A crown — a life-like “cap” made of dental porcelain that permanently covers an existing tooth — is an effective way to restore a still-viable decayed or broken tooth’s appearance. Properly fitting the crown over the tooth requires some healthy tooth structure above the gum line.
But what if the tooth has broken down to the gum line? In this case, we would need to perform a common procedure known as crown lengthening to expose more of the tooth.
Crown lengthening is a minor surgical procedure performed with local anesthesia to numb the tooth, surrounding gum tissues and supporting bone. We first make tiny incisions inside the gum-line on both the cheek and tongue side of the tooth to expose the bone, and then carefully remove a small amount of bone from either side of the tooth; this will expose or “lengthen” the tooth. Once finished, we suture the gum tissue back into place with self-dissolving sutures against the bone and tooth.
Most procedures take only sixty to ninety minutes, and the mild discomfort afterward is usually managed with pain relievers like ibuprofen. While the gum tissues may appear to be healed after a week, we typically wait six to eight weeks to perform the final crown restoration to give the tissues time to fully mature.
Crown lengthening may not work in all situations, especially with a severely fractured tooth. In these cases, we may need to evaluate the long-term viability of the tooth and consider other restorative options. Depending on your bite, it may also be necessary to treat with orthodontics first: not only will the tooth move into a better position, but the treatment may move both the gum and bone down with the tooth. Subsequent crown lengthening will then only affect the intended tooth and not adjacent ones, resulting in a more even smile.
The first step is for us to decide after a thorough examination if you would benefit from crown lengthening. If so, this minor surgical procedure could pave the way for better mouth function and a more attractive smile.
While tooth decay is a potential problem at any age, the risk increases as you grow older. Not only are senior adults more susceptible, decay is often more difficult to treat. That’s because cavities can occur at or below the gum line, often due to gum recession.
If that’s the case, we won’t be able to fill the cavity in the usual way because the gum tissue is in the way. To make it possible to treat, we may need to perform a minor surgical procedure known as crown lengthening.
As the name implies, the procedure helps expose more of the crown, the tooth’s visible part, from the surrounding gum tissue. In basic terms, we’re repositioning the gum tissue away from the biting surface of a tooth to make room for a filling. It’s also useful for improving a tooth’s appearance by making it look longer, or creating room for a crown or other dental restoration.
After applying a local anesthesia, the dentist (or periodontist, a specialist in the gums) creates a tiny flap of gum tissue with a series of incisions. This allows the dentist to move the affected gums out of the way to access the underlying bone. The dentist then reshapes the bone to adequately support the gum tissue when it’s finally repositioned to expose the crown. In its new and improved position, the dentist sutures the gum tissue in place.
For a few days afterward, the patient will need to restrict their diet to soft foods, avoid strenuous activities and apply an ice pack to help reduce swelling the day of surgery. They will also prescribe a pain reliever and possibly an antibiotic to reduce the chances of infection.
While most people return to normal activities a few days later, you’ll usually have to wait a few weeks for the gums to heal before undergoing any further treatments for the affected teeth. But even with the wait, crown lengthening could make it possible to not only save your tooth but improve your smile as well.
If you would like more information on treating 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 “Crown Lengthening: This Common Surgical Procedure Restores Function and Improves Appearance.”
Now that we’re into the New Year, it’s a good time to look over your list of resolutions. Did you remember to include dental health on your list? Here’s one simple resolution that can help keep your smile bright and healthy through the New Year and beyond: Floss every day!
Your oral hygiene routine at home is your first line of defense against tooth decay and gum disease. While brushing your teeth twice a day effectively removes much of the food debris and dental plaque from your teeth, brushing alone is not sufficient to remove all the plaque that forms on your teeth and around your gums. For optimal oral health, flossing once a day is also necessary.
Which teeth do you need to floss? Any dentist will tell you, “Only the ones you want to keep!” And yet according to a national survey of over 9,000 U.S. adults age 30 and older, nearly 70% don’t floss every day, and nearly one third admit that they don’t floss their teeth at all. Unfortunately, if you don’t floss, you’ll miss cleaning about a third of your tooth surfaces. When plaque is not removed, this sticky film of bacteria releases acids that cause cavities and gum disease. With dental floss, however, you can clean between the teeth and around the gums where a toothbrush can’t reach.
