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With the advancement of modern cosmetic dentistry into all porcelain crowns from traditional porcelain fused to metal crowns (PFM crowns), many have wondered if the

Porcelain Crowns Marielaina Perrone DDS

The Natural Look of Porcelain Crowns

porcelain crowns would be as durable over the long term. Well, recent clinical studies have shown that they are just as strong and also have the ability to maintain their beauty over time as well.

The main differences in porcelain crowns are the type of porcelain used, and how they are fabricated in a dental laboratory. Different porcelain types and strengths are used for different reasons. Remember also, that a lab created porcelain crown, is of higher fabrication quality and fit, than an in office computer milled crown.

Long Term Study – Porcelain Crowns

The researchers at the Medical University at Innsbruck studied a little over 1,300 all porcelain crowns placed between 1987 and 2009. They were tested for predictability and strength and found to have a high,(93.5% probability of survival) success over a 10 year period. The study was published in the International Journal of Prosthodontics). The study included those with root canal teeth, and those who grind their teeth.

A total of 302 patients (120 men and 182 women) participated in the study. They were examined at the university during regularly scheduled visits for dental examination. Patient-specific data about sex, age, tooth sensitivity, smoking, and grinding  were noted, as well as self-reported data regarding their level of

Cosmetic Dentist Marielaina Perrone DDS

satisfaction with their restorations: excellent, good, medium, or none. The porcelain crowns were broken down into areas of mouth as well, into front( anterior), and back( premolar, and molar) regions.
All 1,335 porcelain crowns had been placed at the university between November 1987 and December 2009. Of these porcelain crowns, 451 were observed over a 10-year period, 84 for 15 years, and 24 over 20 years.

Dental examinations were completed by two dentists in the spring of 2010. One dentist had placed the majority of porcelain crowns, whereas the other dentist involved in examinations had placed none of them. California Dental Association/Ryge criteria were used to rate each porcelain crowns as a success, relative failure, or absolute failure.

Any porcelain crowns that had severe enough issues to warrant replacement were considered an absolute failure. If a finishing procedure or polishing was able to fix the issue, the porcelain crown was labeled a relative failure.

Of the 1,300+ porcelain crowns in the study, only 95 porcelain crowns were rated as failures, 79% of which were absolute failure. Most failures occurred in the anterior region, with 65, while 19 occurred in premolars and 11 occurred in molars.

Success rates remained strong over time. The estimated survival rate was 97.3% at five years, 96% at eight years, 94% at 10 years, 85.8% at 15 years, and 78.5% after 20

Porcelain Crowns Marielaina Perrone DDS

The Beauty Of Porcelain Crowns

years. Almost half of all porcelain crown failures happened in the first 8 years..

The most frequent reason for failure was fracture,(cracks) of the ceramic, according to the researchers, followed in order by cracks in the ceramic and decay.

Root canal teeth and patients who grind their teeth, had higher failure rates.

Patient responses to questions about satisfaction were very positive. With 96% rating it as excellent and 4% rating it as good. The surprising thing about this study was that even patients with failures thought that porcelain crowns were an ideal dental restoration and would do it all over again.

Porcelain Crowns Conclusion

Porcelain crowns are a proven part of cosmetic dentistry and with continued advances in dental porcelain (like e.max porcelain crowns) these results will be even better into the future. Porcelain crowns are an ideal restoration due to their color, shape, and light reflecting properties. The study just proves that they are a valuable asset to any dental patient’s smile.

 

Almost one third of all Americans diagnosed with cancer each year will develop oral health issues. Patients who undergo life saving treatments for various cancers are usually unaware they may develop painful and debilitating conditions following their cancer treatment. A thorough dental examination is a critical step in maintaining their overall health throughout cancer treatment. This includes examination prior to, during, and after cancer treatments. Untreated oral disease can also complicate cancer treatment. The dentists role in patient management can be beneficial to the patient beyond their oral cavity.

Cancer can be treated or slowed down with proper treatments like, chemotherapy and radiation therapy. The type of treatment can be very effective but also can have very debilitating or even painful side effects that can can affect other parts of your body. These can include your mouth, teeth, gums, oral tissues and salivary glands. Being aware of these possible cancer treatment side effects can help patients reduce and manage them with help from physicians and dentists alike.

How can your oral health be affected by cancer?

Chemotherapy and radiation therapy treatment for cancer can have oral side effects. This varies depending on the type of cancer and the aggressiveness of the treatment. Those side effects can display

American Cancer Society

American Cancer Society

themselves in different ways:

-Dry Mouth (Xerostomia). Salivary production and flow are affected because the salivary glands can be affected during treatments for cancer.

-Tooth Decay. This can happen very rapidly due to the dry mouth condition.

-Burning Mouth Syndrome. There might be a painful or burning feeling in the mouth, tongue and gums. This also occurs from the reduction in salivary flow.

-Erosion of teeth due to high acid in the mouth following reflux and vomiting

-Stiffness in jaws..

-Problems with eating, speaking, and swallowing.

-Alteration of taste sensation. Your ability to taste properly will decrease..

