Posts for category: Dental Procedures

By Smart Family Dental Care
July 23, 2018
Category: Dental Procedures
Tags: cleft lip   cleft palate  
LiporPalateCleftscanbeEffectivelyRepaired

About one American baby in 700 is born with some form of lip or palate cleft—and the percentage is even higher in other parts of the world. At one time this kind of birth defect sentenced a child to a lifetime of social stigma and related health issues. But thanks to a surgical breakthrough over sixty years ago, cleft defects are now routinely treated and repaired.

Oral and facial clefts happen because a child’s facial structure fails to develop normally during pregnancy. This causes gaps or “clefts” to occur in various parts of the mouth or face like the upper lip, the palate (roof of the mouth), the nose or (more rarely) in the cheek or eye region. Clefts can have no tissue fusion at all (a “complete” cleft) or a limited amount (an “incomplete” cleft), and can affect only one side of the face (“unilateral”) or both (“bilateral”).

There was little that could be done up until the early 1950s. That’s when a U.S. Navy surgeon, Dr. Ralph Millard, stationed in Korea noticed after reviewing a series of cleft photos that tissue needed to repair a cleft was most often already present but distorted by the defect. From that discovery, he developed techniques that have since been refined in the ensuing decades to release the distorted tissue and move it to its proper location.

This revolutionary breakthrough has evolved into a multi-stage approach for cleft repair that often requires a team effort from several dental and medical professionals, including oral surgeons, orthodontists and general dentists. The approach may involve successive surgeries over several years with dental care front and center to minimize the threat of decay, maintain proper occlusion (the interaction between the upper and lower teeth, or “bite”), or restore missing teeth with  crowns, bridgework or eventually dental implants.

While it’s quite possible this process can span a person’s entire childhood and adolescence, the end result is well worth it. Because of these important surgical advances, a cleft defect is no longer a life sentence of misery.

If you would like more information on treatment for a cleft lip or palate, 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 “Cleft Lip & Cleft Palate.”

SavingaDiseasedPrimaryToothCouldMeanBetterOralHealthLaterinLife

It’s often best health-wise to preserve even the most troubled tooth—including a child’s primary (“baby”) tooth. If that sounds like too much effort for a tooth that lasts only a few years, there’s a big reason why—if it’s lost prematurely, the incoming permanent tooth above it could erupt out of position.

Preserving a decayed primary tooth could include procedures similar to a root canal treatment, commonly used in adult permanent teeth with inner decay. However, we may need to modify this approach to protect the primary tooth’s pulp. This innermost layer plays a critical role in early dental development.

Because an adult tooth has reached maturity, removing diseased pulp tissue has little effect on its permanent health. But the pulp contributes to dentin growth (the layer between it and the outer enamel) in primary and young permanent teeth, so removing it could ultimately compromise the tooth’s long-term health.

Our goal then with a child’s tooth is to remove as much diseased tissue as possible while involving the pulp as little as possible. What techniques we use will depend on how much of the pulp has become infected.

For example, if decay has advanced to but hasn’t yet penetrated the pulp, we may remove all but a small amount of the decayed structure just next to the pulp to avoid its exposure. We may then apply an antibacterial agent to this remaining portion and seal the tooth to curb further infection.

If on the other hand the pulp has become infected, we may try to remove only the infected portion and leave the remaining pulp intact. We’ll only be able to do this, however, if we deem the remaining pulp healthy enough to remain infection-free after the procedure. If not, we may need to remove the entire pulp as with a traditional root canal. This option, though, is a last resort due to the possible effect on dentin growth and the tooth’s long-term health.

As you can see attempts to preserve a primary tooth can be quite involved. But if we can help it reach its full life span, it could mean better dental health for a lifetime.

If you would like more information on caring for primary 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 “Root Canal Treatment for Children’s Teeth.”

By Smart Family Dental Care
June 13, 2018
Category: Dental Procedures
Tags: root canal  
DontFeartheRootCanal-itCouldSaveYourTooth

Many people consider a root canal treatment to be potentially an unpleasant experience. You might even feel a few butterflies fluttering in your stomach if we were to recommend one for you.

But there’s nothing actually to dread about this common and very effective treatment. The procedure doesn’t cause pain; in fact, it most likely relieves tooth pain. What’s more, it could save a tooth that would be otherwise lost.

The name comes from narrow passageways extending from the tip of the root to the innermost tooth pulp. The pulp contains nerves and other structures once vital to early tooth development. And although they’re not as important in a fully mature tooth, those nerves still function. In other words, they can still feel stimulation or pain.

That shouldn’t be a problem with a healthy tooth. But if tooth decay invades the inner pulp, those nerves now under attack will begin firing. You’ll know something’s wrong. As bad as it feels, though, the toothache isn’t your worst problem: if the decay isn’t stopped, it can spread through the root canals to the bone that could eventually lead to losing the tooth.

