

• Hold the child in the parent's lap during the exam

Difficulty creating an oral care routine

• Involve the whole family - brush together at the same time each day to create a good habit

Gradeschoolers

Love of sweets

• Give children healthy snack options, like carrots, raisins, and yogurt

Stains from antibiotics

• Speak to the pediatrician before any medication is prescribed

Teenagers

Braces

• Make sure that teens brush well around braces, using a floss threader to remove all food particles

Oral accidents from sports

• Encourage children to wear mouthguards during sports

The following are key preventative measures to preserve oral health through childhood:

Fluoride treatments to strengthen tooth enamel and resist decay.

Dental sealants to provide a further layer of protection against cavities. Sealants are made of plastic and are painted on the teeth  by a dentist.

A fun oral care regimen to help encourage children to brush more regularly. 

If you have any questions about your child's oral health, please call Omni Dental Group. We have three locations to serve you and your family.

North Austin on Hymeadow Drive:  (512) 250-5012

Central Austin on Jollyville Road:  (512) 346-8424

South Austin on William Cannon:  (512) 445-5811

Source:  Crest

Periodontal Disease and Systematic Health

Research clearly shows that there is a strong correlation between oral (periodontal) infections and generalized (systematic) medical problems. There are over 300 different types of bacteria normally found in the human mouth, and the mouth is connected to the entire body.

A gum infection is similar to an infection that might occur elsewhere in your body. Bacteria are everywhere, including in our mouths. When the bacteria multiply past a critical number, problems begin. Why would the bacterial count change? Poor oral self-care, genetics, prescription medication, illness or systematic problems, and diminished salivary flow might contribute. When the body recognizes bacterial invaders, the immune system initiates a response to fight off the invader.

                                              

You might say, "My gums have always bled like this," and not seek treatment. Imagine seeing blood gushing from your eyes when you washed your face. You would seek immediate medical attention, perhaps even go to an emergency room!

Gum disease is an infection in your mouth, no different than an infection elsewhere in your body. The bacteria invade the soft tissues and the bone and get into the blood stream.  In this way, they are then able to circulate throughout the entire body. Along with bacteria are dead cells, metabolic by-products, toxins, food debris, and viruses.

Just as we know that smoking has adverse affect on our health, science is examining a link between gum disease and many systematic conditions such as cardiovascular and respiratory disease, chronic obstructive pulmonary disease, premature birth and low birth weight, stroke, diabetes mellitus, and possibly rheumatoid arthritis. Although the scientific data have yet to confirm the links as diagnostic indicators, it is important for us to recognize the possible implications. The oral cavity is part of the human biology linked to all other body systems and is a portal of entry for a host of infective organisms. It only makes sense to keep it as clean as possible to reduce the risk of not only oral infection but possibly systematic inflammation as well.

Thorough oral self-care need not be difficult or time-consuming. The benefits are more than just sweet breath and a great looking smile. Spending just a few minutes a day caring for your teeth and gums and coming in for the professional hygiene visits at the intervals we advise can make the difference between whole body health and disease. After all, the jaw bones are connected to all our other bones!

If you have any questions about periodontal disease, please call Omni Dental Group at (512) 250-5012.

Extraction

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 orthodontics 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.

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.

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 question about reasons for dental extraction, please feel free to call us @ 512-250-5012.

Smoking and Adult Periodontitis

If you are a smoker, you are at a higher risk for not only lung and circulatory problems but oral disease as well. Smoking causes cell death and may be responsible for more than 50% of cases of adult periodontics. It has been reported that more than 85% or all periodontal cases are present in people who spoke. And, more than 90% of gum infections that appear to be resistant to treatment (refractory gum disease) are found among smokers. Smokers are 2.6 to 6 times more likely to have periodontal disease. Former smokers are more likely to have periodontal disease. A person who smokes will not heal as well and does not respond as well to periodontal therapy as does a nonsmoker.

Thousands of chemicals are released during smoking, which causes a profound effect on the immune system that is responsible for helping us ward off infections. And since we now know that periodontal disease is an infection, it is easy to make the connection. Many smokers show few areas of bleeding during a periodontal charting because one of the effects of smoking is reduced circulation.

If you are reading this, you are most likely a smoker who has periodontal disease. Many smokers would like to stop this habit. Quitting is not as difficult as you may imagine. The thought of it is probably the most difficult aspect. There really are many aids today to help is to make that leap to a healthy decision about our dental and general well-being. Our office can be a great source for some suggestions to help you stop smoking. If you would like us to make suggestions for a healthier lifestyle, do not hesitate to ask!

If you have any questions, please give us a call @ 512-250-5012. 

