Dental Implants
Did you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.
A Solution of Choice for Replacing Missing Teeth
Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.
Twenty years ago, these patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them a number of other problems. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Of even greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often doom fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every seven to 15 years.
Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that “fuses” with the jawbone through a process called “osseointegration,” dental implants never slip or make embarrassing noises that advertise the fact that you have “false teeth,” and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.
After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.
Dental Implants and Roots
The key benefit of dental implants over other tooth replacement systems is that an implant connects directly to the jaw bone. It’s obviously not the same as the original connection, but functions just the same. When a tooth is lost, bone loss will eventually occur in that region because the root is no longer stimulating and stabilizing the bone. By using titanium–which biochemically joins to bone–to replace the root, you get a bond that more accurately replicates the one found in nature.
What Happens When You Lose a Tooth?
When you lose a tooth, especially a back tooth, you may feel you don’t need to replace it, since no one can see that it’s missing and you have plenty of other teeth. However, there is more bone loss going on under the surface once a tooth is lost. Surrounding each tooth is an alveolar bone that supports the tooth and when the tooth is lost, that bone basically melts away. This is why people who have lost most of their teeth and are not wearing dentures appear to have a caved-in appearance to their mouths.
Besides causing damage to the immediate area, tooth loss affects remaining teeth as well. Teeth create a structure for the face and their loss can shift the surrounding teeth, creating esthetic issues and bite problems. A lost tooth can also affect facial structures such as the jaw, muscles, jaw joints, and even the skin. If several teeth are lost, it’s not uncommon to suffer from social consequences and poor nutrition.
Rebuilding Bone
When the supporting alveolar bone melts away, it’s gone for good, but through grafting, a skilled dental professional can recreate bone to fuse with and support an implant. This is wonderful news, but it is still best to have a dental implant as soon as possible after the tooth is lost for the most predictable esthetic outcome.
Timeline
Replacing a tooth with an implant and a crown is not a one-day procedure. The implant needs time to properly adhere to the bone and create a healthy fusion before the crown can be attached and full bite force can be applied. In most cases, it will take a few months to complete the process.
If you are interested in receiving an implant or would like more information please set up a consultation with Dr. Malcolm.
Veneers
Porcelain veneers are thin pieces of porcelain used to recreate the natural look of teeth, while also providing strength and resilience comparable to natural tooth enamel. It is often the material of choice for those looking to make slight position alterations, or to change tooth shape, size, and/or color.
Veneer Consultation
Visiting with Dr. Malcolm and asking about veneers is the first step in determining if veneers are the right option for you, or if there are alternate solutions available. Dr. Malcolm will spend time clearly identifying what cosmetic improvements you want to accomplish.
You’ll often hear people say that celebrities have veneers and this may seem like the best way to replicate picture-perfect teeth, but each mouth is different and veneers need to be carefully researched.
Dr. Malcolm will most likely begin with a smile analysis to determine what steps are necessary to achieve the smile you desire. In addition, a diagnostic mock-up that will allow you to “try on” veneers and other procedures to see if the final result is actually what you’re looking for.
The Hows and Whys of Porcelain Veneers
Porcelain laminate veneers consist of a compilation of several thin ceramic layers which replace original tooth enamel, and an adhesive layer. To apply a veneer, a very small amount of the original tooth enamel must be removed, usually less than a millimeter. This is essential as it creates room for the porcelain veneer to fit within the mouth and most accurately restore natural tooth function while creating an even better appearance than the original tooth.
The bond between original tooth and porcelain veneer is critical as it not only provides the esthetic perfection desired, but also a strong bond which is essential for correct veneer function. Light-sensitive resin is placed between the original tooth and the veneer and then hardened using a special curing light.
Porcelain veneers are a very successful option in many situations where the original tooth has developed poor color, shape, and contours. It is also a good choice for fractured teeth, gaps between teeth, and in some situations where the tooth position is compromised and there are minor bite-related problems. For some people, superficial stains do not respond well to tooth whitening or bleaching. In these situations, a porcelain veneer may be the best option.
