MY TOOTH IS WORN, SHOULD I HAVE IT FIXED?

Have you noticed your front teeth getting shorter and darker in the middle?  There is no cavity so should I get it fixed?  These are questions I get asked from patients.  When I first started in practice the mantra: "if it isn't a cavity, if it isn't broken" all made sense, so I didn't restore these teeth. What I found is that these teeth often get shorter and shorter and when I finally restored them, I was amazed at how much I was "putting  back that had worn off".  Not only does this make the teeth look better but it keeps them from wearing and chipping away. The middle of the tooth is much softer and more vulnerable to erosion from the acids in our mouth.

Another issues with worn teeth is that it can allow for the teeth opposing to move to touch the worn tooth. This can cause shifting of the bite and interferences when one chews.

How do we restore these teeth?  Sometimes bonding with a composite resin can build up the tooth.  Other times a veneer or crown will be needed.  The first step is to look at the bite, evaluate where everything touches and evaluate if there is room to restore what was lost or just to restore enough to prevent future wear.  Your dentist might even take impressions of your teeth and a registration of the position of your teeth to mount on an articulator (an instrument that is used to simulate the mouth movements) so your bite can be evaluated outside of your mouth.

How long do these restorations last?  A lot depends on your habits:  clenching, bruxing, biting on hard objects (pins, nails, etc), good bonding technique and how well you care for your mouth. I would guess few of us would not appreciate a more beautiful smile.  Restoring the tooth before too much damage is done may save you money over the long haul. 

Visit your dentist and see what he or she can do to make your SMILE more BEAUTIFUL!

What is Cracked tooth syndrome? How is it treated and diagnosed?

Author:  Janice G. Scott D.D.S.

     Have you ever had something cold to eat or drink and a tooth just screamed "ouch" but it went away immediately after the cold was gone?  The KEY to the problem is that the pain went away.  How do you determine if it is cracked tooth syndrome versus a nerve dying on a tooth?  The first significant sign is how long it lingers.  It your tooth hurts a LOT to hot or cold but it goes away quickly - there is a good chance it is cracked tooth syndrome.  If the pain was to linger for a long time to hot, you may have a tooth that the nerve is dying and a root canal might be in order. Also biting on a stick over each corner of the  tooth can tell the dentist if that is the offending tooth, based on your response.
   
     So, what causes cracked tooth syndrome?  It can be biting on something very hard and causing crack lines in the tooth.  Often it is from old fillings (silver fillings) which last a long time but expand and contract over time and cause crack lines in the tooth.  The nerve endings in the tooth are affected by this movement and can cause pain.  Grinding, or bruxing - especially at night time, can cause stress in the tooth also.

     The good news is that often the discomfort is short and one might "live" with the discomfort.  The bad news is that often the cracks deepen and the sharpness of the pain becomes more severe.  It is not a cavity that will get larger but it can become so uncomfortable that it is time to do something to the tooth.  You just don't want to wait too long that the crack line deepens so far into the tooth that the tooth splits and now it has to be removed - it cannot be repaired.

     So, how do we take care of cracked tooth syndrome?  A quick fix is to put a band around the tooth (like an orthodontic band).  The negative of this is that it is hard to clean around and is only a temporary fix.  The long-term "fix" is often a crown or cap over the tooth.  This allows the tooth to be held together and protected and lessen the discomfort on the tooth.

     How do we prevent cracked tooth syndrome? Watch what you eat! No old maids: those kernels of popcorn that never popped and ouch, they can hurt to bite on.  Avoid hard candies and biting on ice cubes. If you grind your teeth a lot, talk to your dentist about making you a bite guard.

     Remember, take care of and protect your adult teeth.  It can be a lot cheaper to take care of them than to replace a tooth!  Our goal at Deer Park Dental is to educate our patients in prevention and help them achieve a healthy mouth and beautiful smile.   

I don't like my dentures, what can I do? Implants, All-on-4, "teeth in a day" and other options

Author: Janice G. Scott D.D.S.

