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Dental emergencies seem to arise at the most inconvenient times. Some dental emergencies are serious while others are inconveniences at best. Anyone who has had a temporary crown or a permanent dental crown/onlay/porcelain veneer should be aware that it could eventually come off. They may be able to be placed back on, or may need to be completely replaced…But why does it happen?

How Do Dental Crowns Stay On Your Teeth?

Dental crowns are placed over your prepared tooth using a special adhesive cement. This cement has the ability to bond to both your natural tooth structure as well as the inner lining of the dental crown. Depending on the type of dental crown your dentist will use a different type of cement. The shape of the tooth is also important in keeping the crown on. The tooth is prepared by the dentist to be “retentive”, meaning that the shaping of the tooth itself helps to keep the crown on as well.

Why Would My Dental Crown Come Off?

Tooth Decay. A tooth that has a dental crown needs to be kept clean through brushing, flossing and rinsing. Tooth decay can still occur at the margins of the dental crown, (where the crown edge ends and the tooth begins)  and eventually make their way up and under the dental crown. If tooth decay does occur under a crown, it may need a new crown to be fabricated or if the tooth decay progresses far enough a root canal may be needed to salvage the tooth.

Sticky, Chewy Foods. This can occur from continual use or just one time chewing a sticky piece of candy. Generally, over time these sticky, chewy foods can slowly break the cement seal and work a dental crown loose. If it is just pulled off from a candy, your dentist will examine both the tooth and the crown to ensure there is no tooth decay or damage to the tooth or crown. If all is well, your dentist may be able to simply recement the crown and you will be on your way.

Crown Damage. A dental crown is a man made tooth shell that is capable of fracturing or breaking over time. Our teeth absorb extreme amounts of force on a daily basis. The metal or porcelain on a crown can wear through, chip, or fracture.

Oral Habits. Yes, our habits can effect the longevity of a dental crown. Bad habits include teeth grinding (bruxism), clenching, nail biting, ice chewing, using teeth to open packages and bottles, chewing on pens, etc.. These forces will break porcelain, wear metal, and stress the adhesive bond causing the dental crown to loosen over time,.

Small/Short Teeth. This can usually be overcome by your dentist “building” your tooth back up with dental resins but in some instances all of  the teeth are shorter due to teeth grinding. The shortness is directly related to a decrease in retentiveness. This creates an issue over time, as the crown adhesive is working doubly hard to maintain its place on the tooth.

Cement Breakdown. This can occur when the margin seal is broken causing the cement to leak out, or if a small amount of blood or saliva gets under the dental crown while cementing. If there is any moisture (saliva or blood) on the tooth upon cementation this can cause a weaker bond to develop for the cement. This will lead to a loosening of the crown over time. Simple fix in most cases is to just recement the dental crown back on either using a different cement or ensuring the area is clean and dry.

Poor Fit. Sometimes a tooth is not prepared ideally, an impression of the tooth is distorted, the lab creates a poor fit to the tooth, or it is not completely seated on the tooth during cementation. When these issues occur, leakage of bacteria and saliva occur under the crown and loosen it.

Conclusion

As mentioned earlier, a dental crown coming off is a routine dental emergency but usually not a painful one. In many cases (if the dentist is unavailable), the patients try to temporarily recement their dental crown back on using fixodent (denture adhesive), toothpaste, or temporary dental cement from the local drug store. The best course of action is to see your dentist as soon as you can to ensure you do not experience any discomfort, do not swallow the dental crown, or permanently damage the tooth or crown.



Interceptive Orthodontics is a phased type of orthodontics. Growth is utilized to correct developmental occlusion problems. Staging the treatment can correct immediateInterceptive Orthodontics Marielaina Perrone DDS problems and future issues. Interceptive orthodontics simply means diagnosing and treating malocclusions as soon as they are detected. The American Academy of Orthodontics now says all children should have an orthodontic assessment no later than the age of seven.

