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

Is dental insurance worth the cost?

You need medical insurance, if only to protect against the cost of an accident or illness so expensive that you could be ruined financially. But do you really need dental insurance?
It’s an interesting question, because you can avoid the most likely causes and expenses of dental problems, decay and gum disease, by brushing and flossing your teeth diligently. But some teeth are more prone to problems, and when they have a problem, the costs can mount quickly.

The price of insurance
About 64 percent of Americans have dental insurance. Nearly all of them have coverage through work or a group plan like AARP, Medicaid, Tricare (for military families) and the federal Children’s Health Insurance Program, according to Evelyn Ireland, executive director of the National Association of Dental Plans, in an email interview.
Most dental preferred provider organizations and regular insurance (indemnity) plans have an average deductible of $50 and a maximum yearly benefit of $1,000, Ireland says. Only 2 percent to 4 percent of Americans with dental insurance use up their yearly maximum allowance.
Dental plans offered through a workplace typically are one of three types:

• Indemnity plan: You choose your provider, and your plan pays a percentage of the fees.
• PPO: Preferred provider organization plans have groups of practitioners who agree to reduced fees for patients within the network. Your costs are lower with network dentists. You may see out-of-network dentists, but it’ll cost you more.
• HMO: Health maintenance organizations cut costs by requiring members to use only providers within the network.

Premiums for group dental plans in 2014 (the latest information available) averaged from $19 to $32 a month ($228 to $384 annually), said the NADP.
Is insurance worth it?
The NADP describes these elements of coverage in a typical plan:

• Preventive care: periodic exams, X-rays and, for some age groups, sealants -- 100 percent.
• Basic procedures: office visits, extractions, fillings, root canals (sometimes) and periodontal treatment -- 70 percent to 80 percent.
• Major procedures: crowns, bridges, inlays, dentures and sometimes implants and root canals -- 50 percent or less.

Orthodontics coverage usually can be purchased as a rider, said the NADP. Cosmetic care isn’t covered.
Dental insurance isn’t always worth the cost. It depends on your plan, your needs and the cost of the services available to you.
In deciding if an insurance plan is right for you, weigh:

• The annual premium
• The cost of the dental care you need
• Your policy’s limit on how much it pays out in benefits and whether you can roll over unused benefits from the previous year
• Policy coverage

“While many dental policies focus on preventive measures by offering two annual visits, you’ll really start seeing the savings with more expensive treatments, like root canals and crowns,” according to Angie’s List.
Help from the Affordable Care Act 
The ACA requires providers to offer dental insurance for children younger than 18. “Although the new act does not require dental coverage for adults, most state marketplaces will also offer dental coverage for adults,” said the American Dental Association. Adult dental coverage may be offered as part of a comprehensive health plan or as stand-alone dental insurance. Here’s more about the ACA and dental coverage:

• The ADA tells how to compare and assess dental plans.
• Use this Healthcare.gov plan locator to find ACA dental plans locally and compare costs.

Dental insurance isn’t the only way to cut dental bills. In fact, 36 percent of Americans have no dental insurance. Here are 10 other ways to cut your costs:

1. Self-pay
It may be less expensive to pay out of pocket than buy a plan. Fees vary by dentist’s office and by geographic region. Here are average costs in the U.S. for several common procedures, from the ADA Health Policy Institute’s 2013 Survey of Dental Fees (the latest data available):

• Teeth cleaning (prophylaxis) adult: $85
• White dental filling (one surface, anterior): $149
• Silver filling (one surface, primary or permanent): $125
• Porcelain crown fused to noble metal: $1,003
• Complete series of intra-oral X-rays: $124

2.  Preventive care
In many cases, the best way to save on dentistry is to take excellent care of your teeth and gums, and to teach children healthy dental routines. For example, did you know that fruit juices, carbonated drinks and acidic foods can help wear away your tooth enamel?
The ADA tells you how to brush correctly, how to floss effectively and offers more information on dental health.
Delta Dental, an insurer, has more tips on preventive care.

3. Cut back to one cleaning a year
Several studies have shown that visiting the dentist twice a year doesn’t deliver notable benefits compared with one exam a year. If you don’t have serious dental issues, you can probably get by with one cleaning annually.
But don’t skip that one annual cleaning and exam. It could save you from costly and serious problems.

4. Discount dental plans
Discount plans charge an annual fee in exchange for discounted services from network providers. Before you buy into a plan, look over its list of covered procedures to see if they’re ones you are likely to use.
PolicyGenius, an independent insurance broker, compared five dental insurance and dental discount plans. Costs vary a lot depending on where you live and because the state insurance marketplaces created under the ACA offer different plans. It’s hard to comparison-shop for dental plans: Companies don’t easily share information on costs and coverage until after you’ve subscribed, PolicyGenius found. Even so, “all five plans we looked at delivered better value than paying cash outright.”
A tip: The cheapest dental plans don’t offer much value, but don’t just go with an expensive plan -- do some careful research. “If you know you’re going to be spending some time in the dentist’s chair soon -- and especially if you require an expensive dental procedure immediately -- the right discount plan could save you hundreds of dollars,” PolicyGenius writes.

