While we often associate tooth decay with cavities forming in a tooth’s visible or biting surfaces, the occurrence of this all too common disease isn’t limited to those areas. Cavities can develop in any part of a tooth exposed to bacteria.
Gum recession, the shrinking back of the gums from the teeth, can cause such exposure in areas normally covered by the gums. Because these areas are usually more vulnerable to infection when exposed, cavities can develop at or right below the gum line. Because of their location it can be difficult to fill them or perform other treatments.
One way to make it less difficult is to perform a crown lengthening procedure. While the term sounds like we’re increasing the size of the tooth, we’re actually surgically altering the gums to access more of the affected tooth surface for treatment. It’s typically performed in a dental office with local anesthesia by a general dentist or a periodontist, a specialist in the gums.
During the procedure, the dentist starts by making small incisions in the gums to create a tissue “flap” that can be lifted out of the way. This exposes the underlying bone, which they then reshape to support the gum tissue once it’s re-situated in its new position. The dentist then sutures the gums back in place. Once the gums heal, the decayed area is ready for treatment.
Crown lengthening is also useful for other situations besides treating cavities. If a tooth has broken off at the gum line, for example, there may not be enough remaining structure to support a crown. Crown lengthening can make more of the underlying tooth available for the crown to “grab” onto. It’s also useful in some cases of “gummy smiles,” in which too much of the gum tissue is visible in proportion to the tooth size.
Because crown lengthening often involves removing some of the bone and is thus irreversible, you should discuss this procedure with your dentist in depth beforehand. It could be, though, this minor procedure might make it easier to preserve your teeth and even make them look more attractive.
Your teen is about to embark on an orthodontic journey to a straighter, more attractive smile. But although you're excited about the outcome, you both may be steeling yourselves for a few years of "life with braces."
But maybe not—your teen may be able to take advantage of a different kind of corrective appliance: clear aligners. This 21st Century teeth movement method has a number of advantages over braces. For teens, though, there's one big one that could have a huge impact on their social life—clear aligners are nearly invisible to other people.
Clear aligners consist of a series of clear, removable, computer-generated trays based on photographs, models and x-rays of an individual patient's teeth and bite. Each of the trays is slightly different from the previous one in the series, and by wearing each one for about two weeks before moving on to the next, the aligners gradually move the teeth to the desired new positions.
Besides reducing embarrassment often associated with wearing metal braces, clear aligners have other benefits. Unlike braces, they can be removed for eating, easier oral hygiene or for rare special occasions (although for best effectiveness, they should be worn for 20 to 22 hours each day). Recent developments like added elements that help target certain teeth for movement or "power ridges" for more controlled and efficient force have increased the range of bite problems they can be used to correct.
While this means clear aligners can be used for many bite problems, in some severe cases braces and other orthodontic treatments might still be necessary. And because they're not fixed like braces (only the orthodontist can remove them) the patient must have the maturity and self-discipline to wear them consistently.
Your teen will need to undergo a thorough orthodontic examination to see if clear aligners are a viable option for them. If so, it could make the next few treatment years less stressful for both of you.
If you would like more information on clear aligners, 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 “Clear Aligners for Teens: User-Friendly Orthodontics.”
If you’re facing cancer treatment, we wish you the best outcome possible. Treating this disease has advanced tremendously in recent decades, but the available options are still often challenging to endure. It will be your primary focus for the foreseeable future.
As a dental provider we also want you to be aware how the two main treatments, chemotherapy and radiation, could adversely affect your teeth and gums, especially if you’re receiving radiation therapy near the head and neck. The aim of cancer treatment is to attack and destroy cancer cells to prevent their growth. Unfortunately, it can also destroy neighboring healthy cells and lead to harmful consequences in different parts of the body, including the mouth.
Salivary glands, for example, are especially vulnerable to damage during cancer treatment. This could create a situation where the mouth no longer produces adequate saliva flow, leading to a condition called xerostomia or dry mouth. Besides a lot of discomfort, restricted saliva flow can also increase your risk of tooth decay and other dental diseases. This is because saliva is the body’s acid neutralizer (acid can erode tooth enamel) and its first line of defense against microbial infection.
To guard against this, it’s important to support salivary flow as much as possible if you experience dry mouth symptoms during treatment (as well as beyond—it’s possible the damage to these glands could be permanent). Since some medications also contribute to dry mouth, you should speak with your physician about the prescriptions you’re taking: if any have dry mouth side effects ask if there’s an alternative drug without these side effects. You should also drink more water during the day and especially when taking medications. And consider substances like xylitol gum that can help boost saliva flow.
Unfortunately, it may not be possible to fully avoid the effects of these treatments on your teeth and gums. So, be sure you keep up daily brushing and flossing and see your dentist regularly for cleanings and checkups. If necessary, there are a number of restoration options to restore your smile after you’ve completed your treatment.
Have you started orthodontic treatment recently? Are you having a little trouble getting used to your braces? If so, you are not alone: Everybody goes through an adjustment period during which they momentarily wonder if they’ll really ever get used to this. Don’t worry — you will! And we’ve never heard anyone say, on the day their braces come off and their new smile is revealed, that they aren’t glad they went the distance. Just ask Houston Rockets all-star center Dwight Howard, who discussed his own orthodontic treatment in a recent interview.
“I’m sure I was no different than anyone else who has ever had braces,” he told Mediaplanet. “At first I hated them so much… That changed once I got used to them and I actually grew to love them.” What’s Howard’s advice? “Do exactly what your orthodontist says and know that the outcome is well worth it in the end.” We couldn’t agree more! Here are some tips for wearing braces comfortably:
Our goal is to make your orthodontic treatment as comfortable as possible on the way to achieving your all-star smile. If you have questions about adjusting to braces, contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Caring for Teeth During Orthodontic Treatment.”
There’s only one way to effectively halt the progressive damage of periodontal (gum) disease — completely remove the bacterial plaque and hardened deposits (calculus) from above and below the gum line that are causing the infection. Although we can accomplish this in most cases with hand instruments called scalers, ultra-sonic equipment or both, some cases may require periodontal surgery to access and clean deeper “pockets” of infection.
As this damaging disease progresses, the supporting bone dissolves and the gum tissues will begin to detach from a tooth, leaving an open space known as a “periodontal pocket.” Besides plaque and calculus pus may also form as a result of the infection. All of this material must be removed from the pocket before healing and, hopefully, tissue reattachment can begin.
Shallow pockets near the gum line are usually accessed and cleaned with hand instruments. But deeper pockets (5 millimeters or greater in depth) may require a surgical procedure to completely clean the area also allowing for regenerative procedures to be done to regain attachment. This will reduce the depth of the periodontal pockets that will make them more accessible for future cleanings and maintenance. Flap surgery is a common type of such a procedure: a small opening (similar to the flap of a letter envelope) is surgically created in the gum tissue to expose the area of infection around the tooth root and bone.
There are also other types of periodontal surgery for repairing and stimulating regeneration of damaged gum tissues. Using grafts or other enhancements, these plastic surgical techniques are especially useful where gum tissues have receded above the natural gum line, leaving more of the underlying tooth below the enamel exposed to disease. These procedures have become more effective in recent years with the development of specialized technologies called “barrier membranes” and biologic growth factors. These materials have allowed bone grafts to be more successful as this technology is engineered for targeted tissue growth and repair, and then dissolve at an appropriate point in the regeneration process.
Periodontal surgery isn’t appropriate for every situation. Still, these procedures do play an important role for many patients to put a halt to the damage caused by gum disease.
If you would like more information on surgical procedures for gum disease, 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 “Periodontal Surgery: Where Art Meets Science.”
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