Smile Solutions by Emmi Dental

Should my Root Canal last forever?

Patients ask me every week why did that dental procedure they had fail by the other dentist. When I explore the question further, it may be a filling placed 10 years ago, or a root canal done 15 years ago, or a crown that got decay below it margins done 13 years ago, or any number of procedures done by me or another dentist.
I then ask what in their body is as good as it was 10-20 years ago. All body parts are in a state of failure. Nothing lasts forever. A new hip or knee may only last 5-10 years. The mouth is a very difficult area to survive in. The mouth has extremes in temperature daily. Drinking fluids that are 40 degrees colder then ambient mouth temperature. Or drinking or eating stuff that is hotter then ambient temperatures. This sometimes happens many times during one meal!! The expansion and contraction caused but radially variant temperatures causes stresses on dental materials.
Additionally, the mouth is a wet damp place and materials and procedures must follow strict protocols to allow the material to adhere to the tooth so that it gets its maximum life expectancy. The dental procedures are also exposed to forces that can exceed their limit of material strength. People that grind or clench notoriously break teeth, fillings and most any dental devise placed in the mouth. Also, many patients have missing teeth or rotated teeth which place loads on teeth that are at angles that cause shear forces beyond their capacity to absorb.
So my rule of thumb for most procedures, unless specifically informed of a reason for less time, is at least a decade. I want to do work that lasts at least that long and most times longer. I always think of my brand new car that I loved and was new and shiny when purchased. After 150,000 miles or 10 years, I have many found memories, but there are certainly scratches, dents and certain failing parts I have learned to accept because of the age and wear and tear on the car. Teeth and dental procedures are no different. If you maintain your teeth as if it was a prized vehicle, garage kept and never driven hard, they will last a very long time. If you “ride” your teeth hard then you will get less time and use from them. It’s just a natural law of cause and effect.
Make sure you have a good relationship with your dentist so he/she can discuss all these parameters before the procedure so you know exactly why you need it and how long it will last you.

“Can you re-cement my crown?”

“Can you re-cement my crown?”
What does this statement mean to a dentist?
1. It could simply mean the cement washed out and needs to be re-cemented.
2. It could be that decay has decayed the tooth so that the crown is no longer viable.
3. It could mean that the tooth fractured under crown.
4. It could mean that the bite is off so the crown loosens due to an off bite.

I see patients every week with this issue. The first step is to access the problem. Patients need to remember that everything in the mouth happens for a reason. It may be that your crown really does need to be re cemented. But the situation has to be evaluated by the dentist.

How long does cement last?
1. It depends on the amount of tooth supporting crown
2. It depends on the type of cement.
3. It depends on the material of the crown
Many things effect the cementation of a crown. It’s a good rule of thumb that if a patient can get a decade out of most of their dental restorations then it was done well.
What are some additional factors effecting crown cementation?
1. The load on the crown dictated by the number of teeth in mouth.
2. The kind of bite the patient has.
3. If the patient is a grinder.
4. How well the patient brushes and flosses.
So as you can see, when I see a patient on my schedule for a “recementation of a crown”, I don’t think it is simply a matter to get the “good” glue out and put it back in.

Call Smile Solutions for more information. 302-999-8113

Should I save my tooth or pull it?

I hear this question every day in my dental office. Unfortunately, many times the patient is in pain and wants immediate relief. The quickest and “cheapest” way to get out of pain is to pull the tooth.
The problem always arises when the patient eventually asks, “How can I replace the tooth so I don’t see the black gap in my smile?” At this point, the answer is slightly more complicated. There are options that involve a removable tooth or a non-removable tooth.
The removable tooth is called a flipper and varies in size but usually is not tolerated well if only replacing one tooth because of the size it needs to be to be strong enough to maintain biting forces. The non-removable tooth can be an implant or a bridge. Both of these choices are more like having a natural tooth.
The bridge advantage is that it can be done quicker. And if the teeth on either side of the space are weak, the bridge will strengthen those teeth. So by filling the space, you have actually improved the overall strength on that side of your mouth. But a disadvantage if the teeth on either side are not weak, then I will have to drill them. And that is done all the time, but now that we have implant therapy, there is an alternative to drilling on good teeth.
An implant to fill a gap is most often ideal. It replaces a single lost tooth with a single implant tooth. Although, implants are not as good as natural teeth they are the best we have at this point in time. Implants can have disadvantages. If a person has lost too much bone then bone must be replaced to get an implant. That additional procedure can be more complicated if it involves the sinus area so the cost can be significant to add and grow new bone. Since implant therapy is an invasive dental surgery, similar to an extraction, the health of the patient matters more. Some medical and habitual conditions affect the healing potential of new bone growth and implant healing. Smoking and diabetes are the two main health issues that cause more risk to implant failure. Although many other conditions are important as well, so a complete medical review and clearance from your Physician is warranted in some situations.
The moral of this story is that making decisions while in pain may result in a more expensive dental procedure to undo what was done to alleviate the immediate concern of pain. The best option is always to maintain good dental hygiene and go to regular dental visits and do the preemptive work before it turns into a painful situation that will lead to poor decisions made from a painful situation.
Feel free to contact my office for a free consultation on this or any dental topic. Call 302-999-8113

