Ask Dr. G
There is no substitute for experienceDr. Richard Gangwisch graduated from Ohio State University College of Dentistry in 1977. After teaching dental students at Emory University's School of Dentistry for nine years, he earned his Fellowship and Mastership from the Academy of General Dentistry, awards for staying at the forefront of dentistry. In 2007, he attained diplomate status in the American Board of General Dentistry. This board certification has been achieved by relatively few general dentists. Dr. Gangwisch is currently a part-time assistant professor of General Dentistry at the Dental College of Georgia at Augusta University. The questions in this section are answered not only with book knowledge, but also utilizing over 30 years of practical experience.
- Cosmetic Dentistry
- Porcelain Laminates
- Tooth-Colored Fillings
- Amalgam Fillings
- Worn Teeth (Attrition)
- Functional Orthodontics
- Invisible Braces
- Braces for Tilted Teeth
- Braces for Worn Teeth
- Braces for Missing Teeth
- Pediatric Dentistry (Dentistry For Children)
- Root Canals
- Oral Surgery
- Gum Disease (Periodontics)
- Replacement of Missing Teeth
What are porcelain laminates?
Porcelain laminates are cosmetic coverings for front teeth. In this technique, a small amount (.5mm) of tooth structure is removed from the front of the teeth and then an impression is taken and sent to a laboratory. In the lab, space-age porcelain materials are formed into a very thin piece called a laminate veneer. This porcelain can be formed and colored to appear incredibly tooth-like. The laminates are then tried on the tooth and are glued into place with special bonding materials. An opaquing substance can be mixed with the bonding material to mask any dark colors of the underlying tooth. Porcelain laminates are very conservative because only a minimal amount of tooth enamel must be removed to make room for the porcelain. The technique can be used to cover stained teeth, to close gaps, and to reshape deformed teeth. It can be used to straighten crooked teeth giving the impression of "instant orthodontics". Click on the links below to view some examples of porcelain laminates.
Porcelain Laminates To Cover Tetracycline Stain
Porcelain Laminates To Close Gaps
What is bonding?
In bonding, the white composite material that is used for filling cavities in front teeth is layered onto the front of teeth for cosmetic purposes . The results look great initially, however, the technique is not very permanent, and must be redone periodically. This technique has now been replaced by porcelain laminates in adults. It is still used in children since no tooth enamel must be removed allowing for flexibility in future cosmetic decisions. Bonding is also used to repair fractured teeth when the dentist does not recommend a crown (cap). Click on the links below to view some examples of bonding.
Bonding To Widen Small Teeth And To Close Gaps
Bonding To Create A Winning Smile
Peg Lateral Corrected With Bonding
How do you handle teeth bleaching?
Bleaching can be done in the office in one hour or at home which can take anywhere from 2-6 weeks. Since studies have shown that the final results are the same and patient satisfaction is only 47% with in-office bleaching vs. 96% for at-home bleaching, we utilize the at-home bleaching technique exclusively. The in-office method utilizes a strong light to heat a very strong bleach solution which can cause a lot of temperature sensitivity. There is very little sensitivity in teeth when doing the at-home system. We make a mold of a patient's teeth, then construct an extremely thin, clear plastic mouthpiece to hold the bleach. The patient wears this mouthpiece at night while they sleep with the bleaching gel for up to a few weeks.
Tooth-colored fillings vs. silver amalgam fillings?
Silver amalgam fillings contain mercury as part of their composition. Free mercury is very toxic, however, when it is combined with silver, it forms a very stable compound which locks in the mercury and makes it inert. Since amalgam has been used for well over 100 years, there has yet to be a population study that shows any ill effects from amalgam usage. The early tooth-colored filling materials that were available did not hold up very well. They stained and chipped and wore down in a relatively short amount of time. The newer "composite" tooth-colored filling materials show much better promise. They look great, not showing the dark grey of the silver fillings. Their longevity is still not as long as the metal ones, but they are to the point where they are a much more esthetic alternative.
Tooth Colored Fillings in Back Teeth
What can you tell me about tooth-colored fillings?
