What’s the difference between a crown and a cap?

Posted December 30th, 2014 by Dr. John Artemenko, DDS and filed in Dental Articles

These are restorations to repair a severely broken tooth by covering all or most of the tooth after removing old fillings, fractured tooth structure, and all decay.  The restoration material is made of gold, porcelain, composites, or even stainless steel. Dentists refer to all of these restorations as “crowns”. However, patients often refer to the tooth-colored ones as “caps” and the gold or stainless steel ones as “crowns”.

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A Crown in a single visit?? ….CEREC

Most dental restorative methods require more than one visit to the dentist. This means that on the first visit, you get an injection of anesthesia, your tooth prepared, an impression taken, and a temporary restoration put on your tooth. You make a second appointment for a couple of weeks later, and get an injection, have the temporary pried off, and have a permanent restoration put on. Why go to the dentist a second time when you don’t have to? With CEREC, the procedure is done in a single appointment, start to finish.

What is CEREC and how does it work?

CEREC (Chairside Economical Restoration of Esthetic Ceramics) is made by Sirona Dental Systems, Inc., an international company that designs, manufactures, and markets dental equipment. It was founded in 1997 when the dental division of Siemens AG was bought out.

CAD/CAM stands for Computer Aided Design and Computer Aided Manufacturing, and is a type of vector software used by other professions besides dentistry – engineers, for example. It combines aspects of graphics and mathematics to create very precise designs in three dimensions.

A CEREC tooth restoration isn’t just convenient, it is also healthy. Many years ago, dentists had few options to repair decayed and damaged teeth other than amalgam, gold, and other metals. With CEREC, Dr. Artemenko can use strong, tooth colored ceramic materials to restore your teeth to their natural strength, beauty, and function. These materials closely match the composition of natural tooth structure. This means when you eat hot food and then drink something cold, the restoration and tooth expand and contract at almost equal rates. So, your tooth does not crack, and you can go on enjoying your evening. Also, the materials are chemically bonded to your tooth, so Dr. Artemenko can save as much healthy tooth tissue as possible while providing you with a dental restoration that strengthens your tooth.

Regular dental exams are essential to preventing problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for decay. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.

Gum recession

Gum recession is a common problem affecting millions of Americans to some degree. If you have it, you will notice that the pink gum tissue surrounding one or more of your teeth has shrunk or receded and left the tooth-root surfaces exposed. How does this happen? And does it require treatment? The answers to both of these questions will vary from person to person. The good news is that treatment is available for those who need it.

The way you care for your teeth can be a major factor in gum recession. If you do not effectively remove plaque (bacterial biofilm) from your teeth daily, you may develop gum inflammation, gum disease and/or recession. Conversely, if you brush or floss too hard or for too long, you can also damage your gums. Please remember that it doesn’t take a lot of pressure to remove biofilm; you just need to make sure you get to each tooth, right down to the gum line.

Other causes of gum recession include: mal-positioned and/or prominent teeth that are not fully encased in supporting bone; muscle attachments (frenums) pulling at the gum line; habits such as holding foreign objects (nails, pins) between the teeth that press on the gum tissues; and badly fitting oral appliances such as dentures, braces and?? even tongue bolts and lip piercings.

Besides not looking too great, gum recession can lead to anything from minor tooth sensitivity to tooth loss in the most severe cases. If you are experiencing any discomfort from a loss of gum (also called “gingival”) tissue, we’d certainly like to know about it. We would be happy to examine your condition and make recommendations.

I can actually see a halo Where the nerve used to be…..


