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Dental implants are widely spread throughout dentistry and have become mainstream for many patients. In the past, patients were presented other options…go without a tooth or teeth, wear a removable denture, or have a cementable bridge made. Dental implants have allowed for a great additional option which does not cut down existing teeth, and is strong and unmovable. Unfortunately, many of us forget that dental implants need to be cared for and maintained just like  natural teeth.

What Are Dental Implants?

Dental implants are an artificial tooth root (usually made of titanium) that a periodontist or oral surgeon places into your jaw to support restorations that resemble a tooth or group of teeth. Dental implants can replace a single tooth, support  a bridge, or support a denture (making it more comfortable and secure).

Dental implants are an ideal option for people in generally good oral health who have lost a tooth or teeth due to periodontal disease, injury, fracture or decay. Dental implants are actually more tooth saving than traditional crowns and bridges, since dental implants do not cut down healthy teeth or rely on adjacent teeth for support.

Sufficient bone, and good overall health will give you the best prognosis for ideal oseointegration, (the way bone fills in around the implant for strength). Dental implants are intimately connected with the underlying bone and gum tissues in the mouth. So, proper fit, good occlusion, and excellent oral hygiene are necessary for long term success. With technique and material advances, dental bone grafts are now more successful than ever and can be used to augment your natural bone. Periodontal disease, diabetes, bleeding problems, etc. can cause difficulty in placement, healing and longevity of the dental implants. Be upfront with your dentist regarding health issues so that the proper steps can be taken to give you the highest chance of success. There is an increased risk of failure in patients who are smokers. For this reason, dental implants are frequently placed only after a patient has stopped smoking.

Top Tips For Caring For Your Dental Implants

-Toothbrushing. Usual toothbrushing applies. It is recommended that you brush twice a day but it is even more beneficial to brush after every meal if that is possible.

-Flossing. Yes, flossing is important even with dental implants. Flossing is able to clean around the dental implants along the gum line. Just because the dental implants cannot get tooth decay it does not mean you cannot lose them. Bone loss is still possible around the dental implants which can lead to their loss.

-Maintain Regular Dental Visits.  Dental implants should be cleaned with different types of dental instruments as not to scratch the surface. They should again not be cleaned with ultrasonic or vibrating dental instruments of any kind. It is important to examine the dental implants at least once per year along with your regular professional cleaning schedule. Your dentist will evaluate the bone levels along with the soft tissues and occlusion. The important takeaway here is to have frequent examinations to catch any issues that might arise early enough so proper corrections can take place.

-Use A WaterPik. A great way to clean around dental implants is to use WaterPik.  The WaterPik is a water spray that cleans in between and around the teeth. But keep in mind again too much pressure may cause damage to the pocket so keep it at the lowest level possible. Recent studies have shown the WaterPik to remove up to 145% more debris than regular dental floss alone. Periogen in the waterpik can help remove tartar buildup around implants making it easier to keep them clean.

-Do Not Smoke. Smoking has been known to decrease oxygen flow to the gum tissues. This results in delayed healing, deterioration of the oral tissues, and bone loss. Bone loss and inflammation will cause your implant to loosen and fall out. If you want to protect your investment, do not smoke.

-Avoid Extremely Hot Liquids. Dental implants are made of metal and metal has ability to retain heat more readily than our oral tissues. If you drink extremely hot liquids, the metal of the dental implant  may heat up from the liquid and stay hot. The heat may cause a burning of a thin layer of cells around the implant. With repeated small damages this may cause inflammation around the implant. This is not backed by research, but is worth mentioning.

Caring For Dental Implants Conclusion

Just like your natural teeth, dental implants should be maintained if you wish to keep them. With proper maintenance, both at home and in the dental office, dental implants can last a lifetime. Dental implants can strengthen, and enhance your smile for years to come.

Crooked teeth (also called malocclusion) can affect almost 75% of all American adults. Malocclusion can significantly affect oral health over the course of a lifetime, leaving you with increased chances of developing periodontal disease and increased wear and trauma to teeth.

Types Of Malocclusion

-Crossbite – A crossbite is when the lower teeth overlap or come out even with the upper teeth. In a normal occlusion the upper teeth overlap the lower ones but when a crossbite (can occur on either side or both) is present, the opposite is true. This can lead to premature wear, increased risk of chipping or fracturing your teeth, development of abfraction (small notch in tooth at the gumline), and periodontal disease.

