lajolladental

• Are you missing one or more teeth other than your wisdom teeth?
• If not, evaluation complete.
• If so, were the teeth removed for orthodontic reasons (braces)? In that case, are the spaces fully closed, or do you have gaps? If no gaps or spaces, evaluation complete.
• If you are missing teeth, for orthodontic reasons or not, and this has caused spaces to be present between teeth, are your teeth shifting toward those spaces? Has the alignment of your teeth changed over the last several years?
• If so, a dental evaluation is indicated. Perhaps, with appliance therapy, the teeth can be realigned and an implant or two can be placed and restored.
• It may be that the shifting does not need to be corrected, and implant placement and restoration can proceed straight away.
• Do you have a fixed or removable bridge to replace one or more missing teeth? If it is fixed (cemented over some of the teeth), at some point it will fail and need to be replaced. At that point, have an implant or two placed and restored and new crowns can be placed over the adjacent teeth. If the bridge is removable, wouldn’t it be nice to replace it with implant supported teeth?
• Consider the miracle of Implant Dentistry!

MIssing Tooth

After Implant and Crown

Yours for better dental health,

Dr. Charles Briscoe

Perhaps you are one of the 30 or more million people missing more than one tooth. Could be a whole arch of teeth or even a whole mouth of missing teeth. Are dentures or partial dentures your only option?

Thru the miracle of dental implants, the answer in most cases is no! You do have an option! Multiple implants can be placed and appliances built with teeth on them that will allow chewing comfortably and efficiently.

Dental Implant Dentistry is a long term project. There is a three to six month healing time for the bone to grow into the implant and make it secure. Then, the implant(s) can be restored with final restoration.

Should a bone augmentation  surgery be required prior to implant placement, another four months will be needed. The fees for the implant placement and restoration can be substantial, but wel worth it. The implants will not decay or abcess. Implant failure is rare.

• Dental implants will help you eat the foods you want to eat, while chewing comfortably and confidently.
• Dental implants will allowyou to avoid embarrassment, with teeth that look good and feel good.
• Dental implants will help you regain lost function and feel whole again.
• Dental implants will help you reestablish a healthy life and then help you preserve that health, allowing you to live longer.

Before Treatment with Missing Tooth

After Treatment Including an Implant and Crown

Yours for better dental health,

Dr. Charles Briscoe

Let me introduce you to Implant Dentistry. Through the miracles of modern science and experiences for the last 25 plus years, implant dentistry is very predictable and successful. Implant Dentistry works best for:

1) Patients missing only one or two teeth

2) Patients who have a dental bridge that is failing and needs replacing

3) Patients who are about to lose teeth due to decay or fracture

4) Trauma victims – motor vehicle or sports accidents where function and appearance need attention

5) Patients losing teeth due to gum disease

6) Patients that want to recapture their youthful appearance

7) Denture wearers – both full and partial dentures

Patients with advanced cases of bone loss causing loss of support for the face

9) Patients whose conditions seem to get worse over time.

    Dental Implantsare man-made tooth roots that are surgically embedded in the bone. After a healing period of three to six months, the implants can be built on with crowns and bridges. Or, attachments can be placed on the implnats and long span bridges can be built on the attachments. Even dentures can rest on these attachments so as to not rest directly on the bone. 

   When the teeth have been missing for a long time, the bone may have shrunken to the point where there is not enough volume of the bone (height and width) in which to plave the implant. Don’t dispair, the bone can be augmented thru surgical procedures, and then implants can be placed.

  When teeth are removed, the jaw bone shrinks away.Dental Implants help to maintain the jaw bone and facial esthetics. You’ve seen people, perhaps some older folks, whose faces from the eyes to the chin seem sunken inward.

They are missing teeth and the supporting bone. The facial muscles lose their tone and allow the face to collapse. Life has to be better than that!

Before Implant

After Implant

 

 

 

 

 

 

 

 

 

    Meet Gretchen, a twenty-eight year old mother of two that lost her front tooth due to a traumatic injury – her baby bumped his head against her front tooth and the tooth fractured. Actually, the root fractured, so the tooth had to be removed. How depressing is that? She had a gorgeous smile and now it was not so pretty.

  

  After some time, Gretchen had an implant placed and we finished that up with a nice looking crown to blend in with her other teeth. Now she feels good again about her smile and going out in public.

