Breath Control

Breath Control Treatment

Bad breath is a concern to all of us at some time. Many people believe that oral malodor (bad breath) comes from the stomach, but most commonly the source of bad breath is the crevices deep in the back of the tongue.


Bad breath can also originate in the periodontal pockets. Naturally occurring bacteria thrive in these hidden areas and form odorous volatile sulfur compound (VSC’s). The VSC's have a strong unpleasant smell of rotten eggs.


Routine dental cleanings and examinations enable dentists to help you maintain long-lasting fresh breath along with your healthy teeth and gums. All of us suffer from bad breath on from time to time, but chronic bad breath can be is usually from more serious problems. If you have concerns about your breath, do not hesitate to ask your dentist to help you take control of this sensitive issue.

The Troublesome Tooth - Boulder Implant Dentistry

The Troublesome Tooth

As a child, Barbara had had a root canal done on her upper right front tooth, tooth #8. Over the years, Barbara had several dental crowns on that tooth but never really liked how they looked. For 45 years, the tooth did not cause any pain until one day she began having pain and pressure especially when chewing. This is when she first sought treatment from Dr. Adler. Based upon the exam, x-rays, and prior history of a root canal, Dr. Adler recommended that Barbara have an apicoectomy.

Dr. Adler's Patient Excited with Her New Smile:



An apicoectomy is usually performed after a tooth has had at least one root canal but continues to develop infections. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in those branches and possibly prevent healing or cause re-infection later. During Barbara’s apicoectomy, the root tip was accessed directly through the bone instead of up through the tooth as in a root canal treatment. The root tip, or apex, was removed along with the infected tissue. A filling was then placed to seal the end of the root and a suture is placed to close the access opening. In order to stabilize the tooth, Barbara then had an all porcelain crown and carbon fiber post placed.

For a year after the apicoectomy, the tooth was symptom free but unfortunately the tooth became infected again forming an abscess. A tooth or root abscess is pus enclosed in the tissue of the jaw bone at the tip of an infected tooth that usually originates from a bacterial infection that has accumulated in the soft pulp of the tooth. If left untreated, an abscess can continue to grow and may become large enough to perforate bone and extend into the soft tissue. It will continue to follow the path of least resistance and spread either internally or externally which can lead to severe complications. Dr. Adler performed another apicoectomy in an effort to save the tooth hoping that it was another root tip infection. During the procedure, Dr. Adler saw a fracture in the tooth that extending from tip to crown and it was determined that the tooth could not be saved due to the vertical root fracture.

Patient After Extraction of the Infected Tooth:



Dental Patient After Tooth Extraction is Fully Healed:



The tooth was extracted and a bone graft, allograft, was placed by Dr. Cheri Brown to help replace the bone that had been lost due to the abscess. Dr. Cheri Brown, a Boulder Colorado periodontist, works with Dr. Adler at Adler Cosmetic & Family Dentistry. A removable temporary partial, custom made prior to the appointment, was fitted so that Barbara was able to leave the office without a gap in her smile while she continued to heal. While the graft was healing, Dr. Adler was able to perform guided tissue recontouring. Guided tissue recontouring reshapes the gum around the tooth giving a more aesthetic look. This was done for Barbara by slowing adding material to tooth on the temporary partial where it presses against the gum line. Overtime the tissue is gently formed into the desired shape to better match the other teeth.

Dentistry Patient's Dental Implant as it is Healing:



Once the graft had healed and become stable, Dr. Brown placed the titanium implant. The implant was placed during a surgical procedure, directly into the jawbone and under the gums. The implant with a healing cap attached was then allowed to heal for four to six months so that the bone will grow around the implant and "osseo-integrate". Dr. Brown later placed a soft tissue graft because Barbara needed more connective tissue to support the implant. After six months of healing, Dr. Adler placed a zirconium implant post, also known as an abutment, that connected to the implant. The post was made of zirconium to allow for ideal translucency once the all porcelain crown was place about a month later. So today, Barbara is no longer bothered by that troublesome tooth and she looks great.

Dr. Adler's Patient Excited with Her New Smile:





For more infomation about dental restorations contact Boulder dentist Dr. Michael Adler, DDS.

Cracked Tooth Syndrome: The Hidden Fracture

You are having frequent but sometimes intermittent pain, discomfort, and sensitivity in your tooth. The cause of the pain is not visible to the naked eye and does not show up on the dental x-rays. You are beginning to wonder if the pain is all in your head until the doctor tells you that you have cracked tooth syndrome.

