Sure, it’s big news when celebs tweet selfies from the dental office… if you’re still living in the 20th century. But in Hollywood today, it’s harder to say who hasn’t posted snaps of themselves in the dentist’s chair than who has. Yet the pictures recently uploaded to Twitter by Mark Salling, the actor and singer who regularly appears as Noah “Puck” Puckerman on the popular TV series Glee, made us sit up and take notice.
“Getting my chipped tooth fixed. Also, apparently, I’m a big grinder,” read the caption. The photo showed a set of upper front teeth with visible chips on the biting surface. What’s so special about this seemingly mundane tweet? It’s a great way of bringing attention to a relatively common, but often overlooked problem: teeth clenching and grinding, also called bruxism.
Although bruxism is a habit that affects scores of people, many don’t even realize they have it. That’s because the condition may only become active at night. When the teeth are unconsciously ground together, the forces they produce can wear down the enamel, cause chipping or damage to teeth or dental work (such as veneers or fillings), or even loosen a tooth! While it’s common in children under 11 years old, in adults it can be a cause for concern.
Sometimes, mouth pain, soreness and visible damage alert individuals to their grinding habits; other times, a dental professional will notice the evidence of bruxism during an exam or cleaning: tooth sensitivity and telltale wear and tear on the chewing surfaces. Either way, it’s time to act.
Bruxism is most often caused by stress, which can negatively impact the body in many ways. It may also result from bite problems, the overuse of stimulating substances (caffeine, alcohol, tobacco, and illegal drugs), and as a side effect of certain medications. Sometimes, simply becoming aware of the habit can help a person get it under control. Common methods of stress reduction include exercise, meditation, a warm bath or a quiet period before bedtime; these can be tried while we monitor the situation to see if the problem is going away.
If stress reduction alone doesn’t do the trick, several other methods can be effective. When bruxism is caused by a minor bite problem, we can sometimes do a minor “bite adjustment” in the office. This involves removing a tiny bit of enamel from an individual tooth that is out of position, bringing it in line with the others. If it’s a more serious malocclusion, orthodontic appliances or other procedures may be recommended.
When grinding is severe enough to damage teeth or dental work, we may also recommend a custom-made night guard (occlusal guard), which you put in your mouth at bedtime. Comfortable and secure, this appliance prevents your teeth from being damaged by contacting each other, and protects your jaw joints from stresses due to excessive grinding forces.
Whether or not you have to smile for a living, teeth grinding can be a big problem. If you would like more information about this condition, call our office to schedule a consultation for a consultation.
Porcelain veneers represent one of the best values in cosmetic dentistry, capable of radically changing a person’s smile with little tooth surface preparation. Still, the small amount of tooth enamel usually removed to accommodate them will permanently alter the affected teeth, to the point they will require a veneer or other restoration from then on.
The traditional veneer has remarkable versatility for solving a number of minor cosmetic problems, correcting mild tooth positioning problems and replacing lost or damaged enamel. But to avoid an unnatural bulky appearance, a portion of the tooth enamel must be permanently removed to accommodate them.
In recent years, though, a new concept known as “prepless veneers” has emerged in the field of cosmetic dentistry. Understandably, this new, “drill-free” veneer application has caused a lot of debate among dentists and patients alike, with concerns of bulky, overly-contoured teeth resulting from the technique. But the concept is growing as many well-regarded dentists have incorporated both minimal prep and prepless veneers into their service offerings.
The prepless veneer offers a cosmetic solution that doesn’t alter the tooth permanently. Using techniques such as feathering, which tapers and blends the veneer seamlessly with the tooth at the gum line, we can avoid an unnatural appearance while offering patients a much less invasive outcome.
The main disadvantage of prepless veneers at this time is that they’re not appropriate in every case. In fact, careful patient selection is a key to a successful outcome. For example, relatively large teeth or teeth positioned too far forward don’t work well with an added layer of thickness.
If, on the other hand, you have small, short or worn teeth, or teeth overshadowed by your lips — just to name a few likely scenarios — then you may benefit immensely from prepless veneers without permanent alteration to your teeth. A detailed examination is your first step to finding out if this new technique could provide you with a less-invasive smile makeover.
If you would like more information on drill-free porcelain veneers, 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 Veneers without the Drill.”
Before she began hosting the long-running TV competition Top Chef, Padma Lakshmi was a well-known model and successful cookbook author. (Appropriately, she is said to have been “discovered” by a modeling agent while sitting in a café in Madrid.) Yet the Indian-born beauty's striking look — at once exotic and familiar — doesn't come from any cookie-cutter mold.
So when Lakshmi had cosmetic work done on her teeth, early in her career, her dentist didn't use a cookie-cutter approach either: Instead, her smile was carefully designed, using small amounts of bonding material to brighten her teeth and to bring their shape and spacing into harmony with her facial features.
Dentistry by Design
What exactly is smile design — and what could it do for you? Essentially, it's the process of evaluating your smile in concert with the appearance of your entire face, and visualizing the changes — some dramatic and some subtle — that will make it really shine. Some aspects we consider include the face's shape, the proportion or “balance” of facial features, the complexion, eye and lip color and form, and the overall dimensions of the smile.
Based on dental aesthetics and clinical experience, we will probably have a number of suggestions to make on how you can improve your smile. Your input will also be very important; while some individuals prefer perfectly even teeth and a sparkling “Hollywood white” smile, others are looking for a result that's more in keeping with a “natural” look: slight irregularities in tooth shape, spacing, and even color.
