Restorative Material Choices for Dental Crowns -Pros and Cons.

Innovation in dental materials over the last decade has made a number of choices available for restoring teeth with full coverage restorations. Although gold crowns, considered the gold standard have proven predictable in the long term, improvements in the beauty, strength and durability of materials like porcelain and zirconia  have made more natural looking and lifelike cosmetic restorations possible.

What is the right crown material?

Consider the following aspects to help with the decision.

Why do I need a crown?

Do I grind my teeth?

Is the restoration on a front tooth or a back tooth?

Is the tooth visible in my smile zone?

Are my teeth sensitive?

Am I allergic to any materials?

What is the long term predictability with each material option?

What is my periodontal condition?

Frequency of periodontal maintenance

Is my opposing tooth a natural tooth or restored?

If restored, with what material?

Answering the above questions will make the selection of crown material far more predictable and comfortable.

Four types of crowns are available:

Porcelain fused to Metal (PFM) is the most commonly used crown. PFM, or porcelain dental crowns, are lined by metal on the inside (See figure 2.) and shaped with tooth colored porcelain which is baked onto the metal inside, simulating the natural tooth in shape, shade and anatomy.

All Ceramic crowns are a popular esthetic choice and their strength characteristics are comparable to the strength of porcelain. With the range of ceramics currently available, ceramic crowns can be used to fabricate crowns or bridges both in the front and back of the mouth. Their esthetic qualities are the best in dentistry. Since ceramic crowns have no metal, these restorations are best suited for individuals with metal allergies or those who find the grey discoloration of a metal margin objectionable.

Gold Alloy has been used in dentistry for over 100 years and crowns fabricated in gold are still the most long lasting crowns. Other than its objectionable color in the current esthetic age, gold alloy is still most compatible in wear and other properties to the natural teeth. With good hygiene practices, good crowns usually last a lifetime and are a great choice for teeth in the back of the mouth.

Resin Crowns are the least used in dentistry but can be used in a bite that is aggressive to prevent wear of the opposing teeth. Gold crowns wear through and porcelain wear outs the opposing teeth in a heavy bite. Resin crowns do wear and roughen over time.

Cost is not significantly different for the different material (except resin) and the choice is based on what is best suited for the mouth and patient preference. Regardless of the material choice, crowns do last a long time and considered to be the most successful procedure in dentistry. Contact us today for tooth crowning in Chino CA.

Figure 1. Outside: PFM (Left) vs. Ceramic (Right) 

Figure 2. Inside: Ceramic (Left) vs. PFM (Right)  

Figure 3. Variety of Crown Materials

Gum Disease/Periodontal Disease

Some form of gum and bone disease is present in most adult mouths.

Periodontal disease is unrecognized because the condition is generally painless and slow in progression. Symptoms include red, inflamed gums, which bleed easily with brushing and flossing, bad breath and teeth becoming loose as condition worsens.

The supporting structures of the teeth including the gums and bone are termed Periodontium.

Gum and bone breakdown begins at the gum line with gingivitis and progresses to the more severe periodontitis. When oral hygiene is neglected and poor over all health is encountered, gum disease begins.

Gingivitis is a mild inflammation of the gum tissue when food deposits, dental plaque or the more calcified calculus are allowed to remain on the teeth.

Periodontitis is when food deposits, plaque and calculus continue to remain on the teeth, over time the bone begins to degenerate. This condition is termed Periodontitis.

As bone surrounding the root degenerates, teeth loosen, drift, migrate eventually leading to the loss of tooth. Proper treatment can still save most teeth.

Gum Disease Treatment Alternatives:

The success of conservative gum disease treatments rests on significant coordination and cooperation between the patient and the dental professional. Periodontal health can be stabilized with conservative treatment alone but in some cases the more invasive conventional therapy is required.

Conventional Periodontal Therapy is usually surgical. It involves gently lifting away the gum tissue from the affected teeth, removing and root planing the calcified calculus, re contouring the irregularities on the root and bone surfaces and carefully placing back and securing the reflected tissue. After a healing period and maintenance of good oral hygiene, the periodontal condition can be improved or stabilized.

