Before and After Dental Photos

A smile tells a lot about an individual person. Before babies can speak and communicate verbally, they have the ability to relate to the human smiles, especially those of their mothers. Smiles have a complex language structure, depending on how wide we smile and how much teeth we show, combined with other cues. We use smiles to express our emotion non-verbally when we meet someone, eventhough we might not speak the same language. A smile is an essential part of human communication with each other and everyone deserves to have a beautiful and healthy one. Below is an example of how modern dentistry can improve a person's smile. Please ask us how we can improve yours!

This nice gentleman has worn his same dentures for over 20 years! They were worn out, loose, uncomfortable, painful, stained and chipped. His biggest complaint was that he could no longer chew food properly as he used to. You can see how his face was collapsed because of the worn out teeth. He could not hold his teeth together for them to touch. Dr. Vuong made a new set of dentures, keeping in mind the proper esthetics, fit, and phonetic aspects for the ideal function. This patient didn't want extremely white teeth. He didn't want the fake look. We took a step further and customized the teeth position to make them look more natural. He now could even eat steak since the dentures fit better with better bite and are no longer loose. The best part is that he now smiles all the time! He didn't realize he could look so much younger too!

This young lady hasn't been to the dentist in over 10 years due to many factors. As you can see there were obvious issues she presented to Dr. Vuong for help. We addressed many of her concerns and executed them in stages to make them possible on a tight budget. We treated her bleeding and sensitive gums from early periodontal disease, and removed a badly broken down and hurting tooth. After her gums healed, Dr. Vuong spent about 2 hours rebuilding many of the damaged front teeth from deep cavities with direct tooth-colored composite bonding, also known as white fillings. Ideally, these teeth should have received all porcelain crowns or porcelain veneers. Meticulous care was taken to assure proper shade/color match, contacts, contour, and that there were no ledges or open margins. We avoided root canals on these teeth. She couldn't believe in seeing her new smile! While this patient's treatment is no where completed, she can go on and keep smiling and regaining her new self-confidence!

This young gentleman came to Dr. Vuong wanting to look better, and becoming dentally healthy and not having to deal with pain all the time. He has lived with this condition for many years. While many of these teeth can be saved, they would require extensive work as decay is too advanced. They would need root canal therapy, crowns and bridges to build missing tooth back up and replace many other missing teeth. He also had a few failed root canal treated teeth, cross bite, and crowding. We devised a treatment plan that was affordable to him, while maintaining good overall dental health for the remaining teeth. We also wanted to achieve the best cosmetic and long term result. The second adjacent picture was taken one day after oral surgery when we removed the badly decay and broken teeth, and delivered the immediate upper denture and lower partial dentures. When time and proper steps are taken, Dr. Vuong often achieves excellent result with the fit, comfort, bite, and esthetics for immediate dentures. We needed only minor adjustments for this case! And of course, the patient was very happy! He smiles all the time now and has regained much self-confidence!

Amanda wanted to have straight teeth fast for her upcoming wedding. She explored options with porcelain veneers, Invisalign clear braces, and traditional metal brackets and wires braces. Porcelain veneers can be aggressive in cutting down good tooth structures, while Invisalign and traditional braces take too long for her immediate needs. 6 Month Braces is a great solution! We focused on the front teeth that show when she smiles, and used tooth colored brackets and wires. Teeth were straightened out in 6 months, perfect timing for her beautiful wedding photos!

This lady presented to Dr. Vuong with some challenges. Her old partial denture didn't fit anymore because one of her lower back teeth broke off from decay, among others that would need extensive work. She had a complete denture that was old and also worn out from a bad bite. We discussed the options, and came up with the best solution for her budget. We took out some bad teeth, made a brand new partial denture, and a complete economy upper denture. Dr. Vuong addressed many of her concerns, phased the treatment according to her budget, and paid special attention to esthetics, comfort, and function. We also chose esthetic clasps for the partial to hide the metal when she smiles. Not only was she able to chew and eat again, she was thrilled with the result!