Illustration of the Progression of a Cracked Tooth:


Cracked tooth syndrome describes the recurring pain, discomfort, and/or sensitivity that is caused by an incomplete fracture or crack in a tooth. The fracture involved is often difficult to detect and may be completely invisible to the naked eye and may not appear on dental x-rays. A cracked tooth can be caused several different ways. Clenching and grinding teeth can weaken them causing fractures. Teeth that have undergone root canal treatment and are not restored after treatment with large fillings can cause your teeth to lose strength, making them brittle. Every day your teeth endure a tremendous amount of pressure from biting and chewing, so if you bite down on something hard like a popcorn kernel, the force can cause the tooth to fracture, especially if it is weakened.

Treatment of a fractured tooth usually depends on the location of the fracture as well as the extent of the damage. If only the outer enamel is cracked then we remove the affected portion and restore the tooth with a crown or onlay to stabilize it and protect it from further damage. If the crack extends into the underlying dentin or pulp layers then more extensive treatment may be required, such as a root canal, before a final restoration can be placed to stabilize the tooth. In some rare instances, a crack will extend all the way through the tooth and under the bone. In these extreme cases, there is no way to restore the tooth and we have no other option but to extract it. Fortunately, most cracked teeth can be saved. The key is early detection and appropriate treatment. Since diagnosis is often based on patient symptoms, it is very important to tell your dentist of any pain or discomfort you have been experiencing as soon as you have it.

Cracked Tooth as the Fracture is Uncovered:


Dr. Craig Beyer a Boulder lasik eye surgeon of the Beyer Laser Center is a good example of a those rare cases where a fracture extends through the tooth. Dr. Beyer came to Dr. Adler complaining of that he was having pain when he was biting down. Based upon the symptoms Dr. Beyer described, photographs, and x-rays, Dr. Adler determined that Dr. Beyer had a fractured tooth and recommended a crown. The tooth was prepped and fitted with an all porcelain Cerec crown. The fracture became even more apparent once the tooth had been prepped for the crown and had decay indicator placed on the tooth. Decay indicator is a dye that helps make decay more visible, it can also be used to see tooth fractures because the dye will run along the crack. Interoral pictures allow the doctor to get an up-close look at the teeth allowing him to see cracks that might otherwise be missed. If the fracture had been an oblique fracture, extending into the enamel or dentin but not the pulp layers, as was first assumed then the crown would have solved the problem. Unfortunately, Dr. Beyer continued to have symptoms of pain. Dr. Adler then performed a root canal believing that the fracture extended into the pulp of the tooth. During the root canal procedure, Dr. Adler saw that fractured propagated through the tooth and that the root canal would not be sufficient treatment to save the tooth. Since the fracture extended through the tooth splitting it, the tooth could not be saved and had to be extracted and replaced with a titanium implant.

Bill is a common example of cracked tooth syndrome. Bill had been having sensitivity with a tooth on his upper left side for about one year whenever he would bite down but didn’t think much of it since it only hurt when he bit down and wasn’t a constant pain. After mentioning to the dental hygienist at his cleaning that he was having this continuous problem, the doctor diagnosed a fracture in the tooth. An old filling was removed from the tooth and a decay indicator was placed on the tooth in order to see the extent of the fracture. The decay indicator along with the interoral pictures allowed Dr. Adler to see that the fracture, an oblique fracture, extended across and into the tooth but had probably not yet entered the pulp chamber. Dr. Adler placed an all porcelain Cerec crown on the tooth to stabilize and to help prevent the fracture from propagating further through the tooth. The crown also kept the fracture from expanding and contracting which can increase the pain or sensitivity that a patient experiences. Since the crown was placed, Bill has been symptom free.


Cracked Tooth Once Fracture is Fully Uncovered:


For more information contact Boulder Dentist, Dr. Michael Adler, DDS by visiting his website or calling 303-449-1119.

Complete Cosmetic Dentistry Makeover - Case Study

Sarah came to our office in need of a complete mouth makeover. She was having muscle spasms on her right side, felt like her bite was off, and had TMJ pain. In addition, she was complaining of jaw pain and pain when chewing. Sarah was concerned about having healthy teeth and gums and a comfortable bite.

