Altered Passive Eruption: Hard Tissue

Teeth are composed of two basic, visible parts—the root portion and the crown (enamel-covered) portion. The term crown does not refer to the type of tooth replacement fabricated by a dental laboratory. Rather, it is the part of the tooth that is normally seen when you speak.

The present-day esthetic dental philosophy, demonstrated by people who have beautiful teeth and smiles, shows that there must be a certain amount of enamel-covered tooth visible for an attractive smile. The ratio is about 1.6:1, length to width. Teeth that are shorter than this look progressively less attractive. They look short and stubby. If they are actually worn down from a clenching or grinding problem, this is a different type of problem. But it may not be that the teeth themselves are too short. It could be that there is not enough of the crown of the tooth that can be seen. The remainder that should be seen is covered with gum or gum and bone tissue. This is known as altered passive eruption. It is not entirely clear why this happens. It may become obvious as early as age 14. The teeth may have a pleasing color and be very straight, but they still leave something to be desired because they are too small and too much gum shows when you smile.

This can be a severe cosmetic problem when coupled with the type of lip line that frames the teeth. A low lip line will probably hide most or all of the gum covered part of the tooth, so there is less of a need to correct the defect. A medium or high lip line, especially a high lip line, will show all of the tooth and gum. As the lip line gets higher, the attractiveness of the smile goes down. The situation can be so severe that the patient will train his or her muscles to artificially hold the upper lip stiff or cover the mouth with a hand when smiling. In this way, the short teeth or the great expanse of gum tissue will be hidden from view. It can cause significant psychological problems.

The solution can be easy or complicated, depending on the exact nature of the problem. If there is only a small amount of gum tissue to be removed from a single tooth or multiple teeth, and there is a medium lip line, then the tissue is easily removed with a laser or electrosurgical cutting device. Scalpels and stitches are not needed in small cases. As more gum must be removed and more tooth is exposed, there may be some underlying bone that must be reshaped. Bone removal will be followed, about 2 months later, by the soft tissue removal mentioned earlier. The first surgery must heal long enough for the tissue to reach its final position before the second can be completed. Remember, you are looking at differences of several millimeters to a fraction of a millimeter that will cause the case to be a success or failure. A two-step procedure is better than a one-step procedure.

The biting edges (enamel and/or dentin) of one or more teeth may be reshaped if there is a need not only to lengthen the teeth but also to make it appear that they have actually been placed higher in the smile line. This is for top teeth, of course. If a great deal of tooth must be reshaped to accomplish the desired effect, root or dentin may be exposed, making the tooth sensitive. These teeth will need to be covered with porcelain veneers or crowns to achieve the proper esthetics. Even if only a little amount of tooth is reshaped, the veneers or crowns may be indicated to get the exact appearance you want. We will discuss this with you before you begin treatment. It is important that you know what is being done, how long it will take to complete, and what you will look like when it is finished,

We will make the veneers or crowns and reshape the teeth. We will determine what can be done. We may also do the soft tissue contouring. This is most common. For procedures that involve a reshaping of the bone, you may be referred to our periodontist. Since we will do the restorative treatment, we know exactly where the soft tissue should be. We are the cosmetic specialists. We will establish the final position of the gum line. In extreme cases, the problem will be corrected with a combination of the above-mentioned procedures and orthognathic surgery to reposition the jawbone and teeth. This can be done by our oral surgeon. With a comprehensive examination, we can tell you what is appropriate for you. You do not have to live with an unattractive smile because you have short-looking teeth due to showing too much gum tissue. These problems can be corrected. Let us know what you do not like about your smile or teeth. More than likely, the smile you now have can be made into something you will like to show off.