The modern tooth colored filling materials consist of a resin which hold together finely ground quartz crystals. The resin can be tinted to get the filling close to the color of the tooth, and the quartz crystals will reflect the underlying natural color to obtain a very good match. Unfortunately, the resin in the tooth colored fillings tend to absorb stains from the mouth over time and the bond between the tooth and the filling material can break down making it possible to get decay around the edges of the filling.
Tooth Colored Fillings
What can you tell me about worn teeth (attrition)?
Grinding one's teeth while they sleep can not only cause jaw joint problems, but can result in significant wear of the teeth. Once the enamel coating has been worn away, then the softer inner layer (the dentin) will abrade at a much faster rate, leaving cupped out areas of the chewing surfaces of the teeth. The best way to handle this problem is prevention. Once the enamel coating has worn away, then the only way to treat the problem is to place porcelain crowns over the teeth to prevent any further damage. The best way to prevent this from happening is to wear a professionally constructed mouthpiece called a nightguard while sleeping. The "boil and bite" athletic mouthpieces are not recommended because it restricts the jaw movement during sleep and if the bite is not in perfect position, then it could lead to future jaw joint problems.
What is erosion?
Erosion is a chemical process where acids in the mouth will dissolve the enamel surface. This acid can come from the stomach, from sucking on citrus fruits such as lemons, or from carbonated beverages. Damage from stomach acid will tend to erode the back side (lingual) of the teeth. Lemon sucking will dissolve the edges of the front teeth. And carbonated beverages tend to erode at the neck of the teeth (cervical) at the level of the gums. Although cervical erosion can be repaired with tooth colored fillings, too much damage on the incisal edges leaves only the brittle enamel on the edges making them very susceptible to chipping. The only solution to repair this problem is with full coverage with porcelain crowns (caps). This will improve the smile immensely and will protect the teeth from further erosion.
Erosion Case #1
Erosion Case #2
What is abrasion?
Abrasion is any type of mechanically induced loss of tooth structure. It is mainly caused by brushing the teeth improperly. We will show you the proper method to brush your teeth and which type of toothpaste to use to minimize any further wear. Improper tooth brushing can cause not only loss of tooth structure, but also gum recession. This usually leads to sensitivity to cold liquids and foods. We can apply desensitizing agents to the root surface to help relieve the discomfort, but the best method is prevention.
What is functional orthodontics?
Functional orthodontics utilizes various appliances in the mouth to utilize muscle function and growth patterns to do its work. These retainer-like appliances are usually worn full time, even while eating. As the child grows, the forces of the appliances will redirect the growth of the jaws into a more favorable position. Since the jaw muscles are adapting to the different size and shape of the jaws, it results in a much more stable, long lasting result. These appliances can be used to make larger jaws to accommodate more teeth therefore lessening or eliminating crowding. They can even be used to make the lower jaw longer to help eliminate bad overbites. These appliances must be used at the proper age in order for the muscles to adapt to the changes permanently. There are even times that the need for braces can be totally eliminated.
Functional Orthodontics Case #1
Functional Orthodontics Case #2
Functional Orthodontics Case #3
Invisible Braces Case #1
Invisible Braces Case #2
Invisible Braces Case #3
Orthodontics For Tilted Teeth
Orthodontics For Worn Teeth
Orthodontics For Missing Teeth #1
Orthodontics For Missing Teeth #2
What extra precautions do I need to take for my teeth while I am pregnant?
Due to hormone changes during pregnancy, any plaque that is left behind will tend to cause an exaggerated response with a condition of swollen, bleeding gums called gingivitis. If this condition is left untreated, it can lead to periodontitis, an infection of the bone that holds the teeth in. Also, pregnancy can cause a craving for sugary foods and an increase in snacking. This can allow an increase in cavities. Contrary to popular folklore, this is not due to the baby pulling calcium from the mother's teeth. Therefore, meticulous oral hygiene must be performed daily while pregnant and post-partum until the hormone balance is restored.
When do I need to start cleaning my child's teeth?
As soon as the teeth erupt, you should brush and floss their teeth. You will need to keep this up until your child gets old enough to handle those chores on their own.
