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PreservingthePulpisPriorityOnewithaNewlyEruptedPermanentTooth

The change from primary teeth to permanent is an announcement to the world that a boy or girl is "growing up." "Growing up," though, is still not "grown"—the new teeth are still in a period of development that can affect how we treat them if they're injured or diseased.

While a new tooth erupts with all its anatomical layers, the middle dentin is somewhat thinner than it will be after it matures. The pulp, the tooth's innermost layer, produces new dentin and gradually increases the dentin layer during this early development period. While the pulp continues to produce dentin over a tooth's lifetime, most of it occurs in these early years.

To prevent or stop any infection, we would normally perform a root canal treatment in which we remove the pulp tissue and fill the empty pulp chamber and root canals. This poses no real issue in an older tooth with mature dentin. Removing the pulp from an immature tooth, though, could interrupt dentin development and interfere with the tooth's root growth. Besides a higher risk of discoloration, the tooth could become more brittle and prone to fracture.

That's why we place a high priority on preserving a younger tooth's pulp. Rather than a root canal treatment, we may treat it instead with one of a number of modified techniques that interact less with the pulp. Which of these we use will depend on the extent of the pulp's involvement with the injury or disease.

If it's unexposed, we may use a procedure called indirect pulp therapy, where we remove most of the tooth's damaged dentin but leave some of the harder portion intact next to the pulp to avoid exposure. If, though, some but not all of the pulp is damaged, we may perform a pulpotomy: here we remove the damaged pulp tissue while leaving the healthier portion intact. We may then apply a stimulant substance to encourage more dentin production to seal the exposure.

These and other techniques can help repair an injured young tooth while preserving most or all of its vital pulp. Although we can't always use them, when we can they could give the tooth its best chance for a full life.

If you would like more information on caring for your child's 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 “Saving New Permanent Teeth after Injury.”

By Robert D. Ory, D.D.S.
May 18, 2019
Category: Oral Health
Tags: tooth wear  
3ThingsYoucandotoSlowToothWear

Unlike our primitive ancestors, our teeth have it relatively easy. Human diets today are much more refined than their counterparts from thousands of years ago. Ancient teeth recovered from those bygone eras bear that out, showing much more wear on average than modern teeth.

Even so, our modern teeth still wear as we age—sometimes at an accelerated rate. But while you can't eliminate wearing entirely, you can take steps to minimize it and preserve your teeth in your later years. Here are 3 things you can do to slow your teeth's wearing process.

Prevent dental disease. Healthy teeth endure quite well even while being subjected to daily biting forces produced when we eat. But teeth weakened by tooth decay are more susceptible to wear. To avoid this, you should practice daily brushing and flossing to remove disease-causing dental plaque. And see your dentist at least twice a year for more thorough dental cleanings and checkups.

Straighten your bite. A poor bite, where the top and bottom teeth don't fit together properly, isn't just an appearance problem—it could also cause accelerated tooth wear. Having your bite orthodontically corrected not only gives you a new smile, it can also reduce abnormal biting forces that are contributing to wear. And don't let age stop you: except in cases of bone deterioration or other severe dental problems, older adults whose gums are healthy can undergo orthodontics and achieve healthy results.

Seek help for bruxism. The term bruxism refers to any involuntary habit of grinding teeth, which can produce abnormally high biting forces. Over time this can increase tooth wear or weaken teeth to the point of fracture or other severe damage. While bruxism is uncommon in adults, it's still a habit that needs to be addressed if it occurs. The usual culprit is high stress, which can be better managed through therapy or biofeedback. Your dentist can also fashion you a custom guard to wear that will prevent upper and lower teeth from wearing against each other.

If you would like more information on minimizing teeth wear, 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 “How and Why Teeth Wear.”

By Robert D. Ory, D.D.S.
May 13, 2019
Category: Dental Procedures
Tags: dental implants   dentures  
DentureswithImplantsCouldHelpYouAvoidBoneLoss

Even with modern prevention and treatment advances, losing teeth in later life is still a sad but common part of human experience. Just as generations have before, many today rely on dentures to regain their lost dental function and smile.

But although effective, dentures have their weaknesses. The most serious: they can't prevent jawbone deterioration, a common problem associated with tooth loss.

Bone health depends on chewing forces applied to the teeth to stimulate replacement growth for older bone cells. When teeth are gone, so is this stimulation. Dentures can't replicate the stimulus and may even accelerate bone loss because they can irritate the bone under the gums as they rest upon them for support.

But there's a recent advance in denture technology that may help slow or even stop potential bone loss. The advance incorporates implants with dentures to create two hybrid alternatives that may be more secure and healthier for the supporting bone.

