Dental Information | Diamond Head Dental

Cosmetic dentistry is a term that is often used, but doesn't have a strict definition. In reality, in can refer to anything that is done to increase oral esthetics. This can include anything from changing the colour of the teeth via bleaching or covering the surface of teeth with veneers, crowns or fillings, changing the position of the teeth via orthodontic treatment, or by changing the shape of teeth by recontouring them or through the use of veneers, crowns, or fillings. If necessary, skeletal changes can also be made with orthognathic surgery. A combination of these treatments can also be used, depending on the situation. For major cases, it is often useful to take some pre-treatment models and have the changes made in wax on the stone models. This wax-up provides a useful communication tool and also acts as a template to help the dentist in completing the work.

Whitening teeth can be done in two main ways. You can actually change the colour of the teeth, through bleaching, or you can cover/mask the natural colour of teeth with veneers, crowns or fillings.

Tooth sensitivity is a fairly common problem. It is often due to exposed dentin or cementum (root surfaces) of teeth and can be worsened by aggressive tooth brushing, use of abrasive toothpastes, grinding or clenching, or acidic diets. Sensitivity can also be due to cavities, newly placed restorations (especially if they are deep), restorations that are high in your bite, leaky restorations or cracked teeth. Appropriate treatment depends on the cause of the sensitivity and can range from something as conservative as changing your toothpaste, gum surgeries to cover exposed root surfaces, diet changes, nightguards to prevent grinding, desensitizing varnishes, occlusal/bite adjustments, or placement of new restorations or crowns.

Caries, or cavities as they are commonly known, occur when bacteria consume sugars/carbohydrates and produce acids which dissolve away tooth structure. In light of this, prevention is based around reducing the bacteria count in the mouth (through brushing and flossing), decreasing the intake, and particularly the frequency of intake, of sugars,and also in creating an environment resistant to decay, through materials like fluoride and through regular professional cleanings where hardened calculus/tartar deposits can be removed.

Wear, or physical damage to teeth, refers to loss of tooth structure by mechanisms other than decay. In the literal sense, they are still 'cavities' or holes in teeth, but they are not formed in the same way. The damage can be due to several sources. Erosion is damage due to acids in the mouth (not from bacterial origin), attrition is damage from the teeth contacting one another, abrasion is damage from foreign objects (like tooth brush abrasion), and abfraction is loss of tooth structure at the gumline due to clenching and grinding. They can all contribute to sensitivity and in some instances they should be restored as a traditional cavity would.

Bruxism refers to clenching or grinding of the teeth, often nocturnally. This type of hyperfunction can result in generalized breakdown and chipping of teeth. In some situations this can lead to collapse of the bite/becoming over-closed, tooth sensitivity, or even temperomandibular joint/jaw problems.

Sometimes cracks can form on teeth. This is especially common in heavily-restored or root-canaled teeth, or in patients who clench/grind. Cracks can sometimes form on the external surface of the tooth, or can also form on the inside, underneath an existing restoration. They can be difficult to diagnose and the treatment needed can vary depending on the location or extent of the crack. If the crack extends into the pulp of the tooth, often a root-canal is indicated. If it still appears superficial, often the tooth can be adequately treated with a crown or inlay/onlay. Sometimes, if a crack extends under the gumline or onto the root of the tooth, the tooth may be left unrestorable and require an extraction.

Inflammation of the pulp chamber, or living tissue inside the tooth, can cause a tooth to be quite sensitive to different stimuli, like temperature or biting pressure. The cause of this inflammation can include trauma (such as grinding/clenching), deep fillings and deep cavities. Sometimes this inflammation is reversible, meaning the tooth can recover on it's own, while in other cases it is irreversible and the inflamed and/or infected tissue requires removal as part of a root-canal treatment. The pulp tissue can also die, or become necrotic. This can make it more susceptible to infection, and in the case of a necrotic tooth, a root-canal is also indicated.

An abscess is essentially an infection of the pulp, or soft tissue inside the tooth, that manifests in an accumulation of purulent material around the tip of one of the roots. Similar infections of the gum tissue, or gingival abscesses, are also possible.