You may have heard Dr. Artemenko mention at your restorative appointment that he can actually see a halo to wear the nerve in the tooth has previously been…..
With most restorative dental work, we remove the decay from the tooth without anticipation that a root canal will be needed unless Dr A has reviewed an Xray and related to the patient a concern of nerve exposure once the decay would be cleaned out of the tooth completely.  In the cases when we let the patient know it may be a possibility we have removed the decay to run into an area that seems to appear as a pink/brown halo indicating where the nerve had been prior to secondary dentin or reparative dentin had been laid down inside the tooth as we mature in age. In most cases it could be said that if the person had been 5-10 years younger the nerve would’ve been exposed at that point but (as seen in the picture) we get to a point where inside the tooth, the dentin continues to lay tooth structure down at a very slow rate. We can place a medicated liner to help with any future sensitivity knowing we are within paper thickness of the nerve away.  Although I have heard Dr A mention this to patients over the years, I have not been able to see this appearance myself as Dr A uses ‘loops’ (magnified glasses) and I do not. I thought I would share this information to those who have been fortunate due to maturity to avoid a root canal procedure, to see it for themselves!

After existing restoration had been removed, the chalky/black area of decay exposed

After removal of the decay the ‘Halo’ is now visible

The final completed restoration

Foods and Habits That Stain Your Teeth

Determined to keep those pearly whites their whitest? You already know how important it is to brush and floss daily and to see a dentist periodically — and to avoid smoking or chewing tobacco. But dentists say you should also be mindful of certain foods and beverages that stain teeth.

As you might imagine, intensely colored foods and beverages tend to be the biggest offenders. “If you’re worried about spilling [the food or beverage] on your white tablecloth, you can be sure it’s got the potential to stain teeth,” says Matthew J. Messina, DDS, a dentist in private practice in Cleveland. “The more intense the color, the more potential there is for staining.”

The color in these foods and beverages comes from chromogens, intensely pigmented molecules with an unfortunate penchant for latching on to dental enamel. But the presence of chromogens isn’t the only thing that determines the staining potential of foods and beverages.

Acidity is another factor. Acidic foods and beverages — including some that are not brightly colored — promote staining by eroding the dental enamel, temporarily softening teeth and making it easier for chromogens to latch on. And finally, a family of food compounds known as tannins promotes staining by further boosting chromogens’ ability to attach to enamel.
The Top Teeth-Staining Foods and Beverages

1. Wine. Red wine, an acidic beverage that contains chromogens and tannins, is notorious for staining teeth. But white wine, too, promotes staining. In a study conducted recently at New York University School of Dentistry, teeth exposed to tea were stained more severely if they previously had been exposed to white wine. So if you’re fond of following up that glass of Chardonnay with a cup of Earl Grey, you may be giving your teeth a double whammy.

2. Tea. Like wine, the ordinary black tea most people drink is rich in stain-promoting tannins. Dentists say it’s a bigger stainer than coffee, which is chromogen-rich but low in tannins. “Tea’s pretty aggressive,” says Mark S. Wolff, DDS, PhD, chairman of the department of cariology and comprehensive care at New York University School of Dentistry in New York City. Herbal, green, and white teas are less likely to stain than black tea.

3. Cola. Acidic and chromogen-rich, cola can cause significant staining. But even light-colored soft drinks are sufficiently acidic to promote staining of teeth by other foods and beverages. “Carbonated beverages have similar acidity to battery acid,” Messina says, adding that cola-stained teeth are most common among “people who have a can on their desk all the time and sip all day long.”

4. Sports drinks. Recent research led by Wolff found that highly acidic sports drinks can soften tooth enamel — setting the stage for staining.

5. Berries. Blueberries, blackberries, cranberries, cherries, grapes, pomegranates, and other intensely colored fruits (and juices, pies, and other foods and beverages made from them) can cause stains.

6. Sauces. Soy sauce, tomato sauce, curry sauce, and other deeply colored sauces are believed to have significant staining potential.

7. Sweets. Hard candies, chewing gum, popsicles, and other sweets often contain teeth-staining coloring agents. If your tongue turns a funny color, dentists say, there’s a good chance that your teeth will be affected, too. But unless they are consumed regularly, these sweets probably play a minor role in teeth staining, says Maria Lopez Howell, DDS, a dentist in private practice in San Antonio

Ironically, many of the foods and beverages that stain teeth are loaded with antioxidants, which, of course, have key health benefits. So if you’re worried about stained teeth, you might want to cut back on these foods and beverages rather than cut them out entirely. “Moderation and a balanced diet are key,” Howell says.

