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SAME DAY CROWNS FOR A BEAUTIFUL AND HEALTHY MOUTH

A very common procedure in dentistry is called a crown. When a tooth has decay that is too large to be restored by a filling a crown is indicated. They are also indicated if an old filling has worn out, if there are cracks in a tooth, if the tooth is broken, or after endodontic treatment (root canal). Crowns are very common and are effective.

HOW DOES A DENTAL CROWN WORK?

A crown fits over the tooth and mimics the natural tooth. After the decay (or old filling) are removed the tooth is shaped to receive the crown. Reduction between 1mm-2mm will be needed to make space for the crown.  Once the final crown is completed it is cemented on the remaining tooth structure and will not come off. They are not removable. The look and feel like a natural tooth.

ARE THERE DIFFERENT OPTIONS FOR CROWNS?

There are many different options for the crown material and how the crown is made.  Traditionally impressions were made and sent to a dental lab for fabrication.  This process would mean two visits to the dentist. The first for the crown prep and the second for the delivery of the final crown after it has be fabricated from the lab.  This method is still a great way to fabricate crowns. The technique has been exacted over the years and works well.

With dental technology advancing, so have the methods to fabricate a crown. For example, we can now fabricate the crown in the office in the same appointment. This can be done without the uncomfortable dental impressions. This is done by Computer-aided design & computer-aided manufacturing or CAD CAM. Your teeth are scanned with a special dental camera. The image is then used to digitally design a crown. After the design is done in the computer, the file is sent to a machine, here in our office, where the crown is made. It is then placed in a small furnace for final curing. The crown is now ready to be cemented. This entire process takes about 30 minutes and is all done in our office.

This new technology has been used in dentistry for over 15 years.  There are some instances where an in office crown would not be the material of choice. If that does happen a lab fabricated crown would be the best option.

At Fine Dentistry in Las Vegas, we implement both methods for crown fabrication.  We are happy to provide the highest and latest standard of care.  Please view this simple animation for an example of in office crown procedure.

As always please call if you ever need anything or have any questions. 702.798.7724

Your Dentist, Your Friend

Dr. David Ross
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I joined the United States Army just before entering dental school in 2008. I am currently serving as a Dental officer for the United States Army Reserve. I have been serving in the Reserves since 2016. From 2012 to 2016 I was active duty Army stationed at Ft Bragg North Carolina. I come from a long line of military service. My father was an officer in field artillery for 20 years. My father-in-law was a dentist in the Army for 2 years. My brother was deployed to Iraq as a field artillery soldier during Operation Iraqi Freedom. Both of my grandparents served in the Navy. My wife’s grandfather was a pilot in the Air Force.

KEEPING OUR SOLDIERS HEALTHY AND READY

The military has a large contingent of dentist that help keep America’s fighting force ready to protect her interest and her people. The role of a dentist in the military is to keep the soldiers battle ready. Most units that are deployed will take with them one or more dentists. The military relies on units and teams. The dentist’s responsibility is to make sure that these teams are maintained and the soldiers are not removed from the fight due to oral complications. The military has sophisticated field dental units that help make this possible.

HOW AMERICA TAKES CARE OF OUR SOLDIERS DENTAL NEEDS

The military installations in America and around the world have dental clinics on site. Military instillations are like little cities. Dentist on the military sites function as your regular dentist that you see every year, they just do it in military uniform.

The military not only has Dentist in their ranks but they also have education programs to train them. The military offers education and certification in all dental specialties including;

• Advanced general dentistry,
• Endodontics,
• Periodontics,
• Oral surgery,
• Prosthodontics, and,

Even though the dentist’s role is the oral health of the soldier, they are also trained to military standard in all aspects expected of soldiers in the fighting force. They are expected to maintain all standards and training of anyone else who would enter into military service. Even though they are dentist, they are soldiers first.

A dentist has earned the Medal of Honor, the highest military accommodation that there is. This was given post humously for his valiant efforts while fighting in South-East Asia in 1944 during World War II. His name was Ben Salomon. A recount of his deeds can be found here on the Army medical department’s website.

