Dr. Frank Dentremont, DMD

Good evening. You don't specify the type of jaw surgery and there are just too many variables to give you an exact answer to this question. My own daughter had jaw surgery decades ago and she had limited opening for about a month. They were "wired" with elastics so they could be removed in an emergency but she was able to eat soft foods and speak ok. BTW, she lost about 20 lbs in that month! I wouldn't recommend this for weight loss but it's a side effect nevertheless unless you drink food supplements. Again, talk to your physician or dental specialist about your concerns.

Closing a gap with braces is a fairly straightforward procedure in certain situations. In children under 11 traditional braces can be "segmented" to bring the front teeth together and keep them together until the permanent teeth such as the canines erupt around age 11. Once all the permanent teeth have erupted then a gap may need to be closed by full-arch braces. This process goes relatively quickly (5-9 months) until puberty and then slows down after all growth has occurred (has to do with the physiology of growth patterns). In adults you can sometimes use aligners (think "Invisalign") or traditional braces depending on your bite discrepancy. You would think that just putting a small elastic between the front teeth would move them together, but I don't recommend that since you would lose one gap between the central teeth and open 2 more by the lateral teeth! One quicker solution might be to simply put veneers or crowns on the front teeth to close all the gaps evenly. That in essence takes only two visits to your dentist! Much quicker than braces at approximately the same price!

Invisalign is an orthodontic solution to moving or straightening your teeth and has been around for several decades now. It can correct many types of crooked (misaligned) teeth. Whether it's Invisalign or some other straightening program, the corrected bite MUST be retained (kept from moving) by either a removable or fixed retainer. The primary reason is that the teeth follow the subtle changes in your jaw shape over time. Look at photos of your parents at different ages. The face changes as the jaws change shape and the teeth follow suit. Retainers are the only way to prevent a relapse of a corrected bite - whether it's Invisalign or other braces program.

Veneers are an excellent way to get that more perfect smile that you've always wanted! One of my first big veneer cases was for my own daughter back in 1994. She still has them on (now going on 28 years!) There are several types of veneers. Resin (composite) veneers are non-porcelain restorations that are usually done chairside by your dentist. There are laboratory-created veneers that come in 2 kinds: the kind that is glued over your teeth with minimal alterations or the kind where significant alterations of your teeth are needed to make the laboratory veneers. I use both types where indicated. If your front teeth have gaps and are essentially just looking for a cosmetic enhancement then minimal-alteration veneers (Often called "Lumineers" which come from a predominant lab) can be perfect for you. Think of this type as "press-on-teeth". They are actually fitted over your existing teeth so they will be wider and longer than your natural ones. Great if you need those gaps or chips fixed.
The second type of Veneer involves substantial alteration of the front of your teeth. If your teeth are discolored, disfigured, misaligned, etc, this type of veneer is for you. Since we're changing the way your existing teeth look then the dentist has to change the actual tooth surface to make them fit within the confines of the width and length of your teeth. I hope this serves as a brief introduction.
Now back to your question: Are veneers safe? Veneers are a more conservative way to cosmetically and functionally restore the smile zone of your front teeth. Veneer placement involves some reduction of the surface of the tooth at the sides, the top, and the front. We normally do not touch the tongue side of the tooth except at the tip of the tooth where we wrap the veneer to give the tip a natural look and some security as well.
Veneers are more conservative therefore than a full-coverage crown. Unfortunately, dental insurance companies disdain paying for cosmetic restorations like veneers but would rather pay for the dentist to fully reduce a tooth to make a crown. Seems senseless but I don't make the rules! Anyway, veneers can give you an excellent smile and can last a long time! How long? Well, like a new car, it will last for a long time with proper care and preventive maintenance. Brush them, floss them, and use a fluoride rinse. They are safe, but they are not normally reversible. Once reduced you can't go back (well maybe close to the originals if you remove the "Lumineers"). Discuss your concerns with your dentist. He or she can give you a better smile in as little as two visits to their office.

