Why is it important to replace missing teeth with restorations such as dental implants? You might be surprised to find that the damage caused by missing teeth is much greater than the simple gaps left in your smile.

As the years go by, teeth lost early in adulthood cause structural changes in a person's face. By age 45 changes in facial structure are already visible in the form of sunken cheeks. By 60, cheeks and lips lose their support, resulting in an aging look. This process continues and if the teeth are not replaced, much of the structural support of the person's face is lost.

These changes are caused by loss of bone. Although it may seem static, bone is actually living tissue that needs constant stimulation to maintain its form and density. With normal stimulation it is in a constant state of resorption (breaking down) and deposition (building up). Teeth provide the needed stimulation for the bone that surrounds them (called alveolar bone) as they meet each other during biting, chewing, and speech. When the stimulation continues, the bone continues to rebuild itself. Without this stimulation, the bone resorbs, does not build up again, and loses substance.

Without stimulation, alveolar bone loses width, height, and volume. Since your teeth and their surrounding bone support your chin, cheeks, and lips, this has a powerful effect on your appearance. It may also affect your ability to chew and to speak.

As alveolar bone diminishes, the next layer of bone also begins to resorb. This is the bone of the jaw itself. The lower part of the face begins to collapse, and the cheeks become hollow. This effect is especially noticeable for people with no teeth (edentulous).

Usually the first tooth to be lost, due to infection and decay, is a molar (back tooth). In the past, a missing single back tooth was frequently replaced by a fixed partial denture (FPD). A crown is provided for each of the two teeth on the sides of the gap, called abutment teeth, to support a false tooth in the middle. However, if they are not well cared for, the abutment teeth may be the next to succumb to decay.

Today the treatment of choice is an implant. A dental implant is a tooth-root replacement made of titanium, which fuses with the bone — making it very stable. Above the gums it is covered by a crown that looks like a natural tooth. The benefit of the implant is that it continues to provide stimulation to the alveolar bone, preventing bone loss.

Implants are also a good choice in the case of multiple missing teeth. They can be used to support bridges or false teeth (dentures). The results are an improved, younger appearance and better functionality.

Contact us today to schedule an appointment to discuss your questions about missing teeth. You can also learn more by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

In our office, many of our patients are always asking us if over-the-counter (OTC) mouthwashes or mouthrinses are truly effective tools for curing bad breath. Unfortunately, nearly all of them merely mask any odorous smells temporarily — regardless of how refreshing they taste. There are mouthrinses available that are effective for treating gingivitis and tooth decay, but you must visit our office to obtain a proper diagnosis and a prescription for them. Reality is that a mouthrinse alone can't cure bad breath; however, there are products available that can make a positive impact on your dental health. The key is to match the right mouthrinse to your specific dental need.

• OTC mouthrinses that contain about 0.05% sodium fluoride are an effective tool that when combined with good oral hygiene can significantly reduce the development of tooth decay.
• OTC mouthrinses that contain alcohol, triclosan, sanguinaria extract, zinc and/or essential oils such as menthol can somewhat help reduce the bacteria in plaque, which in turn can reduce gum inflammation (gingivitis) and bad breath when used in combination with proper brushing and daily flossing.
• Prescription mouthrinses containing chlorhexidine may be more effective in helping to control both gingivitis and tooth decay in certain circumstances. This is because chlorhexidine inhibits the formation of dental plaque by preventing bacteria from sticking to your teeth.

While bad breath may seem unbearable, it is often treatable. The key is to determine and then address what is causing your bad breath. A simple trip to our office for a proper exam, assessment and thorough cleaning along with improved oral hygiene may just do the trick. Contact us today to schedule a consultation for an examination and treatment plan.

Learn More

To learn more about mouthrinses, read the Dear Doctor article, “Mouthrinses.”

Scientists don't know much about sleep even though it has been extensively studied. We do know that several hours of deep, restful sleep per night are essential for a healthy life.

Many people remain tired and unrefreshed, even after a full night's sleep. About a third of them are affected by sleep related breathing disorders (SRBD). Dentists can play a significant role in helping patients overcome these disorders, which range from frequent snoring to severe Obstructive Sleep Apnea (OSA). If you think you may have such a disorder, read on.

Under normal conditions, your upper airway is open, allowing air to flow from your nose, through your throat, and into your lungs. If you suffer from SRBD, you experience frequent reductions in the flow of air to your lungs during sleep. You may not be aware of it, but sometimes your breathing may even stop for brief periods. These reductions happen when your tongue and other soft tissues in the back of your throat collapse backwards and block your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stages of sleep your body needs.

The resulting reduced oxygen flow to your heart and to your brain can cause serious damage. You will also be tired during the day and experience a lack of energy, even if you sleep for seven or eight hours per night. This constant drowsiness puts you at greater risk for accidents.

