Repairing a decayed tooth may be as simple as removing the damaged tooth material and filling the void. Many filling materials can now match the color of a tooth, so the dental work is hardly noticeable.
Sometimes, though, the decay is too extensive or we've treated the tooth several times and it won't support another filling. If the tooth is still viable, we may be able to cover it with a custom crown.
Also known as a cap, a crown fits over and is securely affixed to the tooth with bonding material or cement. Crowns have been used for decades to restore teeth, but the materials they're made of have changed with time.
The original crowns were made of metal, usually gold or silver. They were strong and could hold up well to the daily forces produced by chewing or biting. They did, however, visually stand out and came to be regarded as unattractive. There were porcelain materials available that could closely mimic the life-likeness of teeth, but they could be weak and brittle.
Dentists came up with a hybrid crown that could supply strength as well as an attractive appearance. These were composed of two parts: an inner metal frame for strength overlaid with porcelain for appearance. These fused crowns were the most popular until the mid-2000s.
About that time, newer forms of porcelain came on the market that were not only attractive, but also durable. Although caution should still be taken when biting something hard, they've proven to stand up well to biting forces. Fused porcelain to metal is still in use, but usually for back teeth where biting forces are higher and the crown won't be as noticeable as on front teeth.
Crowns can also address cosmetic issues with chipped, fractured or excessively worn teeth. But with any crown you should be aware that much of the original tooth material must be removed to accommodate the fit. The altered tooth will require a crown or other restoration from then on. Crowns must also be custom-made by a dental technician in a process that can take weeks.
Still, the process can be well worth it. With proper care and maintenance, a crown could serve you and your smile well for many years to come.
If you would like more information on crowns and other restoration options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Crowns & Bridgework.”
It's difficult to measure how x-ray imaging has transformed dentistry since its use became prominent a half century ago. As equipment and methods standardized, the technology revolutionized the way we diagnose tooth decay and other mouth-related issues.
One of the more useful of these methods is called the bitewing x-ray. The term comes from the shape of the device a patient holds between their teeth with the film attached on the side toward their tongue. We direct the x-ray beam to the outside of the patient's cheek, where it passes through the teeth to expose on the film. Its particular design provides clearer images since the patient's bite helps keep the film still and distortion-free, making it easier to view signs of early tooth decay.
Bitewing x-rays usually consist of four films, two on either side of the mouth, necessary to capture all of the teeth (children with smaller jaws, however, often only require one film per side). How frequently they're conducted depends on a number of factors, including the patient's age: children or young adolescents are usually filmed more frequently than adults, usually every six to twelve months. Frequency also depends on a patient's particular decay risk — the higher the risk the more frequent the x-ray.
Regardless of how often they're performed, a similar application principle applies with bitewing x-rays as with any other radiological method: As Low As Reasonably Achievable (ALARA). With the ALARA principle in other words, we're looking for that sweet spot where we're able to detect the earliest stages of dental disease with the least amount of radiation exposure.
Bitewings fit this principle well: a patient receives only a fraction of the radiation exposure from a four-film bitewing as they do from a daily dose of environmental radiation. Factor in new digital technology that reduces exposure rates and bitewings pose virtually no health risk to patients, especially if conducted in a prudent manner.
The benefits are well worth it. Thanks to bitewing x-rays we may be able to diagnose decay early and stop it before it causes you or your family member extensive tooth damage.
Contrary to what you might think, a knocked out tooth doesn’t inevitably mean tooth loss. Time is of the essence — the shorter the interval between injury and replanting the tooth, the better the tooth’s long-term survival. The longer the interval, on the other hand, the less likely the tooth can survive beyond a few years. That phenomenon is due to the mouth’s natural mechanism for holding teeth in place.
The tooth root maintains its attachment with the jaw bone through an intermediary tissue known as the periodontal ligament. Tiny fibers from one side of the ligament securely attach to the tooth root, while similar fibers attach to the bone on the opposite side of the ligament. This maintains stability between the teeth and bone while still allowing incremental tooth movement in response to mouth changes like tooth wear.
While the ligament fibers will attempt to reattach to a replanted tooth’s root, the longer the tooth is out of the socket the less likely the fibers will fully reattach. An “ankylosis” may instead form, in which the root attaches directly to the jaw bone without the periodontal ligament. In this situation the body no longer “recognizes” the tooth and begins to treat it like a foreign substance. In all but the rarest cases, the tooth root will begin to resorb (dissolve); at some point (which varies from patient to patient) the attachment becomes too weak for the tooth to remain in place and is lost.