Dr. Adler saw that Sarah had several problems that needed to be addressed. Her upper arch had crowding, wear, and large silver fillings that needed to be replaced to avoid fracturing the teeth. Her lower arch had cavities, wear, and crowding. She also had alignment issues, variations in gum height and tooth shade, a deep bite, and her midline was off center. The wear, deep bite, alignment issues, and off center midline concerned Dr. Adler because these along with her symptoms of neck and jaw pain are often signs of TMD (temporal mandibular disorder).

Before Pictures:





Just as house needs a level foundation, your mouth also needs a level foundation called the plane of occlusion to work properly. When the plane of occlusion is properly aligned with the forces of occlusion (your bite force) then the forces are evenly transferred through the maxilla (upper jaw) to the rest of the cranial bones of the skull. If this alignment is off, then the force is not evenly distributed and can cause muscle strain, headaches, and the body becomes unhealthy due to the constant stress. If muscles must strain to get your teeth together you set up a muscle vs. tooth war in your mouth. If your muscles win, you have rapid tooth wear. If your teeth win, you have muscle tension and stress along with headaches and other TMD problems, or worse you will experience a combination of both. Sarah showed a combination of both wear and jaw pain with headaches.

Sarah’s treatment began by doing a K7 evaluation. This involves taking diagnostic cast so we have an accurate model of her mouth and bite. The K7 produces scans that measure the muscles, range of motion, and joint noise among other things. EMG or electromyography measures the muscles at rest and during function-clench. CMS (computerized mandibular scan) measures joint function, habitual freeway space, swallowing, and range of motion. Sonography measures joint sounds. TENS or Transcutaneous Neural Stimulation relaxes the muscles in the face and neck to find their true resting state and establish the occlusion at that position. Material is then placed in the patient’s mouth to capture that ideal position, known as the bite registration. Sarah’s scans showed dramatic improvement when preformed with the bite in place. The bite registration was used in Dr. Adler’s study of her bite and was used by the laboratory to fabricate a fixed orthotic that was bonded to her lower teeth to establish that ideal position. The orthotic was worn and adjusted for several months and gave Sarah a good trial run for how her bite would feel after permanent restoration was completed. The orthotic temporarily alleviated pain symptoms associated with TMD and ensured that her neuromuscular occlusion was correct before undergoing more advanced treatment.

Fixed Appliance Photo:



Sarah underwent a very dramatic change the day she came in and had all of her teeth prepared for restoration. Every tooth was fitted for all porcelain crowns. The procedure was completed in a single day, thereby reducing the number of visits the patient needed to make and insuring the correct bite. Due to the extensive nature of the case, the crowns were sent to a lab for fabrication. The lab is then able to custom craft the entire mouth instead of trying to piece together and match the teeth had they been done separately over a period of time. The lab will insure that her smile is not only aesthetically beautiful but also functional and in the proper bite. Although Sarah will not have her final restorations for a few more weeks, even just her temporaries show the remarkable change that she has undergone.

After Temps Photo:



Stay tuned for postings and pictures of Sarah’s astonishing smile makeover.

Truly Restorative Dentistry - Case Study

Picking up the Pieces

Ryan suffered a traumatic fall that severely damaged his front teeth. Tooth #8 (his upper front tooth on the right) had sustained the most damage and had had a third of the tooth broken off. Ryan was suffering pain and sensitivity due to the fracture. Tooth #9 (located to the left of #8) was also fractured but not to the same extent. After his accident Ryan went to Boulder cosmetc dentist Dr. Michael Adler, DDS to explore his options for treatment.



Dr. Adler performed a root canal on tooth #8 as part of his emergency treatment to get the patient out of pain. The teeth were temporarily bonded to make the teeth look normal while Ryan was completing his treatment. The root canal was necessary because the severe fracture exposed the pulp of the tooth to bacteria that live in the saliva. If left untreated, the tooth would continue to be a source of infection and eventually weaken the body’s immune system. The pulp is contained within an inner chamber of the tooth called the pulp chamber. Pulp is commonly referred to as the nerve but is actually a soft tissue make up o nerves, arteries, and veins. The pulp extends from the pulp chamber down through narrow channels, called the root canals, to the tips of the roots. The fear and pain associated with root canals are over rated. For most patients, getting a root canal is no more traumatic that having a filling done. During the process of the root canal, the doctor goes into the tooth and removes the pulp, cleaning the cavity.

