My Blog
By Pankaj Narkhede, DDS, MDS
April 13, 2018
Category: Dental Procedures
Tags: porcelain veneers  
WhatYouShouldKnowAboutVeneersforTeenagers

Porcelain veneers are a great way to enhance an unattractive smile. But are they appropriate for teenagers? The answer usually depends on a patient’s current development stage and the type of veneer used.

Veneers are thin layers of porcelain bonded to the front of teeth. But even though quite thin, they can appear bulky if we don’t first remove some of the tooth’s enamel surface. This is irreversible, so the tooth may require a restoration from then on.

This could be a major issue for teens whose permanent teeth are still developing. During this period the tooth’s central pulp is relatively large and the dentin layer not fully developed. As a result, the pulp’s nerves are often closer to the surface than in an adult tooth. This increases risk of nerve damage during veneer preparation; if nerve damage occurs, the tooth could ultimately require a root canal treatment to save it.

On the other hand, some types of veneers don’t require tooth alteration (or only very little) beforehand. These “no-prep” or “minimal prep” veneers are best for certain situations like abnormally small teeth, so we must first determine if using such a veneer would be appropriate for your teen.

In effect, we’ll need to weigh these and other factors before determining if veneers are a safe choice for your teen. That being the case, it may be more advisable to consider more conservative cosmetic techniques first. For example, if enamel staining is the main issue, you could consider teeth whitening. Although the often amazing results eventually fade, whitening could still buy some time until the teeth have matured to safely apply veneers.

Slight deformities like chipping can often be corrected by bonding tooth-colored composite material to the tooth. In artistic hands it’s even possible to create a full veneer effect with very little if any tooth preparation. How much we can apply, though, depends on tooth size, and it won’t be as durable as a porcelain veneer.

With that said, veneers could be the right solution to enhance your teen’s smile. But, we’ll need to carefully consider their dental situation to ensure their new smile remains a healthy one.

If you would like more information on cosmetic solutions for smile appearance problems, please contact us or schedule an appointment for a consultation.

By Pankaj Narkhede, DDS, MDS
March 29, 2018
Category: Oral Health
AvoidBoneLossaroundToothRootsthroughRegularDentalCare

Periodontal (gum) disease is a serious matter. Not only can it wreak havoc with your gums, it could also cause bone loss in the jaw that supports your teeth.

Gum disease is a bacterial infection that originates from a thin film of food particles on tooth surfaces called plaque. If you're not diligent about removing plaque through daily brushing and flossing, it can become a feeding ground for certain strains of bacteria that trigger gum infections. Left untreated, the disease can advance deeply into the teeth's supporting structures.

We're particularly concerned about furcations, the specific locations where multiple roots of a tooth fork or separate. When these locations become infected we call it a furcation involvement or invasion. The bone along the furcation will begin to deteriorate and dissolve, following a progression of stages (or classes) we can measure by probing the gum tissue or through x-ray evaluation:

  • Class I: the furcation feels like a groove, but without any noticeable bone loss;
  • Class II: a depression of about two or more millimeters develops indicating definite bone loss;
  • Class III:  bone loss now extends from one side of the root to the other, also known as “through and through.”

Treating furcation involvements can prove challenging because the infection is usually well below the gum line (sub-gingival). As with all gum disease treatment, our primary approach is to remove all plaque and calculus (hardened plaque deposits) where we find it, including around the roots. We typically use specially shaped instruments to clean the root surfaces. We can also employ an ultrasonic device that loosens plaque and calculus with high-frequency vibrations and flushed away with water.

Sometimes, we may need to surgically access involved furcations to clean them and stimulate bone growth with grafting. We can also use surgery to make the areas easier to clean — both for you and for us during your regular office cleanings — to prevent reoccurrences of infection.

Of course, preventing gum disease in the first place is your best defense against oral problems like furcation bone loss. Be sure you brush and floss every day, and visit us for thorough cleanings at least twice a year (unless we recommend more). This will help make sure not only your gums, but the bone that supports your teeth stays healthy.

If you would like more information on treating periodontal (gum) disease, 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 “What are Furcations?

By Pankaj Narkhede, DDS, MDS
March 14, 2018
Category: Dental Procedures
AntibioticsCouldHelpEnsureyourImplantSurgeryisSuccessful

If you're considering dental implants to replace one or more missing teeth, you'll need to undergo a minor to moderate surgical procedure (depending on the number of implants) to install them. Depending on your current health status and medical history, you may need antibiotics before or after the procedure to help ensure a successful outcome.

Although implants have a high success rate (over 95%), they can still fail — and bacterial infection is a major culprit. Installing implants requires surgically accessing the bone through the gum tissues; you may also need other invasive procedures like tooth extraction or bone or gum tissue grafting. These disruptions to the soft tissues can introduce bacteria into the bloodstream.

In certain individuals, this can increase infection risk not only around the implant but also in other parts of the body. You may be at higher risk, for example, if you have serious health problems like cardiovascular disease or diabetes, a weakened immune system, you use tobacco or you're over or under normal weight. The American Dental and American Heart Associations both recommend antibiotics before dental implant surgery as a preventive measure against infection if you have a prosthetic heart valve, a history of infective endocarditis, a heart transplant or some congenital heart conditions.

