SERVICE WITH A SMILE
CORROSIVE EFFECT OF EATING DISORDER
OUT OF THE ROTATION
LASER TOOTH-DECAY DETECTION
DENTURE-ADHESIVE ADVISORY
PROFESSIONALLY SUPERVISE TOOTH WHITENING
FULL MOUTH RECONSTRUCTION
DISPLAYING SENSITIVITY
COSMETIC BENEFIT OF DENTAL IMPLANTS
GUM TREATMENT MAY HELP DIABETICS
STRINGING ALONG
GETTING TO THE ROOT
IS TOOTH REGENERATION IN THE FUTURE?
EAT BETTER, AGE BETTER
THE GUM DISEASE/PRETERM BIRTH LINK
COSMETIC CONCERNS
SAME-DAY TOOTH IMPLANTS
FLOSSING FOR APPEARANCE'S SAKE
BRIDGE BUILDING
INFLAMMATORY SITUATION
YOU KNOW THE DRILL! OR DO YOU?
2 + 2 = HEALTHY TEETH AND GUMS
BABY-BOTTLE TOOTH DECAY
TAKING IT ON THE JAW
GETTING THE FULL TREATMENT
THE DENTAL FACELIFT
DIABETICS AND GUM DISEASE
HEROES AND VILLAINS
FAT CHANCE!
TOOTH RESHAPING
PLAQUE DETECTION
ALL-PORCELAIN CROWNS
ROOT CAUSE OF PAIN
CHOOSING SUITABLE REPLACEMENTS
TEETHING REMEDY WARNING
SMILE MAKEOVER
FULL (DENTURE) DISCLOSURE SWEET
ARTFUL RESTORATION
COLLAR ID
EROSION CONTROL
CROWNING TOUCH
SENSITIVITY TRAINING
GOOD REASONS TO SMILE
HOW WHITE A SMILE?
PARTIAL SOLUTIONS
ARE YOU DIGGING A HOLE FOR YOURSELF?
ARE YOU AMONG THE MISSING?
ARE TOOTH IMPLANTS APPROPRIATE FOR CHILDREN?
REVERSING ANESTHETIC NUMBNESS
RECESSION FEARS
LINGERING OVER THE LATTE?
WHAT YOU KNOW MAY SAVE YOU
SECOND THOUGHTS
LAPSE IN THE POOL
FILLINGS THAT ARE AS GOOD AS GOLD
|
By maintaining good oral-health practices at home and scheduling regular office visits, most patients can avoid many common dental problems. Daily brushing and flossing, and the application of sealants, can help youngsters avoid tooth decay. Adults can avert their most common problem, gum disease, with regular professional care. In cases where tooth loss, breakage, or misalignment does occur, the dentist is expert in a variety of advanced restoration and replacement techniques. In addition, there are a number of cosmetic procedures, including tooth whitening, veneers, and bonding, that effectively remedy chipped, discolored, and gapped teeth. The more patients know about dental health, the better their smiles. In the weeks and months ahead, this column will address all aspects of dental care.
P.S. Flossing is every bit as important as daily brushing in fighting plaque buildup and tooth decay.
CORROSIVE EFFECT OF EATING DISORDER
The eating disorder known as bulimia poses a problem for the teeth that may be overlooked. Repeated purging of stomach acids can cause significant loss of tooth enamel. In one such case, a person with a history of bulimia began treatment to correct a closed bite, characterized by decreased vertical tooth dimension and an abnormal overbite in which the lower jaw protrudes. Due to stomach acid-induced enamel loss, the patient’s incisors lost one-third to one-half of their original length. The closed bite was caused by over-eruption of the lower incisors into the space created by eroded teeth. Fortunately, treatment of the eating problem led to aesthetic correction involving porcelain veneer crowns that could be used to restore the damaged teeth.
P.S. People who habitually drink high-acid citrus beverages have also been known to experience significant loss of tooth enamel.
OUT OF THE ROTATION
There are instances in which a permanent tooth will be rotated on its axis so that it isn’t aligned properly with either adjacent or opposing teeth. As a result of its twisted orientation, the rotated tooth creates a space on both of its sides where it should otherwise stand shoulder-to-shoulder with the teeth next to it. In cases where the rotation is not too extreme, the dentist can augment the rotated tooth with color-matching bonding material. This composite restoration is undertaken in an incremental manner to slowly fill in gaps and build up the tooth in areas where it is needed. All the while, care must be taken to ensure correct tooth dimension and attain the desired aesthetic result.
Dr. Mary Hanley’s state of the art dental office at 2200 Waukegan Road here in Glenview offers complete family dental care. She can be reached in Glenview at 847-729-8580 and in Chicago at 773-271-5200. Emergency services are available – appointments can be made within 24 hours.
P.S. Teeth can be altered so that they appear larger or smaller than they actually are.
LASER TOOTH-DECAY DETECTION
While x-rays and probing instruments are important tools for identifying tooth decay, a laser that detects cavities can uncover even the smallest amounts of decay in the hardest-to-reach places. The DIAGNodent utilizes a laser-probe hand piece that emits pulsed light of a known wavelength on tooth surfaces. Once a baseline measurement of the patient’s healthy tooth surfaces is established, further examination of potentially problematic areas creates changing levels of fluorescent light, which the unit’s internal processor interprets. An audible signal warns of an indication of caries (tooth decay). The laser unit can also be used to keep track of early symptoms of tooth decay, which translates into earlier treatment and better tooth preservation.
P.S. DIAGNOdent claims a 90 percent accuracy rate when it comes to tooth-decay detection.
DENTURE-ADHESIVE ADVISORY
Denture-wearing patients should know that GlaxoSmithKline has ceased manufacture of their denture adhesives Super Poligrip Original, Ultra Fresh, and Extra Care over concerns of “potential health problems associated with the long-term excessive use of our zinc-containing denture adhesive products.” While the manufacturer states that their products are safe when used as directed, use of excessive amounts of the product over a period of years may pose a threat of neurological symptoms and blood problems (such as anemia) linked with ingestion of the adhesive. It should be noted that zinc is not absorbed through the mouth, but only when swallowed. As a precaution against unwanted effects arising from misuse of the product, GlaxoSmithKline plans to reformulate their products without zinc.
P.S. Any questions that denture wearers might have concerning the continued use of or replacements for Super Poligrip Original, Ultra Fresh, and Extra Care should be posed to their dentist.
PROFESSIONALLY SUPERVISE TOOTH WHITENING
Even if you’re considering using an over-the-counter tooth whitener, the American Dental Association recommends that you consult with your dentist. This recommendation is made because tooth-whitening systems containing carbamide peroxide or hydrogen peroxide can be uncomfortable for those with sensitive teeth or gum recession. In addition, most products will only whiten natural tooth enamel, which means that the presence of tooth-colored filings, veneers, crowns, or partial dentures may yield uneven results. With this in mind, the dentist can evaluate whether tooth-whitening is a good idea for your teeth. While tooth whitening usually reduces most stains caused by age, smoking, and regular coffee/tea drinking, it will not remove tooth discoloration caused by the use of tetracycline in children under age 8.
P.S. Tooth-whitening products are not recommended for children under age 16; pregnant women (or women who are breast-feeding); or people with sensitive teeth, gum disease, or worn tooth enamel.
FULL MOUTH RECONSTRUCTION
In some cases, patients’ teeth may be so decayed, injured/fractured, or worn/eroded that they may require extensive treatment known as “full mouth reconstruction.” Also known as “full mouth restoration” and “full mouth rehabilitation,” this rebuilding/restoring process typically involves every tooth in both the upper and lower jaws. The process begins with a thorough examination and evaluation of the patient’s teeth, gums, and occlusion (bite). It continues with an assessment of the color, shape, size, and proportion of the teeth with respect to how they relate to the gums, lips, mouth, side profile, and face. Then, after taking x-rays, impressions, and photographs, the dentist (in conjunction with specialists, if necessary) can recommend procedures and techniques for totally restoring the teeth.
P.S. Full mouth restoration can include procedures such as crown lengthening; gum recontouring; jaw surgery; permanent restorations (crowns, bridges, inlays/onlays, veneers, and implants); and orthodontics.
DISPLAYING SENSITIVITY
If you have sensitive teeth, you are hardly alone. It is estimated that 40 million Americans share your discomfort. Fortunately, the cause of most cases of tooth sensitivity has been identified, and the cure may be as easy as modifying your tooth-brushing technique. According to a nationwide survey of 700 dentists, aggressive brushing and acidic foods and beverages are the leading culprits when it comes to tooth sensitivity, which results from nerve irritation. Other contributing factors include the use of certain toothpastes, mouthwashes, and tooth-whitening products, as well as cracked teeth, bulimia, and acid reflux disease. A switch to a desensitizing toothpaste and a toothbrush with softer bristles usually helps relieve the problem.
P.S. If you drink acidic soft drinks and fruit juices, avoid brushing your teeth immediately after drinking, when enamel is most vulnerable.
COSMETIC BENEFIT OF DENTAL IMPLANTS
Aside from restoring biting and chewing capability to the mouth, dental implants also serve a cosmetic function. The most obvious benefit to an implant patient’s appearance is that the replacement tooth fills in the gap left by the lost tooth with a natural-looking substitute. On a deeper level, dental implants help patients avert bone loss. Without implants, missing teeth and associated bone loss cause the lower third of the face to collapse and shrink inward. As the anchoring portion of a dental implant forms a strong bond with the jaw, it stimulates the surrounding bone and preserves it. As a result, the bone loss that would otherwise be inevitable with missing teeth is avoided.
P.S. One of the factors that is used to assess a patient’s suitability for a dental implant is the amount and density of underlying bone in the jaw.
GUM TREATMENT MAY HELP DIABETICS
Recent research has uncovered links between gum disease and other parts of the body that previously may have seemed unlikely. For instance, periodontitis has been associated with an increased risk of heart disease and stroke, which makes a good case for addressing gum inflammation. More recently, researchers have discovered another potential benefit of keeping gum disease at bay. According to research, it has been found that treating periodontal disease in diabetics may lower their insulin levels. Researchers suggest that the connection is based on bacterial infections of the mouth that cause inflammation, which results in chemical changes that reduce the effectiveness of insulin produced in the body. As a consequence, diabetics find it more difficult to control their blood sugar.
P.S. Previous research has found that 90 percent of patients with periodontal disease were at risk for developing Type 2 diabetes.
STRINGING ALONG
The reason that dentists insist that their patients floss (as well as brush) their teeth is because flossing does nearly half the work necessary to remove “plaque.” Unless this sticky bacteria-laden substance is removed from between teeth, where toothbrush bristles may not reach, tooth decay and gum disease will result. Patients with receding gums or large spaces between their teeth are advised to use a flat, wide dental tape. If teeth are closely spaced, thin floss is best, especially non-shredding floss. Patients with bridges and braces are likely to find it necessary to use a floss threader to get underneath restorations or wires between teeth. There is also floss with a stiff end that does the job equally well.
P.S. Patients who do not have the dexterity needed to use dental floss may want to try soft wooden plaque removers.
GETTING TO THE ROOT
In the event of a tooth becoming abscessed (due to infection) or traumatized (due to injury), it is often necessary to perform root canal therapy to remove the dead or damaged root pulp. The goal of the procedure is to save the crown (white outer portion of the tooth). The pulp is the area inside the crown that extends down into the gums with nerves and blood vessels. The dentist can check to see if the tooth is alive by testing whether the patient can feel cold on the tooth or reacts to an electrical stimulation on the tooth. The procedure involves removing the pulp from the non-vital tooth and filling and sealing the area and securing the crown.
P.S. A tooth’s pulp tissue contains not only nerve fibers, but also arteries, veins, lymph vessels, and connective tissue.
IS TOOTH REGENERATION IN THE FUTURE?
Each year, dentists treat millions of cavities that result from the enamel-eating acids emitted by sugar-eating bacteria missed by flossing and brushing. While drilling out tooth decay and filling cavities with amalgam or composite fillings has proven extremely effective in preserving the remaining healthy tooth structure, patients often wish they could somehow magically eliminate any decay and simply regenerate the tooth back to its previous healthy state. That wish may someday be a reality because scientists have identified a peptide known as MSH (melanocyte-stimulating hormone) that encourages cells within decayed teeth to regenerate in about one month. When introduced into the teeth in a gel or film in the laboratory, cavities disappeared and were replaced by healthy tooth structure.
P.S. MSH (melanocyte-stimulating hormone) has not demonstrated any ability to prevent cavities, which means that it is no substitute for flossing and brushing.
EAT BETTER, AGE BETTER
While seniors generally consume fewer calories because of their slowing metabolisms, they must be sure to get sufficient calories to sustain their health. Weight loss at an advanced age for whatever reason may lead to malnutrition and/or worsening of existing health conditions. With this in mind, seniors should make sure their teeth (or dentures) and gums are in good working order. If it hurts to chew, people eat less. Healthy teeth and properly fitting dentures ensure that seniors can avail themselves of all the nutrition in healthy meals. The National Institutes of Health is funding research to determine how oral health may affect memory. It is thought that a healthy diet may be linked with less cognitive decline among seniors.
P.S. Oral health should be viewed in an overall context because it is an important component that contributes to the health of other bodily systems and organs.
THE GUM DISEASE/PRETERM BIRTH LINK
While research has already established a link between periodontal (gum) disease in pregnant women and an increased risk of giving birth to babies of low birth weight prematurely, a new study provides additional news on the link between gum disease and premature birth. According to researchers, pregnant women who undergo successful treatment are less likely to give birth early. This finding is based on a study of nearly 900 pregnant women, with and without gum disease, who were pregnant for between six and twenty weeks. This study provides a good argument for women to incorporate dentists into their prenatal healthcare team. Maintaining good oral health before and during pregnancy is in the best interests of both mother and child.
P.S. So far, research suggests that periodontal disease triggers increased levels of biological fluids that induce labor.
COSMETIC CONCERNS
It hardly comes as a surprise that cosmetic, or aesthetic, dentistry has grown to be so popular among patients. After all, straight, white teeth are as essential to appearance as nice skin and coiffed hair. The most sought-after procedure is tooth-whitening, which can be performed in-office, at home, or a combination. The most aggressive yet painless tooth-whitening techniques result in smiles several shades whiter in one office sitting. Next on the list of patient popularity are veneers used to correct cracked, chipped, discolored, and worn teeth. These ultra-thin tooth coverings made of porcelain or composite materials look like natural teeth, only they are perfect. If a less-expensive option is desired, resin bonding provides a simple, effective method of tooth supplementation.
P.S. Because porcelain and ceramic tooth replacements look like real teeth, they blend beautifully with existing teeth.
SAME-DAY TOOTH IMPLANTS
While traditional dental implants usually require up to six months for the titanium implant to successfully bond with the surrounding bone ("osseointegration"), same-day dental implants don't require a long waiting period. The ability of these "immediate-load" tooth implants to be readily available as foundations for replacement teeth is a direct outcome of their advanced design. As a result, patients can leave the dental office with an immediate-load implant on the same day they have a tooth extracted. With preplanning, it is even possible to have a permanent replacement tooth in place instead of a temporary. Same-day tooth implants cut down on office visits, spare patients the embarrassment of enduring visible gaps, and ensure excellent gum interface with the replacement tooth.
P.S. As with dental implants, immediate-impact implants are not suitable for all patients. Consultation with the dentist can help patients make the tooth-replacement decision that best suits their needs and circumstances.
FLOSSING FOR APPEARANCE'S SAKE
After brushing but not flossing, about 40% of tooth surfaces will continue to harbor sticky bacteria (plaque) that give rise to tooth decay and gum disease. If this percentage does not motivate everyone to floss daily, it should be noted that failure to floss can also make a person look older. Overgrowth of plaque creates gum inflammation that can lead to gum recession and bone loss. In fact, the term for aging "long in the tooth" derives from receding, uneven gumlines that make people look older. On top of that, when gum disease leads to bone loss, lips and cheeks cave in and wrinkles form. This puckered, hollowed-out look cannot necessarily be fixed with cosmetic surgery. Prevention is best.
P.S. Once a tooth is lost, there is no reason for the underlying bone to continue to exist.
BRIDGE BUILDING
A "bridge" is a fixed dental restoration that is commonly used to replace no more than four adjacent front teeth or two side teeth. Much like a highway bridge, it is supported by two abutments, which are structurally healthy teeth on either side of the gap. The span, or "pontic," is a metal framework attached to the abutments at each end with the necessary number of attached artificial teeth. When properly crafted, the artificial teeth and abutment crowns should match the contour and color of natural teeth and appear to be growing out of the gums. However, the pontic should barely touch the gums because exerting unnecessary pressure on the gums and underlying bone can damage them.
P.S. There should be sufficient space on the underside of the pontic of a dental bridge so that dental floss can be passed beneath it to keep it clean.
INFLAMMATORY SITUATION
Not only does the buildup of the sticky, bacteria-laden material known as "plaque" increase the incidence of decayed tooth enamel, it also promotes "gingivitis" (inflammation of the gums). When these sticky deposits of bacteria, mucus, food particles, and other irritants accumulate around the base of the teeth, they exert a toxic effect that causes the gums to become irritated, red, and swollen, and to bleed more easily. These symptoms are all signs of gum disease. Left untreated, gingivitis can develop into the more serious condition called "periodontitis," inflammation of the membranes around the base of the teeth, which can lead to erosion of the bone holding teeth in place and resultant tooth loss. To avert these potential problems, brush and floss daily.
P.S. Because plaque collects on teeth on a daily basis, it is necessary to brush and floss at least twice daily to rid teeth of this potentially harmful material.
YOU KNOW THE DRILL! OR DO YOU?
Many patients think that drilling away decay and filling cavities in teeth is an all-or-nothing matter. Those patients who hold this view may be surprised to learn that they have it in their power to reverse some instances of dental decay and avoid the drill entirely. The key point to remember is that regular dental checkups enable the dentist to identify tooth decay in its earliest stages. At this point, when the acid produced by bacteria-laden plaque has only partially penetrated the outer enamel surface, the damage can be reversed with better adherence to home oral care (brushing and flossing) and applications of fluoride that encourage calcium and phosphates in the saliva to "remineralize" the tooth surface.
P.S. A drill-less procedure recently introduced to the United States from Germany, called Icon, treats "intermediate" cavities with a clear resin that prevents the cavity from progressing.
2 + 2 = HEALTHY TEETH AND GUMS
By adhering to the "two plus two" rule, patients can help better their oral health. Most dentists recommend that at least "two" minutes of tooth-brushing is required to thoroughly clean teeth. Although many people think they are following the two-minute tooth-brushing regimen, actual timing of their routines may prove otherwise. If necessary, patients should use an old-fashioned egg timer to time themselves. Flossing is also a must at least once a day because it reaches between teeth where toothbrush bristles cannot go. Regarding regular visits to the dentist, "two" visits a year is acceptable for most patients, while visits every three to four months is preferable for those with bridges, crowns, or a history of gum disease.
P.S. Brushing the tongue is important because that is where the bulk of bacteria collect that cause bad breath.
BABY-BOTTLE TOOTH DECAY
Few things relax infants more than sucking milk or fruit juice from a bottle. When babies are allowed to suck on a bottle at bedtime until they go to sleep, however, this habit can prove to be potentially harmful. Bathing teeth in a sugary liquid in this manner promotes tooth decay. According to various studies, as many as 11% of pre-school children have cavities caused by sucking on a bottle. If a bottle-fed child's mouth is not properly cleansed after sucking on a bottle by lightly swabbing his or her teeth and gums with a water-dampened cloth, plaque will accumulate to cause cavities. If your child must have a bottle at bedtime, provide one filled with water.
P.S. Mothers who breast-feed their children must also clean their babies' mouths with a damp cloth.
TAKING IT ON THE JAW
A serious potential consequence of periodontitis (advanced inflammation or infection of the gums) is tooth loss due to jaw-bone shrinkage and damage. The latest effort to counter this threat comes in the form of a drug called teriparatide, which has recently been proven to regrow bone in jaws. According to one study, patients with tissue damage caused by periodontitis developed nearly ten times more bone with teriparatide treatment than those receiving daily placebo injections. The significant gains in bone produced by the drug developed over a relatively short six-week period. These improvements were sustained, and even improved upon, over a succeeding 12-month period. This jaw-regrowing ability may also prove useful for potential tooth implant patients, who need more foundation bone.
P.S. Periodontitis is a major cause of tooth loss that affects more than one in five U.S. adults.
GETTING THE FULL TREATMENT
Fluoride treatments during regular professional cleanings make sense for adults because they still get cavities. This is especially true at the root surfaces and under crowns, which become exposed as adult gums recede. Particularly susceptible to cavities are root surfaces because they lose mineral faster than enamel does. With this in mind, higher concentrations of fluoride provided by topical treatments may be needed for adequate protection. It should also be noted that many adults take certain medications and have medical conditions that cause dry mouth, which is a condition that increases the risk of cavities in adults. Fluoride makes teeth more resistant to acids produced by bacteria and helps remineralize tooth surfaces that are under attack.
P.S. Getting too much fluoride can be as harmful as getting too little. The dentist assesses the need for fluoride on an individual basis.
THE DENTAL FACELIFT
The "dental facelift" is a non-surgical approach to improving the contours and dimensions of the face, with the comprehensive and coordinated application of veneers on tooth surfaces. As a result of this cosmetic procedure, patients not only emerge with more youthful, whiter smiles, they have added volume to their faces that helps fill in sunken cheeks and shrunken lips and jaws. To understand how this can be accomplished, it is important to look at the teeth as playing a major role in the framework of the face. As we age, teeth wear down and the jaw recedes, which leads to decreasing facial height and a ¬slackened appearance. By building up tooth surfaces with veneers, the face can be subtly reshaped.
P.S. A dental facelift restores the cusp tips of the teeth to rebuild the bite, which increases facial height and improves chewing ability.
DIABETICS AND GUM DISEASE
Diabetics should be conscientious about visiting the dentist as often as recommended. According to a recent review of data from seven studies, patients with both diabetes and gum disease who were treated for their periodontal conditions over a four-month period displayed better glucose control than diabetic patients whose gum disease was left untreated. Periodontal disease, a bacterial infection of the gums that induces redness and inflammation, can be effectively treated with antibiotics and plaque removal by the hygienist. Plaque is the bacteria-laden, sticky substance that collects on tooth surfaces. This buildup may cause chemical changes that weaken diabetics' ability to metabolize glucose. Thus, diabetic patients should be scrupulous about brushing and flossing at home and scheduling regular professional tooth cleanings.
P.S. Because plaque reforms on the gums on a continual daily basis, brushing and flossing daily is essential to staving off tooth decay and gum disease.
HEROES AND VILLAINS
One villain responsible for tooth decay is the bacterium streptococcus mutans, which breaks down sugar and produces the sticky molecules (glucans) that are responsible for allowing bacteria to cling to our teeth. This villainous bacterium also produces an enamel-eroding acid responsible for cavities. The heroes that counter these effects are called "polyphenols," which are found in the fermented stems, seeds, and grape skins left over from wine production. These compounds, which are also found in cranberries, block streptococcus mutans' ability to produce glucans. As helpful as polyphenols are, however, no one is suggesting that we drink wine or sugary cranberry drinks to prevent tooth decay. Instead, scientists hope to isolate these compounds and put them in toothpaste and mouthwashes.
P.S. The beneficial compounds found in wine leftovers and cranberries mentioned above are called "A-type proanthocyanidins."
FAT CHANCE!
Not only does gum disease afflict a large portion of the adult population and pose the threat of tooth loss, this inflammatory condition has also been linked with an increased risk of heart disease, stroke, and other serious conditions. With this in mind, patients should be scrupulous about oral care at home and scheduling regular dental appointments. It may also pay to increase consumption of omega-3 fatty acids found in fish. New research indicates that omega-3s significantly decrease the risk of gum disease. People consuming the most DHA (one of the principal omega-3 fatty acids found in fish) were 22 percent less likely to suffer periodontitis; EPA (the other important fish-oil omega-3) also lowered the risk, but not as much.
P.S. Four of every five Americans suffer from some form of gum disease, according to the National Institute of Dental and Craniofacial Research, which is part of the National Institutes of Health (NIH).
TOOTH RESHAPING
When minor defects such as small chips, shallow pits, and worn edges detract from a smile, "dental contouring" (or "tooth reshaping") provides a quick, safe, and easy fix. This cosmetic procedure may also help correct crooked and overlapping teeth and may even be a substitute for braces under certain circumstances. The procedure involves using a sanding drill to artfully and gradually remove minute amounts of tooth enamel in order to attain the desired shape or eliminate any unwanted characteristic. The dentist will likely mark the teeth with a pencil prior to the procedure to outline the work. As the teeth are sculpted, imperfections are eliminated or minimized. Finally, the teeth are smoothed and polished. Anesthetic is rarely needed.
P.S. Tooth reshaping may be used to correct minor bite problems.
PLAQUE DETECTION
Although your teeth may seem clean, they still may be encrusted with germ-laden plaque, especially between teeth and at the gum line. To detect just how effective tooth brushing and flossing are in removing the sticky substance that causes both tooth decay and gum disease, patients can undergo a plaque detection test either at home or in the dental office. The home version of the test utilizes special tablets that contain red dye. Once the tablet is chewed and mixed with saliva, the dye is swished around in the mouth for about 30 seconds. After a water rinse, the teeth are examined. Any pink residue on the teeth indicates remaining plaque, which poses a threat to teeth and gums.
P.S. The dentist or hygienist can perform a plaque detection test in the office using special fluorescent solution and an ultraviolet plaque light.
ALL-PORCELAIN CROWNS
When it comes to choice of material for replacement crowns, porcelain provides the most natural appearance. Much like natural teeth, translucent porcelain does not have a monochromatic appearance. Instead, it displays color variation that results from the internal play of light. Porcelain's texture also plays a role in imparting an organic look to replacement teeth by breaking up light reflections. The first all-ceramic crowns introduced over a century ago were the porcelain-jacket type. While they offered superior cosmetic appearance, they were not thought to be strong enough to be used on back (chewing) teeth. More recently, however, proprietary materials and processes have been developed for fabricating all-ceramic crowns out of solid blocks of material that combine excellent strength and beauty.
P.S. All-ceramic crowns tend to be more natural looking than porcelain-fused-to-metal (PFM) dental crowns, and they give no indication of the metal edge of their substructure like PFM crowns do.
ROOT CAUSE OF PAIN
When a deep cavity or crack causes infection that damages a tooth's pulp (which contains blood vessels, nerves, and connective tissue), severe pain results. If left untreated, the damage can spread to the surrounding bone, causing further problems. For this reason alone, patients with an infection in the pulp of a tooth need to undergo endodontic treatment that involves drilling to the core of the tooth; removing the damaged pulp; and then cleaning, shaping, filling, and sealing the tooth. A "root canal" procedure derives its name from the fact that the pulp branches down each root through canals that stop just short of the bottom tip of the tooth. Endodontic treatment preserves teeth and circumvents the need to extract them.
P.S. Root canal treatment removes the source of pain caused by an infected pulp; because the procedure is performed with local anesthetic, it does not cause pain.
CHOOSING SUITABLE REPLACEMENTS
While fluoridated drinking water has helped ensure that people under age 50 have an excellent chance of keeping all their teeth, older individuals may not be so fortunate. In fact, the Centers for Disease Control and Prevention reports that one-quarter of American adults over the age of 65 have lost all their teeth; the National Institute of Dental and Craniofacial Research indicates that 58% of Americans over age 50 have fewer than 21 of the normal 32 teeth. Missing teeth lead to poor nutrition as well as a possible collapse of the vertical dimension of the lower face. To avert these potential problems, dental implants provide the best functioning, and most natural-looking, replacements.
P.S. Dental implants are rooted inside the jawbone, which prevents the bone resorption that causes the bone underlying lost teeth to shrink.
TEETHING REMEDY WARNING
The FDA recently issued a safety announcement that warns parents against using benzocaine teething products in children under the age of two years. The use of these products (including Orajel, Baby Orajel, Orabase, and Anbesol) can lead to a serious condition known as "methemoglobinemia," which involves the inability of the oxygen-carrying protein in red blood cells to transport oxygen to the body's cells and tissues. Fortunately, there are a number of alternative treatments to benzocaine teething gels, including chilled rubber rings that babies can chew on to soothe their teething discomfort. Solid frozen rings, on the other hand, should be avoided since they can cause injury to baby's tender gums. Parents can also massage their baby's gums with clean fingertips.
P.S. A good teething remedy is a wet washcloth that is twisted into a rope and set in the freezer for a few minutes. Teething babies can chew on the washcloth until it returns to room temperature.
SMILE MAKEOVER
Because your smile is one of the first things that people notice about you, it makes sense to have your teeth, gums, and lips carefully assessed by the dentist. To begin with, tooth-whitening can improve the color of yellowed and stained teeth, and replacement of amalgam (silver) fillings with tooth-colored composite materials can further whiten smiles. If necessary, composite bonding or porcelain veneers can be used to cover damaged teeth, while bridges, crowns, or implants fill in the gaps left by missing teeth. Irregularities in tooth length and shape can be addressed with tooth-contouring procedures so that the smile line formed by the edges of the upper teeth follows the curvature of the lower lip. These changes get noticed!
P.S. Most people recognize a pleasing smile as one in which the two central front teeth have a width-to-length ratio of 4-to-5.
SWEET!
Those concerned about both their overall health and oral health should take note of the benefits of the naturally occurring sugar substitute known as "xylitol." First discovered in the late 19th century, and popularized as a safe sweetener for diabetics that would not impact insulin levels, xylitol was later found to have significant dental benefits as well. This substance, which is found in a variety of fruits and vegetables, is just about as sweet as sucrose (ordinary sugar) but has fewer calories and no aftertaste. More importantly, xylitol prevents decay-causing bacteria from sticking to teeth, thereby reducing plaque formation. Research also shows that xylitol helps repair damaged enamel by stimulating saliva production. Look for xylitol in sugarless gum.
P.S. If you can't conveniently brush your teeth after a meal, rinse your mouth and pop in a piece of gum or mint containing xylitol.
FULL (DENTURE) DISCLOSURE
Patients fitted with full dentures may mistakenly believe that they no longer must worry about scheduling comprehensive oral exams. After all, there are no natural teeth left to examine. However, the mouth and bite change constantly, which means that the dentist must regularly assess denture fit. If that is the case, the dentist will reline full dentures that do not fit as well as they should. Patients should also note that any man-made material will eventually show signs of wear. This is particularly true of plastic that is subjected to the considerable forces exerted by the jaws while biting and chewing. Gum tissue underlying dentures must also be regularly examined for signs of irritation and pre-cancerous lesions.
P.S. If a patient is unable to successfully wear full dentures, the dentist may recommend implants or anchoring an overdenture to existing tooth roots.
ARTFUL RESTORATION
A dental "inlay" is a dental restoration that is often used to repair areas of decay that are too large to support a filling but not so large that a crown is necessary. Inlays generally cover chewing surfaces between cusps in molars, and "onlays" are used to restore fractured cusps. To prepare an inlay, the dentist makes a wax mold of the space left after the damaged portion of the tooth is removed. Then, the mold is sent to a lab, where the custom inlay is created (usually out of gold alloy). Finally, the inlay is set into place, using cement. The resulting restoration is more durable than amalgam or composite fillings but less expensive than a crown.
P.S. Porcelain is fast becoming the material of choice for dental inlays due to its strength and color-matching ability.
COLLAR ID
One of the wonders of the mouth is how the gums wrap tightly around the teeth much like a turtleneck collar hugs the neck. At the edge of the gumline, the gum tissue folds back underneath itself, creating a snug, 1- to 3-millimeter furrow around each tooth (the "gingival sulcus"). To measure the health of the gums, the hygienist or dentist gauges the depth of the gingival sulcus at several points around each tooth by inserting a thin measuring rod (periodontal probe). A depth of over 3 millimeters may indicate that a pocket is forming between the tooth and gum, which is evidence of gum disease. Treatment prevents mild gum disease (gingivitis) from progressing to severe gum disease (periodontitis).
P.S. Plaque that is allowed to build up in the gingival pocket may lead to possible infection and damage that reaches even further down the tooth, eventually compromising the tissues that hold it in place.
EROSION CONTROL
Tooth enamel may be the hardest tissue in the body, but it is still susceptible to the erosion that occurs as a result of brushing teeth too hard. Excessive consumption of fruit juices and soft drinks can also lead to erosion of the tooth surface, which begins with gum recession and tooth sensitivity. The tooth enamel will eventually show signs of erosion that usually takes the form of horizontal notching at the gumline. Eventually, the enamel may wear through, and the underlying dentin becomes exposed, which leads to severe tooth sensitivity. Fortunately, this problem can be adequately addressed with resin bonding, which fills in the eroded tooth with a resin material that exactly matches the original tooth color.
P.S. To circumvent abrasion caused by tooth-brushing that can lead to enamel erosion, patients should use soft-bristled brushes and avoid exerting too much pressure on the handle of the toothbrush.
CROWNING TOUCH
When the portion of the tooth covered by enamel becomes so damaged from decay or trauma that it must be replaced, the dentist prepares a restoration known as a "crown." The first step involves tapering the outside edges of the damaged tooth into the form of a peg (or post, if root-canal treatment is necessary) that will later accept the overlying "cap." Then, impressions of the tooth and the teeth immediately adjacent to it are prepared, from which the lab will construct the replacement crown. The crown may be fabricated of gold alloy, metal covered with porcelain veneer, or resin. During the second visit to the dentist, the temporary crown is removed and the permanent crown is cemented into place.
P.S. Even though a tooth is crowned, it still must be flossed and brushed along with the rest of the natural teeth.
SENSITIVITY TRAINING
If a bite of ice cream triggers tooth pain, you may be suffering from tooth sensitivity. Although this problem may result from a cavity, cracked tooth, or broken filling, it is most often caused by receded gums or worn tooth enamel, which leaves underlying "dentin" exposed. This second layer of tooth tissue, which is typically pale yellow, connects with tooth nerves that can become irritated in response to cold, hot, sweet or sour drinks, pressure, or cold air. To guard against this problem, it helps to limit intake of acidic foods and drinks; avoid overzealous brushing; and treat any underlying case of "dry mouth," since saliva plays a critical role in neutralizing acid and restoring minerals to teeth.
P.S. Tooth sensitivity, which affects up to 35 percent of adults, may be caused by nightly tooth grinding.
GOOD REASONS TO SMILE
If you doubt the importance of a bright smile, there is research to show the effect that your smile can have. For instance, one study concerned with uncovering the subliminal effect of smiling reveals that, within just four milliseconds, those greeted with smiles experience a mini emotional high before they even consciously register the image. And, as you might have noticed, when you smile, you are likely to get one in return. Moreover, different cultures read smiling faces differently. While people in some parts of the world tend to focus on the eyes of a smiling person, we in this country focus on mouths. These are good reasons to pay special attention to the health of our teeth and gums.
P.S. If you are self-conscious about your smile, you owe it to yourself to discuss various cosmetic treatments that can brighten your teeth and effectively eliminate tooth and gum imperfections.
HOW WHITE A SMILE?
Those looking to emulate the pure-white smiles of magazine-cover models should know that "Chiclet teeth" are more a matter of photo enhancement than reality. Patients should bear this in mind when undergoing teeth-whitening and tooth-replacement procedures. In the latter case, the dentist makes aesthetic decisions based on tooth size in relation to surrounding teeth, surface texture, contour, shape, and color. As far as tooth color is concerned, teeth are not completely white, but are made up of yellows, blues, grays, greens, and oranges. Thus, unless a patient is set on a career in the movies, he or she would be better off with lighter teeth that mimic enamel's subtle range of hues than with pure white teeth.
P.S. Teeth tend to be darker at their bases than at their edges.
PARTIAL SOLUTIONS
As a tooth-restoration device, a "partial denture" is similar to a bridge in that it spans the gap left by missing teeth with artificial teeth on a metal frame. Unlike a permanent bridge, however, a partial denture may be removed. It simply attaches to the crown of adjacent (abutment) teeth with a metal clasp or precision attachment. The replacement teeth are attached to pink, gum-colored plastic bases that are connected by metal framework. Some patients find partial dentures made of flexible materials more comfortable. These types of partial dentures use nylon or vinyl composite material instead of metal to build their framework. This thin material forms not only the denture base, but the clasps as well.
P.S. Dental implants replace missing teeth with the look and feel most like natural teeth; however, they are more expensive than either bridges or dentures.
ARE YOU DIGGING A HOLE FOR YOURSELF?
Do you wonder how cavities actually form? Tooth decay begins with harmful bacteria in the mouth that feed on sugars and carbohydrates. If poor oral hygiene allows these bacteria to continue to grow without interference, the acid they produce (as a by-product of metabolizing sugar) can demineralize (dissolve) tooth enamel. Ordinarily, this process happens slowly, giving the body time to replenish (remineralize) the enamel. However, when populations of bacteria outpace the body's ability to rebuild enamel, the first stage of tooth decay (dental caries) results, appearing as a spot discernable only to the dentist or on an x-ray. The dentist may stop this decay process by applying fluoride, but once the decay has penetrated the tooth enamel, a cavity forms.
P.S. Fluoride and minerals in saliva help increase remineralization of teeth.
ARE YOU AMONG THE MISSING?
It is estimated that about 46 percent of Americans over the age of 65 are missing six or more teeth. This is a problem because, aside from leaving unsightly gaps, missing teeth compromise chewing ability. Equally important, missing teeth tend to throw the bite off balance, which leads to malocclusion (“bad bite”) and increased likelihood of damage occurring to the remaining teeth. Malocclusion also increases the prospect of gum disease and may be a contributing factor to temporomandibular joint (TMJ) syndrome. Beyond these effects, there is the serious potential for misalignments of remaining teeth due to lack of support and restraint from missing teeth. These are all good reasons to see the dentist immediately after losing a tooth.
P.S. Twenty percent of Americans over age 65 have lost all their teeth.
ARE TOOTH IMPLANTS APPROPRIATE FOR CHILDREN?
When children lose permanent teeth due to accidents or sports-related injury, the teeth can sometimes be re-implanted if the knocked-out tooth is handled properly and reinserted quickly. Otherwise, children and parents must work with the dentist to come up with an appropriate tooth-replacement solution. While dental implants are normally the treatment of choice, their use in children with underdeveloped jaws may impede jaw growth and prevent other teeth from growing into their natural positions. With this in mind, girls must wait until they are at least 14-15 years old to get dental implants, and boys should be at least 17 years old. Until then, the dentist can fill the gap caused by a missing tooth with a denture.
P.S. If a permanent tooth is knocked out and can be recovered, it is important to hold it by the crown (top portion), rinse it (not scrub) very carefully in saline solution or tap water, gently put it back in its socket, and immediately get to the dentist’s office.
REVERSING ANESTHETIC NUMBNESS
While patients are usually grateful that local anesthesia blocks the pain that they might otherwise feel as a result of removing tooth decay with a dental drill, many dislike the discomfort associated with lingering numbness after they leave the office. Fortunately, there is something that can be done about this inconvenience. OraVerse® is an injectable drug (phentolamine mesylate) that reverses the effects of local anesthetic and allows patients to experience normal sensation in their lips and tongues about twice as fast as they normally would. As a result, patients can smile, speak, and drink sooner. OraVerse® is not recommended for use in children under 6 years of age or weighing less than 33 lbs.
P.S. The administration of OraVerse® does not hurt since it is injected into a part of the mouth that is already numb from anesthetic.
RECESSION FEARS
The term “long in the tooth” refers to the fact that gums tend to recede as we age. When they do, “cementum” and “dentin” are left exposed. Cementum is a thin, pale-yellow layer of calcified substance that covers the tooth root; dentin is the bone-like tissue that makes up the largest portion of the tooth. Exposure of these parts of the tooth to bacteria and acids renders the tooth root vulnerable to decay. This is why more than 60% of people over age 65 have root caries, making it one of the most pervasive oral-health problems faced by older adults. Roughly one-half of these lesions have not been filled, which leaves teeth vulnerable to further caries and pulp death.
P.S. Mandibular (lower jaw) molars are the most common location to find root caries, followed by mandibular premolars.
LINGERING OVER THE LATTE?
Oddly enough, adults may share a tooth-decay problem that is normally associated with infants. The common denominator is the behavior of bathing the teeth for long periods in sugary liquids. In the case of babies, “bottle mouth” is the decay that occurs as a result of bathing their teeth in bottle-fed sugary liquids (fruit juices, milk, and formula) as they sleep or latch on to their bottles. In the case of adults, “latte decay” occurs as a result of nursing either lattes or cups of coffee mixed with milk and/or sugar throughout the day. In either case, the constant exposure to sugar provides food for the bacteria (Streptococcus mutans) responsible for metabolizing carbohydrates and sugar into enamel-eating acid.
P.S. If you drink a good deal of sugary beverages or snack on carbohydrate-rich foods, you may want to ask the dentist about fluoride rinses.
WHAT YOU KNOW MAY SAVE YOU
The good news is that deaths from mouth and throat cancer have declined since the early 1990s. Unfortunately, this benefit has largely been limited to non-smokers and those with access to timely health care. In the interest of more widespread cancer prevention, readers of this column are advised to give up the smoking habit if they are currently smokers. Beyond that, everyone should know that a simple visual check of the mouth during a regular dental exam can prove very useful in detecting oral cancers when they are most treatable. Mouth and throat cancers cause symptoms such as persistent sore throat or ear pain, trouble swallowing, and/or a lump in the throat that lasts longer than a couple of weeks.
P.S. Aside from smoking, alcohol abuse and the human papillomavirus (HPV) have been linked to mouth and throat cancers.
SECOND THOUGHTS
Dental patients have many reasons to prevent periodontal (gum) disease before it exerts far-ranging adverse effects. Aside from the more immediate potential consequences of gum disease, which include inflammation and possible tooth loss, research links gum disease with heart disease, diabetes, lung problems, and premature and low-weight babies. Fortunately, early stages of gum disease can be reversed with professional cleanings and at-home brushing and flossing. In more severe cases that involve buildups of hardened tartar, professional “scaling” and “root planing” may remove unwanted deposits above and below the gumline. However, only patients have it in their power to reduce exposure to secondhand smoke, which research now shows increases the likelihood of developing severe gum disease by 30% to 60%.
P.S. Both smokers and non-smokers who are exposed to secondhand smoke may come in contact with toxins in the smoke that increase inflammation and oxidative stress.
LAPSE IN THE POOL
If you’re going to be spending a lot of time swimming in a pool this summer, you should know that chlorinated water has the potential to erode tooth enamel. The problem largely rests with poorly maintained pools in which the pH of the pool water is allowed to go too low (too acidic). One immediate indication of this problem is a burning sensation in the eyes, which is due to low pH (not necessarily too much chlorine). Highly acidic pool water has the potential to corrode tooth enamel, resulting in stained teeth. According to one study, 39% of competitive swimmers suffered from dental enamel erosions when pH levels dropped to 2.7 (compared with the recommended pH of 7.2 to 7.8).
P.S. If necessary, purchase pH test strips and test the water in pools that you regularly frequent.
FILLINGS THAT ARE AS GOOD AS GOLD
Aside from being rare, gold has a number of qualities (including purity and malleability) that make it such a highly regarded precious metal. Not only is it the oldest dental filling material, it is also the most reliable and long-lasting. Additionally, gold is less likely to compromise the color of the surrounding tooth than traditional amalgam filling material, and it does not chip or crack. Filling cavities with this high-quality material involves first eliminating any decay, just as with any cavity-filling procedure. Then, small bits of gold are pressed into the prepared area until its surface is level with the surrounding enamel. Gold is comfortable to chew on, will not deteriorate, and is completely biocompatible.
P.S. Gold is a preferred material for fabricating dental onlays and inlays, many of which last a lifetime.
|