Prevention of gingival and periodontal disease only requires optimal oral hygiene practices, healthy diet and a restriction on tobacco and alcohol use.

Maintenance of periodontal health may require more frequent dental hygiene visits and adherence to individual hygiene recommendations made to you by the dental professional.

Oral Health is Important to Overall Health Maintenance. Let Smile Artistry, a trusted dentist in Chino, help you achieve your best smile yet!

Visit wwwsmileartistrychino.com for additional information

Cracked teeth

A good one third of the population has a problem with clenching and grinding of their teeth.

Human teeth are subjected to enormous forces in the mouth and as a result cracking teeth is unavoidable, especially as we age. Cracked teeth are painful and can occasionally cause loss of the tooth.

To understand the various types of cracks and appreciate the variations in treatment options, a basic understanding of the tooth anatomy will be helpful

Cracks in enamel only are generally asymptomatic and require no real treatment. Almost all adults have cracks in the enamel of teeth. These are caused by eating hard foods, biting accidents, contact sports and aging. Some preventative measures include softening hard foods before biting into them and avoiding hard and brittle foods like peanut brittle, corn nuts and chewing ice.

Cracks in dentin cause sharp pain when biting especially when there is contact on the cracked portion of tooth. Contact with sweets also causes lingering pain. Cracks in dentin above the gum line are easily corrected by removing the cracked portion of tooth and placing a crown covering the tooth including the cracked defect.

Cracks in dentin extending below the gum line require a surgical modification of the surrounding bone away from the fracture line and a subsequent placement of crown. This combination of treatment can become questionable if crack extends deep down into the root surface, especially when exact extent of crack cannot be determined. Tooth removal and replacement with implant or bridge can be an alternative.

Cracks into pulp can be very painful and usually need immediate attention. Conservative treatment options are of limited value and generally involve removal of tooth and replacement with a bridge, implant or removable prosthesis. Sometimes, a root canal therapy is performed and root temporarily restored and observed for several weeks and if asymptomatic, restored with a more permanent crown. If pain persists, an extraction becomes necessary.

Only superficial cracks can be left with no treatment. Most cracked teeth require treatment as soon as pain is experienced. Early treatment can mean less invasive and less expensive treatment. 

If you are concerned about a fracturing or a cracked tooth, feel free to call our office for a no obligation 10 minute consultation. Call 909 627 6699 or visit www.smileartistrychino.com

FREE SMILE MAKEOVER!

NOMINATE SOMEONE FOR A FREE SMILE MAKEOVER!

Dr. Cherukuri and her Team at Smile Artistry Chino Valley will change the life of one very lucky Chino resident. We are searching for a Chino resident deserving of a complimentary smile makeover (up to $2,000).The nominee can be a friend, family member, or even yourself.To nominate someone please submit a photo of the person showing their teeth and full smile. You will also need to provide a brief (100 words or less) explanation on why your nominee deserves a new smile.

 You may submit your nomination to lovemydentist@gmail.com

Nominations will be accepted until June 3, 2016.

For additional details call Samantha at (909) 627-6699

Our Raffle Winner is...

Congratulations Diane!!! 
You are the winner of our $100 VISA Gift Card Raffle! 

Envious???

Make sure you are receiving emails from our office so you are updated about our promotions and contests. If you don't receive emails from us, but would like to, please let us know so we can add you to our newsletter recipients list. You can add your email by submitting a request to 

lovemydentist@gmail.com or you may call our office and a team member will assist you.

Office Phone Number:  (909)627-6699

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Sealants

All teeth in the back of the mouth have grooves in them. Many of the grooves are defects where the tooth did not develop properly. They may have openings into the inside of the tooth. They collect food debris and are the starting point of dental decay.

If the grooves are detected at the right time, which is soon after they have erupted and no decay has set in, the grooves can be sealed with a plastic resin or a sealant which can prevent decay from starting.

Various sealant materials are available to close the defects in the tooth before decay starts. Teeth sealants are either natural tooth colored or slightly off color for easy observation of their retention on the tooth.

