Blog of the Day: Provisional Crowns

                                                                *qacdentistry.co.uk

When a crown is being fabricated for you, the tooth or teeth treated will have an acrylic provisional (temporary) restoration that is retained by temporary cement. This is part of the treatment and does not warrant an additional fee.  However, there are several instances when provisional crowns need to be made as a separate and intermediate procedure. Because of extra time and work involved, beyond that needed for a crown or bridge, there is a separate fee for the procedure.

One situation where a provisional crown warrants a separate fee involves a tooth or teeth that are severely decayed or broken, where the vitality of the nerve or the periodontal (gum) health is in question. It may be necessary to rebuild the tooth as soon as possible so that the health of the nerve inside the tooth, and the periodontal tissue surrounding the tooth, can be evaluated over time before proceeding with the final crown. When multiple teeth need this treatment, it is customary to place the provisional crowns on each at the same time. If each tooth is taken to completion individually before beginning the next tooth, there is too much opportunity for the remaining damaged teeth to deteriorate further, thereby complicating treatment and adding to the total cost. Provisional crowns may be in place for several months before further treatment is started on the tooth,  after which time the tooth will need to have further preparation and a new provisional crown made.

When the nerve in the damaged tooth has a chance of dying, it is easier to save the tooth with root canal therapy if the final crown has not been placed. It often takes months for the health of the nerve to be determined. And, in fact, despite using a long-term provisional crown, the nerve may die years after the final crown is placed. When that happens, the access for the endodontic treatment is made through the crown. With respect to the periodontal tissues, if they are infected or in poor health, they must be healed before final impressions are made. Periodontal treatment coupled with a well-fitted provisional crown will promote proper healing. After the periodontal tissue is healthy, its position with respect to the crown margins will change, and the tooth will be re-prepared and a second provisional restoration will be made.

Another reason for long-term provisional crowns to be placed is to stabilize loose teeth and determine the necessary support for the final cast crowns. When a tooth involved in support for a bridge or splint has a questionable prognosis, it is a good idea to make a provisional bridge first and let the tooth (or teeth) function together for some time to see how well they respond. If the tooth turns out to be hopeless, it can be removed. If teeth are restored in quadrants at a time (three, four, five, or more), it may be necessary to do the opposing arch in long-term provisional crowns in order to establish the ideal occlusal (biting) relationships between the arches.

There are many and varied reasons why long-term provisional bridges might be needed. They might stay in place from months to years, especially in very complicated cases such as many teeth that are broken down and moderate to severe gum disease needing correction before the crowns are finally placed. In larger cases, financial limitations may dictate that treatment be phased over a longer time frame. Rather than let the teeth get worse during this time, long-term provisional crowns are made to hold things in place until the treatment can continue.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information. 

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Blog of the Day: The Wisdom on Wisdom Teeth

                                                                    *health.usnews.com

"You know the old colloquialism, let sleeping dogs lie? Well these dogs are not sleeping," warns Richard Haug, executive associate dean at the University of Kentucky College of Dentistry. Ongoing study links even pain-free wisdom teeth to early gum disease that worsens over time, sometimes causing havoc far beyond the mouth. Indeed, pregnant women with gum disease around their wisdom teeth appear to be much more likely to give birth prematurely than unaffected pregnant women. The latest data suggest that as many as 80 percent of people will develop problems with their wisdom teeth.

But controversy lingers about when to take action. Most experts no longer believe that crowding is a concern, but the American Association of Oral and Maxillofacial Surgeons typically recommends pre-emptive pulling in young adulthood, before symptoms arise, when roots haven't yet fully formed and surgical risks are lowest. "If you have to have them out when you're 45, you will not enjoy that," promises Tony Pogrel, chair of the department of oral and maxillofacial surgery at the University of California-San Francisco.

Andrew Ziolkowski, 59, can attest to that. A dental checkup a couple of years ago revealed that cysts had formed around his impacted wisdom teeth and damaged his jawbone—a surprise to Ziolkowski, who hadn't experienced any pain. The necessary surgery required that his jaw be wired shut for weeks afterward and resulted in some nerve damage, a rare complication. "To this day I have no sensation in my lower lip and chin," says the architect from Germantown, Md.

Nonsurgeons are less gung-ho about preventive pulling. "If they're not causing pain or infection, and they're coming in straight, I usually take a wait-and-see approach," says Cynthia Sherwood, a general dentist and national spokesperson for the Academy of General Dentistry. Those who wait are advised to have their wisdom teeth checked yearly, since they are tough to keep clean and may get infected or shift position. "You're committed to that treatment plan until you die," says Thomas Dodson, associate professor of oral and maxillofacial surgery at Massachusetts General Hospital.

