For several decades, dentists have been saving teeth from tooth decay following a few basic guidelines: 1) Identify decay as soon as possible; 2) Thoroughly remove decayed tooth structure; and 3) Fill any cavities. With millions of diseased teeth rescued, observing these simple steps have proven a rousing success.
But as with most things, even this successful protocol isn't perfect. For one, some healthy tissue gets removed along with the diseased portions. The average percentage of "collateral damage" has dropped over the years, but it still happens—and a reduction in healthy tissue can make a tooth less structurally sound.
Another drawback, at least from the patient's perspective, is the dental drill used for removing decay and preparing cavities for filling. Many people find drilling unpleasant, whether from its vibrations in the mouth or its high-pitched whine. The drill's burr head design also contributes to greater healthy tissue loss.
But those weaknesses have lessened over the last few years, thanks to innovations on a number of fronts.
Better risk management. Tooth decay doesn't occur out of thin air—it arises out of risk factors unique to an individual patient like personal hygiene, bacterial load, saliva production or even genetics. Taking the time to identify a patient's "tooth decay risk score" can lead to customized treatments and practices that can minimize the occurrence of decay.
Earlier detection. Like other aspects of dental health, the sooner we detect decay, the less damage it causes and the more successful our treatment. X-rays remain the workhorse for detecting decay, but now with improvements like digital film and better equipment. We're also using newer technologies like laser fluorescence and infrared technology that can "see" decay that might otherwise go undetected.
Less invasive treatment. The dental drill is now being used less with the advent of air abrasion technology. Air abrasion utilizes a concentrated spray of particles to remove diseased tooth structure more precisely than drilling. That means less healthy tissue loss—and a more pleasant (and quieter!) experience for the patient.
In effect, "less is more" could describe these improvements to traditional decay treatment. They and other methods promise healthier teeth and happier patients.
If you would like more information on current treatments for tooth decay, 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 “Minimally Invasive Dentistry: When Less Care is More.”
October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.
This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.
In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.
In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.
The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.
It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.
Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.
You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.
Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.
If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.
Dental plaque, that gritty bacterial film coating your teeth, is the top cause for tooth decay and periodontal (gum) disease. You can see and feel a lot of it—but not all of it. Some deposits can lodge snugly between your teeth, and can cause dental disease just as much as what's out in the open.
The problem with between-teeth plaque is that even a solid brushing habit might not effectively remove it. That's why you flossing should also be part of your daily oral hygiene.
If the thought of flossing, however, causes you to let out an audible sigh, we understand. Flossing typically engenders less enthusiasm than brushing, mainly because many find flossing time consuming and difficult to do.
If traditional flossing isn't your bag, we may have a reasonable alternative. Oral irrigation is a hygiene method for removing plaque between teeth using a pressurized water spray. You direct the water spray between your teeth using a handheld wand (which somewhat resembles a power toothbrush) and small hose attached to a countertop pump appliance.
A mainstay in dental offices, oral irrigators (or water flossers) have been available for home use since the 1960s. They're ideal for people who have problems with manual dexterity or who may not want to contend with flossing thread. They also make it easier for patients wearing braces to clean between their teeth, a monumental task using regular floss.
As to effectiveness, oral irrigation appears to match that of regular flossing, especially for orthodontic patients. Clinical studies in the early 2000s compared patients with braces using oral irrigation with those who were brushing only. Those using irrigation were able to remove five times as much plaque as the other group.
There are a number of comparable oral irrigation brands on the market from which to choose, and your dentist can advise you on features to look for when purchasing one. Just be sure you're using some method, oral irrigation or traditional flossing, to remove disease-causing plaque from between your teeth—either will go a long way in keeping your teeth and gums healthy.
If you would like more information on flossing methods, 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 “Cleaning Between Your Teeth.”