Sealants are most indicated for the permanent first and second molars. First molars erupt around age six and second molars usually around age twelve. It is best to seal them within six months of their eruption. Premolars, the teeth in front of the molars; are not as prone to formation of grooves as the molars and may not need sealant protection on a routine basis. Occasionally, sealants can be considered for baby or deciduous teeth. It is not always easy to detect the onset on decay even with electronic gauging devices and therefore best to seal the permanent molar teeth as soon as they erupt as a preventative measure. Sealant placement cannot be successfully placed after the onset of decay in the tooth. Placement of teeth sealants is relatively simple and does not need the use of any anesthetic. Various isolation techniques are used to keep the tooth dry- a mild acid will cleanse the tooth and create microscopic pores to mechanically lock and retain the sealant material. Plastic is applied and hardened and the sealant is completed. Teeth sealants need to be observed at recare visits to ensure that the edges or thin area of the sealants are not worn out and if needed, they need to be repaired or replaced.

It is estimated that more than 50 % of the back molar teeth will have decay if not protected with sealants. Restoring teeth with fillings is usually more expensive and invasive than the simple placement of a sealant for teeth. Waiting to place a sealant for teeth that are fully erupted in the mouth has risks of starting decay that can be easily avoided.

Sealants for teeth are a simple, well-documented measure of protecting teeth from decay. They preserve tooth structure and reduce the cost of oral health care

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INVISALIGN

Invisalign  has revolutionized the world of Orthodontics by providing a virtually invisible, predictable and removable treatment option for straightening teeth.

Invisalign involves the use of a custom made series of aligners that gradually shift teeth into better positions in the jaws and mouth. There are no uncomfortable metal brackets to attach or wires to tighten. A new set of sequential aligners are changed every two weeks until the teeth have moved into the pre-planned desired position.

Advantages to Invisalign

Virtually invisible teeth straightening

Easy access to brushing and flossing

Less irritation to gums and cheeks

Minimal disruption to daily life activities and socializing

Attractive orthodontic option for all age groups

Disadvantages to Invisalign

Patient compliance is a huge component in the success of Invisalign treatment

Conventional treatment may work more effectively in some orthodontic cases

Discuss your best option with the dentist.

Benefits of having properly aligned teeth extend far beyond a confident and beautiful smile. Swollen, red gums are often a result of teeth crowding. Unfortunately, they are also signs periodontal disease.Properly aligned teeth allow the healthiest defense against potential periodontal problems and other overall health hazards.

Most dental insurances provide coverage for Invisalign treatment just as they would other orthodontic treatment. In addition, flexible and comfortable monthly payments are also available with Care credit and other third party financing agencies. with

Over three million individuals of all ages enjoying beautiful and confident smiles after Invisalign treatment is a positive testament of its popularity, versatility, comfort and convenience. 

Call Janice at 909 627 6699 to schedule a complimentary consultation

Visit www.smileartistrychino.com for additional practice information.

Snoring and Sleep Apnea

It is estimated that 30-50% of patients snore while sleeping- the incidence of snoring increases with age and men snore more frequently than women. Most people are unaware that there is professional help available for snoring.

A related condition, sleep apnea or obstructive sleep apnea (OSA) is a condition where the breathing space in the back of the mouth is closed off. OSA causes significant pauses in breathing and can be life threatening.

Dentists are associated with the treatment of both snoring and OSA. However, a team approach is a safe and effective means to treat these conditions. Dentists work with dental laboratories; sleep technicians and board certified sleep physicians as a team to curb snoring and sleep apnea.

Causes of snoring are partial or complete closure of airway is the cause of snoring as seen in:

Obstruction of nasal airway

Weak throat muscles

Lower jaw being too far back closing off throat

Sleeping posture- sleeping on back causes closure of breathing space

Fat accumulation in and around throat

Loss of muscle tone related to aging

Use of muscle relaxants including alcohol and sedative hypnotics

Snoring Effects:

Sleep deprivation

Social and marital challenges

Increased potential for heart attack and stroke

Snoring can be reduced or eliminated with relative ease but the associated condition of OSA needs more consideration. The pauses in breathing in children and adults happen between 5- 30 times an hour and causes daytime fatigue, slow reaction time and vision problems. About 15% of the American population suffers from sleep apnea. It is a serious condition that can be life threatening. Since OSA is associated with snoring, it must be addressed as part of the treatment for snoring.