As a general practitioner for 40 years, I've seen literally thousands of overbite situations in patients. Some are mild and can be corrected with traditional orthodontics and some are severe and require surgical intervention in adults and orthopedic orthodontics in children.
Generally speaking, an overbite can be either Dental - just a bad bite, or skeletal - a developmental condition.
We now realize that developmental conditions can be mitigated early by orthopedic correction of constricted airway conditions and/or developing skeletal overbite situations. There's really no set "percentage" that I'm aware of, but orthodontic Cephalometric analysis -which can be done by a simple Cephalometric X-ray and digital software - can determine when certain anatomical landmarks are over a pre-determined set of mathematical and geometrical angles. Fundamentally, a deep overbite will give a person a life-long disadvantage in chewing, appearance, TMJ and Sleep apnea situations, and overall self-worth. If you're a parent and see signs of overbite (bottom teeth deeply behind the upper teeth in the front) then, by all means, see your dentist and get a timely referral to an orthodontist or an airway corrective practitioner. Almost all overbites can be corrected non-surgically now before a child's last growth spurt in their mid-teens. After their last growth spurt, surgical treatment is sometimes the best option for permanent correction. If you're an adult, there are some exciting new - but surgical - options for correcting a deep overbite. Those are best explained by your dentist or an oral surgeon. Finally, if you are dead set against surgery there are some restorative options such as full crown coverage on the lower arch which are not economical but are a great investment in mitigating a deep overbite.

Root canal procedures - from a dentist's perspective - are indicated when a tooth is damaged to the point where the nerve is involved irreversibly. That's a discussion for another topic but teeth are living organs like other parts of your body and can be "bruised" (reversible damage) or "fatally" affected (irreversible damage). Generally, preparing a tooth for a bridge (which I'm sure has been explained to you) involves reducing the size of the tooth by about 1/16th inch to accommodate the width of the replacing bridge material (commonly now Zirconium). On a healthy tooth this is not a severe procedure leading to infection. On a tooth which has had medium or large fillings on it or a tooth which has had a severe fracture then the risk of needing a root canal increases. In that case a preventive (we use the term prophlyactic) root canal may be indicated so that the bridge anchor won't need to be drilled through at a later time to do a root canal. Root canals performed by an experienced practitioner are on average 95% successful in saving an infected tooth. No medical procedure is 100% guaranteed as I'm sure you are aware. Have a candid discussion with your restorative dentist about your concern. I generally do NOT recommend preventive root canals but that's just my personal observation over 40 years of practice whereby maybe 10% or less of bridge anchors require root canal therapy after their insertion. A bigger reason for bridges that involve future root canals are typically a bad bite on the finished restoration. Make absolutely sure that your bridge finished "bite" is comfortable in every direction which you chew: up, down, forward, backwards, and side to side. It's critical in my opinion that if ANY difference in the way you bite on your bridge feels different it needs to be corrected by your dentist, and NOT your dentist's assistant. Your subconscious will try to grind it away during your sleep or even when awake, causing trauma to the nerves beneath the bridge. That's the biggest reason for post-bridge tooth infection requiring root canal therapy.

Antibiotics are one of the modern miracles of 20th Century medicine which nowadays we take for granted - until they no longer work due to the rise of super-resistant bacteria. Gum surgery is normally required when Periodontal ("Gum") disease damages the supporting bone which holds the teeth in place. When the gum disease is mild it can be treated non-surgically but I'm sure that you've been diagnosed with moderate to severe gum disease if you're having gum surgery. My accolades to you for proceeding with this tooth-saving procedure. As to whether you're in need of antibiotics: that would really be a discussion with your periodontic surgeon. In my general practice with gum surgery is performed I usually do NOT give antibiotic therapy unless the patient is immunocompromised. There are inherent risks in giving antibiotic therapy such as allergic responses and inviting super resistant bacteria to inhabit the healing site. Typically, post-operatively you are given access to pain medication and intraoral rinses to ease discomfort and discourage bacterial growth. You haven't mentioned if you are getting traditional gum surgery or are getting the newer laser-treatment therapies which I believe are the future of gum disease treatments. Both are equally effective in stopping gum disease in its tracks so don't have any consternation about your decision to have this procedure done. Speak to your gum surgeon about your inquiry and best wishes for a successful outcome.

