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.”

By Dr. Manson
March 24, 2014
Category: Oral Health
Tags: gum disease   loose teeth  
TreatingLooseTeethandtheUnderlyingCauses

Adult teeth aren’t meant to be loose — it’s a sign that something is wrong. And while there are treatments, time is of the essence before permanent tooth or bone loss occurs.

Loose teeth can occur for many different reasons. Bite-related problems are fairly common, referred to as occlusal trauma (“occlusal” – bite; “trauma” – injury). This could be the result of excessive force placed on otherwise normal teeth and jaws — chronic clenching or grinding habits, for example. On the other hand, even normal biting or chewing can cause teeth to loosen if bone loss from gum disease has become excessive, reducing the remaining attachment to bone to inadequate levels. In some cases it can be a result of both excessive force and weakened bone levels.

Of these reasons, the most common cause is the weakened attachment of the teeth to the bone due to gum disease. If this is the case, it’s important first to treat the gum disease by an appropriate strategy for the disease present and then implement an effective dental hygiene program to inhibit reoccurrence.

As for the problem of loose teeth, there are measures to address it. Occlusal bite adjustment reduces the degree of force when biting or chewing by reshaping the biting surfaces through selective grinding. Splinting is another technique in which the teeth are joined together to make them more rigid and to redistribute the biting force among several teeth. This can be done with material bonded across the outside of several teeth or with a metal splint affixed within a pre-cut channel across the teeth. A more permanent option is to create a series of crowns to affix to the teeth and then fuse them together.

Although more complex, orthodontics to correct misaligned teeth is another option. Not only will it improve the bite and potentially reduce bite forces, it may also improve the health of the supporting periodontal attachment.

Before undertaking any treatment, you should first undergo a thorough exam to determine the true cause of your loose teeth and any underlying conditions. From there we can recommend the best approach for treating and preserving your teeth.

If you would like more information on treatments for loose 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 “Treatment for Loose Teeth.”

PlanYourSportsNutritionandHydrationtoReduceToothDecayRisk

If you or your family has an active sports lifestyle, you probably already know the importance of food and liquids for energy and hydration. But what you eat and drink (and how often) could unintentionally increase your teeth’s susceptibility to tooth decay. With that in mind, you should plan your nutrition and hydration intake for strenuous exercise to maximize energy and reduce the risk of tooth decay.

On the general health side, carbohydrates are your main source of energy for sports or exercise activity. You should eat a substantial carbohydrate-based meal (such as pasta, cereal or sandwiches) a few hours before a planned event. An hour before, you can snack on something easily digestible (avoiding anything fatty) to prevent hunger and as additional energy fuel.

It’s also important to increase your liquid intake before strenuous activity to avoid dehydration, usually a couple of hours before so that your body has time to eliminate excess fluid. During the activity, you should drink three to six ounces of water or sports drink every ten to twenty minutes to replace fluid lost from perspiration.

While water is your best hydration source, sports drinks can be helpful — they’re designed to replace electrolytes (sodium) lost during strenuous, non-stop activity lasting more than 60 to 90 minutes. They should only be consumed in those situations; your body gains enough from a regular nutritional diet to replace lost nutrients during normal activity.

In relation to your oral health, over-consumption of carbohydrates (like sugar) can increase your risk of tooth decay. The acid in most sports drinks also poses a danger: your teeth’s enamel dissolves (de-mineralizes) in too acidic an environment. For these reasons, you should restrict your intake of these substances — both what you eat and drink and how often you consume them. You should also practice regular oral hygiene by brushing and flossing daily, waiting an hour after eating or drinking to brush giving your saliva time to wash away food particles and neutralize the acid level in your mouth.

Knowing what and when to eat or drink is essential to optimum performance and gain in your physical activities. Along with good oral hygiene, it can also protect your oral health.

If you would like more information on the best sports-related diet for both general and oral 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 “Nutrition for Sports.”

By Dr. Manson
March 12, 2014
Category: Oral Health
Top5SymptomsofGumDisease

Do you have gum disease? According to the U.S. Centers for Disease Control, about half of the adults in America have a mild, moderate or severe form of this disease. But if you’re 65 or older, your chance of having it goes up to 70 percent! Periodontal (gum) disease is sometimes called a “silent malady” because major symptoms may not appear until it has reached an advanced stage. How can you recognize the early warning signs? Here are some clues to look for:

  1. Redness and irritation of gums. Having red, swollen or sore gums can be a sign of gum disease; however, it could also result from brushing your teeth too vigorously, or using a brush with hard bristles. That’s why we recommend using a soft-bristled brush and a gentle cleaning stroke. If you’re doing this but you still have irritated gums, it could be an early signal of gum disease.
  2. Bleeding when you brush. Despite what you may think, this is never a normal occurrence. If your gums regularly bleed after brushing, it’s usually an indication that gum disease is present. You should come in for an examination as soon as possible.
  3. Bad breath or a bad taste in your mouth. Bad breath or unpleasant tastes could be caused by what you ate last night — or they could result from gum disease. If the odor or taste is persistent — that is, if it doesn’t seem to go away over time — it could indicate a problem with your gums.
  4. Gum recession. When you have gum recession, the healthy, pink tissue surrounding the teeth begins to pull back, or recede. This exposes more of the tooth’s structure — even its roots — and makes teeth look longer. While gum recession is a common condition that is primarily caused by periodontal disease, many people don’t realize they have it because it occurs so gradually. They also may not realize that by the time it is noticed, some underlying bone tissue has already been lost. Gum recession is a condition you shouldn’t ignore: If left untreated, it can result in the destruction of more gum and bone tissue, and even tooth loss.
  5. Tooth Sensitivity or pain when chewing. Many things can cause tooth pain or sensitivity: an old filling, tooth decay, even a cracked tooth or a root canal problem. Gum disease can also cause this unpleasant sensation. Receding gums may expose the tooth’s roots, which aren’t as well protected from the mouth’s harsh environment as the chewing surfaces; this may cause a sensation of pain when chewing or brushing. If this sensation persists, it’s time for an examination to find out what’s causing it.

Gum disease is a widespread problem — but it’s also very treatable. If you would like more information, call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Warning Signs of Periodontal (Gum) Disease” and “Understanding Gum (Periodontal) Disease.”





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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
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New York, NY 10022