When should my child first visit the dentist?
It is generally recommended that your child should first visit the dentist 6 months after the first tooth erupts. In our office, we usually recommend that we see the child during one of Mom or Dad's routine checkups. We can look into the child's mouth and check for cavities, make certain that proper oral hygiene is being performed, and provides a good opportunity to answer any questions. Unless cavities are seen, the best time to start routine cleanings, examinations, and fluoride treatments is around three years of age.
What are baby bottle cavities?
When the teeth are exposed to sugary fluids for a prolonged period, there can be a rapid advancement of decay. This happens mostly when putting a toddler to bed with a baby bottle. Even liquids like milk or fruit juice have enough sugar to fuel the decay process. This problem is characterized by multiple cavities especially in the front teeth at a very early age. As a rule of thumb, if you are going to put your child to bed with a bottle, only have it filled with water.
What type of toothpaste is best for my child?
Make sure that the toothpaste that you and your child use has the American Dental Association seal of approval. The toothpastes with this seal have undergone stringent, independent testing to make sure that the manufacturer's claims are accurate. It must also have fluoride in it. The fluoride will strengthen the tooth enamel making it more acid resistant and will reduce the bacterial population that causes plaque.
Is the fluoride in the water safe?
Water fluoridation is the best way to reduce decay for your child. The fluoride is incorporated into the tooth enamel while the teeth are actively forming thus making it much stronger and more decay resistant. Fluoride has been used in municipal water systems for more than 50 years and there have been no studies that have shown any ill health effects.
When should my child lose their first tooth?
Even though the lower front teeth are usually lost around age 6, there is no need to panic if your child has not lost their first tooth by their 7th birthday. There is a normal range of between age between 5 and 8 years old. If a child has not lost a tooth by age 9, there could be an indication of an endocrine problem and your pediatrician should be consulted.
If the baby teeth are going to fall out eventually, why is it important that we try to save them?
Although they are less important in the front teeth, the back molars are very important in holding space for the permanent teeth. If a baby molar is lost too early. then the surrounding teeth will drift into that space and crowd out the erupting permanent tooth. If a baby molar is lost too early, it is best for the dentist to place a device called a space maintainer to hold the space open for the permanent tooth to erupt.
My child is a thumbsucker, when should I start to be concerned?
Thumbsucking is very common in infants and young children. If the habit continues once the permanent teeth erupt, then the tongue and other oral muscles will be trained improperly for swallowing and can result in misalignment of the teeth and improper growth of the mouth and jaws. I recommend starting to break the habit around age 5. Do it by praising the child when they are not sucking. Peer-pressure at school can also be a big help. If the habit still continues, then consult your dentist for advise.
What are sealants?
Dental sealants are thin, plastic coatings that are applied to the chewing surfaces of the back teeth to help prevent decay. It is impossible to get the bristles of a toothbrush into the base of these cervices and therefore, these areas are more prone to decay. Even though many insurance plans will not cover the cost of sealants, the fee for a sealant is significantly less than doing a filling and applying a sealant involves no drilling on the tooth. Sealants do not protect against cavities that form between the teeth and along the gumline, so daily brushing and flossing is still a must.
How often should I bring my child in for regular checkups?
Your dentist should tell you the period of time that meets your individual child's needs best. I usually recommend every six months as a good time period for both children and adults. Especially in children, decay can expand much faster, and if these areas are caught early enough, then they can be repaired with minimal measures.
When should I start thinking about orthodontics for my child?
Your dentist can tell you during your routine checkups when the time is right for your child to visit an orthodontist. Since we do orthodontics in our office, we can stay on top of the situation, so if you live in the Atlanta area, give us a call. For crowding situations, some children can be a candidate to expand their jaws with retainers. We usually start those cases around age 7. Cases involving bad overbites are usually started around age 11. With spaces between the teeth, I like to wait until all of the permanent teeth are in before deciding on a course of treatment.
