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Posts for category: Dental Procedures

ThoughnotAlwaysSeenitsStillImportanttoReplaceaMissingBackTooth

Your front teeth are the stars of your smile — so it makes perfect sense to replace them if they’re missing. But is it really necessary to replace a largely unseen back tooth with an implant or bridgework?

The answer is an unequivocal yes. Your individual teeth are an interactive part of a dynamic mechanism that enables you to eat, speak and smile. They’re highly adaptable and can move incrementally to accommodate mouth changes — especially when one of them is lost.

Back teeth not only help us chew food efficiently, they also ease some of the pressure from front teeth as we chew. Our efficiency while chewing suffers when they’re missing; other teeth will wear faster and tend to move out of position, “drifting” into the space left by the missing tooth. And without their stimulation during chewing, new bone may grow at a slower rate to replace older bone, reducing bone volume over time.

So, whether visible or not, replacing a back tooth is the best course to take to prevent these adverse consequences. Your two best options are fixed bridgework or dental implants, each with their own advantages and disadvantages.

Bridgework has been the traditional method for replacing one or a few missing teeth: they’re long-lasting if cared for properly, have a life-like appearance that blends well with other teeth and are a good option when implants aren’t. But they require extensive altering of the anchor teeth (those used on either side of the bridge to secure it) and they’re highly prone for trapping food between them and the gums, increasing the risk of disease.

Dental implants are easily maintained and their installation doesn’t affect adjacent teeth as with a bridge. They’re also durable with a 95% success rate after ten years. On the other hand, the installation process can take several months and visits, and they require a certain amount of bone mass for proper placement and so aren’t ideal for certain patients.

Regardless of its location, if you have a missing tooth or one that may need to be removed, you should visit us for a complete examination. From there we can tell you how your mouth has been impacted by the missing tooth and which replacement option is best for you.

If you would like more information on tooth replacement options, 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 “Replacing Back Teeth.”

By George Debbaneh, DDS
January 26, 2019
Category: Dental Procedures
Tags: dental implants   dentures  
Implant-SupportedDenturesCouldBoostYourJawboneHealth

People have depended on dentures for generations—and they still do. That's because they work, both in restoring dental function and a smile marred by missing teeth.

But they have one major drawback related to bone health. That's because living bone has a life cycle: as older cells die, new ones form to take their place. The pressure generated when we chew stimulates this growth. But when this stimulus goes missing along with the teeth, the cell replacement rate slows and bone volume and density gradually diminishes.

Traditional dentures can't transmit this chewing pressure stimulus. And because they rest directly on the gum ridges, they can adversely affect the underlying bone and actually accelerate bone loss.

But implant technology potentially solves this bone loss problem with dentures by using implants rather than the gums to support them. It's a two-fold benefit: first, the implants relieve much of the irritation to the gums and bone caused by traditional dentures. Primarily, though, the implants themselves can slow or even stop continuing bone loss.

Most implants are made of titanium, not only because it's compatible with the body, but also because it has an affinity with bone. Over time bone cells grow on the titanium post imbedded in the jawbone. This process not only creates stability and durability, it can improve bone health.

In recent years dentists have incorporated implants with dentures to create two exciting treatment options. With one option, the dentist installs two or more implants in the jaw, to which a specially fitted removable denture can be attached. You would still have the ease of removing the denture for cleaning, while gaining greater stability and a reduced risk of bone loss.

The other option is a fixed denture (or bridge) attached permanently to implants. For this option, a patient's jawbone must be adequate and healthy enough to support at least four to six implants. A fixed denture is also often costlier and more complex than a removable denture, but it can feel more like real teeth. It also promotes better bone health too.

Although both options are more expensive than traditional dentures, they can pay dividends for long-term dental health. Implants could help you enjoy your new dentures and resulting smile for a long time to come.

If you would like more information on dental implant-supported restorations, 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 “Overdentures & Fixed Dentures.”

