Posts for: May, 2017

By Edward Joseph, D.D.S.
May 29, 2017
Category: Oral Health
Tags: missing teeth  
ComplicationsfromMissingTeethCouldLimitYourReplacementOptions

There are plenty of options today for replacing missing teeth, including dental implants. But if the teeth have been missing for some time, complications can arise that limit your restorative options.

The most consequential possibility is bone loss. Bone has a life cycle: old cells dissolve (resorb), and are then replaced by new cells, stimulated to grow by the forces applied to the teeth during chewing. But the bone won't receive this stimulation if a tooth is missing — so growth slows down, which causes the bone volume to diminish with time.

Another complication can occur involving other teeth around the open space. These teeth will naturally move or “drift” out of their normal position into the missing tooth space. As a result we may not have enough room to place a prosthetic (false) tooth.

If either or both of these complications occur, we'll need to address them before attempting a restoration. Bone loss itself could eliminate dental implants as an option because they require a certain amount of supporting bone for correct placement. Bone loss could also make correcting misaligned teeth difficult if not impossible.

It might be possible, though, to regenerate lost bone with a bone graft. The graft is placed, sometimes along with growth stimulating substances, within the diminished bone area. It then serves as a scaffold upon which new bone can form.

If the bone becomes healthy again, we can then attempt to move any drifted teeth back to where they belong. Besides braces, there's another treatment option especially popular with adults: clear aligners. These are a series of removable, clear plastic trays that, like braces, exert gradual pressure on the teeth to move them. Patients wear each individual tray for about two weeks, and then switch to the next tray in the series to continue the process.

Unlike their traditional counterparts, clear aligners can be removed for cleaning or for special occasions. More importantly, they're much less noticeable than traditional braces.

Once any problems with bone health or bite have been addressed and corrected, you'll have a fuller range of options for replacing your missing teeth. With a little extra time and effort, you'll soon be able to regain a smile you'll be proud to display.

If you would like more information on dental restoration, please contact us or schedule an appointment for a consultation.


LookatYourOptionsforSavingaToothFirstBeforeReplacingit

It's no exaggeration — dental implants have revolutionized teeth replacement. Life-like and durable, implants are the closest thing in design and function to a natural tooth.

In fact, there's only one thing better than a dental implant — a real tooth. For function and long-term oral health, you can't beat what nature provided you in the first place. So before you finally decide to remove and replace that problem tooth, consider these other options for saving it.

Root canal therapy. Tooth decay can do more than cause cavities — it can work its way into the pulp, the innermost layer of a tooth. If it isn't stopped here, it could continue on to the roots and put the tooth in real danger of loss. A root canal treatment removes the infection from the pulp and root canals and replaces the space with a filling. A life-like crown is then bonded or cemented to the tooth to protect it from further infection.

Aggressive treatment for periodontal (gum) disease. This other dental disease is just as damaging as tooth decay. Caused by bacterial plaque, the gums around a tooth become infected and inflamed. As it moves deeper into the tissues and inflammation progresses, it can affect supporting bone causing it to dissolve. To prevent this potential bone loss, it's important to seek out and remove hidden pockets of plaque. This may require surgery to access the roots for plaque and calculus (tartar) removal, but it's well worth it to preserve the tooth.

Bone grafting. As mentioned before, gum disease can ultimately lead to bone loss. But even when bone loss has occurred (a substantial threat to a tooth's survival) we may be able to reverse it with bone grafting techniques. During this procedure we insert grafting material at the loss site along with substances that stimulate growth. The graft serves as a scaffold for new bone cells to grow upon. Over time the bone volume increases and helps stabilize a weak tooth.

Of course, your best option is to avoid dental disease in the first place with daily brushing and flossing and regular dental visits for cleanings and checkups. That and treating dental disease in its earliest stages will help ensure you'll have the best teeth possible — your own.

If you would like more information on options for treating diseased teeth, 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 “Save a Tooth or Get an Implant?


TechniquesforKeepingImpactedCanineTeethfromSpoilingYourSmile

Although usually an orderly process, some permanent teeth don't come in as they should. In fact, they may not come in at all and remain hidden in the gum — a situation called impaction. This creates multiple problems for function, health and, in the case of front canines, appearance.

Canines are the longer and more pointed teeth on each side of the front-most incisors. They help tear and cut food during chewing, a function impaction eliminates. Besides a higher risk for developing abscesses (isolated areas of infection) and cysts, they can also put pressure on neighboring teeth and damage their roots or cause them to erupt abnormally.

Dentists often remove impacted wisdom and other back teeth to lessen these potential problems. Removing canines, though, has additional considerations: besides compromising ideal chewing function, missing canines often create an unattractive smile.

