Posts for: August, 2013
Lose a baby tooth when you're a young kid, no big deal — you'll grow another. Lose a permanent one and there's cause for concern. For one thing, tooth loss is often a symptom of an underlying oral health problem, such as tooth decay or gum disease, so it's important to identify the cause and treat it to prevent it from progressing. It is equally important to replace the tooth — not simply for the immediate impact it can have on your smile or bite, but for long-term function, esthetics and the health of the bone that supports your teeth.
The primary options for tooth replacement are fixed bridgework and dental implants. Both result in esthetically pleasing outcomes; the main difference is how each is attached. With a bridge, the replacement tooth, referred to as a “pontic,” uses the two natural teeth on either side of the gap — referred to as “abutments” — for support. The pontic is sandwiched between two other crowns, which fit over and are bonded or cemented to the teeth on either side of the gap. To ensure the companion crowns fit properly, the enamel must be removed from each abutment.
Placing dental implants, by contrast, involves working only on the affected area. The “implant” is actually a small titanium rod with spiraling threads just like a miniature screw that is carefully inserted into the jawbone as though it were a natural root. The replacement tooth, a customized crown, is secured to the end portion of the implant by way of an intermediary referred to as an abutment, which firmly anchors it in place.
Both bridges and implants are natural looking, functional, predictable, and reliable. Each has its advantages and disadvantages, and based on your oral health, one may be more appropriate than the other.
If you would like more information on tooth loss and replacement, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “The Hidden Consequences of Losing Teeth” and “Dental Implants vs. Bridgework.”
Did you know that tooth decay (dental caries) is the second most frequently occurring disease — surpassed only by the common cold? It can start as soon as toddlers sprout their first teeth and by middle age, more than 90% of adults are affected by the problem! Fortunately, you can significantly lower your risk for decay. The key is to nurture health-promoting (protective) factors in your mouth while discouraging those that are disease causing (pathologic).
The top two traditional steps can't be stressed enough:
Good Oral Hygiene. Diligent brushing and flossing, along with routine professional cleanings, help limit a buildup of bacterial plaque (biofilm). This whitish film is attractive to decay-producing bacteria (among the many types of bacteria — including beneficial ones — that normally live in the mouth). These microbes like to snack on sugars and carbohydrates (perhaps part of that bagel you had for breakfast or the midafternoon candy bar), and in the process they produce acid. A healthy oral environment has a neutral pH — a perfect balance between acids and bases. But in a more acidic environment, minerals in the protective enamel of your teeth start to dissolve, exposing the dentin and root surfaces underneath that are even more vulnerable.
Sensible Diet. Keep decay-producing bacteria in check by limiting your intake of sugars and carbohydrates; the bacteria need these nutrients to grow and reproduce. Choose products containing natural sugars, such as those in fruits and vegetables, over those containing added sugars, such as sodas and candy. Be aware that Xylitol, an “alcohol sugar” used in some chewing gums and dental products, can actually help reduce pathogenic bacteria. And don't forget that frequent consumption of acidic foods and beverages, such as sipping coffee during the day, can create an acidic environment in your mouth that can contribute to decay by eroding tooth enamel and weakening its defenses.
Individual Risk Factors
You also may have individual risk factors as well that our office can help you identify and address. For example, the shape of everyone's teeth varies and some of us have more valleys, tiny grooves and pits than others. These likely places for bacteria to congregate can be the most difficult to reach with a toothbrush, but invisible sealants can be applied to prevent bacteria from reaching those areas.
If you would like more information about tooth decay and prevention, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Tooth Decay” and “Tooth Decay — How To Assess Your Risk.”
Are you ready to suit up for sports? Mouthguards have been called the most important part of an athlete's uniform. Designed to absorb and distribute the forces of impact received while you participate in athletic activities, your mouthguard is a protective appliance that covers and cushions your teeth and gums to prevent and reduce injury to your teeth, jaws, lips and gums. A properly fitted protective mouthguard is comfortable, resilient, tear resistant, odorless, tasteless, not bulky, fits well, and has sufficient thickness where needed. If you wear it when engaging in contact sports it can prevent injury, pain, suffering and years of expensive dental treatment.
Here's why athletes need mouthguards:
- Sports related dental injuries account for more than 600,000 emergency room visits each year. Mouthguards are recommended particularly for contact sports such as boxing, football, hockey and lacrosse.
- An athlete is 60 times more likely to suffer harm to the teeth when not wearing a mouthguard. It is estimated that mouthguards prevent more than 200,000 injuries each year.
- Properly fitted mouthguards protect the soft tissues of the lips, cheeks, gums and tongue by covering the sharp surfaces of the teeth that can cause lacerations on impact. They also reduce the potential for tooth injury, jaw damage or jaw joint fracture and displacement by cushioning against impact — absorbing and distributing the forces that can cause injury.
- Custom-fitted mouthguards are made from exact and precise models of your teeth. They are effective, comfortable, easy to clean, and do not restrict breathing. The best mouthguard is custom designed to fit your mouth and made in our office after your athletic needs have been assessed. For a growing child or adolescent, a custom made mouthguard can provide space for growing teeth and jaws.
- A mouthguard properly fitted in our office costs little in comparison to the cost of treatment after injury. If your teeth are knocked out and are not properly preserved or replanted you may face lifetime dental costs of as much as $10,000 to $20,000 per tooth.