Once a root canal has been performed, the tooth is structurally weakened and prone to fractures and breaking if left as is. Dental crowns are a common option for a root canalled tooth. In Ryan’s case, both tooth #8 and 9 were both crowned not only because of the root canal but because of the fractures caused by the accident. The teeth are prepared for the crown by removing any damaged areas and/or decay. In the case of tooth #8 a carbon fiber post was placed to adequately support the crown so the bite force would be properly distributed so that the tooth did no fracture. The tooth is then shaped to securely hold the crown. The crown is either custom fabricated in the office using CAD/CAM CEREC system or sent to a laboratory. Ryan’s was sent to a laboratory and an impression of the tooth was taken so the dental lab could make an accurate model of his mouth, and then created a crown that precisely fit his mouth and bite. Ryan received all porcelain crowns on #8 and 9. Unlike porcelain fused to metal crowns, all porcelain crowns are translucent and allow light to pass through the tooth like a natural tooth opposed to reflecting all the light which can make the tooth appear dark. Porcelain fused to metal crowns can also have a dark ring near the gum line which is not present with all porcelain crowns. The shade of the teeth is also very important to maintain the natural appearance. An underlying shade is taken of the prepared tooth, known as a stump shade, to better match the natural and subtle hues of the tooth. The shade of the crown is also determined by the adjacent teeth. Whitening is done before this outer shade is taken to make sure the crown closely matched the other teeth and because crowns are not effected by the whitening process and so will remain the same color as they are made.





Prior to the crowns being custom made, Ryan had his teeth whitened using our in-office ZOOM laser whitening. The main ingredient in Zoom is hydrogen peroxide, which works by oxygen enter the enamel and dentin was it breaks down. The oxygen bleaches colored substances and doesn’t harm the tooth structure. The Zoom light aids in activating the hydrogen peroxide and helps it penetrate the surface of the tooth. It is a simple procedure that can produce great results. With this new brighter smile, Ryan was ready to have the shade taken and the crowns seated.

The results of Ryan’s treatment were both dramatic and were a great improvement from the post accident appearance. When accidents happen, we are here to help you pick up the pieces.

YouTube: Boulder Cosmetic Dentistry

Boulder, Colorado cosmetic dentist Dr. Michael Adler has launched his TV commercial video on YouTube. Dr. Adler invites you to visit his video on YouTube titled Boulder Cosmetic Dentistry and please post a comment while you are there.


He is excited to know what you think.


Below the video that is embedded in this blog you can find the subtitles for this video.





Subtitles:


"A great smile.
Bright, white, straight, even and healthy teeth.
A great smile comes from Adler Cosmetic Dentistry.
Using the latest thecnology Dr. Adler can imvisibly straighten your teeth.
With comfortable, transparent, removable Invisalign braces.
Repair chipped or broken teeth.
Replace ugly metal fillings with tooth colored fillings.
Remove stains and discoloration.


Hi, I'm Dr. Michael Adler.
For a great smiles call us today for a free smile consultation."


For more information visit Boulder dentist Dr. Adler's website.

Completing a Smile

For someone who has had a broken smile for a number of years, today has been a long time in coming. We met Tony in the beginning of 2007 and began soon after to restore his smile. A titanium implant and bone graft were placed where tooth #7 used to be.



If a tooth is missing, the gums and bone it was attached to are no longer stimulated by the blood supply and activity of that tooth. Therefore, with the tooth gone, the surrounding bone and gums may resorb or melt away. Furthermore, the opposing tooth (on the opposite jaw) no longer has something to bite against, and may grow towards the space created by the missing tooth. Implants not only stabilize the restoration that sits on top of it, but also stimulate bone growth around the implant.

www.AdlerDentistry.com

The implant was placed during a surgical procedure, directly in the jawbone and under the gums. The surgical site with the implant was then left (under the gums) to allow the bone to grow around the implant and "osseo-integrate". Six months after the first surgery, the implant was uncovered from under the gums. An "abutment" or implant post was then connected to it, and the gums were given time to heal around this abutment. About a month later, a final tooth restoration is custom-made to fit onto the abutment. Today was that day. After waiting patiently, Tony was able to come in today and have his custom-made crown permanently fitted and left with his mouth restored.



Today the Boulder cosmetic dentistry team completed a smile.