Toothbrush Abrasion: Preventing Tooth Destruction

The Cause

Brushing improperly (especially with a hard-bristled toothbrush) can cause erosion/abrasion of your tooth or teeth. This is a very common problem. It begins as a small V- or U-shaped area of wear near the gingival (gum) tissue right next to the tooth, usually where the tooth and gum meet. Improper brushing causes the gum tissue to recede; and the tooth may become sensitive to heat, cold, or air stimulation. With time, more enamel wears away and a small horizontal notch is seen on the tooth at the gumline. This is not an area of decay, but a mechanical “cavity” cut in the tooth. Eventually the enamel is worn completely through and the dentin becomes exposed. When that occurs, some people experience severe tooth sensitivity. It may be so severe that it is painful to drink cold fluids, breathe in air, or just brush your teeth. However, others experience little to no extra tooth sensitivity.

Once enough of the gum is brushed away, the root of the tooth becomes exposed. The root surface is not covered with enamel and is much softer than the enamel. It can also be unsightly to have the tissue recede. Since the root surface is not protected by hard enamel, if the improper brushing continues, the root cementum will be worn through and notch will be made in the dentin. This notch will increase in size, weaken the tooth, and sometimes make the area more prone to decay.

Tooth Sensitivity  

Some patients with little loss of tooth structure experience extreme sensitivity. This problem can usually be corrected with the application of a dentin-bonding material or other desensitizing chemicals. The sensitivity problem is often completely cured. The treatment can last (depending on your brushing habits) for 6 months or longer. If necessary, the tooth can be re-treated if the sensitivity returns.

Some patients with a tremendous loss of tooth structure notice little tooth sensitivity. Whether or not the teeth become sensitive, it is advisable to correct the brushing problem to slow down or eliminate the wear process. It is also recommended that the notches be restored with a tooth-colored filling material. This will restore the appearance of the tooth and protect the previously exposed dentin. In this way, even if you continue to brush improperly, the tooth will be protected.

In cases of minor sensitivity, we might recommend the use of desensitizing toothpaste as a low-cost alternative to the placement of bonded materials. Some cases might also be managed through the use of topical fluoride applicants.

Preventing Abrasion

The problems of improper toothbrushing are easily and inexpensively corrected when they are diagnosed in the early stages of development. If allowed to progress, the tooth damage will increase, as the cost to repair it. The best solution is prevention!

Brush your teeth thoroughly but not abusively. Do not scrub them or cross brush them (an exaggerated horizontal brushing motion). We will select a method of toothbrushing that will best meet your needs and teach you to care for your mouth. Use a soft toothbrush. Change to a new tooth brush every 3 months. But if it happens that you are creating the problem of toothbrush abrasion, get it corrected as soon as it is diagnosed. 

Gingivitis

Almost everyone knows what a cavity is. Because of the far-reaching effects of advertising by toothpaste and oral rinse manufacturers, by 2004 almost everyone had heard of gingivitis. What may not be quite clear to you, however, is exactly what gingivitis. You may recognize it as a problem but not know how serious it might be. You may even know that this is a type of gum (periodontal) disease. You may also know that it is somewhere related to plaque and tartar (calculus) on teeth. But why should you be concerned about having it?

Gingivitis is an infection of the gum tissues surrounding the teeth. It is a very common infection and affects almost 95% of the world’s population. This infection can be characterized by redness, swelling, and bleeding of the gums around the teeth. This gum infection absolutely needs to be treated as soon as possible. Gum infections are almost always preventable with sound daily oral self-care.

Gingivitis is the mildest form of periodontal disease and is reversible. By definition, there is no loss of bone that supports the tooth. If treated early, gingivitis can be eliminated. If left untreated, it can progress into the more serious form of periodontal disease called periodontitis. In its more serious form, the bone and gum tissues can be permanently affected. Bleeding gums, one of the signs of gingivitis, are a sign of infection in the mouth. Your gum tissues should never bleed. It is not normal for blood to appear on your toothbrush when you have finished brushing. Gingivitis does not generally hurt, so you may not even know that you have it. It can be localized (around a few teeth) or generalized (around most of your teeth. Gingivitis is seen most often in patients who do not brush and floss well daily, but it can also be related to medications. Bad breath can be another sign of gingivitis. If you are using mouthwash to get rid of bad breath, you may need dental attention. While bad breath can be related to some medical problems, most often it is just debris that is not cleaned properly from your teeth, gums, and tongue that is decomposing in the dark, warm, and moist environment of your mouth—a perfect place to breed gums.

If you have bleeding gums, you should be concerned. Healthy tissue anywhere in our bodies does not bleed. So what can you do to stop the bleeding?

