Health Talk With Dr. Gross

My Crown Fell Off. Can You Glue It Back On?

This is such a common question in my office. Every single week, I see patients who present themselves with a crown in their hand…actually, it usually in a little plastic bag… and ask me our lead question for this week. I never know the answer until I examine the patient and possible take an x-ray. My computer repair person has taught me that when something unexpected happens on a computer to ask, “what has changed recently?” The same applies to our unglued crown. Have we started a new diet? Are we under stress and clenching our teeth? Did we just have teeth extracted which resulted in a changed eating habit? The questions can go on and on. I am trying to determine the reason for the loosening of the crown.

Age of the crown is also a factor. The older the crown, the greater the likelihood that the cement started to weaken. If this is all there is, then placing new cement or dental glue will allow me to put the crown back in. The tooth needs to be examined and in the case of an old crown to see if decay is present on the tooth where the cement weakened. I want to be very clear about the previous point. Crowns can not decay, only teeth can decay. So if the underlying tooth gets a cavity, then the existing crown will no longer fit and falls off. If this is the case, I can’t just glue the crown back on. A new crown is needed to cover and aid in protecting the tooth in that area where the decay was presetnt. This decay caused leakage under the crown and the ultimate loosening of the crown.

I just saw a patient last week who asked me to replace a lost crown. She told me that when she tries to put it back in it does not stay. After examining the crown, I saw immediately that the tooth has actually fractured inside the crown. This was due to no back teeth and heavy chewing in the front of her mouth, where her crown was So much pressure was brought to bear on her tooth that it broke and of course the crown then fell out. This is why, there was no way to glue that crown back in the mouth because there was nothing left to hold it.

In cases like that, we have a couple of options. One choice is to remove the tooth and replace it with an implant or permanent bridge. Unfortunately, this is sometimes the only option. If there is a little left of the tooth, I can move the gum away from the tooth and give the tooth more structure to serve as a base for the new crown. So, in this case, the actual tooth does not have to be removed, but a new crown is necessary. I can usually provide a provisional crown for the patient so at least they have a repair to function and provide a tooth for them. I have saved many teeth this way. This is an adaptation of an older technique, which many people are not willing to take the time or spend the effort to do this and save the tooth. Extraction is always easier, but not necessarily appropriate. Also the patient is missing a tooth and has no replacement in comparison to saving the tooth. Schools today, don’t really teach this and many doctors are not even aware of the possibility. This is why, when you present me with a crown in your hands, I have to judge all of the possibilities for repair. Determining the cause and the health of the tooth will drive my decision. If all looks good, I just clean the inside of the crown and the tooth, and glue the crown back in. The next time that something breaks loose or comes off, please call me at 440.951.7856. I will do my best to put you back together as simply and as quickly as possible.

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Permanent Teeth Thoughts

Hi, Can you tell us about your experience at The Healthy Smile?

Yes, and it was great…absolutely wonderful. I’ve been to three dentists before I came here and I had nothing but trouble before. The teeth would not fit in my mouth and as time went by, I became so depressed that I didn’t even want to go out.There was no reason to.

I came here and Dr. Gross took care of me and I love my teeth. They stay in my mouth and life is back to normal again.

Well, we are glad that you love your teeth. Thank you for coming to see us.

Thank you, thank you so much.

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Instant Teeth Create A Great Smile

Hi, How are ya?
Good, how are you?
Good.

How was your experience here at The Healthy Smile?
Absolutely fantastic. Dr. Gross was just so caring and so concerned about everything that was going on.

How do you love your new teeth?
I like my new teeth a lot!

You look wonderful.
A lot better than they were before.

They look fabulous.
Thank you. I think so too.

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Listen to a Positive Experience

How was your experience with The Healthy Smile?
Well, I have to tell you that Dr. Gross is absolutely the Best. I got partials from him
and I put them in and they have been comfortable from the beginning.

So are you happy with your new smile?
Very happy!

Were we friendly and courteous the whole time
that you were here?
Everybody was very courteous and very friendly.

Thank you for being our patient. We look forward
to seeing you the next time.Okay, I’ll see you at my checkup.

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Converting from Removable to Permanent Implant-Supported Dentures

 Implant-Supported Dentures- Smiling man with apple
Updated on April 4, 2017 @ 15:30

The benefits of implant-supported dentures

Implant dentistry has revolutionized the dental industry and the lives of the patients who benefit from them. Today, dental implants are considered the primary treatment option for people with missing teeth. In fact, according to the American Association of Oral and Maxillofacial Surgeons (AAOMS), The average success rate of dental implant treatment is more than 95 percent! People with many or all of their teeth missing will often be prescribed implant-supported dentures. In contrast to traditional dentures, patients with implant-supported dentures (also known as ‘overdentures’) are able to eat, speak, and smile with confidence, knowing that their dentures are securely in place. Furthermore, implant-supported dentures can actually improve a patient’s oral health by improving chewing functions, speech, & preventing jawbone disintegration & loss.

