Your teeth are held in your jaw by the bone that surrounds them. When you have teeth, your normal functioning (chewing etc.) stimulates the bone around your teeth, telling it to remain in position. When you choose to or have to remove a tooth, your bone loses that stimulation an the bone level changes. Dentists call these changes “bone remodeling”.
When you have teeth, your jawbone has a scalloped appearance with the high points located between your teeth. So when you’ve lost a tooth, at first, the bone changes are helpful—otherwise you’d have spiky points left behind that could irritate your tongue! If you’ve had a tooth or teeth out, you’ve probably noticed that over time the area becomes more saddle shaped rather than scalloped.
Unfortunately, these bone changes don’t stop there. Without the stimulation that your tooth provides, your jaw bone keeps getting smaller and smaller and shorter and shorter. Over time, this can make wearing dentures (and making them for you) more difficult.
Think in today’s day and age that no one would need dentures? Today 35 Million people have no teeth and 90% of those wear dentures. And 23 million geriatric people have no teeth with an additional 12 million having no teeth in one arch (upper or lower). That's a lot of people!
There is a common belief that having no teeth means having no pain. If most denture wearers are honest, they will tell you that they’ve had periods of pain and discomfort because of their dentures. Traditional dentures rest on your gums. Any areas that push too firmly or rub on your gums, can create a sore spot. If you let it go, it can even create an ulcer. Also, food and other debris can get under the denture base and irritate your gums.
Even though your jaw bone is changing and shrinking all the time once your teeth are lost, the denture base itself doesn’t change—so over time, you may find that your denture rubs in areas that it didn’t before, or digs in to your gums, or doesn’t fit as well as it used to. The worst thing? Bad fitting dentures may cause more bone loss.
Dentists call the toothless bony area (that's covered by your gums) a ridge. Remember that this ridge is shrinking all the time. Unfortunately, the shorter the height of your remaining ridge, the harder it is to make you a new denture that will stay in place and allow you to function (chew etc.). Even the best fitting dentures provide only a fraction of the chewing force you have with your own teeth, so you really can’t afford to lose more because of not having enough ridge height to make a good fitting denture.
Are there ways to keep your bony ridge? Yes, there are. Ideally, you should try to keep your own teeth if it's possible. This might mean choosing to have a root canal and then restoring the tooth instead of removing your tooth. Dental implants provide some stimulation to the bone to keep ridge height in the areas where the implants are placed. They can also provide an anchor point for your appliance so that it’s not just relying on the close fit to your gums and the seal that creates to stay in place. Studies show that while an implant supported appliance does not quite match the chewing force of natural teeth, it does far exceed the chewing force provided by traditional gum-borne dentures.
**Note: Information in this article is not meant to replace the clinical judgment of your healthcare professionals.
At least once a week I hear the phrase “I only want what my insurance covers.” While I can certainly understand the desire to use the dental insurance that you have, doing only what your dental insurance covers is not always the best option. The dental treatment you decide to do should be decided between you and your dentist based on your mouth and your situation. Do not allow a dental insurance company to dictate what is right for you. (They will try to do so by denying treatment that you need or by saying you didn’t submit a pre-determination to them. You’re not legally required to submit one.) You should choose the treatment that is the best for you regardless of your dental insurance coverage.
What you need to understand is that your dental insurance is not meant to cover all of your dental fees. It’s supposed to be an aid to affording your dental care. The maximum annual payout amount for dental insurance has remained the same (usually $1000) for many years. Only in the past few years have we seen some companies start inching the amount up to between $1500 and $2000. These days, a single severely broken down tooth could eat up all that $1000 (or even $2000!) quite easily.
There are other aspects to your dental insurance also.
- Most dental insurances have an annual maximum that they will pay. This is the most dollars that they will pay out in any benefit period (for most this is a calendar year, but some insurances do have a different benefit year period). Once they've paid that maximum, they will not pay any more until the benfefit period renews. So even if you think you get "two free cleanings a year" if your insurance has already paid out it's maximum amount for that year, the 100% coverage for preventive services that you count on (and makes it what you call "free") is invalid and you will have to pay for those service out of your own pocket.
- Be sure to find out your annual deductible (what you have to pay before your insurance kicks in). For many insurances, your cleanings fall outside of the deductible (though some policies apply the deductible to any dental service). In most cases, any other dental treatment will be subject to the deductible, so you will have to pay that amount in addition to your copayment.
- Copayments: Dental insurance companies divide dental services into categories and pay different percentages on different categories. The percent that they do not pay is called your copayment. You cannot rely on the percentages that the insurance company publishes. Most insurances will use a UCR (UCR=usual, customary, reasonable) to calculate their plans. The insurance companies survey a geographic area to find the average fee and then take 90% of that average to create their UCR rate. (Remember that discount clinics are included in the survey and their fees bring down the overall average.) Therefore, almost every private practice dentist will have fees over the UCR. Insurance companies would rather say the dentist’s fees are above the UCR than say that their benefits are low. This is especially important if you are using the services of a dentist who does not participate with your plan or if your plan is a traditional one which allows you to go to any dental office since in those cases you will be fully responsible for the portion that your insurance company does not pay.
