Posts for category: Dental Procedures
As permanent teeth gradually replace primary (“baby”) teeth, most will come in by early adolescence. But the back third molars—the wisdom teeth—are often the last to the party, usually erupting between ages 18 and 24, and the source of possible problems.
This is because the wisdom teeth often erupt on an already crowded jaw populated by other teeth. As a result, they can be impacted, meaning they may erupt partially or not at all and remain largely below the gum surface.
An impacted tooth can impinge on its neighboring teeth and damage their roots or disrupt their protective gum attachment, all of which makes them more susceptible to tooth decay or periodontal (gum) disease. Impacted teeth can also foster the formation of infected cysts that create areas of bone loss or painful infections in the gums of other teeth.
Even when symptoms like these aren’t present, many dentists recommend removing the wisdom teeth as a preemptive measure against future problems or disease. This often requires a surgical extraction: in fact, wisdom teeth removal is the most common oral surgical procedure.
But now there’s a growing consensus among dentists that removing or not removing wisdom teeth should depend on an individual’s unique circumstances. Patients who are having adverse oral health effects from impacted wisdom teeth should consider removing them, especially if they’ve already encountered dental disease. But the extraction decision isn’t as easy for patients with no current signs of either impaction or disease. That doesn’t mean their situation won’t change in the future.
One way to manage all these potentialities is a strategy called active surveillance. With this approach, patient and dentist keep a close eye on wisdom teeth development and possible signs of impaction or disease. Most dentists recommend carefully examining the wisdom teeth (including diagnostic x-rays and other imaging) every 24 months.
Following this strategy doesn’t mean the patient won’t eventually have their wisdom teeth removed, but not until there are clearer signs of trouble. But whatever the outcome might be, dealing properly with wisdom teeth is a high priority for preventing future oral health problems.
If you would like more information on wisdom teeth and their potential impact on dental health, 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 “Wisdom Teeth: Coming of Age May Come with a Dilemma.”
We always look forward to seeing our patients, but not all of you look forward to seeing us! If you’re one of them, don’t worry — we don’t take it personally. Dental anxiety prevents many people from seeking the care they require to restore or maintain a healthy smile.
But if dental problems are allowed to progress, they can affect not only the beauty of your smile and health of your mouth, but your overall wellness, too. Infection can travel from the mouth to other areas of the body, and dental disease exacerbates chronic health conditions like heart disease or diabetes.
Fear should never be an obstacle (in the immortal words of President Franklin Roosevelt, “…the only thing we have to fear is fear itself…”). And fortunately there are some safe options for those of us who can’t get past our anxiety when it comes to dental care:
Oral Sedation. A sedative medication can be prescribed that you take by mouth approximately an hour before your dental visit to minimize anxiety and promote relaxation.
Intravenous (IV; “intra” – inside, “venous” – vein) Sedation. If oral sedation isn’t entirely effective in facilitating treatment, then a medication combining a sedative for relaxation and a pain-blocking anesthetic can be delivered through or small needle or catheter that is gently inserted into a vein. This is referred to as “conscious sedation” because you are in a semi-awake state during which you are able to respond to verbal direction. It takes effect quickly, and you can come out of it quickly. However, you may not remember much about your procedure. It is very different from general anesthesia during which you are completely unconscious.
Dentists who offer IV sedation receive extensive training after which we must pass an exam and apply for a special permit that we maintain through continuing education. We carefully screen patients for eligibility and monitor you throughout so you can rest easy before, during, and after your procedure.
If you would like more information about sedation in dental care, please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “Oral Sedation Dentistry.”
Although dental implants are best known as single tooth replacements, they can actually play a role in multiple or complete tooth loss (edentulism) restorations. While replacing multiple teeth with individual implants is quite expensive, there’s another way to incorporate them in a restoration at much less cost — as supports for bridges.
In this case, only a few strategically placed implants are needed to support restorations of multiple crowns fused together into a single unit. Implant-based bridges consist of two main types: the first type is a fixed bridge, which is permanently attached to the implants and can’t be removed by the patient. It’s often the preferred treatment for patients who’ve lost most or all of their teeth but have not yet experienced significant bone loss in the jaw.
This choice, however, may not be the best option for patients with significant bone loss. In these cases, there’s a second type of fixed bridge: an implant-supported fixed denture. This type of fixed denture provides support for the lost bone support of the lips and cheeks. If a fixed bridge is not possible due to finances or inadequate bone support to place 4 to 6 implants, a removable denture (also known as an overdenture) that’s supported and held in place by implants is the next best alternative. Unlike a fixed bridge, an overdenture can be removed by the patient for cleaning purposes, and will require less investment than a fixed bridge.
For people with bone loss, the overdenture does more than restore chewing and speech function. Because bone loss can diminish support of the facial structures — actually shorten the distance between the chin and the tip of the nose — an overdenture provides additional bulk to support these structures to improve appearance. Depending on what the patient needs for facial support, overdentures for the upper jaw can be designed as “full palates,” meaning the denture plastic completely covers the upper jaw palate, or open in which the plastic doesn’t completely cover the palate.
Besides the condition of your teeth, gums and bone, your own personal preferences and financial ability will also play a role in which option is best for you. After considering all these factors, we can recommend which of these types of implant-based restorations will fit your needs. With either bridge, fixed or removable, you’ll certainly benefit from the improvement to both your mouth function and your smile.
If you would like more information on implant-supported bridges, 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 “Fixed vs. Removable.”
Dental implants are all the rage. And why not — not only are these tooth replacements life-like and highly functional, they have an amazing 95% ten-year success rate.
Some of that success is due to their unique design. Technically a root replacement, an implant's metal titanium post is surgically placed in the jawbone, where bone grows and adheres to it over time. This creates a strong connection that stands up well to the forces created by biting and chewing.
But there's more to their longevity than design. Success also depends on a careful, planned process that begins long before surgery.
It starts with a detailed oral examination to determine the best placement for the implant. Besides regular x-rays, we may also perform CT scans to create a three-dimensional view of your jaw. With this we can locate and avoid nerves, sinus cavities or other structures near the implant site.
The examination also helps us determine if you've experienced any bone loss, a normal occurrence after tooth loss. Implants require an adequate amount of bone to achieve the best position. A good position ensures future bone integration and the best appearance result.
The same attention to detail extends to the actual surgery to place the implant. We fashion the site to receive the implant by sequentially drilling larger tapered channels until we achieve the right size fit for the implant. During drilling we avoid overheating the bone, which could ultimately weaken and damage the implant's stability.
We'll also need to provide protection for the implant while it integrates with the bone. In most implantations, we do this by suturing the gum tissue over the implant. We take a different approach with a “Tooth in a Day” procedure where we attach a crown (the visible portion of the tooth) right after implant surgery. In this case we'll install a crown (which is actually temporary) that's a little shorter than the adjacent teeth. The natural teeth around it will absorb the forces produced while chewing and not the implant crown.
Focusing on these and other factors will greatly reduce the risk of implant failure. Paying careful attention to them helps ensure your new smile is a lasting one.
If you would like more information on dental implants to restore your smile, 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 Implants: A Tooth Replacement Method That Rarely Fails.”
When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.
“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”
The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”
A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.
It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.
So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”