Types of Sleep Apnea:

Obstructive sleep Apnea- occurs when soft tissue in the back of throat relaxes during sleep and blocks airway and causes loud snoring

Central Sleep apnea- much less common condition and occurs when the nervous system fails to signal the muscles that control breathing

Complex Sleep apnea- a combination of OSA and central sleep apneas and is associated with significant medical problems

All forms of sleep apnea often go unnoticed and can become serious when left untreated over time.

Snoring and Sleep Apnea Treatments:

Continuous Positive Airway Pressure (CPAP)

Anti snoring oral appliances / mouthpiece for snoring

Surgery

Medications

Losing Weight

Stopping Smoking

Sleeping on Side

Over the Counter Nasal Sprays

Nasal Strips or Clips

Anti Snoring Pillows

CPAPs and anti snoring devices are the most used and most successful treating options. Severity of snoring and OSA condition is measured by a sleep monitoring device to select appropriate treatment. Assuming that the OSA is not severe, sleep apnea dental appliances can easily control snoring and OSA.



Potential Side Effects of Oral Appliances:

Jaw/facial pain

Bite Changes

Tooth Pain

Jaw Joint Pain

Drooling

Dry Mouth

Sound, restful and peaceful sleep is possible. Cost of our sleep apnea dental appliances, or our mouthpiece for snoring are very minimal considering the huge benefits of sound sleep and increased productivity. 

Visit www.smileartistrychino.com for more information on our services.

Teeth Whitening

Do you want your teeth to be whiter? Whitening of teeth is universally desirable and accepted well around the world. It is the most conservative and economical option of improving your smile and self esteem.

There are almost no side effects to this process if the whitening is carried out properly. There can however be too much whitening. A good rule to gauge an adequate white is to match to the shade of white in the eyes.

Some patients also experience sensitivity following whitening but this usually goes away within a few days.

Some tooth shades respond better to whitening than others do.

Discoloration due to a pulp breakdown does respond initially to whitening but the discoloration tends to return over time.

Internal tooth discolorations during tooth development in childhood can often be lightened with some degree of success.

Florosis (excessive floride) can be resistant to significant shade changes but can be aided by whitening

Staining of teeth from a diet comprised of dark color foods such as coffee, tea or chocolate is very easily removed.

Discolorations as a result of aging also noticeably respond to whitening.

Options for teeth whitening:

Veneers and Crowns are a great alternative when the internal discoloration in teeth is significant and whitening is unlikely to significantly lighten the shade. The restorative alternatives are more expensive and extensive but can also correct decay, misshapen and mal positioned teeth.

Bonding is the process of adding a thin layer of resin material over the surface of the tooth to improve shade and minor defects on the surface of the tooth. Although less expensive than a veneer or a crown, bonded restorations can significantly improve esthetics but may discolor over time needing replacement.

At Home Whitening This widely used and hugely successful whitening technique is the most popular one in dentistry. A flexible tray is custom made for your mouth. After adequate instructions are given by the dental staff, you are given hydrogen peroxide to take home with you. Each day you will place a small amount of material into the tray and seat in the mouth for various lengths of time as instructed. The progress is monitored by the dental staff to avoid unwanted effects. Several days later, a significant whitening of teeth is observed. There may be slight sensitivity with the procedure, which goes away in a couple of days.

In Office Whitening is a supervised whitening which takes place within the office. In office whitening uses higher concentrations of hydrogen peroxide compared to at home whitening. The major advantage to doing in office whitening is the result is accomplished much faster but the disadvantage is that there could be more tooth sensitivity because of the rapid pace of whitening. De sensitizers can be applied to the sensitive areas to reduce post -whitening sensitivity.

Cost is moderate for both the options.

A wide range of whitening products are available over the counter (OTC) that produce varying degrees of results. Some work better than others and depend on the degree and the nature of discoloration. In general, OTC products are less effective than the dentist supervised products. Do seek dental professional guidance in selecting the best OTC whitening products to help maintain a shade that blends with your natural teeth and dental restorations. OTC products however, do not have the predictability of professional whitening.

