The Tooth about Dental Implants

If you're missing a tooth and have been to a dentist recently. Chances are your dentist will have recommended having a dental implant. Theres a lot to say about implants but I'll go over the basics that will allow you to make the right decision for you.

DOES GETTING AN IMPLANT HURT? No. The implant placement procedure is about as painful as getting a filling. Very little pressure or sensations. Just lots of water and noises. Sit back and watch a movie. You will be sore after you go home so read my post on extraction to get some tips to help!

WHAT IS A DENTAL IMPLANT: A dental implant an artificial tooth made to be placed in the original spot of a missing tooth. It is made out of 3 pieces:

1. The replacement root or "Fixture". This is the part that involves surgery. After an old tooth is removed. The hole that it leaves is filled in with bone by your body. In order to put a new root in the spot, that bone needs to be removed to make space. The "fixture" is made out of titanium because that is the strongest material that the body does not reject. Most other prostheses in other parts of the body are also made from titanium.

2. The replacement tooth head or "crown" which is the part you will see and chew on. It is very similar to a crown that you get when you get a root canal or when you broke a tooth. It is typically a gold-metal hybrid coated in porcelein but sometimes it is made in all porcelein.

3. The abutment is the piece that connects the pieces 1 and 2. It is hand screwed into the implant. This is the piece that tends to get loose after several years of use. If you find that your implant is loose and moving, this is typically where the problem is. Its not a big problem, the dentist just needs to cut a whole through the crown to find the screw, tighten it with a wrench, and fill the whole. This usually does not have any pain associated with it.

WHY SHOULD I CHOOSE A DENTAL IMPLANT? To answer this question you basically have to understand the drawbacks of the other options. Whenever you need to replace a tooth you have 3 main options:

1) Partial Denture:  This prosthesis is typically bulky. It has clasps to hold onto other teeth and fake teeth to replace your missing ones. Because of its size, it tends to get in the way of your tongue and other tissue. It can generate sores. It can cause your jaw bone to receed from long term stress. It will catch food underneath. Overall its not sometime I would will on any of my friends or family. Its an affordable solution and something is better than nothing, but I would rather save my money for something more comfortable.

2) Bridge:      A bridge is basically putting a crown on the two teeth adjecent to the open space and attaching a fake tooth to them effectively "bridging" the gap. The best things about this solution are a) it feels very similar to having real teeth, since you are using  other teeth to support it, you still have similar chewing and sensations, b) its fast: the dentist can have this back to you in about 2-3 weeks. Whats the problem? Well as you can see, those two adject teeth are ground down quite a bit to what they used to be; and if they were perfectly good teeth, you just ground down about half of each healthy tooth. The other reason is this is a 3 piece unit which means that if any of these pieces fail, the whole thing fails. If you get a cavity on one of these teeth, you have to do it over again. If you lose one of the teeth to periodontal disease, you have to lose the whole bridge. SO its a good solution for the short term, but long term is has problems.

3) Implant: So basically the best thing about the implant is that its a stand alone soluation. No other teeth need be damaged and it relies on no other teeth. If you take care of it, you can take it to your grave. The only real problem with the implant is that it takes time. Usually somewhere between 3-9 months of treatment time. What are the factors that make up the time difference?

- Time to heal: The implant needs time to heal and "integreate" into your body. If you started to chew on it immediately, there is a good chance that it will never form bone around the implant and it would fall out.

- Do you have enough bone? If the tooth is lost for a long time the bone with atrophy away. This means the dentist may need to add some artifical bone around the implant to support it. This requires additional healing time

- Are you in good health? The implant site heals just like any other part of your body. Having health problems like diabetes can impair healing , requiring extra healing time.

-Do you smoke? If you smoke you can cause your gums and bone to not heal during this time. The dentist will tell you not to smoke, but not to say you will definately fail the implant if you do; it just really helps if you dont.

Jeffrey Chung DDS

The Tooth about Pulling Teeth

Its been a while since I had posted I apologize, I'll keep more regular update as much as possible!

"Pulling Teeth" or dental extractions get a lot of bad press just like root canals. The term "hard like pulling teeth" makes it seem like its a long painful process. Lets delve into what goes into a dental extraction so you understand the basics shall we?

