Posts for: April, 2015
As a new permanent tooth develops, the roots undergo a process of breakdown and growth. As older cells dissolve (a process called resorption), they’re replaced by newer cells laid down (deposition) as the jaw develops. Once the jaw development ends in early adulthood, root resorption normally stops. It’s a concern, then, if it continues.
Abnormal root resorption most often begins outside of the tooth and works its way in, beginning usually around the neck-like (or cervical) region of the tooth. Also known as external cervical resorption (ECR), the condition usually shows first as pink spots where the enamel is being undermined. As these spots continue to erode, they develop into cavity-like areas.
While its causes haven’t been fully confirmed, ECR has been linked to excessive pressure on teeth during orthodontic treatment, periodontal ligament trauma, teeth-grinding or other excessive force habits, and bleaching techniques performed inside a tooth. Fortunately, ECR is a rare occurrence, and most people who’ve had these problems won’t experience it.
When it does occur, though, it must be treated as quickly as possible because the damage can progress swiftly. Treatment depends on the size and location of the resorption: a small site can often be treated by surgically accessing the tooth through the gum tissue and removing the offending tissue cells. This is often followed with tooth-colored dental material that’s bonded to the tooth to replace lost structure.
A root canal treatment may be necessary if the damage has extended to the pulp, the tooth’s interior. However, there’s a point where the resorption becomes too extensive to save the tooth. In these cases, it may be necessary to remove the tooth and replace it with a dental implant or similar tooth restoration.
In its early stages, ECR may be difficult to detect, and even in cases where it’s been diagnosed more advanced diagnostics like a CBCT scanner may be needed to gauge the extent of damage. In any case, it’s important that you have your teeth examined on a regular basis, at least twice a year. In the rare chance you’ve developed ECR, the quicker it’s found and treatment begun, the better your chances of preserving the tooth.
A crown restoration is a fabricated replica of a natural tooth. The mechanics and methods to prepare the tooth and attach the new crown are standard procedures in dentistry. But the crowns themselves — their individual shape, color and material from which they’re constructed — can differ greatly depending on each patient’s individual needs and desires. All these factors can have a bearing on cost — not to mention the process a dentist may employ to produce a custom crown.
Crowns are usually fashioned by a dental laboratory technician using castings of the patient’s mouth prepared by the dentist. These professionals should be considered artists as well as scientists. And, like artists with certain areas of strength and expertise, individual technicians may also develop high practical skill for a particular type of tooth replacement; it’s not uncommon for a dentist to use a different dental technician for a particular type and size of tooth to be restored. This could prove to be a factor in the final cost.
The efforts to create the best color in the crown can also affect cost. While we think of teeth as uniformly “pearly white,” there really are variations and gradations in normal tooth color (even within the same tooth). Again, a bit of artistry is important here, as the dentist communicates with the technician on not only the color but also the subtle hue gradations along the length of the crown. Your input as a patient is also valuable in determining color — you must be satisfied with the final product. Fortunately, it’s now possible to take a “test drive” of your potentially new look with a provisional crown that will allow you to see just how your permanent crown (which will be made of longer-lasting, higher quality materials) will appear.
These factors, as well as the limitations you may face by your insurance coverage, can greatly influence the final cost of treatment. As your dentist, we will consult and work with you to find the best crown restoration option that will fit both your dental needs and your financial ability.
If you would like more information on your options for crowns and other restorations, 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 “Value of Quality Care.”
We all know how much better we feel after a good night’s sleep: refreshed, energized and ready to handle — even excel at — our day-to-day responsibilities. Yet millions of people, young and old, are robbed of a good night’s rest by sleep-related breathing disorders such as sleep apnea, in which the soft tissues in the back of the throat block the airway during sleep. This temporarily disrupts airflow, causing numerous “micro-arousals” (sleep interruptions) that we may not even be aware of. A lack of sleep can make us drowsy, irritable and unfocused. In children, these typical symptoms of sleep apnea can lead to mistaken diagnoses of Attention Deficit Hyperactivity Disorder (ADHD).