If you have any questions about altered passive eruption, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

6 Ways to Ease Your Child’s Anxiety at The Dentist

"It's time to go to the dentist," are seven words no adult or child wants to hear. While these are not words most people like to hear they are words you need to hear if you care about your smile. Sadly, many children are terrified by even the thought of going to the dentist. May officials have often encouraged the use of sedation dentistry even amongst small kids to help them deal with the nerves associated with visiting the dentist which has led to a widespread debate on if children should be allowed to take in such drug. Despite the debate one thing remains in order to keep healthy teeth your children must go to the dentist here are just a few ways you can help calm your toddler when it's time to go to the dentist:

Speak Positive Words

When it comes to going to the dentist it is terrifying for both children and adults. In order to eliminate anxiety before going to the dentist it is important that you let your child know that the visit will be an exciting one versus telling them they should be afraid.

Embrace Brushing Teeth at Home

It is recommended that you begin brushing your child's teeth once they start growing in. This not only encourages overall healthy teeth but it also helps children get used to having something on their teeth so that they are not paralyzed by fear when their first trip to the dentist arrives.

Start with a Pediatric Dentist

Pediatric dentists specialize in only children's teeth which may be the best bet for your little one as they get used to visiting the dentist. Not only is a pediatric dentist an expert in pediatric tooth care but he is also an expert in making sure your child does not have a full blown while getting take care of.

Play Pretend

Kids love playing pretend and using it as a tactic in overcoming fear will make playing pretend so much better. Set up a play date a few days before your child visits the dentist and have his or her room set up like a dentist office. Pretend to be the dentist and let them be the patient as you explore their teeth and gums. Your child is sure to love this game and most of all you are prepping them for their visits in a few days.

Don't Bribe Your Child

When taking your child to the dentist the last thing you want to do is bribe your child with things such as candy or other sweet treats. Bribing your child with sweets would be counterintuitive to what the dentists does for the teeth. It is best to simply calm your child's nerves. If you must bribe your child bribe them with stickers and or other fun activities.

Avoid Words that Promote Fear

Using the words "pain." "shot" or even "doctor" can be frightening for small children so try not to let your child know that they are going to see a doctor. Instead, share with them that they are going to see someone who cares about how strong their teeth and gums are. Using less fearful words could also help with decreasing anxiety.

By: Stephanie R. Caudle
http://www.huffingtonpost.com/stephanie-r-caudle/6-ways-to-ease-your-child_b_11549086.html

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

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

8 Tips for a Brighter Smile

Want a brighter smile? Try these tips!

1. Avoid foods that stain
Avoid foods and beverages that are filled with sugar or are too acidic. If you're not careful, consuming these kinds of foods can damage and stain your teeth. It can be helpful to drink beverages that stain through a straw as well. This helps you circumvent those smile dulling liquids altogether! Brushing your teeth immediately after eating sugary foods may also help prevent staining. Be careful though, if a food is too acidic, you will want to wait at least thirty minutes before brushing your teeth in order to prevent enamel erosion. If you cannot brush your teeth for some reason, opt for swishing water in your mouth which is naturally filled with fluoride. (Water is not a substitution for your daily dental routine).


2. Use dental cleaners
Between brushing, use dental cleaners to minimize the food build-up between your teeth. These brushes are disposable and very handy if you find yourself away from home without a toothbrush. You can also use them to clean the areas between teeth and brace wires if you have braces. They're sold at most grocery stores and can even be found online. 



3. Try toothpaste for sensitive teeth
If your teeth are especially sensitive, try using a toothpaste created specifically for people with sensitive teeth. If you're wondering whether or not you have sensitive teeth, here's a simple way to tell: Do your teeth feel uncomfortable when they are exposed to extreme hot and cold temperatures? If so, be sure to ask your dentist for help and additional information. 

4. Regular dental checkups
This one might seem obvious, but it is so important! Be sure to visit your dentist regularly to have your teeth inspected and cleaned. Without regular dental checkups, you run the risk of facing disease and other problems in the future. Routine dental visits help prevent the advancement of such diseases and are always a good idea. 

5. Avoid chewing on hard foods
Ice cubes pose a particular threat to the safety of teeth. Never chew on ice. You could crack or chip your teeth! Be cautious when eating popcorn, nuts or any other tough to chew food. If you believe that your teeth are chipped or cracked, see a dentist immediately to prevent pain or even bacteria growth in the cracked tooth. 



