Why is it important to replace missing teeth with restorations such as dental implants? You might be surprised to find that the damage caused by missing teeth is much greater than the simple gaps left in your smile.

As the years go by, teeth lost early in adulthood cause structural changes in a person's face. By age 45 changes in facial structure are already visible in the form of sunken cheeks. By 60, cheeks and lips lose their support, resulting in an aging look. This process continues and if the teeth are not replaced, much of the structural support of the person's face is lost.

These changes are caused by loss of bone. Although it may seem static, bone is actually living tissue that needs constant stimulation to maintain its form and density. With normal stimulation it is in a constant state of resorption (breaking down) and deposition (building up). Teeth provide the needed stimulation for the bone that surrounds them (called alveolar bone) as they meet each other during biting, chewing, and speech. When the stimulation continues, the bone continues to rebuild itself. Without this stimulation, the bone resorbs, does not build up again, and loses substance.

Without stimulation, alveolar bone loses width, height, and volume. Since your teeth and their surrounding bone support your chin, cheeks, and lips, this has a powerful effect on your appearance. It may also affect your ability to chew and to speak.

As alveolar bone diminishes, the next layer of bone also begins to resorb. This is the bone of the jaw itself. The lower part of the face begins to collapse, and the cheeks become hollow. This effect is especially noticeable for people with no teeth (edentulous).

Usually the first tooth to be lost, due to infection and decay, is a molar (back tooth). In the past, a missing single back tooth was frequently replaced by a fixed partial denture (FPD). A crown is provided for each of the two teeth on the sides of the gap, called abutment teeth, to support a false tooth in the middle. However, if they are not well cared for, the abutment teeth may be the next to succumb to decay.

Today the treatment of choice is an implant. A dental implant is a tooth-root replacement made of titanium, which fuses with the bone — making it very stable. Above the gums it is covered by a crown that looks like a natural tooth. The benefit of the implant is that it continues to provide stimulation to the alveolar bone, preventing bone loss.

Implants are also a good choice in the case of multiple missing teeth. They can be used to support bridges or false teeth (dentures). The results are an improved, younger appearance and better functionality.

Contact us today to schedule an appointment to discuss your questions about missing teeth. You can also learn more by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

Bad breath can have a serious impact on a person's social and business life. Americans are well aware of this fact, and spend nearly $3 billion each year on gums, mints, and mouth rinses in order to make their breath “minty fresh.”

Bad breath or halitosis (from the Latin halitus, meaning exhalation, and the Greek osis, meaning a condition or disease-causing process) can originate from a number of causes; but oral bacteria are the most common source. About 600 types of bacteria grow in the average mouth. If bacteria act on materials that have been trapped in your mouth, many of them produce unpleasant odors.

Most often, bad breath starts on the back of the tongue, the largest place in the mouth for a build-up of bacteria. In this area bacteria can flourish on remnants of food, dead skin cells, and post-nasal drip. As they grow and multiply these bacteria produce chemical products called volatile sulfur compounds or VSCs. These compounds emit smells of decay reminiscent of rotten eggs.

In addition to bacteria on the tongue, halitosis may come from periodontal (gum) disease, tooth decay, or other dental problems. If you have halitosis, it is thus important to have a dental examination and assessment, and to treat any such problems that are found. Treating bacteria on the tongue without treating underlying periodontal disease will only temporarily cure bad breath.

The next step is to take control of tongue bacteria by brushing or scraping your tongue, with possible addition of antiseptic mouth rinses. People who have bad breath have more coating on their tongues than those who don't, and regularly cleaning the surface of the tongue has been demonstrated to reduce bad breath.

Implements have been designed specifically for the purpose of scraping or brushing the surface of the tongue. Using a toothbrush is not as effective because it is designed to clean the hard tooth surface, rather than the spongy surface of the tongue. To keep your breath fresh, you must regularly remove the coating from your tongue. This means acquiring a tongue scraper or brush and using it every day.

Contact us today to schedule an appointment to discuss your questions about tongue cleaning and bad breath. You can also learn more by reading the Dear Doctor magazine articles “Tongue Scraping” and “Bad Breath.”

Getting enough sleep is necessary for good health. We all know how energetic we feel when we are sleeping well at night. Yet, many of us do not feel rested, even after seven or eight hours of sleep. Let's answer some common questions about snoring and sleep apnea, problems that are often called sleep related breathing disorders (SRBD).

What is the purpose of sleep?
Scientists know we need sleep, at a particularly deep level, to be rested, but they are not sure why we need sleep. Sleep may have evolved as a way to conserve energy in the body, to conserve food supplies, or to reduce our risk during darkness. Sleep appears to give the brain a chance to store and organize its information and the body a chance to recuperate. Sleep studies have shown that in order to get the full benefits of sleep we need to sleep long and deeply enough to enter into a series of sleep cycles including Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep.

What kinds of problems get in the way of the type of sleep we need?
There are eight main categories of sleep disorders, but the ones affecting the largest numbers of people are insomnia, SRBD, and Circadian Rhythm Sleep Disorders. SRBDs include snoring and Obstructive Sleep Apnea (OSA), which is a serious health problem.