Have you ever been faced with dentures or have them and hate them?  What are my options?

     If you have had dentures for a long time, they might not fit well because when the bone does not have "teeth" to hold onto, it tends to slowly resorb or "melt away".  The denture, fitting to where your bone and tissue used to be, now has a smaller area to rest on and may move around more.  This can cause the bite to feel off.  It can cause sore spots on your gums and ridges.  It can also cause more resorption due to uneven pressures.  

     First we can start by seeing if relining the dentures with bring them back to a comfortable fit.  The lower dentures are the hardest to fit because they often do not get the fit and suction of an upper denture.  If the bite has changed drastically a new set of dentures is an option.  This will cause the denture to fit to your mouth better and can open the bite to where you used to be, resulting in a nicer smile and comfort.

     If the only discomfort is a lower denture, than a reasonably lower cost option would be to put in two implants in the bone in the lower arch to allow the denture to snap into the implants and hold them in place. There is a ring that fits between the denture and the implant that can wear out and will need to be replaced every 1-2 years on average.

     If you have really good ridges and bone, full mouth implants with bridges can be an option but this is very costly. If you wish more stability but the cost of full mouth implants is not an option, ALL-ON 4 may be the choice for you.

     What is ALL-ON-4?  This is where 4 implants are placed on the maxillary (upper) ridge and 4 implants are placed on the mandibular (lower) ridge and a denture is attached to these implants.  This can be an immediate option after having extractions of all your teeth and still being able to go home with teeth right away.  A full upper and lower denture is made before the extractions.  The surgeon uses this as a guide to level the bone to have enough room for the implants, the bar connecting the implants and the denture.  After the implants are placed and the surgery is done, the temporary denture is attached to the implants with an implant screw.  The implants are then left for at least 4 months to heal and to allow the bone to connect to the implants.

     After the healing is complete, there are several types of teeth that can go on top of the implants.  The first option is a new, very aesthetic denture which is started with teeth set in wax.  Once the patient approves the aesthetics then a gold bar is made over the implants and embedded into the final denture for stability and the denture is then completed (processed).  Another option is a zirconium (very hard porcelain) U-shaped bridge that is made to attach to the implants.  This is can be very beautiful and natural looking and durable but will be more costly than the denture with plastic teeth.

     So, what are the advantages of ALL-ON-4? Taste is a big one.  With a complete denture, many of the taste buds that are on the roof of your mouth will be covered by a full denture.  If one is a gagger, this takes all of the plastic of the denture off the roof of your mouth and allows the denture to feel more like natural teeth.  It is fixed in place so it doesn't move around and unseat if you bite on something hard.  Your chewing will be better.  Conventional dentures have about 1/10th of the chewing power of natural teeth.  

     Dentures are not a replacement for teeth, they are a replacement for NO teeth.  Today we have many more options to give you a natural and beautiful smile. If you have dentures that just are not working for you or if you are in a place where dentures is one of the options you are having to look at, ALL-ON-4 may be an option for you.

Tooth Whitening 101: Why Slow and Steady Wins the Race

Author: Chris von Tersch, D.D.S.

What types of teeth whitening are available?  What works the fastest?  Is teeth whitening bad for my teeth? What is the best teeth whitening procedure for me?  I answer questions like this all the time.  Over the years, ideas have changed regarding teeth whitening and it is worth while to delve into the subject.

Teeth whitening, or "bleaching" has been around for decades and remains the most requested cosmetic dental procedure performed by dentists across the country.  Teeth whitening usually involves the topical use of either hydrogen peroxide or carbamide peroxide (which breaks down into hydrogen peroxide) on the teeth. The enamel has microscopic pores which build up stain over the years from pigmented foods and beverages. (ie: spaghetti sauce, berries, coffee, tea, red wine, etc)  The hydrogen peroxide enters the pores of the tooth and bubbles out the stain with the end products being oxygen and water.  This process can cause short-term sensitivity in some individuals which may determine how long he or she elects to whiten per session.  Other whitening techniques involve the mechanical removal of surface stains but if harsh abrasives are used, the enamel could be damaged.  For the sake of this article I will refer to three categories of teeth whitening: home remedies, over-the-counter solutions, and services provided by dental professionals.

