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Reduction, Reshaping, and Stabilization

Crowns are used when a tooth has been damaged in a way that makes other forms of repair, such as a filling, impossible or unreliable. Broken teeth, severely cracked teeth, or teeth with underlying inflammation may warrant treatment with a crown. We begin by reducing, reshaping, and otherwise preparing what remains of the tooth to accept the crown (cap).  One guide in determining how to reshape or reduce the tooth is the removal of the damaged or diseased portions of the tooth, so that further damage doesn’t continue to occur underneath the crown once it has been placed.  Teeth with underlying inflammation get a root canal before they have a crown placed over them. A root canal involves removing the tooth’s pulp (the core of the tooth that contains the nerves and runs down through canals into the roots) and replacing it with a rubbery filler.

A second guide in reduction and reshaping is removing enough of the tooth to allow the crown to be thick enough to be strong and durable as well as cosmetically pleasing. Usually, a crown needs to be about a sixteenth of an inch thick, although our measurements in preparing and designing crowns are far more precise than that. A third guide is to create a certain tapered shape that permits the crown to easily but snugly slip over the top of the remaining tooth.  The more of your tooth we can leave, the more stable the finished product will be. Sometimes, we apply special materials to “build-up” what remains of a severely damaged tooth in order to increase the strength and durability of the end result. This overall reduction and health restoration results in the tooth being properly stabilized to receive a crown.

Off to the Lab

Once we have created a stable base to work on, it’s time to begin the “design” of the crown (cap).  We place a putty-like substance into your mouth and create an impression of the prepared base, the surrounding tissue and adjacent teeth. This impression is sent off to the lab where a stone-like mold is created that allows the lab to precisely model a crown to fit into your mouth as naturally as possible.

The lab will return the custom-designed crown to us within one or two weeks. Meanwhile, we select and place a temporary crown over the prepared tooth to protect it and allow you to chew with relative ease until the precisely fitted crown is ready.

Perfecting the Fit

While the lab delivers a precisely crafted crown back to us, we will always perform our own quality checks and minor, but exceedingly precise and important adjustments to the crown. To give you a great fit and appearance, we will:

•    Verify that the overall shape and coloration of the tooth is as close to natural as possible
•    Confirm that there is a precise marginal seal between the prepared tooth base and the inner surface of the crown (This preserves the health of the live tooth base.)
•    Verify and adjust as needed the contacts between the crown and adjacent teeth
•    Check the way your bite fits with the opposing teeth, adjusting as needed to ensure a good balance

Just as with your natural teeth, you need to exercise care to keep the crown intact. Avoid chewing ice and other hard substances like popcorn kernels that could cause the crown to develop cracks. Even with good care, your crown may not last a lifetime. For this reason, many dental insurance companies will permit replacement of crowns – usually after five to eight years, depending on the policy. Our staff can help you verify your benefits should you ever need a replacement.

Believe it or not, it’s not because we like to hear ourselves talk! It’s about trying to make you feel relaxed and comfortable. Every member of our staff wants to make you more comfortable during your visit. In fact, our offices – from the reception area to the exam rooms – were also specially designed to help you feel relaxed during your visit.

And yes, we’ll probably start a conversation while you’re in the chair. The main reason is that talking is a distraction.  (That’s why using a cell phone while driving can be hazardous!)  It is our hope that our talking to you will help the time you spend in our office pass quickly. We know it can help because we receive specialized training in dental school that helps us be very sensitive to the patient’s experience and point of view while we’re working.

Part of a dentist’s training is to learn and practice different techniques that can help you relax during routine exams and specific procedures. We’ve been trained well in the science of dentistry, as well as in the art of combining both psychological and pharmacological approaches (sedation dentistry) to keep each unique individual comfortable.