5. Request 10 percent off
Some dentists will take 10 percent off the cost of a visit or procedure if you pay at the time of the visit. Some offer a discount for cash.
If your dentist doesn’t provide a discount, ask (politely, of course) if he/she could do so. Or shop around for a dentist, gathering recommendations from friends and then phoning those offices to find out if they offer a discount.

6. Charitable clinics
Look for low-cost or free dental clinics in your community offered by local dentist volunteers.
Find opportunities in your area through America’s Dentists Care Foundation. Another charitable organization with volunteer dental professionals is Dentistry From the Heart, a global nonprofit organization. Or ask your state’s dental association about low-cost care.

7. Dental schools
Dental schools at many colleges and universities around the U.S. often offer free or reduced-cost care. Accredited programs are listed at the ADA website.

8. Federally qualified health centers
Private health centers offering dental services exist in cities and counties across the country. They receive some government funding and charge according to what you can afford. Use the clinic locator at the federal Health Resources and Services Administration website.

9. Consider dental tourism
Dental tourism -- traveling to other countries to get treatment, often at a fraction of the U.S. cost -- is a huge business. Among the top countries that have a thriving dental industry catering to foreigners are Mexico, Thailand, Spain, Turkey, Czech Republic, Costa Rica, Poland, Philippines and Hungary.
“Dental tourism companies and corporate dental chains are increasingly advertising ‘all inclusive’ travel packages that include dental procedures, hotel room reservations, side trips to tourist attractions, and airline tickets to lure international clients,” said an article in the International Journal of Contemporary Dental and Medical Reviews.
Do plenty of research to ensure that you’re getting safe, high-quality care. Some resources:

• The American Dental Association has information and cautions about dentistry outside the U.S.
• OSAP, the Organization for Safety and Asepsis Procedures, tells how to assess infection-control practices in a dentist’s office and gives a checklist for obtaining safe dental care abroad. It cautions:

“The decision to visit another country for dental care should go beyond simply comparing prices or even evaluating the dentists’ expertise. Countries differ in their standards for infection control and safety. The use of fresh gloves, sterile instruments and safe water are not standard practice in all countries. Without these precautions, patients could be infected with diseases such as hepatitis B.”

10. Get out of town
Dentist fees in rural counties typically are lower than in urban areas. Comparison-shop for the procedure you need by phoning offices of ADA member dentists outside your metro area and asking about fees. Here’s how to locate an ADA member dentist.

By: Mariyln Lewis, CBS News
http://www.cbsnews.com/news/is-dental-insurance-worth-the-cost/


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

Doctors, Dentists Seek New Ways to Reach Millennial Patients

Kate Morgan, 25, hasn't seen a doctor for a checkup since before she went to college, when she saw her pediatrician at age 18.

"Nothing's bothering me, I don't have any symptoms, why go see a doctor?" reasoned Morgan, who recently moved from Voorhees, N.J. to Hummelstown, Pa. When she has needed medical care, she either went to the emergency department or visited an urgent care clinic.
For now she has insurance under her dad's policy, but that's ending with her 26th birthday next week. She works multiple part-time jobs, so she can't get employer-based insurance.

"I have no idea how the health insurance marketplace works or if I can afford it," she said. "I haven't looked into it because it's kind of daunting."
Morgan is not alone. According to the 2015 Investing in the Health and Well-Being of Young Adults report, only 55 percent of Americans ages 18 to 25 visited a doctor's office in 2009 and only 34 percent visited a dentist.
There are lots of reasons: feeling invincible, difficulty navigating the health care system, concerns about costs and co-pays, and the inconvenience of making an appointment and seeing a doctor or dentist. Under the Affordable Care America Act (also known as Obamacare), everyone who can afford it is legally obligated to get health insurance or pay a penalty. One of the main reasons some major insurers have cited for leaving the exchanges is the lack of young, healthy people signing up, leaving the exchanges full of older and less healthy people who cost more to cover.

