Sometimes you need only a single solution to improve your smile: teeth whitening to brighten stained teeth; porcelain veneers or crowns to mask dental flaws; or a life-like dental implant to replace a missing tooth. But not all dental situations are that simple and sometimes require a combination of treatments.
A case in point: restoring a missing tooth within a poor bite. The absent tooth itself may be the cause of the bite problem if it’s been missing for some time: The nearby teeth tend to move or “drift” into the empty space, leaving no room for implant placement.
When this happens, you’ll first need orthodontic treatment to correct the bite problem. Not only will this open the space for the implant, it also comes with its own benefits. It obviously improves your smile appearance—but straighter teeth are also easier to keep clean of bacterial plaque, which reduces your disease risk. You may also experience better digestion after your teeth are properly aligned and able to function as they should during eating.
The traditional way to improve a bite is through metal braces. But there are some downsides: For one, braces can make it difficult to keep teeth adequately clean, making wearers more susceptible to tooth decay and gum disease. Braces are also quite visible and can detract from a person’s appearance (even more so if a missing tooth is involved).
Unless your situation requires braces, you can choose clear aligners as an alternative. These clear, computer-generated plastic trays are worn in sequence to gradually move teeth to their desired positions. Unlike braces, you can remove aligners for eating, cleaning or rare special occasions. And, they’re barely noticeable to others.
If you also have a missing tooth, you can have a temporary prosthetic (“false”) tooth built into your aligner trays. In this way you can still enhance your smile while undergoing aligner treatment.
Once your bite has been corrected, we can then proceed with restoring your missing tooth permanently with a dental implant. Although orthodontics adds to the time and expense of restoration, its often necessary to achieve the best result. Your future smile will be the better for it.
Discovering a loose tooth can be exciting — if you're six, that is, and anticipating a windfall from the tooth fairy. If you're an adult, a loose tooth is a different story. You're in real danger of it becoming a lost tooth, and there won't be another one coming in to replace it.
Fortunately, that result isn't inevitable, but we have to take quick action if we're going to save your tooth. The first step is to find out why it's loose.
Tooth looseness occurs primarily because the gum and bone structures that hold teeth in place have been damaged in some way. Otherwise healthy teeth and gums can be injured in an accident or with dental habits like teeth grinding or clenching that increase the biting forces against teeth. The latter could require some intervention like a night guard to prevent teeth from grinding to reduce the abnormal biting force.
But disease is often the root cause for tooth looseness. Periodontal (gum) disease, a bacterial infection triggered by bacterial plaque, can inflame and weaken gum tissues, eventually causing bone loss followed by the gum tissue detaching from the teeth. In this weakened condition even normal biting forces could loosen a tooth.
If gum disease is the primary culprit, our treatment starts there. By aggressively removing plaque and calculus (tartar) from the tooth surfaces, including deep below the gum line around the root, the gum tissues become less inflamed and begin to heal. This in turn can strengthen their attachment to a loose tooth. In more advanced cases, we may need to surgically graft lost bone and gum tissue to rebuild the attachment.
We may also need to stabilize a loose tooth while we're performing these other treatments. The most common way is to join or splint a loose tooth to nearby stable teeth. There are varieties of splints: one type involves rigid dental material bonded across the enamel of the loose tooth and its neighbors. In another, we cut a small channel in the involved teeth, and then insert a metal splint, bonding it within the channel.
Whatever needs to be done, we need to do it promptly — if you notice a loose tooth, contact us as soon as possible. The earlier we begin treatment the more likely we'll save your loose tooth.
If you would like more information on treating loose teeth, 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 “Treatment for Loose Teeth.”
Baby (primary) teeth look and function much like their permanent counterparts. Besides having a visible crown, they also have roots that maintain contact with the jawbone.
But there are some differences, the biggest one being the normal process whereby primary tooth roots dissolve or, in dental terms, resorb. Root resorption eventually leads to the tooth coming loose to make way for the permanent tooth.
Adult tooth roots can also resorb — but it's decidedly not normal. If adult root resorption isn't promptly treated, it could also lead to tooth loss — but there won't be an incoming tooth to take its place.
Although it can begin inside a tooth, adult root resorption usually begins on the outside. One type, external cervical resorption (ECR), begins around the neck-like area of the tooth not far below the gum line. Its initial signs are small pink spots where the tooth enamel has eroded; those pink cells within the space are doing the damage.