Orthodontics Without Braces
Orthodontics Without Braces For Overbites
A root canal is a procedure that a dentist performs to remove the contents of the "root canal" and seal the ends of the roots with an inert filling material. The "root canal" of a tooth is a hollow area in the center that houses a collection of nerves and blood vessels called the dental pulp.
Why would I need a root canal?
There are a number of different reasons that a root canal may need to be performed. Most commonly, the nerve will become inflamed or infected so much that it will never recover its viability. Sometimes, a fracture can split the tooth far enough that the crack invades the nerve space allowing bacteria to slip in. There could be a teeth grinding problem that abrades the chewing surface all of the way into the nerve space. There also may be a need to perform a root canal procedure if a tooth is slated for a crown (cap) if the tooth is tilted abnormally, there is not enough enamel to get a good cosmetic result, or if the pulp chamber is too large.
Are root canals as painful as their reputation suggests?
Even though root canals have been great fodder for late night comedians and for party stories, most root canals involve little or no discomfort during the procedure and maybe some temporary soreness afterwards. This soreness can usually be controlled with ibuprofen or acetaminophen or a mild prescription pain medication. The root canals that have fed the popular stories stem from cases where someone will wake up at 2:00 in the morning, swollen out past their ear, and when they come in to have it treated, it can be very difficult to get numb. That person will come away from that telling everyone how bad their root canal experience was, when, in reality, it was the circumstances surrounding the procedure, not the root canal itself.
Will I need further work on my tooth after I have had a root canal?
It depends on the situation. I always recommend that a chewing tooth be covered with a crown (cap) since they these teeth get very brittle with the loss of the tooth nerve. Some front teeth can be filled with a tooth-colored filling material and left as-is. These teeth will tend to darken with time.
My front tooth had a root canal many years ago, and now it is much greyer than my other teeth. What can be done?
A strong bleaching agent can be placed in the empty pulp chamber to lighten the tooth back to its original shade.
What happens if I do not get my back tooth capped after a root canal?
The dental pulp keeps the inside of a tooth moist and thus, tend to resist fracturing. When the dental pulp is removed during a root canal, the tooth becomes very dry and brittle. It is now very subject to fracture. Many times, these fractures can extend all of the way down into the root and the tooth must be removed. Then, you have paid for a root canal for a tooth that is now in your hand. It is best to cover the tooth with a crown before that happens.
What kind of long term success can I expect out of a root canal?
The national average for five year success of a root canal is about 95%. This is for properly restored teeth. That is pretty good odds that you will have success. I have done many root canals that have continued to be fully functioning teeth 25 years after I performed the treatment.
What is an apicoectomy?
On the rare occasion that a root canal is not successful, it may be due to a difficulty in getting a good seal at the end of the root tip. A root canal is done through the tooth. Sometimes, canals can be very clogged with hard calcifications or very tortuous, making it difficult to get the root canal filling material to seal well. Therefore, an apicoectomy is performed. It is a surgical procedure where the end of the root is exposed from under the gum and a filling is placed in the end of the root.
Why do wisdom teeth need to be removed?
Third molars, also known as wisdom teeth, are vestiges of our cave man days. Having the extra molars to chew their extra-coarse diets came was very handy when trying to survive. As time has passed, modern man has progressed to a much softer diet. We can survive with a smaller jaw. This means that many times there is not enough room for the wisdom teeth to erupt. Quite often, they are lying in an odd position called an impaction. If there is enough room for the wisdom teeth to come in and be properly cleaned, then it is best to leave them as is. The old "spare tire" theory comes into play. It may be needed later on in life due to loss of other molars. However, if the wisdom teeth are impacted, they can form cysts that can enlarge and destroy jaw bone, or they can push up against the second molar and damage some of its root. If the wisdom tooth is partially impacted, then it can be a constant source of gum infections.
Should all impacted wisdom teeth be removed?
The final decision of the need to remove impacted wisdom teeth must come from your dentist. The best time to remove them is in late teens to early twenties. At this time, the roots have not fully matured allowing for less complications from the surgery. There are nerves that course through the lower jaw that provide innervation to the lower lip. Once the roots have grown to their full length, they can hook around this nerve. If they are removed at this point in time, then there is a possibility of permanent numbness in the lip.
