Archive for February, 2008

Everyone knows that they should keep their teeth clean to prevent tooth decay, or cavities.  And while this is very true, there is much more to oral health than just brushing!

Gum disease is a chronic, or long term, infection of the gums.  Gum disease can silently, usually painlessly dissolve the bone support away from teeth, causing them to loosen and eventually fall out.  Most folks wearing dentures suffered from gum disease, and now pay the price of missing teeth having to be replaced with dentures.  This disease process can be halted, but it first needs to be identified, and then positive therapy needs to be actively pursued.

In addition to causing bone and tooth loss, gum disease can affect many other systems in the body.  The gums are very vascular – there is tremendous blood supply in gum tissues.  That is good news when we remove the factors causing gum disease, because the great blood supply helps the area heal fast.  But if the factors are not removed, the large blood flow means the infection is transmitted throughout the body.  A chronic bacteremia, or long standing elevation of bacteria in the bloodstream, may cause serious damage elsewhere.  Research is showing strong relationships between certain heart diseases and gum disease.  There are also relationships between gum disease and incidence of stroke, diabetes, and complications with pregnancy. 

This high blood supply to the gums also means that some systemic problems can be noticed early in the mouth.  Earlier detection of problems can lead to a better and healthier you!  It is very important to have regular dental examinations that include periodontal measurements (evaluating gum health) and soft tissue examinations and oral cancer screenings.  It is also important that the areas in between teeth, the bone support, and the root tips be evaluated with x-rays as needed.

If you are missing a tooth, there are four options available.

Leave a gap where the tooth is missing. This is often not a great option, because other teeth will try to shift into the gap left where the tooth used to be. This may mean that teeth behind the gap tip forward, then when biting the forces are not aligned with the long axis of the tooth, they tend to tip it further. When biting forces are then applied “sideways” to the tooth, it may fail. It is also harder to clean under a tipped tooth, so more likely to get decay or gum disease. Teeth above or below a gap may try to “grow into” the gap, again causing imbalance in the bite and more possibility of decay and gum disease. With teeth missing, other teeth have to do more than their share of the work, setting them up to fail sooner. And one final problem with leaving a gap… it usually doesn’t look very good!

A removable partial denture. This is a denture made to hug onto healthy teeth, and replace teeth that are missing. There are often little silver colored fingers visible as they hold on to other teeth, and a thin framework in front of the tongue or over part of the roof of the mouth. It is taken out to clean it and the natural teeth. An advantage of an “RPD” is that it can replace multiple teeth with one appliance. Major disadvantages are the fact that it is removable and there is a framework to get used to inside your mouth.

A fixed bridge. When there is a strong tooth on both sides of the gap, sometimes a bridge can be placed. This involves placing a crown on each of those teeth, and building a new tooth in between them. These are then bonded in place and look and feel like natural teeth. There is no framework to get used to, and it is relatively quickly accomplished. Disadvantages would be that a bridge needs strong teeth on both sides of the gap, and the wider the gap, (the more teeth that are missing) the more complicated the bridge gets. Also, if you were ever to break a tooth that is part of the bridge, the whole bridge may need to be replaced.

A dental implant. Implants offer some real advantages – they can be placed where a tooth is missing without disturbing the healthy teeth on either side of the gap. They can be placed where there are not teeth on both sides of the gap, like the very back tooth on an arch. They can even support complete dentures, if a person has no teeth at all! Implants are gently placed in the jawbone, where they act as artificial roots to take the forces of eating and provide good looking strong teeth!

Just about two weeks ago we made some dramatic progress in a case for a young mother.  She had had really uncomfortable teeth, with large brown and black decayed areas all over her remaining teeth.  As painful as her teeth were, the biggest pain was that she could not smile!  She would continually cover her mouth with her hand, hoping people could not see how really bad her teeth looked!  We removed the decay from her front teeth, and rebuilt them with porcelain crowns and veneers, as needed.  When we finished the first appointment, she had beautiful temporary crowns and veneers, shaped and colored like we wanted the final porcelain restorations to be.  She was so excited!  She could smile freely!  She wore the temporary restorations for about 3 weeks, while the lab worked on creating her beautiful new porcelain.  When she came in to have the temporaries exchanged for the final porcelain, I asked again how she had been doing with the temps.   She said we had changed her life!  She felt more self assured, was doing better at work, and even her small children at home were happier.  She said they felt their mother was happier, and therefore they felt happier and more secure!

We continually hear stories about how people feel much better about themselves and their lives when they feel good about their smiles.  I think many people feel guilty when their teeth look bad, and the guilt permeates their personalities and affects their outlook on life.  They may be afraid others will judge them as unhealthy, unconcerned, or just grumpy and unfriendly.  When these people have their smiles restored, it seems their personalities are restored as well!  Often they dress better, groom themselves better, and are free to let their real selves show!  It is very fulfilling to see people come out of their shells; to see their true personalities set free!