My Blog

By Kevin S. Midkiff, D.D.S. Family & Cosmetic Dentistry
January 17, 2022
Category: Dental Procedures
Tags: celebrity smiles   crowns  
HowCelineDionOvercameHerSmileObstacle

For over three decades, Celine Dion has amazed audiences and fans with her powerful singing voice. Best known for her recording of "My Heart Will Go On," the theme song for the movie Titanic, Dion has amassed global record sales topping 200 million. In her early singing days, though, she struggled with one particular career obstacle: an unattractive smile.

The Canadian-born performer had a number of dental defects including crooked and discolored teeth, and—most prominent of all—abnormally large cuspid or "canine" teeth (located on either side of the four front incisors). They were so noticeable that one Quebec celebrity magazine gave her the unflattering nickname "Canine Dion."

This isn't an unusual problem. Since human canines are already the longest teeth in the mouth, it doesn't take much for them to stand out. Our ancient hunter-gatherer ancestors needed these large, pointed teeth to survive. But with the evolution of agriculture and industry, canine teeth have become gradually smaller—so much so that when they're abnormally large, they don't look right in a smile.

So, what can be done if your canines embarrassingly stand out from the rest? Here are some of the options to consider.

Reduce their size. If your canines are just a tad too long, it may be possible to remove some of the enamel layer in a procedure called contouring. Using this technique, we can reduce a tooth's overall size, which we then re-shape by bonding composite resin to the tooth. It's only a good option, though, if your canines have an ample and healthy layer of enamel.

Repair other teeth. The problem of prominent canine teeth may actually be caused by neighboring teeth. When the teeth next to the canines are crooked, the canines can appear more prominent. Alternatively, other teeth around the canines may be abnormally small. Braces or clear aligners can correct crooked incisors, and applying porcelain veneers to smaller teeth could help normalize their length.

Apply dental crowns. In some instances, we can reduce the canines in size and then bond porcelain crowns to them. This is the option that Dion ultimately chose. The natural teeth are still intact, but the crowning process transforms them into properly proportioned, life-like teeth. There is, however, one caveat: The alteration to these teeth will be permanent, so they will need a crown from then on.

Besides crowning her canine teeth, Dion also underwent other dental work to straighten and whiten her other teeth. As a result, this superstar performer now has a superstar smile to match and so can you if your teeth are less than perfect. These or other cosmetic enhancements can give you the look you truly desire. All it takes is an initial visit with us to start you on the road to a transformed smile.

If you would like more information about various cosmetic solutions for your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Dental Crowns.”

By Kevin S. Midkiff, D.D.S. Family & Cosmetic Dentistry
January 07, 2022
Category: Oral Health
Tags: oral health   osteoporosis  
SomeOsteoporosisTreatmentsCouldImpactDentalCare

Millions of Americans live with osteoporosis, a degenerative bone disease that can turn a minor fall into a potential bone fracture. Literally meaning "porous bone," osteoporosis causes the natural marrow spaces in bone tissue to progressively grow larger and weaken the remaining bone.

Many osteoporosis patients take medication to slow the disease's process. But due to the dynamic nature of bone, some of these drugs can have unintended consequences—consequences that could affect dental care.

As living tissue, bone is literally "coming and going." Certain cells called osteoblasts continuously produce new bone, while others called osteoclasts remove older tissue to make way for the new. Drugs like bisphosphonates and RANKL inhibitors interrupt this process by destroying some of the osteoclasts.

As a result, more of the older bone remains past its normal lifespan, helping the bone overall to retain strength. But ongoing research is beginning to hint that this may only be a short-term gain. The older, longer lasting bone is more fragile than newer bone, and tends to become more brittle and prone to fracture the longer a patient takes the drug. This tissue can also die but still remain intact, a condition known as osteonecrosis.

The femur (the large upper leg bone) and the jawbone are the bones of the body most susceptible to osteonecrosis. Dentists are most concerned when this happens in the latter: Its occurrence could lead to complications during invasive procedures like oral surgery or implant placement.

Because of this possibility, you should keep your dentist informed regarding any treatments you're undergoing for osteoporosis, especially when planning upcoming dental procedures like oral surgery or implant placement. You might be able to lower your risk by taking a "drug holiday," coming off of certain medications for about three months before your dental work.

As always, you shouldn't stop medication without your doctor's guidance. But research has shown drug holidays of short duration won't worsen your osteoporosis. If you're already showing signs of osteonecrosis in the jaw, a short absence from your prescription along with antiseptic mouthrinses and heightened oral hygiene could help reverse it.

Fortunately, the risk for dental complications related to osteoporosis medication remains low. And, by working closely with both your dentist and your physician, you can ensure it stays that way.

If you would like more information on osteoporosis and your dental care, 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 “Osteoporosis Drugs & Dental Treatment.”

By Kevin S. Midkiff, D.D.S. Family & Cosmetic Dentistry
December 28, 2021
Category: Dental Procedures
Tags: Root Canal  
GotQuestionsAboutRootCanalsWeHaveAnswers

You might have a few questions should you find out you need a root canal for a tooth infected with advanced decay. Most will be about what you should expect before, during and after a procedure.

But first, let's deal with a couple of your obvious concerns right upfront:

  1. No, contrary to your Uncle Bill, it won't be painful (if the infected tooth is throbbing, though, the procedure will relieve your pain);
  2. Yes, based on outcomes for millions of treated teeth over several decades, the odds are high the procedure will save your tooth.

As to other questions you might have, here's a basic 411 concerning your upcoming root canal procedure.

