Posts for: September, 2014
For decades, dental amalgam — the common “silver” fillings found in the mouths of millions — was the best option for restoring teeth after the removal of decay. This time-tested material is still going strong, but in recent years it's had serious competition from newer restoration techniques that use tooth-colored substances to make fillings. If you've heard of these new materials and want to know more, you can start with the following five facts.
1) Filling materials must match the properties of natural teeth.
When properly cared for, teeth are strong, resilient, and superbly functional. A good filling material should mimic the strength and durability of natural teeth under biting forces. It should also last a long time in the mouth, be relatively easy to place, and be economical in cost. In the past, amalgam fillings were the best choice to do the job. But that was then.
2) Tooth-colored filling materials offer similar benefits, plus aesthetic appeal.
Composite resins and dental porcelains are tough, durable materials that have been found to hold up well under years of use. Unlike traditional silver fillings, however, they match the appearance of natural teeth quite closely. This means that even a restoration in the front of the mouth may be virtually undetectable. And who wouldn't like that?
3) Tooth-colored resins may allow more conservative treatment in decay removal.
In order to keep them securely in place, amalgam (silver) fillings may require “undercutting,” which removes more of the tooth structure. The process involved in bonding tooth-colored restorations, however, generally requires removal of less tooth material. This means a stronger base for rebuilding the tooth's structure.
4) Different treatment methods are used for different degrees of tooth restoration.
Small cavities can be treated by direct “chairside” techniques, which are very similar to the methods used for traditional amalgam (silver) fillings: in one brief visit, it's all done. When a greater volume of tooth structure must be replaced, we may be able to create a larger tooth-colored filling in a longer visit. Or, we might need to have a special restoration made to match your teeth; then, you can come back to have it securely bonded for a natural and long-lasting result.
5) Both amalgam and tooth-colored fillings are safe and effective.
Each has advantages and disadvantages in particular cases. But as the technology of tooth-colored filling systems evolves, some dental researchers have heralded the beginning of the “post-amalgam era.” Are tooth-colored fillings right for your individual situation? We're the ones to ask.
If you would like more information about tooth-colored fillings, 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 “The Natural Beauty of Tooth-Colored Fillings.”
Jillian Michaels, personal trainer and star of television's The Biggest Loser isn't afraid of a tough situation — like a heart-pumping exercise routine that mixes kickboxing with a general cardio workout. But inside, she told an interviewer from Dear Doctor magazine, she's really a softie, with “a drive to be one of the good guys.” In her hit TV shows, she tries to help overweight people get back to a healthy body mass. And in doing so, she comes face-to-face with the difficult issue of sleep apnea.
“When I encounter sleep apnea it is obviously weight related. It's incredibly common and affects millions of people,” she says. Would it surprise you to know that it's a problem dentists encounter as well?
Sleep apnea is a type of sleep-related breathing disorder (SRBD) that's associated with being overweight, among other things. Chronic loud snoring is one symptom of this condition. A person with sleep apnea may wake 50 or more times per hour and have no memory of it. These awakenings last just long enough to allow an individual to breathe — but don't allow a deep and restful sleep. They may also lead to other serious problems, and even complications such as brain damage from lack of oxygen.
What's the dental connection? Sleep apnea can sometimes be effectively treated with an oral appliance that's available here at the dental office. The appliance, worn at night, repositions the jaw to reduce the possibility of the tongue obstructing the throat and closing the airway. If you are suffering from sleep apnea, an oral appliance may be recommended — it's a conservative treatment that's backed by substantial scientific evidence.
As Michaels says, “I tell people that [sleep apnea] is not a life sentence... It will get better with hard work and a clean diet.” So listen to the trainer! If you would like more information about sleep-related breathing disorders, please contact us for a consultation. You can learn more in the Dear Doctor magazine article “Sleep Disorders and Dentistry.”
One of the possible side effects of dental work is the introduction of oral bacteria into the bloodstream, a condition known as bacteremia. Although not unusual — it can also occur when you eat or brush your teeth — bacteremia could trigger a dangerous infection for some patients.
For many years, we in the dental profession have taken extra precautions with two such categories of patients: those with congenital (“at birth”) heart conditions who are more susceptible to infective endocarditis, a life-threatening infection of the heart lining or heart valves; and patients who’ve undergone joint replacements and are at a higher risk of developing blood-borne infections at the replacement site. It’s been a standard practice for many years to administer antibiotics to patients in these two categories sometime before they undergo a dental procedure as a way of curtailing the effects of any resulting bacteremia.
Recently, however, the guidelines for antibiotic pretreatment for dental work have changed as two major medical associations have revised their recommendations on the procedure. The American Heart Association (AHA) now recommends dentists administer antibiotic pretreatment only to heart patients with a history of endocarditis, artificial valves or repairs with artificial material, heart transplants with abnormal heart valve function and other similar conditions.
Likewise after a series of joint studies with the American Dental Association on infections in dental patients with orthopedic implants, the American Academy of Orthopedic Surgeons no longer recommends pretreatment for artificial joint patients. It’s now left to the dentist and patient to determine whether antibiotics before a procedure is appropriate based on the patient’s medical history. For example, premedication may still be prudent for joint replacement patients with compromised immune systems caused by systemic illnesses like cancer or diabetes.
Although the guidelines have narrowed, it’s still important for you tell us about any heart condition you may have, or if you’ve undergone any type of joint replacement therapy. It’s also advisable for you to discuss with your primary doctor how your condition might be impacted by any proposed or scheduled dental procedure. Our aim is to always minimize any risk to your overall health as we treat your dental needs.
While dental implants are the preferable choice for teeth replacement, your life circumstances may cause you to postpone it or some other permanent restoration. In the meantime, you need a temporary solution for your tooth loss.
Removable partial dentures (RPDs) have met this need for many years. RPDs are traditionally made of rigid, acrylic plastic resin and fasten to existing teeth with metal clasps. While effective as temporary tooth replacements, RPDs do have their drawbacks: they can be uncomfortable, develop a loose fit and are prone to wear and staining.
Recently, though, new RPDs made of a flexible type of nylon are addressing some of these drawbacks. Because the nylon material is thermoplastic (able to change shape under high heat), it can be injected into a cast mold of a patient’s mouth to create the denture base, to which life-like replacement teeth are then attached. And rather than a metal clasp, these RPDs have thin, finger-like nylon extensions that fit snugly around existing teeth at the gum line.
The new RPDs are lightweight, resistant to fracture and offer a more comfortable, snugger fit than the older RPD. And because the nylon material can be made to closely resemble gum tissue, the base can be designed to cover receding gum tissue, which may further improve the appearance of a patient’s smile.
On the downside, these new RPDs are difficult to reline or repair if they’re damaged or the fit becomes loose. And like all RPDs, they must be regularly removed and cleaned thoroughly to prevent any accumulating bacterial biofilm that could increase the risk of gum disease or tooth decay (the attachment extensions are especially susceptible to this accumulation). They should also be removed at night, since the reduction in saliva flow while you sleep can worsen bacterial buildup.
Still, the new flexible RPD is a good choice to bridge the time gap between lost teeth and a permanent restoration. They can restore lost function and improve your smile during the transition to implants or a fixed bridge.
Braces are certainly the most recognized means for moving misaligned teeth. But depending on your or your family member’s particular malocclusion (bad bite), your orthodontist may also include other “anchorage” appliances to achieve the best results.
We can move teeth because of a mechanism that already exists in the mouth. The periodontal ligament, which holds teeth in place by attaching the tooth surface to the jawbone, allows teeth to move if needed in response to biting forces or normal tooth wear. Using braces or similar appliances, orthodontists can apply gentle but constant pressure to move teeth to new and better positions.
This applied pressure, however, soon encounters an “equal and opposite reaction,” in accordance with Newton’s third law of motion. In a way, we’re playing tug-of-war with the periodontal ligament — and as in the playground game, the key to “winning” is having the stronger point of resistance, something we call anchorage.
We often use the teeth themselves to establish this anchorage with the help of elastics (rubber bands) attached at various locations in the braces. Sometimes, though, the situation requires a different form of anchorage. In a younger patient, for example, we may want to influence the facial structure’s growth and development along with tooth movement. In this case we might use the patient’s skull for additional anchorage by having a strap running around the back of the head that attaches to brackets affixed to the teeth.
Another method involves a temporary anchorage device (TAD) directly implanted into the jawbone. We use TADs to isolate teeth we want under pressure from teeth we don’t (as with moving front teeth back without causing the back teeth to move forward). Usually made of stainless steel that won’t fuse with bone, TADs are relatively simple to remove once treatment is complete. Another form of anchorage is a titanium micro-implant, a miniature version of a dental implant that’s also inserted into the bone; like its larger relative, micro-implants fuse with the bone to add greater stability. Their diminutive size, however, eases any difficulty in their eventual removal.
Though some of these appliances aren’t visually appealing, they are temporary in nature and only applied for as long as needed. The end result, though, is permanent — beautifully aligned teeth that perform well and look great.