This beautiful lady has had many esthetic concerns about her teeth. The case took us almost a year to complete due to many factors. Her main complaint was her shortened upper front teeth because many "white fillings" have turned black from recurrent decay. In order to make these restorations successful and take the load off the front, we needed to make a lower partial for her since she had lost those teeth in the back. She decided not to have implants placed at this time, we planned it so that she could choose that option in the future. A few other teeth have had root canal treatment incompleted and had temporary fillings. Dr. Vuong did a complete workup and treatment plan, keeping in mind the esthetic results as well as the ideal bite for comfort and function. We chose to have porcelain fused to metal (PFM) substructure crowns on the back teeth for strength. As for the above case, we elected to have the esthetic clasp partial so that no metal shows. For the six upper front teeth, we chose 3M ESPE Lava zirconia all porcelain crowns for strength and the most esthetic results, and avoided the risk of black gums caused by PFM crowns. She could not stop smiling and looking in the mirror as she discovered her new self! She's become a good flosser and her gum has become very healthy too!

This lady has had problems with her existing removable partial dentures for her missing 4 front teeth and many back teeth. They were not pleasant looking, or fitting properly, and were very loose. She couldn't eat regular food. Also, she couldn't wear her lower partial denture. Dr. Vuong made a new set of cosmetic partial dentures after treating her gum condition and any existing cavities. At the same time, he improved the patient's bite. We had a few limitations and couldn't hide the metal clasps on the back, but made the esthetic clasps for the front teeth so that they wouldn't show too much when the patient smiles. Metal frameworks were needed for rigidity and support of many missing teeth. Due to limited budget, could we make crowns on the back teeth, she would have a wider and more attractive smile!

Teeth Whitening is one of the safest and least expensive way to enhance an already beautiful smile. The above photos were taken Before and After customized take home teeth whitening treatment with professional guidance to give the result that the patient wanted. We used the same shade/color guide for comparison and to show that these photos were not manipulated or processed. This patient was very pleased with the result after a short period of treatment! We wish he would allow us to show his full face, but you can imagine that every time he smiles, his beautiful teeth light up his face! :)

This lady has not been to the dentist in over 10 years due to fears. She was aware of loose teeth and was looking for a solution to her unpleasant smile. Dr. Vuong spent time on her first visit to discuss her concerns and goals. We determined that all of her teeth were not save-able due to advanced periodontal or gum disease. Dr. Vuong worked out a plan to make treatment possible based on her schedule and budget. We made the upper and lower immediate healing dentures and removed all her remaining teeth. The patient was able to carry on her usual activities as a public speaker during the healing period. We noted the esthetic issues for improvement, since these were temporary dentures. We plan on placing implants in the next few months and make a new set of final and definitive implant supported over-dentures. The implants will help keeping the dentures tightly secured in place. Look at the dramatic changes in her smile! Imagine the significant change in her overall appearance! The patient was very pleased with the result!

A Saturday morning emergency patient! This man had an accident and broke his front tooth. A large piece came off. Fortunately, there was no nerve exposure or root fracture, and he had no pain. The challenge was to cosmetically rebuild the missing tooth fragment freehand without any template or mould. Dr. Vuong prepared the area and used composite tooth colored bonding material to rebuild the tooth to its original shape, size, color, contour, and contacts. This gentleman is also bruxer, as you can see in his worn out teeth and other chipped edges. A nightguard such as the NTI-tss Plus is recommended to protect these teeth from further damage.

This young man had a concern about his lower front tooth sticking out, and that he may end up losing it. He was not too concerned about crookedness or uneven look. Dr. Vuong noticed that there were cavities between those two front teeth, as the patient had difficulty keeping them clean. The solution: 6 Month Braces! After 6 month of orthodontic movement, the teeth were straightened out. Dr. Vuong now could fix the cavities where they were not possible to reach in between! The patient could also floss to keep his gums healthier. The added bonus is that he now has a much more handsome smile to show off!

This patient didn't like the way her old fillings look due to the stain. She has also noticed inflammed and tender gingival tissues due to plaque trapped in the rough margins and overhangs. These 3 fillings actually had leaky margins and recurrent decay underneath them. Dr. Vuong replaced them with newer ones. He also paid special attention to the contour, contact, shape, color match, gingival health, and margin integrity. The dark halo of the pre-molar tooth comes from the exisiting amalgam filling. Dr. Vuong can replace that when the patient requests it, since it is relatively intact and doesn't need replacement at this time.

This case involved a correction of a filling that caused food trap, sensitivity to cold, and tender bleeding gums because of open contact and open margin (void). Note also the decay or cavity lesion on the molar, and other jagged margins that make flossing difficult. These large fillings will need correction in the future. Without correction, this open margin may result in the need for a root canal when the cavity gets deeper. As you can see, that the new filling got bigger and closer to the nerve canal. You can see another similar tooth that needed root canal treatment because it was painful to the patient. Dr. Vuong replaced the filling and also treated the cavity in the molar, established tight contact, respected the embrasures and contour of the two teeth, and ascertained that there was no overhang to make flossing easy. These are important criteria to keep gingival tissues healthy from chronic inflammation and recurrent problems.

