Posts for category: Dental Procedures

DakotaJohnsonandHerMissingToothGapSparksOnlineDebate

Celebrities’ controversial actions and opinions frequently spark fiery debates on social media. But actress Dakota Johnson lit a match to online platforms in a seemingly innocent way—through orthodontics.

This summer she appeared at the premier of her film The Peanut Butter Falcon missing the trademark gap between her front teeth. Interestingly, it happened a little differently than you might think: Her orthodontist removed a permanent retainer attached to the back of her teeth, and the gap closed on its own.

Tooth gaps are otherwise routinely closed with braces or other forms of orthodontics. But, as the back and forth that ensued over Johnson’s new look shows, a number of people don’t think that’s a good idea: It’s not just a gap—it’s your gap, a part of your own uniqueness.

Someone who might be sympathetic to that viewpoint is Michael Strahan, a host on Good Morning America. Right after the former football star began his NFL career, he strongly considered closing the noticeable gap between his two front teeth. In the end, though, he opted to keep it, deciding it was a defining part of his appearance.

But consider another point of view: If it truly is your gap (or whatever other quirky smile “defect” you may have), you can do whatever you want with it—it really is your choice. And, on that score, you have options.

You can have a significant gap closed with orthodontics or, if it’s only a slight gap or other defect, you can improve your appearance with the help of porcelain veneers or crowns. You can also preserve a perceived flaw even while undergoing cosmetic enhancements or restorations. Implant-supported replacement teeth, for example, can be fashioned to retain unique features of your former smile like a tooth gap.

If you’re considering a “smile makeover,” we’ll blend your expectations and desires into the design plans for your future smile. In the case of something unique like a tooth gap, we’ll work closely with dental technicians to create restorations that either include or exclude the gap or other characteristics as you wish.

Regardless of the debate raging on social media, the final arbiter of what a smile should look like is the person wearing it. Our goal is to make sure your new smile reflects the real you.

If you would like more information about cosmetically enhancing your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Space Between Front Teeth” and “The Impact of a Smile Makeover.”

By Vincent J Castellano DMD
January 13, 2020
Category: Dental Procedures
Tags: dental implants   dentures  
CelebratingPaulReverePatriotandDentalCraftsman

While celebrating all that a new year brings, take a moment to remember the New Year's Day birthday of a true American patriot: the legendary Paul Revere. Ironically, he became a legend some 80 years after his midnight trek to warn colonists of approaching British troops, thanks to Henry Wadsworth Longfellow's 1861 poem “Paul Revere's Ride.” He was much better known to his fellow Bostonians as a prosperous silversmith, engraver—and “artificial teeth” maker.

That's right. Among his many business endeavors, Revere's résumé also included dental prosthetics, specifically custom dentures made of ivory. For the time, his work was state-of-the-art technology that far surpassed older tooth replacement methods.

But when we compare Revere's foray into the dental arts and today's restorations, his high quality 18th Century dentures were the proverbial “horse and buggy,” while modern denture technology seems like “supersonic transport.” Not only are today's dentures made of superior materials that are more “toothlike” in appearance, the means to create them using digital technology gives wearers a more secure and comfortable fit.

The modern denture—an appliance that replaces multiple or all lost teeth—is composed of a polymer base, usually acrylic that is colored to resemble gum tissue. Attached to this base are the prosthetic (“false”) teeth that replace those lost along the jaw. These new teeth are usually made of a durable dental material like porcelain that looks and functions like real teeth.

The basic design of today's denture hasn't changed much in the last century. What has changed is our ability to create dentures that follow an individual jaw contours much more precisely. Using the latest digital technology, we're able to obtain highly accurate impressions of the mouth to guide the manufacturing process. Fit is critically important for how dentures feel and function in the mouth. If they are too loose, they become uncomfortable and limit which foods you can eat.

If that weren't enough, recent advancements with dental implants have taken dentures to an entirely new level, beyond anything imaginable in Revere's day. We're now able to create dentures that connect or are permanently affixed to implants set within the jaw, which makes them more stable and secure. An implant-supported denture also helps prevent bone loss, a weakness of traditional dentures, causing them to loosen over time.

As amazing as they are, we wouldn't have the modern version of dentures without craftsmen like Paul Revere who helped advance the cause of dental restoration. So, lift a glass of holiday cheer this season to this hero of the American Revolution—and of American dentistry.

