BRUXISM AND NIGHTGUARDS

By thedentistauthority | Published: April 23, 2010

Bruxism is a dental term, which refers to the habit of grinding one’s teeth.  This habit may manifest during times in the day or while one sleeps.

The movement usually involves moving the central incisors and canines laterally against one another.  It can involve clenching and grinding of the molars as well.

At first this may go unnoticed but accelerated wear begins to show in the loss of enamel.  Edges begin to flatten and as this habit would continue unchecked for year’s teeth may be worn to stubs.

Children as young as 5 or 6 may grind their teeth, this makes a disturbing noise.  This habit usually goes away as their permanent teeth erupt into occlusion.  It does not mean they will grind their teeth as adults.

Bruxism will have adverse effects so it is in one’s best interest to stop.  It is easier said than done.  Some strategies are employed to help learn new habits to combat bruxism.  Try this tongue exercise, when you feel yourself clenching place your tongue against the roof of your mouth just behind the incisors and make the sound like “nnn.”  This will prevent clenching.

Stress is a factor that contributes to bruxism.  Try to find ways to reduce your stress or tension.

Eliminating any nicotine or caffeine a few hours before you rest may reduce bruxism during the night, while sleeping.  Try a glass of herbal tea instead.  If your partner hears you grinding your teeth at night have them wake you.  Get up straighten out your pajamas and your covers.  Maybe have a glass of milk and go back to bed.  Try to learn a new habit.

Your dentist can make Nightguards or occlusal splints.  A hard acrylic night guard can be comfortable and 95% of the people get used to them.  It is a measure of protection and not a cure.  It can provide relief from all the soreness that can be associated with bruxism.

Bruxism is disruptive to your sleep, can involve sore muscles, clicking or popping sounds when chewing, difficulty opening your mouth and even damage to the TMJ.  You should see your dentist for an evaluation.

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WHY DO MY DENTURES HURT?

By thedentistauthority | Published: December 10, 2009

There are many reasons why a denture may hurt.  One of the major factors is the loss of fit.  The denture will move up and down on the tissues and cause irritations or sore spots.  A person may have lost a lot of weight, which would cause the gums or tissue to shrink.  Unfortunately, the denture does not shrink along with the tissue.  Therefore, the denture may start to feel loose.

Secondly, the denture may hurt due to excessive wearing of the dentures.  This means many patients will wear them all day long.  They may never be removing them.  The proper way is to remove the dentures at night before going to bed.  This allows the gums and tissues to relax and stay firm.  Many times when a denture is worn constantly the tissue becomes way loose and flabby along the ridge.  When this occurs the dentures begin to move as well.  The gum tissue on the patients’ ridges should be hard and firm.   This allows for a more stable fit.

In some cases dentures may hurt due to long standing wearing of dentures.  Patients, who have worn dentures for a good part of their lives, often have reduced jawbones due to lack of support.  In these cases the ridges become very thin over years of wearing the dentures.  The ridges become so thin that the nerve becomes close to the surface causing severe pain when the dentures are placed.  Bone addition or augmentation can sometimes be done to raise the ridge again to allow a base to build up on.

In many cases denture pain can be overcome.  It may simply be by adjusting the dentures.  In other cases, tissue may need to be removed to firm up the ridges.  Lastly, implants may be an option to help stabilize a patient’s denture.

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DENTAL IMPLANTS

By thedentistauthority | Published: December 7, 2009

Am I a candidate for dental implants?  There are many factors that play a role to determine it a patient can have dental implants.

The first concern is bone height and width.  In order for a dentist to place an implant it must determined if there is sufficient bone.  There are numerous sizes and shapes of implants.  In some cases, smaller diameter and length of implants can be used if the bone is thin or shallow.  In patients who have had teeth missing for many years the bone has shrunk or atrophied to the point where an implant would not work.  In these cases it is sometimes possible to place a bone graft.  This is usually placed over the jaw in an attempt to increase the height and width in order to now place an implant.

