My Blog
By Mark L Randall, DMD
September 24, 2019
Category: Dental Procedures
Tags: bone grafting  
WecanBuildupLostBoneBeforeYourImplant

The “magic” behind a dental implant’s durability is the special affinity its imbedded titanium post has with bone. Over time bone grows and attaches to the titanium surface to produce a strong and secure hold.

But there’s one important prerequisite for ultimate implant success—there must be an adequate amount of bone available initially to properly position the post during implantation. Otherwise, the implant may not have enough support to position it properly or cover the implant surface completely with bone.

Inadequate bone can be a problem for patients who lost teeth some time before and now desire to an implant restoration. This happens because when teeth are missing, so are the forces they generate during chewing. These forces stimulate new bone growth around the tooth root to replace older, dissolved bone at a healthy rate. If that replacement rate is too slow, the volume and density of bone may gradually diminish.

There is a way, though, to build up the bone for future implantation. Known as bone preservation procedure or a ridge augmentation, it’s a surgical procedure in which the dentist adds bone grafting material to the extraction socket or the bony ridge. The graft serves as a scaffold for new bone cells to grow and multiply. If successful, there will be enough new bone volume after several months of healing to support proper implant placement.

Bone grafting can add more time to the implant process. It may also mean you will not be able to undergo immediate crown placement after implantation (a “tooth in one day” procedure). Instead we would probably suture gum tissue over the implant to protect it and allow for full integration with the bone over a few more months. In the meantime, though, we could fit you with a temporary restoration like a removable partial denture (RPD) or a bonded bridge to improve the appearance of the space while the bone continues to heal.

After several months, your implant will have a better chance of a secure hold and we can then attach a life-like crown. Even if you’ve suffered bone loss, you’ll then have the benefit of not only a durable implant but also a new smile.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.

By Mark L Randall, DMD
September 14, 2019
Category: Oral Health
JamieFoxxChipsaTooth-ThisTimebyAccident

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.”

By Mark L Randall, DMD
September 04, 2019
Category: Dental Procedures
Tags: tooth replacement  
3WaystoCorrectMissingFrontTeeth

Roughly 75% of American adults are missing at least one tooth, mostly from disease, trauma or extraction for other dental reasons. A few missing teeth, though, never erupted in the first place.

It’s a rare occurrence, but sometimes people are born without certain teeth, usually back molars or premolars that may not be as visible. Occasionally, though, it’s the more visible upper lateral incisors positioned on either side of the central incisors (the two front teeth on either side of the midline of the face).

Missing incisors can lead to poor bites and create difficulties for speech development and nutrition. But these highly visible (or in this case, “invisible”) teeth can also detract from an otherwise attractive smile.

There are ways, however to correct a smile with missing lateral incisors. Here are 3 of those ways.

Canine substitution. We can fill the vacancy created by the missing incisors by orthodontically moving the canines (the “eyeteeth,” normally next to them) into the space. Braces can close the gap in a conservative way, while possibly correcting any existing bite problems. Because canines are larger than incisors, its often necessary to re-contour them and restore them with a crown, veneer or bonding material to look more natural.

Fixed bridge. A second way to fill the space is with a dental bridge. A bridge consists of a series of crowns fused together in a row. The middle crowns replace the missing teeth; the end crowns cap the natural teeth on either end of the gap, which establishes support for the bridge. Another variation is a cantilever bridge in which only one natural tooth is capped for support. With either type, though, the capped teeth will be permanently reduced in size to accommodate the crowns.

Dental implants. This popular restoration is also a favorite for correcting missing incisors. Implants provide a life-like and durable replacement for missing teeth, while not requiring any alterations to existing teeth as with a bridge. But they are more expensive than the other options, and they require adequate space between the adjacent teeth for insertion, as well as healthy bone for proper placement and anchorage. This is also an option that must wait until the jaw has fully matured in early adulthood.

If you would like more information on treating congenitally missing teeth, 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 “When Permanent Teeth Don't Grow: Treatment Options for Congenitally Missing Lateral Incisors.”

