Dentist - Towson
8600 LaSalle Rd. Suite 406 Severn Bldg.
Towson, MD 21286
410-321-0551

Posts for: October, 2013

By Dr. Mark Shulman
October 29, 2013
Category: Dental Procedures
Tags: crown  
WhatsYourCrownMadeOf

Like the ones worn by kings and queens of old, dental crowns were traditionally made of that most “royal” of metals: solid gold. This style of crown is still going strong after over a hundred years, but recent advances may have stolen some of its luster. Want to learn more about the different materials from which crowns can be made? Read on!

Gold crowns have stood the test of time, and many still consider them the best. Gold is one of the earliest materials to be successfully used for making crowns, and when properly done, it also lasts the longest: over 50 years in some cases. For these and other reasons, many dentists prefer to get gold restorations for their own teeth.

But in recent years, the use of gold crowns has been in decline — especially when the crown is for one of the front teeth. Why? In one word: aesthetics! With the advent of porcelain and porcelain-fused-to-metal (PFM) crowns, many people have opted to go with these more natural-colored tooth restorations.

PFM restorations have been in use for some four decades. They combine the strength of precious metals (gold or platinum) with the appeal of a finish that appears more like a natural tooth. With proper care, a PFM restoration may have a functional life of around 20 years.

With their pearly luster and semi-translucent sheen, all-porcelain crowns have an incredibly lifelike appearance. Porcelain itself is a glass-like material, which is specially modified to add strength when it's used in dentistry. In the past, there were some problems with brittleness in all-porcelain restorations. Today, newer formulations have been designed to avoid these issues.

High-tech materials that have recently become available to dentistry include a polycrystalline ceramic substance called zirconium dioxide or “Zirconia.” It shows great promise in terms of aesthetics and strength, and is the subject of much ongoing research. One day, it may replace other materials and become the new “gold standard” of crowns.

Depending on the particular situation, one or more of these materials may be considered for your crown.

If you would like more information about crowns, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Porcelain Crowns & Veneers” and “Gold or Porcelain Crowns?”


WithProperCareVeneersareaLong-TermOptionforStainedTeeth

Your otherwise beautiful smile has one noticeable flaw — one or more of your teeth are deeply discolored or stained. More than likely this staining is deep within the teeth, what we refer to as intrinsic staining. There are a number of reasons this can occur — from fillings or use of antibiotics, for example — and our first approach should be to attempt a whitening technique.

However, if that doesn't produce the desired result, porcelain laminate veneers are another option you might consider. Veneers are made of dental porcelain, a bio-compatible material that can be shaped and colored to closely match neighboring teeth. After a minimal amount of tooth reduction (removal of some of the enamel from the tooth surface) to prepare for the laminate, the veneers are then permanently bonded to the tooth surface and cover the discolored natural tooth. Besides changing the appearance of discolored or stained teeth, veneers can also be used to correct other imperfections such as chipped or misshapen teeth.

Patients, however, have a common question: how long will the veneers last? With proper care, veneers can last anywhere from seven years to more than twenty years. It's possible, though, to damage them — for example, you can break them if you bite down on something that goes beyond the porcelain's tolerance range, such as cracking nut shells with your teeth (not a good idea even for natural teeth!). You should also keep in mind that veneers are composed of inert, non-living material and are attached and surrounded by living gum tissue that can change over time. This process may eventually alter your appearance to the point that the veneer may need to be removed and reapplied to improve the look of your smile.

If a veneer is damaged, all is not necessarily lost. It may be possible to re-bond a loosened veneer or repair a chipped area. The worst case is replacement of the veneer altogether. Chances are, though, this will only happen after the veneer has already served you — and your smile — for many years.

If you would like more information on porcelain laminate veneers, 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 “Porcelain Veneers.”


By Dr. Mark Shulman
October 18, 2013
Category: Oral Health
FluorideisaProvenWeaponintheFightAgainstToothDecay

In the early 1900s, a Colorado dentist noticed many of his patients had unusual brown staining on their teeth — and little to no tooth decay. What he unknowingly observed was the power of a chemical substance in his patients' drinking water — fluoride. While commonplace today, fluoride sparked a revolution — and some controversy — in dental care during the 20th Century.

After decades of research and testing, most dentists now agree that fluoride reduces decay by interfering with the disease process. The optimum pH level for the mouth is neutral; however, this environment constantly changes as we eat, especially if we ingest foods or beverages high in acidity. A high acid level softens tooth enamel (a process called de-mineralization) and can lead to erosion if not neutralized. In addition, a thin layer of bacteria-rich plaque called biofilm that adheres to tooth surfaces is also acidic and is the cause of tooth decay, possibly more so in teeth made more susceptible from enamel erosion.

When fluoride is in “the right place” (present on the tooth surface and in our saliva, the body's natural acid neutralizer), it helps inhibit de-mineralization and aids in the re-hardening of the enamel (re-mineralization).

