My Blog
By Raul A. Montalvo, D.D.S.
October 21, 2018
Category: Dental Procedures
Tags: gummy smile  
IsYourSmileTooGummyHeresHowWeMightBeAbletoImproveit

Your gums not only support and protect your teeth they also help present them in a visually attractive way. But some people’s gums seem to stand out too much — what’s commonly called a gummy smile — which diminishes their smile appeal. There’s no precise definition, but as a rule of thumb we consider a smile too gummy if four or more millimeters (about an eighth of an inch) of the gums show.

Fortunately, there are some techniques to improve a gummy smile. Which technique is best for you, though, will depend on why the gums are prominent — and causes vary. For example, you could have a gummy smile because your teeth appear too short compared to your gums.

Permanent teeth normally erupt to about 10 mm of visible length. But less than that, say 8 mm, could skew the visible proportion of gums to teeth too much toward the gums. Teeth can also appear shorter due to accelerated wear caused by grinding habits. Another cause could be the amount of upper lip rise when you smile. The lip may rise too high in a condition called hypermobility. This could reveal too much of the gums when you smile.

It’s important then to match the treatment to the cause. For example, we can enhance the appearance of shorter teeth through a surgical procedure known as crown lengthening. During this procedure a surgeon reshapes the gum tissues and underlying bone to expose more of the tooth’s length.

For upper lip hypermobility, we can restrict movement with Botox, a drug that paralyzes tiny parts of the involved muscles. This approach, though, will wear off in a few months — a more permanent solution is surgery to reposition the muscle attachments so as to prevent excessive movement.

If you’re concerned about a gummy smile, see us for a full examination and consultation. Once we know the reason why, we can offer a solution that will make your smile more attractive.

If you would like more information on enhancing the appearance of your gums, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gummy Smiles.”

By Raul A. Montalvo, D.D.S.
October 11, 2018
Category: Oral Health
Tags: oral hygiene   flossing  
IsTraditionalFlossingtooDifficultConsiderWaterFlossing

A critical part of effective, daily oral hygiene, flossing removes bacterial plaque from between teeth that can’t be accessed with brushing. Unfortunately, it’s often neglected — string flossing requires a bit more dexterity than brushing and can be difficult to do properly.

It can be even more difficult for people with implants or who wear orthodontic appliances. For brace wearers in particular, getting access to areas between teeth with string floss is next to impossible; the metal brackets and tension wire also have a tendency to catch and retain food debris that’s difficult to remove with brushing alone.

Water flossing, using a device called an oral irrigator, is an effective alternative that addresses many of these difficulties. First available for home use in the 1960s, an oral irrigator delivers pulsating water at high pressure through a handheld applicator that forcefully flushes material from between teeth.

There’s no question that string flossing is effective in plaque removal between teeth — but what about oral irrigators? A 2008 study looked at a group of orthodontic patients with braces who used oral irrigators and compared them with a similar group that only brushed. The study found that five times as much plaque was removed in the group using the oral irrigators as opposed to the group only brushing.

Oral irrigators may also be effective for people who’ve developed periodontal (gum) disease. In fact, oral irrigators coupled with ultra-sound devices are routinely used by dental hygienists to remove plaque and calculus (hardened plaque deposits) in periodontal patients. As with regular oral hygiene, though, it’s important for patients with gum disease to include water flossing with daily brushing (at least twice a day) and regular cleaning sessions at the dentist to ensure removal of all plaque and calculus.

If you’re interested in using an oral irrigator, be sure to consult with us at your next appointment. Not only can we recommend features to look for in equipment, but we can also instruct you on the techniques to make water flossing an effective plaque remover.

If you would like more information on water flossing, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cleaning Between Your Teeth.”

JulianneHoughSharesaVideo-andaSong-AfterWisdomTeethComeOut

Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.

That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!

Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.

Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”

One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.

Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.

Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”  Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.

