Impacted Teeth

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

The graphic above shows what an impacted tooth looks like under the gumline.

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 diagnosis 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 too close 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 it is 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 to allow the impacted tooth be 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.

If you have any questions about impacted teeth, please feel free to ask us at (512)250-5012.


Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.

Acid Reflux and Dental Health

Teeth are so hard you would think they would be indestructible and that they would not be adversely affected by anything.  Due to the strength of enamel and bone, they should remain the same from the day the teeth come into the mouth to the day they are no longer needed.  Unfortunately, this is far from true.  While we would like to think of teeth as being strong and unchanging, most people know that teeth can be damaged by tooth decay -- causing bacteria. We know, too, that teeth can be damaged by mechanical means -- attrition caused by tooth grinding and clenching and abrasion caused by improper toothbrushing.  However, few people know that there is a third factor that can destroy teeth -- chemical erosion.

Chemical erosion is caused by excess acid coming in contact with a tooth for extended periods of time.  The acid attack can be self-inflicted (bulimia) or more commonly from a problem with acid reflux.  In acid (gastric) reflux, the acidic and partly digested contents of the stomach are returned back into the throat and oral cavity.  Normally, the lower esophageal sphincter muscle (LES), connecting the esophagus with the stomach, closes once food passes into the stomach.  This closure prevents the stomach contents from flowing back up into the esophagus.  Acid reflux occurs when this sphincter does not work properly and allows acidic fluid to return to the esophagus and higher -- the mouth.

This condition can actually be noted by a dentist long before it is acknowledged by a patient or physician.  The dentist will see a characteristic smooth and circular erosion of the cusp tips of the lower first molars.  The cusp tips (bumps on a tooth) lose their peak, flatten, and become concave.  Soon the enamel cover is broached and the underlying dentin is exposed.  Because dentin is "softer" than enamel, the erosion can progress more quickly.  This acid erosion has a very different appearance from tooth loss due to a mechanical etiology.  Attrition and abrasion have a very sharp, edged, and well-delineated look.  Chemical erosion has a softer and more rounded presentation and is localized first to lower first molars (lower first molars are the first permanent molars to erupt into the mouth) so that the permanent teeth have the longest potential exposure.  When the acid refluxes (returns) to the mouth, it pools mostly around the lower first molars.  This is the site of the most erosive features.

A significant portion of the population experiences acid reflux at least once a month.  About 25% of those who are affected are unaware of their problem.  Infants and young children can be affected, and there may be a genetic component to this disease.  Early diagnosis from erosion of the permanent lower first molars can be made as early as 7 or 8 years of age.  A hiatal hernia may weaken the LES and cause acid reflux.  Diet and lifestyle contribute to acid reflux.  Chocolate, peppermint, citrus, tomatoes, fried or fatty foods, coffee (especially acidic coffee), alcoholic beverages, garlic, and onions are foods to avoid.  Weight gain (also weight gain associated with pregnancy) and smoking (by relaxing the LES) may be contributing factors.  Further information may be obtained from the Internet by going to a search engine and typing in "acid reflux," "gastric reflux," or "gastroesophageal reflux diseas (GERD)."

These foods are among a list that can cause acid reflux.

As is true with most medical and dental problems, the earlier the diagnosis is made, the easier it is to treat.  If we have brought this condition to your attention, we ask that you speak to your physician.  Variable factors include the nature and severity of the problem, as well as frequency and the type of fluid that refluxes from the stomach.  Change in diet, eating habits, and/or medication (over-the-counter or prescription) can be effective.  Dentally, once the enamel is broached and the dentin becomes visible, it is recommended that the affected areas be protected by covering them with an enamel replacement -- a tooth-colored bonding material.  This material not only protects the dentin and enamel but it also may be more resistant to the acid than is naturally occurring dentin.  Many times, drilling preparation is not needed.

If you have any questions about acid reflux, please feel free to ask us at (512)250-5012.

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.

Crown Lengthening Procedures

A crown lengthening procedure is necessary when there is insufficient tooth structure remaining clinically visible or accessible for proper retention of a cast restoration (a crown or onlay) or for routine restoration (filling).  It is also necessary if the gum tissue has poor position or contour or for improving the cosmetic appearance of the teeth.  It may also be required in order to make a successful impression for a cast restoration.  The soft gingival tissues will be modified, repositioned, or reshaped so that a restoration can be placed.  If the tooth has been severely decayed, crown lengthening may be necessary to more completely expose the decayed area and allow better preparation for the final filling.

Many times, this crown lenthening will be minimal and it can be done in our office.  This may involve electrosurgery or a scalpel and suturing procedure.  We will select the method based on your individual circumstances.  If the modification is extensive, involving many teeth or the supporting bone, you may be referred to a periodontist (gum specialist) for evaluation and treatment.  At times, after the crown lengthening is completed and the tissue is healed, the tooth may exhibit temporary sensitivity to thermal changes.  With time, the sensitivity decreases.  Also, we do not want the tissue that is removed to grow back.  If it does grow back, which can happen, it may need to be removed again.

