My Blog

By Lokesh C. Rao, D.D.S.
July 12, 2018
Category: Oral Health
LifeIsSometimesaGrindforBrookeShields

Ever since childhood, when her career as a model and actress took off, Brooke Shields has enjoyed worldwide recognition — through advertisements for designer jeans, appearances on The Muppet Show, and starring roles in big-screen films. But not long ago, that familiar face was spotted in an unusual place: wearing a nasal anesthesia mask at the dentist's office. In fact, Shields posted the photo to her own Instagram account, with the caption “More dental surgery! I grind my teeth!” And judging by the number of comments the post received, she's far from alone.

In fact, researchers estimate that around one in ten adults have dental issues that stem from teeth grinding, which is also called bruxism. (Many children also grind their teeth, but it rarely causes serious problems, and is often outgrown.) About half of the people who are teeth grinders report problems like persistent headaches, jaw tenderness and sore teeth. Bruxism may also result in excessive tooth wear, and may damage dental work like crowns and bridges; in severe cases, loosened or fractured teeth have been reported.

Researchers have been studying teeth grinding for many years; their findings seem to indicate that it has no single cause. However, there are a number of factors that play a significant role in this condition. One is the anatomy of the jaw itself, and the effect of worn or misaligned teeth on the bite. Another factor relates to changes in brain activity that occur during the sleep cycle. In fact, nocturnal (nighttime) bruxism is now classified as a sleep-related movement disorder. Still other factors, such as the use of tobacco, alcohol and drugs, and a high level of stress or anxiety, can make an individual more likely to experience bruxism.

What can be done for people whose teeth grinding is causing problems? Since this condition may have many causes, a number of different treatments are available. Successful management of bruxism often begins by striving to eliminate the factors that may cause problems — for example, making lifestyle changes to improve your health, creating a soothing nighttime environment, and trying stress-reduction techniques; these may include anything from warm baths and soft music at bedtime, to meditation and mindfulness exercises.

Several dental treatments are also available, including a custom-made occlusal guard (night guard) that can keep your teeth from being damaged by grinding. In some cases, a bite adjustment may also be recommended: In this procedure, a small amount of enamel is removed from a tooth to change the way it contacts the opposite tooth, thereby lessening the biting force on it. More invasive techniques (such as surgery) are rarely needed.

A little tooth grinding once in a while can be a normal response to stress; in fact, becoming aware of the condition is often the first step to controlling it. But if you begin to notice issues that could stem from bruxism — or if the loud grinding sounds cause problems for your sleeping partner — it may be time to contact us or schedule an appointment. You can read more about bruxism in the Dear Doctor magazine article “Stress and Tooth Habits.”

By Lokesh C. Rao, D.D.S.
July 01, 2018
Category: Oral Health
Tags: oral health   mouth sore  
HowtoDealwiththatIrritatingMouthSoreyoukeepRe-Biting

We've all done it — suddenly bit the inside of our mouth while chewing food. All too often our cheek, lip or tongue finds itself in the way of our teeth.

The small wound caused by these types of bites usually heals quickly. But it's also common for the natural swelling of these wounds to cause the skin to become prominent and thus more in the way when we eat. As a result we bite it again — and again. If bit a number of times, the old wound can form a bump made of tougher tissue.

Also known as a traumatic fibroma, this growth is made up of a protein called collagen that forms into strands of fibers, similar to scar tissue or a callous. As you continue to bite it, the fibers form a knot of tissue that becomes larger with each subsequent bite and re-healing.

Unlike malignant lesions that form relatively quickly, these types of lumps and bumps usually take time to form.  They're not injurious to health, but they can be irritating and painful when you re-bite them. We can alleviate this aggravation, though, by simply removing them.

The procedure, requiring the skills of an oral surgeon, periodontist or a general dentist with surgical training, begins with numbing the area with a local anesthetic. The fibroma is then removed and the area closed with two or three small stitches. With the fibroma gone, the tissue surface once again becomes flat and smooth; it should only take a few days to a week to completely heal with mild pain medication like ibuprofen to control any discomfort.

Once removed, we would have the excised tissue biopsied for any malignant cells. This is nothing to cause concern: while the fibroma is more than likely harmless, it's standard procedure to biopsy any excised tissue.

The big benefit is that the aggravating lump or bump that's been causing all the trouble is no more. You'll be able to carry on normal mouth function without worrying about biting it again.

If you would like more information on minor mouth sores and wounds, 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 “Common Lumps and Bumps in the Mouth.”

SavingaDiseasedPrimaryToothCouldMeanBetterOralHealthLaterinLife

It’s often best health-wise to preserve even the most troubled tooth—including a child’s primary (“baby”) tooth. If that sounds like too much effort for a tooth that lasts only a few years, there’s a big reason why—if it’s lost prematurely, the incoming permanent tooth above it could erupt out of position.

Preserving a decayed primary tooth could include procedures similar to a root canal treatment, commonly used in adult permanent teeth with inner decay. However, we may need to modify this approach to protect the primary tooth’s pulp. This innermost layer plays a critical role in early dental development.

Because an adult tooth has reached maturity, removing diseased pulp tissue has little effect on its permanent health. But the pulp contributes to dentin growth (the layer between it and the outer enamel) in primary and young permanent teeth, so removing it could ultimately compromise the tooth’s long-term health.

