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Posts for category: Dental Procedures

By David E. Shapiro, DMD
May 20, 2019
Category: Dental Procedures
J-LosUnluckyBreakChippingaToothonStage

Whether she’s singing, dancing or acting, Jennifer Lopez is a performer who is known for giving it all she’s got. But during one show, Lopez recently admitted, she gave a bit more then she had planned.

“I chipped my tooth on stage,” she told interviewers from Entertainment Tonight, “and had to finish the show….I went back thinking ‘Can I finish the show like this?’”

With that unlucky break, J-Lo joins a growing list of superstar singers—including Taylor Swift and Michael Buble—who have something in common: All have chipped their teeth on microphones while giving a performance.

But it’s not just celebs who have accidental dental trouble. Chips are among the most common dental injuries—and the front teeth, due to their position, are particularly susceptible. Unfortunately, they are also the most visible. But there are also a number of good ways to repair chipped, cracked or broken teeth short of replacing them.

For minor to moderate chips, cosmetic bonding might be recommended. In this method, special high-tech resins, in shades that match your natural teeth, are applied to the tooth’s surface. Layers of resin, cured with a special light, will often restore the tooth to good appearance. Best of all, the whole process can often be done in just one visit to the dental office, and the results can last for several years.

For a more permanent repair—or if the damage is more extensive—dental veneers may be another option. Veneers are wafer-thin shells that cover the entire front surface of one or more teeth. Strong, durable and natural-looking, they can be used to repair moderate chips, cracks or irregularities. They can also help you get a “red-carpet” smile: brilliant white teeth with perfectly even spacing. That’s why veneers are so popular among Hollywood celebs—even those who haven’t chipped their teeth!

Fortunately, even if the tooth is extensively damaged, it’s usually possible to restore it with a crown (cap), a bridge—or a dental implant, today’s gold standard for whole-tooth replacement. But in many cases, a less complex type of restoration will do the trick.

Which tooth restoration method did J-Lo choose? She didn’t say—but luckily for her adoring fans, after the microphone mishap she went right back up on stage and finished the show.

If you have a chipped tooth but you need to make the show go on, 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 David E. Shapiro, DMD
May 10, 2019
Category: Dental Procedures
Tags: tooth loss  
ToothLossAHealthRiskforOlderAdults

Tooth loss is a problem that affects many seniors—and since May is Older Americans Month, this is a good time to talk about it. Did you know that more than a quarter of adults over age 75 have lost all of their natural teeth? This not only affects their quality of life but poses a significant health risk.

According to a study in The Journal of Prosthodontics, significant tooth loss is associated with increased risk for malnutrition—and also for obesity. If this seems like a contradiction, consider that when you have few or no teeth, it’s much easier to eat soft, starchy foods of little nutritional value than it is to eat nutritious fresh fruits and vegetables. If all of your teeth are missing, it’s especially critical to replace them as soon as possible.

There are several ways to replace a full set of missing teeth, including removable dentures, overdentures, and fixed dentures:

Removable dentures are the classic replacement teeth that you put in during the day and take out at night. (However, if you suffer from sleep apnea, research has found that keeping dentures in at night may help keep the airway open, so if you have this condition, be sure to mention it to your doctor and dentist it). Dentures have come a long way in terms of how convincing they look, but they still have some disadvantages: For one thing, they take some getting used to—particularly while eating. Also, wearing removable dentures can slowly wear away the bone that they rest on. ¬†As that bone gradually shrinks over time, the dentures cease to fit well and require periodic adjustment (re-lining) or a remake.

Overdentures are removable dentures that attach onto a few strategically placed dental implants, which are small titanium posts placed in the bone beneath your gums. Strong and secure, implants prevent the denture from slipping when you wear it. Implants also slow the rate of bone loss mentioned above, which should allow the denture to fit better over a longer period of time. The ability to maintain hygiene is easier because you can remove them for cleaning.

Fixed implant-supported dentures are designed to stay in your mouth all the time, and are the closest thing to having your natural teeth back. An entire row of fixed (non-removable) replacement teeth can usually be held in place by 4-6 dental implants. Dental implant surgery is an in-office procedure performed with the type of anesthesia that’s right for you. After implants have been placed and have integrated with your jaw bone—generally after a few months—you can enjoy all of your favorite foods again without worry or embarrassment.

If you would like more information about tooth-replacement options, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Overdentures & Fixed Dentures” and “Removable Full Dentures.”

By David E. Shapiro, DMD
April 30, 2019
Category: Dental Procedures
Tags: pulp capping  
YouMightAvoidaRootCanalwithThisTooth-SavingProcedure

The sooner you get treated for tooth decay, the less likely you'll lose your tooth. That could mean a simple filling—or you might need a root canal treatment if decay has reached the inner pulp.

There's also another procedure for advanced decay called pulp capping. It's a bit more involved than filling a cavity but less so than a root canal. We can use it if decay has exposed or nearly exposed the pulp, but not yet infected it—otherwise, you may still need a root canal treatment to remove the diseased pulp tissue.

There are two types of pulp capping methods, direct and indirect. We use direct pulp capping if the pulp has been exposed by decay. After isolating the tooth to protect other teeth from contamination, we remove all of the decayed dentin up to the pulp. This may cause some bleeding, which we'll stop, and then clean and dry the tooth area.

