My Blog

By Dr. Edward Portnoy and Dr. Grace D'oria
June 21, 2018
Category: Dental Procedures
Tags: dental implants   smoking  
3ReasonsWhySmokingDoesntMixwithDentalImplants

If you smoke, you know better than anyone how a hard a habit it is to kick. If you want to quit, it helps to have a motivating reason—like lowering your risk for cancer, cardiovascular disease or similar conditions.

Here’s another reason for quitting tobacco: it could be making your teeth and gums less healthy. And, if you’re facing a restoration like dental implants, smoking can make that process harder or even increase the risk of failure.

So, to give your willpower some needed pep talk material, here are 3 reasons why smoking doesn’t mix with dental implants.

Inhaled smoke damages mouth tissues. Though you may not realize it, the smoke from your cigarette or cigar is hot enough to burn the top layer of skin cells in your mouth, which then thickens them. This could affect your salivary glands causing them to produce less saliva, which in turn could set off a chain of events that increases your risk of tooth decay or periodontal (gum) disease. The end result might be bone loss, which could make installing dental implants difficult if not impossible.

Nicotine restricts healthy blood flow. Nicotine, the chemical tobacco users crave, can restrict blood flow in the tiny vessels that course through the mouth membranes and gums. With less blood flow, these tissues may not receive enough antibodies to fight infection and fully facilitate healing, which could interfere with the integration of bone and implants that create their durable hold. Slower healing, as well as the increased chances of infection, could interrupt this integration process.

Smoking contributes to other diseases that impact oral health. Smoking’s direct effect on the mouth isn’t the only impact it could have on your oral health. As is well known, tobacco use can increase the risk of systemic conditions like cardiovascular and lung disease, and cancer. These conditions may also trigger inflammation—and a number of studies are showing this triggered inflammatory response could also affect your body’s ability to fight bacterial infections in the mouth. Less healthy teeth, gums and underlying bone work against your chances of long-term success with implants.

If you would like more information on dental implants, 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 “Dental Implants & Smoking: What are the Risks?

By Dr. Edward Portnoy and Dr. Grace D'oria
June 11, 2018
Category: Oral Health
Tags: dental injury  
JuneIsNationalSafetyMonthBePreparedforDentalEmergencies

The National Safety Council has designated June as National Safety Month. A key component of staying safe is being prepared for emergencies, and this includes dental emergencies. Would you know what to do if you suffered any of the following dental mishaps?

Chipped tooth: One common dental injury is a chipped tooth. If this happens to you, save the missing chip if possible because we may be able to bond it back onto the tooth—but don’t be tempted to glue the chip back on by yourself! However, even without the missing chip, the tooth can most often be repaired with bonding material.

Cracked tooth: If you crack a tooth, rinse your mouth with warm water. If it is bleeding, hold a clean washcloth or gauze to the area until the bleeding stops, but don’t wiggle the tooth around or bite down hard. Keep in mind that the sooner your tooth is repaired, the better. Depending on how bad the crack is, if the tooth can be treated, it will most likely continue to function pain-free for years to come.

Displaced (“luxated”) tooth: If an injury causes your tooth to become loose, shoves it sideways or pushes it into or out of its socket, don’t try to force the tooth back into position on your own. Instead, call the dental office right away and leave it to us to bring the tooth back into its proper place and determine the extent of the injury.

Knocked out tooth: If a permanent tooth is knocked out of your mouth, pick it up without touching the root and rinse it off with cold water, but do not scrub. For the best chance of saving the tooth, place it firmly back in its socket within five minutes and hold it in position for a few minutes. If this is not possible, keep the tooth between your cheek and gum or in a glass of cold milk so that it doesn’t dry out. Call the dental office immediately.

If a baby tooth is knocked out, there is no need to place it back in the socket since baby teeth are not reattached. However, it is still important to have us examine the injury.

Being prepared for dental emergencies can help save a tooth as well as avoid more costly dental treatment down the road. But no matter what type of dental injury you have, it is important to come in for a consultation as the injury may extend beyond the part of the tooth that is visible. With today’s materials and technology, there’s a very good chance your smile can look as good as before—and often even better!

If you have questions about dental injuries, please contact our office or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Artistic Repair of Front Teeth with Composite Resin.”

By Dr. Edward Portnoy and Dr. Grace D'oria
June 01, 2018
Category: Oral Health
GameSetMatchMilosRaonicSaysAMouthguardHelpsHimWin

When you’re among the top players in your field, you need every advantage to help you stay competitive: Not just the best equipment, but anything else that relieves pain and stress, and allows you to play better. For top-seeded Canadian tennis player Milos Raonic, that extra help came in a somewhat unexpected form: a custom made mouthguard that he wears on the court and off. “[It helps] to not grind my teeth while I play,” said the 25-year-old up-and-coming ace. “It just causes stress and headaches sometimes.”

Mouthguards are often worn by athletes engaged in sports that carry the risk of dental injury — such as basketball, football, hockey, and some two dozen others; wearing one is a great way to keep your teeth from being seriously injured. But Raonic’s mouthguard isn’t primarily for safety; it’s actually designed to help him solve the problem of teeth grinding, or bruxism. This habitual behavior causes him to unconsciously tense up his jaw, potentially leading to problems with muscles and teeth.