Our goal then with a child’s tooth is to remove as much diseased tissue as possible while involving the pulp as little as possible. What techniques we use will depend on how much of the pulp has become infected.

For example, if decay has advanced to but hasn’t yet penetrated the pulp, we may remove all but a small amount of the decayed structure just next to the pulp to avoid its exposure. We may then apply an antibacterial agent to this remaining portion and seal the tooth to curb further infection.

If on the other hand the pulp has become infected, we may try to remove only the infected portion and leave the remaining pulp intact. We’ll only be able to do this, however, if we deem the remaining pulp healthy enough to remain infection-free after the procedure. If not, we may need to remove the entire pulp as with a traditional root canal. This option, though, is a last resort due to the possible effect on dentin growth and the tooth’s long-term health.

As you can see attempts to preserve a primary tooth can be quite involved. But if we can help it reach its full life span, it could mean better dental health for a lifetime.

If you would like more information on caring for primary 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 “Root Canal Treatment for Children’s Teeth.”

By Lokesh C. Rao, D.D.S.
June 25, 2018
Category: Dental Procedures
Tags: bonding  
3AdvantagesforImprovingYourSmilewithCompositeResins

Are you embarrassed by your front teeth? Maybe it’s just moderate defects—a chipped tooth here, an irregularly shaped tooth there—but it’s enough to make you less confident to smile.

There are a number of ways to transform your teeth’s appearance like porcelain veneers or crowns. But a relatively inexpensive method that’s less involved is to bond dental material called composite resin to your teeth to correct defects. Made of synthetic resins, these restorative materials can mimic your own natural tooth color. We can also artistically shape them to create a more natural look for an irregular tooth.

If you’re looking to change the way your front teeth look, here are 3 reasons to consider composite resins to restore them.

They can be applied in one office visit. Although effective, veneers, crowns and similar restorations are typically outsourced to dental labs for custom fabrication. While the results can be stunning, the process itself can take weeks. By contrast, we can colorize, bond and shape composite resins to your teeth in just one visit: you could gain your “new smile” in just one day.

They don’t require extensive tooth alteration. Many restorations often require tooth structure removal to adequately accommodate them, which can permanently alter the tooth. Thanks to the bonding techniques used with composite resins, we can preserve much more of the existing tooth while still achieving a high degree of artistry and lifelikeness.

Composite resins are stronger than ever. Over the years we’ve learned a lot about how teeth interact with each other to produce the forces occurring during chewing and biting. This knowledge has contributed greatly to the ongoing development of dental materials. As a result, today’s composite resins are better able to handle normal biting forces and last longer than those first developed a few decades ago.

Composite resins may not be suitable for major cosmetic dental problems, but you might still be surprised by their range. To learn if composite resins could benefit your situation—even a large defect—see us for a complete examination.

If you would like more information on composite resin 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.”

JimmyFallonCanrsquotCatchaBreak-ExceptinHisTooth

Want to know the exact wrong way to pry open a stubborn lid? Just ask Jimmy Fallon, host of NBC-TV’s popular “Tonight Show.” When the 40-year-old funnyman had trouble opening a tube of scar tissue repair gel with his hands, he decided to try using his teeth.

What happened next wasn’t funny: Attempting to remove the cap, Fallon chipped his front tooth, adding another medical problem to the serious finger injury he suffered a few weeks before (the same wound he was trying to take care of with the gel). If there’s a moral to this story, it might be this: Use the right tool for the job… and that tool isn’t your teeth!

Yet Fallon is hardly alone in his dilemma. According to the American Association of Endodontists, chipped teeth account for the majority of dental injuries. Fortunately, modern dentistry offers a number of great ways to restore damaged teeth.

If the chip is relatively small, it’s often possible to fix it with cosmetic bonding. In this procedure, tough, natural-looking resin is used to fill in the part of the tooth that has been lost. Built up layer by layer, the composite resin is cured with a special light until it’s hard, shiny… and difficult to tell from your natural teeth. Best of all, cosmetic bonding can often be done in one office visit, with little or no discomfort. It can last for up to ten years, so it’s great for kids who may be getting more permanent repairs later.

For larger chips or cracks, veneers or crowns may be suggested. Veneers are wafer-thin porcelain coverings that go over the entire front surface of one or more teeth. They can be used to repair minor to moderate defects, such as chips, discolorations, or spacing irregularities. They can also give you the “Hollywood white” smile you’ve seen on many celebrities.

Veneers are generally custom-made in a lab, and require more than one office visit. Because a small amount of tooth structure must be removed in order to put them in place, veneers are considered an irreversible treatment. But durable and long-lasting veneers are the restorations of choice for many people.

Crowns (also called caps) are used when even more of the tooth structure is missing. They can replace the entire visible part of the tooth, as long as the tooth’s roots remain viable. Crowns, like veneers, are custom-fabricated to match your teeth in size, shape and color; they are generally made in a dental lab and require more than one office visit. However, teeth restored with crowns function well, look natural, and can last for many years.

So what happened to Jimmy Fallon? We aren’t sure which restoration he received… but we do know that he was back on TV the same night, flashing a big smile.

If you would like more information about tooth restorations, please contact us or schedule a consultation. You can learn more in the Dear Doctor magazine articles “Porcelain Crowns & Veneers” and “Artistic Repair Of Front Teeth With Composite Resin.”





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