By Brock Orthodontics
November 24, 2021
Category: Oral Health
Tags: tooth decay  
TheresMoreWeCanDoAboutToothDecayBesidesDrillandFill

Until recently, the standard treatment for tooth decay remained essentially the same for nearly a century: Remove any decayed structure, then prepare and fill the cavity. But that singular protocol has begun to change recently.

Although "drilling and filling" saves teeth, it doesn't fully address the causes of decay. In response, dentists have broadened their approach to the disease—the focus now is on an individual patient's particular set of risk factors for decay and how to reduce those.

At the heart of this new approach is a better understanding of oral bacteria, the true cause of decay. Bacteria produce acid, which can erode tooth enamel and create a gateway into the tooth for decay to advance. We therefore want to lower those risk factors that may lead to bacterial growth and elevated acidity.

One of our major objectives in this newer approach is to reduce plaque, a thin film of food particles used by bacteria for food and habitation. Removing plaque, principally through better oral hygiene, in turn reduces decay-causing bacteria.

Plaque isn't the only mechanism for bacterial growth and acidity. Appliances like dentures or retainers accumulate bacteria if not regularly cleaned. Reduced saliva flow, often due to certain medications or smoking, limits this fluid's ability to buffer acid and acid reflux or acidic beverages like sodas, sports or energy drinks can disrupt the mouth's normal pH and increase the risk for enamel erosion.

Our aim, then, is to develop a long-term strategy based on the patient's individual set of oral disease risk factors. To determine those, we'll need to examine their medical history (including family), current health status and lifestyle habits. From there, we can create a specific plan targeting the identified risk factors for decay.

Some of the elements of such a strategy might include:

  • Daily brushing and flossing, along with regular dental cleanings;
  • Fluoride dental products or treatments to strengthen enamel;
  • Changes in diet and excess snacking, and ceasing from any tobacco use;
  • Cleaning and maintaining appliances, as well as monitoring past dental work.

Improving the mouth environment by limiting the presence of oral bacteria and acid can reduce the occurrence of tooth decay and the extent of treatment that might be needed. It's a more nuanced approach that can improve dental health.

If you would like more information on tooth decay prevention and treatment, 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 “Tooth Decay: How to Assess Your Risk.”

AddressingTheseFactorsHelpsEnsureaSatisfyingExperienceWithImplants

Patients and dentists alike love dental implants. For one, they're unique among other dental restorations because they replace the tooth root as well as the visible crown. It's actually their role as a root replacement that makes them so durable and lifelike.

But it still falls to the dentist to create as natural an appearance as possible through proper implant placement. It requires extensive technical skill and artistry to surgically place an implant in the precise location inside the jawbone to gain the best outcome. It's even more critical when the tooth is a highly visible one within the "smile zone"—the teeth others see when we smile.

With a patient's smile appearance on the line, it's important that we carefully consider a number of factors that can impact implant success and address them as needed in our treatment plan.

The gums. The gums are to the teeth as a frame is to a masterpiece painting. If the gums don't correctly cover the new implant, the final outcome won't look natural. Positioning the implant precisely helps ensure the gums look attractive. It may also be necessary to augment the gums, such as grafting surgery to encourage growth of lost gum tissue, to achieve the most lifelike result.

The socket. For simple extractions (as opposed to surgical removals), a dentist deftly manipulates the ligament holding the tooth in place to loosen and remove it. It's important to do this carefully—if the tooth's bony socket becomes damaged in the process (or because of other trauma), it can complicate implant placement in the future.

The supporting bone. Likewise, the bone in which the implant is imbedded must be reasonably healthy and of adequate volume. Besides not providing enough support, inadequate bone also makes it difficult to place an implant for the most attractive result. Bone grafting at the time of extraction minimizes bone shrinkage. If bone shrinkage had occurred, the Inadequate bone may require grafting, particularly if there is a lag time between extraction and implantation. In extreme cases, though, a patient may need to choose a different restoration.

The usual process for implants—planning, surgical placement and the healing period after surgery—can take time. Paying attention to these and other factors will help ensure that time and the effort put into this process has a satisfying outcome—an attractive, natural and long lasting 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 “Immediate Dental Implants.”

LoveandHipHopHostsNo-GapSmileandHowYouCanHaveOneToo

Nina Parker, the host of Love & Hip Hop for six seasons, is now busy with the new game show Blockbusters and her own talk show The Nina Parker Show. But even with a full plate, she took time recently for some personal care—getting a new smile.

Parker's fans are familiar with her noticeable tooth gap. But a video on TikTok in February changed all that: In the video, she teasingly pulls away a mask she's wearing to reveal her smile—without the gap.

Parker and other celebrities like Madonna, Michael Strahan and David Letterman are not alone. Teeth gaps are a common smile feature, dating back millennia (even in fiction: Chaucer described the Wife of Bath as being "gap-toothed" in The Canterbury Tales).

So, what causes a tooth gap? Actually, a lot of possibilities. The muscle between the teeth (the frenum) may be overly large and pushing the teeth apart. There may be too much room on the jaw, so the teeth spread apart as they develop. It might also have resulted from tongue thrusting or late thumb sucking as a child, influencing the front teeth to develop forward and outward.

