timberlake dental

Is Morning Sickness Ruining Your Teeth?

What is Morning Sickness?

Morning sickness is a commonly used term to describe the nausea and vomiting that affects many women during pregnancy.  It’s a bit of a misnomer, as most women who experience this phenomenon say it actually happens throughout the entire day and not just in the mornings.  Morning sickness affects between 70-85 percent of pregnant women!  While most women experience morning sickness in the first 16-20 weeks of pregnancy, some of the unlucky ones have symptoms throughout the entire pregnancy.

Morning sickness affects a person’s ability to work, perform necessary tasks around the home, and/or care for children or other dependents in the household.  Many women state that morning sickness forced them to reveal their pregnancy earlier than they would have preferred.

How Does Morning Sickness Affect My Teeth?

The reason morning sickness is damaging to teeth is that the nausea and vomiting brings acid from the stomach up into the mouth.  Healthy stomachs are filled with acid, which breaks down food as an important part of the digestion process.  However, that acid is supposed to stay in the stomach.  Stomach acid has a pH of 1.5-3.5.

In contrast, a healthy mouth has a pH that is slightly above neutral, in the range of 7.1-7.5.  Teeth can stay strong at this pH.  The enamel covering our teeth begins to weaken when the pH drops to 5.5 or below.

When someone vomits, the acid in the stomach is pulled up the esophagus and into the mouth.  This stomach acid is far below the pH threshold for enamel damage.  When the mouth is subjected to this strong acid with such a low pH repeatedly, the enamel is weakened and may begin to erode.

Enamel erosion is the gradual degradation of the enamel surface of teeth caused by exposure to acids.  This includes any acid, like sodas, lemon juice, and any carbonated drink.  Because stomach acid is more acidic than these things, it can cause more damage in a shorter amount of time.  The photos below show examples of severe enamel erosion.  The enamel becomes thinner and is even missing in some areas.  On front teeth, this can cause the teeth to appear translucent or “see-through”.  On back teeth, the enamel can erode away from a filling, leaving the filling taller than the tooth surface.

    

Because enamel is a tooth’s defense against decay, anything that weakens enamel makes a tooth more likely to get a cavity.  Loss of enamel also causes tooth sensitivity.

How Do I Protect My Teeth From Morning Sickness?

There are several steps you can take to protect your teeth if you are suffering from morning sickness.

  • After vomiting, do not immediately brush your teeth.  Rinse your mouth thoroughly with water, wait 30 minutes and then brush.
  • Use an over-the-counter mouthrinse that contains fluoride before bed each night. Fluoride can strengthen the enamel and protect it against acid.
  • Chew sugar-free gum throughout the day. This stimulates your natural saliva production, which raises the pH in your mouth.
  • See your dentist. If you are suffering from morning sickness, let Dr. Chowning know.  They can assess your risk for enamel erosion and make specific recommendations for you.

What Else Can Cause Acid Erosion of Teeth?

  • GERD – Severe acid reflux can keep the pH in the mouth much lower than normal.
  • Bulimia – As with morning sickness, consistent vomiting causes enamel erosion.
  • Lemon juice cleanses – Lemon juice is as acidic as stomach acid and should never touch the teeth.

Are You Suffering With Morning Sickness?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.  He can help you manage the risks associated with morning sickness and help you protect your teeth.

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Do I Really Need to Have My Wisdom Teeth Removed?

Winter break is approaching, and for a lot of high school and college students, this may mean it’s time to have their wisdom teeth removed.  Does everyone need to have their wisdom teeth removed?  Not necessarily.  There are many criteria that dentists evaluate to determine whether or not a patient’s wisdom teeth need to be removed.  There are also different criteria that we use to determine when they should be removed.  As with any type of medical procedure, there are risks and benefits, and we always weigh the risks vs. benefits to determine if the procedure is right for each specific person.

What are wisdom teeth?

Wisdom teeth are the third set of permanent molars in an adult mouth.  The first molars come in, or erupt, at about age 6-7 years, so they are also referred to as 6 year molars.  The second molars erupt at about 12 years of age and are also called 12 year molars.  If third molars erupt at all (many do not; instead they stay hidden under the gums), it’s typically between ages 18-25, so they’ve earned the nickname “wisdom teeth”.

