Your son just crashed his skateboard and cracked a tooth, or maybe your daughter fell off the monkey bars at school and now has a chipped front tooth. For children, and some adults, repairing chipped or damaged teeth with tooth-colored restorative materials directly bonded to the teeth may be the perfect solution to restore their smiles.

What is Involved: Composite bonding is a technique that has been developed to correct chipped teeth and other minor dental imperfections. It may also be used to correct mild crookedness or gaps between teeth. The procedure requires the application of a tooth-colored composite resin material to the surfaces of teeth, which is then sculpted to the desired shape. It can be performed in a single visit for one or multiple teeth. The procedure usually takes between one and two hours, and the end result is a beautiful, natural-looking smile.

Advantages for Kids and Adults: Composite resin bonding is a good choice for kids and teens since their jaws are still growing and developing, and they may still be engaged in high-risk activities. After your child's teeth and jaws are fully developed, we can discuss options for more permanent restorations such as porcelain veneers or crowns. These require removal of more tooth structure, which could compromise the long-term health of your child's teeth if done too soon. Composite resin restorations, which bond straight to the teeth and require little to no tooth preparation or drilling are therefore a good option for fixing chipped teeth, and they're less expensive than choosing veneers.

Disadvantages: The longevity of composite resin restorations is related to how well you maintain your teeth. Many people can go for ten or fifteen years before they need to have the bonded resins repaired or replaced. Others will tend to stain and wear after only one or two years and will need some touch-up work.

Contact us today to schedule an appointment to discuss any questions you may have regarding dental bonding. Read more about this topic in the Dear Doctor magazine article “Repairing Chipped Teeth.”

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 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.”

Getting enough sleep is necessary for good health. We all know how energetic we feel when we are sleeping well at night. Yet, many of us do not feel rested, even after seven or eight hours of sleep. Let's answer some common questions about snoring and sleep apnea, problems that are often called sleep related breathing disorders (SRBD).

What is the purpose of sleep?
Scientists know we need sleep, at a particularly deep level, to be rested, but they are not sure why we need sleep. Sleep may have evolved as a way to conserve energy in the body, to conserve food supplies, or to reduce our risk during darkness. Sleep appears to give the brain a chance to store and organize its information and the body a chance to recuperate. Sleep studies have shown that in order to get the full benefits of sleep we need to sleep long and deeply enough to enter into a series of sleep cycles including Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep.

What kinds of problems get in the way of the type of sleep we need?
There are eight main categories of sleep disorders, but the ones affecting the largest numbers of people are insomnia, SRBD, and Circadian Rhythm Sleep Disorders. SRBDs include snoring and Obstructive Sleep Apnea (OSA), which is a serious health problem.

How do I know if I have OSA or another SRBD?
Often, your bed-partner will tell you that you snore. Chronic loud snoring is an indicator of OSA. To make a diagnosis your physician must take a thorough sleep and medical history. The diagnosis may then be confirmed by a study in a sleep lab.

What causes sleep apnea or OSA?
Snoring and OSA happen when your tongue and other soft tissues in the back of your throat collapse backwards and block airflow through your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stage of sleep your body needs.

What are the treatments for sleep apnea?
Treatments include CPAP therapy, in which patients wear a mask while sleeping. The mask pushes air through the airway, keeping it open. In Oral Appliance Therapy (OAT) patients wear a device that moves the lower jaw forward, allowing more room for air to move down the airway. Oral surgical procedures and orthodontic approaches also have the goal of moving the tongue away from the throat. These are all treatments that can be carried out by a dentist who has training and experience in treatment of sleep disorders.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Sleep Apnea Frequently Asked Questions.”

Scientists don't know much about sleep even though it has been extensively studied. We do know that several hours of deep, restful sleep per night are essential for a healthy life.

Many people remain tired and unrefreshed, even after a full night's sleep. About a third of them are affected by sleep related breathing disorders (SRBD). Dentists can play a significant role in helping patients overcome these disorders, which range from frequent snoring to severe Obstructive Sleep Apnea (OSA). If you think you may have such a disorder, read on.

