You’ve lost your tooth … Now what?

Despite your best efforts, you’ve lost one of your teeth. Maybe it left a gaping hole in your smile and you want to fix it. Maybe you can’t see the gap, but you’ve read my post on why you should replace a missing tooth and were persuaded. There are two important considerations: how to make the replacement tooth look good, and how to make it as functional as possible.

For looks, ceramic is more tooth-like than plastic (see Bondings vs. Veneers).

In terms of function: when you bite, you’re exerting about 150 pounds per square inch on your teeth. That's a lot of pressure. Fixed teeth are more stable, more efficient, and usually also more comfortable than removable teeth.

The most expensive options are not necessarily the best for everyone; your health and the state of your finances are both legitimate considerations. What are your options?

 

Implants

Today’s top-of-the-line tooth replacements are implants, which have been around for decades. In look and function, an implant is the closest you can get to having your real tooth back. It’s a ceramic tooth on top of a metal post that’s anchored in your jawbone. If we decide you’re a good candidate for an implant, you first need to visit an oral surgeon to have the post set into your jaw. After 3 to 6 months of healing, the post is firmly set. During that time, you have a temporary tooth to fill in the gap. Then you come back to my office to have an impression made for the ceramic tooth, which can be fabricated in about 10 days. The current way to do this is via computer-assisted design / computer-assisted manufacturing (CAD/CAM), which carves the tooth out of a solid block of porcelain, creating a tooth that’s precisely shaped and extremely durable.

A well-made implant will last decades. However, implants are not a good choice if you have problems with your bones or if you have a condition that makes surgery inadvisable. You should also be aware that many insurance plans do not cover implants, because implants are an expensive option that require the services of both a dentist and an oral surgeon. (See my post on insurance.)

 

Crown-and-bridge units

A “crown and bridge” is a ceramic tooth that’s permanently anchored to teeth on either side, rather than anchored into your jaw. (That’s why it’s called a “bridge”.) Depending on how many substitute teeth are between the two teeth that anchor it, it could be a 3-unit, 4-unit, or 5-unit bridge—or even more. To have a bridge made, you must have teeth on either side of the missing tooth whose roots are still solidly attached to the bone. To make one, I create a crown for the top of each anchor tooth, and then recreate the missing tooth or teeth between them. Then the whole unit gets permanently attached to the two teeth on the ends. Years back, a crown-and-bridge unit meant having silver or gold metal showing in your mouth. Today a crown and bridge can be metal free, and almost indistinguishable from your real teeth.

Like the tops of implants, the crowns and the replacement teeth are carved from porcelain blocks. On average, a well-made crown-and-bridge lasts 5 or more years. I have patients who’ve had them for more than 20 years.

You’re a good candidate for a crown and bridge if you have a condition that makes implant surgery inadvisable, or if you can’t afford implants. You’re not a good candidate if you have many teeth missing in a row, or if you don’t have teeth on either end that can serve as strong anchors for the replacement teeth.

 

Removable bridge

A removable bridge is like the crown-and-bridge described above, except that the ceramic replacement teeth aren't permanently attached to the supporting teeth on either end. Instead the rest on the gums and "hold onto" the remaining teeth. This is less expensive than a crown and bridge because it doesn’t require the making of the crowns to anchor the bridge. On the other hand, because it’s not permanently attached, a removable bridge might wobble a bit when you chew.

 

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net or through my website,www.DoctorDurante.com. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

 

Bonding or Veneers?

Bondings and veneers are both ways to repair minor damage or imperfections to teeth, such as a chipped tooth, a gap between teeth, discoloration, or uneven teeth. Both are cosmetic: if you have a cavity, a loose tooth, or a crack in a tooth, you’ll need other types of care. Both are painless.

Bonding involves applying a combination of resin and porcelain to a tooth. I mix the composite material so that it matches the color of your other teeth, then shine a blue light on it to “cure” it. The whole procedure might take 30 to 60 minutes, all on the same office visit. The composite material is pretty resilient: I’ve had patients whose bondings still look good after 20 years, although the norm is two to five.

If you do things that stain your teeth (smoke, or drink a lot of coffee or tea), the bonding may stain, in which case it can be polished like the rest of your teeth. When a bonding fails, it’s most often because of trauma or excessive force. If you like to crack nuts with your teeth, bonding is not the best choice for you.

A veneer is more expensive than bonding (typically about four times the price), but looks more like a natural tooth. That’s because the composite material used for bondings is opaque, but natural teeth are slightly translucent. Veneers, however, are made of ceramic, so the light passes through them as it does through fine china.

