My Blog

Posts for category: Dental Procedures

By Gary W. Machiko, DMD
January 18, 2019
Category: Dental Procedures
Tags: dental specialists  
ComplexMouthConditionsCallforDentalSpecialties

Hopefully, you’ve developed a long-term care relationship with your family dentist. Better known as a general dentist, these professionals are the central players in maintaining your oral health, and your first stop when you have a problem with your teeth or gums.

But there are times when a particular dental situation calls for a specialist, a dentist with additional training (as much as three years or more in their area of specialty) and the equipment and advanced techniques for your particular need. Here, then, are some of the other kinds of dental professionals your general dentist may refer you to if you need specialized care.

Periodontist — From the Latin peri (“around”) and dont (“tooth”), this dentist cares for the supporting structures of the teeth, particularly the gums and bone. Besides treating advanced cases of periodontal (gum) disease, they’re also adept at reconstructive and cosmetic gum procedures or the placement of dental implants.

Orthodontist — Although known commonly as the “braces” doctor, orthodontists have a much wider concern: the interaction and alignment of teeth and jaws. With a keen understanding of growth and development, orthodontists can employ a number of treatments, including braces, to bring teeth into better positions that will improve function and appearance.

Endodontist — Teeth damaged from disease or injury may need treatments that involve the interior of the tooth — the pulp and root canals. While your general dentist can perform basic root canal treatments, an endodontist has the added knowledge and equipment to treat more difficult cases.

Prosthodontist — As with a prosthetic limb that replaces a lost arm or leg, prosthodontists specialize in replacing lost teeth (prostho means “artificial”). Prosthodontists can skillfully create functional, life-like dentures, as well as natural tooth and implant crowns to replace portions of visible teeth.

Oral Surgeon — These dentists are skilled in the diagnosis and surgical treatment of conditions involving the head and neck (the “maxillo-facial” region). They often work in consultation with general dentists and other specialties for treating complex mouth conditions. Besides tooth extraction and other dental procedures, oral surgeons can also surgically correct jaw alignment or treat trauma to the face and neck area. They also place grafts to stimulate bone growth for future implants.

If you would like more information on how dental specialties can benefit your health, 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 “The Dental Universe.”

By Gary W. Machiko, DMD
January 08, 2019
Category: Dental Procedures
Tags: crown lengthening  
CrownLengtheningHelpsusTreatHardtoReachCavities

While we often associate tooth decay with cavities forming in a tooth’s visible or biting surfaces, the occurrence of this all too common disease isn’t limited to those areas. Cavities can develop in any part of a tooth exposed to bacteria.

Gum recession, the shrinking back of the gums from the teeth, can cause such exposure in areas normally covered by the gums. Because these areas are usually more vulnerable to infection when exposed, cavities can develop at or right below the gum line. Because of their location it can be difficult to fill them or perform other treatments.

One way to make it less difficult is to perform a crown lengthening procedure. While the term sounds like we’re increasing the size of the tooth, we’re actually surgically altering the gums to access more of the affected tooth surface for treatment. It’s typically performed in a dental office with local anesthesia by a general dentist or a periodontist, a specialist in the gums.

During the procedure, the dentist starts by making small incisions in the gums to create a tissue “flap” that can be lifted out of the way. This exposes the underlying bone, which they then reshape to support the gum tissue once it’s re-situated in its new position. The dentist then sutures the gums back in place. Once the gums heal, the decayed area is ready for treatment.

Crown lengthening is also useful for other situations besides treating cavities. If a tooth has broken off at the gum line, for example, there may not be enough remaining structure to support a crown. Crown lengthening can make more of the underlying tooth available for the crown to “grab” onto. It’s also useful in some cases of “gummy smiles,” in which too much of the gum tissue is visible in proportion to the tooth size.

Because crown lengthening often involves removing some of the bone and is thus irreversible, you should discuss this procedure with your dentist in depth beforehand. It could be, though, this minor procedure might make it easier to preserve your teeth and even make them look more attractive.

If you would like more information on crown lengthening, please contact us or schedule an appointment for a consultation.

By Gary W. Machiko, DMD
December 29, 2018
Category: Dental Procedures
Tags: porcelain veneers  
ChangeYourSmilefortheBetterwithPorcelainVeneers

Are you tired of those stained, chipped, slightly crooked or—in a word—unattractive teeth? We have an effective solution for you: cover them with life-like porcelain veneers.

