My Blog

By Christopher Couri, DDS, MS
October 12, 2019
Category: Oral Health
Tags: gum disease  
PeriodontalMaintenanceCanHelpYouAvoidAnotherEpisodeofGumDisease

To keep a healthy smile, brushing and flossing your teeth every day should be at the top of your to-do list, along with regular dental visits. Dental visits are usually scheduled every six months when your dental professional will remove any built-up plaque and tartar (hardened plaque deposits) missed during everyday hygiene.

If you've experienced periodontal (gum) disease, however, these dental visits may become even more important toward preventing a re-infection. For one thing, your dentist may want to see you more frequently.

Gum disease is caused by bacteria living in dental plaque, which first infect the superficial layers of gum tissue. Even though the body initiates an inflammatory response to fight it, the infection continues to grow as long as there is plaque present to fuel it. The problem isn't just plaque on the visible tooth surface—hidden plaque beneath the gum line can create deep pockets of infection that can be difficult to treat.

To stop the infection, dentists must manually remove plaque through procedures known as scaling and root planing. Any and all plaque and tartar deposits must be removed, even those deep around the roots, to arrest the infection. This often requires several treatment sessions and sometimes gum surgery to access areas below the gum line.

These types of treatments, especially in the disease's early stages, have a good chance of restoring health to your gums. But because of the high possibility of reinfection, your dentist will need to step up your regular dental maintenance from now on. This could mean visits as frequent as every few weeks, depending on your particular case of gum disease and your dentist's recommendation.

Your dental visits after gum disease may also become more involved than before. Your dentist will now monitor you closely for any signs of reinfection and at the first sign initiate a new round of treatment. You may also need surgical procedures to make some areas around your teeth more accessible for future cleaning and maintenance.

Periodontal maintenance after gum disease helps ensure another infection doesn't rise up to undermine your progress. To paraphrase a well-known quote, eternal vigilance is the price of continuing good dental health.

If you would like more information on professional dental health maintenance, please contact us or schedule an appointment for a consultation.

By Christopher Couri, DDS, MS
October 02, 2019
Category: Oral Health
Tags: celebrity smiles   retainer  
MargotRobbieKnowsAGreatSmileIsWorthProtecting

On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.

“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”

Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.

Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.

A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.

Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.

So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.

If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”

By Christopher Couri, DDS, MS
September 22, 2019
Category: Oral Health
Tags: jaw pain   tmj disorders  
TwoMouthandFacePainDisordersandWhatYouCanDoAboutThem

Chronic pain affects the quality of life for an estimated 50 million adults in the U.S. alone. The American Chronic Pain Association designates September as “Pain Awareness Month” to highlight the many conditions that cause chronic pain and strategies to manage them. Among these are conditions that can involve your oral or facial health. Here are two painful mouth and face disorders and what you can do about them.

Temporomandibular Joint Disorder (TMD). TMD is a common condition often seen in the dental office. The temporomandibular joints connect the lower jaw to the skull and facilitate activities like eating or speaking that require jaw movement. If they and their associated muscles become inflamed, this can trigger debilitating chronic pain. If you suffer from TMD symptoms, make sure we know about it so we can make your dental visits as comfortable as possible.

When possible, avoid irreversible and invasive treatments for TMD that may permanently change your bite, such as surgery or having teeth ground down. Instead, most healthcare professionals recommend a more conservative approach. Try the following tips to alleviate TMD pain:

  • Eat soft foods so you do not aggravate the jaw joint.
  • Avoid extreme jaw movements like suddenly opening your mouth very wide.
  • Use ice packs and moist heat to relieve discomfort.
  • Ask us about jaw exercises to stretch and relax the jaw.
  • Practice stress-reduction techniques, such as meditation, yoga, tai chi or taking short walks to clear your mind.

Burning Mouth Syndrome. The sensation that the mouth has been burned or scalded without an obvious cause is most common among women during menopause. While researchers can’t yet pinpoint clear causes for it, the list of suspects includes hormonal changes, neurological or rare autoimmune disorders or medication-induced dry mouth.

The first step to treatment is an oral exam along with a complete medical history to identify any possible contributing factors. Depending on the results, we can offer recommendations to manage your symptoms. The following tips often help:

  • Keep your mouth moist. We can recommend an artificial saliva product or medication to increase saliva flow if needed.
  • Change your toothpaste if it contains irritating ingredients.
  • Identify and avoid foods and beverages that seem to precede an episode. These may include spicy foods, coffee and alcoholic beverages.
  • Quit smoking, as this is often linked to burning mouth episodes.

