My Blog
By Dr. Michael A. Evans
February 18, 2020
Category: Dental Procedures
Tags: chipped tooth  
OneVisitMayBeAllYouNeedtoRestoreaChippedTooth

As tough as teeth are, life can take its toll on them and sometimes lead to parts of them chipping off. Although it might not affect a tooth's overall health, it can certainly downgrade its appearance.

But we can restore a chipped tooth like new, and it may not require extensive dental work. Thanks to a versatile dental material called composite resin, we can often bring back a tooth's natural appearance in just one visit.

Tooth-colored resins have been around for decades, but their application has been limited due to issues with durability. Recently developed bonding techniques, though, have made them a workable option for restoring mild to moderate tooth defects.

We do this by applying and bonding the composite resin to a tooth to “fill in” the missing portion. While it's often a short process, it does require a thorough understanding of tooth anatomy, function and aesthetics.

We begin with a comprehensive exam to assess the true condition of a chipped tooth. Some dental defects might be better served with a porcelain restoration like a veneer or crown for best results. Still, there are a wide range of defects for which composite resins is a solid repair choice.

Once we've determined bonding is appropriate, we prepare the tooth by first roughening its outer surface and then etching it with an acid solution to increase bonding strength. We then apply a luting agent, a kind of dental cement, also to aid with bonding.

We then begin applying the composite resin in liquid form, one layer at a time. This layering process helps simulate the color depth and shape of the tooth, and to further incorporate strength into the restoration. We're also careful at this point to match the variations of color with those of the surrounding teeth so that it looks as natural as possible.

As we finish each layer, we apply a curing light to harden the resin. We can then polish the finished product and make adjustments for the bite. The end result is a tooth that not only looks whole, but natural and blended with the rest of your teeth. Bonding could truly change your smile in just one visit.

If you would like more information on cosmetic dental restorations, 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 “Artistic Repair of Front Teeth With Composite Resin.”

By Dr. Michael A. Evans
February 08, 2020
Category: Oral Health
Tags: dental injuries  
TakeTheseStepstoSaveaKnocked-OutTooth

Even though teeth are resilient, they're not indestructible. An accidental collision involving the face could damage teeth, even knocking a tooth completely out of its socket.

At first, it might seem like the end of the line for that particular tooth. But it doesn't have to be—if you know what to do. But you'll have to act quickly: The longer the tooth is out of its socket, the less chance it will survive long-term.

Here are the steps you should take to save a knocked-out tooth.

Find the tooth. It's important that you locate the missing tooth quickly. When you do, don't handle it by the root end: It still contains delicate periodontal cells that are essential if the tooth is going to rejoin with the ligaments and bone. Use clean water to rinse off any dirt or debris.

Reinsert the tooth. Holding it by the crown and not the root, reinsert the tooth into its empty socket, hopefully within an hour (the faster the better). You want to make sure it's good and snug, so apply a little force when you do this. Place some clean gauze or cloth between the tooth and its opposite on the other jaw, then have the person bite down and hold it in place.

Get immediate dental care. It's preferable to find a dentist as soon as possible (if not, then the nearest emergency medical facility). The dentist will x-ray the tooth to make sure it's positioned properly, and may adjust it further if necessary. They may also splint the tooth to adjacent teeth to help stabilize it until it fully reattaches with the jaw.

Again, time is of the essence—the quicker you can perform the above steps, the better the tooth's chances. Any delay could jeopardize the tooth's ability to reattach, or it could shorten its lifespan.

You can also get guidance on treating a knocked-out tooth and other dental emergencies with a free mobile app developed by the International Association of Dental Traumatology (IADT). Just look in your Android or IOS app store for ToothSOS.

If you would like more information on what to do during a dental emergency, 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 “When a Tooth is Knocked Out.”

TheRealTruthBehindEdHelmsMissingToothinTheHangover

Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.

In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.

Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.

Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.

If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.

The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.

Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.

If you would like more information about restoring missing teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Dental Implants.”

