Replacement of missing teeth

Basically there are three methods to replace missing teeth,

1.      Denture
2.      Bridge
3.      Implant

Denture

There are 2 types of denture:

• Acrylic denture- a removable appliance with the whole appliance is made of plastic and primarily uses the gums (full denture) or teeth and gums(partial denture) for support

Removable partial denture

Full acrylic denture

  

• Chrome denture- an appliance that is removable, has a metal framework with plastic teeth added to the framework and this uses the other teeth and gums for support.

Removable partial chrome denture

Advantages

1.      Most economic

2.      Simple procedure

3.      Treatment duration: Short 1 – 3 weeks

4.      Easy to take care and maintain (removable)

5.      Easy to adjust, repair

Disadvantages

1.      Feel like not real (fake teeth) – removable

2.      Big and bulky-uncomfortable

3.      Easily worn off & stained-acrylic/plastic teeth

4.      Easy to trap food

5.      Easily break

6.      Chewing food not the same as the natural teeth

Bridge

A fixed bridge uses the adjacent teeth around the space to support a false tooth to replace the missing teeth

Advantages

2.      Highly aesthetic –multiple shade to select                                   

3.      Comfortable – No palate or lower ridge coverage

4.      Strong, durable-made from porcelain

5.      Chewing food almost as real as natural teeth

Disadvantages

1.      Price: Moderate

2.      Complexity: Simple to complex

3.      Treatment duration: Medium 2 – 3 weeks

4.      The adjacent teeth required to be reduced in size for support

5.      Easily trap food under the bridge

6.      Maintenance: Difficult (Required to floss under the bridge)

7.      No suitable for all the case
 

Implant

Dental Implants are replacements for your tooth roots.  A Titanium post is placed in the bone and a crown is attached to the new root to replace the missing teeth.

Advantages

1.      Feel like real teeth – porcelain is sitting on the implant

2.      Highly aesthetic – multiple shade to select

3.      Comfortable – No palate or lower ridge coverage

4.      Strong, durable – teeth is made from porcelain

5.      Does not involve the adjacent teeth

6.      Food trap: very minimal

7.      Maintenance: simple to take care

8.      Can replace missing teeth in edentulous and free end saddle

9.      Chewing food almost as real as natural teeth

Disadvantages

1.      Price: Expensive

2.      Complexity: Complex – required good planning

3.      Duration of treatment: Long 3 – 6 months

4.      Required to undergo minor oral surgery

5.      Required sinus augmentation, bone harvesting if not enough bone height for implant insertion

6.      Higher risk of failure in smoker, diabetic and medically compromised patient

7.      Risk of injuring other structure during implant insertion: ID nerve, antrum (depend location of implant)

Is dental implantation a successful way of replacing missing teeth?

Improved Appearance

Shrinkage jawbone happen continuous after losing teeth and it make us look older. However, dental implants can usually slow or stop ongoing shrinkage of the jawbone process. Since denture sit on the top of jawbone and gums, continuous shrinkage of jawbone happen.

Improved Comfort

Dental implants often eliminate the pain and discomfort of removable full or partial dentures. Slipping or rocking of the dentures result from shrinkage of jawbone from time to time. Implant supported replacement teeth are closer to natural teeth because they are anchored securely to your jawbone.

  

Eat Better

Dental implants can restore chewing efficiency comparable to that of natural teeth. Unlike dentures they do not move when you chew on them. This usually allows you to eat your favorite foods with confidence and without pain. Full coverage of palate in a full upper denture reduced the taste of food while implant can eliminate it. So, we can better taste and enjoy our food. 

Convenience

You will no longer need to cover your mouth when you laugh, for fear that your denture could pop out. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues

Protect Your Remaining Natural Teeth

Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. A significant long-term benefit to your oral health if more of your tooth left untouched

Reliable

The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement. 

Enjoy life without worrying about your missing teeth.

Eat what you want!

Smile as broadly as you’d like!

Laugh out loud!

Tootless Smile

Tooth loss is when one or more teeth fall out or pull out from the jaw. It is normal for deciduous teeth (baby teeth), when they are replaced by adult teeth. Otherwise, losing teeth is undesirable of injury or disease. Decades ago it was considered normal to lose your teeth as you grew old. Nowadays there are methods to replace missing teeth, or to care for your oral health in order to keep your teeth forever.

Toothless really embarrassing because it isn’t exactly aesthetically pleasing. Moreover,it will undermined your confident as people like to judge a book by it's cover.

You may be wondering what causes a tooth to fall out. In fact, there are plenty of possible causes.