It’s all about the implants

“I currently have removable implant-supported dentures. Can I convert to a permanent solution?” The answer to that is a resounding “maybe”. It all depends on the number and position of the implants. Let’s think about this together. Many people think that you need an implant for each tooth that you are missing. This couldn’t be further from the truth. In fact, with as little as 4 implants, you can support 10-12 teeth.

Removable vs permanent implant-supported dentures & the spacing they require

However, there’s a catch. The implants have to be spaced properly so teeth are not extended way beyond the implants. If there is too much of an extension of permanent teeth beyond the implant, the permanent dentures can break due to lack of support. A denture that you remove and insert that is held in place partially by implants also rests on the gum. It is being supported all over. Implant spacing is important but not as important as in a permanent solution. A denture can be helped and made more stable with as little as 2 implants in the front of the mouth.

Clearly, in the case of front implants only, the teeth in the back have no implant support. They have gum support. A permanent solution requires implant support, not gum support. That requires proper implant spacing.

This doesn’t mean that a permanent solution is not an option if you only have front implants. If the situation allows, implants can be added to the back of the mouth to give proper support for the permanent teeth. Then you can move to permanent teeth and eliminate the denture.

Permanent dentures need space to avoid breakage

The other factor to consider is the space between the top of the existing implants and the top of the teeth that they are chewing against. In other words, if we have existing top implants, we need to measure the space between these top implants and the bottom teeth. It doesn’t make a difference if the bottom teeth are natural, crowns or a denture. Permanent teeth need space to avoid breakage. If the space is too small then the strength of the teeth is compromised and fractures are likely.

Proper evaluation is required

This is why we evaluate you via a visual exam, x-rays, CT scans, and models. There are many factors that come into play and can influence whether or not you can make the conversion from something removable to something that is permanent.

If you have questions about existing dental implants or, even questions regarding if you are a candidate for implant dentistry, please call me at 440-951-7856.  I am more than happy to talk to each and every one of you and help with your dental implant awareness.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

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Should I Drink or Not Drink Coffee?

Once again, that is a great question whose answer goes well beyond today’s column. However, we’ll try and touch on a few points. To even suggest that we cut out coffee is sacrilegious to most coffee drinkers. Part of the reason is that coffee contains caffeine which in and of itself can be habit forming. We need the kick of the caffeine to get us going. We all know that excess caffeine can have negative effects on us and therefore moderating the amount or avoiding some real “high test” versions from our local coffee store may be desirable.

On the positive side, a new study that discussed the relationship of coffee to liver health. Coffee might help reduce cirrhosis of the liver which is associated with eating too much and drinking to much alcohol. Researchers looked at data from previous studies and found that drinking 2-3 more cups of coffee a day was associated with a 44 percent risk reduction in developing cirrhosis of the liver.1 cup per day was associated with almost 22% lower risk of cirrhosis and 4 cups per day was associated with a 65% lower risk. Cirrhosis involves hardening, followed by destruction of liver tissue. This disease is potentially fatal. Coffee is a very complex beverage with hundreds of chemical compounds. Exactly which helps protect the liver we don’t know. Coffee is known to have antioxidant properties as well as reduce inflammation. Of course, if you are obese, smoke or have a poor diet, coffee is not the magic bullet for you, but it definitely will have a role in a healthy lifestyle.

So not that we are drinking 2-4 cups of coffee per day, what happens to our teeth? When we talk about the benefits of coffee, we must all remember that by drinking that super large, extra sweet latte will negate many of the positive effects of coffee. Perhaps more importantly, more than 55% of the drinks in a United Kingdom survey equaled or exceeded the World Health Organization’s maximum daily recommended amount of sugars for teens and adults, which is 30 grams or 7 teaspoons. Also, 35% of the drinks had the same or a greater amount of sugar than a can of Coca-Cola, which has 9 teaspoons. So these drinks will add weight to you and do a number on your teeth resulting in decay and breakdown of fillings.

If we just focus on basic coffee with its positive qualities we still see undesirable consequences to the coffee. Our teeth slowly stain and turn brown. So one easy fix is , to minimize the exposure of the teeth to the coffee. One way is to drink your coffee through a straw. This reduces the time that your teeth are bathed in the liquid. The other way would be to drink coffee in 1 or 1 gulps. Then if you immediately rinse your mouth or brush your teeth there will be less time for the stain to develop. Of course, a large part of coffee drinking is the relaxation and/or social aspect. Guzzling down the coffee will not fit with that lifestyle.