Who can keep theirs?

Unfortunately, not many people fall into the category of those who can keep their wisdom teeth with minimal risk of future problems.  In order to keep wisdom teeth with the least risk of cavities and gum disease, people need to have:  1) very large jaws with enough room for the wisdom teeth to fully erupt (come through the gums into the mouth), 2) wisdom teeth that are erupting in the correct alignment with the rest of the teeth, and most importantly, 3) great oral hygiene.  The average adult jaw does not have enough space behind their second molars for another molar to naturally reach the correct position for chewing and proper cleaning.

What are the risks of keeping them?

Assuming wisdom teeth have enough space and do come into their correct position behind the second molars, they are located in an area that is very difficult to keep clean.  Even the best brushers and flossers have trouble reaching the back of a wisdom tooth.  This leads to an accumulation of plaque and bacteria and food debris, which in turn, leads to tooth decay and gum disease.    This accumulation of bacteria also predisposes the adjacent second molar to both cavities and gum disease.

When wisdom teeth do not have enough space to fully erupt into the appropriate location, several problems can occur.  If the location of the tooth causes it to be partially covered by gum tissue, there is a very high risk of pericoronitis, an inflammation of the gum tissue that surrounds and often lays over the top of the tooth.  Because this partial covering creates a pocket where plaque and food can collect, painful inflammation easily develops, and can even lead to an infection.

When wisdom teeth are positioned at an angle, they are unable to erupt into the mouth (this is referred to as “impacted”) and can damage the adjacent jaw structures, as well as any adjacent teeth.  When this occurs, often both the second and third molars have to be extracted.

Why take them out preventively?

If your dentist determines that you are at risk for any of the problems noted above, she will recommend preventive extraction of the wisdom teeth and refer you to an oral surgeon.  This prevents potential pain and suffering from problems with the wisdom teeth themselves, and also protects the second molars from the higher risk for cavities and gum disease associated with the presence of wisdom teeth.

Why so young?

Teeth form from the biting surface down toward the roots.  At age 18, a wisdom tooth is much smaller than it is at age 25.  Earlier extraction of wisdom teeth means the removal of a much smaller tooth.  This results in smaller surgical site, smaller extraction sockets, quicker healing, and lowest risk of future infections.  Later extraction, after the tooth has fully formed roots, leaves the patient with a larger surgical site, a larger socket, and longer healing time.

Still have questions about your wisdom teeth?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.  He will evaluate your wisdom teeth using 3D imaging technology to determine whether or not you (or your child) need to have your wisdom teeth removed.

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Give Thanks for Your Teeth: They’ll Work Hard This Week.

Be Thankful for Your Teeth

It is easy to take things, like good health, for granted. Here are a few reasons you should be thankful for your teeth this holiday season.

  • Chewing – Teeth are absolutely essential for chewing food. Many people do not realize that chewing is the first step in the digestive process.  The breakdown of food does not begin in the stomach.  It begins in the mouth.  Being unable to properly chew food means missing an important link in the chain of digestion.  Chewing breaks large particles of food down into smaller pieces that will not damage the esophagus.  Smaller food particles also help the stomach metabolize food more efficiently.  When we chew, our salivary glands release digestive enzymes that begin digesting the food on a microscopic level.  Missing even just a few teeth reduces chewing efficiency.  Be thankful for your ability to chew!
  • Speaking – Speech is highly dependent on the presence and position of teeth. It is possible to communicate with no teeth, but certain sounds are distorted.  Anyone who has worn an Invisalign® aligner can attest to the fact that even the smallest changes to the teeth can change the way you speak.  If your family can understand you over the Thanksgiving table this week, thank your teeth!
  • Smiling – Another thing that is easy to underestimate is the power of a smile. A smile is the fastest way to communicate kindness and friendliness without words.  People who are missing teeth are much less likely to smile at others, giving the impression of shyness or a lack of friendliness, because they are embarrassed to show an incomplete smile.  A smile makes other people thankful for your teeth, too.

