After we have completed the full exam, a lot of patients are ready to proceed with restorative work. There are a variety of restorations that we do in our practice. These include different types of tooth-colored fillings, bondings, veneers, crowns, bridges, implants and dentures.
The key to a successful restoration is ensuring that whatever is done fits in and supports the overall oral system. On the larger level, this requires proper understanding of function, speech, bite, hygiene and so on and on the more detailed level, precision and attention to detail is key.
Restorative procedures in my office typically last thirty minutes for a single filling to ninety minutes for a crown to three hours for restoring a larger section. The reason they are so time consuming is because I pay a lot of attention to detail in order to ensure the best chance of long-term use and comfort of the finished product.
For example, when I do a filling or crown preparation, I use multiple caries detection techniques. One is caries detector which is 95% accurate in identifying diseased remnants of the cavity. Another is the Diagnodent, a light sensor that detects the off gas put out by bacteria. The third method is the halogen light which raises the visibility of the caries. Combined use of these three tools allows for exceptional precision and success in removing the disease from the site being worked on. When this is done, I am ready to proceed with the actual restoration.
For fillings, I use the latest generation of sealers and desensitizers which help to virtually eliminate sensitivity by blocking the tubules where the nerves reside and sealing them closed. Next I place the primer which is essentially a very thin filling below the filling. This is an important step because that is the first line of defense to protect against new cavities. After the primer we put in the solid filling material in stages in layers to ensure proper curing. Finally, we are ready for the tooth-colored top coat, which we customize to the natural teeth colorings surrounding and shape to accurately work with the natural bite process.
When the restoration is too large to be completed with a filling, I typically proceed with some type of crown restoration. I use a Cerec machine to custom mill the restoration. I have chosen this method because it allows for the most conservative type of restoration and the most accurate fit, not to mention that, in most cases, you have your permanent crown the same day, eliminating the need for a second visit.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
Dental Care for Children
Dear Laura,
Let me try to answer your questions as listed.
1. Should root canals be appropriate for a 7 year old?
Root canals are use when the nerve of the tooth is damaged or dead. This will cause the leakage of toxins into the body. Usually an abscess is the result with a variety of consequences. Root canals for children fall into two categories: for permanent teeth or baby teeth. if it is for a permanent tooth it is usually a very good idea. If it for a baby tooth, it depends on how much longer the tooth is needed before its eventual loss. Baby teeth serve many purposes: they are important in helping jaws develop and holding the place for the soon to be present permanent teeth. So whether the baby teeth should be root canaled the answer is maybe. Your dentist will be able to answer the pros and cons for treatment.
2. Should all cavities be filled?
Again, the answer is usually. If the tooth is not in hopeless condition and there is continued need for the tooth then the answer is yes. With a baby tooth I usually try to gauge the size of the cavity with the expected time for the loss of the tooth. If the cavity will not grow to big and cause nerve damage or affect the tooth next to it I will not repair it. I always inform the parent so they can be in on the decisions.
3. Should Mercury fillings be used?
Mercury fillings are also known as Amalgam fillings. The material is approximately 50% mercury and 50% silver. I do not believe it should be used for any reason. Mercury is very dangerous for children and women in the child bearing years. Once mercury enters and is absorbed in the body it is very difficult to remove, not to mention the expenses for removal. There are other materials that will restore the teeth as well without the possibility of risk.
4. How to prevent cavities?
This is a great question. Prevention is where the battle should be fought. So your areas to concentrate on are:
A. Control diet. Everything that can cause cavities should be controlled. The list is numerous but the management is doable.
B. Good oral hygiene with toothbrush and floss. These are very inexpensive and have a huge bang for your buck.
C. The use of sealants. This wonderful tool is very under utilized.
D. Oral hygiene instruction from your dentist. Always ask the dentist or the hygienist for an evaluation at each visit because each hygiene appointment should be a learning time. Patients should clean their own teeth and the professionals should instruct.
E. Frequent hygiene appointments with a dental checkups each visit. This is the standard in our office. This allows for the aforementioned instruction and for the prompt discovery of problems early in the game.
F. X-rays routinly taken. The are invaluable to help in prevention of serious problems. If you can, have digital x-rays taken. Digital x-rays have a significant reduction in the exposure of the x-ray.
I hope this helps.
www.dentalwellnessarts.com
Locked Jaw – What To Do
This week brought two new patients that have locked jaws. Their “TMJ joints” either have been displaced or they are having muscle spams. There was a significant differences in age as well as both sexes.
So what do we do? First, I always start with a full exam. This includes history of the injury or event along with full dental exam. I check muscles and all the related supporting structures to get an idea of the extent of the problem.