This case illustrates what cosmetic dentistry can achieve and what your white fillings should look like. These are treatments for cavities in between contacts of each tooth, as well as for those on the top chewing surface. Cavities between contacts can be caused by lack of flossing or inadequate hygiene, and can only be detected by x-rays, similar to the case above. When you see a hole in your tooth, the cavities are too big already. Note the existing white filling which has a ledge that causes plaque trap and serious recurrent decay (or cavity, do you see the dark halo?) on the tooth next to it. Dr. Vuong took proper steps to ensure that the contacts are tight and embrasures of these teeth have no overhangs or ledges, so that flossing can be achieved easily. Floss should slide through without any shredding, and food should not be trapped in between to maintain a healthy condition for your gums and long lasting restorations. The fillings should be comfortable without any severe post-operative sensitivity. Now it is critical that the patient flosses regularly to prevent future problems.

Gum Disease Gingivitis Periodontitis

What is gum disease that you hear often in the news? You may have heard of the term gingivitis, but what is periodontitis? Are you at risk for it? What is the consequence of no treatment?

You can ask yourself some of these questions: When was the last time you were at a dentist? Do you notice that your gum bleeds when you brush or floss? Do you have problem with the floss shredding? Do you have unpleasant breath? Food trapped easily between your teeth? How about any tooth that is loose? Sensitive when you chew or experience cold temperature?

Those are some of the signs of gum disease, better known as periodontal disease. Here's a summary: 

Red, swollen, tender gums 

Gums that bleed easily 

Gums that have pulled away from the teeth 

Persistent bad breath or bad taste

Pus between your teeth and gums 

Permanent teeth that are loose or separating 

Sensitive when chewing hard chewy food 

Any change in the way your teeth fit together when you bite

Any change in the fit of your partial dentures 

You may have periodontal disease and have no warning signs. Gum disease may not cause any pain either. That is why it is important to visit your dentist regularly for comprehensive checkups and periodontal examination. Gum treatment options depend on the severity and its progression.  

Periodontal disease is classified into two major stages: gingivitis and periodontitis. 

Gingivitis is the early stage of gum disease, where there is an increased inflammation of the gum. The gum bleeds easily, can be swollen, and red due to increased vascularity of the tissues. When you touch the tissues, the blood vessels break and bleed. The inflammation is caused by build up of plaque, or a layer of bacteria. Over time, the plaque buildup hardens by a process known as calculus formation. Calculus creates a haven and matrix for faster bacteria colonization. Your body tries to protect against the bacteria by making more blood vessels and to remove the toxins produced by the bacteria. Gingivitis can be easily treated by professional cleaning, good oral hygiene with the use of anti-baterial mouth rinse, regular brushing and flossing to remove plaque buildup. In addition, removal of plaque buildup would also prevent cavities, especially those in between the contacts of teeth.

A periodontal abscess that caused 

a toothache, resulted from bone loss,

gum infection, swelling, bad taste.

Periodontitis, also known as pyorrhea, is the later stage of gum disease, combined with attachment breakdown and bone loss. The tooth root will separate from the bone. Left untreated, it can become too severe that the bone lost can not be replaced or rebuilt. Most people with periodontitis may not have any symptoms. On occasion, someone may have a periodontal abscess and dull toothache from advanced periodontal disease. Dr. Vuong recommends a full set of x-rays to show the bone level, and sometimes the amount of calculus buildup, or harden minerals could be seen on the radiographs. Visual exam may miss the early stages of periodontal disease. We determine the amount of periodontal pocket depths or amount of gum detachment from your teeth. We will provide the appropriate treatment recommendations, depending on the severity of the disease. The earlier gum disease is diagnosed and treated, the better the prognosis in saving your teeth.

Early periodontitis shows swollen, puffy, sensitive, easily bleeding red gums, and calculus (white hardened) buildup. 

This young patient had early gum disease. Notice the red puffy gum and black buildups along the gum line. Besides sensitivity to cold, the gum is very tender and sensitive, and bleeds readily when brushing or touching even gently. This patient has sought treatment at the appropriate time, and he will have a beautiful healthy smile in a short time. Had he waited too long, gum disease can become very advanced, as illustrated in the case below. 

