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Preventing disease is an important part of dental service, perhaps the most important. With good care, your teeth may last you a lifetime; however, without regular recare by your dentist or preventive disease specialist (a hygienist-dentist-expanded duty dental assistant), you are taking chances with your dental health. At preventive disease appointments, an examination is performed which can find dental disease that may have started or is occurring in your mouth.

Early treatment of the disease is most often inexpensive and painless. If you have crowns in your mouth, checking the strength of the cement can allow early re-cementation before dental disease may seep in around the borders of the crowns under the teeth. Occasionally, patients will be of the opinion once their teeth are capped(crowned) they no longer are vulnerable to tooth decay in that tooth--NOT TRUE; crowned teeth are nearly as susceptible to decay as any other teeth. Further, gum disease and bone loss cause the loss of more teeth than dental decay.

With regular recare, the process of bacteria causing your gums and bone to pull back can be treated early and many times stopped, slowed or prevented from occurring in the future. There are several laws of dentistry and care; one of them is: "The dentist cannot overcome what the patients will not do for themselves." Conscientious dental professionals will help you learn how to best care for your teeth and prevent dental diseases.

Our team will attempt to make you regular preventive disease appointments, and your record of making those appointments or refusing those recommendations will be so noted in your dental chart. You may even receive a warning letter suggesting you are taking chances with your dental health by not following recommendations for routine recare(tooth cleaning, decay- detecting radiographs or other radiographs).

Dental diseases(decay, bone loss, gum disease, infections) can occur and develop quickly; again, if the disease process is caught in time, a tooth or adjacent teeth may be prevented from their being lost to the disease.

Occasionally, a patient will mistakenly be of the opinion, the cleaning appointments are for the benefit of the dentist?s pocketbook; not true, recare is not an expensive service and will not sustain a dental office?s overhead. Dental preventive disease appointments are in the patient?s best interests--solely.

Listen and care for your teeth well; make your recare appointments as recommended. Most recare is at 6-month intervals; however, your dentist may find very good reasons to suggest you follow a recare schedule of 2-3 months if you are in danger of a disease or habit-process damaging your teeth, gums, bone or jaw joints.

Patients who smoke have more gum-bone disease because the tar and nicotine coat the crown and root surfaces of your teeth pushing the gums and bone back. Frequent tooth cleaning (prophylaxis = prevention) can help prevent smoking from causing the early loss of your teeth due to bone loss.

Do your best to maintain the best health of your teeth; if you ignore your teeth, they will go away; this is another law of dentistry.

2. HOW MAY MY BADLY INJURED OR UNATTRACTIVE TEETH BE RESTORED, AND DO BADLY DAMAGED TEETH ALWAYS NEED ROOT CANALS?

Restoration of the diseased portion of your damaged teeth may require fillings, crowns or veneers. On some occasions, teeth need root canal treatments in combination with crowning. This can be due to a tooth previously having disease or damages that have injured the nerve in a tooth. The nerves in our teeth, due to injury or disease, may first become aggravated and hypersensitive and later become very painful.

When a tooth is sensitive to cold, then hot, and becomes painful with the tapping of an instrument, most often , that tooth will need a root canal. Occasionally, a patient?s teeth will have very large nerves, and even routine preparation of the tooth for a crown may result in the need for the nerve to be removed and the canal filled (root canal treatment). On some occasions, a tooth will develop a crack and become sensitive first to cold and then hot. This tooth?s nerve may stop hurting and heal with a crown placed; however, if pain does not go away, the nerve may have to be removed and a root canal filling placed.

Crowns and veneers are often placed on teeth for cosmetic improvement of a patient?s smile. With the process of crowning or veneering teeth, there is some gum removed for the purpose of making an accurate impression; care of your gums, thereafter, should have special care and after-impression instructions importantly followed.

Gums take two weeks to heal new skin, and it is not uncommon for your gums to be sore after the preparation for the placement of a new crown. This is usually short-lived and healing is usually uneventful; however, on occasion, a groove or line in a gum contour may result from a tooth?s preparation for either a veneer or crown.

Bridges, crowns or veneers are wonderful dental care services; and with the temporary discomforts experienced, patients most often heal in a short period of recovery time, and the temporary pains are overcome by the gains of the needed or desired restorative service(bridge, crown(s), veneer)

3. WHAT IS THE DIFFERENCE BETWEEN A VENEER AND CROWN?

Often, patients will ask what is the difference between a veneer or crown? A crown covers all of a tooth; whereas, a veneer covers the face side of the tooth and varying amounts of the biting edge and sides, leaving the tongue side of the tooth without preparation.