LiketheProstheAthleteinYourFamilyNeedsaMouthguardtoPreventDentalInjuries

Super Bowl LIV is set for February 2 at Hard Rock Stadium in Miami Gardens, Florida, where the top two teams in pro football will vie for the coveted Vince Lombardi Trophy. Unfortunately, many of their fellow competitors (and some of their teammates) will still be nursing injuries from a long, grueling season. Injuries are a fact of life for one of America's most popular sports, with every part of a player's body vulnerable to trauma—including their teeth, gums and jaws.

But although they do occur, dental and oral injuries aren't at the top of the list of most frequent injuries in the NFL. That's because of the athletic mouthguard, an oral appliance small enough to hold in the palm of your hand. Made of pliable plastic, a mouthguard helps absorb damaging forces to the face and mouth generated by the inevitable hits that players take in the course of a game. According to the American Dental Association, a player is 60% more likely to incur a dental injury when not wearing a mouthguard.

And they're not just for the pros: Mouthguards are regarded as an essential part of protective gear for all participants of organized football and other contact sports. They're the best defense against injuries like fractured (cracked) teeth or tooth roots, knocked out teeth or teeth driven back into the jaw (tooth intrusion).

Mouthguards are readily available in sporting goods stores, but the best type of mouthguards are those that are custom-made by dentists for the individual player, created from impressions taken of that individual's teeth. Because custom mouthguards are more accurate, they tend to be less bulky than “boil and bite” mouthguards, and thus provide a better and more comfortable fit. And because of this superior fit, they offer better protection than their retail counterparts.

Because they're custom-made, they tend to be more expensive than other types of mouthguards. And younger athletes whose jaws are still developing may need a new mouthguard every few years to reflect changes in jaw growth. Even so, the expense of a custom mouthguard pales in comparison with the potential expense of treating an impact injury to the teeth or mouth.

If you or a member of your family are avid participants in football, basketball, hockey or similar high-contact sports, a mouthguard is a must. And just like the pros, a custom mouthguard is the best way to go to for comfort and ultimate protection.

If you would like more information about oral sports protection, please contact us or schedule an appointment. To learn more, read the Dear Doctor magazine articles “Athletic Mouthguards” and “An Introduction to Sports Injuries & Dentistry.”

By Dr. Michael A. Evans
January 09, 2020
Category: Dental Procedures
Tags: veneers  
AvoidPermanentToothAlterationWithNoPrepVeneers

Looking for an affordable way to beautify your smile? The answer could be dental veneers, thin wafers of porcelain bonded to the front of teeth to hide stains, chips or other deformities. Custom-made veneers can look so much like natural teeth in color and shape, it’s hard to tell they’re there.

To achieve this realism, though, it’s usually necessary to alter the tooth first. That’s because a veneer can look unnaturally bulky when bonded to an unprepared tooth. To compensate, we often remove a slight amount of surface enamel so that the veneer’s width won’t be unattractive.

This alteration doesn’t harm a tooth as long as it has a veneer or some other restoration to protect any exposed underlayer of dentin. And because the alteration is permanent, the tooth will need a veneer or other protective covering from then on.

In recent years, though, two new options called no-prep or minimal-prep veneers make it possible to avoid or at least decrease the amount of enamel reduction needed. This is possible thanks mainly to improvements in the strength composition of the dental material used in them.

As a result, these veneers are as thin as contact lenses and may only require slight enamel reshaping to smooth out the sides of the teeth for a better fit. And, unlike traditional veneers, you can have them removed and return to your original look without the need for another restoration.

Low prep veneers are best suited for patients with teeth that are small (or appear small), worn, narrow or only slightly stained or misshapen. Someone with oversized teeth, on the other hand, or that jut forward may still need extensive tooth preparation or even orthodontic work beforehand.

If you do meet the criteria, though, you may be able to benefit from low prep veneers. Because there’s no tooth preparation, you may not even need local anesthesia. And you can reverse the restoration if you desire without harm to your teeth.

To find out if you might benefit from these new kinds of veneers, see us for an initial dental examination to see if you qualify. It’s your first step toward a more beautiful and confident smile.

If you would like more information on no-prep or minimal-prep veneers, 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 “No-Prep Porcelain Veneers.”





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