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Posts for category: Dental Procedures

By Emanuel Kontos, DMD
April 30, 2020
Category: Dental Procedures
Tags: tooth pain  
WhyandHowtoSaveaDiseasedTooth

Let's say you have a diseased tooth you think might be on its last leg. It might be possible to save it, perhaps with a significant investment of time and money. On the other hand, you could have it replaced with a life-like dental implant.

That seems like a no-brainer, especially since implants are as close as we have to natural teeth. But you might want to take a second look at salvaging your tooth—as wonderful as implants are, they can't beat the real thing.

Our teeth, gums and jaws form an intricate oral system: Each part supports the others for optimum function and health. Rescuing a troubled tooth could be the best way to preserve that function, and replacing it, even with a dental implant, a less satisfying option.

How we save it will depend on what's threatening it, like advanced tooth decay. Caused by bacterial acid that creates a cavity in enamel and underlying dentin, decay can quickly spread into the tooth's pulp and root canals, and eventually threaten the supporting bone.

We may be able to stop decay and save the tooth with a root canal treatment. During this procedure, we remove diseased tissue from the pulp and root canals through a drilled access hole, and then fill the empty spaces. We then seal the access and later crown the tooth to protect it against future infection.

A second common threat is periodontal (gum) disease. Bacteria in dental plaque infect the outer gums and, like tooth decay, the infection quickly spreads deeper into the root and bone. The disease weakens gum attachments to affected teeth, hastening their demise.

To treat gum disease, we manually remove built-up plaque and tartar (hardened plaque). This deprives the infecting bacteria of their primary food source and “starves” the infection. Depending on the disease's advancement, this might take several cleaning sessions and possible gum surgery to access deep pockets of infection around the root.

Because both of these treatment modalities can be quite in-depth, we'll need to assess the survivability of the tooth. The tooth could be too far gone and not worth the effort and expense to save it. If there is a reasonable chance, though, a rescue attempt for your troubled tooth might be the right option.

If you would like more information on whether to save or replace a tooth, 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 “Save a Tooth or Get an Implant?

ASmileMakeoverDependsonBalancingTechniquewithBeauty

“Redesigning” a smile is a lot like remodeling a house: the technicalities of construction must blend seamlessly with what is perceived as elegant and beautiful. The first aspect — the proper materials and techniques to achieve a sound restoration — is absolutely crucial. But the aesthetic is just as important for assuring the final restoration evokes beauty and style.

Balancing these two aspects of a smile makeover requires thoughtful intent and planning. What may be pleasing aesthetically may not be technically feasible; but what may be technically sound may not have that sought-after “curb appeal.”

You and your dentist must work together to achieve the successful blending of these two aspects. That’s why it’s important for you to have full confidence in your dentist: that he or she is both technically skilled and experienced in cosmetic procedures and artistically aware of what will look best aesthetically.

The first step in your makeover is a thorough dental examination to determine the overall state of your oral health. With this “bigger picture,” your dentist will have a better understanding of what’s possible and practical for you and your situation. The exam may also reveal problems that should be treated first before any cosmetic work.

From there, you must communicate clearly to your dentist what you perceive as wrong with your smile and what you would like to have changed. While there are general principles of beauty best followed, your dental work could hypothetically take different paths depending on your desires and expectations. You might prefer a more “sexy” look or one that’s “sophisticated.” Or perhaps you only want subtle changes that still retain features expressing your individuality.

Ultimately, though, your expectations must line up with reality. Much like your house contractor, your dentist will advise you on what’s both practical and possible. And with their experience in smile enhancement, they can also help you determine what will look most attractive given your facial structure and features.

With this preliminary planning, you can be confident as the work proceeds that the end of the project will be both exciting and satisfying. And just as with your newly renovated home, you’ll be more than happy to share your smile with others.

If you would like more information on enhancing your smile through cosmetic dentistry, 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 “Beautiful Smiles by Design.”

