Although dental disease prevention has made great strides over the last century, tooth decay and periodontal (gum) disease continue to pose a major health threat. People who’ve lost all of their teeth (edentulism) or most of them suffer the most with adverse effects on their overall health, function and appearance.
Removable dentures have been the traditional and most affordable means to treat edentulism. But even with material and construction advances in recent years, dentures can still lose their fit over time as the bone in the jaw shrinks. This happens because the bone no longer has the stimulus of natural teeth and older cells can’t be replenished at a healthy rate; the continuing compression of traditional dentures on the jaw’s bony ridges compounds the problem.
As the bone shrinks the dentures become loose and uncomfortable to wear. Among other results, this poor fit can drastically affect how you eat: studies of denture wearers have found a decrease in their diet’s nutritional value because they’re eating fewer vegetables or fibrous, “chewy” foods and more foods with refined carbohydrates and fats that are easier to eat but less nutritious.
There is an alternative, though, that might slow bone loss and provide a better long-term fit: an overdenture supported by dental implants. With this appliance, a few implants are strategically installed in the upper or lower jaw. Matched attachments securely fasten the denture to the implants. In this case, the implants not the jaw ridge and gums support the denture thereby preserving the bone.
If you’re healthy enough to undergo a tooth extraction, you should be able to handle implant surgery, a minor procedure usually performed with local anesthesia and with little to no discomfort afterward. It may even be possible to retrofit your current denture to work with the implants, but that will need to be determined during the planning stages.
Although more expensive than a traditional denture, overdentures are much more affordable than fixed restorations stabilized with implants. The difference, though, is the increase in your quality of life — for better nutrition, physical health and social confidence.
If you would like more information on treatment for teeth loss, 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 “Implant Overdentures for the Lower Jaw.”
You've seen ads for “Teeth in One Day” that promise immediate implant placement at the same time you have the problem tooth removed. But this presumes the gums and underlying bone are healthy and able to support and protect the implant. If that's not the case, it may be ill-advised to place an implant on the same day.
Even with immediate placement, there will be a small degree of bone and gum opening or space around the implant after it's placed into the socket. This can often be remedied by placing a bone graft and sometimes a gum graft when we install the implant. It's also possible for natural healing to gradually fill in the space, but we'll need to monitor the site carefully for several weeks.
On the other hand, if we detect significant bone loss (or strongly suspect it will occur), immediate placement may not be an option — there's not enough bone or it's too weak to support an implant. In this case, it's necessary to wait on placement and focus on improving the bone health and quantity, beginning when we remove the old tooth and place a bone graft.
After completing the extraction, we typically place a bone graft in the empty socket. The graft will become a “scaffold” for new bone cells to grow upon. We may then allow about two to four months for new bone to partially replenish the area and then place the implant. The bone will continue to regenerate as it grows and attaches to the titanium implant to create a solid attachment.
If the site, however, still appears fragile even after partial bone growth, we may opt to wait another two to four months before attempting placement. From a long-term perspective, this is the best scenario for ensuring a durable foundation for the implant. It also allows for a socket severely compromised by disease to heal more thoroughly.
To determine which of these placement scenarios is best for you, we'll first need to conduct a thorough dental examination. From there we'll be in a better position to discuss the right implant timeline for your situation. Our main goal is to ensure we can securely place your implant in just the right position to achieve the most successful and attractive result.
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 “Implant Timelines for Replacing Missing Teeth.”
Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.
Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.
Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”
Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.
There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.
So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.
Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”
If you have questions about cosmetic dentistry, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Magic of Orthodontics.”
Daily personal care is essential for optimal oral health. Brushing and flossing in particular keep bacteria and acid, the main causes of dental disease, at manageable levels. But to gain the most benefit from your personal care, you need to perform these tasks effectively with the proper techniques and equipment.
For most people brushing begins with a soft-bristled, multi-tufted toothbrush with fluoride toothpaste that helps strengthen enamel. You should hold the brush at a slight angle and brush with a gentle motion to remove plaque, the main cause of gum disease and tooth decay — if you’re too aggressive by brushing too hard or too long, you could damage the gums. You should brush no more than twice a day for two minutes, and at least thirty minutes to an hour after eating to allow saliva time to neutralize any remaining acid and help restore minerals to enamel.
Although some people find flossing difficult to perform, it remains an important component of daily care. Flossing once a day removes plaque from between teeth where a brush can’t reach. If you need help with your technique using string floss, we’ll be glad to provide instruction at your next visit. If you have bridges, braces or other dental restorations or appliances that make string flossing difficult, you might consider other options like floss threaders or a water flosser.
There are also dietary and lifestyle choices you can make to enhance your daily care: limit sugary or acidic foods to mealtime and avoid between meal snacks to reduce bacteria and acid in the mouth; drink water to keep your mouth moist, which will inhibit plaque buildup; and stop tobacco use, excessive alcohol consumption and chewing habits like clenching or biting on hard objects. Above all, be sure to visit us at least twice a year for cleanings and checkups, or when you notice abnormalities like bleeding gums, pain or sores.
Keeping your teeth and gums healthy can be done, but it requires a daily care commitment. Performing these hygiene habits in an effective manner will help preserve your teeth for a lifetime.
Your gums not only support and protect your teeth they also help present them in a visually attractive way. But some people’s gums seem to stand out too much — what’s commonly called a gummy smile — which diminishes their smile appeal. There’s no precise definition, but as a rule of thumb we consider a smile too gummy if four or more millimeters (about an eighth of an inch) of the gums show.
Fortunately, there are some techniques to improve a gummy smile. Which technique is best for you, though, will depend on why the gums are prominent — and causes vary. For example, you could have a gummy smile because your teeth appear too short compared to your gums.
Permanent teeth normally erupt to about 10 mm of visible length. But less than that, say 8 mm, could skew the visible proportion of gums to teeth too much toward the gums. Teeth can also appear shorter due to accelerated wear caused by grinding habits. Another cause could be the amount of upper lip rise when you smile. The lip may rise too high in a condition called hypermobility. This could reveal too much of the gums when you smile.
It’s important then to match the treatment to the cause. For example, we can enhance the appearance of shorter teeth through a surgical procedure known as crown lengthening.Â During this procedure a surgeon reshapes the gum tissues and underlying bone to expose more of the tooth’s length.
For upper lip hypermobility, we can restrict movement with Botox, a drug that paralyzes tiny parts of the involved muscles. This approach, though, will wear off in a few months — a more permanent solution is surgery to reposition the muscle attachments so as to prevent excessive movement.
If you’re concerned about a gummy smile, see us for a full examination and consultation. Once we know the reason why, we can offer a solution that will make your smile more attractive.
If you would like more information on enhancing the appearance of your gums, 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 “Gummy Smiles.”
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