The primary reason that dentists (and medical professionals) recommend an extended dosage of antibiotic medication is so that all the microorganisms circulating through your body are killed. Different antibiotic regimens will kill different groups of disease-causing microorganisms at different rates. The bacteria that cause tooth infections are primarily a type that the Penicillin Family (including Amoxicillin) do particularly well against. BUT: if you only take a partial dosage (say, 3 or 4 days' worth) then you've left the strongest bacteria still alive to reproduce and cause an even GREATER infection. These stronger "bugs" will then need an even GREATER strength of antibiotic.
So to directly answer your question - taking less than the recommended dosage may cause your infection to return worse than the original infection. That being said, there are extenuating circumstances whereby a healthcare provider may prescribe a different length of antibiotic treatment. For example, I routinely don't prescribe 500mg Amoxil to female patients because women frequently react adversely to that strength of that particular medicine (read: UTI problems). If a woman requires that specific medication at that specific dosage I frequently lower the dosage from 30 caps (10 days) to 24 caps (8 days). To close: if you want to change your dosing instructions talk to your doctor or health care provider to obtain permission.

Zirconia has taken the dental industry by storm over the past 2 decades due to its hardness which enables crowns to be made without an inner core (base) of metal. Older style crowns have porcelain fused (baked) to metal (hence called a PFM crown) and the porcelain can often chip or discolor with age. The main problem initially with Zirconium crowns was that the zirconium only came in a limited shade selection and dental laboratories had mixed results with adding a surface shade. In the past few years, they have developed a "sintering" technique whereby they mix zirconium and porcelain together to produce a hard material with better shading. We now can place these Porcelain/Zirconium crowns in the front (anterior) region. They look nice and are stronger than all-porcelain anterior teeth. There ARE crowns out there which are softer than zirconia but are more life-like than zirconia so we now have two types of materials in the front to treat our patients: Porc/Zirc crowns for grinders/bruxers and "Emax-style" crowns for more aesthetic needs/wants. Consultation with your dentist will assist you and he/her in making a proper choice. I typically use all Zirc crowns from the 1st premolar posteriorly and Porc/Zirc crowns from the canines forwards. This philosophy is dependent on the increased grinding pressure of your food towards the back.

In 2017 The dental association and the orthopedic association met and hammered out new guidelines. In all cases of use your orthopedic or Primary Care Provider (PCP) is controlling, ie, they decide on your course of antibiotic treatment if needed. The standard now in dentistry (circa 2022) is that NO antibiotic therapy is required beyond 6 months from implant placement. Your orthopedist may insist on antibiotic therapy beyond six months. Here's the gist of the current regimen: Studies have revealed that more people die from allergic reactions to the antibiotics than die from the complications of joint infections. So the dental association has gone with the odds. Two additional notes: the antibiotic of choice is Keflex (Cephalexin) rather than amoxicillin (but amoxicillin is acceptable); also it is now recommended to dentists that IF the orthopedic surgeon requires antibiotic treatment BEYOND six months that this antibiotic prescription be obtained by the surgeon and NOT the dentist - the reasoning seems to be that the risk of joint infection to patients be diagnosed by their physician and is beyond the realm of the general dentist. This means that when you visit your dentist and have had joint implants in the past and it's beyond 6 months that your dentist should NOT refill your prescription without written notification of your orthopedic surgeon or PCP, and if they require it, THEY must prescribe it and NOT the dentist unless notified otherwise.

Implant retained dentures are an excellent choice for patients when the diagnosis supports their need. In fact, the American Dental Association (ADA) now promotes lower implant retained full dentures as "standard of care". The cost for implants may impede the use of implants so this standard is slowly being introduced. Insofar as upper implant retained dentures are concerned, I recommend them only if a patient has an extreme gag reflex to standard full dentures. The bone density on the upper arch is much less than that on the lower arch and the failure rate on upper implant retained dentures is above what we consider normal. One final note: the failure rate for implants in general is very high for smokers - to the point where many surgeons will now refuse to place implants on smokers. I've not seen studies on whether this includes cannabis smokers or vape users. This failure rate with smokers can reach 50%. so keep that in mind.