Minimal Prep or “No-Prep” Veneers
Some patients are looking for an alternative to traditional dental veneers or bonding, but be aware that this treatment option is not appropriate for everyone.
Just as with porcelain veneers, “no-prep” or minimal preparation veneers— so called because they typically don’t require the dentist to remove as much tooth material—are bonded to the front surface of your teeth. Often, the placement of no-prep veneers can be done more quickly and with less discomfort than traditional veneers.
Dr. Malcolm will let you know if you are a good candidate for minimal preparation or “no-prep” veneers and if this option makes a sensible treatment plan.
The Benefits of Veneers
Since veneers are individually sculpted for each patient, it is nearly impossible to tell the difference between a veneer and a natural tooth. Unlike natural teeth, custom-made veneers resist coffee and tea stains, and cigarette smoke because they are made of high-tech materials.
With veneers—as opposed to crowns—your natural teeth remain largely intact with only a minimal amount being altered to fit the veneer.
For teeth that resist whitening, veneers can make even the darkest teeth appear bright white.
Veneers are also recommended to quickly fix minor twists, overlaps, and small gaps in the front teeth.
Potential Veneer Downsides
Because a portion of the original tooth enamel is reduced, a veneer is not considered a reversible treatment. Although adjustments and even new veneers can be made, you can never reliably return to the original condition of the tooth.
Creating porcelain veneers requires some laboratory time, so expect at least a week before they’re ready to be applied.
After the porcelain veneers are attached you will probably have some sensitivity to hot and cold temperatures due to the removal of that thin layer of enamel. This typically disappears within a few days. In a healthy mouth properly treated with porcelain veneers—and where destructive forces are minimized or eliminated—a patient should be able to use porcelain veneers like his or her own teeth. Although they’re very strong, veneers are also brittle. You should avoid the same excessive stresses you would avoid with non-veneered teeth: don’t bite your fingernails, chew ice, or open beer bottles with your veneers!
Maintenance of a Porcelain Veneer
Maintaining porcelain veneers is actually quite simple: Treat them as you would your original teeth, with routine brushing and flossing. Using non-abrasive fluoride toothpaste will typically be suggested by your dental professional.
One week after your veneers are placed, you will be required to return to the office for a follow-up visit and evaluation so the dentist can see how your mouth is reacting to the veneers. Even if you feel the veneers are a success, this appointment is vital to your future oral health.
If you have a habit of grinding or clenching your teeth, Dr. Malcolm may fit you with a nighttime bite guard so you do not damage your veneers.
You should also return to your dentist for regular professional maintenance because porcelain veneers should be polished with a specially formulated, non-abrasive paste, and because your dentist needs to inspect your dentistry for any sign of potential failure.
BOTOX
Cosmetic Uses of Botox
Doctors have been using Botox for years to successfully treat wrinkles and facial creases. Botox is a brand name of a toxin produced by the bacterium Clostridium botulinum. There are also other brand names, such as Dysport and Xeomin.
How Does Botox Work?
Botox blocks signals from the nerves to the muscles. The injected muscle can’t contract. That makes the wrinkles relax and soften.Botox is most often used on forehead lines, crow’s feet (lines around the eye), and frown lines. Wrinkles caused by sun damage and gravity will not respond to Botox.
How Is a Botox Procedure Done?
Getting Botox takes only a few minutes and doesn’t require anesthesia. Botox is injected with a fine needle into specific muscles with only minor discomfort.
It generally takes three to seven days to take full effect, and it is best to avoid alcohol starting at least one week before the procedure. You should also stop taking aspirin and anti-inflammatory medications two weeks before treatment to reduce bruising.
How Long Does a Botox Injection Last?
The effects from Botox will last four to six months. As muscle action gradually returns, the lines and wrinkles begin to reappear and need to be treated again. The lines and wrinkles often appear less severe with time because the muscles are being trained to relax.
What Are the Side Effects of Botox?
