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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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.

How can I have a cavity if my tooth does not hurt?

June 22, 2011 alexnguyen

Your tooth will only hurt if the cavity penetrates the chamber which houses the nerve inside your tooth. A cavity begins from the outside surface of your tooth and usually balloons inwards until it penetrates the nerve. Bacteria from the cavity and temperature exposure will cause the nerve to become inflamed and eventually ... die. That's when it really hurts.

The best way to diagnose the extent of a cavity is to use proper radiographs. Regular check-ups allow your dentist to catch cavities in their early stages of development. A small cavity is much easier and inexpensive to fill, than to wait until that cavity dictates the need for root canal, build-up, and crown treatments.

The Xray below shows 3 cavities on a patient who has not been to the dentist in a number of years. This patient has no pain in her dentition, yet it is a matter of time before these cavities become big problems for her dental health.

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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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What is a Hybrid Prosthesis in Implant Dentistry?

March 26, 2011 alexnguyen

Implant dentistry can really change people's lives. In cases where there have been significant amounts of bone and tissue loss, this type of restoration allows the patient to regain both the function and the look of a real dentition. Here is a rough outline of the process:

1. Before the treatment was executed, proper diagnostics were done with study models, X-rays, CT Scan, etc.

2. The implants were then placed, and allowed to integrate with the patient’s bone.

3. An accurate impression was done to capture the implant positions and was sent to the laboratory.

4. The lab then created a duplicate model of the patient’s arch (with the implants replicated exactly how they are in the mouth).

5. A Cad Cam scan was done to design a titanium framework for the prosthesis. See my blog entry dated Dec 4, 2010 about the Cad Cam technology for this same case.

6. The titanium bar is tried in the mouth on the actual implants to ensure accurate fit.

7. Teeth and gum colored materials are placed over the titanium bar.

8. The final prosthesis was placed precisely over the implants in the patient’s mouth. The entire prosthesis was held in placed by screws that fit into the implants. Openings at the screw access were filled with proper composite materials to blend in with the surrounding areas.

9. Proper contacts and functional guidance of the bite were checked and fine-tuned.

The patient once again has a full arch of teeth fixated to his/her arch to replace the missing teeth. This type of restoration takes away the pain and inefficient chewing problem for patients who maybe suffering from the lack of ability to simply … eat.

Case Photos:

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

The titanium bar on the stone model:

The prosthesis on the stone model. Note the access holes where the implants were positioned.

The final hybrid prosthesis in the mouth. Note all implant access holes were filled.

The patient's smile at completion of treatment.

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CAD/CAM Technology in Dental Implant Treatments

December 3, 2010 alexnguyen

CAD/CAM is a technology utilized in many aspects of dentistry. In dental implant treatment for patients who have lost all teeth, we can take advantage of this powerful tool to survey our patient's dentition, review existing position of implants, and design the final prosthesis. Today's sophisticated computer softwares allow the dentist and lab team to review restorative cases in multiple dimensions before fabricating the prosthesis.

In the example below we were able to identify a positioning problem with one of the implants. Rather than producing a compromised restoration, we were able to resolve the issues before proceeding.

This is one of the many ways we deliver quality practice to our patients everyday.

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