Your gums not only support and protect your teeth they also help present them in a visually attractive way. But some people’s gums seem to stand out too much — what’s commonly called a gummy smile — which diminishes their smile appeal. There’s no precise definition, but as a rule of thumb we consider a smile too gummy if four or more millimeters (about an eighth of an inch) of the gums show.
Fortunately, there are some techniques to improve a gummy smile. Which technique is best for you, though, will depend on why the gums are prominent — and causes vary. For example, you could have a gummy smile because your teeth appear too short compared to your gums.
Permanent teeth normally erupt to about 10 mm of visible length. But less than that, say 8 mm, could skew the visible proportion of gums to teeth too much toward the gums. Teeth can also appear shorter due to accelerated wear caused by grinding habits. Another cause could be the amount of upper lip rise when you smile. The lip may rise too high in a condition called hypermobility. This could reveal too much of the gums when you smile.
It’s important then to match the treatment to the cause. For example, we can enhance the appearance of shorter teeth through a surgical procedure known as crown lengthening.Â During this procedure a surgeon reshapes the gum tissues and underlying bone to expose more of the tooth’s length.
For upper lip hypermobility, we can restrict movement with Botox, a drug that paralyzes tiny parts of the involved muscles. This approach, though, will wear off in a few months — a more permanent solution is surgery to reposition the muscle attachments so as to prevent excessive movement.
If you’re concerned about a gummy smile, see us for a full examination and consultation. Once we know the reason why, we can offer a solution that will make your smile more attractive.
If you would like more information on enhancing the appearance of your gums, 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 “Gummy Smiles.”
A root canal treatment is a commonly known but often misunderstood procedure. Contrary to popular belief, these treatments aren't painful — in fact, they often stop a toothache. More importantly, a “root canal” can give a tooth on the verge of loss another lease on life.
Still, if you've never experienced a root canal treatment before, you probably have questions. Here are the answers to a few of the most common.
Why do they call it a “root canal”? This is the popular shorthand term for a procedure that removes diseased tissue from a decay-infected pulp, the innermost part of a tooth and the actual root canals themselves. Root canals are the narrow, hollow channels that run from the tip of the root to the pulp and are also involved in the procedure.
Why do I need one? Once infected, the pulp's bundles of blood vessels, nerves and other tissues become diseased. This often results in a painful toothache that can also suddenly disappear once the nerves within the pulp die. But there's still a problem: If we don't clean out the diseased and dead pulp tissue, the infection could spread through the root canals to the bone and endanger the tooth's survival.
What happens during the procedure? After deadening the tooth and surrounding gums with local anesthesia, we enter the pulp through an access hole we create. Using special instruments we remove the diseased tissue and shape the root canals to seal them with a filling material called gutta percha. Sealing the access hole is then necessary to prevent re-infection. Later we'll cap the tooth with a porcelain crown to restore its appearance and add further protection against fracture or cracking of the tooth.
Who can perform a root canal treatment? In many cases a general dentist can perform the procedure. There are some complex situations, however, that require a root canal specialist with additional training, expertise and equipment to handle these more difficult cases. If your tooth is just such a case it's more than likely your general dentist will refer you to an endodontist to make sure you get the right kind of care to save it.
If you would like more information on root canal 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 “Root Canal Treatment: What You Need to Know.”
The next time you visit your dentist you might see an item quite different from the other dental instruments and equipment in the office: a blood pressure cuff. Checking blood pressure is becoming a more common occurrence in dental offices across the country.
Abnormal blood pressure and some of the medications used to treat it are often a factor in some dental procedures, particularly if anesthesia is involved. But your dentist may also check your blood pressure for another reason: dental visits represent another avenue to screen for this condition that increases the risk of serious health problems.
Undiagnosed high blood pressure is a prevalent but often “silent” problem because the early stages of the condition may not display any symptoms. Many people first become aware they have an issue only after a blood pressure check at their family doctor, pharmacy or a health fair, for example. Otherwise, they could go months, even years without this vital knowledge about their health.
But while people may only visit their doctor once a year (or less) many see their dentist much more often, even twice a year, for routine cleanings and checkups. Including blood pressure screenings as a routine part of dental treatment could alert patients to a potential issue much earlier than their next doctor’s visit.
