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Monday, May 15, 2017

Dentures: What Are My Options?

Mini-implant retained denture
The main goal of dentures is comfort, natural appearance and normal function. Replacing missing teeth will help restore your smile and possibly even improve its look especially if you've lost your natural teeth due to disease or decay.

Options for replacement:

1. Full upper and lower dentures
2. Implant assisted
3. Implant supported

Replacing your teeth with a denture will aid your speech and eating but what about the health of your jaw bone? Once the teeth are no longer in place, the lack of stimulation overtime will cause your jaw bone to deteriorate and resorb (gradually break down and shrink). This loss of bone mass will make the fit of your dentures loose and create difficulty in speaking and eating. When this happens full dentures will eventually need to be remade to fit properly because they are fully supported by your jawbone. Proper denture care, repair and refitting is essential to maintaining optimal oral health.

If you opt for an implant assisted or implant supported denture there are many advantages. This type of denture is more stable and comfortable which allows for more natural biting, chewing and even smiling. The implants act as roots which will help preserve your jawbone. Implant retained dentures tend move less under function and feel more like natural teeth. The difference between the two is the number of implants placed in the jaw. Healthy bone is required to place any type of implant. When considering an implant-retained denture there are other options to consider (mini-implants, traditional implants) depending on your bone health. A consultation after a thorough examination of your mouth is the primary way to find your best option.

Wednesday, April 26, 2017

Tooth Sensitivity and Solutions

Everyone has tooth pain when they bite into something hot or cold, right? 

No! Hypersensitivity is actually your first indication that something is wrong. Tooth sensitivity affects about 1 in 2 adults. There are many causes tooth sensitivity and it is an easily treatable condition.

Causes of tooth sensitivity

  • How you brush your teeth. Brushing with too much force or using the incorrect toothbrush are the most common reason for tooth sensitivity. Over time, your enamel may get worn down and the dentin tubules (cover your tooth surface and are like pores that lead to the nerve) are exposed which causes pain especially when you eat acidic, sticky or hot or cold beverages. Over-zealous brushing can also cause gum recession, which exposes the tooth root and the delicate nerve endings which causes sensitivity. Solution: brush gently with the proper toothbrush.
  • You may clench or grind your teeth (bruxism). You may do it while awake, especially under stress but you not even know you are doing while you sleep. If you wake with sore jaw muscles, suffer from headaches, notice teeth are chipped, cracked or worn this could be the cause. Solution: Dr. Bertolini can do a comprehensive exam to evaluate your specific treatment plan. This plan will most likely include wearing an occlusal splint or night guard while you sleep to prevent further damage and relieve some of the pressure of your bruxing. These are custom made by Dr. Bertolini or his lab to ensure it treats your unique situation.
  • You whiten your teeth. For some people, tooth whitening can cause tooth sensitivity. This is temporary and treatable. Solution: Dr. Bertolini recommends wearing our whitening trays for two-30 minute periods every other day instead of overnight to reduce this pain. Following up with a desensitizing toothpaste 30 minutes after whitening. He also recommends beginning whitening treatment with a low-concentration product and increase if you do not have symptoms.
  • You may have a cavity. When decay occurs, the tooth structure becomes softer and more porous and the enamel is not able to protect the tooth properly, which may be causing the sensitivity. Solution: Have the decay removed and restoring the tooth with a crown, onlay or bonding.
  • You may have gum disease. When you have gum disease, your gums may begin to recede and expose your tooth root and the delicate nerve ending which can cause sensitivity. Solution: Having regular check-ups are your best defense to detect and treat gum disease at its earliest stage. Desensitizing toothpaste, Dr. Bertolini recommends one containing potassium nitrate which works by shielding the exposed nerve endings which reduces the sensitivity.

Managing tooth sensitivity

Depending on the cause of your sensitivity, using a desensitizing toothpaste, containing potassium nitrate might be all you need. Unfortunately, these do not work for everyone. Another option is a fluoride varnish Dr. Bertolini would apply to the sensitive areas to strengthen the tooth enamel and reduce the pain. A third option is a bonding resin he can apply to protect the sensitive root surfaces. If your pain is caused by excessive loss of gum tissue, a surgical gum graft may be your best solution. An office visit is the only way to determine the cause of your sensitivity and the best solution for your unique situation

