Posts for: March, 2015
Let’s say you’re traveling to Italy to surprise your girlfriend, who is competing in an alpine ski race… and when you lower the scarf that’s covering your face, you reveal to the assembled paparazzi that one of your front teeth is missing. What will you do about this dental dilemma?
Sound far-fetched? It recently happened to one of the most recognized figures in sports — Tiger Woods. There’s still some uncertainty about exactly how this tooth was taken out: Was it a collision with a cameraman, as Woods’ agent reported… or did Woods already have some problems with the tooth, as others have speculated? We still don’t know for sure, but the big question is: What happens next?
Fortunately, contemporary dentistry offers several good solutions for the problem of missing teeth. Which one is best? It depends on each individual’s particular situation.
Let’s say that the visible part of the tooth (the crown) has been damaged by a dental trauma (such as a collision or a blow to the face), but the tooth still has healthy roots. In this case, it’s often possible to keep the roots and replace the tooth above the gum line with a crown restoration (also called a cap). Crowns are generally made to order in a dental lab, and are placed on a prepared tooth in a procedure that requires two office visits: one to prepare the tooth for restoration and to make a model of the mouth and the second to place the custom-manufactured crown and complete the restoration. However, in some cases, crowns can be made on special machinery right in the dental office, and placed during the same visit.
But what happens if the root isn’t viable — for example, if the tooth is deeply fractured, or completely knocked out and unable to be successfully re-implanted?
In that case, a dental implant is probably the best option for tooth replacement. An implant consists of a screw-like post of titanium metal that is inserted into the jawbone during a minor surgical procedure. Titanium has a unique property: It can fuse with living bone tissue, allowing it to act as a secure anchor for the replacement tooth system. The crown of the implant is similar to the one mentioned above, except that it’s made to attach to the titanium implant instead of the natural tooth.
Dental implants look, function and “feel” just like natural teeth — and with proper care, they can last a lifetime. Although they may be initially expensive, their quality and longevity makes them a good value over the long term. A less-costly alternative is traditional bridgework — but this method requires some dental work on the adjacent, healthy teeth; plus, it isn’t expected to last as long as an implant, and it may make the teeth more prone to problems down the road.
What will the acclaimed golfer do? No doubt Tiger’s dentist will help him make the right tooth-replacement decision.
If you have a gap in your grin — whatever the cause — contact us or schedule an appointment for a consultation, and find out which tooth-replacement system is right for you. You can learn more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Crowns & Bridgework.”
A dental crown is a tooth-shaped “cap” or cover that we place over a tooth that is badly damaged from trauma or decay to restore its shape, strength, size and functionality. We also use them for cosmetic reasons to improve a tooth's appearance with natural, life-like results. Crowns are generally handcrafted by dental laboratory technicians using high-quality dental porcelains (ceramic materials) that are made to fit on precise replicas (molds) of the prepared teeth. In our office, we generally make temporary crowns to protect the teeth to keep them comfortable and functional while the permanent crown(s) is being made. And once a crown is placed (cemented into position), it fully encases the entire visible portion of the tooth that lies at and above the gum line.
When Are They Necessary?
There are many reasons a crown may be needed. Some of these include:
- To repair a tooth that is worn down, broken or badly damaged by decay or injury.
- To restore a tooth so severely damaged by decay that the tooth's structure is no longer intact enough to place a filling or where a filling can't restore the tooth to its former strength.
- To protect a tooth that has minor cracks or fractures from further damage.
- To create a bridge to replace a missing tooth, in which the teeth on either side, known as abutments, must be “crowned” to attach to the “pontic” (from the French word, “pont” that means bridge).
- To create the visible part of the tooth that sits atop a dental implant.
- To improve the appearance of a tooth providing a more appealing shape and color.
While most dental problems are caused by disease or trauma, sometimes the root problem is psychological. Such is the case with bulimia nervosa, an eating disorder that could contribute to dental erosion.
Dental erosion is the loss of mineral structure from tooth enamel caused by elevated levels of acid in the mouth, which can increase the risk for decay and eventual tooth loss. While elevated acid levels are usually related to inadequate oral hygiene or over-consumption of acidic foods and beverages, the practice of self-induced vomiting after food binging by bulimic patients may also cause it. Some of the strong stomach acid brought up by vomiting may remain in the mouth afterward, which can be particularly damaging to tooth enamel.
It’s often possible to detect bulimia-related erosion during dental exams. The bottom teeth are often shielded by the tongue during vomiting, so erosion may be more pronounced on the unshielded upper front teeth. The salivary glands may become enlarged, giving a puffy appearance to the sides of the face below the ears. The back of the mouth can also appear red and swollen from the use of fingers or objects to induce vomiting.
Self-induced vomiting may not be the only cause for dental erosion for bulimics. Because the disorder causes an unhealthy focus on body image, bulimics may become obsessed with oral hygiene and go overboard with brushing and flossing. Aggressive brushing (especially just after throwing up when the tooth enamel may be softened) can also damage enamel and gum tissue.
Treatment must involve both a short — and long-term approach. Besides immediate treatment for dental erosion, a bulimic patient can minimize the effect of acid after vomiting by not brushing immediately but rinsing instead with water, mixed possibly with a little baking soda to help neutralize the acid. In the long-term, though, the eating disorder itself must be addressed. Your family doctor is an excellent starting point; you can also gain a great deal of information, both about eating disorders and treatment referrals, from the National Eating Disorders Association at their website, www.nationaleatingdisorders.org.
The effects of bulimia are devastating to mental and physical well-being, and no less to dental health. The sooner the disorder can be treated the better the person’s chance of restoring health to their mind, body — and mouth.
If you would like more information on the effect of eating disorders on oral health, 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 “Bulimia, Anorexia & Oral Health.”
If you’re taking medication to regulate your blood pressure, you may be familiar with some of the general side effects, like nausea, drowsiness or dizziness. But some blood pressure drugs might also cause complications with your oral health.
This is true of one class of drugs in particular used for blood pressure regulation. Calcium channel blockers (CCBs) are used to regulate blood pressure by dilating (relaxing) blood vessels, making it easier for the heart to pump blood. They’re often prescribed to patients who can’t tolerate beta blockers, another common blood pressure drug.
Besides other general side effects, CCBs can also cause gingival hyperplasia (gum overgrowth) and mouth dryness. The former condition occurs when the gum tissues grow and extend beyond their normal size over the teeth. Besides pain and discomfort, hyperplasia creates an abnormal appearance which can be embarrassing. Research findings also indicate that hyperplasia development from CCB use is also linked to poor hygiene habits, which give rise to periodontal (gum) disease.
Mouth dryness is defined as less than normal saliva flow. Besides discomfort, the condition may increase your risk of dental disease: saliva is a key part in keeping bacterial levels low and maintaining the mineral content of enamel. Inadequate saliva flow can’t maintain this balance, which increases the bacterial population in the mouth and the risk of infection leading to gum disease or tooth decay.
To avoid both of these side effects, it’s important first to let us know if you’re taking blood pressure medication and what kind. You may also need more frequent dental visits, especially if you’re displaying symptoms of dental disease. Studies have found that frequent dental visits to remove bacterial plaque and calculus (hardened plaque deposits) may significantly reduce gum overgrowth in patients taking a CCB. You should also maintain a recommended daily regimen of oral hygiene (brushing and flossing).
Because of possible effects on your dental health from a number of drugs, it’s always important to let us know the medications you’re regularly taking. As with CCBs, we can incorporate that knowledge into your dental treatment to assure your safety and optimal oral health.
If you would like more information on managing your oral care while on medication, 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 “Blood Pressure Medications.”