Young Adults and Dental Care

Young adulthood is the period when proper early care makes the most significant impact. Those who have not learned how to brush or floss properly will become concerned about bleeding gums, bad breath, removal of unnecessary wisdom teeth, and their first bout with a real toothache. This is also the stage during which exploring or new activities lead to accidents requiring swift and expensive action to ensure proper dentition preservation. This period is also when those who had braces and did not practice proper oral hygiene will require cosmetic work. The growth spurt is nearing its end or is complete, and implants’ placement to replace missing teeth can start.

For many, this is the time when they find themselves in a place other than home for purposes of college, job, or relationships. Many will neglect dental care by trying to save money or by not spending. Some have skipped out on the extraction of wisdom teeth earlier and now find that they will have to take time off from their job or school to pursue extractions and recovery.

Those who had never had a bad dental experience and did not practice the habit of brushing after all meals and flossing twice per day will start to struggle with bad breath, gum disease, and cavities. Long hours on the job or at school make the terrible habits worse. Treatment by the dentist for repeated bouts of teeth and mouth infections is commonplace. Those with good habits may try to improve their teeth by doing bleaching or cosmetic bonding.

Braces and Dental Care

Braces make performing proper hygiene more complex, and I always recommend that during active orthodontic treatment, instead of cleanings twice per year, the patient receives cleanings four times per year. The savings of proper oral hygiene and the need for minor gum surgery afterward will more than pay for the two additional treatments per year. 

Without proper and additional hygiene measures, the breakdown of enamel around the brackets will result in the enamel’s deterioration. The process is similar to the breakdown from pregnancy or excessive soda use without proper and immediate brushing and flossing afterward.

Activities That Pur Your Teeth At Risk

Motorcycling, partying, skiing, contact sports of all types, seizures, and altercations can lead to the immediate destruction or loss of teeth. This will need immediate treatment to minimize the damage, and many young people may not have saved up an emergency fund for a situation like this. 

Many end up in later years spending tens of thousands of dollars to take care of defects that they were unable to take care of at the time of the emergency. Others will end up in dentures or temporary appliances of various types. These temporary measures can affect the social life of a young adult and decrease their self-confidence.

Even Dentist Have Poor Dental Habits As Young Adults

One of the rites of passage from being a dental student to being a dentist is practicing a procedure for the first time on your lab partner. We practiced impressions on each other. We practiced cavity detection on each other. We practiced injections on each other. One day, my lab partner was doing a periodontal (gum disease) evaluation on me.

“Bert! You have gum disease!”

“What,” I said.

“Gum disease. You have bleeding, lots of bleeding points. Have you ever been treated for gum disease?”

“No,” I said. “How bad is it?”

“You have some pocketing and bleeding from the pockets. Here, let me go over it with you.”

I spent numerous visits in the clinic getting my gum disease treated and perfecting my brushing and flossing techniques. It was disheartening, and I felt lousy for neglecting my dental health for so long. I was happy that I did not have to go through the trauma of extractions again because of my neglect.

Gum Disease in Young Adults

Young adults often ignore a bloody toothbrush, but that is a mistake. Gum disease starts slowly and painlessly. In smokers, it can be undetected because of nicotine’s effect in constricting blood flow; therefore, they may not see bleeding as readily as nonsmokers. Smokers also need more regular check-ups to detect oral cancers.

A traditional cleaning will not be sufficient to decrease gum disease. Additional treatment of scaling and root planing with local anesthesia and/or conscious sedation may be needed. You may need repeated treatments or more advanced surgery. More than two visits to the dentist per year may be required to keep gum disease at bay. Sulcular (space between the tooth and the gum) and oral antibiotics, as well as rinses, may be necessary. A visit with a periodontist (dental specialist in treating gum disease) is in order in cases that do not respond appropriately. Gum disease is the most common cause of bad breath.

Dealing With Toothaches

Toothaches can occur for the first time during this transitional time. As I refer to it, a real toothache is one in which decay breaks down the teeth to the point where bacteria get into the nerve and cause irreversible pulpitis(inflammation of the tooth pulp). The options at this time do not include a filling; remove the tooth’s nerve or extract the tooth. 

The removal of the nerve and subsequent post buildup and then a crown usually takes care of the problem, but the dentist will usually do an extraction if it does not. Filling the extraction site with bone-grafting material preserves the bone, and in several months a replacement tooth implant can be placed.