Single tooth implants like these have a greater than 97% success rate at the 10 year mark.

• They will never decay or need a root canal.
• They are relatively easy to keep clean at home and patients report they feel like normal teeth.
• Dental implant patients also have the psychological advantage of feeling whole again.

 

Before Treatment

After Treatment Including an Implant

 

 

 

 

 

 

 

 

 

Yours for better dental health,

 

 

 

 

 

 

 

Dr. Charles Briscoe

Are you missing a tooth or two, perhaps toward the back where nobody notices?

Have your teeth started to shift toward the space of the missing tooth?

Is your bite changing so as to cause the teeth to strike differently, creating chipping and fractures to occur in those pearly whites?

70% Missing at Least 1 Tooth!

You are not alone.

Seventy percent of the US adult population is missing at least one tooth.

More than 18 million people in the US have no teeth, while an additional 12 million folks have no upper teeth but retain some lower ones.

The lifespan of the elderly has increased to an average 80 years, and 42% of them have no teeth.

And of course, stories abound of calamities that occur because of missing teeth.

Like the lady whose denture fell out at lunch while laughing with some lady friends.

Or the man who was missing one front tooth but had an artificial tooth on a retainer like mouth appliance – the tooth broke off and before he realized it, some of his customers saw his smile.
Neither situation was funny at the time, and both could have been avoided.

Perhaps you are one of the 70% of US adults currently missing at least one tooth.

Even a single missing tooth will gradually, but ultimately, create damage to other teeth.

Seems hard to fathom! But let’s look closer.

The teeth are designed to work as a group, a set. They stand next to each other, “shoulder to shoulder,” with each one helping to support the adjacent ones. The upper set strikes the lower set, and the force of the bite is cushioned by the teeth standing adjacent to each other.

Remove just one tooth somewhere in the set, and the adjacent teeth move toward the space. The opposing tooth will also move toward the space as there is not a tooth there to stop it.

As the teeth shift, and they gradually will, the risk for decay increases as does the incidence of gum problems.

The bite is gradually thrown off, and the front teeth often strike each other with greater magnitude. This creates fractures, worn edges, chips, tooth looseness, bone loss, gum disease, decay, and tooth loss. The front teeth will begin to appear shorter.

You may have already replaced that one missing tooth with a bridge.

Studies say that bridges will fail in less than 10 years due to decay. And, 15% of the supporting teeth for the bridge will have the nerve die and require a root canal.

If you have lost one tooth, you are at a greater risk for losing more teeth.

Missing Tooth

After Implant and Crown

Yours for better dental health,

Dr. Charles Briscoe

Many people do!

Some will because they don’t know that what is going on in their mouth is pathologic.  Other people don’t know what to do about it.  They ask their dentist and get told not to worry, their wear and fractured teeth are a part of aging.  TIME TO FIND A NEW DENTIST!

To live in a chronic state of bruxism without any treatment is a downward spiral:

• The teeth will continue to wear.  Once sufficient tooth structure is missing on the front teeth, the back teeth will become flatter.
• Crowns, fillings and teeth will fracture and break with prolonged bruxism.
• The gums will be more challenging to keep healthy as bruxer’s gums are hypersensitive to normal levels of plaque.  Inflamed gums will lead to bone inflammation and loss.  This leaves less support to hold the teeth in the mouth.
• Tooth looseness will increase both as number of teeth affected as well as the severity of the looseness of each tooth.
• Muscle and joint awareness may increase to pain.  If they are already painful, a chronic period may lead to depression and despair.  Insomnia could result.
• Headaches may become more frequent, last longer or be more intense.
• The once short teeth will become even shorter, leading to collapse of the bite (Your nose and chin will come closer together as there is less tooth height between them).  Facial wrinkles will occur around the mouth.
•  As teeth wear and the enamel fractures off, the substructure under the enamel, the dentin, is exposed.  Dentin wears seven times faster than enamel, so the teeth will become even shorter at a faster rate.
•  Added to this is the erosion of the dentin that will occur from the acid in the saliva.  As the dentin erodes, the enamel will fracture away.

The downward spiral continues!

As you can see, the smile teeth that are short or have fractured off edges or are worn even with each other all the way across the smile are that way because of bruxism. While not necessarily a quick fix, grinding and clenching can be controlled by a well trained dentist.  The resulting damaged teeth can then be restored to give back a beautiful, healthy and functioning smile and bite.

Yours for better dental health,

Charles Briscoe, DDS

You’ve identified that your teeth are shorter than they should be.  You know that your wear is greater than normal, and you have found the cause of your bruxism and believe to have the situation under control.

Will your teeth grow back now?  Will the length of your front teeth increase to a more appropriate dimension?  Are you cured?

The answers are NO and YES.

No, the teeth chips and length do not grow back on their own.  And no, you are not cured.  You may be under control, and that is the best we can obtain.

Yes, the missing edges can be recreated by your dentist.  Your dentist may also be able to increase the length of the teeth.  And yes, he or she can help to control the situation so no further pain is felt or wear occurs.

The dental treatment options may include:

• Precision bite analysis to determine how the upper and lower teeth strike each other.
• Orthodontics to move teeth into better alignment and then a lifetime of retainers to keep the teeth in the new position without relapse.
• Splint, biteguard, or nightguard therapy to keep the teeth apart all the time or just at night, and to relax the jaw muscles.
• Occlusal adjustment of the teeth to allow the uppers and lowers to meet without interference.
• Instant orthodontics to move teeth into better alignment without moving the roots.
• The edges of the chipped teeth can be filled in with tooth colored composite resin (bonding) or with porcelain that will actually strengthen the teeth (porcelain laminate veneers or porcelain crowns).
• Length can be added with porcelain.
• A combination of some or all of the above.

Tim After

Hal After

John After

These Folks had worn teeth, bite correction, porcelain crowns and veneers to restore form and function.

Yours for better dental health,

Charles Briscoe, DDS

To begin with – cognitive therapy. All this means is that you need to become aware of when your bruxism is occuring – during your waking hours or while sleeping.

If your bruxism is active while sleeping, your dentist can create a custom-made bite guard of hard material that will protect your upper teeth from your lower teeth.You can wear out the guard instead of your teeth.

NOTE:  If the guard is therapeutically designed it will also relax your facial muscles and guide you into a more appropriate bite.

Beware of the boil and bite sports guards sold at the sporting goods stores.  They are not for night grinders.  The soft material actually promotes muscle activity.

Likewise, beware of the internet specials.  You want a hard custom made mouth piece that will relax your muscles and keep the upper teeth from touching the lowers.

During waking hours, avoid tooth contact except when chewing or swallowing.  Eat softer foods and don’t chew gum.

Avoid opening wide to eat.  Minimize or eliminate caffeine, a stimulant, found in coffee, colas and chocolate.

Stay hydrated with water and get plenty of rest and sleep.  Minimize or eliminate alcohol consumption.

For muscle or joint soreness apply warm, moist heat or ice to the muscles and joints.  Either the heat or the cold can have a beneficial effect.  Massaging these same areas can be effective.

Anti-inflammatory medications can help.  Try Motrin or Advil.  The severity and intensity of the bruxism and the resulting soreness or pain will dictate the duration of medication.

Other treatment options include behavior modification such as stress management and relaxation therapy.  Bio-feedback has also helped some people and physical therapy to learn proper jaw function and to help unlearn some destructive bruxing habits.

Professional massage therapy of the face, neck, shoulders and back can be very helpful, at least on a temporary basis.

For more severe situation, your dentist may utilize a prescription for muscle relaxation medication.

A combination of several of the fore going suggestions is often utilized to help stop or at least control the bruxism and its effects.

Yours for better dental health,

Charles Briscoe, DDS

OK, you are bruxing. The wear on your teeth is not just from normal eating and swallowing. You need to understand why this is happening before you have the bruxism treated and the resulting damage corrected.

Here are some reasons why people brux:

• Anxiety, stress, tension – these situations may be temporary or more on going. They may be related to your occupation, family, social standing, or other situations. The longer the psychological stress is present and the greater magnitude of the stress, the more intense the bruxism and its resulting damage.
• People can be depressed to some extent and not realize it. Bruxism can certainly follow depression. Once the depressed condition is identified the bruxism may intensify.
• Misalignment of teeth – if the upper and lower teeth do not fit together properly, bruxism can result. The severity of the clenching or grinding is determined by the amount of teeth misalignemt.
• Posture during the walking hours will contribute to Bruxism. Hunched over, rigid, un-relaxed posture can really get the bruxing going.
• Diet – hard foods like nuts or candies should be avoided. Chewy foods also. And opening wide to eat or yawn may intensify bruxing.
• Sleeping habits can contribute to grinding and clenching. Ideally sleeping on your back with a comfortable pillow will support your head and neck. Sleeping on your side(s) or stomach will cause lower jaw to deviate to one side or the other and create muscle activity in the face. This can set off the bruxing habit.
• Drinking alcohol while taking certain medications such as anti depressants may worsen the bruxism.

