timberlake dental

Is your mouth making you sick?

Wednesday, October 18, 2017

How Oral Health Impacts Systemic Health

At Timberlake Dental, we take healthcare seriously.  While we are specifically concerned with our patients’ oral health, we acknowledge its role in a person’s overall health.  Unfortunately, the mouth has always been treated by a realm of healthcare (dentistry), which has historically been completely separate from general medicine.  Because of this, some people are under the impression that the mouth is therefore independent and unrelated to the rest of the body.  This is a dangerous myth!

What systemic issues are connected with the mouth?

In 2000, the surgeon general released a report called “Oral Health in America”.  The purpose of this report was to inform and educate the nation about oral health, its prevalence in our nation, and how it affects a person’s overall health.  This report was based on a review of published scientific literature and is still considered the authority on the link between oral health and systemic health.

There are many links between the mouth and the rest of the body.  In this article, we will limit the discussion to the most harmful health conditions that are affected by the health of your mouth.

  • Osteoporosis – Osteoporosis is a condition of decreased bone density and often brings to mind a picture of a frail old lady whose bones break easily. Osteoporosis can affect any bone in the body, even the jawbones.  This is especially important in patients who have lost teeth and wear dentures.  The jawbones in a patient with osteoporosis will diminish much more rapidly than in a patient with healthy bones, causing the denture to become loose and uncomfortable.  In a patient with all of their teeth, osteoporosis causes an increased risk for periodontal bone loss.  It has even been suggested that bone loss around the teeth could be a warning sign of osteoporosis.
  • Immunosuppression – There are many different diseases, disorders, and conditions that suppress the immune system, including HIV, autoimmune diseases, organ transplants and cancer treatments. A suppressed immune system makes any type of infection worse because your body cannot fight it naturally.  This puts a person at higher risk for periodontal disease and dental abscesses.  Because these infections also affect other areas of the body, the impact on the overall health is much greater in an immunocompromised patient.  Anyone who has a problem with their immune system should keep to a strict oral hygiene routine and continuing care schedule with their dentist.
    Some people with a weakened immune system will suffer from persistent mouth sores and ulcers that do not heal.  Often a dentist is the first person to catch these signs of a suppressed immune system.
  • Pulmonary Disease – Because the bacteria in the mouth have a quick pathway to the lungs, there is a link between oral disease and pulmonary disease. COPD (chronic obstructive pulmonary disease) is associated with poor oral health, and patients with periodontal disease are at a higher risk of developing bacterial pneumonia.
  • Diabetes – The link between periodontal disease and diabetes is considered a two-way connection: meaning diabetes makes periodontal disease worse, and periodontal disease makes diabetes worse. Diabetes worsens periodontal disease through its affect on blood flow, inflammation and healing ability.  Periodontal disease worsens diabetes by contributing to hyperglycemia and complicated metabolic controls.  This association is thought to be true of diabetes with any chronic infection in the body.
  • Heart Disease – The bacteria present in the mouth of a patient with periodontal disease can contribute to heart disease through a few different mechanisms of action: 1) small localized infections of blood vessel walls, which leads to plaque formation, atherosclerosis, and in severe cases, a heart attack, 2) an influence on platelets causing them to aggregate and form clots in the bloodstream, which could block a coronary artery, leading to heart attack.  People with periodontal disease have a 25% higher risk of heart disease than people with healthy gums.
  • Stroke – The increased risk of a stroke in patients with periodontal disease is based on the same mechanism of action noted above: increased risk for clot formation, which can travel to the brain and occlude a cerebral artery, blocking blood flow to brain tissues.
  • Adverse Pregnancy Outcomes – There is a correlation between periodontal disease and low birth weight infants. The mechanism is in need of more scientific research.  At this time, it is thought to arise from two possible consequences of periodontal disease:  1) The bacteria present in periodontal disease produce toxins that could enter the blood stream, cross the placenta, and cause damage to the fetus.  2) The maternal inflammatory response to these toxins could interfere with fetal growth.

How do I reduce my risk of health problems?

All people should be aware of the health risks associated with dental diseases.  Because most oral health problems are preventable, you can be instrumental in lowering your risk for systemic health problems.


  1. See your dentist and dental hygienist regularly for cleanings and oral evaluations.
  2. Practice good oral home care with regular brushing, flossing, and rinsing with the proper mouthwash.
  3. Treat dental problems as they arise. Do not wait until something hurts!  Periodontal disease is often called a “silent” disease because it rarely causes pain.
  4. See your medical doctor to be as preventive as possible with conditions like diabetes and cardiovascular diseases.

What if I am concerned that my mouth is affecting my overall health?

Call our office today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will discuss your medical history with you and outline how it can affect your oral health and vice versa.

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Dental Implants: Restoration of a Missing Tooth

October 11, 2017

A Missing Tooth

In dentistry, we use the term prognosis to describe how long a tooth will continue to function properly.  That term also encompasses any treatment done on a tooth as a predictor of how long the treatment itself will last and keep the tooth in proper function.  Giving a prognosis of a tooth or treatment is a little like predicting the future.  We are not giving an exact timeline; we are making an educated guess.  We want your teeth and the work we perform on them to last as long as you do!

