My Blog
By Paul E. Marcuz, DDS, PC
November 29, 2020
Category: Dental Procedures
Tags: missing teeth  
3WaysWeCanImproveaSmileAffectedbyUnformedTeeth

On the way to adulthood, permanent teeth steadily erupt until, if all goes normally, you have a full set of teeth. Sometimes, though, one or more teeth may fail to form. This not only can affect your dental health, but it could also diminish your smile.

For example, if the lateral incisors on either side of the central incisors (the two teeth front and center) don't develop, it could create a smile that's “not quite right.” But we can vastly improve such a smile in one of three unique ways.

The first is to fill the resulting gap through canine substitution. This is an orthodontic method in which we use braces to move the pointed canine teeth, which normally position on the other side of the missing laterals, closer to the central incisors. This choice is determined by the size of the canine teeth. If they are slim in width, they can be re-shaped to make them appear more like a lateral incisor, and the gums possibly reshaped as well around them through cosmetic surgery.

We can also install a dental bridge, an appliance that fills the missing lateral space with prosthetic teeth. A traditional bridge requires the teeth on either side of the gap to be reduced in size, which becomes a permanent alteration to accommodate these crowns. This is a disadvantage in a young person.  We can also use a “bonded bridge” which uses adhesives to attach extended pieces (or “wings”) of dental material from either side of the prosthetic tooth to one or more supporting teeth.  These wings are behind the permanent teeth.  Though not as durable as a traditional bridge, it does avoid altering the support teeth.

Finally, we can replace the missing teeth with dental implants. In this method, we install titanium metal posts into the jawbone at the missing tooth locations and then attach a life-like crown to each one. Implants may be more costly than other restorative methods and can take several months to complete. But they are life-like, highly durable, and don't require any alteration to other teeth. A disadvantage is that you should wait until at least 19 years of age to consider this option.  What many people do is use a temporary solution until the proper age to do a dental implant.

Each of these methods have their advantages and disadvantages, which should be thoroughly reviewed in consultation with your dentist. And each may also require other dental work, such as initial orthodontics to open adequate space for a restoration. But any of these methods for correcting a missing lateral tooth can be effective and help restore both a healthier mouth and a more attractive smile.

If you would like more information on treating congenital dental defects, 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 “When Permanent Teeth Don't Grow.”

By Paul E. Marcuz, DDS, PC
November 19, 2020
Category: Oral Health
Tags: tooth decay  
AddressingRiskFactorsTakingtheFightAgainstToothDecaytoaNewLevel

Tooth decay is more prevalent than diseases like cancer, heart disease or influenza. It doesn't have to be—brushing with fluoride toothpaste, flossing, less dietary sugar and regular dental cleanings can lower the risk of this harmful disease.

Hygiene, diet and dental care work because they interrupt the disease process at various points. Daily hygiene and regular dental cleanings remove dental plaque where oral bacteria flourish. Reducing sugar eliminates one of bacteria's feeding sources. With less bacteria, there's less oral acid to erode enamel.

But as good as these methods work, we can now take the fight against tooth decay a step further. We can formulate a prevention strategy tailored to an individual patient that addresses risk factors for decay unique to them.

Poor saliva flow. One of the more important functions of this bodily fluid is to neutralize mouth acid produced by bacteria and released from food during eating. Saliva helps restore the mouth's ideal pH balance needed for optimum oral health. But if you have poor saliva flow, often because of medications, your mouth could be more acidic and thus more prone to decay.

Biofilm imbalance. The inside of your mouth is coated with an ultrathin biofilm made up of proteins, biochemicals and microorganisms. Normally, both beneficial and harmful bacteria reside together with the “good” bacteria having the edge. If the mouth becomes more acidic long-term, however, even the beneficial bacteria adapt and become more like their harmful counterparts.

Genetic factors. Researchers estimate that 40 to 50 hereditary genes can impact cavity development. Some of these genes could impact tooth formation or saliva gland anatomy, while others drive behaviors like a higher craving for sugar. A family history of tooth decay, especially when regular hygiene habits or diet don't seem to be a factor, could be an indicator that genes are influencing a person's dental health.

To determine if these or other factors could be driving a patient's higher risk for tooth decay, many dentists are now gathering more information about medications, family history or lifestyle habits. Using that information, they can introduce other measures for each patient that will lower their risk for tooth decay even more.

If you would like more information on reducing your risk of tooth decay, 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 “What Everyone Should Know About Tooth Decay.”

By Paul E. Marcuz, DDS, PC
November 08, 2020
Category: Dental Procedures
Tags: dental injury  
ActQuicklyWithaKnockedOutToothtoEnsureItsLong-TermSurvival

We Americans love our sports, whether as participants or spectators. But there's also a downside to contact sports like soccer, football or basketball: a higher risk of injury, particularly to the mouth and face. One of the most severe of these is a knocked out tooth.

Fortunately, that doesn't necessarily mean it's lost: The tooth can be reinserted into the empty socket and eventually return to normal functionality. But it must be done as soon as possible after injury. The more time elapses, the lower the chances of long-term survival.

That's because of how teeth are held in place in the jaw, secured by an elastic, fibrous tissue known as the periodontal ligament. When a tooth is knocked out some of the ligament's periodontal cells remain on the tooth's root. If these cells are alive when the tooth is reinserted, they can regenerate and reestablish attachment between the ligament and the tooth.

Eventually, though, the cells can dry out and die. If that has already happened before reinsertion, the tooth's root will fuse instead with the underlying bone. The tooth may survive for a short time, but its roots can eventually dissolve and the tooth will be lost.

