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Posts for category: Dental Procedures

ThatSpaceBetweenYourFrontTeethMaybeCausedbyOvergrownMuscle

The various structures in your mouth — your teeth and gums, of course, as well as periodontal tissues that hold teeth in place within the jaw — all function together to create your smile. This includes muscles like the frenum, a fold of muscle tissue that connects the gums to the upper lip, which helps pull the lip upward when you smile.

Unfortunately, an overly large frenum could contribute to an unattractive space between your two upper front teeth. The problem occurs when the frenum grows beyond its normal range and runs between the front teeth to connect with the gums behind them at the forefront of the roof of your mouth. The resulting space that may develop can be closed with orthodontics, but unless the excess frenum tissue is addressed the space may eventually reopen.

The frenum is just one cause among many for a noticeably wide space, including bite problems (malocclusions), finger-sucking habits or missing teeth. We would, therefore, need to examine your mouth to determine the exact cause before beginning any treatment. If indeed the frenum is the source of the problem, it will be necessary to ultimately remove the excess portion through a procedure known as a frenectomy.

A frenectomy is a minor surgical procedure performed by a periodontist, oral surgeon or a general dentist with surgical training. After numbing the area with local anesthesia, the tissue behind the teeth is dissected or reduced in size with a small scalpel or a surgical laser. The wound is then closed with a few stitches; any post-surgical discomfort is usually minimal and managed with non-steroidal anti-inflammatory pain medication. The wound will completely heal within a few weeks.

Most frenectomies are performed after orthodontics to close the space. Removing it prior to tooth movement may result in scar tissue that prevents the space from closing. It’s also easier for the surgeon to gauge how much tissue to remove after space closure to avoid removing too much, which can leave a “black” triangular hole where gum tissue should normally be.

Treating an abnormally large frenum isn’t difficult, but it needs to be coordinated with orthodontic treatment for the best outcome. The end result is a smile that’s both healthy and attractive.

If you would like more information on teeth spacing problems, 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 “Space between Front Teeth.”

OralSedationHelpsReduceAnxietyDuringDentalTreatment

Eliminating pain and discomfort is one of our major objectives during dental treatment. To that end, our profession has developed a number of anesthetic drugs and deliveries that ensures your experience in the dentist’s chair is as pain-free as possible.

But there’s another experience many people have with dental care that’s different from physical discomfort — emotional anxiety. These negative emotions can range from nervousness about a procedure to extreme fear. Very often the patient has no control over these emotions — they’ve become imbedded from earlier experiences or the influence of others.

Although each can influence and heighten the other, anxiety and physical discomfort are different and require a different approach. Physical pain and sensation is eliminated through anesthesia, either locally through topical application or injection or generally through intravenous medication that renders a person unconscious. Anxiety, on the other hand, requires first building a trustful relationship with an understanding dentist. But it may also call for certain drugs that sedate — promote a feeling of relaxation — rather than numb sensation.

We’ve incorporated a number of sedative medications in dentistry like Valium or Ativan that work well to reduce anxiety before and during treatment. Many are taken orally, usually just before scheduled treatment, and they dissipate from the system quickly afterward. Some medications also have “amnesic” qualities, meaning you won’t remember anything or little at all about the treatment period. This can be helpful in amassing positive treatment experiences that may diminish negative feelings you’ve developed about dental treatment.

It’s important, though, to find the right types of medication that work well for you. For that reason we’ll take a thorough medical history, including prescription or over-the-counter medications and supplements you’re taking and any medical conditions you may have. It’s also important to discuss your diet (certain foods can inhibit the action of some sedatives) as well as if you use tobacco or regularly drink alcoholic beverages.

Taken properly, oral sedation can effectively reduce your anxiety during treatment. As a result, it will be much easier and pleasant for you to receive the care you need for a healthy mouth.

If you would like more information on reducing anxiety during dental treatment, 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 “Oral Sedation Dentistry.”

By James A. Hosner, DDS
March 09, 2019
Category: Dental Procedures
Tags: partial denture   bridge  
ATeensMissingToothMayRequireaTemporaryReplacement

Besides reduced biting and chewing function, a missing tooth can cause an embarrassing inhibition to healthy social interaction. This can be especially so for teens who greatly value peer relationships and acceptance.

Be that as it may, we typically discourage a permanent replacement for teens with a missing tooth, particularly dental implants. While we value a patient’s psychological needs, the long-term effect on dental health may be too great to advise otherwise.

The effect we’re concerned with involves jaw growth and development. Although a person’s permanent teeth have usually all erupted by early adolescence, the jaws continue to grow until the late teens or early twenties. Natural teeth can adapt to this growth because the periodontal ligament that holds them in place allows for incremental tooth movement. The teeth move in response to jaw growth and are thus able to maintain their proper relationship and alignment in the jaw as growth occurs.

Dental implants, on the other hand, are imbedded into the jaw bone: they, therefore, can’t move like natural teeth and thus can’t adjust their position with jaw growth, particularly the upper jaw as it grows forward and down. This can result in the implants appearing as though they are left behind or retreat into the jaw. It can also affect the position of the gums and inhibit their growth around the implants.

It’s best then to hold off implants and other permanent restorations until the jaw has finished developing. That, however, isn’t always easy to determine: specialized x-ray diagnostics may help, but it’s not an exact science. Your input as a parent will also be helpful, such as whether you’ve noticed the end of growth spurts (not changing clothes or shoe sizes as often) or your child’s recent similarity in appearance to other adult members of your family. It thus becomes a judgment call, based on examination and experience, as to whether it’s safe to proceed with implants — and may require erring on the side of caution.

In the meantime, there are temporary restorations that can improve appearance while you wait for the appropriate time to undertake a permanent restoration. Two of the most useful are removable partial dentures (RPDs) or a bonded bridge, a less invasive form of the traditional bridge. With a proper assessment we can advise you on which option is your best choice.

If you would like more information on tooth restorations for teenagers, 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 “Teenagers & Dental Implants.”

By James A. Hosner, DDS
February 17, 2019
Category: Dental Procedures
3Age-RelatedDentalProblemsandwhatyoucandoAboutThem

Like other aspects of our lives, aging can take a toll on our smile. Over a lifetime the effects of disease, teeth wearing and the foods we eat can cause our teeth and gums to look unattractive.

Here are 3 of the most common age-related dental problems and how we can help you "turn back the clock" on each one.

Discoloration. Teeth can dull and grow darker over time. And not just from what we eat or drink—age-related structural changes in the tooth can also cause discoloration. We can often alleviate external staining temporarily with teeth whitening. If the staining is heavy or it originates inside the tooth, then we can install life-like porcelain veneers or crowns to cover the discoloration. We can also use composite dental materials to alter the color of one darkened tooth so that it doesn't stand out from the rest of your teeth.

Wearing. Our teeth naturally wear down over time. If the wearing is excessive, though, teeth can look shorter and less youthful. Again, we can use veneers or crowns to change a tooth's outward appearance and make them look longer. We can also employ enamel contouring and reshaping that smoothes out sharper edges caused by wearing to give your teeth a softer, more youthful look.

Receding gums. On the other end of the spectrum, gums that have shrunk back or receded from the teeth can make them look much larger and unattractive. Our first step is to treat any gum disease present—the most common cause of recession—which often helps the tissues to regenerate. If your case is more advanced, though, you may also need grafting surgery to restore lost gum tissue. Using in-depth microsurgical techniques, surgeons attach grafted gum tissue at the recession site. Over time new tissue will grow, restoring adequate gum coverage.

You can also improve your appearance at any age with orthodontics. Besides a more attractive smile, properly aligned teeth tend to wear more slowly and evenly. This and proper daily oral hygiene and regular dental care can keep your teeth looking younger even in your later years.

If you would like more information on gaining a more youthful 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 “How Your Dentist can help you Look Younger.”

By James A. Hosner, DDS
January 28, 2019
Category: Dental Procedures
Tags: dental implants  
DentalImplantsBetterthanEverthankstoOngoingTechAdvances

While many people still consider dental implants the "new kids on the block" in dental restoration, they're now in their fourth decade of use. And since their inception implant technology has continued to improve and revolutionize how we replace missing teeth.

Implants are a different "species" compared to other restoration methods. To be precise, an implant is a tooth root replacement—usually a titanium metal post imbedded directly into the jaw bone. Titanium is not only a biocompatible metal, but bone cells naturally grow on its surface to create a strong and durable hold. It's this secure hold that's most responsible for implants' high long-term success rate.

But we should also credit some of this success to the steady stream of advances over the years in implant construction and supporting technologies. For one thing, we're now more accurate and precise with implant placement thanks to advances in computer tomography (CT) and cone beam CT (CBCT) scanning.

These digital processes merge a series of images taken by a special camera to form a three-dimensional model of the jaw. We can manipulate this model on a computer monitor to view it from different vantage points. It can help us locate and avoid anatomical structures like nerves and sinuses when determining where to place a future implant. CT and CBCT are especially useful when there's a concern about adequate available bone, a necessity for stable implants.

Technology has also improved how we create surgical guides, often used during implant surgery to obtain the most accurate results. Surgical guides are custom-made devices that fit over the teeth with the drilling locations for the implants marked on them. Recent advances in 3-D printing have made these guides even more accurate so that they fit more securely in the mouth. This greater stability increases their accuracy during the drilling sequence during surgery.

These and other advances are helping ensure every implant is a success story. The end result is both a functional restoration and a beautiful smile.

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 “How Technology Aids Dental Implant Therapy.”