 

How often

How often a person should get a physical exam depends on whom you ask, said Janice Hillman, an adolescent-medicine physician at Penn Medicine.
"A medical provider will say once a year for an annual physical," she said. "But if you ask insurance, they'll say 18-34 year olds are your ideal patient population because they're never sick, so well-checks should be every two years and three years with some insurance plans."
But it's about more than an insurance quagmire. The millennials (19-35 year-olds) are a lost generation for health care, Hillman said. They hate to, as they see it, waste time and money; they don't place as much store as their elders on having a personal relationships with a provider; and they go to the internet for answers. When they do get sick, they choose retail clinics and emergency rooms for the convenience.
"Most millennials cannot believe that our outdated, inefficient system says, 'You're sick today, come in two weeks when I have an appointment for you,'" Hillman said. "So they go where they can be seen at the time and place of their choosing."
The health care system is taking notice. Online apps such as DocASAP and Zocdoc; telemedicine, where doctors work with patients via phone and web; and an increase in physician assistants who can examine, diagnose and treat patients, are gaining popularity. ERs are developing parallel tracks so they can accommodate true emergencies as well as patients who use the ER as a primary care office. Many doctors and hospital systems are communicating with patients through text messages, the favorite tool of the tech-savvy generation.

"The millennials want efficiency, value, to be treated with respect, and customer service, and we have to listen," said Hillman.

 

Pediatrician

For some young adults, that means sticking with their pediatrician. The National Ambulatory Medical Care Survey analysis estimates that there were 700,000 visits to pediatricians by 19-28 year olds in 2002, 1.4 million in 2007 and 2.4 million in 2012.
The fact that they are seeing any doctor is good news, said Patience White, director at the Center for Health Care Transition Improvement, a group that studies the transition from pediatric to adult health care.
Karly O'Toole, 24, doesn't feel regular checkups are worth the trouble. "The doctor that I had is in West Chester and it's not easy to get there," said the Center City resident. An account executive still on her parents' insurance, she doesn't want to take time off from work or lay out the co-pay.
"It's more of a chore to me than it is a benefit. If I'm feeling okay, I don't feel the need to get a checkup."
O'Toole does see a specialist for a recurring heart issue and sees the gynecologist for birth control. But for anything else she'll consult her mom or the pharmacist, and if necessary, go to an urgent care facility. She eschews dentists.
Dental care recommendations include a cleaning every six months, four basic x-rays once a year and a full set of x-rays every four to five years, said dentist Jeff Cabot, owner of Queen Village Family Dentistry. But there's an obvious gap in the millennial age group, he said.
"Dentistry is best done on a routine basis," he said, noting that by the time there's pain, what could have been a simple filling might turn into a root canal or crown - or even systemic health problems.
"Gum disease increases your risk for heart disease, diabetes, low-birth-weight babies of pregnant mothers, and there's a connection with Alzheimer's disease because it's literally an infection that can travel through your entire body," he said.
Cabot chalks up the reluctance to young people feeling invincible, and also fear of the cost of dentistry.

"A lot of people think it's expensive but if you do it properly it can actually reduce your overall costs," he said.
That's what happened to Morgan. Though she was cavity-prone as a kid, until last year, she hadn't seen a dentist in seven years. When she finally did go, she needed extensive work. "Now I go regularly and am very much committed to dental care," she said.
"But I've yet to do the same with regular health care."

By: Terri Akman
http://www.philly.com/philly/health/20160918_Doctors__dentists_seek_new_ways_to_reach_millennial_patients.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

Back to School Means It's Time for a Dental Checkup

Some states have gone to great lengths to ensure that children start out the school year on the right foot.

In Illinois, for example, children entering kindergarten, second and sixth grade must have a dental examination performed by a dentist before the end of the previous school year or provide proof that one is scheduled.

"Dental examinations are needed during second and sixth grades as the back teeth, or molars, usually erupt during this time," said Dr. Darryll Beard, president of the Illinois State Dental Society. "This allows your dentist the opportunity to apply dental sealants to these teeth to help prevent future decay."

The Illinois state law requires compliance from students in all public, private and parochial schools. If the child has had a recent dental examination, or one completed within the 18 months of the end of the school year, the requirement has been fulfilled.

"With the undeniable link between oral health and overall health, children will have a much better school year with less absenteeism and more confidence if dental issues are regularly addressed," said Dr. Beard.

The beginning of the school year is an appropriate time for dentists to remind parents and caregivers about some of the risks associated with tooth decay and ways to prevent it.

Decay is on the rise in some children, and many dentists believe that diet and overconsumption of soft drinks are to blame. Allowing children to sip on sugary snacks and drinks for prolonged periods of time can increase the risk of decay.

During a professional cleaning and oral exam, the dentist removes plaque bacteria from teeth to help fix early decay. Dentists can also advise parents about effective preventive measures for children's teeth, such as the use of sealants and fluoride, and brushing and flossing techniques, as well as mouthguards for any sport or activity that could result in a blow to the face or mouth.

For more information about dental health, visit ADA.org.
Colgate Care Center
http://www.colgate.com/en/us/oc/oral-health/life-stages/childrens-oral-care/article/oral-health-tips-for-summer-0714

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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

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.