The CAT scan is a relatively recent technique in dentistry, used to get an image of what’s happening deep within your jaws. You may be wondering what a CAT scan tells us that a conventional x-ray picture does not, and whether it is worth the extra expense to get one. And how does a CAT scan compare with a conventional x-ray in terms of radiation exposure?
CAT stands for “computer assisted tomography.” Often it’s just called a CT scan, for “computerized tomography.” The word “tomography” comes from roots meaning “slice” and “write.” Tomographic techniques take repeated two dimensional pictures, similar to repeatedly slicing through an object, and then assembles them with a computer to produce a three dimensional (3-D) image.
The latest type of CT scan used in dentistry is called CBCT, or Cone Beam Computed Tomography. The Cone Beam refers to a spiral beam of x-rays, which is used to create a series of two dimensional images from which a computer creates a 3-D image. Such an image is of great value in assessing problems and planning treatment.
Here are just a few examples of how a CBCT scan can be used. Orthodontists can see skeletal structures and developing teeth that are still inside the jawbone while planning strategies for directing the teeth in order to arrive at a better bite. Oral surgeons can find impacted or missing teeth, see their locations, and view their proximity to nerves and sinuses, assisting them in planning surgeries. These scans are particularly useful for root canal specialists because they show root canals that are less than a millimeter wide and even reveal accessory canals that may not be visible on conventional x-rays. In cases of sleep disorders such as sleep apnea, a CBCT during sleep can be used to view a person’s airway and how it may be blocked by the tongue and other soft tissues in a person’s throat during sleep.
Compared to background radiation, the amount of radiation delivered in dental x-rays is minimal. A CBCT delivers a dose of radiation that is less than a typical full mouth x-ray series but more than a typical two dimensional panoramic radiograph. Generally CBCT scanners deliver lower doses than medical CT scanners.
With one low-dose CBCT scan, we can get an accurate idea of the internal structure of your bones and teeth and how they are situated in relation to each other. Prior to the availability of such images, many of these relationships had to be discovered in the course of a surgery or other treatment. Thus such a scan can aid greatly in the quality of treatment you will receive.
A tooth that's been chipped doesn't mean it's no longer healthy. The same, unfortunately, can't be said about the attractiveness of your smile, especially if it's one of your front teeth. A chipped tooth can be quite noticeable and make you self-conscious.
The good news is a chipped tooth can be restored cosmetically to look just as normal and attractive as your other teeth. Depending on the application there are two different materials we commonly use: porcelains, a type of oven-fired ceramic most often found in veneers or crowns; or composite resins, a mixture of glass and plastic substances we apply in liquid form that hardens in built-up layers on the tooth's surface to ultimately resemble normal tooth shape and color.
So, which of these two materials is the best option for your tooth? That depends on the extent and location of the tooth damage. Composite resins are most often used for mild to moderate chipping or breaks in the enamel (and somewhat for the underlying dentin) or decayed areas in the front teeth. Porcelain veneers or crowns are better for more extensive damage or discoloration.
Both materials have their advantages and disadvantages. Composite resins can be applied in one office visit, but they require a skillful technique and an artistic eye to achieve a life-like appearance; although their strength has improved over the years, they're also limited in their durability and longevity compared to porcelain. Porcelain, on the other hand, is quite durable and has an excellent tooth-like appearance; they do, however, require removal of more tooth material than a composite resin to accommodate the new veneer or crown, along with more than one visit and the services of a dental lab to create the restoration.
The best way to find out which option is best for you is to visit us for a thorough dental examination. From there we can review with you our findings, our recommendations and the costs associated with each option. But whichever material we use, porcelain or composite resins, you can look forward to a new smile you'll be proud to display.
If you would like more information on cosmetic treatments for 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 “Artistic Repair of Front Teeth with Composite Resin.”
Sure, it’s big news when celebs tweet selfies from the dental office… if you’re still living in the 20th century. But in Hollywood today, it’s harder to say who hasn’t posted snaps of themselves in the dentist’s chair than who has. Yet the pictures recently uploaded to Twitter by Mark Salling, the actor and singer who regularly appears as Noah “Puck” Puckerman on the popular TV series Glee, made us sit up and take notice.
“Getting my chipped tooth fixed. Also, apparently, I’m a big grinder,” read the caption. The photo showed a set of upper front teeth with visible chips on the biting surface. What’s so special about this seemingly mundane tweet? It’s a great way of bringing attention to a relatively common, but often overlooked problem: teeth clenching and grinding, also called bruxism.
Although bruxism is a habit that affects scores of people, many don’t even realize they have it. That’s because the condition may only become active at night. When the teeth are unconsciously ground together, the forces they produce can wear down the enamel, cause chipping or damage to teeth or dental work (such as veneers or fillings), or even loosen a tooth! While it’s common in children under 11 years old, in adults it can be a cause for concern.