For advanced gum disease, most often patients end up with all teeth removed and immediate dentures made, as illustrated in the case above.

Some factors increase the risk of developing periodontal disease (not in order of significance):

Tobacco smoking or chewing
Systemic wide diseases such as diabetes
Some medications such as steroids, anti-epilepsy drugs, cancer therapy drugs, calcium channel blockers, and oral contraceptives
Bridges and partials that no longer fit properly
Crooked teeth
Fillings or dental restorations that have become defective
Pregnancy and puberty
Genetic predisposition--research shows 30% of population is genetically susceptible
Stress, clenching, and grinding of teeth
Poor oral hygiene and lack of regular professional care

In this video, Whoopi Goldberg talks about her personal experience with periodontal disease, particularly about a severe periodontal abscess!

Advanced periodontitis that has been treated, 

well maintained, and stabilized.

This is a case that Dr. Vuong has treated for advanced periodontitis. The patient has been very diligent in maintaining plaque control, and keeping gums and teeth clean. Not all advanced periodontal disease will lead to dentures! Though bone has been lost, the gum tissue is very healthy and the teeth are strong! 

Good oral hygiene at home is important to keep periodontal disease from becoming more serious or recurring. You may have had gum treatment in the past, but without regular maintenance, you may still have active gum disease. You don't have to lose teeth to periodontal disease! Brush regularly, clean between your teeth by flossing, eat a balanced diet, and schedule your regular dental visits for a lifetime of healthy smiles! 

Periodontal disease is serious, but don't let fear or embarrassment keep you away from seeking care. 

What Is Root Canal?

Many people have misleading information about root canal treatment or root canal therapy, sometimes simply called a "root canal." Root canal is the inner aspect of the tooth that contains nerve fibers and blood vessels in a system of canal spaces, together they provide normal sensation, vitality, support, and nourishment for that tooth. Root canal treatment is the treatment of the canal spaces, with the goal to alleviate pain, infection, and preserve and protect the tooth. What does it mean when you need a root canal? When do you need a root canal? Does it hurt? Is it a myth that root canals don't work? Is it better to take the tooth out instead of trying to save it with a root canal? These are the questions that you should ask your dentist.


A tooth usually needs a root canal when it is broken with nerve exposure (think trauma to the front tooth), extensive decay that goes into the nerve or pulp (too sensitive?), an abscess and/or swelling, toothache that doesn't go away with lingering pain and keeps you up at night, or sometimes a dead nerve that doesn't present with any symptom at all. A recent large and deep filling on a tooth close to the nerve that was sensitive to cold prior to the work and has gotten worse usually indicates the need for root canal therapy. On occasion, the new filling must be evaluated for other problems and root canal may be avoided. 

A parulus on a chronically infected tooth which

has had root canal treatment. 

One sign of a dead nerve may be a pimple on your gum (dentally known as a parulus, also known as gumboil). A parulus may indicate a need for root canal therapy, but it may also be caused by a periodontally abscessed tooth, which may not need root canal therapy. Sometimes you may notice a bad taste, or a bleeding point along your gum that doesn't quite heal. A parulus is the drainage point of pus buildup of an abscessed tooth. Drainage may or may not be present. This is a serious condition and should be addressed as soon as possible to prevent severe flare up and swelling all of a sudden without any warning. Further, chronic swelling and resolution (recurrence of drainage and healing) can cause further damage to the bone support and result in tooth loss.

A deep cavity causing a lot of pain which 

needed root canal therapy to save it. 

This tooth had recurrent decay or cavity under the existing filling which was done by another dentist many years ago (black arrow). The decay was very advanced and had already reached the nerve (white arrow), and was painful to the patient. The nerve had died over a period of time. In order to save the tooth, root canal therapy was needed and we could keep the tooth root. You can compare how deep the cavity on this tooth with the other one, which could be treated simply with a new filling.

Dr. Vuong corrected a faulty filling that caused food trap, sensitivity, and gum bleeding. 

Each tooth is different, and the complexity of the canal systems may make the treatment of infected nerve a challenge. Some teeth should best treated by a root canal specialist called an endodontist. 

"Does it hurt?" You will be numbed before the procedure is started. It should not hurt. On contrary, root canal is one of the treatments for a toothache (besides pulling that tooth out) and it should resolve the pain that you have presented. Pain can be managed by adequate anesthesia, pain medication, and/or antibiotics. Each person as well as each situation is different. It should not hurt (didn't I just say that?). Dr. Vuong will discuss with you and provide appropriate recommendations. 

