Posts Tagged ‘teeth’

Tooth loss can have a far-reaching effect on your dental health and personal appearance. When you lose one or more teeth, your remaining teeth can drift out of position. This can lead to a change in the bite, the loss of additional teeth, decay and gum disease.

Dental implants can be an effective method to replace one tooth or several teeth. Each implant consists of a metal anchor that is inserted into the jawbone (the implant), and a protruding post (abutment), which is outfitted with an artificial tooth (crown). Implants can also support a bridge, replace a partial denture or secure a denture. The process requires surgery and may take up to a year to complete.

Note: I restore the implant with the crown or bridge, the actual implant is placed by the oral surgeon or periodontist.

In the first procedure under anesthesia, a metal anchor (implant), or artificial root, is placed into the jawbone.  Bone grows around the anchor.  This takes about three to six months.	Next, a “healing” cap is placed when the implant is uncovered.
Then, the healing cap is removed and a metal post (abutment), may be attached to the anchor.	An impression or mold is made of the abutment, and the surrounding teeth.
When your gums and jawbone have healed, an artificial tooth (crown) is constructed, then screwed or cemented to the post.  Fitting your new tooth properly may take several appointments.
Single Tooth This type of prosthesis is used to replace one or two missing teeth.   Each prosthetic tooth attaches to its own implant.
Complete Denture This type of prosthesis replaces all the teeth in your upper or lower jaw.   The number of implants varies, depending on the type of prosthesis you choose.
Bridge This type of prosthesis can replace two or more teeth.  It is the most commonly performed implant procedure, and may require only two or three implants.

• What Is Teeth Whitening
• What Is Discoloration
• Types Of Whitening

What Is Teeth Whitening?

It’s a process that lightens discolorations and removes stains from the enamel and dentin of the teeth.

before	after

What Is Tooth Discoloration?

There are many causes, and there is a distinction between internal and external stains.

• internal stains: aging, trauma, tetracycline (while teeth are forming), excessive fluoride (greater than 10 ppm while teeth are forming), nerve degeneration
• external stains:  coffee, tea, tobacco, some juices (grape, apple) – over years these can also get into the enamel crystals and become internal stains

Types of Whitening

• home, professional << RECOMMENDED
• in-office, professional
• over-the-counter

Home, Professional
Professional home bleaching is very effective and has long lasting results.  It most often utilizes custom mouth trays and viscous bleaching gels.  Typically the gel is a carbamide peroxide (10-35%), but can be a hydrogen peroxide (7.5-9.5%).

In-Office, Professional
In-office professional whitening is the fastest method; however, to have long-lasting results it must include home bleaching as a follow-up.  Current in-office whitening typically uses bleaching gels that are light activated, e.g. Zoom, BrightSmile. 

Over-The-Counter
Whitening strips are effective, although they whiten teeth slowly, AND require reapplication at least every 6 months.  Professional whitening is far more effective for darker colored teeth, easier to use, and faster. Whitening toothpastes and related over-the-counter products are for external stains. 

Who May Benefit From Teeth Whitening?

Almost everyone. However there are some cases where the treatment may be less effective. The most difficult situations to whiten are those teeth with tetracycline staining.  Also, and this is important, teeth whiten; however, crowns (caps), fillings, and veneers do not.  If you are planning any crowns, fillings and/or veneers as part of your overall treatment, you may want to whiten your teeth first.

During The Process

Sometimes the biting edges and the sides of the teeth whiten more quickly than the rest of the teeth. This occurs because your enamel is thicker in these areas and responds faster to the whitening process. As you continue to use the whitening gel, the rest of your teeth will catch up and the color will even out.

Is The Process Safe?

Yes, extensive research and clinical studies indicate that whitening teeth under the supervision of a dentist is safe.  In fact, many dentists consider whitening the safest cosmetic dental procedure available.  Tooth whitening product is not recommended for children under 13 years of age and women who are pregnant or breast-feeding (in office whitening is not recommended for children under 18 years of age).

The whitening process does not damage enamel or weaken a tooth.  For some people, teeth become more sensitive during the process, but this always goes away when you stop the whitening process (if you’re doing the home professional whitening and teeth become sensitive consider using your trays every 2nd or 3rd day rather than discontinue). The bleaching gel can be quite irritating if it gets on the gums.

Evaluation (before whitening)

• no cavities (examination and x-rays required)
• all fillings, crowns, etc. sealed tightly
• not recommended during pregnancy or nursing
• 13 years or older

Note

• fillings, veneers, crowns, bonding (i.e. restorative materials) will not whiten
• teeth may become more sensitive during whitening – reversible when stopped

Products And Methods

I recommend home professional whitening with trays as the most effective. The home professional whitening I prefer utilizes very concentrated carbamide peroxide whitening gel in custom mouth trays (custom whitening trays are critical to making the process effective).  30-minute* treatments for 10-14 days typically complete the process; however, the final result is something you determine.

Store whitening gel out of sunlight and away from heat.

* 30-35% carbamide peroxide gels are the most concentrated gel available for home use.  At this concentration the maximum wear time is 30 minutes.  If desired, two 30-minute sessions can be used with a minimum 4 hour interval between sessions (no more than 2 sessions per day).
Home professional whitening requires two short office visits:

1. evaluation: find out what you want to accomplish and evaluate your teeth (color, shape, etc.), make the molds of your teeth for the custom whitening tray
2. try-in and deliver the custom whitening tray, answer your questions, and review instructions

NOTE:  Some professional home bleaching products still have directions for night time or extended (2 or more hours) wear, but current research shows that effective whitening does not occur after the first hour.  What will occur with longer wear is an increase in sensitivity.

