My Blog

By Drake Tollefson DDS
April 01, 2014
Category: Oral Health
Tags: gummy smile  
TreatingaGummySmileDependsonitsCause

Something about your smile isn’t quite right. It’s too “gummy” — too much of the upper gum line is visible and it looks out of proportion to your teeth and lips. Most dentists identify a smile as too gummy if four millimeters or more (approximately an eighth of an inch) of the gum tissue is visible at a full smile.

Fortunately, there are ways to minimize this effect. It’s important, though, to first determine the true cause before we embark on any treatment plan.

Your teeth may be the actual cause. As we mature, teeth “erupt” through the gums and the supporting bone and appear in the mouth. They continue to erupt until meeting their “antagonists,” the opposing teeth from the opposite jaw. In addition, the gums go to the proper position where the root meets the enamel of the teeth around late adolescence. The normal result is a length of the crown (the visible portion of the tooth) of approximately 10 mm.

If the teeth don’t erupt fully or the gums don’t go to their proper position, the teeth appear shorter and the gums more prominent. Using a surgical technique called crown lengthening, we remove excess gum tissue and, if necessary, reshape the underlying bone to reveal the proper amount of tooth length. Teeth also shorten due to excessive wear; the teeth continue to erupt to compensate for the wear that occurs over time. The attached gum tissue follows with the tooth. This can be corrected with orthodontic treatment (for bite correction) and porcelain veneers.

Two more causes of a gummy smile are when a person has a hyper-mobile upper lip — the upper lip can raise too much lift when smiling — and an upper jaw length that appears too long for the face. If lips rise higher than the normal 6-8 mm when we smile, too much of the gum line appears. This can be treated temporarily with Botox injections to reduce the mobility of the muscles, or there is a surgical procedure that reduces the mobility of the upper lip. For an elongated upper jaw, orthognathic (“to straighten the jaw”) surgery relocates the jaw to a more upward position that diminishes the amount of gum tissue that shows during smiling.

Treatments for a gummy smile range from simple techniques to more complex surgical procedures. Only a thorough dental exam will reveal the best treatment path to follow.

If you would like more information on treatments for “gummy” smiles, 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 Drake Tollefson DDS
March 24, 2014
Category: Oral Health
Tags: oral health   oral hygiene  
TLCforYourToothbrush

Your toothbrush serves the invaluable purpose of minimizing bacterial buildup (plaque) that can irritate gums and lead to periodontal disease, infection of the bone and tissues supporting your teeth. Brushing also helps dislodge food particles that certain oral bacteria would otherwise feed on, producing acids in the process that can eat through protective tooth enamel and the vulnerable dentin below. Given its importance to your oral health, you can maximize your toothbrush’s effectiveness by using and storing it properly, and replacing it (or the brush head if you have a powered model) regularly.

Using and Storing Your Brush
All that’s needed to dislodge plaque from oral surfaces is a relaxed grip and a gentle jiggling motion. Too much pressure can wear away tooth enamel, cause gum tissue to recede, and shorten the life of your brush head.

When you’re done using your brush:

  1. Thoroughly rinse it to remove any remaining tooth paste, food particles, etc.
  2. If you’re super-vigilant, you also can disinfect your brush by soaking it in mouthwash, brush-sanitizing rinse, or a half water/half hydrogen peroxide solution, or dipping it in boiling water for 5 to 10 seconds.
  3. Air dry in an upright position and do not routinely cover your toothbrush or store it in a closed container. A dark, moist environment is more conducive to the growth of microorganisms.

Replacing and Recycling Your Toothbrush
Even with the best of care, toothbrush bristles become frayed and worn and their cleaning effectiveness diminishes after 3 or 4 months, according to the American Dental Association, though it could be sooner depending on factors unique to each patient. Besides checking the bristles regularly, a good way of keeping track is to write the date you start using your toothbrush in permanent pen on a big-enough spot on the handle (or doing it on masking tape applied to the base of a power brush).

Once your brush has passed its useful life for oral hygiene, you can still get plenty of mileage out of it. You’ll find plenty of ideas on the internet for cleaning grout between tiles and grime-filled spots around taps and toilet lid hinges; removing mud from boot treads; scrubbing off corrosion from around car battery terminals and more!

If you would like more information about oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Toothbrush Lifespan” and “Manual vs Powered Toothbrushes.”

ToothPainDuringPressureChangesCouldBeWarningofaBiggerProblem

People who fly or scuba dive know firsthand how changes in atmospheric pressure can affect the body: as minor as a popping in the ears, or as life-threatening as decompression sickness. Pressure changes can also cause pain and discomfort in your teeth and sinuses — in fact, severe pain could be a sign of a bigger problem.

Barotrauma (baro – “pressure;” trauma – “injury”), also known as a “squeeze,” occurs when the unequal air pressures outside and inside the body attempt to equalize. Many of the body's organs and structures are filled with air within rigid walls; the force created by equalization presses against these walls and associated nerves, which in turn causes the pain.

The sinus cavities and the middle ear spaces are especially sensitive. Each of these has small openings that help with pressure equalization. However, they can become swollen or blocked with mucous (as when you have a head cold), which slows equalization and contributes to the pain.