6. Brush your teeth properly
Brush your teeth from the gum line moving towards the center of your mouth. This will help get rid of food bits that hide under your gums. Scrubbing side to side is always good, but don't forget to brush with an up and down motion as well. If your gums or mouth bleed while brushing, be sure to meet with a dentist or periodontist. Bleeding gums are often a sign of gum disease, which is a major issue when left untreated. 


7. Swirl that Mouthwash
One common misunderstanding regarding oral health is that brushing is all you need for a healthy mouth. Mouthwash is often neglected in daily dental practice, but it's an essential step towards your brighter smile. Mouth wash cleans, disinfects, and reaches places your toothbrush simply cannot. Rinse twice per day when you brush those pearly whites.




8. Drink your Milk! 
In addition to providing a good source of calcium, dairy has shown to help your teeth fight cavities. If you're lactose intolerant or simply dislike dairy products, don't worry! Dark leafy greens like kale or collards, broccoli, tofu, and even almonds are all excellent natural sources of calcium.



If you have any questions regarding the health of your teeth or simply want to see a doctor, call one of our three convenient locations to set up an appointment. We are here to provide excellent service in a friendly environment.  

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

X-Rays and the Dentist

If you've been to the dentist recently, then you have most likely had an X-ray done. While they aren't taken during every visit, they are very helpful for establishing a patient's oral health as well as predicting which areas need to be focused on. Today we are going to give a brief overview of what exactly they are and why they are necessary. 

1.  What are X-rays? 

In 1895, Wilhelm Conrad Roentgen was working in his lab conducting research when he accidentally discovered X-rays. Since then, science and technology have evolved to use X-rays in a beneficial manner. During an exam, a patient is exposed to short bursts of radiation. This allows the doctor to view teeth in a more thorough manner than an examination. Some people are nervous about getting X-rays, however, it is important to note that the doses of radiation are too minute to cause adverse effects. In fact, during a dental X-ray, patients are only exposed to the same amount of radiation as a short airplane flight. 

2. Do I have to get X-rays?

Whether you need to look for fractures in bone or simply to check in on teeth, X-rays are the best way to do it. Dentists rely on this technology because it allows them to perceive problems before the naked eye is able see them. Some examples include, but are not limited to: periodontal disease, bone infections, hard to see tooth decay, and even some tumors. X-rays are an important part of preventative care and are nothing to be afraid of.

3. What if I'm pregnant?
This is always a great question to ask! It is best to consult your physician before exposing yourself to small quantities of radiation. Informing your dentist of this is an absolute necessity, but there is no need to forgo X-rays altogether. With pregnant patients, a thyroid collar and a leaded apron are used to prevent radiation exposure.

Source: Mouth Healthy by the American Dental Association

If you have questions concerning X-rays and the health of your teeth, feel free to call one of our three offices to schedule a consult. We are here to address any of your concerns and to provide you with a stress-free dental experience.

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

Drinking Coffee Accelerates Orthodontic Tooth Movement

What is orthodontic tooth movement?
A unique process where a solid object (tooth) is made to move through a solid medium (bone). Orthodontic tooth movement occurs due to the pressure that is transmitted to the clinical crown of the tooth, down to the root, and ultimately to the periodontal ligament (the tissue that attaches the tooth to the bone) and alveolar bone surrounding the root.

On the surface of the tooth in the direction where the tooth is being moved, the periodontal membrane is squeezed, resulting in compression of the periodontal fibers within the membrane. The bone surface contacting the periodontal membrane begins to resorb due to the activation of cells called osteoclasts.

On the surface of the root from which the tooth moves, the periodontal membrane becomes stretched. This activates cells called osteoblasts. These cells regenerate new alveolar bone in the area where the tooth was once located. That is why teeth may be slightly loose during orthodontic treatment. Once the movement has stopped, the ligaments are no longer stretched or squeezed and the bone regenerates and fills in around the periodontal ligament, causing the tooth to be more secure in the bone.