If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”

By Raul A. Montalvo, D.D.S.
September 21, 2018
Category: Oral Health
Tags: oral health  
WhatAthletesHavetoTellUsAboutOralHealth

Considering all the intensive conditioning, practice and training they do, most people would expect elite athletes to be… well… healthy. And that’s generally true — except when it comes to their oral health. A major study of Olympic contenders in the 2012 London games showed that the oral health of athletes is far worse than that of the general population.

Or to put it more succinctly: “They have bodies of Adonis and a garbage mouth.”

That comment, from Dr. Paul Piccininni, a practicing dentist and member of the International Olympic Committee’s medical commission, sums up the study’s findings. In terms of the numbers, the report estimates that about one in five athletes fared worse in competition because of poor oral health, and almost half had not seen a dentist in the past year. It also found that 55 percent had cavities, 45 percent suffered from dental erosion (excessive tooth wear), and about 15 percent had moderate to severe periodontal (gum) disease.

Yet, according to Professor Ian Needleman of University College, London, lead author of the study, “Oral health could be an easy win for athletes, as the oral conditions that can affect performance are all easily preventable.”

Many of the factors that had a negative impact on the athletes are the same ones that can degrade your own oral health. A follow-up paper recently published in the British Journal of Sports Medicine identified several of these issues. One is a poor diet: The consumption of excessive carbohydrates and acidic foods and beverages (including sports drinks) can cause tooth decay and erosion of the protective enamel. Another is dehydration: Not drinking enough water can reduce the flow of healthy saliva, which can add to the damage caused by carbohydrates and acids. The effects of eating disorders (which are more commonly seen in certain sports, such as gymnastics) can also dramatically worsen an individual’s oral health.

Sound familiar? Maybe it’s because this brings up some issues that dentists have been talking about all along. While we don’t mean to nag, this study does point out that even world-class competitors have room for improvement with their oral hygiene. How about you? Whether you’re a triathlete in training, a weekend warrior or an armchair aficionado, good oral health can have a major effect on your well-being.

If you have additional questions about oral health, please contact us or schedule an appointment for a consultation. For more information, see the Dear Doctor magazine article “Good Oral Health Leads to Better Health Overall.”

By Raul A. Montalvo, D.D.S.
September 11, 2018
Category: Dental Procedures
Tags: dental implants  
DontLetSmokingIncreaseYourChancesofImplantFailure

There are plenty of good reasons to quit smoking. Here's one more if you're considering replacing a missing tooth with a dental implant: smoking increases your risk of implant failure.

By and large, dental implants are the most reliable and durable tooth replacement option, with more than a 95% success rate after ten years. But that still leaves a small percentage that fail — and twice as many of those failures are in smokers than in non-smokers.

To understand why, we need to look at how smoking affects oral health. Besides burning and thickening the surface skin cells inside the mouth, inhaled smoke can also damage salivary glands and lead to dry mouth. Reduced saliva creates an environment friendly to bacteria, which increases the risk of infection and disease.

The nicotine in tobacco also restricts the myriad of blood vessels that course through the teeth and gums. The resulting reduced blood flow deprives teeth and gums not only of nutrients but disease-fighting antibodies. The mouth takes longer to heal and can't fight infection as well.

The key to an implant's success lies with its titanium post imbedded in the jaw bone to take the place of the tooth root. Titanium attracts bone cells, which grow and adhere to the post over a period of time and create a stronger hold. But the health effects of smoking inhibit this process. Furthermore, slower healing caused by smoking increases the risk of infection, the number one cause of early implant loss.

If you want to improve your chances for a successful implant — not to mention improve your overall health — you should quit smoking. The prospect of a dental implant could be a useful incentive to enroll in a smoking cessation program.

At the very least we suggest you stop smoking a week before implant surgery and then for at least two weeks after to help promote good healing. And you should pay close attention to your daily oral hygiene — brushing and flossing at least once — and regular, semi-annual dental visits for cleanings and checkups.

Smoking can harm your health. If you're considering an implant, it could also harm your chances of a successful outcome.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants & Smoking.”





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