By Ronald Ritsco DMD, MS
December 05, 2019
Category: Dental Procedures
Tags: dental implant  
GettingaNewToothinOneDayWillDependonYourBoneHealth

If you've thought the ads for a “new tooth in one day” seemed too good to be true, we have…sort of good news. You can get a new “tooth” in one visit, but only if your dental situation allows it.

The restoration in question is a dental implant, a metal post (usually titanium) surgically imbedded into the jawbone. They're especially durable because bone cells naturally grow and adhere to an implant's titanium surface, a process called osseointegration. Over time this process creates a strong bond between implant and bone.

Usually, we allow a few weeks for the implant to fully integrate with the bone before attaching the visible crown. With “tooth in one day,” though, we attach a crown at the same time as we install the implant, albeit a temporary crown. It's more aesthetic than functional, designed to avoid biting forces that could damage the implant while it integrates with the bone. When that process finishes, we'll install a permanent porcelain crown.

The health of your supporting bone and other structures will largely determine whether or not you're a candidate for this “tooth in one day” procedure. Your bone must be sufficiently healthy, as well as the gums surrounding the implant and the tooth's bony socket.

If, on the other hand, you have significant bone loss, gum recession or socket damage, we may first need to deal with these, usually by grafting tissue to the affected areas to stimulate new growth. Your implant, much less a temporary crown, will likely have to wait until the affected tissues have healed.

The bone can also be healthy enough for implant placement, but might still need time to integrate with the implant before attaching any crown. Instead, we would suture the gums over the implant to protect it, then expose and attach a permanent crown to the implant a few weeks later.

Obtaining even a temporary crown the same day as your implant can do wonders for your appearance. A more important goal, though, is a new tooth that you can enjoy for many, many years. To achieve that may mean waiting a little longer for your new beautiful smile.

If you would like more information on restoring missing teeth with dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implant Timelines for Replacing Missing Teeth.”

By Ronald Ritsco DMD, MS
November 25, 2019
Category: Oral Health
Tags: snoring   sleep apnea  
SleepApneaMightbeRobbingyouofMorethanaGoodNightsSleep

Fatigue, a “foggy” mind, and irritability are all signs you’re not getting enough sleep—and neither might your sleeping partner from your continuous snoring. You might have a common form of sleep-related breathing disorder (SRBD) known as obstructive sleep apnea.

Sleep apnea occurs when the airway becomes obstructed (usually by the tongue), resulting in a lack of oxygen. The body rouses from sleep just enough to correct the obstruction. This can occur and interrupt deep sleep several times a night, causing the aforementioned problems as well as personality changes, high blood pressure or increased stomach acid reflux. If the problem persists, sleep apnea could also become a long-term factor in the development of heart disease, diabetes or other serious conditions.

Fortunately, we can do something about it. While some may require more invasive intervention, most cases of sleep apnea can be alleviated through continuous positive airway pressure (CPAP) therapy. In this therapy, an electrical pump supplies pressurized air into a face mask worn while sleeping. The increased air pressure helps to keep the airway open.

For some patients, however, CPAP can cause discomfort like claustrophobia, nasal congestion and dryness. If that’s a concern for you, you might want to consider an oral appliance provided by your dentist.

Customized to your own individual mouth contours, this appliance is usually a two-part hinged device that draws the lower jaw and the tongue forward to open the airway. Easily adjustable, these appliances are usually more comfortable to wear than a CPAP and don’t require electricity or have the attendant noise of a CPAP pump.

They do, however, have a few drawbacks: they can disrupt saliva flow, causing either too much or too little; they may result in some morning soreness; and they can stimulate unnecessary tooth or jaw movements. For most, though, these side effects are minor compared to a better night’s sleep.

If you suspect you may have some form of SRBD, you’ll need to have it confirmed through a physical examination and possibly sleep lab testing. If it is sleep apnea, your physician and dentist can work together to help you find the right therapy to regain the benefits of a good night’s sleep.

If you would like more information on sleep apnea, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sleep Disorders & Dentistry.”

By Ronald Ritsco DMD, MS
November 15, 2019
Category: Dental Procedures
TeensMayNeedaTemporaryRestorationforMissingTeeth

While not as prevalent as adults, teenagers can have missing teeth, usually from injury or from never having been formed. Fortunately, life-like dental implants can replace missing teeth. But unfortunately for teens, implants aren't usually a good option—yet.