Under normal conditions, your upper airway is open, allowing air to flow from your nose, through your throat, and into your lungs. If you suffer from SRBD, you experience frequent reductions in the flow of air to your lungs during sleep. You may not be aware of it, but sometimes your breathing may even stop for brief periods. These reductions happen when your tongue and other soft tissues in the back of your throat collapse backwards and block your upper airway or windpipe. You may briefly awaken as many as 50 times per night because of these breathing lapses. These brief awakenings, called micro-arousals, keep you from reaching the deep stages of sleep your body needs.

The resulting reduced oxygen flow to your heart and to your brain can cause serious damage. You will also be tired during the day and experience a lack of energy, even if you sleep for seven or eight hours per night. This constant drowsiness puts you at greater risk for accidents.

Because dentists generally see their patients at six-month or other regular intervals, we are in a good position to screen and refer patients with suspected SRBD to physicians for diagnosis and treatment. Dentists can also treat SRBD in a number of ways.

• One of these is Oral Appliance Therapy (OAT), in which a device that looks something like an orthodontic retainer holds your lower jaw in a forward position relative to your upper jaw, preventing your tongue and soft tissue from collapsing into your airway.
• Another consists of breathing equipment called Continuous Positive Airway Pressure (CPAP). The CPAP is a mask connected to a machine that pushes air into your lungs.
• Other treatments include oral surgery or orthodontia. The goal of these techniques is to increase the volume of air passing through your upper airway by pushing your tongue forward.

Medical insurance usually covers the cost of much of these treatments.

Contact us today to schedule an appointment to discuss your questions about sleep disorders and their treatments. You can also learn more by reading the Dear Doctor magazine article “Sleep Disorders and Dentistry.”

As the Boy Scouts say, it's best to be prepared. You may never have a traumatic injury to your teeth. But what if you do? Here are four questions and answers about such injuries and their treatment that may be helpful some day.

What are traumatic injuries?
We are talking about physical damage caused by a fall, an accident, or a blow to the face. The word trauma comes from the Greek root meaning “wound.”

A traumatic injury can also cause broken, cracked, or split teeth, or a fracture to the root of the tooth. A tooth may be dislodged from its proper position, pushed sideways, out of or deeper into its socket. It may even be completely knocked out of your mouth.

What should you do if your tooth is knocked out?
With proper treatment, the tooth can be restored to its original place. You must handle the tooth gently and seek professional help as soon as possible. Rinse the tooth in cold water if it is dirty, but do not use any cleaning agent. Avoid touching the root. While hurrying to your dentist, keep the tooth from drying out by keeping it in a container of milk or of your saliva, or by holding it in your mouth between gum and cheek. It is vital to keep the tooth's living tissues moist until it can be professionally assessed and replanted in its socket. If a tooth has been dislodged but not knocked out, it must be repositioned in its socket and may be stabilized with a splint.

Who can treat a tooth that is damaged by a traumatic injury?
A general dentist, an oral surgeon or an endodontist is trained to treat such injuries. An endodontist is trained to treat the root canal(s) inside a tooth. The word comes from “endo” the Greek word for “inside,” and “odont,” the word for “tooth.” After a tooth is replaced in its socket and stabilized, root canal treatment is often needed.

What is root canal treatment?
A tooth is composed mostly of dentin, a living tissue. The top part or crown is covered by hard mineralized enamel. The soft tissue inside the tooth, the pulp, contains blood vessels, nerves and connective tissues. It extends from the crown to the tip of the roots. Treatment of dental pulp injuries is called root canal or endodontic treatment and is usually needed to treat teeth that have been dislodged or fractured.

Contact us today to schedule an appointment to discuss your questions about injuries to teeth and related nerve damage. You can also learn more by reading the Dear Doctor magazine article “Trauma & Nerve Damage to Teeth.”