This is where professional cleanings come into play. We can’t or won’t do the suggestions that I just mentioned. We want or desire that very magical beverage. At the same time we desire to maintain that envious and attractive smile. Seeing our hygienists, Sarah or Shani, will help you restore the luster that coffee may have tarnished. If we are talking about cosmetics and a beautiful smile, you can come to us for a cleaning only more often than once every 6 months. Some patients come every 3 months and some come more often for that great looking smile. If you come to us on a monthly basis, we will give you every third cleaning for free. Call us at 440.951.7856 and schedule your visit towards creating a beautiful and healthy smile.

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Some Sugar Free Drink Can Also Damage Your Teeth

I have discussed in the past how sugar free drinks are better for your teeth compared to those filled with sugar, but now there is new information that explains that not all sugar free drinks are created equal and some can actually damage your teeth the same way sugar does.

Researchers at the Oral Health Cooperative Research Centre (Oral Health CRC) based at the University of Melbourne, Australia tested 23 different types of sugar free drinks, (including soft drinks and sports drinks) and found that those that contained acidic additives and those with low pH levels cause damage to tooth enamel.

When ingesting a sugar filled drink, the sugar forms a plaque on the tooth surface that bacteria digest and turn into acid. The acid then attacks the teeth and starts dissolving the enamel. It can progress to where it actually can expose the soft pulp inside the tooth. So, drinks that are acidic can also erode teeth.

Most oral health experts agree that use of sugar substitutes such as xylitol and sorbitol can help reduce tooth decay in children. However, Prof. Reynolds of the Melbourne Dental School notes that consumers need to be aware that many sugar free products remain harmful to teeth due to their chemical composition. Six of the eight sports drinks that were tested in the studies caused a loss of dental enamel. The two that did not cause any problems had a higher calcium content.

The Oral Health CRC is recommending that sugar free products – candy or sports drinks – in addition to soft drinks need to carry labels with this information in order to help the consumer decide what works best for their oral health.

If the labels say that the drink contains acidic additives such as citric acid or phosphoric acid, the following steps are recommended:

1. Do not brush your teeth immediately after ingesting. Rinse your mouth out with water and wait about an hour before your brush.

2. Chew sugarless gum after drinking can help increase saliva flow and neutralize the acid.

The Academy of General Dentistry explains that because saliva helps neutralize acids, the worst time to drink soda is when you are thirsty, due to low levels of saliva. I as well as other experts in the field recommend that you drink water to quench your thirst.

Are you interested in these topics? Did you miss my seminar last week? Just call and ask to talk to me. Better yet, call and schedule a preventative exam and we can talk about whatever you would like. I look forward to hearing from you at 440.951.7856.

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I’m Missing A Lot of Teeth. What Are My Options?

One column is not adequate to talk about all the possiblites for tooth replacement. Many factors come into play when we make a decision. The number of teeth, the location of the missing teeth, the condition of the other teeth in your mouth, time and finances are some of the considerations that we must evaluate.

Many patients place financial criteria first and formost. I’d like to spend some time and discuss some of the options which may work and be affordable to you. Often times, a tooth or teeth which can be removed by you is left behind in our discussions. Today, I want to explore some of these options. Some patients like a removeable partial denture because they are fearful of dental work. Many times this type of replacement teeth can be made without having to do anything to any other teeth in the mouth. This alone is attractive for many of my patients.

Of course if the rest of your teeth go every which way, we may need to do something so that the teeth can come in and out easily. Now once they are in, the teeth need to be stable to allow you to chew. This stability is accomplished by grabbing onto othe teeth for support. If there are not enough other teeth to aid in the fit, then we need to hug the gums for our stability. When I look at restoring missing teeth, I always need to evaluate the rest of the mouth. Gum disease or decay must be dealth with in order to gain proper support.

You must learn to place and remove your removeable partial denture. To some people this is a challenge and to others it is very simple. As my music teacher used to say, “practice makes perfect” Don’t get discouraged if you struggle at first. The partial denture may feel a little strange intially, but within a few days you should become accustomed quite nicely to it. You should never bite your teeth into place. Even though we tell patients with a full denture and implants that biting may be appropriate, but it is not indicated for a partial denture.

Sore spots will appear from time to time. I am more than happy to see you and adjust these for you. Typically, I will never charge you for these visits. Some people would call that a warranty. I’ll let you decide what term you would use to describle that service that I provide.

Modern material and techniques can make your partial almost invisable to anyone around you. But as we all know, it more than just the materials. You need someone with experience who will take time to work with you and understand your needs and desires. I try my best to be that person and spend a lot of time trying to figure out what is best in each situation. If a partial isn’t in your best interest, I am not shy to inform you accordingly. January is almost over. Let’s fix up our teeth for this year. Don’t put off any longer the gift of beautiful smile. Call me at 440.951.7856 and let me help you.

