My Blog
By David J. Adams, DMD, MS, PA
November 24, 2020
Category: Dental Procedures
Tags: dental implants  
ImplantsCanMakeItEasiertoRestoreMissingTeethinStages

A fair number of people with total tooth loss have arrived at this point after a long history of dental issues. It's quite likely they've had a series of bridges or partial dentures over the years to accommodate lost teeth at various times before moving to full dentures.

For many, it often seems easier to extract any remaining teeth at some point and simply move on to a total restoration. It's often better for oral health, however, to preserve any remaining teeth for as long as possible and update restorations as needed. Dental implants could make this type of staged restoration strategy much easier to manage.

Implants are tiny metal posts surgically imbedded in a patient's jawbone. Over time, bone cells grow and adhere to the implant's titanium surface, creating a strong and durable hold. Its most familiar application is as a replacement for an individual tooth.

But because of their strength and durability, this advanced dental technology is also used to support other restorations like bridges and partial or full dentures by way of a few strategically placed implants. And it's in that role that they can be useful in planning and implementing future restoration upgrades when needed.

Under this strategy, we add implants to supplement pre-existing implants from earlier restorations to support the updated dental work. For example, we might have previously placed an implant supporting a single tooth or a small bridge. When the need later arises for a partial denture, we can add additional implants to be used with the earlier one to support the new denture.

If the earlier implants have been well-placed, we need only to add enough implants necessary to support a full denture when the time comes. How many will depend on the particular type of denture: A removable lower denture may only require one additional implant with one already in place. A fixed upper or lower denture will require enough to bring the number to between four and eight.

Taking this long-term approach can be more cost-effective in the long-run. More importantly, it can make for a smoother path for the patient and help preserve remaining teeth for as long as possible.

If you would like more information on restoration options for lost 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 “Replacing All Teeth but Not All at Once.”

By David J. Adams, DMD, MS, PA
November 14, 2020
Category: Dental Procedures
Tags: partial denture  
ARPDCouldBeYourAnswertoReplacingMissingTeeth

Before implants, people often turned to a removable appliance to replace multiple missing teeth. Known as a removable partial denture (RPD), this appliance could restore both appearance and function at an affordable price.

But although implants may have diminished their use, RPDs haven't gone extinct. They're still a viable option for patients who can't afford implants or fixed bridgework, or who can't obtain implants due to the state of their dental health.

Although replacing only a few teeth rather than an entire arch, RPDs are similar in basic concept to full dentures. The prosthetic (artificial) teeth are anchored in a resin or plastic that's colored to resemble the gums, precisely placed to fit into the missing gaps. This assembly is further supported by a frame made of vitallium, a lightweight but strong metal alloy. The appliance fits upon the arch with the missing teeth, supported by vitallium clasps that grip adjacent natural teeth.

Each RPD must be custom designed for each patient to fit perfectly without excessive movement during chewing. Too much movement could warp the fit, reduce the RPD's durability or damage other teeth. To achieve this secure fit, dentists must take into account the number and location of missing teeth to be replaced, and then apply a specific construction pattern to balance the appliance.

There are RPDs that are meant to be used short-term, as with a teenager whose jaw isn't yet mature for dental implants. But the metal-framed RPDs we've described are designed for long-term use. There is, however, one primary downside: RPDs have a propensity to collect dental plaque, a thin biofilm most responsible for dental disease that could further deteriorate your dental health.

To avoid this, you'll need to keep both the RPD and the rest of your teeth and gums as clean as possible with daily brushing and flossing, and appliance care. And like dentures, it's best to remove the RPD when you go to bed at night to discourage the growth of harmful bacteria.

To see if an RPD to replace your missing teeth is an option for you, visit us for a complete dental exam. From there, we can advise you further as to whether an RPD could affordably restore your missing teeth and your smile.

If you would like more information on RPDs, 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.”

By David J. Adams, DMD, MS, PA
November 04, 2020
Category: Oral Health
Tags: dental care  
AMildNSAIDMayBeAllYouNeedToManageDiscomfortAfterDentalWork

Undergoing dental work is for the most part a pain-free affair. But once you're home and the anesthetic begins to wear off, you may have some discomfort.