For a veneer, I take an impression of your tooth and have a dental lab create a ceramic tooth-cover that exactly fits over the tooth. The veneer is not only translucent, but has striations like a natural tooth - very difficult to mimic in a bonding. To get a veneer, you’ll need one office visit to have the impression made, and another visit several days later to have the veneer applied. Again, I wouldn’t recommend veneers for patients who like to crack nuts with their teeth.

Veneers are ideal if you want to correct minor imperfections to one or several of your front teeth without getting braces on or having the teeth replaced. I can make the veneer’s color match that of the teeth to either side of the veneer. If you’re having all your front teeth done and want a slightly brighter smile, we can adjust the color of the veneers.

If you’re not sure whether your problem is cosmetic or functional, come in for a check-up and we can talk about your options.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net or through my website, www.DoctorDurante.com. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

 

 

 

 

"Do You Take Insurance?"

People often ask if I take insurance: a tricky question, because it can have two meanings. On the one hand, I'm happy to fill our your insurance company’s forms. In fact, I submit them on line, so that you'll be reimbursed more quickly.

On the other hand, I do not accept any insurance company’s payment as full payment for my services. For most procedures, an insurance company’s payment is well below the price that I usually charge—often barely half of the “customary and usual” fee. The provider is expected to be able to make up the difference through volume, by filling his schedule with other patients referred by the insurance company. You've probably sat for hours in the waiting room of a health-care provider who participates in insurance plans: that’s because the conscientious physician or dentist is struggling to get through a crowded schedule that often allows only a quarter- or half-hour for procedures that should take much longer.

I respect my patients and myself too much to work that way. My fees are not arbitrarily set: they depend on the time required for a procedure, its difficulty, and the materials required. I schedule enough time to do procedures properly. I constantly monitor the dental labs that I use to produce crowns, dentures, veneers, and so on, making sure they produce superior work that often fits perfectly on the first try, and that will last as long as possible. A typical insurance payment will often not even cover the price of good-quality lab work, never mind your time with me.

Can anyone but me tell the difference in quality? Apparently so, since I often see patients who have been to a dentist who participates in their insurance plan, but have come back to me for major work or to fix dental work that was poorly done. Did you know that a simple filling requires up to 15 separate steps? Skimping on any one of them can cause the filling to fail prematurely. Imagine the possibilities if your dentist rushes through the steps of a more complicated procedure—for example, making a crown or doing a root canal—because half a dozen patients are backed up in his waiting room.

So: my fees are what they are for very sound reasons, and I do not accept any insurance company’s determination of what they ought to be. I want your business on mutually acceptable terms: your satisfaction with work well done, and my full price for it. Yes, you will be responsible for whatever part of my fee your insurance company does not pay. But I will be happy to help you find out how much they allow for various procedures, and to discuss a range of treatment plans to fit your budget, so that you can make an informed decision about what you want done.

 If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Digital Dental X-Rays

For a traditional x-ray, you bite down on a piece of film in a cardboard holder while the dentist shoots x-rays at it. The dentist removes the small piece of exposed film  and develops it (about 15 minutes), then views it on a light-box at approximately life size, in shades of gray, to determine if there are any problems with your teeth. Here’s an example:

I’ve used digital x-rays instead of traditional x-rays for the past 12 years. For digital x-rays, you bite down on a computer chip in a holder, I aim the x-ray machine at it, and the results appear immediately on my computer screen. Here’s an example:

There are several major advantages to digital x-rays.

1. If a second image is necessary, I can take it immediately, not 15 minutes later. The fact that the image is digital also means that I can back it up (to safeguard your records), and if necessary I can transmit it to another dentist or physician instantaneously, without worrying whether the lone copy of the x-ray will be lost or damaged in transit.

2. Because the computer chip is much more sensitive than traditional x-ray film, taking a digital x-ray requires far less radiation. The amount of radioactivity you’re exposed to with either type of dental x-ray is negligible in terms of what you’re exposed to outdoors year after year, but if I can decrease the amount of your exposure, why not? (For more on average exposure to radioactivity, see http://www.iem-inc.com/primrite.html.)

3. The major advantage in digital x-rays is the fact that I can view them at much larger than life-size on a computer screen, in a range of colors that indicates density (i.e., soft or hard tissue). This also makes it much easier for me to show you what’s going on, so that we can discuss your treatment options.

I pride myself on providing the best quality service for my patients, including recent technological advances that I consider best for maintaining your dental health. Please call if you’d like to make an appointment for a check-up with digital x-rays.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

 

Snoring & Sleep Apnea: How a Dental Appliance Can Help

A person who has sleep apnea stops breathing for ten or more seconds while sleeping, then wakes enough to start breathing again and falls back asleep. This can happen as many as 60 times a night. It's a problem because sleep isn’t simply a blackout: it runs in cycles of lighter and deeper sleep, which are disrupted when breathing stops. Someone suffering from sleep apnea can be in bed for 8 hours but wake up exhausted, because of the frequent disruption of his or her sleep cycles.

