Dental patients have amazing options for tooth replacement. Dental implants, for example, can replace the entire tooth, root and crown, giving patients a new tooth nearly as good as the old one.
Nearly—but not exact. Even implants can't match the full benefits of a natural tooth, including one in less than perfect shape. Our first goal as dentists, then, is to save a diseased tooth if at all practical before considering replacing it.
That often involves a root canal treatment to address decay threatening a tooth's interior. The procedure requires drilling into the tooth to access its innermost pulp, cleaning out the pulp and root canals, and then filling the empty spaces. Since all dentists are trained in basic root canal treatment, your general dentist may be able to perform it.
But some dental situations call for more advanced endodontics, the dental specialty for treating disease and other problems inside a tooth. So, in what situations would you see an endodontist?
When your dentist refers you. Your dentist wants you to receive the level of treatment necessary to save your tooth. After examination, they may determine your situation would be better served by the advanced training, equipment and techniques (including surgery) of an endodontist.
When your tooth has complications. Patients often need an endodontist when existing factors complicate treatment of advanced tooth decay. A patient may have dental pain that's difficult to pinpoint, requiring the diagnostic resources of an endodontist. It's also common for a tooth's root canal network to be highly intricate, and which respond better to treatment with specialized endodontic tools and techniques.
When root canal treatment fails. Most root canal treatments are successful in protecting the tooth from further infection. That said, it's still possible for a root-canaled tooth to become re-infected or develop more problems. Again, an endodontist and their “tool chest“ re-treating a root-canaled tooth may be the best option for saving it.
You also don't have to wait for a referral—you can see an endodontist if you believe they would be best to treat your decayed tooth. You can find one near you by visiting an online endodontist directory at www.aae.org/find. An endodontist may be the lifesaver your diseased tooth needs.
Before we begin correcting a malocclusion (poor dental bite), we need to ask a few questions: How extensive is the malocclusion? How far must we move the teeth to correct it? How might the patient's jaw size impact treatment?
Answering these and other questions help us develop an effective treatment plan. And depending on the answers, we might need to look at other procedures before we install braces—like removing one or more of the teeth.
This isn't a subject to approach lightly: All teeth play an important role in dental function and smile appearance, and ordinarily we want to preserve teeth, not remove them. Sometimes, however, it may be a necessary action to achieve our goal of an improved dental bite.
For example, it might be necessary for correcting a malocclusion caused by severe teeth crowding. This occurs when one or both of the jaws hasn't grown to a sufficient size to accommodate all of the teeth erupting on it. As a result, some of the teeth could come in out of their proper alignment.
If caught early before puberty, we may be able to use other techniques to alleviate crowding, like a device called a palatal expander that influences an upper jaw to widen as it grows. If successful, it could provide later teeth more room to erupt in their proper positions.
But even if additional jaw growth occurs, it may not be enough to avoid a malocclusion or treatment with braces. Alleviating further crowding by removing teeth in little noticed areas could help with subsequent orthodontics.
Removing teeth may also be the answer for other problems like an impacted tooth, in which the tooth has not fully erupted and remains submerged in the gums. It's sometimes possible to use a technique to “pull” the tooth down where it should be; but again, that will still require jaw space that may not be available. The more effective course might be to remove the impacted tooth.
Whether or not tooth extraction will be needed can depend on a thorough orthodontic evaluation and full consideration of all the available options. Even though the ideal situation is to correct a bite with all teeth present and accounted for, it may be for the better good to sacrifice some.
If you would like more information on orthodontic techniques, 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 “Removing Teeth for Orthodontic Treatment.”
What a difference forty years can make: Dental bridges once occupied the top spot for choices to replace missing teeth until the arrival of dental implants in the 1980s. Today, dental implants are the gold standard for dental restoration.
But although bridgework may have lost “first chair” in the orchestra of restorations, it's still a viable option. In fact, it can be the best option in certain situations.
Bridges consist of a series of porcelain crowns fused together like fence pickets. The center crowns, known as the pontics, “bridge” the gap left by a missing tooth or teeth. The crowns on each end, the abutment teeth, crown the natural teeth on either side of the gap to support the bridge.
Bridges are effective and durable, but with a major downside: To accommodate the abutment crowns, we must reduce the size of the natural teeth to which they'll be attached. This alteration can weaken those teeth's structure and require them from then on to have some form of restoration. They're also at higher risk for tooth decay.
Implants, on the other hand, don't require this alteration, and may also be more durable than bridges. Why then consider a bridge?
Price can be a factor: Implants may be more expensive, especially involving multiple teeth. Keep in mind, though, that this only compares the initial cost: Because implants have a 95% or more ten-year success rate, with further evidence they could potentially last for decades, they may actually cost less in the long-run than bridge restorations that have a higher chance of being replaced sooner.
But the prime reason is that some dental situations aren't suitable for dental implants. For instance, implants require a certain amount of bone for proper placement, so people with extensive bone loss may not be able to acquire them. Health conditions like uncontrolled diabetes or a compromised immune system can also complicate implant installation. A bridge in these cases may represent a better alternative.
With the help of your dentist, you'll need to consider your individual situation, dental and financial, in deciding between an implant or a bridge. And, if a dental bridge is your best option, it will be a solid choice for restoring your missing teeth and your smile.
If you would like more information on various dental restoration 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 “Crowns & Bridgework.”
Howie Mandel, one of America’s premier television personalities, rarely takes it easy. Whether performing a standup comedy gig or shooting episodes of America’s Got Talent or Deal or No Deal, Mandel gives it all he’s got. And that intense drive isn’t reserved only for his career pursuits–he also brings his A-game to boosting his dental health.
Mandel is up front about his various dental issues, including multiple root canal treatments and the crowns on his two damaged front teeth. But he’s most jazzed about keeping his teeth clean (yep, he brushes and flosses daily) and visiting his dentist regularly for cleanings and checkups.
To say Howie Mandel is keen on taking care of his teeth and gums is an understatement. And you can be, too: Just five minutes a day could keep your smile healthy and attractive for a lifetime.
You’ll be using that time—less than one percent of your 1,440 daily minutes—brushing and flossing to remove dental plaque buildup. This sticky, bacterial film is the main cause of tooth decay and gum disease. Daily hygiene drastically reduces your risk for these tooth-damaging diseases.
But just because these tasks don’t take long, that’s not saying it’s a quick once-over for your teeth: You want to be as thorough as possible. Any leftover plaque can interact with saliva and become a calcified form known as calculus (tartar). Calculus triggers infection just as much as softer plaque—and you can’t dislodge it with brushing and flossing.
When you brush, then, be sure to go over all tooth areas, including biting surfaces and the gum line. A thorough brushing should take about two minutes. And don’t forget to floss! Your toothbrush can’t adequately reach areas between teeth, but flossing can. If you find regular flossing too difficult, try using a floss threader. If that is still problematic, an oral irrigator is a device that loosens and flushes away plaque with a pressurized water stream.
To fully close the gate against plaque, see us at least every six months. Even with the most diligent efforts, you might still miss some plaque and calculus. We can remove those lingering deposits, as well as let you know how well you’re succeeding with your daily hygiene habit.
Few people could keep up with Howie Mandel and his whirlwind career schedule, but you can certainly emulate his commitment to everyday dental care—and your teeth and gums will be the healthier for it.
If you would like more information about daily dental care, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Daily Oral Hygiene: Easy Habits for Maintaining Oral Health” and “10 Tips for Daily Oral Care at Home.”
Daily oral hygiene and regular dental cleanings help keep your natural teeth and gums healthy and disease-free. But they're also a priority with dental implants. Here's why.
Unlike other restorations, an implant replaces both a tooth's crown and root, the latter by way of a titanium metal post imbedded into the jawbone. Bone cells grow and adhere to the metal surface, forming a secure and lasting hold.
But although quite durable, this hold differs significantly from natural teeth, which are actually held in place by a tough, elastic tissue called the periodontal ligament. The attachment of the ligament's tiny fibers to both tooth and bone secure the tooth in place, as well as supply it and the surrounding gums with nutrients and defensive antibodies to fight infection.
Implants don't have this relationship with the periodontal ligament. The tissues around an implant are thus susceptible to an aggressive form of periodontal (gum) disease called peri-implantitis. This kind of gum infection can progress rapidly, leading eventually to bone loss and possible failure of the implant.
Daily brushing and flossing of both natural and implant-supported teeth lowers the risk of gum disease, particularly peri-implantitis. It's also imperative that you undergo regular cleanings, at least every six months, with your dentist or dental hygienist.
These, however, won't be the typical cleanings performed on natural teeth. Hygienists don't use metal cleaning implements to remove plaque and tartar deposits because they can scratch the metal materials of the implant and crown. These microscopic scratches can then attract bacteria that trigger gum infections. Instead, they'll use instruments made of plastics or resins.
Hygienists also rely heavily on ultrasonic equipment that vibrates plaque loose on or around implants, which are then flushed away with water. The tips used with these instruments are also typically made of nylon or plastic sheathing.
Even with the extra hygiene care needed, implants still enjoy a 95% or higher survival rate after ten years. You can ensure your implants achieve that level of durability by keeping them clean and seeing your dentist at the first sign of a gum infection.
If you would like more information on maintaining dental implants, 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 “Dental Implant Maintenance.”
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