Dr. Bob's Blog
By Dr. Malenius
January 27, 2019
Category: Oral Health
JamieFoxxChipsaTooth-ThisTimebyAccident

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.”

By Dr. Malenius
January 17, 2019
Category: Dental Procedures
Tags: porcelain veneers  
ANewVeneerwithMinimalorNoToothAlteration

Dental veneers, thin layers of porcelain bonded to chipped, stained or slightly crooked teeth, are an effective and affordable way to transform your smile. Their color, translucence and shape blend so well with the rest of your teeth that it's often difficult to tell them apart.

But traditional veneers have one drawback: although they're less than a millimeter in width, they can still appear bulky on unprepared teeth. To help them look more natural, we often have to remove some of the enamel layer from the tooth surface. Enamel doesn't grow back, so this alteration is permanent and the prepared teeth will require a restoration from then on.

But you may be able to avoid this—or at least keep the alteration to a minimum—with no-prep or minimal-prep veneers, two new exciting choices in cosmetic dentistry. About the width of a contact lens, we can bond these much thinner veneers to teeth with virtually no preparation at all or, in the case of a minimal-prep veneer, needing only an abrasive tool to reshape and remove only a tiny bit of the enamel.

These ultra thin veneers are best for teeth with healthy enamel, and can be placed in as few as two appointments. And besides being less invasive, the procedure is reversible—we can remove them and you can return to your original look without any follow-up restoration. One caveat, though: because of the strong bonding process used, it's not always easy to remove them.

Although their thinness makes it possible to avoid or minimize alterations, there are some dental situations like oversized teeth that may still require extensive tooth preparation. With some poor bites (malocclusions) orthodontic treatment to straighten the teeth may also be needed first.

All in all, though, no-prep or minimal-prep veneers could help you avoid the permanent tooth alteration that usually accompanies their thicker cousins. What's more, you'll have the beautiful, transformed smile that veneers can achieve.

If you would like more information on minimal or no-prep veneers, 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 “No-Prep Porcelain Veneers.”

PorcelainVeneersMightnotbetheBestOptionforTeenagers

For chipped, stained, or slightly crooked teeth, dental veneers might be the ideal solution. These thin layers of porcelain bonded directly over the teeth with the perfect blend of color, sizes and shapes, can transform a person’s smile for a relatively modest cost.

But if the teeth belong to a teenager, veneers might not be appropriate. This is because in most cases, we’ll need to remove some of the tooth enamel so that the applied veneers won’t look unnaturally bulky. This alteration is permanent, so the teeth will require some form of restoration from then on.

While not usually a major issue with fully matured adult teeth, it could be with the developing teeth of pre-teens and teens. During childhood and adolescence the tooth’s inner pulp plays an important role in dentin production, and so the pulp chamber is relatively large compared to an adult tooth. This larger size places the pulp closer to the enamel surface than with an adult tooth.

Because of its proximity to the enamel, there’s a greater chance veneer alterations could damage a teenager’s tooth pulp and its nerve bundles. If that happens, we may need to perform a root canal treatment to save the tooth—also not an optimal situation for a developing tooth.

That’s why we need to take into consideration a patient’s age and stage of dental development first, including x-raying the affected teeth to measure the depth of the tooth pulp. If we deem it too risky at the moment, there are other ways to improve dental appearance at least temporarily. This includes whitening externally stained teeth with a bleaching agent, or applying tooth-colored composite resin material to chipped areas. We can also apply a composite material veneer that, although not as durable as traditional porcelain, doesn’t require much if any tooth alteration.

To know your options, have your teenager undergo a thorough dental examination. Your dentist will then be able to discuss with you whether veneers can be safely attempted. And be sure the dentist who may perform the work has experience performing cosmetic procedures on teenagers.

If you would like more information on restoration choices 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 “Veneers for Teenagers.”

By Dr. Malenius
December 28, 2018
Category: Uncategorized
Tags: pulp capping  
Less-InvasivePulpCappingCouldSaveYourTooth

There’s one sure thing about tooth decay: you can’t ignore it. In fact, the best outcomes result from finding it early and treating it before it enters the pulp in the center of the tooth, often a filling or similar treatment.

If it does advance to the pulp, you may need a root canal treatment to save the tooth. This is a moderately invasive procedure where we access the pulp and root canals, tiny passageways leading to the root and supporting bone. We then remove all the diseased tissue and fill the empty pulp chamber and root canals with a special filling. Later we’ll crown the tooth for added protection against future infection or fracture of the tooth.

But there’s also another less-invasive method than a root canal called pulp capping. It’s only appropriate to use, however, if the pulp has become exposed or almost exposed by decay, but hasn’t yet shown signs of disease.

Pulp capping can be either direct or indirect. We use direct pulp capping if the healthy pulp has been exposed by the disease process. We first isolate the tooth from the rest of the mouth to prevent contamination and then proceed to remove all of the tooth’s decayed dentin structure. We then apply a biocompatible material directly over the pulp to protect it from further decay and to facilitate healing. We then restore the tooth, usually with a filling, to its proper function and life-like appearance.