When a tooth has a hopeless prognosis, the only treatment option is removal of the tooth by extraction.  When a tooth or the proposed treatment to save a tooth has a poor long-term prognosis, we will always give you the option to remove the tooth.  Once the tooth is removed, you will have several options for replacing it.  We believe that your time, effort and money are best invested in something that will last.  The treatment option with the highest success rate for replacing a missing tooth is a dental implant.

Anatomy of a Dental Implant

One of the reasons a dental implant has such a high success rate is that its anatomy mimics a natural tooth more closely than any other treatment option available in dentistry.  This configuration allows a dental implant to stand alone; it does not anchor or rest on any other teeth the way a bridge or a removable partial does.

A dental implant consists of three parts:

  1     Implant body – The implant body is the root replacement. It is made from titanium, like implants and prostheses used in other parts of the body.  This titanium root form comes in many different sizes, and using our 3D image of your jawbones, we will select the proper size for your specific missing tooth.  In some cases, the implant can be placed at the time of extraction, called an immediate implant.  In other situations, it is necessary to allow the jawbone to heal for several months between the extraction and the placement of the dental implant. Once the implant has been placed into the jawbone, it must heal for several months, allowing the bone to grow into the threads of the implant form, which is a process called osseointegration.  After a minimum of 3 months of healing, we assess the level of osseointegration of the implant to ensure that the implant is stable and ready to withstand chewing forces.


  2    Abutment – The abutment is the connector between the implant root and the dental crown. An abutment can be made from several different materials, as needed for appearance.  The abutment is affixed to the implant root with a small screw, and it protrudes from the gums, providing the core structure for a crown.

   3    Abutment-supported crown – An abutment-supported crown is very similar to a traditional dental crown. It covers the entire abutment form to the gumline and restores the natural anatomy of the tooth, enabling you to return to normal function in this area.

What Is the Process for Replacing a Missing Tooth with a Dental Implant?

Visit 1:  Implant Planning

At this visit, images are taken of the proposed implant site, including photographs, dental x-rays, an intraoral scan and a 3D CBCT image.  Dr. Chowning determine which size dental implant will best restore your missing tooth and discuss the details of the upcoming surgical visit.

Visit 2: Surgical Placement of the Implant

During the surgical visit, you have the option to be sedated, and if you desire this, please discuss it with Dr. Chowning BEFORE this visit.  You can also elect to have the procedure done with local anesthetic only, meaning you are awake throughout.  Implant placement is a relatively quick procedure and usually causes less discomfort than a tooth extraction so many people choose to remain awake for this visit.  You should feel only vibration as the site in the bone is being prepared and the implant placed.  You will be given very strict post-operative instructions regarding your stitches, care of the surgical site, and oral hygiene to follow.

Visit 3: Post-operative evaluation

Between one and two weeks later, you will return for the post-operative evaluation of the surgical site.  This is typically a very quick visit, and most, if not all, post-operative pain or discomfort has subsided by this time.

Visit 4: Uncovering and Testing Implant

At four months post-op, the implant will be exposed to the mouth (if it is not already) by removing the gum tissue over it with a dental laser.  If the implant shows the correct amount of stability, we can proceed with visit 5.

Visit 5: Scanning for Abutment and Crown

This visit may be done in combination with visit 4 if the implant has osseointegrated.  Using our 3D CEREC scanner, we take an image of the implant site and the surround teeth. The abutment and crown are designed and fabricated using our CEREC software and milling system.  A healing cap may be placed to maintain the position of the gum tissue while the abutment and crown are being made.

Visit 6: Final Placement of Abutment and Crown

When the abutment and crown are completed, the healing cap is removed from the implant, and the abutment and crown are placed.  The abutment is attached to the implant via a small screw, which is torqued to the appropriate tightness.  Dental x-rays confirm the fit of the crown.  Once the crown meets our standards and feels perfect to you, it will be cemented and cleaned.

Do You Have a Missing Tooth that You Would Like Restored with a Dental Implant?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.  He will discuss your treatment options in detail and help you choose what is right for you.


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All-on-Four Implant-Supported Dentures

How are All-on-Four Dentures Different from Other Dentures?

In our previous blog, we discussed options to replace missing teeth for someone who has lost all of their teeth, including traditional dentures and implant-supported dentures.  Both of these treatment options are removable.  The dentures are removed from the mouth to clean and are typically left out overnight.

There is another treatment option for replacement of an entire arch of teeth, and the difference is that it does not require removal of the denture: a fixed-hybrid denture, commonly referred to as “all-on-four”.  This name is based on the traditional procedure of four implants placed into the jawbone to support a dental prosthetic which replaces all of the teeth in that arch.  The procedure is not limited to four implants, and sometimes more than four implants are used to adequately support the new teeth.