A word about x-rays: I recommend a complete set of x-rays as well as additional x-rays of the TMJ. For the x-rays of the TMJ, there is a single cone x-ray called an I-Cat. The I-Cat gives a great hard tissue view of the bone. If I need additional information after I see the I-Cat, I may request an MRI. This kind of X-ray will fill in the blanks of soft tissue information that the I-Cat will not have.
With the combination of the exam, history and supporting documentation can give me a great idea as to the health of the TMJ and a prognosis. Having an accurate diagnosis is what dictates treatment and projected outcome. Based upon this information, I design and make a TMJ splint. A well designed TMJ splint is essnetial for TMJ treatment as well as for aiding in the diagnosis.
Locked jaws are nothing to waste time about. One of the most important factors determining recovery is the time lapse between the event and a visit to your dentist. Time is critical. The sooner care is started the better the chance of complete recovery. I am pleased to say that I expect these two patients from last week to make good recoveries.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
My Brushing Routine
Well I can’t believe I am doing this, but it seems like a good idea to lead by example and share with you how I brush my teeth. Please bear with me.
My routine is preformed 2 times daily, once in the morning and once before bed. I am consistent six days a week, although it may vary depending on how tired I am.
The sequence is floss, then brush, then hydrofloss. Not very exciting, but very practical.
Flossing needs to be taught to you by a dental professional. I use the “wrap around the middle finger technique” that leaves the other fingers free to direct and control the floss. I will floss each side of a tooth ten times. Any floss will do, but I prefer the non-waxed floss because it gives me satisfaction when I hear it start to squeak. I like to floss first because I then use the brushing to remove the dislodged bacteria .
Brushing should take at least four minutes by the clock. How much day dreaming can you do looking at yourself for four minutes twice a day? I find an electric toothbrush to be more efficient and I can very effectively brush in 2 minutes. I use a Rotadent because I think it is the best on the market.
Next is a tongue scraper. This helps with odor control.
Lastly I use a waterpik called a Hydrofloss, also the best on the market. I add a couple cap-fulls of BreathRX to help me with odor control.
Total time: 4 minutes.
Best wishes,
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
Why Does My Veneer Keep Falling Off?
This is a true story told to me by a new patient named Stacey.
Stacey is originally from the East Coast and was given my name by a dentist who attended the Pankey Institute, an entity that teaches a sophisticated way to repair mouths.
Anyway, back to my story. Stacey asked me how long a veneer should last. The answer is usually a long time. Some of the first ones I placed almost 25 years ago are still in the mouth and functioning well. Stacey, on the other hand, has had three replacements of her veneer in the last three years. This is obviously far too frequent, especially since she had had to pay each time. To make matters worse, these three replacements did not include the multiple times she had to have them re-cemented them. When I met Stacey today, she was missing her right front tooth. Obviously this was not a pretty sight and she was not happy. I asked her if she wanted to find out WHY and, to her credit, she decided to let us discover the problem and plan the cure.
So this is what we did…
I started with a complete exam. This told me Stacey’s mouth has three problems:
1. She has been grinding her teeth!
2. The way her bite hit was causing all the force of the bite to come down right on the veneers which caused them to break the cement junction!
3. Her teeth are significantly worn down. This changes the the forces and dynamics of her mouth accentuating the harmful forces.
After completing the exam, I placed a temporary bonding on the front teeth. Stacey was ecstatic and I thought, “not bad if I did not say so myself.”
I also made some molds of her teeth to make her a TMJ splint called a MAGO. This appliance is used to help diagnose the true jaw position called CR (Centric Occlusion) and then we can find true, neutral position. Finally, after discovering the CR and the neutral positions, we are ready for the full diagnosis and we can develop the PLAN.
In the meantime, I think the temporary bonding will last through this time, giving Stacey a temporary beautiful smile while we work to give her her permanent, stable one. I will keep you posted.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
Should Cavities in Baby Teeth Be Filled?
This question was posted by one of our readers, Jess:
Dear Jess,
For the most part, teeth should be fixed as soon as possible. Cavities have a tendency to grow quickly in children, however baby teeth (sometimes called primary teeth) will most likely fall out. Baby teeth are lost over a 5- or so year time frame. The question for the ones with cavities is: will they be lost first or will they abscess? Your dentist should be able to give you an idea as to which ones are at a higher risk for abscess and help you decide a good time frame to follow for treatment.
This situation begs another question as to why your son has so many cavities. This should be addressed so he does not have a repeat experience with the permanent teeth. I encourage you to work with your son in developing good oral hygiene habits as well as good eating habits to help him enjoy a a healthy mouth for the rest of his life.
I hope this answers the questions.
Respectfully,
Help! I’m Grinding My Teeth!
Renee, one of our blog readers, posted this question:
Dear Renee,
Uncontrolled grinding of teeth is never good. In healthy mouths, the amount of time teeth are in contact is very little. It is important to find the reason for your grinding. For some people, some medications can be the cause, but in the majority of cases I see, it has to do with a mal-alignment of teeth.
