One of the most widely used forms of dental imaging is the bitewing x-ray. So called because of the shape of the device that holds the exposable film a patient clenches between their back teeth, the bitewing x-ray is an effective means for detecting the earliest stages of tooth decay.
These early signs are small lesions on a tooth surface caused by mineral loss in the enamel. While we can identify them on front teeth through visual examination or bright lighting, they’re nearly impossible to see on the biting surfaces of back teeth. The bitewing x-ray solves this problem.
During the procedure, a narrow beam of x-rays is directed at the back teeth area. Since X-rays can transmit through solid matter, they pass through the teeth and gums to expose the film attached to the bitewing assembly.
X-rays pass through matter at different rates depending on the density of the tissue — a slower rate for harder tissues like teeth and bone and a faster rate for soft tissues like the gums. As a result, x-rays through teeth expose less of the film and appear as a lighter image than the gums. This difference is so precise even a tooth’s softer dentin appears slighter darker than its harder outer enamel.
This precision helps us identify decay lesions. Because the lesions on the enamel are less dense than the normal enamel, they’ll appear as dark spots. By detecting them at this stage we have a better chance for reversing the effects of decay or at least minimizing damage that’s already occurred.
Because x-rays emit radiation, there’s a natural concern about over-exposure and we go to great lengths to reduce it. Children may undergo a bitewing x-ray twice a year for developing teeth, while adults with healthy teeth are typically x-rayed just once a year. Advances in digital film and other technology have also helped lower the exposure rate.
Today’s standard 4-film bitewing x-ray produces about four days worth of what we receive on average from normal background radiation, so the health risk is quite negligible. The benefit, on the other hand, is much greater — the early detection of tooth decay could ultimately save a tooth.
Fans of the primetime TV show The Middle were delighted to see that high school senior Sue, played by Eden Sher, finally got her braces off at the start of Season 6. But since this popular sitcom wouldn’t be complete without some slapstick comedy, this happy event is not without its trials and tribulations: The episode ends with Sue’s whole family diving into a dumpster in search of the teen’s lost retainer. Sue finds it in the garbage and immediately pops it in her mouth. But wait — it doesn’t fit, it’s not even hers!
If you think this scenario is far-fetched, guess again. OK, maybe the part about Sue not washing the retainer upon reclaiming it was just a gag (literally and figuratively), but lost retainers are all too common. Unfortunately, they’re also expensive to replace — so they need to be handled with care. What’s the best way to do that? Retainers should be brushed daily with a soft toothbrush and liquid soap (dish soap works well), and then placed immediately back in your mouth or into the case that came with the retainer. When you are eating a meal at a restaurant, do not wrap your retainer in a napkin and leave it on the table — this is a great way to lose it! Instead, take the case with you, and keep the retainer in it while you’re eating. When you get home, brush your teeth and then put the retainer back in your mouth.
If you do lose your retainer though, let us know right away. Retention is the last step of your orthodontic treatment, and it’s extremely important. You’ve worked hard to get a beautiful smile, and no one wants to see that effort wasted. Yet if you neglect to wear your retainer as instructed, your teeth are likely to shift out of position. Why does this happen?
As you’ve seen firsthand, teeth aren’t rigidly fixed in the jaw — they can be moved in response to light and continuous force. That’s what orthodontic appliances do: apply the right amount of force in a carefully controlled manner. But there are other forces at work on your teeth that can move them in less predictable ways. For example, normal biting and chewing can, over time, cause your teeth to shift position. To get teeth to stay where they’ve been moved orthodontically, new bone needs to form around them and anchor them where they are. That will happen over time, but only if they are held in place with a retainer. That’s why it is so important to wear yours as directed — and notify us immediately if it gets lost.
And if ever you do have to dig your retainer out of a dumpster… be sure to wash it before putting in in your mouth!
If you would like more information on retainers, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Why Orthodontic Retainers?”
Today, dental implants are an increasingly popular option for replacing lost teeth — an issue faced by many older Americans. It’s not hard to see why these high-tech prosthetic teeth are preferred: They look, “feel” and function just like natural teeth… and with proper care they can last the rest of your life. Unfortunately, many people who could benefit from implants also face an additional health problem: diabetes, a metabolic disease that can affect many different parts of the body, sometimes severely.Â Uncontrolled diabetes can lead to nerve and tissue damage, and may adversely impact your oral health. So if you have diabetes, does it mean you won’t be able to get dental implants?Â
The short answer is no — but there are some considerations that diabetics (and their health care providers) need to keep in mind. For example, it has been demonstrated that wounds in diabetics tend to heal more slowly, and are more prone to infection than those in non-diabetics. Also, people with diabetes sometimes experience a chronic inflammatory response, which can eventually lead to tissue damage or other problems.
Because the placement of dental implants requires minor surgery, dentists and researchers have questioned whether people with diabetes are good candidates for implants. Now there’s encouraging news: Several recent studies have come to the conclusion that many diabetics can indeed undergo an implant procedure without undue risk.
One key consideration is how well an individual can control his or her blood glucose levels. Researchers have found that diabetics with good blood glucose control, those with poor glucose control, and non-diabetics all have similar implant success rates (above 95%). However, in diabetics with poor glucose control, more time may be needed for the jawbone to heal in the area where the implant procedure was done. That doesn’t by any means rule out the placement of a dental implant — but it does mean that special considerations apply to individuals in this situation.
So if you are considering an implant procedure but have trouble controlling your blood glucose levels, ask us how we can help. Just remember that in most cases, having diabetes doesn’t mean you won’t be able to enjoy the benefits of dental implants. If you have additional questions, contact us or schedule an appointment.
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.”
“You need a root canal,” isn’t something you want to hear during a dental visit. But whatever your preconceptions about it may be, the fact is root canal treatments don’t cause pain — they alleviate it. What’s more, it may be your best chance to save a tooth that’s at high risk for loss.
First of all, root canal treatments address a serious problem that may be occurring inside a tooth — tooth decay that’s infiltrated the pulp chamber. If it’s not stopped, the decay will continue to advance through the root canals to the bone and weaken the tooth’s attachment. To access the pulp and root canals we first administer a local anesthesia and then create an opening in the tooth, typically in the biting surface.
After accessing the pulp chamber, we then remove all the pulp tissue and clean out any infection. Â We then fill the empty pulp chamber and root canals with a special filling and seal the opening we first created. The procedure is often followed some weeks later with a laboratory made crown that permanently covers the tooth for extra protection against another occurrence of decay and protects the tooth from fracturing years later.
Besides stopping the infection from continuing beyond the roots and saving the tooth from loss, root canal treatments also alleviate the symptoms caused by decay, including tenderness and swelling of surrounding gum tissue and sensitivity to hot and cold foods or pressure when biting down. And, it reduces pain — the dull ache or sometimes acute pain from the tooth that may have brought you to our office in the first place.
General dentists commonly perform root canal treatments; in more complicated cases they’re performed by an endodontist, a specialist in root canal treatments. Afterward, any discomfort is usually managed with non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen or aspirin.
Root canal treatments are a common procedure with a high rate of success. Undergoing one will end the pain and discomfort your infected tooth has caused you; more importantly, your tooth will gain a new lease on life.
If you would like more information on root canal treatments, 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 “Common Concerns about Root Canal Treatment.”
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