SERVICE IN THE AMERICAN MILITARY AS A DENTIST

I have enjoyed serving the United States as a soldier dentist. I can tell you from first hand experience that our men and women serving this nation are the best trained soldiers in the world. Their personal sacrifices and the sacrifices of their families are great.

If you are in need of anything don’t hesitate to call. 702-798-7724

Your Dentist Your Friend,

Dr. David Ross

According to pop culture the phrase “You need a root canal” is one of the most dreaded in a dental office. This post will show that fear is unfounded. In fact, the treatment can quickly alleviate pain and remove infection from the body that could otherwise make a person quite sick, beyond the pain of a toothache.

What is a Root Canal?

When you hear “root canal” the dentist is referring to something called root canal therapy or endodontics. The procedure can be performed by a general dentist, or a specialist called an endodontist. Most of the time the procedure will last about an hour. Root canal therapy is the removal of the vital tissue that resides inside the tooth. This tissue (when you need a root canal) is damaged and can cause infection and pain.

After the removal of the tissue the dentist will place a sealer inside the root canal space.  This will seal the tooth and bring it back to health. At the end the dentist will place a filling to cover the access hole made. Depending on the location of the tooth and the severity of the decay it may also be necessary to prepare the tooth for a crown. Root canal therapy has a success rate between 86%-95%.

What causes the need for Root Canal Therapy?

Root canal therapy is most often indicated due to decay or a large cavity. As the cavity progresses and grows, it moves closer to the vital tissue of the tooth. This tissue is called the pulp. Once it has reached the pulp the tissue is damaged and will become infected. Another cause for root canal therapy is trauma. This trauma can include a fall, a car accident, or a blow to the face or mouth. Teeth can also break and expose the tissue.  Once the tissue is exposed it will need a root canal treatment.

Is Root Canal Therapy Painful?

There is the stigma that root canal therapy is one of the most painful procedures to have at a dental office.  This is false.  Like any dental procedure, once the dentist has administered the anesthesia and you are profoundly numb there should be no pain. Often patients will feel much better after the anesthetic has taken place.

What is truly painful are the causes leading up to the need for root canal therapy. The cavity can be painful and the infection or abscess can also be painful. The root canal therapy will alleviate this pain and put you back on the path to healing. Where you may not have been able to eat properly or concentrate or sleep well, you will now have no pain and life will be much better.

I have included a brief animation of a root canal therapy.

If you have any questions please call:  702-798-7724

Your Dentist, Your Friend

Dr. David Ross

One question I hear all of the time is; what type of toothbrush should I buy or what is the best? There are three main types of toothbrushes you can buy. These options are Manual, Sonic, and Oscillating. They all have benefits and their negatives. There have been numerous studies to demonstrate which one is best. I have read a lot of these articles so that you do not have to. So which one is the best? The simple answer is, they all are! Read on and let me clarify.

Electric vs. Manual

Studies have been occurring on this particular issue for years. Some studies go back to the 1970s. For the most part, the results and conclusions are the same. These studies usually state that an electric brush is superior to a manual toothbrush. However, it turns out that if you brush for an average of 2 minutes twice a day, a manual brush can achieve satisfactory cleaning of the teeth and gum tissue. It depends on the user. A patient person who has good manual dexterity can do a great job with a manual brush. The results rival the electric brush. The problem is that most of us are not proficient or patient enough to achieve these results. Therefore having an electric brush tends to give better results.

Which Electric Toothbrushes Are Best?

Electric brushes come in different varieties. I recommend a brush that has an internal battery that will recharge. Usually, these types of brushes have basic useful features. The main idea is to brush for a minimum of two minutes. The brushes with an internal battery have a timer that will notify you when you have reached two minutes. They will also have a feature that will notify you when it is time to switch sides. A huge advantage of an electric brush is that it does much of the work for you. All you have to do is hold the brush adjacent to the teeth and it is working. You only have to guide the brush along the teeth.