The following article shows that daily coffee consumption enhances orthodontic tooth movement, and consequently can shorten the duration in which patients have to wear braces.

The Study
Caffeine has been shown to affect bone metabolism through regulation of osteoclast, osteoblast, and calcium balance. This study investigated the effects of drinking coffee on orthodontic tooth movement (OTM). Drinking coffee, as a daily habit of many people, can be an effective accelerator of tooth movement with little side effects. Caffeine can break the calcium balance in bone tissue and directly inhibit the development of osteoblasts, leading to temporary decreased bone mineral density and consequently inducing faster orthodontic tooth movement.

Why is it important?
Developing new methods to enhance orthodontic tooth movement and shorten the duration of treatment has always been desired. However, to date, no therapies have been widely used in clinics. Much effect has been made to explore therapies to shorten the orthodontic treatment period with limited success. Daily coffee consumption may be a promising approach to enhance orthodontic tooth movement for its reversible effect on bone mineral density and calcium balance.

The setup
30 male Wistar rats were randomly divided into two groups:

1. regular OTM = rO
2. coffee + OTM = cO

At 5 weeks of age, the cO rats began receiving daily intragastric administration of coffee according to body weight.

At 13 weeks of age, the left maxillary first molar of the both groups was moved mesially with a nickel-titanium coil spring

After 3 weeks, the OTM amount was measured. 

How was it measured?
The alveolar bone mineral density (BMD) was analyzed with micro-computed tomography (uCT).
Immunohistochemical staining was done for TRAP and RANKL expression in the periodontium. The periodontal ligament (PDL) tissue model was established through 3D culturing human PDL cells in poly lactic-co-glycolic acid (PLGA) scaffolds.

What did they find?
Compared with rO, the cO rats had significantly larger tooth movement. Meanwhile, the cO had significantly lower alveolar BMD, indicated decreased bone mineralization. Moreover, in the compression periodontium, the cO had significantly more TRAP+ osteoclasts and higher RANKL expression, indicating increased osteoclastogenesis. 

Summary
This study found that drinking coffee accelerates OTM, probably through the effects of caffeine on osteoclastogenesis enhancement via RANKL elevation. This research was supported by the National Nature Science Foundation of China.

Click here to read the study.

Click on this link to read another study about how carbonated soft drinks DECREASES the rate of orthodontic tooth movement. "The role of soft drinks in decreasing tooth movement might be related to its effects on bone metabolism."

Scaling and Root Planing

What is scaling?
Scaling is a periodontal dental procedure in which plaque and calculus are removed from the tooth both above (supragingival) and below (subgingival) the gum (gingiva). 

What is root planing?
Root planing is a procedure in which diseased or altered portions of the root surface, the cementum, and dentin are removed and the resulting new surface is made smooth and clean. The more altered and damaged the root surface has been from calculus (tartar) accumulation, the more the need for root planing.

Why is it necessary?
The purpose of scaling and root planing is to remove all debris from the teeth. Any item that can cause inflammation of the gum tissue must be eliminated. The root surface must be made as smooth as possible. Irregularities in the root surface can contribute to gum inflammation. Irregularities are sites for bacteria and plaque buildup. The bacteria and the toxins they produce in the plaque are held against the tooth by the calculus. In this way, plaque and calculus on the teeth have been positively linked to gum disease.

What is the procedure like?
Depending on the severity of your particular periodontal problem, scaling and root planing may be the definitive treatment and no further procedures will be required. In many cases scaling and root planing are only a necessary part of the overall therapy. It is a demanding procedure. It requires much more time than the familiar adult prophylaxis (cleaning). It is usually done in multiple appointments, treating a quarter, half mouth, or your full mouth at each appointment. In this office we find that most patients are most comfortable if the area to be treated during the root planing procedure is anesthetized with a local anesthetic.