Secondly, a patient’s health may be a determining factor when placing implants.  Some severely brittle diabetics or heavy smokers, it may not be an option due to poor healing abilities.

Certain medications may also inhibit ones chances of receiving implants.  i.e. blood thinners, osteoporosis drugs are a few examples.

If a person is interested in having implants the best advice is to contact their dentist and consult with him or her.  Also, obtain more than one opinion.

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WHY ARE MY TEETH SENSITIVE?

By thedentistauthority | Published: December 4, 2009

One of the most common problems facing patients as well as Dentists is the treatment of sensitive teeth.

Many times patients will present issues of hot, cold, sweet or sour discomfort.  As the population is aging and people are retaining their teeth much longer than before, these issues are becoming more prominent.

One of the main reasons for sensitive teeth is due to what is called recession.  Recession is basically the natural shrinkage of the gum tissue around the neck of the tooth.  As this occurs the root surface becomes more exposed to external stimuli namely hot or cold liquids or foods.  When the hot or cold stimuli contact these surfaces, patients may experience mild to severe sensitivity,  “feels like a nerve is exposed” comments are often mentioned.   To combat these issues, sensitive type toothpastes and rinses have been developed to curb these problems.  In many cases they aid in lessening the sensitivity.

Secondly, sensitivity may be due to hairline cracks or fracture of the outer enamel of teeth.  Patients usually state that their teeth hurt when heavy chewing is applied to one or more teeth.  This may indicate a fracture.  If this is only minimal, a cap or crown may be needed to cover the tooth to help prevent further fracturing.

Thirdly, sensitivity may be due to excessive brushing with a hard bristle brush.  Many patients feel that the harder they scrub or brush the cleaner the teeth.  What this causes is erosion or wearing away of the root surface of the tooth.  A “ditching” of the root can occur.  A bonded type filling will then be placed to build-up the worn away surface.  This idea is contraindicated.  It is recommended to brush with a soft bristle brush with little pressure. Brush longer for at least 3 minutes. This technique is much more safe and effective.  There are many battery-powered toothbrushes on the market that are great for this reason.  The Sonicare, the Oral-B Braun and the Crest spin brush are among the top sellers.  These units offer soft bristle heads and the control of less pressure on the teeth.

In Conclusion, one can see there are many causes for sensitivity with teeth.  To be sure, patients should seek the care and advise of their Dentist for the proper diagnosis and treatment.

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ORTHODONTICS (Cont.)

By thedentistauthority | Published: June 30, 2009

Distal Jet Space Maintainer: A fixed appliance that moves upper teeth back to correct a Class II bite problem. It replaces the traditional headgear. An appliance may be unilateral (one sided) or bilateral (two sided). the appliance is cemented in place and then adjusted by the orthodontist at specific intervals. the springs on the appliance are used to manipulate the molars into the correct relationship. Once the molars are in position, the braces are put on.

Spacers: Small (metal, plastic or rubber) devises placed between molars one week to two weeks prior to braces being placed. spacers move teeth apart slowly until they are far enough apart to accommodate a band. Spacers may not be necessary if space already exists between molars.

Banding: Process of cementing brackets and fastening arch wires

Deband: Process of removing brackets and arch wires, polishing teeth and taking a retainer impression. Final records are taken at this appointment. Retainers must be placed by the orthodontist within two weeks after debanding.

Limited Orthodontics: Orthodontic treatment of one arch or partial arches.

Full Orthodontics: Orthodontic treatment on both arches.

Records: Impressions, cephalometric (full head) x-ray, panoramic x-ray and photos. Records are taken prior to starting treatment (initial diagnostic records) and when treatment has been completed (final records).

Ortho Adjustment: Review progress, check or replace wire, possibly add elastics or power chain (like a bunch of ligatures tied together).

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ORTHODONTICS

By thedentistauthority | Published: June 30, 2009

Retainers: A fixed or removable appliance designed to maintain your teeth in their corrected position. the fibers that hold your teeth to the bone have lots of memory and it takes 6 months for the fibers to mend and then remember 1/2 the distance moved. That’s why you’re asked to wear your retainers all the time the first year, and at night after that. Retainer check appointments are necessary to monitor appliance condition and function.