By Mark L Randall, DMD
August 25, 2019
Category: Dental Procedures
Tags: dental implants  
LookattheLong-TermCostsWhenConsideringDentalImplants

You’ve probably heard a lot of great things about dental implants as a replacement for missing teeth. But there’s one aspect about implants that may cause you hesitation about choosing them: the cost. If you have multiple teeth to be replaced, the expense of implants may seem even further beyond your means.

But before you decide against what’s widely considered the premier tooth replacement option, it would be beneficial for you to look at their cost from a long-term perspective. You may find implants are actually a cost-effective investment in both your oral health and your smile.

So, what sets the dental implant apart from other options? One of its most important attributes is its life-like appearance. Not only does the visible crown resemble the color, shape and texture of natural teeth, the implant’s placement can so precisely mimic the appearance of natural teeth emerging from the gums, it’s indistinguishable from the real thing.

They’re not just attractive, but also durable. This is due in large part to titanium, the most common metal used in implants, which has the unique quality of being osseophilic, or “bone-loving.” Bone cells naturally attract to titanium and over time will grow and adhere to the implant in a process known as osseointegration. As a result, the implant’s attachment in the jaw becomes strong and secure.

This durability gives implants a greater longevity on average than most other replacement options. If you thus compare the total costs for an implant (including maintenance) over its projected life with the costs of other options like dentures or fixed bridges, you’ll find implants may actually cost less over time.

That may sound affordable for one or two missing teeth — but what about several? Replacing multiple teeth individually with implants can be quite high; but implants are also versatile — just a few strategically placed implants can support a fixed bridge or overdenture. This “hybrid” solution combines the affordability of these other options with the stability of implants.

Before weighing your options, you should first undergo a complete dental examination to see if you’re a candidate for implants. From there we can help you decide whether implants are the right investment for your health and your smile.

If you would like more information on dental implants, 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 “Dental Implants 101.”

By Mark L Randall, DMD
August 15, 2019
Category: Oral Health
Tags: tooth decay  
EvenAll-NaturalFruitJuiceCouldIncreasetheRiskofToothDecay

All-natural fruit juice with no additives: now what could be wrong with that? Nothing—unless your child is over-indulging. Too much of even natural fruit juice could increase their risk of tooth decay.

To understand why, we first need to look at the real culprit in tooth decay: mouth acid produced by oral bacteria as a byproduct of their digestion of sugar. Acid at high levels softens and erodes tooth enamel, which causes tooth decay. Acid levels can rise as populations of bacteria increase often fueled by sugar, one of bacteria's primary food sources.

And not just the added sugar found in soft drinks, snacks or candies—even fructose, the natural sugar found in fruit, can feed bacteria. To lower the risk of tooth decay, dentists recommend limiting the daily amount of sugar a child consumes, including natural fruit juices without added sugar.

That doesn't mean you should nix natural fruit juices altogether—they remain a good source of vitamins, minerals and other nutrients. But you'll need to keep your child's juice consumption within moderation.

As a guide, the American Academy of Pediatrics (AAP) has issued consumption recommendations for children regarding all-natural fruit juice. The academy recommends the following daily juice amounts by age:

  1. 7-18: 8 ounces (1 cup) or less;
  2. 4-6: 6 ounces or less;
  3. 1-3: 4 ounces or less;
  4. Under 1: No juice at all.

You can further reduce your child's decay risk by limiting their juice intake to mealtimes, a good practice with any sweetened beverage. Sipping through the day on juice or other sweetened beverages can cause some sugar to stay in the mouth over long periods. This can interfere with the natural ability of saliva to neutralize any acid buildup.

If you're wondering what children could drink instead of juice, low-fat or non-fat milk is an acceptable choice. But the most tooth-friendly liquid to drink is plain water. Drinking nature's hydrator is not only better for their overall health, by reducing the risk of tooth decay, it's also better for their teeth.

If you would like more information on how sugar can affect your child's dental health, 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 “Squeeze Out the Juice.”





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