Posts for: April, 2014
When a natural tooth can’t be preserved, it is important to have it replaced as soon as possible. Presently, there are two excellent tooth-replacement systems in wide use: traditional bridgework and high-tech dental implants. What’s the difference between the two methods?
Essentially, it comes down to how the replacement tooth is secured in the mouth. In the dental implant system, a natural looking prosthetic tooth is solidly anchored in place by a screw-like titanium implant. This is inserted directly into the bone of the jaw in a minor surgical procedure, and over a short period of time (usually 6 – 12 weeks) its titanium metal structure will actually become fused with the living bone.
With bridgework, however, the support for the prosthetic tooth (or teeth) comes from the healthy teeth adjacent to it. These teeth must be prepared (shaped) by carefully removing some of the outer tooth material (enamel and some dentin), which enables them to be fitted with coverings called crowns or caps. Crowns are often used on their own, to restore teeth that are missing too much of their structure to be treated effectively with standard fillings. But the bridgework system goes one step further.
Instead of making individual crowns for each tooth, a dental lab will fabricate a bridge — a single unit consisting of crowns for the prepared teeth, plus complete prosthetics to replace the missing tooth (or teeth). A three-unit bridge, for example, consists of one complete prosthetic tooth to replace the one that’s missing, plus two crowns for the adjacent “abutment” teeth. It’s possible to have larger bridges as well: For example, a six-unit bridge might consist of two complete prosthetic teeth in the center, with two crowns for abutment teeth on each end, all linked together in one piece.
While bridgework has been used effectively for decades, it is now being gradually supplanted by dental implants. Implants don’t require the removal of healthy tooth material from abutment teeth, and they don’t place extra stress on those teeth; plus, they generally last much longer than natural tooth bridges. However, the dental bridge remains a viable alternative for tooth replacement in many circumstances.
When a tooth is lost, it’s important to restore your mouth to its proper function and appearance with a permanent replacement, such as a dental implant or a bridge. Recently, the implant system has received the lion’s share of attention (for some good reasons); however, in certain situations, dental bridgework offers a viable alternative. What would cause one method to be favored over the other?
In general, implants are now considered the gold standard for tooth replacement. They have the highest success rate (over 95 percent), last the longest (quite possibly the rest of your life), and don’t affect the integrity of adjacent teeth. Bridges, by contrast, require the removal of tooth structure from adjacent teeth, which can potentially compromise their health. Yet implants aren’t necessarily ideal for every situation. When might a bridge be preferred?
Some people don’t have the proper quantity or quality of bone in the jaw to support an implant; or, they may have anatomical structures (nerves or sinuses) located where they would interfere with an implant. It is possible in some cases to work around these obstacles with bone grafts, or by placing implants in alternate locations; in other cases, a bridge may be a better option.
While most tolerate the implant process quite well, a few people aren’t good candidates for the surgical procedure required to place an implant. Certain systemic diseases (uncontrolled diabetes, for example), the use of particular medications, or a compromised immune system may make even minor surgery an unacceptable risk. In these cases, a decision may be made after consulting with an individual’s other health care providers. Additionally, a few behaviors or lifestyle issues, like heavy smoking or a teeth-grinding habit, tend to make implants have a less favorable success rate.
There are also a few circumstances that could argue in favor of a bridge — for example, if you already have a need for crowns on the teeth adjacent to the gap, it can make the process of getting bridgework easier and more economical. Financial issues are often an important consideration in planning treatment — but it’s important to remember that while bridges are generally less expensive than implants in the short term, the much longer expected life of implants can make them more cost-effective in the long run.
If you have questions about dental implants or bridgework for tooth replacement, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine article “Crowns & 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.”
When most people think of orthodontic treatment, they may think of braces worn during the teenage years. But there are some types of malocclusions (bad bites) that may benefit from intervention much earlier than adolescence. A cross-bite is one example.
A cross-bite occurs when the front teeth of the lower arch bite in front of the upper teeth rather than behind them. The condition can have an adverse effect on any of the six front teeth of either arch. This type of malocclusion can develop quite early in childhood.
Orthodontists have developed a two-phase treatment for a cross-bite, with the possibility that the first phase may be all that’s needed. If your child has a cross-bite, your orthodontist may first recommend he or she wear a specially-designed retainer for a few months. The retainer could stop and correct an existing problem before it becomes worse, or it could prevent a deeper problem from developing in the first place. The retainer could also help guide jawbone development during these formative years, even as early as age 7, for children at risk.
Even if this first phase doesn’t fully correct the cross-bite and the second phase (most likely braces or a similar orthodontic device) becomes necessary, it could still help to make the second phase easier and less costly. On the other hand, if orthodontic treatment is postponed until adolescence when the mouth structures are more fully formed it may become quite difficult or even impossible to correct the problems that have developed.
As a result, early intervention for this or similar orthodontic conditions is the most efficient strategy, even when later treatment is necessary. As part of your child’s regular dental care (which should begin ideally around their first birthday), we can advise you on any need for an orthodontic evaluation based on our observations. An orthodontist can then best advise whether waiting until later for treatment is best, or whether intervention now could lessen problems later.
If you would like more information on preventative orthodontics, 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 “Preventative & Cost Saving Orthodontics.”
They work hard, and put in lots of time on the field and at home. They learn the rules of the game — as well as the unwritten rules of sportsmanship and teamwork. They receive the proper training, and wear appropriate protective equipment. But sometimes, in spite of everything, kids who participate in sports can be subject to injury. Fortunately, in today's dentistry there are a variety of treatments, as well as preventive measures, which can help.
When faced with serious dental injury, time is of the essence in saving teeth. So, don't delay — come in to see us immediately! If treated promptly, it's possible for teeth which have been dislodged — or even knocked out of the mouth — to be put back in position and stabilized. Afterwards, follow-up treatment will ensure that the tooth has the best chance of recovery.
The treatment of kids' dental injuries is sometimes different than that of adults. For example, in adults, a root canal would generally be necessary, followed by a tooth restoration (crown). But some kids may not need this treatment, since their teeth are still developing. Also, replacing a missing primary (baby) tooth may not be recommended, since it may hinder development of the permanent teeth. Based on his or her individual circumstances, we can develop an appropriate treatment plan for your child.
Luckily, the most common dental injuries aren't nearly as serious — they typically involve chipped or cracked teeth. Most can be repaired by reattaching the broken piece, or using a tooth-colored restoration. If a large part of the structure of a permanent tooth is missing, a crown or “cap” may be placed on the visible part, above the gum line. Smaller chips, even in primary teeth, can be successfully repaired by cosmetic bonding with composite resin materials.
Finally, if your child is involved in athletic activities — or if you are — consider obtaining a custom-made mouthguard. Numerous studies have shown that this protective gear can help prevent many dental injuries. Unlike the off-the-shelf types found in some sporting-goods stores, the ones we provide are individually fabricated from an exact model of the teeth. They're strong, fit comfortably, and offer superior protection at a reasonable cost.
If you have questions about the treatment of sports-related dental injuries, or about mouthguards, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Trauma & Nerve Damage to Teeth” and “Mouthguards.”