Teeth Replacement: Dental Bridge vs. Implant

Missing even just a tooth poses a serious problem to one’s oral health. Missing teeth can have a negative impact on dental health as the condition triggers the misalignment of the remaining teeth and the physical condition of the gums, which consequently changes the mouth’s overall appearance and functionality.

There are many ways to replace missing teeth. Two are of the most popular procedures are dental bridge and dental implants. For the best option, numerous factors have to be considered, such as cost, life span, and appearance.

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While both serve the same purpose, dental bridge and dental implant differ mainly in structure. Bridges are technically dentures that are placed between two adjacent natural teeth. They are attached to natural teeth with resin cement and metal bands. Dental implant, meanwhile, is an artificial tooth that is installed directly into the jaw.

In terms of appearance and function, dental implants look more natural. They are also stronger and more efficient for chewing. Unlike bridges, a dental implant can stand on its own without requiring healthy teeth for installation.

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Compared to bridges, which has a lifespan of eight to 15 years, dental implants are considered a permanent replacement for missing teeth. Although they may be more expensive and may require months to be fully installed, they can be more cost-effective over time.

Dr. John Pasqual performs a full suite of procedures for both for adults and children, including dental implant surgery and wisdom tooth. Learn more about his expertise through this website.

Wisdom Teeth Extraction for Patients with TMD

People who have problems with the muscles around their jaw are diagnosed with a temporomandibular disorder, after the temporomandibular joint (TMJ), which is the hinge that connects the jaw to the skull and allows the jaw to move up and down and side to side. While doctors have yet to determine the exact cause of TMD, certain complications may occur when the patient wishes to undergo a wisdom tooth extraction. Many patients express concern that this procedure, which would require the patient to open his or her jaw widely for a long period, may lead to pain or lock-jaw afterwards. There has also been speculation on the use of wisdom teeth removal as a form of treatment for TMD

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Recent medical studies have given insufficient evidence to claim any relationship between TMD and wisdom teeth extraction. While there may be some pain associated with both the operation and the disorder, neither contribute to each other’s inflammation or sensation. Dentists and dental surgeons are also fully aware of how to deal with each condition and ensure a fast and safe procedure and recovery. It must also be noted that wisdom teeth do not cause TMD nor should they be extracted to alleviate TMD pain. Again, studies have failed to refute or support hypotheses that suggest either of the two beliefs. Wisdom teeth should only be removed when events justify the extraction, such as inflammation or when the third molars negatively impact the neighboring teeth.

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Understand the proper reasons for wisdom tooth extraction from trusted dentist, Dr. John Pasqual. More about Dr. Pasqual here.

Addressing Concerns: Does Wisdom Teeth Removal Change Face Shape?

A major concern for many patients is whether a wisdom tooth extraction can change the shape of the face. There have been many speculations; but medically speaking, the procedure does not cause any significant change to the face. The extraction of wisdom teeth, which are usually impacted and not yet fully erupted should not cause deformity of any kind. However, there are two conditions that may potentially affect face shape, but only for a limited amount of time: 

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Multiple extractions: Removing several back teeth may give the patient a sunken look or cause the face to appear thinner or more angular. The only way to correct this is to replace the missing teeth. 

Immediate post-op complications: Some patients tend to experience swelling in the mouth area after the operation. The swelling should only last for a few days, but if the mouth area still continues to appear swollen after a week, the patient may be suffering from an infection and should immediately visit his dentist. It must be noted that several studies have shown that having one’s wisdom tooth removed when older significantly increases the risk of infection and swelling. Post-operative plans should be discussed by older adults and their dentist before the operation. 

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There is a growing trend of having their back teeth removed to define further their jaw structure and facial features. It is known that many professional models had their wisdom teeth removed to give them a more defined look. However, this is highly discouraged by many dental professionals as these extractions should be done for health reasons and not for any aesthetic purposes. 

Dr. John Pasqual specializes in wisdom teeth extraction and dental implants. To learn more about his practice, visit this website.

Doing it right: Four common tooth brushing mistakes and how to fix them

Brushing the teeth is the most commonly recommended oral hygiene practice in the world, but surprisingly, many people still do it incorrectly. The following are four common tooth brushing mistakes and how to remedy them.

1. Brushing too hard

The purpose of brushing the teeth is to remove plaque, the film of bacteria, bits of food, and saliva residue that forms on the teeth and causes tooth decay. Plaque is soft and does not require a heavy hand to brush away. Plaque that has hardened to tartar is removed by dental scaling performed by a dental health professional. It cannot be removed by brushing alone.