Want more information? Attend a FREE seminar on Thursday, February 18, 2016, 6:00 PM at 34586 Lakeshore Blvd.
We’ll talk about dental implants, tooth replacement and more!
Call 440.951.7856 to reserve your spot as seating is limited.

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I Had A Cavity in My Crown. It Doesn’t Feel Right Now.

Everybody should be asking the same question. If a crown or cap (they are same thing) is not my real tooth, how could I get a cavity? This is really a good question as the term “decay” in the biological world refers to living tissue. By the way the words “decay” and “cavity” have the same meaning in dentistry. So, if a dental cavity can only happen on living tissue, how can my artificial tooth develop a cavity?  It sounds impossible and actually it is.

What typically happens is that due to years of chewing on a crown, some materials, usually metal, can get so thin that they actually develop a hole. Once the artificial tooth, the crown or cap, develops a hole, bacteria can invade the actual living tooth underneath it and create a cavity on the living tooth. In fact decay on the underneath tooth is most common reason that we replace crowns or bridges (made up of multiple crowns). Bacteria attack and wreak havoc on the tooth tissue, not on artificial metal or porcelain.

So let’s get back to our story. What happened with this patient was such extensive decay that when the dentist tried to simply fill the hole, discomfort developed and the tooth then needed a root canal. The root canal was done right through the crown. Now when a replacement filling was done after the root canal into the crown, the bite was no longer even and caused issues with the patient.

What should have happened is the following. Whenever a hole is found on a crown, the entire crown should be removed and the underlying tooth checked and evaluated. If the decay is minimal, then cleaning it up and making a new crown is all that is needed. If the decay is extensive, then the possibility exists for a root canal procedure to be performed. This needs to be done before the crown is redone. That’s exactly what I did. I removed his crown and the rest of the bridge that was attached to it. I then balanced the bite and made him a provisional bridge to evaluate our progress and technique.

We call crowns “permanent”, because you can’t take them off and we have no intention of removing them. Permanent does mean forever. It is used to convey the idea of firmly attaching or gluing it to the tooth underneath.  Crowns will last for many years and even a decade or two, but if you are blessed sufficiently to live long enough, you probably need your crown replaced due to a cavity or glue washing out due to acid and enzymes in your mouth.

This thought underscores the need for a periodic checkup and cleaning. During this time we look at the condition of your existing fillings, crowns, bridges, partial dentures or even full dentures. We can spot signs of wear or breakdown and advise replacement while it is still an easy procedure. If you have any questions about any of your existing work, please feel free to call me at 440.951.7856 and allow me to advise you on the correct approach for your situation.

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Why Won’t My Insurance Pay for White Fillings?

That is such a great question. Before I can answer that, let’s talk about how insurance, specifically dental insurance works. Your insurance that you receive from your employer, union, etc.,  is a contract between your employer and the insurance company. If doesn’t make a difference whether you pay for all of the premium yourself, split it with your boss or it’s a freebie to you. It is still a negotiated contract. The rules and limitations of the contract are all spelled out before anyone signs anything or pays any premium.  The problem usually is that unless you are a dentist, you may not understand the ramifications of all of the exclusions and rules. Almost every insurance plan that I see pays less or doesn’t pay at all for a white filling on a back tooth. I haven’t done silver fillings in over 12 years. So white fillings are not experimental or are they cosmetic per se. They are the way that dentistry has moved to fill back teeth.

However, silver filling still do exist. They are faster to do, they are less money than white fillings  and easier for the dentist to perform. As such the fees for silver fillings are less. Since silver fillings are a legitimate way to fill a tooth, your insurance always reimburses your expenditure in the most favorable way to them. Translate this into English, that means giving your dentist the least amount of money for his work. The insurance company has fulfilled it’s part of their contract by providing you with a filling. If you want current and a state of the art procedure, you need to pay for this yourself.

White fillings are bonded into place and may cause teeth to fracture less over time. Silver as a metal will expand and contract differently and lead to fractures of teeth requiring removing of the tooth or crowning the tooth. Because the white filling is bonded into place, the hole that is made to hold the filling can be smaller than used for a silver filling. Translate this into more conservative dentistry.

Because of bonding reasons, many teeth can be held together better with a white filling than a silver filling. This is important when old silver fillings are replaced and the patient is complaining about developing sensitivity on the tooth.

These are some of the reasons that I choose to you use white fillings as my go to procedure when we find decay in the mouth. If you have any questions about this or any other procedure. Please feel free to call me at 440.951.7856 I am always happy to talk to you.

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