In addition, consider taking steps to minimize the contact between your teeth and stain-promoting substances. Dentists offer several suggestions:

Use a straw. Sipping beverages through a straw is believed to help keep teeth-staining beverages away from the teeth — the front teeth, in particular. No, you’re probably not eager to use a straw for coffee or wine. But it shouldn’t be too much trouble to use a straw for cola, juices, and iced tea.
Swallow promptly. Swallowing stain-causing foods and beverages quickly is also believed to help protect teeth from stains. Obviously, it’s important to chew foods thoroughly before swallowing. And gulping can, of course, cause choking. But don’t retain things in your mouth for long periods of time. In other words, savor flavors — but not for too long. “There’s no question that the quicker you drink something the lower the exposure [to stain-promoting substances],” says Debra Glassman, DDS, a dentist in private practice in New York City.

Swish with water. It’s not always convenient to brush your teeth after having something to eat or drink. Even when it is, it might be better not to: dental enamel is highly vulnerable to abrasion from tooth brushing for up to 30 minutes after the consumption of an acidic food or beverage. So it’s safer simply to swish with water — and brush later, once the enamel has had a chance to re-harden. Another way to remove stain-causing substances without brushing, Howell says, is to chew sugarless gum after eating or drinking.

By David Freeman
WebMD Feature

Tongue cleaner

From Wikipedia

A tongue cleaner (also called a tongue scraper or tongue brush) is an oral hygiene device designed to clean the bacterial build-up, food debris, fungi, and dead cells from the surface of the tongue. The bacteria and fungi that grow on the tongue are related to many common oral care and general health problems.In addition, decaying bacteria produce volatile sulphur compounds on the rear of the tongue; these molecules account for 80 to 95 percent of all cases of fungi (bad breath)

The top surface of the tongue can be cleaned using a tongue cleaner, a tongue brush/scraper or a toothbrush. However, toothbrushes are not considered as effective for this purpose because they are designed for brushing the teeth, which have a solid structure unlike the spongy tissue of the tongue

Ergonomic tongue cleaners are shaped in accordance with the anatomy of the tongue, and are optimized to lift and trap the plaque coating and effectively clean the surface of the tongue. There are many different types of tongue cleaners; they are made from plastic, metal or other materials. Their effectiveness varies widely depending on the shape, dimensions, configuration, quality of the contact surfaces and materials used. In addition, tongue cleaning gels used in association with the tongue cleaners as anti-bacterial agents may enhance cleaning effects.

Tongue cleaning may remove some of the millions of bacteria (up to 500 different types, decaying food debris, fungi (such as Candida), and dead cells, from the rear surface of the tongue. Tongue cleaning is generally viewed as an effective solution for many cases of halitosis, or bad breath.

Scientific studies have shown tongue bacteria produce malodorous compounds and fatty acids, that may account for 80 to 95 percent of all cases of bad breath.The remaining 5–20% of cases originate in the stomach, from the tonsils, from decaying food stuck between the teeth, gum disease, tooth decay, or plaque accumulated on the teeth.

Clinical studies have shown that using tongue cleaners on a daily basis has a significant effect on eliminating anaerobic bacteria and decreasing oral malodor. Dental specialists generally assume that a majority of cases of halitosis originate on the back of the tongue, an area that can be cleaned efficiently by using an ergonomically designed tongue cleaner.

In the past several years, dental professionals (dentists and hygienists)have studied the importance of tongue cleaning as a way to maintain a high level of oral hygiene.

The surface of the tongue may be viewed as an excellent breeding ground for different bacteria. These microorganisms colonize and multiply on the protein-rich areas of the tongue, and eventually, through the saliva, reach all areas of the mouth including the teeth and gums. These bacteria are considered as major contributors to periodontal problems, plaque on the teeth, tooth decay, gum infections, gum recession and even tooth loss.

In addition, physicians have reevaluated the link between oral health and pathologies of the rest of the body. Many clinical studies concluded that oral bacteria are associated with a number of serious systemic diseases.

