SERVICE WITH A SMILE
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.
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FIRMLY ROOTED
Because it so closely resembles the structure of a natural tooth, a dental implant is often viewed as the preferred method for tooth (or teeth) replacement. The chief benefit of an implant is that it is firmly rooted in the jawbone, much as the root of a natural tooth is. The implant is made out of titanium, which has been proven able to biochemically join with the surrounding bone. As a result, the man-made crown to which it is attached (with an abutment connector) can be expected to remain as steadfast as nature’s own creation. Just as importantly, the implant stimulates the surrounding bone and guards against the bone loss that would otherwise occur when a tooth is lost.
P.S. Because dentures do not prevent the loss of bone that occurs with tooth loss, denture wearers’ mouths may eventually develop a caved-in appearance.
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REPLACING MISSING TEETH
Patients with one or more successive missing teeth can choose between two replacement possibilities other than dental implants. A “bridge” is a permanent dental appliance that consists of a pontic (false tooth) and two crowns that are cemented into place on the abutment teeth (on either side of the space). Unlike removable partial dentures, fixed bridges cannot be taken out of the mouth. Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by a metal framework. Removable partial dentures attach to the patient’s natural teeth with metal clasps or devices called “precision attachments.” Precision attachments are generally more aesthetic than metal clasps and are nearly invisible.
P.S. A precision attachment consists of precision-machined, interlocking “male” and “female” components that connect a removable partial denture to fixed bridgework.
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THE OTHER TYPE OF TOOTHBRUSH
While most people find it simple and easy enough to brush their teeth at least twice a day, some lack either the dexterity or discipline needed to floss daily. This is understandable considering the fact that it takes some time and effort to correctly loop the ends of the floss around the fingers and guide it gingerly between teeth. While there are some flossing products available that help with the process, not everyone gets the hang of them. If so, it should be pointed out that there are small, easy-to-use, pointed brushes known as “interdental brushes” that are nearly as effective as flossing. They not only remove bacterial buildup (plaque) between teeth, they also stimulate gums.
P.S. Interdental brushes not only lend themselves to cleaning hard-to-reach areas, but they also reach concavities on tooth surfaces that floss may not be able to reach.
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WHY SO SENSITIVE?
According to recent research published in the Journal of the American Dental Association, one in eight adults suffers from a condition known as “sensitive teeth.” The pain associated with this condition is often triggered by eating or drinking cold, hot, acidic, or sweet foods or beverages. While overzealous brushing or tooth-whitening products may cause sensitive teeth, the primary culprit is gum recession. As the gum tissue recedes with age, pores (or tubules) on the surface of the tooth root become increasingly exposed. Because these tubules travel to the nerve of the tooth, the nerve becomes more susceptible to painful triggers. Gentle brushing, avoidance of home tooth-whiteners, and use of toothpastes created for sensitive teeth can help alleviate pain.
P.S. If you have sensitive teeth, avoid acidic drinks or rinse your mouth with water immediately after drinking them, and avoid brushing your teeth right after eating or drinking; wait 10-15 minutes.
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MAKING WISE CHOICES
When it comes to deciding whether or not to have wisdom teeth extracted, there are a number of factors to consider. While some individuals have enough room in their dental arches to accommodate all their wisdom teeth, those with smaller jaws often find that their wisdom teeth erupt improperly. As a result of coming in crookedly, their third molars are difficult to brush and floss, which can lead to increased risk of gum disease and cavities. To avert these potential problems, some patients elect to have their wisdom teeth extracted. However, some people do not realize that their wisdom teeth are impacted (trapped beneath the gums) until an x-ray indicates as much. If so, a consultation with the dentist is needed.
P.S. Wisdom teeth (third molars) are the last teeth to erupt, usually somewhere between the ages of 14 and 21.
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OVERCOMING REFLEXIVE RESPONSE
If dental appointments make you anxious, you should make your feelings known to the dentist and dental hygienist, who can help you overcome your anxiety. A fuller explanation of the procedure at hand often helps patients know what to expect and prepare for any mild discomfort that they may feel. Topical and injected anesthetics make pain a non-issue; however, simply the thought of experiencing pain arouses such anxiety that patients feel a bit overwhelmed. Recent research published in The Journal of the American Dental Association shows that the urge to gag that many patients experience is often founded in fear. Once patient worries are properly addressed with reassurance, soothing music, and/or medication in some cases, dental appointments become worry-free.