There are two main options when you use an electric brush. They are oscillating and sonic. Each can give great results. Some studies state that there is no significant difference between the two, and others will state one or the other is mildly superior. The main takeaway is that an electric brush used correctly will yield good results. I own all of these toothbrushes, and I use them all regularly. It is a personal preference as to which brush is better. I tend to feel the oscillating brush leaves a better clean feeling while the sonic brush feels gentler. The main negative to electric brushes is their cost. Some can cost over $200 while a manual brush is only $2.

I’ve included a few links below with studies and suppliers’ websites.

Feel free to call my practice with any questions.

(702) 798-7724

Dr. David Ross, Your dentist Your friend.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459492/#:~:text=Conclusion%3A,this%20reduction%20is%20not%20known.

https://www.unmc.edu/news.cfm?match=715

https://pubmed.ncbi.nlm.nih.gov/15190692/

https://www.usa.philips.com/c-m-pe/electric-toothbrushes#triggername=color_white

https://oralb.com/

Caries, the disease that causes dental decay, is the most common disease known to man. However, as with many diseases, we now know much about its cause, how it attacks, and thus how to prevent the destruction it causes.

The purpose of this paper is to assist those who wish to become proactive in preventing dental decay and even to reverse the early stages of the disease visible as white spots on the teeth.

How does caries decay teeth?

Tooth decay occurs when the carbohydrates we eat interact with a biofilm that covers the tooth surface resulting in acid formation. This acid can then overcome the protective influences of healthy saliva and dissolve the tooth itself.

Our saliva is a mechanism developed by our bodies to protect our teeth. However, the success of this mechanism depends on many factors related to our overall health and lifestyle choices.

What factors increase the risk of tooth decay?

Salivary dysfunction factors-

• Inadequate amount of saliva
• Inadequate buffering capacity of saliva
• Inadequate viscosity of saliva

Lifestyle factors-

• High sugar diet
• Grazing pattern of eating
• Acidic foods and drinks

How does saliva work to protect the teeth?

Almost everyone’s mouth contains bacteria which can cause caries and result in tooth decay. Healthy adequate saliva is our main defense against that decay. It does this by:

First, controlling the amount of acid in our mouths. Saliva should contain chemicals which buffer (neutralize) the acid produced by bacteria or taken into our mouths through food. This acid concentration is measure by a value known as pH. pH should be neutral or have a value of approximately 7. The farther it varies from this value, either up or down, the more problems we have with oral disease. Lower numbers mean we have too much acid. Higher numbers mean we have too much alkali.

Second, providing lubrication through chemicals called mucins and pralines. Our bodies produce these chemicals when we drink a proper amount of water and eat diets rich in healthy proteins.

Third, providing antimicrobial action through salivary enzymes. An enzyme called lysozyme destroys bacteria by splitting the cell walls. Another, lactoferin deprives bacteria of iron. Yet another, hypothiocyanate inhibits bacterial reproduction(?).

Fourth, by remineralizing enamel. Calcium and phosphate found in healthy saliva can actually reenter the tooth and reverse decay which has recently begun.

And fifith, by maintaining the health of the soft tissues (gums) which support the teeth. The mucins mentioned above as well as the electrolytes in the saliva protect and nourish the gums and, when healthy, fully cover the root to protect it from chemical attack.

In all of these 5 ways, healthy saliva protects our teeth from the effects of acid, erosion, and bacteria.

How does our lifestyle affect our dental health?

There are 4 primary ways in which our lifestyle choices affect the amount of dental decay we experience:

First, choose a healthy diet. A high sugar diet is a well known negative factor. Sugar provides nourishment for the bacteria that live in the biofilm that normally covers our teeth. They become so numerous that they and their waste products produce what we call “dental plaque”, that fuzzy substance we scrub off when we brush our teeth or the dental hygienist removes during dental cleanings. The bacteria produce acidch lowering the pH of the tooth surface. When the pH is in the range of 5.5-3.5 the tooth surface begins to dissolve. The bacteria are then able to reach further and further into the tooth itself, eventually even to the pulp causing abscess, pain, and death of the tooth.

Choosing to add vegetables, fruits, grains, nuts, and seeds to your diet will assure that the proper chemicals are available to produce a protective saliva.

Second, the timing of our eating is also an important choice. Eating a limited number of times reduces the exposure of teeth to acidic and sugary foods. However, our culture encourages us to eat in a pattern called “grazing”. That is, we eat small amounts frequently – snacking as we work, relax, or socialize. Tests consistently show that the number of exposures to cariogenic (decay producing) foods is the most important factor in producing caries or tooth decay. There is no clear relationship between the actual amount of sugar or acid in our food and the amount of tooth decay. It is the amount of time the tooth is exposed to such foods that is important.

The third choice we make that can seriously affect our teeth is our choice of acidic foods. The obvious such choice would be a habit of sucking on lemons. The sour taste of a lemon is due to the high acidic content and, as we have seen, acid dissolves teeth. But there are other foods which we might not think of as acidic and which we more commonly choose.

What we choose to drink is a frequent negative factor in our culture. Soft drinks, especially cola and high-energy drinks are very acidic. Sugar is often added to mask the sour or bitter taste of the acid, doubly threatening our dentition. All sweetened drinks like coffee, tea, soda, even fruit juices and milk, can decrease the pH of our mouths and threaten our teeth. Babies who are constantly given bottles or “sippy cups” of such beverages will quickly develop a circle of decay on their front teeth. The recent popularity of high energy colas and rehydrating sports drinks has produced an epidemic of new tooth decay. Water with its neutral pH is really the best drink for our dental health.

There is a fourth group of substances which, when we choose to use them, can also negatively affect our dental health. These are substances which affect the amount and quality of saliva we produce such as caffeine, alcohol, nicotine, some types of prescription drugs, and illegal drugs, most seriously methamphetamine. “Meth mouth” the decay of all teeth, often to the gum line, is the obvious give away of the methamphetamine addict. Learn more about this dangerous group of substances below.

Remember that lifestyle choices can increase your dental decay and dental decay can limit your lifestyle opportunities!

How is saliva dysfunction treated?

Since saliva is the body’s main defense mechanism against dental decay, efforts to encourage copious amounts of saliva will reap protective benefits.

The first thing we can do is to BE AWARE OF FACTORS WHICH REDUCE OR PREVENT THE FLOW OF SALIVA. Many useful and necessary prescription and over-the-counter medications interfere with saliva production through the same mechanism that is protective in other instances. The following is a list of such substances. Review the list looking for medications or other substances or treatments which may be reducing your saliva flow:

1. Drugs and medications such as anorectics (appetite suppressants), cold medications such as decongestants and anticholinergics (for mucous), antidepressants, smoking cessation drugs, sedatives, hypnotics (sleep aids), antihistamines (allergy medications), anti-Parkinsonian drugs, antihypertensive agents (blood pressure medications), and diurectics (water pills).
2. Radiation and chemotherapy.
3. Organic disease such as Sjogren’s syndrome.
4. Dehydration caused by strenuous exercise or heat without adequate water and mineral replacement.
5. Caffeine, a diuretic which removes water from the body resulting in partial dehydration.
6. Alcohol, another diuretic substance.
7. Nicotine which is a vasoconstrictor resulting in restriction of salivary gland function. In addition, nicotine provides a low oxygen environment which encourages the multiplication of bacteria, another factor in caries development.
8. Methamphetamine, an illegal drug that is noted for the dry mouth it produces.

If you find that you are at risk of reduced saliva flow through exposure to any of the above substances and you cannot avoid the substances, HERE IS A LIST OF REMEDIES that can assist you in increasing your saliva production:

1. Chew sugarless gum. – Chewing gum stimulates saliva flow. Sugarless gum avoids sugar and the acid production that results. Today some gums are sweetened with XYLITOL, a naturally occurring sugar that actually inhibits bacterial growth. Trident makes a xylitol sweetened gum. Biotene makes a xylitol-containing gum which does not stick to dental work, but does break up in a shorter than normal period. The best time to chew gum is directly after eating for at least 20 minutes.
2. Drink plenty of water, especially during the day and with meals. This will help to avoid subliminal dehydration and wash fermentable food particles from the mouth.
3. Avoid caffeine, nicotine, alcohol, and cola, high-energy, and sports drinks. Especially avoid methamphetamine. All reduce the amount of saliva produced.
4. Use artificial saliva. Biotene Oral Balance liquid is an artificial saliva which can be squirted directly into the mouth frequently during the day when your mouth feels dry or when extra saliva is needed such as after eating. It contains many of the helpful chemicals found in natural saliva.
5. Suck on sugarless hard candies and breath mints. Some are even sweetened with xylitol. People with reduced saliva flow tend to have increased tendency for halitosis (bad breath). Saliva bacteria reach 10,000,000,000/ml. With low salivary flow the clearance of bacteria and desquamated epithelial cells is greatly reduced. In addition, without adequate saliva flow, the opportunity for bacteria to ascend the salivary ducts and infect the glands increases.
6. Try Oral Balance Gel by Biotene. This unique oral lubricant moistens tissues and heals minor irritations. It also contains antibacterial enzymes which neutralize odors and unpleasant taste. A ¬Ω inch strip of the gel is placed on the fingertip and applied to the tongue. Additional amounts may be applied to affected areas.

What can be done about lifestyle threats?

Again avoid risky lifestyle choices like sugar, snacks, nicotine, alcohol, caffeine, colas, energy drinks, sports drinks, and drugs. But where this is not practical, there are lifestyle choices which can help to overcome some of their effects.

1. Be meticulous about oral hygiene. Brush frequently with a good antibacterial toothpaste containing fluoride. Most well-known toothpastes contain fluoride. Colgate Total containing both fluoride and antibacterial agents has been shown to reduce the bacteria with an effect which lasts for up to 12 hours. CLOSYS toothpaste and mouthwash by Rowpar contain an antibacterial. Biotene toothpaste has 3 salivary enzymes plus xylitol. You can use all in a rotating pattern. Also remember to have regular dental cleanings. Your dentist may recommend more frequent cleanings to keep your teeth free from acidic plaques.

   Do a thorough cleaning. This can be done with the traditional toothbrush and floss; however, recent evidence shows that using an electric toothbrush is at least as effective as the brush/floss combination. The Oral B brush by Braun and the Sonicare are both of the quality required. WaterPik-type irrigation devices are effective at cleaning between teeth and below the gum line. In addition they can be loaded with antimicrobial mouthwash to further reduce the bacterial concentration in the mouth. Remove all the plaque from every tooth surface. It is actually more beneficial to clean your mouth before you eat than afterwards. Removing the dental plaque before you eat, removes the decay-causing bacteria so acid is not produced by metabolized sugars.

2. Use fluoride. Daily use of a fluoride toothpaste is an easy choice. In addition, a 5% fluoride varnish may be applied by your dental hygienist every 3 months as an effective treatment for those susceptible to caries, especially root caries.

3. Use Xylitol. This naturally-occurring sweetener reduces dental decay by inhibiting growth of streptococcus mutans, the main bacterial agent in caries. Xylitol is usually added to gum, candy, and toothpaste. Use of the gum and/or candy may stimulate saliva production. It is also available in a granular form for use as a sugar substitute.

   Since caries is a bacterial disease, it is contagious. Research has demonstrated that new mothers and pregnant women who chewed xylitol gum reduced the risk of transmitting bacteria to the mouths of their infants.

4. Remineralize! Dental decay is first visible as white spots on the surface of the tooth. Now these carious lesions can often be remineralized. Destruction is stopped and reversed. This is done by treating with MI Paste by Recaldent which contains calcium phosphate. When placed on the surface of the affected tooth, a chemical is produced which can diffuse into the tooth. Disappearance of the white spot means that remineralization has occurred. MI paste also promotes the uptake of fluoride into the tooth surface reducing sensitivity and hardening the enamel. This treatment is contraindicated in the case of true lactose intolerance. MI Paste Plus also contains fluoride for ready access.

It is my hope that you will find this information to be a practical guide which you can start using immediately to promote your own better dental health.