Important information Dr. Hertz would like his patients to know:
WHY DO I NEED A CROWN
A crown is placed when there is not enough tooth structure remaining to support a filling.
A crown is a helmet for the tooth. It surrounds the tooth and covers the remaining tooth structure.
The tooth must be prepared so that there’s an adequate amount of space for the material of the crown.
The crown can be made of a solid material (in gold) or can have porcelain baked over a metal substructure (sort of like a thimble) or it can be all ceramic. There are several types of ceramic crowns including pressed ceramics, cad cam milled or layered porcelains. The best one for you is determined by the location of the tooth to be restored personal habits as well as what remains of the tooth and the surrounding teeth. Your dentist will help decide which type of crown is best.
Because a crown is placed after there is no longer enough tooth structure to support a filling, this tooth has been beaten up. It has a history of fillings, breaks and or trauma. For this reason most teeth with crowns have root canal therapy first. This is not necessarily the case but it is true most of the time. We know a root canal is necessary if the tooth becomes sensitive or if we prepare into the nerve chamber because of exiting decay.
Although a broken tooth requiring a crown may not be sensitive before preparation it could be sensitive after preparation. The work done to make the crown itself is an additional trauma to the tooth and we never know what the “last straw” going to be.
Oral appliances: Here to Stay
As oral appliances (OAs) become more accepted as an alternative to CPAP, sleep laboratories, sleep dentists, And OA manufactures are working together to give patients the most appropriate appliance to treat snoring and mild to moderate OSA. CPAP is still the gold standard for the treatment of mild to moderate OSA, but there are a number of signs that oral appliances (OAs) are becoming a popular and wildly accepted alternative. More than 2 years ago, the American Academy of Sleep appliance therapy, opening the door for sleep physicians to prescribe OAs as an option for the treatment of mild to moderate OSA, Of course CPAP remains the most widely used treatment for OSA, but there are signs that OAs are beginning to gain market share.
Heavy Snoring as a cause of carotid Artery Atherosclerosis
Recent studies have suggested that snoring and obstructive sleep apnea hypopnea syndrome may be important risk factors for the development of Carotid Atherosclerosis and stroke. Previous studies have not made it clear if snoring per se is independently related to the risk of developing Carotid Atherosclerotic plaque. The investigators conducted this observational study using volunteers examined in a sleep laboratory. One hundred ten volunteers (snorers and nonsnorers with only mild, nonhypoxic obstructive sleep apnea hypopnea syndrome) underwent polysomnography with quantification of snoring, bilateral carotid and femoral artery ultrasound with quantification of atherosclerosis, and cardiovascular risk factor assessment. Subjects were categorized into three snoring groups: mild (0%-25% night snoring), moderate (>25%-50% night snoring), and heavy (>50% night snoring).
Results showed that the prevalence of carotid atherosclerosis was 20% with mild snoring, 32% with moderate snoring, and 64% with heavy snoring. Appropriate statistical analysis was used to determind the independent affect of snoring on the prevalence of carotid and femoral atherosclerosis. After adjustment for age, sex, smoking history, and hypertension heavy snoring was significantly associated with carotid atherosclerosis but not with femoral atherosclerosis. The authors concluded that heavy snoring significantly increases the risk of carotid atherosclerosis and the increase is independent of other risk factors, including measures of nocturnal hypoxia and obstructive sleep apnea severity. Considering the high prevalence of snoring in the community, these findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.
Sleep Apnea Risk and Severity in a Population of Dental Patients
Obstructive sleep apnea is a commonly undiagnosed chronic disease. While dentists represent an important resource for identifying people at risk for primary snoring and sleep apnea, less than 50% of dentists are capable of identifying the common signs and symptoms of sleep disordered breathing. The purpose of this study was to assess the prevalence of probable obstructive sleep apnea/sleep disordered breathing and symptoms associated with this condition a population of dental patients using a validated questionnaire and software that could be administered in a dental office. A retrospected analysis was conducted using questionnaire responses obtained from 170 men and 156 women, and sleep study data obtained in the patients homes from 75 men and 30 women with a portable recorder.
