My Blog

Posts for: August, 2014

By Paul D. Nifong, Jr, DDS, PA
August 25, 2014
Category: Oral Health
Tags: dental implants   oral health   smoking  
SmokingmayIncreasetheRiskofEarlyImplantFailure

In a recent study, 92% of dental implants were found to have survived the twenty-year mark — an impressive track record for any dental restoration.

Still, implants do fail, although rarely. Of those failures, tobacco smokers experience them twice as often as non-smokers. The incidence of early failure (within the first few months after implantation) is even higher for smokers.

Early implant failure typically happens because the titanium implant and the surrounding bone fail to integrate properly. Titanium has a natural affinity with bone — the surrounding bone will attach and grow to the titanium in the weeks after surgery, forming a strong bond. An infection around the implant site, however, can inhibit this integration and result in a weaker attachment between bone and implant. This weakness increases the chance the implant will be lost once it encounters the normal biting forces in the mouth.

Smokers have a higher risk of this kind of infection because of the way tobacco smoke alters the environment of the mouth. Inhaled smoke burns the mouth’s top skin layers and creates a thick layer of skin called keratosis in its place. Smoke also damages salivary glands so that they don’t produce enough saliva to neutralize the acid from food that’s left in the mouth after eating. This creates an environment conducive to the growth of infection-causing bacteria. At the same time, the nicotine in tobacco can constrict the mouth’s blood vessels inhibiting blood flow. The body’s abilities to heal and fight infection are adversely affected by this reduced blood flow.

The best way for a smoker to reduce this early failure risk is to quit smoking altogether a few weeks before you undergo implant surgery. If you’re unable to quit, then you should stop smoking a week before your implant surgery and continue to abstain from smoking for two weeks after. It’s also important for you to maintain good brushing and flossing habits, and semi-annual dental cleanings and checkups.

Although smoking only slightly raises the chances of implant failure, the habit should be factored into your decision to undergo implant surgery. Quitting smoking, on the other hand, can improve your chances of a successful outcome with your implants — and benefit your life and health as well.

If you would like more information on the effects of smoking on dental health, please contact us or schedule an appointment for a consultation.


By Paul D. Nifong, Jr, DDS, PA
August 15, 2014
Category: Dental Procedures
AvoidingtheJimCarreyChipped-ToothLook

Fans of the classic bumbling-buddies comic film “Dumb and Dumber” will surely remember the chipped front tooth that Jim Carrey sported as simpleminded former limo driver Lloyd Christmas. Carrey reportedly came up with the idea for this look when considering ways to make his character appear more “deranged.” He didn't need help from the make-up department, however… He simply had his dentist remove the dental bonding material on his left front tooth to reveal the chip he sustained in grade school!

Creating a Bond
A dental cosmetic bonding involves application of a composite filling material that our office can color and shape to match the original tooth. Bonding material can be used to replace the lost portion of tooth or to seamlessly reattach the lost portion if it has been preserved and is otherwise undamaged. Little to no removal of existing tooth surface is needed. This is the quickest and lowest-cost option to repair a chip.

Alternatives
When a relatively large portion of the tooth is missing, a crown is often the better choice. It fully encases the visible portion of the remaining tooth above the gum line and is shaped and sized to match the original. It can be made of tooth-colored porcelain fused to metal crowns or all-ceramic (optimal for highly visible areas). A small amount of the existing tooth surface will be removed to allow the crown to fit over it.

A veneer can be used to hide smaller areas of missing tooth. This is a thin, custom-made shell placed on the front of the tooth to give it a new “face.” Some removal of existing tooth surface also may be necessary to fit a veneer.

A chipped tooth makes an impression, but generally not a flattering one. Nearly 20 years after “Dumb and Dumber” hit the theaters, the only thing Jim Carrey had to do recently to hint at a sequel for his nitwitted character was tweet a photo of that goofy grin!

If you would like more information about repairing a chipped tooth, 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 “Artistic Repair of Front Teeth With Composite Resin.”


By Paul D. Nifong, Jr, DDS, PA
August 01, 2014
Category: Oral Health
Tags: gummy smile  
FrequentlyAskedQuestionsaboutGummySmiles

Q: What is a gummy smile? I’ve never heard that term before.
A: You may not have heard the phrase, but you’ve probably noticed the condition. A “gummy smile” occurs when too much gum tissue (in technical terms, over 4 millimeters, or about one-eighth of an inch) is visible in the smile. Different people have different ideas about when this issue becomes a problem… but if you feel it detracts from your appearance, there are several ways dentists can treat a gummy smile.

Q: What can cause a smile to appear “gummy”?
A: A number of factors can contribute to this perception. One is simply that an excess of gum tissue is covering up the teeth. Another is that the teeth themselves are relatively short; this can be a natural anatomical feature, or it can result from the teeth being worn down by a grinding habit or another cause. In some cases, the problem is that the upper lip is hypermobile, meaning it rises too high when you smile. And in rare instances, the upper jaw is proportionately too long for the face, making the gums and teeth extend down too far.

Q: What’s the best way to fix this condition?
A: It all depends on what is causing the smile to appear gummy. If it’s too much gum tissue, a periodontal procedure called “crown lengthening” can be used to remove the excess tissue and reveal more of the teeth. If the teeth themselves are responsible, they can be crowned (capped), or covered by porcelain veneers. A hypermobile lip can be controlled temporarily with Botox injections, or permanently with a minor surgical procedure. Jaw problems present the most complex condition, but can be successfully treated with orthognathic (jaw-straightening) surgery. Orthodontic treatment may also be recommended in conjunction with these therapies.

Q: I’m unhappy with the way my smile looks, but I’m not sure exactly what’s wrong. What should I do?
A: A great-looking smile comes from the harmonious dynamic between teeth, lips and gums. If you feel your smile could use a little improvement, we can help you identify the things you like about it, and point out the things that need improvement. Working with an experienced cosmetic dentist is the best way for you to get the smile you’ve always dreamed about.

If you’d like more information about cosmetic gum treatments or cosmetic dentistry in general, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Gummy Smiles.”