- Limitations/exclusions to your policy: your plan may not cover certain procedures (exclusions) or limit how often it will pay for certain procedures (limitations or frequency limits) or limit when it will cover certain procedures (limitations). For example, many plans exclude cosmetic procedures such as teeth whitening or veneers. Many plans will only pay for crowns or dentures once every 5 years (so if you lose your denture that's 3 years old, your insurance will not pay for it again for 2 more years!). Your plan may say it will cover 2 cleanings a year or 1 every 6 months--there's a difference! with the first option, you could have a cleaning in January and again in February and both would be paid. With the second option, you'd have to have your second cleaning 6 months + 1 day after the first if you want your dental insurance to pay for it. A dental insurance might also say that you can't have a periodontal maintenance cleaning unless you've had scaling and root planing ("deep cleaning") or surgical gum treatments.
- Also remember as new procedures emerge, they are often considered “experimental” by insurance companies. It can be hard to get this designation changed even though the procedure becomes more routine and more reliable. (Dental Implants are a good example of this.)
Remember, insurance companies are a for-profit business. This may mean that what they cover is not the best choice for you.
If you need help understanding your dental benefits, ask at your dental office. I know we are glad to help our patients try to understand their dental benefits and get the maximum use from it.
*Note: The information in this article is not meant to replace the clinical judgement of your health care professionals.
Dr. Jennifer Robb is a private practice dentist who sees both children and adults in her general dentistry practice.
1320 Cooper Foster Park Rd.
Lorain, OH 44053
As a parent, you strive to instill good habits in your children: looking both ways for traffic, doing chores or washing behind the ears. Be sure you also include sound habits for teeth and gum care.
Daily brushing and flossing should be at the top of that habit list. These hygiene tasks remove dental plaque, a bacterial film that builds up on teeth and is most responsible for diseases like tooth decay or periodontal (gum) disease.
Although you'll have to perform these tasks for them early on, your aim should be to teach them to do it for themselves. The best approach is to teach by example: If your child sees you're serious about your own oral hygiene, they're more likely to do so as well.
You should also help them form habits around the foods they eat. Like other aspects of our health, some foods are good for our teeth and gums, and some are not. The primary food in the latter category is sugar: This popular carbohydrate is also a favorite food source for disease-causing oral bacteria.
It's important, then, to minimize sugar and other processed foods in your child's diet, and maximize their consumption of whole grains, fresh fruits and vegetables, and other foods rich in calcium and phosphorous. Instilling good eating habits at an early age can boost both their dental and general health throughout their lives.
Finally, help the budding star athlete in your family develop the habit of wearing a protective mouthguard during contact sports. Your best choice is a custom-made mouthguard by a dentist: Although they cost more than the more common “boil and bite” mouthguard, they tend to offer more protection and are more comfortable to wear. A mouthguard could help your child avoid a costly dental injury that could affect them the rest of their life.
Adopting good dental hygienic, dietary, and safety habits at an early age can have a huge impact on your child's teeth and gum development. And if those early habits “stick,” it could mean a lifetime of disease-free dental health.
If you would like more information on helping your child develop sound dental habits, 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 “How to Help Your Child Develop the Best Habits for Oral Health.”
May 31st is National Smile Day. People smile more when they like how their smile looks. We get many questions from people wanting whiter, brighter teeth. Is it just vanity or are there benefits to tooth whitening? First, let’s look at some of the overall pluses and minuses:
- Whiter teeth-which are often associated with youth, a healthy lifestyle and beauty.
- Improved appearance—a bright smile gives others a place to focus and because you may be inclined to smile more, you may be perceived as being more friendly.
- Increased self-confidence—you feel you look your best
- Your gums may get sore during the treatment
- Your teeth may become sensitive, particularly to cold, during treatment—this is actually the most common complaint and occurs in a high number of people.
- Some stains and tooth colorations are resistant to whitening--dark colorations, blue-gray staining, and tetracycline stains are the most difficult to lighten.
- Crowns, bridges, and fillings do not whiten—if you have these in visible areas, you may need to replace them after whitening.
Even if you do not plan to use a dental office’s whitening product, it is still a good idea to have a dentist check over your teeth prior to starting the process. Whitening materials do penetrate your teeth and may cause additional tooth problems if you have decay, cavities, or a cracked tooth.
Now that you’ve decided to whiten your teeth, which type is right for you? Let’s take a look at your options and what you can expect.
In office whitening
- Uses a special gel and sometimes a special device to activate the gel.
- Commonly takes 1-2 hours in the office.