-Excessive Overjet – This occurs when the upper front teeth are too far out in front of the lower teeth. This can lead to increased trauma as well as an increase to chipping or fracturing of teeth (especially the front ones).

-Edge To Edge Bite – This occurs when the teeth touch one another edge to edge (or cusp to cusp). The teeth do not fit together propely allowing the biting surfaces to touch. This will lead to increased risk of chipping and fracturing, Temperomandibular Joint (TMJ) pain, as well as short, worn down teeth.

-Open Bite – This is a common occurence from thumb sucking or can be genetic. It is when there is a space between the front upper teeth and the front lower teeth upon closing. Not only is this an unesthetic option but it can lead to abfraction, is difficult to bite and tear food ,and causes excessive, premature wear of the back teeth.

-Over Bite- This is when the upper front teeth completely cover the lower front teeth. Often, the lower teeth hit into the backs of the upper teeth and sometimes into the roof of the mouth.

-Under Bite- This occurs when the lower jaw has grown more quickly than the upper jaw. The lower front teeth and jaw have grown in front of the upper teeth.

-Tooth Size Arch Length Discrepency- When your teeth are too large for your jaw space and cause extreme crowding or when your teeth are too small for your mouth. Crowding can lead to decay, fracture, and periodontal disease. Small teeth are generally a major cosmetic issue.

The General Health Danger

Gum disease is commonly found along with malocclusion, due to difficulty in maintaining good oral hygiene when teeth are not in proper position.

Periodontal disease has been linked to many systemic diseases through various studies. Some of these diseases include heart disease, diabetes, and alzheimer’s. Periodontal disease generally takes years of neglect to develop. There are various stages of periodontal disease progression, they include:

-Gingivitis – The earliest stage. The only stage that is reversible with proper dental care. This stage is characterized by swollen, red gum tissues, bleeding upon brushing, as well as bad breath (halitosis). If treated before it progresses, it can be reversed back to a normal, healthy, gingival state.

-Periodontitis – This is the stage that develops following ginigvitis. It is not reversible but can be controlled. Damage to teeth, bone, and gums can be limited with proper dental care. During this stage, the supporting tissues around the teeth may break down leading to gum recession and bone loss around the teeth.

-Advanced Periodontitis – This stage increases the bone loss and gum recession leading to loosening of teeth with the real possibility of losing one or more teeth.

How Do Crooked Teeth Affect Our Mouths?

When teeth are crowded and not aligned properly, the plaque and bacteria that forms on our teeth during everyday food consumption  becomes much more difficult to remove. This makes it difficult to  maintain a good state of health. Many times, flossing and brushing areas of overcrowded teeth will become very difficult. These areas are generally called a “plaque trap” for their ability to constantly trap food and debris.  As mentioned earlier, without proper care, plaque traps can lead to bone loss, gum recession, and even tooth loss.

Another cause for concern is wear and trauma to the teeth. Poorly aligned teeth can create unnatural stresses on the teeth and the jaws. Teeth subjected to excessive pressures can develop chipping, fracturing, and abfractions. Premature wear can also lead to lost teeth, loose teeth and even root canal therapy.

Finally, crowded teeth affect your systemic health by allowing bacteria to grow and flourish unabated in these crowded areas. Over time, this can lead to devastating life threatening effects like heart disease and stroke.

What Can Be Done To Combat Crooked Teeth?

Fortunately, in many cases the simple solution is increased visits to the dentist for professional cleanings as well as diligent  home care.  When there is undue stress placed on the teeth that can cause trauma and wear over time, Orthodontics is the answer in most cases. Orthodontics is a type of dentistry dealing with crowded or misaligned teeth. Proper orthodontic treatment can, in many cases, restore your smile and make it easier to maintain it.

Orthodontics Conclusion

Orthodontics is not just for cosmetic reasons. We are not all born with perfectly straight teeth and sometimes we need a little help to get there. The bottom line is to have beautiful teeth and gums that make you feel confident and healthy. Your smile should  last you a lifetime!