Fortunately, most post-procedure pain can be managed with non-steroidal anti-inflammatory drugs or NSAIDs. And while stronger versions of these pain relievers can be prescribed, you may only need one sold over-the-counter.

NSAIDs like ibuprofen or acetaminophen work by inhibiting the release of prostaglandins, substances that stimulate inflammation in traumatized or injured tissues. It differs in this way from the two other primary pain medications: Steroids act like natural hormones that alleviate physical stress in the tissues; and narcotics like morphine or codeine suppress the brain's reaction to nerve firings.

While these stronger types are effective for stopping pain, they can have several serious side effects. Narcotics in particular can be addictive. Although they may be necessary in serious cases of acute pain, most dentists turn to non-addictive NSAIDs first, which are usually effective with the kind of discomfort associated with dental work and with fewer side effects.

That's not to say, however, that NSAIDs are risk-free—they must be taken properly or you could suffer serious health consequences. For one, NSAIDs have a blood-thinning effect that's even more pronounced when taken consistently over a period of weeks. This can lead to bleeding that is difficult to stop and erosion of the stomach lining leading to ulcers. Prolonged use can also damage the kidneys.

As a rule of thumb, adults shouldn't take more than 2400 milligrams of ibuprofen or other NSAIDs in a day, unless otherwise directed by their doctor. For most, a 400-milligram oral dose taken with food (to minimize stomach upset) is usually sufficient to relieve pain for around five hours.

You'll usually avoid unwanted health effects by keeping within your dentist's recommended doses and taking an NSAID for only a few days. Taking an NSAID properly can help keep your discomfort to a minimum after dental work without the need for stronger drugs.

If you would like more information on managing dental pain, 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 “Treating Pain With Ibuprofen.”

By David J. Adams, DMD, MS, PA
October 25, 2020
Category: Dental Procedures
TheRealTruthBehindEdHelmsMissingToothinTheHangover

Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.

In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.

Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.

Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.

If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.

The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.

Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.

If you would like more information about restoring missing teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Dental Implants.”

By David J. Adams, DMD, MS, PA
October 15, 2020
Category: Oral Health
Tags: mouth sore  
TheresaQuickFixForThatIrritatingMouthSoreYouKeepBiting

As the old Fifties song goes, “Little things mean a lot.” They can also be the most irritating, like a hangnail, a papercut—or a certain kind of oral sore. Although rarely concerning to health, this particular kind of “bump” in the mouth can be unnerving.

Although known as a traumatic fibroma, it's not as dire as it sounds: It's simply a small wound created when your inside cheek gets in the “line of fire” between your teeth while biting or chewing. It's an experience most of us have had, and though it's a minor occurrence, it can make us wince with pain.

But the pain usually lasts only a few seconds—until the next time, which is a distinct possibility. The body creates a protective callous over the wound made of fibers (hence the name fibroma) of a protein called collagen. This creates a rise in the skin surface that increases the chances the area will again get in the way of the teeth and be bitten. Each bite leads to another layer of collagen, a more prominent rise and even greater probability of another bite.

Rather than let this irritating situation repeat itself, you can undergo a minor surgical procedure to remove the fibroma. Usually performed be an oral surgeon or periodontist, the area is numbed first with a local anesthetic and the fibroma removed with a scalpel; the resulting wound is then closed with a few stitches or a laser, in which case no stitches are necessary. As a result, the cheek surface flattens out and becomes less likely to get in between the teeth.

The dentist may also preserve some of the removed tissue and submit it for a biopsy to check for any cancer cells or other abnormalities. You shouldn't be concerned about this: Examining excised tissue is a routine step performed for a variety of surgical procedures. It's used to verify the tissue in question is benign, which in this case is the vast majority of the time.

After the procedure, you might experience some minor discomfort for a few days, usually manageable with a mild pain reliever like aspirin or ibuprofen. The procedure itself only takes about fifteen minutes, but it can provide you lasting relief from that bedeviling little sore in your mouth.

If you would like more information on treating mouth sores, 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 “Common Lumps and Bumps in the Mouth.”





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