Bruxism is a common issue that’s often caused or aggravated by stress. You don’t have to be a world-class athlete to suffer from this condition: Everyday anxieties can have the same effect. The behavior is often worsened when you consume stimulating substances, such as alcohol, tobacco, caffeine, and other drugs.

While bruxism affects thousands of people, some don’t even suspect they have it. That’s because it may occur at any time — even while you’re asleep! The powerful jaw muscles that clench and grind teeth together can wear down tooth enamel, and damage both natural teeth and dental work. They can even cause loose teeth! What’s more, a clenching and grinding habit can result in pain, headaches and muscle soreness… which can really put you off your game.

There are several ways to relieve the problem of bruxism. Stress reduction is one approach that works in some cases. When it’s not enough, a custom made occlusal guard (also called a night guard or mouthguard) provided by our office can make a big difference. “When I don’t sleep with it for a night,” Raonic said “I can feel my jaw muscles just tense up the next day. I don’t sense myself grinding but I can sort of feel that difference the next day.”

 An occlusal guard is made from an exact model of your own mouth. It helps to keep your teeth in better alignment and prevent them from coming into contact, so they can’t damage each other. It also protects your jaw joints from being stressed by excessive force. Plus, it’s secure and comfortable to wear. “I wear it all the time other than when I’m eating, so I got used to it pretty quickly,” said Raonic.

Teeth grinding can be a big problem — whether you put on your game face on the court… or at home. If you would like more information about bruxism, contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Stress & Tooth Habits” and “When Children Grind Their Teeth.”

By Dr. Edward Portnoy and Dr. Grace D'oria
May 22, 2018
Category: Dental Procedures
Tags: porcelain veneers  
AvoidPermanentToothAlterationwithNo-PrepVeneers

Porcelain veneers have become a popular way to transform a smile. They're ideal for stained, chipped or slightly misaligned teeth. But although they don't need as much tooth preparation as crowns or other bridgework, the traditional veneer still requires some permanent tooth alteration.

Now, there's an alternative: no-prep veneers. With this option we can avoid any tooth structure removal or keep it to a minimum. And it may not even require local anesthesia while applying them.

Veneers are as their name implies: a wafer-thin layer of tooth-colored porcelain that's bonded to the outside of a tooth, much like siding on a house. Although the traditional veneer is usually no more than a millimeter in width, they can still add an unnatural bulky look and feel to a tooth. To compensate, we remove portions of the enamel. A tooth permanently altered this way will henceforth require some form of restoration.

No-prep veneers are much thinner; they also don't extend under the gum line like traditional veneers. At the most the new veneers may only require us to perform some minor reshaping of the enamel, but not to the extent of traditional veneers. And because your tooth isn't permanently altered, we could presumably remove the veneer and return the tooth to its natural state and appearance (although removing the bonding might not be that easy).

There are some situations where some tooth alteration may still be necessary, like oversized or forward-jutting teeth. A bad bite (malocclusion) may require orthodontic treatment first — which in some cases could be an alternative treatment to veneers altogether.

To find out if you're a candidate for no-prep veneers, visit us for a complete examination. From there we can discuss your options and whether we can transform your smile with little change to your teeth.

If you would like more information on cosmetic solutions like porcelain veneers, please contact us or schedule an appointment for a consultation.

By Dr. Edward Portnoy and Dr. Grace D'oria
May 12, 2018
Category: Oral Health
Tags: snoring   sleep apnea  
NotaFanofUsingCPAPforYourSleepApneaConsideranOralAppliance

Do you wake up in the morning still feeling tired? Are you drowsy, irritable or have difficulty concentrating? And is your snoring habit a running joke around your household?

If you mostly answered yes, you may have obstructive sleep apnea (OSA). This condition is more than an irritation—it could also have major health implications if not addressed.

OSA occurs when the airway becomes temporarily blocked during sleep. The tongue (or other mouth structures like tonsils or the uvula) is often the cause as it relaxes and covers the back of the throat. Although you’re asleep, the brain notices the drop in oxygen and initiates arousal to unblock the airway. As this action usually only takes a few seconds, you may not fully awake every time; but because it can occur several times a night, it can rob you of the deep sleep you need for well-being.

If you’re diagnosed with OSA, your doctor may recommend continuous positive airway pressure therapy (CPAP). This treatment uses a pump device to supply continuous pressurized air through a hose connected to a face mask worn during sleep. The elevated pressure helps keep the airway open.

While this approach is quite effective, many people find wearing the equipment uncomfortable or confining, and may choose not to use it. If that describes you, a qualified dentist may be able to provide you with an alternative called oral appliance therapy (OAT).

OAT uses a custom-made plastic oral appliance you wear while you sleep. The most common snaps over the teeth and uses a hinge mechanism to move the lower jaw (and the tongue with it) forward.

OAT is recommended for people with mild to moderate OSA, or those with severe symptoms who can’t tolerate CPAP. If you’d like to see if an OAT appliance could help you, contact us for a complete oral examination. Either treatment can improve your sleep and daily lifestyle, as well as help prevent certain health issues in the future.

If you would like more information on treatments for sleep apnea, 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 “Oral Appliances for Sleep Apnea.”





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