Wisdom Teeth

Wisdom teeth are third molars that normally erupt between the ages of 17 and 21.  Since they are the last teeth to erupt into the mouth, usually at the time of young adulthood; an age associated with budding maturity and wisdom; they are more popularly known as "wisdom teeth".

Wisdom teeth, when properly positioned can add to being able to chew well but are not always necessary for optimal function.  Because of their position so far back in the mouth, they can be difficult to clean.

As we, as a society; evolve into consuming more refined foods, which require lot less vigorous chewing, the need for teeth and the corresponding jaw size diminishes. The Aborigines of Australia, supposedly still have their 42 teeth.!

 Wisdom teeth are often impacted  as a result of the discrepancy in the size of the jaws and the number of teeth.  When impacted, the third molars are trapped beneath the gum and bone and against the teeth in front of them.

 The 3 major categories of impaction are-

Horizontal Impaction or a sleeping tooth is where the third molar grows into the mouth horizontally , heading straight towards the root surface of the second molar. These teeth, unless symptomatic are best left alone.

Angular Impaction  is a third molar growing into the mouth at an angle, only partially erupting and trapping food deposits often resulting in pain, swelling  and infection. These are the teeth most likely to need removal to prevent  pain, infection and teeth migration.

Vertical Impaction is  less common and is generally found when the jaws are under developed. Often, these impactions do not cause any pain and are  discovered in dental exams with radiographs ( X rays).

Wisdom extractions can be  performed under local anesthesia and pain or anxiety- reducing medications are available when appropriate.

Teeth positions have a significant bearing on facial profile and timely removal of  impacted teeth is an important aspect of managing facial forms and dental health.

Visit www.smileartistrychino.com for information on additional services or to schedule an appointment.

Why does my filling need to be replaced?

A tooth that has decay or fractures will need either a filling or other restoration depending on the extent of decay.  Poor oral hygiene, a poor diet, gum recession or a lack of saliva can contribute to tooth decay. Para functional habits like clenching and grinding and traumatic occlusion are usually the cause of teeth fractures.

Choices of restorations

Composite filling: Is a tooth colored plasticed material that is bonded to the tooth when a small area of tooth that is decayed needs to be restored.  This is a popular option considering the capability of matching shades to the tooth, conservative prep design preserving natural tooth and affordability.

Amalgam filling: This option has fallen out of vogue because of potential mercury toxicity, silver color compromising aesthetics and the technique requiring removal of a lot of tooth structure to achieve mechanical retention. Many dental offices no longer offer this procedure.

Onlay/Inlay: Is a lab processed restoration usually chosen when a small area of the tooth needs to be restored with better seal and marginal integrity for long term success. It is a two visit procedure that entails a higher cost for lab fabrication. These can be processed in tooth colored porcelain or gold based on patient preference.

Full coverage crown: restores the entire coronal portion of the tooth and is usually indicated on endodontically treated teeth (root canal), extensive breakdown of tooth from fractures and/or decay. They are lab fabricated and also entail two visits.  Crowns can be fabricated in gold, non precious metal or various porcelains depending on patient preference, cost considerations and aesthetic demands.

 A dental filling usually lasts many years before it needs replacing. However, teeth are subject to constant stress from chewing, clenching and grinding. All of these can cause a filling to gradually wear away, chip, crack or fall out.

Reasons for replacement

Recurrent decay
Fracture of filling
Fracture of tooth
Material upgrade

Regular dental examinations are important to maintain soft tissue health, assess existing restorations and maintain bite and functionality of the mouth.  Detecting a failing filling early can reduce damage to tooth and eliminate the need for more invasive and complicated procedures.

Visit www.smileartistrychino.com or call 909 627 6699  for more information. Feel free to stop by our office on 10th street in Chino, California.

Preventing Bad Breath

Preventing and battling bad breath is essential to self -esteem. Halitosis or bad breath is an unpleasant condition that's a cause for embarrassment. Some individuals with bad breath are not even aware of the problem and interestingly, some who don't have bad breath are convinced that they do( a condition called halito-phobia).

Bacteria that reside in the mouth, especially on the back part of the tongue are primarily responsible for bad breath Teeth and dentures not cleaned properly harbor odor causing bacteria and produce the foul smelling compounds.

Certain foods like garlic and onions contribute to objectionable breath because they contain odor causing compounds that directly enter the blood stream and then transferred t the lungs where they are exhaled. Until the body eliminates these compounds, oral hygiene will only temporarily mask the odor.

Bad breath is also induced by tobacco products including cigarettes, cigars, pipes and smokeless tobacco.  These products also increase the risk for oral and lung cancer.

Dieters can experience bad breath a a result of the breakdown of reserve fat and protein for energy, releasing ketones (organic compounds) in the breath.

Dental and systemic disease are also causes of bad breath. Persistent bad breath and bad taste are warning signs for periodontal disease and may signal other medical disorders like chronic sinusitis, chronic bronchitis, diabetes, GERD ( frequent reflux of stomach contents), oral and pharyngeal cancer, liver and kidney disease.

Dry mouth is another condition associated with bad breath. Normal salivary flow cleanses the mouth and removes odor causing particles. Dry mouth occurs when salivary flow is reduced as a side effect of medications, salivary gland problems , auto immune conditions  and from mouth breathing.

TIPS for Preventing Bad Breath:

Avoid constant use of breath mints and other hard candies that temporarily mask malodor and lead to decay.

Discuss your medications with a pharmacist, physician and dentist to reduce dosage or substitute medications that cause drying of the mouth.

Adhere to dental hygiene recommendations made by dentist and hygienist.