If you would like more information about tooth replacement restorations, please contact us or schedule an appointment. To learn more, read the Dear Doctor magazine article “Removable Full Dentures.”

By Vincent J Castellano DMD
January 03, 2020
Category: Dental Procedures
Tags: veneers  
VeneersMayNotBetheBestOptionforYourTeenagersTeeth

Just like adults, teenagers experience chipped, stained or disfigured teeth. And during a life stage where issues with appearance can be acutely painful, these defects call out for a solution.

And, there is one: porcelain veneers. These thin wafers of custom-made porcelain are bonded to the front of teeth to cover dental flaws. They’re one of the least invasive—and most affordable—methods for smile enhancement.

There is one caveat, though: The affected teeth will most likely need alteration. Veneers can look bulky when bonded directly to teeth, so we compensate for this by removing some of the surface enamel. This changes the tooth permanently, to the point that it will always require a veneer or some other form of restoration.

But although this may be a minor issue for an adult, it could pose a problem for a teenager. That’s because the pulp, the innermost layer of a tooth containing nerves and blood vessels, is larger in a younger adolescent tooth than in an older adult tooth. Because of its size, it’s closer to the tooth’s surface. During enamel reduction for veneers on a young tooth, this could lead to inadvertent nerve damage. If that happens, the tooth may need a root canal treatment to preserve it.

If the adolescent tooth needing a “facelift” has already been root canaled or sustained significant structural damage, then altering it for veneers may not be too concerning. Likewise, if the teeth are smaller than normal, the bulkiness of a veneer may actually improve appearance and not require alteration. We’ll need to examine a young patient first before making any recommendations.

There are also alternatives to veneers for improving smile appearance. Enamel staining could be enhanced temporarily with teeth whitening. Small chips can be repaired with bonded dental material, or in skilled hands be used to “build” a veneer one layer at a time with no enamel reduction. Although not as durable as regular veneers, these bonding techniques could buy time until the tooth is more mature for veneers.

Whichever path we take, there are effective ways to transform a teenager’s flawed tooth. And that can make for an even better smile.

If you would like more information on dental restorations 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.”

By Vincent J Castellano DMD
December 14, 2019
Category: Dental Procedures
TheRealTruthBehindEdHelmsMissingToothinTheHangover

Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.

In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.

Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.

Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.

If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.

The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.

Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.

If you would like more information about restoring missing teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Dental Implants.”

By Vincent J Castellano DMD
December 04, 2019
Category: Dental Procedures
StopBiteProblemsEarlyWithInterceptiveOrthodontics

Every year many parents learn their “tweenager” or teenager needs their bite corrected, often with specialized orthodontics. Imagine, though, if these families could go back in time to when their child’s poor bite was just developing to stop or slow it from forming.

Time travel may still be science fiction, but the approach suggested isn’t. It’s called interceptive orthodontics, a group of techniques and procedures performed during the early stages of jaw development. The focus is usually on getting abnormal jaw growth back on track, enough so that a poor bite won’t form.

The upper jaw, for example, may be growing too narrow, reducing the amount of available space for tooth eruption. If it isn’t corrected, teeth can erupt out of position. To correct it, an orthodontist places a palatal expander in the roof of the child’s mouth (palate). The appliance applies gentle pressure against the inside of the teeth, which stimulates the jaws to develop wider.

The expander works because of a separation in the bones at the center of the palate, which later fuse around puberty. The pressure applied from the expander keeps this gap slightly open; the body then continues to fill the widening expansion with bone, enough over time to widen the jaw. If you wait until puberty, the gap has already fused, and it would have to be reopened surgically to use this technique. Ideally, then, a palatal expander should be employed at a young age.

Not all interceptive techniques are this extensive—some, like a space maintainer, are quite simple. If a primary (baby) tooth is lost prematurely, teeth next to the empty space tend to drift into it and cause the intended permanent tooth to erupt out of place due to a lack of space. To prevent this an orthodontist places a small wire loop within the space to prevent other teeth from moving into it.

These are but two examples of the many methods for stopping or slowing a developing bite problem. To achieve the best outcome, they need to be well-timed. Be sure, then, to have your child undergo an orthodontic evaluation around age 6. If an interceptive orthodontic approach is needed, it could eliminate the need for more extensive—and expensive—treatment later.

If you would like more information on treatments to get ahead of bite problems, please contact us or schedule an appointment for a consultation.