DOES IT HURT TO HAVE YOUR TEETH EXTRACTED? Lets get the most pressing question out. No you should not feel pain during the actual extraction. Just like how root canals get a bad repuation, the history of pulling teeth being painful came from a time when our anesthetics were not as good as they are today. You should be completely numb during the time of the extraction and you should always ask for more anesthetic if you feel a sharp pinch. Don't worry after the initial pinch from getting numb you should not feel a 2nd, because the gums numb a lot more easily than the tooth.

Now for the confusing part.... where you won't feel pain, you will feel a lot of PRESSURE. Anesthetic cannot remove the pushing feeling of trying loosening and finally removing tooth. I'll go into whats actually happening next.

HOW DOES A DENTIST REMOVE A TOOTH? The term "pulling" a tooth is actually very misleading because there is very little pulling of the tooth. In fact if you were to attempt to pull your own tooth -- and you literally took a pair of pliers and pulled on the tooth, you would find that it does not come out unless you bench 250. Why is this? Because a tooth is held into your jaw by tiny fiber ligiments that attach directly into the bone. So basically the tooth is glued into the bone. If you want to remove something that glued shut, you don't just grab it and yank, you'll destory it and some of it will probably still be stuck! You want to loosen up the glue until its much weaker and then tease it our gently. This is how dentists remove teeth.

The process of extracting a tooth involves two things: loosening up those fibers and expanding the jaw bone. Bone is actually a little flexible (especially the upper jaw) and by wiggling the tooth or wedging an instrument between the bone and the tooth will allow it to "give" a little. While its wedged this is where you'll feel a lot of the pressure I was referring to before.

WHY ARE SOME TEETH HARD TO PULL? Okay, so while 90% of all teeth come out without much fuss, theres still 10% of them that put up a fight. So if your dentist is taking more than just 15 minutes getting your tooth out you probably have one or more of these:

- Highly decayed tooth below the gum line: nothing to grab on to, nothing to wedge against
- Very dense and unflexible bone: particularly common in african americans and the lower jaw
- A tooth that had a root canal and highly decayed: its brittle so it tends to shatter
- Curved roots - Try getting a crow bar out of cement and you'll understand
- Long Roots - More root = more fibers

WHAT DOES THE DENTIST DO WHEN TEETH DON'T WANT TO COME OUT? Okay STOP reading if you don't like details. At this point the dentist has realized this tooth is not going to simply loosen and come out, so he has to go to plan B. Usually plan B consists of moving the gums out of the way to see better, cutting the tooth into a few pieces so hes not trying to tackle all of it at once, or removing some of the jaw bone around the tooth so he can gain some extra tooth to lean on. Bottom line is you will be a little extra sore after the procedure is done.

WHAT IF THE TOOTH DOESN'T COME OUT? Now we're into the 1% probability range. Very rarely the dentist cannot get the tooth out because its either fused into your bone of the piece is so small, but when it does happen the dentist will usually choose to leave it in. Why? Because the damage he would need to inflict to you in order to get that little piece out is much worse than everything up to that point. What will happen? Either a) the body will just pretend its a piece of bone and intergrate it into your jaw, or b) you body will just gradually push it out until it comes out on its own.

TIPS for getting a tooth pulled:

- Take Ibuprofen 600 mg 4x a day 2 days prior to treatment (if you don't have health problems taking Ibuprofen. This will decrease pain and soreness during and after the treatment.

- If you feel any pain, ALWAYS ask for more anesthesia, don't "tough it out"

- Give yourself a few days to recover just to take it easy

- Don't feel that its going to be a big deal. Most of the time its a fairly simple procedure with minimal discomfort

Jeffrey Chung DDS

The Tooth about White Fillings

Recently the world of dentistry has converted to predominantly white fillings as opposed to the silver fillings. What people don't really understand is what these fillings are and what their limitations are. Briefly I will say that the silver fillings known as Amalgam are very strong, safe, and reliable fillings. I will go into detail about them in another post. Lets talk about white filling known as Composite.