P.S. It is the pain that occurs before treatment that makes root-canal therapy so uncomfortable. Most patients report that the root-canal procedure itself is no more painful than having a filling placed.
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THE NATURAL LOOK OF PORCELAIN
Whether it is used to create veneers, crowns, or fixed bridges, porcelain is the material of choice because it so closely matches the appearance, durability, and longevity of tooth enamel. Porcelain mimics the light-reflecting qualities of natural teeth better than opaque resins. All-porcelain dental crowns also generally provide a better natural color match than any other material, making them a good choice for veneers and replacing front teeth. On the other hand, when it comes to crowns and fixed bridges, porcelain-fused-to-metal dental crowns provide the needed added strength that an underlying metal structure can provide. Porcelain crowns not only look and feel like natural teeth, they also require the same degree of care.
P.S. Porcelain matches natural enamel’s translucency, enabling light to pass through it and bounce off the inner (more opaque) layer.
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OLYMPIANS FACE BIG HURDLE
What effect can energy drinks, gels, bars, and frequent snacking have on athletes’ teeth? The dental director for the International Olympic Committee reveals that a great many Olympic athletes have broken teeth, abscesses, decay, and other dental issues. The problem is that many of them consume acidic, sugary drinks and energy bars that attack teeth while their dehydrated bodies do not produce enough saliva to remineralize their tooth enamel. In addition, most Olympic athletes are ages 16 to 25 years old, which is the group at highest risk for tooth decay. As these young adults fly the family nest and abandon many of their healthy eating habits, they become more susceptible to tooth decay. Athletes and exercisers take careful note.
P.S. Many competitive athletes grind their teeth at night, probably in response to the competitive pressures they face.
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MISSING SOMETHING?
If you are missing one or more teeth and think that you can get along fine without them, keep in mind the old adage “nature abhors a vacuum.” If missing teeth are not replaced with a bridge or implant, the teeth adjacent to the open space(s) will shift out of their normal positions and fill in the empty spaces on their own. Moreover, the corresponding teeth in the opposing jaw will begin to protrude, because there are no biting forces holding them down. As a result of all these unchecked movements, missing teeth can lead to chewing problems and looseness of remaining teeth. Instead, work with the dentist to develop a plan to replace missing teeth before further problems arise.
P.S. While a bridge may cost less than a dental implant, implants provide greater value, have a more natural look and feel, and require no preparation of surrounding teeth.
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CORRECTING A GUMMY SMILE
A “gummy smile” (excessive gingival display) exposes too much gum tissue when a person smiles. Due to factors that include undersized teeth, overgrown gum tissue, an overactive elevation muscle of the upper lip, or an upper lip that joins too closely to the gum tissue, the ratio of lips, gums, and teeth is out of balance. While Botox injections may be used to treat an over-developed elevation muscle, the surgical procedure known as “myotomy” offers more permanent results. When the joint between the upper lip and the gums inside the mouth is over-developed, surgically decreasing the space between the upper lip and gum tissue reduces gum exposure. Lastly, overgrown gums can be corrected with “laser gingivectomy.”
P.S. Laser gingivectomy removes excess gum tissue and seals blood vessels so that no stitches are required.
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WHERE THERE’S NO SMOKE, THERE’S ALSO CANCER
If you think that smokeless tobacco is a healthier alternative to cigarettes, you should know that “snuff dippers” consume (on average) ten times the amount of cancer-causing substances (nitrosamines) that cigarette smokers do. While cigarette smokers are six times more likely than non-smokers to develop oral cancers, users of smokeless tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips. Moreover, smokeless tobacco users absorb nicotine at 2-3 times the rate that cigarette smokers do. When you put just these two facts together, you get a lethal combination. The 5- and 10-year survival rates for patients with all stages of oral cavity and pharynx cancers are 56% and 41%, respectively.
P.S. Babe Ruth, who was one of a large number of baseball players who liked to “dip” smokeless tobacco, died at age 52 of an oropharyngeal tumor, a cancerous tumor in the back part of the throat.
