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By Eric Romano DDS
July 26, 2019
Category: Dental Procedures
Tags: dental implants   smoking  
DentalImplantsandSmoking-CauseforConcern

You probably already know that using tobacco causes significant health risks: It increases your odds of getting various cancers and coronary diseases, to name just a few. Unfortunately, not everyone is able to kick the habit, even when they know they should. Tooth loss is another issue that can cause trouble for your health, in the form of bone loss, malnutrition, and social or psychological problems. Dental implants are a great way to replace missing teeth — but does smoking complicate the process of getting implants?

The short answer is yes, smoking can make implant placement a bit riskier — but in the big picture, it doesn’t mean you can’t (or shouldn’t) have this procedure done if it’s needed.

Smoking, as you know, has harmful effects in your mouth (even leaving aside the risk of oral cancer). The hot gases can burn the oral cavity and damage salivary glands. Nicotine in smoke reduces blood flow to the soft tissues, which can affect the immune response and slow the processes of healing. At the same time, smoking promotes the growth of disease-causing oral bacteria.

How does this affect dental implants? Essentially, smoking creates a higher risk that implants may not heal properly after they are placed, and makes them more likely to fail over time. Studies have shown that smokers have an implant failure rate that’s twice as great as non-smokers. Does this mean that if you smoke, you shouldn't consider implants to replace missing or failing teeth?

Not necessarily. On the whole, implants are the most successful method of replacing missing teeth. In fact, the overall long-term survival rate of implants for both smokers and non-smokers is well over 90 percent — meaning that only a small percentage don’t work as they should. This is where it’s important to get the expert opinion of an implant specialist, who can help you decide whether implants are right for your particular situation.

If you do smoke, is there anything you can do to better your odds for having a successful dental implant? Yes: quit now! (Implants are a good excuse to start a smoking-cessation program.) But if you can’t, at least stop smoking for one week before and two weeks after implant placement. And if that is not possible, at least go on a smoking diet: restrict the number of cigarettes you smoke by 50% (we know you can at least do that!) Try to follow good oral hygiene practices at all times, and see your dentist regularly for checkups and cleanings.

If you have questions about smoking and dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine article “Strategies to Stop Smoking.”

26MillionFansLikeJustinBiebersChippedTooth

Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”

Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.

Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:

A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.

If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.

Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.

Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.

Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.

If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”

4AdvantagestoUsingCompositeResinsforRestoringTeeth

Restoring chipped, stained or decayed teeth with dental porcelain is a tried and true method that’s been used for decades. In recent years, though, restorations made with composite resin have become a popular alternative.

Made of a plastic-based matrix with added glass filler, composite resin can be molded and bonded to teeth to replace missing structure with color to match. While they can’t be used for every problem situation, they’re an efficient and economical way to transform your smile.

Here are 4 advantages for using composite resin to restore moderately defective teeth.

They require very little tooth preparation. Crowns, veneers and other porcelain restorations require removing some healthy tooth structure to accommodate them. With the development of stronger bonding materials, composite resins can restore even many large defects in teeth caused by decay or trauma with little structural removal and still remain durable.

Most composite resin restorations are “single-visit” procedures. Unlike porcelain restorations, applying composite resin doesn’t require a dental lab, a process that can take multiple visits. In most cases, a skilled dentist can apply them during a single visit.

They have excellent color matching capabilities. We usually think of teeth as one single shade of white — actually, a single tooth can have varying gradations of color from the root to the tip. As mentioned before, composite resins can be prepared to match those color shades precisely, so your restored teeth look natural and blend well with your other teeth.

Composite resins can be an effective temporary fix for young injured teeth. Because children’s teeth are still developing, permanent restorations for traumatized teeth aren’t usually advisable until they’ve fully matured. Composite resin can be used to restore a young tooth’s form and function until it’s ready for a permanent solution.

If you would like more information on restoring teeth with composite resin, 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 “Artistic Repair of Front Teeth with Composite Resin.”

SingerDuaLipaSeestheWisdominPostponingTourDates

When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.

“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”

The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”

A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.

It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.

So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!

If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”

By Eric Romano DDS
January 17, 2019
Category: Dental Procedures
Tags: teeth whitening  
StainsfromWithinaToothRequireProfessionalWhitening

Whether performed in a dental office or using a home kit, teeth whitening applications are quite effective for bleaching exterior (extrinsic) stains on enamel surfaces. But what if your discoloration comes from inside the tooth? In this case, extrinsic teeth whitening won’t work — you’ll need to undergo an “internal bleaching” method, which can only be performed in a dentist's office.

There are a number of causes for “intrinsic” staining, including too much fluoride exposure or tetracycline use during childhood. One of the more common causes, though, occurs from root canal treatments used to remove the remnants of the pulp tissue inside a tooth’s pulp chamber and root canals. Certain cements used during the procedure to help seal in the filling material and leftover blood pigments can cause the tooth to darken over time.

To alleviate this discoloration, we use a bleaching agent, usually sodium perborate mixed with a diluted solution of hydrogen peroxide to achieve a safe, accelerated color change. After determining that the root canal filling is still intact and the bone is healthy, we create a small cavity in the back of the tooth to access the pulp chamber. The chamber is cleaned of any debris or stained material and then thoroughly irrigated. The original root canal filling is then sealed off to prevent leakage from the bleaching agent.

We then place the bleaching agent in the cleaned-out space with a cotton pellet and seal it in with a temporary adhesive. This step is repeated for several days until we achieve the desired shade of white. Once that occurs we then seal the dentin with a more permanent filling and then restore the cavity we created with a composite resin bonded to the enamel and dentin.

If we’re successful in achieving the desired color, intrinsic whitening could help you avoid more costly options like veneers or crowns for an otherwise healthy and attractive tooth. The end result would be the same — a beautiful smile without those unsightly stains.

If you would like more information on treating internal tooth stains, 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 “Whitening Traumatized Teeth.”