Dental Veneers- Ceramic or Composite- What are the Considerations?

For a discolored tooth, chipped tooth, misshaped tooth or a tooth slightly out of alignment, a dental veneer may be an option.

 An explosion of dental materials and techniques have provided ample solutions to correct the condition and there are several considerations to assess to arrive at the best choice for you..

Age, cost and  durability are usually at the top of the consideration list. Location of the defect, is defect natural or acquired, oral habits, smile line, personality, occupation are other important considerations.

Veneer is a thin covering that is placed over the front of the tooth. Any stain or decay present on any additional surfaces will more likely be better served with a crown or other full coverage restorations making a veneer an inadequate choice.

The age of the patient is another important consideration. A conservative composite veneer is an excellent choice for a tooth is the developing stage. A developing smile which is constantly evolving is best fitted with a composite veneer that is economical and  can be easily modified with changes in shape, shade and configuration, unlike a lab fabricated ceramic veneer.

Ceramic veneers are thin shells made of a strong, stain resistant and durable dental ceramic. A very small amount of tooth structure is removed  to make room for a natural and ideal looking tooth form.This restoration involves more than one visit and is fabricated in the dental lab. Ceramic veneers are the most natural looking with customizable,  polychromatic shades to exactly match and compliment the adjacent teeth- an ideal option for highly visible smiles requiring a confidence boost. These are  the veneers that are highlighted in the much publicized smile make overs. A thorough understanding of the underlying design principles and identifying dental labs and technicians that are detail oriented and take pride in their creations is the key to achieving these results.

Teeth must be healthy and free of decay and active periodontal disease prior to veneer preparation. The process is irreversible once the enamel is removed.

Patients who clench and grind their teeth are not good candidates for veneers, because the thin veneers may chip or break. A plastic dental nightguard is usually recommended to help minimize the stress on the teeth.

No special maintenance is needed other than good oral hygiene each day. Avoid biting fingernails and chewing on hard objects such as pencils or ice to keep veneers well maintained.

Visit www.smileartistrychino.com or call our office at 909 627 6699 to schedule a cosmetic consultation. 

Smile, You're on Intraoral Camera

A tiny new camera allows patients to see the insides of their mouth by projecting the image on a TV monitor.  For many patients, this is the first time they have had a clear view of  the inside of their mouth. And what they are seeing is not always a pretty picture.  Many patients are surprised if not shocked by their oral condition.

An image can be worth a thousand words when motivating patients to improve their oral health.  Once an image is projected on the monitor, the dentist can easily discuss any problems and explain the treatment. 

Because oral conditions can be magnified, this method provides better visibility than direct vision.  Once on the screen, the image can be rotated, saved, printed and sent electronically to family, a specialist or submitted as supporting documentation.

Another valuable and common use of camera is helping patients make cosmetic decisions about their teeth.  The image of a patient's teeth can be projected onto the screen and manipulated to show how the person's smile might look after treatment. Patient's can get a good idea of what the recommended procedure will look like before it is even done.  

Call our office 909 627- 6699  or visit our website www.mydentistchino.com for more information.

Palliative Treatment for Frail and Older Adults (Article 4 of 4)

The goal of palliative treatment is to enhance the quality of life during a painful episode  or for someone with a terminal illness A dentist's role could greatly enhance patient comfort and quality of life as the mouth is often the first site on pain.

  The first step in  palliative oral care is establishing good communication with the patient. With a good understanding of the patient's health circumstance, conducting a thorough oral exam  and asking for symptoms, severity and frequency is very important to determine the most bothersome issue and dealing with it promptly.

The most common oral complaint is dry mouth  If possible increase water consumption or use ice chips if choking is not a concern.. Foam swabs are helpful with providing moisture although not effective for plaque removal.  The swabs can be soaked  in warm salt water or an alcoholfree mouth rinse prior to swabbing the inside of patient's mouth.
 Daily oral hygiene is essential with modifications as needed for the palliative patient. An ultra soft  small toothbrush head can be used to promote comfort.

Candidiasis or fungal infections are common in palliative patients.  Anti fungal gels can be applied if patient cannot rinse.  Dentures can be scrubbed with soap and water and antifungal gel applied on the under surface of denture.

Preserving dignity is important part of palliative care. Maintaining a satisfactory facial appearance may be important to some patients and dentures, if needed should be made.

This concludes the series on dental care for the older adults.  Call 909 627 6699  or visit www.mydentistchino.com for more information.

Treatment Planning for Frail Older Adults (Article 3 of 4)

 Treatment planning  for frail and dependent patients should meet the objectives of preventing pain and infection, maintaining function, preventing systemic complications and improving or maintaining quality of life.

Frail adults live in the community but have varying degrees of functioning limitations.Their treatment options are guided by their level of dependency- no dependency, medium dependency or high dependency status.

For medium dependency adults, the recommendation is to treat teeth conservatively. Restore carious lesions using atraumatic techniques and floride releasing restorative materials. Dentures or removable teeth replacements should be designed to facilitate hygiene and easy removal.

Dependent older adults typically live in long term care settings and are home  bound. For homebound and long term care residents, recommendations include managing discomfort and infection and performing  only procedures necessary for social interactions and normal function.

Early in the interactions with frail or dependent patients, it is important to gauge the patients ability to comprehend treatment recommendations and independently make competent decisions. Patient's financial resources, general health, cognition and  capacity for home care must be taken into account. The benefit from the proposed treatment must be weighed very carefully against the physical discomfort and mental anguish a particular patient may experience.  The focus is to address the patient's primary concern.

For more information call 909 627 6699 or visit www.mydentistchino.com