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FUSING METAL TO BONE
The aspect of dental implants that makes them so durable and effective, “osseointegration,” occurs when bone cells attach themselves directly to the titanium surface of the dental implant. This phenomenon was discovered quite by accident over 50 years ago by a Swedish surgeon who was conducting research into the healing patterns of bone tissue. He found that, when pure titanium comes in contact with living bone tissue, they form a permanent biological adhesion. Dentists were quick to make use of this phenomenon for dental implantation. Today, this innovation stands at the center of tooth-implant technology that utilizes titanium implants to serve as the rooted foundation for the attachment of prosthetic teeth that feel and look like natural teeth.
P.S. Dental implants are composed of the titanium implant (which is inserted directly into the bone), the abutment (which connects the implant device to the prosthetic tooth), and the overlying crown or denture.
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THE IMPORTANCE OF DENTAL CARE FOR DIABETICS
While daily brushing and flossing and regular visits to the dentist are important for everyone, people with diabetes face a particular challenge since poorly controlled blood sugars raise the risk of a number of oral health problems. Uncontrolled diabetes impairs white blood cells, the body’s main defense against bacterial infections that can occur in the mouth. As diabetics’ ability to fight bacterial infections is reduced, they face a higher risk of developing gum inflammation (gingivitis and periodontitis). Other potential oral problems related to diabetes include dry mouth (which can lead to soreness, ulcers, infections, and tooth decay) and fungal infections (thrush) that arise from antibiotic use. Diabetics who smoke face an even higher risk of developing thrush and periodontal disease.
P.S. Because diabetes causes blood vessels to thicken, diabetics who do not properly control their blood sugar levels may not heal quickly after oral surgery or other dental procedures.
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TOOTH-COLORED FILLINGS
While dental amalgam has proven itself to be an effective and relatively inexpensive material for filling cavities caused by tooth decay over the past 150 years, it is not the most pleasing aesthetic choice. Amalgam’s silver color stands in stark contrast to natural tooth color when placed in visible tooth surfaces. For this reason, patients are likely to prefer composite-resin tooth-colored fillings, which can so closely approximate their natural tooth color as to be virtually unnoticeable. Composite resins may be somewhat less durable than amalgam fillings, and they may cost more, but patients’ concerns over cosmetics have made them an increasingly popular choice. As far as dentists are concerned, the best filling is no dental filling. Prevention is preferred.
P.S. Composite resin material, which is composed of a tooth-colored plastic and glass mixture, can be used to reshape disfigured teeth.
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REBUILDING TOOTH ENAMEL
If you experience tooth sensitivity and/or eat a lot of sugar and simple carbohydrates, you may want to consider using tooth products that help reduce (or even reverse) early decay by virtue of a process called “remineralization.” This involves delivering extra doses of calcium and phosphate to replace minerals lost in the ongoing battle against bacteria and acids. To maintain the mineral building blocks that are essential to tooth strength, saliva containing calcium and phosphate helps replenish minerals dissolved by acidic plaque or food. This balance may be upset when more minerals are lost than gained and teeth become vulnerable to decay. While fluoride greatly helps saliva’s natural remineralization, toothpastes that deliver calcium phosphate may speed up the process.
P.S. The remineralizing properties of new toothpastes could be of great benefit to adults suffering from dry mouth.
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OPEN AND SHUT CASES
Some patients experience abnormal occlusal (bite-related) conditions that occur when the upper and lower teeth do not make contact at the same time. In some cases, one tooth may contact its opposing counterpart before the rest of the teeth in the dental arch. When this happens, it can result in non-uniform stresses in the mouth while chewing, which can be problematic. Another condition involving abnormal occlusion (malocclusion) is tooth-grinding (bruxism). Approximately one-third of all adults grind and clench their teeth, which causes excessive tooth wear. Yet, because many tooth-grinders are unaware of their conditions, the problem persists. If the dentist finds evidence of any of these problems, they can be brought to the patient’s attention and addressed.
P.S. In some cases, all it takes to correct a problematic bite is to grind down a protruding portion of tooth.