There's no right or wrong answer here: Having a “perfect” smile means what's perfect for you, so it's very important for dentists and patients to communicate openly during the smile design process. But sometimes, words alone just aren't enough to convey the subtle dimensions of beauty.
The Trial Smile
Fortunately, it's now possible to preview your “perfect” smile using a number of different techniques. Advances in computer imaging make this the first step in previewing your new smile — you can see the changes before a single tooth is touched! Still, many people find that having a more concrete picture is helpful. The next step is to make a 3-D mock-up the proposed dental work on an actual model of your mouth. That way, you can see a physical representation of the final results — and even turn it around and hold it in your hands.
There's still one more way to really experience the difference cosmetic treatments can make without committing to a permanent change: the provisional restoration. Here, tooth-colored bonding material and other techniques are used to actually create the new smile — temporarily. This gives you time to “live with it,” and see if the proposed changes work for you. If everything goes well with the provisional work, the permanent restoration is guaranteed to please.
So if you want holiday treats, get out the cookie cutter — but if you're looking for a smile that's uniquely yours, and one that enhances your own individual appearance… call our office and ask about a smile design consultation. You can learn more in the Dear Doctor magazine articles “Great Expectations — Perceptions in Smile Design” and “Beautiful Smiles by Design.”
After months of treatment we’ve removed your braces and your new smile emerges. Upon closer view, however, you notice a number of chalky white spots on your teeth.
These pale areas are white spot lesions (WSLs), the result of mineral breakdown from the long-term contact of acid with the enamel surface. The underlying cause is built-up bacterial plaque due to inadequate oral hygiene, and as such WSLs are the beginning stages of tooth decay.
While anyone can develop WSLs, brace wearers are highly susceptible because of the extra care required to clean around orthodontic hardware. Poor dietary habits such as frequent snacking on sugary or acidic foods and beverages also increase the risk of WSLs.
To reduce the risk of developing this condition, brace wearers must give extra attention and effort to daily oral hygiene, including brushing and flossing. The extra effort required in brushing can be aided by specialized toothbrushes designed to clean around brackets and wires, along with prescription-level fluoride toothpastes for added enamel strength. Floss threaders or a water flosser, a device that uses pulsating water under high pressure, may help you maneuver around hardware to remove plaque between teeth. It's also important to maintain a healthy mouth environment by limiting intake of sugary or acidic snacks and beverages, avoiding tobacco or excessive alcohol or caffeine, and drinking plenty of water to keep your mouth from drying out.
If you’ve already developed lesions, it’s important to stop the decay process before it causes more damage. One way is to assist your body’s natural mechanism for re-mineralizing tooth enamel with fluoride pastes or gels or re-mineralizing agents, or undergoing micro-abrasion to repair a tooth’s surface.
To improve a tooth’s appearance a procedure known as “caries infiltration” involves injecting a liquid tooth-colored resin into the lesion, which is then hardened with a curing light. The spot becomes less noticeable and appears more like normal enamel. For extensive defects, conventional bonding with composite resins or porcelain veneers can be used to cosmetically cover the tooth.
Getting ahead of the problem with effective oral hygiene and good dietary and lifestyle practices will keep WSLs at bay while you undergo orthodontic treatment. If they do develop, however, there are ways to minimize their effect and restore the look of your teeth.
So you’re tearing up the dance floor at a friend’s wedding, when all of a sudden one of your pals lands an accidental blow to your face — chipping out part of your front tooth, which lands right on the floorboards! Meanwhile, your wife (who is nine months pregnant) is expecting you home in one piece, and you may have to pose for a picture with the baby at any moment. What will you do now?
Take a tip from Prince William of England. According to the British tabloid The Daily Mail, the future king found himself in just this situation in 2013. His solution: Pay a late-night visit to a discreet dentist and get it fixed up — then stay calm and carry on!
Actually, dental emergencies of this type are fairly common. While nobody at the palace is saying exactly what was done for the damaged tooth, there are several ways to remedy this dental dilemma.
If the broken part is relatively small, chances are the tooth can be repaired by bonding with composite resin. In this process, tooth-colored material is used to replace the damaged, chipped or discolored region. Composite resin is a super-strong mixture of plastic and glass components that not only looks quite natural, but bonds tightly to the natural tooth structure. Best of all, the bonding procedure can usually be accomplished in just one visit to the dental office — there’s no lab work involved. And while it won’t last forever, a bonded tooth should hold up well for at least several years with only routine dental care.
If a larger piece of the tooth is broken off and recovered, it is sometimes possible to reattach it via bonding. However, for more serious damage — like a severely fractured or broken tooth — a crown (cap) may be required. In this restoration process, the entire visible portion of the tooth may be capped with a sturdy covering made of porcelain, gold, or porcelain fused to a gold metal alloy.
A crown restoration is more involved than bonding. It begins with making a 3-D model of the damaged tooth and its neighbors. From this model, a tooth replica will be fabricated by a skilled technician; it will match the existing teeth closely and fit into the bite perfectly. Next, the damaged tooth will be prepared, and the crown will be securely attached to it. Crown restorations are strong, lifelike and permanent.
Was the future king “crowned” — or was his tooth bonded? We may never know for sure. But it’s good to know that even if we’ll never be royals, we still have several options for fixing a damaged tooth. If you would like more information, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Crowns and Bridgework.”
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