Posts for: May, 2019
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.”
X-ray imaging is such an intricate part of dentistry, we usually don't think twice about it. Without it, though, the fight against dental disease would be much harder.
At the same time, we can't forget that x-rays are a form of electromagnetic radiation that can penetrate human tissue. It's that very quality and the difference in the absorption rate between denser bone and teeth and softer diseased tissue that makes disease diagnosis possible.
But this same penetrative power can potentially harm the tissues it passes through. For that reason when practicing any form of x-ray diagnostics, dentists follow a principle known as ALARA, an acronym for "As Low As Reasonably Achievable." In lay terms ALARA means getting the most benefit from x-rays that we can with the lowest dose and exposure time possible.
While practicing ALARA with x-rays is important for patients of any age, it's especially so for children who are more sensitive to radiological energy given their smaller size and anatomy. We can't use the same settings, dosages or exposure times with them as with an adult.
To protect children, dentists have developed techniques and protocols that lessen their exposure time and rate, while still providing usable images for diagnosing disease. The bitewing is a good example of safe and effective pediatric x-ray imaging.
A bitewing is a plastic device holding exposable film that patients bite down on and hold in their mouth while x-raying. The x-rays pass through the teeth and gums and expose the film behind them on the bitewing. Using a bitewing we can capture a set of two to four radiographs to give us a comprehensive view of the back teeth, while exposing the child less radiation than they normally receive daily from background environmental sources.
This and other advances in equipment and digital imaging greatly reduce the amount of radiation patients receive during x-rays. If, though, you're still concerned about your child's x-ray exposure, talk with your dentist who can explain in more detail the x-ray safety protocols they follow. Just like you, they want your child to be as safe as possible while still benefiting from the diagnostic power of x-rays.
If you would like more information on safety precautions using x-rays with children, 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 “X-Ray Safety for Children.”
Teenagers and adults alike can improve their smile appearance with dental solutions like teeth whitening or orthodontics. But there are a few cosmetic solutions like porcelain veneers that are better suited for more mature teeth.
Veneers are composed of thin layers of dental porcelain that are bonded to the outside of teeth. They're kind of a tooth "mask" that hides blemishes like chips, discoloration or mild bite problems. They're often less involved and expensive than other types of dental restoration.
Even so, we usually need to remove some of the natural tooth's enamel before applying them. Veneers placed directly on unprepared teeth can appear bulky, so we remove some of the enamel to create a more natural look. And although usually only a slight amount, the alteration is permanent and will require the tooth to have some form of restoration from then on.
This usually doesn't pose a major issue for adults, but it could for a teenager's younger teeth. The nerve-filled dentin in a teenager's still developing tooth is thinner and closer to the pulp (nerve tissue) than in more mature teeth.
There's at least one situation, though, where veneers might be applied safely to a teenager's teeth without this concern. If the teen has abnormally small teeth and are receiving veneers to improve their appearance, they might not need alteration. Because the teeth are already thinner than normal, the "no-prep" veneers may not look bulky when directly bonded to them without preparation.
With most cases, though, it might be best to pursue other options that at the very least can make a cosmetic difference until their teeth are mature enough for veneers. For example, we might be able to repair chipped areas with composite resin material that we form and bond to the tooth to achieve a life-like appearance.
We can discuss these and other options for safely improving your teenager's smile. The important thing is to achieve a more confident appearance without endangering their future health.
If you would like more information on cosmetic treatments for teenagers, 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 “Veneers for Teenagers.”