The best method for permanently replacing a missing tooth is with a dental implant. But did you know that there are two main techniques for placing implants? Implants can be placed either using a one stage or a two stage surgical technique, and as their names suggests, one is performed in one step while the other requires a second surgery.

With a one-stage procedure, a healing abutment is placed at the time of surgery. An abutment is a connector that attaches the implant from the bone into the mouth and which protrudes through the gum tissues. Following a 3 to 6 month healing period in which the implant fuses to the bone, a crown is then placed on the implant restoring the immediate appearance of a healthy, normal tooth. One-stage implant systems are generally used when the bone quality is good, guaranteeing good initial implant stability. They are also used when cosmetics is not a concern, such as the back areas of the mouth.

Under special conditions an implant can be placed and a crown placed on top of it at the same time. However, this is a very special circumstance requiring ideal conditions and surgical experience as well as crown fabrication know-how. It is generally safer and wiser not to subject an implant to biting forces until it is fully healed and integrated with the supporting bone.

A two-stage procedure is typically used for replacing teeth where there is no immediate need for a cosmetic solution and when more of a margin of safety is required. With this approach, the implant(s) are placed into the jawbone and the gum tissues cover them. They are not exposed to the mouth, but stay buried and left to heal. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is used when there is poorer bone quality or quantity. This may make it necessary to regenerate bone around the implant at the time of its placement. There may also be other health considerations dictating that a two-stage approach may be indicated.

Depending on your individual situation and medical status, our implant team will determine which approach is best for you. To learn more about these two procedures, read the Dear Doctor article, “Staging Surgery In Implant Dentistry.” You are also welcome to contact us to discuss your questions or to schedule an appointment.

We know from research extending back to the 1930s that very small amounts of fluoride in drinking water can significantly reduce dental caries (cavities) with no negative health effects. Fluoridated water is currently available to 70% of all Americans. However, we have also learned that excess fluoride from combined sources can result in staining of teeth called “fluorosis.”

What is the optimum fluoride concentration for healthy teeth?
A fluoride concentration of about 0.7-1.20 milligrams per liter (mg/L), or .7 to 1.2 ppm (parts per million), in the water supply seems to be optimum for dental health without causing negative effects. This concentration is about the same as a grain of salt in a gallon of water. An amount of 1 ppm was originally considered the safe standard, but since today Americans have access to more sources of fluoride than they did when water fluoridation was first introduced, the recommended amount has been reduced to .7 mg/L or .7 ppm.

The crucial amount to measure is the quantity of fluoride that is swallowed. Generally, the optimal level of fluoride per day from all sources is thought to be about .06 milligrams per kilogram of body weight, or about a sixth of the weight of a grain of salt for every two pounds of body weight.

It is probably not possible to calculate the precise amount of fluoride each person ingests per day, because the amount depends on more than just the amount of tapwater you drink. Bottled waters, soft drinks and juices also contain fluoride. Breast milk and cow's milk are very low in fluoride, but infant formulas may contain higher levels. Foods found to have high fluoride content include teas, dry infant cereals and processed chicken, fish and seafood products. Toothpaste can contribute to a child's total fluoride intake if the child swallows it.

What are the effects of too much fluoride?
Dental fluorosis produces a “mottling” of the outer coating of the tooth, the enamel. Mottling may show as staining ranging from small white striations to stained pitting and severe browning of the enamel surface.

The first six to eight years of life is the most risky time for development of dental fluorosis. Parents need to monitor their children to make sure they use small amounts of fluoride toothpaste (an amount the size of a pea on the brush is recommended). Watch for white spots on the enamel (hard outside coating) of your child's teeth. White spots from fluorosis mean it is time to pay attention to how much fluoride your child is getting from various sources, and to cut back on the total. You want fluoride's protection against cavities for your child's teeth, without the unsightliness of dental fluorosis from too much fluoride.

Contact us today to schedule an appointment to discuss your questions about fluoride. You can also learn more by reading the Dear Doctor magazine articles “Fluoride & Fluoridation in Dentistry” and “New Fluoride Recommendations.”

Anytime you have a tooth that does not erupt (surface) correctly but rather stays submerged below the gum you have a problem. Sometimes this situation can cause significant pain, while other times it can be totally pain-free. When this occurs to a wisdom tooth (third molar), you have what is commonly referred to as an impacted wisdom tooth. This generally occurs when there is insufficient room in the mouth, and the wisdom tooth “impacts” or butts up against an adjacent tooth.