Ideally, a knocked out tooth should be replanted within 5 minutes of the injury (for step-by-step instructions, refer to The Field-Side Guide to Dental Injuries available on-line at www.deardoctor.com/dental-injuries). Even if you pass the 5-minute window, however, it’s still advisable to attempt replanting. With a subsequent root canal treatment (to remove dead tissue from the inner tooth pulp and seal it from infection), it’s possible the tooth can survive for at least a few years, plenty of time to plan for a dental implant or similar tooth replacement.
If you would like more information on treatment for a knocked out tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Knocked Out Tooth.”
Is having good oral hygiene important to kissing? Who's better to answer that question than Vivica A. Fox? Among her other achievements, the versatile actress won the “Best Kiss” honor at the MTV Movie Awards, for a memorable scene with Will Smith in the 1996 blockbuster Independence Day. When Dear Doctor magazine asked her, Ms. Fox said that proper oral hygiene was indeed essential. Actually, she said:
"Ooooh, yes, yes, yes, Honey, 'cause Baby, if you kiss somebody with a dragon mouth, my God, it's the worst experience ever as an actor to try to act like you enjoy it!"
And even if you're not on stage, it's no fun to kiss someone whose oral hygiene isn't what it should be. So what's the best way to step up your game? Here's how Vivica does it:
“I visit my dentist every three months and get my teeth cleaned, I floss, I brush, I just spent two hundred bucks on an electronic toothbrush — I'm into dental hygiene for sure.”
Well, we might add that you don't need to spend tons of money on a toothbrush — after all, it's not the brush that keeps your mouth healthy, but the hand that holds it. And not everyone needs to come in as often every three months. But her tips are generally right on.
For proper at-home oral care, nothing beats brushing twice a day for two minutes each time, and flossing once a day. Brushing removes the sticky, bacteria-laden plaque that clings to your teeth and causes tooth decay and gum disease — not to mention malodorous breath. Don't forget to brush your tongue as well — it can also harbor those bad-breath bacteria.
While brushing is effective, it can't reach the tiny spaces in between teeth and under gums where plaque bacteria can hide. But floss can: That's what makes it so important to getting your mouth really clean.
Finally, regular professional checkups and cleanings are an essential part of good oral hygiene. Why? Because even the most dutiful brushing and flossing can't remove the hardened coating called tartar that eventually forms on tooth surfaces. Only a trained health care provider with the right dental tools can! And when you come in for a routine office visit, you'll also get a thorough checkup that can detect tooth decay, gum disease, and other threats to your oral health.
Bad breath isn't just a turn-off for kissing — It can indicate a possible problem in your mouth. So listen to what award-winning kisser Vivica Fox says: Paying attention to your oral hygiene can really pay off! For more information, contact us or schedule an appointment for a consultation. You can read the entire interview with Vivica A. Fox in Dear Doctor's latest issue.
Although highly preventable, total tooth loss continues to affect millions of people worldwide, harming their nutrition, health and social standing. In the United States alone, a quarter of adults between 65 and 74 suffer from total tooth loss.
Fortunately, there are a number of ways to restore lost teeth, including fixed bridgework and dental implants. These fixed solutions, though, can put a strain on finances; implants in particular require a minimum amount of bone in the jaw, which may not be present in people with extensive tooth loss. In these cases, removable dentures, time-tested and affordable, are a viable option.
While the technology is simple, adaptable and effective, creating custom-fitted dentures is a painstaking process. It begins with an impression mold of the patient’s jaw ridges that once supported the natural teeth. A dental lab technician uses the impression to fashion a life-like plastic resin base, making sure the final dimensions won’t interfere with the patient’s cheeks, lips, and jaw movement.
The prosthetic (artificial) teeth, each chosen to match the patient’s facial structure and past appearance, are then carefully positioned on the base. Teeth positioning on each denture arch must also balance with the opposing arch to assure a good bite. Once delivered, the dentist may make other adjustments to assure they fit comfortably within the patient’s mouth.
Dentures also require regular care and maintenance to ensure a continuing good fit and an overall healthy mouth. Your gums will still be susceptible to disease, so cleaning and maintaining both your dentures and the mouth’s soft tissues is an ongoing necessity.
The lack of natural teeth can also lead to more bone loss, which can cause the dentures to lose their accurate fit and make them uncomfortable to wear. To remedy this, we can add more resin material to the dentures to refit them or, in extreme cases of poor fit, create a new denture to match current gum contours. Alternatively, we can install a few dental implants that will support the denture instead of the gum ridges, which would inhibit further bone loss.
To learn whether dentures could be a good option for you, we’ll first need to conduct a thorough examination of your mouth. It could be this original tooth replacement system will bring back the teeth and smile you’ve lost.
If you would like more information on dentures, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Removable Full Dentures.”
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