Wednesday, April 12, 2017

Some Wisdom On Extracting Wisdom Teeth

In our previous blog post, Some Wisdom On Wisdom Teeth, we discussed what wisdom teeth are and why you may need to have them removed. Today we are covering what will happen if they do need removed and post-op instruction to achieve proper, timely healing.
If your wisdom teeth are extracted by our dental office, Dr. Bertolini will give you a local anesthetic to numb the area of removal. If your teeth are severely impacted, Dr. Bertolini will refer you to an oral surgeon for the extraction and they would use a general anesthetic which would cause you to be asleep for the procedure. In either scenario, after the extraction you may need stitches to promote healing of the tissue. Some stitches will resorb or dissolve over time and others will need to be removed by the doctor. Dr. Bertolini will tell you whether yours need to be removed.

The recovery period after an extraction should only last for a few days and you can avoid complications if you follow these instructions:

Right after surgery

  • Keep gentle pressure on the extraction site by biting on gauze. 
  • Use 2 pieces of gauze folded in half and in half again. 
  • Check every 10-15 minutes, changing gauze as needed. Call our office or the oral surgeon if bleeding persists after 24 hours.

For the first 24 hours 

  • Eat soft foods today and chew more toward the front of your mouth.
  • Be careful not to bite the inside of your cheeks, lips or tongue while you are still numb. 
  • Do not eat or drink things that are very hot (temperature hot or spicy hot) or things that are very cold. You don’t want to shock the extraction sites. 
  • Do not smoke and do not drink through a straw - both can dislodge the blood clot in the extraction site, causing a dry socket (which can be very painful.)
  • Do not drink alcohol or carbonated beverages. 
  • If needed, for discomfort, take what you would normally take for muscle aches or if Dr. Bertolini prescribed something for pain, take as directed.
  • Do not lie flat, elevate your head and chest with pillows.
  • Use ice packs on the outside of your cheeks, do this for about 20 minutes at a time.
  • No strenuous activity, it may cause an increase in bleeding.
  • Continue your regular oral hygiene, carefully near the extraction site.

24 hours after extraction

Extraction Upper Extractions Sites

  • Starting 24 hrs after surgery, rinse the area with a mixture of sea salt or non iodized salt in warm water (1/4 tsp. salt in 8 oz. warm water). 
  • Do this after each meal to keep the sites clean. 
  • Do this rinse at least 7-10 days after the surgery. 
  • Use moist heat for discomfort after the first 24 hours. This could be a wash cloth or hot water bottle (just not too hot).

Lower Extraction Sites

  • Starting 24 hrs after surgery, fill the plastic syringe you were given by our office with a mixture of sea salt or non iodized salt in warm water (1/4 tsp. salt in 8 oz. warm water). 
  • Looking into the mirror over the bathroom sink, aim the tip of the syringe at one of the sites, gently press on the plunger of the syringe to push water into the site and remove any food debris. 
  • Continue with the other side. 
  • Do this after each meal to keep the sites clean. 
  • Do this rinse for at least 7-10 days after the surgery. 
  • Use moist heat for discomfort after the first 24 hours. This could be a wash cloth or hot water bottle (just not too hot).
Please contact Dr. Bertolini if anything unusual occurs: bleeding will not stop, pain lasting beyond 72 hours that the pain reliever will not relieve, fever greater than 101.
Complete healing of gums may take three to four weeks. For the first day or two, eating soft foods and avoid things that could get stuck in the extraction site is best. As the sites begin to heal, regular foods that require chewing can be added back into your diet.
If you do need your wisdom teeth removed, it's best to have the procedure done promptly because the more time that passes increases risks of complication and longer healing time.

Wednesday, April 5, 2017

Some Wisdom On Wisdom Teeth

What are wisdom teeth?

Wisdom teeth is another name for the last teeth in your permanent dentition, also known as third molars, usually arriving between the ages of 17-25 years. While most people have wisdom teeth, it is common to have a varying number of them, usually between one and four but occasionally more. Most wisdom teeth are impacted, which means you would not be able to see them when you look in your mouth because they have not erupted through your gingival tissue (your gums and supporting tissue).
If they are not visually present, Dr. Bertolini will confirm their presence with a panoramic x-ray and give you a diagnosis. If they do not need to be extracted because they have room to erupt through the tissue and won't cause problems for the surrounding molars, it is very important that they be examined regularly at your hygiene appointments. The location of wisdom teeth in your mouth can make it extremely difficult to clean and floss around effectively.

Why remove wisdom teeth?