That's because a teenager's jaws are still growing, and will continue until early adulthood. Dental implants don't adjust to this growth like natural teeth and will eventually look out of place. It's best, then, to consider a temporary restoration for a teenager. And, there are two excellent options: one removable and one fixed.

The first is a removable partial denture (RPD). Like a full denture, an RPD has an acrylic base that resembles gum tissue, to which prosthetic (false) teeth are attached to match the positions of the missing teeth. It's usually held in place with metal or nylon clips that slide under part of the natural teeth at the gum line.

RPDs are versatile and durable. But they're not designed to be worn indefinitely, so they can be damaged if subjected to excessive biting forces like biting into something hard. And, peer-pressured teens may also feel self-consciousness about wearing a “denture.”

The other option is a bonded bridge. It's similar to a traditional bridge, except how it's supported in the mouth. A traditional bridge gains its support from the crowns on each end attached to natural teeth, which must be permanently altered for them. By contrast, a bonded bridge has strips of dental material extending from both sides of its back that are bonded to the back of the adjacent natural teeth.

With the bonding material behind the bridge, it can't be seen—and the natural teeth won't require permanent alteration. But a bonded bridge is usually more costly than an RPD and less secure than a traditional bridge. And not every teen is a viable candidate for one: issues like how the teeth fit together and if the teen has a tooth grinding habit could be strikes against this fixed option.

Your dentist can help you sort out the best of these options for your teen. If cared for and maintained properly, either restoration can buy you time until your teen is ready for dental implants.

If you would like more information on restoring a teenager's smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Temporary Tooth Replacement for Teens: What Are the Options?

By Ronald Ritsco DMD, MS
November 05, 2019
Category: Dental Procedures
NewFrontTeethforaTeenagedDavidDuchovny

In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?

“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.

How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.

With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.

In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.

While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.

Which method is best for you? Don’t try using paranormal powers to find out: Come in and talk to us. If you would like more information about tooth replacement, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Crowns & Bridgework,” and “Dental Implants.”

By Ronald Ritsco DMD, MS
October 26, 2019
Category: Dental Procedures
Tags: bonding   chipped tooth  
WhyBearaChippedTooth

Having a chipped tooth certainly can make life more difficult. It not only keeps you from wanting to smile, but it may also make it harder to eat your favorite foods. And that can be a major problem — especially if you need to eat up to 80 pounds of bamboo every day to stay healthy.

Just ask Bai Yun, the female giant panda at the San Diego Zoo. The 23-year-old animal recently chipped one of her lower canines, and her keepers were concerned that it might impair her ability to get good nutrition (pandas spend as many as 12 hours a day munching on the woody plants). So they decided it was time for a little dental work!

What followed was not unlike a regular visit to the dental office… except that, instead of sitting in a chair, the 227-pound panda reclined on a large table. After being anesthetized, the patient’s teeth were examined, and x-rays were taken. A composite resin was applied to the damaged tooth, and it was cured with a special light. After the repair work was done, her teeth were given a professional cleaning. When the anesthesia wore off, Bai Yun was released in good health — and ready to eat more bamboo.

Tooth bonding with composite resin is the restoration of choice in many situations. This method can be used to repair small chips or cracks in the teeth, and to clear up some spacing irregularities. The resin itself is a mixture of tough, translucent plastic and glass components that can be made in a number of different shades, which look remarkably like the tooth’s natural enamel coating. And the bonding material links up so well with the tooth structure that this treatment can be expected to last for years.

Another benefit of bonding is that it can be done right in the office — there’s no lab work involved (as there could be for veneers or crowns, for example). That makes it a relatively simple and economical treatment that can typically be completed in a single visit. It’s ideal for fixing minor flaws that don’t involve a great deal of tooth structure. It’s also a cost-effective solution for teenagers who need cosmetic dental work, but must wait until they have stopped growing to get more permanent restorations.

While it isn’t usually as long-lasting as restorations like crowns and veneers, cosmetic bonding is a minimally invasive, reversible treatment that can keep your smile healthy and bright for years to come. And that’s important — whether or not you spend most of your day eating bamboo and posing for snapshots at the zoo.

If you have questions about whether cosmetic bonding could help your smile look its best, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Artistic Repair Of Front Teeth With Composite Resin.”





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