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By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
October 19, 2021
Category: Oral Health
Tags: osteoporosis  
OsteoporosisCanCauseComplicationsForSomeTypesofDentalWork

October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.

This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.

In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.

In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.

The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.

It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.

Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.

You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.

Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.

If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
October 09, 2021
Category: Oral Health
Tags: dental injuries  
HeresWhatToDofor4KindsofDentalInjuries

Although kids are resilient, they're not indestructible. They're prone to their share of injuries, both major and minor—including dental injuries.

It's common for physically active children to suffer injuries to their mouth, teeth and gums. With a little know-how, however, you can reduce their suffering and minimize any consequences to their long-term oral health.

Here are 4 types of dental injuries, and what to do if they occur.

Chipped tooth. Trauma or simply biting down on something hard can result in part of the tooth breaking off, while the rest of it remains intact. If this happens, try to retrieve and save the chipped pieces—a dentist may be able to re-bond them to the tooth. Even if you can't collect the chipped pieces, you should still see your dentist for a full examination of the tooth for any underlying injury.

Cracked tooth. A child can experience intense pain or an inability to bite or close their teeth normally if a tooth is cracked (fractured), First, call the dentist to see if you need to come in immediately or wait a day. You can also give the child something appropriate to their age for pain and to help them sleep if you're advised to wait overnight.

Displaced tooth. If a child's tooth appears loose, out of place or pushed deeper into the jaw after an accident, you should definitely see a dentist as soon as possible—all of these indicate a serious dental injury. If they're unavailable or it's after hours, your dentist may tell you to visit an emergency room for initial treatment.

Knocked-out tooth. Minutes count when a tooth is knocked completely out. Quickly locate the tooth and, holding it only by the crown and not the root, rinse off any debris with clean water. Place it in a glass of milk or attempt to place it back into the socket. If you attempt to place it back into the socket, it will require pressure to seat the tooth into position. You should then see a dentist or ER immediately.

A dental injury can be stressful for both you and your child. But following these common-sense guidelines can help you keep your wits and ensure your child gets the care they need.

If you would like more information on pediatric dental treatment, please contact us or schedule an appointment for a consultation.

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
September 29, 2021
Category: Dental Procedures
StraighteningYourTeethCouldRejuvenateYourSmile

Advanced cosmetic dental techniques are helping people around the world achieve their dream smiles. But long before many of these procedures existed, straightening teeth with braces could make a big difference in a person's appearance.

Improving a smile isn't the primary reason a person should undergo teeth straightening—a poor bite can lead to an unhealthy mouth. Misaligned teeth set up conditions in which you're more prone to diseases like tooth decay or gum disease. Correcting a bite should be first and foremost about protecting your dental health.

Even so, realigning your teeth can lead to a more attractive smile—and it's often necessary first before undergoing other cosmetic restorations. Think of it like renovating a house. You usually need to fix a faulty foundation before you start building an addition.

That's why it's always a good idea to get a complete dental exam before undertaking cosmetic work. There may be underlying problems that should be treated first. If that includes a poor bite, your next visit will most likely be with an orthodontist. Using advanced diagnostics, they'll determine what kind of bite problem you have and what it will take to correct it.

In years past, that meant braces. But now patients have another option: clear aligners, a series of clear plastic trays based on the individual patient's teeth. Each tray in the series is worn for about two weeks in succession, each new tray taking up where the other tray left off moving the teeth. Not only are they nearly invisible to observers, they can be removed for eating, cleaning or special occasions.

On the cosmetic front, straightening your teeth may be all you need to realize a more attractive smile. But orthodontics can also be part of an overall "smile makeover" that may include other cosmetic procedures, usually performed after realigning the teeth. In this case, it's often necessary to coordinate orthodontic treatment with these other procedures, especially if it's necessary to remove some teeth.

Whether it stands alone or is part of an overall makeover plan, straightening teeth can be a game changer when it comes to your appearance. Not only will it help you have healthier teeth and gums, it could give you the new smile you desire.

If you would like more information on orthodontic 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 “The Magic of Orthodontics.”

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
September 19, 2021
Category: Dental Procedures
UnlikeBradPittYouDidntMeanToChipYourToothWeCanStillFixIt

It's not unusual for serious actors to go above and beyond for their roles. They gain weight (or lose it, like Matthew McConaughey for True Detective). They grow hair—or they shave it off. But perhaps nothing tops what Brad Pitt did to assume the character of Tyler Durden in the movie Fight Club—he had his dentist chip his teeth.

While a testament to his dedication to the acting craft, Pitt's move definitely falls into the category of "Kids, don't do this at home." Fortunately, people deliberately chipping their teeth isn't a big problem. On the other hand, accidentally chipping a tooth is.

Chipping a tooth can happen in various ways, like a hard blow to the jaw or biting down on something too hard. Chipping won't necessarily endanger a tooth, but the missing dental structure can put a damper on your smile.

But here's the good news: you don't have to live with a chipped tooth. We have ways to cosmetically repair the damage and upgrade your smile.

One way is to fit a chipped or otherwise flawed tooth with a dental veneer, a thin wafer of dental porcelain bonded to the front of a tooth to mask chips, discolorations, gaps or other defects. They're custom-made by a dental lab to closely match an individual tooth's shape and color.

Gaining a new smile via dental veneers can take a few weeks, as well as two or more dental visits. But if you only have slight to moderate chipping, there's another way that might only take one session in the dentist's chair. Known as composite bonding, it utilizes plastic-based materials known as composite resins that are intermixed with a form of glass.

The initial mixture, color-matched for your tooth, has a putty-like consistency that can be easily applied to the tooth surface. We apply the composite resin to the tooth layer by layer, allowing a bonding agent in the mixture to cure each layer before beginning the next one. After sculpting the composite layers into a life-like appearance, the end result is a "perfect" tooth without visible flaws.

Unlike Brad Pitt, it's pretty unlikely you'll ever find yourself in a situation requiring you to purposely damage your teeth. But chips do happen—and if it happens to you, we have more than one way to make your teeth as good as new.

If you would like more information about repairing dental flaws with veneers or composite bonding, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Artistic Repair of Front Teeth With Composite Resin.”

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
September 09, 2021
Category: Dental Procedures
TemporarySmilesforTeensWaitingonDentalImplants

Here's some good news: Teenagers are less likely than adults to lose teeth to dental disease. But there's also a flip side. Teens can still lose teeth, more likely from traumatic injury.

Fortunately, there are several options for replacing lost teeth like dentures or bridges. But the choice considered best by most dentists and patients is a dental implant. An implant tooth looks and functions like the real thing—and it's durable, capable of lasting for years, if not decades.

But there's a hitch with teens getting an implant: Even though they may have all their permanent teeth by adolescence, their jaws are still growing and developing. Natural teeth, with their attachment to the jaws by way of a periodontal ligament, can keep pace with this growth—but implants can't.

That's because an implant doesn't have this attachment to gum tissue like natural teeth, but to the jawbone alone. Hence, an implant tooth can't keep up with jaw development, and may eventually look like it's "sunk" into the gums in relation to the teeth around it.

It's best, then, to wait until a teen's jaws have fully developed before attempting an implant. In the meantime, though, they don't have to endure a smile marred by missing teeth, but can replace them with a temporary restoration. The two most common options are a partial denture or a modified bridge.

The partial denture is a lightweight version that's quite affordable. Although not as durable as other types of dentures, the appliance is only intended to last until the patient is old enough for a permanent implant.

The modified bridge is a prosthetic tooth with strips of dental material extending behind it that are bonded to the backs of the teeth on either side to hold it in place. It's likewise not as durable as a traditional bridge, but it can fill the bill until time to place an implant.

Although this adds an additional step in a teen's restorative journey after losing a tooth, it's necessary—waiting to place an implant after jaw maturity will help ensure a long-lasting result. In the meantime, a temporary tooth replacement will help them to enjoy a normal smile.

If you would like more information on dental restorations for teens, 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 “Dental Implants for Teenagers.”





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