Sometimes, mouth pain, soreness and visible damage alert individuals to their grinding habits; other times, a dental professional will notice the evidence of bruxism during an exam or cleaning: tooth sensitivity and telltale wear and tear on the chewing surfaces. Either way, it’s time to act.
Bruxism is most often caused by stress, which can negatively impact the body in many ways. It may also result from bite problems, the overuse of stimulating substances (caffeine, alcohol, tobacco, and illegal drugs), and as a side effect of certain medications. Sometimes, simply becoming aware of the habit can help a person get it under control. Common methods of stress reduction include exercise, meditation, a warm bath or a quiet period before bedtime; these can be tried while we monitor the situation to see if the problem is going away.
If stress reduction alone doesn’t do the trick, several other methods can be effective. When bruxism is caused by a minor bite problem, we can sometimes do a minor “bite adjustment” in the office. This involves removing a tiny bit of enamel from an individual tooth that is out of position, bringing it in line with the others. If it’s a more serious malocclusion, orthodontic appliances or other procedures may be recommended.
When grinding is severe enough to damage teeth or dental work, we may also recommend a custom-made night guard (occlusal guard), which you put in your mouth at bedtime. Comfortable and secure, this appliance prevents your teeth from being damaged by contacting each other, and protects your jaw joints from stresses due to excessive grinding forces.
Whether or not you have to smile for a living, teeth grinding can be a big problem. If you would like more information about this condition, call our office to schedule a consultation for a consultation.
Your teeth and gums are filled with nerves that make the mouth one of the most sensitive areas in the body. But thanks to local anesthesia, you won't feel a thing during your next dental procedure.
The word anesthesia means “without feeling or pain.” General anesthesia accomplishes this with drugs that place the patient in an unconscious state. It's reserved for major surgery where the patient will be closely monitored for vital signs while in that state.
The other alternative is local anesthesia, which numbs the area that needs treatment, while allowing the patient to remain conscious. The anesthetics used in this way are applied either topically (with a swab, adhesive patch or spray) or injected with a needle.
In dentistry, we use both applications. Topical anesthesia is occasionally used for sensitive patients before superficial teeth cleaning, but most often as an “opening act” to injected anesthesia: the topical application numbs the gums so you can't feel the prick of the needle used for the injectable anesthetic. By using both types, you won't feel any pain at all during your visit.
Because of possible side effects, we're careful about what procedures will involve the use of local anesthesia. Placing a sealant on the exterior of a tooth or reshaping enamel doesn't require it because we're not making contact with the more sensitive dentin layer beneath. We've also seen advances in anesthetic drugs in which we can now better control the length of time numbness will persist after the procedure.
All in all, though, local anesthesia will make your dental care more comfortable — both for you and for us. Knowing you're relaxed and comfortable allows us to work with ease so we can be unhurried and thorough. By keeping pain out of the equation, your dental care has a better chance for a successful outcome.
If you would like more information on managing discomfort during dental care, 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 “Local Anesthesia for Pain-Free Dentistry.”
When you first received your removable dentures the fit was firm and comfortable. Lately, though, they’ve become loose, making it difficult to eat or speak without slippage.
The problem may not be with your denture, but with bone loss. Human bone goes through a natural cycle of dissolving (known as resorption) and new growth to take the lost bone’s place. The jawbone receives further stimulation to grow from the forces generated by natural teeth when we bite or chew.
When natural teeth are missing, however, the jawbone lacks this stimulation, which over time results in bone loss and gum tissue shrinkage. Traditional dentures can’t transmit this stimulating force to the jawbone either, so the bone and gum structure under a denture will also shrink. This results in a looser fit for the denture.
The simplest option to correct a loose-fitting denture (especially if it’s the first occurrence) is to reline the dentures with additional material to re-form the fit to the new conditions in the mouth. A permanent relining will require sending your dentures to a dental laboratory to apply the new material based on a mold of your current anatomy beneath the denture.
If, however, your dentures have already undergone a few relinings, or after examining your gums we determine a relining won’t provide the fit and stability needed, then it may be time for a new denture. Although this is more costly than a relining, a new appliance could provide a more accurate fit to the current contours in your mouth.
The latter option may also give you a chance to benefit from advancements in denture technology or materials since you received your current denture. One such advancement is a removable denture that’s supported by implants. It’s possible to achieve this new supporting foundation for the denture with as few as two strategically-placed implants in the lower jaw.
If you’ve begun to notice denture looseness, be sure to make an appointment for an examination. From there, we can advise you on what will work best in your particular case.
If you would like more information on your options regarding removable dentures, 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 “Loose Dentures.”
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