My Blog
By Daniel Brengman DDS, PA
October 20, 2018
Category: Dental Procedures
Tags: anesthesia  
LocalAnesthesiaEliminatesPainCompletelyDuringDentalWork

Your teeth and gums are filled with nerves that make the mouth one of the most sensitive areas in the body. But thanks to local anesthesia, you won't feel a thing during your next dental procedure.

The word anesthesia means “without feeling or pain.” General anesthesia accomplishes this with drugs that place the patient in an unconscious state. It's reserved for major surgery where the patient will be closely monitored for vital signs while in that state.

The other alternative is local anesthesia, which numbs the area that needs treatment, while allowing the patient to remain conscious. The anesthetics used in this way are applied either topically (with a swab, adhesive patch or spray) or injected with a needle.

In dentistry, we use both applications. Topical anesthesia is occasionally used for sensitive patients before superficial teeth cleaning, but most often as an “opening act” to injected anesthesia: the topical application numbs the gums so you can't feel the prick of the needle used for the injectable anesthetic. By using both types, you won't feel any pain at all during your visit.

Because of possible side effects, we're careful about what procedures will involve the use of local anesthesia. Placing a sealant on the exterior of a tooth or reshaping enamel doesn't require it because we're not making contact with the more sensitive dentin layer beneath. We've also seen advances in anesthetic drugs in which we can now better control the length of time numbness will persist after the procedure.

All in all, though, local anesthesia will make your dental care more comfortable — both for you and for us. Knowing you're relaxed and comfortable allows us to work with ease so we can be unhurried and thorough. By keeping pain out of the equation, your dental care has a better chance for a successful outcome.

If you would like more information on managing discomfort during dental care, 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 “Local Anesthesia for Pain-Free Dentistry.”

WhyemBigBangTheoryemActressMayimBialikCouldntHaveBraces

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”

ClearAlignersReduceRiskforDevelopingGumDiseaseBetterthanBraces

Wearing braces isn't just for teenagers — straightening teeth can be just as viable a need when you're an adult. For example, it may be necessary to first move teeth away from an empty tooth socket before you obtain a dental implant or other restoration.

But braces could have complications, especially if you have periodontal (gum) disease. These infections caused by plaque, a thin film of bacteria and food particles, inflame and weaken gum tissues and erode supporting bone. It can be treated and brought under control — but keeping it under control requires daily brushing and flossing, along with frequent office cleanings and checkups.

Braces can make this more difficult: it's harder to brush and floss effectively through the hardware of brackets and wires, which can give plaque a chance to build up. Patients susceptible to gum disease are more likely to have re-infections while wearing braces. The hardware can also cause enamel to come in prolonged contact with acid, which can dissolve its mineral content and open the door to tooth decay.

Clear aligners are an alternative to braces that can accomplish tooth movement while minimizing infection flare-ups for people with gum disease. Aligners are a series of customized clear plastic trays worn over the teeth, with each succeeding tray incrementally moving the teeth further than the preceding one. After wearing one tray for a specified time period, you then switch to the next tray. The teeth gradually move to the desired new position over the course of the aligner series.

This option is especially advantageous for gum disease patients because the trays can be removed temporarily for brushing and flossing. There are also other benefits: we can hide a missing tooth space with a temporary false tooth attached to the aligner; and, they're nearly invisible so it won't be obvious to others you're undergoing orthodontic treatment.

Not all orthodontic situations benefit from this alternative, while some cases may call for a combination approach between aligners and braces. But in the right setting, clear aligners are a good choice for not only obtaining better teeth position, but also helping you avoid a new encounter with dental disease.

If you would like more information on orthodontic treatments for adult teeth, please contact us or schedule an appointment for a consultation.

By Daniel Brengman DDS, PA
September 20, 2018
Category: Dental Procedures
Tags: dental implants  
YourNewImplantsNeedProperHygieneJustasMuchasyourOtherTeeth

So, you’ve just acquired an attractive restoration with dental implants. You may be thinking at least with these teeth you won’t have to worry about dental disease.

Think again. While the implants and their porcelain crowns are impervious to decay the surrounding gums and bone are still vulnerable to infection. In fact, you could be at risk for a specific type of periodontal (gum) disease called peri-implantitis (inflammation around the implant).

Bacterial plaque, the thin bio-film most responsible for gum disease, can build up on implant crowns just as it does on natural tooth surfaces. If it isn’t removed with daily brushing and flossing and regular dental cleanings the bacteria can trigger an infection in the gums.

Besides weakening gum tissues, gum disease can also cause bone loss, of critical importance to dental implants. An implant depends on the bone they’re inserted in to hold them in place. If the bone around an implant becomes infected it could begin to be lost or dissolve (resorb), which could lead to loss of the implant.

That’s why it’s critical to keep the natural tissue structures supporting your implants infection-free. Not only is daily hygiene a must, but your implants and any remaining natural teeth should undergo professional cleaning at least twice a year or more if your dentist recommends it.

Cleanings involving implants will also be a bit different from natural teeth. While the dental materials used in the crown and implant post are quite durable, regular cleaning instruments can scratch them. Although tiny, these scratches can become hiding places for bacteria and increase your risk of infection.

To avoid this, your hygienist will use instruments (known as scalers and curettes) usually made of plastics or resins rather than metal. The hygienist may still use metal instruments on your remaining natural teeth because their enamel can tolerate metal without becoming scratched creating a smoother surface.

While keeping implants clean can sometimes be a challenge, it’s not impossible. Implants on average have a long-term success rate above 95%. With both you and your dentist caring and maintaining these state-of-the-art restorations, you may be able to enjoy them for decades.

If you would like more information on caring for dental implants, 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 Implant Maintenance: Implant Teeth must be Cleaned Differently.”

By Daniel Brengman DDS, PA
September 10, 2018
Category: Dental Procedures
Tags: dental implants   bone graft  
NotEnoughBoneSupportforanImplantHeresaWaytoRebuildIt

Due to financial circumstances, people often have a lost tooth restored with a removable partial denture, an effective appliance that restores function and a degree of aesthetic appearance. Later, though, they may want to improve both function and appearance with a dental implant.

If this describes you, you’re making a great choice. Dental implants are the closest technology we have to a natural tooth. But there may be a roadblock to your implant, especially if a long time has passed since your tooth loss—there may not be enough bone at the site to place an implant.

The heart of an implant is a titanium metal post surgically imbedded in the jawbone. The titanium naturally attracts bone cells, which grow and adhere to it to form a solid hold that can support a porcelain crown or other restorations like bridges or dentures. But to achieve a natural appearance it’s important that the implant is placed in the right location. To achieve that requires adequate bone.

But there may not be adequate bone if the tooth has been missing for a while. The forces generated when we chew travel through the teeth to the jawbone, which stimulates bone growth. If that stimulus is absent because of a missing tooth, new bone cells may not replace older ones at a healthy rate and the total bone volume begins to diminish. A denture can’t compensate and, in fact, accelerates bone loss.

But there may be a solution: bone grafting. With this procedure we place a donor bone graft into the area of bone deficiency some time before implant surgery. The graft serves as a scaffold for new bone cells to grow upon. Hopefully, this will produce enough healthy bone to support an implant. If the bone deficiency is minor, we may place the implant and the bone graft at the same time.

If you have experienced bone loss, we must first determine the amount of bone at the missing tooth site and whether grafting is a viable option. Bone grafting postpones your implant, but the delay will be worth the wait if we’re successful. With increased bone volume you’ll be able to obtain a new tooth that’s superior to your current restoration.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.





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