A root canal treatment removes the decayed pulp tissue and protects the tooth from re-infection. We first deaden the tooth and surrounding tissues with a local anesthesia and set up a rubber dam around the tooth to protect it from contamination from the surrounding environment. We then drill a small access hole through the enamel and dentin to reach the pulp chamber and root canals.

Using special instruments, we remove all the diseased tissue from the pulp and flush out the empty chamber and root canals with antibacterial solutions. After re-shaping the root canals, we fill them and the pulp chamber with gutta-percha, a rubber-like biocompatible material that conforms well to the root canal walls. We seal the gutta-percha with adhesive cement and then fill the access hole. Later, we’ll give the tooth further protection with a custom crown.

After the procedure, you may experience short-term minor discomfort usually manageable with over-the-counter pain relievers like ibuprofen. The good news, though, is that the excruciating nerve pain from within the tooth will be gone—and your tooth will have a new lease on life.

If you would like more information on saving a problem tooth with 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.”

By Smart Family Dental Care
May 14, 2018
Category: Dental Procedures
Tags: crown lengthening  
CrownLengtheningOpensupNewTeethRestorationPossibilities

A crown — a life-like “cap” made of dental porcelain that permanently covers an existing tooth — is an effective way to restore a still-viable decayed or broken tooth’s appearance. Properly fitting the crown over the tooth requires some healthy tooth structure above the gum line.

But what if the tooth has broken down to the gum line? In this case, we would need to perform a common procedure known as crown lengthening to expose more of the tooth.

Crown lengthening is a minor surgical procedure performed with local anesthesia to numb the tooth, surrounding gum tissues and supporting bone. We first make tiny incisions inside the gum-line on both the cheek and tongue side of the tooth to expose the bone, and then carefully remove a small amount of bone from either side of the tooth; this will expose or “lengthen” the tooth. Once finished, we suture the gum tissue back into place with self-dissolving sutures against the bone and tooth.

Most procedures take only sixty to ninety minutes, and the mild discomfort afterward is usually managed with pain relievers like ibuprofen. While the gum tissues may appear to be healed after a week, we typically wait six to eight weeks to perform the final crown restoration to give the tissues time to fully mature.

Crown lengthening may not work in all situations, especially with a severely fractured tooth. In these cases, we may need to evaluate the long-term viability of the tooth and consider other restorative options. Depending on your bite, it may also be necessary to treat with orthodontics first: not only will the tooth move into a better position, but the treatment may move both the gum and bone down with the tooth. Subsequent crown lengthening will then only affect the intended tooth and not adjacent ones, resulting in a more even smile.

The first step is for us to decide after a thorough examination if you would benefit from crown lengthening. If so, this minor surgical procedure could pave the way for better mouth function and a more attractive smile.

If you would like more information on crown restorations, please contact us or schedule an appointment for a consultation.

By Smart Family Dental Care
May 04, 2018
Category: Dental Procedures
Tags: porcelain veneers  
WhatYouShouldKnowAboutVeneersforTeenagers

Porcelain veneers are a great way to enhance an unattractive smile. But are they appropriate for teenagers? The answer usually depends on a patient’s current development stage and the type of veneer used.

Veneers are thin layers of porcelain bonded to the front of teeth. But even though quite thin, they can appear bulky if we don’t first remove some of the tooth’s enamel surface. This is irreversible, so the tooth may require a restoration from then on.

This could be a major issue for teens whose permanent teeth are still developing. During this period the tooth’s central pulp is relatively large and the dentin layer not fully developed. As a result, the pulp’s nerves are often closer to the surface than in an adult tooth. This increases risk of nerve damage during veneer preparation; if nerve damage occurs, the tooth could ultimately require a root canal treatment to save it.

On the other hand, some types of veneers don’t require tooth alteration (or only very little) beforehand. These “no-prep” or “minimal prep” veneers are best for certain situations like abnormally small teeth, so we must first determine if using such a veneer would be appropriate for your teen.

In effect, we’ll need to weigh these and other factors before determining if veneers are a safe choice for your teen. That being the case, it may be more advisable to consider more conservative cosmetic techniques first. For example, if enamel staining is the main issue, you could consider teeth whitening. Although the often amazing results eventually fade, whitening could still buy some time until the teeth have matured to safely apply veneers.

Slight deformities like chipping can often be corrected by bonding tooth-colored composite material to the tooth. In artistic hands it’s even possible to create a full veneer effect with very little if any tooth preparation. How much we can apply, though, depends on tooth size, and it won’t be as durable as a porcelain veneer.

With that said, veneers could be the right solution to enhance your teen’s smile. But, we’ll need to carefully consider their dental situation to ensure their new smile remains a healthy one.

If you would like more information on cosmetic solutions for smile appearance problems, please contact us or schedule an appointment for a consultation.