While we often associate tooth decay with cavities forming in a tooth’s visible or biting surfaces, the occurrence of this all too common disease isn’t limited to those areas. Cavities can develop in any part of a tooth exposed to bacteria.
Gum recession, the shrinking back of the gums from the teeth, can cause such exposure in areas normally covered by the gums. Because these areas are usually more vulnerable to infection when exposed, cavities can develop at or right below the gum line. Because of their location it can be difficult to fill them or perform other treatments.
One way to make it less difficult is to perform a crown lengthening procedure. While the term sounds like we’re increasing the size of the tooth, we’re actually surgically altering the gums to access more of the affected tooth surface for treatment. It’s typically performed in a dental office with local anesthesia by a general dentist or a periodontist, a specialist in the gums.
During the procedure, the dentist starts by making small incisions in the gums to create a tissue “flap” that can be lifted out of the way. This exposes the underlying bone, which they then reshape to support the gum tissue once it’s re-situated in its new position. The dentist then sutures the gums back in place. Once the gums heal, the decayed area is ready for treatment.
Crown lengthening is also useful for other situations besides treating cavities. If a tooth has broken off at the gum line, for example, there may not be enough remaining structure to support a crown. Crown lengthening can make more of the underlying tooth available for the crown to “grab” onto. It’s also useful in some cases of “gummy smiles,” in which too much of the gum tissue is visible in proportion to the tooth size.
Because crown lengthening often involves removing some of the bone and is thus irreversible, you should discuss this procedure with your dentist in depth beforehand. It could be, though, this minor procedure might make it easier to preserve your teeth and even make them look more attractive.
You brush and floss every day to rid your teeth and gums of disease-causing plaque. But while “showing up” is most of the battle, the effectiveness of your technique will win the war.
So, how good are you at removing plaque? One quick way to find out is the “tongue test”—simply rub your tongue along your teeth: they should feel smooth and “squeaky” clean. Surfaces that feel rough and gritty probably still contain plaque.
For a more thorough evaluation, your dental hygienist may use a product during your regular dental visit called a plaque disclosing agent. It’s a solution applied to your teeth that dyes any bacterial plaque present on tooth surfaces a certain color while leaving clean surfaces un-dyed. The disclosing agent shows you where you’re effectively removing plaque and where you’re not.
These products aren’t exclusive to the dental office—you can use something similar at home if you’d like to know how well you’re doing with your hygiene before your next visit. You can find them over-the-counter as tablets, swabs or solutions. You may even find some that have two dye colors, one that reveals older plaque deposits and the other newer plaque.
You simply follow the product’s directions by first brushing and flossing as usual, then chewing the tablet, daubing the swab on all tooth and gum surfaces, or swishing the solution in your mouth like mouthwash for about 30 seconds before spitting it out. You can then use a mirror to observe any dye staining. Pay attention to patterns: for example, dyed plaque scalloping along the gum line means you’ll need to work your brush a little more in those areas.
The dye could color your gums, lips and tongue as well as your teeth, but it only lasts a few hours. And while plaque disclosing agents are FDA-approved for oral use, you should still check the ingredients for any to which you may be allergic.
All in all, a plaque disclosing agent is a good way to occasionally check the effectiveness of your plaque removal efforts. By improving your technique you may further lower your risk of dental disease.
If you would like more information on learning how effective your oral hygiene really is, 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 “Plaque Disclosing Agents.”
During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.
Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.
For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.
When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.
But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.
Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.
So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…
If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”
If you’re committed to providing your family nutritional, low-sugar snacks, you’re not only helping their physical well-being but their dental health too. If you have school-age children, though, you might be concerned about other snacks available to them while away from home.
To begin with, any potential problems at school with available snack items might not be as bad as you think. A few years ago the U.S. Department of Agriculture (USDA) established new snacking guidelines for public schools. Known as the Smart Snacks in Schools initiative, the new guidelines require schools to only allow snacks sold on school grounds that meet minimum nutritional standards. In addition, these guidelines promote whole grains, fruits, vegetables and low-fat dairy products.
Still, the guideline standards are only a minimum, which could leave plenty of room for snacks that don’t meet your nutritional expectations. And school-offered snacks aren’t the only ones available on campus: there are also those brought by other students, which often get swapped around. The latter represent tempting opportunities for your child to consume snacks that aren’t the best for dental health.
But there are things you can do to minimize the lure of these poor snacking opportunities at school. First and foremost is to educate your child on why some snacks are better for them than others. In other words, make nutrition an instilled family value—and, of course, practice what you preach.
You can also send them with snacks you deem better for them than what’s available at school. Of course, you’ll be competing with a lot of exciting and enticing snacks, so try to inject a little “pizzazz” into yours like a dusting of cinnamon or a little parmesan cheese on popcorn. And use a little creativity (even getting your kids involved) to make snack choices fun, like using cookie-cutters to shape whole-grain bread and cheese into shapes.
And consider getting involved with other parents to encourage school administrators to adopt stricter snack standards over and above the Smart Snacks in Schools initiative. This not only may improve the nutritional content of available snacks, but also transform a “family value” into a community-wide appreciation for snacks that promote healthy teeth and gums.
If you would like more information on dental-friendly snacking, 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 “Snacking at School.”
Losing teeth will certainly disrupt your otherwise beautiful smile. It could also potentially affect your food choices and whether or not you receive proper nutrition.
But something else just as consequential could be happening beneath the surface of your gums—you could be losing bone. Significant bone loss in the jaw could adversely affect remaining teeth and facial structure, as well as limit your future restoration choices.
To understand why this occurs we must first consider what bone is: living, cellular tissue. Like the body's other cells, bone has a life cycle: cells form, live and eventually dissolve (or resorb), and are then replaced by new cells. Stimulation from forces generated during chewing traveling up through the tooth roots to the jawbone keep this cycle going at a healthy pace.
But when a tooth is missing, so is this stimulation. This could slow the replacement rate and cause bone volume to gradually decrease. The jawbone width could decrease by as much as 25% the first year alone and several millimeters in height after just a few years.
Although dentures (a popular and affordable choice) can restore lost function and appearance, they can't duplicate this needed stimulation. They even accelerate bone loss by irritating and creating compressive forces on the bony ridges and the gums they rest upon.
One restoration, however, can actually help stop bone loss and may even reverse it: dental implants. This happens because an implant's metal titanium post imbedded in the jawbone attracts bone cells to grow and adhere to its surface. This could actually increase bone density at the site.
To gain this advantage, it's best to obtain implants as soon as possible after tooth loss. If you allow bone loss to occur by waiting too long, there may not be enough to properly support an implant. Even then it might be possible to build up the diminished bone through grafting. But if that's not possible, we'll have to consider a different restoration.
To determine the condition of your bone after losing teeth, visit us for a complete examination. Afterward, we'll be able to discuss with you the best way to address both your overall dental health and your smile.
If you would like more information on treating missing 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 “The Hidden Consequences of Losing Teeth.”
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