What are Dentures?
Dentures are replacements for missing teeth that can be taken out and put back into your mouth. While dentures take some getting used to, and will never feel exactly the same as one’s natural teeth, today’s dentures are natural looking and more comfortable than ever.
There are two main types of dentures: full and partial. Your dentist will help you choose the type of denture that’s best for you based on whether some or all of your teeth are going to be replaced and the cost involved.
How do Dentures Work?
With full dentures, a flesh-colored acrylic base fits over your gums. The base of the upper denture covers the palate (the roof of your mouth), while that of the lower denture is shaped like a horseshoe to accommodate your tongue.
Dentures are custom-made in a dental laboratory from impressions taken of your mouth. Your dentist will determine which of the three types of dentures described below is best for you.
Conventional or Immediate Full Denture.
- Conventional Full Denture
A conventional full denture is placed in your mouth after any remaining teeth are removed and tissues have healed. Healing may take several months, during which time you are without teeth.
- Immediate Full Denture
An immediate full denture is inserted immediately after the remaining teeth are removed. (Your dentist takes measurements and makes models of your jaw during a prior visit.) While immediate dentures offer the benefit of never having to be without your teeth, they must be relined several months after being inserted. The reason is that the bone supporting the teeth reshapes as it heals, causing the denture to become loose.
- Partial Denture
A partial denture rests on a metal framework that attaches to your natural teeth. Sometimes crowns are placed on some of your natural teeth and serve as anchors for the denture. Partial dentures offer a removable alternative to bridges.
How Long Before I Get Used to My Dentures?
New dentures may feel awkward or uncomfortable for the first few weeks or even months. Eating and speaking with dentures might take a little practice. A bulky or loose feeling is not uncommon, while the muscles of your cheeks and tongue learn to hold your dentures in place. Excessive saliva flow, a feeling that the tongue does not have adequate room, and minor irritation or soreness are also not unusual. If you experience irritation, see your dentist.
How Long do Dentures Last?
Over a period of time, your denture will need to be relined, remade, or rebased due to normal wear. Rebasing means making a new base while keeping the existing denture teeth. Also, as you age, your mouth naturally changes. These changes cause your dentures to loosen, making chewing difficult and irritating your gums. At a minimum, you should see your dentist annually for a checkup.
Here are tips for caring for your dentures:
- When handling your dentures, stand over a folded towel or basin of water. Dentures are delicate and may break if dropped.
- Don’t let your dentures dry out. Place them in a denture cleanser soaking solution or in plain water when you’re not wearing them. Never use hot water, which can cause them to warp.
- Brushing your dentures daily will remove food deposits and plaque, and help prevent them from becoming stained. An ultrasonic cleaner may be used to care for your dentures, but it does not replace a thorough daily brushing.
- Brush your gums, tongue and palate every morning with a soft-bristled brush before you insert your dentures. This stimulates circulation in your tissues and helps remove plaque.
- See your dentist if your dentures break, chip, crack or become loose. Don’t be tempted to adjust them yourself — this can damage them beyond repair.
©2001-2012 Aetna All rights reserved
Why are Teeth Removed?
Teeth are extracted for a variety of reasons:
- Decay has reached deep into the tooth
- Infection has destroyed a large portion of the tooth or surrounding bone
- There is not enough room for all the teeth in your mouth
Many dentists recommend extracting impacted teeth that are only partially erupted. Bacteria can enter around a partially erupted tooth and cause an infection, which can extend into the surrounding bone and become extremely serious. Impacted teeth continue trying to break through the gum tissue even if there is not enough room to accommodate them. The continued pressure caused by this attempted eruption can eventually damage the roots of nearby teeth. Removing a tooth that is impacted can often prevent infection, damage to adjacent teeth and bone, and save pain in the years to come.
X-rays reveal the length, shape, and position of the tooth and surrounding bone. From this information, your dentist can estimate the degree of difficulty of the procedure and decide whether to refer you to a specialist called an oral surgeon.
Before removal, the area around your tooth will be anesthetized. Dentists use a local anesthetic to numb the area of the mouth where the extraction will take place.