Third molars come in typically between the ages of 17 and 25, when a moderate amount of “wisdom” is supposedly achieved. Most people have four wisdom teeth; however, it is possible to have more or less. The key to not having issues generally depends upon one main factor: having adequate space for them to grow and erupt into proper position.

The most common consequence of having an impacted wisdom tooth is gum (periodontal) disease and damage to adjacent healthy teeth. This makes removing the impacted tooth so important. Another problem with impacted wisdom teeth is that they can affect other adjacent structures like gum, bone, nerves, blood vessels and sinuses. They can also become cystic, a condition in which the submerged tooth is surrounded by a closed sac or membrane that can cause possible infection and loss of bone.

We stress the importance of routine dental exams between the ages of 17 and 25 to catch problems with wisdom teeth before they start. The best time to remove a wisdom tooth is when it is not causing problems and the sooner and younger you are the better!

To learn more about the symptoms and treatment options of impacted wisdom teeth, continue reading the Dear Doctor magazine article “Wisdom Teeth.” Or, you can contact us today to schedule an appointment to discuss your questions.

One question we are most often asked by parents of athletes or those who participate in physical sports is, “Do mouthguards really work?” And when we respond, “yes,” a common follow-up question is, “Is there any scientific evidence to support this claim?” Based on this scenario, we feel it is important to provide you with some interesting and evidence-based facts on this topic.

The first reported use of mouthguards was in the sport of boxing. And because participants and bystanders in the 1920s quickly witnessed their effectiveness even back then, the trend's popularity grew to the point that boxing became the first professional sport to require them. However, other sports soon started following this lead — especially those high-contact sports. The American Dental Association (ADA) started mandating the use of mouthguards for football in 1962 and the US National Collegiate Athletic Association (NCAA) currently requires mouthguards for football, ice hockey, lacrosse and field hockey. The ADA has since expanded their recommendations to now include 29 different sports and exercise activities. So now that you know more about the professional organizations pushing the use of mouthguards, let's get back to the second question, “What's the evidence?”

There have been numerous studies over the years regarding the properties of mouthguards, and more specifically their shock absorbing capabilities. Other studies have been based upon their protective abilities due to their stiffness, hardness and strength. This research has enabled us to vastly improve upon the effectiveness of mouthguards. For example, years ago latex rubber was a popular material used to create mouthguards. However, today we use products such as ethylene vinyl acetate or polyurethane because they are far superior in durability and flexibility. And impact studies have shown that the chances of fracturing teeth is dramatically reduced when wearing one of these mouthguards...especially when compared to individuals wearing no mouthguard at all. In fact, research has revealed that by not wearing a mouthguard during physical sports or exercise, individuals are 60 times more likely to experience an injury to the mouth and/or teeth.

To learn more about the importance of protective mouthguards, continue reading the Dear Doctor magazine article “Athletic Mouthguards.” Or you can contact us today to schedule an appointment to discuss your questions about mouthguards.

You didn't have your teeth straightened as a child. Is it too late, or should you have orthodontic treatment now as an adult?

Orthodontics is a sub-specialty of dentistry devoted to the study and treatment of improper bites, or malocclusions. Orthodontic treatment has the goal of slowly applying pressure to teeth in a way that moves them into proper alignment in your mouth.

Recommendations are for children to have their teeth assessed for orthodontic treatment before the age of seven. The whole process can be done more easily while their teeth are coming in and their jaws are still growing.

However, if your teeth are overcrowded, you have an overbite or an underbite, or your teeth are misaligned in other ways, it is never too late. If you “missed the boat” on orthodontic treatment before, here are seven reasons to consider doing it now.

1. Orthodontic treatment brings teeth, lips and face into proportion, resulting in a beautiful smile.
2. An attractive smile contributes to self-esteem, self-confidence and better self-image.
3. Because of improved self-esteem, you may see improved social and career success.
4. Teeth that are in proper alignment will function and wear better over the years as you age.
5. Properly aligned teeth are easier to keep clean, making you less prone to periodontal (gum) disease.
6. If you have any missing teeth that need to be replaced, this can be done more effectively if your remaining teeth are put into their correct spacing and position first.
7. Current options for treatment include fixed appliances (traditional braces) in which bands and brackets are bonded to the teeth and wires are threaded through them — or as an adult you may be able to use removable clear aligners. These consist of a series of nearly invisible computer-generated clear plastic trays that progressively move the teeth into better alignment.

Take the first step: call our office for an orthodontic evaluation. Having orthodontic treatment as an adult may be just the thing to give you an attitude boost as you move forward in your life.

Contact us today to schedule an appointment to discuss your questions about teeth straightening. You can also learn more by reading the Dear Doctor magazine article “Why Straighten Teeth?”