Traditional Braces: A self-ligating system that eliminates the need for elastic or metal ties. Treatment time is typically shorter because the high technology wires move teeth faster. Benefit to patients is a beautiful result, increased comfort and fewer appointments. Type of procedure and length of time needed may effect scheduling options for some visits. Generally appointments are every 8-12 weeks.

Clear Orthodontic trays: A treatment option that involves wearing a series of clear, removable aligners (for about 12 months) that gradually move teeth without wires or brackets. Trays must be worn 24 hours a day and may only be removed when eating and brushing your teeth. If trays are not worn as specified, your teeth will not move as expected and you will not achieve your desired results. Trays are worn in a specific order, for a two week period. Save all used trays; do not discard when you change aligners. Periodic office visits are required to monitor progress and ensure optimal results.

Clear Orthodontic tray express: A less costly, faster treatment option for mild or less severe malocclusions that involves wearing a series of clear, removable aligners (for 6 months or less).

RPE (rapid palatal expander): An appliance, generally fixed but may be removable, designed to widen the upper jaw and allow more room for teeth to erupt into the mouth. An RPE may also be used to correct a cross-bite. The appliance is activated by turning a screw or key, as directed by the dentist. Common appointment sequence: spacers, impression, insert. Brief office visits, scheduled like an adjustment, are required to check the expansion. the appliance must stay in place for a minimum of 4 months after the desired expansion has been achieved. An expander is often used prior to full orthodontic treatment.

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ORAL HYGIENE

By thedentistauthority | Published: June 30, 2009

Regular prophylaxis (dental cleaning) appointments are an essential part of a good dental care regimen. Dental x-rays are recommended to evaluate teeth for decay (cavities) and bone loss around teeth. It is recommended to have your teeth cleaned every 6 months minimally. In some cases more frequent dental cleanings are recommended.

During a dental cleaning soft plaque and calculus, also known as tartar are removed from the tooth surface above and below the gumline. Calculus is calcified or hardened plaque. Plaque contains numerous bacteria that can lead to gingivitis, periodontal disease (gum disease) and tooth decay. The bacteria in plaque can also cause or worsen other conditions in the body. Oral bacteria is linked to complications with heart disease, diabetes, stroke, ulcers and pre-term births.

Gingivitis is inflammation of oral gum tissue caused by bacterial plaque. It is identified by swollen, tender, bleeding gums. Healthy gum tissue does not bleed. Gingivitis is reversible with good oral hygiene and regular dental visits. Thorough plaque removal involves brushing 2-3 minutes at least twice daily and flossing below the gumline at lease once a day.

Periodontal disease is a disease of the supporting structures of the tooth called the periodontium. The periodontium includes the bone that surrounds the tooth, and the small ligaments and connective tissue that anchor the tooth to the bone.

Bacteria that accumulate below the gumline trigger the immune system. The repeated bacterial attack and immune system response leads to a breakdown in the connective tissue and bone. If periodontal disease progresses, the result is infection and tooth loss. Periodontal disease is treated by removing calculus (hardened plaque) from beneath the gumline. If the space under the gumline is deep it is called a periodontal pocket. A normal space is 1-3 mm. A pocket that is 4-5 mm is usually a result of gingivitis (inflammation). A pocket that is 6mm or greater indicates periodontal disease.

Anesthetic may be administered to make the removal of the calculus more comfortable. It may take several visits to remove all of the calculus deposits. Once the calculus is removed the tissue will heal and pocket depths should decrease. If plaque is kept off of the teeth with good daily brushing and flossing there is a much better chance of controlling the periodontal (gum) disease. Bone that is lost around the teeth due to gum disease is permanent. Prevention of further bone loss is essential. Smoking, diabetes and a compromised immune system can contribute to periodontal disease.

