My Blog

By Joseph A. Revak, DMD
January 21, 2021
Category: Dental Procedures
Tags: celebrity smiles   veneers  
HowVeneersRestoredHowieMandelsWinningSmile

You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.

The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.

But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.

Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.

His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.

One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.

In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.

Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.

If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”

By Joseph A. Revak, DMD
January 11, 2021
Category: Oral Health
Tags: sensitive teeth  
TipsforWinterToothSensitivity

If a breath of crisp winter air makes you say, “Ouch!” you're not alone. According to a study published in the Journal of the American Dental Association, one of every eight people suffers from tooth sensitivity. And for those individuals, winter can be a particularly challenging time of year.

Tooth sensitivity can result when the inner part of the tooth, called dentin, is exposed. Dentin is normally protected by enamel above the gum line and cementum below, but if the protective coating is lost, then temperature, pressure and acid from food and drinks can activate the nerves inside the tooth.

If you suffer from tooth sensitivity, these tips may help:

Avoid acidic foods and beverages. It may be common sense to stay away from foods and drinks that are hot or cold enough to make you wince, but also avoid those that are acidic, as acid can erode tooth enamel and increase tooth sensitivity.

Wait an hour to brush your teeth. After consuming acidic food or beverages, give your saliva time to neutralize the acid and strengthen the enamel surface to prevent erosion.

Brush gently. Gums can recede due to over-aggressive brushing, exposing sensitive tooth roots. So brush your teeth gently with a soft-bristled toothbrush and rinse with lukewarm water.

Use toothpaste for sensitive teeth. Toothpaste that is specially formulated for sensitive teeth blocks the pores in the tooth's surface where sensitivity can occur. It may also to help to rub the toothpaste on sensitive areas.

Sometimes, however, sensitive teeth result from dental problems that need professional treatment in the form of an at-home prescription, an in-office treatment like bonding or sealants, or a procedure like a gum graft or root canal. Accordingly, here's the most important tip of all:

Schedule a dental appointment. In an exam, we can look for the cause of your tooth sensitivity so it can be treated properly. Sensitivity may result from receding gums, tooth decay, erosion of the enamel, or other dental problems, such as the following:

  • Tooth-grinding. If we detect signs of a nighttime tooth grinding habit that you may not even be aware of, we may recommend a nightguard to wear while sleeping.
  • A root infection. If your tooth remains sensitive 30 seconds after eating or drinking something hot or cold, the pulp inside your tooth may be damaged. You may need root canal therapy to remove the infection and stop it from spreading.
  • A cracked tooth. A crack in a tooth may not be visible due to its size or location, but a compromised tooth surface can cause sensitivity and could lead to bigger problems if not treated.

Don't let tooth sensitivity get you down this winter. Come see us so we can discuss the right treatment for you.

If you would like to know more about treating sensitive teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Treatment of Tooth Sensitivity.”

By Joseph A. Revak, DMD
December 31, 2020
Category: Dental Procedures
Tags: dental implant  
SmokingCouldIncreasetheRiskofanImplantFailure

Although they can be expensive upfront, dental implants often prove to be a wise investment in the long-term. With a success rate that outperforms other teeth replacement restorations, dental implants could be the answer to a more attractive smile that could last for decades.

But while their success rate is high (95% still functioning after ten years), they can and do occasionally fail. Of those that do, two-thirds happen in patients who smoke.

This unfortunate situation stems from smoking's overall effect on dental health. The nicotine in tobacco constricts oral blood vessels, inhibiting the flow of nutrients and antibodies to the teeth and gums. Inhaled smoke can scald the inside skin of the mouth, thickening its surface layers and damaging salivary glands leading to dry mouth.

These and other effects increase the risk for tooth decay or gum disease, which in turn makes it more likely that a smoker will lose teeth than a non-smoker and require a restoration like dental implants. And blood flow restriction caused by nicotine in turn can complicate the implant process.

Long-term implant durability depends on bone growth around the imbedded implant in the ensuing weeks after implant surgery. Because of their affinity with the titanium used in implants, bone cells readily grow and adhere to the implant. This integration process anchors the implant securely in place. But because of restricted blood flow, the healing process involved in bone integration can be impaired in smokers. Less integration may result in less stability for the implant and its long-term durability.

To increase your chances of a successful implant installation, you should consider quitting smoking and other tobacco products altogether before implant surgery. If that's too difficult, then cease from smoking for at least one week before surgery and two weeks after to better your odds of implant success. And be as meticulous as possible with daily brushing and flossing, as well as regular dental visits, to reduce your risk of disease.

There are many good reasons to quit smoking. If nothing else, do it to improve your dental health.