However, there are the more common three,
1. Congenital absence
 No successor (permanent tooth) to replace baby tooth
 Not uncommon
2. Trauma
 Sport-related injury
 Automobile accident
 Fall down
3. Dental diseases (decay, gum problems)
 Decay –dental caries/cavity progress to the extent that teeth are beyond the ability to be restored in function or significant infection in the bone leading to necessary tooth extraction to prevent further infectious complications
 Gum problem-periodontal disease which is a bacterial infection in the gums and supporting structures of the teeth leading to loss of bone


Many people leave gaps in their mouth for years, especially if the missing teeth are in the back. However, a gap due to even a single missing tooth will effect of other problems.
Here’s a list of tooth loss consequences:

Affects Diet -- May have trouble chewing food. If all teeth are missing, patients will be reduced to "gumming" their meals and their diet will have to be adjusted to softer foods.

Speech problems-- Based on the position of the missing teeth, especially the upper front teeth.

Biting Force Changes -- The force your jaw exerts while biting and chewing changes to compensate for tooth loss(less teeth to use), causing more stress and possible damage to existing teeth.

Replacement of missing teeth more difficult – Over-eruption of opposite tooth. Other than that, migration of neighbour tooth especially front teeth will lead to poor aesthetic due to gapping

Crooked Teeth -- The resulting pressure on existing teeth will cause them to shift. Jaw pain is often a side effect of shifting teeth.

Tooth Decay -- Teeth that have shifted from the pressure tend to be harder to clean.

Bone Loss -- If a tooth is missing, the bone begins to deteriorate and gums begin to shrink. Your teeth are actually what stimulate your jawbone.

Premature Aging -- the jaw will shrink and the structure of the face to collapse after complete teeth loss. The lack of structure forces the skin to sag and creates a hollow appearance.

Psychology -- Avoiding going out in public because of social embarrassment. Anxiety and self-consciousness

‘Although a missing tooth might look cute on a six-year-old, it's no laughing matter once you grow up. Lost adult teeth cannot be replaced, and the tooth fairy definitely isn't going to put a quarter under your pillow!’

Hence, you must prevent tooth loss by,
• Brushing and flossing: Gum disease and tooth decay occur often as a result of poor oral hygiene. Brush your teeth twice a day to keep dental problems at bay. Flossing helps remove food debris in between your teeth and is recommended.
• Regular visits to dentist: It is recommended to visit your dentist regularly to identify oral problems in their initial stage.(every six months)
• Fluoride therapy: use of fluoridated toothpaste and mouth rinse is advisable as it prevents dental caries and hence tooth loss.
• Dental sealants: Dental sealants are often applied in children on the chewing surfaces of back teeth as it acts as a physical barrier against dental caries.

Root canal treatment = The tooth saver?

Anatomy or sturcture of a tooth

Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth.

At the center of a tooth is a hollow area that houses of soft tissue, known as pulp or nerve. This hollow area contains a relatively wide space in the coronal portion of the tooth called the pulp chamber. This chamber is connected to the tip of the root via narrow canal(s); hence, the term "root canal."

A tooth's nerve and pulp can become irritated, and infected because of deep decay, large fillings, a crack or chip in the tooth, or trauma to the face. If the infected or dead pulp untreated, pus can build up at the root tip in the jawbone, forming an abscess which can destroy the bone surrounding the tooth and cause unbearable pain.

 

What is a Root Canal Treatment?
Root canal treatment, also known as endodontic treatment, is the process removal of the tooth pulp, a small, thread-like tissue in the center of the tooth. Once the damaged, diseased or dead pulp is removed, the remaining space is cleaned, shaped and filled. The root canal is sealed off.

What Are the Signs That a Root Canal Treatment Is Needed?

 You may need a root canal treatment if,

• Severe toothache pain while chewing
• Prolonged sensitivity/pain to heat or cold  

      temparature

• Discoloration/yellowish of the           

          tooth                       

• Swelling and tenderness in the nearby gums
• A persistent or recurring pimple on the gums
• Sometimes no symptoms are present

What are the procedures of root canal treatment?

From left to right: images of procedure of root canal treatment

• Decay is removed to expose the nerve tissues and access into the canal.
• The pulpal tissue is removed with special files
• The canals are cleaned, shaped to allow filling of the root canal system

• The canals are filled and restored with temporary filling

 

Video of root canal treatment:

Will the tooth need any special care or additional treatment after endodontic treatment?

You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. 

A post is needed if tooth structure not sufficient to support the crown

A crown or other restoration placed on the tooth to protect and restore it to full function.                                                          

Full restoration of root treated tooth

Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.

Is a root canal treatment painful?

Pain, the fear of pain is the main reason of us delay our visit to the dentist for dental check up. Finally end up suffering much more pain than those visiting their dentist early for proper treatment.

Endodontic treatment can relieve the toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure. 

However, the tooth may feel sensitive for the first few days following the completion of a root canal due to natural tissue inflammation, especially if there was pain or infection before the procedure.