In the past, orthodontic treatment did not begin until around age 12-14. This is when all the permanent teeth are already erupted or very close to it. It was also common for your dentist to remove  permanent teeth to correct the bite and allow for room for the final phase of tooth movement. Modern orthodontists now advocate a way to keep permanent teeth, with phased  interceptive orthodontics. In interceptive orthodontics, children are treated at much earlier ages (usually between age 7-11 years old) to take advantage of continuing growth. Patients at this age tend to be more receptive to, and compliant with treatment. Interceptive orthodontics allows for fewer teeth to be extracted and also allows for  better end results.

Why Does My Child Need Interceptive Orthodontics?

Parents and patients need to understand that when interceptive orthodontics is performed there is usually more than one phase of of treatment. Phase two will begin when all the permanent teeth are in place. Going through phases allows for the second phase to be shorter in duration, since the major corrections happened in the interceptive orthodontics phase. Sometimes interceptive orthodontics are needed to correct problems related to skeletal development, and sometimes it is needed as a direct result of oral habits.

Correction of Thumb Sucking and Pacifier Habits. Persistent thumb sucking, and extended use of a pacifier effect the development of the mouth. Thumb sucking, and pacifier use after the age of three could result in:

– a reshaped jawbone given its soft and pliable nature

– mis-aligned teeth growing out of position

– narrower dental arches

-extreme tongue thrust habits

– protruding front teeth which may be more susceptible to injury

– “open bites” that would require extensive orthodontic treatment to straighten

Some developmental issues requiring interceptive orthodontics include:

-constricted palate, causes misalignment of back teeth commonly called crossbite

-crowding of teeth

-uneven development of upper and lower jaw

Interceptive Orthodontics Marielaina Perrone DDS

Examples of Interceptive Orthodontics:

Expansion of the upper jaw to eliminate a crossbite

Expansion of one or both jaws to create space for overly crowded teeth

Early removal of specific baby teeth to facilitate the proper eruption of permanent teeth

Maintaining space for permanent teeth after the premature loss of a baby tooth

Reducing the protrusion of upper incisors to decrease the likelihood of fracture from trauma

What are the advantages of interceptive orthodontics?

Some of the most direct results of interceptive treatment are:

-Creating room for crowded, erupting teeth

-Creating facial symmetry by influencing jaw growth

-Reducing the risk of trauma to protruding front teeth

-Preserving space for unerupted teethLas Vegas Cosmetic Dentist Marielaina Perrone DDS

-Expanding the palate to properly position back molars

-Reducing the need for tooth removal

-Reducing treatment time

Is your child a candidate for Interceptive Orthodontics?

Orthodontics is not just for improving the appearance of the smile. Orthodontic treatment improves malocclusions.  Malocclusions occur as a result of tooth or jaw misalignment. Malocclusions affect the way you smile, chew, clean your teeth or even the way you feel about your smile. Recent studies have shown that malocclusions left untreated can result in problems as we age. Crowded teeth are much more difficult to brush and floss which may contribute to tooth decay and periodontal disease. Protruding teeth are more susceptible to accidental chipping. Crossbites can result in unfavorable growth and uneven tooth wear. Openbites can result in tongue-thrusting habits and speech impediments.

Interceptive Orthodontics Conclusion

In the end, orthodontics is not just about a pretty smile. It adds to ones function and ability to maintain healthy teeth throughout their lives.



As we get older, our oral health becomes more important than ever. Maintaining proper oral hygiene is not just for your teeth and gums. Senior adults have unique dental needs and challenges. This includes a vital link between a person’s general health and their oral health. A healthy mouth makes all the difference in the world if you want to feel good, stay healthy, and look great throughout your life. By adopting healthy oral habits at home, seeking regular dental care, and making smart choices about diet and lifestyle, you will be well on your way to keeping your teeth strong and sparkling for a lifetime.

Across the United States, 10,000 adults reach senior age every day and the number is growing rapidly.  Bt age 65, statistics show that older adults are managing a minimum of two chronic conditions and are usually taking multiple medications. The taking of multiple medications increases their risk for dry mouth, which can quickly lead to tooth decay and gum disease. Untreated dental disease can result in pain, infection, poor nutrition, and lowered self esteem, all of which can have a very large impact on the quality of life.