It's also possible to experience tooth pain during pressure change. This is because the back teeth in the upper jaw share the same nerve pathways as the upper jaw sinuses — pain originating from the sinuses can be felt in the teeth, and vice-versa. In fact, it's because of this shared pathway that pressure changes can amplify pain from a tooth with a deeper problem, such as a crack, fracture or a defect in dental work.

Besides problems with your teeth, the severe pain could also be related to temporo-mandibular joint dysfunction (TMD), which is pain or discomfort in the small joint that connects your lower jaw to your skull. There are a number of causes for this, but a common one for scuba divers is an ill-fitted regulator mouthpiece that they are biting down on too hard while diving. A custom-fitted mouthpiece could help alleviate the problem.

If you've been experiencing tooth pain during pressure change events, you should see us for an examination before you fly or dive again. There might be more to your pain — and correcting these underlying problems could save you extreme discomfort in the future.

If you would like more information on the effects of atmospheric pressure changes on teeth, 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 “Pressure Changes Can Cause Tooth & Sinus Pain.”

UnderstandingtheSignsandSymptomsofToothDecayandaDiseasedRootCanal

Tooth decay can be relentless: left untreated it can work its way into a tooth’s inner core — the pulp chamber or better known as the root canal. Once this occurs, the best course of action to save the tooth may be a root canal treatment to clean out the diseased pulp (nerve) and seal the canal from further decay.

So, what signs and symptoms might you encounter if decay has invaded a tooth’s root canal? When the pulp is first infected you may experience acute pain; over time, however, the pain may suddenly dissipate. This doesn’t mean the tooth has healed itself — quite the contrary, it may mean the infected pulp tissue, including the nerves, has died. Once the nerves die, they no longer transmit pain signals to the brain.

While the pain may cease, the infection hasn’t and will continue to travel from the end of the tooth root into the bone. At this point, you may encounter pain whenever you bite on the tooth. This time the pain is originating in nerves located in the periodontal ligament that surrounds the tooth root and joins the tooth with the jawbone. This can lead to an acute abscess (with accompanying pain) or a chronic abscess that may have no pain symptoms at all. As the decay progresses you may eventually suffer bone and tooth loss.

The important point here is that you may or may not notice all the signs and symptoms that indicate deep decay within a tooth. That’s why it’s important to undergo a thorough dental examination if you have any symptoms at all, especially acute pain that “mysteriously” disappears.

A root canal treatment and removal of the decayed tooth structure will stop the progress of tooth decay and preserve the tooth. The longer you delay, though, the greater the risk your tooth will eventually lose the battle with tooth decay and infection will continue to spread.

If you would like more information on root canal treatment, 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 “Signs and Symptoms of a Future Root Canal.”

By Drake Tollefson DDS
March 04, 2014
Category: Oral Health
Tags: oral health   oral hygiene  
TopFiveWaystoPreserveYourTeethforLife

You may have heard the expression: “If you just ignore your teeth, they will go away.” That may be true — but by practicing good oral hygiene, more and more people are now able to keep their natural teeth in good condition for their entire life. So we prefer to put a more positive spin on that old saw: “Take care of your teeth and they will take care of you — always.” What’s the best way to do that? Here are our top five tips:

  1. Brush and floss every day. You knew this was going to be number one, right? Simply put, tooth decay and gum disease are your teeth’s number one enemies. Effective brushing and flossing can help control both of these diseases. Using a soft-bristle brush with fluoride toothpaste and getting the floss into the spaces between teeth (and a little under the gum line) are the keys to successful at-home tooth cleaning and plaque removal.
  2. Don’t smoke, or use any form of tobacco. Statistically speaking, smokers are about twice as likely to lose their teeth as non-smokers. And “smokeless” tobacco causes tooth discoloration, gum irritation, an increased risk for cavities, and a higher incidence of oral cancers. Of course, smoking also shortens your life expectancy — so do yourself a favor, and quit (or better yet, don’t start).
  3. Eat smart for better oral (and general) health. This means avoiding sugary between-meal snacks, staying away from sodas (and so-called “energy” or “sports” drinks), and limiting sweet, sticky candies and other smile-spoiling treats. It also means enjoying a balanced diet that’s rich in foods like whole grains, fruits and vegetables. This type of diet incorporates what’s best for your whole body — including your teeth.
  4. Wear a mouthguard when playing sports. An active lifestyle has many well-recognized health benefits. But if you enjoy playing basketball, bicycling, skiing or surfing — or any other sport where the possibility of a blow to the face exists — then you should consider a custom-fitted mouthguard an essential part of your gear. Research shows that athletes wearing mouthguards are 60 times less likely to suffer tooth damage in an accident than those who aren’t protected — so why take chances with your teeth?
  5. See your dentist regularly. When it comes to keeping your smile sparkling and your mouth healthy, we’re your plaque-fighting partners. We’ll check you for early signs of gum disease or tooth decay — plus many other potential issues — and treat any problems we find before they become serious. We’ll also help you develop healthy habits that will give you the best chance of keeping your teeth in good shape for your whole life.

If you would like to learn more about keeping your teeth healthy for life, please contact us or schedule an appointment for a consultation. For more information, see the Dear Doctor magazine articles “Tooth Decay — The World’s Oldest & Most Widespread Disease” and “Dentistry & Oral Health For Children.”





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