Month: April 2014

Restore Fractured Tooth — A Real World Example

Fractured tooth is a common dental emergency because it may require immediate attention to save the tooth.  Usually when a patient comes to my office with a “broken” tooth, I would first take an xray radiograph to see the extent of the defect.  The purpose of evaluating the extent of defect is to determine whether the tooth has enough tooth structure for the proper restoration to take place in order to save the tooth.  I would evaluate whether it has any additional crack line.  If there is crack line and it does not involve the root area, usually the tooth can be saved.  Also, I will determine how deep the defect is.  The purpose of determining how depth of the defect is to determine whether a restoration can be properly used to repair the tooth.  If the defect is superficial above the gum line, the tooth can be repaired.  However, if the defect is slightly below the gum line, I can perform some simple surgery to give the tooth more solid structure for the restoration to be placed.  However, if the defect is too deep or at the root level, a dentist cannot possibly put a filling material or put a crown in that area because it can cause rejection by the tissue around the new restoration and then the tissue may become swollen and may cause pain.

Dental Fracture Tooth Cusp, Porcelain Crown

Tooth with a fractured lingual cusp portion.

So this patient came in to see me with a broken tooth.  I have taken some xray images of the tooth and evaluate the tooth to be restorable.  There is no additional crack line.  The nerve chamber is not involved and patient is not in pain.  The defect is slightly below the gum line so I am going to do some simple gum surgery to allow me to properly place the restoration.  The type of restoration is going to be a crown because the defect is large and the existing amalgam filling is not strong enough.  Crown is able to give a full coverage protection to the remaining tooth structure so that it can hold the tooth together in one wholeness.

Dental Buildup Tooth

Mid Treatment: a dental buildup material is put in place to give the tooth a solid foundation.

Next I would have to reinforce the tooth by performing a procedure called the Buildup of the tooth.  It repairs the tooth back to its original shape.  The buildup material relies on both mechanical and chemical retention to hold it on place.  Basically it is almost like a large filling.  However, due to its large size and also its location, when patient bites, the lower teeth is going to hit on it and may make it to come loose.  Thus, the final step is to put a crown onto the tooth to give it additional strength.

The last step is to perform a crown prep procedure.  I would properly prepare the tooth and then a impression of the tooth is taken.  The impression and model is going to be sent to the lab.  The lab will use the model and make a dental porcelain crown.

So the patient comes back a few days ago and we are ready to put on the dental porcelain crown.  I would cement the crown in place.  This is how a full restored tooth looks like with a crown:

Dental Porcelain Crown

Final Step: a dental porcelain crown

The tooth looks like it has never been broken.

 

 

 

 

 

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

 

 

Pregnancy Gingivitis

Pregnancy gingivitis is the gingivitis happen during pregnancy.  During pregnancy, a woman’s body undergoes numerous changes, especially changes in the hormone balance in the body.  The hormonal changes would cause the gingivitis via two primary routes.

The hormonal changes causes the increased blood flow to the gum tissue, making it more irritable, more sensitive and more swollen.  Secondly, the hormonal changes decrease the body’s normal immune response to bacteria.  So when there is plaque, the bacteria in the gum tissue would be more likely to grow and causes the infection to the gum.  This is called the pregnancy gingivitis.

Thus, good oral hygiene is generally recommended during pregnancy.  Routine dental checkup and cleaning would help minimize the effect of gingivitis.  However, if the gingivitis is left untreated, it may progress into a more severe form called the periodontitis.  The periodontitis is a periodontal disease characterized by increased bone loss, gingival infection and inflammation and tooth mobility.

Usually after child birth, the condition of the gum would return back to normal.  Bleeding and swelling should subside.   However, if the symptoms continue, please contact your dentist for checkup.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Bleeding Gum and Diabetes

Sometimes when we brush our teeth, we notice our gum bleeds.  Often we would perceive this as a small problem and we would ignore it.  We think that it will eventually go away.

However, bleeding gum can be a warning sign.  The gum bleeds because there could be some infection within the gum.  And these infection is called periodontitis.  Periodontitis can be caused by poor immune system, lack of proper oral hygiene, pregnancy and uncontrolled diabetes.

Proper oral hygiene can decrease the effect of periodontitis. Proper oral health can also improve the oversall systemic health.  For example, recent research studies indicate that there is a relationship between diabetes and perioddontitis.  Controlling the diabetes can help controlling the disease progress of periodontitis.  And vice versa: keep the mouth and gum healthy can help decrease the disease progress of diabetes.  As a family dentist, I have the priviledge of seeing patient in regular routine checkup intervals and be able to monitor their dental and periodontal status of my patients.

