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Posts for category: Dental Procedures

LoveandHipHopHostsNo-GapSmileandHowYouCanHaveOneToo

Nina Parker, the host of Love & Hip Hop for six seasons, is now busy with the new game show Blockbusters and her own talk show The Nina Parker Show. But even with a full plate, she took time recently for some personal care—getting a new smile.

Parker's fans are familiar with her noticeable tooth gap. But a video on TikTok in February changed all that: In the video, she teasingly pulls away a mask she's wearing to reveal her smile—without the gap.

Parker and other celebrities like Madonna, Michael Strahan and David Letterman are not alone. Teeth gaps are a common smile feature, dating back millennia (even in fiction: Chaucer described the Wife of Bath as being "gap-toothed" in The Canterbury Tales).

So, what causes a tooth gap? Actually, a lot of possibilities. The muscle between the teeth (the frenum) may be overly large and pushing the teeth apart. There may be too much room on the jaw, so the teeth spread apart as they develop. It might also have resulted from tongue thrusting or late thumb sucking as a child, influencing the front teeth to develop forward and outward.

A tooth gap can be embarrassing because they're often front and center for all the world to see, but they can also cause oral health problems like complicating oral hygiene and increasing your risk for tooth decay. They can also contribute to misalignment of other teeth.

Fortunately, there are ways to alleviate a gap. One way is to move the teeth closer together with either braces or removable clear aligners. This may be the best approach if the gap is wide and it's contributing to misalignment of other teeth. You may also need surgery to alter the frenum.

You can also reduce less-pronounced gaps cosmetically with dental bonding or porcelain veneers. Bonding involves applying a type of resin material to the teeth on either side of the gap. After some sculpting to make it appear life-like, we harden the material with a curing light. The result is a durable, tooth-like appearance that closes the gap.

A veneer is a thin wafer of porcelain, custom-made to fit an individual patient's tooth. Bonded to the front of teeth, veneers mask various dental flaws like chips, deformed teeth, heavy staining and, yes, mild to moderate tooth gaps. They do require removing a small amount of enamel on the teeth they cover, but the results can be stunning—completely transformed teeth without the gap.

Getting rid of a tooth gap can be a wise move, both for your smile and your health. You may or may not take to social media to show it off like Nina Parker, but you can feel confident to show the world your new, perfect smile.

If you would like more information about treating teeth gaps and other dental flaws, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Space Between Front Teeth.”

By Lee Oppenheimer, DDS, PA
August 16, 2021
Category: Dental Procedures
Tags: crown lengthening  
CrownLengtheningOpensupNewTeethRestorationPossibilities

A crown — a life-like “cap” made of dental porcelain that permanently covers an existing tooth — is an effective way to restore a still-viable decayed or broken tooth’s appearance. Properly fitting the crown over the tooth requires some healthy tooth structure above the gum line.

But what if the tooth has broken down to the gum line? In this case, we would need to perform a common procedure known as crown lengthening to expose more of the tooth.

Crown lengthening is a minor surgical procedure performed with local anesthesia to numb the tooth, surrounding gum tissues and supporting bone. We first make tiny incisions inside the gum-line on both the cheek and tongue side of the tooth to expose the bone, and then carefully remove a small amount of bone from either side of the tooth; this will expose or “lengthen” the tooth. Once finished, we suture the gum tissue back into place with self-dissolving sutures against the bone and tooth.

Most procedures take only sixty to ninety minutes, and the mild discomfort afterward is usually managed with pain relievers like ibuprofen. While the gum tissues may appear to be healed after a week, we typically wait six to eight weeks to perform the final crown restoration to give the tissues time to fully mature.

Crown lengthening may not work in all situations, especially with a severely fractured tooth. In these cases, we may need to evaluate the long-term viability of the tooth and consider other restorative options. Depending on your bite, it may also be necessary to treat with orthodontics first: not only will the tooth move into a better position, but the treatment may move both the gum and bone down with the tooth. Subsequent crown lengthening will then only affect the intended tooth and not adjacent ones, resulting in a more even smile.

The first step is for us to decide after a thorough examination if you would benefit from crown lengthening. If so, this minor surgical procedure could pave the way for better mouth function and a more attractive smile.

If you would like more information on crown restorations, please contact us or schedule an appointment for a consultation.

By Lee Oppenheimer, DDS, PA
August 06, 2021
Category: Dental Procedures
Tags: gum recession  
GumRecessionDoesntHavetobePermanent

The worst outcome of periodontal (gum) disease is tooth loss—but it isn't the only form of misery you might suffer. One of the more troublesome results associated with gum disease is gum recession.

Normal gum tissue covers teeth from just above the visible crown to the roots, providing protection against bacteria and oral acid similar to the enamel on the crown. But advanced gum disease can weaken these tissues, causing them to pull away or recede from the teeth.

Not only can this diminish your smile appearance, but the exposed areas are more susceptible to further disease and painful sensitivity. And it certainly can accelerate tooth loss.

But there are some things we can do to reduce the harm caused by gum recession. If we're able to diagnose and treat a gum infection early while the gums have only mildly receded, the tissues could stabilize and not get worse.

The chances for natural regrowth are unlikely, especially the more extensive the recession. In such cases, the gums may need some assistance via plastic periodontal surgery. Surgeons reconstruct gum tissues by grafting like tissues to the area of recession. These grafts serve as a scaffold for new tissues to gradually grow upon.