Recare
The scaling and root planing may have to be repeated in the future. It is customary to place the patient on a 3- to 4-month hygiene recare schedule. Scientific evidence clearly shows that for individuals who have demonstrated a predisposition to periodontal disease, an interval of 6 months is too long. We will determine the appropriate interval for you. As your situation changes, there may be changes in the length of these intervals as well.

What happens after treatment?
Other than the teeth being somewhat sensitive after the scaling and root planing procedure, there is little postoperative discomfort. The sensitivity will diminish with time. If you have been diagnosed as having severe periodontal infection, the sensitivity may remain for quite some time and further procedures may be needed to eliminate sensitivity. Although many procedures in dentistry can be considered elective, we consider scaling and root planing to be a necessity for your dental health.

Post-procedure Tips:

• If therapeutic prophylaxis has been completed because your gingival (gum) tissue showed signs of infection and inflammation, and if you had significant calculus (tartar) buildup:

• You may notice that your teeth feel different where the calculus was removed. The soft tissues may be sensitive or sore for approximately one day as they begin to heal. You may find that taking an over-the-counter pain reliever (aspirin, ibuprofen, etc.) will help during this 24-hour period. You may also rinse your mouth every few hours with warm salt water. Make sure that you brush and floss your teeth during this time period as you have been instructed. be gentle, because the brushed areas may be sore, but be thorough! You do not want to have the periodontal infection begin again.
• If scaling and root planing, or other more involved periodontal procedures has been completed:

• You can expected your gingival (gum) tissues to be quite sore. This is normal when the gum tissues have been infected and inflamed for some time. The more severely they have been affected, the more discomfort you can expect. This soreness should go away very quickly. You may rinse with warm salt water every few hours until the soreness is gone.
• If scaling and root planing has been completed:

• You may also notice that the teeth have become sensitive to temperature changes after the scaling and root planing. This sensation frequently occurs when the surfaces of the roots of your teeth have been cleaned. Removal of the debris covering the roots and attached to the roots leaves the roots open to temperature stimulus. If the problem persists, please let us know.
• When you examine your gums closely in a mirror, you will also observe that the color, texture, and position of your periodontal tissues will undergo a change as the healing takes place. The swollen, reddened gum tissue will shrink, become more firm, and return to a healthy pink color. Watch for these welcome signs of improvement and be encouraged by the healing process.
• Please do not forget to brush, floss, and use other periodontal cleaning aids as you have been taught. It is important that you begin establishing proper oral self-care habits immediately. If you find that the recently treated areas are sensitive to the brushing and flossing, be gentle - but be thorough! With proper technique you cannot damage the teeth or gingival tissues.
• Brush after ever meal with a fluoride-containing toothpaste. Rinse with a fluoride-containing mouthrinse once each day.

Preventing Recurrence
Once scaling and root planing has been completed, it is most important for you to practice the brushing and flossing techniques in which you will be instructed. If we have recommended any additional periodontal aids, you must use them, too. Your cooperation is vital if the procedures are to be successful. To remain disease-free, you will need to remain constant in your oral self-care regimen.

If you have any questions about scaling and root planing, please feel free schedule a comprehensive dental exam with our office at 512-250-5012.

Instruments of a Dental Office

When you go to your dentist, do you ever wonder what those tools going into your mouth are used for? They can be pointy, sharp, loud and very scary looking! We are here to put your fears to rest! These tools are simple and were made to make your dental visit pain-free.

The prophy cup polishes teeth after cleaning 

 An explorer detects breaks in enamel

A perio probe measures sulcus depth

 The high speed handpiece prepares teeth for fillings, etc

The slow speed handpiece removes soft decay

The sonic scaler cleans teeth quickly and easily

The Micro Air-Abrasion handpiece prepares teeth for fillings

 The high velocity suction removes water quickly

 The slow speed suction keeps the mouth dry

 The curing light is used to harden white fillings

The air/water syringe squirts air and/or water

Takes diagnostic x-rays of your teeth 

Click here to HEAR what sound each instrument makes!

