There are three common reasons why people lose their teeth. 1) The tooth is ruined by decay. 2) The bone support is destroyed by periodontal disease. 3) The tooth is knocked out by some trauma. I lost my tooth due to another, less common, cause. I was having intermittent mild pain in the tooth so we took an x-ray which revealed a condition called external root resorption. Essentially the root begins to dissolve for unknown reasons. This is different from erosion or abrasion which causes notching of the root surface usually at the gumline. My root dissolved below the gum and bone level. Treatment for this condition does not have a good success rate so instead I decided to have it removed and move the other lower front teeth together to close the space.
Dr Munib Derhalli, a periodontist, removed the tooth. He is an excellent surgeon, and because I may have lost bone around the problem area, I wanted him to be able to place a bone graft immediately if needed. The root was compromised because a portion of it had dissolved. So it was no surprise that it broke during the extraction and Dr Derhalli had to carefully remove the root tip without damaging the bone. Fortunately, no grafting was required so I moved on to the next phase.
Dr Michael Brown placed braces on both my top and bottom teeth because there are some other irregularities to correct. I will be wearing them for about 18 months and I will have rubber bands on the back teeth on one side. This is the third time I have worn braces and I hope it is the last. I have had the appliances on for about three weeks now. My tongue is still sore, and I still bite off chunks of my cheek when I try to chew. So I can be very sympathetic with all of you who are going through the same experience.
If you are wearing braces now, let me know how your experience is going.
With Care
Dr Stafford
Thursday, December 1, 2011
Monday, July 18, 2011
What's the Big Deal about Baby Teeth?
When facing the decision to invest in restoring decayed primary teeth, I am often asked the legitimate question by parents. “Why should we put money into the baby teeth? Aren’t they just going to come out anyway?”
Primary teeth are smaller and less durable than permanent teeth which have much thicker enamel and larger roots. This second set is designed to last a lifetime, the first is not. So why bother repairing them when they get decayed? Why not just leave them alone or take them out? Here are my top three reasons:
1. Primary teeth can get badly infected due to untreated decay and cause an abscess in the jaw. This can be very painful for the child and damage the permanent tooth that is forming in the bone.
2. The jaw grows from the back not the front. Once the 1st permanent molars come in at age 6, the distance around the arch from molar to molar is established and will not grow on its own. If primary teeth lose their size due to decay, or are prematurely removed, the permanent molars will drift forward reducing the arch size. This space can only be regained through orthodontic treatment.
3. Dental decay is an infection. If cavities in primary teeth are not treated, the permanent teeth that erupt into this infected environment are more likely to decay themselves.
Having said this, there are exceptions to treating all decay in primary teeth.
-If the primary tooth will be gone within 6 months and the decay is in the very early stages, I often do not treat it.
-If the primary tooth will be gone within 6 months and the decay is very severe, I will remove the tooth early.
Taking proper care of primary teeth is essential to the health of permanent teeth designed to last a lifetime. So follow the recommendations of your dentist and dental hygienist in order to give your child the best chance of having a cavity free mouth.
This will be my last column in the Clackamas Review. If you have found value in the information I have shared, you can continue to read articles I will write through our Facebook account at www.facebook.com/staffordsmiles.
Yours for excellent dental health,
Dr S
Primary teeth are smaller and less durable than permanent teeth which have much thicker enamel and larger roots. This second set is designed to last a lifetime, the first is not. So why bother repairing them when they get decayed? Why not just leave them alone or take them out? Here are my top three reasons:
1. Primary teeth can get badly infected due to untreated decay and cause an abscess in the jaw. This can be very painful for the child and damage the permanent tooth that is forming in the bone.
2. The jaw grows from the back not the front. Once the 1st permanent molars come in at age 6, the distance around the arch from molar to molar is established and will not grow on its own. If primary teeth lose their size due to decay, or are prematurely removed, the permanent molars will drift forward reducing the arch size. This space can only be regained through orthodontic treatment.
3. Dental decay is an infection. If cavities in primary teeth are not treated, the permanent teeth that erupt into this infected environment are more likely to decay themselves.
Having said this, there are exceptions to treating all decay in primary teeth.
-If the primary tooth will be gone within 6 months and the decay is in the very early stages, I often do not treat it.
-If the primary tooth will be gone within 6 months and the decay is very severe, I will remove the tooth early.