In addition, brushing teeth with too much force can wear down and create notches in enamel and cause the gums to recede.

To avoid brushing teeth too aggressively, use a toothbrush with soft bristles and brush in a gentle, circular motion.

2. Brushing too quickly or too long
Some people brush their teeth for too long while others don't brush for long enough.

Speeding through the process won't leave a person with enough time to clean teeth and the surrounding areas thoroughly. Brushing for too long, on the other hand, can lead to receding gums, sensitivity, and damage to the dentin area around the roots of teeth.

Most experts recommend brushing teeth for two to three minutes.  

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3. Brushing just the teeth

Harmful, cavity-causing bacteria can be found in the entire mouth, not just on the teeth. When brushing, make sure to go over the gums, cheeks, and tongue. Flossing can also remove food particles stuck between teeth that regular toothbrushes can't reach.  

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4. Not caring for dental implants and prosthetics

Just like real teeth, dental implants and the prosthetics they anchor need to be cleaned thoroughly and regularly to prevent gum disease. If bacteria accumulate at the base of an implant, it could lead to inflammation, and eventually, peri-implant disease, a type of periodontal disease that affects people with dental implants.

Brush dental implants regularly with a soft-bristled toothbrush and use an interdental brush to remove gently food particles and bacteria from the space between the prosthetic and the gums.Simply practicing proper brushing technique can go a long way in preventing tooth decay and other dental problems.

Dr. John Pasqual is an oral and maxillofacial surgeon. For more articles on dental health, subscribe to this blog.

The Importance of Aftercare for Your Dental Implants

The importance of proper dental hygiene can’t be stressed enough. Regularly caring for the teeth prevents dental health problems. However, many people do not make oral health care a priority. As a result, some of them suffer from damaged or decayed teeth and need replacement for extracted teeth. In modern dentistry, dental implants are the best replacements for missing teeth.

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But just like with natural teeth, good oral hygiene is also critical for dental implants. In fact, many dentists stress that good oral care habits must be practiced before, during, and after placement of the dental implant to maintain oral health and prevent complications.

Regular brushing is one of the critical aspects of aftercare for dental implants. Although there has been debate on the best toothbrush to use, several studies found that there is no significant difference between sonic, electric, or manual toothbrushes. What is important is that the patient brushes the implant(s) twice daily to remove bacterial plaque with a low-abrasive dentifrice. In addition, nylon-coated interdental brushes or proxabrushes are excellent alternatives to clean especially tight and hard-to-reach areas around the implants.

Flossing is another important element of dental implant aftercare. Although there are various types of floss in the market, dentists recommend unwaxed tape or implant-specific to protect the tissue surrounding the implant properly. It is also important to follow the correct technique when flossing: insert the floss in contacts on both sides of the implant, wrap it in a circle and crisscross in front, switch hands, and move in a shoe-shine motion.

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Lastly, a regular dental checkup completes the trio of good dental care habits. With regular visits to the dentist, patients can communicate concerns they have about their implants. A recent British study found that “patients with new dental implants may be able to detect signs of trouble early enough to help prevent complications that can damage gums and bone.”

Implants can last for decades provided that they are properly cared for. This is what Dr. John Pasqual teaches his patients who have received implant-supported restorations. Learn more about post-implant care here.

Pain Begone: Having Impacted Wisdom Teeth Removed

Wisdom teeth are third molars located at the back of the mouth, and the last adult teeth to erupt. Most people have four wisdom teeth – two on the top and two on the bottom. Although the jaw can accommodate 32 permanent teeth, most of the time, it is too small to hold two more teeth each. Thus, the inadequate space prevents the wisdom teeth from erupting and results in dental impaction. There are three types of impaction:

1. Soft tissue impaction, where there is insufficient room to allow the gum tissue to retract for adequate cleaning of the tooth;
2. Partial bony impaction, where there is enough space for the tooth to erupt partially, but it cannot function properly in the chewing process and creates cleaning problems, among others; and 
3. Complete bony impaction, where there is no space for the tooth to emerge and remains embedded in the jaw bone. The impacted wisdom tooth may also be in an unusual position.

Regardless of the type, impacted wisdom teeth can cause several dental problems, including red or swollen gums and bad breath. Some people may also encounter difficulty in opening the mouth and prolonged headache or jaw pain. Moreover, impacted teeth can cause extreme pain when they become infected or damage other teeth.

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It is important to see a dentist immediately if the impacted wisdom teeth cause discomfort, pain, and other dental problems. An x-ray of the mouth and jaw will be performed to determine the exact position of the impacted wisdom teeth and the best strategy for removal. An oral surgeon will perform the extraction, which usually takes 45 minutes or less. An incision is made in the gums and any bone blocking the impacted tooth is removed before the extraction. If the impacted tooth is too large to extract in one piece, the surgeon needs to use a drill to cut the tooth into smaller pieces. After the extraction, the incision is stitched shut. Non-removal of impacted wisdom teeth can result in cyst development, chronic mouth discomfort, and gum disease.

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Oral and maxillofacial surgeon Dr. John Pasqual has years of experience handling various dental procedures, including wisdom teeth removal. Visit his clinic’s official website for more information.

After-care guide to wisdom teeth removal

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It is estimated that 95 percent of American teenagers develop impacted wisdom teeth. While not generally detrimental to health, impacted wisdom teeth are generally recommended to be removed if they pose the risk of gum disease. Most individuals opt for the removal because it also frees up space in the mouth and relieves pressure on the jaw structure. The actual procedure will take a maximum of a few hours. Being a generally standard dental practice, recovery time and after-care guidelines are short and easy to follow. Still, it is important to take the following into consideration after undergoing the procedure:

There may be bleeding and/or swelling: There may be some oozing of blood during the first day after a wisdom teeth removal. Patients should avoid excessive spitting so as not to dislodge the blood clot and encourage the recovery process. Patients should also replace the gauze over the extraction site at the recommended time frame set by their dentists. Bruising and swelling may also occur. For these cases, an ice pack is used as directed by the dentist or surgeon.

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Avoid smoking and drink plenty of water: This is a simple extraction process, but it is still a traumatic event for the body. In order to hasten the recovery process, patients should drink plenty of water after the surgery and avoid tobacco use for at least 72 hours after the procedure.

Be careful around the site: Most dentists will tell their patients to not brush, rinse, spit, or use mouthwash during the first 24 hours after surgery. Normal dental activities can resume after that, although one should be particularly gentle around the wound and rinse their mouth with warm salt water every two hours and after their meals for around a week.

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Following these guidelines should make the recovery process painless and easy. If there is excessive bleeding, swelling, or pain after 24 hours, patients should see their dentist or surgeon immediately.

Dr. John Pasqual is a practiced oral surgeon. Find out more about oral health by following this Facebook page.

REPOST: Is Happy Hour Hurting Your Teeth?

Sugary snacks and acidic fruit juices don’t do the teeth any favors. And now, another hidden source of damage to molars has been discovered by the Australian Dental Journal.

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If you’re a vino-lover, you might sometimes worry about your favorite red staining your teeth. But discoloration isn’t the only downside to drinking wine: The acid in the drink can eat away at your tooth enamel too, leaving you at risk for cavities, sensitivity, and pain. Plus, the damage can happen faster than you might expect. A new study in Australian Dental Journal found that just 10 one-minute wine tasting sessions can significantly soften enamel. And while you may not be tasting wine so much as gulping (er, sipping) it, all it takes is a few minutes of repeated exposure to cause harm.

To protect your choppers from your Cab habit, order water alongside your wine. When you finish a glass of the latter, swish with the former to rinse away any acids clinging to your teeth, suggests Thomas Schell, D.M.D., a dentist in Lebanon, NJ. Just make it flat water; some sparkling types are more acidic, which can worsen damage. (Or if you’re really brave, try oil.)

Also smart: munching on cheese between sips, says Schell. Cheese is alkaline, so it can neutralize the acids in wine, preventing them from eating away at your enamel. (Learn How To Whiten Teeth Naturally with Food.)

Finally, if you’re really worried about the state of your teeth, consider asking your dentist for a prescription-state fluoride toothpaste or rinse, recommends Schell. This will help re-harden weakened enamel and can ward of future damage.

But avoid brushing with it (or any toothpaste) immediately after drinking wine (or other acidic beverages, like OJ), warns Schell. This will just work the acid deeper into your teeth, accelerating the damage.

Suscribe to this Dr. John Pasqual blog  for more discussion on oral health.

REPOST: Check dentist’s experience before getting costly implants

Before getting expensive treatments and procedures, it's best to do your research. This Star Telegram article discusses the importance of having an experienced dentist when getting dental implants.

The cost of a dental implant can be prohibitive, ranging from $3,000 to $4,500 per tooth. | Image Source: star-telegram.com

Dental implants are taking off as an alternative to bridges, dentures and single-tooth partials.

But patients should be cautious before jumping into the expensive procedure: All dentists can do an implant regardless of whether they’ve had specific training. And prices for the three-step process can vary widely.