How do I know if I have OSA or another SRBD?
Often, your bed-partner will tell you that you snore. Chronic loud snoring is an indicator of OSA. To make a diagnosis your physician must take a thorough sleep and medical history. The diagnosis may then be confirmed by a study in a sleep lab.

What causes sleep apnea or OSA?
Snoring and OSA happen when your tongue and other soft tissues in the back of your throat collapse backwards and block airflow through your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stage of sleep your body needs.

What are the treatments for sleep apnea?
Treatments include CPAP therapy, in which patients wear a mask while sleeping. The mask pushes air through the airway, keeping it open. In Oral Appliance Therapy (OAT) patients wear a device that moves the lower jaw forward, allowing more room for air to move down the airway. Oral surgical procedures and orthodontic approaches also have the goal of moving the tongue away from the throat. These are all treatments that can be carried out by a dentist who has training and experience in treatment of sleep disorders.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Sleep Apnea Frequently Asked Questions.”

Scientists don't know much about sleep even though it has been extensively studied. We do know that several hours of deep, restful sleep per night are essential for a healthy life.

Many people remain tired and unrefreshed, even after a full night's sleep. About a third of them are affected by sleep related breathing disorders (SRBD). Dentists can play a significant role in helping patients overcome these disorders, which range from frequent snoring to severe Obstructive Sleep Apnea (OSA). If you think you may have such a disorder, read on.

Under normal conditions, your upper airway is open, allowing air to flow from your nose, through your throat, and into your lungs. If you suffer from SRBD, you experience frequent reductions in the flow of air to your lungs during sleep. You may not be aware of it, but sometimes your breathing may even stop for brief periods. These reductions happen when your tongue and other soft tissues in the back of your throat collapse backwards and block your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stages of sleep your body needs.

The resulting reduced oxygen flow to your heart and to your brain can cause serious damage. You will also be tired during the day and experience a lack of energy, even if you sleep for seven or eight hours per night. This constant drowsiness puts you at greater risk for accidents.

Because dentists generally see their patients at six-month or other regular intervals, we are in a good position to screen and refer patients with suspected SRBD to physicians for diagnosis and treatment. Dentists can also treat SRBD in a number of ways.

• One of these is Oral Appliance Therapy (OAT), in which a device that looks something like an orthodontic retainer holds your lower jaw in a forward position relative to your upper jaw, preventing your tongue and soft tissue from collapsing into your airway.
• Another consists of breathing equipment called Continuous Positive Airway Pressure (CPAP). The CPAP is a mask connected to a machine that pushes air into your lungs.
• Other treatments include oral surgery or orthodontia. The goal of these techniques is to increase the volume of air passing through your upper airway by pushing your tongue forward.

Medical insurance usually covers the cost of much of these treatments.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine article “Sleep Disorders and Dentistry.”

As the Boy Scouts say, it's best to be prepared. You may never have a traumatic injury to your teeth. But what if you do? Here are four questions and answers about such injuries and their treatment that may be helpful some day.

What are traumatic injuries?
We are talking about physical damage caused by a fall, an accident, or a blow to the face. The word trauma comes from the Greek root meaning “wound.”

A traumatic injury can also cause broken, cracked, or split teeth, or a fracture to the root of the tooth. A tooth may be dislodged from its proper position, pushed sideways, out of or deeper into its socket. It may even be completely knocked out of your mouth.

What should you do if your tooth is knocked out?
With proper treatment, the tooth can be restored to its original place. You must handle the tooth gently and seek professional help as soon as possible. Rinse the tooth in cold water if it is dirty, but do not use any cleaning agent. Avoid touching the root. While hurrying to your dentist, keep the tooth from drying out by keeping it in a container of milk or of your saliva, or by holding it in your mouth between gum and cheek. It is vital to keep the tooth's living tissues moist until it can be professionally assessed and replanted in its socket. If a tooth has been dislodged but not knocked out, it must be repositioned in its socket and may be stabilized with a splint.

Who can treat a tooth that is damaged by a traumatic injury?
A general dentist, an oral surgeon or an endodontist is trained to treat such injuries. An endodontist is trained to treat the root canal(s) inside a tooth. The word comes from “endo” the Greek word for “inside,” and “odont,” the word for “tooth.” After a tooth is replaced in its socket and stabilized, root canal treatment is often needed.

What is root canal treatment?
A tooth is composed mostly of dentin, a living tissue. The top part or crown is covered by hard mineralized enamel. The soft tissue inside the tooth, the pulp, contains blood vessels, nerves and connective tissues. It extends from the crown to the tip of the roots. Treatment of dental pulp injuries is called root canal or endodontic treatment and is usually needed to treat teeth that have been dislodged or fractured.

Contact us today to schedule an appointment to discuss your questions about injuries to teeth and related nerve damage. You can also learn more by reading the Dear Doctor magazine article “Trauma & Nerve Damage to Teeth.”