We can help you eliminate the gingivitis. It involves a good professional cleaning and good oral self-care habits. Plaque (soft debris made up of bacteria) and tartar (calculus or hardened debris) must be removed before the gum tissues can heal and the infection can be eliminated. If it has some time since you had your teeth cleaned properly, it may take more than one appointment to get you back into shape.

Get your teeth and gums cleaned on a regular basis. Keep then clean with daily brushing and flossing. The infection you have will be eliminated. If you keep your teeth and gums cleaned, they can be healthy and trouble-free for your whole life.

Enamel Recontouring

Most people want straight, beautifully aligned, white teeth. Unfortunately, most people are not naturally born that way. When teeth are in poor alignment, rotated, tilted, and/or crowned, one obvious way to correct the problem is by orthodontics (braces). However, there are situations where it may not be possible or desirable to use braces to straighten teeth. You might feel that you are too old (although this is rarely the case), the cost of the orthodontics may preclude their use, you may not want to wear braces, or perhaps there are only a few areas that need attention and full orthodontics are not indicated.

In certain select cases, the appearance of your top and bottom teeth can be slightly or dramatically improved by recontouring the enamel. The upper and lower incisors and canines can be routinely altered. Sometimes teeth further back in your mouth can also be cosmetically improved. Recontouring is useful when there is slight to moderate overlapping if the front teeth, uneven wear, or teeth that do not have their biting and incising edges in harmony, in effect, an uneven “picket fence” look. Enamel recontouring is a painless procedure and no local anesthetic is needed. The enamel that is overlapping or poorly shaped is removed, recontoured, and polished. Depending on your individual needs, one or several teeth may require some reshaping. Different amount of enamel may be removed from different teeth. The teeth do not become prone to decay, are not made more sensitive to temperature changes, and are not made significantly weaker or damaged by the procedure.

Many times, recontouring is all that is necessary to significantly improve your appearance. Other times, when the poor alignment is more pronounced, it may be done in conjunction with a bonding procedure. The extent of your treatment will depend on your present conditions and on what you would like to see changed.

The procedure is not difficult for the patient and can often be done in only one appointment. The resulting change is immediate and permanent. Is does not take and artistic approach on the part of the dentist to determine what possibilities for change exist. We need to determine what enamel needs to be removed, where we must add material, and where the orthodontics is the treatment of choice.

If you have any questions about enamel contouring, please give us a call at 512-250-5012.

Metal Sensitivity

It has become clear that many people can develop sensitivity to some of the metals commonly used in dental restorations. This may or may not have been the case in past years. Perhaps patients were not as sensitive to metals then, or may be the sensitivity was not recognized and diagnosed properly. There are many different kinds of metals used in dentistry. We in this office have, for years, limited your exposure to possible problems by using either materials that have fewer combinations of metals or metals that have a very low potential for sensitivity reactions.

Women appear to have more reactions to metals then men. Studies indicate that at least one woman in seven has an adverse reaction to metals. It may be related to the costume jewelry that women wear, especially earrings for pierced ears. The posts can be made of stainless steel that contains nickel. You might then notice, after some time wearing the jewelry, that your earlobes get red, dried out, or itchy. It can also be seen any place that jewelry comes into contact with your skin—wrist, neck, fingers, etc. If this is your case, you are having a metal sensitivity reaction. If you have any of these problems, it is probably advisable that you limit contact with the problem metals. This can include metals used in restoring your teeth.

At times, you could even notice a metallic taste in your mouth. This can come from silver amalgam fillings that are commonly used. Some studies show leakage of metal through the tooth into the tooth supporting structures (periodontal ligament) from the posts bonded into the tooth after the root canal treatment. These posts are entirely surrounded by tooth or restorations and are not at all in contact with the oral environment. Other oral signs of metal sensitivity include gum tissue that remains chronically red and swollen or bleeds easily where it comes into contact with the metal crown or filling.

Which metals are used in dentistry? Silver fillings (available since approximately 1816) can contain copper, silver, zinc, mercury, and other metals. At this time, we know that several countries have mandated reduced use of silver fillings because of health concerns. Crowns are composed of gold, silver, platinum palladium, and others. A post used to strengthen a tooth after a root canal is either stainless steel or titanium. Sensitivity to each of these metals has been exhibited—some more than others. Gold and titanium rank low. Titanium has been used for years for joint replacements. Pure gold is too soft to be used in dental restorations and titanium is too brittle. If you have a metal sensitivity and need a crown, it may be better to use a metal that is only gold and platinum—or perhaps a bonded ceramic material. While these options may prove to be more expensive than others, metal sensitivity should be avoided.

Nonmetal Options

Options to metal restorations include bonded resins, ceramics, and porcelain. While it is possible that you could have sensitivity to some of the bonding materials, these types of sensitivities are not at all common. The advantages of silver fillings are that they are quick to place and comparatively inexpensive. Advantages of cast metal used under porcelain crowns is similar; the metal/porcelain crowns are less expensive to make and easier to place then full ceramic varieties.

