My Blog
By Barbara Preussner, DMD
November 07, 2018
Category: Oral Health
JamieFoxxChipsaTooth-ThisTimebyAccident

Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.

“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…

For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.

When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.

A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.

But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.

Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!

If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”

By Barbara Preussner, DMD
October 28, 2018
Category: Oral Health
Tags: sedation dentistry  
3ThingsYouNeedtoKnowaboutEasingAnxietyOverDentalVisits

Although dental visits are routine for most people, it’s a different experience for a few. About one in ten adults have high anxiety or fear of going to the dentist and may avoid it altogether—even when they have an acute situation.

If you’re one of those with dental visit anxiety there’s good news—we may be able to help you relax and have a more positive experience. Here are 3 things you need to know about reducing your anxiety at the dental office.

It starts with the dentist. While every patient deserves a compassionate, understanding dentist, it’s especially so if you suffer from dental visit anxiety. Having someone who will listen to your concerns in a non-judgmental way is the first step toward feeling more comfortable in the dentist’s chair. It also takes a sensitive practitioner to work with you on the best strategy for relaxation.

Relaxation often begins before your visit. There are various degrees of sedation (which isn’t the same as anesthesia—those methods block pain) depending on your level of anxiety. If you experience mild to moderate nervousness, an oral sedative an hour or so before your appointment could take the edge off and help you relax. Oral sedatives are also mild enough for use with other forms of sedation like nitrous oxide gas, and with local anesthesia.

High anxiety may require deeper sedation. If your level of anxiety is greater, however, we may recommend IV sedation to induce a much more relaxed state. The sedation drugs are delivered directly into your blood stream through a small needle inserted into a vein. Although you’re not unconscious as with general anesthesia, we can place you into a “semi-awake” state of reduced anxiety. The drugs used may also have an amnesiac effect so you won’t remember details about the procedure. This can help reinforce positive feelings about your visit and help reduce future anxiety.

If you’re anxious about dental visits, make an appointment with us to discuss your concerns. We’re sure we can work out a strategy to reduce your anxiety so you can receive the dental care you need.

If you would like more information on sedation therapy, 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 “IV Sedation in Dentistry.”

3FactorsThatCouldAffecttheSuccessofaRootCanalTreatment

A tooth with deep decay is in real peril. If the disease isn’t stopped, it can eventually infect the bone and greatly increase the risk of losing the tooth. But tooth decay removal and a root canal treatment can stop advancing decay and resulting infection in its tracks.

During this common procedure we first drill into the tooth to access the inner pulp. After removing the infected pulp tissue, we disinfect and fill the empty chamber and root canals with gutta percha. We then seal the tooth and crown it to protect against re-infection.

But while most root canals are successful and long-lasting, sometimes the tooth becomes re-infected. Here are 3 factors that could affect the long-term success of a root canal treatment.

Early treatment. Like many health problems, the sooner we detect decay and treat it, the better the outcome. A tooth in which the infection has already advanced beyond the pulp is at greater risk for re-infection than one in which the infection is localized in the pulp. Keeping up your regular dental visits as well as seeing the dentist at the first sign of abnormality—spots on the teeth or pain—can increase your chances of early diagnosis.

Tooth complications. Front teeth with their single roots and canals are much easier to access and treat than a back molar with an intricate root canal network. Root canals can also be extremely narrow making them easy to miss during treatment. In cases like this the expertise and advanced equipment of an endodontist (a specialist in root canal treatment) could help increase the odds of success in complex situations.

The aging process. Teeth do wear over time and become more brittle, making them increasingly susceptible to fracture. A previous root canal treatment on an aging tooth might also increase the fracture risk. To avoid this, it’s important for the tooth to receive a crown after the procedure to protect the tooth not only from re-infection but undue stress during chewing. In some situations, we may also need to place a post with a bonded composite buildup within the tooth to give it extra support.

Even if a tooth has these or similar complications, a root canal treatment may still be advisable. The benefits for preserving a decayed tooth often far outweigh the risks of re-infection.

If you would like more information on root canal treatments, 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 “Root Canal Treatment.”

By Barbara Preussner, DMD
October 08, 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.”

FifthHarmonysCamilaCabelloChipsaToothbutConcertStillWorthIt

Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand. Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.

Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.

A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.

Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.

If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.

If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”





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