Posts for: April, 2014

MakingtheRightChoicesWithRemovablePartialDentures

Removable partial dentures (RPDs) are a common replacement option for multiple lost teeth. However, they're not the best long-term option; in fact, one particular type of RPD could be a poor choice if you wish to wear them long-term.

Made primarily of plastic, these RPDs are sometimes referred to as “flippers” because of how the tongue can easily flip them out of the mouth. While some people see them as a permanent replacement for their lost teeth, in reality plastic-based RPDs are a transitional replacement — a stepping stone, if you will, to a permanent solution. They are most useful during healing following a periodontal procedure or during the waiting period after implant surgery.

However, they can pose problems to your long-term oral health if worn permanently. Because of the manner in which they fit to the gums and any remaining teeth, they tend to settle into and compress the gum tissues. If you have gum disease, they force infection deeper into the tissues. They also allow and promote bacterial plaque growth. This in turn may lead to increased incidences of decay and gum disease.

On the other hand, a metal RPD, ideally made of cast vitallium or gold alloy, fits more snugly and accurately in the mouth. They still can cause increased plaque and food retention, but if the wearer also adheres to sound daily oral hygiene practices, regular dental checkups and diligent care of the RPD, they can be used successfully for many years.

Although a metal RPD costs more than its plastic counterpart, they cost less than more permanent teeth replacements. They are lighter in weight than plastic RPDs and fit more securely to deflect the forces generated by biting.

In considering your options for replacing lost teeth, you should not view plastic transitional RPDs as a permanent solution, but rather as a temporary one until you can obtain a more permanent solution. And although not the most optimal choice, the metal RPD could be considered a more permanent cost-effective solution.

If you would like more information on your options regarding removable partial dentures, 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 “Removable Partial Dentures.”


YourDentistMayHavetheSolutiontoYourSnoringandSleepApnea

Your snoring isn’t just an annoyance to other members of your household — it could indicate a serious health issue. Fortunately, there are treatments, some of which your dentist might be able to provide.

Snoring is the result of soft tissue structures in the back of the throat, including the tonsils, the uvula, the tongue or fat deposits, collapsing on each either and obstructing the flow of air into your lungs. The obstructions produce a vibration that is the source of the snoring.

These obstructions could lead to a serious condition known as Obstructive Sleep Apnea (OSA). As the name implies, the obstruction causes a complete cessation of airflow for several seconds. As oxygen levels drop, the body responds by waking for one to three seconds (known as “micro-arousals”) to restore airflow. These disruptions can occur several times a night, as much as fifty times an hour. The depletion of oxygen and resulting low quality of sleep can contribute to high blood pressure, a higher risk of heart attack or stroke, and the possibility of accidents caused by lower alertness during the day.

You can help reduce the effect of OSA by losing weight and exercising. You may also be a candidate for Continuous Positive Airway Pressure (CPAP) therapy, which utilizes a device that delivers pressurized air into the airway while you sleep.

Depending on the exact cause and extent of your OSA, you might also benefit from treatments provided by your dentist. We can develop a custom-fitted oral appliance, similar to an orthodontic retainer or sports mouthguard, which you wear while you sleep. These devices work by repositioning the lower jaw forward, thereby maintaining an open airway by also moving the soft tissue of the tongue forward. For more advanced conditions, certain surgical procedures that realign the jaw or remove excess tissue, the tonsils and adenoids, or parts of the uvula or soft palate could be considered.

To know your best treatment course, you should schedule a complete oral examination to determine the exact cause of the obstruction, and possibly a polysomnogram, an overnight study performed in a sleep lab. And as your dentist, we might be able to provide the key for a better night’s sleep and a healthier tomorrow.

If you would like more information on how we can address your problems with 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 “Snoring & Sleep Apnea.”


UltrasonicScalerscanEffectivelyCleanMostPatientsGumTissues

While you may most associate professional dental cleanings with that “squeaky” clean feeling you have afterward, there is a much higher goal. What is also referred to as “non-surgical periodontal therapy,” these cleanings seek to remove bacterial plaque and tartar (hard deposits) not only from the visible portions of the tooth but also the root surfaces (scaling), so as to reduce the risk and occurrence of periodontal gum disease.

For generations, this was primarily achieved by dental hygienists using hand-held instruments specially designed to manually remove plaque from tooth surfaces. Since the 1950s, though, a new technology known as ultrasonic or power scaling has become more prevalent in use. Initially only used in the outer most portions of the gum tissue (the supra-gingival area) power scaling is increasingly employed to clean the sub-gingival area, much closer to the tooth roots. As this technology has developed, it’s been shown to be just as effective, if not superior in some cases, to manual scaling for removing plaque and tartar.

Ultrasonic or power scalers work by emitting high vibration energy that crushes and removes plaque and calculus (tartar). The resulting shockwaves also tend to disrupt bacterial cell function. The hygienist uses water to flush away the dislodged calculus. They have a number of advantages over manual scaling: they’re quite effective on deep gum pockets, especially when specially designed tips are used; they require less time than manual scaling; and when used correctly power scalers are gentler to tooth structures.

However, they do have a few drawbacks. Because they produce an aerosol effect, power scalers can project contaminants from the patient’s mouth into the atmosphere, requiring special protective equipment for the hygienist. They’re not recommended for patients with hypersensitive teeth, especially regarding temperature change, or for teeth with areas of de-mineralization (the loss of mineral content in the enamel). Care should be taken when they’re used with implants or porcelain or composite crowns — specially designed tips are necessary to avoid scratching the restoration. They may also have an effect on cardiac pacemakers.

In the end, the best approach is a combination of both power and manual scaling techniques. Depending on your individual needs, ultrasonic scaling can do an effective job in removing plaque and tartar and help you avoid gum disease.