There are two general types of grafting procedures. One is called free gingival grafting. The surgeon completely removes a thin layer of skin from elsewhere in the mouth (such as the palate), then shapes and attaches it to the recession site. Both the donor and recession sites heal at approximately the same rate, usually within 14-21 days. This procedure replaces missing gum tissue, but doesn't cover exposed tooth roots to any great extent.

In cases of root exposure, dentists usually prefer another type of procedure, known as connective tissue grafting.  The donor tissue is usually taken again from the palate, but the design of the surgery is different. A flap of tissue at the recipient site is opened so that after the connective tissue from the palate is placed at the recipient site to cover the exposed roots, the flap of tissue covers the graft to provide blood circulation to the graft as it heals.

Both kinds of procedures, particularly the latter, require detailed precision by a skilled and experienced surgeon. Although they can successfully reverse gum recession, it's much better to avoid a gum infection in the first place with daily oral hygiene and regular dental care.

If you would like more information on treating gum recession, 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 “Periodontal Plastic Surgery.”

ARoutineDentalProcedureSavesThisMLBStandoutsBrokenTooth

During this year's baseball spring training, Minnesota Twins center fielder Byron Buxton got into a row with a steak dinner—and the beefsteak got the better of it. During his meal, the Gold Glove winner cracked a tooth.

Fortunately, he didn't lose it. Buxton's dentist rescued the tooth with a dental procedure that's been around for over a century—a root canal treatment. The dependable root canal is responsible for saving millions of teeth each year.

Dentists turn to root canal treatments for a number of reasons: a permanent tooth's roots are dissolving (a condition called resorption); chronic inflammation of the innermost tooth pulp due to repeated fillings; or a fractured or cracked tooth, like Buxton's, in which the pulp becomes exposed to bacteria.

One of the biggest reasons, though, is advanced tooth decay. Triggered by acid, a by-product of bacteria, a tooth's enamel softens and erodes, allowing decay into the underlying dentin. In its initial stages, we can often treat decay with a filling. But if the decay continues to advance, it can infect the pulp and root canals and eventually reach the bone.

Decay of this magnitude seriously jeopardizes a tooth's survival. But we can still stop it before that point with a root canal. The basic procedure is fairly straightforward. We begin first by drilling a small hole into the tooth to access the inner pulp and root canals. Using special instruments, we then remove all of the infected tissue within the tooth.

After disinfecting the now empty spaces and reshaping the root canals, we fill the tooth with a rubber-like substance called gutta percha. This, along with filling the access hole, seals the tooth's interior from future infection. In most cases, we'll return sometime later and bond a life-like crown to the tooth (as Buxton's dentist did for him) for added protection and support.

You would think such a procedure would get its own ticker tape parade. Unfortunately, there's a cultural apprehension that root canals are painful. But here's the truth—because your tooth and surrounding gums are numbed by local anesthesia, a root canal procedure doesn't hurt. Actually, if your tooth has been throbbing from tooth decay's attack on its nerves, a root canal treatment will alleviate that pain.

After some time on the disabled list, Buxton was back in the lineup in time to hit his longest homer to date at 456 feet on the Twins' Opening Day. You may not have that kind of moment after a root canal, but repairing a bothersome tooth with this important procedure will certainly get you back on your feet again.

If you would like more information about root canal therapy, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “A Step-By-Step Guide to Root Canal Treatment.”

PeriodontalSurgerymaybeNeededtoHaltGumDiseaseandEncourageHealing

There’s only one way to effectively halt the progressive damage of periodontal (gum) disease — completely remove the bacterial plaque and hardened deposits (calculus) from above and below the gum line that are causing the infection. Although we can accomplish this in most cases with hand instruments called scalers, ultra-sonic equipment or both, some cases may require periodontal surgery to access and clean deeper “pockets” of infection.

As this damaging disease progresses, the supporting bone dissolves and the gum tissues will begin to detach from a tooth, leaving an open space known as a “periodontal pocket.” Besides plaque and calculus pus may also form as a result of the infection. All of this material must be removed from the pocket before healing and, hopefully, tissue reattachment can begin.

Shallow pockets near the gum line are usually accessed and cleaned with hand instruments. But deeper pockets (5 millimeters or greater in depth) may require a surgical procedure to completely clean the area also allowing for regenerative procedures to be done to regain attachment. This will reduce the depth of the periodontal pockets that will make them more accessible for future cleanings and maintenance. Flap surgery is a common type of such a procedure: a small opening (similar to the flap of a letter envelope) is surgically created in the gum tissue to expose the area of infection around the tooth root and bone.

There are also other types of periodontal surgery for repairing and stimulating regeneration of damaged gum tissues. Using grafts or other enhancements, these plastic surgical techniques are especially useful where gum tissues have receded above the natural gum line, leaving more of the underlying tooth below the enamel exposed to disease. These procedures have become more effective in recent years with the development of specialized technologies called “barrier membranes” and biologic growth factors. These materials have allowed bone grafts to be more successful as this technology is engineered for targeted tissue growth and repair, and then dissolve at an appropriate point in the regeneration process.

Periodontal surgery isn’t appropriate for every situation. Still, these procedures do play an important role for many patients to put a halt to the damage caused by gum disease.

If you would like more information on surgical procedures for gum disease, 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 “Periodontal Surgery: Where Art Meets Science.”