If the periodontitis is left untreated, it can progress to toothache, tooth looseng and tooth loss.  Overall health can be affected also because untreated periodontitis can affect the diabetes and the heart.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dentures — How to Take Care and Daily Hygiene

Dentures are made for restoring missing teeth.  Average life span of a denture is about 5 to 7 years.  With proper care, the user of the denture can expect a more pleasant and comfortable experience in wearing the denture.

As a family dentist, I would see elderly members of the family and advise them on how to take care of their dentures.

Daily hygiene includes proper brushing and cleaning of the denture.  Prefer to use a toothbrush with soft bristle and do not use toothpaste.  The ingredient of the toothpaste might be too abrasive for the polished surface of the denture.  The polished surface helps to minimize the adherence of food debris on the denture.

Denture, Complete Dentures, Denture Adhesive, Denture Tablet, Tempe Dentist, Chandler, Mesa, Phoenix, Gilbert ArizonaBefore going to bed, one should take off the denture and soak the denture completely in a cup of water with one denture tablet.  The denture tablet will quickly dissolve in the water and its active ingredients can kill off bacteria, yeast and fungi organism on the surface of the denture.  Also the water can prevent desiccation of the denture.  If the denture is over-dried, it would crack.

Some food and cigarette smoking can cause the denture to stain.  Routinely brushing the denture with soft toothbrush can help remove the stain.

Denture is made of sturdy materials like metal frame and hard acrylic teeth.  However, it breaks because the elderly people with limited dexterity drops the denture on the floor by accident when they try to take the denture off from their mouth.  Thus, I would demonstrate to them howto remove the denture from their mouth.  I would tell them to fill the sink with water or put a towel in front of them.  Then I would tell them to lean forward and then hold the denture with both hand to gently remove it from the mouth.  Just in case if they drop the denture, the water in the sink or the towel would absorb the impact of the falling denture.  With this method, nobody would break their dentures.

Denture teeth are usually made of acrylic material and they are not the same as the natural teeth.  The front denture teeth are especially subject to wear and tear.  Thus, I would suggest to patient to cut food into small pieces and then chew with the back denture teeth.

With times, the denture will have usual wear and the jaw bone of patient may change.  Dentist would usually suggest patient to change their denture every 5 years.

 

Written by Daniel Tee, DDS, MS

Practicing Dentist Serving Tempe, Chandler, Mesa, Phoenix and Gilbert in Arizona

Oral Candidiasis — Fungal Infection in The Mouth

Oral Candidiasis is the fungal infection to the mucous membrane in the mouth.  It is commonly caused by a type of fungi called Candida albican.  The candidiasis can occur on the tongue, cheek, corner of the lips. Dentist can verify the infection by taking samples from the infected area and take to the lab for culturing.  Through culturing and examination under microscope, dentist can verify the infection.

Human tongue infected with oral candidiasis, Funal Infection, Tempe, Chandler, Mesa, Phoenix, Gilbert in ArizonaThe cause of candidiasis is infection by yeast or fungi organisms in the mouth.  The fungal infection could be due to the decreased immune system, medication affecting the immune system, systemic diseases, innate immunal deficiency, radiotherapy, leukemia, hormonal imbalance, diabetes, etc.  Dentally, inadequate oral hygiene, improper cleaning of the denture, and smoking can also cause candidiasis.

Oral candidiases can be treated with the antifungal medication (such as mycostatin, clotrimazole, fluconazole, etc) and also medicated mouth rinse (such as nystatin mouth rinse.)

Dentist can perform checkup and detect occurrence of candidiasis.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving Tempe, Chandler, Mesa, Phoenix, Gilbert in Arizona

Root Canal Therapy — For Treating Dental Infection

To effectively perform root canal, a dentist must understand the anatomy of a tooth.  Our tooth is constructed with multple layers: the outer most layer is enamel; the middle layer is dentin; and the innermost layer is the pulp chamber.  The enamel and dentin are harden mineralized tooth structure.

Pulp is made of nerve and blood vessels.  Generally, when a person experiences pain, it is because the tooth is under external stimulation.  These stimulation can be due to bacterial infection or damage to tooth structure which compromises the protection of the tooth.  The tooth in compromised condition is more easily stimulated.  Tooth cavity,crack and damage to tooth structure can decrease the self-defense ability of the tooth.

Under mild stimulation, the tooth would generally recover itself upon the removal of stimulus.  For example, if the tooth filling is to repair the cavity, the tooth will no longer experience pain.

