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Posts for category: Dental Procedures

TheRealTruthBehindEdHelmsMissingToothinTheHangover

Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.

In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.

Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.

Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.

If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.

The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.

Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.

If you would like more information about restoring missing teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Dental Implants.”

By Don Fortner, DMD
November 02, 2019
Category: Dental Procedures
Tags: oral health   braces  
ChronicMouthBreathingCouldCreateConditionsforaPoorBite

Breathing: You hardly notice it unless you're consciously focused on it—or something's stopping it!

So, take a few seconds and pay attention to your breathing. Then ask yourself this question—are you breathing through your nose, or through your mouth? Unless we're exerting ourselves or have a nasal obstruction, we normally breathe through the nose. This is as nature intended it: The nasal passages act as a filter to remove allergens and other fine particles.

Some people, though, tend to breathe primarily through their mouths even when they're at rest or asleep. And for children, not only do they lose out on the filtering benefit of breathing through the nose, mouth breathing could affect their dental development.

People tend to breathe through their mouths if it's become uncomfortable to breathe through their noses, often because of swollen tonsils or adenoids pressing against the nasal cavity or chronic sinus congestion. Children born with a small band of tissue called a tongue or lip tie can also have difficulty closing the lips or keeping the tongue on the roof of the mouth, both of which encourage mouth breathing.

Chronic mouth breathing can also disrupt children's jaw development. The tongue normally rests against the roof of the mouth while breathing through the nose, which allows it to serve as a mold for the growing upper jaw and teeth to form around. Because the tongue can't be in this position during mouth breathing, it can disrupt normal jaw development and lead to a poor bite.

If you suspect your child chronically breathes through his or her mouth, your dentist may refer you to an ear, nose and throat (ENT) specialist to check for obstructions. In some cases, surgical procedures to remove the tonsils or adenoids may be necessary.

If there already appears to be problems brewing with the bite, your child may need orthodontic treatment. One example would be a palatal expander, a device that fits below the palate to put pressure on the upper jaw to grow outwardly if it appears to be developing too narrowly.

The main focus, though, is to treat or remove whatever may be causing this tendency to breathe through the mouth. Doing so will help improve a child's ongoing dental development.

If you would like more information on treating chronic mouth breathing, 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 “The Trouble With Mouth Breathing.”

HeresWhattoExpectBeforeDuringandAfterImplantSurgery

When you hear the word “surgery,” your first thought might be of a high-charged operating room with a surgeon operating intently as a nurse mops sweat from their brow. While there are high-stakes surgeries, most aren’t quite that dramatic.

Dental implant surgery falls into the latter category. It does qualify as a surgical procedure because we make incisions and tissue alterations for the implant. But it’s no more rigorous than a surgical tooth extraction.

Still, if you’re new to implant surgery, it’s natural to feel some apprehension about it. To calm any nervousness, here’s a rundown of what to expect before, during and after the procedure.

Pre-Planning. Implant surgery is usually a routine affair because of meticulous planning beforehand. Often, we map out the implant site using CT scanners or other high-level imaging, identifying obstacles like nerves, blood vessels and sinus cavities, verifying there’s enough bone present to support an implant. With this information we can create a surgical plan or guide for placement in the mouth to accurately situate the implant.

Site Prep. On the day of the surgery we’ll first administer local anesthesia to numb the entire work area to pain. We’ll start with a few small gum incisions to expose the bone. Then using the surgical plan or guide, we’ll create a small channel for the implant with a drilling sequence that successively enlarges it until we achieve the best fit for the implant.

Implant Placement. Once we’ve completed drilling the channel, we’ll remove the implant from its sterile packaging and install it in the channel. After we’ve made any necessary adjustments and verified proper placement with x-rays, we’ll suture the gum tissue back into place.

After the Surgery. You might experience mild to moderate discomfort afterward that’s usually manageable with over-the-counter pain relievers like ibuprofen or acetaminophen. We can, if necessary, prescribe medication if you require something stronger. We may also prescribe an anti-bacterial mouth rinse for a short time to reduce the risk of infection.

After the implant has integrated with the bone which usually takes about 8-12 weeks, we’ll install your life-like crown or restoration. Your new smile and improved dental function will be well worth the process.

If you would like more information on the process for obtaining 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 Implant Surgery.”

YourQuestforaDentalImplantMightBeInterruptedbyBoneLoss

Years ago, disease or trauma robbed you of one of your teeth. At the time you might have opted for an affordable solution, like a partial denture. But now you'd like to restore that missing tooth with a dental implant, the most life-like tooth replacement available.

That's a great decision. But there may be a hiccup along the way to your new implant: the state of the underlying jawbone. Implants need a certain amount of bone for proper placement. If not enough is present, that may cause an interruption in your plans—and that could be a real possibility if your tooth has been missing for some time.

That's because, like other living tissues, bone has a growth cycle: Old bone cells die and dissolve, while new cells form to take their place. In the jaw, the force produced by teeth during chewing helps to keep this growth process in the bone functioning at a healthy pace.

When a tooth goes missing, though, so does this chewing stimulation. A lack of stimulation can slow the growth rate for that part of the bone and its volume can diminish over time. It's possible for a quarter of the bone volume to be lost within the first year after losing a tooth.

If you've experienced that level of bone loss, we may not be able to place an implant—yet. You might still have a few options. For one, we could attempt to regenerate some of the bone through grafting. Bone material grafted into the affected area can serve as a scaffold for new bone cells to form and adhere. Over time, this could result in a sufficient amount of regenerated bone to support a dental implant.

Another possibility might be to install a smaller diameter implant like those used to support removable dentures. Because they're smaller they require less bone than standard-sized implants. They're not for every situation, though, and are best suited for situations where aesthetics isn't a priority.

To know what your options are regarding an implant-based restoration, you'll need to undergo a thorough evaluation of your oral health, including supporting bone. Depending on your situation, you may still be able to renew your smile with this premier tooth replacement option.

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 After Previous Tooth Loss.”

By Don Fortner, DMD
September 23, 2019
Category: Dental Procedures
TheBeforeDuringandAfterofRootCanalTreatments

Root canal treatments have suffered a bad rap over the years—and undeservedly. While we applaud root canal therapy for the millions of decayed teeth the procedure has saved, the worn-out cliché that it's painful still lingers on.

So, let's set the record straight: a root canal treatment doesn't cause pain, it most often relieves it. Let's look a little closer at what actually happens before, during and after this tooth-saving treatment.

Before: a tooth in crisis. Tooth decay can damage more than a tooth's outer enamel. This aggressive bacterial infection can work its way into a tooth's interior, destroying the nerves and blood vessels in the pulp, before moving on to the roots and supporting bone through the root canals. Untreated, this devastating process can lead to tooth loss. A root canal treatment, however, can stop the invading decay and save the tooth.

During: stopping the disease. The dentist first numbs the tooth and surrounding gum tissues with local anesthetic—the only thing you might normally feel during treatment is a slight pressure. They then drill into the tooth to access the inner pulp and root canals and remove all diseased tissue. Once the interior spaces of the tooth have been disinfected, the dentist then fills the empty pulp chamber and root canals with a pliable filling called gutta percha to prevent future infection.

After: preventing re-infection. With the filling complete, the dentist then seals the access hole. There may be some minor soreness for a few days, similar to the aftermath of a routine filling, which can usually be managed with over-the-counter pain relievers like ibuprofen. Sometime later, the dentist will normally finish the treatment with a new crown on the tooth. This accomplishes two things: It helps strengthen the tooth against stress fracturing and it provides another layer of protection against future decay.

Root canal treatments have an exceptional track record for giving diseased teeth a second chance. There's nothing to fear—and everything to gain for your troubled tooth.

If you would like more information on root canal treatment, 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 “Root Canal Treatment: What You Need to Know.”