Because dentists generally see their patients at six-month or other regular intervals, we are in a good position to screen and refer patients with suspected SRBD to physicians for diagnosis and treatment. Dentists can also treat SRBD in a number of ways.

• One of these is Oral Appliance Therapy (OAT), in which a device that looks something like an orthodontic retainer holds your lower jaw in a forward position relative to your upper jaw, preventing your tongue and soft tissue from collapsing into your airway.
• Another consists of breathing equipment called Continuous Positive Airway Pressure (CPAP). The CPAP is a mask connected to a machine that pushes air into your lungs.
• Other treatments include oral surgery or orthodontia. The goal of these techniques is to increase the volume of air passing through your upper airway by pushing your tongue forward.

Medical insurance usually covers the cost of much of these treatments.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine article “Sleep Disorders and Dentistry.”

As the Boy Scouts say, it's best to be prepared. You may never have a traumatic injury to your teeth. But what if you do? Here are four questions and answers about such injuries and their treatment that may be helpful some day.

What are traumatic injuries?
We are talking about physical damage caused by a fall, an accident, or a blow to the face. The word trauma comes from the Greek root meaning “wound.”

A traumatic injury can also cause broken, cracked, or split teeth, or a fracture to the root of the tooth. A tooth may be dislodged from its proper position, pushed sideways, out of or deeper into its socket. It may even be completely knocked out of your mouth.

What should you do if your tooth is knocked out?
With proper treatment, the tooth can be restored to its original place. You must handle the tooth gently and seek professional help as soon as possible. Rinse the tooth in cold water if it is dirty, but do not use any cleaning agent. Avoid touching the root. While hurrying to your dentist, keep the tooth from drying out by keeping it in a container of milk or of your saliva, or by holding it in your mouth between gum and cheek. It is vital to keep the tooth's living tissues moist until it can be professionally assessed and replanted in its socket. If a tooth has been dislodged but not knocked out, it must be repositioned in its socket and may be stabilized with a splint.

Who can treat a tooth that is damaged by a traumatic injury?
A general dentist, an oral surgeon or an endodontist is trained to treat such injuries. An endodontist is trained to treat the root canal(s) inside a tooth. The word comes from “endo” the Greek word for “inside,” and “odont,” the word for “tooth.” After a tooth is replaced in its socket and stabilized, root canal treatment is often needed.

What is root canal treatment?
A tooth is composed mostly of dentin, a living tissue. The top part or crown is covered by hard mineralized enamel. The soft tissue inside the tooth, the pulp, contains blood vessels, nerves and connective tissues. It extends from the crown to the tip of the roots. Treatment of dental pulp injuries is called root canal or endodontic treatment and is usually needed to treat teeth that have been dislodged or fractured.

Contact us today to schedule an appointment to discuss your questions about injuries to teeth and related nerve damage. You can also learn more by reading the Dear Doctor magazine article “Trauma & Nerve Damage to Teeth.”

Studies have shown that as many as 75 out of every 100 people fear dental visits; and for 10 to 15 of them, the fear is so great that they never get treatment — leading to serious dental problems and worse. Untreated disease in your teeth and gums can negatively affect the health of your entire body.

How can you conquer your fears so you can get the treatment you need? The answer includes (a) working with us to overcome your fears and have a positive experience while undergoing dental treatment, and (b) using oral sedation or anti-anxiety medication to help you quell your fears and relax.

Overcoming Your Fears

People develop fear of the dentist when they have a bad dental experience themselves, or sometimes when they hear of a bad experience someone else has had. The more you are afraid, the more you feel the symptoms of fear, and the more you connect those symptoms with the experience. You need to stop this negative memory sequence and replace the feelings of fear and loss of control with memories of good experiences and feelings of being in control.

It helps to know that you are not alone in your fears and that you can do something positive about them. First, make an appointment to discuss your fears with us, your dental professionals. Start with small procedures that cause only mild anxiety, and give yourself adequate time to get over your fears.

Using Oral Sedation

You have already gradually reduced your fear through your discussions and previous appointments. When you are ready to go to the next step, consider using oral sedatives or “anxiolytics” (meaning that they dissolve anxiety) to help you feel relaxed and comfortable.

Oral sedation — so called because you take it by mouth — allows you to let your guard down and focus on feeling peaceful, yet you remain awake and in control. The medication is either placed under your tongue and dissolved there (sublingual) or swallowed whole. Since it is taken by mouth, it does not require an injection, so it is easily taken by people who are afraid of injections.

The oral sedative and anxiolytic medications dentists use have been subjected to rigorous research and testing and have a long safety record after decades of use.

By using this two-step process you can reduce your fears and begin to get the care you need. And we, your dental professionals, are able to work more efficiently because we can focus on the work at hand, knowing that you are comfortable and relaxed.

Contact us today to schedule an appointment to talk about any fears you may have. You can also learn more by reading the Dear Doctor magazine articles “Overcoming Dental Fear & Anxiety” and “Oral Sedation Dentistry.”