Taking proper care of primary teeth is essential to the health of permanent teeth designed to last a lifetime. So follow the recommendations of your dentist and dental hygienist in order to give your child the best chance of having a cavity free mouth.
This will be my last column in the Clackamas Review. If you have found value in the information I have shared, you can continue to read articles I will write through our Facebook account at www.facebook.com/staffordsmiles.
Yours for excellent dental health,
Dr S
Thursday, June 30, 2011
Dental implants Simplified
One of the most positive developments in dentistry during the last decade is the increase in the success and popularity of dental implants to replace missing teeth. In this article I intend to outline, in ordinary language, what dental implants are and what they are used for.
Dental implants are pure titanium cylinders that are surgically placed into the upper or lower jaw to replace natural tooth roots. The bone heals so closely around an implant that it is described as “integrated.” Once this occurs, the implant is very stable and a variety of different attachments can be connected to it.
The most common attachment is a single tooth. These are very successful and have become the standard of care to replace a missing tooth. If several teeth are missing, multiple implants can support bridges that are permanently attached. And in a situation where there are no natural teeth remaining, implants can provide greatly enhanced support and retention for a denture.
Following are some frequently asked questions and their answers:
Aren’t implants very expensive?
The cost will vary depending on the situation, but it will be a significant investment. Remember that price is what you pay, and value is what you get. In most cases implants are the very best solution for missing teeth.
Will my dental insurance cover implants?
Not always, but it is becoming more common.
Do they ever fail?
Yes, but it is very rare and the risk can usually be determined prior to placement.
Who can place dental implants?
Any dentist can place implants. No special license is required, but this is a very technique sensitive procedure, so it is important to find a doctor with the training and experience to do it well. Often a surgeon will place the implant and work with a general dentist who restores the teeth.
If you or someone you know would like more information about dental implants, I would be pleased to provide a complimentary consultation to discover if this is the most appropriate treatment.
Yours for excellent dental health,
Dr S
Dental implants are pure titanium cylinders that are surgically placed into the upper or lower jaw to replace natural tooth roots. The bone heals so closely around an implant that it is described as “integrated.” Once this occurs, the implant is very stable and a variety of different attachments can be connected to it.
The most common attachment is a single tooth. These are very successful and have become the standard of care to replace a missing tooth. If several teeth are missing, multiple implants can support bridges that are permanently attached. And in a situation where there are no natural teeth remaining, implants can provide greatly enhanced support and retention for a denture.
Following are some frequently asked questions and their answers:
Aren’t implants very expensive?
The cost will vary depending on the situation, but it will be a significant investment. Remember that price is what you pay, and value is what you get. In most cases implants are the very best solution for missing teeth.
Will my dental insurance cover implants?
Not always, but it is becoming more common.
Do they ever fail?
Yes, but it is very rare and the risk can usually be determined prior to placement.
Who can place dental implants?
Any dentist can place implants. No special license is required, but this is a very technique sensitive procedure, so it is important to find a doctor with the training and experience to do it well. Often a surgeon will place the implant and work with a general dentist who restores the teeth.
If you or someone you know would like more information about dental implants, I would be pleased to provide a complimentary consultation to discover if this is the most appropriate treatment.
Yours for excellent dental health,
Dr S
Thursday, June 16, 2011
Dental Insurance 201
In my last column I explained the difference between medical “insurance” and dental “benefits.” Understanding this is critical. The next step is to find out just exactly what benefits you have. It is important for you, the policy holder, to obtain this information from the insurance carrier or the human resources department at your work.
A dental office can give you estimates of your benefits based on general information they have about similar policies, but it is your responsibility to understand the specifics of your plan. Since you are the policy holder, it is also easier for you to get the details.
Here is the information you need to know before you visit a new dentist.
- Are my benefits the same regardless of which dentist I choose? If not, what is the difference?
- What is the annual maximum benefit for my plan?
- Is the annual benefit based on a calendar year or some other interval?
- What are my remaining annual benefits?
- Do I have a deductible amount? How much is it for me? For my family?
- Do I have a waiting period before my benefits begin?
- Do I have a limit on how many times per year I can get my teeth cleaned? How is this calculated?
- How do I find out what amount will be covered for specific procedures?
When you are equipped with this information prior to your dental visit, everything will go smoother and there will be less potential for misunderstanding. Remember that your plan is not designed to cover all of your costs. It is more like getting a discount. So the more you know about your plan, the more you will know about your actual discount.