When the pulp is threatened by decay but not yet exposed, we may then use the indirect method. In this approach we first remove most of the decayed dentin, but leave a small amount next to the pulp to keep it covered. We then treat this remaining dentin with a material to help it heal and re-mineralize, followed by a temporary filling of the tooth. A few months later we’ll remove this filling and inspect the treated dentin. If it has regenerated sufficiently, we remove any remaining decay and permanently restore the tooth.

As we said, pulp capping is only used with patients with deep decay whose pulp tissue is healthy. But when we can use it we can avoid some of the permanent alterations that often come with a root canal treatment and still save the tooth.

If you would like more information on treatments for 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 “Pulp Capping: A Procedure that May Save a Decayed Tooth.”

SingerDuaLipaSeestheWisdominPostponingTourDates

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.”

CrownLengtheningMightbeNecessaryforSeniorswithToothDecay

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.”

By Dr. Malenius
November 28, 2018
Category: Dental Procedures
Tags: gum disease  
AreLasersforGumDiseaseTreatmentinOurFuture

One of the most important revolutions in healthcare in recent decades is the increasing use of lasers. Now, laser technology is making a showing in dental care for the treatment of periodontal (gum) disease.

Lasers (an acronym for "Light Amplification by Stimulated Emission of Radiation") narrowly focus and amplify light within a small area. First developed in the early 1960s, laser technology rapidly advanced in the ensuing decades with more compact and precise devices that were eventually safe and effective for many types of medical procedures. Its remarkable features are now available for the primary focus of gum disease treatment—removing bacterial plaque.

Plaque is a thin, built-up film of bacteria and food particles on tooth and gum surfaces that serves as a haven for the bacteria that cause gum disease. The continuing presence of plaque and calculus (tartar) enables the infection to thrive and advance within the gum tissues, ultimately damaging them along with supporting bone. As the tissues weaken and bone volume diminishes, the teeth are at greater risk for loss.

It's necessary, therefore, first and foremost to remove all detectable plaque and calculus to stop the infection. This is traditionally done with special hand tools called scalers used to manually remove plaque, or with ultrasonic equipment that vibrates plaque loose to be flushed away with water. These procedures can take numerous sessions and may result in some minor post-procedural discomfort and bleeding during the cleaning.

But lasers specifically designed for plaque removal can minimize tissue damage and resulting discomfort. Because the particular laser light used reacts only with plaque and diseased tissue, it can remove them without disturbing nearby healthy tissue usually more efficiently than traditional scaling. Dentists who've used the technology frequently report less bleeding and higher patient satisfaction.

But before lasers for gum disease treatment are widely adopted, the procedure must undergo further scrutiny. Reports from dentists notwithstanding, not enough research studies have been performed to date that meet the necessary scientific criteria. But if the evidence so far from the field holds up, it's quite possible lasers will one day become a regular part of dental practice for treating gum disease.

If you would like more information on treating gum disease, 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 “Lasers Versus Traditional Cleanings for Treating Gum Disease.”

By Dr. Malenius
November 18, 2018
Category: Dental Procedures
Tags: dentures  
DenturesareStillaViableChoiceforToothReplacement

Edentulism, the loss of all of a person’s teeth, is more than an appearance problem. As one in four Americans over 65 can attest, total tooth loss can lead to emotional suffering, social embarrassment and a lack of nutrition caused by limited food choices.

But there are solutions like the removable denture, an effective dental restoration for more than a century. In its current advanced form, the removable denture is truly a functional, affordable and attractive way to restore lost teeth.

Creating an effective denture begins first by taking detailed impressions of a patient’s gum ridges. We use the measurements obtained from this process to create a plastic resin base colored to resemble the natural gums.  Using old photos and other resources documenting how the patient looked with teeth, we choose the best size and shape of porcelain teeth and then position them onto the base.

Finally, we fine-tune the dentures the first time they’re in the patient’s mouth to make sure they have a secure fit and a balanced bite when the jaws come together. We also want to be sure the dentures are attractive and blend well with other facial features. The result:  a new set of teeth that can do the job of the old ones and look nearly as real and attractive.

Dentures, though, do have one major drawback: they can’t stop bone loss, a common consequence of missing teeth. In fact, they may even accelerate bone loss due to the pressure they bring to bear on the gum ridges. Continuing bone loss could eventually cause their once secure fit to slacken, making them less functional and much more uncomfortable to wear.

But a recent innovation could put the brakes on bone loss for a denture wearer. By incorporating small implants imbedded at various places along the gums, a denture with compatible fittings connects securely with the implants to support the denture rather than the gum ridges. This not only relieves pressure on the gums, but the titanium within the implants attracts bone cells and stimulates their growth.

Thanks to this and other modern advances, dentures continue to be a solid choice for tooth replacement. Not only can they restore a lost smile, they can improve overall health and well-being too.

If you would like more information on dental restorations for missing 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 “Removable Full Dentures.”





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