How are All-on-Four Dentures Different from Implant-Supported Dentures?

There are two main differences between all-on-four dentures and implant-supported dentures.

  • The implant-supported dentures we discussed in our previous blog have better retention by locking onto an invisible attachment hidden underneath the denture and do not rely only on the shape of the bony ridge and muscle control to stay in place, as a traditional denture does.  However, they are still removed for cleaning and left out overnight.  The patient is able to easily remove these dentures.  An all-on-four denture is not removable.  The prosthetic teeth are fixed to the implants by retaining screws by the dentist and are only removed by the dentist when needed.
  • The other difference between implant-supported dentures and all-on-four dentures is the angle of the implants. Implants placed in implant-supported dentures are placed to direct biting forces along the implant body.  Implants used in all-on-four are angled quite differently in order to create stability.  In a typical all-on-four case, the two front implants are straight, and the two back implants are placed at up to a 45° angle.  This angulation utilizes available bone instead of requiring a bone graft.

What are the Benefits of All-on-Four Dentures?

  • Immediate Teeth – A temporary prosthetic is placed over the implants the same day the implants are surgically placed.
  • Increased Comfort – Because of the support received by the implants, it is not necessary for the all-on-four denture to have bulky extensions into the lips, cheeks, under the tongue, and onto the roof of the mouth.
  • Improved Appearance – Because it is much smaller in size than a traditional denture or an implant-supported denture, an all-on-four denture can create a more natural appearance of the face.
  • No Need for Removal – Because the all-on-four dentures are retained by screws, which are tightened and covered by the dentist on the day of placement, the patient is not able to remove them. This creates a closer simulation of natural teeth, reducing the emotional complications that come with losing all of one’s teeth.

What is Required to Get Started with All-on-Four Dentures?

Pre-operative planning is a critical step in all-on-four denture treatment.  A three-dimensional scan of the jawbone allows Dr. Chowning to use precise measurements to prescribe the proper location for the four implants.  The prescribed location of the implants is translated from the three-dimensional planning software to the mouth via a surgical guide.  This guide ensures the correct placement of the implants and the perfect fit of the provisional denture.  Once the implants are in place, a provisional denture is attached to the implants.  This temporary prosthesis allows a patient to have “teeth” while the implants are healing into the jawbone.

What Post-Operative Care is Required for All-on-Four Dentures?

During the healing phase, which lasts approximately 4-6 months, it is extremely important to strictly follow the post-operative instructions.  These instructions are aimed at creating the healthiest and safest environment for the implants to heal into the jawbone.

The most important one regards eating only a soft diet during the healing phase.  This may seem like a long time to eat soft foods.  However, remember that many people in traditional dentures only eat soft foods because they’re unable to eat crunchy or chewy foods at all.  With all-on-four, this dietary restriction is only temporary.

Another important aspect of post-operative care is maintaining the cleanliness of the surgical sites.  An implant cannot get a cavity, but it can get periodontal disease.  It is essential to keep plaque and bacteria away from the implants and the denture.  In order to do this, a patient must follow the brushing and rinsing instructions prescribed by Dr. Chowning.

Could All-on-Four Dentures be Right for You?

Call our office today at 940-382-1750 to schedule a consultation with Dr. Chowning to discuss your best treatment options.

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How Implants Make Dentures Better

The History of Dentures

More than 36 million Americans do not have any teeth.  Unfortunately, this state, called edentulism, is nothing new.  Teeth have been removed due to decay and gum disease for thousands of years.  People have also been attempting to replace those missing teeth for thousands of years.  There is historical evidence that dentures were made as far back as 700 BC!  Contrary to popular belief, President George Washington’s dentures were not made from wood, but from a combination of carved ivory, human teeth and animal teeth.

The history of dentures has been a long, ever-changing one.  Man has been attempting to improve “false teeth” for thousands of years.  Most of these changes have been in the materials and techniques by which the dentures are made.  In general, dentures have relied on the remaining jawbone for their only structural support.  And as the jawbone continually changes in response to the absence of teeth, maintaining a proper fit with full dentures is a constant battle.  Only in recent decades have we been able to give a full set of dentures something to anchor onto: Dental implants!

The Trouble With Dentures

A traditional full set of dentures has a large acrylic base that holds the false teeth.  This base simply rests on the gums and jawbone remaining in the mouth after all of the teeth have been extracted.  The gum and jaw bone remaining after the teeth are pulled are called the alveolar ridge.  The upper and lower jaw bones are unique in that their only purpose is to support teeth.  Once teeth are removed, the bone shrinks and recedes because it no longer has anything to hold onto.  This process happens slowly over a period of years.  As the ridge shrinks, there is less and less for the denture to sit on, so dentures become increasingly loose and difficult to wear.  Some people are able to adapt to full dentures and use the muscles in their cheeks, lips and tongue to hold them in place while eating and talking.  However, many people are not able to achieve that level of muscle control and struggle to keep their dentures in place, often suffering difficulty chewing, and embarrassment when talking or laughing.