We would prefer not to use silver/mercury fillings, especially for children and women planning to have children. Bonded tooth-colored resins significantly reduce the need for drilling a tooth. They look better and help keep the tooth stronger than silver fillings. If you have a proven metal sensitivity, we will automatically choose materials with less potential for causing you problems.

Wisdom Teeth (Third Molars)

Human beings have more teeth than they actually need: four more teeth, to be exact. The third molars (wisdom teeth) are the last teeth on each side and in each arch of the mouth. If we don’t need them, why do we have them? Hundreds of thousands of years ago, our ancestor didn’t look a great deal like we do today. They had smaller bodies but larger and more powerful jaws. Their diet dictated this jaw structure and number of teeth. Our ancestors ate a tougher and more abrasive type of food. It wasn’t cooked well, and it wasn’t ground up well. There were a lot of hard grains and foods that required lots of chewing. Big jaws were capable of holding more teeth for this chewing.

Today, we don’t need the heavy grinding capacity that early humans had. Food is easier to eat, less abrasive, and much softer. Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles. The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total). Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing. The wisdom teeth often do not have enough room to grow properly. Eventually, thousands of years from now, humans will not have wisdom teeth. They have lost their function and are gradually disappearing, just like the appendix.

Since the jaw is too small (for most people) to accommodate the third molars, they come into the mouth partially, poorly positioned, or not at all. They can be fully erupted, partially erupted, a soft tissue impaction, of full bony impaction. If teeth come in well and you are able to keep them clean, we leave them alone. If they are crowded or poorly positioned and cannot be kept clean, they are like an accident waiting to happen. Decay and gum infection are likely to result. These teeth are usually removed—ideally before they begin to cause big problems with the second molars that are directly ahead of them. Teeth that are partially erupted should always be removed: there is too much opportunity for gum infection to begin. If the teeth cannot be cleaned, chronic painful inflammation may occur (pericoronitis). The earlier they are removed, the better your healing will be.

Less complex extractions (fully erupted teeth or partial soft tissue impactions) can be done by a general dentist. We will refer difficult extractions to an oral surgeon for treatment. Depending on the type of extraction and the medical history of the patient, the extractions may be done in an office or in the hospital. This will be determined after viewing radiographs of the teeth. Having all four wisdom teeth out at the same time is a common practice. Postoperative discomfort can be minimal to extreme—in the case of difficult full bony impactions. Anti-inflammatory and pain relief medications are prescribed appropriately.

We do not need wisdom teeth to eat well. If they need to come out, it is better they come out (1) before they cause problems with the adjacent teeth that you really need and (2) when you are younger and heal well. If you need to have one wisdom tooth taken out, also have the opposing wisdom tooth removed. When a tooth does not meet an opposing tooth, it “super erupts” or continues to grow out of the normal position. When left for some time, the remaining tooth can develop decay and gum disease and cause the same thing to happen to the tooth in front of it.

You Can Have Whiter Teeth!

The least damaging and most conservative way of making your teeth lighter is with the use of a whitening solution. Contrary to what you might think, brushing your teeth harder with an abrasive toothpaste will not make your teeth white, but rather may darken them faster. The tooth-whitening concept has been around for many years, and the techniques have become easier and less expensive to accomplish. Tooth whitening was noted in the dental literature in the 1920s. The technique has become easier and the cost has decreased. Today, there are two convenient methods to whiten dark teeth: At-Home Whitening and In-Office Whitening.

Why Do Teeth Get Yellow?

The intrinsic (normal) color of your teeth is related to the color and thickness of the enamel and dentin, as well as the types of foods and liquids you ingest. The thinner the enamel, the darker the underlying dentin; the more coffee, tea, cola beverages, and red wine you drink, the darker your teeth will be. Cracks that are commonly found in the enamel of your teeth may provide a pathway for discoloring fluids to reach the underlying dentin.

If you have a yellow, brown, or orange shade to your teeth, in most cases it can be made lighter by the whitening procedure. Whitening works very well in removing age-related darkening of your teeth. This age-related darkening is most likely due to years of drinking the darkening beverages, or other environmental factors, rather than genetics. No drilling or anesthesia is required for whitening. Your teeth will not become weaker. Because the mineralization of teeth varies so much from person to person, there is no way to determine how many office visits it will take to effect the color change or how white the teeth will get. The darker your teeth are, the more time required for the change and the more distinctive the color change will be.

The whitening procedure will also work to a lesser degree on the teeth with tetracycline discoloration. We have seen several fair to good results from both in-office and at-home whitening. It does take more time to achieve good results on this type of stain, and unfortunately, sometimes the change is minor.