Do you have a missing tooth (or teeth) that need to be replaced? Throughout our lives, teeth can be lost for a variety reasons. They can be lost from tooth decay, periodontal disease, nutritional neglect, and accidents. Missing teeth can compromise your eating habits, speech, health, and appearance. The loss of a front tooth can negatively affect the appearance of your smile, your speech, and your self confidence. Losing a tooth in the back of your mouth can lead to a number of issues affecting your ability to chew, your ability to properly clean your teeth, jaw collapse, teeth shifting, and the health of your remaining teeth. Replacing a lost tooth will prevent further destruction and help save your remaining teeth. Replacing lost teeth can save you time, money, keep you healthier,and prevent many other oral difficulties in the future.

The loss of a single tooth can start a devastating chain reaction of events. After a back molar tooth is lost, a series of destructive events occurs including the displacement and tilting of other teeth around it including a supra eruption (when a tooth continues to grow into the mouth because it is not being kept in place by it’s opposing tooth) of the tooth above it, decay, drifting and formation of periodontal pockets. Eventually, bone loss and periodontal disease, to the teeth surrounding the lost tooth, tend to cause further destruction. If you fail to replace a lost back tooth, you may cause the loss of other teeth.

What Can Happen If Lost Teeth Are Not Replaced?

-Shifting of Teeth - When a tooth is lost, for whatever reason, the surrounding teeth will begin to drift into the open space. This includes both adjacent teeth as well as teeth in the other arch. A once straight smile can quickly turn into a crooked one. Replacing a lost tooth sooner, rather than later, can prevent this from happening As the number of lost teeth increases, the further the damage to the overall eveness of the bite  and, making it harder to replace later on. The altered position of teeth causes the forces to be applied incorrectly while chewing, making fractures and bone loss much more likely. The incorrect forces also cause wear which can result in loss of tooth height and subsequent facial changes.

-Temperomandibular Joint Issues (TMJ Disorder) - As your teeth shift out of their normal alignment, bite issues usually develop. When the upper and lower teeth do not meet properly, it can strain and eventually damge the TMJ. This can lead to head, jaw, and ear pain, headaches, dislocations, clicking and popping, as well as permanent damage to the joint.

-Periodontal Disease - When teeth begin to shift, it makes it that much harder to keep your teeth clean. It will be harder to brush and floss certain areas which have, essentially, created a trap for plaque and food debris to build up. When plaque and bacteria are not removed and allowed to build up the result can be tooth decay and periodontal disease. When teeth shift and drift, they oftentimes create a root exposure problem, and allow forces to move them in unnatural ways. This can loosen teeth, and make them very sensitive. Periodontal disease can lead to further tooth loss.

Options For Replacing Missing Teeth

Patients have multiple options when teeth are lost. They can include fixed ( permanent and not removable) or removable options. These procedures can include:

-Removable Dentures - This option has been the longstanding traditional option when multiple teeth are missing. Removable dentures are often the fastest and least expensive alternative in the short term. There are some disadvantages to removable dentures. Removable dentures work by attaching to exisiting teeth. This often leads to these “anchor” teeth becoming loose, worn, decayed, or broken. There can also be bone loss under the denture, which over time will make the denture more and more mobile and uncomfortable. Removable dentures can also be inconvenient to clean after eating especially if out at a restaurant. Lastly, removable dentures have about 1/3 the chewing power and efficiency of natural teeth. This can lead to poor chewing and lack of good nutrition in one’s diet.

-Fixed Bridge - This entails cutting down surrounding teeth, and fitting them with fused crowns to replace any missing teeth. The most popular type of fixed bridge is called a 3 unit bridge. This means that the two natural teeth adjacent to the missing tooth serve as anchors. This is a very stable option but does also have disadvantages. Disadvantages include:

-Removal of good tooth structure from adjacent teeth.

-Difficulty maintaining good dental hygiene under bridges as normal flossing is not possible

-Long term prognosis of most dental bridges in between 8-10 years before it needs replacing. This is an average. Some bridges can and will last longer.

-Dental Implants – Dental implants are the largest initial investment, but most cost effective long term solution for replacement of missing teeth available today. The main disadvantage to dental implants is the time it takes to be completed. Following placement of the dental implant a 4-6 month healing time is generally needed before the tooth can be restored. Dental implants are the ideal solution for many tooth replacements in dentistry today.