There are occasions when veneers are popularly selected over crowns and they preserve some of the tooth from being cut and reduced; however, they should be considered a half a crown or more, and when the tongue side of a tooth is weakened by decay and previously- placed fillings, many times a crown is a better care. Both can be performed very well with ideal color results; however, crowns have some advantages in that they may be custom-made to contour and color-correct appearance more easily.

Also, crowns may be cemented with intermediate cements that allow the crown to be removed, repaired, and replaced easily or with minimal stress to a tooth. Veneers, on the other hand, are strongly cemented and if something happens to damage the veneer or it leaks its cementing media, the entire veneer would have to be replaced.

Crowns, most often, have metal inside for strength; as a result, they are usually much stronger than veneers. Porcelain veneers usually do well for years at a time; however, they are more fragile than metal reinforced crowns.

Also, porcelain veneers cannot be removed, once placed; whereas, crowns cemented with an intermediate strength cement, most often, may be removed and repaired if they are damaged. Veneers and metal reinforced crowns or all porcelain crowns are excellent services, and they can provide many years of successful service.

4. WILL MY CROWNS BE CEMENTED PERMANENTLY? WHAT ARE MY CHOICES?

Patients often ask if their crown will be cemented with a permanent cement? Unfortunately, there is no such thing as a permanent cement; none of us is permanent nor is a permanent hairstyle obtained from your hairdresser--permanent.

Cements are classified as: l)Extra-strong, 2) Strong, 3) Intermediate, and 4)Weak.

Cementation of crowns and bridges may be recommended to be performed in an intermediate cement. This allows a crown or bridge to be removed, if needed. There are many advantages to this cement?s use; however, this cement needs to be checked with regular recare. Short teeth require a stronger cement and cements are often increased in strength after a patient has comfortably worn a crown for a period of time.

5. HOW LONG WILL MY CROWNS, VENEERS, BONDINGS OR FILLINGS LAST?

Another frequent question about crowns and bridges is: "How long will my crowns, veneers, bondings, fillings or bridges last?" The answer is: There is no way to give you an exact answer to this question. Crowns, veneers, and bridges could last twenty or thirty years, or they could last less than five years if abused. Bondings are usually discolored in 5 years and may need to be replaced at that interval.

Fillings can last many years; however, many times the margins of the tooth around the filling will deteriorate with considerable time. All of these restorative services? lives are shortened:

1)When patients fail to follow their recommended preventive disease appointments;

2) When patients grit, grind or clamp their teeth together;

3)When patients change a habit and start eating something that causes root decay--Certs, hard candies, occasionally Tums;

4)When patients lose bone through gum-bone disease around their teeth and completed crowns or bridges.

Restorative dentistry provides many benefits for patients; however, there is no warranty or implication the services will last the test of a lifetime. Largely bonded tooth surfaces have a lesser life span than porcelain veneers, will discolor over three to five years, and they may decay around the areas of the bonded surfaces.

With good preventive care and avoiding damaging habits that can cause further dental decay, restorative services may last for decades, and the main determination of how long these services last will be determined by the person you see when you look in a mirror--you!

6. WHY ARE MY TEETH BECOMING LONGER?

Patients will wonder, from time to time: "Why are my teeth becoming longer?" This can occur naturally to some extent. The Bible talks about "becoming long in teeth." That reference relates to the process of the gums pulling back with time, tooth clenching or with dental diseases. Excellent home oral hygiene care in combination with following recommendations for regular preventive disease can slow this process in occurring, and in many patients, there is little perceptible increase in tooth length over a decade or two.

However, when gums are shrinking, the roots of a tooth will often be exposed to the mouth's fluids and foods making the tooth's root much more susceptible to decay than the crown. Many times, patients will mistakenly think the whole tooth is composed of an outer surface of enamel.

Unfortunately, the tooth's root has a much softer surface than the enamel on the clinical crown of a tooth; it is called cementum. This material (cementum) is likened to bone and is much less hard and much more susceptible to decaying influences such as: acids from candies, troches, cough drops, soda pops, and other sweets.

7. WHAT IS A ROOT CANAL, HOW LONG WILL IT LAST, AND DOES IT REQUIRE ADDITIONAL DENTAL SERVICES?

Each tooth has one or more nerves; incisors and canines usually have one major root; premolars sometimes have two or more, and molars have three or more, and often four. There is also the possibility of a tooth having small accessory microscopic canals where a nerve or blood vessel traveled through it. When a nerve in a tooth dies, it is said to become "necrotic."

The process of a nerve dying is like any other necrotic process; necrosis gives off gases and by-products of the dying process that may accumulate pressure at the tooth?s root end, causing pain. There are two possibilities with a nerve dying:

1) The tooth will develop an acute abscess with pain; the preferred method of treatment is a root canal in combination with the administration of antibiotics; or

2) The tooth will develop a chronic abscess.

