Getting a new crown for a front tooth is a standard procedure performed in thousands of dental offices around the country. But dental patients are sometimes surprised to find that the price of this routine treatment can vary by a substantial amount. What accounts for the difference? The answer tells us a lot about how crowns are made, and the value of aesthetics in dentistry.

Crowns may be made of several different materials. Gold, the most traditional restoration material, makes for a time-tested, functional and durable crown, lasting as long as 50 years. Gold is a precious (and expensive) metal, but considered over the lifetime of the restoration, it's an economical choice. Yet, even for back teeth, it's losing out in popularity to more aesthetically pleasing alternatives.

Porcelain-fused-to-metal (PFM) crowns and all-porcelain crowns replicate the look of natural teeth more accurately. The kind of porcelain used in restorations must have special strengtheners added, which enable it to stand up to wear and tear in the mouth. There are different porcelain materials used in dental restoration, each with a different look, quality and longevity. There are also new, high-tech ceramic materials. Each one has advantages and drawbacks, and each one's cost is different.

Besides the material, another large part of a crown's cost is the custom-fabrication of every piece. Since it must match the other teeth in form and function — and often in looks as well — every crown must be made to an individual's exact requirements. This includes the tooth's exact size and shape, its spacing, and (often) its particular color.

Making this happen is a multi-step process. First, a dentist carefully prepares a model of the affected tooth and its neighbors. Then, the fabrication work is normally performed by a highly skilled laboratory technician, at the dentist's direction. Finally, the dentist prepares the tooth for the restoration, performs final adjustments, and attaches the finished crown. When it's done, the restored tooth can be difficult to tell apart from any other.

The level of craftsmanship involved at the dental laboratory can vary — and along with it, the price. Dentists may even choose different technicians based on the quality level they're striving for. All of these factors affect the final cost of the crown, and its value to the patient.

It has been said that beauty is in the eye of the beholder, and this is certainly true in the case of dental restorations. The choice of a “best” crown is different for every person — more than one alternative may be available, and each comes with its own price. If you have more questions about your options for a crown restoration, don't hesitate to ask us!

If you would like more information about crowns, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Value of Quality Care,” “Porcelain Crowns & Veneers,” and “Gold or Porcelain Crowns.”

Everyone's heard the jokes about root canals. Now, let's go beyond the myths and get to the “root” of the matter. Here are a few things everyone should know about this relatively painless and beneficial procedure.

1) If you experience discomfort after eating hot or cold foods, sharp pain when biting down, swelling of the gum tissue, or acute tooth pain, you may need root canal treatment.

All of the above are symptoms of disease in the pulp tissue, which lies deep within the roots of teeth, inside tiny canals that go from one end of the root to the other. Pulp tissue can become infected or inflamed for a variety of reasons, such as trauma or deep tooth decay, causing pain and leading to further complications.

2) Diseased pulp tissue in the root canal must be removed to prevent more problems.

The acute pain may go away — but without treatment, the infection in the pulp tissue won't. It will eventually travel through the ends of the tooth's roots and into surrounding areas. This can lead to dental abscesses, and may even cause systemic problems and diseases in other parts of the body.

3) Root canal treatment is effective.

Removing the diseased pulp tissue removes the infection. Pulp tissue itself is a remnant of tooth development which the tooth no longer needs. After the tissue is removed, the root canal is filled with a biocompatible material, and then it is sealed. A crown or other restoration is usually done after root canal treatment to restore the tooth to its full function.

4) Root canal treatment is generally pain-free.

Just like having an ordinary filling, the process begins with an anesthetic administered to numb the tooth and the nearby area. A tiny hole in the tooth's biting surface provides access to the canal, and minute instruments are used for the procedure. Afterwards, over-the-counter pain relievers are typically all thatâ??s needed to relieve the sensitivity that may persist for a day or two following the treatment.

5) A properly done root canal preserves your natural teeth.

A tooth that has had appropriate root canal treatment and restoration can last just as long as a natural tooth. That's important, because the other option — removal of the tooth — can lead to issues like unwanted tooth movement and bite problems. Saving your natural teeth should be the first priority in proper dental care.

If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”

Modern dental implants, sometimes called “your third set of teeth,” have revolutionized the practice of dentistry. As permanent replacements for missing teeth, dental implants are highly successful.

A dental implant is composed of two parts. The implant actually replaces the tooth root (like the root of your original tooth). It is usually made of commercially pure titanium, which has the capacity to fuse with the bone of your jaw. This fusion is called osseo-integration, meaning “becoming part of the bone.” When this happens, living bone cells actually fuse with the surface layer of the titanium implant, which stabilizes the bone as well. A crown (the part of the tooth that is visible above the gum line) is attached to the implant and can be made of ceramic material that exactly matches the appearance of your natural teeth.

