Posts for category: Dental Procedures

By Bradford J. Rhodes D.M.D.
April 04, 2019
Category: Dental Procedures
Tags: crown lengthening  
CrownLengtheningCouldHelpwithTreatingHardtoReachCavities

There is a primary principle dentists follow regarding tooth decay—treat it as soon as you find it. Something as simple and routine as filling a cavity could prevent future tooth loss.

But treating a cavity at or below the gum line could be anything but simple and routine. Older adults who may also be dealing with gum recession are more likely to have these kinds of cavities where the gums block clear access to it.

But there is a way to access gum-covered cavities with a minor surgical procedure known as crown lengthening. Crown lengthening is commonly used in cosmetic dentistry to expose more of the visible teeth when there's an overabundance of gum tissue or if the teeth are disproportionately small. We can use it in this instance to surgically relocate the blocking gum tissue out of the way of the cavity.

After numbing the area with local anesthesia, tiny incisions will be made in the gums to create a tissue flap. After reshaping the underlying bone to recreate normal anatomy but at a different level, this flap is then moved and sutured to a new position. This exposes enough tooth structure so that the cavity can be repaired after gum healing.

As with any minor surgery, there's a very slight risk of bleeding and/or infection with crown lengthening. If you undergo this procedure, you'll receive post-care instructions for the first few days afterward including avoiding strenuous activities, eating only soft foods and using an ice pack the day of surgery to help control swelling.

This versatile procedure can help save a tooth that might otherwise be lost due to decay. And, it might even improve your appearance.

If you would like more information on treatment options for tooth decay, 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 “Crown Lengthening: This Common Surgical Procedure Restores Function and Improves Appearance.”

By Bradford J. Rhodes D.M.D.
March 15, 2019
Category: Dental Procedures
Tags: gummy smile  
ImprovingaGummySmileDependsonitsCause

A “gummy” smile, in which the upper gums are too prominent, is a common condition. There are several causes for gummy smiles — determining which one is the first step to having your appearance changed.

Although perceptions vary from person to person, most dentists agree a gummy smile shows 4 mm or more of gum tissue, and the amount is out of proportion with the length of the crown (the visible tooth). Teeth normally erupt through the gums during childhood and continue development until early adulthood, shrinking back from the tooth until stabilizing in place.

This typically produces a crown length of about 10 mm, with a “width to length” ratio of about 75-85%. But variations can produce differences in the relationship between teeth and gums and the width to length ratio of the teeth. The teeth may appear shorter and the gums more prominent. Worn teeth, caused by aging or grinding habits, may also appear shorter.

If tooth to gum proportionality is normal, then the cause may be upper lip movement. When we smile, muscles cause our lips to retract 6-8 mm from the lip’s resting position. If the amount of movement is greater (meaning the lip is hypermobile), it may show too much of the gums. The upper jaw can also extend too far forward and cause the gums to appear too prominent.

There are a number of ways to improve gummy smiles, depending on the cause. Periodontal plastic surgery known as crown lengthening removes and reshapes excess gum tissue to reveal more of the tooth. Lip hypermobility can be reduced with Botox injections (to paralyze the muscles) or in some cases with surgery to reposition the muscle attachments. Orthognathic surgery can be used to surgically reposition an overextended upper jaw. Other cosmetic enhancements such as orthodontics, bonding or porcelain restorations can also prove effective.

The first step is to obtain an accurate diagnosis for your gummy smile. From there, we can devise the best treatment approach to bring your smile back into a more attractive proportion.

If you would like more information on minimizing a gummy smile, 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 “Gummy Smiles.”

By Bradford J. Rhodes D.M.D.
January 24, 2019
Category: Dental Procedures
CharlizeTheronBackinActionAfterDentalSurgery

When they’re introducing a new movie, actors often take a moment to pay tribute to the people who helped make it happen — like, you know, their dentists. At least that’s what Charlize Theron did at the premiere of her new spy thriller, Atomic Blonde.

"I just want to take a quick moment to thank my dentists," she told a Los Angeles audience as they waited for the film to roll. "I don’t even know if they’re here, but I just want to say thank you."

Why did the starring actress/producer give a shout-out to her dental team? It seems she trained and fought so hard in the action sequences that she actually cracked two teeth!

“I had severe tooth pain, which I never had in my entire life,” Theron told an interviewer from Variety. At first, she thought it was a cavity — but later, she found out it was more serious: One tooth needed a root canal, and the other had to be extracted and replaced with a dental implant — but first, a bone grafting procedure was needed. “I had to put a donor bone in [the jaw] to heal,” she noted, “and then I had another surgery to put a metal screw in there.”