There may be occasional slight pain; however, it is not a throbbing pain which awakens a patient from sleep, as occurs with an acute abscess. A chronically abscessed tooth may develop serious bone loss leading to the loss of the tooth and also, adjacent teeth. For this reason, root canals are equally important for chronically abscessed teeth as well as a painful, acute abscessed tooth.

Root canals require the filing away of the interior of a tooth?s nerve canal. After filing is completed, the removal of the nerve is accomplished with small files of increasing diameters ( sizes).

Occasionally, a root is so curved its treatment with a root canal is difficult or even impossible. In some situations, files may break during the opening of a small, curved canal; however, a file may be occasionally used to close and finish a root canal filling. Most times, the nerve canal is filled with a plastic material and a cement. Root canals have good percentages of success, about 95 however, over a period of 20 years, a root canal- treated tooth may need re-treatment or a further root canal service such as the placing of a filling at the root end of a tooth inside the bone--this is called a "surgical root canal."

Surgical root canals have varying degrees of success and probably range in the neighborhood of 75over five years. When a tooth having a root canal continues to be sensitive, there may be a crack in the tooth or the tooth?s root may have very small accessory canals that cannot be filled.

Occasionally, a tooth?s interior will continue to calcify to the extent the tooth?s canal will become smaller and smaller and eventually not be seen on a radiograph, or found with files in an attempt to perform root canals. One may say, the tooth had performed its own root canal filling; however, there may remain a need for the root canal to be performed(such as a need for a post to restore the tooth with a crown), and on a few rare occasions, posts are successfully placed in completely calcified tooth roots.

The major difficulty with root canal-treated teeth is the lose of blood supply causes the tooth to become more and more brittle. As a tooth?s root becomes brittle, it may split and then all of the restorative service for that tooth is lost. In today?s broad range of available dental treatment, it may be better to consider replacing a tooth with a dental implant, rather than performing a root canal which may or may not be successful for the next twenty years. It has been Dr. LuBovich?s experience, patients with root canal-treated teeth are much less successful over long periods of time, in contrast to dental implants, which generally have a much better history over long periods of time.

Nonetheless, root canal dental services are very successful and routinely performed by most dental professionals. Since a root canal removes the inside of a tooth and makes a tooth brittle, root canal teeth need crowns. If the tooth is a small root, like an incisor, canine or premolar, the tooth will need a post that extends into a portion of the root canal and extends above, for the purpose of supporting a crown.

A molar, which is larger, may not need a post to support a crown, and this is determined by the amount of tooth material remaining after the decay has occurred and fillings, crowns or root canal have been performed. Often, molars need posts, also. Posts may be made of small metal dowels to which plastic composites are attached to make a post and core. Posts may be made from plastic patterns cast into a one-piece complex of metal. For single-rooted teeth and small double-rooted teeth, most times, a cast post is stronger and will last longer.

Dowels and plastic cores for crowns usually will not last as long as a cast metal post, and what may occur is the plastic core breaking away from the cemented dowel and the crown coming off with the broken plastic core.

8. IF I EXTRACT ALL OF MY TEETH AND HAVE DENTURES MADE, WILL I ELIMINATE ALL OF MY DENTAL PROBLEMS?

No, in reality, what you are doing is exchanging one set of dental difficulties for another. If your natural teeth are so troublesome you are considering this alternative, consider replacing some of them with dental implants which is a potentially permanent solution; conventional dentures usually compromise the quality of your life, not improve it. There are some occasions when natural teeth have to be replaced with dentures, and there are some other occasions when a patient is committing dental suicide by having their natural teeth extracted and dentures placed. There are many considerations in the choice of having multiple tooth extractions and a denture placed; they are:

1. Bone takes one and one-half years to heal from an extraction.

2. Bone falls into the socket with healing and does not fill from the bottom up. There will be 30less bone present after one year, prior to the extraction.

3. The denture will need periodic re-lines during this shrinkage process and this is needed over one year and one-half. After this length of time, the denture will need a new base.

4. The dentures have flanges(essential parts for the development of suction), and these parts are 2-3 mm thick. Consider, your upper and lower lip now fit against the bone and skin of the upper and lower jaw. When a denture is first placed, it usually has to fill out your lip more than it was previously. Many patients find this a surprise and upsetting to their view of how they appear before and after their dentures are made. We have a more detailed narrative on the consequences of multiple tooth extractions and this should be read carefully, for the consideration of the choice of extracting all of one?s teeth is an irreversible process with multiple far-reaching consequences. Ultimately, after teeth are extracted, the bone in the jaws shrinks much faster and averages about one mm/year. Consider the middle-aged patient who extracts all of his teeth and at sixty years old, can no longer wear dentures. Consider, also, the few, strong-gagging patients who can never tolerate dentures and "wear" them inside a glass in their cabinet, purse or pocket. Often, those patients? only course to a better quality of life is through complex dental implant care which is much more complex than would have been required with either keeping teeth or placing implants at the time of extractions.