Better Dentures

The solution for this worsening problem with ill-fitting dentures is dental implants.  Dental implants improve dentures in two different ways.

  • The root form: Dental implants are placed into the jawbone and function similarly to a natural tooth root.  The jawbone responds to an implant the way it would to a tooth root and does not shrink in height or width.  The dental implant acts to maintain the jawbone, giving the denture more surface area of the alveolar ridge to rest on, which is less likely to shrink and change over time.
  • The abutment: The abutment is the portion of the dental implant system that projects out of the gum tissue. Abutments come in many shapes in sizes, depending on their purpose.  For the purpose of denture retention, a locator abutment is placed into the implant root form.  The denture contains a cap set into the denture acrylic base for each locator abutment in the jawbone.  There is a range of caps available, giving you and your dentist flexibility in how tightly your denture locks onto the locator abutment.  Because of this locking action, the dentures do not move when you chew or talk!

This is a vast improvement from traditional dentures, which depend on a person’s muscles to hold them in place.  In this scenario, rather than having an acrylic denture base which simply fits over the gums, there are interlocking pieces on both the implant and the denture, creating a secure connection.  This connection eliminates the embarrassment and fear that plagues traditional denture wearers.

Dr. Chowning’s Implant-Supported Dentures

At Timberlake Dental, Dr. Chowning places dental implants, which will be used to support dentures, using the same three-dimensional technology he uses for a single-tooth replacement implant.  It begins with 3D imaging for preoperative planning.  The images are used to choose the exact location for the implants.  Then a surgical guide is made from these digital images so that Dr. Chowning can translate the prescribed location of each implant into reality during their surgical placement.  This preoperative planning gives the most predictable, successful long-term results for both the implants themselves and the denture they will support.

Do You Have Poorly Fitting Dentures?

If you are interested in implant-supported dentures, please call our office today at 940-382-1750 to set up a consultation with Dr. Chowning.

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How 3D Technology Makes Dental Implants Better

September 20, 2017

What is a Dental Implant?

Dental implants have been used predictably and successfully to replace missing teeth for decades.  An implant is considered the best way to restore a missing tooth because it most closely resembles a natural tooth.  It has a root form in the jawbone (simply called the implant or implant body), an abutment that projects out of the gums, and a crown that is built on the abutment to create a natural tooth shape.  It restores the proper look and function of a tooth without depending on the surrounding teeth for support.  Implants themselves have not changed much.  What has changed is the technology surrounding the process of dental implants and their restoration, making it more accurate and more predictable.  In order to provide the best possible result for your dental implant, Dr. Chowning uses the latest technology available in dentistry to plan and properly execute the entire implant process.

How does a 3D image make a dental implant better?

Dental implants must be completely encased in the bone of the jaws in order to function as a tooth.  A two-dimensional image (like a traditional dental x-ray) is not able to give the exact dimensions of the jawbone in a site that is proposed for placement of a dental implant.  A three-dimensional image, like the CBCT image obtained by the Galileos®, enables Dr. Chowning to measure the height, width, and length of an implant site, as well as the location of important surrounding anatomical structures.  This includes nerves, sinus cavities, and other teeth.  The importance of this pre-operative planning cannot be overstated.

How does 3D CEREC technology make a dental implant better?

Because an implant must be placed into adequate jawbone, it is common for the bone to be the only consideration made by some dentists when placing implants.  Dr. Chowning is different.  In addition to digitally planning and visualizing the correct position of an implant on a 3D x-ray, Dr. Chowning is able to integrate the final crown’s size, shape, and position into his pre-operative planning.  This creates an ideal situation where the angle and position of the implant properly absorb the chewing forces the final crown will undergo.  An implant that is placed into healthy jawbone at an improper angle relative to the final crown will have a higher risk of failure in the long run.  By planning the crown first, Dr. Chowning can design the entire implant system (implant body, abutment, and crown) for the best long-term success.

What is the process for a dental implant using 3D technology?

  1. Planning:  The first stage is planning.  Chowning will gather information about the proposed implant site, including a 3D CBCT image and a 3D intraoral scan.  These only take a few minutes for the patient.  The real work goes on behind the scenes.  Dr. Chowning will use the CEREC machine software first to design the size, shape, contours, and position of the final crown.  Then he will integrate the digital model of the crown into the CBCT software (the 3D x-ray of the underlying bone) to determine the appropriate position of the dental implant using the final crown as his guide.  The final implant position is communicated back to the CEREC machine, which makes a tool called a surgical guide.
  2. Surgery – During the implant surgery, Dr. Chowning uses the surgical guide to translate all of the digital planning into the precise and accurate placement of the dental implant. The dental implant is placed into the prescribed position in the jawbone, covered with a healing cap, and left alone to heal for several months. (The healing time is different for each patient.)
  3. Restoration – Once the implant has healed and has adhered to the jawbone, it is ready to withstand chewing forces. In a single visit similar to that of a CEREC Same-Day Crown, Dr. Chowning will design your final abutment and crown with the same principles of size, shape, contour and position used during the planning.  The three-dimensional design is then communicated to the CEREC milling machine, which creates the physical abutment and crown.  The abutment and crown are fitted to the implant and permanently secured.