-Gum inflammation and swelling, Periodontal disease can develop.

-The immune system is weakened.

In order to manage all the side effects from cancer, your dentist can make you recommendations to keep your mouth comfortable and healthy.

Dental Examination Before Treatment of Cancer

A pretreatment dental examination can identify potential issues and help educate the patient about the importance of maintaining good oral care. This examination can be completed by a your local or by a hospital based dentist. The evaluation includes a thorough examination of hard and soft tissues It will also include x-rays to detect trauma and possible sources of infection. Before cancer treatment begins, the dentist can also do the following:

-Removal of orthodontic bands if highly stomatotoxic chemotherapy is planned or if the bands will be in the field of radiation.

-Evaluate comfort and fit of dentures and oral appliances.

-Any teeth that need to be removed or have large fillings, crowns, should be performed at least two weeks prior to the beginning of radiation therapy to allow for proper healing, and at least 7-10 days before myelosuppressive cancer chemotherapy starts.

-For adults receiving head/neck radiation, removing teeth that may pose a problem in the future. The jaw bone , after being exposed to radiation does not heal properly following trauma, a simple removal of a tooth can result in bone death (osteonecrosis) which can destroy large areas of jaw bone. If you receive head and neck radiation you will need to take extreme precaution to avoid needing extractions for the rest of your lifetime.

-For children, consider extracting highly mobile primary teeth and teeth that are expected to fall out during the cancer treatment window.

-Instruct patients on the maintenance of proper oral hygiene, nutrition, the use of fluoride gel, rinses, dry mouth products, and the need to avoid tobacco and alcohol use.

During the examination, the patient will also learn about home care to protect oral tissues and minimize oral complications. The dentist or hygienist will instruct the patient on special brushing and flossing techniques, mouth rinses, and other approaches to keep the mouth as moist and clean as possible to reduce the risk of infection and pain.

Oral Care during Treatment

Even with examinations before cancer treatment, regular oral exams and care are necessary during cancer treatment. Good communication and planning between physician and dentist can reduce the Dental Carerisks of oral complications and maximize the efficacy of dental and supportive care. Specific oral health symptoms to remember when treating patients undergoing chemotherapy or radiation include the following:

Symptoms can include:

-A sticky, dry feeling in the mouth.

-Trouble chewing, swallowing, tasting or speaking due to dryness in oral cavity.

-A burning feeling in the mouth.

-A dry feeling in the throat and tongue.

-Dry,Cracked lips.

-Mouth sores.

-A fungal infection in the mouth or at the corners of the lips, like oral candidiasis.

Chemotherapy Issues

-Fever of unknown origin may be linked to an oral infection.

-Have the patient schedule appointments carefully. Patients should be seen when blood counts will be at safe levels.

-Conduct blood work 24 hours before dental treatment to determine whether the patient’s platelet count, clotting factors, and absolute neutrophil count are at adequate levels to prevent hemorrhage and infection.

-If the patient has a central venous catheter, careful consideration should be given to implementing the American Heart Association (AHA) prophylactic antibiotic regimen before any dental work.

Radiation Therapy Issues

-Treat infections. Ulcerations and dry, friable tissues are easily infected.

-Nutrition.Instruct the patient on the importance of healthy eating to maintain nutritional status, emphasizing the need to avoid foods that irritate sore tissues or cause dental decay.

-Show patients exercises to reduce tightening of mouth muscles,( trismus). Fibrosis of the tissue may occur if the chewing muscles are in the direct field of radiation. Ask your dentist to teach you how to exercise and stretch these muscles properly to avoid or alleviate the symptoms.

Follow up Dental care

Patients may continue their regular dental care schedule once all complications from chemotherapy have subsided and blood counts have recovered.

Once radiation therapy has been completed and acute oral complications have subsided, the patient should be evaluated by a dentist every four to eight weeks for the first six months. After that the dentist can decide the schedule the patient needs based on findings.

Post Cancer Treatment

Head and neck radiation therapy can cause oral complications that continue or emerge long after treatment has been completed. Although cancer patients may no longer be under an oncologist’s care at that time, what they learn about oral health during their treatment will affect how they deal with subsequent complications. Patients receiving radiation therapy need to know about its risks:

-High dose radiation treatment carries a lifelong risk of osteonecrosis, xerostomia and dental cavities

-Because of the risk of osteonecrosis, people who have received radiation should avoid invasive surgical procedures (including extractions) that involve irradiated bone

-Radiation to the head and neck may permanently reduce the quantity and quality of normal saliva. Daily fluoride application, good nutrition and maintaining proper oral hygiene are very important.

-Radiation can change oral tissues. Dentures may need to be remade or relined after treatment is completed and the tissues have become stable. Some patients are never able to wear dentures following cancer treatment again because of friable tissues and xerostomia

-A dentist should closely observe children who have received radiation to craniofacial and dental structures. They want to ensure that abnormal craniofacial growth and skeletal development does not occur.

Cancer can be a very debilitating disease in many areas. But if planned accordingly before cancer treatment, we can limit those issues together and face them head on to create the scenario for the best possible outcome from cancer.