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Crown lengthening is a surgical procedure in which gingival tissue alone or gingival tissue and bone is recontoured or removed to expose more tooth structure than was previously visible. This procedure can be functional in nature, exposing more tooth to expose decay for a restoration, or to add to the length of a tooth to enhance retention of a crown.
This procedure can also be used for cosmetic enhancement when the teeth look too short because of excess coverage by the gingiva. Crown lengthening can be performed to correct this situation and expose more tooth structure, sculpting the gum line to create a more pleasing proportion between gum and tooth resulting in a more balanced smile.
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The outer most visible part of a tooth is the enamel. It is the hardest structure in the human body and is designed to resist chewing force, breakage, and staining. The bulk of a tooth consists of dentin, which is an organic component that can conduct sensation to the nerves that are deep inside the tooth in the dental pulp. The other constituents of the dental pulp are blood vessels and connective tissue. The root of the tooth is covered by cementum. Between the cementum of the tooth and the surrounding bone are the fibers of the periodontal ligament that anchor the tooth in place, yet give it a small amount of movement in the bone.
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The root canal is the hollow space inside the root of a tooth that in a healthy state is occupied by the dental pulp. The dental pulp consists of nerves that provide sensation inside the tooth, blood vessels which supply oxygen and nutrients to the tooth and connective tissue. If a tooth is decayed or fractured deeply enough that it causes pain, it is the nerves of the dental pulp that convey that message to the brain.
When the contents of the root canal system deteriorate due to trauma or bacterial attack, the resulting abscess can necessitate endodontic treatment, also called root canal therapy.
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Also known as tooth decay, a cavity is the deterioration of the tooth structure caused by acids in bacterial plaque. The decay can damage both the dentin (the inner part of a tooth) and the enamel (the outer portion of a tooth). The process of decay starts when foods containing carbohydrates (starches and sugars) are left on the teeth. The bacteria in plaque consume the food and produce acid as a by-product. The acid erodes the enamel, allowing the bacteria to attack the dentin inside the tooth.
When bacteria penetrate sufficiently deeply inside a tooth, sensitivity and pain can result. If detected and treated early, decay will not destroy a large amount of tooth structure and usually is not painful. If not detected early, and allowed to progress, the bacterial invasion can reach the dental pulp, resulting in a painful abscess.
A dry socket can occur following removal of a tooth if the blood clot that normally fills in the extraction site does not form properly or is lost because of poor healing, smoking, eating or drinking too soon after the extraction. The condition is painful because due to the loss of the blood clot, the extraction site is exposed to air, food, fluids and oral debris. A dry socket is almost always accompanied by some degree of infection and will frequently have a foul taste or odor. The condition, if present, generally appears two or three days following the removal of the tooth and can presist for five or 6 days.
The best way to prevent a dry socket is to follow postoperative instructions. If one occurs, it is most often treated by packing with a medicated dressing and/or taking antibiotic medication.
Dental cleaning (prophylaxis) by a dental hygienist at specified intervals is intended to remove plaque, calculus (mineralized plaque) and stains that still develop even with careful brushing and flossing, especially in areas that are difficult for people to clean at home. A typical maintenance cleaning for a healthy person includes scaling with hand instruments and tooth polishing.
For someone who has not had dental care for an extended period of time, or who tends to accumulate heavy deposits and staining, mechanized ultrasonic instruments may be used. This is a device that uses high frequency vibration and water spray to remove deposits from the teeth.
For most healthy people, having the teeth professionally cleaned twice annually will suffice. More frequent cleaning and examination may be necessary for those whose home care is poor, who have rapid accumulation of plaque and calculus or have deep periodontal pockets due to periodontitis.
Between cleanings by a dental hygienist, good oral hygiene practices that thoroughly remove plaque and stimulate the oral tissues are essential for preventing decay, gingivitis and periodontal disease.
Dentists sometimes see patients with facial injuries that result in loosening or total loss of teeth. The patients are most often young people with play or sporting injuries or adults with injuries from traffic accidents. A tooth that has been knocked from its socket can effectively be treated if the treatment occurs very soon after the injury.