GoodBoneHealthEssentialforObtainingTeethinOneDayImplants

You've seen ads for “Teeth in One Day” that promise immediate implant placement at the same time you have the problem tooth removed. But this presumes the gums and underlying bone are healthy and able to support and protect the implant. If that's not the case, it may be ill-advised to place an implant on the same day.

Even with immediate placement, there will be a small degree of bone and gum opening or space around the implant after it's placed into the socket. This can often be remedied by placing a bone graft and sometimes a gum graft when we install the implant. It's also possible for natural healing to gradually fill in the space, but we'll need to monitor the site carefully for several weeks.

On the other hand, if we detect significant bone loss (or strongly suspect it will occur), immediate placement may not be an option — there's not enough bone or it's too weak to support an implant. In this case, it's necessary to wait on placement and focus on improving the bone health and quantity, beginning when we remove the old tooth and place a bone graft.

After completing the extraction, we typically place a bone graft in the empty socket. The graft will become a “scaffold” for new bone cells to grow upon. We may then allow about two to four months for new bone to partially replenish the area and then place the implant. The bone will continue to regenerate as it grows and attaches to the titanium implant to create a solid attachment.

If the site, however, still appears fragile even after partial bone growth, we may opt to wait another two to four months before attempting placement. From a long-term perspective, this is the best scenario for ensuring a durable foundation for the implant. It also allows for a socket severely compromised by disease to heal more thoroughly.

To determine which of these placement scenarios is best for you, we'll first need to conduct a thorough dental examination. From there we'll be in a better position to discuss the right implant timeline for your situation. Our main goal is to ensure we can securely place your implant in just the right position to achieve the most successful and attractive result.

If you would like more information on 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 “Implant Timelines for Replacing Missing Teeth.”

By George Debbaneh, DDS
January 06, 2019
Category: Dental Procedures
Tags: root canal  
SettingtheRecordStraightonRootCanalTreatments

If there was an “Unsung Hero” award for dental procedures, the root canal treatment would win hands-down. Much aligned in popular culture, today’s root canal treatment is actually a valuable tool for saving teeth that would otherwise be lost. And contrary to popular belief, root canal treatments don’t cause pain — they relieve it.

To help you understand its true worth, here are some common questions and answers about the root canal treatment.

What problem does a root canal treatment fix?
A root canal treatment stops a bacterial infection that has invaded the innermost part of a tooth — the pulp — and is advancing toward the end of the root through small passageways known as root canals. Most people first notice the problem as a sharp pain in the affected tooth that may suddenly dissipate in a few days. The infection has attacked the inner pulp tissue, rich in nerve fibers; when the nerve fibers die they stop sending pain signals. The infection, however, hasn’t died: as it advances, you may then begin to experience pain when you bite down or when you encounter hot foods. You may also notice tenderness and swelling in nearby gums.

How does the procedure stop the infection?
A root canal treatment removes all the infected or dead tissue and cleanses the pulp chamber. We enter the pulp chamber through a small access hole created in the tooth’s biting surface. After tissue removal, we then “shape” and prepare the empty chamber and root canals (often with the aid of microscopic equipment) to be filled with a special filling. After filling, the tooth is then sealed to prevent re-infection (most often, we need to install a permanent crown at a subsequent visit for maximum protection).

How much pain can I expect during and after the procedure?
During the procedure, none — the tooth and surrounding gums are fully anesthetized before we begin the procedure. Afterward, you may experience mild discomfort for a few days that can be relieved with over-the-counter medications like aspirin or ibuprofen.

What’s the ultimate value for a root canal treatment?
The procedure can save a tooth severely damaged by the infection. Even covered by an artificial crown, a living tooth continuing to exist and function normally within the mouth is usually more conducive for optimum oral health than an artificial tooth replacement.

If you would like more information on root canal treatments, 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 “Common Concerns About Root Canal Treatment.”

WhyemBigBangTheoryemActressMayimBialikCouldntHaveBraces

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”