Two Available Techniques

There are two types of whitening available. One is done by the patient at home, and the other is done by us during an office visit. They can be done separately or in conjunction with each other. The at-home technique involves using a soft, thin, comfortable mouthgurad-like tray. An impression is made of your teeth, and custom whitening trays are fabricated. Then at home, you can place the whitening solution in the trays and wear them for an hour or two each day or sleep with then in place all night. With in-office whitening, you come to the office for 1 or 2 hours, and a stronger whitening solution is applied by us and activated for that time. Usually only one visit is required.

The color change should last for 3 to 7 years in most people. The color change you see immediately after the whitening is completed will regress one shade over the course of 1 to 3 months, with most change taking place in the first week. If you drink a lot of coffee, tea, cola beverages, red wine, or if you smoke, the teeth may begin to turn darker again. When this happens, the whitening process can be repeated.

The possible side effects include temporary white discoloration of the gum tissue of the office whitening solution comes into contact with the gum. This goes away quickly. The teeth may become slightly sensitive to temperature changes for a short time. This also goes away quickly. There is no damage to the tooth enamel, dentin, or pulp from the whitening process. Fillings and crowns do not whiten. When your teeth change to a lighter color, you may need to have those fillings and/or crowns redone. We will let you know whether this is a possibility before we whiten your teeth. There are other adverse effects known.

The teeth that show when you talk, smile, or eat are the teeth that would benefit your appearance most if whitened. Usually the top teeth are whitened because they are much more visible than the bottom teeth, but both arches can be successfully whitened. The lower teeth take about three times as long to reach the color change of the top teeth.

Impacted Teeth

An impacted tooth is a tooth that has not erupted (emerged fully in to the oral cavity). The impacted tooth can be totally surrounded by bone (a fully bony impaction), can be partially surrounded by bone (partial bony impaction), or be only surrounded by soft gum tissue (a soft tissue impaction).

Traditionally, the term impacted teeth usually refers to the wisdom teeth (the third molars, the teeth furthest back in the mouth). Both top and bottom wisdom teeth can be impacted. Many times if they appear to be causing no problems for the patient, they are left alone. If they are positioned in a fashion that they appear to be pushing up against the roots of the second molars (the next teeth forward) or if they are causing periodontal (gum) problems, they will need to be removed. While most general dentists are comfortable removing teeth, patients with impacted teeth are usually referred to a specialist (oral surgeon) for their removal.

Wisdom teeth are not the only teeth that can be impacted. Every permanent tooth can be impacted. If the impaction does not appear to affect adjacent teeth, no treatment may be required. If it affects other teeth, it may need to be removed.

It is not uncommon for “eye” teeth (canine teeth) to be impacted. This is usually discovered early in life, and recommendations for orthodontic treatment (braces) will be made accordingly. Most often, these impacted teeth are not removed, but rather surgically exposed and orthodontically moved over several months into their proper position. Early detection and diagnostic is important to the successful treatment of this situation.

Normally, there is bone separating tooth roots from adjacent teeth. If the impacted tooth, because of its angle and position, gets closer to the roots of the next tooth, the bone between the two teeth will dissolve. If this happens, it is possible that a deep, pathologic periodontal pocket may form. Further deterioration of the periodontal tissues surrounding the tooth in normal position could compromise its health and lead to additional dental treatment. To prevent this from happening, the impacted tooth is removed. If the impaction is deep and difficult to approach, and if there are four wisdom teeth to be removed at the same time, the dentist may elect to perform the procedure in a hospital or surgical center setting.

The more bone that surrounds the impacted tooth, the more difficult is it to remove. The position of the tooth near other teeth or nerves and the manner in which the impacted tooth is angled in the bone also affects the difficulty level of the extraction. The younger the patient is, the better and easier the healing appears to be. If there is a great deal of bone that is removed, the dentist may choose to place some “bone fill” material in the place the tooth used to be (the socket) to promote better healing of the bone.

Xerostomia: Dry Mouth Syndrome

Xerostomia (dry mouth) is not a condition everyone should expect. You may notice it as you age due to a change in hormones, medication, and/or radiation therapy in the head and neck region.

Why Xerostomia Is a Problem

Saliva is important to oral health for several reasons. The flow of saliva helps clear debris from the oral cavity. It provides minerals necessary to support the process of remineralization. Tooth enamel daily underdoes acid attack that removes inorganic minerals from teeth. This is called demineralization. Remineralization is the opposite of demineralization. It occurs when inorganic molecules flow into a region of weekend enamel and make it stronger.