Forty-six percent of the men and 19% of the women reported snoring frequently or always. Of the 67% of the men and 28% of the women identified as having a high pre-test probability (high risk) of having at least mild sleep apnea, over 33% of the men and 6% of the women surveyed were predicted to have moderate or severe sleep apnea. In a subgroup of 105 patients classified at high risk who completed an overnight sleep study, 96% had an apnea hypopnea index (AHI) greater than 5 events per hour. Seventy percent of those predicted to have moderate or severe OSA by questionnaire had an AHI greater than 20. All patients previously diagnosed with sleep apnea were correctly classified at high risk. There was a high concordance between the predicted OSA risk and the degree of sleep disoriented breathing.
The high prevalence of undiagnosed sleep apnea in dental patients suggests that dentists could provide a valuable service to their patients by incorporating sleep apnea screening and treatment into their practice. Those who practice sedation dentistry should consider additional precautious when managing patients with risk of sleep apnea.
Contratulations on your pregnancy!
while it'simportant to eat healthy and exercise appropriately,
you also need to take good care of your teeth and
gums. Scientists have recently learned that your
oral health may affect your baby's birth-weight.
Thanks to an important study researchers at
the University of Norht Carolina, scientist have
found a connection between a serios gum disease,
called periodontitis, and pregnant women whose
babies were born too early or at a low weight.
What Is Periodontitis?
Periodontitis is a bacterial gum infection that can lead to the destrcution of the bone and fibers that support your teeth. It cam usually be easily treated when discovered early. Signs of periodontitis may include tenderness, bleeding, swelling of the gums or loose teeth. You may, however, have no signs at all. Only a dental professional can tell for sure, so it is important to see a dentist regularly.
How Can Periodontitis Affect My Baby?
As in other infections, when you have periodontitis, your body tries to fight it to stay healthy. Scientists bealive that this fight produce byproducts and chemicals that can travel through your blood stream into other parts of your body. if these chemicals reach your uterus (womb), they may cause you to go into labor before your baby has fully developed.
According to some estimates, periodontitis may contribute to as many as 45,500 preterm, low birth-weight babies every year in the United States alone. That is more than those attributed to smoking and alcohol use.
What is Invisalign®?
- Invisalign® is the invisible way to straighten your teeth without braces.
- Invisalign® uses a series of clear removable aligners (pictured to the left) to straighten your teeth without metal wires or brackets.
- Invisalign® has been proven effective in clinical research and in orthdontic practices nationwide. In fact, over 70% of all U.S. orthodontists are certified to treat patients with Invisalign®.
How Does Invisalign® Work?
- You wear each set of aligners for about 2 weeks, removing them only to eat, drink, brush, and floss.
- As you replace each aligner with the next in the series, your teeth will move - little by little, week by week - until they have straightened to the final position your orthodontist or dentist has prescribed.
- You'll visit your orthodontist or dentist about once every 6 weeks to ensure that your treatment is progressing as planned.
- Total treatment time averages 9-15 months and the average number of aligners worn during treatment is between 18 and 30, but both will vary from case to case.
- Click here to download an informational video from the Invisalign® website to learn more about Invisalign and hear from actual patients.
How Are Aligners Made? You'd Be Amazed...
- The aligners are made through a combination of your orthodontist's or dentist's expertise and 3-D computer imaging technology. (click here to open the Invisalign® website into a new browser window)
Patient Prefer Invisilign to traditional braces
- Since there are no brackets or wires the Invisalign trays are smooth to the tongue and almost invisible to others. They are especially good for retreatment of lapsed orthodontic cases where the teeth have shifted undesirably after the original treatment was completed.