The succinct answer to your question is to visit your dentist and have the tooth examined by a professional. If you can see the cavity then it's certainly time to get it looked at and if need be have it x-rayed. X-rays can see beneath the surface of the tooth to find the amount of damage there. Now, if you just have an "aversion" to a dentist right now then here are the symptoms of a "really bad" cavity: When a cavity gets deep enough, it develops certain symptoms, primarily unprovoked pain. In other words, you can be sleeping or at your desk at work and it will suddenly start hurting. That means that the cavity is probably down to the nerve and you've waited too long. And don't forget swelling and redness around the tooth and probably a nasty taste and smell. Yep, that cavity is really bad. Get it looked at ASAP.

Dental bone grafts require sutures ("Stitches") to ensure complete closure of the bone graft from the oral environment for the best graft success. Dentists may vary on the type of closure he/she may utilize, but typically we place the graft and then cover it with a biologically compatible material and stich that in place. In my practice I use a fine non-dissolvable suture which is about the thickness of a human hair. We want that to stay a minimum of 7 to 10 days and then I have the patient come back and remove the suture. By then the graft is covered over by your own skin tissue. So to answer your direction directly: in my practice the stitches stay in 7-10 days. Some other dentist may use a dissolvable stitch such as a Chromic stitch which should last at least 8 days. If you've gotten a non-dissolvable stitch it's upon you to make sure to return to the dentist to have it removed.

A root canal procedure performs an important function to remove the infectious bacteria from the inside of the tooth, and then fill the tooth with a compound to seal it up from bottom to top to prevent a re-infection. When a tooth is opened, we necessarily have to remove a certain amount of tooth structure to perform the root canal. This removal weakens the overall integrity of the tooth and that's why we cover the tooth with a crown after repairing the lost tooth structure with what insurance companies call a "build-up". Another important factor to consider is where the tooth is. Think of your jaw as a nutcracker: the strongest crunching power if you will is in the back at the hinge. Nuts - and teeth - break easier in the back than in the front. From a technical standpoint, you can break a tooth immediately after the root canal is performed if it's not permanently filled or restored by a buildup and crown.. A practical consideration is made sometimes to delay the permanent filling either by necessity (endodontists make the root canal but refer back to the home dentist for restoration) or financial considerations. We strongly - STRONGLY recommend performing the permanent filling ASAP. Some practitioners do this by performing the root canal, buildup. and Crown prep the same day. I'm not personally a fan of this since the root canal procedure is a meticulous procedure where success is measured literally in millimeters and if you immediately tinker with that root canal fill then you can disturb the newly places seal which is still not dry. Bottom line: get the permanent filling immediately after the root canal or as soon as you can. The longer you wait the greater the possibility that you'll break it. As the saying goes, "you break it you bought it". It's on you to get the permanent filling and everyday with every meal you risk the possibility of breaking the tooth to the point it's no longer restorable and needs to be removed. You've squandered your money and time for a valuable procedure.

The ultimate success of a dental implant relies on several facets... some you can control - such as being a non-smoker (not judging, it's just a fact that up to 50% of implants placed in smokers fail). Other factors you can't control such as bone density - the "hardness" of the bone holding the implant, and bone volume - the amount of bone necessary to successfully keep an implant in your jaw. By nature, the lower jaw has better bone density than the upper jaw. Also by nature, the upper jaw has less bone volume in the back of the jaw than the front of the upper jaw. Dentists NEED good bone volume and bone density to assure a long-lasting implant. We often need to add a bone graft to an upper posterior area of the jaw in order to give the implant the best chance at success. This is primarily due to the presence of your sinuses in the upper skull. So, a procedure is done to add bone to an area of low bone volume and/or density. It is a common procedure nowadays when a tooth is extracted that if we are treatment planning a future implant there, we'll automatically place a bone graft into the extraction site to maximize future bone volume. So, to answer your question directly, not all dental implants require a bone graft, but certain parts of the jaw require a certain volume of bone to ensure a successful implant. If your dentist has recommended a bone graft, you can rest assured that your dentist is wanting your future implant a good chance of success.

