Gregory E. Oxford, DDS, MS, PhD  &  Isabell G. Oxford, DMD
100 Whetstone Place, Suite 308, St. Augustine, FL 32086  (904) 810-2345

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Posts for category: Dental Procedures

By Oxford Dental Associates
February 24, 2021
Category: Dental Procedures
HowAFVsAlfonsoRibeiroSavedHisTooth

Remembered fondly by fans as the wacky but loveable Carlton on The Fresh Prince of Bel-Air, Alfonso Ribeiro is currently in his fifth year hosting America's Funniest Videos. It's the perfect gig for the 48-year-old actor, who loves to laugh and make others laugh as well. This is quite the opposite experience from one he had a few years ago that he remembers all too well: a severely decayed tooth.

After seeing his dentist for an intense toothache, Ribeiro learned he had advanced tooth decay and would need root canal treatment. Ribeiro wasn't thrilled by the news. Like many of us, he thought the procedure would be unpleasant. But he found afterward that not only was the root canal painless, his toothache had vanished.

More importantly, the root canal treatment saved his tooth, as it has for millions of others over the last century. If you're facing a situation similar to Alfonso Ribeiro's, here's a quick look at the procedure that could rescue your endangered tooth.

Getting ready. In preparation for root canal therapy, the tooth and surrounding gums are numbed, often first with a swab of local anesthesia to deaden the surface area in preparation for the injection of the main anesthesia below the surface. A dental dam is then placed to isolate the infected tooth from its neighbors to prevent cross-contamination.

Accessing the interior. To get to the infection, a small access hole is drilled. The location depends on the tooth: in larger back teeth, a hole is drilled through the biting surface, and in front teeth, a hole is drilled on the backside. This access allows us to insert special tools to accomplish the next steps in the procedure.

Cleaning, shaping and filling. Small tools are used to remove the diseased tissue from the interior tooth pulp and root canals. Then the empty spaces are disinfected. This, in effect, stops the infection. Next, the root canals inside the tooth are shaped to allow them to better accept a special filling called gutta percha. The access hole is then sealed to further protect the tooth from future infection, and a temporary crown is placed.

A new crown to boot. Within a couple weeks, we'll cap the tooth with a long-lasting lifelike crown (or a filling on certain teeth). This adds further protection for the tooth against infection, helps strengthen the tooth's structure, and restores the tooth's appearance.

Without this procedure, the chances of a tooth surviving this level of advanced decay are very slim. But undergoing a root canal, as Alfonso Ribeiro did, can give your tooth a real fighting chance.

If you would like more information about root canal treatments, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “A Step-By-Step Guide to Root Canal Treatment” and “Root Canal Treatment: How Long Will It Last?

By Oxford Dental Associates
February 14, 2021
Category: Dental Procedures
Tags: dental implants  
HowLongIstheImplantProcessItDependsonYourBoneHealth

If you're thinking about getting dental implants, you may be curious about how long it might take. The answer depends on the health of your supporting bone.

Bone is an integral part of implant functionality as bone cells gradually grow and adhere to the newly placed implant to give it its characteristic strength. The implant also requires an adequate amount of bone to accurately position it for the best appearance outcome.

If the bone is sufficient and healthy, we can proceed with the surgical placement of the implant. The most common practice following surgery is to allow a few weeks for the bone integration described previously to take place before finally attaching the crown. With an alternative known as a “tooth in one day” procedure, we install a crown right after surgery, which gives you a full smile when you leave.

There's one caveat to this latter method, though—because the implant still requires bone integration, this immediate crown is temporary. It's designed to receive no pressure from biting or chewing, which could damage the still integrating implant. We'll install the permanent crown after the implant and bone have had time to fully mesh.

So, if your supporting bone is sound, the complete implant process may only take a few weeks. But what if it's not—what if you've lost bone and don't have enough to support an implant? In that case, the length of process time depends on the severity of the bone loss and if we're able to overcome it. In some cases, we can't, which means we'll need to consider a different restoration.

But it's often possible to regenerate lost bone by grafting bone material at the implant site. If the bone loss is moderate, it may take 2 to 4 months of regrowth after grafting before we can perform implant surgery. If it's more significant or there's disease damage to the socket, it may take longer, usually 4 to 6 months. It largely depends on the rate of bone regeneration.