Do you need a dental implant?

Call our office at 940-382-1750 today to set up a consultation with Dr. Chowning.  He will discuss the entire process with you, as well as any specifics that may be unique to your case.

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CBCT 3D Imaging

CBCT Advanced Technology

Dentistry is a constantly evolving and growing field.  There are advances in technology and technique that allow us to improve the way we take care of our patients.  One of the advances in dentistry that we are proud to offer at Timberlake Dental is three-dimensional imaging via cone beam computed tomography (CBCT).  This imaging technology is the most advanced system available to dentistry for three-dimensional imaging of the head and neck.  Our Galileos® imaging system allows complex imaging to be obtained with control of the radiation exposure each patient receives.  This means it is customizable for each person based on age, size, and risk factors.    We have integrated this technology into our office to allow for more detailed diagnosis and treatment planning.  Dr. Chowning and his entire team believe in a comprehensive approach to dentistry, and the only way to have a completely healthy mouth is to understand its relationship to the entire body.

CBCT Collects More Information

Dentistry has progressed to incorporate evaluation and correlation of the airway, the teeth, the periodontal structures, the temporomandibular joint (TMJ) and the sinuses.  Three-dimensional imaging allows Dr. Chowning to determine the condition of the bone surrounding the teeth and the TMJ and determine if proper support and function is present to

achieve long lasting, predictable dentistry.  Traditional two-dimensional imaging of the head has provided a stable foundation for dentistry; however, it has limitations in diagnosis.  With three-dimensional imaging, Dr. Chowning can now give his patients information in the following ways that is unavailable with two-dimensional imaging.



  • Airway Volume – Measuring airway volume is particularly important in determining a person’s risk level for sleep-disordered breathing such as sleep apnea.
  • TMJ anatomy – The jaw joint can be seen in detail with a CBCT image and is important for determining stability in the bite and possible causes of pain.
  • Implant planning – The Galileos software allows for pre-treatment planning of proper implant positioning and restoration.
  • Impacted Teeth – A three-dimensional image allows the surgeon to determine the exact position of an impacted tooth prior to starting surgery. This is particularly useful for third molars (wisdom teeth).
  • Evaluation of root canals and tooth infections – With 3D imaging, we are able to closely evaluate the bone surrounding a tooth that has an existing root canal or a tooth with an infection. Seeing it in three dimensions means we can more closely pinpoint the source of the problem and give a more accurate diagnosis and treatment.
  • Orthodontics – This imaging allows for better treatment planning of tooth movement and accurate progress tracking.
  • Tumors and Growths – A three-dimensional image allows for detection and evaluation of the position, density and growth of tumors or other abnormalities of the head and neck.

CBCT Emits Less Radiation

One important benefit of the three-dimensional images obtained with the Galileos CBCT imaging system is a smaller amount of radiation than traditional two-dimensional x-rays like a panoramic or cephalometric radiograph.  Because we can customize each scan for individual patients, we can set the parameters to get the most information with the lowest amount of radiation.

In short, a three-dimensional image gives Dr. Chowning more information about your mouth and jaws than any traditional dental x-rays while exposing you to less radiation.  We believe that more information enables us to be more comprehensive in the diagnosis and treatment of any dental problem our patients may have.  And that helps us continue to meet our goal of providing excellent dental care to each patient who walks through our doors.

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CEREC Same-Day Crowns

At Timberlake Dental, Dr. Chowning is committed to providing the latest technology so that you can have the best patient experience in our office.  One of the most common procedures performed in every dental office is a crown (also known as a cap).  A crown’s purpose is to completely cover and strengthen a tooth that has been weakened by a variety of things including: a large cavity, a fracture, a filling that composes more than 50% of the exposed tooth structure, or a root canal treatment.  A crown serves to protect a tooth in any of these situations, give it the best long-term prognosis, and restore it to normal function.

How is a traditional crown made?

In the past, a crown has been a two-visit dental procedure.  During the first visit, the dentist prepared the tooth for the crown by shaping it down to the proper dimensions, took an impression (mold) of the prepared tooth, and made a temporary crown that the patient wore over the tooth for 2-3 weeks.  In that time, a dental lab technician fabricated the permanent crown, usually in an off-site facility.  There are many problems that can present during the interim period while the tooth is covered with a temporary crown.  Temporary crowns can break, come off completely, or have the wrong contours, causing discomfort while wearing it.  Often, a patient would have to return to the dentist during the temporary crown phase to have it remade, recemented, or adjusted.

The second visit with your dentist involved removal of the temporary crown for the fitting of the permanent one.  Once the crown was correctly fitted to the prepared tooth, it was cemented into place and cleaned.

How does the CEREC Same-Day Crown system work?

