DiMariano Family Dentistry Blog

Posts for: October, 2015

By Drs. Jeff DiMariano & Shaina DiMariano
October 27, 2015
Category: Dental Procedures
Tags: wisdom teeth  
RemovingWisdomTeethnowmayPreventDentalProblemsLater

Teeth damaged by decay, periodontal (gum) disease or trauma are often removed (extracted) if they’re deemed beyond repair. But there’s another reason we may recommend an extraction: a tooth is causing or has the potential to cause problems for other teeth and your overall oral health.

Some of the most frequent cases of “preventive extraction” involve the third molars, or wisdom teeth, located in the very back of the mouth. They’re usually the last permanent teeth to come in, which is related to some of the problems they can cause. Because they’re trying to come in among teeth that have already erupted they don’t always erupt properly, often at abnormal angles or not fully erupting through the gums, a condition called impaction.

Impacted or misaligned wisdom teeth can put pressure on adjacent teeth and their roots, which can cause root resorption that damages the second molar. They can also increase the risk of periodontal (gum) disease in the gum tissues of the second molars, which if untreated can ultimately cause teeth and bone loss.

Because of current or possible future problems with wisdom teeth, we often consider removing them at some early point in the person’s dental development. Such a consideration shouldn’t be undertaken lightly, since wisdom teeth extraction is often complex and fraught with complications, and it usually requires a surgical procedure.

That’s why we first conduct a comprehensive examination (including x-ray or other imaging to determine exact location and possible complications) before we recommend an extraction. If after careful analysis an extraction appears to be the best course, we must then consider other factors like planned orthodontics to determine the best time for the procedure.

Once performed, a wisdom tooth extraction can resolve existing problems now and reduce the risks of gum disease or malocclusions in the future. When it comes to wisdom teeth, removing them may be in your or your family member’s best interest for optimal dental health.

If you would like more information on wisdom 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 “Wisdom Teeth.”


By Drs. Jeff DiMariano & Shaina DiMariano
October 19, 2015
Category: Dental Procedures
Tags: dental implants  
KnowtheRisksandBenefitsforSame-DayToothReplacement

While there’s usually a period of months between implant placement and the permanent crown, a new technique known as same-day tooth replacement installs both the implant and a temporary crown during the same visit. But be advised — it does have its risks and isn’t for everyone.

Successful same-day replacements require special attention during the three phases for implants: the removal (extraction) of the existing tooth; placement of the implant in the bone; and attachment of the crown, the visible tooth, to the implant. The tooth extraction lays the foundation for the entire process; the extraction procedure must be performed carefully to avoid undue damage to the socket. In addition, if infection or disease has compromised the site, an implant may not be possible immediately.

The implant must then be placed in the bone so that it’s stable and immovable. All implants stabilize with time as the bone grows and adheres to them, but we need greater stability for a same-day tooth replacement when an extraction is performed.

Our last consideration is positioning the implant so that the attached crown blends in naturally with the surrounding gum tissue and adjacent teeth. We must place it at the proper depth below the gum tissues so that the crown appears to emerge from them in the proper tooth length.

Taking extra care during all these phases, including the angle of crown attachment, will increase our chances of success. We still run a risk of implant damage or failure, however, from biting forces before the implant fully integrates with the bone. This means avoiding chewy foods and other situations that might increase the force on the implant. We may also use a temporary crown that’s slightly shorter than adjacent teeth so it won’t make full contact with the opposing tooth.

If you’d like to know if you’re a good candidate for a same-day tooth replacement, see us for a detailed examination. After reviewing your needs, we’ll be able to discuss with you the risks and benefits for a new look in one day.

If you would like more information on same-day tooth replacement, 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 “Same-Day Tooth Replacement with Dental Implants.”


By Drs. Jeff DiMariano & Shaina DiMariano
October 18, 2015
Category: Dental Procedures
Tags: dental implants   diabetes  
DentalImplantsandDiabetes

Today, dental implants are an increasingly popular option for replacing lost teeth — an issue faced by many older Americans. It’s not hard to see why these high-tech prosthetic teeth are preferred: They look, “feel” and function just like natural teeth… and with proper care they can last the rest of your life. Unfortunately, many people who could benefit from implants also face an additional health problem: diabetes, a metabolic disease that can affect many different parts of the body, sometimes severely.  Uncontrolled diabetes can lead to nerve and tissue damage, and may adversely impact your oral health. So if you have diabetes, does it mean you won’t be able to get dental implants? 

The short answer is no — but there are some considerations that diabetics (and their health care providers) need to keep in mind. For example, it has been demonstrated that wounds in diabetics tend to heal more slowly, and are more prone to infection than those in non-diabetics. Also, people with diabetes sometimes experience a chronic inflammatory response, which can eventually lead to tissue damage or other problems.

Because the placement of dental implants requires minor surgery, dentists and researchers have questioned whether people with diabetes are good candidates for implants. Now there’s encouraging news: Several recent studies have come to the conclusion that many diabetics can indeed undergo an implant procedure without undue risk.

