Broken Teeth

Here you can see a maxillary first premolar fractured between its two cusps. Fractures commonly occur here due to natural stress points in the enamel and dentin. This tooth was fractured down into the root space and needed to be extracted. 

Like any hard object, enamel tends to crack or fracture when subjected to a large amount of force. Hence, broken teeth are a very common source of dental pain. Symptoms can range from mild discomfort to pain when chewing or a constant radiating soreness. They are sometimes preceded by an audible "crack" or "pop" while chewing a hard object. No matter your current state, a cracked tooth needs to be addressed by a dentist before the symptoms will subside.

One of the trickiest parts of treating cracked teeth is that they are difficult to see. Traditional X-Rays frequently miss cracks, as they are trying to represent your three dimensional tooth in a 2-D image. Visual inspection will reveal some cracks, particularly vertical fractures through the crowns. However, smaller crack and cracks in the root area are impossible to spot with the naked eye. The most reliable way to see if a tooth has broken is by imaging with a Cone Beam CT scanner. Here, a specialist (often times an endodontist or oral surgeon) will take a 3D image of your tooth, revealing any cracks or defects throughout its structure. 

Once a tooth is confirmed as cracked, it will typically need to be extracted. Large splits in enamel running into root structure are impossible to repair or remineralize. Still, some shallower cracks in ideal locations can be treated with a crown and/or root canal. Here, the actual cracked portion of the tooth is removed, preventing the possibility of the defect propagating and getting bigger. However, it is important to note that these conditions are rarely met and extraction is the most typical course of treatment for a broken tooth. 

The most important thing to remember is don't wait and suffer in pain! Especially if you have pain while chewing or feel your teeth "flex" or "shift" when you bite down, there is a good chance you cracked your tooth. This discomfort will not resolve on its own; in fact there is a good chance it will worsen with time. If you have any type of dental discomfort, call our office as soon as possible. We can help you alleviate pain, reach a proper diagnosis and plan for the best course of action for getting your mouth back to normal. 

Dental Questions: Are my child's front teeth coming in normally?

Here, you can see the child's permanent teeth erupting behind the similar baby tooth. 

We often get calls to our office from parents concerned that their child's adult teeth are coming in behind or in front of the corresponding primary tooth. This can create a "shark tooth" appearance that looks to be preventing the permanent tooth from coming in straight. On the contrary, a retained primary tooth is usually not a problem and will come out on it's own. The permanent tooth should "push" the baby tooth out enough that it becomes loose. If the permanent tooth is fully erupted and the baby tooth still isn't loose, a dentist will usually extract the primary tooth before a problem arises. 

Dr. Kari's son Duke with his two mandibular primary central incisors erupting. These are usually the first teeth to appear.

Likewise, the mandibular primary central incisors are the first baby teeth to be lost (notice the permanent tooth erupting it its place). 

Retained teeth are usually a problem localized to the mandibular and maxillary incisors (four front teeth). The two mandibular primary central incisors are the first teeth to erupt at about six months. Subsequently, they are the first baby teeth lost at five to six years. They make way for the mandibular permanent central incisors, which typically erupt at ages six to seven. You can definitely see how a small overlap in timing can create the "double tooth" problem. 

Overall, any concerns with your child's dentition should be brought up at their yearly checkup. We pride ourselves in being an educational and informative office and want you to leave with peace-of-mind.  If you have any concerns with your family's oral health, please call our office!

Dental Questions: What are my options in improving the esthetics of a single tooth?

This new tooth was restored using only bonding and disking. What a change!

Teeth can become cosmetically damaged through a number of different means; from chipping to fractures, staining, decay or even as a result of problems in development. Likewise, our office offers a variety of ways to restore your teeth and make them appear natural in your mouth once again.

As with any procedure, we start the process by making sure the tooth in question is sill alive and healthy. There is no sense in restoring a tooth with serious underlying problems. Secondly, we assess the extent of the damage. For minor chips and blemishes, a combination of bonding and “disking” may be the perfect fix. This process is virtually drill-less and conserves as much tooth structure as possible. You may be surprised to see what we can achieve without a crown or veneer!

For teeth with larger blemishes, or those missing a substantial amount of structure, we will often elect to utilize a crown or veneer. Cosmetic veneers are usually placed on anterior (front) teeth to modify their appearance. Since they are cemented to only one surface, they do not add any additional structural integrity. In other words, the underlying tooth must be in good condition to receive a veneer. In contrast, crowns can be used to improve the cosmetics of a tooth that has lost a significant amount of structure.  Since crowns wrap around the tooth, they can restore shape in every dimension while adding strength and rigidity to the underlying enamel and dentin.

In any instance, the result of your treatment will be a beautiful and natural looking tooth. We pride ourselves in offering high quality cosmetic solutions, no matter what the problem. If you would like to know more about bonding, veneers or crowns, please give us a call!