Because wisdom teeth don't form until around age 5, Anthony Silvestri, director of dental anatomy and occlusion at Tufts University's dental school, foresees a day when lasers will be used to prevent that from happening. He and colleagues have had success in animals. "It doesn't make sense," he says, "that everyone should be having surgery for a useless tooth."

Article from: health.usnews.com

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Blog of the Day: An Overview of Dentures

                                                                *hooperdentistry.com

Dentures are removable appliances that can replace missing teeth and help restore your smile. If you’ve lost all of your natural teeth, whether from gum disease, tooth decay or injury, replacing missing teeth will benefit your appearance and your health. That’s because dentures make it easier to eat and speak better than you could without teeth—things that people often take for granted.

When you lose all of your teeth, facial muscles can sag, making you look older. Dentures can help fill out the appearance of your face and profile. They can be made to closely resemble your natural teeth so that your appearance does not change much. Dentures may even improve the look of your smile.

Types of dentures:

Conventional. This full removable denture is made and placed in your mouth after the remaining teeth are removed and tissues have healed, which may take several months.

Immediate. This removable denture is inserted on the same day that the remaining teeth are removed. Your dentist will take measurements and make models of your jaw during a preliminary visit. You don’t have to be without teeth during the healing period, but may need to have the denture relined or remade after your jaw has healed.

Overdenture. Sometimes some of your teeth can be saved to preserve your jawbone and provide stability and support for the denture. An overdenture fits over a small number of remaining natural teeth after they have been prepared by your dentist. Implants can serve the same function, too.

New dentures may feel awkward for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place. It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should go away. Follow-up appointments with the dentist are generally needed after a denture is inserted so the fit can be checked and adjusted. If any problem persists, particularly irritation or soreness, be sure to consult your dentist.

Even if you wear full dentures, you still have to practice good dental hygiene. Brush your gums, tongue and roof of your mouth every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque.

Like your teeth, your dentures should be brushed daily to remove food particles and plaque. Brushing also can help keep the teeth from staining.

Rinse your dentures before brushing to remove any loose food or debris.

Use a soft bristle toothbrush and a non-abrasive cleanser to gently brush all the surfaces of the dentures so they don't get scratched.

When brushing, clean your mouth thoroughly—including your gums, cheeks, roof of your mouth and tongue to remove any plaque. This can help reduce the risk of oral irritation and bad breath.

When you’re not wearing your dentures, put them in a safe place covered in water to keep them from warping.

Occasionally, denture wearers may use adhesives. Adhesives come in many forms: creams, powders, pads/wafers, strips or liquids. If you use one of these products, read the instructions, and use them exactly as directed. Your dentist can recommend appropriate cleansers and adhesives; look for products with the ADA Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.

If you have any questions about your dentures, or if they stop fitting well or become damaged, contact your dentist. Be sure to schedule regular dental checkups, too. The dentist will examine your mouth to see if your dentures continue to fit properly.

Article from: mouthhealthy.org

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Blog of the Day: Sports & Energy Drinks Damage Teeth

                                                                     *monicacardone.com

Sports drinks hit the wire today with a red light that their level of acidity is increasingly responsible for irreversible damage to teeth, especially amongst adolescents and younger adults, their predominant target market.

The report is published in the May/June 2012 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry. Lead author of the study, Poonam Jain, BDS, MS, MPH confirms the findings:

"Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are 'better' for them than soda ... Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid."

The acidity levels are responsible for eroding tooth enamel, the hard, shiny, white outer surface of the teeth. Once this is compromised, the inner softer dentine can start to decay quite easily, with the tooth cavity making a perfect breeding ground for bacteria.

Researchers looked at acidity levels in 13 different sports drinks and found levels varied greatly between both brands and different flavors of the same brand. Scientists immersed samples of tooth enamel in each beverage for 15 minutes and then replaced them in artificial saliva for two hours. The cycle was repeated four times per day for five days to mimic the equivalent of drinking four smart drinks per day. At all other times, the teeth were stored in the artificial saliva.

After just five days, the damage was already evident, with energy drinks causing double the damage of more balanced sports drinks. Some fifty percent of US teenagers are reported to consume energy drinks and as many as sixty two percent consume at least one sports drink per day. Parents and young adults should be made aware of the downside to the heavily marketed products, says the report.

Pooman continues that :

"Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are 'better' for them than soda ... Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid."

While AGD spokesperson Jennifer Bone, DDS, MAGD cites her experience with patients :

"Teens regularly come into my office with these types of symptoms, but they don't know why ... We review their diet and snacking habits and then we discuss their consumption of these beverages. They don't realize that something as seemingly harmless as a sports or energy drink can do a lot of damage to their teeth."

Dr. Bone advises her patients to minimize their intake of sports and energy drinks and also consider chewing sugar free gum to promote saliva production, as well as washing the mouth with water, to assist the body in returning the mouth to its natural pH. a little quicker. Another good point she makes is to wait at least an hour before brushing teeth to avoid rubbing the acids directly onto the tooth surface.

Although marketers might not want to admit it, natural fruit juices and especially coconut water which has excellent re-hydrating properties, might make a better alternative to smart drinks, which are often loaded with sugar, caffeine and artificial ingredients, and can be costly, not only in purchase price, but also in dentistry bills.

Article from: Rupert Shepherd, Medical News Today

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Blog of the Day: Fluorosis, Mottled Enamel, and White Spots

Fluorosis and Mottled Enamel

                                     *colgateprofessional.com

Fluoride is the dental marvel of our lifetime and a definite benefit to the oral health of our nation. But too much of a good thing can cause problems! Fluorosis of the teeth and mottled enamel can occur when there is too much fluoride uptake by the teeth while the teeth are forming. Prescription fluoride vitamins of the proper dosage are normally given to children. But a child can get too much fluoride if it’s available from multiple sources. Children with access to a public water system containing fluoride may also be prescribed fluoride supplements or they may swallow fluoride-containing toothpastes, mouthrinses, or certain fruit drinks, which may increase their fluoride intake above recommended levels. Fluorosis is a condition in which teeth form with unsightly dark spots on them. Some medications and illnesses can also cause a similar problem. These dark spots, most often seen on the permanent teeth, are not more prone to decay, just unattractive. One, several, or all of the teeth can be affected. The color change (usually brown/orange or 

flat/opaque white) can be mild, moderate, or severe.

Treatment Options

Generally speaking, three solutions are possible. Sometimes the stain is very superficial and can be merely polished off. It does not return. There is no pain involved in this procedure. The enamel is simply polished and made smooth again.

Many times it is quite easy to whiten the brown spots to match the surrounding tooth color. This is most often an in-office procedure (as opposed to whitening yellow teeth, which can be done at home with custom-made tooth-whitening trays). Strong whitening chemicals are placed on the dark area and activated by light or heat or both. Several applications (in the same visit) are done, and the spot usually disappears in one visit!

If the spot is very dark or goes deep into the enamel, the whitening may work, but not enough to remove the total discoloration. In this instance, a combination of whitening and a bonded composite tooth-colored restoration will solve the problem. The tooth is whitened, and then the remaining dark area is prepared (drilled) to receive a bonded-type filling. The natural color of the tooth is matched and a resin is bonded into the prepared section. The color match can be nearly perfect, and patients see a big improvement over what was there before.

White Spots

White spots on teeth can also be caused by too much fluoride, illness, medication, or an interruption of the proper enamel formation. The spots may be barely visible, or they may contrast with the surrounding tooth. If the teeth dry out, as in the case of a patient who routinely breathes through his or her mouth, the white spots become quite prominent. Most of the time, these spots can be simply polished off. If they go too deep into the tooth, however, they must be restored with tooth preparation and bonding of a tooth-colored material. Once removed, they do not return. White spots affect the permanent teeth more than baby teeth. While they cannot be bleached out, as can fluorosis discolorations, whitening of all the teeth may make them less noticeable.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: omnidentalgroup.com for more information. 

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Blog of the Day: Flap Procedures

Periodontal flap procedures may be the most universal and commonly used of all periodontal surgical techniques. A flap is a section of gum tissue that has been freed from its underlying attachment in order to gain direct vision and access to the periodontal structures that are underneath. These periodontal structures are not normally accessible to the patient or dentist. The length and shape of the flap relate to the particular region of the surgery and the nature of the required treatment. An excellent analogy is that the procedure is like lifting the flap of an envelope to look at the contents, then closing the flap when done.

Indications
Flap procedures are indicated in cases of periodontal disease with active or non-responsive pockets that are too deep to be treated successfully with scaling, root planing, or curettage. The flap may be raised to treat one tooth, a sextant (six teeth), or a quadrant (eight teeth). The advantage of the flap procedure is the shorter treatment time needed due to the improved access to the affected area. The root surfaces can be seen directly for better and more accurate cleaning. Pockets can be selectively reduced, or regeneration of lost tissues can be attempted. Many times the flap procedure is used strictly for correcting soft tissue defects. At other times, when the damage is more severe, the flap is used to gain access to the hard periodontal supporting structures for osseous (bone) surgery. 