One key consideration is how well an individual can control his or her blood glucose levels. Researchers have found that diabetics with good blood glucose control, those with poor glucose control, and non-diabetics all have similar implant success rates (above 95%). However, in diabetics with poor glucose control, more time may be needed for the jawbone to heal in the area where the implant procedure was done. That doesn’t by any means rule out the placement of a dental implant — but it does mean that special considerations apply to individuals in this situation.

So if you are considering an implant procedure but have trouble controlling your blood glucose levels, ask us how we can help. Just remember that in most cases, having diabetes doesn’t mean you won’t be able to enjoy the benefits of dental implants. If you have additional questions, contact us or schedule an appointment.


By Drs. Jeff DiMariano & Shaina DiMariano
October 10, 2015
Category: Dental Procedures
AToothlessTiger

Let’s say you’re traveling to Italy to surprise your girlfriend, who is competing in an alpine ski race… and when you lower the scarf that’s covering your face, you reveal to the assembled paparazzi that one of your front teeth is missing. What will you do about this dental dilemma?

Sound far-fetched? It recently happened to one of the most recognized figures in sports — Tiger Woods. There’s still some uncertainty about exactly how this tooth was taken out: Was it a collision with a cameraman, as Woods’ agent reported… or did Woods already have some problems with the tooth, as others have speculated? We still don’t know for sure, but the big question is: What happens next?

Fortunately, contemporary dentistry offers several good solutions for the problem of missing teeth. Which one is best? It depends on each individual’s particular situation.

Let’s say that the visible part of the tooth (the crown) has been damaged by a dental trauma (such as a collision or a blow to the face), but the tooth still has healthy roots. In this case, it’s often possible to keep the roots and replace the tooth above the gum line with a crown restoration (also called a cap). Crowns are generally made to order in a dental lab, and are placed on a prepared tooth in a procedure that requires two office visits: one to prepare the tooth for restoration and to make a model of the mouth and the second to place the custom-manufactured crown and complete the restoration. However, in some cases, crowns can be made on special machinery right in the dental office, and placed during the same visit.

But what happens if the root isn’t viable — for example, if the tooth is deeply fractured, or completely knocked out and unable to be successfully re-implanted?

In that case, a dental implant is probably the best option for tooth replacement. An implant consists of a screw-like post of titanium metal that is inserted into the jawbone during a minor surgical procedure. Titanium has a unique property: It can fuse with living bone tissue, allowing it to act as a secure anchor for the replacement tooth system. The crown of the implant is similar to the one mentioned above, except that it’s made to attach to the titanium implant instead of the natural tooth.

Dental implants look, function and “feel” just like natural teeth — and with proper care, they can last a lifetime. Although they may be initially expensive, their quality and longevity makes them a good value over the long term. A less-costly alternative is traditional bridgework — but this method requires some dental work on the adjacent, healthy teeth; plus, it isn’t expected to last as long as an implant, and it may make the teeth more prone to problems down the road.

What will the acclaimed golfer do? No doubt Tiger’s dentist will help him make the right tooth-replacement decision.

If you have a gap in your grin — whatever the cause — contact us or schedule an appointment for a consultation, and find out which tooth-replacement system is right for you. You can learn more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Crowns & Bridgework.”


By Drs. Jeff DiMariano & Shaina DiMariano
October 02, 2015
Category: Dental Procedures
Tags: teeth whitening  
DeterminingtheRightWhiteningApproachisKeytoBrighteningaDullSmile

Bright, naturally white teeth are a key component in a beautiful smile. But the opposite is also true: nothing diminishes an otherwise attractive smile more than stained or discolored teeth.

There is good news, however, about tooth staining: it can be greatly reduced with the right whitening technique. But before taking action we need to first uncover the cause for the staining — whether from the outside or inside of the tooth, or a combination of both.

If it’s an external cause — known as extrinsic staining — our diet is usually the source. Foods and beverages that contain tannins, like red wine, coffee or tea fall in this category, as do foods with pigments called carotenes as found in carrots and oranges. Besides limiting consumption of stain-causing foods and maintaining daily oral hygiene, you can also diminish extrinsic staining with a bleaching application.

There are two basic ways to approach this: with either a professional application at our office or with a home kit purchased at a pharmacy or retail store. Although both types use similar chemicals, the professional application is usually stronger and the whitening effect is obtained quicker and may last longer.

Discoloration can also occur within a tooth, known as intrinsic staining, and for various reasons. It can occur during tooth development, as with childhood overexposure to fluoride or from the antibiotic tetracycline. Poor development of enamel or dentin (the main sources of natural tooth color), tooth decay, root canal treatments or trauma are also common causes of intrinsic discoloration.

There are techniques to reduce the effects of intrinsic staining, such as placing a bleaching agent inside the tooth following a root canal treatment. In some cases, the best approach may be to restore the tooth with a crown or porcelain veneer. The latter choice is a thin layer of dental material that is permanently bonded to the outer, visible portion of the tooth: it’s life-like color and appearance covers the discoloration, effectively renewing the person’s smile.

If you’ve been embarrassed by stained teeth, visit us for a complete examination. We’ll recommend the right course of action to turn your dull smile into a bright, attractive one.

If you would like more information on treatments for teeth staining, 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 “Teeth Whitening.”