Your window of opportunity for taking advantage of these live periodontal cells is only 5-20 minutes with the best chances in those earlier minutes. You should, therefore, take these steps immediately after an injury:

  1. Find the tooth, hold it by the crown (not the root end), and rinse off any debris with clean water;
  2. Reinsert the root end into the empty socket with firm pressure;
  3. Place clean gauze or cloth in the person's mouth between the tooth and the other jaw, and ask them to bite down gently and hold their bite;
  4. Seek dental or emergency medical care immediately;
  5. If you're unable to reinsert the tooth, place it quickly in a container with milk and see a dentist immediately.

You can also obtain an Android or IOS smartphone app developed by the International Association of Dental Traumatology called ToothSOS, which will guide you through this process, as well as for other dental emergencies. The quicker you act, the better the chances that the injured person's knocked out tooth can be rescued.

If you would like more information on what to do in a dental emergency, 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 “When a Tooth is Knocked Out.”

By Paul E. Marcuz, DDS, PC
October 29, 2020
Category: Oral Health
NBAPlayersInjuryPointsOutNeedforMouthguards

Basketball isn't a contact sport—right? Maybe once upon a time that was true… but today, not so much. Just ask New York Knicks point guard Dennis Smith Jr. While scrambling for a loose ball in a recent game, Smith's mouth took a hit from an opposing player's elbow—and he came up missing a big part of his front tooth. It's a type of injury that has become common in this fast-paced game.

Research shows that when it comes to dental damage, basketball is a leader in the field. In fact, one study published in the Journal of the American Dental Association (JADA) found that intercollegiate athletes who play basketball suffered a rate of dental injuries several times higher than those who played baseball, volleyball or track—even football!

Part of the problem is the nature of the game: With ten fast-moving players competing for space on a small court, collisions are bound to occur. Yet football requires even closer and more aggressive contact. Why don't football players suffer as many orofacial (mouth and face) injuries?

The answer is protective gear. While football players are generally required to wear helmets and mouth guards, hoopsters are not. And, with a few notable exceptions (like Golden State Warriors player Stephen Curry), most don't—which is an unfortunate choice.

Yes, modern dentistry offers many different options for a great-looking, long lasting tooth restoration or replacement. Based on each individual's situation, it's certainly possible to restore a damaged tooth via cosmetic bonding, veneers, bridgework, crowns, or dental implants. But depending on what's needed, these treatments may involve considerable time and expense. It's better to prevent dental injuries before they happen—and the best way to do that is with a custom-made mouthguard.

Here at the dental office we can provide a high-quality mouthguard that's fabricated from an exact model of your mouth, so it fits perfectly. Custom-made mouthguards offer effective protection against injury and are the most comfortable to wear; that's vital, because if you don't wear a mouthguard, it's not helping. Those "off-the-rack" or "boil-and-bite" mouthguards just can't offer the same level of comfort and protection as one that's designed and made just for you.

Do mouthguards really work? The same JADA study mentioned above found that when basketball players were required to wear mouthguards, the injury rate was cut by more than half! So if you (or your children) love to play basketball—or baseball—or any sport where there's a danger of orofacial injury—a custom-made mouthguard is a good investment in your smile's future.

If you would like more information about custom-made athletic mouthguards, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Athletic Mouthguards” and “An Introduction to Sports Injuries & Dentistry.”

By Paul E. Marcuz, DDS, PC
October 19, 2020
Category: Oral Health
Tags: dental care  
IfYouThoughttheLastCenturyWasAmazingforDentalCareJustWait

What a difference a hundred years can make—especially the last one hundred. In the early 20th Century, trains were the prime mode of cross-country transportation, electrical power was not universally available, and only the well-to-do could afford automobiles and telephones. We live in a far different world, transformed by digital media, air travel and instantaneous global communication.

Dental care has also made exponential leaps. Dentists in the early 21st Century have more effective and powerful treatments for disease, as well as life-like and durable restorations for missing teeth and less-than-perfect smiles. As far as dentistry goes, you couldn't live in a better time.

But if you thought the last century was amazing for dental care, you won't believe what may soon be coming your way this century. Here are a few of the incredible possibilities poised to become reality in the near future.

Regenerating teeth. As of now, the permanent teeth you have is all you're going to have—but that may soon change. Researchers are closing in on the ability to grow new dentin—and if that becomes practical, other parts of teeth may be next. Utilizing a person's stem cells, the building blocks of specialized human tissue, may yield the greatest prize of all, a completely regenerated tooth.

Targeting bacteria. Tooth decay and other dental diseases are most often caused by bacteria—but not every strain. The true culprits are a select few like Streptococcus mutans, which causes tooth decay. Based on growing knowledge of the human genome, we may one day be able to develop therapies that block transmission of specific bacteria from caregivers to infants, or inhibit these bacteria's ability to produce acid that erodes tooth enamel.

Employing “nano” tools. Nanotechnology tools and devices are no bigger than 100 nanometers (a nanometer is a one billionth of a meter), and perform tasks on the cellular level. Many researchers believe we may soon develop a device of this size that can seek out and destroy tiny clusters of cancer cells within the human body before they spread. This could be a game-changer for treating deadly oral cancer.

The current state of dental care would have amazed our great-grandparents. But we may soon be just as amazed at what 21st Century brings us.

If you would like more information on advances in dental care, please contact us or schedule an appointment for a consultation.





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