For other patients with low to moderate risk for infection, there's vigorous debate on administering antibiotics before implant surgery. There are some side effects to antibiotic use, ranging from diarrhea to allergic reactions, and an increased concern in general to the developing resistance of many infectious agents due to the prevalent use of antibiotics. Many dentists and physicians are becoming more discriminate in the patients for which they prescribe antibiotics before surgical procedures.

It really comes down, then, to your particular case: not only the specific procedures you need but also your general health. After weighing these factors against the possible benefits for protecting your health and improving your odds of a successful outcome, we'll recommend whether antibiotic treatment for implants is right for you.

If you would like more information on the role of antibiotics in dental procedures, please contact us or schedule an appointment for a consultation.

By Pankaj Narkhede, DDS, MDS
February 27, 2018
Category: Oral Health
NoahGallowaysDentallyDangerousDancing

For anyone else, having a tooth accidentally knocked out while practicing a dance routine would be a very big deal. But not for Dancing With The Stars contestant Noah Galloway. Galloway, an Iraq War veteran and a double amputee, took a kick to the face from his partner during a recent practice session, which knocked out a front tooth. As his horrified partner looked on, Galloway picked the missing tooth up from the floor, rinsed out his mouth, and quickly assessed his injury. “No big deal,” he told a cameraman capturing the scene.

Of course, not everyone would have the training — or the presence of mind — to do what Galloway did in that situation. But if you’re facing a serious dental trauma, such as a knocked out tooth, minutes count. Would you know what to do under those circumstances? Here’s a basic guide.

If a permanent tooth is completely knocked out of its socket, you need to act quickly. Once the injured person is stable, recover the tooth and gently clean it with water — but avoid grasping it by its roots! Next, if possible, place the tooth back in its socket in the jaw, making sure it is facing the correct way. Hold it in place with a damp cloth or gauze, and rush to the dental office, or to the emergency room if it’s after hours or if there appear to be other injuries.

If it isn’t possible to put the tooth back, you can place it between the cheek and gum, or in a plastic bag with the patient’s saliva, or in the special tooth-preserving liquid found in some first-aid kits. Either way, the sooner medical attention is received, the better the chances that the tooth can be saved.

When a tooth is loosened or displaced but not knocked out, you should receive dental attention within six hours of the accident. In the meantime, you can rinse the mouth with water and take over-the-counter anti-inflammatory medication (such as ibuprofen) to ease pain. A cold pack temporarily applied to the outside of the face can also help relieve discomfort.

When teeth are broken or chipped, you have up to 12 hours to get dental treatment. Follow the guidelines above for pain relief, but don’t forget to come in to the office even if the pain isn’t severe. Of course, if you experience bleeding that can’t be controlled after five minutes, dizziness, loss of consciousness or intense pain, seek emergency medical help right away.

And as for Noah Galloway:  In an interview a few days later, he showed off his new smile, with the temporary bridge his dentist provided… and he even continued to dance with the same partner!

If you would like more information about dental trauma, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Trauma & Nerve Damage to Teeth” and “The Field-Side Guide to Dental Injuries.”

By Pankaj Narkhede, DDS, MDS
February 12, 2018
Category: Oral Health
Tags: nutrition   sugar  
ReduceSugarConsumption-foraHealthierMouthandBody

Tooth decay doesn't appear out of nowhere. It begins with bacteria, which produce acid that softens and erodes tooth enamel. Without adequate enamel protection, cavities can develop.

So, one of our prevention goals is to decrease populations of disease-causing bacteria. One way is to deprive them of carbohydrates, a prime food source, most notably refined sugar. That's why for decades dentists have instructed patients to limit their intake of sugar, especially between meal snacks.

Ironically, we're now consuming more rather than less sugar from a generation ago. The higher consumption impacts more than dental health — it's believed to be a contributing factor in many health problems, especially in children. Thirty years ago it was nearly impossible to find a child in the U.S. with type 2 diabetes: today, there are over 50,000 documented juvenile cases.

Cutting back isn't easy. For one thing, we're hard-wired for sweet-tasting foods. Our ancestors trusted such foods when there was limited food safety knowledge. Most of us today still have our "sweet tooth."

There's also another factor: the processed food industry. When food researchers concluded fats were a health hazard the government changed dietary guidelines. Food processors faced a problem because they used fats as a flavor enhancer. To restore flavor they began adding small amounts of sugar to foods like lunch meat, bread, tomato sauce and peanut butter. Today, three-quarters of the 600,000 available processed food items contain some form of added sugar.

Although difficult given your available supermarket choices, limiting your sugar intake to the recommended 6 teaspoons a day will reduce your risk for dental and some general diseases. There are things you can do: replace processed foods with more fresh fruits and vegetables; read food labels for sugar content to make better purchasing decisions; drink water for hydration rather than soda (which can contain two-thirds of your daily recommended sugar allowance), sports drinks or juices; and exercise regularly.

Keeping your sugar consumption under control will help you reduce the risk of tooth decay. You'll be helping your overall health too.

If you would like more information on the effect of sugar on health, 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 “The Bitter Truth about Sugar.”





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