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

Dental Injection

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

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

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



Shots that are less likely to hurt:
Loose tissue: In some locations, the tissue receiving the injection is comparatively "loose," thus making it easy for the injected anesthetic solution to find a space to occupy.

• In locations where the tissue is relatively loose and flabby, the anesthetic solution will flow into the tissue easily and you probably will not feel the injection process much at all. Shots given on the cheek side of a person's upper molars, and probably even this bicuspids, involve this type of tissue and are often remarkably painless.

Shots that are more likely to hurt:
Dense tissue: In other areas, the construction of the tissue will be dense and tight. The anesthetic solution is injected, and it must forcibly make its own space - this is what pinches so much.

• In situations where the soft tissue receiving the injection is relatively tight and dense, the anesthetic liquid must force its way in. This type of instance is where you are likely to feel discomfort. As an example, injections given directly into the type of tight gum tissue that surrounds a person's teeth and covers over their palate are likely to pinch.

Will my shots hurt?
Ask your dentists what to expect with any specific injection. You may be pleasantly surprised to learn what they have to say.

What can I do to ease the pain?
Give your dentist some cooperation with the injection process. The more you cooperate with your dentist, the more pleasant the experience will be.

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

If you have apprehensions about injections, let your dentist know in advance. They can address your concerns and take steps to make the process as pleasant for you as possible.