The CEREC same-day crown system uses CAD/CAM 3D milling to allow Dr. Chowning to make your crown in the office in 20-30 minutes.  CEREC stands for Chairside Economical Restoration of Esthetic Ceramic, and was developed in 1980.  The first successful use of CEREC crowns on a patient was in 1985, which means there have been over 30 years of implementation and advancement of this system in dentistry.

The CEREC system uses three-dimensional technology in three parts: its intraoral scanning, its software in which the dentist designs the crown, and the milling machine itself.

  • The intraoral scanning creates a three-dimensional digital impression of the prepared tooth, the adjacent teeth, and the bite.
  • The CEREC software allows the dentist to digitally design the crown on a virtual model of the prepared tooth, creating the correct size, shape and contours for each individual tooth in all three dimensions.
  • The milling machine uses the digital information from the CEREC software to create the prescribed crown shape from a block of porcelain.

What does a typical CEREC dental appointment include?

A CEREC same-day crown appointment with Dr. Chowning is booked for about 2 hours.  The initial stages of your visit will be very similar to a traditional crown appointment.  Once the tooth is anesthetized, Dr. Chowning will prepare the tooth to the proper shape for restoration with a crown.  From there, the appointment is very different from a traditional crown.  Instead of a gooey impression, the tooth is scanned digitally with a wand-like instrument that takes hundreds of pictures, splicing them together to create a 3D model of the area being imaged.  Then you can relax, watch TV, read or play on your phone while your crown is designed and milled by the CEREC.  Many of our patients enjoy watching the milling process.  It is very interesting to see the small block of porcelain milled and shaped into a dental crown!

Once the CEREC milling machine completes the crown, it will be adjusted if necessary and fitted to your tooth.  From here, the process is the same as that of a traditional crown.  The fit is confirmed with an x-ray, and the crown is cemented to your tooth.  All excess cement is cleaned from the teeth and gums, and the process is complete.

What are the advantages of CEREC Same-Day crowns?

  • Only one dental visit required!
  • Less time spent in the dental chair.
  • No need for temporary crowns, and all of their accompanying problems.
  • Your crown is designed by your dentist, who is well acquainted with your teeth and bite, instead of a lab technician.
  • No gooey impressions!

Want to know more about CEREC Same-Day crowns?

Call the office at 940-382-1750 to set up a consultation with Dr. Chowning.  He and his staff will answer any of your questions about crowns and your specific dental needs.

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Back to School

For many people, this time of year is more than just back to school.  It is back to daily and weekly routines, back to bedtimes and alarm clocks, and back to good habits that may have gone by the wayside in the easygoing days of summer.  Add this to your list of daily activities as you get back into the swing of things: taking great care of your teeth!  There are many things involved in pursuing a healthy mouth.  Here are some tips to getting that oral hygiene routine back on track.


  • In order to properly remove plaque (the soft, sticky substance that causes cavities and gum disease), it is necessary to brush your teeth twice a day with a soft or extra-soft bristled toothbrush.
  • The most commonly missed area in brushing is at the gumline, so make sure the bristles of your toothbrush are gently touching the gums as you brush.
  • Check the bristles of your toothbrush often.  The American Dental Association recommends replacing toothbrushes every 3-4 months or sooner if bristles are splayed and worn (like the photo shows).  A worn toothbrush cannot do a thorough job of cleaning teeth.
  • Please remember: never share a toothbrush with anyone, especially your child.
  • If you or your child is sick with any type of infection, replace your toothbrush or run it through your dishwasher’s “Sanitize” cycle.
  • Supervise your children’s brushing.  They should only be brushing their own teeth if they can tie their shoelaces or write their name in cursive.  Otherwise, you should still be brushing their teeth for them.


Brushing alone cannot quite get the job done when it comes to removing all of the plaque from your teeth.  The nooks and crannies between your teeth are havens for clumps of bacteria where even the best brusher is not able to reach.  Flossing removes this plaque and reduces your risk for cavities and gum disease.  When you skip flossing, you miss over 35% of the surface of a tooth.  Studies have shown that flossing every day can prolong your life by six years.

Because flossing is a more difficult skill to master, you should floss your children’s teeth until they show they can properly do it on their own.  The easiest way to floss your child’s teeth is to sit on a bed or the floor, and have the child lay down with his head in your lap.  Have the child tilt his head up so that you can look straight down into his mouth.  This gives you the simplest access for flossing (also good for brushing).  The earlier you start this process, the easier it is to accomplish.

