My Blog

By John P. Ducar, DDS, Inc
September 22, 2018
Category: Oral Health
JamieFoxxChipsaTooth-ThisTimebyAccident

Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.

“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…

For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.

When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.

A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.

But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.

Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!

If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”

By John P. Ducar, DDS, Inc
September 12, 2018
Category: Dental Procedures
ARootCanalCanStopToothDecayandSaveYourTooth

Tooth decay can wreak more havoc than just producing cavities. It can work its way into the innermost parts of the tooth — the pulp and tiny passageways called root canals that lead to the tooth's connection with the bone.

If that happens, you'll need more than “drilling and filling.” Without intervention, your tooth could be lost. That intervention is a root canal treatment, a procedure that removes the infection from within the tooth and preserves it from re-infection.

You've probably heard the old belief that root canal treatments are painful. With modern anesthetic techniques to deaden pain, that's not true. In fact, root canal treatments stop the pain caused by infected nerves within the pulp and root canals. More importantly, it saves your tooth.

Root canals can be performed by a general dentist. More extensive decay or complex root canal networks may require the services of an endodontist, a dentist who specializes in root canal anatomy and treatments. Endodontists have advanced techniques and equipment to handle even the most difficult case.

Regardless of who performs it, the basic procedure is the same, as is the goal: to completely remove all diseased tissue within the tooth and seal it with a special filling to prevent re-infection. To access the diseased pulp, we first drill an access hole, usually in the biting surface of a back tooth or the back of a front tooth. We then use specialized instruments to remove the infected tissue and flush out the space with antibacterial solutions.

We then insert a filling called gutta percha into the empty pulp chamber and root canals, seal off the filling with adhesive cement, and close the access hole with filling. These fillings and sealants prevent bacteria from reentering the tooth. For added protection against infection and fracturing, we also recommend placing a full-coverage dental crown. This also enhances the appearance of the tooth, which must be modified during the root canal procedure.

The end result: your once endangered tooth has been preserved for hopefully many years to come. So if we recommend you undergo a root canal treatment, don't wait — the tooth you save may be your own.

If you would like more information on root canal treatment, please contact us or schedule an appointment for a consultation.

By John P. Ducar, DDS, Inc
September 02, 2018
Category: Dental Procedures
Tags: orthodontics   oral surgery  
ExposingandPreservingImpactedCanineTeeth

The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.

At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.

Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.

Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.

At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.

If you would like more information on the effects and treatment of impacted 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 “Exposing Impacted Canines.”

By John P. Ducar, DDS, Inc
August 23, 2018
Category: Dental Procedures
Tags: dental injury  
WhenSummertimeSportsLeadtoDentalDilemmas

Summer is a great time to go outdoors and get your game on—no matter whether your court is set up for tennis or basketball, whether you’re on the diamond or on the greens. Regular physical activity can help you maintain your optimal weight, reduce your risk for certain diseases, and even lower stress levels. But many of our favorite outdoor sports also carry a risk of accidental injury…and frequently this involves injuries to the mouth.

Because they’re front and center, the incisors (front teeth) are the ones most often affected by accidental injuries. While serious damage is relatively rare, chips and cracks are not uncommon. Fortunately, dentistry offers a number of good ways to restore chipped or broken teeth. Which one is best for you depends on exactly what’s wrong—but a procedure called cosmetic bonding is one of the most common ways to repair small to moderate chips where the tooth’s soft pulp isn’t exposed.

In dental bonding, a tooth-colored material is applied directly to the tooth’s surface to fill in the chip or crack. The material itself is a high-tech mixture of tough plastic resins, translucent glass-like fillers, and other substances. Strong, durable and lifelike in appearance, these composite resins can be matched to the natural shade of your teeth.

Bonding is a conservative procedure, meaning that it requires little or no preparation of the tooth. It can be done right in the dental office, often in a single visit and without the need for anesthesia. Unlike porcelain veneers or crowns (caps), it usually doesn’t involve removing significant amounts of healthy tooth structure.

While the results can last for years, bonded restorations aren’t as durable as porcelain veneers or crowns, which are made in a dental laboratory. Bonding also isn’t suitable to repair major damage, or in cases where the tooth’s pulp could become infected; in this situation, you may need a root canal and a crown. However, for moderate chips or cracks, bonding can be an appropriate and economical way to restore your teeth to full function and aesthetic appearance.

Of course, it’s often said that an ounce of prevention is worth a pound of cure. That’s why it’s best to wear a protective mouthguard whenever you’re on the field. We can provide a custom-made mouthguard that’s comfortable to wear and offers maximum protection against dental injury—just ask!

If you have questions about cosmetic bonding or mouthguards, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Artistic Repair of Front Teeth with Composite Resin” and “Athletic Mouthguards.”

By John P. Ducar, DDS, Inc
August 13, 2018
Category: Dental Procedures
MasterIllusionistBenefitsfromtheMagicofOrthodontics

Magician Michael Grandinetti mystifies and astonishes audiences with his sleight of hand and mastery of illusion. But when he initially steps onto the stage, it’s his smile that grabs the attention. “The first thing… that an audience notices is your smile; it’s what really connects you as a person to them,” Michael told an interviewer.

He attributes his audience-pleasing smile to several years of orthodontic treatment as a teenager to straighten misaligned teeth, plus a lifetime of good oral care. “I’m so thankful that I did it,” he said about wearing orthodontic braces. “It was so beneficial. And… looking at the path I’ve chosen, it was life-changing.”

Orthodontics — the dental subspecialty focused on treating malocclusions (literally “bad bites”) — can indeed make life-changing improvements. Properly positioned teeth are integral to the aesthetics of any smile, and a smile that’s pleasing to look at boosts confidence and self-esteem and makes a terrific first impression. Studies have even linked having an attractive smile with greater professional success.

There can also be functional benefits such as improved biting/chewing and speech, and reduced strain on jaw muscles and joints. Additionally, well-aligned teeth are easier to clean and less likely to trap food particles that can lead to decay.

The Science Behind the Magic

There are more options than ever for correcting bites, but all capitalize on the fact that teeth are suspended in individual jawbone sockets by elastic periodontal ligaments that enable them to move. Orthodontic appliances (commonly called braces or clear aligners) place light, controlled forces on teeth in a calculated fashion to move them into their new desired alignment.

The “gold standard” in orthodontic treatment remains the orthodontic band for posterior (back) teeth and the bonded bracket for front teeth. Thin, flexible wires threaded through the brackets create the light forces needed for repositioning. Traditionally the brackets have been made of metal, but for those concerned about the aesthetics, they can also be made out of a clear material. Lingual braces, which are bonded to the back of teeth instead of the front, are another less visible option. The most discrete appliance is the removable clear aligner, which consists of a progression of custom-made clear trays that reposition teeth incrementally.

How’s that for a disappearing act?!

If you would like more information about orthodontic treatment please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “The Magic of Orthodontics.”





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