When the salivary flow is reduced, a chain of events occur. The natural cleansing action is diminished, as are the buffering action and remineralization properties of saliva. People with diminished salivary flow experience a very fast rate of decay, many times faster and over several teeth. This type of dental decay is typically noted along the gumline, around existing dental work, and on exposed root surfaces.

Prevention

• You can help prevent dental decay that can result from xerostomia.
• Brushing and flossing correctly at least once each day becomes very important.
• Frequent sips of water during the day can help moisten the mouth and can help clear debris.
• Daily use of a mouthrinse containing fluoride can help remineralize the teeth.
• Use toothpaste containing sodium fluoride.
• We recommend a daily brushing with a prescription, high-concentration sodium fluoride gel or paste. We will either dispense this or give you a prescription for it.
• Chew sugarless gum or a rubber band to help stimulate salivary flow.
• In moderate to severe cases, special fluoride delivery trays can be made for you to use at home. These will keep the high-concentration fluoride in a position to “soak” your teeth with fluoride for several minutes at a time.
• We recommend that you have your teeth cleaned, polished, and an office-applied topical fluoride treatment every 3 months while the condition persists. 

 Dry mouth can have serious dental consequences and must be treated accordingly. 

Junk Drink Alert

We have recently noticed a developing and serious decay problem. What we are seeing in out dental practice is tooth decay that progresses much more quickly than we are accustomed to seeing. This decay is seen around the margins of restorations (fillings) and crowns (caps) where the tooth and restorative material meet. In some individuals these restorations were only places a short time ago. From discussion with the patients who exhibited this extreme and unusual type of decay, there seems to be two common factors. First, by far and away, the majority of these people are female, and second, they drink diet beverages, mostly soda and bottled iced tea. Their brushing and flossing habits appear to be adequate. They are taking no medication. The age range is from 12 to 55 years. All seem to be concerned with their weight, which is why they are consuming the diet drinks.

Years ago, this type of decay was seen in patients who kept candy, mints, or other edible breath fresheners in their mouths for hours on end, causing decay at the gum lines of teeth. Although another factor or factors may be the actual or contributing causes if this problem, the only currently detected causes are the diet beverages—soda and artificially sweetened bottled iced tea.

Sugar in food and drink feeds the bacteria present in dental plaque, allowing the bacteria to produce lactic acid. The lactic acid breaks down the minerals in the tooth enamel, which causes cavities. Although diet drinks are sugar-free, they are also very acidic. By the time the saliva dilutes these acids enough to bring the mouth back to its proper acidity, new or additional decay may already be in progress. Or worse, before the mouth does recover its proper acid balance, the patient is already uncapping another bottle of that diet drink!

Suggestions for the reduction or elimination of this type of decay include reduction or cessation of the drinking of these diet drinks, rinsing your mouth with water as soon as possible after the beverage contact, use of fluoride mouth rinses, and stronger prescription topical fluoride treatments both in office (four times each year) and at your home. We may even need to recommend the use of special fluoride delivery trays to increase the time that fluoride can remain in contact with the teeth. This will help make the enamel of the teeth stronger to resist the acid attack that starts decay. It will also promote a better equilibrium in the constant enamel demineralization/remineralization process that occurs in everyone’s mouth. Decay lesions in the very beginning stages can be stopped and even reversed in this way.

Though most of us could stand to lose a few pounds, be aware that some of the things you put in your mouth, in the hope of losing weight, may actually have an adverse effect of losing teeth.

Have Missing Teeth Replaced

Most adults can expect to have 32 teeth. The four third molars, or “wisdom” teeth, are often extracted because they do not grow into the mouth well or there is not enough room for them in proper alignment. It is very small unusual to have wisdom teeth replaced. But the other 28 teeth are needed. Your mouth, jaw, and body developed together over millions of years. They are designed to operate together at peak efficiency. When you lose a tooth, the efficiency decreases and function suffers. When you lose a tooth, you lose some ability to chew food properly. This may mean that you either place more stress on the other teeth in order to chew all the food you eat, or you do not chew well enough and what is swallowed is not quite ready to be digested. This can lead to digestive difficulty. Or you might switch to a diet that consists of softer foods that do not have to be chewed as much. You might have to eliminate certain favorite foods because you cannot chew them thoroughly. For each missing tooth, you lose approximately 10% of your remaining ability to chew food.