In a nutshell, then, the health of your jaw's supporting bone has a lot to do with whether the implant process will take a few weeks or a few months. Regardless of the time, though, you'll gain the same result—new, functional teeth and a more attractive smile.

If you would like more information on dental implant 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 “Implant Timelines for Replacing Missing Teeth.”

By Oxford Dental Associates
January 25, 2021
Category: Dental Procedures
TopicalFluorideCouldBoostYourChildsAvoidanceofToothDecay

Tooth decay is perhaps the biggest danger your child's teeth can face. Not only can it rob them of primary teeth now, but the loss of teeth at this early age could also lead to future bite problems.

That's why it's important to reduce the risk of tooth decay through daily brushing and flossing and regular dental cleanings. You child may also benefit from another measure that enhances those other hygiene efforts—topical fluoride applied directly to tooth surfaces.

Fluoride is a naturally occurring chemical that's been demonstrated to strengthen tooth enamel against contact with acid, the main cause of tooth decay. Today, fluoride is added not only to toothpastes and other dental hygiene products, but also in minute amounts to drinking water supplies across the country.

Even if your child takes in fluoride through one or more of these sources, there may still be a benefit to a topical application. For one, topical applications are usually stronger than fluoride toothpaste or fluoridated water supplies and can have greater effect. And because fluoridated water is ingested first before traveling through the bloodstream to the teeth, directly applied fluoride can strengthen them much faster.

But are these stronger concentrations of topical fluoride safe? Studies have shown no long-term health risk, but there can be temporary side effects like stomach pain, vomiting or headaches if the patient accidently swallows too much of the solution during the application. These side effects, however, can be minimized through safety measures dentists put in place during the procedure.

One study by the Cochrane Oral Health Research Group seems to show that the long-term benefit of topical fluoride is well worth this minor risk of side effects. After reviewing several scientific studies involving thousands of patients, the group found an overall 28% reduction in decayed, filled or missing teeth over a number of years among those who received a topical fluoride treatment.

Because of these and other forms of evidence, fluoride applications in either gel, foam or varnish forms have become a routine part of preventive care for children. Discussing it with your dentist, you may find it could be an extra weapon for your child in fighting tooth decay.

If you would like more information on how to protect your child's teeth from decay, 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 “Fluoride Gels Reduce Decay.”

TargetedToothRemovalCouldAidTreatmentforCertainBiteProblems

Before we begin correcting a malocclusion (poor dental bite), we need to ask a few questions: How extensive is the malocclusion? How far must we move the teeth to correct it? How might the patient's jaw size impact treatment?

Answering these and other questions help us develop an effective treatment plan. And depending on the answers, we might need to look at other procedures before we install braces—like removing one or more of the teeth.

This isn't a subject to approach lightly: All teeth play an important role in dental function and smile appearance, and ordinarily we want to preserve teeth, not remove them. Sometimes, however, it may be a necessary action to achieve our goal of an improved dental bite.

For example, it might be necessary for correcting a malocclusion caused by severe teeth crowding. This occurs when one or both of the jaws hasn't grown to a sufficient size to accommodate all of the teeth erupting on it. As a result, some of the teeth could come in out of their proper alignment.

If caught early before puberty, we may be able to use other techniques to alleviate crowding, like a device called a palatal expander that influences an upper jaw to widen as it grows. If successful, it could provide later teeth more room to erupt in their proper positions.

But even if additional jaw growth occurs, it may not be enough to avoid a malocclusion or treatment with braces. Alleviating further crowding by removing teeth in little noticed areas could help with subsequent orthodontics.

Removing teeth may also be the answer for other problems like an impacted tooth, in which the tooth has not fully erupted and remains submerged in the gums. It's sometimes possible to use a technique to “pull” the tooth down where it should be; but again, that will still require jaw space that may not be available. The more effective course might be to remove the impacted tooth.

Whether or not tooth extraction will be needed can depend on a thorough orthodontic evaluation and full consideration of all the available options. Even though the ideal situation is to correct a bite with all teeth present and accounted for, it may be for the better good to sacrifice some.

If you would like more information on orthodontic techniques, 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 “Removing Teeth for Orthodontic Treatment.”

By Oxford Dental Associates
December 06, 2020
Category: Dental Procedures
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.”