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Posts for category: Dental Procedures

By Carl H. Tegtmeier, DMD
December 11, 2018
Category: Dental Procedures
Tags: porcelain veneers  
PorcelainVeneersMightnotbetheBestOptionforTeenagers

For chipped, stained, or slightly crooked teeth, dental veneers might be the ideal solution. These thin layers of porcelain bonded directly over the teeth with the perfect blend of color, sizes and shapes, can transform a person’s smile for a relatively modest cost.

But if the teeth belong to a teenager, veneers might not be appropriate. This is because in most cases, we’ll need to remove some of the tooth enamel so that the applied veneers won’t look unnaturally bulky. This alteration is permanent, so the teeth will require some form of restoration from then on.

While not usually a major issue with fully matured adult teeth, it could be with the developing teeth of pre-teens and teens. During childhood and adolescence the tooth’s inner pulp plays an important role in dentin production, and so the pulp chamber is relatively large compared to an adult tooth. This larger size places the pulp closer to the enamel surface than with an adult tooth.

Because of its proximity to the enamel, there’s a greater chance veneer alterations could damage a teenager’s tooth pulp and its nerve bundles. If that happens, we may need to perform a root canal treatment to save the tooth—also not an optimal situation for a developing tooth.

That’s why we need to take into consideration a patient’s age and stage of dental development first, including x-raying the affected teeth to measure the depth of the tooth pulp. If we deem it too risky at the moment, there are other ways to improve dental appearance at least temporarily. This includes whitening externally stained teeth with a bleaching agent, or applying tooth-colored composite resin material to chipped areas. We can also apply a composite material veneer that, although not as durable as traditional porcelain, doesn’t require much if any tooth alteration.

To know your options, have your teenager undergo a thorough dental examination. Your dentist will then be able to discuss with you whether veneers can be safely attempted. And be sure the dentist who may perform the work has experience performing cosmetic procedures on teenagers.

If you would like more information on restoration choices 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 Carl H. Tegtmeier, DMD
November 21, 2018
Category: Dental Procedures
BobbyBonesDancesHisWaytoDentalDamage

The long-running hit show Dancing with the Stars has had its share of memorable moments, including a wedding proposal, a wardrobe malfunction, and lots of sharp dance moves. But just recently, one DWTS contestant had the bad luck of taking an elbow to the mouth on two separate occasions—one of which resulted in some serious dental damage.

Nationally syndicated radio personality Bobby Bones received the accidental blows while practicing with his partner, professional dancer Sharna Burgess. “I got hit really hard,” he said. “There was blood and a tooth. [My partner] was doing what she was supposed to do, and my face was not doing what it was supposed to do.”

Accidents like this can happen at any time—especially when people take part in activities where there’s a risk of dental trauma. Fortunately, dentists have many ways to treat oral injuries and restore damaged teeth. How do we do it?

It all depends on how much of the tooth is missing, whether the damage extends to the soft tissue in the tooth’s pulp, and whether the tooth’s roots are intact. If the roots are broken or seriously damaged, the tooth may need to be extracted (removed). It can then generally be replaced with a dental bridge or a state-of-the-art dental implant.

If the roots are healthy but the pulp is exposed, the tooth may become infected—a painful and potentially serious condition. A root canal is needed. In this procedure, the infected pulp tissue is removed and the “canals” (hollow spaces deep inside the tooth) are disinfected and sealed up. The tooth is then restored: A crown (cap) is generally used to replace the visible part above the gum line. A timely root canal procedure can often save a tooth that would otherwise be lost.

For moderate cracks and chips, dental veneers may be an option. Veneers are wafer-thin shells made of translucent material that go over the front surfaces of teeth. Custom-made from a model of your smile, veneers are securely cemented on to give you a restoration that looks natural and lasts for a long time.

It’s often possible to fix minor chips with dental bonding—and this type of restoration can frequently be done in just one office visit. In this procedure, layers of tooth-colored resin are applied to fill in the parts of the tooth that are missing, and then hardened by a special light. While it may not be as long-lasting as some other restoration methods, bonding is a relatively simple and inexpensive technique that can produce good results.

If you would like more information about emergency dental treatment, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor articles “The Field-Side Guide to Dental Injuries” and “Knocked Out Tooth.”

By Carl H. Tegtmeier, DMD
November 11, 2018
Category: Dental Procedures
4SignsYourChildMayHaveaPoorBite

Although tooth decay is a major problem to watch for in your child’s teeth, it isn’t the only one. As their teeth transition from primary (“baby”) to permanent, you should also be on the lookout for a developing poor bite or malocclusion.

Although the signs can be subtle, you may be able to detect an emerging malocclusion, starting usually around age 6, if you know what to look for. Here are 4 signs your child may be developing a poor bite.

Excessive spacing. This is something that might be noticeable while the child still has their primary teeth. If you notice an excessive amount of space around the front teeth, the sizes of the jaws and the teeth may be disproportional.

Abnormal overlapping. The upper teeth normally just cover the bottom teeth when the jaws are closed. But a malocclusion may be forming if the lower teeth cover the upper (underbite), the upper teeth extend too far over the lower (deep bite) or there’s space between the upper and lower front teeth (open bite).