Sometimes it is recommended to see a periodontist, a specialist in the treatment of periodontal disease. Surgery to help reduce pocket depth or to re-contour or replace diseased bone may be recommended.

It is generally recommended to have your teeth cleaned every 3-4 months if you have gum disease.

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DENTAL EMERGENCIES

By thedentistauthority | Published: June 30, 2009

A broken tooth is one of the most common dental emergencies.  Depending on the pain involved relates to how serious of an emergency.  Rinse it with warm water and floss it gently if there is food impacted.  If you have a lot of pain take some ibuprofen or Tylenol and call your dentist.  If the discomfort is minimal go to your pharmacy and get some temporary filling material to cover it up, until you get in for your appointment.

A fractured tooth is one that is split vertically like a wedge splits a log.  The severity with the fracture relates to the prognosis.  A complete fracture into the root usually results in tooth loss, so it is extracted.  Often the fracture is repairable.  Rinse it with warm water and don’t bite on it.  Severe lasting pain means you have a serious problem that might involve a root canal and crown, or an extraction.  Take Tylenol or ibuprofen to control the pain

A microscopic fracture might only give you a sharp pain when you bite on it a certain way.  This happens because as you bite and force some shifting of the two pieces the dental pulp or nerve is excited.  Don’t bite on it.  You might make it worse.  Help yourself to prevent these emergencies by not chewing on ice or popcorn kernels.  If you grind your teeth ask your dentist about a bruxism appliance.

A blow to the face, causing trauma can lead to a partial displacement of your tooth.  This is an emergency and the tooth should be pushed, slowly back into its proper position.  This is best accomplished by your dentist.  The tooth will need to be splinted or stabilized, for a while.  Follow up care is required.

Worse than a partial displacement is avulsion, or total displacement, where the tooth is knocked out.  This is an emergency and time is of the essence.  The cells on the root surface are very sensitive and should not be scrubbed or allowed to dry out.  Rinse the tooth under warm water while holding it gently from the crown (the white part).  Then place it back into the socket and hurry to your dentist.  Do not store it in water but cold milk is ok or saliva.  So if you are not able to replant it put it in a cup with milk or hold it gently in your mouth.  A tooth replanted within the first 5 minutes has a much better prognosis.  After one hour there is less success.  Your dentist will need to replant it and stabilize it.  Root canal therapy will be performed soon and follow up appointments for about 5 years.

Avulsed primary or baby teeth are not replanted, just apply a cold compress to control the bleeding and minimize the swelling.  Follow up with your dentist.

Sport mouth guards are highly recommended and could prevent about half of this type of injury.  The custom fit ones made by your dentist are the best because they offer you the most protection.  In ages 6-12 there are erupting teeth, and allowances in their design leave the room required for eruption.

Trauma to the lips or tongue sustained during these injuries usually heals well because of the vascularity in the area.  Stitches may be required.  If so, your dentist might do this or you might see a plastic surgeon at the emergency room.

Swelling of your face or gums is a dental emergency.  You should seek prompt attention for treatment at your dentist or emergency room.  You probably need antibiotics to minimize your infection.  Your dentist will make your diagnosis and help design your treatment

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IMPLANTS

By thedentistauthority | Published: June 30, 2009

Within the last 15-20 years implants have become on of the most important and significant additions to the dental field.  It has revolutionized the way dentists can replace missing teeth.  Patients can now have fixed (i.e. permanent) teeth.  Rather than dentures of partial dentures.  Patients can now expect to have implant retained crowns and bridges.

Simply put, an implant is a metal screw or post, which is implanted into the jaw.  From there it can be used as an anchor for retaining a single crown or used for multiple bridges or a denture.    The metal is usually made from titanium.  The procedure can be performed on an out patient basis.  Typically implant placement is performed by either a periodontist or an oral surgeon.  But as popularity has grown many general or family dentists are placing them as well.  Be sure that if a general dentist performs the work that he or she has continuing education in the area.  They should have taken courses relating to implant placement.