Teeth serve many roles for the body. One of the important roles is to help position the upper and lower jaws in relation to each other. They act as nerve extenders that are highly sensitive (about 20 million nerves per tooth) so if the teeth do not send the correct message to your brain like “Do not grind” then your natural defense mechanisms are not working. In other words, grinding is used by the body to help keep the jaw in alignment by wiping away the interferences that keep you from closing properly. This is why it is important to find the cause of the interference and address it to protect both the jaw joint and the tooth structures.
Regarding mouth-guard /splints: when made well and properly adjusted, they can be highly effective in protecting the mouth. The key is properly understanding how the mouth is supposed to function so that the splint works in harmony with the jaw joint. I use splints to help me diagnose the extent of the mal-alignment. This help me decide what are the best choices to present to the patient for solution. Once the plan is devised then the implementation can take place. I feel a significant amount of dental problems are related to uncontrolled grinding.
I hope this helps answer your question.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
What Makes a Good Dental Restoration?
After we have completed the full exam, a lot of patients are ready to proceed with restorative work. There are a variety of restorations that we do in our practice. These include different types of tooth-colored fillings, bondings, veneers, crowns, bridges, implants and dentures.
The key to a successful restoration is ensuring that whatever is done fits in and supports the overall oral system. On the larger level, this requires proper understanding of function, speech, bite, hygiene and so on and on the more detailed level, precision and attention to detail is key.
Restorative procedures in my office typically last thirty minutes for a single filling to ninety minutes for a crown to three hours for restoring a larger section. The reason they are so time consuming is because I pay a lot of attention to detail in order to ensure the best chance of long-term use and comfort of the finished product.
For example, when I do a filling or crown preparation, I use multiple caries detection techniques. One is caries detector which is 95% accurate in identifying diseased remnants of the cavity. Another is the Diagnodent, a light sensor that detects the off gas put out by bacteria. The third method is the halogen light which raises the visibility of the caries. Combined use of these three tools allows for exceptional precision and success in removing the disease from the site being worked on. When this is done, I am ready to proceed with the actual restoration.
For fillings, I use the latest generation of sealers and desensitizers which help to virtually eliminate sensitivity by blocking the tubules where the nerves reside and sealing them closed. Next I place the primer which is essentially a very thin filling below the filling. This is an important step because that is the first line of defense to protect against new cavities. After the primer we put in the solid filling material in stages in layers to ensure proper curing. Finally, we are ready for the tooth-colored top coat, which we customize to the natural teeth colorings surrounding and shape to accurately work with the natural bite process.
When the restoration is too large to be completed with a filling, I typically proceed with some type of crown restoration. I use a Cerec machine to custom mill the restoration. I have chosen this method because it allows for the most conservative type of restoration and the most accurate fit, not to mention that, in most cases, you have your permanent crown the same day, eliminating the need for a second visit.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
What is a Full Exam?
In our office the full exam is the initial gathering of all the important information about the patient. The information includes existing tooth conditions, dental history, health history, x-rays, photographs, study models, periodontal review, cancer screening, TMJ exam, orthodontic analysis and esthetic analysis.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
What is a TMJ Exam?
A TMJ exam is the reviewing of the systems that move and support the temporal-mandibular joint. In our office, this has several componants:
1. We examine all the muscles and palpate the joints for discomfort. Healthy TMJs are not sensative to touch.
2. We listen to the movement joint with a Doppler. We are listening for bones rubbing and discs slipping. What we hear can also give us an idea of the health of the bone surfaces and the cartilaginous disc.
3. We also measure the range of motion that the jaw can move. Normal ranges are from 38-45 mm for women and 42-50mm for men.
4. Pain evaluation.
Healthy joints do not pop, click or hurt. If any of these conditions are present, or if other concerns are found during the exam, the patient may be referred for additional diagnostic x-rays, such as the I-CAT.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com
What is Periodontal Review?
As its name implies, periodontal review is examination of the health of your gums.
The first portion of the exam involves periodontal measurements which are readings, taken at the gumline with a hand probe, around each tooth. Measurements are taken millimeters. Healthy gums have a measurement of 0-3 mm and diseased gums are indicated by measurements of 4mm and greater.
Next we examine the gum tissue’s color and texture. Healthy gums are firm and do not bleed. Gum tissue responds rapidly to disease and when disease is present, they will change in color appearance and may begin to bleed.
We also check bone height. The bone supports the tooth and is very susceptible to bacterial infection and trauma from clenching and grinding.
Finally, we examine the esthetic component and look at how the gums line up in relationship to the smile line.
Dr. Boyajian, West Los Angeles
www.dentalwellnessarts.com