For Your Dental Health,
Dr S
A dental office can give you estimates of your benefits based on general information they have about similar policies, but it is your responsibility to understand the specifics of your plan. Since you are the policy holder, it is also easier for you to get the details.
Here is the information you need to know before you visit a new dentist.
- Are my benefits the same regardless of which dentist I choose? If not, what is the difference?
- What is the annual maximum benefit for my plan?
- Is the annual benefit based on a calendar year or some other interval?
- What are my remaining annual benefits?
- Do I have a deductible amount? How much is it for me? For my family?
- Do I have a waiting period before my benefits begin?
- Do I have a limit on how many times per year I can get my teeth cleaned? How is this calculated?
- How do I find out what amount will be covered for specific procedures?
When you are equipped with this information prior to your dental visit, everything will go smoother and there will be less potential for misunderstanding. Remember that your plan is not designed to cover all of your costs. It is more like getting a discount. So the more you know about your plan, the more you will know about your actual discount.
For Your Dental Health,
Dr S
Monday, June 6, 2011
Dental Insurance 101
In my experience, the topic which causes the most misunderstanding in dentistry is dental insurance. My goal in this series of articles is to give you some basic information to help you understand this often confusing issue.
First of all the term “insurance” is really a misnomer in the context of dentistry. The word “insurance” literally means protection against future loss. This term is commonly used in medicine, as catastrophic loss can occur as a result of sickness or accident and the benefit limits are very high to cover this.
“Benefit” is a word which more accurately describes the allowance which is negotiated for an employee between his/her place of employment and a dental “insurance” company.
All dental “insurance” companies have a maximum annual benefit which rarely exceeds $1500 per calendar year. This amount is very close to the benefits of the 1960′s when dental “insurance” first began. In those days $1500 would cover the majority of treatment that anyone required in a year. If dental benefits were to have kept up with inflation and technology, as they have with medical insurance, they would amount to over $10,000 per year. This amount would be more than enough to cover the treatment most people would need in a year. However because the annual limit that most insurance companies provide has not increased, usually only preventive maintenance and small restorations are covered.
So while a dental benefit plan is nice, it should never be considered insurance against loss. The best way to reduce risk is the following:
- Let your dentist and hygienist know that you want a proactive plan to prevent dental decay and gum disease.
- Ask your dentist to make sure that all of the existing restorations in your mouth are of the highest quality.
More coming on this subject in Dental Insurance 102
Yours for excellent dental health,
Dr S
First of all the term “insurance” is really a misnomer in the context of dentistry. The word “insurance” literally means protection against future loss. This term is commonly used in medicine, as catastrophic loss can occur as a result of sickness or accident and the benefit limits are very high to cover this.
“Benefit” is a word which more accurately describes the allowance which is negotiated for an employee between his/her place of employment and a dental “insurance” company.
All dental “insurance” companies have a maximum annual benefit which rarely exceeds $1500 per calendar year. This amount is very close to the benefits of the 1960′s when dental “insurance” first began. In those days $1500 would cover the majority of treatment that anyone required in a year. If dental benefits were to have kept up with inflation and technology, as they have with medical insurance, they would amount to over $10,000 per year. This amount would be more than enough to cover the treatment most people would need in a year. However because the annual limit that most insurance companies provide has not increased, usually only preventive maintenance and small restorations are covered.
So while a dental benefit plan is nice, it should never be considered insurance against loss. The best way to reduce risk is the following:
- Let your dentist and hygienist know that you want a proactive plan to prevent dental decay and gum disease.
- Ask your dentist to make sure that all of the existing restorations in your mouth are of the highest quality.
More coming on this subject in Dental Insurance 102
Yours for excellent dental health,
Dr S
Wednesday, May 25, 2011
Pearls from Boston
I recently returned from the annual conference of the American Academy of Cosmetic Dentistry in Boston. This meeting, more than any other, re-ignites my passion for dentistry and gives me a higher vision of what is possible to achieve. The lectures and workshops I attended were first rate, and the knowledge and skills I acquired will immediately raise the level of care I provide. Following are a few pearls from the courses I took:
- We have been successfully placing porcelain veneers for many years. New products and techniques now allow us to place these amazing smile enhancing restorations, in many cases, with no preparation to the underlying teeth, making them non-invasive and essentially reversible.
- New products, techniques, and ongoing research provide increasing support for what everyone wants: a new tooth in one day. If you have a front tooth that for some reason needs to be replaced, in many cases the tooth can be removed, a root replacement implant installed, and a temporary tooth attached to the implant, all in the same day.