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ALL FOR ONE, ONE FOR ALL
When the gap left by missing teeth is bordered by healthy teeth, a “partial denture” provides an affordable solution. This type of prosthetic usually consists of replacement teeth attached to gum-colored plastic bases, which connect to surrounding teeth with either metal clasps or devices known as “precision attachments.” These are generally more esthetic than metal clasps and are nearly invisible. As is the case with complete dentures, partial dentures are removable. Patients receive thorough instruction on how partial dentures should be inserted and removed. They should fit easily into place and never be forced. Over time, it may be necessary to adjust the fit of partial dentures, which can be accomplished during a regular office visit.
P.S. It is important to clean dentures daily since they are susceptible to becoming coated with plaque, which poses a threat to gums and remaining natural teeth.
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ROOT CAUSE AND EFFECT
In the event that tooth decay penetrates the tooth’s crown and pierces the root chamber, the root becomes infected with all the attendant pain. At this point, the patient has the choice of having the tooth extracted or undergoing “root canal treatment.” Extraction is a quick fix that poses two drawbacks. The first is that the gap left behind must be filled. The second is that, when teeth are extracted, the supporting bone under the gum shrinks. Thus, as a general rule, it is best to keep the roots of natural teeth as long as possible. A tooth with an infected root can usually be saved with root canal treatment, after which an artificial crown can be set in place.
P.S. Root canal treatment with a crown restoration is a cost-effective way of treating an infected tooth because it is usually less expensive than extraction and placement of an implant.
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TOOTHBRUSH REPLACEMENT
Toothbrushes eventually wear out and need to be replaced. Numerous studies show that, after three months of normal wear and tear, the nylon bristles in toothbrushes are a good deal less effective at removing plaque from tooth surfaces and gums than new ones. To be effective, bristles must be able to make their way into the crevices that harbor the bacteria that are constantly forming to pose a threat to tooth enamel and gums. In addition to replacing toothbrushes, it is also important to allow them to air dry after use since wet bristles are breeding grounds for unhealthy bacteria and fungi. Be sure to replace toothbrushes after a bout with a common cold to reduce the risk of reinfection.
P.S. If you need a reminder to replace your toothbrush regularly, purchase one with bristles that change color as they degrade.
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TONGUE THRUSTING
“Tongue thrusting” is the infantile technique of swallowing that involves thrusting the tongue against the teeth while swallowing. This swallowing technique helps develop the muscles of the tongue and cheeks, and it strengthens the swallowing reflex. If it is not halted by about ten years of age, the pressure exerted on permanent teeth can affect the alignment of children’s teeth and even their speech. It is estimated that more than two-thirds of children between the ages of five and eight years exhibit tongue thrust, which can be a difficult problem to correct since, unlike thumb-sucking, tongue thrusting is done unconsciously. Fortunately, regular dental examinations will reveal any dental irregularities that the dentist may use to diagnose the problem.
P.S. The average person swallows about 1,200 to 2,000 times every 24 hours, with about four pounds of pressure exerted with each swallow.
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WHAT YOUR MOUTH SAYS ABOUT YOUR HEALTH
Older adults’ oral health speaks volumes about their overall wellness. Consider the fact that about 40% of those ages 65 years and older suffer from periodontal (gum) disease. If left unchecked, the more severe form of gum disease, periodontitis, can not only lead to tooth and bone loss, but it can also become more severe and worsen serious health conditions such as diabetes and heart disease. For these reasons, seniors should do all they can to prevent and/or treat infections of their gums and surrounding tissues, which develop when plaque (sticky bacteria-laden film that coats teeth) accumulates along and under the gum line. Persistent dry mouth, bleeding gums, and bad breath are warning signs of gum disease that warrant examination.
P.S. Caused by smoking, drinking high amounts of alcohol or caffeine, and taking certain medications, dry mouth occurs when the salivary glands do not produce enough saliva to keep teeth and gums healthy.
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JAWBONE PRESERVATION
After a tooth extraction, the portion of the jawbone (“aveolar process”) that once held the tooth in place begins to shrink (resorb). As a result, an overlying denture will increasingly find itself on an unstable foundation. This leads the denture to become looser and looser until it eventually has to be refitted/refabricated. For this reason, many patients turn to dental implants to replace lost teeth. This prosthetic device so closely approximates the look and function of a natural tooth root that it minimizes bone resorption. Once the titanium anchor is placed in the bone to function much like a natural tooth root, it becomes integrated with the bone, thereby minimizing bone loss. This provides a solid anchor for replacement teeth.
