You may have noticed, as you get older, that the enamel of your teeth is looking worn in certain areas. Sometimes tooth wear takes the form of a minor chipping or fracturing at the incisal (cutting) edges of the teeth, or a loss of tooth material from the area near the gum line. In more severe cases, worn teeth look quite a bit smaller than they used to. Why does this happen?

Some wear with age is natural. But too much wear can interfere with your bite, expose more sensitive inner parts of the tooth to decay, and give you a more aged appearance.

There are things you can control that affect wear:

Your habits: Clenching or grinding habits, also called “bruxism,” is a major cause of tooth wear. The motion of teeth sliding over each other with forces that are beyond what's normal for biting or chewing causes a mechanical removal of tooth enamel. This can happen during sleep or periods of high stress. In either case there are therapies available, such as a thin, professionally made mouthguard that prevents your teeth from coming into contact with each other. Holding foreign objects, such as nails and bobby pins, between your teeth can also cause wear.

Your diet: Tooth enamel can be eroded (dissolved away) by acidic beverages, such as sodas, sports drinks and juices. Frequent snacking on sugary foods encourages the growth of oral bacteria that produce acid as a byproduct — also leaving your teeth vulnerable to tooth decay. Your saliva can buffer the effects of the acid in your mouth in about half an hour; if you consume these types of foods and beverages continually, there won't be enough time for this to work.

We can restore the appearance and function of worn teeth in a variety of ways. Porcelain crowns and veneers, for example, can re-establish the normal thickness and length of teeth while improving their color and giving you a more youthful appearance.

If you have any questions about tooth wear, please contact us today to schedule an appointment for a consultation. You can learn more about tooth wear by reading the Dear Doctor magazine article “How And Why Teeth Wear.”

Most people think of bone as rock-solid, but it's actually a living tissue that's constantly changing. This has significant implications for your oral health, general health, and appearance — if you are one of the 70% of Americans missing at least one tooth.

Throughout the day, your top and bottom teeth make hundreds of fleeting contacts with each other. These small stresses are transmitted though the periodontal ligament (“peri” – around; “odont” – tooth) that supports each tooth in its socket like a hammock. Think of it as a gentle push on the hammock, which causes the tooth to gently bump the underlying bone. The bone then builds up in the spot that's receiving stress to counteract it. This constant remodeling of bone is what allows bone to stay healthy and strong.

When a tooth is lost, the bone does not receive that gentle stress. It reacts by literally melting away. Sometimes this happens fairly quickly — in a matter of months. After the tooth-supporting bone is lost, the jawbone itself begins the same process of deterioration. This could eventually change the shape of the face, as the distance from nose to chin can decrease — even if only a few back teeth are missing. The results aren't pretty. But the good news is, there's a way to prevent all this.

Dental implants, which function as substitute tooth roots, actually save underlying bone when teeth are lost. They do this because they are made of titanium, which fuses to the bone in which it's set, stabilizing it. The implant is topped by a realistic-looking crown, which replaces the part of the missing tooth that was visible in the mouth. Together, they look and function just as your natural tooth did.

If you are missing a lot of teeth, implants can also be used to anchor bridges or even removable dentures while providing that same bone-saving benefit. And when you consider that they are so durable they should never need replacement, implants are a great investment.

If you have any questions about dental implants, please contact us, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

Scientists don't know much about sleep even though it has been extensively studied. We do know that several hours of deep, restful sleep per night are essential for a healthy life.

Many people remain tired and unrefreshed, even after a full night's sleep. About a third of them are affected by sleep related breathing disorders (SRBD). Dentists can play a significant role in helping patients overcome these disorders, which range from frequent snoring to severe Obstructive Sleep Apnea (OSA). If you think you may have such a disorder, read on.

Under normal conditions, your upper airway is open, allowing air to flow from your nose, through your throat, and into your lungs. If you suffer from SRBD, you experience frequent reductions in the flow of air to your lungs during sleep. You may not be aware of it, but sometimes your breathing may even stop for brief periods. These reductions happen when your tongue and other soft tissues in the back of your throat collapse backwards and block your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stages of sleep your body needs.

The resulting reduced oxygen flow to your heart and to your brain can cause serious damage. You will also be tired during the day and experience a lack of energy, even if you sleep for seven or eight hours per night. This constant drowsiness puts you at greater risk for accidents.

Because dentists generally see their patients at six-month or other regular intervals, we are in a good position to screen and refer patients with suspected SRBD to physicians for diagnosis and treatment. Dentists can also treat SRBD in a number of ways.

