If we could go back in time, we all probably have a few things we wish we could change. Recently, Dr. Travis Stork, emergency room physician and host of the syndicated TV show The Doctors, shared one of his do-over dreams with Dear Doctor magazine: “If I [could have] gone back and told myself as a teenager what to do, I would have worn a mouthguard, not only to protect my teeth but also to help potentially reduce risk of concussion.”
What prompted this wish? The fact that as a teenage basketball player, Stork received an elbow to the mouth that caused his two front teeth to be knocked out of place. The teeth were put back in position, but they soon became darker and began to hurt. Eventually, both were successfully restored with dental crowns. Still, it was a painful (and costly) injury — and one that could have been avoided.
You might not realize it, but when it comes to dental injuries, basketball ranks among the riskier sports. Yet it’s far from the only one. In fact, according to the American Dental Association (ADA), there are some two dozen others — including baseball, hockey, surfing and bicycling — that carry a heightened risk of dental injury. Whenever you’re playing those sports, the ADA recommends you wear a high-quality mouth guard.
Mouthguards have come a long way since they were introduced as protective equipment for boxers in the early 1900’s. Today, three different types are widely available: stock “off-the-shelf” types that come in just a few sizes; mouth-formed “boil-and-bite” types that you adapt to the general contours of your mouth; and custom-made high-quality mouthguards that are made just for you at the dental office.
Of all three types, the dentist-made mouthguards are consistently found to be the most comfortable and best-fitting, and the ones that offer your teeth the greatest protection. What’s more, recent studies suggest that custom-fabricated mouthguards can provide an additional defense against concussion — in fact, they are twice as effective as the other types. That’s why you’ll see more and more professional athletes (and plenty of amateurs as well) sporting custom-made mouthguards at games and practices.
“I would have saved myself a lot of dental heartache if I had worn a mouthguard,” noted Dr. Stork. So take his advice: Wear a mouthguard whenever you play sports — unless you’d like to meet him (or one of his medical colleagues) in a professional capacity…
People are choosing dental implants at an increasing rate to replace missing teeth, either as an individual tooth or as a support for other restorations. But unlike other replacement options, we must surgically install the titanium post at the heart of the system directly into the jawbone.
While the term “surgery” might make you nervous, there's nothing at all to worry about. Here's what you need to know about before, during and after this relatively minor procedure.
Before. While the actual procedure is no more complicated than a tooth extraction, it ultimately depends on careful planning beforehand. Using x-ray diagnostics, we prepare a precise surgical guide to help us locate the best position to place them for a successful outcome. We'll also need to check bone volume to make sure there's an adequate amount to securely anchor the implant. If the bone is insufficient you may need bone grafting to build up the site or another replacement option.
During. The actual procedure begins, of course, with local anesthesia to numb the site — you should feel no pain and very minimal discomfort. We access the bone through the gums; often using a surgical guide for alignment, we create a small channel or hole with a sequence of drills that gradually increase the size until it can accommodate the implant. We remove the implants from their sterile packaging and install them immediately into the channel. After confirming their proper positioning with x-rays, we can close the gum tissues over it for protection during healing or attach a healing abutment that extends through the gum tissue thereby avoiding a second surgical procedure.
After. Because we disrupt relatively little of the soft tissue and bone, there's only minimal discomfort afterward easily managed with aspirin, ibuprofen or similar anti-inflammatory medication. We may also prescribe antibiotics to guard against infection while the gums heal. During the next several weeks, the titanium post, which has an affinity to bone, will become more secure as bone cells grow and adhere to it. It's also during this time that a dental lab creates your permanent crown or other restoration that matches the color and tooth shape so it will blend with your other teeth.
This process is complete when we install the final restoration onto the implant. You'll have a new smile and better function.
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.”
Tooth decay is a primary cause of tooth damage and loss, with annual treatment costs in the billions of dollars. It arises mainly from oral bacteria, which proliferates in the absence of effective oral hygiene. There are, however, other risk factors besides poor hygiene that could make you more susceptible to this disease.
Many people, for example, have genetically inherited deeper grooves (fissures) and depressions (pits) than the average tooth anatomy. These may be harder to reach with a toothbrush and can become havens for bacterial plaque. Others may have health conditions that indirectly affect the mouth: bulimia or anorexia, psychological conditions that involve self-induced vomiting, or GERD, gastro-esophageal reflux disease, in which stomach acid could regurgitate into the mouth. These conditions could result in a highly acidic mouth environment.
Some medical and — ironically — dental treatments could also increase your tooth decay risk. Some medications can reduce saliva flow, which inhibits acid neutralization and re-mineralization of enamel. Retainers, braces, bite guards or other dental appliances may also reduce the saliva wash over teeth, and can make brushing and flossing more difficult.
There are also risk factors that result from our lifestyle choices. Eating a lot of foods rich in sugars and other carbohydrates, for example, or acidic beverages like soda, energy or sports drinks contributes to the rise of bacteria in our mouths.
There are ways to reduce the effects of these risk factors. In addition to a daily habit of effective brushing and flossing, you should also include semi-annual cleanings and checkups at our office a part of your routine. If you have genetic, medical or dental issues that are out of your control, we can discuss solutions, such as alternatives to medications or different techniques for cleaning around dental appliances. For lifestyle-related factors, you should consider removing the habit or modifying it: for example, snacking at specific times or drinking acidic beverages only at mealtime.
While tooth decay is a serious, destructive disease, it is highly preventable. Addressing all your risk factors, not just hygiene, will reduce your chances of having it.
If you would like more information on tooth decay prevention, 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.”
Once they learn to walk, there's no stopping most children. Sometimes it can be a little jarring, as when you discover your toddler on top of the kitchen counter reaching in the cupboard on tip-toes for a snack!
Fortunately, children are fairly resilient. Unfortunately, they're not invincible — some of their adventures could result in physical injuries, especially to the highly vulnerable area of the mouth.
Even if you've carefully “child-proofed” your home, it's still best to be prepared for mishaps. Here are 3 common dental injuries and how to handle them.
Soft tissue injuries. Making contact with the ground or hard objects like furniture can injure the lips, tongue, cheeks or gums and cause bleeding, cuts or bruising. First, clean the area with clean water and a cloth or gauze as best you can, making sure there aren't any trapped pieces of tooth or dirt. Apply gentle, continuous pressure with a clean cloth to control bleeding, and apply ice packs or cold compresses for swelling. Don't apply bleach, aspirin or similar medications to open wounds. If the bleeding won't stop or the wounds look serious or deep, go to an emergency room.
Chipped or displaced tooth. A blunt force mouth injury can chip or push (displace) teeth out of position. In this case try to save any chipped pieces you find — your dentist may be able to re-bond them to the tooth. A displaced tooth is a dental emergency, so contact your dentist immediately. Don't try to re-position the tooth yourself unless it's completely knocked out.
Knocked-out tooth. Actions to take with a knocked-out tooth depend on whether it's a permanent or primary (baby) tooth. If permanent, rinse the tooth with clean water. Handle it by the crown (never by the root) and gently place it back in the empty socket. If that's not possible, place the tooth between your child's cheek and gum (if the child is old enough not to swallow it by mistake. You can also place it in a glass of cold milk. Get to a dentist or an emergency room as soon as possible — minutes count for a successful reattachment. Conversely, don't try to put a primary tooth back in its socket — you could damage the developing permanent tooth beneath the gum line. But do see a dentist as soon as possible for an examination.
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
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