Some degree of whitening is reversed within days of the whitening procedure and stabilizes within a couple of weeks and only slowly progresses towards a darker color overtime. The whitening process may need to be repeated within a year and sometimes months.

Visit www.smileartistrychino.com for details or call 9-09 627 6699 for an appointment.

Snap ON Smile

Is a great smile make- over option that is affordable, easy, reversible and painless that can be used as a temporary or a more permanent enhancement.

Snap on Smiles offer an excellent alternative for missing, crooked, stained or discolored teeth, teeth with spaces where implants, bridges and other restorative alternatives are not an option.

Snap on smile is also a comfortable and affordable alternative to patients unhappy with the fit and feel of a removable partial denture.

Snap on Smile is manufactured using a proprietary dental resin that is thin, yet strong. The processing starts with taking precise impressions of the upper and lower jaw with instructions to the lab of the desired shade and other characteristics of the desired restoration. A second appointment about three weeks following the impression visit is for seating of the Snap on Smile.

Snap on Smiles can be made for upper or lower teeth and have proven to be a life changing and confidence building alternative to the more expensive and invasive restorative options. Maintenance is simple with some specially formulated cleaning and disinfecting solutions. 

Call 909 627 6699 for a free consultation of visit our website for more information www.smileartistrychino.com

MINI IMPLANTS or Small Diameter Implants

Dental Implants are small metal screws that are surgically placed in the bone and are considered the most important innovations in the history of dentistry. 

Many denture patients have difficulty holding their dentures securely in the mouth because of reduced bone quantity. Dental implants have allowed these patients to restore a good fit and function of the dentures.

Types of dental implants:

There are many types of implants and the ones most currently used are the ones in the shape of a root of tooth. Dental implants vary in length and diameter. Small diameter implants are only 2mm in diameter.

Small implants are needed in mouths with significant bone loss where very little jaw bone is remaining to place standard implants Alternatively, patient can undergo bone- grafting to surgically enhance bone formation but many patients prefer non traumatic procedures or overall health may limit surgical intervention.

Uses of small diameter implants:

Retention of Lower complete denture

Retention of Upper complete denture

Retention of Removable Partial dentures

Anchoring Fixed Bridges

Single tooth replacement

The number of small diameter implants necessary to facilitate the above functions depends on the quality and quantity of remaining bone and needs to be addressed on an individual basis.

Advantages of Mini Implant:

Surgery is minor and usually with no complications

Simple placement

Retention of dentures is immediate

Lower cost compared to standard implant options

Almost anyone with an ill-fitting denture is a candidate for mini implants. The difference in the fit and function is immediate and is a source of instant gratification for the patient and the dentist.

Call our office at 909 627 6699  if you would like to schedule a consultation.  Visit www.smileartistrychino.com for our practice information.

Antibiotics and Dental Procedures

The mouth is packed with various strains of bacteria, which in a healthy individual maintain optimal oral health. During daily routines like chewing, brushing or flossing, the bacteria can enter the blood stream but don’t present a problem for most of us  when the immune system is healthy. In compromised health, bacteremia (bacteria entering blood stream) can cause infections elsewhere in the body.

Specific heart conditions and orthopedic implants such as artificial joints have known to be the more vulnerable sites for potential infections. 

Antibiotic prophylaxis, or preventative use of antibiotics prior to a dental visit is recommended in conditions like-

-Artificial heart valves

-History of infection of the lining of the heart or heart valves known as Infective Endocarditis

-A heart transplant

-Congenital heart conditions like Cyanotic congenital heart disease

-Defects repaired with a prosthetic device

The criteria for antibiotic prophylaxis is periodically updated by the American Heart Association and the American Dental Association depending on current research and development. Currently, the AHA recommends prophylactic antibiotics only on patients with a history of endocardial bacterial endocarditis.

American Associations of Orthopedic Surgeons in their revised guidelines no longer recommend antibiotics for patients with artificial joints.

In an abundance of caution, our office coordinates with the patient’s physician to determine the appropriate antibiotic protocol. 

Visit www.smileartistrychino.com to E mail us at lovemydentist@gmail.com

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.