During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.
Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.
For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.
When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.
But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.
Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.
So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…
If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”
Over the last century and a half millions of people have had a tooth cavity filled with “silver” amalgam. Perhaps you’re one of them. The use of this effective and durable filling has declined in recent years, but only because of the development of more attractive tooth-colored materials.
At the same time there’s another issue that’s been brewing in recent years about this otherwise dependable metal alloy: the inclusion of mercury in amalgam, about half of its starting mixture. Various studies have shown mercury exposure can have a cumulative toxic effect on humans. As a result, you may already be heeding warnings to limit certain seafood in your diet.
So, should you be equally concerned about amalgam fillings — even going so far as to have any existing ones removed?
Before taking such a drastic step, let’s look at the facts. To begin with, not all forms of mercury are equally toxic. The form causing the most concern is called methylmercury, a compound formed when mercury released in the environment combines with organic molecules. This is the form certain large fish like salmon and tuna ingest, which we then ingest when we eat them. Methylmercury can accumulate in the body’s tissues where at high levels it can damage various organ systems.
Dental amalgam, on the other hand, uses elemental mercury. Dentists take it in liquid form and mix it with a powder of other metals like silver, tin and copper to create a pliable paste. After it’s placed in a prepared cavity, the amalgam hardens into a compound in which the mercury interlaces with the other metals and becomes “trapped.”
Although over time the filling may emit trace amounts of mercury vapor, it’s well below harmful levels. You’re more likely to encounter “un-trapped” mercury in your diet than from a dental filling. And scores of studies over amalgam’s 150-year history have produced no demonstrable ill effects due to mercury.
Although it now competes with more attractive materials, amalgam still fills (no pun intended) a necessary role. Dentists frequently use amalgam in less visible back teeth, which encounter higher chewing pressures than front teeth. So, if you already have an amalgam filling or we recommend one to you, relax — you’re really in no danger of mercury poisoning.
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
Many people learn they have periodontal (gum) disease after noticing gum swelling, soreness or bleeding. But what you can see or feel may be only the tip of the iceberg — the damage may extend much deeper.
Gum disease is caused mainly by dental plaque, a thin film of bacteria and food particles built up on teeth due to ineffective brushing and flossing. Infection of the visible gums is only the beginning — left untreated, it can advance well below the gum line and even infect supporting bone.
One critical concern in this regard is the areas where the roots of a tooth separate from each other, known as furcations. Here an infection known as a furcation invasion can cause the bone to weaken and dissolve.
This usually occurs in stages (or classes) we can detect through manual probing and/or with x-rays. In the earliest stage, Class I, we might only notice a slight pocket in the gums with no significant bone loss. In Class II, though, the pocket between the roots has become a horizontal opening of two or more millimeters, indicating definite bone loss with increased pocket depth getting “under” the crown of the tooth. Class III, the last and most serious stage, describes an opening we can probe under the crown all the way to the other side of the tooth; the bone loss now extends “through and through” the furcation.
The basic goal of gum disease treatment is to remove plaque and calculus (tartar) from all tooth and gum surfaces. But removing plaque below the gum line, especially “into” the furcations, can be challenging. We will need instruments called scalers to clean root surfaces, assisted sometimes by ultrasonic equipment to vibrate plaque loose. With furcations we may also need to employ surgery to aid gum or bone tissue regeneration or to make the area easier to access for future cleaning.
Of course, the best way to protect against furcation invasions is to prevent gum disease in the first place. Be sure to brush and floss daily and visit us for thorough dental cleanings and checkups at least every six months.
And don’t delay contacting us if you see any signs of teeth or gum problems. The sooner we can identify gum disease, the more likely we’ll be able to prevent it from doing serious damage to your gums, bone and teeth.
If you would like more information on treating gum disease, 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 “What are Furcations?”
Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand.Â Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.
Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.
A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.
Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.
If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.
If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”
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