What to Do When an Inlay Falls Out ?

July 14, 2012 alexnguyen

I know this is totally random, but do you know any place I can buy some adhesives to attach an metal inlay back to a tooth? The inlay is either Au-Ag-Pd alloy or nickel chrome alloy... An inlay is a restoration made to fit the space in the tooth where a typical filling would occupy. Sometimes inlays are chosen over fillings because they are stronger, and depending on the extent of the decay they may adapt to the tooth better than a filling. An inlay can be made out of porcelain or a type of metal such as a gold alloy mix.

My answer to the patient's question above was:

Temporary pastes are available at the drug store, but they do not work very well long term.

When an inlay falls out, it could be due to two possible causes:

1. There is decay underneath the inlay. If this is the case, cementing the inlay back will not work long term because the decay is soft and has moisture.

2. The bite force is causing the inlay to debond from the tooth structure. If this is true, then you will have problems with other teeth and not just this inlay.

I would recommend having it checked by a dentist as soon as you can to determine the best course of action. In the mean time, you should leave the inlay in the tooth so that the adjacent tooth will not move into the empty space.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Why Should Adults Consider Orthodontic Treatments?

August 28, 2011 alexnguyen

It is not uncommon that I recommend my patients to consider orthodontic treatments to straighten their teeth. Sometimes my adult patients' initial reaction would sound something like: "I am too old for that, and I never thought about the cosmetics of my smile..." Having straight teeth is not ALL about cosmetics.

The misalignment of teeth can cause a variety of problems ranging from TMJ issues, to bone loss, to excess fractures and wear facets on the teeth. This type of break down in the dentition can take many years to manifest. Unfortunately, sometimes when the patient starts to notice the problems, the solutions may require a complex combination of orthodontics and restorative treatments.

Properly aligned teeth actually follow very scientific principles created by nature to establish the most stable functional foundation. When teeth are properly aligned, certain functional movements of the jaw allow for optimum chewing, relaxed muscle state, and ideal joint health. The cosmetics of the smile is automatically achieved secondarily when the functional foundation is established. Finding the right orthodontist is key to successful treatment.

Hence, when you choose to have orthodontic treatment done, you are stabilizing the most important aspect of the dentition: To allow you to sustain life by being able to chew effectively throughout the course of your life span. As the human life span continues to lengthen, it is extremely important to make sure that you will continue to have a stable dentition for your chewing needs.

In the photos below you will find a smile with "crooked teeth". Whereas the patient was never concerned with the cosmetics of her smile before, she has lately been concerned with the fractures lines and wear facets indicated by the red arrows. Her question to me at the last check-up was: "What would my teeth look like...say ten years down the line..."

My answer to her was: "They would look more broken down, and you will also notice problems with the back teeth as well."

So as you can see... My recommendation for this patient to choose orthodontic treatment was based on achieving proper function, and not ALL about cosmetics.

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What is tetracycline stain?

June 27, 2011 alexnguyen

Tetracycline is an antibiotic. At the age of three, children have already developed tooth buds of the permanent teeth inside the jaw. When tetracycline is given to children, this drug penetrates the developing tooth buds and incorporates itself into the tooth structure. When the teeth erupt into the mouth, the result is bands of dark stains with usually a combination of brown, gray, and yellow colors. These stains make up the actual colors of the teeth and are impossible to bleach completely into normal white teeth colors.

Note: Once a tooth has erupted into the mouth and the root of that tooth has completely formed, tetracycline cannot affect that tooth. It is also a misconception that all antibiotics will cause yellowing of teeth.

The human eyes are used to seeing the smile with white teeth. Smiles with dark tetracycline teeth are not as esthetically pleasing as smiles with normal white shades of teeth.

Porcelain veneers done on tetracycline stained teeth are very difficult for many reasons. A clinician has to mask out the dark colors underneath, and create at the same time the proper tooth form, contour, texture, and details of the edges of the natural tooth.

Here are the before and after photos of a case where I used porcelain veneers to enhance a severely tetracycline stained smile. The after photo was taken two weeks after delivery. The gum tissue will continue to heal and adapt to the new porcelain, and the colors of the porcelain teeth will become even more realistic after some time. In this case the patient opted for a super white shade, yet with proper planning and execution we can still create a natural looking smile.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

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Allergies and Toothache

April 12, 2011 alexnguyen

The arrival of Spring induces allergy symptoms such as itchy/watery eyes, excess nasal irritation and drainage, dry cough, skin rash, etc. However, there is a unique symptom which occurs sometime in conjunction with excess drainage in the sinus: Toothache on the upper molars or bicuspids. The upper bicuspid and molar roots are embedded in the sinus cavity. When the sinus cavity is filled with excess drainage from allergies, pressure from the sinus on the roots can cause a discomfort which mimics a toothache. An improper diagnosis may result in unnecessary root canal treatments to alleviate the associated pain. Careful examination and tests should be done to rule out toothache associated with sinus drainage or infection.

In this case, a regiment of antibiotics and antihistamines may very well alleviate the toothache-like problem. Yes, sometimes you can blame pollen for your toothache !

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Naturally Beautiful Smiles

March 5, 2011 alexnguyen

Occasionally I have the pleasure to invite some of my patients to do a photo shoot for ... fun ! Here are some samples of our latest collection of beautiful smiles. Whether it is a full mouth of restorative works or a few enhancements, I want the smiles to be simply beautiful and natural looking.

Thanks to Ivy, Alydia, and Saifon for allowing me to showcase your smiles.

My sincere appreciation to our stylist Jackie ( www.jolidejackie.com) and our photographer Paul (www.ferradasphotography.com).

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

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