For a simple extraction, once the area is anesthetized, the tooth is loosened with the help of a tool called an elevator, then extracted with dental forceps. Your dentist may also want to smooth and recontour the underlying bone. When he or she is finished, they may choose to close the area with a stitch.
What can I Expect After an Extraction?
It is critical to keep the area clean and prevent infection immediately following the removal of a tooth. Your dentist will ask you to bite down gently on a piece of dry, sterile gauze, which you must keep in place for up to 30 to 45 minutes to limit bleeding while clotting takes place. For the next 24 hours, you shouldn’t smoke, rinse your mouth vigorously, or clean the teeth next to the extraction site.
A certain amount of pain and discomfort is to be expected following an extraction. In some cases, your dentist will recommend a pain killer or prescribe one for you. It may help to apply an ice pack to the face for 15 minutes at a time. You may also want to limit strenuous activity, as well as avoid hot liquids and not drink through a straw. The day after the extraction, your dentist may suggest that you begin gently rinsing your mouth with warm salt water (do not swallow the water). Under normal circumstances, discomfort should lessen within three days to two weeks. If you have prolonged or severe pain, swelling, bleeding or fever, call your dentist at once.
What Is Periodontal Disease?
If your hands bled when you washed them, you would be concerned. Yet, many people think it’s normal if their gums bleed when they brush or floss. In a 1999 study, researchers at the U.S. National Institutes of Health (NIH) found that half of Americans over 30 had bleeding gums.
Swollen and bleeding gums are early signs that your gums are infected with bacteria. If nothing is done, the infection can spread. It can destroy the structures that support your teeth in your jawbone. Eventually, your teeth can become so loose that they have to be extracted.
“Peri” means around, and “odontal” refers to teeth. Periodontal diseases are infections of the structures around the teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone. In the earliest stage of periodontal disease, gingivitis, the infection affects only the gums. In more severe forms of the disease, all of the supporting tissues are involved.
For many years scientists have been trying to figure out what causes periodontal disease. It is now well accepted that bacteria in dental plaque are the major villains. Researchers also are learning more about how an infection in your gums can affect your overall health.
In recent years, gum disease has been linked to other health problems. This is a new and exciting area of research. Many questions remain. Studies have produced varying answers about how much of a connection exists between gum disease and other medical problems. More research is needed.
Researchers are studying possible connections between gum disease and:
- Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease. It also is believed to worsen existing heart disease.
- Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.
- Premature births — A woman who has gum disease during pregnancy may be more likely to deliver her baby too early. The infant may be more likely to be of low birth weight.
- Diabetes — Diabetic patients with periodontal disease may have more trouble controlling their blood sugar than diabetic patients with healthy gums.
- Respiratory disease — Bacteria involved in gum disease may cause lung infections or worsen existing lung conditions. This is particularly important for elderly adults in institutions such as nursing homes. In this group, bacteria from the mouth may reach the lungs and may cause severe pneumonia.
What Causes Periodontal Disease?
Periodontal disease is caused by bacteria in dental plaque. Plaque is the sticky substance that forms on your teeth soon after you have brushed. In an effort to get rid of the bacteria, the cells of your immune system release substances that inflame and damage the gums, periodontal ligament or alveolar bone. This leads to swollen, bleeding gums, a sign of gingivitis (the earliest stage of periodontal disease). Damage from periodontal disease also can cause teeth to become loose. This is a sign of severe periodontitis (the advanced stage of disease).
You can prevent periodontal disease by practicing good oral hygiene and visiting your dentist regularly. Most people should see the dentist about once every six months. But if you already have gum disease you may need to visit more often.
Daily brushing and flossing, when done correctly, can help to remove most of the plaque from your teeth. Professional cleanings by your dentist or dental hygienist will keep plaque under control in places that are harder for a toothbrush or floss to reach.
If oral hygiene slips or you skip dental visits, plaque builds up on the teeth. Eventually, it spreads below the gum line. The bacteria are protected there because your toothbrush can’t reach them. If plaque is not removed, the bacteria will continue to multiply. Your gum inflammation may get worse.