Other problems also occur. The teeth adjacent to the space to the left by the missing tooth will eventually shift. If for example, a lower tooth is extracted, the opposing tooth in the upper jaw will grow slowly (or sometimes quickly) longer in a downward direction into the missing tooth space. This is called extrusion or supereruption. The teeth on either side of the missing tooth space will move and tilt off their proper vertical axis and drift into the missing tooth’s space. This can make these teeth more prone to decay and gum disease because it is much harder to keep the teeth clean when they are not aligned properly. Root structure that is normally covered by gum and bone may become exposed. All this can happen if one tooth is lost. Other major problems can occur if multiple teeth are lost. There is a loss of the arch length, the distance from the back of the last tooth on one side of your mouth to the back of the last tooth on the other side of your mouth. With collapsed bite and loss of vertical dimension, the distance from your chin to the tipoff your nose decreases, making your face shorter. Extrusion and movement of your maxillary (upper) alveolar bone until the gum tissue from the upper jaw can touch the teeth or gum tissue of the other jaw causes loss of facial tone and shape. The facial muscles of the cheeks and mouth sink into the edentulous (extraction) site. There can also be severe cosmetic problems when the extracted tooth’s space is visible when you talk or smile. This is not a pretty sight to anyone. There is a loss of self-image and self-esteem and a feeling that you are getting old. Once you start losing teeth, you can actually start to look old. Losing a tooth is pretty serious. The longer you wait after a tooth is extracted, the more difficult and expensive it can become to make the replacement you need. With very few expectations, it is better to replace missing teeth as soon as possible. Evolution designed you to chew your food with 28 teeth.

We will discuss with you the type of replacement that would be best suited for you. You can choose to do nothing at all and leave the space or spaces, but as you can tell, this is not usually recommended. You can have a fixed replacement made that could be an implant, a conventional bridge (crowns/caps), a bonded resin bridge, or a combination of implants and bridges. You could also have a removable partial denture made. The advantages of the fixed replacements are that they are not designed to come out of your mouth at any time, they are the easiest to live with, feel more like the original teeth, and are perhaps more cosmetic then removable dentures. A removable partial denture is held in place by metal claps that may be visible. It is bulkier and may interfere with your speech for a period of time. However, generally, dentures cost less than a fixed replacement.

Your chewing apparatus, jaws, and teeth were evolved to function in a particular fashion. The interaction is complex and marvelous. Loss of teeth degrades this function. Preserve your health. Replace missing teeth as soon as suggested.

If you have any questions, please call Omni Dental Group at 512-250-5012.

   

For a Lifetime of Great Oral Health

Prevention is the key to great oral health. Better diet, medical care, and other factors are allowing us to live longer lives. Unfortunately, our teeth have not adapted to our long life span and need help to last as long as we do. If you want to have your teeth for your whole life, here is what you do:

• Brush, floss, and use recommended dental aids correctly, at least once a day. Use fluoride-containing mouth rinse daily.
• Come to the office for the recare hygiene appointments at the intervals we recommend. Let us provide a prescription-strength topical fluoride treatment at every recare appointment.
• Let us take radiographs when we believe they are necessary.
• Teeth age at wear, just like the rest of your body. The outer covering of hard enamel can get thin, break off, or wear through and expose the softer dentin. Dentin erodes very quickly. When we see exposed dentin, let us get it covered and protected.
• Have sealants places on all teeth that can benefit from them.
• Don’t ask to “patch” anything. Patchwork dentistry is contrary to the concept of keeping your teeth trouble-free for a lifetime. If small repairs are possible and appropriate, we will tell you.
• Choose the procedure or restorative material that will last you the longest. All dental materials have a life expectancy, after which time they fail and must be replaced. Each time a tooth is redrilled, it gets weaker. Only solid, yellow gold could last for your entire life. Tooth-colored ceramics and porcelain may last as long. It is your choice.
• Bonded restorations (current state-of-the-art) require less drilling than silver fillings. Less drilling is good. The tooth retains more strength and the restoration lasts longer. Let us do the good stuff.
• Gum disease can start at any time. Genetics, diet, oral self-care, medications, and general health can all have an influence. Gum disease is both site-specific (most often starts in a localized area) and episodic (can begin at any time). It is also painless in its early stages. We will tell you as soon as we spot gum disease. It will need to be treated properly and immediately.
• Our treatment recommendations are always based on your needs, not on what your insurance company wants or its bottom line. There are dozens of common dental procedures that are not part of benefit packages. Dental insurance carriers are in business to make money. They want to pay out as little as possible as late as possible. An attitude of “If my insurance company doesn’t pay for it, I don’t want it,” only hurts you and YOUR oral health.
• We have listened to what you want, examined your mouth, and know your dental needs. Most patients can have all the best dentistry they want and deserve. It just takes a little planning. We can help with that, too. If you want all of your teeth, all of your life, follow the above recommendations and do it right the first time.

Diastemas: Closing Spaces Between Teeth

The cause

A diastema is space between teeth, that is, adjacent teeth that do not touch. There are a number of reasons why spaces may exist between teeth. The two most common are an arch length discrepancy (teeth are too narrow for the arch that supports them), or because there are congenitally missing teeth. The remaining teeth then either shift or merely don’t touch the next available tooth. The spaces between the teeth can be just a fraction of a millimeter wide or so wide that a straw can easily fit between the teeth.

