The basics for treating tooth decay have changed little since the father of modern dentistry Dr. G.V. Black developed them in the early 20th Century. Even though technical advances have streamlined treatment, our objectives are the same: remove any decayed material, prepare the cavity and then fill it.
This approach has endured because it works—dentists practicing it have preserved billions of teeth. But it has had one principle drawback: we often lose healthy tooth structure while removing decay. Although we preserve the tooth, its overall structure may be weaker.
But thanks to recent diagnostic and treatment advances we’re now preserving more of the tooth structure during treatment than ever before. On the diagnostic front enhanced x-ray technology and new magnification techniques are helping us find decay earlier when there’s less damaged material to remove and less risk to healthy structure.
Treating cavities has likewise improved with the increased use of air abrasion, an alternative to drilling. Emitting a concentrated stream of fine abrasive particles, air abrasion is mostly limited to treating small cavities. Even so, dentists using it say they’re removing less healthy tooth structure than with drilling.
While these current advances have already had a noticeable impact on decay treatment, there’s more to come. One in particular could dwarf every other advance with its impact: a tooth repairing itself through dentin regeneration.
This futuristic idea stems from a discovery by researchers at King’s College, London experimenting with Tideglusib, a medication for treating Alzheimer’s disease. The researchers placed tiny sponges soaked with the drug into holes drilled into mouse teeth. After a few weeks the holes had filled with dentin, produced by the teeth themselves.
Dentin regeneration isn’t new, but methods to date haven’t been able to produce enough dentin to repair a typical cavity. Tideglusib has proven more promising, and it’s already being used in clinical trials. If its development continues to progress, patients’ teeth may one day repair their own cavities without a filling.
Dr. Black’s enduring concepts continue to define tooth decay treatment. But developments now and on the horizon are transforming how we treat this disease in ways the father of modern dentistry couldn’t imagine.
With a 95-plus percent survival rate after ten years, dental implants are one of the most durable replacement restorations available. Implants can potentially last much longer than less expensive options, which could make them a less costly choice in the long run.
But although a rare occurrence, implants can and do fail—often in the first few months. And tobacco smokers in particular make up a sizeable portion of these failures.
The reasons stem from smoking’s effect on oral health. Inhaled smoke can actually burn the outer skin layers in the mouth and eventually damage the salivary glands, which can decrease saliva production. Among its functions, saliva provides enzymes to fight disease; it also protects tooth enamel from damaging acid attacks. A chronic “dry mouth,” on the other hand, increases the risk of disease.
The chemical nicotine in tobacco also causes problems because it constricts blood vessels in the mouth and skin. The resulting reduced blood flow inhibits the delivery of antibodies to diseased or wounded areas, and so dramatically slows the healing process. As a result, smokers can take longer than non-smokers to recover from diseases like tooth decay or periodontal (gum) disease, or heal after surgery.
Both the higher disease risk and slower healing can impact an implant’s ultimate success. Implant durability depends on the gradual integration between bone and the implant’s titanium metal post that naturally occurs after placement. But this crucial process can be stymied if an infection resistant to healing arises—a primary reason why smokers experience twice the number of implant failures as non-smokers.
So, what should you do if you’re a smoker and wish to consider implants?
First, for both your general and oral health, try to quit smoking before you undergo implant surgery. At the very least, stop smoking a week before implant surgery and for two weeks after to lower your infection risk. And you can further reduce your chances for failure by practicing diligent daily brushing and flossing and seeing your dentist regularly for cleanings and checkups.
It’s possible to have a successful experience with implants even if you do smoke. But kicking the habit will definitely improve your odds.
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 Implants & Smoking.”
In her decades-long career, renowned actress Kathy Bates has won Golden Globes, Emmys, and many other honors. Bates began acting in her twenties, but didn't achieve national recognition until she won the best actress Oscar for Misery — when she was 42 years old! “I was told early on that because of my physique and my look, I'd probably blossom more in my middle age,” she recently told Dear Doctor magazine. “[That] has certainly been true.” So if there's one lesson we can take from her success, it might be that persistence pays off.
When it comes to her smile, Kathy also recognizes the value of persistence. Now 67, the veteran actress had orthodontic treatment in her 50's to straighten her teeth. Yet she is still conscientious about wearing her retainer. “I wear a retainer every night,” she said. “I got lazy about it once, and then it was very difficult to put the retainer back in. So I was aware that the teeth really do move.”
Indeed they do. In fact, the ability to move teeth is what makes orthodontic treatment work. By applying consistent and gentle forces, the teeth can be shifted into better positions in the smile. That's called the active stage of orthodontic treatment. Once that stage is over, another begins: the retention stage. The purpose of retention is to keep that straightened smile looking as good as it did when the braces came off. And that's where the retainer comes in.