9. WILL MY TEETH LAST A LIFETIME WITH GOOD CARE BY MYSELF?

Many patients? teeth will, with good home and professional care, last a lifetime; however there are no guarantees. Occasionally, there is the patient whose roots will shorten with time and teeth will become loose. Also, there occurs bone loss with teeth; however, this is much less than occurs with early extraction of teeth. By far, the greatest damage to teeth occurs with the terrible self-destructive habit of tooth clenching, gritting, grinding or clamping of one?s teeth.

When a patient wears through the enamel, from tooth gritting or grinding, teeth become easily cracked or broken. It is interesting to observe the causes of tooth loss over a patient?s lifetime; tooth loss is usually related to the damaging habits that cause decay, gum, and bone disease, and a patient?s grinding, clenching or clamping their teeth together. All of these causes of tooth damage are usually habits patients have, and habits can be changed or controlled by good professional guidance--providing, the patient follows those recommendations and makes an effort to control or change their potentially destructive habits.

Smoking has to be a consideration in this group of causes for tooth loss. This habit, when unchecked, without frequent regular professional tooth cleaning, will cause the early loss of one?s teeth. Smoking coats the surfaces of the teeth, including the root space areas of teeth, with tar and nicotine. The tar and nicotine push the gums and bone back, causing the tooth to eventually become loose. It is not an uncommon occurrence to see patients who experience the loss of one tooth exactly where they place one cigarette after another, hour after hour, day after day.

Consider a cigarette like a gun; what you are doing is shooting yourself, and that area of the cigarette placement is the barrel where the destructive nicotine, tar, and ash are shot against your teeth. By far, the fastest loss of teeth is associated with the intake of tobacco and the grinding or gritting of one?s teeth. Rapid tooth loss is particularly associated with tooth gritting or grinding in dignified patients who grind their teeth.

Dignified teeth are more brittle and often by 70 years of age, if one grits or grinds their teeth, they will find themselves breaking their teeth and losing them more rapidly in their golden years. A valuable philosophy in tooth use is to: KEEP YOUR LIPS TOGETHER AND YOUR TEETH APART. This philosophy may seem unusual to a patient who holds his teeth together nearly or most of the time; however, it is most appropriate.

Remember, your teeth were designed to last a lifetime providing you do not abuse your teeth. Remember, your teeth were designed for: EATING, TALKING, AND SMILING. Think about it, when you are eating, are your teeth really touching; NO, they nearly touch. Think about it, when you are talking, are you talking through your teeth; NO, they should not touch when you talk.

Think about it, do your teeth touch when you smile? NO, again, smiling need not make your teeth touch, particularly hard. If you are in the habit of clenching your teeth, a by-product of tooth clenching will develop large jaw muscles; it may also cause degeneration of your jaw joints, and it may cause frequent headaches.

Perhaps you have heard of a painful process called temporomandibular joint pain? This is a painful headache-like process that is usually associated with tooth-clenching behavior. Sometimes, temporomandibular joint pain is caused by an injury such as an automobile accident or injury from a fall or a blow to the chin.

10. EXACTLY WHAT IS TMJ?

A common abbreviation of a difficulty many patients experience is called TMJ. Unfortunately, this is really a misnomer; TMJ means temporo-mandibular-joint. The process that one experiences jaw pain with an injury or tooth-clenching activities is actually a dysfunction, an injury of the joint that causes head and neck pain.

Also, pain behind the eyes is a frequent occurrence that occurs with temporo-mandibular-joint dysfunction. Many times, patients will benefit from conservative treatment with custom-made orthopedic devices to either free up the jaw to heal or to capture the disc, if the jaw disc is in a position to recapture.

In the early eighties, there were many occasions when patients? joints were operated on, and this was not very fruitful then nor is it now. The joint is a highly mobile, high-stress joint, and operating on the disc is not greatly successful.

The best care for pain associated with jaw pain is to reduce stresses by refraining from tooth clenching or grinding activities.

There are prescriptions and devices dentists can make to assist patients in the process of improving a patient?s temporo-mandibular-joint dysfunction, and many times improvement in this dysfunction-pain syndrome can be improved with lessening pain for the patient. Unfortunately, serious jaw joint dysfunction can take months or years to improve.