My Blog
By Dr. Sanford M. Cates
February 18, 2018
Category: Oral Health
Tags: teeth grinding  
TeethGrindingCouldbeCausingYourTeethtobeLoose

There are a lot of reasons (including a blow to the mouth) why one of your permanent teeth might become loose. The most common: advanced periodontal (gum) disease that has weakened the gum attachment to the tooth.

There's also another, less common reason: you have a grinding habit that's producing higher than normal biting forces. Besides accelerating tooth wear, the constant jaw movement and teeth clenching can stretch periodontal ligaments and loosen their attachment to a tooth.

If the gums are disease-free, teeth grinding is most likely the main culprit for the damage, what we call primary occlusal trauma. Our treatment goal here is to reduce the effect of the grinding habit and, if necessary, secure the teeth with splinting while the ligaments heal. We can often reduce the grinding effect with a custom bite guard worn while you sleep. We may also prescribe minor muscle relaxants and mild pain medication like aspirin or ibuprofen.

Sometimes we may need to perform other measures like re-shaping your teeth's biting surfaces so they don't generate as much biting force. You may also benefit from counseling or other psychological treatment to help you address and cope with stress, a prime driver for teeth grinding.

Even if you don't have a grinding habit, biting forces may still contribute to tooth looseness if you have advanced gum disease. Advanced disease results in excessive bone loss, which in turn reduces the remaining amount of ligaments attached to the tooth. This type of damage, known as secondary occlusal trauma, and ensuing tooth looseness can occur even when your biting forces are normal.

It's necessary in these cases to treat the gum disease, primarily by manually removing plaque and calculus (hardened plaque deposits), which causes and sustains the infection. Once removed, the gums can begin to heal and strengthen their attachment. We may also need to apply splinting or perform surgical procedures to encourage gum and bone reattachment.

Whatever has caused your loose tooth, our goal is to remove the cause or lessen its effects. With your tooth secure and the gums regaining their healthy attachment, we have a good chance of saving it.

If you would like more information on teeth grinding and other potentially damaging oral habits, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Loose Teeth: Biting Forces can Loosen Teeth.”

By Dr. Sanford M. Cates
February 03, 2018
Category: Dental Procedures
Tags: gummy smiles  
TreatingaGummySmileStartswithFindingouttheCause

You’re a bit self-conscious about your smile. But not because of your teeth — it’s your upper gums, which seem too prominent when you smile. While “too much” is a matter of perception varying from individual to individual, it’s generally accepted that a smile is “gummy” if four or more millimeters (a bit more than an eighth of an inch) of the gums are visible.

The good news is there are ways to improve the appearance of your gums. Which method we use, though, will depend on the underlying reason why the gums are prominent. The amount of gum tissue, in fact, may not be the problem at all, but could be the size of the crowns (the visible parts of teeth), the upper lip’s range of motion, the upper jaw’s position in relation to the face, or a combination of any of these.

For example, if your teeth didn’t erupt and develop properly, the gums might not have moved back to their proper position and stabilized as they should in your late teens or early twenties. A normal crown (the visible part of a tooth) is about 10 millimeters long, with a ratio of width to length of about 75-85%. Below those measurements the teeth can appear smaller, making even normal gum tissue appear larger. In another scenario, the upper lip may rise too high when you smile (hypermobility), which reveals too much of the gums.

If tooth size is the problem, we may recommend a periodontal surgical procedure called crown lengthening that reveals more of the tooth. A hypermobile lip can be treated with Botox shots to temporarily restrict the movement (it must be repeated every six months) or by surgically repositioning the lip muscles that control movement. Similarly, surgically repositioning an overlong upper jaw to make it appear shorter may be the right course.

That’s why our first step is to determine why your gums are too prominent with a complete dental examination. Knowing exactly why they stand out will help us devise a treatment plan that will greatly enhance your smile.

If you would like more information on improving a gummy smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gummy Smiles.”

By Dr. Sanford M. Cates
January 19, 2018
Category: Dental Procedures
CharlizeTheronBackinActionAfterDentalSurgery

When they’re introducing a new movie, actors often take a moment to pay tribute to the people who helped make it happen — like, you know, their dentists. At least that’s what Charlize Theron did at the premiere of her new spy thriller, Atomic Blonde.

"I just want to take a quick moment to thank my dentists," she told a Los Angeles audience as they waited for the film to roll. "I don’t even know if they’re here, but I just want to say thank you."

Why did the starring actress/producer give a shout-out to her dental team? It seems she trained and fought so hard in the action sequences that she actually cracked two teeth!

“I had severe tooth pain, which I never had in my entire life,” Theron told an interviewer from Variety. At first, she thought it was a cavity — but later, she found out it was more serious: One tooth needed a root canal, and the other had to be extracted and replaced with a dental implant — but first, a bone grafting procedure was needed. “I had to put a donor bone in [the jaw] to heal,” she noted, “and then I had another surgery to put a metal screw in there.”

Although it might sound like the kind of treatment only an action hero would need, bone grafting is now a routine part of many dental implant procedures. The reason is that without a sufficient volume of good-quality bone, implant placement is difficult or impossible. That’s because the screw-like implant must be firmly joined with the jawbone, so it can support the replacement tooth.