Flossing is an essential component of good oral hygiene. Still, daily flossing seems to be a harder habit to get into than brushing. Some people tense up their cheek muscles while flossing, making it harder to comfortably reach the back teeth, so remember to relax as you floss. If unwaxed floss doesn’t glide easily between teeth, try waxed floss. If you have trouble using traditional dental floss, you can try threader floss, which has a rigid tip, interdental brushes, floss picks, or a water flosser, which cleans by way of pressurized water.
It’s not too late to add one more resolution to your list, and flossing is a habit that will go a long way toward keeping you in the best oral health. And along with good dental hygiene at home, regular professional dental cleanings and checkups are key to a healthy smile. If you would like more information about maintaining excellent dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Daily Oral Hygiene” and “Flossing—A New Technique.”
You have a lot of options for replacing missing teeth, from state-of-the-art dental implants to affordable, but effective partial dentures. But if the teeth in question have been missing for a while, you may first have to undergo orthodontic treatment. Here's why.
While they may feel rigid and firm in the jawbone, teeth are actually held in place by periodontal (gum) ligaments. These elastic tissues lie between the teeth and the bone and attach to both with tiny filaments. This mechanism allows the teeth to incrementally move over time in response to biting pressures or other environmental factors.
When a tooth goes missing the teeth on either side of the space naturally move or "drift" into it to help close the gap. This natural occurrence can reduce the space for a restoration if it has gone on for some time. To make room for a new prosthetic (false) tooth, we may have to move the drifted teeth back to where they belong.
If you're thinking metal braces, that is an option—but not the only one. Clear aligners are another way to move teeth if the bite problem (malocclusion) isn't too severe. Aligners are a series of custom-made, clear, plastic trays worn over the teeth. The patient wears each tray, slightly smaller than the previous one in the series, for about two weeks before changing to the next one. The reduction in size gradually moves teeth to their intended target position.
Many adults prefer clear aligners because they're nearly invisible and don't stand out like metal braces. They're removable, so you can take them out for cleaning or for special occasions. And, we can also attach a prosthetic tooth to the tray that temporarily covers the missing tooth space.
Whichever orthodontic treatment you choose, once completed we can then proceed with restoration to permanently replace your missing teeth. While it can be a long process, the end result is a beautiful smile that could last for years to come.
If you would like more information on your dental restoration options, 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 “Straightening a Smile before Replacing Lost Teeth.”
Like many other families, you may use formula instead of breast milk as a safe and healthy alternative to feed your infant. But, if you use a powdered form that you mix with water your child may be taking in more fluoride than they require.
Fluoride is a natural chemical that can strengthen tooth enamel and help prevent decay. After decades of study it's also been shown to pose no serious health risks. Because of fluoride's benefits and safety, many water utilities add tiny amounts to their drinking water supply.
But it can have one side effect called enamel fluorosis. If a child ingests too much fluoride during early development it can cause discoloring mottled spots or streaking in permanent teeth. Although it doesn't affect their health, the teeth can be unattractive and require cosmetic attention.
That's why it's best to keep fluoride consumption to a healthy minimum for children. That, however, is often easier said than done, since we can encounter hidden fluoride in a variety of places. Besides hygiene products and fluoridated drinking water, you may find fluoride in prepared juices and other beverages, bottled water or in foods processed with fluoridated water. There are no labeling requirements for fluoride, so you'll have to research to find out if a product contains fluoride.
There are, however, some things you can do to control your child's fluoride intake. First, know as much as you can about known sources your child may encounter like your water supply. You can find out if your utility adds fluoride and by how much by contacting them or visiting My Water's Fluoride online at https://nccd.cdc.gov/DOH_MWF/.
If you use fluoride toothpaste apply only a “smear” on the end of the brush for children under two and a pea-sized amount for older children. If you have fluoridated drinking water, consider breastfeeding your infant, use ready-to-feed formula or mix powdered formula with bottled water labeled “de-ionized,” “purified,” “demineralized” or “distilled.”
And, do feel free to discuss your concerns with us during your child's regular checkup. We'll help you adjust their diet, water intake and hygiene habits to be sure they're receiving the right amount they need for developing strong teeth — and no more.
If you would like more information on appropriate fluoride levels for children, 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 Development and Infant Formula.”
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