The pain and discomfort caused by these and other oral conditions can put a dent in your life. A visit to your dentist, though, could be the first step to finding relief.

If you would like more information about oral conditions that produce chronic pain, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Seeking Relief From TMD” and “Burning Mouth Syndrome.”

By Christopher Couri, DDS, MS
September 12, 2019
Category: Dental Procedures
ALittleOrthodonticMagicCouldHelpanImpactedToothErupt

Bite problems aren't limited to teeth simply out of position. The problem could be some teeth aren't there—visibly, that is. They still exist below the gums and bone, but they've been crowded out and blocked from erupting. We call this condition impaction.

Any tooth can become impacted and affect the bite, but a person's smile suffers more if it involves visible front teeth. This is especially so if the teeth in question are upper canines or "eye teeth"—the smile doesn't look normal without these pointed teeth on either side of the central and lateral incisors.

Impacted teeth can also contribute to more than a cosmetic problem: they're more susceptible to abscesses (pockets of infection) or root damage both to themselves or neighboring teeth. To minimize these potential health issues, we'll often remove impacted teeth surgically (as is often done with wisdom teeth).

But because of their important role in not only appearance but also bite function, we may first try to assist impacted canines to fully erupt before considering extraction. It takes a bit of orthodontic "magic," but it can be done.

Before we can make that decision, though, we want to precisely locate the impacted teeth's positions and how it may affect other teeth. This initial evaluation, often with advanced diagnostics like CT scanning or digital x-rays, helps us determine if the impacted teeth are in a workable position to save. If they're not, we may then need to consider removing them and ultimately replacing them with a dental implant or similar restoration.

But if their position is workable and there are no other impediments, we can proceed with helping them erupt. To do this we'll have to first expose them by creating a small opening in the gums through minor surgery. We then bond a small bracket to the tooth, to which we'll attach a small chain that we then attach to orthodontic braces. This enables us to exert continuous pressure on the tooth.

Over time, the pressure coaxes the tooth to erupt. We may still need to apply other forms of orthodontics and cosmetic procedures, but using this procedure to rescue impacted canines can produce a healthier and more attractive smile.

If you would like more information on treating complex bite problems, 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.”

By Christopher Couri, DDS, MS
September 02, 2019
Category: Oral Health
Tags: tooth decay  
NewMinimallyInvasiveTechniquesareImprovingToothDecayTreatment

Although techniques and materials have changed, dentists still follow basic principles for treating tooth decay that date from the late 19th Century. And for good reason: They work. These principles first developed by Dr. G.V. Black—the "father of modern dentistry"—are widely credited with saving millions of teeth over the last century.

One of the most important of these treatment protocols is something known as "extension for prevention." In basic terms, it means a dentist removes not only decayed tooth structure but also healthy structure vulnerable to decay. But although effective in saving teeth, practicing this principle can result in loss of otherwise healthy tissue, which can weaken the tooth.

But with new advances in dentistry, decay treatment is getting an overhaul. While Dr. Black's time-tested protocols remain foundational, dentists are finding new ways to preserve more of the tooth structure in a concept known as minimally invasive dentistry (MID).

Better diagnostic tools. Because tooth decay can ultimately infect and damage the tooth's interior, roots and supporting bone, the best way to preserve more of the tooth structure is to treat it as early as possible. Now, new diagnostic tools like digital x-rays, microscopic magnification and optical scanning are helping dentists detect and treat decay earlier, thus reducing how much tissue is removed.

Better prevention methods. Oral hygiene and regular dental care are our basic weapons in the war with tooth decay. In addition, utilizing topical fluoride in combination with a milk-derived product called CPP-ACP dentists can get more of the cavity-fighting organic compound into the tooth enamel to strengthen it against acid attack.

Better treatment techniques. Using air abrasion (a fine particle spray that works like a miniature sandblaster) and lasers, dentists can now remove decayed structure with less harm to healthy tissue than with a traditional dental drill. And new, stronger dental fillings like those made with composite resins require less structural removal to accommodate them.

With these innovative approaches, dentists aren't just saving teeth, they're preserving more of their structure. And that can improve your overall dental health for the long-term.

If you would like more information on minimally invasive dentistry, 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 “Minimally Invasive Dentistry: When Less Care is More.”





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