Wednesday, January 28, 2015

Missing a Tooth?

The implant restoration above the gumline that appears natural
It wasn't too long ago that when teeth were lost, only less than ideal options were considered. Even today, in many parts of the world, the only dentistry that is performed is the removal of teeth. Even in advanced societies including the United States, less than ideal options are only considered.

For roughly the last 20 years or so, dental implants have been placed at a higher rate each and every year. Fortunately, there are now many more practitioners placing dental implants.

Basically there are several options for a missing tooth. These are listed from worst to best.

1. Do nothing. Just leave the space
2. Restore with a removable partial denture
3. Restore with a bridge
4. Place a dental implant

Teeth drift toward the space
The worst option is to just leave the space. This isn't merely a cosmetic issue, it's a functional issue. Firstly, there are fewer teeth to perform the function of chewing. The remaining teeth must bear more force than they are designed to. This will obviously cause problems with the remaining teeth. This situation is similar to ripping out studs from the framework of a house. The remaining studs must now carry a greater load. Secondly, when teeth are missing, the remaining teeth move. Teeth posterior to the missing tooth tend to tilt forward. This will create forces that are not in alignment. Just as if the studs of a wall are placed at odd angles. Another issue is that the opposing tooth will drift into the missing space and further malign the teeth. This is similar to a situation when gears have teeth that do not line up properly. How many miles would you get out of a car that has gears with teeth not only missing, but out of alignment? Not many I'm sure.

Partial dentures
The second option is obviously much better than the first. A partial denture will distribute the forces and prevent movement of the remaining teeth. The disadvantage with this option is that it must be taken out nightly. It does not remain in the mouth permanently. In addition, the denture tends to loosen the teeth that make contact with it.

The third option is a more permanent option. However, I still don't like this option for two reasons. First, the teeth adjacent to the space must be cut and shaped even if there wasn't a problem with them to begin with. So now we compromise two additional teeth to replace a missing tooth. The second reason I don't like this option is that hygiene is significantly compromised. It is much more difficult cleaning under the bridge. The supporting teeth are now more susceptible to recurrent decay. In fact the average lifespan of a bridge is only eight years.

The implant option is by far the best way to restore a missing tooth. Depending on which studies are cited, the success rate is approximately 95%. They will outlast a person life-span. I don't know if my assurances to my patients are true because we haven't done them for five thousand years, but I often joke and tell them that they will still be in place in 5,000 years. I guess archaeologists will confirm my outrageous assurance to my patients. Even if I'm wrong and they only last 100 years, I'd still consider it a success.

Missing tooth replaced with an implant

Not everyone is a good candidate for dental implants. If you have a missing tooth, your dentist should be able to determine if you are a good candidate. I will discuss implants in more detail in a future blog.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, January 22, 2015


Many of us want to find the Fountain of Youth. More Americans than ever are trying to maintain their youthful appearance. California is well known for their vanity. I know, I lived in Los Angeles for the first 18 years of my life. Now, where I practice near St Louis, just as nearly anywhere else in the US, people are equally concerned about their appearance.

In dentistry, we are mostly concerned with the youthful appearance of teeth. However, we cannot overlooked the face if we want to truly achieve a more youthful appearance. 

As teeth are worn, the face will appear to shorten thereby creating unwanted wrinkles. We will often see the corners of the mouth develop a downward line that gives the appearance of a frown--even when the person is smiling.  But the muscles around the face also influence the development and progression of wrinkles. We can do something about this.

Treatment with Juvederm

Treatment with Juvederm

By placing Juvederm just under the skin, we fill in unwanted lines that will not disappear when the muscles are relaxed. This is commonly done in the wrinkles around the nose and mouth. Juvederm is material that is incredibly safe and well tolerated. The effect will typically last about a year.

When we have wrinkles that will disappear by simply relaxing the muscles, we have the option of using Botox. Botox simply prevents the muscles from contracting, thereby eliminating the lines that are formed by their contraction.

Treatment with Botox

If you choose to pursue this type of treatment, ensure that it is performed by a well trained health-care provider that is well versed in the anatomy of the face. This will ensure that only the desired muscles are relaxed. 

I must also mention that the worst two things someone can do to their skin is smoke and expose themselves to excessive UV radiation (sun and tanning booths). It amazes me how many people want to retain their youth, but instead accelerate the aging process with these two things.

Stay Young!

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Monday, January 12, 2015

Are Toothpicks Bad For You?

I was at a martial arts event in Chicago recently. A few of the competitors and I met at a Korean restaurant. After our meal, one of the guys started picking aggressively at his teeth. I thanked him for giving me my next blog topic.

Toothpicks have been used by humans for thousands of years. In fact, even some primates use twigs to clean debris from their teeth. Well, now it's 2015 and we are certainly more advanced than primates. We have better alternatives. Use a toothbrush and floss instead of using a toothpick.

So, are toothpicks bad for you? Well, if used carefully, then the answer is no. However, the chances of damaging the teeth and gums are very good. One reason why is that some people just aren't capable of being careful with toothpicks. Another reason is that even though we may attempt to be careful, we'll still lacerate the gums or get splinters.

My friend defended the use of toothpicks by stating he gets food stuck in between his teeth regularly. If you have lost some of the gums to recession, then you will likely develop spaces that are prone to getting food stuck. We call these spaces "black triangles:". This is the result of gum loss resulting from gingivitis or periodontitis. If this occurs, then a visit to the dentist is indicated.

Some people may also have a hole in the tooth that may be prone trapping food debris. That's a cavity. A visit to the dentist is also indicated under these circumstances.

If you have toothpicks at home, I suggest you throw them away or simply use them for something completely different such as food preparation or building wooden models of whatever you desire to create.

Toothpicks can be used to hold folds in place 
An impressive use of toothpicks

One more thing for the cool guys out there.......toothpicks are not a fashion statement.

All kidding aside, only use them if you must, but use them sparingly and be super gentle.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Tuesday, January 6, 2015

Is Chewing Gum Bad For You?

I'm certainly not going to make the case that one should never chew gum. However, I will certainly try to discourage excessive gum chewing. 

Now what is excessive gum chewing? There is no precise answer for this. The good news is that there are some indicators that might give you some clues. For example, sore muscles, joint pain and tooth decay.

Four things immediately come to mind:
  1. More cavities
  2. Excessive tooth wear
  3. Decreased facial dimensions
  4. Joint and muscle issues (TMD--temporal mandibular disorders)

When chewing gum that is loaded with sugar, the results are very predictable. More sugar equals more cavities. However, chewing sugar-free gum can actually decrease the potential for cavities. If after eating a meal you find that you don't have a toothbrush readily available, I recommend rinsing with water. If water is not available, then sugar-free gum can be helpful in removing debris from the teeth thereby decreasing the potential for cavity formation.

Excessive tooth wear
Excessive chewing will lead to excessive tooth wear. Take a look at the picture on the right. You can see that it appears as though someone has taken a file to these teeth and have made them completely flat. This likely wasn't the case. It's more likely that other issues such as clenching/grinding may have been the primary cause of wear in this particular case.

This next picture demonstrates TMD and a decrease in the vertical dimensions of the face. Notice the size of her jaw muscles. They are incredibly well developed. Overuse will lead to muscle/joint pain, damage and dysfunction. 

Also notice that her teeth have worn down and her face has gotten shorter. Cosmetically, it makes people appear much older. In this case, Dr. Sam Muslin improved her overall appearance by not only fixing her teeth, but by increasing her vertical dimensions.

Courtesy of Dr. Sam Muslin

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit