Preventing dental problems or disease from happening is the primary focus of the dental profession. Using proper brushing and flossing techniques along with regular cleanings at the dentist office can prevent almost all dental problems depending on a your lifestyle choices. Diet, environment, genetics and personal habits all play an important role in dental health but with proper preventative care you can greatly reduce the chances you will face many of the common dental problem
What are the Common Problems
Cavities and gum disease represent the most common dental problems people face. Proper and consistent homecare with a tooth brush and floss along with fluoridated water will minimize if not eliminate cavities and most cases of gum disease. Technique, frequency and time are essential to proper technique. If you have questions on proper techniques be sure to ask your hygienist at your next cleaning appointment. In general, brushing very well once per day for 2 to 3 minutes and flossing should be sufficient to clean all surfaces of the teeth.
Better Diet and Habits
Prevention wouldn’t be complete without discussing diet and personal habits. Cavities are caused by bacteria in your mouth which feed on sugar from the foods you intake. Sweets and sugary drinks in excess can significantly increase the amount of decay affecting your teeth. Personal habits such as smoking or chewing tobacco not only change the environment in your mouth but also affect blood supply, immune system, and tissue elasticity all of which contribute to gum disease. If you are interested in making better choices about diet or tobacco use ask your physician or dentist about resources that can help.
Visiting your hygienist at least every six months is an excellent way to prevent dental problems. If tartar builds on your teeth brushing and flossing wont remove all of the tartar. Your hygienist removes the tartar and identifies any changes in your mouth at your cleaning appointment. The hygienist is also able to recommend and preventative treatments such as fluoride, sealants, or mouth rinses which may help you maintain your healthy mouth in addition to the regular home care of brushing and flossing. The American Dental Association recommends cleanings every 6 months or more often if there is gum disease.
Gum disease or periodontitis is caused by the build-up of bacteria under the gumline and along the root surface of the teeth. If the bacteria is not properly and frequently removed, the plaque along these areas will calcify into calculus or tarter and stick to the side of the tooth similar to barnicles on the side of a ship. This tarter is teeming with bacteria that causes an immune response in which you begin to break down the bone holding the teeth in place.
Gum Disease Progression
If the disease is not treated, then you will continue losing bone until the tooth becomes mobile and is lost due to lack of support or infection of the tissue around the tooth. Tissue will also be lost, but at a much slower rate than the bone leading to deeper and deeper periodontal pockets. This is the depth of the gums from where they start to the point that they attach to the tooth. A healthy mouth has 3 mm or less pocket depth. 4 mm is classified as gingivitis while 5 mm and more falls in the periodontitis category. The bone loss seen in gum disease is what is seen when someone is referred to as “long in the tooth” as it takes time to progress.
Treatment for Gum Disease
Initial treatment is a deep cleaning or periodontal scaling and root planing. In this, the patient is numbed and instruments are taken below the gumline to remove all of the tarter and bacteria. The patient is often placed on an anti-bacterial rinse such as chlorhexidine to further kill off the bacteria in the mouth. For deeper pockets, an anti-bacterial agent may need to be placed under the gums as well to further decrease the pocket depth, and sometimes tissue removal may be necessary. Once the bone is lost, there is no way to really get it back, treatment is meant to stop any further disease progression and decrease pocket depth to the manageable 3 mm or less (this depth can be cleaned by a toothbrush and floss at home). The goal of treatment is to cause shrinkage of the tissue back to the levels of the bone which in turn will expose more root surface and make the tooth look longer. This will make the areas easier to clean and possible to maintain lower bacterial counts.
Prevention of Gum Disease
Gum disease is the most preventable disease in existence. All that is required to prevent it is using proper techniques for tooth brushing, daily flossing, and regular cleanings with your dentist and dental hygienist. In short proper dental hygiene is all that is required to prevent damage from periodontal disease.
Orthodontics is the area of dentistry that deals with changing the position of teeth. Although mostly associated with the cosmetic goals of creating “straight” teeth for a more symmetric smile, orthodontics can be used to create space for tooth or implant restorations where teeth have drifted over time into spaces of missing teeth. Orthodontics have been used to change tooth position to relieve jaw pain associated with how teeth come together. Systems to accomplish these goals vary from fixed or traditional bands and brackets to removable plastic trays such as Invisalign.
Traditional braces with bands and brackets are cemented to teeth and connected to other teeth with wires in order of some or all the teeth. Traditional braces can be used to relieve crowding, reduce overbites, correct rotated or tilted teeth, close spaces or gaps or help impacted teeth erupt. Traditional braces usually require the patient to wear elastics and maintain excellent hygiene throughout treatment which typically lasts 2 or more years.
Orthodontics can also be accomplished using removable appliances. Typically these are made up of a series of plastic trays which are fabricated to move the teeth while in the patient’s mouth. The trays can be removed by the patient for eating and cleaning both the teeth and trays. The trays are usually more limited than traditional braces as to the conditions that can be corrected and require the patient to be more responsible about wearing the trays as prescribed by the dentist.
A dental implant is an artificial tooth root made out of titanium that is placed in the bone to replace a missing tooth. After placement and healing, a single implant can have an abutment screwed into the implant and a crown attached to replace the missing tooth, or if an entire arch of teeth is missing, multiple implants can be fitted to attachments that allow a denture to snap onto the implants or they can be connected to form a bar the a denture can attach on to.
Pros and Cons of Implants
The nice thing about a dental implant is it is just like having your natural tooth back only it can never get decay. You can floss between it, unlike a bridge, and you can chew pretty much whatever you want. The negatives are the time it takes to complete after extraction range from 4 months to close to a year due to healing rates. Implants in general are also the most expensive form of tooth restoration, but they do tend to have the highest satisfaction rate of any missing tooth replacement.
Implant Success Rate
95-98% of dental implants are successful. However, as with all forms of man-made implanted items there is a small percentage of rejection that occurs. Generally speaking, when this occurs, the implant is removed and bone healing of the socket is allowed to occur before placing another implant in the site. The risk factors are relatively low with implant surgery.
Alternatives to Implants
Alternative treatment for single tooth replacement would be a bridge or removable partial. For multiple teeth, alternatives include a partial or denture.
Endodontic or root canal treatment must be performed on a tooth once the tooth nerve has been compromised. This happens whenever the bacteria associated with tooth decay has reached the nerve area called the pulp or when the nerve and blood vessels have died due to deep decay, restorations, or tooth fracture. All of these senarios have led to or will lead to a tooth abscess and pain if treatment is not received.
Root Canal Procedure
To perform root canal treatment, a dentist will numb the tooth and use a handpiece to make a hole in the biting surface of the tooth until they reach the pulp chamber in the center of the tooth. This area is the largest part of the tooth containing the nerves and blood vessels. The dentist then proceeds to remove all remnants of nerve, blood vessel, and infection from the chamber and down the roots of tooth. They then open up the canals running down the roots in order to get a filling material called gutta purcha, a rubbery plastic material, down to the tips of the root. They will use this material to seal the inside of the canals so the bacteria and infection cannot reenter the tooth. After this, an amalgam (silver) or composite resin (tooth-colored) material will be used to seal the hole in the biting surface of the tooth and most commonly a crown will be needed to hold the tooth together as teeth tend to get brittle and break after the blood supply is removed.
Root Canal Success Rate
Generally speaking, the success rate of endodontic treatment runs between 90-95%. The most common cause of failure is not properly restoring the tooth with a crown after the root canal treatment, Decay getting back into the root canal space either under the existing crown or restoration, or root fracture due to the overall brittleness of the tooth.
Alternatives to a Root Canal
The only alternative treatment available at this time is tooth extraction which if this path is chosen, the tooth can be replaced by either a partial denture, fixed bridge, or a dental implant.
Dentures, partial dentures and oral surgery are a necessary part of dentistry. Dentures and partials are removable appliances designed to replace missing teeth. They improve chewing ability which is the beginning of the digestive process, and they enhance facial appearance, thus restoring the patient’s smile and self-confidence.
Complete dentures are designed for the patient who is missing all the teeth in a single arch, whether upper or lower. The soft and hard tissues of the mouth support these appliances. Some patients may opt for non-conventional dentures that may clasp onto existing teeth or dental implants. This supplies additional stability for the denture and is especially helpful with lower dentures in patients who may have insufficient ridge structure. Generally, adapting to a maxillary (upper) denture is a relatively simple and successful process. The mandibular (lower) denture can be a difficult appliance for the patient to learn to wear. Our dentists will work with our patients as they progress through this learning curve and adjustment period.
Partial dentures are constructed to replace teeth missing in an arch when other, natural teeth, are still present. The natural teeth provide support to these appliances. There are three general types of partial dentures:
- Resin based: similar to the base of a full denture but contains wires that attach to the remaining teeth to hold it in place
- Duraflex: has a flexible base and a pink clasp to attach to the remaining teeth
- Cast partial: has a metal base and metal clasps to attach to the remaining teeth
Many of our appliances are made in house, and for those requiring the services of a lab, we utilize trusted labs that we have maintained relationships with for many years. Most tooth removal is performed by our own dentists. If you need the services of an oral surgeon we have a referral list for your convenience.
Tooth decay is a disease process caused by the by-product of bacteria in the mouth. Unfortunately, the only treatment once the disease has progressed is restoration of the tooth with fillings, such as amalgams (silver) or composite resins (tooth-colored) or if the decay is more advanced, then crowns (caps), root canal therapy, or extraction may be the only course of treatment.
Process of Tooth Decay
Tooth decay or caries occurs when the bacteria found in the plaque that forms on teeth after eating and drinking is not removed quickly enough by brushing and flossing. These bacteria give off an acidic by-product that given enough time, will eat a hole through the enamel, or outside layer, of the tooth and leave a “soft spot” in the tooth. This hole will continue to get larger and deeper until the tooth is properly treated.
Treatment of Tooth Decay
Treatment involves numbing the tooth so the dentist can use a handpiece to remove all of the soft diseased tooth and all the bacteria, and then using a restorative filling material such as amalgam or composite resin to seal the hole left behind. If the decay has removed too much tooth for the tooth to adequately support a filling, a crown may be needed to hold the tooth together. Likewise, if the decay has reached the nerves and blood vessels in the center of the tooth, a root canal may be needed as well to remove the nerves to prevent future tooth pain.
Prevention of Tooth Decay
Tooth decay can be prevented using a combination of two things. The first is fluoride. The National Institute of Health found that fluoride in the water system was the # 1 most important health advancement made in the 20th century. It has been proven to decrease the depth of the pits and grooves in the teeth which are prone to trapping bacteria and leading to decay and helps expose the tooth enamel to fluoride molecules. Also, using fluoridated toothpaste exposes the enamel to the fluoride molecules which leads to a chemical change in the tooth enamel that actually leaves the enamel stronger and more resistant to the bacterial acids. The second form of prevention is the mechanical removal of the bacteria through brushing and flossing your teeth. The less bacteria on the teeth, the less the chance the bacterial by-products can cause irreversible damage.
Cosmetic Dentistry offers ways to improve your appearance and self-confidence through your smile. From tooth whitening to complete smile makeovers, cosmetic dentistry can change the color, shape and even the alignment of your teeth to give you the smile you have always wanted. Cosmetic dentistry can include whitening (or bleaching), porcelain veneers, orthodontics, and even more common dental work such as fillings and crowns. As is true for all dental work, home-care with your brush and floss is essential for the success of cosmetic dentistry.
Teeth darken with age and also as a result of the food and drink we consume. Although excellent home care with over the counter products like whitening tooth paste and regular visits to the hygienist can help, sometimes a stronger bleaching agent is needed to remove those stubborn stains. With take home bleaching and heat activated in-office bleaching, your teeth can be 2 to 4 shades whiter in a few hours to a few weeks. A strong hydrogen peroxide solution is placed in trays which cover the teeth and allowed to whiten for 30 minutes to 1 hour. This process is safe and effective and can repeated often to achieve the desired color. Some patients experience some minor sensitivity during the bleaching process which resolves after the bleaching is discontinued. For teeth that have had root canal treatment but have turned dark internal bleaching can be used when the other whitening options are not effective.
Porcelain veneers are very thin porcelain which are cemented to your teeth. The process often requires little or no need for preparation and can be placed without anesthesia if the patient prefers. Using veneers we can change the shape and color of your teeth creating a more beautiful smile. Veneers are an effective way to treat teeth that are resistant to bleaching such as with tetracycline stains. Veneers can also be used in some cases to treat worn or chipped teeth without the need for a crown.
Esthetic Restorative Materials
Often by simply replacing older fillings and crowns with newer more esthetic materials, you can restore your smile. Newer materials are more translucent allowing the transmission of light in a way more like natural teeth. In addition, materials stain over time causing them to become darker than the surrounding tooth structure. Composite materials are now available in many shades to match teeth. Older crowns can show dark lines around the gums where the metal substructure shows over time. With new all porcelain crowns or zirconia crowns these dark lines can be eliminated while providing the strength needed for normal chewing function. New crowns can also be used in conjunction with porcelain veneers to completely change your smile.
The most common cause of oral cancer is tobacco use, chewing tobacco being a more common cause than smoking, but both can lead to it. Interestingly, smoking pipes and cigars leads to more oral cancer than cigarettes, statistically speaking, presumably due to how deeply the smoke is inhaled. Excessive alcohol consumption also leads to a higher risk of oral cancer and is considered the second highest risk factor. The best prevention for oral cancer is to not use tobacco and to only use alcohol in moderation.
Signs and Common Areas to find Oral Cancer
The most common site for oral cancer is on the back of the tongue to one side or the other. Chewing tobacco users will commonly develop lesions in their cheeks where they hold their tobacco, but it is possible to develop lesions anywhere in the mouth. A malignant lesion normally looks white or red and often appears ulcerated, but generally has little or no pain. Skeletal cancer will exhibit atypical bony changes on a radiograph.
Oral Cancer Screening
Screening is done by the doctor at each of the patients normal cleaning recall appointment. At each recall and during a patient’s initial comprehensive examination, the examining dentist will check the soft tissue of the mouth and tongue for any atypical lesions. Also, radiographic x-rays are taken periodically to also check for any skeletal abnormalities.
Treating Oral Cancer
Oral cancer most commonly needs surgical intervention for treatment and depending on the extent and type of cancer, this surgery may involve the removal of only soft tissue like the tongue or cheek, or removal of hard tissue as well such as the jaw bone. Other treatment such as radiation and chemotherapy depends on the type and progression of the disease.
So you have been told that you need a tooth crowned but it had a filling in it before. Why can’t it just be filled again? A crown or “cap” is a dental restoration that caps over the entire tooth in order to hold it together when the tooth has lost a great deal of existing tooth structure. Teeth that are in need of crowns rather than fillings have generally lost so much tooth structure that the tooth risks breakage and even possible loss of the tooth if a filling is placed. The purpose of the crown is to fit over the entire tooth and hold it together to try to prevent breakage and give a solid structure with which to chew.
A bridge is prepared similarly to crowns as they are effectively multiple crowns made in one piece meant to replace a missing tooth or teeth, usually in between the two ends of the bridge. Generally for bridges, the tooth on either end of the missing tooth is prepared for crowns and the two crowns are connected to the false tooth in the middle. These are made when the patient wants to replace the missing tooth with something that is not removable from their mouth and is not willing or able to place a dental implant. Unfortunately, since the bridge is made with purpose of replacing missing teeth, the teeth on either side of the false tooth that are prepared for crowns may not actually need the crowns due to loss of tooth structure.
Preparation for Crown and Bridge
For both a crown and the teeth holding a bridge, preparations requires numbing the tooth and removing a minimum of 1.5-2 mm of tooth structure across the top and around the sides of the tooth in order to make space to place the crown over the tooth. Impressions are made of the prepared tooth to fabricate the custom made restoration in the laboratory and a provisional or “temporary” crown is placed over the tooth for the patient to wear until the crown is completed, usually in a week or two. The patient then comes back at a later appointment to have the final restoration adjusted and cemented into place. There are milling machines that can produce crowns “while you wait” and bypass the need for the provisional restoration. These are generally functional crowns, but do give up strength that you can get from crowns that require more time to produce.
Longevity of Crown and Bridge
Crowns and bridges can last anywhere from a few years to 30+ years depending on how well the patient takes care of them and how prone a patient is to dental decay. The most common reason that someone has to replace a crown or bridge is a cavity starting at the edge of the crown, most commonly in between teeth. Therefore, maintenance requires brushing and flossing AT LEAST on a daily basis and having regular biannual cleanings and exams and annual x-rays. Prevention or early treatment is the key to longevity of these restorations.