Be Kind to Your Teeth: Make Good Choices for Your Teeth on Thanksgiving

It is our biggest meal of the year, and people tend to eat the same traditional dishes every year.  Thanksgiving dinner is certainly better for your teeth than the candy-filled holidays of Valentine’s Day and Halloween.  Here are a few tips to keeping your teeth clean and healthy on the biggest eating day of the year.

  • Turkey – Our favorite fowl can be brined and stuffed and roasted or fried. However it is prepared, it is the focal point of most Thanksgiving feasts.  Turkey is packed with protein and is a great source of nutrition.  The downside is that the tender tendrils of meat can get stuck between your teeth.  One other potential consequence of turkey is forgetting to brush and floss because you’re too sleepy after your big meal.  Leaving food stuck between your teeth can irritate your gums, causing gingivitis.
  • Starches like mashed potatoes, dressing, macaroni & cheese – Not only do starchy foods like potatoes, breads, and pastas make you over-full and more likely to doze through your nighttime brushing and flossing regimen. The refined carbohydrates are the perfect fuel for bacteria in our mouths that love to cause cavities.
  • Sweets – Everyone knows that sugar causes cavities. Just like Halloween candy, there are certain types of sweets that are worse for your teeth.  Anything with a very sticky texture (ahem, pecan pie and cranberry sauce . . .) will keep that sugar on the tooth surface for a longer period of time, which increases the risk for cavities.  Drink lots of water with your desserts and don’t allow any sugary treat to stay stuck on the teeth.
  • Wine – Many people celebrate a Thanksgiving feast with wine flowing in bountiful amounts. While wine can help diffuse family tensions, it can create some problems for your teeth.
    • Acids – All wines have an acidic pH, and acids can weaken the enamel of your teeth if they are allowed to stay in contact with them for an extended period of time. Our saliva has properties that fight the acid in wine, so it is best to drink your wine with the Thanksgiving meal.  Sipping wine between meals for an extended period of time keeps the pH in your mouth lower than normal and predisposes teeth to cavities.
    • Staining – With red wine comes stained teeth. Drinking large amounts of red wine will leave its mark on the teeth.  You can reduce this staining by sipping water along with your wine or limiting wine to mealtime only.  If you prefer to let the teeth become stained and then whiten them later, come see Dr. Chowning to discuss your whitening options so you can get your sparkling smile back by Christmas!
  • Other tips:
    • Limit snacking. Eating one large meal is better for your teeth than grazing all day.
    • Drink lots of water. Water can help combat the acids in wine, flush out the stickiness of sweets, and wash away food debris.
    • Do not miss brushing and flossing Thursday night before bed. We know such a heavy meal makes you fall asleep on the couch during the Cowboys game.  Resist the urge to stumble straight to your bed.  Make a stop at the bathroom sink and be good to your teeth.  They’ve been good to you.

Thanksgiving Wishes

From all of us at Timberlake Dental, we wish you and yours the happiest of Thanksgivings.  We are grateful for each and every patient, and the trust you place in us each time you enter our doors.

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Pizza Burns, Popcorn Shrapnel, and Tortilla Chip Daggers: Soft Tissue Injuries in Your Mouth

Have you ever been so excited for your pizza that you just could not wait for it to cool down?  You are starving.   You cannot wait one more second.   So you take a big bite of piping hot pizza, only to feel the searing pain of a tomato sauce burn on the roof of your mouth instead of the simple gustatory satisfaction of bread, tomatoes, cheese and {insert your favorite topping here}.

Maybe Mexican food is your weakness.  The chips and salsa start calling your name as soon as you walk in the door.  You toss the whole chip with its twists and turns into your mouth, but when you bite down, a shard stabs into your gums.

At the movie theater, you eat hot, buttery popcorn by the giant handful.  When one shell of a kernel finds its way between your teeth, you spend the entire movie contorting your tongue to try to work it out and curse yourself for not carrying floss with you at all times.

Most everyone can relate to these slightly over-dramatized examples.  In some cases, the damage is very minor and only bothers you for an hour or two.  In other cases, the injury leads to a painful ulceration or a localized gum infection if not handled correctly.  Here is what you need to know about reducing your risk for these types of injuries and how to handle them when they inevitably happen.

