Category Archives: Dental Products

Dentures & Partials

Overview

A full set of dentures; full upper and lower dentures.

A full set of dentures; full upper and lower dentures.

Dentures are a removable set of teeth designed to replace your teeth following extractions (the removal of all teeth). These false teeth are embedded in acrylic designed to match the pigment of the natural gum tissue. Ideally, the acrylic is designed to rest on your gums or oral soft tissue that is firmly attached to bone.

When are dentures necessary?

  1. In the course of a lifetime, when home care and/or professional dental care is either neglected or absent, your teeth may suffer tremendous damage.
  2. Large fillings, fractures, or premature loss of teeth (causing the remaining teeth to tip and drift) creates a situation that can be too expensive and overwhelming for the average dental patient to fix. In many situations, the patient chooses to have all of their teeth removed and replaced by dentures.
  3. In uncontrolled Gum Disease (Periodontal Disease), when your teeth are missing sufficient bone support, full dentures may be your only choice to restore your ability to chew. The problem with the loss of bone is that there will be less bone available to support and retain your denture.

What are the different types of dentures?

Immediate dentures

These types of dentures are constructed when you do not want to go without teeth in the transition between having your own remaining teeth and getting your denture. After the dentures are constructed, your teeth are removed and the dentures are placed on the same day. This procedure means that you do not have to be without teeth for any period of time.

These dentures will likely become loose in about three to four months as the swelling decreases and your bone and gums heal. To help with the loose fit, your dentist may recommend a “reline” of your dentures at about three-six months. A reline is an acrylic lining that fills the space on the underside of the denture, allowing it to make greater contact with your gum tissue, producing a better fit. Although a reline will help improve the fit of your dentures, over time your bone continues to shrink (resorbs) without the presence of teeth. Further relines and/or a remake (a new set of dentures) may be necessary given time.

Advantage:

1.    You do not have to be without teeth for any period of time.

Disadvantages:

  1. The complete remolding of the bone and the discomfort following full-mouth extractions takes time and patience to resolve.
  2. During the healing phase, it may be necessary to have several adjustments due to “denture sore spots.”
  3. Before it is time to do a reline, it may also be necessary to use a denture adhesive; adhesives come in the form of pastes, powders, and a cloth-like material. You may find the use of these adhesives very necessary yet undesirable.

Dentures following healing

These types of dentures are constructed after all of your teeth have been removed and bone and gums are healed. If it doesn’t bother you to be without teeth, you can have your teeth removed, wait about three to six months, and then have your dentures constructed. Over time, without teeth, your bone continues to shrink (resorb)  and your dentures may need to be reline.

Advantages:

  1. Initially, this is a better-fitting denture than an immediate denture, because the bone and gums are healed prior to construction.
  2. Healing prior to construction eliminates the need for a six-month reline (but will probably require a reline over long periods of time).

Disadvantages:

  1. You are without teeth for three-six months during the healing phase.
  2. Without the presence of your teeth to chew food, you may likely lose weight.
  3. Following any weight loss (as little as five pounds), your dentures may become loose.

Implant-supported dentures/bar over-dentures

Bone resorption is probably the single most misunderstood factor in any decision to restore your mouth with dentures. Without the presence of teeth, your bone will continue to dissolve and shrink throughout your lifetime. Eventually, the fit and retention of your dentures, especially the lower denture, will be affected by this resorption. This is why a dental professional may discourage young patients from removing their teeth as an answer to their dental problems.

When there is not enough bone to support your dentures, bone grafts and implants can give you amazing support and retention. Once the implants have firmly attached themselves to your jaw bone (in about four to six months), the dentures can snap on over the implants or onto a bar attached to several implants. In some instances, the dentures are screwed onto the implants.

Advantages:

  1. An implant-supported denture demonstrates superior retention.

Disadvantages:

  1. Implants need to be cleaned thoroughly twice daily at home, just like your own teeth.
  2. Implants need to be cleaned by a dental professional at regular intervals.
  3. Without appropriate home care, the bone surrounding your implants can be affected by bacterial plaque, just like the bone around your natural teeth.

Partial Dentures

Overview

Partial dentures, or partials, accomplish just what the name implies: They are a removable set of teeth designed to fill the spaces between teeth you are planning to keep. There are basically two types of partials: the conventional cast chrome and acrylic partial and the “flexible” or all acrylic partial.

 

What are the different kinds of partials and how are they held in place?