Restorations placed on sound tooth structure will last the longest possible time.  One tooth or several teeth may be involved in the lengthening procedure.  In many cases, it would be impossible to obtain a satisfactory result if the crown lengthening were not performed.  Postoperative discomfort is usually minimal unless the crown lengthening has been extensive, as when the underlying bone must be recontoured.  Over-the-counter pain relievers are usually very adequate.  Healing time varies, depending on the extent of the procedure.  Sometimes we will elect to finish the restoration or make the final impression at the time of the crown lengthening; other times we must wait for the site to heal.  Healing time may be 4 to 6 weeks.  This will be discussed with you when the crown lengthening procedure is suggested.

If a crown lengthening is recommended, you should have it done, or the final restoration may be compromised and the chance of obtaining a clinically successful restoration would be seriously reduced.

If you have any questions about the crown lengthening procedure, please feel free to ask us at (512)250-5012

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.

When Radiographs (X-Rays) Are Necessary

We only take necessary radiographs at this office.  A necessary radiograph is one that is used to diagnose the extent of a dental problem that we already know exists, such as a broken tooth, a cavity, or an abcess.  We also must use radiographs as part of an initial or periodic oral examination.  In these examinations, radiographs are used to determine whether there are problems in a beginning stage that cannot be seen merely by looking at the tooth or area.




We can only see about 50% of your oral conditions without radiographs.  Radiographs allow us to see, among other things, in between the teeth, at and below the margins of fillings and crowns, and the location and density of bone that supports your teeth.  With this information we can make a full diagnosis, treating little or hidden problems before they become really big problems.  Radiographs are not considered a preventative measure.  However, they do allow us to diagnose and treat a problem early, thus preventing it from becoming worse.


Sometimes we must take several radiographs of one particular area.  Radiographs are only a two-dimensional, black and white representation of a three-dimensional, colored tooth and bone.  Radiographs taken from different angles give a more three-dimensional and therefore truer look at various anatomic features.  We will have a much clearer picture of kind, size, and locations of any problems.

The healthier your mouth is and the more unremarkable your dental history, the fewer radiographs we need to advise.  The more dental problems you have had, the more monitoring and therefore the more radiographs we will need.  However, if we don't take the radiographs, the problem will grow undetected and even more radiographs than originally advised may be necessary.

Radiation Safety
We are very concerned with radiation safety.  Appropriate protective lead shields are always provided to you.  We work in the office around the radiograph units all day, every day.  We have a vested interest in taking only necessary radiographs for both your health and ours.  Be assured that the only radiographs we recommend are those we need in order to accurately diagnose and treat.

If you have any questions about radiographs, please feel free to ask us at (512)250-5012.

Prevention of Dental Disease in Infants and Children

There a  number of positive steps that you can take to ensure that your child has few, if any, cavities and dental-related problems.  A daily routine of proper and effective oral self-care (toothbrushing and dental flossing) is the most important part of prevention.  Scheduled visits with the dentist and dental hygienist for examinations and prophylaxis (cleaning) procedures are also very important for your child's dental well-being.  These suggestions will help keep your child's teeth and gums disease-free.

1.  Clean your infant's teeth daily with a wet washcloth or a wet two-inch-square gauze pad.
2.  Floss your child's teeth daily until the child can develop the ability to do it alone.  This may not be an easy transition, but it is well worth the effort.
3.  Once the teeth can be seen breaking through the gum tissue, night bottles should contain only water.  Fluids from the night bottles pool behind the teeth while the infant sleeps.  Night bottles containing milk, juice, punch, soda, etc. can cause extensive decay.
4.  If you do not live in an area with fluoridated water, the infant should be given a fluoride vitamin supplement.  Dosage will depend on the age and weight of the infant.  This should continue until the child develops wisdom teeth -- well into the teen years.  Your pediatrician or your dentist can write a prescription for these very important systemic fluoride vitamins.
5.  Children do not develop the dexterity to properly brush and floss their own teeth until about age 6 or 7.  You must make sure that the job is done well, even if it means doing this oral self-care for them.  Your own good example of brushing and flossing your teeth daily will greatly enhance your child's willingness and abilities in this area.
6.  Your child's first visit to the dentist should be as an infant, as teeth are just beginning to erupt.  During the visit we will give you guidelines as to what you can expect in terms or oral development and what type of nutrition and oral self-care tips are appropriate for your child.
7.  Your child's first treatment visit to the dentist should take place at 2.5 years of age.  An examination, cleaning, and fluoride treatment will be completed at this time.
8.  The topical fluoride treatment given at the time of the child's regular cleaning appointment is important.  It helps make the teeth that are already in the mouth stronger and more resistant to decay and plaque accumulation.  Systemic fluoride vitamins strengthen the enamel of unerupted teeth.  Topical fluoride takes over after that.
9.  A plastic coating known as a sealant can be placed on the chewing surfaces of the back teeth.  This sealant can reduce the incidence of decay on the treated surfaces by 90%.  It should be placed on most back teeth, both premolars and molars, as soon as it is possible to keep these teeth dry enough for bonding the sealant in place.  It is sometimes placed on baby teeth in special situations.  A separate handout is available that will cover this topic in more detail.  Sealants are usually applied when children are about 6 years old.  The dentist or hygienist will advise you as to when he or she believes the sealant can be successfully placed.
10.  When your child can understand and perform the "rinse and spit" routine, it is time to begin using fluoridated mouthrinse.  This is not a mouthwash used to cover bad breath.  It is actually a nightly supplement to the topical fluoride treatments your child receives at the dentist's office.  However, it is not nearly as strong as the office version.  This is not a prescription medication.