Porcelain laminates, also termed Porcelain Veneers, involve a procedure that was invented by a New York City ceramist Adrian Jurim in about 1982. As he tells it he was trying to make a new smile for his wife and he didn't want bonded filling material placed on her teeth nor did he want her to crown her teeth. He collaborated with several different New York City dentists in developing this technique in which a thin cosmetic layer of porcelain is bonded to enamel and the process of using porcelain veneers to cover the teeth was successfully developed . He has been granted a patent for this process of etching the veneers with hydrofluoric acid so that bonding material would stick to the porcelain(this strengthens the porcelain and allows the veneer to be attached to tooth structure.
Porcelain laminates can be a terrific way to get a new smile. In a relatively short amount of time, with out the need for extreme tooth preparation, a cosmetic dentist can create a new more pleasing smile. This is especially good for people with worn or miss positioned front teeth. Also, If after attempting bleaching, you are still unhappy with your teeth's color, laminates can be used to change the color as well as the shape and position of your teeth. Dr. Spindel is an experienced cosmetic dentist who can specify a highly gifted and artistic technician to create your new teeth and there numerous success stories attesting the value and length of service of well done cosmetic porcelain laminates.
Before beginning this treatment Dr. Spindel sends photographs and study models to a special cosmetic dental laboratory. Usually Dr.Spindel requests that a special wax-up preposal be made so that the final result can be previewed by him and the patient. After a final smile treatment has been approved by him and the patient a beautiful final result can be accomplished in as little as one week. Preparation of the teeth is usually necessary to provide room for a ceramicist to fabricate attractive facing for the teeth that are not bulky. Although some techniques claim to not need any preparation of the teeth, lack of any preparation of the teeth tends to result in bulky, non natural looking final results.
An impression is made of the prepared teeth, the opposing teeth and a bite registration and these and other records are sent to a specialized dental laboratory for the veneer fabrication. While waiting for the final veneers the patient often doesn't need to wear temporary restorations since the waiting time is usually about one week and the preparation of the teeth is minimal. If the patient desires, temporary veneers can be fabricated.
After the veneers have been fabricated they are tried in to check their form and color. Minor adjustments can be accomplished at this time, but if either the patient or Dr. Spindel isn't satisfied they will have to go back to the laboratory for major changes.
Once a satisfactory result has been achieved, Dr Spindel carefully applies bonding to the teeth and places the veneers in the mouth. After placement, , excess bonding material must be carefully removed so as not to irritate the surrounding tissues. All surfaces must be carefully checked for smoothness and if any rough margins are detected they should be smoothed by the dentist at this time.
Porcelain laminates that have been properly fabricated and carefully placed can last for many years. It is not uncommon for them to remain attractive and functional in the mouth for more than ten years. Patient home care and habits are important to achieving a result that lasts... Good oral hygiene, including proper brushing and flossing technique, is a must. With that in mind, there is no reason why someone desiring a more attractive smile shouldn't consult their dentist about whether porcelain laminate might be a good option for improving their smile.
Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.
An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have "chronic halitosis," which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.
Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.
What causes bad breath?
Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth - on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.
Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.
Gum disease is caused by plaque - the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.
Here are characteristic bad breath odors associated with some of these illnesses:
- Diabetes - acetone, fruity
- Liver failure - sweetish, musty
- Acute rheumatic fever - acid, sweet
- Lung abscess - foul, putrefactive
- Blood dyscrasias - resembling decomposed blood
- Liver cirrhosis - resembling decayed blood
- Uremia - ammonia or urine
- Hand-Schuller-Christian disease - fetid breath and unpleasant taste
- Scurvy - foul breath from stomach inflammation
- Wegner`s granulomatosis - Necrotic, putrefactive
- Kidney failure - ammonia or urine
- Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor
- Syphilis - fetid
Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.
Caring for bad breath
Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.
Controlling periodontal disease and maintaining good oral health helps to reduce bad breath. If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.
Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.
If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.
Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.