These tools help make modern dentistry possible! You can come for your dental appointment without worry of pain!

Here are some antique dental tools that, thankfully, no longer are used!

Douglas Lever: a combination of elevator and forceps

Clockwork Drill: the first drill that could rotate continuously to remove damage from a tooth

Civil War era set of dental forceps: the drill in the center telescoped to work on the root of the tooth being extracted. Can you believe that during this time, the dental anesthetic still had not been popularized?! Ouch!

If you have any questions about what instruments Omni Dental uses or how we use it, please feel free to check out our website or give us a call at 512-250-5012

Check out this article for a more in-depth look at antique dental tools: http://gajitz.com/the-whole-tooth-5-truly-terrifying-antique-dental-tools/

Splinting Teeth

Healthy Teeth Are Strong and Steady
In their normal state, teeth surrounded by healthy supporting structures exhibit very little mobility. Mobility can be defined in this case as movement of the teeth. Pushing on the teeth with dental instruments may cause the tooth to be deflected slightly from the "at rest" position, but this movement will be very, very slight.

Why Teeth May Need To Be Splinted
When the supporting bone is compromised and affected by periodontal disease, the teeth will show more mobility. If the tooth or teeth are subjected to trauma, they can be loosened in their sockets. Bruxing and grinding habits can also loosen teeth.

Teeth that are not too severely damaged by trauma will return to their former stability. Temporary splinting of the loosened teeth to each other or to other undamaged teeth may be required.

If the mobility is caused by clenching or grinding of the teeth, adjustment of the bite (occlusion) and the fabrication of a protective antigrinding/bruxing appliance may be indicated. In this case, no splinting of the teeth would be required.

The most common reason for splinting teeth is mobility cause by periodontal disease. The teeth show more movement as the bone support for the teeth diminishes. Multi-rooted teeth (molars) often show less mobility than single-rooted teeth with the same amount of bone loss. But the need for treatment is just as important. The more mobile the teeth, the more damage has been done, and the more splinting will be necessary.




The Splinting Procedure

Fixing periodontal disease

The first step in elimination of tooth mobility is to begin to correct the periodontal problem. If the teeth are mobile, the periodontal problem is probably advanced and the corrective measures could be both involved and time-consuming. Splinting may be started immediately. It involves attaching the mobile and perhaps non-mobile teeth together with a wire, acrylic, or a combination of the two. Attaching the teeth together gives them all more strength. Splinting has a limited life expectancy and must be repaired or replaced periodically. There is often a fee separate from the initial splinting fee associated with these procedures. You will be informed as to what your particular condition requires for short- and long-term therapy.

A more extensive form involves splinting the teeth together with cast and cemented restorations - crowns, bridges, bonded metal retainers, etc. This type of splinting will last much longer and is more expensive. The purpose is the same as that of external splinting - to attach the mobile teeth together so that they derive more strength and move less.

Teeth that are splinted will also require different and more involved brushing and flossing on your part. We will demonstrate these procedures for you.

Fees
Costs for splinting procedures vary greatly. It will depend on the number of teeth to be splinted, severity of the mobility, prognosis of the teeth, and the type of splinting selected.

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

Dentin Decay

Detect decay by inspecting the color and hardness
Usually, dental decay is fairly easy to detect. When a cavity is just beginning, it is typically identified by a brown or white color or a change in the translucency of the enamel of the tooth. The dentist or dental hygienist uses a special dental instrument called an explorer to feel the suspect area and check its hardness. If the area is hard, in other words, if no break in the enamel layer is detected, we feel there is not a cavity present. If, however, the surface feels soft and the explorer "sticks" in the suspect site, we feel a cavity is present.

