Posts for category: Dental Procedures

By Vincent J Castellano DMD
May 28, 2019
Category: Dental Procedures
CrazyLittleThingCalledHyperdontia

The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.

The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.

Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces).┬áSome people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.

Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.

After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.

Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.

If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”

ConsideranEffectiveandAffordableRPDforTeethReplacement

If you have a few missing teeth but can't afford dental implants or fixed bridgework, consider a removal partial denture (RPD). Although implants may be the superior choice aesthetically and functionally, an RPD can still effectively give you back your teeth.

RPDs are designed to replace one or more missing teeth but not a full arch like a full denture. Considered a permanent restoration, RPDs are also more durable than transitional "flippers," denture appliances that are flexible and light enough to be flipped out of the mouth with a flick of the tongue.

The key to both their affordability and durability is vitallium, a strong but lightweight metal alloy most often used in their frame construction. To it we attach artificial teeth usually made of porcelain or glass-filled resins that occupy the precise location of the missing teeth on the gum ridge. The artificial teeth and frame are surrounded by gum-colored plastic for a more natural look.

Each RPD is custom-made depending on the number and location of the missing teeth. Its construction will focus on minimizing any rocking movement of the RPD during chewing or biting. Too much of this movement could damage the adjacent teeth it's attaching to and cause the appliance to be uncomfortable to wear. We can stabilize the frame by precisely fitting it between teeth to buttress it. We also insert small rests or clasps made of vitallium at strategic points to grip teeth and minimize movement.

RPDs do have some downsides: their unique attachment with teeth encourages the accumulation of dental plaque, the thin bacterial film that's the leading cause of tooth decay and periodontal (gum) disease. These diseases can affect your remaining teeth's health and stability, which could in turn disrupt the fit of the RPD. Also, too much movement of the appliance can make the teeth to which it's attached become more mobile. It's important, then, if you wear a RPD to remove it daily for cleaning (and to thoroughly brush and floss your natural teeth), and to remove it at night to give the attaching teeth a rest.

A RPD can give you back the teeth you've lost for many years to come—if you take care of it. Maintaining both your RPD and the rest of your teeth and gums will help extend the life and use of this effective and affordable replacement restoration.

If you would like more information on teeth replacement options, 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 “Removable Partial Dentures: Still a Viable Tooth-Replacement Alternative.”

By Vincent J Castellano DMD
April 28, 2019
Category: Dental Procedures
Tags: tooth decay  
YourSinusInfectionMightbeaSignofaToothProblem

Each year thousands of people develop sinus infections from various causes. But there's one cause for sinusitis that might surprise you—tooth decay.

Tooth decay begins when the acid produced by oral bacteria erodes a tooth's enamel protection to create a small hole or cavity. Left untreated, the infection can move into the inner pulp of the tooth and tiny passageways leading to the roots called root canals. The decay can then infect and break down the structure of the supporting jawbone.

This could affect the sinus cavities, hollow air-filled spaces in the upper portion of the face. The maxillary sinus in particular sits behind the cheek bones just above the upper jaw. Tooth roots, particularly in back teeth, can extend quite near or even poke through the floor of the maxillary sinus.

If decay affects these roots, the bone beneath this floor may begin to break down and allow the bacterial infection to enter the sinus. We call this particular kind of sinus infection maxillary sinusitis of endodontic origin (MSEO), "endodontic" referring to the interior structure of teeth.

While advanced decay can show symptoms like pain or sensitivity with certain hot or cold foods, it's also possible to have it and not know it directly. But a recurring sinus infection could be an indirect indication that the root of your suffering is a deeply decayed tooth. Treating the sinus infection with antibiotics won't cure this underlying dental problem. For that you'll need to see a dentist or an endodontist, a specialist for interior tooth issues.

The most common way to treat deep tooth decay is with root canal therapy. In this procedure, the dentist enters the decayed tooth's pulp (nerve chamber) and root canals and removes the diseased tissue. They will then fill the empty pulp and root canals with a special filling and seal the tooth to prevent future infection. The procedure stops the infection and saves the tooth—and if you have MSEO, it eliminates the cause of the sinus infection.