Dental Questions: Why shouldn't I use mall bleaching?

If you’ve been to a shopping mall recently, chances are you walked past booths offering “professional” teeth whitening in under an hour. They are usually decorated with scientific looking instruments, comfortable chairs and big blue lights to “speed up” the treatment.  You may be tempted to try a session for a mid-day shopping break, but we suggest you take a different detour. These bleaching services may not be worth your time or money.

 Any bleaching product that will work should contain a peroxide compound. This chemical oxidizes the “staining” molecules that are stuck in the dentin layer of your teeth, turning them more transparent/white. The American Dental Association recommends that any concentration over 10% hydrogen peroxide equivalent should be administered by a dental professional, to avoid burning or damaging the gum tissue.

It is important to understand that the employees operating these booths are not dental professionals. Therefore, they cannot be administering anything stronger than a Crest Whitestrip-type product. Some may claim that they use 35% bleach-- which is true, except they are using the significantly weaker carbamide peroxide instead of hydrogen peroxide.  

In some states, these bleaching booths have been shut down for practicing dentistry without a license. In response, their employees are not allowed to actually administer any part of the whitening. They are usually only allowed to hand you a bleach tray and tell you to position the light on your own. In this sense, you’re paying the price of an entire box of over-the-counter whitening products for a single treatment!

The ADA recommends that you talk with a dentist before performing any type of whitening treatment. Although this may seem trivial, it could save you hours of pain or headaches later. Don’t be fooled by the gimmicks or convenience of mall whitening. Over-the-counter products will get you real results for the same price. If you do want instant results, we provide that safely and effectively at our office. Our Zoom! whitening system is scientifically proven to lighten tooth shade in one treatment. If you would like to know more about bleaching systems, how they work, or any potential drawbacks, please call our office!

Dental Questions: Why shouldn't I use store bought nightguards?

Are all night guards the same? Not quite...

Store bought night guards, often called "boil and bite" guards are sold at almost every pharmacy and chain store nation wide. If you have problems with grinding your teeth at night (also called "bruxism"), they may seem like a great way to save your smile. Initially, these products will work as advertised, protecting your teeth from premature wear. However, inexpensive guards can create serious problems with longterm use. 

Your jaw muscles can produce a tremendous amount of force, almost 500 Newtons worth. When clenching on a store bought night guard (as you do subconsciously when you grind your teeth at night), these forces are unequally distributed: that is, you will not be biting everywhere at the same time with the same force. This uneven pressure can worsen existing headache/migraine problems or create new ones. You may be saving your teeth, but you will be creating a whole host of other problems!

A professional night guard made by a dentist is fundamentally different from a "boil and bite" night guard. Our guards are custom molded to your bottom teeth using a special clear hard acrylic. The top of the night guard is smooth and contoured so that all your top teeth touch it at the same time with the same force. It is also polished completely smooth, making it feel easy and natural to wear while sleeping. This combination of features allows you to avoid grinding your teeth at night, without introducing new headache pains. If you would like to know more about night guards, please give our office a call!

Dental Questions: What's the difference between Zoom whitening and bleach trays?

A whitening procedure performed at our office in addition to Invisalign invisible braces. 

You have probably heard of two main types of bleaching systems offered at dental offices: "ZOOM" whitening and bleach trays. While they both achieve the same results, there are some differences between the two procedures that you should take note of:

ZOOM Whitening is the name brand for Phillip's in-office bleaching system. Here, the entire "whitening" procedure is performed in our exam rooms. We use a blocking material to shield your gums and apply several layers of concentrated peroxide gel to your teeth. A special light is utilized to speed up the chemical reaction by activating the gel. Overall, ZOOM takes about an hour and twenty minutes from being seated in a chair to leaving our office. In the meantime, you will be set up with Pandora music, cable TV or Netflix movies. While this is the fastest way to whiter teeth, it is also the most likely to cause temporary sensitivity issues afterwards. 

Bleach Trays are a home whitening system that is administered and monitored by a dentist. You will need an initial appointment for a consultation and impressions of your teeth. Later that day or the following day, your new bleach trays will be ready. You then perform the actual "whitening" at home using a peroxide gel (similar to ZOOM, but lower in concentration). Typically, patients are instructed to whiten for one hour once a day for 14 days, followed by once a month as needed. This type of whitening does work slower, but usually causes less sensitivity issues and can be adjusted to your personal comfort level. 

Overall, you can see the similarities and differences between ZOOM and bleach trays. Some of our patients even combine the two procedures- that is, have one ZOOM session and bleach trays made for maintenance (done in the same visit). Since both services rely on the same peroxide gel, they can be used together for additive action. If you have any further questions on bleaching, bleach trays or other cosmetic procedures, please give our office a call!

Dental Questions: What do I do if I lose a temporary crown

Temporary crowns are not as developed or strong as permanent crowns because they are only intended to function for about two weeks. 