Is it worth to save instead of extracting it?

Extraction may be a quicker and cheaper alternative, but seldom is it in the best interest of the patient. Most of  times, an extraction leads to subsequent problems such as general instability of the whole dental arch because the adjacent teeth will over growing and shifting.

Endodontic treatment with full restoration usually cheaper than a bridge or an implant placement following extraction. It is a cost-effective way to treat teeth with damaged pulp. 


Teeth with diseased or injured pulps were removed at years ago. Today, root 
canal treatment enable keep the teeth that would otherwise be lost. 
Most endodontically treated teeth last as other natural teeth as far as oral health care is concerned.

"Nothing, not even the most advanced bridges and implants, can truly replace your natural tooth"

Save your natural tooth should always be your first choice

Gum Disease

Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting

When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak. They also spoil your smile.

In estimation, 80% of world’s population experience gingivitis. Gingivitis is a very common and mild form of gum disease and we may not be aware that we have this condition. But, it is important to take it seriously and treat it promptly because it can lead to more serious gum disease (periodontitis) and eventually tooth loss.

What do I know if I have gingivitis?

gingivitis

There are few classical symptoms which including,

•       Swollen gums
•       Bleeding gums during brushing teeth 
•        Bright red appearance to gums
•       Gums that are tender when touched
•       Shiny appearance to gum

What are the causes of gingivitis? 

The main cause of gingivitis is plaque. Plaque is the soft, sticky, colorless film of bacteria that forms constantly on the teeth and gums. If plaque is inadequately removed, it turns into a hard deposit called tartar that becomes trapped at the tooth and on or under the gum.  Plaque and tartar produces toxins that can irritate the gum tissue, causing gingivitis. Severity of the gingivitis depends on the person’s health, age or oral hygiene habits.

Plaque & Tartar on gum line

Why my teeth become loose and longer?

periodontal disease

 

Periodontitis occurs when inflammation of the gums (gingivitis) is untreated or treatment is delayed.

Symptoms of periodontitis:

• Swollen, bright red gums 
• Loose teeth 
• Persistent breath odor or a bad taste in your mouth
• Gums that feel tender when touched
• Gums that pull away from your teeth (recede), making your teeth look longer than normal
• New spaces developing between your teeth
• Pus between your teeth and gums
• Change in the way your teeth fit together when you bite

 
PERIODONTITIS ALWAYS DEVELOPS FROM A PRE EXISTENT GINGIVITIS,
however 
GINGIVITIS DOES NOT ALWAYS DEGENERATE INTO PERIODONTAL DISEASE 

What should I do to get rid of gingivitis/periodontitis?

•   Brushing teeth twice daily, morning and night  
•  Use a fluoridated toothpaste
•  Floss at least once daily or use interdental toothbrush to  clean space between the teeth
• Visit the dentist at least once in 6 months for regular check up
•  Avoid sugary foods, tobacco and drinking excessive amounts of alcohol.
•   Keep all removable dental appliances as clean as you would keep your teeth

牙齿刺痛的原因

牙齿刺痛的原因 牙齿刺痛是牙髓的神经受到刺激所引致。常见原因：  蛀牙 蛀牙洞内的细菌引起牙髓发炎，刺激牙髓神经。 象牙质外露(牙齿敏感) 象牙质内满布管道，如果这些管道因牙龈萎缩或因牙齿表面受损（例如：被牙  刷刷蚀又或被酸性食物侵蚀）而外露，冷、热、甜、酸的食物便会透过这些管 道刺激牙髓神经。与此同时，牙齿表面的牙菌膜的毒素亦有可能透过外露的象 牙质，刺激牙髓神经。 牙齿崩裂 牙齿崩裂导致象牙质或牙髓外露令牙髓神经受到外界刺激。   牙龈疼痛的原因 压龈疼痛是牙周组织发炎所引致，常见原因：  蛀牙 严重的蛀牙令牙髓坏死，细菌在牙髓内滋生，并经由牙根管感染牙周组织，引致发炎及出现脓疮 牙周病 牙菌膜的毒素引致牙周组织发炎。  智慧齿冠周炎 由於智慧齿的牙冠与覆盖它的牙龈之间容易积藏食物渣滓和细菌，导致牙周组织发炎 处理方法 应尽快见牙科医生，找出原因，对症下药：   蛀牙 治疗方法： 牙髓治疗 、 补牙 、 人造牙冠  牙周病 治疗方法： 洗牙 、 牙根刮治 、 牙周手术  智慧齿冠周炎 治疗方法： 洗牙 、 服用抗生素、 拔牙  象牙质外露 治疗方法： 涂搽高浓度氟化物 、 补牙 、 人造牙冠 牙齿崩裂 治疗方法： 拔牙 、 补牙 、 人造牙冠 、 牙髓治疗