Dental emergencies can cover a wide range of topics, from trauma to infection. In the case of an infected tooth, they can often be treated temporaily with antibiotics, but until a dentist is consulted and the actual issue is dealt with, often with either a root-canal or extraction, the infection will recur. Another common emergency would be trauma. Trauma can result in any number of scenarios including broken teeth, teeth that have been moved or luxated, avulsed teeth, or damage to the surrounding soft tissue or bone. In the case of avulsed teeth, or teeth that come entirely out of the socket, time is of the essence. Sometimes these teeth can be saved if they are gently cleaned and reinserted and splinted back in the mouth in a timely fashion. While on the way to the dentist, if you are not comfortable replacing the tooth in its socket, it can be stored in a glass of milk or tucked under the lip or cheek to best preserve it.

In edentulous areas, or areas where teeth are missing, there are several options for replacement. One option would be a denture. They are the most affordable option and are quite useful if several teeth are missing, and on both sides of the mouth. They are, however, fairly bulky, removable, and patient's often find it takes some time to adapt to wearing them. The next option is a bridge. In this case the tooth or teeth on either side of the space are crowned, and a false tooth or teeth are attached in the middle. This is advantageous as it is fixed in place. The disadvantages are the need to crown the teeth on either side of the space and the difficulty then to adequately clean around the teeth and bridge. An implant is the third and best option. In this case a titanium implant is place in the bone where the tooth used to sit. It, like the bridge, is fixed in place, but unlike a bridge it requires no modification to the neighboring teeth, replaces both the crown and root of the tooth (helping to preserve bone), and can be cleaned and flossed around just like a natural tooth.

Gum disease, at a basic level, refers to inflammation of the soft tissue around a tooth. This inflammation can lead to a puffy red appearance and a propensity to bleeding. Sometimes, this gum disease can also lead to destruction of the surrounding bone. This aggressive form of gum disease is called periodontitis, while inflammation with no active bone loss is called gingivitis. The problem with both these conditions is that they are often asymptomatic and damage can progress without the patient being aware. Certain things like smoking or diabetes can make patients more susceptible to periodontitis. The best treatment is regular hygiene. Cleaning done by the patient at home is the most important mode of prevention, but regular cleanings at a dental office are also important, especially if you already have some existing bone loss or if you have a lot of hard build-up (tartar/calculus) on the teeth.

Recession is the process by which gum tissue is lost around the neck of the tooth. It is thought to be a multi-factorial process, with inflammation, genetics, position of the tooth, oral habits and trauma, sometimes associated with aggressive tooth-brushing or things like intra-oral piercings, all being contributory factors. Once the gum tissue is lost, it can expose the root of the tooth, which is more sensitive to touch or temperature. If recession is severe enough, you can also run out of true gum tissue and actually have mucosal tissue surrounding the tooth. Treatment of recession can range from attempting to desensitize exposed roots and attempting to prevent further damage/progression, to replacement of the tissue, often via a type of gum surgery called gingival grafting.

Much like other parts of the body, the soft tissue in the oral cavity can be subject to many different types of pathology. At a very innocent level, you can see changes induced due to trauma, much like a callus developing on your hand or foot. However, intra-oral dysplasias or carcinomas are also possible. A full soft-tissue exam from your dentist can help catch any suspicious looking areas early. These areas can then be biopsied, if deemed appropriate, and the tissue changes can be looked at on a microscopic basis so that a definitive diagnosis can be obtained.

Primary teeth, or baby teeth, are the set of twenty teeth that are originally formed in a child's mouth. These teeth are then later replaced by the secondary, or adult, teeth. Since these teeth eventually exfoliate, some parents don't see the benefit in caring fo them or restoring them when damaged. These teeth can get cavities, just like adult teeth, and when those cavities reach the pulp or nerve of the tooth, bacteria can enter the bloodstream and a chronic infection and pain can be the result. If these teeth have to be extracted before they are supposed to exfoliate, it can create a loss of space for the adult teeth and result in crowding. Also, many adults link a fear or aprehension towards dentistry and dentists to childhood experiences. There is great value in preventing this.

