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Posts for category: Dental Procedures

By Edward C. Smith, DMD, MPH, LLC
June 18, 2019
Category: Dental Procedures
Tags: cosmetic dentistry  
KnowtheKindofSmileYouWantBeforeCosmeticDentalTreatment

Before we discuss cosmetic options for transforming your smile, and before any preparations for treatment, there’s one question that needs to be answered: What do you want to be different about your smile?

There’s a common misconception that cosmetic changes to the teeth and gums — a “smile makeover” — is primarily a technical achievement based on rigid principles of beauty. Patients believe they must defer to their dentists for what will look best. But that’s not the entire picture: what’s often lost in the understanding is that it’s your smile — the smile at the end of the process you must be comfortable showing with confidence.

In this regard, there are two types of patients, with no right or wrong view — simply what a patient perceives as the smile they want. Some want the “perfect” smile — the greatest level of regularity between teeth shape, size and alignment and the maximum level of brightness. Others are more comfortable with a “natural” smile, a more subtle look with just enough change to create something new and different. The latter may even desire a less than perfect look that doesn’t “fix” all their imperfections — the ones they believe give their face “character.”

Knowing to which side you lean is important at the outset. It’s then important for you to communicate those expectations with us. While we’re focused on the technical aspects of treatment — tooth length, the lineup of teeth with other facial features or the gum-to-lip distance — only you can express what’s going to be a beautiful yet comfortable smile for you. By meshing the technical requirements with your personal desires, we’re able to formulate a makeover plan that fits you.

It all begins with a comprehensive examination to determine the exact health state of your mouth, and it may be necessary to first perform dental work to improve it. From there we can discuss what is and isn’t possible to change the appearance of your teeth and gums. In the end, we want the same result as you — a beautiful smile you’re happy and confident to show the world.

If you would like more information on smile makeovers, 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 “Great Expectations: Is what you get what you want?

By Edward C. Smith, DMD, MPH, LLC
May 09, 2019
Category: Dental Procedures
Tags: dental implants  
GettingDentalImplantsRequiresMinorSurgery

Dental implants are best known as restorations for single missing teeth. But there’s more to them than that—they can also be used to support and secure removable dentures or fixed bridges.

That’s because a dental implant is actually a root replacement. A threaded titanium post is inserted directly into the jawbone where, over time, bone cells grow and adhere to it. This accumulated bone growth gives the implant its signature durability and contributes to its long-term success rate (95%-plus after ten years). It can support a single attached crown, or serve as an attachment point for a dental bridge or a connector for a removable denture.

The method and design of implants differentiates it from other restoration options. And there’s one other difference—implants require a minor surgical procedure to insert them into the jawbone.

While this might give you pause, implant surgery is no more complicated than a surgical tooth extraction. In most cases we can perform the procedure using local anesthesia (you’ll be awake the entire time) coupled with sedatives (if you have bouts of anxiety) to help you relax.

We first access the bone through small incisions in the gums and then create a small channel or hole in it. A surgical guide that fits over the teeth may be used to help pinpoint the exact location for the implant.

We then use a drilling sequence to progressively increase the size of the channel until it matches the implant size and shape. We’re then ready to insert the implant, which we remove at this time from its sterile packaging. We may then take a few x-rays to ensure the implant is in the right position, followed by closing the gums with sutures.

There may be a little discomfort for that day, but most patients can manage it with over-the-counter pain relievers like aspirin or ibuprofen. It’s what goes on over the next few weeks that’s of prime importance as the bone grows and adheres to the implant. Once they’re fully integrated, we’re ready to move to the next step of affixing your crown, bridge or denture to gain what you’ve waited so long for—your new implant-supported smile.

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 “Dental Implant Surgery: What to Expect Before, During and After.”

By Edward C. Smith, DMD, MPH, LLC
March 30, 2019
Category: Dental Procedures
Tags: bridge   partial denture  
ATeensMissingToothMayRequireaTemporaryReplacement

Besides reduced biting and chewing function, a missing tooth can cause an embarrassing inhibition to healthy social interaction. This can be especially so for teens who greatly value peer relationships and acceptance.