Learning to make you feel comfortable and at ease during your visits is a whole art unto itself, and one that must be learned along with a tremendous body of medicine and science that supports your safe and effective treatment. We sometimes jokingly refer to surgeons and some types of physicians as “lucky” in this regard – because they often put patients completely “out” before performing any procedure on them. That means they don’t have to worry about learning and practicing this special art like dentists do.

There’s also one more strategy behind our striking up a conversation. If you’re relaxed, we also find it may be easier for you to share with us any dental concerns and needs that may have come up since your last visit. Remember, we’re not here to practice our oratory skills. We’re here to help you maintain good oral health and give you a smile you can be proud of. Our goal is to make your experience with us as pleasant as possible. The more we can help you relax while you’re here, the more likely you’ll feel good about coming back and being proactive about maintaining your oral health.

•    Food – Spicy foods, such as those containing onion and garlic, can’t really be covered up with tooth brushing, flossing, and rinsing with mouthwash after the meal. Those measures only help to a degree. That’s because many foods stay in the body for 72 hours or more, are absorbed by other body tissues, and continue to make their presence known on the breath. Believe it or not, garlic rubbed on the soles of your feet can eventually show up on your breath!  Even coffee can often be smelled on the breath days after you drink it.

Even if you avoid the types of food that leave lingering breath odor, foods with little or no odor can also be a major cause of bad breath. Aside from causing tooth decay, any food particles left behind by poor oral hygiene begin decaying and can produce bacteria that cause bad breath odors.  To help ensure that this isn’t your problem, your oral hygiene regimen may need to include brushing not only the teeth, but also the tongue, gums, and roof of your mouth – any place that food and beverage residue can become trapped. Saliva is nature’s way of trying to wash away food particles in the mouth. So, if your mouth tends to be dry for some reason, you may need to be even more attentive to your oral hygiene and food particle removal than most other people.

•    Common oral diseases – I’ve mentioned dry mouth (xerostomia) as one condition that can lead to halitosis. Certain medications, radiation treatments, or even skipping meals can all be causes of a dry mouth condition.

Periodontal (gum) disease is another cause of bad breath. In periodontal disease, plaque – a sticky film of bacteria that forms on your teeth – can build up and cause gum irritation that results in inflammation, receding gums, and even damage to underlying bone tissue. Good oral hygiene, rinsing with anti-bacterial mouthwashes, and regular dental exams and cleanings are the best defenses against periodontal disease.

There are some special dental products, such as CloSYS, that are especially effective at combating the sulfonamides that develop from bacterial growth in the mouth. A reputable comprehensive dentistry provider can help you bring these dental conditions and diseases under control, and also help you decide what dental hygiene products and procedures you can use at home to manage or avoid the disease.

•    ENT infections – Ear, nose, throat, and sinus (ENT) infections, because of their close proximity to the mouth, can be another cause of bad breath. These should generally create only a short-term problem, clearing up when the infection does. However, some conditions, such as sinusitis and bronchitis, can be chronic and result in a persistent problem with bad breath until the condition is alleviated. Talk with your dentist about any problem with bad breath that you are experiencing. By discussing the problem during your regular check-up, you and your dentist may be able to more quickly pinpoint the most likely cause, and you can see a medical professional if an ENT infection seems to be the culprit.

•    Problems with major organs – There’s a natural tendency for all of us to assume that bad breath is caused by something in or in close proximity to the mouth. When we’ve eliminated some of the other causes discussed above, it’s important to consider other causes, such as problems with other body organs. Issues with lungs, liver, stomach, and kidneys can all result in an outgassing of bacteria or other abnormal by-products that are vented from the body on your breath.

A comprehensive dentistry provider is your first line of defense in both identifying and treating oral health issues, and can point you to other medical professionals who may need to be involved. Don’t be afraid to ask if you have a concern – tens of millions of people share this problem. If the source of the problem isn’t obvious to your dentist during a regular check-up, he may ask you to return for a follow-up to further discuss and evaluate the problem. It is only logical to start by assessing the oral health possibilities because dentists receive special training on the potential causes of halitosis.

For more information on comprehensive dentistry or halitosis, contact Dr. Robert Williamson today!

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What Happens During an Extraction & Why Do I Need to Have One?

Without being too graphic, a tooth extraction is the removal of a tooth from its socket in the bone. Usually, whenever you have a cavity or some other type of damage to your tooth that’s the result of decay, the dentist will try to fix it by filling in the cavity or using a crown or doing a root canal. However, sometimes the damage is simply beyond repair which means that the tooth needs to come out. The reason that you cannot simply leave the tooth in is because the already infected tooth can actually spread bacteria to the rest of your mouth as well as to your gums, thus getting into your blood stream and making you sick.

There are also several other reasons that your dentist may suggest a tooth extraction:

• Overcrowding: Sometimes extractions are necessary due to “overcrowding” in your mouth (ie. you have a lot of teeth and a tiny mouth).
• People Getting Braces: Sometimes teeth need to be extracted to make room for teeth that will be shifting.
• People Receiving Radiation Treatment: Any teeth blocking the radiation may need to be removed.
• Wisdom Teeth: At times, wisdom teeth may become impacted under the gums, causing pain to the individual. Additionally, because they are so far back in the mouth, wisdom teeth tend to decay-at which point they must be removed- otherwise you risk gum disease as well as other health-related issues due to bacteria entering your blood stream.

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!

Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease. Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away the tissues’ waste products. Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes. This can weaken the resistance of gum and bone tissue to infection.

To compound this marked weakness in gum and bone tissue is the fact that many bacteria thrive on glucose, the very same sugar that can easily rocket out of control in diabetics. Aside from diabetics, anyone who practices poor oral cleaning habits is prone to periodontal disease, and once you have it you might soon be suffering from bad breath, loss of teeth, or even heart disease. According to the New York Times: Studies have reported that people who have heart disease have a 1.5 – 4 times increased risk for periodontal disease.

The risk is [of heart disease]highest for patients with extensive gum disease, bleeding from every tooth.) Acute coronary syndrome, high blood pressure (hypertension), and high cholesterol have also been associated with periodontal disease.

Combating periodontal disease can have many positive repercussions around the body, from keeping your mouth minty fresh, to maintaining a healthy heart!

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!

Dry mouth can have many causes. It can occur when a person is stressed or upset, may be a sign of aging, and can also be caused by radiation therapy, chemotherapy, diseases like AIDS or diabetes, and mny different medications. In fact, studies have shown that up to 400 medications, both prescription and over-the-counter, can contribute to dry mouth. Some of these types of medicines include certain anti-depressants, antihistamines, decongestants, muscle relaxants, and pain-killers.

People experiencing dry mouth need to maintain good oral hygiene and nutritional habits. Adding fluoride to your diet and increasing the amount of water you drink are an important line of defense to battle dry mouth. Sugar-free candy or gum also will help stimulate saliva flow, and alcohol, caffeine, and smoking should be avoided. Citrus juices, overly salty foods, and dry foods like toast or crackers should also be eliminated from your diet if you experience dry mouth. Above all, the most important thing is to keep visiting your dentist regularly. He or she can properly diagnose your condition, offer suggestions and solutions to help the problem, and replace moisture in your mouth with artificial saliva and oral rinses.

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!

A problem that can arise with wisdom teeth is that they don’t always come in properly. The lower wisdom teeth in particular can sometimes only come in partially. This leaves the rest of the tooth under a flap of gum. When this happens, bacteria and pieces of food can get trapped under this flap, causing the gum to swell and become irritated. This infection is called pericoronitis.

Symptoms of pericoronitis can include pain in the area around your teeth, a bad taste in the mouth or bad breath, swelling of the gums around your back teeth, and a difficulty in opening your mouth all the way. If the pericoronitis is severe, the swelling and infection may extend past the jaw all the way to the cheeks and neck.

The pain of pericoronitis can be somewhat alleviated by swishing warm salt water around the mouth, but people experiencing these symptoms should see their dentist. The dentist can clean the area to remove damaged tissue or pus, and also prescribe antibiotics for the pain. If the pain and swelling are severe, oral surgery may be necessary to remove the flap of gum or wisdom tooth.

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!

When women are pregnant, they have a higher chance in general of developing swollen gums because of the hormonal changes that take place in the body right after conception. Usually these effects are temporary, but this condition is still important to treat. It’s believed that in some women, the oral bacteria that’s responsible for the gum disease enters the bloodstream – not only exposing the baby to the bacteria, but also alerting the immune system to send signals to the uterus that the baby needs to be delivered. The American Academy of Periodontology speculates that “the likely culprit is a labor-inducing chemical found in oral bacteria called prostaglandin.”

While more research needs to be done in this area, studies have already been done to establish the risk of premature birth from gum disease. Professor Steven Offenbacher from the University of North Carolina at Chapel Hill tested 357 women for gum disease when they were less than 26 weeks pregnant and again three days after their babies were born. His study concluded that the women with gum disease during pregnancy had a higher than average rate of going into labor more than three weeks early.

So what can be done to prevent premature birth from gum disease? Visiting the dentist regularly, just as people should throughout their lives, can help identify potential problems before they escalate. Also, eating at least three servings of foods high in calcium each day can help prevent gum disease as well.

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!

First of all, most dentists recommend picking a soft-bristled toothbrush. These are best for removing plaque and debris from your teeth. Harder brushes may wear away the enamel on your teeth, and damage your teeth or gums. Secondly, the toothbrush should be small enough to be comfortable in your mouth and reach all surfaces of your teeth, including the hard-to-reach back teeth. When brushing properly, the bristles should go a little under the gumline and around the edges of each tooth. A smaller brush is more effective in getting thoroughly around the teeth, and getting closer to the gumline where bacteria like to flourish. Adults with smaller mouths might even do better to use a kid’s toothbrush.

Your toothbrush should be replaced every 3 months or so, or whenever the bristles start looking worn or bent. Some toothbrushes have a color indicator that tells you when it’s time to replace your brush. If you’ve been sick, you should also replace your toothbrush so that the sick bacteria doesn’t spread to your healthy, germ-free mouth and cause re-infection. An electric toothbrush is another option. These can do a better job of cleaning the teeth, and are especially beneficial to those who can’t easily reach all their teeth, or who have arthritis or other problems with their hands or arms.

Whatever toothbrush you use, it is important to also visit your dentist for more intensive cleanings at your regular check-ups. Such preventative action can put a stop to dental problems in the future.

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!

The American Dental Association (ADA) reports that 43% of dentists believe maintaining good oral hygiene/preventive care is going to be the main oral health issue facing the baby-boomer generation, while thirty-two percent believe periodontal disease will be the primary concern. While these may be the most pressing issues, a survey of the baby boomers’ most requested procedures showed that this generation of adults is instead more concerned with their improving the look of their teeth. The number-one requested procedure by adults aged 40 to 60 was named as teeth whitening by 63% of dentists, with veneers, bonding, and crowns ranking as the second most requested procedure. Treatment for periodontal disease ranked third according to 55% percent of dentists.

Focusing more on periodontal disease would be beneficial for baby boomers. According to the U.S. Department of Health and Human Services, periodontal or gum disease is the second most prevalent disease in the U.S. after heart disease, affecting more than 50 million Americans — and only 15–20% receive treatment. Baby boomers would do well to brush twice daily, floss at least once before bed, and visit their dentist regularly, which is the same dental advice given to everyone throughout their lives. It sounds simple, but has many benefits, and will prepare adults for a lifetime of healthy smiles.

For more information on comprehensive and cosmetic dentistry, contact Dr. Robert Williamson today!