-All on Four Dentures - When many or all  teeth are lost, or if you are rapidly progressing to full mouth breakdown, This dental implant/denture option is an excellent choice. The best thing about this procedure is that you have your entire procedure done and walk out with teeth the same day. There are usually 4 dental implants placed and a titanium bar supported denture placed. It is screwed down, but can be removed if needed. The biggest negatives here are price, and post operative possibility of bruising and discomfort while healing.

Tooth Replacement Conclusion

Tooth loss can happen at any time to anyone. Losing a tooth due to a trauma, disease, habits, etc. can be a big problem for a variety of reasons. If not replaced, they can cause issues for you including bone loss, periodontal disease, and more tooth loss. Replacing lost teeth as soon as possible will save you discomfort and greater expense in the future. Knowing your options, and being informed can help you and your dentist come up with the best treatment options for you. Remember, sooner is better than later, but know that whenever you are ready to move forward with tooth replacements there will always be options!

Peri-implantitis - is a destructive  process affecting the gums and bone surrounding dental implants. The various periodontal bacteria found surrounding failing dental implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.

Peri-implantitis is a unique complication when dealing with dental implants. Dental implants have a very high success rate but do fail for various reasons. These can include failure to integrate with bone, poor oral hygiene by patient, rejection by the body, trauma, or peri-implantitis. Peri-implantitis becomes a factor in patients with poor oral hygiene, diabetes, smoking, and when there is residual cement stuck to the implant surface.  Peri-implantitis will cause the destruction of bone and gum tissue exposing part of the dental implant to the outside. This will cause the possibility for the dental implant to become less stable and cause the patient to lose the implant and restoration if not treated in a timely manner.

How Is It Diagnosed?

A dentist will use x-rays and measuring instruments to determine the level of the bone surrounding the dental implant. If it is found there is some level of bone loss beyond normal surrounding the dental implant, then the diagnosis becomes that of peri-implantitis. It is normal to see some minor bone loss 1-2 years out following placement of the dental implants. It should be no more than 1-1.5 mm in the first year and no more than 0.2 mm in each subsequent year. As stated earlier peri-implantitis of a  dental implant that goes undiagnosed will lead to complete failure and have to be removed.

Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms are:

- Color changes of the gum tissue around the implant.

- Bleeding during brushing, probing or measuring.

- Increased pocket depth around the implant.

- Pus drainage from around the dental implant.

- Thinning of the tissue causing transparency around the implant..

- Progressive loss of bone height around the implant.

-X-rays showing loss of bone around the implant.

Peri-Implantitis Treatment Options

The course and success of treatment revolves around when the peri-implantitis is diagnosed. If the initial bone loss is limited there will be a higher chance of success in saving the dental implant. However, the later treatment begins the lower the chance of saving the dental implants. There are various methods used to treat peri-implantitis. All have varying degrees of success. These include the following:

-Mechanical Debridement (professional cleaning using instruments). A patient with dental implants must follow normal treatment schedules to maintain his/her dental implants. This includes regular dental visits. At these visits radiographs will be taken to ensure the dental implant and surrounding tissues are in a  healthy state. At these visits the patient will also undergo a professional cleaning for the dental implants and/or natural teeth. Dental implants require special tools for cleanings. The standard dental implant instruments used for cleaning include plastic, graphite, or gold tipped instruments. Ultrasonic tips may be used. The goal in cleaning the implant is to remove debris and bacteria without damaging the exterior coating of the dental implant.

-Perioscope. A microscope guided cleaning deep below the tissues to remove debris and otherwise  undetectable cement residue.

-Localized Drug Delivery. Since dental implants by nature have rough surfaces (to allow better integration with surrounding bone), removing infection tends to be quite a challenge using just hand instruments. It is recommended that a chemical anti microbial agent be used along side hand instrumentation. Recent studies have shown the combination of hand instruments and chemical agents have proven effective in eliminating peri-implantitis in its earliest stages. Drugs used can include chlorhexidine rinse, oral antibiotics such as tetracycline, minocycline, doxycycline hyclate, or Arestin, an antibiotic placed directly into the pocket.

-Bone regrowth factors. Emdogain can be placed along with bone grafting material to help stimulate new bone growth.

Conclusion

The primary goal once peri-implantitis has been diagnosed is to stop the disease process from progressing. If untreated, it will ultimately lead to loss of the dental implants. The #1 goal should be to see your dentist regularly to avoid the complication of peri-implantitis. It is important to note any signs that may be occurring so you can be proactive about your dental health.