If someone who sleeps with or near you has sleep apnea, you’ll probably hear loud snoring, then an abrupt silence, then a snorting or choking sound as the person starts breathing again. On the other hand, if you’re the one with the problem you may not realize it: people with this sleep disorder often don’t remember waking up in the night. You will nevertheless feel the effects of lack of sleep, which include morning headaches, excessive sleepiness during the day, and irritability. Left untreated, sleep apnea can make you unable to function well during the daytime and can lead to high blood pressure, heart attack, or stroke.

The way to find out if you have sleep apnea is to visit a physician specializing in sleep disorders, who will make a diagnosis based on your medical history, a physical examination, and an overnight sleep study to find out the number of times your sleep is interrupted during the course of a night.

How is sleep apnea treated? That depends on the reasons for the apnea. The milder form—fortunately also the most common— is obstructive apnea, in which the muscles of the throat relax so much that the airway collapses. Your physician may suggest not sleeping on your back, losing weight, or quitting smoking. For some, a simple dental appliance that repositions the lower jaw and tongue may be all that's needed. This same dental appliance is, incidentally, used to prevent or lessen snoring.

Sleep apnea is a condition that must be diagnosed by a physician, not a dentist. If a physician confirms that you have the problem, or if you snore and want to stop, I’ll be happy to make a custom-fitted dental appliance and adjust the fit to make it work as effectively as possible.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

 

 

 

Why Replace a Lost Tooth?

The obvious reason to replace a lost tooth is so you can eat as efficiently as you did previously. If you lose one of your molars, you lose the chewing area between it and the corresponding molar above it: a quarter of your chewing surface. If you lose a canine, you’ll have to tear at that beef jerky with the other side of your mouth.

Besides the loss of function, there is the fact that your other teeth may shift to fill in the gap: that’s what usually happens. Of course, statistics don’t determine what will occur in your particular case, but there’s a reason for the statistics. Teeth push and lean against each other, both within the same arch and from the opposing arch (that is, your upper and lower teeth). If the lost tooth is “missed” by the adjacent teeth or opposing teeth, the teeth that remain will shift until the forces are in balance again. The results of that are unpredictable. Molars may end up not meeting the opposing molars as neatly. New gaps between teeth can become traps for food particles, leading to tooth decay and gum disease, hence to loss of more teeth.

 The most common ways to fill spaces left by missing teeth are bridges and implants. These have different maintenance requirements from your own teeth, but the amount of time you need to maintain them is small, compared to the number of times you probably use the teeth in a day. If you’re a candidate for either one, we can discuss which is best suited to you.

 If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Air Abrasion

There ought to be a more attractive name for air abrasion: it sounds a scrape, but in fact it’s the most wonderful invention in decades for patients who hate dental drills. And that would be about 100% of the patients I’ve seen in my 25 years of practice.

Air abrasion uses a fine stream of aluminum oxide to scour away decay. Think of it as a sandblaster geared to the scale of an ant: it’s extremely small and precise. When I use air abrasion, I usually don’t have to give you an anesthetic injection (no needle!), and you can eat or drink as soon as the filling is set, without worrying about whether your numb lip is hanging down to your chin.

Air abrasion is also much quieter than drilling and produces no vibration. The worst that can be said about it is that it produces a fine dust, which I mostly vacuum away as I work. Whatever isn’t vacuumed out, you simply rinse out with water. In the 12 years I’ve been using this technique, not a single patient has said he wished I'd used the drill.

What’s the catch? Air abrasion usually can only be done on cavities that are not already causing pain. I’m able to use air abrasion on more than half the cavities I treat. You can increase your chances of being treated with air-abrasion by having regular check-ups, so that we catch and treat cavities early.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

 

 

 

Dental Check-Ups: How Often Should You Have One?

The standard recommendation for dental check-ups is every six months. Why? Because in 6 months, a new cavity is less likely to eat through the tooth into the nerve, causing you serious pain. Also, if you have your teeth professionally cleaned every six months, it's less likely that plaque and tartar will cause gum disease.

That said, 6 months is an average. Several factors affect how often you, as an individual, should have a routine check-up.

1. Dental hygiene

Are you diligent about brushing and flossing? Cavities are caused by bacteria feasting on the sugars in food remnants. If you brush and floss every 24 hours or so, fewer food particles and bacteria will be there to cause damage. As you get older, you may have to up your dental-hygiene routine. For example, if your gums are receding or your teeth have become crooked, there may be new places vulnerable to cavities that need to be carefully cleaned.