  1. Conventional metal based partials have clasps made of metal “arms” that wrap around the teeth on either side of the space being restored by the artificial teeth in the partial. One of the disadvantages of clasps is that they may be seen when you talk or smile.
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  2. Precision attachments, although more expensive, cannot be seen and may be a desirable alternative if you don’t want anything to show when you talk or smile. Precision attachments are built into the partial and added to a Crown or a Bridge with “boy and girl” parts. Once the crown with the attachment is cemented into place, the partial snaps down onto the crown, making the partial virtually undetectable to the average eye.
  3. This is a "flexible" partial denture: this type of partial is very flexible with no metal.

    This is a “flexible” partial denture: this type of partial is very flexible with no metal.

    Flexible partials have clasps as well, however they are made out of the tooth or gum color of the flexible material; these partials show no metal, but have some disadvantages: it is difficult to add teeth to flexible partials if the patient should lose another tooth.

Care of your dentures and partials ( and teeth that anchor your  partial)

Partials must be removed every night, and the remaining teeth must be thoroughly cleaned. Without proper home care and regular visits to a licensed dentist and dental hygienist, partials can create the further loss of teeth because it is very difficult to clean teeth with spaces throughout the mouth.

These removable appliances need to be thoroughly cleaned every day to remove bacterial plaque using an appropriate cleanser designed for dentures and partials only. Toothpaste is designed for teeth and is inappropriate for dentures and partials. Toothpaste will scratch the acrylic and create areas where bacteria and fungus can more effectively hide and grow. Do not use bleach or peroxide on these appliances, as they will lighten and whiten the color of the pink acrylic, and these agents will not whiten the teeth.

Remove your dentures and/or partials every night and soak them in a denture cleaner. The nighttime removal of your appliances allows your soft tissue to relax; if you neglect to remove them while sleeping, the tissue may become compressed and the appliance may start to feel loose. Furthermore, no matter how well you clean the tissue side of your appliances, they will still harbor bacteria against your soft tissue that may contribute to denture sore spots and mouth odor. In the morning, use a denture brush (not a toothbrush) and disinfectant hand soap to remove the loosened bacteria.

If your appliance should break, do not repair it with superglue. This type of repair will probably not hold up for any significant period of time. Superglue embeds itself into the acrylic and irreversibly alters the chemistry of the acrylic, making it more difficult to repair in the future.

Fluoride

Overview

Fluoride is controversial subject for many people. Many patients oppose the use of fluoride in any form. Fluoride is used in two different ways, 1) Systemic- taking in fluoride in drinking water whether it is added by the Public Health Department or occurs naturally 2) Topical- where it is applied directly on to the surface of the teeth. Research has shown however that drinking fluoridated water (.7-1.0 ppm) reduces tooth decay by up to 60%, with little proof of harmful side effects.

Systemic Fluoride

Systemic fluoride involves the introduction fluoride into the bloodstream through drinking water, at a level of seven tenths to one part per million – a level shown to significantly help prevent tooth decay. Fluoride joins with the enamel as it forms within the tooth bud (a sack within the jaw bone where the tooth grows) and helps prevent tooth decay by making the enamel more resistant to the acid made by bacteria.

If the water supply where you live does not contain fluoride, your doctor should supply the necessary concentration of fluoride, in a dietary supplement, for infants and toddlers. Once your child is old enough to start seeing a dentist, usually at about the age of two, your dentist or physician should monitor your child’s fluoride levels to prevent discoloration of enamel due to a higher than recommended fluoride intake (see Enamel Fluorosis).

Topical Fluoride

Topical fluoride is a gel, foam, or varnish applied to surface of the teeth. Use of topical fluoride should continue as long as you have teeth. It “soaks” into enamel, microscopic cracks and exposed root surfaces, further protecting against tooth decay. This is most important in later years, when many people experience a decline in saliva production. Topical fluoride does not cause enamel fluorosis once the enamel is fully formed.

From the Centers for Disease Control and Prevention:

There is some potential for developing enamel fluorosis when children consume fluoride during the time when teeth are forming under the gums (birth through age eight). Primary, or “baby,” teeth begin to develop at about the fourth month of gestation. Development of the “permanent” teeth begins at about the age of three to four months and continues to about 12-16 years of age. To help prevent both tooth decay and enamel fluorosis, the Centers for Disease Control and Prevention (CDC) recommends the following:

For parents:

Children younger than six have a poor swallowing reflex and tend to swallow much of the toothpaste on their brush, which can contribute to a child’s total fluoride intake. Therefore, as soon as the first tooth appears, begin cleaning by brushing without toothpaste with a small, soft-bristled toothbrush and plain water after each feeding. Begin using toothpaste with fluoride only when the child has reached two years of age, but only in pea-sized amounts. Use toothpaste with fluoride earlier if your child’s physician or dentist recommends it.