How to Reduce the Risk of Injury

Slow down!  Many of these injuries happen because someone is eating too quickly, not allowing food to cool properly, or taking bites that are too large.  In order to lower your risk of these types of injuries, always wait for your food to cool to a manageable temperature.  Only take bites that are appropriate for your mouth, and chew slowly.  When teeth are aligned properly and chewing is performed at a normal rate, the anatomy of the mouth provides protection for the gum tissues, lips, cheeks and tongue as you chew.

How to Handle a Soft Tissue Injury

Keep your mouth as clean as possible!  The initial injury, whether it is a burn, laceration, or impacted food, can quickly progress to an inflammation or infection if not cleaned properly.  Our mouths are full of bacteria, and it is imperative to keep sores clean until they heal.  Gentle swishing of warm salt water or over-the-counter Peroxyl® mouthrinse can keep the injured site clean and promote rapid healing.

Use mild oral care products.  The injured site can be very tender and overly sensitive.  If you find that your normal mouthrinse and toothpaste cause a stinging or burning sensation to the injured area, you should switch to mild, hypoallergenic products like those made by Biotene.

Alter your diet.  Areas of ulceration or inflammation are easily irritated by very hot temperatures, very spicy foods, and acidic foods and beverages.  In order to keep the injured site as soothed as possible, you should avoid drinking hot coffee or tea.  Do not eat food that is extremely hot; allow it to cool down before taking a bite.  During the healing period, eat a mild diet that is not spicy or acidic.  Steer clear of foods high in tomato or citrus content until the area has resolved.

Avoid toothpicks.  If you feel that a popcorn kernel or other food debris is lodged between your teeth and gums, do not use a traditional wooden toothpick to attempt retrieval.  Ironically, we have removed more fragments of wooden toothpicks from patient’s gum tissues than popcorn kernels.  Only use dental floss or small interdental brushes (like a Proxabrush) to remove the embedded food particles.

Be careful when flossing.  It is possible to floss too aggressively and cause damage to your gum tissue.  When you floss with the intent to remove a popcorn kernel or other food particle, it is important to be gentle and monitor your progress.  Ideally, you want the floss to reach under the foreign body and pull it out.  If you feel that your flossing is actually pushing the material further into the gum tissue, stop immediately!

Come see us.  If you are unable to remove a piece of food or debris, it is important to see your dentist sooner rather than later.  The longer the irritant stays in place, the more likely it is to cause inflammation and can lead to infection.  If you have a painful burn or ulceration, we can prescribe a prescription mouthrinse and/or topical ointment to alleviate the painful symptoms and promote healing.

Have You Injured Yourself?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.  He will evaluate your injury and help you reduce its symptoms.

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Caring for Teeth While in Braces

Wednesday, November 8, 2017

Best Day Ever

The day you get your braces off should be the best day ever. After months, maybe even years, of hiding your metal mouth and constantly digging food out of the brackets and wires, you will feel a newfound sense of freedom and won’t be able to pass a mirror without smiling at yourself. The end result of orthodontics is always worth the time, money, and effort you put into it. Not only are straight teeth beautiful; they are actually healthier than crooked teeth.

There are two reasons straight teeth are healthy teeth: 1) Many people understand that crowded and crooked teeth allow more plaque accumulation because of the various nooks and crannies created by overlapping and rotated teeth. 2) Research studies have shown that the types of bacteria collecting on crooked teeth are different than the bacteria typically found on straight teeth. They are more periodontopathogenic – more likely to cause periodontal disease!

How the Best Day can become the Worst Day

If the braces come off, and instead of exposing a beautiful, straight smile, a mouth full of discolored and decayed teeth is revealed, the Best Day has now become the Worst Day. Braces create a dental hygiene challenge that many people, especially preteens and teenagers are not aware of or prepared for. The extra apparatuses on the teeth are havens for plaque, bacteria, and food debris, causing a person’s risk for gum disease and cavities to sky-rocket.  The most common problem we see after braces is a phenomenon called “white spot lesions” that outline where the bracket was.  The white spots are areas of demineralization or weakening of the surface enamel where plaque was allowed to linger for too long and damaged the tooth structure surrounding the bracket.