Inauguration night is usually a lavish, Washington, D.C., affair with hundreds attending inaugural balls throughout the city. And when you're an A-List celebrity whose husband is a headliner at one of the events, it's sure to be a memorable night. As it was for super model Chrissy Teigen—but for a slightly different reason. During the festivities in January, Teigen lost a tooth.
Actually, it was a crown, but once she told a Twitter follower that she loved it “like he was a real tooth.” The incident happened while she was snacking on a Fruit Roll-Up (those sticky devils!), and for a while there, husband and performer John Legend had to yield center stage to the forlorn cap.
But here's something to consider: If not for the roll-up (and Teigen's tweets on the accident) all of us except Teigen, her dentist and her inner circle, would never have known she had a capped tooth. That's because today's porcelain crowns are altogether life-like. You don't have to sacrifice appearance to protect a tooth, especially one that's visible when you smile (in the “Smile Zone”).
It wasn't always like that. Although there have been tooth-colored materials for decades, they weren't as durable as the crown of choice for most of the 20th Century, one made of metal. But while gold or silver crowns held up well against the daily grind of biting forces, their metallic appearance was anything but tooth-like.
Later, dentists developed a hybrid of sorts—a metal crown fused within a tooth-colored porcelain shell. These PFM (porcelain-fused-to-metal) crowns offered both strength and a life-like appearance. They were so effective on both counts that PFMs were the most widely used crowns by dentists until the early 2000s.
But PFMs today make up only 40% of currently placed crowns, down from a high of 83% in 2005. What dethroned them? The all-ceramic porcelain crown—but composed of different materials from years past. Today's all-ceramic crowns are made of more durable materials like lithium disilicate or zirconium oxide (the strongest known porcelain) that make them nearly as strong as metal or PFM crowns.
What's more, coupled with advanced techniques to produce them, all-ceramic crowns are incredibly life-like. You may still need a traditional crown on a back tooth where biting forces are much higher and visibility isn't an issue. But for a tooth in the “Smile Zone”, an all-ceramic crown is more than suitable.
If you need a new crown (hopefully not by way of a sticky snack) or you want to upgrade your existing dental work, see us for a complete exam. A modern all-ceramic crown can protect your tooth and enhance your smile.
If you would like more information about crowns or other kinds of dental work, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Crowns & Veneers.”
Are your stained teeth bumming you out? There's good news—you can transform that dull and dingy smile yourself with a tooth whitening product.
There are dozens of over-the-counter whitening kits that allow you to brighten your own smile. Although not as controlled and long-lasting as a dentist's professional whitening, these DIY kits can still give you effective results.
But since these products involve chemical solutions that bleach tooth enamel, there's a common concern about their safety. Could you be harming your teeth by using a home whitening kit?
The answer is no—as long as you follow the manufacturer's directions for using the product. These kits have been formulated with a lower percentage of bleaching agent (usually 10% carbamide peroxide) than whitening solutions used by dentists. They've also been subjected to several clinical studies gauging both their effectiveness and safety.
That said, though, exceeding a product's recommended directions and frequency of use could cause you problems. If not used properly, a bleaching solution can erode tooth enamel—and this protective tooth layer doesn't grow back! As long as you whiten "within the lines," so to speak, you shouldn't encounter this kind of situation.
With that said, though, there are good reasons to consult your dentist before using a whitening product, or have them perform the whitening for you.
For one thing, an over-the-counter whitening product won't work if the staining originates from inside a tooth. It's wise, then, to have a dental examination first before using a whitening product to uncover this or any other underlying dental problems that should be addressed first.
You may also find a professional whitening will give you a more desirable result. A stronger professional bleaching solution under a dentist's expert control can produce a brighter, longer lasting smile than a home use product. A dentist may also be able to control the level of brightness better to help you achieve the smile effect you desire, from subtle white to ultra-bright.
Whichever way you go, your dentist can advise you on your options and make sure your teeth are in good shape for whitening. The end result can be a brighter smile—and a brighter mood.
If you would like more information on teeth whitening, 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 “Tooth Whitening Safety Tips.”
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