If my lower wisdom teeth are bothering me, why would my upper wisdom teeth need to be removed also?
If a lower wisdom tooth is removed and not the opposing upper one, then the upper tooth will continue to erupt until it starts to chew against the lower gum. Since the healing time and level of post operative discomfort is about the same, it's not a bad idea to get the upper ones removed at the same time.
What should I expect from wisdom teeth surgery?
The biggest factor in determining the after effects of wisdom teeth surgery is whether they are impacted or not. If they are impacted, then allow for 3-4 days of healing time with the probability of moderate swelling of the cheeks. Impacted or not, there will be the need for pain medication to control post operative discomfort. The surgery itself should not be something to get too worried about. It is an in-office procedure that can be performed under a local anesthetic with or without sedation. If you wish to view a slideshow of an actual surgical removal of impacted wisdom teeth, then click on the link below. Warning - it is vary graphic, so don't watch it if you are squeamish about the sight of blood.
Impacted Wisdom Teeth Surgery Video
What are some reasons that other teeth need to be removed?
We usually prefer to save all teeth in the mouth if possible, however, there are situations when this is not feasible. Teeth can become so decayed that they may not be restorable. Gum disease could be so far advanced that the jaw bone will not hold the teeth in. There could be an opposing tooth that is missing, making a particular tooth not worthy of extensive restoration. We also sometimes need to remove teeth for orthodontic purposes to make room to straighten the teeth.
What type of after-care should I do after an extraction?
Biting on gauze placed over the extraction site for an hour will help stop the bleeding. Taking ibuprofen or acetaminophen, if your medical condition allows, will help ease the post-operative discomfort. Otherwise, just leave the extraction site alone. Don't drink through a straw or swish your mouth out for the first 24 hours. This could dislodge the blood clot and cause a dry socket.
What is a dry socket?
A dry socket occurs when the blood clot is lost prematurely. It is usually manifested by a marked increase in pain usually 3-4 days after the extraction. Contact your dentist for treatment if this condition occurs. Packing medication into the socket for a few days will usually take care of the symptoms until the area heals.
What other times should I contact my dentist after an extraction?
Although most extractions will heal uneventfully, you should contact your dentist if you have bleeding that will not stop or unexpected swelling, especially if accompanied by a fever. Infections in the jaw can become very serious if left unattended.
Should I be worried about oral cancer?
Although oral cancer is very uncommon, it is still taken very seriously. Early detection is of vital importance. Your dentist should do an oral cancer screening exam during your routine checkups. If you have any unusual swellings or sores that don't go away, it would be best to consult your dentist.
What is gum disease?
Gum disease can be gingivitis, an inflammation of the gums, or periodontitis (pyorrhea), an inflammation of the bone that holds the teeth. Gingivitis, although not serious alone, is a precursor to periodontitis and should be treated before the disease progresses. Periodontitis attacks the bone itself. If left unchecked, it can destroy enough bone so that the teeth will loosen and could even fall out.
What can I do to help prevent gum disease?
Something as simple as brushing and flossing every day can usually be all that is needed to keep gum disease at bay. Gum disease is caused by bacteria that normally resides in your mouth. When you eat sugar, the bacteria uses that as fuel to form a sticky substance in order to stick to your teeth. This colony of bacteria is called plaque. Since they are stuck in little nooks and crannies of your teeth, the antibodies in your saliva cannot reach them. The plaque will excrete acids and other toxins that will not only cause gum disease, but also tooth decay. By simply removing this layer of plaque at least once a day (preferably more often), you can keep these toxins from injuring your gums.
How do you treat gingivitis?
All that is needed to treat gingivitis is daily brushing and flossing, and a routine professional cleaning to remove calculus (tartar). A prescription-strength fluoride preparation can also help. Ask your dentist about that.
How do you treat periodontitis?