- Have you ever noticed a smile that doesn’t quite look right because too much gum tissue shows or the teeth seem to be going downhill on one side? A beautiful smile has just as much to do with where the teeth are located in the smile as it does with the color and shape of the teeth themselves. New treatment options and tools for diagnosis allow us to accurately assess and correct this important aspect of smile design.
- Implant supported attachments offer a much better solution to loose dentures than adhesive products. If an existing denture is otherwise satisfactory, these procedures can often be performed without the expense of replacing the denture or the embarrassment of going without it.
Please let me know if you have questions or would like to discuss any of these procedures further.
Yours for excellent dental health,
Dr S
- We have been successfully placing porcelain veneers for many years. New products and techniques now allow us to place these amazing smile enhancing restorations, in many cases, with no preparation to the underlying teeth, making them non-invasive and essentially reversible.
- New products, techniques, and ongoing research provide increasing support for what everyone wants: a new tooth in one day. If you have a front tooth that for some reason needs to be replaced, in many cases the tooth can be removed, a root replacement implant installed, and a temporary tooth attached to the implant, all in the same day.
- Have you ever noticed a smile that doesn’t quite look right because too much gum tissue shows or the teeth seem to be going downhill on one side? A beautiful smile has just as much to do with where the teeth are located in the smile as it does with the color and shape of the teeth themselves. New treatment options and tools for diagnosis allow us to accurately assess and correct this important aspect of smile design.
- Implant supported attachments offer a much better solution to loose dentures than adhesive products. If an existing denture is otherwise satisfactory, these procedures can often be performed without the expense of replacing the denture or the embarrassment of going without it.
Please let me know if you have questions or would like to discuss any of these procedures further.
Yours for excellent dental health,
Dr S
Friday, May 6, 2011
The Truth about Tooth Colored Fillings
In the last decade tooth colored fillings have become a very popular alternative choice to traditional silver/mercury amalgams. The latest insurance company statistics show that 65% of the fillings placed in the US are tooth colored composites compared to 35% amalgam. If you prefer tooth colored fillings, there are some things you need to know.
Tooth colored fillings are completely different from amalgam fillings. They are not just the same hole filled with a different material. Everything from the preparation to the way the filling is placed is different and much more technique sensitive.
Before you choose a composite restoration you should ask your dentist four questions.
1) Do you use a dental dam or other device to completely isolate the tooth? Saliva contamination during the filling process will severely compromise the final result and must be avoided.
2) How do you determine that all of the decay has been removed? Complete decay removal is critical to the bond of a composite filling to the tooth. There are products available that can confirm total decay elimination.
3) Do you place the composite filling all at one time, or in separate, small layers that are individually cured? Composite fillings shrink as a percentage of their volume when cured. Larger filling increments shrink more and make the restoration more prone to post operative sensitivity and premature failure.
4) Do you offer both silver amalgam fillings and tooth colored composites? Because they are do different, you may want to choose dentists who focus their skills and training on tooth colored composites only.
Millions of silver amalgam restorations have been placed by US dentists over the years and have proved to be a valuable service to many. Tooth colored composites now rival amalgams for durability, but only if placed using the proper techniques.
For your dental health,
Dr S
Tooth colored fillings are completely different from amalgam fillings. They are not just the same hole filled with a different material. Everything from the preparation to the way the filling is placed is different and much more technique sensitive.
Before you choose a composite restoration you should ask your dentist four questions.
1) Do you use a dental dam or other device to completely isolate the tooth? Saliva contamination during the filling process will severely compromise the final result and must be avoided.
2) How do you determine that all of the decay has been removed? Complete decay removal is critical to the bond of a composite filling to the tooth. There are products available that can confirm total decay elimination.
3) Do you place the composite filling all at one time, or in separate, small layers that are individually cured? Composite fillings shrink as a percentage of their volume when cured. Larger filling increments shrink more and make the restoration more prone to post operative sensitivity and premature failure.
4) Do you offer both silver amalgam fillings and tooth colored composites? Because they are do different, you may want to choose dentists who focus their skills and training on tooth colored composites only.
Millions of silver amalgam restorations have been placed by US dentists over the years and have proved to be a valuable service to many. Tooth colored composites now rival amalgams for durability, but only if placed using the proper techniques.
For your dental health,
Dr S
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