Posts for: December, 2019
Among dental restorations, implants are the closest prosthetic we have to real teeth. They not only replace the visible crown, but the titanium post imbedded in the jawbone adequately substitutes for the tooth root. Because of their unique design, implants are not only life-like, they’re highly durable and could potentially last for decades.
But while their success rate is remarkably high (more than 95% exceed the ten-year mark), they can fail. Ironically, one possible cause for implant failure is periodontal (gum) disease. Although an implant’s materials are themselves impervious to disease, the tissues and underlying bone that support the implant aren’t. If these natural tissues become infected, the secure hold the implant has can weaken and fail.
A gum infection usually begins with dental plaque, a thin biofilm of bacteria and food particles that builds up on tooth surfaces. Certain strains of bacteria within plaque can infect the gums. One particular form of the disease known as peri-implantitis starts as an initial infection and ensuing inflammation of gum tissues around an implant. The disease can quickly spread down to the bone and destroy the integration between the bone and the implant that helps keep the implant in place.
That’s why it’s important for you to keep the implant and the tissues around it clean of plaque, just as you would the rest of your natural teeth. This requires daily brushing and flossing around the implant and other teeth, and visiting your dentist regularly for more thorough dental cleanings.
You should also be alert to any signs of disease, especially around implants: gum redness, swelling, bleeding or pus formation. Because of the rapidity with which peri-implantitis can spread, you should see your dentist as soon as possible if you notice any of these signs.
Preventing gum disease, and treating it promptly if it occurs, is a key part of implant longevity. Preserving your overall dental health will help make sure your implant doesn’t become a loss statistic.
The change from primary teeth to permanent is an announcement to the world that a boy or girl is "growing up." "Growing up," though, is still not "grown"—the new teeth are still in a period of development that can affect how we treat them if they're injured or diseased.
While a new tooth erupts with all its anatomical layers, the middle dentin is somewhat thinner than it will be after it matures. The pulp, the tooth's innermost layer, produces new dentin and gradually increases the dentin layer during this early development period. While the pulp continues to produce dentin over a tooth's lifetime, most of it occurs in these early years.
To prevent or stop any infection, we would normally perform a root canal treatment in which we remove the pulp tissue and fill the empty pulp chamber and root canals. This poses no real issue in an older tooth with mature dentin. Removing the pulp from an immature tooth, though, could interrupt dentin development and interfere with the tooth's root growth. Besides a higher risk of discoloration, the tooth could become more brittle and prone to fracture.
That's why we place a high priority on preserving a younger tooth's pulp. Rather than a root canal treatment, we may treat it instead with one of a number of modified techniques that interact less with the pulp. Which of these we use will depend on the extent of the pulp's involvement with the injury or disease.
If it's unexposed, we may use a procedure called indirect pulp therapy, where we remove most of the tooth's damaged dentin but leave some of the harder portion intact next to the pulp to avoid exposure. If, though, some but not all of the pulp is damaged, we may perform a pulpotomy: here we remove the damaged pulp tissue while leaving the healthier portion intact. We may then apply a stimulant substance to encourage more dentin production to seal the exposure.
These and other techniques can help repair an injured young tooth while preserving most or all of its vital pulp. Although we can't always use them, when we can they could give the tooth its best chance for a full life.
If you would like more information on caring for your child's 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 “Saving New Permanent Teeth after Injury.”
Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.
Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.
Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”
Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.
There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.
So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.
Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”
If you have questions about cosmetic dentistry, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Magic of Orthodontics.”