Although fluoride needs to come into direct contact with tooth enamel for optimum effectiveness, ingesting it can also prove beneficial. The fluoride we ingest eventually becomes deposited in bone. As bone grows and changes it releases this reserved fluoride back into the bloodstream where it eventually becomes part of saliva; the saliva brings it into contact with tooth surfaces.

The two most prominent ways we encounter fluoride are through fluoridated drinking water and in toothpaste. There continues to be concerns about what constitutes safe levels of fluoride in drinking water and over possible side effects like teeth staining and changes in bone structure. However, extensive studies have conclusively shown that even minimal levels of water fluoridation and the use of fluoride toothpaste have reduced tooth decay.

As the Colorado dentist discovered over a hundred years ago, fluoride is truly remarkable as a cavity fighter. Whether you have access to fluoridated water or not, we encourage you to use fluoride toothpaste to strengthen your teeth against decay.

If you would like more information on fluoride, 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 “Fluoride & Fluoridation in Dentistry.”


By Dr. Mark Shulman
October 11, 2013
Category: Oral Health
Tags: sensitive teeth  
TreatingPainfulToothSensitivityBeginsWithFindingitsSource

If you wince while eating certain foods and beverages, you're not alone — one in three Americans suffer from the pain of tooth sensitivity. Fortunately, there are ways to treat it and reduce the pain.

Dentinal hypersensitivity occurs when dentin loses its protective cover. Dentin, a living tissue within a tooth, is composed of tiny tubules that act as conduits for transmitting sensations from the surface of the tooth to the nerves in the inner pulp. These tubules are protected by cementum, a hard, outer layer that covers the tooth root. But when the root becomes exposed, the cementum is easily stripped from the root. The tubules become more sensitive to sensations of temperature or pressure.

Receding gums are the main culprit for root exposure. This condition can result from periodontal disease, which arises mainly from poor oral hygiene. At the other end of the spectrum, over-aggressive brushing can lead to receding gums. Brushing may also contribute to another source of dentinal hypersensitivity: enamel erosion. The minerals in enamel begin to soften and erode as the acidic level of the mouth rises. Saliva neutralizes the acid and can restore a neutral balance in about thirty minutes to an hour after eating. If you brush before this process completes, you could brush away some of the softened enamel.

To properly treat tooth sensitivity, our first step is to find the cause. If it stems from improper or premature brushing, we can counsel you on proper technique. If periodontal disease is a factor, we would first treat the disease and then work with you on a proper oral hygiene regimen to reduce bacterial plaque, the main cause of the infection.

There are treatments as well to reduce nerve sensitivity and thereby ease the pain. Toothpastes and other mouth products with fluoride help reduce sensitivity, as well as products containing potassium nitrate or potassium citrate. We can also apply a varnish containing a concentrated dose of fluoride directly to tooth surfaces. Another approach is to block the tubules using bonding agents or sealants; this will reduce their capacity to receive and transmit sensations.

If you would like more information on the causes and treatment of tooth sensitivity, 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 “Treatment of Tooth Sensitivity.”


By Dr. Mark Shulman
October 03, 2013
Category: Oral Health
TreatingKidsSports-RelatedDentalInjuries

They work hard, and put in lots of time on the field and at home. They learn the rules of the game — as well as the unwritten rules of sportsmanship and teamwork. They receive the proper training, and wear appropriate protective equipment. But sometimes, in spite of everything, kids who participate in sports can be subject to injury. Fortunately, in today's dentistry there are a variety of treatments, as well as preventive measures, which can help.

When faced with serious dental injury, time is of the essence in saving teeth. So, don't delay — come in to see us immediately! If treated promptly, it's possible for teeth which have been dislodged — or even knocked out of the mouth — to be put back in position and stabilized. Afterwards, follow-up treatment will ensure that the tooth has the best chance of recovery.

The treatment of kids' dental injuries is sometimes different than that of adults. For example, in adults, a root canal would generally be necessary, followed by a tooth restoration (crown). But some kids may not need this treatment, since their teeth are still developing. Also, replacing a missing primary (baby) tooth may not be recommended, since it may hinder development of the permanent teeth. Based on his or her individual circumstances, we can develop an appropriate treatment plan for your child.

Luckily, the most common dental injuries aren't nearly as serious — they typically involve chipped or cracked teeth. Most can be repaired by reattaching the broken piece, or using a tooth-colored restoration. If a large part of the structure of a permanent tooth is missing, a crown or “cap” may be placed on the visible part, above the gum line. Smaller chips, even in primary teeth, can be successfully repaired by cosmetic bonding with composite resin materials.

Finally, if your child is involved in athletic activities — or if you are — consider obtaining a custom-made mouthguard. Numerous studies have shown that this protective gear can help prevent many dental injuries. Unlike the off-the-shelf types found in some sporting-goods stores, the ones we provide are individually fabricated from an exact model of the teeth. They're strong, fit comfortably, and offer superior protection at a reasonable cost.

If you have questions about the treatment of sports-related dental injuries, or about mouthguards, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Trauma & Nerve Damage to Teeth” and “Mouthguards.”




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