Studies have shown that the success rate of dental implants is greater than 95%. Here's what we need to know to make sure dental implants succeed:

• We need to know about your general health. Do you smoke? What medications are you taking? Do you have osteoporosis or a compromised immune (resistance) system?
• We will also perform a detailed assessment of the health of your teeth, gums, and jaws to ensure you are a candidate for dental implants.
• Do you have sufficient bone to anchor the implants? Is the bone quality adequate? Tooth-supporting bone tends to melt away or resorb when a tooth is lost, so it is important to ensure that it is maintained when a tooth is lost or extracted. We can perform bone grafting to minimize resorption and build up bone tissue if necessary. We will consider the quality and quantity of your bone as part of your assessment.
• After the implants have been placed, good dental habits are important. As with your natural teeth, carefully cleaning your new implant crowns and their surrounding gums every day is a necessity.
• Continue to visit us on a regular basis. Regular checkups and maintenance can avoid breakdown of the surrounding bone and gum tissues.
• If you grind your teeth, we can provide you with a night guard to help to protect your implants from wear and undue stress, which can affect the integration with the bone.

Implants are an excellent choice to replace missing teeth. Contact us today to schedule an appointment or to discuss your questions about dental implants. You can also learn more by reading the Dear Doctor magazine articles “Dental Implant Success Rate” and “Dental Implants: Your Third Set of Teeth.”

Dental professionals sometimes use specialized words, and you may not be clear about exactly what we mean. Test yourself on some of the specialized vocabulary concerning tooth whitening. How many of the following can you define correctly?

1. Bleaching?
A method of making yellow, discolored teeth whiter. It is relatively inexpensive and safe, with few side effects.

2. External or extrinsic staining and whitening?
Extrinsic staining mainly results from diet and smoking. For example, foods such as red wine, coffee and tea can produce extrinsic stain. Teeth with these stains are bleached by placing whitening substance in direct contact with the living tooth surface.

3. Internal or intrinsic staining and whitening?
Intrinsic tooth discoloration is caused by changes in the structure of enamel, dentin, or pulp tissue deep within the root of the tooth. When the discoloration originates with the pulp tissue, root canal treatment may be needed to whiten the tooth from the inside.

4. Chromogenic material?
Color generating material that may get incorporated into the tooth's substance. It can be a result of wear and aging, or can be caused by inflammation within the tooth's pulp.

5. Carbamide Peroxide?
A bleaching agent discovered in the 1960s and frequently used for tooth whitening. When used, carbamide peroxide breaks into its component parts, hydrogen peroxide and urea, which bleach the colored organic molecules that have been incorporated between the crystals of the tooth's enamel.

6. Power Bleaching?
This technique is used for severely stained tooth. It uses a highly concentrated peroxide (35 to 45 percent) solution placed directly on the teeth, often activated by a heat or light source. This must be done in our office.

7. Tetracycline?
An antibiotic used to fight bacterial infections. It can result in tooth staining when taken by children whose teeth are still developing.

8. Rubber Dam?
Use of strong bleaching solutions requires protection for the gums and other sensitive tissues in your mouth. This is done using a rubber dam, a barrier to prevent the material from reaching your gums and the skin inside your mouth. Silicone and protective gels may also be used.

9. Whitening Strips?
Strips resembling band-aids that you can use in your home to whiten your teeth. They generally contain a solution of 10 percent or less carbamide peroxide gel. When using them, be sure to read the directions and follow them strictly to avoid injury or irritation.

10. Fade Rate?
The effects of bleaching may fade over time, from six months to two years. This is called the fade rate. It can be slowed down by avoiding habits such as smoking, along with food or drink that causes tooth staining.

Contact us today to schedule an appointment to discuss your questions about tooth whitening. You can also learn more by reading the Dear Doctor magazine article, “Teeth Whitening.”

Thinking or knowing you have an impacted wisdom tooth can be alarming news for some people. Unfortunately, one of the main reasons for this feeling is due to the mythology surrounding wisdom teeth...and especially impacted wisdom teeth. While an impacted wisdom tooth can cause intense pain, some people are quite shocked to learn that they even have impacted wisdom teeth, as it is causing no pain at all.

By definition, an impacted wisdom tooth is a third (and last) molar that gets jammed against an adjacent tooth or other important structures such as gum, bone nerves, blood vessels. And having an impacted wisdom tooth does have its consequences — even if you are unaware you have one. The most common issue is gum (periodontal) disease. This is the main reason why it is so important to have a problematic wisdom tooth removed early when you are young and before periodontal disease has started. If left untreated, you risk damaging and/or losing the impacted tooth and adjacent teeth.

The key to managing wisdom teeth is to monitor them closely through thorough routine examinations and x-rays between the ages of 17 and 25, the time when wisdom teeth typically appear. This is so vital because it allows us to predict the way your wisdom teeth will erupt (become visible) or come into proper position with useful biting function. We can use these visits and x-rays to monitor development so that we are best equipped to determine if or when wisdom teeth need to be treated or removed.

It is also important to contact us as soon as you think you may have an impacted wisdom tooth that is causing pain, swelling or even infection. We can put your mind at rest with the facts of what needs to be done after we've completed our exam.

If you feel that you or a family member has an impacted wisdom tooth, contact us today to schedule an appointment to discuss your questions. Or you can learn more now about the symptoms and treatment options of impacted wisdom teeth by continuing to read the Dear Doctor magazine article “Wisdom Teeth.”