What are the white spots on my teeth?

Some people have a white spot(s) on a tooth or teeth. These spots can be either enamel hypoplasia or hyperpasia. Hypoplasia is more significant since it is defect in the enamel formation. The enamel doesn't form in the proper matrix and these spots are softer and can be more prone to decay if they are not kept clean. They are also more prone to become intrinsically stainned and can appear yellow, creamy or brown.

Often bleaching can help alter the appearance of teeth with these spots, since the rest of the tooth becomes lighter when bleached, so that after significant bleaching , the whitespots can become less noticable. Interestingly, when patients do first start bleaching the white spots immediately become more noticeable because they brighten faster than the rest of the surrounding tooth. hypoplastic enamel is close to the surface and more porous than the rest of the tooth.

Enamel hyperplasia can cause tiny white flecks (or brown) on teeth and can be seen often near the incisal edges or proximal sides of the teeth. These are portions of the enamel that are harder than ordinary enamel and are even more resistant to decay. These are thought to be related to fluoride intake and are more prevalent in populations taking higher doses of fluoride in their water (higher that 1ppm).

What does it mean if my gums bleed when I brush them?

When asked this by one of my patients, usually it means that they have not been brushing and flossing correctly and have gum inflammation. To insure healthier gums, I ask them to brush twice a day for two minutes and clean between their teeth with either floss,proxabrush or stimudents. I often recommend using a good electric tooth brush, such as a Braun Oral B electric toothbrush. The good news is often the bleeding goes away after a patient has had a cleaning and starts an improved oral hygiene regime at home.

Getting a regular prophylaxis at the dentist definitely helps reduce gingival inflammation and also gives your dental team an opportunity to give some tips on you might to do a better job at home . It is always a good idea for a patient to demonstrate their brushing and flossing techniques for their dental hygienist or dentist. Afterwards we can see what changes you might try to improve your results.

What causes cracked teeth?

There are a number of causes for cracked teeth.. The most common cause is they have overly large fillings . When a tooth has a large filling , it can have its tooth structure 'compromised' and weakened. Teeth that have broad fillings place or have three or more surfaces filled are in what I call the 'crown zone'. They should be protected by full coverage(crowning). I try not to place overly large 'permanent' fillings in teeth at all but instead recommend crowns. Crowns cover the entire biting surface and redistribute the vertical forces on teeth so that the tooth is less likely to fracture.

Another possible cause of cracked teeth is tooth grinding or bruxing at night. Some patients give their teeth a real workout at night and these patients have more cracked teeth than others. They should wear night guards to protect their teeth while they are sleeping.

Using your teeth to crack Ice cubes, bones or chewing on a pipe stem, can crack teeth. Teeth, although hard, can with repeated stresses tend to develop cracks.

Still another cause of cracked or broken teeth are 'food accidents'. Patients eating something soft such as chicken salad, tend to bite hard on these easy to chew foods. If they unexpectedly bite down on something hard (like a chicken bone), they often crack a tooth.

Are Dentists affected by the recession?

This seems to be a question that interests visitors to my blog. In September I wrote a post tittled "Are Dentists recession proof?"and it is turning out to be a popular posting. Seems like a number of people (Dentists?) are interested.

Yes, dentistry, as well as all businesses, are affected by recessions. Dentists are not "Smiling in the Face of Recession". People are cautious right now about spending money. My dental office website received fewer visitors in September (approximately 15% less than average) than in any other month in 2008. Accordingly, my dental office schedule was not as busy as I had anticipated, prior to Wall Street's meltdown.

I have noticed that every month since, my website's traffic has increased slightly(with the exception of December-always a slow month for my dental practice) and in January my office website had more visitors than in any month in 2008.

I think that immediately after the stock market crash, many people were in shock (understandably) . Could it be that now that the recession is old news, they are more likely to take care of their health needs? The sky has not fallen and better than 90% of workers have kept their jobs.

My dental office has gotten busier, but it is not business as usual. Every week a patient comes in and reports that either he or she has gotten laid off or is 'freelancing'. These patients are often not as interested in all preventive services, but are interested in heading off preventable major dental expenditure. Clearly it makes sense to take care of small cavities before they get large and require more extensive dental interventions.

Also as is always the case, dental insurance is a use it or lose it proposition. Those with dental insurance should make use of their benefit each calendar year. This may be especially the case in 2009, since many companies are looking at trimming costs and they may reason that very few workers are likely to jump ship because of a downgrading of dental benefits. It is my sincere hope that people will continue having check ups and cleanings as usual. In the long run, this will save them money and aggravation.

My root canal has failed. Should I retreat it or have an apicoectomy?

In most cases retreating a root canal conventionally is preferable to having and apicoectomy. Retreating a root canal usually has a higher success rate than apical surgical repairs (apicoectomey)since teeth with apicalectomies seem to have a higher failure rate (they get a reoccurring of the infection at the apex).

Apicoectomies are preferable if the canal can no longer be safely renegotiated. This can happen if a post has been placed and an endodontist or dentist doesn't believe it can be safely removed. Also some root canal filling materials can be difficult to remove( a small minority)

Many posts can be safely removed, but some can be more difficult than others. If attempting the removal of a post has a high likelihood of placing the future of the tooth in jeopardy, than an apical procedure or an extraction may be a better option.

Why don't dentists recommend Maryland Bridges anymore?

Maryland Bridges were popular in the 1980's. I fabricated a number of them. They seemed great at first. Not much tooth preparation was needed and the patients like them. The problem was that most of these bridges separated from the teeth in less than 5 years and required remaking or constantly recementing.

The conclusion that I and most of my dental colleagues have reached, is that conventional fixed bridges or implants present a better option for patients. Both of these options tend to outlast Maryland Bridges and are more 'predictable' tooth replacements.

It seems that for these bridges to work well, the amount of preparation must be increased so that the wings have more retention. The wings of the Maryland bridges should wrap around more than 180 degrees of the adjacent teeth. Often the amount of preparation that is needed creates a bridge that is unaesthetic and patients request that the supporting wings be cut back. Reducing the wings makes it more likely to prematurely separate from the teeth .

What can I do about crooked front teeth?

Depending on your situation you have a number of treatment options, including traditional orthodontics, Invisalign, Porcelain Veneers, Simple bonding and Cosmetic recontouring. All of these treatment modalities can be useful and they can if needed, they can be combined to help achieve a pleasing smile makeover.

Porcelain veneers, bonding and cosmetic recontouring can rapidly fix a crooked smile. Veneers can change not only the apparent position of the anterior teeth , but can change the shape and colour of the teeth as well.

Orthodontic tooth movement actually rearranges crowded teeth in a more appealing position. Once this movement has occurred, often no other major corrections are needed. If a patient does desire whiter teeth, bleaching is an option. The patient must be prepared to wear a removable or fixed retainer, to insure the teeth stay in their new positions.

If after orthodontic treatment and bleaching, a patient still desires further improvement, often minor bonding to the edges of the teeth, can provide satisfying results.