Wisdom teeth are the last to develop and despite your best efforts they, more often than not, cause problems because of a lack of space in your jaw. This lack of space causes:

  • Wisdom teeth that do erupt can cause crowding or damage to other molars, because of lack of space.
  • Wisdom teeth can erupt partially and create a place for food and bacteria to get trapped, which then leads to cavities or infection.
  • If wisdom teeth do not erupt in proper position, it is extremely difficult to brush, floss and clean between adjacent teeth.
  • If wisdom teeth are impacted, they will probably never erupt and can cause a cyst to form in the area which can cause damage to surrounding bone and teeth.
Besides disturbing the position of your other molars and difficulty cleaning, wisdom teeth may need to be extracted because the area can become infected. If this should occur, Dr. Bertolini would schedule an emergency extraction.

What are signs of infection?

  • Swollen gum tissue behind the last molar.
  • A bad taste or smell in your mouth.
  • Intense pain in the back of your mouth when biting down.
  • Swelling in the general area of the wisdom teeth; could be teeth, jaw or cheek.
  • Difficulty swallowing, breathing or fever.
If not removed promptly, the infection can damage your other teeth and the bone around the infection site or become cystic. Warm salt water rinses or antibacterial mouth rinse and OTC painkillers can be used as short-term remedies, until your extraction appointment. Prolonged use of painkillers can actually worsen the condition because, while your pain is masked, the infection will worsen without removing its source. 
If you have any of the above symptoms of infection, being seen by Dr. Bertolini at the first sign will help minimize any complications.

Wednesday, September 21, 2016

What's New: CeraRoot Implants

Zirconia oxide implants are the newest  most bio-compatible material on the market. This means they are not only hypoallergenic but that they will integrate seamlessly, your gum tissue will grow back up the tooth like it would on your natural tooth. They have been FDA approved since 2011 and are corrosion resistant, holistic-friendly and will not conduct electricity or heat. 
Another positive to these implants is their color. Because they are ceramic they are white like teeth not gray like metal, which can leave a noticeable line near the gum line. They are also ONE-piece, which eliminates the space for bacterial growth that can cause halitosis (& that bad taste in your mouth), a low grade inflammation around the implant and bone loss.
Some criteria of being a candidate for these implants are being a non-smoker and having no advanced gum disease. The implants are wider than the traditional metal implant or mini-implants so you would need enough healthy bone available to place them. Dr. Bertolini can evaluate your oral tissue and bone health and recommend a periodontist who can place them for you. Your smile is waiting!

Wednesday, September 7, 2016

You Should Still Floss

According to the recent Associated Press report, we should no longer floss because it has yet to be proven effective.  But lack of high-quality evidence is not proof of ineffectiveness! Did you know that there are more than 500 different types of bacteria that can be found in dental plaque? Brushing your teeth will remove that bacteria from your tooth surfaces but how will you get rid of the bacteria that collects between your teeth and just below the gum line? We encourage our patients to think of dental floss like a long toothbrush bristle going between your teeth to remove the plaque your surface brush cannot.
Prolonged exposure to plaque build up can create an inflammatory response in your gums, which often leads to periodontal disease. As it advances, periodontal disease can erode bone and gum tissue supporting teeth, leading to tooth loss. A large body of research links periodontal disease to systemic conditions such as diabetes and heart disease. So by removing the bacteria in hard to reach places you are not only protecting your oral health but your overall health.
One thing the Associated Press failed to mention was that flossing isn't the only way to clean between teeth and below the gums. While flossing with dental floss is one way, there are other options available such as interproximal brushes, waterflossers and even a toothpick (we recommend Stim-U-dent).
According to the U.S. Centers for Disease Control and Prevention, one out of every two American adults over the age of 30 have some form of periodontal disease. There are many factors that contribute to this statistic: including age, smoking, presence of other systemic conditions and family history. However, by continuing to floss as a low-cost and low-risk part of a regular oral hygiene routine (which should also include brushing twice daily and receiving a comprehensive periodontal evaluation every year) you are doing your part to contribute to a life of healthy gums.
An ideal investigation of flossing's impact on gum health - research that has not yet been done, possibly due to the expense and length of research because periodontal disease progresses slowly.  So until this research is conducted, The Francis A. Bertolini Dental Team and the American Academy of Periodontology encourage you to floss on.

Peshoff, Carl M. "Flossing." Received by Francis A. Bertolini, DDS, 31 August 2016.
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