WHAT IS COMPOSITE? Scientifically they are called resin, but simple put, its plastic, very hard plastic. It is comes in 2 basic forms: Squishy and flowy also known as Packable and Flowable. Both of these, when hit by an intense blue light become "cured" and turn very very hard. Most dentists use both of the squishy and the flowy - the squishy type is stronger and has been engineered to be strong enough to withstand most biting forces. The flowy type has been engineered to be extra smooth and polishes to be real shiny. It can reach little nooks and cranies that the squishy type cannot.

HOW IS A WHITE FILLING DONE? Unlike other fillings or restorations, Composite fillings do not rely on a wedging effect to stay in the mouth. They rely on bonding or chemically attaching to the tooth. The benefit of this is the dentist can cut less or zero tooth away to put a composite filling on. Simple place the chemicals on the tooth to prepare it and then put the filling material and then blue light (aka cure). By the way if you taste something funky during all of this, it is the chemicals used to bond to the tooth. The side effect of this is that whenever these fillings have problems, they don't stay in - they pop out. Other fillings, when there are problems, they stay in even if they are decayed all around. You can view this as a positive or negative thing.

CAN WHITE FILLINGS BE USED ALL THE TIME? The short answer is yes, but the real answer is no. They CAN be used all the time, but they probably shouldn't. One of the major weaknesses is  that it relies on the tooth being completely dry when it is done. Often times your tongue or even the moisture in your breath can disturb this and make the filling not as strong as it was designed to be. When working in the back, this can be especially challenges to get a strong bond.

WHAT ARE THE DRAWBACKS? Many patients get sensitivity to cold and sweets after composite fillings are done especially when the cavity is deeper. There are several reasons this can happen. The first is that the inner layers have the tooth have nerves embedded in them and the filling material, because it is plastic has a very slight flex to it. This flexing will disturb those nerves. Also, because of the strength of the Packable composite, if the filling was made to be too high you will not be able to grind it down and that tooth will take more force than other teeth leading to sensitivity. Dentists will always check the bite first to make sure this is not the problem. Another drawback is that plastic just isn't as strong as metal and in some strong jawed patients, it will be strong enough and will break.

The Tooth about Dental Extractions

The term "harder than pulling teeth" has been toss around for years now. It gives a very scary impression of what its like to have a tooth pulled. Lets see if we can dispel some of the rumors.

Again I will start with the most important: HAVING A TOOTH PULLED DOES NOT HURT. Just like root canals, a dental extraction, when fully numb, is done without pain. The one difference between an extraction and other procedures is the physical pushing you feel in your mouth. While there is no pain, there is the sensation of something wedged between your teeth which takes some time getting used to.

Now lets talk about the actual procedure. Many times patients are amazed how quickly it is done. Most of the time it takes more time to get numb than to actually take out the tooth. Most of the time it is not difficult nor long to encourage a tooth to come out. When pulling an adult tooth people get the wrong idea of how it is done. We do NOT just grab it an yank it out. Taking out a tooth is approched similarly to removing a nail from a very dense piece of wood: pulling it will feel like you're doing nothing. We take an very thin instrument and wedge it next to the tooth until the jaw bone around it eases up. Once the bone expands in all directions we simply can pluck the tooth out like a flower.

Pulling baby teeth conversely seems like we're pulling. This is because baby teeth are gradually eaten away by the body as they get older and when we pull them out theres just only the top portion of the tooth remaining that is stuck to the gums. They don't require any dealings with the jaw bone so they are simply plucked out.

Some Facts you may not know about Dental Extractions:

- If a tooth is highly infected, the bacteria in the gums will prevent the anesthesia from working. So many doctors discourage pulling abscessed teeth and usually prescribe antibiotics first.

- Doctors will often encourage placing bone in the left over hole to allow the entire hole to fill with bone. This will give better looking gums and makes it easy to place an implant(quicker and less pain).

- The price for pulling a tooth depends on the how hard it is to get out. Often times if you demand a price from a dentist he will quote you the one for a hard extraction just in case. If you don't ask, often he'll charge you for the easy extraction if it was easy.

- When a tooth pops out, it can fly in any direction, so don't swallow!

- The older you are, the more difficult it tends to be to pull your teeth because the jaw bone tends to be less elastic as it ages.

The Tooth about Dentures

As a dentist, I always hope I never have to give my patient dentures. However I know it is inevitable that many people will need to have them made. Lets start with the basics......

