Cosmetic Dental Contouring

Cosmetic dental contouring can make a lackluster composite restoration lifelike and realistic. The most obvious feature corrected is the elimination of the mamelons, or the small bumps on the edges of the front teeth.





The feature in a smile that is the most overlooked, and the one which makes the teeth look so much more natural is the contour and surface texture of the front teeth. In the first photo, you can see the dull, round surface of the tooth just to the right of center (right on the photo.) In the second photo, the restoration has not been replaced, but only carved and recontoured so that the light reflection is similar to the tooth next to it. This improvement was done quickly, without anesthetic, and at very minimal time and cost.

Sturge-Weber Syndrome - Oral Manifestations

Sturge-Weber Syndrome (SWS), also known as encephalotrigeminal angiomatosis occurs in about 1 of 50,000 births as reported in Nelson's Textbook of Pediatrics.

SWS usually occurs at birth and sometimes is associated with seizures or mental retardation. It's visual characteristic is a facial port wine stain. Few intraoral photos are available of SWS, so I took the following images with permission from one of our patients at the Care Free Dental Clinic in Escanaba, Michigan:

Most apparent on the hard and soft palate are the bright red striations caused by oversized blood vessels.

He reports being told that he is very fortunate, because he has no mental retardation or seizures.

Caries, Decay, Cavities, Acid Erosion

Caries and acid erosion can be seen between these two teeth below:

I recently cared for a young woman who has had recurrent episodes of decay (caries) between her back teeth. She's a soda drinker, and admits that she isn't flossing enough. When I began to remove the decay from between her teeth, I saw what is in the image above. I showed the patient this area, and she remarked that she "would really start flossing and stop drinking pop."

I thought that if the image was helpful for her, perhaps others would benefit by seeing the damage caused by acid attack between teeth. These areas are usually invisible to the patient, and even to the dentist without an x-ray.

The photo is of the area between two teeth. The caries is in it's initial state, as it doesn't show a hole between the teeth yet. Decalcification occurs first, which is the whiter area in the photo. This is the outer layer of the enamel of the tooth that has been thinned or weekened. The next layer of the tooth as you proceed deeper is the dentin. The tooth on the right has begun to have caries form in the dentinal layer, while the tooth on the left has progressed much farther. This second layer of the tooth is much softer than the enamel, and decays and washes out much faster, even traveling laterally undermining sound enamel.

Acid erosion from lack of flossing or from too much soda or sports drinks can cause destruction in a tooth from the inside out. Seeing is believing in this case.

Tonsillolith

A tonsillolith is a semi-hard, cheesy yellow substance found in the side of the throat at the base of the tongue.


A patient reported to my office today with the complaint of a feeling of "something hard or lumpy in the back of my throat." He said that it was present for about a week, and didn't hurt, but he didn't know what it was. His concern was if it should be removed. After examining the area and taking this photo, I removed a small, yellow-white mass which felt like hard cottage cheese. The piece popped right out with a small curette. The most apparent quality of the tonsillolith was an extreme bad smell.

A tonsillolith is reported to be a calcareous mass that can accumulate in the tonsillar crypts in the lateral throat. It is believed that it is generated from an accumulation of food or bacteria in the area, possibly actinomyces bacteria. They are usually not harmful but can contribute to bad breath.

Proud Father and Mother

Last Saturday, Paula and I had the honor of attending a luncheon of the American College of Dentists in Boston at the Yankee Dental Congress Meeting. Our son Bryan Jacobs was presented with a distinguished student award for ethics and leadership in dentistry. The award was introduced by the Dean of Bryan's Harvard School of Dental Medicine, R. Bruce Donoff, DDS, MD.

In attendance were the deans of 4 dental schools, the president of the ACD, the executive director of the American Dental Association, past presidents of the ADA, among others.

Bryan has worked hard and persevered through the demands of dental school at Harvard. He has kept his sights on the goal of completing a quality education in dentistry. He is passionate about his profession and I know he will continue his lifelong quest for learning.

Bryan will soon be the fourth generation of dentists in our family. He will be the first Harvard grad. Paula and I are so proud of him - almost as much as we love him. His grandparents are so proud of him. All of his family, friends, cousins, neighbors, even Linda (soon to be Dr. Linda) are proud of him. What a great example. Way to go Bryan!

Perio-Pod

Perio-Pod TM Definition: (copyright 2010, Paul Jacobs, DDS)


A perio-pod TM is two or more people that share or potentially share similar oral bacteria, pathogens and/or periodontal risk factors. Inclusion in a perio-pod may affect the periodontal treatment decisions or outcomes for an individual based on the profile of the group.

Above are bacterial profiles from Hain-diagnostics showing the similarity in bacterial profiles between spouses and between parents and their children.

Tolerating a Fenestration

Nancy came for a cleaning, but it had been quite a long time since her last cleaning due to some medical issues she was dealing with. When I examined her, I noticed what is apparent in the photo above (mirrored image). This "fenestration", or "window" through her gums was caused by slow, steady pressure on her gums from an ill fitting removable partial denture.

The term fenestration comes from the Italian word for window: finestra. Through the window, you can see the roots of her lower front teeth. She also has clefting on a couple of her teeth. This is similar to a fenestration, but communicates all the way up to the crown of the tooth.

An unusual cause for this fenestration was the fact that Nancy's partial put pressure in that area, and she just tolerated it. I guess you can tolerate alot when it comes at you slowly. As her lower partial settled down in back due to slow bone loss in her lower jaw, her partial rotated down and forward behind her front teeth. This caused the pressure and loss of gum tissue in that area.

Our treatment for this is to first take the pressure off of the gums from the partial. Today, I placed a medicated liner under her partial which lifted the back of the partial up, and rotated the metal from the partial back and away from this area. She will soon be healing, and returning for long-term relining of her partial. She may need periodontal care for repair of the fenestration, and certainly she will need these teeth cleaned up!