Children’s Dentistry

I have long recommend a first checkup by 12 months old to make certain that teeth and jaw development are normal, and even more importantly so that parents and guardians know how to help their children be healthy from the start. The American Academy of Pediatric Dentistry now also recommends the same thing: First Visit by the First Birthday.

Being a ‘good parent’ does not require that you take your child to a Children’s Dentist (pedodontist). I routinely see children, and I do refer to a pedodontist when needed (extensive dental treatment required, special needs, etc.).

Guidelines for working with children

• comfort is always our concern
• parent / guardian consent and guidance are vital, before any procedure
• no restraint is ever used

* Generally it is most effective if parents are NOT in the room during the full time of treatment. If the parents have any dental anxieties, please don’t bring those with you. For your child’s best interest, you will likely be invited to wait in the reception room during treatment.

First Visit

There is a significant value for early well baby dental checkups.  In particular, checkups for very young children address many concerns including teaching adults how to care for their child’s teeth and gums, how to help their children learn to care for themselves, answering parents questions and concerns, and planning for future dental health.

Checkups

Education and prevention are the cornerstones of my concern for the dental health of children.  In addition to teaching parents and guardians about dental care for their child, checkups are an appropriate time to comfortably and easily evaluate:

Home Dental Care Tips

It is often difficult initially to brush your child’s teeth – that’s normal.  They can really put up a struggle, screaming, kicking, crying, running away, not opening their mouths – every kid is different.

Healthy teeth and gums are so important to start out life with.  We’ve often heard the value of choosing your battles with your children, and this is one to choose.

Remember that the initial challenge you face is actually more taxing on you than it ultimately is for your child.

Numbering systems have been developed in order to have a standard way of referring to particular teeth (there are more than 32 different systems). Two are commonly in use in the US today:

• the Universal Numbering System has been adopted by the American Dental Association and is in use by most general dentists today, and
• the Palmer Notation Method is used by some orthodontists, pedodontists (child dental specialist), and oral surgeons (originally called the Zsigmondy system after an Austrian dentist of that name who developed the idea in 1861).

Internationally the two-digit FDI World Dental Federation notation is widely used.

Universal Numbering System

Adults

Tooth number 1 is the tooth farthest back on the right side of your mouth in the upper (maxillary) jaw.

Numbering continues along your upper teeth toward the front and across to the tooth farthest back on the top left side (which is number 16).

The numbers continue by dropping down to the lower (mandibular) jaw.  Number 17 is the tooth farthest back on the left side of your mouth on the bottom.

Numbering continues again toward the front and across to the tooth farthest back on the bottom right side of your mouth (which is number 32).

In this system, the teeth that should be there are numbered.  If you are missing your wisdom teeth, your first number will be 2 instead of 1, acknowledging the missing tooth.  If you’ve had teeth removed or teeth are missing, the missing teeth will be numbered as well.

Children

In the original system, children’s 20 primary teeth are numbered in the same order, except that a small letter “d” follows each number to indicate deciduous (primary) teeth.  So, a child’s first tooth on the upper right would be 1d and the last tooth on the lower right would be 20d.

However, most dentists and insurance companies now use a modified version of the Universal Numbering System for children.  This version uses the letters A through T instead of the number 1 through 20.  So, a child’s first tooth on the upper right would be A and the last tooth on the lower right would be T.

Palmer Notation Method

Adults

In this system, the mouth is divided into four sections called quadrants.  The numbers 1 through 8 and a unique symbol are used to identify the teeth in each quadrant.  The numbering runs from the center of the mouth to the back.

In the upper right section of the mouth, for example, tooth number 1 is the incisor (flat, front tooth) just to the right of the center of the mouth.  The numbers continue to the right and back to tooth number 8, which is the wisdom tooth (third molar.)

The numbers sit inside an L-shaped symbol used to identify the quadrant.  The “L” is right side up for the teeth in the upper right.  The teeth in the upper left use a backward “L.”  For the bottom quadrants, the “L” is upside-down.  The quadrants may also be identified by letters, such as “UR” or “URQ” for the upper right quadrant.

Children

In children, the Palmer Notation System uses uppercase letters instead of numbers.  Following the same order as for adult’s teeth, children’s 20 primary teeth are lettered “A” through “E” in each quadrant.  The same symbol is used to identify the quadrants.

FDI Two-Digit Notation

Adults

In the FDI (Fédération Dentaire Internationale) World Dental Federation ISO-3950 notation 1s are central incisors, 2s are laterals, 3s are canines, 4s are 1st premolars etc., up through 8s which are 3rd molars.  The permanent teeth  quadrants are designated 1 to 4 such that 1 is upper right, 2 is upper left, 3 is lower left and 4 is lower right, with the resulting tooth identification a two-digit combination of the quadrant and tooth (e.g. the upper right central incisor is 11 and the left is 21).  The lower left permanent first molar is 36; however, it is not said thirty-six, but rather three six.  11 is one one, not eleven.

The currently accepted convention to view the FDI notation chart is from the perspective of the patient’s right on the left:

Children

In the deciduous dentition the numbering is correspondingly similar except that the quadrants are designated 5,6,7 and 8.

Thanks to Dr. John Webster BDS, Australia for his clarification on the FDI notation system.

Specific Teeth

Comparison of Tooth Numbering Systems