Teeth are attached to the human jaw by microscopic filaments, which can only be seen by microscope. We call them "Sharpy's Fibers" and in reality they are actually tiny ligaments. There are nerves attached to these fibers as well as to the base of the tooth. We use anesthesia - typically nicknamed "Novacain" - to numb the area where the tooth is to be removed. No, you don't technically need novacain to remove a tooth, but why would you want to go through the pain - and frankly torture - of surgically removing a part of your body without it? Is it fear of the injection? We encounter needle-phobics regularly, and I get it... fear is real to the individual involved. But no person with a rational mind should consider a surgical procedure without anesthesia.

Amoxicillin has no direct effect on dental pain. It's an antibiotic - a medical "marvel" which is a compound that when placed in the human body by mouth or injection enters the bloodstream and attaches itself to bacteria and inhibits (stops) the proper reproduction of these bacteria. This is the classical nature of antibiotics in general. So within 48 to 72 hours multitudes of bacteria are prevented from growing in your body and your immune system - primarily your white blood cells - can kill them off and your body recovers from the bacterial infection. Amoxicillin is the classic antibiotic for the successful destruction of bacteria causing dental infection. In conclusion, the pain you feel is from the effects of the bacterial infection. Once the Amoxicillin "does it's thing" then the pain disappears. So as a rule it takes 2 to 3 days for this to occur. There's no short-cut there unless you want an injectable form of Amoxicillin done in a hospital. That's why dentists normally give 2 to 3 days of pain medication to work until the Amoxicillin has had time to work.

A cavity is like a wound to your tooth. When you cut your arm, the wound is sore for awhile, even after placing a band-aid. How sore that arm gets is directly dependent on how big the cut was, and if the wound was treated before infection sets in. In a severe case, a cut might get infected, get gangrene, and you just might lose that arm. A tooth is absolutely no different. Decay causes the cavity (the wound) and the filling seals the wound-site. So to answer your question directly I would need to see an xray of how deep the cavity was. The key is progressive healing. If every day it begins to feel a little better then you're on the road to recovery. If it stays the same or gets worse then your dentist may not have gotten to the cavity in time and it might need further treatment. One important factor is how you chew on this particular tooth. If the bite is off - even a 10,000th of an inch - you will have chronic pressure sensitivity. This is easily (in 95% of the cases) treated by having your dentist adjust the height of the filling. But don't ignore it. Return to your dentist for further diagnosis and additional treatment if necessary. Your dentist placed the filling (the restoration) with the intention of eradication of the disease in your tooth. Healing doesn't always occur like we would hope. See your dentist but keep faith that your tooth will get better.

One of the fallacies of dentures is that patients think that just because they have no real teeth that their tooth problems - and trips to the dentist - are behind them. To the contrary: dentures are prosthesis. Not unlike an arm or leg prosthetic given to a valiant soldier returning from the war front. Dentures - as all prosthetics - need constant monitoring to keep your overall health in check. Your jawbones (upper and lower), your gums, your cheeks, your jaw joints, and your dentures all change over time. Dental insurances pay for a new denture every 5 years, and you know how insurances HATE to pay out anything unless they have to. So, you now know that at least dental insurance companies tell you to change your dentures every five years. It's highly recommended that you get see your dentist at least once or twice a year and get an oral exam to examine your mouth for signs of abnormality or damage to your dentures or mouth. Bad fitting dentures can cause sores which can lead to tumors, and possibly cancerous conditions if left ignored. The good news (for patients with insurance) is that there now is a dental insurance code for denture wearers to visit the dentist for a "wellness denture visit". Find a dentist you feel comfortable with and can trust with your denture - and dental health.

This is a good question. The short answer is not normally. Traditional mouthwashes contain alcohol, and not the cocktail type of alcohol. Consuming too much would make you sick or worse. There are now available non-alcoholic mouthwashes which while non-alcoholic probably aren't the best choice either. Dentists and the manufacturers wisely advise you to expectorate (spit) the mouthwash afterwards. Now I say "normally" at the beginning of this note because Listerine now (as of September 2020) has a chewable mouthwash tablet that by their instructions you DO swallow afterwards. Easy to carry in your purse, easy to open, no splash or trash, easy to use, easy to swallow.