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!

Dental Questions: Can Any Tooth Be Replaced With An Implant?

Here, you can visualize how important bone space is in placing an implant. 

In theory, an implant could take the place of any tooth position in the mouth under ideal conditions. However, not every tooth will be a good candidate for replacement with an implant. The main limiting factors are space, bone size and bone health. For an implant to function properly, there needs to be enough distance between the adjacent teeth so that it can be placed without damaging the roots (which would necessitate both the implant and the tooth to be removed). Additionally, there needs to be ample bone height for the implant to sit in and integrate. This becomes a particular problem on the upper jaw, where the maxillary sinuses can encroach on potential bone space. Finally, the bone needs to be completely healthy. Patients with bone density disorders, recent infection or a history of taking certain medications may not be eligible for an implant. 

While we can accommodate a number of conditions with special implant shapes and grafting, there are some instances where placing an implant would be unpredictable or dangerous. In any case, a proper examination (with x-rays) is the only way to determine if you are eligible for a dental implant. If you would like to know more about implants, when we can place them and if you are eligible, please call our office!

The Bottle Opener Implant

Warning: the above video includes footage from a dental surgery. Please be advised. 

Here is a service we WON'T be offering at our office! Salta, an Argentinean beer company, decided to support their local rugby clubs in a unique way. Players who lost teeth due to gameplay injuries were sponsored to receive dental implants. However, these were no normal implants. As you can see in the video above, the players' new teeth incorporated working bottle openers- a truly wild idea! While the procedure is "questionable" at best, it does underline the importance of mouth guards and dental safety in contact sports. Implant or not, we never recommend trying to open a bottle (or anything else) with your teeth! 

Dental Library Review: My Tooth is Loose!

Welcome to The Dental Library Review! In this feature, we will be reviewing and highlighting different children’s books we have collected at our office. Our staff have personally used these books with their own children and have had great reception. Today, we will be going over My Tooth is Loose! by Martin Silverman and Amy Aitken. 

This book follows Gorgie, a young boy with a loose tooth. Unsure of what to do with this discovery, Georgie consults his friends. They offer him a number of options on removing the tooth, ranging from eating an apple to tying a string around it. He is unsatisfied with their answers and decides to ask his Mom. She assures him that if he leaves the tooth alone, it will come out on its own. 

Our office recommends this book because it helps ease concerns about loose teeth and what to do with them. Children can have all types of wild ideas on how to remove loose teeth, some of which can be potentially dangerous. It is best to let the teeth loosen and come out on their own. 

My Tooth is Loose! is a Penguin Young Readers level 2 book. As such, it features large pictures, simple sentences and context clues. If you would like to know more about this book or any other books we have at our office, please stop by! We love getting our patients and their children excited about oral health topics!

Dental Questions: Can Sensodyne Pronamel Rebuild Enamel?

Unfortunately, there are no products that can “rebuild” dental enamel in the traditional sense. Our teeth do not have biological mechanisms that will allow them to create more enamel or to integrate new enamel. Any product that advertises otherwise will not be able to live up to its claims.

The enamel in our teeth is essentially a crystal made from calcium, phosphate and other minerals. When we consume acidic foods and drinks, the low pH causes the crystal to demineralize and become softer. This process can be further intensified by the cavity causing bacteria in our mouth. With time, this demineralization and constant acid exposure leads to permanent loss of enamel structure.

What Sensodyne Pronamel can do is remineralize the softened enamel. It contains a therapeutic dose of fluoride, which is extremely beneficial in restoring mineral content, slowing decay and protecting against future acid exposures. It is important to note that any mainstream toothpaste will have therapeutic levels of fluoride and will provide similar results. The most important factor is that you are using a fluoride toothpaste twice a day for two minutes, along with daily flossing.

New Water Fluoridation Levels

You may have seen articles around the Internet noting that the United States Department of Health and Human Services recently lowered their recommended levels for drinking water fluoridation. At first, this may seem like a startling headline. Why would they need to lower their recommendations? Were the levels unsafe before? In reality, there is no reason for concern. The levels of fluoridation in the United States have always been at a safe and therapeutic value.

Previously, the DHHS recommended that fluoride levels were kept within a range between 0.7-1.2 milligrams per liter of water. Under the new guidelines, fluoride levels should be calibrated to a set value of 0.7 milligrams per liter. This change reflects improvements in dental public health services and the increased prevalence of fluoride toothpaste use across the United States. As more and more people (mainly children) are actively using fluoridated dental products, the need for fluoride in water is lessened.

At the current (and historic) levels of fluoride in drinking water, the main concern is the development of fluorosis. Fluorosis is the appearance of white marks or lines on teeth as the result of excessive fluoride exposure during the first 8 years of life. While this may sound alarming, have no fear. Fluorosis is a purely cosmetic condition. In actually, it was difficult to develop this condition before the new guidelines, and will be even tougher now. It is also important to note that the United States has never recommended fluoridation levels that could  lead to toxicity.

Fluoride has been an invaluable tool in providing large populations increased protection against tooth decay. As such, the CDC has named community water fluoridation as one of the Ten Great Public Health Achievements of the 20th Century. If you would like to know more about fluoride, its safety, or how it works, please call our office. We are always happy to keep our patients educated on current events in dentistry!

Happy Mother's Day!

Happy Mother's Day! We hope everyone got to spend this special day with their beloved moms and/or children. Pictured here is Dr. Kari herself at 7 months old. She's sitting in her great grandmother's lap, joined by her mother (center) and grandmother (far left). Four generations of awesome moms in one picture!