The first line of defense for treating periodontitis is a procedure called scaling and root planing. The dental hygienist or dentist will numb your gums, then clean all of the root surfaces very meticulously. This will get rid of most of the factors that were contributing to the periodontitis and allow the gums to heal. However, if daily oral hygiene is not done, then the disease will return. If the bone destruction has progressed too far, then periodontal surgery may need to be performed. This surgery will move or remove gum tissue in such a way to allow you to have enough access to perform daily oral hygiene. As you can tell, it is best to catch the disease before it has progressed this far.
What is a gum graft?
When the gums have receded to far away from a root surface, then a gum graft may be needed. This recession can occur most often by brushing the teeth with too stiff a toothbrush or too vigorously. In a gum graft, a small piece of tissue is removed from the roof of the mouth and sewn into place in the area of damage. With recent advancements, this technique has been highly successful.
What are the options for replacing missing teeth?
There are three options for replacing missing teeth - dental implants, fixed bridges, and removable partial or complete dentures. Implants are great in that no adjacent teeth need to be reduced in size and there is no loose piece of plastic flopping around in the mouth. Fixed bridges also eliminates the need for a loose plastic denture, but there needs to be an adequate number of solid abutment teeth adjacent to the site. Fixed bridges may be necessary in cases where there is not adequate bone available for implants. Removable appliances are available as an economical alternative, but wearing them is not as comfortable.
What are implants?
Dental implants are cylinders of titanium that are implanted into the jaw bone. A small incision is placed in the gum and a hole is drilled into the bone. The implant is then screwed into the bone. As terrible as this may sound, it is actually not a very bad procedure. Since there are no nerve endings in the bone, drilling on it does not cause any discomfort. I have had good feedback from my patients about how easy it was to go through this procedure. The cylinders will sit under the gums for some time undisturbed to allow the bone to grow up to it and solidify its anchorage. Then, we place posts into the cylinders and put crowns on. This recreates the function and cosmetics of the original teeth. Patients love them.
Implant Case #1
Implant Case #2
What are bone grafts and why would I need one?
The ability to place a dental implant depends on having available bone. Certain areas of the mouth tend to have less bone and placing an implant would infringe on nerves or sinuses. These areas can be augmented with various materials to stimulate natural bone growth. These materials are placed under the gums and allowed to heal for a number of months. Then, the site is ready to have an implant placed.
What is a fixed bridge?
A fixed bridge is used to replace missing teeth when there are good, solid teeth on either side of the site. A crown (cap) is placed on the adjacent teeth and are used to suspend artificial teeth across the gap. This procedure is done when there are anatomical limitations to doing implants or when a patient rejects implants due to cost. The teeth must be reduced about 1 mm to make room for the porcelain and metal crowns, however, literally millions have been placed nationwide that have given many years of good service. Most of the bridges that I placed over 25 years ago look as good now as they did on the day that I put them in.
Fixed Bridge Case #1
Fixed Bridge Case #2
What is a Maryland or bonded bridge?
A Maryland bridge serves the same purpose a fixed bridge, but it is bonded to the adjacent teeth enamel instead of being held in place by crowns. Therefore, minimal tooth enamel on the abutment teeth needs to be sacrificed. They can only be placed in selected situations and are only as secure as their bond. By the way - the term "Maryland" came from the fact that this type of bridge was developed at the University of Maryland dental school.
What is a partial denture?
A removable partial denture is a metal and plastic plate that has teeth attached to replace those that are missing. The metal plate is designed to rest on the remaining teeth to make it solid while chewing and metal clasps are used to keep the denture from dislodging while talking or chewing food. It is used in cases when cost is a factor or when there is not adequate bone for implants or enough solid abutment teeth for a bridge.
What do I need to know about complete dentures?
It is certainly best to keep all or some natural teeth, but some times, that is not possible or practical. Complete dentures can still restore a reasonable amount of functionality and cosmetics to someone without teeth. As time goes on, the gums will shrink due to natural resorption or by an ill-fitting denture. If the denture teeth are still in good shape, then the plastic can be relined making the dentures fit as good as new. Even though one does not have any teeth, there is still the need to see the dentist to check for oral cancer.
Disclaimer: This page is provided for informational purposes only. You must consult your dentist for advice on your individual dental needs.