Fortunately, dentists have a way to help your body build new bone: A relatively small amount of bone material can be placed in the missing tooth’s socket in a procedure called bone grafting. This may come from your own body or, more likely, it may be processed bone material from a laboratory. The donor material can be from a human, animal or synthetic source, but because of stringent processing techniques, the material is safe for human use. Once it is put in place your body takes over, using the grafted material as a scaffold on which to build new bone cells. If jawbone volume is insufficient for implants, it can often be restored to a viable point in a few months.

Better yet, when grafting material is placed in the tooth socket immediately after extraction, it can keep most of the bone loss from occurring in the first place, enabling an implant to be placed as soon as possible — even before the end of a movie’s shooting schedule.

Will Atomic Blonde prove to be an action-movie classic? Only time will tell. But one thing’s for sure: When Charlize Theron walks down the red carpet, she won’t have to worry about a gap in her smile.

If you have questions about bone grafting or dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Immediate Dental Implant.”

By Dr. Sanford M. Cates
January 04, 2018
Category: Oral Health
Tags: oral hygiene  
HowtoGettheMostfromYourDailyBrushingandFlossing

Twice a year dental cleanings are an important aspect of optimal oral health. But if you’re not brushing and flossing every day, your dental visits could change from regular maintenance to teeth rescue missions.

These two hygiene tasks don’t take long—a single trip with floss around each tooth and a couple of minutes of brushing at least twice a day—but you’ll need to perform them effectively to get the most out of them. Not to worry, though: with a little practice and helpful advice from us, this small investment in time and effort could save your teeth—and your money.

The first thing to know, though, is the reason behind brushing and flossing: to remove disease-causing bacterial plaque that can build up daily on teeth. Bacteria produce acid, which at elevated levels can erode enamel and lead to decay; and some bacterial strains can cause periodontal (gum) disease. These infections could ultimately lead to gum recession, bone deterioration and tooth loss.

Daily brushing and flossing lowers your risk of this occurring. It’s your preference in what order you do them, but for now let’s start with flossing.

There are a number of techniques—and tools—for effective flossing. If you’re using thread floss, simply cut off about 18 inches and wrap each end around the middle finger from each hand. Use the remaining fingers to create a small amount of floss between the two best fingers for a particular area of the mouth and gently pull the floss in between the tooth gap. Form a “C” shape around one of the tooth sides and rub up and down until you hear a squeak (which you’ll only hear if you use un-waxed floss). Now, repeat the action with the adjacent tooth, then move to the next and each succeeding gap and do the same until you’ve cleaned each side of each tooth.

When brushing, hold your toothbrush gently like a paintbrush or pencil at about a 45-degree angle with just a small amount of toothpaste on the end bristles. All it takes is a gentle scrubbing or wiggling motion and the abrasives and detergents in the toothpaste will do the rest.  Just make sure you fully brush all your teeth and gum surfaces, which should take about two minutes.

Along with regular dental visits and a low-sugar diet to discourage bacterial growth, brushing and flossing will help you avoid disease and enjoy the best oral health possible.

If you would like more information on keeping your teeth and gums clean, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Daily Oral Hygiene: Easy Habits for Maintaining Oral Health.”

By Dr. Sanford M. Cates
December 20, 2017
Category: Oral Health
Tags: oral health  
WithProperCareyoucanLowerYourRiskofToothLossasYouAge

While your chances of losing teeth increase as you age, it's not a given. With proper hygiene and care your teeth could last a lifetime.

But brushing and flossing can become more difficult in later years. Arthritis or strength issues in the fingers and hands make holding a toothbrush an arduous chore and flossing next to impossible.

But you can accommodate these physical changes. Many seniors find using a powered toothbrush much easier to handle and effective for removing disease-causing plaque. A tennis ball or bike handle grip attached to a manual toothbrush can also make it easier to handle. As to flossing, older people may find it easier to use floss threaders or a water irrigator, which removes plaque from between teeth with a pressurized water spray.

You may also find changes in the mouth that increase your risk for dental disease. One such issue is xerostomia, dry mouth. As you age you don't produce as much saliva, which neutralizes acid and restores minerals to enamel, as when you were younger. Dry mouth can also be a side effect of certain medications. Older people are also more likely to suffer from gastric reflux, which can introduce stomach acid into the mouth.

With these dry, acidic conditions, you're more susceptible to both tooth decay and periodontal (gum) disease. You can help offset it by increasing water consumption, taking a saliva stimulator, changing to alternative medications if available, and relieving gastric reflux.

Another area of concern in aging is the higher risk for inflammatory diseases like diabetes or cardiovascular diseases (CVD), which could also increase your risk of periodontal (gum) disease. Seeking treatment for gum disease and other similar systemic diseases may help ease the effects of each one.

Taking care of your mouth can be challenging as you grow older. But tooth loss and other unpleasant results aren't inevitable. Invest in your teeth and gums today and you're more likely to have a healthy life and smile all through your golden years.

If you would like more information on caring for your teeth and gums as you age, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Aging & Dental Health.”





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