Preventive Dental Care

  • Professional cleanings – So let’s say you’re not a perfect brusher and flosser; no one is.  We all have areas that we may miss with our toothbrush or floss.  What happens when sticky, soft plaque is not removed from our teeth?  In 24 hours, it begins to harden into tartar (also called calculus).  Once it has hardened, it cannot be cleaned off with a toothbrush or floss.  It has to be removed by your dentist or dental hygienist.  Tartar buildup that is not removed on a regular basis leads to painful, chronic conditions that require more extensive and more expensive dental treatment.
  • Dental evaluation and x-rays – A dental evaluation by your dentist can uncover problems that can be treated in the early stages, when damage is minimal and restorations may be small.  Dental x-rays show how the teeth are developing and hidden decay that develops between the teeth.  X-rays also allow us to monitor the jawbones for any changes, including cancer or abnormal growths.  These important steps, taken on a regular basis, can help prevent painful, chronic conditions and save money.  Untreated tooth decay is a serious infectious disease for which there is no immunization.
  • Fluoride application – Cavities used to be a fact of life.  Over the past few decades, one thing has been responsible for a dramatic reduction in the prevalence of cavities: fluoride.  The U.S. Centers for Disease Control says that water fluoridation is “one of 10 great public health achievements of the 20th century”.  Fluoride in your water supply is integrated into children’s teeth as they are forming, adding strength and cavity resistance to their enamel.  Teeth can also be strengthened and protected with topical fluoride.  Topical fluoride includes many products you may already use at home (toothpaste, mouthwash and gel), and it can be professionally applied in your dentist’s office.  Your need for professional fluoride treatment should be assessed by your dentist and is based on your cavity risk level.
  • Sealants – Another common area that toothbrush bristles miss is the deep pits and grooves on the biting surfaces of your back teeth.  These types of cavities can be prevented by applying dental sealants over the pits and grooves.  A dental sealant is a thin coating that goes on in a liquid form, flowing into the pits and grooves and then hardening to form a smooth, flat surface that prevents the accumulation of bacteria and food particles.  Sealants are most effective when applied as soon as a back tooth enters the mouth.

If you missed getting in to our office this summer for your preventive care, take a look at your school calendar.  School holidays are busy in our office, and appointments go quickly! Pick the next school holiday for your dental visits and call us today to get on the books for the day you want!

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Bad Breath

It would not be a stretch to say that every single person has experienced bad breath at some point in his or her life.  We are all susceptible to “morning breath” or “garlic breath”, which are neither surprising nor difficult to fix.  Many people suffer from persistent bad breath which seems difficult to cure.  As with most things, finding the cause of the problem will lead us much closer to a solution.  Let’s take a look at the most common causes of bad breath.

What causes bad breath?

When you get to the bottom of bad breath, most of it is caused by bacteria.  Over ninety-percent of bad breath originates in the mouth.  The rest stems from problems in the nose, throat, lungs, or GI tract.  These problems include postnasal drip, sinus infections, tonsil stones, bronchitis and other lung infections, H. pylori infections and GERD (gastroesophageal reflux disease).  These possible causes of halitosis are greatly outnumbered by problems in the oral cavity.  While you should be aware of them and inform your doctor or dentist of the presence of any of these issues, it is important to have your dentist rule out a more likely intraoral issue first.

What happens in the mouth to cause bad breath?

  • Cavities – Cavities, especially big ones, harbor lots of bacteria. When a cavity has gotten big enough to create a hole in the tooth, it collects food particles and plaque in addition to the bacteria that caused the cavity.  Think of it like a tiny kitchen trashcan.  It stinks!  Having the cavity fixed is like emptying the trashcan.
  • Gum (periodontal) disease – Periodontal disease affects the gum and bone supporting the teeth. In most cases, a pocket is formed where the gum and bone detach from the tooth surface.  These pockets are also like the above-mentioned tiny trashcans, collecting plaque, bacteria, food particles, etc . . . Having the proper periodontal treatment to reduce the depth of these pockets will minimize the size of the trashcan.
  • Food impaction – Perfectly shaped and aligned teeth and gums do not provide spaces for food to get caught. But let’s face it: no one is perfect.  Food impaction is the term dentists use for an area in your mouth that is consistently embedded with food debris.  If not properly cleaned out, it leads to more than just bad breath.  It can cause cavities and gum disease in that area.  If you do not feel that you are able to adequately and consistently clean an area of food impaction, please ask Dr. Chowning about your options to change the shape of the teeth so that food does not continue to be caught.
  • Tongue – Tongues are bumpy. The bumps are called papillae.  The papillae vary in size and purpose.  There are some located near the back of the tongue that can be large and create lots of nooks and crannies for bacteria to collect around.  This is where cleaning your tongue can reduce bad breath.  For some people, simply swishing a mouthrinse can effectively clean your tongue.  For others, it may be necessary to brush the surface of your tongue.  And for still others, a tongue scraper is useful in cleaning any bacterial havens on your tongue.
  • Surgical wounds – When you have surgery in your mouth, there is usually something that can allow for the accumulation of bacteria like an extraction socket or stitches. Because surgical sites usually hurt, it is difficult to keep them clean.  Your dentist will give you instructions on keeping the site clean, as well as some adjuncts for your post-surgical oral hygiene like a very soft bristled toothbrush or an antibiotic solution to apply to the site with a Q-tip.  Thankfully, this is a temporary problem.  Follow the post-op instructions closely so healing occurs as quickly as possible.
  • Dry mouth – Saliva plays a big role in fighting bacteria; therefore, it plays a big role in fighting bad breath. If you do not have enough saliva, your dry mouth puts you at risk for bad breath and various oral diseases.  It can cause bad breath by allowing an accumulation of bacteria.  You can read more about dry mouth here.