A tooth gap can be embarrassing because they're often front and center for all the world to see, but they can also cause oral health problems like complicating oral hygiene and increasing your risk for tooth decay. They can also contribute to misalignment of other teeth.

Fortunately, there are ways to alleviate a gap. One way is to move the teeth closer together with either braces or removable clear aligners. This may be the best approach if the gap is wide and it's contributing to misalignment of other teeth. You may also need surgery to alter the frenum.

You can also reduce less-pronounced gaps cosmetically with dental bonding or porcelain veneers. Bonding involves applying a type of resin material to the teeth on either side of the gap. After some sculpting to make it appear life-like, we harden the material with a curing light. The result is a durable, tooth-like appearance that closes the gap.

A veneer is a thin wafer of porcelain, custom-made to fit an individual patient's tooth. Bonded to the front of teeth, veneers mask various dental flaws like chips, deformed teeth, heavy staining and, yes, mild to moderate tooth gaps. They do require removing a small amount of enamel on the teeth they cover, but the results can be stunning—completely transformed teeth without the gap.

Getting rid of a tooth gap can be a wise move, both for your smile and your health. You may or may not take to social media to show it off like Nina Parker, but you can feel confident to show the world your new, perfect smile.

If you would like more information about treating teeth gaps and other dental flaws, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Space Between Front Teeth.”

YourDecayedToothMightNeedaDifferentKindofRootCanalTreatment

Advanced decay doesn't necessarily mean it's curtains for an infected tooth. Millions of teeth in that condition have been saved by a tried and true procedure called root canal therapy.

Although they may vary according to the complexity of a case, all root canal procedures share some similarities. After numbing the tooth and gum areas with local anesthesia, the procedure begins with a small hole drilled into the tooth to access the infected pulp and root canals, tiny passageways inside the root.

The dentist then uses special instruments to clear out infected tissue from the pulp and canals, followed by thoroughly sanitizing the resulting empty spaces. This is followed with filling the pulp chamber and root canals with a rubber-like substance (gutta percha) to seal the interior of the tooth from further infection. Later, the dentist typically crowns the tooth for further protection and support.

Root canals have become the standard treatment for teeth with advanced decay. There are, however, some circumstances where performing a root canal isn't a good idea. For example, a previously root-canaled tooth with a crown and supporting post. A dentist would need to fully disassemble the restoration to gain access into the tooth, which could significantly weaken it.

But there may be another option if a standard root canal is out of the picture: a surgical procedure performed by an endodontist (a specialist in interior tooth treatment) called an apicoectomy. Instead of drilling through the tooth crown, the endodontist accesses the tooth root through the adjacent gum tissue.

Like a traditional root canal, the procedure begins by anesthetizing the tooth and surrounding gums. The endodontist then makes a small incision through the gums to expose the diseased tissues at the tooth's root. After removing the infected tissue and a few millimeters of the root tip, they place a small filling to seal the end of the root canal against infection and suture the gum incision.

This is a specialized procedure that requires the state-of-the-art equipment and advanced techniques of an endodontist. But it does provide another possible option for saving a diseased tooth that might otherwise be lost.

If you would like more information on treatments for tooth decay, 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 “Apicoectomy: A surgical Option When Root Canal Treatment Fails.”

By Brock Orthodontics
October 15, 2021
Category: Oral Health
Tags: loose tooth  
YouNeedtoActFasttoSaveaLooseTooth

Some things in life are almost guaranteed to make you go, "Uh, oh"—your car won't start, your a/c goes out, or, worse yet, you get an unexpected letter from the IRS.

Here's another: One of your teeth is loose. And, if you don't act quickly, that loose tooth may soon become a lost tooth.

But first, we need to find out why it's loose. It's usually due to one of two types of injury related to your bite. One type is called primary occlusal trauma. This results from your teeth encountering higher than normal biting forces. This often happens if you habitually gnash or grind your teeth together outside of normal functions like eating or speaking.

The other type is secondary occlusal trauma. In this case, the supporting gum tissues and bone have been weakened or lost by disease, with the gum tissues possibly becoming detached. Without this support, even normal biting forces could loosen a tooth.

Our treatment approach for a loose tooth may differ depending on which of these is the cause. For primary occlusal trauma, we want to reduce the biting forces that have contributed to loosening the tooth. One way to do this is to create a mouthguard that when worn prevents teeth from making solid contact during grinding episodes.

For secondary trauma, we want to first focus on treating any gum disease responsible for weakening the gum tissues. Once we have it under control, the gums and bone tissues can heal and possibly regain and strengthen their attachment with the tooth.

At the same time, we may also need to stabilize a loose tooth to prevent its loss. This usually involves splinting, whereby we use neighboring healthy teeth to support the loose tooth. One way to do this is to attach a metal strip across the backs of the loose tooth and its more stable neighbors, or by way of a channel cut through the top biting surfaces of the teeth.

If a loose tooth regains its attachment with the gums and bone, it may stabilize and any splinting can be removed. If not, splinting may become a permanent solution. Either way, prompt treatment can help us save your loose tooth.

If you would like more information on treating loose 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 “Loose Teeth: Biting Forces Can Loosen Teeth.”





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