Cosmetic Dentistry for Young Adults

Altercations or on-the-job accidents can cause broken teeth, and the treatment usually requires some type of cosmetic restoration of the teeth. Some teeth may need to be extracted if the fracture line extends below the gum into the supporting bone. Other teeth may need root canal treatment if the fracture is just into the nerve of the tooth. We can treat an un-salvageable tooth with an immediate implant that can have a temporary done immediately after placement. Grafting helps to maintain or create new bone for the implant’s order or provide the bone’s shape, removing large spaces that trap food when using a dental bridge.

Delivering a denture or removable prosthesis to a patient can be very stressful for both doctor and patient for the first time. Sometimes a denture is all they can afford.

I feel very sad when I have to remove a tooth with no cavities because trauma has made it non-restorable. The last choice for a patient is to leave the dentist with the missing tooth’s space unoccupied.

I feel a sense of loss and a bit of remorse when I assist a patient in losing a part of their body, albeit a tooth. After all, someone who loses a part of their body is starting a journey. This is the beginning of a long road that is going in the wrong direction.

Should You Get Dentures?

I will just pull my teeth, which will be the end of my teeth problems, is one mantra that I used to hear a lot. When teeth go, bone and supporting tissues will go also; then, we have to deal with a prosthesis (fixed or removable bridgework). The bone in which teeth erupt is called alveolar bone, the supporting bones of the jaws we call base bone. If you keep your teeth intact throughout your lifetime, you will preserve most of your jawbones. As you lose teeth, the alveolar bone also shrinks, and it shrinks even more if you have a denture putting force on it.

How Dentures Affect Your Mouth and Jawbone

Along with the loss of jawbone, you have movement of teeth into the now-empty space. Fewer teeth mean more collapse of the bite and a more aged, more collapsed look. Generally, the first denture will fit better than subsequent dentures because there is more bone support. Since most people do not strictly adhere to denture removal for six to eight hours per day and replacement of dentures every five to eight years, they will wear away the jawbone even more.

Lower dentures are notorious for moving and should be anchored by implants to preserve bone and prevent denture movement. So a lot of denture wearers spend millions of dollars on denture adhesives. Some’denture adhesives have a high zinc concentration, and because they use more than the recommended dose, wearers get more zinc in their system. Zinc competes with copper for absorption and depletes the amount of copper in the body. Low levels of copper can lead to neurological problems, and there have been incidences where paralysis cases are linked  to copper deficiency. Denture adhesive companies are developing new formulations to reduce and eliminate zinc.

Dentures and Chewing Efficiency

Most denture wearers will not let you know, but the efficiency of chewing using a set of complete dentures is about 35 percent, while normal-functioning teeth are over 90 percent. Nutrition and longevity also suffer because food that is not crushed correctly is more challenging to digest. The diet of most denture-wearing patients contains little in the way of raw leafy vegetables and nuts. This translates into suffering for most denture wearers.

Nutrition suffers. Neurological function suffers. Proper functioning of the gastrointestinal system suffers. Social interactions suffer. Physical beauty suffers, and longevity suffers.

More than ninety years ago, the Mayo Clinic found a positive correlation between natural teeth and length of life in their study of longevity. Better nutrition, better health, and better appearance result from taking care of natural teeth. Loss of appetite, a drying of the mouth from medication and aging, and poorer health result from poor dental hygiene and maintenance.

Other Issues with Dentures

Other particular problems with dentures include a decrease in taste, change in salivation, allergies to acrylic, sore spots, bone shrinkage, and risk of nutritional deficiencies. Health issues increase, shattering the perception that dental health is not essential. Bad breath and dehydration are part of the world of denture wearing.

My best advice for denture wearers is to keep as many teeth as possible; use implants where you can to retain dentures and maintain the alveolar bones of the face.

Cosmetic Dentistry Guide – What You Should Know

For as long as I have been a dentist, I have been taking classes and teaching other dentists the value of cosmetic dentistry. In 1988, my job was to solve our patients’ cosmetic problems in our hospital general practice. Some of these patients had teeth broken after intubation for general surgery. My job was not only to give them new teeth but to make them look good. During those years, I learned the importance of working with various dental specialists and knowing what was needed to get the final results. The doctors doing the treatment were recent dental graduates in their first years of practice.

Since the doctors were graduates of dental schools from all around the United States, they sometimes presented various ways of solving the same problem. I learned just as much as I taught in that program.

Composites

Tooth-colored fillings are what we call composites. These are taking over from acrylics as the long-term filling materials because they can match your teeth’ color and last longer. Composites used in dentistry are basically hydrocarbons with quartz and glass particle fillers.

Composites are widely used in aerospace and other industries to provide lighter, strong materials formed into various shapes. Porcelain is the other long-term material that we use for crowns and bridges, mostly tooth-colored. In the past, porcelain fused to metal or all-metal crowns was the technology for crowning teeth. This technology has served us well and is still the treatment of choice when you have decay or fillings with margins below the gums. Porcelain fused to metal is also the technology used to build porcelain bathtubs.