Although it might sound like the kind of treatment only an action hero would need, bone grafting is now a routine part of many dental implant procedures. The reason is that without a sufficient volume of good-quality bone, implant placement is difficult or impossible. That’s because the screw-like implant must be firmly joined with the jawbone, so it can support the replacement tooth.

Fortunately, dentists have a way to help your body build new bone: A relatively small amount of bone material can be placed in the missing tooth’s socket in a procedure called bone grafting. This may come from your own body or, more likely, it may be processed bone material from a laboratory. The donor material can be from a human, animal or synthetic source, but because of stringent processing techniques, the material is safe for human use. Once it is put in place your body takes over, using the grafted material as a scaffold on which to build new bone cells. If jawbone volume is insufficient for implants, it can often be restored to a viable point in a few months.

Better yet, when grafting material is placed in the tooth socket immediately after extraction, it can keep most of the bone loss from occurring in the first place, enabling an implant to be placed as soon as possible — even before the end of a movie’s shooting schedule.

Will Atomic Blonde prove to be an action-movie classic? Only time will tell. But one thing’s for sure: When Charlize Theron walks down the red carpet, she won’t have to worry about a gap in her smile.

If you have questions about bone grafting or dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Immediate Dental Implant.”

OrthodontistsAnticipateFutureFacialGrowthWhenTreatingPoorBites

Moving teeth to better positions through orthodontics not only improves dental function and health, it can vastly improve your appearance. But to achieve a result that continues to be attractive as you age requires thorough planning and forethought.

That’s because your body continues to change all during life. While the most accelerated growth happens in childhood and adolescence, even older adults continue to change, especially in their facial features. A good deal of research has helped identify and catalog these changes, which orthodontists now incorporate into their corrective treatments for poor bites (malocclusions).

For example, the lips grow until they reach their maximum thickness in girls usually around age 14 and boys age 16. But researchers have also found lip thickness gradually diminishes for most people beginning in their late teens until about age 80. In other words, the appearance of your lips in your elderly years will be vastly different than in your teens. The same holds true for other facial features: our facial profile flattens as the nose becomes longer and more pronounced while the lower part of the face shortens.

Using this knowledge of the effects of aging on the face, orthodontists now attempt to anticipate “where” the facial features will be decades down the road. This projection can help them design a treatment plan that takes advantage of these projected changes.

For example, orthodontists may begin treatment before a patient’s teenage years with techniques that serve to guide jaw growth. Keeping that development on track will help if or when braces may be needed a few years later. Guiding jaw growth will help shorten the distance of where a patient is in their orofacial development and where they should be later in life with normal development.

Orthodontists aren’t predictors of the future. But armed with an understanding of the aging process, they can help patients head in the right direction to produce a smile and facial appearance that will endure well into later life.

If you would like more information on moving teeth to achieve a more attractive appearance, 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 “Understanding Aging Makes Beauty Timeless.”

LingualBracesOfferaLessVisibleAlternativetoTraditionalBraces

We’re all familiar with tried and true traditional braces and perhaps with newer clear aligners for realigning teeth. But there’s an even more novel way that’s quickly becoming popular: lingual braces.

This type of braces performs the same function as the traditional but in an opposite way. Rather than bonded to the front of the teeth like labial (“lip-side”) braces, these are bonded to the back of the teeth on the tongue (or “lingual”) side. While labial braces move teeth by applying pressure through “pushing,” lingual braces “pull” the teeth to where they need to be.

Although lingual braces are no better or worse than other orthodontic methods, they do have some advantages if you’re involved in sports or similar physical activities where mouth contact with traditional braces could cause lip or gum damage, or if your work or lifestyle includes frequent snacking or eating, which requires continually removing clear aligners. And like aligners, lingual braces aren’t noticeable to the outside world.

But lingual braces typically cost more: as much as 15-35% more than traditional braces. They can initially be uncomfortable for patients as the tongue makes contact with the hardware. While most patients acclimate to this, some don’t. And like traditional braces, it’s hard to effectively brush and floss your teeth while wearing them. This can be overcome, though, by using a water flosser and scheduling more frequent dental cleanings while you’re wearing them.

For the most part, lingual braces can correct any poor bite (malocclusion) correctable with labial braces. The treatment time is also comparable, ranging from several weeks to a couple of years depending on the malocclusion. And, as with any other orthodontic method, you’ll need to wear a retainer once they’re removed.

Lingual braces have only been available in a limited fashion for a few years, but their availability is growing as more orthodontists train in the new method. If you’re interested in the lingual braces approach, talk to your orthodontist or visit www.lingualbraces.org to learn more.

If you would like more information on lingual braces, 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 “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”



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Bradford J. Rhodes D.M.D.

503-255-7095
1110 SE 122nd St Portland, OR 97233