There are a variety of different types of brands of implants.  #I, Nobel biocare are two of the major players who fabricate the implants.   From there the dentist will use their system of choice.  It is not unusual for patients to have anywhere from 1-8 placed at one time.

Typically, once the implants are placed the patient has to wait 3-6 months before they can have the final step done.  This is because the bone from the jaw needs to integrate or fuse with the implant.  Once this has been achieved the next step entails taking impressions for the final restorations.  Depending on the number of implants placed and the particular treatment plan, which was discussed prior to the placement of the implants, this determines what the final outcome will be.  It may be as simple as a single crown or multiple bridges or a precision attached partial or full denture.

Whatever the final outcome may be, implants are here to stay.  They have been show to be very strong and retentive.  They are an investment.  Highly restoring a patients function, confidence and smile

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COSMETIC DENTISTRY

By thedentistauthority | Published: June 30, 2009

Cosmetic dentistry is about improving the appearance of your smile.  Imagine altering the appearance of a physical feature with regards to your teeth or gums.  Commonly, by direct application, the color, shape and spacing of your teeth can be modified.  Cosmetic dentistry can also enhance your smile through a periodontal procedure used to “sculpt” your gums.  This can add symmetry and is usually done in conjunction with porcelain crowns or veneers.      The most common treatments are for teeth, and are easily accomplished in just one or two appointments.

White fillings are called composites.  While restoring a chip or cavity with a white filling is considered necessary to maintain dental health, it is also cosmetic.  Insurance companies should cover the service in this case.  Composite fillings can also accomplish purely cosmetic procedures that may or may not be covered procedures.

Diastema is a space between the upper front teeth.  If one prefers to close that space, a layer of composite with a similar shade is applied.  This filling is cured with a light wand, and polished to a smooth high gloss.  The restoration should look perfectly natural.

Amazing cosmetic changes can be had with dental veneers.  Dental veneers are used to improve the appearance of the upper front teeth most often.  They can be of porcelain or composite, and your dentist requires little preparation.  A minor rotation of a tooth can be concealed without orthodontics.  Dental technology has made advances in the materials and cements, improving the longevity and appearance of composites and ceramics.

Cosmetic procedures are either direct of indirect.  Direct restorations are placed and adjusted at one dental appointment.  Indirect restorations generally require two or more visits.  An impression is sent to a dental lab, where a technician creates the restoration by the dentists’ instruction.  At the next dental appointment the restoration is cemented and adjusted.

Composites are a mixture of glass or quartz filler in a resin medium.  Composites are made in a variety of natural shades and one restoration can be blended with different shades to produce a natural effect.  These can withstand moderate chewing pressure and have good durability.  The cost is moderate and depends on the size of the restoration and the technique used by the dentist.  They are subject to wear and do stain or discolor over time.

Porcelain or a ceramic restoration is created at the dental lab from a dental impression.  This material can produce a variety of dental restorations including crowns and veneers.  These restorations can possess the most natural color and translucency.  Their strength depends on the thickness of the porcelain and the bond to the tooth.  They have excellent wear and longevity.  They do not stain or discolor.  Porcelain can wear on opposing teeth.

Composites can be indirect, or created at the lab, and bonded in the mouth at the next appointment.  Composites do not wear on opposing teeth but are prone to stain or discoloration and not as durable as porcelain.

Cosmetic dentistry often involved tooth whitening or bleaching.  (refer to link)

Bleaching leads to a whiter smile and can remove stains or discoloration acquired from food, beverages and tobacco.

Enamel shaping is when your dentist recontours the shape of a tooth slightly.  This is usually combined with composites.

Orthodontics can straighten crooked tooth, close gaps and give you a stable beautiful smile.  Braces are not just for kids.  Invisilign can do this with transparent trays that can be removed for photos or just for eating.  It doesn’t even look like you are wearing anything on your teeth unless you look closely.  Orthodontics can take time but it can give you the cosmetic benefits without the need for restorations.  Straighten your teeth and keep them the way nature made them.

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