Should I feel a cavity? How can I have a cavity if I do not feel it?

I wish that all my patients could feel a cavity on their tooth. My job would be easier and my patients would have better oral health if any small or large cavity was felt as soon as the patient developed it on a tooth because they would call as soon as possible to get it removed. However, that is not how it works in the mouth unfortunately.
Cavities usually develop on enamel first. Enamel is a strong dense boney structure. It does not have pores leading to your pulp (nerve). Because there are no pores in enamel there is no mechanism for you to feel any difference in your tooth. That is a blessing and a curse.
Consider if you developed a tooth ache every single time the enamel started to decalcify or decay? Humans would be in chronic pain or aggravation. I guess it was evolution that allowed us to not feel every single minor ache and pain so we could hunt and gather food. Although, it would make a dentist’s job much easier if the patient told us where it hurts from cavity pain. Patients would be calling and making visits for cavity pain. Or when we saw decay during a cleaning visit, they would say “yeah, I felt that cavity starting”. ”
Conversely, when a patient does feel a “cavity” it’s usually too late to fill. A pain in the tooth from a cavity, mostly, means that the nerve is infected and needs extraction or a root canal. So we are left with getting cavities and having our dentists telling us we have them.
Our office, Smile Solutions, uses an intra oral camera that can actually show the patient a picture of the dark cavity. I try to take one as much as possible so the patient feels comfortable about the procedure and is more educated about their dental health.

If you have any dental concerns, call our office, 302-999-8113, and ask for a free consultation.

Why is my lower denture loose?

Can my lower denture fit better?
A weekly situation in my office, Smile Solutions by Emmi Dental Asssociates, involves a patient asking me to get their lower denture to fit better.
When I explore exactly what they mean by “fit better”, they usually say that their “denture is loose and they want better suction”. The ones with a full upper denture compare the fit and say they want it to be as tight as their upper denture and not move as much. The ones with natural upper teeth want it more like natural teeth.
There are many potential causes for looseness of a lower denture. The primary cause is the anatomy of the lower jaw. Unlike the upper jaw, the lower jaw does not allow for an easily obtained 360 degree seal of denture borders. The denture must allow space for the tongue and the up and down movement of the floor of the mouth. The lower denture must also be fabricated to resist dislodgement by the cheek side gums, called vestibule.
Additional reasons for ill fitting dentures leading to looseness could include:
1. Lack of seal due to inadequate denture border length.
The sides of a denture are called the borders. The borders must be the correct length, not too short or too long for good retention. The borders must also be the correct width to help create a good seal.
2. Resorption of remaining ridge or bone.
There must be enough bone to support a full denture. When a dentist says “you don’t have enough gums” for your denture, what he is really saying is you don’t have enough bone which makes the gums very small and flat. All jaws starts to resorb or disappear once the teeth are removed. It can be a faster process on some versus others but the ridge of the jaw always resorbs once teeth are removed which make denture stability and retention more difficult.
3. Warped denture base.
The surface of the denture touching the gums is called the base. Bases can distort over time if left to dry out when out of the mouth. Also, the ridge can change which makes the denture appear distorted but really it was the jaw that changed not the denture.
4. Decreased in amount and quality of saliva.
A major factor in denture retention is your saliva. Normal saliva aids in the suction of a denture. If your saliva quantity is deficient or if the saliva is thick and ropey the denture will not fit as well. This can be caused by an underlying medical condition or by medicines taken to correct other medical conditions.
5. Patient inability to exert appropriate control of denture by control of tongue, cheeks, and different chewing mechanism of denture versus natural teeth.
Part of the process of eating well with a removable denture is for you to understand that a denture does not function like natural teeth. Therefore, a patient must adapt to how they chew and how they control their tongue and cheeks to help keep the denture in proper position.
Your Dentist must do a thorough examination of your lower ridge, the fit of the denture and determine the changes needed to get a better more comfortable fit of your denture.
Some common solutions are:
1. Perform a hard reline of the denture.
A reline will readapt your denture base to your current ridge anatomy. This can usually be done in a day or two and most times you must go without your denture while the dentist has the reline of your denture completed by a dental lab.
2. Remake the denture.
When a reline is inadequate, a new denture must be fabricated to get the best results. This process can be done in two to five visits under normal conditions. A normal denture should last about 7 years.
3. Or suggest an alternative to a removable denture.
The hands down best alternative and most effective solution to a loose denture is to have dental implants placed to secure your denture. You can have a denture that can still be removed yet held by implants or a denture that cannot be removed that is completely implant supported.
As you can see, there are a multitude of reasons for a loose lower denture. Our body is in a constant state of change. As we age, our jaws change especially when there are no teeth to maintain the integrity of the jaw. If you are experiencing a loose lower denture, go to your dentist and ask for solutions. There is almost always a solution to a loose denture, however, you must decide the extent to which you want to explore to gain the stability and tightness you desire.
Good luck and please call my office, 302-999-8113, if you have any questions or concerns about your denture or for a second opinion to correct your denture problem.