• One of these is Oral Appliance Therapy (OAT), in which a device that looks something like an orthodontic retainer holds your lower jaw in a forward position relative to your upper jaw, preventing your tongue and soft tissue from collapsing into your airway.
• Another consists of breathing equipment called Continuous Positive Airway Pressure (CPAP). The CPAP is a mask connected to a machine that pushes air into your lungs.
• Other treatments include oral surgery or orthodontia. The goal of these techniques is to increase the volume of air passing through your upper airway by pushing your tongue forward.

Medical insurance usually covers the cost of much of these treatments.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine article “Sleep Disorders and Dentistry.”

When you have your teeth bleached in a dental office, the results almost seem like magic. Let's push aside the magician's cape and see what is really happening in professionally-applied, in-office tooth whitening.

How do teeth become discolored?
A tooth's enamel covering is mostly composed of mineral crystals. At a microscopic level, you can see a framework or matrix of organic (living) matter interspersed between the crystals of enamel creating a very irregular surface capable of retaining stains. Chromagenic (color generating) organic compounds can become part of this organic matrix resulting in tooth staining. They can be bleached without affecting the mineral structure of the tooth's enamel.

As people get older and their teeth wear, the enamel loses its youthful translucency and the underlying layer, called dentin, thickens and becomes more yellow. Such changes to the actual tooth structure are called intrinsic staining. Other causes of intrinsic discoloration are exposure to high levels of fluoride or tetracycline antibiotic administration during childhood, tooth decay, or root canal problems, among others. Discoloration can also be caused by external staining from certain foods, drinks, or tobacco products. Such surface stains are called extrinsic staining.

Behind the Magic
Materials used for tooth bleaching are hydrogen peroxide and carbamide peroxide. Peroxides are commonly used as bleach, and you may have seen them used as hair bleaches, for example. Hydrogen peroxide is a strong oxidizing agent that attacks the organic molecules responsible for tooth discoloration, bleaching them until they lose their color. Carbamide peroxide also contains urea, which is a compound that permits the peroxide to remain in contact with the teeth for longer amounts of time without harming them.

Often called power bleaching, the in-office technique uses a high concentration of peroxide solution (35-45% hydrogen peroxide), placed directly on the teeth in the form of a gel. A heat or light source may enhance the peroxide release. The gel is applied with trays custom fitted to your mouth, and specific barriers are applied to protect sensitive gum tissue from the solution. Results show teeth becoming up to ten shades lighter in about an hour.

In-office bleaching under the supervision of my staff and me is recommended if you have severely stained teeth, and particularly if you are about to have veneers or crowns made. It's a way to rediscover the pearly translucency of your youthful smile.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

You've probably heard that old song about the leg bone being connected to the knee bone; it's easy to see how the human skeleton links together. But the concept of anatomical parts being interconnected actually goes further than you might think. Problems in almost any part of the body can have profound effects in other areas. Your gums offer a perfect example.

Believe it or not, medical research has established a connection between gum disease and cardiovascular disease (CVD). They appear to be linked by inflammation, a protective response to infection. Inflammation can be characterized by a redness and swelling of the body's tissues that you can see. Or its effects can be less obvious.

Gum disease is an infection caused by bacteria, which build up in the mouth in the absence of regular or effective brushing and flossing. When left undisturbed, the bacterial biofilms (dental plaque) change over time so that a small set of highly pathogenic (“patho” – disease; “genic” – causing) organisms emerge that cause periodontitis (“peri” – around; “odont” – tooth; “itis” – inflammation).

Periodontitis can cause not just a localized inflammation of the gum tissue, but also a systemic (whole-body) inflammation. And this chronic, low-grade inflammation throughout the body appears to increase the risk of heart disease considerably. The good news is that there is a lot we can do about gum disease. And when we reduce the inflammation it causes, we can also reduce the risks for CVD and the heart attacks and strokes that can result.

The first step is a thorough, professional periodontal cleaning to remove the bacterial biofilm attached to the roots of the teeth. Sometimes a short course of antibiotics is prescribed to further fight the infection. Advanced periodontitis may require surgery so that we can reach all of the contaminated root surfaces for removal of the bacterial biofilm.

We will also review with you how you can prevent the growth of harmful bacteria through an effective daily oral hygiene routine. This is crucial to maintaining your oral health, which in turn affects your general health and overall well-being.

Contact us today to schedule an appointment to discuss your questions about the relationship between gum disease and heart disease. You can also learn more by reading the Dear Doctor magazine article, “The Link Between Heart & Gum Diseases.”