  • Do not brush your child’s teeth more than two times a day with fluoride toothpaste.
  • Apply no more than a pea-sized amount of toothpaste to the toothbrush.
  • Supervise your child’s tooth brushing, encouraging the child to spit out toothpaste rather than swallow it. Additional information is available online at the CDC.
  • If your child’s pediatrician or dentist prescribes a fluoride supplement (or a vitamin supplement that contains fluoride), ask him or her about any risk factors your child has for decay and the potential for enamel fluorosis. If you live in an area with fluoridated water, fluoride supplements are not needed.
  • You can use fluoridated water for preparing infant formula. However, if your baby is exclusively consuming infant formula reconstituted with fluoridated water, there is an increased potential for mild enamel fluorosis. Additional information can be found in a CDC fact sheet on infant formula @ CDC.org.

For health professionals:

  • Fluoride supplements can be prescribed for children at high risk of tooth decay whose primary drinking water has no or a low fluoride concentration. For children under age eight, weigh the risk for decay without fluoride supplements, the decay prevention offered by supplements, and the potential for enamel fluorosis.
  • Counsel parents and caregivers on the use of fluoride toothpaste by young children, especially those younger than two years old. Fluoride toothpaste is a cost-effective way to reduce the occurrence of tooth decay. However, because they do not have a well- developed swallowing reflex and may like the taste of the toothpaste, young children often swallow a large portion of it from their brush.

The prescription dose of fluoride supplements should be consistent with the standards established by the American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics.

Fluoride Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR Recomm Rep. 2001;50 (RR-14):1–42. PMID 11521913. Lay summary: CDC, 2007-08-09.Up to 42% caries reduction

Fluoridation Basics
Water fluoridation prevents tooth decay mainly by providing teeth with frequent contact with low levels of fluoride throughout each day and throughout life. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25 percent over a person’s lifetime.

 

Fillings

Overview

Silver filling with defective margins and a high probability of tooth decay under the filling

Silver filling with defective margins and a high probability of tooth decay under the filling

A filling is a dental procedure where material is used to replace tooth structure that has been lost due to tooth decay or a minor fracture. The filling restores lost tooth structure and re-establishes the contour of the tooth. Fillings are also referred to as “direct restorations” because the decay is removed, the tooth is prepared to receive the filling, and filling material is placed directly into the preparation, restoring the tooth to its original shape. There are three primary types of filling materials that are generally used today; silver amalgam, glass/plastic composite and glass ionomer. Though no longer as popular as in the past, some patients still ask for gold foil, a fourth material option.

Types of fillings

Amalgam (silver filling)

Amalgam restorations, or “silver fillings,” have been used to fill teeth for hundreds of years. Amalgam is composed of mercury and powdered metal called an alloy, which is made up primarily of silver, copper, tin, and zinc. This type of filling material is manufactured in a capsule with a membrane separating the mercury from the metals. When mixed (in a triturator or amalgamator), the membrane breaks and the material gains a thick, creamy consistency. The amalgam is placed in the preparation, condensed, burnished, and carved. The amalgam restoration is fully set in 24 hours.

When a tooth is prepared to receive an amalgam, the preparation needs to have retention grooves and be undercut in order to lock the filling into place. Therefore, in order to use amalgam to replace lost tooth structure, more tooth structure must be removed to be sure the filling will stay in place.

Advantages of amalgam restorations:

  1. Amalgam is cost-effective.
  2. Amalgam is strong and lasts a long time.
  3. The placement of amalgam is less technique-sensitive, making it the preferred restoration in situations where isolation of the tooth from blood or saliva is not possible.

Disadvantages of amalgam restorations:

  1. Amalgam is not tooth-colored, making it less desirable.
  2. Although amalgam can be bonded into the tooth with the use of a metallic bonding agent, tooth structure needs to be shaped through material removal to lock the filling into place.
  3. Because of mercury content, the use of amalgam has been controversial for decades, due to the effect of mercury content on humans.

Composite (white filling)

The left picture shows tooth decay on three teeth; on the left the teeth have been restored with bonded composite fillings.

The left picture shows tooth decay on three teeth; on the left the teeth have been restored with bonded composite fillings.

