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Posts for: January, 2017

By Randall Furman DDS
January 30, 2017
Category: Oral Health
Tags: root resorption  
GetanEarlyStartTreatingRootResorptionBeforeitsTooLate

Baby (primary) teeth look and function much like their permanent counterparts. Besides having a visible crown, they also have roots that maintain contact with the jawbone.

But there are some differences, the biggest one being the normal process whereby primary tooth roots dissolve or, in dental terms, resorb. Root resorption eventually leads to the tooth coming loose to make way for the permanent tooth.

Adult tooth roots can also resorb — but it's decidedly not normal. If adult root resorption isn't promptly treated, it could also lead to tooth loss — but there won't be an incoming tooth to take its place.

Although it can begin inside a tooth, adult root resorption usually begins on the outside. One type, external cervical resorption (ECR), begins around the neck-like area of the tooth not far below the gum line. Its initial signs are small pink spots where the tooth enamel has eroded; those pink cells within the space are doing the damage.

We don't fully understand the mechanism behind ECR, but there are some factors that often contribute. People with periodontal ligament damage or trauma, sometimes due to too much force applied during orthodontic treatment, have a high risk of ECR. Some bleaching techniques for staining inside a tooth may also be a factor.

The key to treating ECR is to detect it as early as possible before it does too much root damage. Regular checkups with x-rays play a pivotal role in early detection. Advanced stages of ECR might require more advanced diagnostics like a cone beam computed tomography (CBCT) scan to fully assess the damage.

If the lesion is small, we can surgically remove the cells causing the damage and fill the site with a tooth-colored filling. If ECR has spread toward the pulp, the tooth's inner nerve center, we may also need to perform a root canal treatment.

Either of these methods intends to save the tooth, but there is a point where the damage is too great and it's best to remove the tooth and replace it with a life-like dental implant or other restoration. That's why it requires vigilance through regular, semi-annual dental visits to detect the early signs of root resorption before it's too late.

If you would like more information on adult tooth root resorption, 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 Resorption.”


By Randall Furman DDS
January 22, 2017
Category: Dental Procedures
Tags: celebrity smiles   crowns  
DentalCrownsfortheKingofMagic

You might think David Copperfield leads a charmed life:  He can escape from ropes, chains, and prison cells, make a Learjet or a railroad car disappear, and even appear to fly above the stage. But the illustrious illusionist will be the first to admit that making all that magic takes a lot of hard work. And he recently told Dear Doctor magazine that his brilliant smile has benefitted from plenty of behind-the-scenes dental work as well.

“When I was a kid, I had every kind of [treatment]. I had braces, I had headgear, I had rubber bands, and a retainer afterward,” Copperfield said. And then, just when his orthodontic treatment was finally complete, disaster struck. “I was at a mall, running down this concrete alleyway, and there was a little ledge… and I went BOOM!”

Copperfield’s two front teeth were badly injured by the impact. “My front teeth became nice little points,” he said. Yet, although they had lost a great deal of their structure, his dentist was able to restore those damaged teeth in a very natural-looking way. What kind of “magic” did the dentist use?

In Copperfield’s case, the teeth were repaired using crown restorations. Crowns (also called caps) are suitable when a tooth has lost part of its visible structure, but still has healthy roots beneath the gum line. To perform a crown restoration, the first step is to make a precise model of your teeth, often called an impression. This allows a replacement for the visible part of the tooth to be fabricated, and ensures it will fit precisely into your smile. In its exact shape and shade, a well-made crown matches your natural teeth so well that it’s virtually impossible to tell them apart. Subsequently, the crown restoration is permanently attached to the damaged tooth.

There’s a blend of technology and art in making high quality crowns — just as there is in some stage-crafted illusions. But the difference is that the replacement tooth is not just an illusion: It looks, functions and “feels” like your natural teeth… and with proper care it can last for many years to come.  Besides crowns, there are several other types of tooth restorations that are suitable in different situations. We can recommend the right kind of “magic” for you.

If you would like more information about crowns, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Crowns & Bridgework” and “Porcelain Crowns & Veneers.”


By Randall Furman DDS
January 07, 2017
Category: Dental Procedures
ResearchConfirmsDentalSealantsReallyWork

Have you heard about dental sealants? These preventive treatments have been available for many decades, and more and more children are taking advantage of them. The National Institutes of Health (NIH) estimates that around 30% of kids from 6 to 11 years of age have had sealants applied to their molars (back teeth). Sealants are designed to reduce the incidence of cavities by filling in or eliminating the pits or crevices found in all molars, where decay-causing bacteria can hide and your brush can't reach. But do they really work?

Now, the research is in, and the answer is clear — YES!

Two major studies, each of which reviewed the results of thousands of patients over several years, recently came to the same conclusion: Dental sealants are effective at reducing cavities, and their benefits can last for four years (or more) after application. In general, the studies showed that kids who didn't get sealants were twice, three times, or even more likely to get cavities, compared to kids treated with sealants.

Sealants themselves are protective coatings made of plastic resins or glass-like materials. They are applied in liquid form, and then hardened by a special light. When “painted on” to the chewing surface of a molar, sealants fill in the tiny crevices, or “pits and fissures,” that are found there. Uneven tooth surfaces form a perfect breeding ground for the bacteria that cause tooth decay; worse yet, the bristles of a tooth brush can't usually reach them. That's what makes these areas highly susceptible to tooth decay.

Applying sealants is a quick and painless procedure that doesn't require any numbing shots or drilling. Many kids start getting sealants when the first permanent molars come in, around age 5 to 7; they may have more sealant treatments when additional molars emerge, between the ages of 11 and 14.

Sealants are recommended by the American Dental Association and the American Academy of Pediatric Dentistry, and have only a modest cost per tooth. On the other hand, having a cavity filled generally costs substantially more, and may result in more trouble (and expense) down the line — so sealants can make sense economically, as well as preventively. This is especially true for those at high risk for tooth decay.

If you have questions about dental sealants, please contact us or schedule a consultation. You can read more in the Dear Doctor magazine article “Sealants for Children,” and “Top 10 Oral Health Tips for Children.”