The "Why." Many consider tooth decay to be mainly a cavity forming in the outer enamel and dentin layers of a tooth. But tooth decay can destroy tooth structure as it advances through to the pulp, the heart of a tooth. The resulting infection will also spread into the root canals to eventually infect the roots and supporting bone. A root canal treatment removes the decay and stops the advancing infection in its tracks.

The "How." There are a number of variations on the procedure, but they all follow this basic process: After thoroughly numbing the tooth and surrounding tissues, we drill a hole into the tooth to access the pulp chamber and the root canals. We then remove all infected tissue through this access and disinfect the tooth's interior spaces. We then fill these spaces with a rubber-like filling to prevent future infection.

The "After." Once we've completed filling, we seal the access hole. Sometime later, we'll crown the tooth to provide further protection against infection and add support to the tooth. In the meantime, you may have a few days of discomfort, which is usually manageable with mild pain-killers like ibuprofen or acetaminophen.

A lot of root canals can be performed by a general dentist, but more complicated cases may require an endodontist. In either scenario, a root canal could give your infected tooth another chance at life that it wouldn't otherwise have.

If you would like more information on root canal therapy, 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 “Root Canal Treatment.”

By Kevin S. Midkiff, D.D.S. Family & Cosmetic Dentistry
December 18, 2021
Category: Dental Procedures
Tags: wisdom teeth  
DecidingtheFateofWisdomTeethMoreNuancedThaninthePast

If you're of a certain age, there's a good chance you've had your third molars—wisdom teeth—removed. At one time, extracting these particular teeth was a common practice, even if they hadn't shown any signs or symptoms of disease or dysfunction. But now, if you have a son or daughter coming of age, your dentist may recommend leaving theirs right where they are.

So, what's changed?

Wisdom teeth have longed been viewed as problematic. As the last of the permanent teeth, they often erupt on a jaw already crowded with other teeth. This can cause them to come in out of position—or not at all, remaining partially or totally submerged (impacted) beneath the gums.

Misaligned teeth are more difficult to keep clean of bacterial plaque, which in turn raises the risk of tooth decay or gum disease. Impacted teeth can put pressure on the roots of neighboring teeth, which further increases the risk for disease or bite problems.

To avoid these common problems associated with wisdom teeth, dentists often remove them as a preemptive measure. Given their size and possible root complexity, this is no small matter: Removing them usually requires oral surgery, making wisdom teeth extraction one of the top oral surgical procedures performed each year.

Today, however, many dentists are taking a more nuanced approach to wisdom teeth. While they still recommend removal for those displaying signs of disease or other problems, they may advise leaving them in place if the teeth are healthy, not interfering with their neighbors, and not affecting bite development.

That's not necessarily a final decision, especially with younger patients. The dentist will continue to monitor the wisdom teeth for any emerging disease or problems, and may put extraction back on the table if the situation merits it.

The key is to consider each patient and their dental needs regarding wisdom teeth on an individual basis. If warranted, removing the wisdom teeth may still be warranted if will help prevent disease, keep bite development on track and optimize oral health overall.

If you would like more information on wisdom teeth, 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 “Wisdom Teeth: Coming of Age May Come With a Dilemma.”

By Kevin S. Midkiff, D.D.S. Family & Cosmetic Dentistry
December 08, 2021
Category: Oral Health
BuffaloBillsStefonDiggsKnowsTheresNeveraBadPlacetoFloss

Buffalo Bills wide receiver Stefon Diggs wrapped up the NFL regular season in January, setting single-season records in both catches and receiving yards. The Bills handily beat the Miami Dolphins, earning themselves the second seed in the AFC playoffs, and Diggs certainly did his part, making 7 catches for 76 yards. But what set the internet ablaze was not Diggs' accomplishments on the field but rather what the camera caught him doing on the sidelines—flossing his teeth!

The Twitterverse erupted with Bills fans poking fun at Diggs. But Diggs is not ashamed of his good oral hygiene habits, and CBS play-by-play announcer Kevin Harlan expressed his support with “Dental hygiene is something to take note of, kids! There's never a bad place to floss” and “When you lead the NFL in catches and yards, you can floss anytime you want.”

We like to think so. There's an old joke among dentists:
Q. Which teeth do you need to floss?
A. Only the ones you want to keep.

Although this sounds humorous, it is borne out in research. Of note, a 2017 study showed that people who floss have a lower risk of tooth loss over periods of 5 years and 10 years, and a 2020 study found that older adults who flossed lost an average of 1 tooth in 5 years, while those who don't lost around 4 teeth in the same time period.

We in the dental profession stress the importance of flossing as a daily habit—and Stefon Diggs would likely agree—yet fewer than 1 in 3 Americans floss every day. The 2016 National Health and Nutrition Examination Survey (NHANES), conducted by the CDC's National Center for Health Statistics, revealed that only 30% of Americans floss every day, while 37% floss less than every day and 32% never floss.

The biggest enemy on the football field may be the opposing team, but the biggest enemy to your oral health is plaque, a sticky film of bacteria and food debris that builds up on tooth surfaces. Plaque can cause tooth decay and gum disease, the number one cause of tooth loss among adults. Flossing is necessary to remove plaque from between teeth and around the gums where a toothbrush can't reach. If not removed, plaque hardens into tartar, which can only be removed by the specialized tools used in the dental office. Regular professional dental cleanings are also needed to get at those hard-to-reach spots you may have missed.

If Diggs can find time to floss during a major NFL game, the rest of us can certainly find a couple minutes a day to do it. While we might not recommend Diggs' technique of flossing from one side of the mouth to the other, we commend his enthusiasm and commitment to keeping his teeth and gums healthy. Along with good dental hygiene at home—or on the sidelines if you are Stefon Diggs—regular professional dental cleanings and checkups play a key role in maintaining a healthy smile for life.

If you would like more information about keeping in the best dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”





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