Dentures are plastic "plates" that people can wear that have plastic teeth embedded in them. They are for patients that have no teeth or will have no teeth after treatment is completed. The positive: They look great. When it comes to getting a beautiful smile, dentures can give a very ideal beautiful look because they are 100% designed and controlled. The negative.... dentures are not real teeth and feel nothing like real teeth. Your ability to chew will be clearly less than before. The analogy I usually use is comparing wearing a boxing glove vs your fingers - its quite clumsy.

Dentures can be made in two ways: Before your teeth come out, or after. To make them before the teeth are pulled are called "immediate dentures"... namely because they are given immediately after the teeth come out. This allows you to never have to walk around with no teeth. There is a drawback however, and that is that the shape of the plate is a laboratory guess. It will fit moderately well the first day and get progressively worse as the jawbone remodels itself  after the teeth have come out. Some of the time after the bone finishes changing, the internal surface of the denture can be relined to fit the new shape of the bone, but this isn't always possible. Thats why I consider the immediate denture to be a temporary denture. The most reliable way to make a denture is to wait 2-3 months after the teeth are removed to shape it to the final shape of the mouth.

Upper dentures are superior to lower dentures. Why? Because there is suction. The upper uses the palate (or roof of your mouth) to create a seal of air and water to behaving like a suction cup. It won't flop around so easily.  This is why sometimes dentists will often be more aggressive when planning for upper dentures because the end result isn't as dramaticly different from a few teeth and a partial denture - it basically will save you money long run. The lower denture however, is terrible. It will move around a lot and the only way to control it is to use yoru tongue properly. It is a skill that requires practice.

Fortunately we now have dental implants to help use these plates. With two implants placed in each jaw, they can hook onto the denture and give a very stable prostheses. They can be so tight that it will take a lot of effort to remove them. In addition if more implants are used, the upper can be made to not cover the palate for increased taste and comfort. I always recommend this option for those who are healthy enough to have dental implants.

The Tooth about Root Canals

Theres nothing like the look in your eyes whenever I say you need a root canal. Its as if rapture has started and the world is collapsing on itself. I'm kidding of course, but it doesn bring a lot of anxiety. Hopefully I can clarify some common misconceptions.

First of all, lets get the big one out of the way: ROOT CANALS ARE NOT PAINFUL. They got the reputation (similarly to pulling a tooth) of being painful back in the days where dental anesthesia products did not work as well as today. Today, we can make teeth 100% numb so the actual procedure itself is just as comfortable as getting a cleaning.

WHAT IS A ROOT CANAL: A root canals is a procedure where the dentist will removed all nerve and vessel tissue from the center and roots of the teeth so it will not be able to feel pain anymore. The dentist will also clean out all the tooth walls on the inside to make sure that theres no bacteria left clinging on the inside. Finally he will put a filling material that will appear white on xrays.

WHY DO I NEED A ROOT CANAL: The most common reason why you need a root canal is your tooth is infected. When a cavity becomes big enough, the bacteria have dug their way to the center of the tooth where the nerve lives which will cause a LOT of pain. However after some time the bacteria will take over the inside of the tooth and it will die, where it becomes a full blown infection. Often times you will notice no pain because the nerve has died. However, after enough bacteria grow, it will create an abscess (or pus pocket) which will cause pain once more and spread to other locations in the body!

There is one case where a tooth infection actually killed a 12 yr old boy so Root Canals can save lives!
http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html

Other FACTS YOU MAY NOT KNOW:

- After getting a root canal, front teeth tend to turn grey because they have lost blood supply

-After getting a root canal, back teeth are typically vulnerable to breaking, so crowns are always placed.

-Mild discomfort between treatment appointments or after treatment is not unusual but you are less likely to have it if you're tooth wasn't completely dead before the dentist started treatment. It is almost always temporary.

-Root canals on teeth further back are significantly more difficult and more expensive.

- Material used to fill the root canal is similar to the material inside of a golf ball!

The Tooth

First of all, I would like to say thank you for visiting and welcome to my Blog! I am dedicating this blog to provide dental information commonly asked and will try to dispel any myths that may scare you. If you have any questions about any information I post here, feel free to contact me at Jchung@myserenitydental.com or you can ask me at http://www.myserenitydental.com/. Thanks again!

Jeffrey Chung DDS