We don't fully understand the mechanism behind ECR, but there are some factors that often contribute. People with periodontal ligament damage or trauma, sometimes due to too much force applied during orthodontic treatment, have a high risk of ECR. Some bleaching techniques for staining inside a tooth may also be a factor.
The key to treating ECR is to detect it as early as possible before it does too much root damage. Regular checkups with x-rays play a pivotal role in early detection. Advanced stages of ECR might require more advanced diagnostics like a cone beam computed tomography (CBCT) scan to fully assess the damage.
If the lesion is small, we can surgically remove the cells causing the damage and fill the site with a tooth-colored filling. If ECR has spread toward the pulp, the tooth's inner nerve center, we may also need to perform a root canal treatment.
Either of these methods intends to save the tooth, but there is a point where the damage is too great and it's best to remove the tooth and replace it with a life-like dental implant or other restoration. That's why it requires vigilance through regular, semi-annual dental visits to detect the early signs of root resorption before it's too late.
If you would like more information on adult tooth root resorption, 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 “Root Resorption.”
Getting a smile upgrade doesn’t necessarily require extensive dental work. You might be able to change your appearance for the better with teeth whitening.
This technique employs a bleaching solution that brightens dull enamel, the outermost layer of teeth. It isn’t a permanent fix, but if cared for properly your brighter smile could last two years or more.
Here’s what you need to know about this proven smile brightener.
Know your options. Enamel whitening is usually obtained in one of three ways: a dentist performing the procedure in-office; at home using custom trays created by a dentist; or at home with an over-the-counter whitening product. The in-office option is the most expensive—but since dentists use a stronger bleaching solution, your brighter tint may last longer and dentists can control the degree of whiteness better.
Know your preferences. That last point is important if you’re looking for a particular look. Teeth whitening can give you a dazzling “Hollywood” smile or one that’s a bit more subtle. It all depends on your lifestyle and personal preferences. Because of their advanced techniques and equipment, you may have better chances getting the look you want from your dentist rather than by doing it yourself.
Know your limitations. This type of teeth whitening won’t work if the staining originates within the teeth—for that you’ll need an invasive procedure only a dentist can perform. You’ll also want to be careful with any whitening if you have dental work like crowns, veneers or fillings: the bleaching solution won’t alter these materials’ color, which could make them stand out beside whitened natural teeth. And if you have diseased teeth and gums, those need to be treated first before any cosmetic procedures like whitening.
Teeth whitening is a great way to take years off a smile. Even if you plan to whiten your teeth at home see your dentist first for a complete examination and helpful tips on products and techniques.
If you would like more information on teeth whitening, 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 “Important Teeth Whitening Question…Answered!”
You may think all crowns are alike—but there can be a world of difference between one crown and another. Getting the crown your dentist recommends and one that's satisfactory to you will depend on a number of factors, including what you'll ultimately have to pay.
Here are 3 things you need to know about crowns before undergoing a crown restoration.
Different materials. Although porcelain is the most life-like material used, earlier types of this glass-based material weren't strong enough to withstand biting forces, especially in back teeth. Years ago, all-metal crowns were most often used until the development of a hybrid porcelain crown with an inner metal substructure for strength. In recent years stronger all-porcelain crowns have risen in popularity. The material type that works best often depends on the tooth to be crowned—all-porcelain may work for a visible front incisor, but a porcelain-metal hybrid might be needed for a back molar.
Level of artistry. While new computer manufacturing systems allow dentists to produce patient crowns in-office, most still require the services and skills of a dental lab technician. The cost difference between crowns usually occurs at this juncture: the more life-like and customized the crown, the more artistry and time required by a technician to produce it. This can increase the cost of the crown.
Limited choices. While you and your dentist want your crown choice to be as individualized and life-like as possible, your dental insurance may limit your options. Many policies only provide benefits for the most basic crown restoration—enough to regain functionality and have an acceptable, but not always the most aesthetic, appearance. To get a higher quality of crown you may have to supplement what your policy and deductible will cover.
Deciding which crown is best will depend on where it will be needed, the level of attractiveness you desire and your insurance and financial comfort level. And your dentist can certainly help guide you to a crown choice that's right for you.
If you would like more information on restorative crown choices, 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 “Porcelain Dental Crowns.”
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