Teeth are the hardest tissue in the body, but they can chip, crack (fracture) or break. Treatment for a broken or chipped tooth will depend on how severely it is damaged. Here are some ways Dr. Ambrose may repair your broken or chipped tooth. Dental Filling or Bonding If you have chipped off just a small piece of tooth enamel, Dr. Ambrose may repair the damage with a filling. Bonding is a simple procedure that typically does not require numbing the tooth. To bond a tooth, the dentist first etches its surface with a liquid or gel to roughen it and make the bonding material adhere to it. Next, the dentist applies an adhesive material to the tooth followed by a tooth colored resin. After shaping the bonding material to look like a natural tooth, the dentist uses a light to harden the material. Dental Cap or Crown If a large piece of tooth breaks off or the tooth has a lot of decay, you may need a crown to replace the missing tooth structure. Permanent crowns can be made from metal, porcelain fused to metal, all resin, or all ceramic. Different types have different benefits. Typically crown procedures take two visits. At the first appointment the dentist will remove part of the remaining tooth in order to cover it with a crown, or tooth-shaped cap. Impressions will be taken and you will go home with a temporary crown. At the second visit, the temporary crown is removed and permanent crown is bonded into place. Dental Veneers If a front tooth is broken or chipped, a dental veneer can make it look whole and healthy again. A dental veneer is a thin shell of tooth-colored porcelain or resin composite material that covers the whole front of the tooth (much like a false nail covers a fingernail) with a thicker section to replace the broken part of the tooth. To prepare your tooth, your dentist will remove from about 0.3 to 1.2 millimeters of enamel from its surface. Next the dentist will make an impression of the tooth to be sent to a dental laboratory, which will make the veneer. When the veneer is ready, usually a week or two later, you'll need to go back to the dentist to have it placed. To place the veneer, your dentist will first etch the surface of the tooth with a liquid to roughen it. The dentist then applies a special cement to the veneer and places the veneer on the prepared tooth. Once the veneer is in position, your dentist will use a special light to activate chemicals in the cement to make it harden quickly. For more information treating a chipped tooth, contact Newton Wellesley Dental Partners. webmd.com
Patients with prosthetic joints frequently ask me if they need to premedicate before dental cleanings and procedures. In the past, I have deferred to contacting the patients’ surgeons and found that some surgeons recommended premedicating for life, some said only for the first two years, and others said no pre-medication at all. In 2014, the American Dental Association (ADA) Council on Scientific Affairs (CSA) assembled an expert panel to update and clarify the clinical recommendations found in a 2012 joint ADA and American Academy of Orthopaedic Surgeons (AAOS) evidence report and guideline.4, 5 In accord with the 2012 ADA/AAOS evidence report, the updated ADA systematic review (published in the January 2015 issue of The Journal of the American Dental Association) found no statistically significant association between dental procedures and prosthetic joint infections (PJI). On the basis of the review of the evidence, the 2015 ADA Clinical Practice Guideline stated, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.”5 The ADA panel found no association between dental procedures and PJIs and no scientifically based efficacy for using antibiotics to prevent PJIs.5 The panel did acknowledge that there may be special circumstances in which a clinician may consider antibiotic prophylaxis despite the lack of scientific evidence. However, the guidelines did not list any special circumstances. Some of the “Take home messages” from the guidelines are the following: There is no evidence to support an association between dental procedures and risk of experiencing PJIs Discussion of available treatment options applicable to each patient relies on communication between the patient, dentist, and orthopedic surgeon, weighing the potential risks and benefits for that patient Discussion of available treatment options applicable to each patient relies on communication between the patient, dentist, and orthopedic surgeon, weighing the potential risks and benefits for that patient If you have a prosthetic joint replacement, talk to your dentist about managing your dental care. Discuss if you are immunosuppressed or immunocompromised, glycemic control (diabetic), history of prosthetic joint infection, and time since last surgery. These will help identify if you need premedication for dental procedures. For more information, contact Newton Wellesley Dental Partners. Source: jada.ada.org
On November 17, the surgeon general issued its first report on alcohol, drugs, and health. More than 20 million people have substance use disorders but only 1 in 10 receive treatment. The report defines substance misuse as the “use of any substance in a manner, situation, amount or frequency that can cause harm to”. Addiction is prolonged, repeated misuse of a controlled substance that impairs health and function. Dentists frequently prescribe opioids like hydrocodone or oxycodone to manage pain. These medications are effective at controlling post-procedural pain but have also become a source of drug abuse. If you are prescribed an opioid, ask your dentist or pharmacist:
- What is the goal of the prescription?
- When and how should I take these? How long should I be on this medication?
- What are the risks of this medication and how do I dispose of extra medication?
The American Dental Society recently reported that nearly 3 in 10 seniors rate their oral health as poor-fair. Some of the common concerns dentists see among senior patients are cavities caused by dry mouth, gum recession & loosening of teeth, and difficulty with oral hygiene due to arthritis. One common causes of tooth decay in older adults is dry mouth. Saliva has many protective qualities for proper tooth hydration and helps wash away plaque. The lack of saliva can increase risk of decay. Usually it is a side effect caused by medications for high blood pressure, high cholesterol, and anxiety. Decay usually occurs on root surfaces along the gumline, underneath crowns and older restorations. The ADA recommends the following for dry mouth:
- Use over-the-counter oral moisturizers, such as a spray or mouthwash.
- Consult with your physician on whether to change the medication or dosage.
- Drink more water. Carry a water bottle with you, and don’t wait until you’re thirsty to drink. Your mouth needs constant lubrication.
- Use sugar-free gum or lozenges to stimulate saliva production.
- Get a humidifier to help keep moisture in the air.
- Avoid foods and beverages that irritate dry mouths, like coffee, alcohol, carbonated soft drinks, and acidic fruit juices.
- Your dentist may apply a fluoride gel or varnish to protect your teeth from cavities.
- Try a battery- or electric-powered toothbrush if you feel strong enough.
- Get a toothbrush with a larger handle, so it’s easier to grip.
- Try a dental floss aid or alternative
The FDA has issued warnings for infant teething tablets and to immediately stop using these products. According to the FDA, "Consumers should seek medical care immediately if their child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation after using homeopathic teething tablets or gels." Recommended treatment for teething are the following: Chill a rubber teething ring. Make sure to read cleaning instructions carefully. If you don’t have a teething ring, freeze a wet washcloth and let your child chew on it. Liquid filled teething rings are not recommended. Administer Baby Tylenol. Do not use aspirin because of the risk of Reye Syndrome. Do not give Tylenol regularly because this can lead to tooth decay and increase risk of liver disease. Serve your child cold foods, like chilled applesauce and yogurt. Use of topicals is not recommended. The FDA does not recommend use of benzocaine in children under the age of 2 because of the risk of methemoglobinemia, a rare condition that may interfere with oxygen transport. For more information on caring for infant teeth, contact Newton Wellesley Dental Partners in Wellesley, MA. Original News stories on CNN and ADA: http://www.newtonwellesleydentalpartners.org/women-and-family/teething-wellesley-weston-dover-ma/ http://www.ada.org/en/science-research/science-in-the-news/fda-warns-against-use-of-homeopathic-teething-gels-and-tablets http://www.cnn.com/2016/10/12/health/hylands-teething-tablets-discontinued-fda-warning/index.html