Composite restorations, or tooth-colored fillings, are composed of powdered glass and plastic resin. Manufactured in light-tight capsules, this material is completely mixed in shades designed to match your teeth. Composite is very light-sensitive and must be covered when not in use because it cures (hardens) in the presence of light.

The technique for placing a composite restoration is very specific and must be followed accurately. Decay is removed from the tooth, along with any loose, jagged enamel (called “loose enamel rods”). There is no need to remove any more tooth structure for retention of the filling, as is necessary for amalgam. The tooth is isolated or kept dry (possibly with the use of a rubber dam), and an acid etch solution is placed in and over the edges of the area of preparation for 10-15 seconds. After a thorough rinse, the preparation is left damp and an adhesive solution is placed, spread out with a stream of air and cured with a UV light. The composite material is then placed in the preparation and cured with a UV light. Composite material may be applied in layers, depending on the size of the preparation. The filling is then shaped and polished.

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Advantages of composite restorations:

  1. Composite is tooth-colored.
  2. Composite is strong and durable.
  3. Composite requires removal of less tooth structure.
  4. Composite is bonded into place and believed to make the entire tooth stronger.

Disadvantages of composite restorations:

  1. Composite undergoes some shrinkage when cured and may need to be placed in layers, therefore requiring more time to complete treatment.
  2. This shrinkage makes such fillings more difficult to place (more technique-sensitive) and can result in extreme tooth sensitivity following placement.
  3. If the preparation is contaminated with blood or saliva during the filling process, the technician must repeat the entire procedure over, beginning with the acid etch. Blood and saliva contamination prevent the composite from bonding to the tooth and the tooth will present with recurrent decay in a short time.
  4. Composite is more expensive.

Glass ionomer (a white filling that releases fluoride)

Glass ionomer restorations are composed of glass and organic acid. Although they are tooth-colored, they are more matte or opaque than composite restorations. Glass ionomers may need to be light cured, or they may set by an acid/base reaction. Glass ionomer restorations release fluoride and are desirable when you have a higher risk of Tooth Decay.

Advantages of glass ionomer restorations:

  1. Glass ionomer is tooth-colored.
  2. Glass ionomer requires minimal tooth removal for placement.
  3. Glass ionomer releases fluoride, and the fluoride is “replenished” when you brush with a fluoride toothpaste or get fluoride treatment at the dentist.
  4. Glass ionomer does not require the bonding agents that composites require, making placement faster.
  5. Glass ionomer does not shrink the way composites can during the setting phase.

Disadvantages of glass ionomer restorations:

  1. Although they are tooth-colored, they do not polish as well as composite restorations.
  2. They are not as strong as composite restorations.
  3. They are about the same cost as composite restorations.

Gold foil (gold fillings)

Gold foil is mentioned only because, even though this type of filling has fallen out of use, there are a few individuals whose teeth still have gold foil as a filling material. Gold foil is manufactured with tiny, soft pieces of gold that are compressed (tapped) into the cavity preparation, carved, and polished.

Advantages of gold foil restorations:

  1. Gold is kind to the opposing teeth, creating the least amount of wear of any dental restorative material.
  2. Gold foil is strong and resists wear.

Disadvantages of gold foil restorations:

  1. Gold foil is not tooth-colored.
  2. Gold foil placement is time consuming.
  3. Depending on the market, gold foil can be expensive.

Indications for a filling

Fillings are indicated when you have lost less than half of the surface structure on the biting surface of the tooth, between the tips of the cusps. Once you lose a cusp or start placing fillings up the inclines of cusps, the strength of the tooth is compromised and a Crown or an Inlay/Onlay should be considered as the preferred means of restoration. Unfortunately, many patients cannot afford the preferred restoration, and many large fillings are placed as an alternative. Some of the problems that may occur when restorations that are too large are placed include, but may not be limited to:

  1. Weakness of the remaining tooth which may lead to a fracture.
  2. Reduction of tooth structure may cause the remaining tooth to flex when you bite down, causing pain.
  3. Overly of large fillings can irritate the pulp (nerve) and cause death of the tooth, requiring a Root Canal Treatment.
The silver filling and the composite or "white" filling; both teeth have recurring cavities and new fillings would be diagnosed had the teeth not been removed.

The silver filling and the composite or “white” filling; both teeth have recurring cavities and new fillings would be diagnosed had the teeth not been removed.

Sometimes fillings are simply replaced due to more decay around the existing filling (called “recurrent decay”). Sometimes silver fillings are fractured and cavity producing bacteria and sugar can seep down into the crack and under the filling, creating more decay; fractured fillings need to be replaced.