The eruption sequence of teeth is meant as a general guideline to growth and development. Some children are ahead of the curve and others behind. Generally there are no adverse affects to being early or late in development, however, if teeth are late to erupt, often x-rays will be taken to check on the development of the adult teeth. Typically all twenty of the primary teeth are erupted by age two and a half or three. Then at age six the first adult molar erupts and between ages six and seven the adult incisors erupt. There is then a quiet period between ages eight and ten where the dentition is mixed, meaning both adult and primary teeth are in the mouth at the same time. Then, between the ages of ten and twelve, the second adult molar and the adult canines and premolars erupt. The wisdom teeth, if they do erupt, often don't do so until around age eighteen, but this can be extremely variable.

Misaligned or crooked teeth, depending on the severity, can often be strictly an esthetic issue or can also affect function or potentially lead to issues with the jaw joint or the creation of abnormal wear patterns on the teeth and unfavorable occlusal/biting schemes. For minor tooth movements, sometimes removable appliances, somewhat similar to retainers, can be utilized, or a product like Invisalign, which substitutes a series of clear mouthguards for braces. However, any major movements still require braces and occasionally will require modification or removal of some teeth, or occasionally jaw surgery if there is a discrepancy in either jaw size or position. There are also newer, more esthetic options, available, such as lingual braces where the brackets and wire are placed on the back side of the tooth instead of the front.

Fluoride has been proven time and again to strengthen teeth and prevent cavities. It can work either systemically or topically. If fluoride is taken as the teeth are developing, it can become incorporated into the structure of the tooth and make it more resistant to acid degradation. Topical or surface applications, such as the fluoride in toothpaste, or the fluoride treatment received at a dental office, have a similar mode of action, but the process is limited to the outermost surface of the tooth.

Wisdom teeth, or third molars, are the molar teeth that erupt in the posterior of the mouth. These teeth are often quite irregular in form and often there is not room for them to erupt. If that is the case, it is sometimes indicated to extract them. The benefit is in the prevention of future problems, including abscesses or cysts or damage to the adjacent teeth. Sometimes, if there are no obvious problems, people opt to leave them in place. The rationale in this case is that any surgery has risks and potential side effects or complications, so if it is elective, some patients will opt to wait and monitor the teeth over time.

Dry mouth, or xerostomia, is a condition related to a decrease in quantity or quality of saliva. Saliva plays an important role in keeping the oral tissue moist, but also in preventing cavities. The saliva helps to buffer acids produced when bacteria metabolize sugar and create acids which dissolve the teeth. People with xerostomia are therefore more prone to getting cavities and having inflamed gum tissue. Sometimes this condition can be made worse by certain medications that patients may be taking. Treatment of xerostomia can involve changing these medications, or using a saliva substitute to augment the natural saliva, behavior modification like drinking lots of water and chewing sugar-free gum to stimulate saliva flow, or by using prescription strength toothpastes.

Bad breath or halitosis can be caused by a number of factors. Sometimes it is the accumulation of bacteria in the mouth, and in some cases even on the surface of the tongue. There are tongue brushes that can be used to help with this. Other times, however, the causes can be due to issues with the sinuses/nasal cavity, tonsils or esophagus/stomach.

Often time, surface discoloration can be due to surface staining or plaque/tartar build-up. Occasionally, though, teeth can erupt with an irregular color pattern or the contour of the tooth can also be irregular. In the case of malformed teeth, there are several common genetic occurrences, such as a 'peg lateral'/small lateral incisor. If not an esthetic issue, often no treatment is indicated. However, some people may choose to have these teeth altered in an attempt to restore their traditional contour. Similarly, some teeth can have a genetic problem that causes the enamel, outermost surface of the tooth, or dentin, the layer underneath the enamel, to form incorrectly. These teeth can have a mottled look to them and it can be a difficult condition to treat. Similarly, some teeth can also erupt with a yellowish-brown or chalky white appearance. The most common causes of this would be fluorosis, or an excess of fluoride as the tooth is developing, or sometimes the use of certain drugs or antibiotics during tooth development can also cause a discoloration.

A relatively rare condition is something known as resorption. It is similar to a cavity, in that a hole is formed in the tooth, and it can originate from the external or internal surface of the tooth. It can be extremely difficult to treat and even the cause/etiology is relatively mysterious. It is thought that the process is related to an autoimmune response wherein the body recognizes something about the tooth as being foreign and attempts to remove it.