We have identified what bruxism is and you have evaluated if you are a “bruxer”. Today we discussed the causes of bruxism. Tomorrow we will discuss ways to stop bruxing.

Yours for better dental health,

Charles Briscoe,DDS

Bruxism may affect the teeth, the facial muscles, the bone supporting the teeth, the jaw joints in front of the ears, and dental implants or removable dentures.

Here’s a partial list of the signs and symptoms of clenching and grinding. This is also your home evaluation for clenching and grinding. Do you have:

• Jaw joint (TMJ) awareness or discomfort. These joints are in front of the ears. This condition could be perceived as earache, and may be more prevalent upon awakening.
• Repeated headaches – dull and constant.
• Wear on teeth – chips and dings out of the front teeth and flattening of the back teeth.
• A history of fractured teeth or restorations. Pieces of teeth, filings or porcelain crowns have broken off.
• Muscles of the teeth are tender upon awaking indicating muscle activity while asleep (grinding or clenching).
• Tooth sensitivity to cold upon awaking.
• Notches forming at the gum line of some teeth – check with your fingernail.
• Increased size of facial muscles – may be a subtle change.
• Noises while sleeping that a partner may hear.
• Loose teeth – thismay be subtle.
• Inability to fall asleep or to stay asleep – due to the awareness of discomfort or pain in the muscles or joints.
• Gum damage – the gums can be hypersensitive to normal levels of plaque in bruxers.

Should you be affected by one or more of these situations a visit to your dentist is encouraged.

Yours for better dental health,

Charles Briscoe, DDS

You’ve seen people with short teeth, a smile without much of those pearly whites that show. Other folks have big chips off several of the biting edges of their smile teeth. Still other people have upper front teeth that are all the same legnth, as if a saw cut them all exactly even with eachother. And there’s that noise,  that awful noise a loved one makes while sleeping.

Tim Before

Hal Before

John Before

Your teeth are short and chipped, but you thought that was normal wear. If asked, you’ll swear you don’t grind or clench your teeth.

Bruxism is an extracurricular activity (not a normal chewing function) that involves grinding and clenching teeth together. Grinding is when you rub your upper and lower teeth together, back and forth, and side to side.

Clenching involves holding your teeth together under constant force without any lateral movement. These grinding and clenching forces are in significant excess of normal chewing forces.

A person may grind or clenchor do both during different times of the day and/or night with grinding being the most common oral habit.

Heavily Worn Lower Front Teeth

Heavily Worn Upper Front Teeth

Millions of children and adults are affected by bruxism.

It is estimated that 50-90% of the adult population of the US is involved. Many don’t know it because they grind or clench their teeth at night while sleeping.

Better than 15% of children brux their teeth. This is heightened during the eruption of their baby teeth, and then again as they lose their baby teeth and permanent teeth erupt.

You thought the wear and chipped edges of your teeth were normal.

You are getting older, so what gives?

OK, I am Going to Get Technical Here for a Minute!

The NORMAL bite force on natural teeth ranges from 5 to 44 pounds per square inch (PSI). It takes a bite force of 28 PSI to chew a raw carrot and a force of 21 PSI to chew meat. Chewing forces are applied on teeth only about 9 minutes each day.

The other NORMAL time forces are applied to teeth is during swallowing, and those forces reach as high as 3-5 PSI. A person swallows 25 times per hour while awake and 10 times per hour while sleeping for a total of 480 times each 24 hour period. This amounts to 20 minutes of contact during swallowing.

The normal chewing force differes from the maximum bite force, and varies widely among individuals. The normal maximum bite force on teeth ranges from 45 to as high as 550 lbs. The maximum biting force of a person who grinds their teeth is greater than normal due to their increased muscle stregnth.

Bruxism can be controlled! Check tomorrows post for a home evaluation for clenching and grinding.

Yours for better dental health,

Charles Briscoe, DDS