+ Cardiovascular problems (heart attack, cerebral stroke),
+ Pneumonia due to inhaling bacteria present in the mouth,
+ Premature birth, and low fetus weight at birth time,
+ Increased risk of diabetes patients,
+ Osteoporosis of the jaw and generalized,
+ Infertility problems for men.

How Root Canals Work

To understand how a root canal works, we need to have a basic understanding of the anatomy of the tooth. A tooth is hollow, like our bones, and is composed of several layers. The outermost layer (above the gum-line) is called the enamel. Enamel is the hardest and most mineralized substance in the body. Beneath the gum-line, a substance called cementum covers the tooth roots. Under the enamel and cementum is the dentin. The dentin is about as hard as bone, and, unlike the enamel, dentin contains nerve endings. Beneath the dentin is the dental pulp. The pulp is a vascular tissue, composed of capillaries, larger blood vessels, connective tissue, nerve fibers, and cells including odontoblasts, fibroblasts, macrophages, and lymphocytes. The pulp is needed to nourish the tooth during its growth and development. After a tooth is fully mature, the only function of the pulp is to let us know if it is damaged or infected by transmitting pain.

Sometimes the pulp becomes infected. When this happens, it must be removed with root canal therapy. A root canal is the only way to save the tooth. A mature tooth can survive very well without the pulp.

How Does the Pulp become infected?

The most common way for the pulp to become infected is from an untreated cavity. A cavity is formed by acid in a rather unexpected way. Inside everyone’s mouth is a legion of bacteria – they are completely normal and there is nothing you can do about them. Some of these bacteria metabolize (eat) carbohydrate-containing foods or beverages and make acid as a by-product. The acid is strong enough to eat through the enamel and dentin. If left untreated, it will eventually expose the underlying pulp to bacteria inside our mouths and it gets infected. The pulp can also get infected from trauma to the tooth. A blow to a tooth can cut off the blood supply to the tooth from our jawbone, and cause the pulp tissue to slowly die. Interestingly, a tooth that breaks within the enamel and dentin during trauma is less likely to need root canal in the future because the fracture may absorb the trauma, sparing blood flow to the tooth.

A third way a tooth can become infected is if there is long standing periodontal (gum) disease around the tooth. Bacteria from the infected gums can enter the tooth through small opening on the root surface (accessory canals) and cause a retrograde infection. Whatever way the tooth becomes infected, the pulp eventually dies, and over time, will cause a painful dental abscess within the surrounding jawbone.

How will I know if I have an infected tooth?

A tooth that becomes sensitive to hot or cold food or beverages or hurts when biting down may indicate an infected tooth. A tooth that becomes discolored or that causes the gums to swell around a tooth may also indicate a dental infection. In some cases, a tooth will have no symptoms, but a dental exam and x-ray will reveal a tooth that requires root canal.

An infected tooth as seen in an x-ray.
The dark circle around the root tip is an advanced dental abscess.


If the tooth is infected, why can’t I use an antibiotic to treat it?

If a tooth has an infection of the pulp, the only options are root canal therapy or extraction. As the pulp dies, the hollow tooth becomes a reservoir for bacteria to hide from the body’s immune system and any drugs that could fight the infection. In some cases a dentist will prescribe antibiotics during or after root canal therapy to kill bacteria within the jawbone and tissues surrounding the tooth, but recent research has shown that this is usually unnecessary.

What’s involved in getting a root canal, and does it hurt?

Root canal therapy is a complex procedure that requires both skill and experience. The dentist numbs the area of the infected tooth with local anesthesia. A clamp is placed over the tooth, and a rubber membrane (rubber dam) is spread over the clamp to isolate the tooth and prepare it for the procedure.

An infected tooth
A small hole is made through the enamel and dentin, and into the pulp. The pulp is then removed with small stainless steel files of increasing diameter. After the pulp has been removed, the inside walls of the roots are shaped, almost like a sculpture. Nickel/Titanium files that fit on a slow speed drill can aid in shaping the canals. During the procedure, fluids (irrigants) such as sodium hypochloride (bleach) and a compound containing ethylenediamine-tetraacetate (EDTA) are used to both kill remaining pulp tissue and bacteria within the roots, and remove dentin shavings produced by the files.