Other Cosmetic Dentistry Technologies

With the advent of Cad Cam technology and zirconium use as a substructure to porcelain, we now have many options to make teeth look beautiful. 3M Company uses technology to color the zirconium substructure the same color as the root structure, and then lab technicians apply porcelain to it, creating beautiful teeth. The resulting crown maintains the tooth color over a long time and is very aesthetic. It costs a little more, but it is well worth the investment.

Cad Cam technology uses a camera to picture the prepared tooth and fabricate the tooth’s missing part, using computer correlation technology to mill it. In-office Cad Cam machines are used to restore posterior (back) teeth.

Most cosmetic anterior aesthetic crowns or veneers are still finished by the artistic skills of trained lab technicians. Some technicians use the Cad Cam technology to fabricate the substructure and then apply porcelain for the final result.

A patient came to my office with an interesting request.

“Hey, Doc, I want a smile just like yours,” she said.

“Do you mean the shade of the teeth or the shape?” I asked.

“I just like the look of your smile.”

I completed my examination and found she had no upper teeth and only the lower front teeth. The remaining bone in the upper was enough to support an upper denture. However, on the lower, I would have to place some crowns and a lower appliance.

“Do you have any pictures of you in your late teens or early twenties? One where you have a full smile,” I asked.

“Yes! And yes, I would like to smile like that again.”

I collected all the information and proceeded to make an upper smile that showed teeth when she smiled. I shaped the contour on the appliance like real gums and made contours of her teeth like her own teeth from the pictures. No metal clips showed on her lower appliance, and we later took pictures together that showed that indeed she could smile as well as I did.

How Cosmetic Dentistry Works

Cosmetic dentistry involves smile creation, and the materials are not always porcelain veneers. All restorations can be used as cosmetic enhancements. I encourage bone grafts after extractions because it creates the contours that we need to enhance the cosmetic result. All dentistry that is considered functional can also be cosmetic.

Is Cosmetic Dentistry Art or Science

Dentists have long known that different styles of teeth fit people with other facial structures. We have used the Golden Proportion concepts to help us with rebuilding an aesthetic and functioning smile. Dentists who are very serious about cosmetic dentistry benefit from joining and participating in the various programs set up by the American Academy of Cosmetic Dentistry. The more an office combines the science of materials and techniques with the artistic talents of sculpting a pleasant smile, the closer they get to great results and a satisfied patient.

As a dental resident at Long Island Jewish Medical Center, I clearly remember a young lab technician who worked on developing thin porcelain wafers to cover unattractive teeth, telling us how they could solve cosmetic problems. They were called porcelain veneers. I became one of the early adopters of this conservative treatment mode, with my longest case that I know of still in place since 1989. Later on, I studied with Larry Rosenthal, who gave hands-on courses for other dentists. His techniques on straightening rotated teeth were beneficial then and are still helpful today. Good fundamentals are always useful. In North Carolina, Ross Nash and Rob Lowe have passed on valuable information to dentists, from photography to lasers used to enhance your results.

Cosmetic dentistry may involve working with various dental specialists to get a cosmetic and functioning occlusion. New types of braces, invisible and internal, can provide answers to adults who may be self-conscious during treatment. The most important part of your cosmetic treatment is that one dentist is in charge of coordinating all the treatment that leads to the patient’s result.

Sometimes part or parts of your treatment have to be done by another dental specialist, and your cosmetic dentist will do the final restorations. A periodontist may be needed to treat your gum disease or sculpt your gums so that the amount of gum shown is not unattractive when you smile. An oral surgeon may be required if you have lost a considerable amount of bone, need your jawbone repositioned, or impacted teeth extracted. A prosthodontist may be necessary if you have had extensive tissue loss from cancer treatment or an accident requiring a unique prosthesis. An oral and maxillofacial radiologist may be needed if a 3-D model shows an unidentified artifact. An endodontist may be necessary if you require a root canal treatment or retreatment of a previous root canal to make your cosmetic restoration feasible.

Most of the cases treated in our office require combination treatments, with or without sedation. Sometimes we have to do an extraction, place an implant, do a bone graft, root canal a tooth, place a fiber post, and then choose the right type of porcelain for each tooth to get the smile to look uniform. Many patients ask for veneers or lumineers; however, they may not be a candidate for those options because several teeth require several other types of treatment.

The more patients know about what they want, the more we can advise them if it is achievable or unrealistic.

Sometimes the achievable requires a little more perseverance on the part of the patient and doctor. Cosmetic Dentistry is a combination of science and art.