If you would like more information on tobacco use and dental 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 “Dental Implants & Smoking.”

AToothinaDayImplantCouldGiveYouaPerfectSmileFromDayOne

Getting a new implant tooth in only one day sounds too good to be true. But it's true—up to a point. Whether or not you can undergo an immediate crown replacement (attaching a crown to an implant right after surgery) will depend mostly on the underlying bone.

Traditionally, an implant crown isn't attached until several weeks after surgery to allow bone cells to grow and adhere to an implant's titanium surface (osseointegration). The gums are sutured back in place to protect the metal implant until it develops a durable hold within the bone. But this also leaves you with a noticeable missing tooth gap during the integration period.

A “tooth in a day” procedure gives you a full smile right after implant surgery. There is one catch, though—this first crown will be temporary and it won't be able to receive biting pressure.

Until the bone and implant fully integrate, attaching a full-sized permanent crown can damage the implant. To avoid this, the initial crown is slightly shorter than the future permanent crown. This prevents it from contacting solidly with teeth on the other jaw while biting or chewing, which can generate enough force to potentially damage the implant.

If you undergo an immediate-load crown on your implant, you'll have to return later for the full-length permanent crown. In the meantime, though, you'll avoid the embarrassment of a missing tooth in your smile.

With that said, the target bone must be healthy and intact for you to undergo a “tooth in a day” procedure. That isn't always the case with missing teeth—over time, bone volume can gradually diminish. The subsequent loss can complicate implant placement, which must be exact to achieve the most natural outcome. If extensive bone loss exists, you may need grafting to build up enough bone to adequately support an implant.

Even if an implant can be placed, the bone may still be too weak to allow for immediate crown placement. In that case, the traditional procedure may be the best course to allow the bone and implant to fully bond.

To determine if you're a candidate for a “tooth in a day” implant procedure, you'll first need to have a thorough dental exam that includes an assessment of bone health. If it's sound, you may be able to have a full smile right after implant surgery.

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 “Same-Day Tooth Replacement With Dental Implants.”

ListentoEllenDeGeneresDontThinkYouCanGetAwayWithoutFlossing

This year's Carol Burnett Award, presented at the Golden Globes, goes to Ellen DeGeneres for her “outstanding contributions to the television medium on or off the screen.” This is the latest in a long list of honors for the comedienne, talk show host and activist that includes Emmys, Grammys and Teen Choice Awards. And one not quite as well-known: a 2004 “Flossy” award.

DeGeneres received this honor from the National Flossing Council in recognition of her passionate promotion of oral hygiene, particularly flossing. She wrote about its virtues in her 2003 book, The Funny Thing Is…., saying, among other things, “Don't even think for a second that you can get away with not flossing.”

DeGeneres's motivational cheerleading for flossing is helpful and necessary because, well, many of us just don't like doing it. It requires more manual dexterity than its more popular sibling, brushing. And the tendency for the floss to gunk up with plaque residue for some is simply unpleasant.

Mainly, though, many folks think brushing is enough. Not so fast, according to dental professionals. While brushing removes disease-causing bacterial plaque from broad tooth surfaces, it can't effectively get into the spaces between teeth. It takes flossing to clear plaque from these more difficult areas.

But don't fret: There are ways to make flossing an easier—and more pleasant—task.

Ask us for help. As we said before, flossing does take some hand dexterity and coordination to perform. You may also wonder if you're doing it effectively. We can provide training and tips on how to be a more effective flosser at your next visit.

Practice, practice, practice. You probably think nothing of riding a bicycle, and yet it probably took you weeks or months as a kid to become proficient. Similarly, your first attempts at flossing might feel awkward, but you'll improve with practice, so don't give up.

Brush before you floss. Most people floss before brushing, but if you tend to encounter a lot of soft plaque debris that makes flossing “icky” for you, then try brushing first to clear a good portion of it out of the way before you floss. Just be aware, most professionals believe that flossing first is better because it loosens up debris between teeth so the bubbles from the toothpaste can carry it away. But any flossing is better than no flossing!

Try flossing tools. For some people, floss picks, small pre-threaded tools you can use with one hand, seem easier to maneuver than regular floss thread. If you have issues with manual dexterity, an oral irrigator can make the task easier: This handheld device uses a stream of pressurized water to loosen and flush away plaque between teeth.

So, follow Ellen DeGeneres's advice she gave Tulane University graduates during a commencement speech: “Remember to exfoliate, moisturize, exercise…and floss.” The latter, along with brushing, will certainly help keep your teeth and gums healthy.

If you would like more information about best oral hygiene practices, please contact us or schedule an appointment. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”





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