Files are used to remove the pulp
After the pulp is removed and the inside of the roots shaped, the canal is dried with paper cones. The canal(s) are then filled with Gutta-percha. Gutta-percha is a miraculous substance that was first introduced by Bowman in 1867. It is a purified form of Mazer Wood Trees indigenous to Indonesia and Malaysia that is combined with zinc oxide and other materials to form the rubbery filling that is placed into the tooth roots. The Gutta-percha is then cemented into the roots with a sealer that usually contains zinc oxide and eugenol. The goal of the filling procedure is to hermetically seal off the tooth against bacteria.

The tooth is filled with gutta-percha

X-ray of a tooth filled with gutta-percha using the warm vertical condensation technique. Accessory canals are visible.
There are two main techniques to filling a root canal, lateral condensation and warm vertical condensation. Although research is scanty, warm vertical condensation appears to have the advantage of more completely filling the tooth roots, especially the accessory canals.Root canal therapy is usually not painful. With the effective use of anesthesia and modern techniques, most root canal therapy can be completed in one visit, and within one hour. A tooth will be sensitive for a few days after root canal therapy, and your dentist can prescribe you medication to alleviate the pain. In the meantime, do not eat on the side of the mouth that has the root canal for a few days.Do different teeth have different numbers of root canals?

Teeth in the front of the mouth called incisors and canines usually have one root, and one nerve canal within the root. Teeth on the side of the mouth called premolars usually have one or two roots and one or two root canals. The upper back teeth (molars) usually have three roots, and three or four root canals. Lower back teeth (molars) usually have two roots and three or four root canals. Generally speaking, the more nerve canals the tooth has, the more complicated the root canal is to complete.

Can any dentist do a root canal?

All dentists are trained to do root canals in dental school; however, skill levels and experience vary widely from dentist to dentist. An experienced general dentist can do almost all root canal therapy successfully, but some general dentists prefer to have a root canal specialist (an endodontist) perform root canal on their patients.

How successful are root canals?

Root canals are successful about 90% of the time when they are done properly. Teeth that have had root canal can become brittle and are susceptible to fracture. In most cases, it is advisable to have a crown (cap) placed over a tooth that has had root canal to rebuild and protect it.

Why do some root canals fail, and how will I know?

A tooth that has root canal can fail if some of the pulp is left inside the roots (a canal is missed), the gutta-percha does not completely seal off the tooth from bacteria, the tooth is damaged during the procedure (perforation), or the tooth fractures between the roots. In most cases, a tooth with a failing root canal will cause pain, usually when biting down.

What can I do if the root canal fails?

In some cases, the root canal can be re-treated. The old gutta-percha filling is removed, the tooth is reshaped and cleaned, and then re-filled. If this is not possible, a procedure called an apicoectomy can be preformed. In an apicoectomy, the tip of the root is surgically removed, and a filling is placed over the cut root tip. If these measures fail, the tooth may have to be extracted.


Article: How Root Canals Work DR. JERRY GORDON

Occlusal Guards or Nightguard

Eliminate jaw pain, headaches and damage to your teeth from grinding and clenching

Headaches, jaw pain and damage to your teeth can all be caused by grinding your teeth and clenching your jaw while you sleep. Dentists term this condition bruxism, and it is much more common than you’d think.

Most patients who brux are completely unaware that they are doing it. Often, it is the spouse of the bruxer who becomes aware of it first, as he or she is disturbed by the grinding or chomping of teeth in the night.

In addition to causing pain and discomfort, bruxism will grind down your teeth or dental work, causing damage well beyond normal wear and tear.

A nightguard or “occlusal guard” is shaped by Dr. Artemenko so that it fits most comfortably. It is placed on one jaw – generally the top – and it acts a protective layer between the two sets of teeth.

Nightguards look similar to mouthguards, but are much less bulky and act only as protection for grinding.

It is a good idea to use a nightguard to avoid major, permanent damage to one’s teeth that is often associated with bruxism.

Beyond the head or jaw pain often caused by bruxism, damage may be caused to the teeth by the constant grinding: cracks, fissures, chipping, weakening and removal of protective tooth enamel that can lead to increased sensitivity to cold and heat.