As the name implies, a veneer is a thin layer of dental porcelain custom-made to match your tooth’s shape and color and permanently bonded to the outside enamel. With its translucent, light-reflective quality similar to tooth enamel, dental porcelain looks completely natural. Veneers are well suited for minor to moderate imperfections, and can even be used to correct slight gaps between teeth.

We begin the process by performing a comprehensive dental exam to begin planning the exact shape and color of your new veneers. We can now do much of this planning with computer imaging, which may also give you the chance to see how your veneers will look on you after treatment.

We often will also need to prepare the teeth to accommodate the veneers when we bond them. Although the alterations shouldn’t be anywhere near as extensive as with a porcelain crown, we will still often need to remove some of the enamel layer so the veneer won’t look bulky. Even though we’ll remove as little as possible, if needed it will still permanently alter your teeth—so they’ll require some form of restoration from then on.

Once we’ve prepared the teeth, it’s then time to create the veneers. This is typically done by a dental laboratory technician through a manual process that may take several weeks. Increasingly, though, equipped dental offices are now able to generate their veneers in-house with computer-aided design/computer-aided manufacture (CAD/CAM) milling technology.

Once the veneers are ready, they’re bonded securely to the teeth with a detailed process that helps ensure they’ll endure biting and chewing forces for a long time. Still, you’ll need to avoid biting into hard objects or using your teeth for such things as cracking nuts. If you have a clenching or grinding habit, we may also recommend you wear a night guard to prevent excessive forces against not just your veneers but your teeth as well.

By taking good care of them, your new veneers can give you many years of service. Most of all, they can transform your embarrassing appearance into a smile you’re proud to show.

If you would like more information on porcelain veneers, 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 “Porcelain Veneers.”

By Gary W. Machiko, DMD
December 19, 2018
Category: Dental Procedures
JohnnysTeethArentRottenAnyMore

Everyone has to face the music at some time — even John Lydon, former lead singer of The Sex Pistols, arguably England’s best known punk rock band. The 59-year old musician was once better known by his stage name, Johnny Rotten — a brash reference to the visibly degraded state of his teeth. But in the decades since his band broke up, Lydon’s lifelong deficiency in dental hygiene had begun to cause him serious problems.

In recent years, Lydon has had several dental surgeries — including one to resolve two serious abscesses in his mouth, which left him with stitches in his gums and a temporary speech impediment. Photos show that he also had missing teeth, which, sources say, he opted to replace with dental implants.

For Lydon (and many others in the same situation) that’s likely to be an excellent choice. Dental implants are the gold standard for tooth replacement today, for some very good reasons. The most natural-looking of all tooth replacements, implants also have a higher success rate than any other method: over 95 percent. They can be used to replace one tooth, several teeth, or an entire arch (top or bottom row) of teeth. And with only routine care, they can last for the rest of your life.

Like natural teeth, dental implants get support from the bone in your jaw. The implant itself — a screw-like titanium post — is inserted into the jaw in a minor surgical operation. The lifelike, visible part of the tooth — the crown — is attached to the implant by a sturdy connector called an abutment. In time, the titanium metal of the implant actually becomes fused with the living bone tissue. This not only provides a solid anchorage for the prosthetic, but it also prevents bone loss at the site of the missing tooth — which is something neither bridgework nor dentures can do.

It’s true that implants may have a higher initial cost than other tooth replacement methods; in the long run, however, they may prove more economical. Over time, the cost of repeated dental treatments and periodic replacement of shorter-lived tooth restorations (not to mention lost time and discomfort) can easily exceed the expense of implants.

That’s a lesson John Lydon has learned. “A lot of ill health came from neglecting my teeth,” he told a newspaper reporter. “I felt sick all the time, and I decided to do something about it… I’ve had all kinds of abscesses, jaw surgery. It costs money and is very painful. So Johnny says: ‘Get your brush!’”

We couldn’t agree more. But if brushing isn’t enough, it may be time to consider dental implants. If you would like more information about dental implants, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implants” and “Save a Tooth or Get an Implant?

By Gary W. Machiko, DMD
December 09, 2018
Category: Dental Procedures
Tags: oral surgery   orthodontics  
ExposingandPreservingImpactedCanineTeeth

The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.

At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.

Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.

Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.

At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.

If you would like more information on the effects and treatment of impacted teeth, 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 “Exposing Impacted Canines.”