P.S. If there is insufficient bone to hold a dental implant, bone grafting may be an option.
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FILM REVIEW
We primarily brush our teeth daily (hopefully two to three times daily) to remove the buildup of food debris, mucus, and bacteria that naturally coats teeth with a layer of film. This bacteria-laden film, called “plaque,” coats each tooth individually. If not removed, it can lead to inflammation, infection, and other health problems. While plaque can easily be removed by brushing after it initially forms, it begins to harden after 48 hours. If not removed, the material solidifies into a substance known as “tartar” that requires removal with sharp scraping instruments in the dentist’s office. To prevent tartar from attacking ligaments and bone that hold teeth in the mouth, it is essential to prevent plaque from reaching damaging levels.
P.S. Regular flossing helps keep plaque from building up in between teeth, where a toothbrush might not reach.
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GETTING TEETH INTO BETTER SHAPE
Teeth that are uneven, overlapping, or rotated can significantly detract from the appearance of an otherwise nice smile. Fortunately, as long as sufficient tooth material is preserved, the look of select teeth can be improved by “tooth recontouring.” This usually painless procedure involves removing, recontouring, and polishing the enamel to produce a more uniform and natural appearance. Many times, recontouring in this manner is all that is required to significantly improve an individual’s smile. If, on the other hand, poor alignment is more pronounced, tooth enamel recontouring might be performed in conjunction with “tooth bonding.” This quick and effective cosmetic procedure supplements tooth enamel with tooth-colored resin that is bonded to the tooth surface.
P.S. One of the primary benefits of tooth recontouring is that it enables dental floss to reach pockets and crevices between teeth that were once blocked by overlapping and irregularly shaped teeth.
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GUMS, CHEEKS, AND TONGUE
The dentist and hygienist are as concerned about the soft tissues in patients’ mouths as they are about their teeth. Nearly everyone occasionally experiences a sore on the lips, tongue, gums, roof of the mouth, or the inner cheeks. Depending on the cause, it may either go away with time or be successfully treated with over-the-counter drugs. Most common mouth sores, such as canker sores, heal within seven to ten days. However, a mouth sore that has not healed within two weeks may signal a more serious problem. Causes can include an infection or frequent contact with a jagged tooth, which may prevent healing. In some cases, a sore in the mouth may be an early sign of cancer.
P.S. A thickened white or red patch in the mouth should be assessed by the dentist.
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PLAYING THE GUARD POSITION
Whether NBA players and their fans think that professional basketball players should serve as role models or not, one aspect of NBA players’ behavior is making a big impression. While relatively few players wore mouth guards to protect their teeth from errant elbows a decade ago, the protective devices have currently become far more commonplace. Fans can hardly watch a game without seeing players inserting the safety devices into their mouths as they enter the game. Aside from helping ensure that a player’s teeth will not be loosened or knocked out, mouth guards may also help the jaw loosen up. As a result, muscle tension may be reduced throughout the body, allowing players to play a more relaxed game.
P.S. The most effective sports mouth guards are the custom-made models that the dentist fabricates from an impression of a patient’s teeth and bite.
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GROWING MORE ATTACHED
Adults lose more teeth as a result of gum disease than from tooth decay. Poor dental hygiene can result in bacteria collecting in the cuffs of gum that surround each tooth. Over time, these bacteria can cause inflammation at the gum line that may worsen, creating even deeper pockets of bacteria around teeth, which contributes to tooth loss. Aside from scheduling regular dental check-ups and practicing good oral hygiene at home, adults can avert periodontal disease-related tooth loss by getting sufficient vitamin D. One study shows that people over age 50 with the highest levels of vitamin D in their blood had about 25 percent more “periodontal attachment” than those with the lowest levels of the nutrient.
P.S. According to a Norwegian study, adults living at higher latitudes with less exposure to sunlight (and consequently less vitamin D production in their skin) experienced much greater tooth loss than those living at more southerly latitudes.