But before considering removal, there's another technique we might be able to use to save the canines and actually draw them down through the gums to their correct position. It's usually part of an overall orthodontic plan to correct a poor bite (malocclusion).

After pinpointing their exact position with x-rays or CT scanning, a surgeon surgically exposes the impacted canines' crowns through the gums. They then bond small brackets to the crowns and attach a small gold chain to each bracket. They fasten the other end of the chains to orthodontic hardware that exerts downward pressure on the impacted teeth. Over several months this pressure can help move the teeth into their normal positions.

Unfortunately, this technique isn't always advisable: one or more of the impacted teeth may be in a difficult position to attempt it. It's usually best in these situations to remove the teeth, usually sooner rather than later for the sake of neighboring teeth.

Fortunately, with today's advanced restorative techniques, we can eventually replace the canines with dental implants, although that's best undertaken after the patient enters adulthood. In the meantime, we can utilize orthodontic means to preserve the open space and provide a temporary restorative solution.

Whatever route taken, these teeth don't have to become a source of problems, especially for your appearance. Whether through orthodontics or restorative dentistry, impacted canines don't have to ruin your smile.

If you would like more information on various orthodontic procedures, 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 “Exposing Impacted Canines.”


By Edward Joseph, D.D.S.
May 12, 2017
Category: Dental Procedures
WecanFixaSmileMarredbyAbsentFrontTeeth

Most children's permanent teeth erupt on a fairly predictable schedule. Sometimes, though, one or more teeth might not develop as they should — or at all.

These absent teeth pose functional problems for chewing and hygiene, which can affect long-term dental health. But they can also have a disruptive effect on an otherwise attractive smile if the missing teeth are the upper lateral incisors in the most visible part of the smile.

You normally find this pair of teeth on either side of the upper central incisors (the two front-most teeth). On the other side of the lateral incisors are the canine or eye teeth, known for their pointed appearance. Without the lateral incisors, the canines tend to drift into the space next to the central incisors. This can produce an odd appearance even a layperson will notice: only four teeth where there should be six!

It's possible to correct this abnormality, but it will take time and expense. The first step is usually to move the teeth in the upper jaw with braces to their correct position. This puts teeth where they should be and also opens space between the canines and central incisors so we can eventually replace the missing teeth with dental implants.

But the key to all this is timing. It's usually appropriate to undertake tooth movement with braces during late childhood or adolescence. But implants shouldn't be installed until the person's jaw fully matures, usually in early adulthood. An implant placed before then could eventually become misaligned.

To accommodate the time between bite correction and implant placement, the patient can wear a retainer appliance that will keep the newly created space open. We can also attach artificial teeth to the retainer to camouflage the empty space.

It usually takes a team of a family dentist, an orthodontist and a surgeon to see this kind of “smile makeover” project through, possibly over several years. But the gains in better aesthetics and health are well worth the time and expense.

If you would like more information on replacing non-developing teeth, 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 “When Permanent Teeth Don't Grow.”


LasersCouldOneDaybeCommonplaceforTreatingGumDisease

There are a variety of methods for treating periodontal (gum) disease depending on its severity — from routine office cleanings to periodontal surgery. But the goal behind all of them remains the same: remove bacterial plaque and calculus (tartar), the root cause for gum disease, from all tooth and gum surfaces.

The traditional method for doing this is called scaling in which we use special hand instruments (scalers) to mechanically remove plaque and calculus. Scaling and a similar procedure called root planing (the root surfaces are “planed” smooth of plaque to aid tissue reattachment) require quite a bit of skill and experience. They're also time-consuming: full treatment can take several sessions, depending on how extensive the infection has spread.

In recent years, we've also seen a new method emerge for removing plaque: lasers. Commonly used in other aspects of healthcare, lasers utilize a focused beam of light to destroy and remove diseased or unhealthy tissue while, according to studies and firsthand accounts, minimizing healthy tissue destruction to a better degree than traditional techniques. Procedure and healing times are likewise reduced.

Because of these beneficial characteristics, we are seeing their use in gum disease treatment, especially for removing diseased and inflamed tissues below the gum line and decreasing sub-gingival (“below the gums”) bacteria.

Dentists who have used lasers in this way do report less tissue damage, bleeding and post-treatment discomfort than traditional treatments. But because research is just beginning, there's not enough evidence to say laser treatment is preferably better than conventional treatment for gum disease.

At this point, lasers can be an effective addition to conventional gum disease treatment for certain people, especially those in the early stages of the disease. As we continue to study this technology, though, the day may come when lasers are the preferred way to stop gum disease from ruining your dental health.

If you would like more information on treating 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 “Lasers Versus Traditional Cleanings for Treating Gum Disease.”




Burbank, CA Dentist
Edward C. Joseph, D.D.S.
2701 West Alameda Ave, Suite #503
Burbank, CA 91505
(818) 842-7628

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