What can I do about bad breath?

  • See your dentist – It is important to rule out cavities & gum disease as the cause of bad breath because they can progress and lead to many long-term health concerns. If you do have any oral disease, proceed with treatment as soon as possible.
  • Practice great oral hygiene – Keeping your teeth clean means reducing the amount of bacteria in your mouth, and therefore reducing bad breath. Add an alcohol-free mouthwash to your daily regimen.  This helps remove bacteria from all areas of your mouth.  It is important to use an alcohol-free mouthwash because alcohol has a drying effect.  Dry=bad.  Also add brushing your tongue or using a tongue scraper to your oral hygiene routine.
  • Take steps to improve dry mouth – Discuss the various options with your dentist. Treatment may include using a salivary supplement, an antioxidant mouth gel, or a prescription mouthwash. 
  • Chew sugar-free gum, preferably containing xylitol – Chewing gum stimulates saliva, which fights bacteria. The flavor of the gum may provide a brief, minty odor to your breath, and the improved salivary flow will keep the bad breath at bay.
  • Avoid substances that have a drying effect on your mouth – Cigarettes and alcohol both reduce salivary flow and predispose you to dry mouth.

Think you may have bad breath?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.

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What are dental sealants?

Dental sealants are a protective barrier, covering the most vulnerable surface of the teeth and shielding them from cavity-causing bacteria. The sealants are most commonly applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most frequently. They can also be applied to any deep pit or groove that is high risk for decay, including the back of upper front teeth.

How does a sealant help prevent decay?

A sealant is a dental material that is applied to the chewing surfaces of the back teeth—premolars and molars. This material has a micromechanical bond to enamel in the deep pits and grooves of the chewing surfaces of back teeth. The sealant acts as a barrier, protecting enamel from plaque, bacteria and acids.
Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth. But in some cases, toothbrush bristles cannot reach the depth of pits and grooves to extract food and plaque. Sealants protect these vulnerable areas by filling in the grooves to prevent any accumulation of bacteria, plaque or food, and by creating a shallower, more cleansable surface for the toothbrush.

Is sealant application a complicated procedure?

Sealants are easy for your dentist or dental hygienist to apply, and it takes only a few minutes to seal each tooth. The teeth that will be sealed are cleaned. Then the chewing surfaces are roughened with an etching solution to help the sealant adhere to the tooth. The sealant is then “painted” onto the tooth enamel, where it bonds directly to the tooth and hardens. Sometimes a special curing light is used to help the sealant harden.
The only difficult aspects of sealant application are the bad taste of the materials used and the need to keep the tooth dry. If a child is very cooperative, the sealant can be applied without his or her ever tasting the materials. There is no pain associated with the application of a sealant.

Sealants are just for kids, right?

The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. Children typically do not have the manual dexterity necessary to adequately clean their teeth, so they are at a higher risk of developing cavities. Adults can benefit from sealants as well. An easy way to determine where a sealant would be most beneficial for an adult is to look for dark stains in the pits and grooves of the teeth. A deep crevice that is accumulating stain which cannot be removed by brushing is a high-risk area for a cavity to start. If it is collecting
stain, it is also collecting bacteria. Over a period of time, the bacteria is very likely to start damaging the enamel surface, leading to a cavity.

“CDC Promotes Dental Sealants in New Report

According to a new U.S. Centers for Disease Control and Prevention (CDC) Vital Signs report, dental sealants are an extremely effective intervention for preventing most of the cavities children get in their permanent back teeth, but the majority of children still don’t have them. The report also found that children from low-income families, who are at increased risk for cavities, are less likely than children from higher-income families to have dental sealants. Increasing sealant use prevalence could substantially reduce untreated decay, associated problems, and dental treatment costs, the CDC report concludes.
Additional findings of the report include:
 School-age children (ages 6-11) without sealants have almost three times more first molar cavities than those with sealants.
 Although the overall number of children with sealants has increased over time, low-income children are 20 percent less likely to have them and two times more likely to have untreated cavities than higher-income children.”

Sounds great! Can I have dental sealants on all of my teeth?

Once a tooth already has decay, it cannot be sealed. The decay must be removed and restored with a filling. A one surface filling to fix this type of cavity costs over $200. Placing sealants can prevent this type of decay, decreasing your costs for dental care in the long run. A thorough evaluation of all of your teeth should be performed by your dentist to determine which teeth could benefit from sealants.

Do sealants last forever?

As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed. They can be damaged by habits such as teeth grinding and chewing ice. During your dental evaluations, Dr. Chowning will confirm the effectiveness of the sealants and have them re-applied when necessary.

Would you like to know more about sealants?

Call our office at 940-382-1750 to set up an evaluation with Dr. Chowning.

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