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.

Basics of Cosmetic Dentistry

The goal of cosmetic dentistry is to enhance, improve, or change the appearance of your teeth. In today's society, appearance is very important. While judgment based solely on appearance may be superficial and not reflective of who you really are, it can still affect how people think of you. When you talk, people focus on your face, your eyes, and teeth. People notice a natural looking mouth, teeth, and smile. An unsightly mouth due to visible cavities, defective fillings, gum disease, or crooked or misshapen teeth is noticed, too. People will often form opinions of you based on what they see.

 








You can get an objective look at how other people see you. Get about 18 inches away from a mirror. This is about as close as most people get to you when you speak with them. If you get any closer to the mirror, the light will not be right and you will not get a true picture of how your teeth look. Smile, talk, laugh, and observe which teeth are visible and what they look like. Then ask yourself, "If I could wave a magic wand over my teeth and change anything I don't like, what would I change?" Write it down, then read on.

Many people think of dentistry as fixing cavities, root canals, false teeth, caps, and gum disease. But you will be fascinated by what we can do to improve your appearance. Here is just a partial list of dental procedures that can improve the way your teeth look. Click on the yellow text to read more about each procedure.

- Replace discolored fillings in front teeth
- Whiten teeth to a lighter color
- Straighten crooked teeth with orthodontics or recontouring your natural enamel
- Close up spaces between teeth
- Porcelain or resin veneers to change the shape and alignment of teeth (bonding)

- Place tooth-colored fillings in back teeth (instead of silver/metal fillings)
- Porcelain or resin inlays or onlays for back teeth
- Cosmetic periodontal surgery to even out gum tissue that is crooked
- Restoration of worn and short teeth to their proper shape
- Fill in toothbrush abrasion notches
- Cover missing gum tissue due to recession with soft tissue grafts
- Replace missing teeth with bridges or implants
- Replace defective and unsightly crowns (caps)
- Cover stained root surfaces
- Remove stained fracture lines from enamel
- Restore chipped teeth (bonding)
- Make teeth appear longer
- Make teeth appear shorter

Costs for these cosmetic procedures vary according to the extent of treatment. Tell us how you wish your smile looked. Then we can tell you what we can do, how long it will take, and what it will cost. Most of the time, people are pleasantly surprised to find that the cost is not as much as they thought. If you have dental insurance, you may often find that some of the procedures are a part of your benefit package.

If you have any questions about improving your appearance by cosmetic dentistry, please feel free to call our office 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.

A World Record Case!

A team led by Dr. Vandana Thorawade at Sir J.J. Hospital in Mumbai, India spent 7 hours removing 232 teeth from 17-year-old's Ashik Gavai's molars. Doctors were stunned to find a world record of 232 teeth inside his mouth.

What was it?

A series of tests revealed there was an abnormal growth on the second molar on his lower right jaw. The 232 "teeth" varied in sizes - some were very tiny and some were the size of a large marble.  

It has been diagnosed as Complex Composite Odontoma, or a benign tumor of the tooth. The tumor fosters a slow-growth tumor inside the jaw capable of birthing additional teeth-like structures. This can cause some difficulties eating, swallowing, and can lead to a swelling on the patient's face. Dr. Sunanda Dhiware-Palwanker, the head of the hospital's dental department, stated that it most likely began its formation in Ashik's younger age, probably in his post-baby teeth years.

Are the structures really teeth?

According to a study in the International Journal of Clinical Pediatric Dentistry, the condition of composite odontoma is characterized by an "eruption of the teeth." During the tumor's development, "enamel and dentin can be deposited in such a way that the resulting structures show an anatomic similarity to normal teeth." 

Whether they should be called teeth or teeth-like structures are still to be determined.

The controversy

Some claim the condition is rare, while others claim that the structures were "wrongly" called teeth. A normal adult mouth cannot hold more than 34 teeth.

Doctors say they have never known a tumor to produce this many teeth. According to medical literature available on the condition, it is known to affect the upper jaw and a maximum of 37 teeth have been extracted from the tumor in the past. In Ashik's case, the tumor was found in the lower jaw, and it had hundreds of teeth.  

Dr. Sunanda Dhiware-Palwanker stated that Ashik will lead an absolutely normal and healthy life after the ejection of so many teeth. Following the procedure, he now has 28 teeth.

Here is another study published on the condition of Complex Composite Odontoma - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697136/