The American Dental Association recommends the use of custom mouthguards in 27 sports/exercise activities. Make an appointment to consult with us to find out more about mouthguards. You can also read the Dear Doctor magazine article “Athletic Mouthguards: One of the most important parts of any uniform!”
The first studies that I read on “root form” implants were done by Dr. P. I. Branemark, a Danish Orthopedic Surgeon. He first placed titanium root form implants in 1965. These implants were successful. In 1981, he partnered with Nobel Pharma to market his implant system. Unfortunately, at this time he only sold the implants to oral surgeons whom he had trained, and often the implants were in areas of good bone but could not be restored properly by the referring dentists. In 1982, Dr. Gerald Niznik, a prosthdontist, formed the Core Vent company that used a “root form” implant that he had developed and used prosthetic attachments that he had also developed. He gave courses in California so that the dentist could both place and restore the implant. I went to California to observe his surgeries and restorations. It was very apparent to me that this was the future of dentistry. It was also apparent that this was a developing field of dentistry and it was not ready to be a day to day procedure. There were just too many cases that were not treatable and I decided to wait and watch the field of implantology develop further. I referred a few cases to oral surgeons and restored them but the cases were just not smoothly done so I decided to wait and watch.
The next several years were tough years for me personally as both my mother and my mother-in-law were in a nursing home. In the nursing homes, I observed that the residents, who had had the finest dental work during their active lives, now seemed to be in the worst shape of all because they could not maintain their fixed crowns and bridges. To make matters worse, their caretakers did not adequately brush their teeth. The residents were in such fragile condition that we could not do extensive dental treatments to restore their teeth. Often, we could not even make them comfortable. This certainly changed how I treatment plan for people who are in their fifty’s and sixty’s. I now have to factor in that this patient has many years to live and I want to do a restoration that will serve them well and not put them in harm’s way when they are the most vulnerable. I now realized that all dental restorations have a life and I must think long term when I design a restoration.
My son, Herbert, came into the practice in 1995 after completing Dental School and a one year residency in Advanced General Dentistry at the University Of Pennsylvania School Of Dentistry. We discussed my feelings about the challenge of maintaining the dentitions of a population that is growing older. We went to Philadelphia to discuss this with his mentors at Penn. They agreed with us that dentistry as it had been done in the past was no longer going to be acceptable. They felt that he should study both the surgical placement and the restoration of implants. They felt that the best place at that time was the Implant Center of the NYU School of Dentistry. He applied there for a two year program in Implant Dentistry. After completing his training, he was asked to join the faculty. He is currently serving as a senior faculty member at the NYU School of Dentistry’s Implant Dentistry Center. For 17 years, he has been totally committed to learning everything he can about total patient care in implant dentistry. We are convinced that an implant is the best possible replacement for a missing tooth. We have done our utmost to keep abreast of all the advancements that have and are taking place in the field of implant dentistry. Last year, Herbert became a Diplomate of the International Congress of Oral Implantology. This is in recognition of his academic, teaching, and clinical skills. Both of us are quite proud of this achievement.
Not long ago, Jane Fonda gave a British interviewer a clue as to how she manages to look so young at her advanced age. During the 2011 Cannes Film Festival, the septuagenarian actress and fitness guru said to a journalist from the London-based Daily Mail, “See these teeth? They cost $55,000. It was teeth or a new car — and I opted for the teeth.”
We think she made the right choice — though she might have overpaid just a tad. Most people don't have that kind of cash to spend on either a car or new teeth. But luckily, you can get either for a lot less — particularly the teeth!
The truth is, at a reasonable cost, cosmetic dentistry really can make you look a lot younger while giving your self-esteem a tremendous boost. It's an investment in both your emotional and oral health as we will never implement a smile makeover without first making sure we've addressed any underlying dental disease. Best of all, it doesn't have to cost anywhere near what you'd pay for the latest-model Jaguar, the price tag of Fonda's smile notwithstanding. Here is a list of the more common cosmetic dental techniques used to enhance a person's smile:
- Whitening — a peroxide-based bleach is applied directly to the teeth to remove minor staining and discoloration.
- Bonding — an acrylic material is applied to a tooth, colored and shaped to match the person's other teeth. Primarily used for chipped, broken or decayed teeth.
- Enamel Shaping — the removal of very tiny amounts of enamel, the tooth's outer layer, for a more pleasing tooth shape.
- Veneers — a thin shell of custom-designed tooth-colored material, usually porcelain, affixed to the front surface of the teeth.
- Crowns and Bridgework — a technique that covers heavily damaged teeth or replaces missing teeth by capping them, or using capped teeth to support one or more false teeth.
- Dental Implants — a small titanium post is surgically implanted in the jawbone to replace the root-part of a missing tooth. A lifelike crown is attached to the implant above the gum line and is the only part of the whole tooth restoration that is visible in the mouth.
- Gum Contouring — a minor surgical procedure altering the position of the gum tissue to improve the look and regularity of the gum line around the teeth.
If you'd like more information on cosmetic dentistry, please contact us or schedule an appointment. To learn more, please read the Dear Doctor magazine articles, “Beautiful Smiles by Design” and “The impact of a Smile Makeover.”