How to Lower the Inherent Risk for Gingivitis and Cavities that comes with Braces

  • Don’t miss a single dental visit. While you’re busy seeing your orthodontist every 4-6 weeks, it is easy to forget your need for dental cleanings and checkups while in braces. Dr. Chowning will be able to reassess your risk for both gum disease and cavities and make recommendations to help you lower your risk. This may include more frequent dental cleanings, a prescription toothpaste, a professional fluoride application, and adjunctive oral hygiene tools for you to use at home.
  • Adjunctive oral hygiene tools – Braces take cleaning your teeth to a whole new dimension. A manual toothbrush usually won’t do the job, and traditional floss is virtually impossible to use alone.
    • Brushing – An electric toothbrush is a must because it can remove more plaque and bacteria around the brackets more effectively than a manual toothbrush.
    • Flossing – Using traditional floss requires the addition of something called a floss-threader, which is like a large plastic needle that can be inserted underneath the wire in order to floss between the teeth. An alternative to this is using small pre-threaded floss picks that will fit underneath the wires, called Platypus flossers.
    • Waterpik – Some people choose to add a Waterpik tool to their oral hygiene regimen. It is an effective way to remove food debris from underneath the orthodontic wires.
  • Additional oral hygiene products – The specific type of oral hygiene products you use matters when you have orthodontic appliances. There are many products available that can strengthen enamel and make it more resistant to damage from plaque and bacteria.
    • A prescription fluoride toothpaste or gel – Dr. Chowning will give you recommendations based on your specific risk levels. If he determines that you are high risk for cavities, you may be given a prescription for a special toothpaste or gel to use on your teeth. Make sure to carefully follow the instructions and store any of these products out of the reach of small children.
    • Mouthwash – A mouthwash is a great way to flush out food debris from around the brackets and wires before you begin the flossing and brushing process. Any alcohol-free mouthwash is appropriate for pre-brush rinsing. Before bed and after brushing and flossing, you should swish with a fluoride-containing mouthwash. Do not rinse this one because the fluoride should stay in contact with your teeth for as long as possible. Our favorite fluoride mouthwash for orthodontics is Phos-Flur.

Questions about Your Risk (or Your Child’s Risk) While in Braces?

Call our office at 940-382-1750 to schedule a consultation with Dr. Chowning. He will assess your risk for gingivitis and cavities while in braces and make the appropriate recommendations for your specific risk.

 

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Don’t Get Tricked by Halloween Treats!

Halloween: Making Good Decisions for Your Teeth

Halloween is almost synonymous with candy, and most people know that candy can cause cavities.  What many people do not know is that some candy is worse and more likely to cause cavities than other types of candy.  As dentists, it is easy to be a killjoy on Halloween.  Since we know kids are going to load up on candy at Halloween, we don’t want to tell you not to eat it.  We want to give you information that will help you make better decisions about Halloween candy.

All Candy is Not Created Equal

The cavity risk associated with candy is based on two factors: 1) the amount of sugar in the candy, and 2) the amount of time the sugar from the candy is exposed to the teeth.  This blog will give you tips to help address both of these factors so that your risk of a Halloween cavity is minimal.

Moderation and Timing is Key

In order the address the amount of sugar in Halloween candy, it is important to exercise moderation.  Try not to binge on Halloween candy, and don’t let your kids do it, either.  Eating large amounts of candy fuels the cavity-causing bacteria in our mouths with unlimited sugar.  Limiting your candy intake to “dessert” (with a meal) also reduces cavity risk by counteracting the high amount of sugar with a high volume of healthy, cavity-fighting saliva.

Make Good Choices

  • Sort through all your Halloween candy. Make three piles: 1) Sticky, gooey candy like caramels, Starburst, any kind of taffy, anything “gummy”.  2)  Hard candies or anything that is held in the mouth for a long period of time like a jawbreaker or any kind of sucker (lollipop).  Even mints fall into this category.  3) Chocolates or candy bars containing fat, anything that would be eaten quickly.
  • Now throw away piles 1 and 2. These sticky and hard candies have a high risk for causing cavities because they expose the teeth to sugar for a long period of time.  The sugar in sticky candies will adhere to the tooth, especially in deep grooves, and provide fuel for bacteria for as long as the candy is stuck to the tooth.  You also fuel those bacteria by sucking on a piece of candy for an extended length of time.
  • Eat your chocolates and candy bars in moderation as explained above.

