Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
Losing teeth will certainly disrupt your otherwise beautiful smile. It could also potentially affect your food choices and whether or not you receive proper nutrition.
But something else just as consequential could be happening beneath the surface of your gums—you could be losing bone. Significant bone loss in the jaw could adversely affect remaining teeth and facial structure, as well as limit your future restoration choices.
To understand why this occurs we must first consider what bone is: living, cellular tissue. Like the body's other cells, bone has a life cycle: cells form, live and eventually dissolve (or resorb), and are then replaced by new cells. Stimulation from forces generated during chewing traveling up through the tooth roots to the jawbone keep this cycle going at a healthy pace.
But when a tooth is missing, so is this stimulation. This could slow the replacement rate and cause bone volume to gradually decrease. The jawbone width could decrease by as much as 25% the first year alone and several millimeters in height after just a few years.
Although dentures (a popular and affordable choice) can restore lost function and appearance, they can't duplicate this needed stimulation. They even accelerate bone loss by irritating and creating compressive forces on the bony ridges and the gums they rest upon.
One restoration, however, can actually help stop bone loss and may even reverse it: dental implants. This happens because an implant's metal titanium post imbedded in the jawbone attracts bone cells to grow and adhere to its surface. This could actually increase bone density at the site.
To gain this advantage, it's best to obtain implants as soon as possible after tooth loss. If you allow bone loss to occur by waiting too long, there may not be enough to properly support an implant. Even then it might be possible to build up the diminished bone through grafting. But if that's not possible, we'll have to consider a different restoration.
To determine the condition of your bone after losing teeth, visit us for a complete examination. Afterward, we'll be able to discuss with you the best way to address both your overall dental health and your smile.
If you would like more information on treating missing teeth, 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 Hidden Consequences of Losing Teeth.”
Your gums can take a lot — they’re resilient and they endure a variety of abrasive foods over a lifetime. But resilience isn’t the same as invulnerability: your gums can be weakened by periodontal (gum) disease or by over-aggressive brushing that causes them to shrink away (recede) from the teeth they protect.
Unfortunately, it’s not a rare problem — millions suffer from some degree of gum recession, caused mainly by gum disease. This aggressive infection arises from bacteria in dental plaque, a thin film that builds up on tooth surfaces due to inadequate oral hygiene. Fortunately, gum disease can be effectively treated in its early stages by removing plaque above and below the gum line. Diseased gums will quickly rebound to their normal health.
Unfortunately, though, heavily recessed gums from advanced stages of gum disease (as well as those who’ve inherited thinner gum tissues and are more susceptible to recession) may not come back fully without help. This can affect the health and survival of affected teeth, as well as your appearance.
Plastic periodontal surgery can help restore these lost tissues. There are a number of procedures that can be used depending on the exact nature of the recession, and most involve some form of tissue grafting. A specimen of donated gum tissue (either from another portion of the patient’s gums or a thoroughly cleansed and properly processed donation from another person) is surgically attached to the gums at the recession site.
The graft can be completely freed from the harvest area or in some cases a part of it remains attached to receive blood supply while the rest is grafted to the site. These procedures, especially the latter, require meticulous skill and sophisticated microsurgical techniques to make an effective attachment. If the tooth root is involved, it must be thoroughly prepared beforehand through polishing and decontamination to ensure the new graft will take. The graft is sutured in place and sometimes covered with a moldable dressing for protection.
As the area heals, the tissues begin to grow around the graft, restoring better coverage for the tooth. Coupled with comprehensive gum disease treatment, this form of plastic surgery can restore new health to teeth and a transformed smile.
If you would like more information on treating gum recession with plastic surgery, 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 “Periodontal Plastic Surgery.”
We’ve developed a number of effective treatments for periodontal (gum) disease. Depending on how far and deep a patient’s infection has advanced, treatment can be quite invasive and even require surgery. The more invasive, the longer and more uncomfortable the healing process can be.
But using a medical laser could make that less so. Although its use for gum disease treatment is still in its infancy, the latest observations from the field seem to show patients undergoing laser treatment may have less tissue trauma and bleeding, less discomfort after the procedure and quicker healing times.
Gum disease is a bacterial infection mostly caused by dental plaque, a thin film of food particles that build up on teeth in the absence of effective oral hygiene. The infection can advance deep below the gum line, weakening gum attachment to teeth and destroying supporting bone. Ultimately the affected teeth can be lost.
Traditionally, the only way to stop the disease is to manually remove plaque buildup on teeth and gum surfaces, which is continuing to sustain the infection, with special hand instruments called scalers or ultrasonic equipment. Because it’s important to remove as much plaque and diseased tissue as possible, we may need to perform a surgical procedure called flap surgery to move some of the gum tissues out of the way to get to these deeper areas. As with any surgery, this can create tissue trauma that may cause discomfort during the healing process.
Our new alternative is to use an Nd:YAG medical laser in a procedure known as Laser Assisted New Attachment Procedure or LANAP. With light energy delivered through a small fiber no more than the width of three human hairs, the laser can pinpoint diseased tissue and destroy bacteria through intense heat. Because of the laser beam’s tiny width and pulsing action, healthy tissue is at less risk for trauma than with the traditional treatment.
Coupled with other techniques, LANAP procedures could remove as much infected tissue and plaque as traditional methods, but with less healthy tissue trauma. In the future, then, patients with advanced gum disease undergoing laser treatment could have less bleeding and discomfort and faster healing times.
If you would like more information on treating gum disease, 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 “Treating Gum Disease with Lasers.”
While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.
“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.
Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.
Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).
For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.
Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.
If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”
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