Fluoride makes our enamel stronger, but dentin decay is harder to detect Because of the widespread use and availability of fluoride in our drinking water, foods, and oral care products, we are seeing a different decay pattern. The appearance is different from the typical pattern of decay and more difficult to detect. As the outer surface of the enamel absorbs fluoride (from toothpaste, for example), the enamel becomes very resistant to demineralization and eventual decay. If there is a small break in the integrity of the enamel, a pit or groove where decay-causing bacteria can live, the bacteria can dissolve the enamel in such a way that the hole in the enamel cannot be detected. Once the decay-causing bacteria reach the underlying dentin, the acids eat away at that substance and quickly make a large cavity - but one that still cannot be easily seen or detected. In this way the enamel becomes undermined. A dentist looking at such a small cavity would think it very easy to restore. However, once the decayed portion of the enamel is removed and the dentin becomes visible, the true extent of the damage becomes obvious. The small cavity becomes a big cavity.

One of the major problems with decay that appears to occur only in the dentin is in the detection. If a radiograph is taken a part of the periodic examination process, we may be able to see dentin decay if it is moderate to extensive. Decay seen on radiographs is typically two to seven times greater in the tooth. Modern high-speed radiographic film and reduced x-ray exposure makes it more difficult to detect early decay on radiographs.

You can prevent decay by using fluoride
The conscientious application of a source of topical fluoride, through either an over-the-counter dentifrice or a prescription fluoride product, and thorough plaque removal are essential. Bonded sealants are also an effective protection against dentin decay. We strongly advice these procedures. Periodic examinations at intervals recommended by the dentist catch decay at the earliest possible time. This is the only way to keep small problems from developing into larger problems.

Click here to check out our blog post on foods that cause decay. 
Click here for our post on how to prevent decay.

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

Smile (Lip) Line

What is the lip line?
How many teeth you show when you smile or speak and how much of each tooth (length) is displayed when you smile broadly, or (at the opposite end of the spectrum) when your lips are at rest, are functions of where your upper lip attaches to your face and how old you are.

3 classifications

There are 3 classifications of "lip line" that dentists use - low, medium, and high. 

A low lip line is one in which very little of your teeth are visible when you talk or smile. Someone with a low lip line will show, at the most, a millimeter or two of the edge of the biting edge of the tooth. 

A medium lip line will allow most of the tooth, up to and including a millimeter or two of the gum tissue, to be visible. 

A person with a high lip line will show all the top front teeth and a significant amount of gum tissue when speaking or smiling.

High Lip Line

Changing your lip line
Dentists (and plastic surgeons) have not been very successful in surgically changing the low, medium, or high lip line. There are some dental "tricks" that can be used in limited situations to reduce the amount of gum display evident with a high smile line. Most of the corrective procedures to improve the esthetics of the situation require significant investments of both time and money. Periodontal (gum) surgery, alone or in conjunction with porcelain veneers or ceramic crowns, is more likely. In extreme cases the only option may be to surgically reposition the entire maxilla (with or without orthodontics). Conversely, the appearance of showing no teeth when talking or smiling is regarded as one associated with advanced aging.

There is another component to how much of your teeth show when your lips are at rest, and it has to do with gravity and time. Your face and lips are composed of soft tissue that is under a constant gravity challenge. Gravity always wins, given enough time. There skin and subskin tissues drop over the years. If, with your lips at rest, you showed about 3 mm of the biting edges of the top two front teeth when you were 20 years old, by the time you are 40, you may show only 2 mm of edge. Someone 50 years of age would show 1 mm, and at 60 years, maybe no tooth is seen when the lips are at rest. The tissues of the human face will drop about 1 mm every 10 years, beginning around age 40. As the facial tissues lose elasticity, they slowly drop. Obviously, some lucky people have better genetics and their faces will stay tighter and the tissue drop will be slower. Correcting the age-related facial tissue drop can be done with plastic surgery - the common face lift.

High, medium. and low lip lines

Genetics or Gravity? 
If you are reading this, then you have either asked questions about your smile and lip line or this issue has been addressed in the broader context of cosmetic dentistry procedures you require. After a thorough examination, we will explain what situation you have and what corrective measures are possible.

If you have any questions about your smile line, please feel free to call our office for a consultation at 512-250-5012.

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.

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.  

Effectiveness
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.