The missing teeth can often do cause a cosmetic problem. In the present culture of the Western world, spaces or gaps between teeth are not regarded as being desirable or attractive.

Treatment Options

There are several options available to treat a diastema. Most of these options work well whether the spaces are large or small or whether there are several spaces or just on space between two teeth.

Orthodontics can be used to move the teeth into a more pleasing alignment. This could be done with a retainer or fixed bands and wires. Clear Invisalign orthodontics aligners are often used to close these spaces. The advantage is that complex restorations are usually unnecessary and you have to worry about the restoration chipping or breaking after years of service. The disadvantage of orthodontics to close a diastema is the time needed to move teeth, which can range from months to 18 months.

The other option is to have the teeth restored with bonding. The bonding can be done with either resin or with porcelain. The resin will be less expensive and work well to close small diastemas. The porcelain takes an additional visit, is more expensive, and is more appropriate for larger cases in which a more significant appearance modification is needed. This would include changing the color of the teeth, the length of several teeth, or the alignment of several teeth. As a rule of thumb for small spaces, a bonded resin will work well; for larger spaces, orthodontics and porcelain must be considered. Porcelain and resin both can be made to exactly match your existing tooth.

Each situation must be individually examined and evaluated before treatment. Often, we will require sturdy model impressions to be made so we can make measurements of the tooth length, width, and amount of separation between teeth. Using this method, we can show you how you can look through the use of a diagnostic “wax up” showing the new shape of the teeth.

An important point to remember is that if you also want a whiter appearing smile, we should complete the whitening process before the bonding process. Teeth can be whitened, but dental materials such as porcelains and resins cannot be whitened. The restorations are placed to match your tooth color at the time they are placed, so whitening has to come first.

Afterwards

After the teeth are moved orthodontically or reshaped with porcelain or resin, your appearance will change! Not only that, but also your teeth will feel different to you. Your lips will be supported differently. Air will be deflected from your teeth in a different fashion. Depending on the amount of change, you may even need to make slight adjustments to your speech. The good news is that all the adjustments take only several hours to a few days to make. Very quickly, additions and changes become natural for you and you don’t even notice that they were done, except that people will compliment you on how lucky you are to have been born with such beautiful teeth.

Reversing Decay

If you were asked to describe a cavity, you would probably say the process was similar to ruse—something that happens on the outside of the tooth that makes the tooth soft and creates a hole that would eventually be visible. You might even have the notion that bacteria are involved. And, you would be right in both cases.

The process of decay is a complicated interplay of an acidic and basic balance of chemistry in the mouth. Salivary flow and content, the presence of decay-causing bacteria, the age of the teeth, diet, and the level of plaque all play a role in the decay (demineralization) as well as the rebuilding (remineralization) process involved in tooth decay.

Demineralization

At the very earliest stage of the decay process, there is not an actual “hole” in the tooth. There is, however, an alteration of the mineral content of the enamel. This stage of decay is completely invisible to the eye. It cannot be detected by an x-ray. It is a microscopic change where, due to the level of acid in the immediate area, the building blocks of enamel (calcium and phosphate) begin to dissolve on a microscopic level. When the acid environment is left unchecked (plaque is allowed to accumulate undistributed against the tooth surface), more and more of the bonds between calcium and phosphate dissolve. This is a process called demineralization. If the acid challenge becomes severe and more of the underlying structure of the tooth begins to dissolve, the outer surface becomes unsupported. It is at this time that the actual hole, or what you call a cavity, appears.

Remineralization

When the outer surface of the enamel is still intact, with no break detectable, there is an opportunity for the bond between calcium and phosphate to become re-linked through a process termed remineralization. And the great news is that dental science discovered that in the presence of fluoride, these bonds actually become stronger that they were initially. It is in this way that an early cavity can be reversed. When this happens, the tooth does not need to be drilled and filled.

The process of demineralization and remineralization can be seen as a tug of war on the molecular level of all surfaces of all your teeth, all the time!

How You Can Promoter Remineralization

There are several steps you can take on a daily basis to help ensure that you are promoting remineralization. These are:

•          Control your diet: watch the type of decay-promoting foods you eat and the quantity
•          Improve your oral self-care by brushing and flossing daily
•          Use tropical fluoride on a daily basis
•          Use antimicrobials and other anticaries agents as directed on a regular basis
•          Maintain your dental hygiene recare schedule

The early stages of dental decay CAN be reversed with no loss of tooth structure, and you can help promote a healthy mouth by following just a few simple rules.