The buildup of plaque below the gum line causes the gums to become inflamed. As the gums swell, they detach from the tooth. This process forms a space, or “pocket,” between the tooth and gum. Bacteria can grow rapidly in the pockets. This encourages further plaque buildup.
If left untreated, periodontal disease may destroy the periodontal ligament and the alveolar bone, the structures that support your teeth.
Another reason to remove plaque promptly is that over time it becomes hardened or calcified and turns into calculus. This is commonly called tartar. Even more plaque attaches to calculus because it’s a rougher surface than tooth enamel. It’s also rougher than cementum, a layer that covers the tooth root. Calculus and plaque build up in layers.
Using a tartar-control toothpaste may help slow the build-up of calculus around your teeth. It can’t affect the tartar that already has formed below the gum line, however.
Risks and Prevention
The bacteria in plaque are the main cause of periodontal disease. But several other factors also can contribute. They include other diseases, medicines and oral habits. These factors can increase your risk of gum disease or make it worse once the infection has set in.
- Genes — Some people are more likely than others to get periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.
- Smoking and tobacco use — Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing periodontal disease under control.
- Misaligned or crowded teeth, braces or bridgework — Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dentists and periodontists can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics. This could straighten out your smile and give you a better chance of preventing disease.
- Grinding, gritting or clenching of teeth — These habits won’t cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don’t work, your dentist or periodontist can create a custom guard appliance to help reduce the pressure of clenching or grinding on the teeth. This device is sometimes called an occlusal guard, night guard, mouth guard or bite guard.
- Stress — Stress can make periodontal disease worse and harder to treat. Stress weakens your body’s immune system. This makes it harder for your body to fight off infection, including periodontal disease.
- Fluctuating hormones — Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.
- Medicines — SSeveral types of medicines can cause dry mouth, or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don’t have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:
- Phenytoin (Dilantin and other brand names), used to control seizures
- Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
- Nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmias.
- Diseases — People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.
- Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.
©2002-2013 Aetna, Inc. All rights reserved.
What is a Root Canal?
Root canal treatment is the removal of the tooth‘s pulp, a small, thread-like tissue in the center of the tooth. Once the damaged, diseased or dead pulp is removed, the remaining space is cleaned, shaped and filled. This procedure seals off the root canal. Years ago, teeth with diseased or injured pulps were removed. Today, root canal treatment saves many teeth that would otherwise be lost.
The most common causes of pulp damage or death are:
- A cracked tooth
- A deep cavity
- An injury to a tooth, such as a severe knock to the tooth, either recent or in the past
Once the pulp is infected or dead, if left untreated, pus can build up at the root tip in the jawbone, forming an abscess. An abscess can destroy the bone surrounding the tooth and cause pain
How is a Root Canal Done?
Root canal treatment consists of several steps that take place over several office visits, depending on the situation. These steps are:
- First, an opening is made through the back of a front tooth or the crown of a molar or pre-molar.
- After the diseased pulp is removed (a pulpectomy), the pulp chamber and root canals are cleaned, enlarged and shaped in preparation for being filled.
- If more than one visit is needed, a temporary filling is placed in the crown opening to protect the tooth between dental visits.
- The temporary filling is removed and the pulp chamber and root canal permanently filled. A tapered, rubbery material called gutta-percha is inserted into each of the canals and is often sealed into place with cement. Sometimes a metal or plastic rod is placed in the canal for structural support.
- In the final step, a crown is usually placed over the tooth to restore its natural shape and appearance. If the tooth is very broken down, a post may be required to build it up prior to placing a crown.
How Long Will the Restored Tooth Last?
Your treated and restored tooth/teeth can last a lifetime with proper care. Because tooth decay can still occur in treated teeth, good oral hygiene and regular dental exams are necessary to prevent further problems.
As there is no longer a pulp keeping the tooth alive, root-treated teeth can become brittle and are more prone to fracture. This is an important consideration when deciding whether to crown or fill a tooth after root canal treatment.