Different overlapping patterns. Watch as well for some of the teeth overlapping normally while others don’t, a sign of a cross bite. For example, the back upper teeth may cover their counterparts in a normal fashion while the lower front teeth abnormally overlap the top front. The roles here between front and back teeth can also be reversed.

Abnormal eruptions. Permanent teeth normally follow a pattern when erupting, but certain factors could disrupt the process. For example, a jaw that’s developed too small can cause crowding as incoming teeth vie for space; as a result, some permanent teeth may erupt out of their proper position. Likewise, if a baby tooth is out of its normal position or prematurely lost, the permanent tooth may erupt out of position too.

The good news with each of these developing bite problems is that we can correct them or at least minimize their future effect if caught early. So if you notice any of these signs or anything else out of the ordinary, see an orthodontist as soon as possible. It’s also a good idea to have your child undergo a thorough orthodontic evaluation around age 6.

If you would like more information on bite problems in children, 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 “Problems to watch for in Children Ages 6 to 8.”

By Carl H. Tegtmeier, DMD
November 01, 2018
Category: Dental Procedures
Tags: cleft lip  
CleftRepaircanRestoreaSmileChangeaLife

Oral and facial clefts are among the most common and heartbreaking of birth defects. Clefts make feeding or even breathing difficult and can affect speech development.

But there's one other profound effect: an “abnormal” face caused by a cleft can have devastating consequences for a person's self-image and social relationships.

About 1 in 700 U.S. babies are born with some type of visible gap or “cleft.” It can occur in their upper lip, soft and hard palate, nose or occasionally extending to the cheek or eye region. We typically classify clefts as “unilateral” (affecting only one side of the face) or “bilateral” (affecting both sides).  We're not completely sure on the root causes, but research so far has uncovered links with the mother's possible exposure to toxic substances, nutrient or vitamin deficiencies, or infections during fetal development.

Taking steps during pregnancy to minimize these exposures is certainly helpful. But what can be done for children born with a cleft?

A great deal, thanks to the development of surgical repair techniques over the last century. The surgical approach relies on the fact that the tissues required to repair the cleft already exist. They're simply distorted by the cleft break.

Even so, the road to restoration is a long and arduous one. Lip repairs usually take place at 3-6 months of age; palate (roof of the mouth) clefts are undertaken at 6-12 months. As the child's jaw and mouth structure develops, further surgeries may be needed to match earlier repairs with development.

Cleft repairs also require a team of specialists including a maxillofacial (oral) surgeon, orthodontist and general dentist. The latter plays an important role during the process, ensuring the child maintains good dental health through prevention and treatment of disease and dental work for at risk teeth.

The road to a normal life is difficult — but well worth it. A repaired cleft vastly improves a child's health and well-being. Moreover, it restores to them something the rest of us might take for granted — a normal face and smile.

If you would like more information on cleft defects and how to treat them, please contact us or schedule an appointment for a consultation.

By Carl H. Tegtmeier, DMD
October 22, 2018
Category: Dental Procedures
Tags: gum recession  
GraftingcanHelpRegenerateGumTissueLostThroughRecession

Gum recession — when the gum tissue covering teeth wears away — is a serious matter. If the roots become exposed you'll not only have increased sensitivity and possible discomfort, your teeth can become more susceptible to decay.

There are a number of reasons for gum recession, including overaggressive brushing and flossing, poor fitting appliances like dentures or braces, or genetics (inheriting a thin gum tissue type or poor tooth position). Perhaps the most common reason, though, is periodontal (gum) disease. Caused by bacterial plaque, a thin film of food particles that builds up on tooth surfaces, the disease weakens the gum tissues around teeth, causing them ultimately to detach and “roll up” toward the roots.

Treating the gum infection by removing the built-up plaque and calculus (hardened plaque deposits) will help stop recession or even reverse it.  As we remove plaque the infection subsides and the gums cease to be inflamed. If they haven't receded too far they may re-grow and renew their attachment to the teeth.

In other cases, though, the recession may have progressed too far and too rapidly toward root exposure. Gums in this condition may require tissue grafts to the recessed area to create or regenerate new tissue.

Most grafting techniques fall into one of two categories. The first is known as free gingival grafting where a thin layer of skin is removed or "freed" from the roof of the patient's mouth (the palate), shaped and then stitched to the recession site.

The second category is called connective tissue grafting, most often used to cover exposed roots. In this case the donor material is transplanted from the donor site to the recipient site, but the recipient site's tissue covers the donor connective tissue graft as it still maintains a physical attachment to the original location. The recipient site can thus maintain a blood supply, which can result in quicker, more comfortable healing than with free gingival grafting.

Connective tissue grafting does, however, require sophisticated microsurgical techniques, along with the surgeon's in-depth skill and art, to prepare both the donor and recipient sites. Allografts (donor skin from another person) may also be used as a donor tissue and placed beneath the recipient site tissue thereby avoiding a second surgical site.

Gum tissue grafting can be an intense undertaking, but the results can be astounding. Not only will restoring recessed gum tissues give your teeth a new lease on life, it will revitalize your smile.

If you would like more information on treatment for gum recession, 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 “Periodontal Plastic Surgery.”