“It’s a very, very popular procedure,” said Dr. Amerian Sones, executive director of continuing education for the Texas A&M University Baylor College of Dentistry in Dallas. “It’s our most popular course for continuing education.”

About 3 million Americans received 5.5 million implants in 2006, according to the American Academy of Implant Dentistry. The service is growing by 500,000 patients a year, according to the academy.

One reason is the aging population, Sones said. About 25 percent of Americans over 60 have lost all their natural teeth, according to the Centers for Disease Control and Prevention. Almost 70 percent of Americans ages 35 to 44 have at least one tooth missing.

Sones said that implants have become the standard in addressing missing teeth and that the success rate is in the high 90 percentile.

But the cost can be prohibitive, ranging from $3,000 to $4,500 per tooth, according to Angie’s List.

Marianne Marriott, a senior citizen in Fort Worth without dental insurance, said she was surprised by an implant center’s estimate of more than $50,000 for eight implants. Another office gave her a $1,000 estimate for a full set of dentures to address her problems, she said.

Sones said major insurers are starting to cover at least some of the cost for implants. The procedure is lengthy and includes surgery to screw a titanium post into the jaw, place an abutment atop the implant so gum tissue grows over it and then secure a permanent crown over the abutment.

The finished product takes up to six months.

“A lot of insurance companies are seeing the benefits of a long-term solution like implants,” she said.

Some discount dental plans, like DentalPlans.com and Brighter.com, offer price breaks on implants of up to 25 percent, but be sure to check on pricing and coverage before you join.

For those who don’t have the coverage and can’t afford the procedure, consider using a dental school. Baylor offers a full treatment — surgery, abutment and crown — for $1,975 per tooth that is open to new patients, Sones said. A $278 screening fee is also required. To get on the waiting list, call 214-828-8981 or go to http://bcd.tamhsc.edu/patients.

“We’re always looking for new patients,” she said. “But they have to be cases that fit our training criteria,” including having adequate health and quality bone for the procedure, she said.

For those who have been missing adult teeth all their lives, the American Academy of Implant Dentistry is starting a foundation within months to provide free implants for those who can’t afford them, said Max Moses, spokesman for the academy.

Training in implants is imperative for a good outcome, Moses said.

“The bottom line in dentistry is if you’re licensed, you’re licensed to do anything,” Moses said. “There is no implant dentistry recognized by the American Dental Association, like pediatrics or orthodontics.”

Even having a specialty in oral surgery or other advanced dentistry doesn’t mean a dentist is trained in implants, he said.

Besides going through continuing-education programs at dental schools, dentists can become fellows at the academy, Moses said.

Fellowships require having five years of experience and 400 hours of education in implant dentistry; passing a written and oral exam; and presenting 10 personal complex cases before peers.

For a list of area dentists with the certification, sorted by ZIP code, go to the directory at www.aaid-implant.org.

Prospective patients should also ask which type of implant is being used. The original implants, by a Swedish manufacturer, have been found to have a high success rate. But newer generic implants have not been studied.

“There are probably hundreds of different implants and knockoffs,” Sones said. “Companies see a big financial gain for being in this business. You do have to look at good long-term clinical outcomes and research. Find out what their statistics are.”

Bottom line: Do your homework before getting an implant, and make sure your dentist has, too.




Dr. John Pasqual is an experience oral and maxillofacial surgeon. Like this Facebook page for more oral health care tips.

Study: Sports drinks can ruin teeth

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Broken bones, pulled muscles, and sprained ankles aren’t the only hazards in endurance sports. Athletes have a high risk of dental erosion through frequent consumption of sports drinks.

Research shows that these energy drinks contain so much acid which can cause tooth erosion and staining only after five days of consistent consumption. Since athletes consume so much of these drinks during endurance exercises, training, and marathons, the enamel of the tooth softens and weakens, leading to severe tooth damage. It could also cause hypersensitivity to touch and to temperature changes.

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In this study, the oral status of 35 triathletes and 35 non-exercising controls was assessed and compared. After an oral examination, saliva test, and questions about their habits (eating, drinking, oral hygiene, plus training and beverage consumption for the triathletes), researchers found that the more an athlete trains, the more he or she is at risk of dental caries (also known as tooth decay).

Many fitness experts note that there are better hydration alternatives available for athletes to get that energy boost without affecting their oral health. Examples of these alternatives are coconut water and regular drinking water with a pinch of natural salt and a squeeze of lemon or lime.

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Dr. John Pasqual is an experienced oral and maxillofacial surgeon. For more information about his practice, visit here.