We’ve been treating one of your decay-prone teeth for some time with one filling after another. Each incident required a little more removal of decayed tooth material until now there isn’t enough structure to support another filling.

We could remove the tooth and replace it with a bridge or a dental implant, both viable restoration options. But keeping the tooth if possible would be more beneficial in the long-run for your gums, bone and remaining teeth. If it still has a healthy and stable root, it’s possible to permanently cover or “cap” the tooth with a life-like crown.

Crowns have been used for decades: the first were mainly composed of metal like gold or silver and later dental porcelain, a ceramic material that could be molded, shaped and oven-fired to resemble a real tooth. The earliest porcelains, though, were brittle, so a hybrid with a metal interior for strength and a fused exterior porcelain layer for appearance came into prominence.

Today, advances in materials have led to all-porcelain crowns strong enough to withstand biting forces. While the metal-porcelain hybrid still account for about 40% of crowns installed annually, the all-porcelain types are steadily growing in popularity.

Regardless of the type, though, the process for fitting any crown is relatively the same. The first step is to reshape the affected tooth so that the future crown will fit over it, followed by an impression mold of the tooth a dental technician will use to form a custom crown. Once the new crown has been prepared, we then permanently bond it to the tooth.

With a crown, you’ll be able to enjoy normal function and have a tooth that looks as healthy and normal as its neighbors. Be aware, though, that your underlying tooth is still subject to decay — so diligent, daily hygiene and regular dental visits are a must. With proper care your newly crowned tooth can continue to serve you and your smile for many years to come.

If you would like more information on dental restoration options, 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 “Crowns & Bridgework.”

If there’s one essential tool for protecting your dental health, it’s the humble toothbrush. The basic manual brush with a long, slender handle and short-bristled head is still effective when used skillfully. The market, though, is full of choices, all of them touting their brand as the best.

So how do you choose? You can cut through any marketing hype with a few simple guidelines.

First, understand what you’re trying to accomplish with brushing: removing dental plaque, that thin film of bacteria and food particles on tooth surfaces that’s the main cause of dental disease. Brushing also stimulates gum tissue and helps reduce inflammation.

With that in mind, you’ll first want to consider the texture of a toothbrush’s bristles, whether they’re stiff (hard) or more pliable (soft). You might think the firmer the better for removing plaque, but actually a soft-bristled brush is just as effective in this regard. Stiffer bristles could also damage the gums over the long term.

Speaking of bristles, look for those that have rounded tips. In a 2016 study, less rounded tips increased gum recession in the study’s participants by 30%. You should also look for toothbrushes with different bristle heights: longer bristles at the end can be more effective cleaning back teeth.

As far as size and shape, choose a brush that seems right and comfortable for you when you hold it. For children or people with dexterity problems, a handle with a large grip area can make the toothbrush easier to hold and use.

And look for the American Dental Association (ADA) Seal of Acceptance, something you may have seen on some toothpaste brands. It means the toothbrush in question has undergone independent testing and meets the ADA’s standards for effectiveness. That doesn’t mean a particular brush without the seal is sub-standard—when in doubt ask your dentist on their recommendation.

Even a quality toothbrush is only as effective as your skill in using it. Your dental provider can help, giving you tips and training for getting the most out of your brush. With practice, you and your toothbrush can effectively remove disease-causing plaque and help keep your smile beautiful and healthy.

If you would like more information on what to look for in a toothbrush, 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 “Sizing up Toothbrushes.”

The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.

In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?

The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.

Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.

So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”

Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.

If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”

Having a chipped tooth certainly can make life more difficult. It not only keeps you from wanting to smile, but it may also make it harder to eat your favorite foods. And that can be a major problem — especially if you need to eat up to 80 pounds of bamboo every day to stay healthy.

Just ask Bai Yun, the female giant panda at the San Diego Zoo. The 23-year-old animal recently chipped one of her lower canines, and her keepers were concerned that it might impair her ability to get good nutrition (pandas spend as many as 12 hours a day munching on the woody plants). So they decided it was time for a little dental work!

What followed was not unlike a regular visit to the dental office… except that, instead of sitting in a chair, the 227-pound panda reclined on a large table. After being anesthetized, the patient’s teeth were examined, and x-rays were taken. A composite resin was applied to the damaged tooth, and it was cured with a special light. After the repair work was done, her teeth were given a professional cleaning. When the anesthesia wore off, Bai Yun was released in good health — and ready to eat more bamboo.

Tooth bonding with composite resin is the restoration of choice in many situations. This method can be used to repair small chips or cracks in the teeth, and to clear up some spacing irregularities. The resin itself is a mixture of tough, translucent plastic and glass components that can be made in a number of different shades, which look remarkably like the tooth’s natural enamel coating. And the bonding material links up so well with the tooth structure that this treatment can be expected to last for years.

Another benefit of bonding is that it can be done right in the office — there’s no lab work involved (as there could be for veneers or crowns, for example). That makes it a relatively simple and economical treatment that can typically be completed in a single visit. It’s ideal for fixing minor flaws that don’t involve a great deal of tooth structure. It’s also a cost-effective solution for teenagers who need cosmetic dental work, but must wait until they have stopped growing to get more permanent restorations.

While it isn’t usually as long-lasting as restorations like crowns and veneers, cosmetic bonding is a minimally invasive, reversible treatment that can keep your smile healthy and bright for years to come. And that’s important — whether or not you spend most of your day eating bamboo and posing for snapshots at the zoo.

If you have questions about whether cosmetic bonding could help your smile look its best, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Artistic Repair Of Front Teeth With Composite Resin.”

Eliminating pain and discomfort is one of our major objectives during dental treatment. To that end, our profession has developed a number of anesthetic drugs and deliveries that ensures your experience in the dentist’s chair is as pain-free as possible.

But there’s another experience many people have with dental care that’s different from physical discomfort — emotional anxiety. These negative emotions can range from nervousness about a procedure to extreme fear. Very often the patient has no control over these emotions — they’ve become imbedded from earlier experiences or the influence of others.

Although each can influence and heighten the other, anxiety and physical discomfort are different and require a different approach. Physical pain and sensation is eliminated through anesthesia, either locally through topical application or injection or generally through intravenous medication that renders a person unconscious. Anxiety, on the other hand, requires first building a trustful relationship with an understanding dentist. But it may also call for certain drugs that sedate — promote a feeling of relaxation — rather than numb sensation.

We’ve incorporated a number of sedative medications in dentistry like Valium or Ativan that work well to reduce anxiety before and during treatment. Many are taken orally, usually just before scheduled treatment, and they dissipate from the system quickly afterward. Some medications also have “amnesic” qualities, meaning you won’t remember anything or little at all about the treatment period. This can be helpful in amassing positive treatment experiences that may diminish negative feelings you’ve developed about dental treatment.

It’s important, though, to find the right types of medication that work well for you. For that reason we’ll take a thorough medical history, including prescription or over-the-counter medications and supplements you’re taking and any medical conditions you may have. It’s also important to discuss your diet (certain foods can inhibit the action of some sedatives) as well as if you use tobacco or regularly drink alcoholic beverages.

Taken properly, oral sedation can effectively reduce your anxiety during treatment. As a result, it will be much easier and pleasant for you to receive the care you need for a healthy mouth.

If you would like more information on reducing anxiety during dental treatment, 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 “Oral Sedation Dentistry.”