Be that as it may, we typically discourage a permanent replacement for teens with a missing tooth, particularly dental implants. While we value a patient’s psychological needs, the long-term effect on dental health may be too great to advise otherwise.

The effect we’re concerned with involves jaw growth and development. Although a person’s permanent teeth have usually all erupted by early adolescence, the jaws continue to grow until the late teens or early twenties. Natural teeth can adapt to this growth because the periodontal ligament that holds them in place allows for incremental tooth movement. The teeth move in response to jaw growth and are thus able to maintain their proper relationship and alignment in the jaw as growth occurs.

Dental implants, on the other hand, are imbedded into the jaw bone: they, therefore, can’t move like natural teeth and thus can’t adjust their position with jaw growth, particularly the upper jaw as it grows forward and down. This can result in the implants appearing as though they are left behind or retreat into the jaw. It can also affect the position of the gums and inhibit their growth around the implants.

It’s best then to hold off implants and other permanent restorations until the jaw has finished developing. That, however, isn’t always easy to determine: specialized x-ray diagnostics may help, but it’s not an exact science. Your input as a parent will also be helpful, such as whether you’ve noticed the end of growth spurts (not changing clothes or shoe sizes as often) or your child’s recent similarity in appearance to other adult members of your family. It thus becomes a judgment call, based on examination and experience, as to whether it’s safe to proceed with implants — and may require erring on the side of caution.

In the meantime, there are temporary restorations that can improve appearance while you wait for the appropriate time to undertake a permanent restoration. Two of the most useful are removable partial dentures (RPDs) or a bonded bridge, a less invasive form of the traditional bridge. With a proper assessment we can advise you on which option is your best choice.

If you would like more information on tooth restorations for teenagers, 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 “Teenagers & Dental Implants.”

By Edward C. Smith, DMD, MPH, LLC
March 10, 2019
Category: Dental Procedures
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 Edward C. Smith, DMD, MPH, LLC
February 08, 2019
Category: Dental Procedures
FAQsKeepingYourMouthHealthyAfterGumDiseaseTreatment

Surgical treatment for periodontal (gum) disease can go a long way toward restoring your mouth to good health; however, it does not change your susceptibility to the disease. That’s why we recommend that you come in regularly for periodontal cleanings after your treatment. Here are some frequently asked questions about keeping your mouth healthy after gum disease treatment.

How often do I have to come in for periodontal cleanings?
There’s no “one-size-fits-all” answer to that question: It really depends on your individual situation. For example, some individuals may have a more aggressive form of periodontal disease that requires more frequent periodontal maintenance (PM) treatments to maintain control. Others may have greater success controlling the buildup of disease-causing plaque with at-home oral hygiene measures, and therefore need PM less often. However, for people with a history of periodontal disease, getting PM treatments at a three-month interval may be a good starting point.

What happens at a periodontal maintenance appointment?
A thorough cleaning of the crown and root surfaces of the teeth, aimed at removing sticky plaque and hardened dental calculus (tartar), is a big part of PM treatments — but there’s much more. You’ll also receive a thorough clinical examination (including oral cancer screening), a review of your medical history, and x-rays or other diagnostic tests if needed. The status of any ongoing periodontal disease will be carefully monitored, as will your success at maintaining good oral hygiene. Decisions about further treatment will be based on the results of this examination.

What else can I do to keep gum disease at bay?
Keeping your oral hygiene in top-notch condition — which includes effective brushing and flossing every day — can go a long way toward controlling gum disease.  In addition, you can reduce risk factors by quitting tobacco use and eating a more balanced diet. And since inflammatory conditions like diabetes, arthritis and cardiovascular disease can make periodontal disease worse (and vice versa), keeping these conditions under control will greatly benefit both your oral health and your overall health.

If you have additional questions about maintaining oral health after gum disease treatment, contact us or schedule an appointment.