“My Hygienist pulled my filling out!”

Can a hygienist or dentist pull a filling or a crown off during a routine cleaning?
The simplest answer is NO!
Now, I don’t mean to say that a crown or filling won’t be “pulled out” when getting cleaned. But a good filling or crown cannot be pulled out by normal cleaning procedures. If a filling or crown does loosen then it needed to be replaced or re cemented anyway.
Here are a few things that can cause a filling or a crown to be loose.
1. Decay under restoration
2. Cement washout due to decay or defect in restoration.
3. A filling that can no longer support the load of chewing
4. A bite that is too strong for the restoration
5. The tooth may actually be loose
6. An ill-fitting restoration
Our dentists will remove the restoration and evaluate the cause and propose a “smile solution” to the loose restoration
Call our office if you have any concerns or questions. 302-999-8113

Can the dentist fill a chipped tooth versus crowning it?

Most times the Dentist can absolutely fill a chipped tooth instead of crowning it. The question is, should he or she?  A tooth chips most times once it has had a filling that is more than 40-60 % of the tooth’s volume. When a tooth has a large filling, it may look as strong as a natural tooth but it is far from it. No filled tooth is as strong as an unfilled tooth.  Here are some reasons teeth chip:

  1. A biting force was applied at a bad angle and the load was too much to prevent a shearing force fracture.
  2. The filling was past its maximum life cycle and could not support chewing forces as well.
  3. The opposing tooth was too strong compared to the filled tooth and it eventually caused the filled tooth to fail.
  4. It had an undiagnosed fracture

There are more reasons than this why a tooth fractures or chips. The life cycle of a tooth is a small filling, larger filling, crown, root canal, extraction and then an implant, bridge or a partial denture. Like the rest of our body parts the tooth is in a state of decline from the moment it erupts into our mouth. Our hope is that your Dentist can extend the life of the tooth/natural root or implant longer then you need it.

So I recommend fixing the chipped tooth with the strongest material and procedure so that it does not have to be retreated again for another decade or two.  A tooth that chips and is filled beyond its capacity to withstand the future loads is like a tire that gets plugged instead of buying a new tire. It will work but it may fail at a very bad time!

Call our office for a free consultation, 303-999-8113

Can you re-cement my crown?

What does this statement mean to a dentist?

1. It could simply mean the cement washed out and needs to be re-cemented.
2. It could be that decay has decayed the tooth so that the crown is no longer viable.
3. It could mean that the tooth fractured under crown.
4. It could mean that the bite is off so the crown loosens due to an off bite.

I see patients every week with this issue. The first step is to access the problem. Patients need to remember that everything in the mouth happens for a reason. It may be that your crown really does need to be re cemented. But the situation has to be evaluated by the dentist.

How long does cement last?

1. It depends on the amount of tooth supporting crown
2. It depends on the type of cement.
3. It depends on the material of the crown
Many things effect the cementation of a crown. It’s a good rule of thumb that if a patient can get a decade out of most of their dental restorations then it was done well.

What are some additional factors effecting crown cementation?