Feel Bad Throwing Candy Away?

At Timberlake Dental, we want to make Halloween as fun as possible while still encouraging good habits.  Consider offering your child a trade-in for his or her Halloween candy.  You can “buy” the candy back at $1 per pound, and then allow then to purchase a non-candy treat with the money, like a Hot Wheels car or sheet of stickers.  You can also use the Halloween candy as an opportunity to teach your child about sharing and giving to others.  Many local shelters and food pantries accept donations of any kind, and they would be happy to receive sweet treats at this time of year.

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Working Together for Excellent Patient Care

Interdisciplinary Dentistry

At Timberlake Dental, not only do we believe that each patient should be treated with excellence; we believe that each individual procedure should be carried out with excellence.  Because our goal is for each patient to receive the best treatment in every aspect of their health care, we cooperate with medical and dental specialists to accomplish interdisciplinary dentistry.

We understand that, as a patient, it is more convenient to have all of your dental care performed in one office.  However, when it comes to a choice between convenience and excellence, we will always choose excellence.  When Dr. Chowning creates a customized treatment plan for his patients, he considers what type of practitioner will best perform each individual procedure.  These decisions are made on a case-by-case basis, much like a primary care physician may treat a case of high blood pressure in his or her office, but refer out a complicated cardiovascular issue to a cardiologist.

Dental Specialties

The American Dental Association recognizes nine dental specialties in dentistry.  These specialties are characterized by residency programs, which add several years to their education, and certifying boards, which recognize their limitation of practice to a specific specialty.  The nine recognized dental specialties are:

  1. Dental Public Health – promotion of oral health and disease prevention
  2. Endodontics – root canals and surgeries related to infections originating within the tooth
  3. Oral & Maxillofacial Pathology – diagnosis of abnormal lesions and diseases of the oral cavity
  4. Oral & Maxillofacial Radiology – interpretation of images of the head & neck complex, including x-rays and cone beam computed tomography
  5. Oral & Maxillofacial Surgery – surgical intervention ranging from simple extraction of teeth to complex realignment of the upper and lower jaws
  6. Orthodontics – realignment of teeth and bite relationships
  7. Pediatric Dentistry – dentistry for children
  8. Periodontics – treatment of diseases and conditions of the supporting structures of the teeth: bones, ligaments, and gum tissue
  9. Prosthodontics – restoration of missing tooth and jaw structures

Many people are surprised to learn that there are currently no recognized specialties for TMJ, cosmetic dentistry, and dental implants.  Advertising claims can be misleading in these areas.

Why Do Some Dentists Pull Wisdom Teeth, Place Implants or Do Root Canals?

Many general dentists have practiced long enough to determine which procedures they are able to perform with excellence, rather than just being competent.  They will spend more time in continuing education learning the procedures that they love, and will consistently improve their skill in specific techniques.  This is why some general dentists are able to provide excellent treatment in areas another general dentist would refer to a specialist.

On the other hand, you may find that a dentist who used to do root canals in his office no longer does.  It is likely that this dentist has found he is not able to efficiently provide the very best root canal for his patients, and they will receive a more positive long-term success rate by seeing an endodontist for that specific procedure.

Medical Specialists

As we discussed in our previous blog on how oral health affects your overall health, there are many connections between the mouth and the rest of the body.  As we continue to gather more information about your head & neck with the 3D imaging and continued learning in dentistry, we are better able to recognize these connections and advise you to see the appropriate medical specialist.

The Importance of the General Dentist

In cases where interdisciplinary dentistry is necessary, the general dentist plays an important role.  In addition to performing certain procedures in the care of the patient, the general dentist is instrumental in organizing and coordinating the flow of communication and treatment among the various specialists.

If you have a complicated dental history and think you need interdisciplinary dentistry, call our office today at 940-382-1750 to schedule a consultation with Dr. Chowning.  His commitment to excellent care will ensure you see the proper doctor for each individual procedure your treatment requires.

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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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