In fact, one study published in the Journal of the American Dental Association looked at a group of dental patients with no reported heart disease risk and who had not seen a doctor in the twelve months before their dental visit. During their visit their blood pressure was checked. Of those then referred to a physician for an abnormal reading, 17% learned for the first time they had an increased risk of cardiovascular disease.
It’s estimated about 80 million Americans have some form of cardiovascular disease and many don’t even know it. Diagnosing and controlling high blood pressure is a key factor in treating these life-threatening conditions. And many dentists are joining the fight by making this simple screening method a part of their dental care services.
If you would like more information on blood pressure screening, 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 “Monitoring Blood Pressure: What you don't know can hurt you.”
Accidents happen, especially to teenagers involved with sports or similar activities. In an instant they can lose one or more teeth and permanently alter their smile.
Fortunately we can restore a teenager’s lost teeth, but often not immediately as a permanent restoration with a dental implant requires maturity of their jaw structure. Our focus then turns to the age of the patient and the condition of the underlying bone. A future dental implant, your best choice for tooth replacement, depends on bone for support, but also the age of the patient as it relates to jaw development.
There are a couple of ways an accidental tooth loss can harm supporting bone: first and foremost, the impact of the accident itself can damage the bony socket. To find out for sure we may need to perform a cone beam scan, a type of x-ray that allows us to view the area three-dimensionally. If we do find damage, we can attempt to repair the socket through bone grafting.
Bone can also suffer from the long-term absence of a tooth. Bone has a growth cycle in which older cells dissolve and new ones form to take their place. The force generated by teeth when we eat or chew helps stimulate this growth. Without stimulation, as with a missing tooth, the bone may not grow at a healthy rate. In time, it could lose some of its volume and density and not be able to support an implant.
Installing an implant right after tooth loss could help avoid this situation. Bone has a natural affinity with the titanium post imbedded in the jaw and will naturally grow and adhere to it. But we can’t place an implant with a teenager. This is because the jaw is still developing so an implant would gradually become misaligned as the jaw grows. It’s best to install an implant later after full jaw development in early adulthood.
Today, we can place a bone graft in the empty socket right after tooth loss. The graft serves as a scaffold for bone cells to grow on and will help keep the bone volume at a healthy level until we can install an implant.
Timing is everything in restoring a teenager’s accidental tooth loss. But with coordination and care for the supporting bone, a teenager can eventually enter their adult years with their smile intact.
If you would like more information on restoring your teenager’s smile after tooth loss, 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 for Teenagers.”
Fatigue, irritability and family complaints about snoring — all tell-tale signs you may have sleep apnea. There’s more to this condition than being grouchy the next day — the long-term effect could increase your risks for life-threatening diseases.
But how do you know if you actually have sleep apnea? And if you do, what can you do about it?
Undergo an exam by a physician trained in “sleep medicine.” Sleep apnea occurs when the airway becomes blocked while you sleep, dropping the body’s oxygen levels; your body awakens to re-open the airway. The event may only last a few seconds, but it can occur several times a night. Even so, sleep apnea is one potential cause among others for snoring or fatigue. To know for sure if you have sleep apnea you’ll need to undergo an examination by a physician trained to diagnose this condition. He or she may then refer you to a dentist to make a sleep appliance if you have mild to moderate apnea.
Determine the level of your apnea’s intensity. Not all cases of sleep apnea are equal — they can range in cause and intensity from mild to advanced, the latter a reason for concern and focused intervention. Your physician may use different methods for determining the intensity of your case: review of your medical history, examining the structures within your mouth or having your sleep observed directly at a sleep lab. Getting the full picture about your sleep apnea will make it easier to develop a treatment plan.
Match the appropriate treatment to your level of sleep apnea. If you have moderate to advanced apnea, you may benefit from continuous positive airway pressure (CPAP) therapy, an electrical pump that delivers pressurized air through a mask worn while you sleep that gently forces the airway open. It’s quite effective, but uncomfortable to wear for some people. Advanced cases may also require surgery to alter or remove soft tissue obstructions. If, you have mild to slightly moderate apnea, though, your dentist may have the solution: a custom-fitted mouth guard that moves the tongue, the most common airway obstruction, down and away from the back of the throat.
If you suspect you may have sleep apnea, see a trained physician for an examination. It’s your first step to a good night’s sleep and better overall health.
If you would like more information on sleep apnea 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 “If You Snore, You Must Read More!”
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