A senior with good oral health not only makes it easier to eat nutritious foods, but it can also give you the confidence to smile, talk, and maintain a high self esteem. Research has shown seniors with good oral health are less likely to develop heart disease, strokes, or diabetes.

Certain dental health problems are more common in seniors, they include the following:

1) Tooth Cavities. Cavities are caused by plaque bacteria which breakdown the enamel and cause holes in the teeth. Soft diet, dry mouth, limited dexterity, a large number of crowns and fillings to clean around, and high sugars or acids in your diet will increase your chances of decay.

2) Periodontal Disease. Seniors are at higher risk of periodontal disease (gum disease). Gum disease occurs when plaque builds up beneath your gum line causing inflammation and bone loss. Certain medications cause the gums to swell and bleed and make it more difficult to remove plaque. This may cause gum recession and periodontal disease.

3) Root Cavities. The roots of the teeth can also decay. Once gums recede, the unprotected root surface is very easy for the plaque bacteria to attack. With no enamel to protect it, the cavity can progress rapidly to the nerve of the tooth.

4) Tooth Sensitivity. As we get older, our gums may recede, exposing root surfaces. The roots have nerve endings close to the surface which can become increasingly sensitive to hot, cold, brushing, and sweets. If you experience sensitivity, try a sensitivity toothpaste (like Colgate Sensitive Pro-Health) . If the problem persists, see your dentist, as the sensitivity may be an indication of a more serious condition, such as a cavity or a cracked or fractured tooth.

5) Dry mouth or Xerostomia. Dry mouth is a common condition in the senior population and one that may be caused by medications or certain medical disorders (like radiation therapy for cancer). If this condition is left untreated, it can cause damage to your teeth. Dry mouth occurs when there is reduced salivary flow. Plaque tends to build up when the mouth is dry, putting you at an increased risk for tooth decay. Your dentist can recommend multiple methods to restore moisture in your mouth, as well as treatments or medications to help prevent the development of cavities. Two products I recommend are Biotene and Listerine Zero.

6) Denture Issues. Many older people wear dentures. If they are not properly cared for, they can cause dental health problems, especially fungal infections such as yeast. A sign of a yeast infection is bright red irritated tissue, itchiness, burning, or a white creamy build up on oral tissues or denture. Just because you have dentures does not mean you do not need a dental examination. You should have an annual check of your denture fit, oral tissues, and oral cancer screening. As well as a jaw x-ray every five years to detect growth or changes in the bone.

 

To help keep your mouth healthy and your teeth strong as we age:

Brush. Brushing your teeth can help to remove the thin film of bacteria that builds up on your teeth after eating. So brush at least twice a day with a soft bristle toothbrush and fluoride toothpaste. An electric toothbrush is recommended for seniors as it easier for them to maintain hygiene properly. Our office recommends the Rotadent electric toothbrush. We also recommend the use of a plaque disclosing solution. This allows the patient to see visually if they left any plaque behind and work on ares they are missing.

Floss.Flossing your teeth can help prevent plaque from building up between teeth. Floss at least once a day. We also recommend the use of floss mate. A variety of companies (Butler GUM floss mate or REACH access flosser), make these products and are easily found at the local drug store. These products work well in patients with minimal or reduced dexterity.

Keep up with dentist appointments. If you maintain a regular appointment schedule your dentist can monitor your dental health and make adjustments to your care to avoid serious problems down the road. Routine dental examinations and cleanings are an important part of maintaining good dental health.

If you smoke…QUIT! In addition to increasing your risk of many health conditions, smoking can increase your risk of tooth decay, gum disease, and oral cancer. There are a variety of methods available to quit to make it as painless a possible.

Take care of dentures. If you have dentures, see your dentist regularly (we recommend at least once a year) to make sure they are fitting properly.

Keep your dentures clean by brushing and rinsing them daily and soaking them at night in a denture cleansing liquid.

There are many dental health challenges as we age, but maintaining good oral hygiene and monitoring to your dental health can keep your smile sparkling for many years to come.

Listerine Zero