1. The load on the crown dictated by the number of teeth in mouth.
2. The kind of bite the patient has.
3. If the patient is a grinder.
4. How well the patient brushes and flosses.
So as you can see, when I see a patient on my schedule for a “recementation of a crown”, I don’t think it is simply a matter to get the “good” glue out and put it back in.

Call Smile Solutions for more information. 302-999-8113

Can the dentist fill a chipped tooth versus crowning it?

Most times the Dentist can absolutely fill a chipped tooth instead of crowning it. The question is, should he or she? A tooth chips most times once it has had a filling that is more than 40-60 % of the tooth’s volume. When a tooth has a large filling, it may look as strong as a natural tooth but it is far from it. No filled tooth is as strong as an unfilled tooth. Here are some reasons teeth chip:

1. A biting force was applied at a bad angle and the load was too much to prevent a shearing force fracture.
2. The filling was past its maximum life cycle and could not support chewing forces as well.
3. The opposing tooth was too strong compared to the filled tooth and it eventually caused the filled tooth to fail.
4. It had an diagnosed fracture

There are more reasons than this why a tooth fractures or chips. The life cycle of a tooth is a small filling, larger filling, crown, root canal, extraction and then an implant, bridge or a partial denture. Like the rest of our body parts the tooth is in a state of decline from the moment it erupts into our mouth. Our hope is that your Dentist can extend the life of the tooth/natural root or implant longer then you need it.

So I recommend fixing the chipped tooth with the strongest material and procedure so that it does not have to be retreated again for another decade or two. A tooth that chips and is filled beyond its capacity to withstand the future loads is like a tire that gets plugged instead of buying a new tire. It will work but it may fail at a very bad time!
Call our office for a free consultation, 303-999-8113

Improve Your Smile with Treatment for a Jutted Tooth

A woman looking at her straight teeth after treatment for a jutted toothA jutted tooth can be impossible to hide when smiling or talking. If a protruding tooth has you feeling self-conscious every time you smile or open your mouth, treatment for a jutted tooth can help. Our team at Smile Solutions by Emmi Dental Associates offers a variety of cosmetic dentistry treatments to improve the appearance of jutted teeth and enhance the smile. To find out if treatment for a jutted tooth is right for you, contact our offices in Wilmington, DE.

The Causes of a Jutted Tooth

In many cases, jutted teeth are genetic in nature. Genetics may be responsible for overcrowding of the teeth, which can cause one or more teeth to jut forward. In other cases, genetics may affect the size of the jaw, causing the jaw to be undersized in relation to the teeth. This can also lead to overcrowding, and consequently jutted teeth. 

Genetics isn't the only cause of a jutted tooth. Some people may develop one or more jutted teeth as a result of a condition called tongue thrust. Tongue thrust is a disorder of the swallowing reflex that causes the tongue to push into the upper teeth instead of the roof of the mouth. If left untreated, this consistent pressure can cause the teeth to jut forward.

Another possible cause of jutted teeth is thumb sucking, pacifier use, or bottle use long after the age of two. Regularly sucking on a pacifier, bottle, or the thumb for years after the teeth have erupted can lead to alignment issues, affect the growth of the mouth, and cause one or more teeth to jut forward.  

Effective Treatments for a Jutted Tooth

The best treatment for correcting a jutted tooth will vary according to the needs of each patient, including the extent a tooth protrudes forward, how many teeth protrude, and other oral health issues. Our dentists will work with you to determine which treatment is best suited to your needs.

Some treatments that can effectively treat a jutted tooth include:

  • Porcelain veneers: When one or more teeth slightly jut forward, porcelain veneers may be a viable treatment option. Porcelain veneers treatment transforms the smile using thin, tooth-shaped shells. These fabrications are bonded to the front surface of the teeth to correct minor dental flaws and enhance the overall appearance of the smile.
  • Orthodontics: Orthodontic treatment can improve the alignment of mild to severely jutted teeth. Traditional braces are highly effective at repositioning the teeth and bringing protruding teeth into proper alignment. Those with less severely jutted teeth may benefit from Invisalign® orthodontics for discreet treatment of their alignment issues.
  • Oral surgery: In some cases, treatment with porcelain veneers or orthodontics may not be sufficient to correct severely jutted teeth. For these patients, oral surgery may be the best course of action. Oral surgery can be used to adjust the jawbone and correct the position of jutted teeth. In serious cases, orthodontic treatment may be recommended after oral surgery to fully correct the alignment of the teeth. 

Schedule a Consultation

For more information about treatment for a jutted tooth, or to discuss your treatment options, we invite you to schedule a consultation today.