There are several different kinds of retainers, but all have the same purpose: To hold the teeth in their new positions and keep them from shifting back to where they were. We sometimes say teeth have a “memory” — not literally, but in the sense that if left alone, teeth tend to migrate back to their former locations. And if you've worn orthodontic appliances, like braces or aligners, that means right back where you started before treatment.
By holding the teeth in place, retainers help stabilize them in their new positions. They allow new bone and ligaments to re-form and mature around them, and give the gums time to remodel themselves. This process can take months to years to be complete. But you may not need to wear a retainer all the time: Often, removable retainers are worn 24 hours a day at first; later they are worn only at night. We will let you know what's best in your individual situation.
So take a tip from Kathy Bates, star of the hit TV series American Horror Story, and wear your retainer as instructed. That's the best way to keep your straight new smile from changing back to the way it was — and to keep a bad dream from coming true.
If you would like more information about orthodontic retainers, please contact us or schedule an appointment for a consultation. You can learn more about this topic in the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.” The interview with Kathy Bates appears in the latest issue of Dear Doctor.
Often as children grow older, their participation in sports or similar activities increases. While generally encouraged, this greater activity does increase injury risk, especially to the mouth.
In fact, the late childhood to early adulthood demographic is the most prone portion of the population to incur dental injuries. To complicate matters, their dental development is often incomplete, posing a number of treatment obstacles for an injured tooth.
For example, the primary means for preserving an injured adult tooth is a root canal treatment: damaged or diseased tissue within the pulp, the tooth’s innermost layer, is removed and the empty chamber and root canals filled and sealed to prevent infection. But while a fully matured tooth can function without the nerves and blood vessels of the pulp, a developing tooth needs these tissues for continued tooth formation. Otherwise, tooth development can stall and cause problems later on.
The most common solution for younger teeth is to remove any damaged tooth structure without disturbing the pulp if at all possible followed by a filling. That’s contingent, though, on whether we find the pulp unexposed or undamaged—if it is, we’ll try to remove only damaged or diseased pulp tissue and leave as much healthy tissue intact as possible. To aid with healing and tissue re-growth, we may also place medicinal stimulators between the pulp and the filling.
Jaw development may also pose a challenge if the injured tooth is too far gone and must be removed. Our best choice is to replace it with a dental implant; but if we install the implant while the jaw is still growing, it may eventually appear out of place with the rest of the teeth. It’s best to postpone an implant until full jaw maturity in early adulthood.
In the meantime we could provide a temporary solution like a removable partial denture or a modified bonded bridge that won’t permanently alter nearby teeth. These methods can adequately restore the function and appearance of missing teeth until the jaw is mature enough for an implant.
While injuries with young permanent teeth do pose extra challenges, we have effective ways to address them. With the right approach, the outcome can be just as successful as with a mature tooth.
If you would like more information on dental care in the formative years, 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 “Saving New Permanent Teeth after Injury.”
When your child says they have a toothache, should you see your dentist? In most cases, the answer is yes.
And for good reason: their “toothache” could be a sign of a serious condition like tooth decay or a localized area of infection called an abscess, which could adversely affect their long-term dental health. The best way to know for sure –and to know what treatment will be necessary—is through a dental exam.
So, how quickly should you make the appointment? You can usually wait until morning if the pain has persisted for a day or through the night—most toothaches don’t constitute an emergency. One exception, though, is if the child has accompanying fever or facial swelling: in those cases you should call your dentist immediately or, if unavailable, visit an emergency room.
In the meantime, you can do a little detective work to share with the dentist at the appointment. Ask your child exactly where in their mouth they feel the pain and if they remember when it started. Look at that part of the mouth—you may be able to see brown spots on the teeth or obvious cavities indicative of decay, or reddened, swollen gums caused by an abscess. Also ask them if they remember getting hit in the mouth, which may mean their pain is the result of trauma and not disease.
You can also look for one other possible cause: a piece of candy, popcorn or other hard object wedged between the teeth putting painful pressure on the gums. Try gently flossing the teeth to see if anything dislodges. If so, the pain may alleviate quickly if the wedged object was the cause.
Speaking of pain, you can try to ease it before the dental appointment with ibuprofen or acetaminophen in appropriate doses for the child’s age. A chilled cloth or ice pack (no direct ice on skin) applied to the outside of the jaw may also help.
Seeing the dentist for any tooth pain is always a good idea. By paying prompt attention to this particular “call for help” from the body could stop a painful situation from getting worse.
If you would like more information on dental care for children, 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 “A Child’s Toothache: Have a Dental Exam to Figure out the Real Cause.”
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