Porcelain repair

There are times a patient may fracture an existing porcelain bridge, crown, or restoration that is either made of porcelain fused to a metal substructure or entirely porcelain. If the integrity of the restoration is intact and the marginal adaptation is uneffected, the repair of the restoration is quite possible and can save the patient thousands of dollars and the need for an additional treatment appointment.
In modern dentistry, the dental material companies have created "porcelain repair kits" that specifically involve the use of etchants and bonding agents for the addition of resin composite to the fractured area.
Some of the kits are useless and do not acheive what the patient needs as far as cosmetic matching and strength. Nevertheless, there are a few that can be used effectively for this purpose and be a lifesaver to the patient.
According to Dr. Gordan Christensen : 
The use of these kits seems logical: Roughen the underlying metal substructure, place some metal adhesive on the surface, place the appropriate color of tooth-colored resin on the surface, cure it, and finish it. The result usually looks good, but stains soon become evident at the junction of the resin repair and the porcelain. In some cases, the resin repair "falls off" within a few months. This is due to the combination of materials and the differences in coefficient of expansion/contraction of the remaining porcelain and resin restorative material.
I use the porcelain-repair concept only for temporary repairs of fractured tooth-colored crowns, and I advise patients that the repairs are temporary. There are many kits available for these repairs. One that has had good reports from Clinical Research Associates evaluators is the Ultradent Products Porcelain Repair Kit — Ultradent Products, Inc., (800) 552-5512.
There are longer-lasting repairs, but they are more complex and cost the patient more money. I suggest using the technique described in the following question for long-term repair of restorations.
Thorne Family Dentistry will provide the patient the service of porcelain repair, even if long term replacement is indicated. We understand every patient's current financial situation is different therefore, the repair can give the patient the cosmetic smile back and save money in time of need.

Composite Polymerization shrinkage

The use of composite resin material to restore cavities is known to exhibit a process called "polymerizationshrinkage". This process simply causes the resin to "leak" and then cause sensitivity and possible recurrent decay. The newest composites are leading the industry in the reduction of polymerization shrinkage. A current research project, I completed, was on this topic and focused on primarily reducing this effect as much as possible for the benefit of patients.

Root surface decay

The amount of gingival recession seen at our office continues to increase. Gingival recession typically exposes the root surface of teeth which is very susceptible to decay. Please note: there are many ways to prevent decay on the roots of teeth. Also, educating patients on the right brushing technique will prevent this recession from worsening. In addition, the root surface exposure, also know as the cementum, can be very sensitive to patients. The treatment includes: proper brushing technique, prescription flouride toothpast, a soft bristled toothbrush, and in severe cases a cosmetic resin composite filling to restore the proper emergence profile and seal the tooth.

Pre-cancer treatment

Today I would like to provide a supplement of information to those that are pre-treatment cancer patients. The dental implications prior to chemotherapy or radiation are extremely important and need to be understood prior to treatment. The team of doctors including the dentist, oncologist, primary care physician, radiologist, and caregivers need work together as a team. The following is a list of typical symptoms associated with head and neck cancer treatment:

• Dry mouth.
• A lot of cavities.
• Loss of taste.
• Sore mouth and gums.
• Infections.
• Jaw stiffness.
• Jaw bone changes.

In addition to proper maintenance and oral hygiene instruction,  extractions prior to head and neck radiation are often recommended to reduce the risk of osteonecrosis of the jaws after radiation.
The proper removal of decay, susceptible fracturing of large fillings, wisdom teeth, root canal therapy, and crown restorations also need to try to be completed before cancer treatment. Then it is important to allow a minimum of 14-21 days of healing prior to the initiation of radiation therapy.
Adjunct procedures that are very important are the use of fluoride trays and prevention of dry mouth.  Either 0.4% stannous fluoride (Gel Kam) or 1.1% sodium fluoride (Prevident) may be used. According to the University of Florida and several other teaching institutions, head and neck radiation patients should begin using fluoride in the custom trays no longer than one week after radiotherapy is completed. Then, it is advisable to repeat this daily indefinitely.  Remember that tooth decay can occur in a matter of weeks if the fluoride is not used properly.
Dry mouth (xerostomia) can also be a troubling side effect and can be caused by a number of factors that persons being treated for cancer can be exposed to such as:

• Medications: Chemotherapy, pain medications, anti-depressants, diuretics (water pills).
• Radiation therapy can cause dry mouth when the salivary glands have been exposed to radiation. The salivary glands produce saliva - the moisture in your mouth or spit. Sometimes, over a period of time, the salivary glands will start to work again but they rarely return to normal function. Dry mouth caused by radiation to the salivary glands can be a life long problem.
• Conditions such as dehydration, or fungal infection of the mouth (candiasis) may lead to xerostomia.

Treating dry mouth may be treating the underlying cause such as dehydration or infection. In cases where medications that can cause dry mouth and the benefits of taking the medication outweigh the side effects - measures to relieve the dry mouth symptom are used. Dry mouth caused by damage to the salivary gland may be a life long problem and requires patience for treating. There are many treatments that may assist in alleviating xerostomia and many of these can be tried on your own.
Things you can do for treating dry mouth:
Keep mouth and lips moist:

• Rinse mouth with water frequently
• Use saliva substitute. 
• Biotene^® products can be purchased without a prescription. Products available for treating dry mouth are: mouthwash, toothpaste, as well as, chewing gum.  
• Apply lip moisturizer often.
• Use a cool mist room humidifier at night in the bedroom.
• Increase fluids.

We can prescribe medications but they will have side effects to consider.
If dehydration is present then treating of the condition leading to dehydration such as nausea, vomiting or diarrhea would be in order. Depending on the degree of dehydration, your doctor may recommend intravenous (IV) fluids. Sometimes this may be done as an outpatient. In severe cases, hospitalization could be required.
If dry mouth is due to infection, medications for treating the infection may be prescribed such as:

• Antifungals: nystatin,clotrimizole, fluconozole
• Antibacterials: Mouthwash antiseptic rinses are the basis of the oral decontamination regimen.
• Antivirals: acyclovir or famciclovir

The key to success is a team approach to the dental health of the patient including prevention, maintenance, and awareness.

Welcome to our blog!

 http://www.thornefamilydentistry.com

We are pleased to provide you with more information about our dental practice here in North Richland Hills.  We are consistently changing and evolving based on new research and technologies. Recently there have been several new treatment approaches based on Glidewell Dental Laboratory techniques and we are open to sharing our clinical experiences and findings with other professionals, patients, and the community to help treat dental disease. You may review they're website here: http://www.glidewelldental.com/
We are also thankful to deliver patients with the consistent results that are beautiful from Glidwell Laboratories. You can even see the clinical videos that are similar to our clinical approach at Thorne Family Dentistry. With the help of Glidewell we also feel that our patients are given the best result and consistently get wonderful feedback after cementation and delivery of fixed and removable restorations.
In addition we now include the use of new phosphor plates to provide superior digital radiography and help prevent cavities from forming, growing, and provide detailed density changes within the periodontium. This allows the patient to get accurate images of the teeth more comfortably than other types of systems. Our practice progressed into digital imaging with the speedy, compact Gendex Scan X Duo. Now we can acquire clear, sharp images and gain fast digital scanning while keeping the office's familiar work flow process and preserving our past investment in x-ray equipment, whether its AC or DC. Flexible and thin, wireless PSP plates match the sizes and are positioned in the same manner as traditional film. In an instant, imaging plates are converted and cleared for re-use, and digital images are ready for review and diagnosis. We can now efficiently eliminate the cost, time, and messiness associated with traditional film.