Fortunately, losing a temporary crown is not a dental emergency. We primarily use them as space holders until the permanent restorations are ready. Even in the span of 2 weeks, the adjacent teeth can start to shift into the area created during the crown preparation. A temporary crown maintains space for the permanent crown, along with providing some chewing function and protection for the underlying tooth. If you lose a temporary crown, call our office and we will see you as soon as possible (typically the same afternoon/ following day). Remaking or recementing a temporary crown only takes about 20 minutes and usually does not require any anesthetic. Do not try to recement the crown on your own using drug store temporary dental cements. These products come with a number of risks, including permanently lodging the crown to the tooth or irritating the gums and periodontal space. Your teeth will not move significantly in the one to two days between losing your crown and having it replaced at our office. 

Dental Questions: Are water flossers a good substitute for dental floss?

Water flossers (commonly known as “Waterpiks,” though that is a name brand) are typically marketed as being a convenient replacement for traditional dental floss. However, they can’t remove plaque and bacteria as thoroughly or completely as threaded floss. Overall, no product rivals the benefits of getting a physical object between the teeth and mechanically removing buildup. Still, a water flosser can be a great addition to your existing home care regimen. They are particularly good at removing packed-in food that your toothbrush can’t dislodge. Patients with gum disease will typically see the most benefit from a water flosser. The lowered height of gingival tissue allows the water to more effectively penetrate the periodontal space and remove debris.

Dental Questions What Causes Bad Breath

Its annoying, embarrassing and tough to avoid: many patients struggle with bad breath on a daily basis. But what causes it? Sometimes, the source is obvious- such as a flavorful meal. However, chronic bad breath can usually be traced to a weakness in your home dental hygiene regimen. Flossing daily is an excellent way to combat odorous breath, as the bacteria in your gums produce a number of foul smelling by-products. Using floss will prevent colonies from spreading, improve your gum health and keep your breath fresh. The tongue may also serve as a source of bad breath, and can be brushed daily to remove bacteria. In some cases, bad breath (particularly in the morning) can be linked to post nasal drip or gastric reflux. In both these cases, solving the underlying problem will eliminate the bad breath.

You have probably tried mouthwashes, mints, gum and even some “miracle cures” found online. Unfortunately, these aren’t permanent solutions. All these products work akin to air fresheners: they remove the smell, not the problem. If you want a lasting solution to your bad breath, make sure you are using well rounded home care. If the problem persists, do not hesitate to schedule a consultation with our office!

Dental Questions: What is a “Same Day” Crown? How Does It Work?

Same day crowns are typically made by scanning the patient's tooth, designing a crown and milling it out of a ceramic/zirconia block.

    You may have seen advertisements for dental offices offering “same day” or “same visit” crowns. These services rely on a common engineering technology called CAD/CAM (computer automated design/ computer automated milling). During this procedure, your impression is taken digitally with a 3D scanner and uploaded to a special software that designs crowns. The dentist then finalizes the crown and sends it to a milling machine. After about an hour, the completed permanent restoration is ready to be finished and delivered to the patient. 

    On paper, this treatment sounds great and you may be wondering why we don’t offer it at our office. The reality is that these same-day crown systems have some serious drawbacks that we do not want to extend to our patients. For starters, an in-office milled crown is only as good as the time invested in it. Theoretically, we could scan your tooth, use a “generic” design, mill and deliver your crown in about 45 minutes. However, for these restorations to look and function properly, they need to be digitally adjusted, glazed and sintered in an oven. When done correctly, this process can take up to 2 hours; time you may not have to wait around! We much prefer utilizing the expertise of our local dental labs. Think of it this way: can a product produced in 45 minutes by a dental office really rival something that takes a master ceramist days to complete? 

    Furthermore, the typical two week turnaround for a dental crown may seem like an inconvenience, but it actually serves a functional purpose. The unfortunate truth is that any time a dentist works on a tooth there is a (typically small) chance the nerve will become irritated and need a root canal. In the two weeks between preparing a tooth and cementing the crown, patients can usually tell if something is wrong with the nerve. Hence, we can provide a root canal before putting on the permanent crown. This can save a lot of headache in the future, particularly with the new, extremely hard zirconia crowns available. 

    Finally, using a CAD/CAM system severely limits the crown material choices available. There are no “one size fits all” dental materials (and anyone who tries to convince you otherwise is pulling your leg!). At our office, we treat each patient holistically and try to provide the best restorations for every tooth in its unique situation. There are a number of materials that these machines can’t use or can’t use well. With these milling units costing upwards of $100,000, many offices feel obligated or “locked-in” to providing CAD/CAM crowns, even when they are not the best option available. 

    As the technology currently stands, we are not comfortable offering in-office milled crowns to our patients. Our office feels that we get better results using a traditional dental lab to make our restorations. If you have any further questions or concerns on our crowns, how they are made or the materials we use, please give us a call!