- Although results may seem instant, your teeth are dry from the procedure. Once they are wet again with saliva they may appear darker, just as clothing or cars appear darker when they are wet. Many people perceive this as a "fading" of the whitening they achieved in the office.
- May need to be combined with home whitening to achieve your desired result.
Waiting room whitening:
- Is supervised by a dentist. Because of this, the whitening material used may be stronger than what you can buy at a store. Usually the device is placed in your mouth, but then you sit with it in for a period of time (possibly in the waiting room-hence the name commonly used) before it is removed.
- More systems for this exist now than in the past. Depending on the system your office uses, it may take more than one visit to accomplish, particularly if the system requires a tray custom-fit to your mouth.
- Results are seen faster than if you whiten at home but may not be as dramatic as in office whitening.
- May need to be combined with home whitening to achieve your desired result.
Custom Fit Bleaching Tray (used at home):
- Uses a tray custom made to fit your teeth so that the product is in close contact with your teeth. This requires the dental office to take impressions or scans of your teeth to make the custom fit tray. The tray is reusable.
- Uses a gel you put in your tray. Worn for 1-8 hours a day (1-2 hrs is most common)
- Results may not be seen for 1-2 weeks.
- Requires returning to your dental office to have your progress checked and to be sure the product is being used correctly.
Ionic Activated Tray (used at home):
- Gel is placed into a tray. A button on the tray is pressed to start the ionic activation of the gel, then you put the tray into your mouth. (The tray is reusable as long as the activator still functions.)
- Worn for 30-60 minutes a day. (Some people choose to do it twice a day, spaced apart, because it is recommended to not drink coffee or tea during the time you are whitening with this material and they want to minimize the length of time they cannot have the beverages.)
- Requires less drying of the teeth, so some studies show less sensitivity of teeth from this process.
Store bought Strips/Paint Ons etc. (home):
- Typically used for 30-60 min. per day once a day.
- Is often not as high strength as what you can get from a dental office
- Utilizes a one size fits most system. If you're not one of the "most" your results may not be the best.
- May interfere with speech during treatment time.
- May not stay in place as well or feel as secure as a custom fit tray.
Mall Kiosks (At one time these were a "thing". Some have been shut down, so I'm not sure you can still find them)
- Use a similar material as in home kits you’d get from your dentist, but you don’t get the same level of supervision. Most kiosk personnel have not trained to work in a dental office, and as such, they may only provide instructions for you to apply the product to your own teeth.
- Recommend weekly visits to the kiosk for best results.
- Achieve results only 78% of the time.
TV or Internet Products:
- Beware or approach these with caution—some contain acids as well as the whitening material. Acids cause harm to your teeth. Remember, cavities are caused by acids eating away at the tooth structure.
- Vary widely in results. Make sure you check testimonials at various consumer rating sites that are not affiliated with the product.
Armed with this information, you can now make the right bright choice for whitening your teeth. If you have questions that weren’t answered in this article or are interested in teeth whitening, please do not hesitate to call my office at 440-960-1940. You can also contact us through our website at www.drjrobb.com or on facebook at www.facebook.com/drjenniferrobb
You have a wonderful pediatric dentist who's great with kids. Their dental office is a children's wonderland with cheerful colors, toys and a staff that tries to make things fun. But no matter what you do—including rewards and positive praise—it's not enough to calm your child's anxiety during dental visits.
Even with the most conducive clinical environment and parental efforts, some children still have an inordinate fear of seeing the dentist. Their anxiety could be a roadblock to getting the treatment they need to maintain good oral health and development. And if that fear carries over into adulthood, they may get into the habit of postponing needed care.
But dentists have an important tool they can use to help children relax: conscious sedation therapy. Using proven sedation medication, dentists can place patients in varying degrees of suppressed consciousness.
Although often used in conjunction, sedation is not the same as anesthesia. The latter is used to eliminate pain during dental procedures. Sedation, on the other hand, aims to calm the negative emotions generated by dental anxiety. A child under sedation can still breathe normally without assistance and respond to physical stimulation or verbal commands.
Sedation medications can be administered orally, usually in syrup form, or with an intravenous (IV) drip. Two of the more popular drugs are Midazolam and Hydroxyzine, both of which act fast and then leave the body quickly after the procedure. These types of sedation drugs have a very low risk of side effects compared to general anesthesia.
While under sedation, the child's vital signs (heart rate, respiration, blood pressure, etc.) are continuously monitored. Afterward, they'll wait in recovery until their vital signs are back to their pre-sedation levels. They can then go home to rest for the remainder of the day, and then usually return to school or other normal activities the following day.
Besides making it easier for a child to receive needed dental care, conscious sedation can also make the overall visit more pleasant, and lead to more positive memories of the experience. This may indeed help them later in life to overcome any lingering anxiety and continue regular dental care throughout adulthood.
If you would like more information on reducing your child's dental visit anxiety, 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 “Sedation Dentistry for Kids.”
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