Procedures
Preoperative radiographs, clinical observation, and periodontal charting assist in planning which procedures are required during the flap procedure. However, none of these procedures give a direct view of the treatment site. Flap procedures are most often done by a periodontal specialist (a periodontist).  While the periodontist may have a specific treatment plan for treating the diseased areas, when the flap is raised, the method for treating your particular problem may be modified. It may involve regenerative procedures. Bone grafting with natural or synthetic bone may be done. Guided tissue regeneration (GTR) may be attempted. These procedures may be done separately or in conjunction with one another. Other options include direct scaling and root planing of calculus (tartar) that might exist and the reshaping of a bone in a particularly difficult area.

The procedure involves the use of a local anesthetic so there is no pain during treatment. After the procedure is done, there is normally little postoperative discomfort. Prescription medication may be provided to deal with this.  It is uncommon for surgical problems to arise after the flap is closed. Sutures will be used and a periodontal dressing (pack) may be placed for one week. After that time, the pack may be left off or reapplied, depending on your individual healing progress. Flaps normally heal quickly and well. Four to eight weeks after the procedure, the tissue appears normal. If indicated, further dentistry (fillings, crowns, etc.), can then be completed.

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Blog of the Day: Oral Health - Americans Score Badly

A new survey from the American Dental Association (ADA) shows that Americans seriously need to clean up their act when it comes to oral health. The ADA's newly launched website, MouthHealth.org that aims to improve oral health reveals that Americans' average score was a 'D' in the survey's range of 'true or false' questions, which included questions like how often should teeth be cleaned, what causes cavities and the age of a child's first dentist visit.

William R. Calnon, D.D.S., ADA president and a practicing dentist in Rochester, N.Y. stated: "The results of the survey were quite shocking and really show how important it is for people to become more involved in their own oral health."

Nine in ten adults aged between 20-64 years have had cavities in their permanent teeth, according to the National Institute of Dental and Craniofacial Research (NIDCR), and almost half of children between the ages from 2 to 11 years have already had cavities in their baby teeth. It is therefore not surprising that the most common chronic disease in children is dental disease.

ADA's new consumer website, www.MouthHealthy.org, which was launched on June 25, provides information on prevention, care and treatments to improve and maintain dental care in addition to the dental IQ test so that visitors to the site can test their own knowledge.

Dr. Calnon pointed out: "Oral health is a critical part of overall health. MouthHealthy.org will help empower people to take charge of their oral health." ADA's national survey, conducted in May 2012, which involved a nationally representative sample of almost 1,500 adults revealed:

• 90% of people believe they should clean their teeth after every meal, whilst ADA recommends cleaning twice a day
• 81% of people believe that cavities are caused by sugar. However, it is not the actual sugar that causes cavities, but germs in the mouth that feed on sugar and produce acid that attacks the teeth enamel, which over time wear down the enamel to such an extent that cavities form
• 75% have no idea at what age they should take a child to the dentist for the first time. According to ADA recommendations, a child's first dentist visit should be within six months after the first tooth appears or before the child's first birthday
• 65% of people think their toothbrush should be replaced twice a year, when it should be replaced every three months
• 59% of people are unaware that germs that can cause cavities can be passed from person to person (The survey included a margin of error of + or - 2.6 points.) 

Answers and other questions like these can all be found on the new website, Mouthhealthy.org, which includes features like dental tips and information on the top 10 dental symptoms for all age groups, how to deal with dental emergencies, an A-Z on oral health topics, and how to find an ADA member dentist and ADA Seal of Acceptance products, in addition to featuring videos, tips and activities.

The website also features a special children's section to make oral health care more interesting and fun for children, including bilingual videos of the famous Sesame Street characters Elmo and Abby Caddaby that teach oral health through Sesame Workshop's latest oral health outreach initiative called Healthy Teeth, Healthy Me.

Dr. Calnon declared:

"MouthHealthy.org is an extremely valuable resource for individuals and families to take care of their oral health. Simple, yet important measures such as eating a balanced diet, brushing twice a day with fluoride toothpaste, flossing daily and visiting a dentist regularly can help prevent dental disease. Teeth are meant to last a lifetime, and the ADA wants Americans to be mouth healthy for life."

He added that any adverts on the MouthHealthy website will be strictly scrutinized under ADA's advertising guidelines. Adverts for sports drinks and soda pops for instance will not be accepted, as these products are contradictive to the website's message of promoting dental health.

Dr. Calnon stated: "MouthHealthy.org is, first and foremost, a source of credible oral health information for the public. America's dentists are committed to help people be mouth healthy for life."

Article from: Petra Rattue, Medical News Today

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