By Emanuel Kontos, DMD
March 31, 2020
Category: Dental Procedures
Tags: wisdom teeth  
RemovingWisdomTeethnowmayPreventDentalProblemsLater

Teeth damaged by decay, periodontal (gum) disease or trauma are often removed (extracted) if they’re deemed beyond repair. But there’s another reason we may recommend an extraction: a tooth is causing or has the potential to cause problems for other teeth and your overall oral health.

Some of the most frequent cases of “preventive extraction” involve the third molars, or wisdom teeth, located in the very back of the mouth. They’re usually the last permanent teeth to come in, which is related to some of the problems they can cause. Because they’re trying to come in among teeth that have already erupted they don’t always erupt properly, often at abnormal angles or not fully erupting through the gums, a condition called impaction.

Impacted or misaligned wisdom teeth can put pressure on adjacent teeth and their roots, which can cause root resorption that damages the second molar. They can also increase the risk of periodontal (gum) disease in the gum tissues of the second molars, which if untreated can ultimately cause teeth and bone loss.

Because of current or possible future problems with wisdom teeth, we often consider removing them at some early point in the person’s dental development. Such a consideration shouldn’t be undertaken lightly, since wisdom teeth extraction is often complex and fraught with complications, and it usually requires a surgical procedure.

That’s why we first conduct a comprehensive examination (including x-ray or other imaging to determine exact location and possible complications) before we recommend an extraction. If after careful analysis an extraction appears to be the best course, we must then consider other factors like planned orthodontics to determine the best time for the procedure.

Once performed, a wisdom tooth extraction can resolve existing problems now and reduce the risks of gum disease or malocclusions in the future. When it comes to wisdom teeth, removing them may be in your or your family member’s best interest for optimal dental health.

If you would like more information on wisdom 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 “Wisdom Teeth.”

By Emanuel Kontos, DMD
March 21, 2020
Category: Dental Procedures
Tags: fillings  
DentalAmalgamContinuestobeaDurableandSafeToothFilling

Recently, a number of new filling materials that mimic tooth color have come into popular use and, so far, have proven more durable than past versions. Even so, the traditional metal-based dental amalgam remains a viable choice, especially for less visible back teeth and their higher biting forces.

Used for more than a century, dental amalgam is a metal alloy composed of silver, mercury, tin and copper. The mixture is carefully proportioned so that potentially hazardous mercury is kept to a minimum and bonded with the other metals. Amalgam in its initial form is quite pliable so that it can be molded into the tooth structure under repair. Afterward it sets hard to form a durable filling that can withstand the daily force generated when we bite and chew food.

Besides durability, dental amalgam rarely causes an allergic reaction in a patient, and it’s easy for trained dentists to apply. On the downside, however, it can cause temporary temperature sensitivity in the tooth just after filling, and the tooth itself may require some removal of healthy structure to help keep the filling in place. And from an aesthetic point of view, its metallic appearance is considered unattractive especially for front teeth.

The presence of mercury in amalgam has also raised concerns over the years. “Free” mercury — atoms that escape through vapor emitted by the metal — can enter the bloodstream and potentially harm the nervous system. But after extensive study and research, U.S. and international health bodies including the American Dental Association have concluded any free mercury released during chewing is extremely low and well below any harmful levels. These studies have also found no ill effects in either children or adults with dental amalgam fillings.

Deciding on the type of filling material to use — dental amalgam or a newer composite resin, resin ionomer or glass ionomer — depends on a number of factors including the location of the teeth to be filled, the extent of decay and your personal preferences. Taking these into account, we’ll be happy to discuss which type of filling will suit you best for repairing decayed teeth.

If you would like more information on filling material options including dental amalgam, 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 “Silver Fillings — Safe or Unsafe?

By Emanuel Kontos, DMD
January 21, 2020
Category: Dental Procedures
LadyGagaWasntBornThisWay

Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"

"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.

The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.

Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.

Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).

The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.

Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.

So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.

If you have questions about orthodontic treatment, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Orthodontics For The Older Adult.”