Home Remedies:  I am not going to comment on the safety/effectiveness of the various home remedies. They usually range from harmless and ineffective to downright destructive.  Most of these techniques have not been adequately tested and could cause damage to ones teeth and gums.  I would exercise extreme caution in considering any "experimental" or  "home" teeth whitening techniques.

Over-the-Counter Solutions:  There are several products that can be purchased over-the-counter that claim to give their users "whiter, brighter smiles".  Some are quite effective and some can be damaging. 

Tooth whitening toothpastes are very common but by themselves are minimally effective at whitening teeth. They are good at removing surface stains and can lighten teeth slightly.  They either use a mild abrasive or hydrogen peroxide or both.  Use caution as some of these toothpastes are too harsh and can remove or damage enamel.  If one is serious about whitening his or her teeth, a gentle whitening toothpaste is a nice maintenance adjunct after achieving your goal shade with a more effective technique.  

"Whitening pens" and other paint on whitening products have become increasingly popular.  They seem to vary in effectiveness so I would read reviews online prior to making a purchase.  Most of them use a concentrated amount of hydrogen peroxide to achieve their effect.  They are nice because they are portable and good if one is interested in "whitening on the go".  Caution should be taken when products claim that they can "whiten veneers and crowns". Surface stains can be removed from porcelain but the color of the porcelain itself cannot be lightened.   

"Whitening strips" are still the most popular over-the-counter technique.  Strips have been around for more than ten years and were made popular by the Crest company.  The strips have a gentler solution of carbmide peroxide or hydrogen peroxide embedded into the plastic strip that the user molds over his/her teeth and leaves in for 30 minutes to an hour.  Some advantages to the strips is the fact that they are reasonably inexpensive (approx $25-$55 per box) and they are effective.  Some disadvantages are that it can take several boxes to attain one's goal shade and also the strips are a fixed size so individuals with larger teeth will not whiten evenly because the back teeth are not covered. I have heard patients complain about their fingers turning white with the product and not liking how the strips can slide around on their teeth.

Spas, medi spas, kiosks at the mall, and so many other "over-the-counter" sources exist which sell bleaching solution that goes into some type of tray and is placed over the teeth.  Some of these trays are to be boiled in water by the consumer and then formed to his or her own teeth. This system produces an ill fitting tray which allows the whitening solution to ooze onto and irritate the gum tissue.  Some vendors actually take impressions of customers teeth in order to make better fitting, custom whitening trays.  This system is the most similar to what a dentist may do, however there is no dental professional to assess if the customer is in fact a good candidate for bleaching.  (Are cavities present?  Is there gum recession or erosion of the roots at the gumline?  Are older fillings present that may be breaking down, allowing for bleaching solution to reach the deeper areas of the the teeth?)  Also there is no dental professional available for follow up or to help personalize the treatment for the individual.

Dental Office Provided Whitening Services:

Years ago, there were many "Extreme Makeover" types of television shows where every participant received either some sort of "Turbo Bleaching" or a mouth full of "Davinci Veneers".  Fast bleaching became popular, whether it was called "laser bleaching", "power bleaching" or went by one of the brand names.  The procedure would happen in the dental office and a dental professional would place a more concentrated solution of either hydrogen peroxide or carbamide peroxide and expose the teeth to a very bright light or laser to "activate" the whitening material.  The patient's smile would be considerably whiter after only one or two sessions.  Now if the procedure was completed with no whitening solution, the result would be virtually identical because a great majority of the whitening effect from this technique is from the light dehydrating the teeth.  If no further whitening techniques are utilized, the teeth will return to the original color once they rehydrate.  Studies have shown that the light has zero effect on the whitening of the teeth and because the light does warm the teeth, it could damage the nerves of the teeth.  