We'll then apply a protective biocompatible material directly over the pulp to promote healing and protect it from further infection. We then restore the tooth's appearance and function with a life-like filling.

We use the indirect method, a two-part process separated by six to eight months, when the pulp tissue is close to the surface but not yet exposed. We initially remove the majority of decayed tooth structure, but leave some of it in place next to the pulp chamber. Although this remaining dentin is softened and decayed, we'll treat it with antibacterial chemicals, then cover it with a biocompatible material and a temporary filling.

Over the next several months the treated structure has a chance to re-mineralize as it heals. We then remove the temporary filling and assess the level of healing progress. If the regenerated dentin appears healthy, we can then remove any remaining decay and restore the teeth as we would after a direct pulp capping.

At the very least, pulp capping could buy your affected tooth time before a root canal will finally be needed. Under the right circumstances, it's an effective way to save an otherwise lost tooth.

If you would like more information on tooth decay 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 “Pulp Capping: A Procedure that may Save a Decayed Tooth.”

By David E. Shapiro, DMD
April 10, 2019
Category: Dental Procedures
HowKathyBatesRetainsHerMovie-StarSmile

In her decades-long career, renowned actress Kathy Bates has won Golden Globes, Emmys, and many other honors. Bates began acting in her twenties, but didn't achieve national recognition until she won the best actress Oscar for Misery — when she was 42 years old! “I was told early on that because of my physique and my look, I'd probably blossom more in my middle age,” she recently told Dear Doctor magazine. “[That] has certainly been true.” So if there's one lesson we can take from her success, it might be that persistence pays off.

When it comes to her smile, Kathy also recognizes the value of persistence. Now 67, the veteran actress had orthodontic treatment in her 50's to straighten her teeth. Yet she is still conscientious about wearing her retainer. “I wear a retainer every night,” she said. “I got lazy about it once, and then it was very difficult to put the retainer back in. So I was aware that the teeth really do move.”

Indeed they do. In fact, the ability to move teeth is what makes orthodontic treatment work. By applying consistent and gentle forces, the teeth can be shifted into better positions in the smile. That's called the active stage of orthodontic treatment. Once that stage is over, another begins: the retention stage. The purpose of retention is to keep that straightened smile looking as good as it did when the braces came off. And that's where the retainer comes in.

There are several different kinds of retainers, but all have the same purpose: To hold the teeth in their new positions and keep them from shifting back to where they were. We sometimes say teeth have a “memory” — not literally, but in the sense that if left alone, teeth tend to migrate back to their former locations. And if you've worn orthodontic appliances, like braces or aligners, that means right back where you started before treatment.

By holding the teeth in place, retainers help stabilize them in their new positions. They allow new bone and ligaments to re-form and mature around them, and give the gums time to remodel themselves. This process can take months to years to be complete. But you may not need to wear a retainer all the time: Often, removable retainers are worn 24 hours a day at first; later they are worn only at night. We will let you know what's best in your individual situation.

So take a tip from Kathy Bates, star of the hit TV series American Horror Story, and wear your retainer as instructed. That's the best way to keep your straight new smile from changing back to the way it was — and to keep a bad dream from coming true.

If you would like more information about orthodontic retainers, please contact us or schedule an appointment for a consultation. You can learn more about this topic in the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.” The interview with Kathy Bates appears in the latest issue of Dear Doctor.

DentalPorcelainisaGreatOptionforCreatingaNaturalAppearance

The mark of a great dental restoration is that you can’t see it. It’s there in plain sight, but others observing your new and improved smile can’t tell the difference between the restoration and your natural teeth. Everything looks, well, natural.

That’s the great advantage of dental porcelain. A dental technician with technical skill and artistic flair can form this inorganic, ceramic material into a life-like replica of your tooth, with a shape and color that blends in with the rest of your teeth. And because of its strength properties, porcelain restorations can hold up to the normal chewing and biting forces in your mouth, as long as you use prudence when biting down on hard substances.

Porcelain is also highly adaptable to different kinds of restorations. For natural teeth still viable but no longer attractive, porcelain can be the main ingredient in two very popular and effective restorations, the veneer and the crown. Although the porcelain material is the same for both, their construction and application are quite different.

Veneers are very thin laminated layers of dental porcelain custom-colored and shaped for bonding to the outer visible portion of a tooth. They’re a great solution for relatively decay-free teeth that have minor to moderate defects like chipping, slight misalignment or heavy staining. They often require some permanent removal of tooth enamel to ensure their appearance isn’t too bulky, but causes minimal impact to the tooth.

Crowns, on the other hand, are complete tooth replicas that are bonded in place over an existing tooth like a cap. They’re a good choice for teeth in which the root and inner layers are still viable, but the tooth has been significantly damaged by decay or trauma. They’re also useful as a protective cover for teeth that have undergone root canal treatment. But unlike the minimal impact of veneers, crowns require significant tooth alterations to accommodate them.

In either case, though, the end result is much the same: both crowns and veneers can be fashioned to precisely mimic the shape, color and texture of natural teeth. In skillful hands, these porcelain restorations can transform your smile for the better and no one but you and your dentist will ever need to know.

If you would like more information on porcelain restorations, 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 “Porcelain Crowns & Veneers.”