10 Tips to Help You Overcome Dentist Phobia


1. Tell the dentist about your fears. This information will help the dentist determine how to best manage and address those fears. By letting the dentist know exactly why the experience is difficult for you, you will feel more control in the examination chair.

2. Remember that dental procedures have greatly improved in the past few years. Modern dentistry offers new methods and treatment options to make you feel comfortable.

3. Your dentist can explain the entire procedure to you beforehand, as well as walk you through step-by-step while the procedure is being performed. You always have the right to fully understand the work being done on your teeth.

4. Consider additional medication to relax. Many dentists recommend nitrous oxide, sedation or anti-anxiety medicine for extremely nervous patients. Find a dentist who offers these options to help you get through the visit.

5. Find a dentist you are comfortable with and establish a trusting relationship. There are many personalities in the dental profession. Find a dentist who makes you feel at ease and is willing to work with you on your fears.

6. Breathe deeply and try to relax. Some dentists recommend practicing relaxation techniques before and during the appointment. Other dentists find that listening to music, or scheduling an appointment first thing in the morning, before the stresses of the day add up, also help patients to relax.

7. Talk to the dentist about stopping if you’re uncomfortable. Many of the dentists surveyed said they establish a signal to “stop” with their patients. This puts you in control of the procedure and alerts the dentist if you’re uncomfortable or need to take a break during the appointment.

8. Visit the dentist regularly to prevent problems. For fearful patients, just going for a check up can be nerve-wracking, but the more you go to the dentist for routine cleanings, the more likely you are to avoid larger problems that result in extensive procedures.

9. Visit the office and talk to the staff before your first appointment. You should feel free to meet with the dentist and to ask questions before scheduling your appointment. Meeting the dentist and his or her staff first will help you find a dentist you like and trust.

10. Go slow. Dentists are happy to go slow with nervous patients. If possible, make sure your first visit is a simple one, such as a cleaning. This will help you build your relationship with the dentist before going in for a more difficult procedure.


provided by: http://psychcentral.com

How does Coffee Stain Teeth?

Posted December 1st, 2014 by Amy & Robin and filed in Ask the Dentist, Dental Articles, Dental Tips

Coffee is the favorite daily beverage of many people throughout the world and a lot of them cannot start their normally without it. They are always at a risk of getting their teeth stained. The stains can be brown, yellow and black in color. The unsightly stains can appear as spots or cover the whole or certain areas of your teeth. Coffee is considered to be a bigger culprit in causing teeth stains as many factors are combined in this drink.

How Coffee Causes Teeth Stains

The tooth’s enamel, the hard protective layer all around that protects it, is porous. That is why the enamel can be easily stained because it is not difficult for substances such as coffee to fill the pores. The nature of enamel also varies from person to person. In some it is rough while in others, it is smooth. Rougher enamels are more likely to get stained as compared to the smooth ones.

Some other factors have an effect on coffee’s staining impact on teeth. Genetic differences such as thicker enamels or natural yellowing due to aging can cause differences in staining due to coffee. At times, some people wrongly make the culprit out of coffee when it is actually their advancing age to blame for yellowing of teeth.

Foods and beverages with high acid content can speed up the teeth staining because they have a corrosive effect on your enamel. Coffee has high acid content. Some other drinks with high acid content are tea, orange juice, tomatoes and many citrus fruits. Coffee with its dark color has to take the blame for causing teeth stains more easily than other foods or beverages. The more you drink these beverages, particularly the dark ones such as tea, coffee and colas, the more you run the risk of staining your teeth.

The wise thing would be to limit your coffee consumption to one or two cups daily. Moreover, you should avoid keeping the drink in your mouth for too long as it increases the exposure to teeth. Having coffee with a straw can also help. Brushing your teeth or rinsing it water every time you have coffee is also a very good way of keeping teeth stains away. Teeth stains from coffee or any other substance may not require a special dental visit, but if you want to try any sort of whitening or teeth cleaning product, do so only after your dentist’s advice.

Article by www.onlymyhealth.com