The first is known as an overdenture, a removable appliance similar to a traditional denture. But instead of deriving its support from the gums alone, the overdenture attaches to three to four implants (or only two, if on the lower jaw) that have been permanently set into the jawbone. This not only increases stability, but the implants made of bone-friendly titanium attract and foster increased bone growth around them. This can help slow or even stop the cycle of bone loss with missing teeth.

The second type is a fixed denture. In this version, four to six implants are implanted around the jaw arch. The denture is then secured in place to these implants with screws. It's a little more secure than the overdenture, but it's also more expensive and requires good quality bone at the implant sites.

If you've already experienced significant bone loss you may first need bone grafting to build up the implant sites for these options, or choose traditional dentures instead. But if you're a good candidate for an implant-supported denture, you may find it provides better support and less risk of continuing bone loss than traditional dentures.

If you would like more information on implant-supported dental restorations, 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 “Overdentures & Fixed Dentures.”

By Robert D. Ory, D.D.S.
May 08, 2019
Category: Dental Procedures
Tags: tooth decay  
YourSinusInfectionMightbeaSignofaToothProblem

Each year thousands of people develop sinus infections from various causes. But there's one cause for sinusitis that might surprise you—tooth decay.

Tooth decay begins when the acid produced by oral bacteria erodes a tooth's enamel protection to create a small hole or cavity. Left untreated, the infection can move into the inner pulp of the tooth and tiny passageways leading to the roots called root canals. The decay can then infect and break down the structure of the supporting jawbone.

This could affect the sinus cavities, hollow air-filled spaces in the upper portion of the face. The maxillary sinus in particular sits behind the cheek bones just above the upper jaw. Tooth roots, particularly in back teeth, can extend quite near or even poke through the floor of the maxillary sinus.

If decay affects these roots, the bone beneath this floor may begin to break down and allow the bacterial infection to enter the sinus. We call this particular kind of sinus infection maxillary sinusitis of endodontic origin (MSEO), "endodontic" referring to the interior structure of teeth.

While advanced decay can show symptoms like pain or sensitivity with certain hot or cold foods, it's also possible to have it and not know it directly. But a recurring sinus infection could be an indirect indication that the root of your suffering is a deeply decayed tooth. Treating the sinus infection with antibiotics won't cure this underlying dental problem. For that you'll need to see a dentist or an endodontist, a specialist for interior tooth issues.

The most common way to treat deep tooth decay is with root canal therapy. In this procedure, the dentist enters the decayed tooth's pulp (nerve chamber) and root canals and removes the diseased tissue. They will then fill the empty pulp and root canals with a special filling and seal the tooth to prevent future infection. The procedure stops the infection and saves the tooth—and if you have MSEO, it eliminates the cause of the sinus infection.

So, if you're suffering from chronic sinus infections, you might talk with your dentist about the possibility of a tooth infection. A thorough examination might reveal a decayed tooth in need of treatment.

If you would like more information on how dental problems can affect your overall health, please contact us or schedule an appointment for a consultation.

ADetailedSmileAnalysisSetstheStageforaSuccessfulMakeover

Cosmetic dentists routinely perform smile transformations once thought impossible. Using the latest materials and techniques, today's practitioners can "make over" the most problematic smiles.

But to achieve these results, it's necessary for both dentist and patient to step back and absorb the "bigger picture." If you're considering a smile makeover, your first step on this transformative journey will be this big picture moment called a smile analysis.

A smile analysis is a comprehensive examination in which your dentist looks at every aspect of your current smile. And not just your teeth and gums—he or she will also carefully evaluate the health of the supporting bone of the jaw. Healthy bone is necessary in particular for dental implants, which require adequate bone for optimum placement. Extensive bone loss could rule out implants, or at least postpone their installation until the bone can be rejuvenated through bone grafting.

The analysis doesn't stop with mouth structures, either: an attractive smile must achieve an aesthetic balance with the shape and complexion of the face, especially the color and position of the eyes and the form and posture of the lips. Your dentist will measure and assess all of these facial features and factor them into your individual smile makeover plan. This increases the likelihood your planned restorations will blend seamlessly with your overall appearance.

Your smile analysis will also include what's going on beneath the surface of your current smile. Many appearance problems are actually the consequences of disease, trauma or inherited conditions. These underlying issues will often need to be addressed first: as with renovating a house, it does little good to paint and hang wall paper if the foundation is faulty. Any treatment for disease or trauma may postpone cosmetic work, but it's absolutely necessary to achieve lasting success for your smile makeover.

Although time-consuming, a smile analysis sets the stage for a successful smile transformation. Your new beautiful smile will be well worth this detailed examination.

If you would like more information on undergoing a smile makeover, 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 “Beautiful Smiles by Design.”





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