By faithfully following these suggestions, your child may never develop any decay.  If decay should begin, it will be small and easy to treat.  Nothing replaces thorough daily brushing and flossing or good eating habits.  Routine dental examination and cleaning appointments are vital.  You will find that following these instructions will prove to be very effective in helping your child to maintain optimal dental health.

If you have any questions about dental disease prevention, please feel free to ask us at (512)250-5012

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.

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 to remain in proper alignment.  It is very 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 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 become exposed.  All this can happen if one 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 tip of 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 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 exceptions, 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 (crown/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 than removable dentures.  A removable partial denture is held in place by metal clasps 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 about replacing missing teeth, please contact us at (512)250-5012.

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.
 

Tried and True Ways to Get Cavities (If You Are Into That Sort of Thing)

A PRIMER ON HOW TO GET ALL THE DECAYED TEETH YOU WANT AND DESERVE...

Decay starts on teeth in specific locations in a fashion that is almost entirely dependent on what you do.  This primer will describe the different types of cavities and what YOU can do to ensure that you get all the rotten teeth you want.

1.  Cavities can start on the biting surfaces of teeth.  In order to get decay in these areas, do the following:
     a. Whether a child, teenager, or adult, do not get protective, painless sealants on your teeth.
     b. Daily and as often as possible, eat and drink foods that have high sugar content.
     c. Eat sticky candy as often as possible.
     d. Do Not brush your teeth daily.  Do Not use a fluoride-containing mouthrinse.

If you desire cavities, under no circumstance should you use mouthrinse and a toothbrush.

2.  Cavities can start between your teeth.  These are called nonflossing cavities.  To get this specific type of decay:
     a. Do Not floss your teeth properly every day.  Rationalize and find excuses not to floss your teeth.  If this proves difficult, only floss the teeth you want to keep.
     b. Do Not use a fluoride-containing mouthrinse on a daily basis.

3.  Cavities can start along the gumline (where the tooth appears to exit the gum tissue).  These are a special type of cavities.  They can progress very quickly to the point where you might even need a root canal!  To get quick and large cavities in these areas (especially back teeth):
     a. Be sure to suck on sugar-rich hard candies, cough drops, and breath mints throughout the day.
     b. Do Not brush your teeth properly.  Make sure the toothbrush bristles do not come in contact with the tooth-gum junction.  If you find this proves hard to do, let the dental hygienist show you how to do it properly and then do the opposite of what you are told.
     c. Do Not use a fluoride-containing mouthrinse.

4.  If you are missing teeth:
     a. Do Not get them replaced in a timely fashion.  The remaining adjacent and opposing teeth will then be able to move to new areas that are difficult to clean and be more prone, not only to decay, but to gum and chewing problems as well.

5.  Do Not see the dentist and dental hygienist on a routine basis (2-4 times per year, depending on your personal situation) to have your teeth checked and cleaned.  If you do go, the dental professionals may find and treat decayed teeth when the decay is minimal.  They are not inclined to let the cavities grow properly.  In fact, if we find the decay when it is really small, we may be able to treat and remineralize the incipient (beginning) decay without even using a drill or having to give an injection!

Under no circumstances use sugar-free gum or mints.  Some of these products have an additive (RECALDENT) in them that has been shown to make enamel stronger and more decay-resistant.  The RECALDENT promotes enamel remineralization.  This could slow down the decay process or even keep some cavities from forming.

If you adhere strictly to the above rules, you will ensure that you get the most and biggest cavities you possibly can.  The responsibility for growing cavities is yours alone.

Information directly from, "Dental Practice Tool Kit: Patient Handouts, Forms, and Letters," 2004, Elsavier Inc.