An avulsed tooth should be wrapped in a wet towel or placed in a container of milk or lightly salted water and taken to the dentist's office at once. There is no time to waste, as the success rate of reimplantation is best if it is reimplanted within 30 minutes to an hour after the accident. It is best not to attempt to clean the tooth yourself. Mixed with debris on the tooth are often soft tissues that can help the tooth reattach to the bone. These tissues can be damaged by improper cleaning.
After carefully cleaning and reimplanting the tooth, the dentist will attach it to nearby teeth that still have firm attachment to lend it stability until reattachment occurs. Following successful reimplanting and splinting, root canal treatment of the avulsed tooth is almost always necessary, as the loss of blood supply to the dental pulp causes loss of vitality.
Although not always ...
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A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth or teeth with prosthetic replacement(s) while being attached to and supported by adjacent teeth or dental implants, usually with crowns.
There are different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Most bridges are made using the indirect (dental laboratory) method of fabrication and are held with crowns on the abutment teeth, however, bridges can be built directly in the mouth using such materials as bonded composite resin.
A bridge is generally created by reducing the teeth on either side of the missing tooth or teeth, making records to facilitate laboratory fabrication of the bridge and placing a temporary bridge in place while the final prosthesis is being made. When it returns from the lab, the final restoration is bonded into place once it has been determined to have met all of the necessary criteria for fit, function, appearance and occlusion (bite).
Materials used for making bridges include gold, porcelain fused to a gold substructure, or all ceramic with no metal framework. The amount and type of preparation done to the abutment teeth varies slightly with the different materials used.
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The term gingivitis refers to inflammation and infection of the gingival (gum) tissue around the teeth. It is caused by retention of bacterial plaque. The bacteria in plaque produce both the acids that cause tooth decay and the toxins that attack the supporting structures for the teeth, the gums and bone.
Gingivitis is more precisely defined as inflammation of the gingival tissue without loss of supporting bone, and is reversible. It is usually caused by bacterial plaque that accumulates in the small gaps between the gums and the teeth and by calculus (tartar) that forms on the teeth. These accumulations may be tiny, even microscopic, but the bacteria in them produce the toxins that cause inflammation of the gums around the teeth. This inflammation can, over the years, cause deepening pockets between the teeth and gums and loss of bone around teeth—the disease known as periodontitis or pyorrhea. Since it is the bone of the jaws that supports and retains the teeth, loss of bone from periodontitis can cause teeth over the years to become loose and eventually to fall out or need to be extracted because of loss of support.
Because gingivitis is preventable and reversible, early detection, professional cleanings and thorough home care (brushing and flossing) are the ...
Richard Venmar grew up in western Pennsylvania. He graduated cum laude from Grove City
College in Grove City, Pennsylvania with a Bachelor's Degree in Biology in 1975. He
completed his dental education at the University of Pittsburgh School of Dental Medicine,
graduating with a D.M.D. degree in 1979. In recognition of his academic record and clinical
skills while in dental school, Dr. Venmar was elected to membership in Omicron Kappa Upsilon
Dental Honorary Society.
Following graduation, Dr. Venmar practiced with Dr. Michael Pawk, his neighbor and mentor,
for one year in his home town of Butler, Pennsylvania before moving to Vermont. In November
of 1980, he opened his practice on Main Street in Barre, above Paige and Campbell Insurance
and remained there until 1990. By then, the practice had outgrown the original space and was
moved to the current Maple Avenue location where doctor and staff enjoy the challenges of
providing wide ranging dental services to people of all ages.
Dr. Venmar enjoys cooking, photography and computers. His grown daughters, Kate and Jaime,
live in Chapel Hill, North Carolina and Balneario Camboriu, Brazil, respectively. Kate has a Ph.D. in
cancer biology from the School of Medicine at Vanderbilt University and is currently employed
by the Metastatic Research Society. Jaime worked in a travel agency in ...