To determine the success or failure of root canal treatment, the most relied-upon method is to compare new X-rays with those taken prior to treatment. This comparison will show whether bone continues to be lost or is being regenerated.
|Tooth pulp damaged by a deep cavity.||The pulp is removed and the root canals cleaned before filling.||The chamber is filled and sealed.|
What is a Filling?
A filling is a way to restore a tooth damaged by decay back to its normal function and shape. When a dentist gives you a filling, he or she first removes the decayed tooth material, cleans the affected area, and then fills the cleaned out cavity with a filling material.
By closing off spaces where bacteria can enter, a filling also helps prevent further decay. Materials used for fillings include gold, porcelain, a composite resin (tooth-colored fillings), and an amalgam (an alloy of mercury, silver, copper, tin and sometimes zinc).
Which Type of Filling is Best?
No one type of filling is best for everyone. What’s right for you will be determined by the extent of the repair, whether you have allergies to certain materials, where in your mouth the filling is needed, and the cost. Considerations for different materials include:
- Gold fillings are made to order in a laboratory and then cemented into place. Gold inlays are well tolerated by gum tissues, and may last more than 20 years. For these reasons, many authorities consider gold the best filling material. However, it is often the most expensive choice and requires multiple visits.
- Amalgam (silver) fillings are resistant to wear and relatively inexpensive. However, due to their dark color, they are more noticeable than porcelain or composite restorations and are not usually used in very visible areas, such as front teeth.
- Composite (plastic) resins are matched to be the same color as your teeth and therefore used where a natural appearance is desired. The ingredients are mixed and placed directly into the cavity, where they harden. Composites may not be the ideal material for large fillings as they may chip or wear over time. They can also become stained from coffee, tea or tobacco, and do not last as long as other types of fillings generally from three to 10 years.
- Porcelain fillings are called inlays or onlays and are produced to order in a lab and then bonded to the tooth. They can be matched to the color of the tooth and resist staining. A porcelain restoration generally covers most of the tooth. Their cost is similar to gold.
If decay or a fracture has damaged a large portion of the tooth, a crown, or cap, may be recommended. Decay that has reached the nerve may be treated in two ways: throughroot canal therapy (in which nerve damaged nerve is removed) or through a procedure called pulp capping (which attempts to keep the nerve alive).
What Happens When You get a Filling?
If your dentist decides to fill a cavity, he or she will first remove the decay and clean the affected area. The cleaned-out cavity will then be filled with any of the variety of materials described above.
How Do I Know if I Need a Filling?
Only your dentist can detect whether you have a cavity that needs to be filled. During a checkup, your dentist will use a small mirror to examine the surfaces of each tooth.
Anything that looks abnormal will then be closely checked with special instruments. Your dentist may also X-ray your entire mouth or a section of it. The type of treatment your dentist chooses will depend on the extent of damage caused by decay.
What are Dental Crowns and Tooth Bridges?
Both crowns and most bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist.
How do Crowns Work?
A crown is used to entirely cover or “cap” a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.
Your dentist may recommend a crown to:
- Replace a large filling when there isn’t enough tooth remaining
- Protect a weak tooth from fracturing
- Restore a fractured tooth
- Attach a bridge
- Cover a dental implant
- Cover a discolored or poorly shaped tooth
- Cover a tooth that has had root canal treatment
How do Bridges Work?
A bridge may be recommended if you’re missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.
Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.
How are Crowns and Bridges Made?
Before either a crown or a bridge can be made, the tooth (or teeth) must be reduced in size so that the crown or bridge will fit over it properly. After reducing the tooth/teeth, your dentist will take an impression to provide an exact mold for the crown or bridge. If porcelain is to be used, your dentist will determine the correct shade for the crown or bridge to match the color of your existing teeth.
Using this impression, a dental lab then makes your crown or bridge, in the material your dentist specifies. A temporary crown or bridge will be put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.
How Long do Crowns and Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by Brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings.
To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.
|Full porcelain fused to metal.||Full cast gold crown.|
|Teeth around the space are prepared.||The bridge is mounted and adjusted for fit and comfort.||The bridge is cemented into position.|