If you would like more information on ultrasonic cleaning techniques, 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 Cleanings Using Ultrasonic Scalers.”


WhenSomeoneYouCareForNeedsToothReplacement

Americans today can expect to have a longer lifespan than ever before. And, as our population ages, our concern is no longer just longevity… it becomes, in addition, the quality of life. These days, the task of helping an older person — perhaps a parent, relative, or friend — to maintain a good quality of life often falls to adult children or others in the extended family. These caregivers have a crucial role in deciding how best to provide for an older person's care.

Eating a healthful diet, getting moderate exercise and having an invigorating social life are factors that can improve quality of life for a person of any age. But we would propose adding one more item: keeping a healthy smile. By age 74, about one in four people have lost all of their permanent teeth. Many more have failing teeth, or only a few teeth remaining. According to actuarial tables, these folks can expect to live, on average, to age 86 — and some will live much longer. That's a long time to go without good replacement teeth.

The Old School: Bridges and Dentures

What's the best method of tooth replacement? The answer depends on several factors. If just a small number of teeth are missing, the best options available are a fixed bridge (also called a fixed partial denture) or a dental implant. If most or all teeth are failing or lost, either complete or partial removable dentures, or implants, may be considered. We'll come back to implants later, but let's look at other methods first.

The dental bridge is a traditional method of closing a gap in your smile — but it has some drawbacks. It requires crowning or “capping” healthy teeth on either side of the gap, so they can be used to anchor a series of prosthetic teeth. This means a significant amount of tooth material must be removed from “good” teeth, which may leave them more susceptible to decay. Root canal treatment may also be required. A bridge can make gum disease more likely, and it is generally expected to need replacement in about ten years.

Removable dentures, both complete and partial, have been around even longer than bridges — in fact, they go back centuries. Denture problems, too, are legendary: They include problems with chewing and speaking, unpleasant smells and tastes, the inability to eat many favorite foods, and the tendency of dentures to become loose and ill-fitting over time. Many of these problems force a person to make compromises in their lifestyle; the last one, however, points to a serious flaw with dentures.

When teeth are lost, the underlying bone in the jaw begins to be resorbed (melted away) by the body's natural processes. This causes the jawbone to become weaker — and, as support for the facial features is lost, it can result in the appearance of premature aging. Dentures don't stop bone loss, in fact, they accelerate it. When dentures stop fitting properly, it's evidence of the process of bone loss at work.

A Modern Solution: Dental Implants

There's a great way to stop bone loss and restore teeth to full function: the dental implant. Whether it's a single tooth or an entire set of teeth that are missing, dental implants are the new gold standard for tooth replacement. Because of the way they become fused with the living bone tissue of the jaw, implants stop bone loss form occurring. They “feel” and function like natural teeth — and they can be almost impossible to tell from the real thing.

A single missing tooth can be replaced by one dental implant, where a bridge would require a minimum of three prosthetic teeth (one for the missing tooth, and two for the supports). On the other hand, an entire arch (top or bottom row) of replacement teeth can be anchored by just four to six implants. And, with regular care, implants can last a lifetime.

So if you're helping someone choose between different methods of tooth replacement, be sure to consider the advantages of dental implants. It's an investment in quality — both the quality of the implant itself, and the enhanced quality of life it provides. If you would like more information, or wish to schedule a consultation, please call our office. You can learn more in the Dear Doctor magazine articles “Dental Implants” and “Removable Full Dentures.”


By Dr. Manson
April 01, 2014
Category: Oral Health
Tags: tooth decay   toothache  
WhatToDoAboutAChildsToothache

It's 3:00 PM, your child has just come back from the school playground — and she's complaining of a toothache that's making her miserable. She can't seem to say if there was a particular injury or a blow, but the more she talks about it, the worse it gets. You're the parent... what are you going to do now?

If you've ever been through this type of situation, you know that a calm demeanor and a little TLC can go a long way. But how do you know whether you're facing a dental emergency, or a routine booboo? Here are a few general rules that may help.

First, relax: Without a fever and facial swelling, a child's toothache isn't usually an emergency. But any tooth pain that keeps a child up at night or lasts into the next day should be evaluated by a dentist. Even if it's nothing but a small cavity (the most common cause of toothache) you don't want to let it go untreated. That could allow it to turn from a small discomfort into a major problem — like a painful abscess.

There are some things you can do at home to try and get a handle on what's causing the pain. Encourage the child to show you exactly where the pain is located, and to tell you when and how it started. Then, examine the area closely. Look for obvious brown spots, or even tiny cavities (holes) on biting surfaces or between teeth, which might indicate decay. Also check the gums surrounding the tooth, to see if there are sores or swelling.

You may find evidence of a traumatic injury, like a cut or bruise — or, if only swelling is apparent, it may mean an abscess has formed. If nothing looks amiss, try gently flossing on either side of the hurting tooth. This may dislodge a particle of food that's causing pain and pressure.

If the pain persists, you can try giving an appropriate dose of ibuprofen or acetaminophen, or applying an ice pack on the outside of the jaw — one minute on and one minute off. But even if you can make the immediate pain go away, don't neglect the situation that caused it. Unless you're absolutely sure you know why the toothache occurred, you should bring the child in for an examination. It will put your mind at rest — and maybe prevent a bigger problem down the road.

If you have questions about toothaches in children, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “A Child's Toothache.”




Contact Us

Steven B. Manson, DDS, FAGD

Long Island City, NY General Dentist
36-01 31st Street
Astoria, NY 11106
(718) 729-8383
Manhattan, NY General Dentist
136 East 57th Street
         Suite 1604
New York, NY 10022