The relationship between sleep apnea and behavioral problems has been highlighted in several recent scientific journal articles, including a major study published several years ago in Pediatrics, the official journal of the American Academy of Pediatrics. The lead author, Dr. Karen Bonuck, said at the time: “We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems. The biggest increase was in hyperactivity, but we saw significant increases across [other] behavioral measures.” Therefore, an accurate diagnosis of a child’s behavioral problems — leading to the right treatment — is crucial. While sleep apnea must be diagnosed by a physician, treatment for the condition is often provided by a dentist.
What can be done for children suffering from sleep apnea? The most common treatment is surgical removal of the tonsils or adenoids. This treatment can sometimes be performed by an oral and maxillofacial surgeon, a dentist who has received several years of post-graduate surgical training. There are several other procedures oral surgeons can perform to open the airway, depending on what anatomical structures are blocking it.
Sometimes a child with sleep apnea can benefit from a procedure to expand the palate (roof of the mouth) to enlarge the airway. This is not a surgical treatment but rather an orthodontic one. An orthodontist (a dentist who specializes in moving teeth) will fit the child with a palatal expander, a butterfly-shaped device that gradually separates the two bones that form the upper jaw and roof of the mouth. This is often done to prevent crowding of teeth and other bite problems, but has been shown in some cases to improve airflow.
There is another dental approach used to treat adults and older children, whose jaw growth is complete. It’s called oral appliance therapy, and it involves wearing a custom-made device during sleep that resembles a sports mouthguard or orthodontic retainer. An oral appliance can maintain an opened, unobstructed, upper airway during sleep in various ways, including: repositioning the lower jaw, tongue, soft palate and uvula; stabilizing the lower jaw and tongue; increasing the muscle tone of the tongue.
If your child has been diagnosed with sleep apnea, we can help you find the best treatment approach. For more information, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders & Dentistry” and “Snoring & Sleep Apnea.”
Since boxers first began using them a century ago, athletic mouthguards are now standard safety equipment for most contact sports. Without them, dental injuries would skyrocket.
But a recent study in the peer-reviewed journal, General Dentistry, indicates there’s another important reason to wear a mouthguard for contact sports or exercise: you may be able to significantly reduce your risk for a mild traumatic brain injury (MTBI), better known as a concussion. It’s believed the mouthguard absorbs some of the force generated during contact, resulting in less pressure to the brain. That reduction is even more significant if your mouth-guard has been custom-made by a dentist.
That last finding is important, because not all mouthguards on the market are equal. There are three basic categories of mouthguards — stock, “boil and bite,” and custom. Stock mouthguards come in limited sizes; they’re relatively inexpensive, but they provide the least level of protection. “Boil and bite” can be customized after purchase to the wearer’s bite, but they don’t always provide complete coverage of back teeth. Custom mouthguards are designed and fashioned by a dentist; they’re relatively expensive (running in the hundreds of dollars), but there’s ample evidence they provide the highest level of protection from mouth injuries.
The General Dentistry study also corroborates custom mouthguards’ effectiveness in preventing concussions. The study followed approximately 400 football players from six different high school teams. While all the players wore the same type of helmet, half of them wore custom-made mouthguards and the other half wore stock guards. 8.3% of the athletes wearing stock guards experienced a concussion injury; by contrast only 3.6% of those with custom guards sustained an injury — greater than half fewer occurrences.
The study also highlights the need not to rely solely on helmets or other protective headgear for concussion prevention. It’s important to include mouthguards along with other athletic protective gear to lower injury risk as much as possible.
So when considering how you can provide the optimum injury protection for you or your child, be sure to include an athletic mouthguard, preferably one that’s custom-made. We’ll be happy to advise you further on what you need to know to prevent traumatic dental injuries, as well as concussions.
If you would like more information on custom-fit mouthguards, 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 “Mouthguards.”