Posts for: August, 2014
The preferred outcome when treating a tooth for decay is to preserve it. If the disease is still in its early stages, we can accomplish this effectively by removing diseased tissue and then restoring the remaining tooth with filling material.
There comes a point, however, when filling a tooth isn’t the best option. If it has already received several fillings, the tooth may have become too weak to receive another. Additionally, a filling may not be enough protection from further fracture or infection for teeth weakened from trauma or abnormal tooth wear or in the event a root canal treatment is necessary.
While a diseased tooth can be extracted and replaced with a durable and aesthetically pleasing dental implant, there may be another option to consider — installing a crown. Like a filling, a crown preserves what remains of a natural tooth, but with better protection, life expectancy and appearance than a filling.
Known also as a cap, a crown completely covers or “caps” a natural tooth. They’re produced in a variety of styles and materials to match the function and appearance of the capped tooth and adjacent teeth. Crowns made of porcelain are ideally suited for visible teeth because of their resemblance to tooth enamel. A less visible tooth that endures more biting force (like a back molar) may need the strength of a precious metal like gold or new-age porcelains that can also withstand significant biting forces. There are also hybrid crowns available that combine the strength of metal for biting surfaces and the life-like appearance of porcelain for the more visible areas of a tooth.
To prepare a tooth for a crown, we first remove any decayed structure and add bonding material to strengthen what remains. We then make a mold of the tooth and bite, which is typically sent to a dental technician as a guide for creating the permanent crown. Recent advances with digital technology have also made it possible to mill the permanent crown out of porcelain in the dental office while you wait.
After the permanent crown is received and permanently bonded to the tooth, you will have a protected and fully functional tooth. From this point on it’s important for you to clean and care for it as you would any other tooth since the underlying tooth is still at risk for decay. The good news is your tooth has been saved with a bonus — a long-term solution that’s also smile-transforming.
If you would like more information on crowns and other tooth restorations, 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 “Crowns & Bridgework.”
Many Hollywood luminaries use porcelain veneers to enhance their smiles. Take actress and singer Hilary Duff, who, according to People magazine, had veneers placed on her two front teeth after chipping them on a microphone during what must have been an extremely energetic performance.
Well, you don't have to be a Hollywood star to benefit from a smile enhanced with porcelain veneers. If you have small chips, cracks, slight tooth rotations or minor spacing problems, veneers may be able to give you back your smile — or an even better one.
The word “veneer” refers to a super-thin covering, and in dentistry a veneer is a thin layer of porcelain that replaces your natural tooth enamel. Porcelain is the material of choice because of its strength, translucency, and ability to resist erosion.
In the right hands, dental porcelain can mimic tooth enamel perfectly. To make veneers, a skilled dental technician will mix porcelain powder (in a shade specified by the dentist) with water and then fire the material in an oven like pottery; the porcelain is built up in layers for a truly lifelike effect.
Before a veneer is bonded to a tooth, often we need to remove a tiny bit of the tooth's existing enamel so that the final effect will not be too bulky. The procedure is virtually painless and can be completed in as little as two visits. Because enamel is removed, this particular cosmetic treatment is not reversible. Sometimes veneers can be added directly onto the tooth surface without any tooth reduction and therefore are reversible if used in this way.
Once you have veneers, please keep in mind that while extremely strong, porcelain veneers are not indestructible; you won't want to do things like crunch ice or break nuts open with your teeth. And if you are a teeth-grinder, you should wear a nightguard to protect your beautiful new smile. With proper care, your veneers will last 20 years or more.
If you would like more information about porcelain veneers, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Smile Design Enhanced With Porcelain Veneers.” Dear Doctor also has more on “Cosmetic Dentistry: A Time For Change.”
Periodontal (gum) disease is an infectious disease that progressively weakens the attachment of supporting tissues to the teeth, including gums, ligaments and bone. If not stopped, the loss of attachment will eventually lead to bone and tooth loss.
A thin layer of plaque that builds up on teeth (mainly due to poor oral hygiene habits) is the main breeding ground for the bacteria that cause gum disease. Our main treatment goal is to remove as much of this plaque as possible from tooth and gum surfaces. Much of the plaque can be removed using special hand or ultrasonic instruments that deep clean dental surfaces, including the roots. But while effective, these manual techniques may not address the full extent of infection, especially if the disease is well advanced.
If severe bone loss has already occurred, deep pockets of infection may have developed. As bone loss progresses, teeth with multiple roots may also develop an anatomical problem known as furcation invasions where the roots of the tooth branch off. If there continues to be signs of disease, like gum inflammation, bleeding or pus formation, it’s these hard to reach areas that may still be a problem even after extensive treatment. If so, we may need to take a different approach with antimicrobial or antibiotic products.
The most effective antimicrobial substance for reducing bacteria in biofilm is a chlorhexidine mouthrinse. The typical 0.12% solution is only available by prescription — if taken for a prolonged time it can result in tooth staining, affected taste or mouth irritation. To assure the solution reaches below the gum line, it will need to be applied by us in the office, followed up flushing irrigation of the affected area.
Another alternative is topically applied antibiotics that can stop or even reverse the progression of gum disease. There’s evidence that topical applications can penetrate into these deeper areas of infection. A common antibiotic used in this way is tetracycline, which has been shown to stop inflammation and infection.
These treatments don’t eliminate the need for mechanical cleaning, and the prolonged use of antibacterial products can have a detrimental effect on “good” bacteria (needed, for example, to complete the digestive process). It will depend on the extent of the gum disease to determine how successful conservative treatment may be. It’s also important that you contribute to your own dental health with a renewed daily oral hygiene habit.
If you would like more information on treatments for gum disease, 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 “Treating Difficult Areas of Periodontal Disease.”