So, if you're suffering from chronic sinus infections, you might talk with your dentist about the possibility of a tooth infection. A thorough examination might reveal a decayed tooth in need of treatment.

If you would like more information on how dental problems can affect your overall health, please contact us or schedule an appointment for a consultation.

By Vincent J Castellano DMD
April 18, 2019
Category: Dental Procedures
J-LosUnluckyBreakChippingaToothonStage

Whether she’s singing, dancing or acting, Jennifer Lopez is a performer who is known for giving it all she’s got. But during one show, Lopez recently admitted, she gave a bit more then she had planned.

“I chipped my tooth on stage,” she told interviewers from Entertainment Tonight, “and had to finish the show….I went back thinking ‘Can I finish the show like this?’”

With that unlucky break, J-Lo joins a growing list of superstar singers—including Taylor Swift and Michael Buble—who have something in common: All have chipped their teeth on microphones while giving a performance.

But it’s not just celebs who have accidental dental trouble. Chips are among the most common dental injuries—and the front teeth, due to their position, are particularly susceptible. Unfortunately, they are also the most visible. But there are also a number of good ways to repair chipped, cracked or broken teeth short of replacing them.

For minor to moderate chips, cosmetic bonding might be recommended. In this method, special high-tech resins, in shades that match your natural teeth, are applied to the tooth’s surface. Layers of resin, cured with a special light, will often restore the tooth to good appearance. Best of all, the whole process can often be done in just one visit to the dental office, and the results can last for several years.

For a more permanent repair—or if the damage is more extensive—dental veneers may be another option. Veneers are wafer-thin shells that cover the entire front surface of one or more teeth. Strong, durable and natural-looking, they can be used to repair moderate chips, cracks or irregularities. They can also help you get a “red-carpet” smile: brilliant white teeth with perfectly even spacing. That’s why veneers are so popular among Hollywood celebs—even those who haven’t chipped their teeth!

Fortunately, even if the tooth is extensively damaged, it’s usually possible to restore it with a crown (cap), a bridge—or a dental implant, today’s gold standard for whole-tooth replacement. But in many cases, a less complex type of restoration will do the trick.

Which tooth restoration method did J-Lo choose? She didn’t say—but luckily for her adoring fans, after the microphone mishap she went right back up on stage and finished the show.

If you have a chipped tooth but you need to make the show go on, 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.”

By Vincent J Castellano DMD
March 29, 2019
Category: Dental Procedures
Tags: gummy smile  
YouDontHavetoLivewithaGummySmileHeresHowWeCanChangeit

A beautiful smile is a balanced smile, especially in regard to your gums. A normal smile usually shows 4 mm or less of gum tissue along with about 10 mm of tooth length. But if your gums show more than that, your smile may seem too gummy. In terms of perceived balance, this could detract from your smile's attractiveness.

Fortunately, you don't have to live with a gummy smile—there are various ways to correct or minimize its effect. First, though, we'll need to determine the underlying cause before deciding on the best treatment. And, there are several possible causes, the obvious being too much gum tissue present. Teeth that appear shorter due to wear or incomplete eruption could also make the gums appear larger.

We may be able to correct these size problems by surgically removing and reshaping excess gum tissues and possibly the underlying bone to reveal more of the teeth. We can also bond composite resins or porcelain veneers to shorter teeth to make them appear larger.

But not all gummy smile problems pertain directly to the teeth and gums; instead, it could be your upper lip moves too far up as you smile (hypermobility). Or, your upper jaw may be too long for your face, which can also cause too much of the gums to show during smiling.

With upper lip hypermobility, we may be able to inhibit the lip muscles' movement temporarily with Botox injections that partially paralyze the muscles (the effect eventually wears off, so this treatment will need to be repeated). A periodontist, an oral surgeon, or a plastic surgeon could also permanently alter the upper lip movement through a surgical procedure. Surgery may also be necessary for an abnormally long upper jaw: orthognathic surgery re-positions the jaw to the skull, which can lessen the amount of gums showing.

If your smile is too gummy, we can transform it. But first, let's find out what the real cause is with a comprehensive dental examination. Once we know, we can better advise you on the best way to bring beautiful balance to your smile.

If you would like more information on improving a gummy smile, 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.”