My family uses a toothpaste that has prescription-strength fluoride and an electric toothbrush that runs for two minutes and beeps at 30-second intervals, to tell the user when to start brushing a new section of the mouth. I also floss with dental tape rather than plain floss (round in cross-section). If you want, ask me for the latest name-brand recommendations when you come for your check-up; they change too often to put up on the web.

2. Heredity

All teeth are not created equal. Some people are born with grooves in their molars that are too narrow for toothbrush bristles to reach into. If you have that sort of teeth, minute food particles will get stuck there even if you brush and floss meticulously, and it's likely that you’ll eventually develop cavities in your molars. Catching such cavities sooner rather than later will prevent pain and help preserve your natural teeth.

3. Food & Drink

As I mentioned in the post on sealants, the absolute worst thing for your teeth is food or drink that’s full of sugar, and that stays in your mouth a long time or that you munch for hours on end. Unless you buy sugar-free versions, all the following can have significant amounts of sugar:

• Sodas
• Fruit juice
• Lollipops, boxes of M&Ms, breath mints
• Cough drops
• Hostess Twinkies and similar snacks

The list of ingredients on packaged food is given in order from the most prevalent to the least. If one of the first 3 ingredients is sugar, corn syrup, fructose, or dextrose, I don’t buy it as a snack and we don’t keep it in the house. An exception now and then (at a party or at a friend’s, for example) won’t have a big effect if you avoid sugars most of the time.

You probably know if you’re cavity prone for any of the above reasons. If you don’t, ask me to tell you based on your existing records, and we’ll talk about how often you should come in for check-ups.

The money spent on check-ups is considerably less than the cost of filling major cavities. And one of the great benefits of catching cavities early—before they become too expansive—is that they can be fixed with a relatively new technique, air abrasion. Air abrasion involves no needles and no numbness. More on that in a future post, or read the Academy of General Dentistry’s description here.

 If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Why Get Sealants for Your Child?

When I was a kid, I loved rock candy, which is pure sugar. Sugary candy that you keep in your mouth for a long time and sugary soda that takes a while to drink are just about the worst things you can do to your teeth. Combine them with less than fanatical toothbrushing habits, and it's no surprise that by the time I was 20, I had a mouthful of silver fillings. So did most of my friends.

My daughter may very well turn 20 without a single major cavity. Part of the reason is that we don't keep candy in the house. Part of the credit goes to the sealants I put on her teeth when she was 9 years old. Sealants have been around for about 30 years and have made a tremendous difference in how many cavities kids get. They're a sort of plastic coating over the molars that takes minutes to apply, and lasts for years. The cost is roughly equal to half the cost of filling one major cavity. Best of all, getting sealants put on is a pain-free process that can save a lot of pain down the road.

Of course you should teach your child to brush and floss, but why not give them a little help while they learn to do it efficiently? I have office hours that will allow you to bring your child in without disrupting his or her school or after-school activities, or your work schedule. (Click here for hours and location.)

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Some of My Happiest Patients Are Those Who Have Had Root Canals

The words “root canal” are synonymous with pain: “I’d rather give birth than have a root canal.” Yet some of the patients who leave my office with the biggest smiles are those who’ve had a root canal.

A root canal is a last-ditch attempt to save a tooth by cleaning out infected soft tissue inside the tooth. It's done because saving your own tooth is usually more convenient and less expensive than having the tooth extracted, then replacing it (with an implant or a bridge) so your teeth stay lined up and your bite remains stable. For a long time, however, having a root canal meant a lot of drilling and a lot of pain.

In the 25 years I’ve been practicing, root canal procedures have improved greatly: better pain control, better treatment techniques, better results. When I was a teenager, watching my dentist make people pain-free was one of the things that inspired me to choose a career in dentistry. (More on this on my website.) That's why I always schedule adequate time to let the local anesthetic take effect. (You can also request nitrous oxide, if you wish.) I also use a top-notch dental lab that produces crowns that usually fit on the first try, and that match your own teeth.

Some patients who’ve been seeing insurance-approved dentists for years come back to me for root canals and other difficult procedures. When it comes to such procedures, a dentist who accepts an insurance payment as full payment is at a disadvantage: he is often forced to rush because he's seeing patients in half-hour slots, and he may have to choose a dental lab not because of the quality of its work, but because its lab fee is low enough to be covered by the insurance company’s payment. (Read more about my policy on insurance payments.) I take pride in providing my patients with the finest quality of care, which includes scheduling adequate time for procedures and using the knowledge and experience gained over 25 years in practice to make each visit as pleasant as possible. That’s why some of the happiest patients are those who have had root canals.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.