However, under some conditions, the tooth may never recover.  Or if the tooth has become dead, the tooth might not cause any pain.  A necrotic tissue within the pulp of the tooth may cause more severe infection.  Often the antibiotics would not be able to penetrate to the inner portion of tooth and antibiotics may not be effective against the dental infection.  Thus, the necrotic tissue in the pulp must be removed by performing the root canal therapy by the dentist.

Root canal therapy is to remove the necrotic tissue in the tooth.  The tissue within the pulp chamber and the nerve canals within the tooth is thoroughly cleaned out.  The empty canal space will then be filled with medication so to prevent bacteria from re-entering into the pulp chamber to cause infection.

There is a misconception that after the root canal therapy, the tooth would become dead and become useless.  Well, this is incorrect.  The treated tooth can still be preserved and function just like any other teeth.

Generally, it is recommended that a crown is put on the tooth after the root canal therapy.

 

Written by Daniel Tee, DDS, MS

Practicing Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Oral Cancer — Diagnosis and Treatment

Oral Cancer is the cancer occurring within the oral cavity and around the mouth.  The oral cancer often occurs on the lips, tongue, cheek, and palate.  Under the microscope, the cancerous tissue has a similar characteristics and they are called the squamous cell carcinoma.  The growth and spread of the cancerous cells can be rapid.  Over 70% of all oral cancer cases can be attributed to the history of smoking.  Other factors can also increase the oral cancer risks:

–  Excessive alcoholic drinking

–  Poor oral hygiene

–  Chronic stimulation from roughen surface of teeth, dental restoration and prosthesis

–  Human Papilloma Virus

Oral Cancer, Squamous cell carcinoma, leukoplakia, tempe dentist, Tempe, Chandler, Mesa, Phoenix, Gilbert, Arizona

Leukoplakia (or white patch) in the mouth needs to be check for possible oral cancer changes.

Oral cancer can start from small ulcer or cyst in the mouth.  Early detection is especially important because the growth of oral cancer can be rapid.  A simple oral cancer biopsy and laboratory analysis can verify if a person has oral cancer.  If the tumor is small, treatment can include excision biopsy.  For more severe cases, treatment would be chemotherapy and radiation therapy.

Oral cancer can be a dangerous type of cancer because the growth and spread of oral cancer cells can be rapid.  The cancerous cells can spread through the lymphantic system and the cancer can spread to other region of the body.  In addition, the morbidity of the cancer is high.  In some cases, cancerous tumor removal requires cutting away part of the facial and oral cavity structure such as tongue, jaw bone and cheek tissue.

Dentist is the first medical professional to review your oral health condition.  I routinely perform intraoral and extraoral cancer check for my patients when they come for periodic checkup and cleaning visits.

 

Written by Daniel Tee, DDS, MS
Practicing General Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona

Dental Bridge — What is Dental Bridge and How to Care for

Dental bridge is used to restore missing teeth.  Its basic requirement is that there must be teeth on either side of the missing teeth area.

Another type of bridge is cantilever bridge, but due to scope of this article, we will not discuss it in this article.

One dental bridge may consist of dental crown on each side of teeth support and the middle part called the pontic area.  The middle pontic area is the fake dental teeth connecting the two side.  The bridge is permanently fixated onto the patient’s natural teeth.

 

Dental bridge looks like natural teeth and functions like natural teeth.  It uses natural teeth for support.

Because underneath the dental bridge are natural teeth, they need to be take care of and cleaned just like any other teeth in the mouth.  Brush with toothbrush and toothpaste at least 3 times a day, after each meal.

Dental bridge is different from the removable denture.  Dental bridge cannot be taken off from the mouth arbitrarily for cleaning.  Food may accumulate in the pontic area of the dental bridge.  Typical dental floss cannot be used to clean in the pontic area because the pontic portion of the bridge is fused with the two crowns on each side.  Luckily, there is a dental hygiene device called the Floss Threader, which can be purchased at the local pharmacies.

Floss Threader in blue color. A dental floss is passed thru the loop

Floss Threader is a long slender plastic piece with a loop on one side.  Dental floss can pass thru the loop and this floss threader can guide the floss into the tight space in the pontic area.

 

 

 

 

 

Floss Threader Demonstration in the Mouth

Once the floss is passed thru, it can be used to swipe back and forth around the pontic area to clean out the food debris.

Also, make a routine visit to your dentist because the natural teeth is covered by the dental bridge and the dentist can use the Xray to check for any cavity.

 

Written by Daniel Tee, DDS, MS
Practicing General Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona