Dr. Marra's Blog

Damaging the crown of a tooth (the part of the tooth that is visible above the gums) is the most common type of dental injury. The tooth may be broken or chipped. It is good to be prepared by knowing how such cases should be treated.

What is the first thing to do if my tooth is chipped or broken?
If fragments broke off the tooth, try to find and save them. They can probably be reattached to the tooth by bonding.

Does a chipped or broken tooth hurt?
The tooth may be sensitive to touch, hot and cold. Depending on the type of injury and how much of the tooth's inner surface is exposed, there may also be pain.

How long can I wait before getting treatment?
Get treatment right away, within 12 hours if possible. Teeth with crown fractures can be treated within 12 hours without affecting long-term outcomes.

What types of treatment may be used?
The treatment recommended depends on the tooth and the type and severity of the injury. Exposure of a tooth's inner pulp can be treated by a pulpotomy (partial pulp removal) technique. Front teeth can be temporarily restored with special cements, or the original tooth fragments may be reattached by bonding. Composite resin bonding may be used to restore the tooth's original appearance and function. Composites can be made in a wide range of tooth colors and can match the original tooth almost exactly.

Is treatment different if the damaged tooth is a primary (baby) tooth?
Chipped or broken primary teeth are generally treated similarly to permanent teeth. The treatment depends on the extent of the injury and damage to the tooth. Treatment of fractured primary teeth also depends on the proximity of the injured tooth to the permanent tooth beneath it, which will ultimately replace it. If a fractured primary tooth cannot be saved, it may be removed.

What if my tooth is loosened but not broken?
If the tooth is loosened but not cracked, broken or chipped, no dental treatment may be required. However, we will collect baseline clinical and x-ray information and keep an eye on the tooth or teeth in the future. We will need to check the tooth during recall visits to see whether the dental pulp is still living or whether it has died as a result of its injury. The latter condition can lead to a variety of problems and will require treatment.

Contact us today at 518-237-0019 to schedule an appointment to discuss your questions about repairing a chipped tooth. You can also learn more by reading the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”

Dentists often recommend bone grafting to ensure the success of dental implants. And it is likewise common for people to squirm a bit at the thought. Bone graft? That sounds serious. And maybe a bit, well, unappealing. These feelings are completely understandable. After all, this may be something you've never had to consider before. But there's no reason to worry. Here's why:

1. Bone grafting is not new or experimental. It is actually a very routine part of the implant process, as well as other types of oral and periodontal surgery. And it is very successful when performed by an experienced doctor.
2. Bone grafting materials are processed for safety. The grafts used — whether synthetic or from a natural source, such as cow or human bone — have been specially treated for medical use.
3. Only a small amount of this bone-grafting material is needed. Once placed in the site of the missing tooth, it serves as a helpful scaffold your body uses to build more of its own bone in that spot.
4. Your implant will be more ideally positioned and may work better. It needs a good, strong foundation with which to fuse. But when teeth are lost, this supporting bone is often lost, too. This loss is often unpredictable and bone grafting limits the change that occurs. In fact that's one of the main benefits of replacing missing teeth with implants: they help prevent bone loss just as a natural tooth does.
5. Your implant will look so much better! Think about it: Your original tooth was supported to a certain height by the underlying bone. If that bone is now gone, the replacement tooth is going to be much longer because of the missing bone height. It may not look quite right without that additional support.

So if you want the best-looking and best-functioning implant possible, have no fear of bone grafting. And please contact us today at 518-237-0019 to discuss any of your concerns, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “Can Dentists Rebuild Bone?”

Grinding, clenching, and gritting your teeth are common reactions to stress — but their results can be quite complex. Here are some questions and answers that will fill you in on what you may not know about this widespread problem.

My dentist said I was bruxing. What does that mean?
Bruxing means that your teeth are grinding upon each other. Many people carry out this habit subconsciously and are not even aware that they are doing it.

Is bruxing or gritting harmful?
Such habits are called “parafunctional” (from para, meaning outside, and function, meaning purpose). This is because these stress habits exert much larger biting forces — as much as ten times more — than in normal biting and chewing activities. This excess pressure can cause damage to jaw joints and muscles, resulting in muscle spasm and pain; and to the teeth, resulting in wear, fractures or looseness. They can also cause headaches, earaches, and even neck and backaches because of the pressures on various structures in the face and mouth.

What is the usual treatment for problems arising from these stress habits?
The first thing we want to do is relieve your pain and discomfort. Second, we want to stop future damage. Application of heat or cold is helpful, and mild anti-inflammatory and muscle relaxant drugs are prescribed for pain and muscle spasm. To prevent future occurrences, we may treat you with biofeedback or refer you to someone who can offer psychotherapy.

What is a night guard and how can it help?
A night guard is an unobtrusive thin plastic appliance that is made to fit over the biting surfaces of your upper teeth. These guards are so unobtrusive that they can even be worn during the day if your stress level is so high that you grind your teeth during the day. The guard is adjusted to leave the lower teeth free to move against the surface of the guard, but they cannot bite into the upper teeth. This prevents wear on the teeth and lets the jaw muscles relax, preventing the pain of muscle spasm.

Contact us today at 518-237-0019 to schedule an appointment to discuss your questions about stress and tooth grinding. You can also learn more by reading the Dear Doctor magazine article “Stress & Tooth Habits.”

You didn't have your teeth straightened as a child. Is it too late, or should you have orthodontic treatment now as an adult?

Orthodontics is a sub-specialty of dentistry devoted to the study and treatment of improper bites, or malocclusions. Orthodontic treatment has the goal of slowly applying pressure to teeth in a way that moves them into proper alignment in your mouth.

Recommendations are for children to have their teeth assessed for orthodontic treatment before the age of seven. The whole process can be done more easily while their teeth are coming in and their jaws are still growing.

However, if your teeth are overcrowded, you have an overbite or an underbite, or your teeth are misaligned in other ways, it is never too late. If you “missed the boat” on orthodontic treatment before, here are seven reasons to consider doing it now.

1. Orthodontic treatment brings teeth, lips and face into proportion, resulting in a beautiful smile.
2. An attractive smile contributes to self-esteem, self-confidence and better self-image.
3. Because of improved self-esteem, you may see improved social and career success.
4. Teeth that are in proper alignment will function and wear better over the years as you age.
5. Properly aligned teeth are easier to keep clean, making you less prone to periodontal (gum) disease.
6. If you have any missing teeth that need to be replaced, this can be done more effectively if your remaining teeth are put into their correct spacing and position first.
7. Current options for treatment include fixed appliances (traditional braces) in which bands and brackets are bonded to the teeth and wires are threaded through them — or as an adult you may be able to use removable clear aligners. These consist of a series of nearly invisible computer-generated clear plastic trays that progressively move the teeth into better alignment.

Take the first step: call our office for an orthodontic evaluation. Having orthodontic treatment as an adult may be just the thing to give you an attitude boost as you move forward in your life.

Contact us today at 518-237-0019 to schedule an appointment to discuss your questions about teeth straightening. You can also learn more by reading the Dear Doctor magazine article “Why Straighten Teeth?”

When you say “ahhhhh,” are you worried about all your unsightly metal fillings? If so, did you know that your dentist can resolve your concerns through the use of tooth-colored fillings?

The public's demand for aesthetic tooth-colored (metal free) restorations (fillings) together with the dental profession's desire to preserve as much natural tooth structure as possible has led to the development of special adhesive tooth-colored restorations. And the demand is not limited to just the front teeth. In fact, many people are opting to replace all of their metal fillings — not just those in the front teeth — so that all of their teeth appear younger, fresher and as if they have never had any cavities.

Can you really mimic natural teeth? Proper tooth restoration is a lot more than just filling holes. It is a unique art applied with scientific understanding. Each tooth's internal shape and structure is the guide to how it must be rebuilt to successfully restore it. However, choosing which material to use to restore or rebuild teeth is a critical one based on scientific understanding, experience and clinical judgment — expertise we use daily in our office. The most popular options include composite resins and porcelains, as they allow us to mimic natural tooth colors and shapes. But for the most life-like, natural tooth-colored filling, your best option is porcelain. Porcelain, which is built up in layers, can be made to mimic the natural translucency and contours of tooth enamel.

But what about matching the color? Will it really match? Absolutely! Whether we use resins or porcelain, through our artistry we will create absolute tooth-like replicas. You will never know your teeth have fillings! And unlike metal alloys, these newer materials bond directly to the remaining enamel and dentin of which the teeth themselves are made, thus stabilizing and strengthening them. These techniques are even suitable for children's teeth and can incorporate fluoride to reduce decay.

Still undecided? If so, we understand. Feel free to contact us today at 518-237-0019 to schedule an appointment to discuss your questions about tooth-colored restorations. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth-Colored Fillings.”

Twenty-first Century techniques can create a replacement for a missing or damaged tooth that looks exactly like a natural tooth and actually fuses with the bone of your jaw. How does this amazing technology work? Test your knowledge on these questions.

What is a dental implant?
A dental implant is actually a replacement for the root of a tooth. In the natural tooth, the root is the part of the tooth below the gum line that is suspended in the bone by ligaments that attach the root to the bone. An implant is a root like substitute that is directly attached to the bone by a process referred to as osteointegration. An implant crown is then attached to the implant and is the visible part that we see above the gum tissues.

What is a modern dental implant made of?
Most are made of titanium. This metal is not rejected by the body and in fact fuses with the bone in which the implant is anchored, making it extremely stable.

How long do implants last?
A successful implant can last a lifetime. Factors that can affect an implant's success are smoking, certain drugs, osteoporosis, a history of radiation treatment, or a compromised immune system. We will evaluate all your conditions of dental and general health before deciding on an implant for you.

What makes the crown look like a real tooth?
The new crown looks real if it matches the shape and color of adjacent natural teeth. Its appearance also depends on what we as dentists refer to as the emergence profile (the way the crown seems to emerge from the gum tissue).

What is the function of a temporary crown?
A customized temporary crown can allow details of color, shape, and emergence profile to be worked out during this “temporary” phase of treatment. It can also test whether the tooth will function correctly for speech, biting and chewing. After these details are worked out, the temporary crown can be used as a blueprint for the permanent one.

What is the first step to getting a dental implant?
Make an appointment with us for a full assessment, diagnosis, and plan for placing the implant and crown.

Contact us today at 518-237-0019 to discuss any additional questions about dental implants. You can also learn more by reading the Dear Doctor magazine article “Dental Implants, Your Third Set of Teeth.”

If you've ever looked through a magazine and viewed the perfectly aligned white smiles of celebrities and models, you may be already familiar with the look of porcelain veneers. To achieve a picture-perfect smile, many Hollywood stars choose porcelain veneers (thin-layers of porcelain) that are bonded to the front of teeth allowing for the alteration of tooth position, shape, size and color. By fixing imperfections, as well as whitening them, veneers offer celebrities a perfect smile that, when maintained properly, can last for several decades.

Evaluation: If porcelain veneers sound appealing, our office can help you decide if you're a good candidate for them. We will ensure you have sufficient tooth structure, that your teeth are in more or less a normal position, and that symmetrical gum contours are present, allowing for proper “framing” of the teeth, necessary for a beautiful smile.

The Process: Once it's been determined that you're a good candidate for veneers, our office will begin a smile analysis using computer imaging to digitally replicate your smile and then fabricate a mock-up smile made of tooth-colored wax. We will work with you to determine the right color and shade for your veneers. You can choose the brightest, whitest “Hollywood smile” or opt for a more natural color and enhanced look.

Next Steps: After your initial appointment, it typically takes the laboratory one week to fabricate your porcelain veneers. The insertion of your veneers can be done with or without a local anesthetic. We will place the veneers on your teeth with a light-sensitive resin, which sets with the use of a white light, effectively bonding them to your teeth. While you may initially experience some tooth sensitivity to hot or cold, this will disappear after a few days. Maintaining your perfect smile requires simple brushing and flossing techniques and routine check ups.

Contact us today at 518-237-0019 to discuss any questions you may have regarding porcelain veneers. Read more about this topic in the Dear Doctor magazine article “Smile Design, Enhanced by Porcelain Veneers.”

If you've lost one or more of your teeth due to tooth decay, trauma, gum disease or a failed root canal, there are a variety of ways that our office can help you to restore your smile and increase your confidence. Crowns, conventional bridges and dentures aren't your only options for replacing missing teeth. Dental implants, surgically placed below the gums, are another alternative for replacing missing teeth.

Getting Started: If you would like to explore the option of having dental implants to replace one or more teeth, you will first need a comprehensive exam. The ideal candidate for implants is in good general and oral health. Adequate bone in your jaw is needed to support an implant. Smokers and those with uncontrolled chronic diseases like diabetes may not be good candidates for dental implants because healing may be impaired or slow. In addition, dental implants aren't appropriate for children or teens until their jaw growth is complete.

The Process: Dental implant surgery can be performed in our office using either a local or general anesthetic. The implants actually replace tooth roots; they are placed into the bone surgically. Generally made of commercially pure titanium, this metal has the remarkable ability to fuse with the bone as it heals forming a union known as osseointegration (“osseo” – bone; “integration” – to fuse with). This process takes two to six months depending upon many factors of which bone quality is the most important.

The next step is to place an abutment (a small connector) which attaches the implant to the crown. The crown is the part of the tooth that is normally seen in the mouth above the gums.

Assessment of your individual situation and deciding if dental implants are right for you takes knowledge and experience. Contact us today at 518-237-0019 to discuss any questions you may have regarding dental implants. Read more about this topic in the Dear Doctor magazine article “Dental Implants: Options for Replacing Missing Teeth.”

In a recent online poll conducted by Dear Doctor, the premier oral healthcare resource for consumers, 77% of those polled planned on visiting their dentist prior to their wedding. For some, this includes a thorough cleaning to remove stains and freshen both their smile and breath. However, a growing number of brides, grooms, and parents of the couple are seeking cosmetic dentistry or more specifically, a smile makeover, to transform their smile for their special day as well as their future.

If this describes your situation, take the first step towards the smile you have always wanted. To create your ideal smile, we will first meet with you to get to know you better and hear your concerns, goals, expectations and wedding day timeline. Bringing in photos or magazine images of smiles that you consider beautiful will help to ensure that we understand what you find attractive, as beauty can vary greatly from individual to individual. During this initial consultation, you will also learn about your smile makeover treatment options and what you could expect immediately prior, during and following each option.

Some subtle improvements we may consider are teeth whitening and bonding. Both of these options can take place in just a few office visits and produce very attractive results. Porcelain veneers and crowns can provide you with longer-term results that can last from 10 to 20 years. However, because they typically require 1 to 4 months advance notice, it is important to see us as soon as possible to ensure you have enough time before your special day. Another procedure that can play a dramatic role in your smile makeover is periodontal plastic surgery to improve and alter your gum tissues and their relationship to your teeth. For example, the appearance of “short” teeth can be corrected by lengthening them during a surgical procedure that has minor discomfort yet results in a life-long change.

Want to learn more?

Contact us today at 518-237-0019 to discuss your smile makeover questions or to schedule an appointment. You can also learn more by reading the Dear Doctor article, “Planning Your Wedding Day Smile.”

Anytime you are considering an implant surgery to replace missing teeth, you should take the time to gather the facts so that you have clear understanding of the procedure, your options and any potential risks. You should also feel comfortable with the dental team who is treating you. For these reasons, we created the following comprehensive list of questions so that you can obtain the answers you need to help you feel at ease prior to treatment.

• Am I a good candidate for dental implants?
• What is the success rate for dental implants?
• How long have you been placing implants and how many do you place each year?
• Can you show me some before and after photos that illustrate your work?
• What are the risks, benefits and alternatives to dental implants?
• Are dental implants ever rejected?
• How do you assess whether I have enough bone to anchor dental implants?
• Can you tell me about the surgical procedure for implant placement?
• How long will the entire process take from my first appointment until I have my implant(s) and crown(s) in place?
• Do I have to go without teeth while my implants are healing?
• What type of anesthesia will you use during my implant surgery?
• What can I expect in the hours and days following my implant surgery?
• How long will it take my implants to heal?
• How long can I expect my implants to last?
• Will there be any maintenance required with my implant(s)?
• How much will dental implant(s) cost?
• Will my insurance cover all or a portion of the cost?

To learn more, read “Dental Implants, Evaluating Your Professional Options For Care.” Or, you can call our office today at 518-237-0019 to make an appointment.