Temporary bruising is the most common side effect of Botox. Headaches, which end in 24 to 48 hours, can happen, but this is rare. A small percentage of patients may develop eyelid drooping. This usually ends within three weeks. Drooping usually happens when the Botox moves around, so don’t rub the treated area for 12 hours after injection or lie down for three to four hours.
Who Should Not Receive Botox?
People who are pregnant, breastfeeding, or have a neurological disease should not use Botox. Since Botox doesn’t work for all wrinkles, you should consult with a doctor first.
Will Health Insurance Pay for Botox?
Botox is not generally covered by insurance when used for cosmetic purposes. Check with your health insurance company for coverage details.
BOTOX® Treatment for Jaw Tension and TMJ
BOTOX® is used as an alternative treatment for TMJ (temporo-mandibular joint) disorders and associated jaw tension and pain. When injected into facial muscles afflicted with soreness and discomfort, BOTOX® relieves TMJ and jaw tension for many patients. The injections often eliminate headaches resulting from teeth grinding, and, in cases of severe stress, BOTOX® can even minimize lock jaw. Although BOTOX® treatment for these conditions is presently experimental; evidence indicates that it can be extremely effective.
How Does BOTOX® Treat Jaw Tension and TMJ Disorder?
Located on both sides of the head at the point where the jawbone meets the skull, the temporo-mandibular joint (TMJ) is used during talking, eating, swallowing, and other everyday activities. If this joint becomes displaced or is overworked through excessive teeth grinding, a person may suffer severe tension headaches, as well as sharp pain in the jaw. BOTOX® relieves jaw tension by making muscles unable to engage in the powerful, often unconscious movement of the jaw that produces headaches and pain.
The BOTOX® alternative treatment for TMJ disorders and jaw tension is usually quick, straightforward, and effective. A non-surgical procedure, BOTOX® injections are administered in a doctor’s office and treatment requires no hospital stay. Most patients experience noticeable improvement within one or two days of their first treatment, although relief can take up to a week.
Areas Affected by TMJ Botox Therapy
Only the areas injected with Botox will be “relaxed.” Botox treatment for TMJ therapy will not affect anywhere else in your body. The injections are mainly in the temporalis, frontalis and masseter (see picture below) additional sites may be injected with Botox depending on the severity of the headaches.
How long is the Botox Treatment Procedure?
The length of the Botox treatment procedure depends on the number of injections needed as determined by the doctor. Still, it is reasonable for the treatment procedure to be completed within 10-30 minutes.
Is the Botox Treatment Painful?
The pain associated with the Botox TMJ Treatment procedure is due to the injections, but it is generally minimal and brief. Some patients have likened the Botox injection pain unto a “bug bite” or “prick”. Pain from the injection can be reduced by numbing proposed injection sites with a cold pack or anesthetic cream. If you are scared of needles the doctor may offer you Happy Gas.
What to Expect After the Botox TMJ Treatment?
After the Botox TMJ Treatment muscle tenderness will start to disappear almost immediately. Wrinkles begin to disappear within 24 – 48 hours after the injections, and you may continue to see the wrinkles diminish up to one week after the Botox treatment procedure.
There may be mild temporary bruising, numbness, or redness around the injection sites. You will not look 20 years younger, but you may find that you look more natural and relaxed or less sad and angry. A small number of patients treated with Botox injections reported no noticeable difference in the reduction of their wrinkles.
What is the Recovery from Botox Therapy for TMJ Treatment Like?
Because the Botox Treatment procedure is non-surgical and non-invasive, it is highly likely that the patient can return to normal activities immediately. However, to avoid spreading the toxin to other muscles, patients should not rub or massage the area injected with Botox and remain upright for many hours. Physical activity should also be limited for a time.
Risks, Limitations & Possible Complications of Botox Injections for TMJ Treatment
As with any medical procedure there are possible risks and side effects when using Botox for TMJ treatment. Since this is a non-surgical treatment procedure, the risks and possible complications are infrequent, minimal and temporary.
If you are interested in receiving a Botox treatment, please set up a consultation with Dr. Malcolm.