This brings us to what many consider to be the gold standard in teeth whitening which is well fitting, professionally made bleaching trays and a carbamide peroxide or hydrogen peroxide solution that is tailored to the needs/whitening goals of the patient. The patient takes them home and uses them at his or her convenience.  Some people will elect to wear their trays more often or for longer periods, if comfortable, in order to achieve their whitening goals.  Some people will need to take breaks of one or more days between the days they bleach if they experience sensitivity.  During the active phase of teeth whitening, the patient comes in for regular "bleaching checks" at the dental office.  These "check" appointments are critical, allowing the dental team to monitor the patient's progress and if necessary, modify the patient's at-home instructions as to help him or her receive maximum benefits.

Most individuals would like his or her smiles to feel great and appear healthy, clean and bright.  In addition to good oral hygiene, professional dental cleanings, and the care of one's dentist, many patients can benefit from teeth whitening.  As discussed, whitening options abound, but the safest, most effective, longest lasting technique is a lower concentration solution used over a greater amount of time under the supervision of a dentist.  So as far as teeth whitening goes, slow and steady does win the race!

Keep Smiling!
Chris von Tersch, D.D.S.  
          

Do you grind your teeth? Do you have Jaw pain? Dental Treatment for TMJ

 

DO YOU GRIND YOUR TEETH? DO YOU HAVE JAW PAIN?

Janice G. Scott DDS

     Sometimes the first time we realize that we grind our teeth is when a family member comments on how LOUD we grind.  You may have noticed that your child or sibling grinds a lot. Your dentist might comment that you are showing some wear on your teeth.  Sometimes it can be seen in the back molars and sometimes on the front teeth, especially the cuspids (some people call these teeth the "eye teeth").  

     Children often grind their teeth and can wear them down a lot.  Some kids will wear their teeth close to the gum-line.  The good news is that your child's grinding is not an indication that it will be a problem in his or her adult teeth.

     Many people find that they first start grinding when they are under a lot of stress!  It could be a new job, a death in the family, a college student going through final exams or just the everyday things that keep our lives so busy each day. Sometimes stress can change the jaw relationship (how your teeth touch each other in your mouth as you open, close, chew, swallow and grind)  from a tolerable one to one your body cannot handle.

     So how do we make things better? First, try engaging in more exercise, meditation, and other stress-relieving activities!  It is good to avoid sugar and caffeine, drink lots of water, make sure that you get enough sleep and exercise, and try to de-stress your life! (This is not always easy!) 

     If that doesn't work, sometimes an appliance, called a "bite guard," can help.  There are many types of bite guards. Some bite guards are soft, like a sports mouth guard.  This can be helpful on some patients by just changing how your teeth touch each other.  In more severe joint disorders, this simple solution may not be good long-term. A hard or soft bite guard can also help prevent wearing away the enamel or causing sensitivity and fractures in your teeth.  It can be a lot less expensive to replace a plastic bite guard that you might wear out than to replace a tooth that is damaged from grinding.  You must also be careful as some types of bite guards, which do not touch all the teeth, can allow the teeth to drift and then your bite can change dramatically making chewing more difficult.

     Other patients with more severe wear or joint disorders and pain may need a more complex appliance.  A bite guard in this case is more like an orthopaedic appliance that will help to center the jaw joint in the socket so that is is more comfortable at night.  We call this an SRA or Superior Repositioning Appliance. It attempts to create a more ideal bite by aligning your teeth around the hard acrylic and guiding the jaw joint closer to the center of the socket. Not only can these appliances protect your teeth and joint but they can also help to relieve pain in your jaw joint by relieving pressure and swelling in the tissues around the joint.

So.... diet, nutrition, exercise and a positive atmosphere can help.
If still not better, see your dentist to see if a bite guard can help you.