"I've heard that root canals don't work." There could be many reasons for failures of teeth that have been treated. Some canals may not have been adequately cleaned out, located, or the infection has recurred. The tooth may be fractured making it not savable. Some patients may fail to return for the follow up appointment to complete the procedure, rendering the re-infection too severe to treat. The good news is that many of these previously treated teeth can be re-treated by a well trained dentist or specialist. Dr. Vuong can discuss with you the prognosis, benefit, and risk of the procedure. 

Dr. Vuong uses specialized root canal instrumentation, such as digital x-ray, apex locator (an electronic instrument to determine appropriate lengths of the canals), magnification, and rotary files to clean and shape the canals. Dr. Vuong also uses a rubber dam to cover your mouth opening for safety and to keep the tooth away from bacteria in your saliva contaminating the canals. The purpose of the root canal is to kill off and clean out the bacteria inside your canal system, so you don't want them to be contaminated. That is why it is important for you to return to the dentist to have the tooth built up and crowned as soon as possible. Root canal treated tooth can become more brittle and prone to fracture. A crown helps protecting it and increases the longevity of the tooth.

Dr. Vuong treated this tooth with root canal therapy because it was hurting, and made a crown to protect it. 

"Is it better to take the tooth out?" Once the tooth is gone, it is gone forever, there's no second chance. Root canal therapy is the best way to save the tooth which may otherwise cost more to replace later on. You can keep the roots of the teeth; the infected inside contents of the root is removed and cleaned out. Root canals have over 90% of success when done properly, when the tooth is restored to its original function. In cases where the tooth is severely broken, or despite all efforts, the tooth is not savable, then it should be removed. That missing tooth can be replaced with a bridge, implant, or removable partial.

Dentures and Partial Dentures

A denture is a custom made removable or fixed dental appliance for missing teeth.  Generally, it is considered a dental prosthesis, the same as a dental crown or bridge, and is a very important appliance to restore function, looks, and comfort.  It has many different varieties, from very basic acrylic and plastic teeth, with reinforced metal framework, to high grade porcelain teeth on precision milled titanium framework, fixed (or screwed in) and supported by dental implants.  

A removal partial denture for missing
front teeth and back tooth

A denture is designed specifically for you, and only you can wear it.  A denture is not neccesarily a replacement for your missing teeth, but a solution to your missing teeth.  Dr. Vuong takes the proper steps and time to make your dentures so that they would fit the best and most comfortably for you.   Together with the dental technician, we will work closely with you to select the color of your teeth and design the dentures, so that we can enhance your smile.  We will also keep in mind to restore your bite to its youthful appearance.

There are two types of dentures, called complete or partial dentures. A complete denture is made when all of your teeth are missing or need to be removed, while a partial denture is made when we can keep some of your teeth. The proper term for a dental bridge is Fixed Partial Denture, since it replaces one or more missing teeth, and is cemented onto remaining teeth.  A removable partial denture, however, requires that you take it in and out to clean.  As mentioned above, a complete denture can also be fixed or cemented.  We want to maintain your remaining teeth for as long as possible. Natural teeth are always better than denture teeth. Your natural teeth not only help keep your dentures stable, but also preserve your bone level.

A removable partial denture replaces many missing back teeth.

Temporary partial dentures can be made when a patient needs a quick turn around time and fast inexpensive solution to a cosmetic concern.  Or when a few teeth need to be removed, a temporary partial denture is needed during healing time.  While there are existing conditions such as cavities, gum disease, or other more pressing situations that can not be met, or when on-going extensive treatment is needed and planned, temporary partial dentures play an important role.  

For example, in the case on the left, gum treatment is needed.  Perhaps this patient will want to have braces to correct his overbite and crowding, or he may want implants to replace these missing teeth.  A bridge could be another option.  We made a temporary partial denture to replace the missing teeth until definitive treatment can be done.  Temporary partial dentures do not fit as well as or as comfortable as the final definitive partial denture that you see above.

When you and Dr. Vuong have determined that all of your teeth need to be removed due to extensive decay or bone loss from gum disease, a special type of denture called an immediate complete denture is made.  Most of the back teeth will be removed first, except the front teeth, and then a denture is made.  Once we have the denture ready, we set up an appointment especially reserved for you to remove the remaining teeth and your denture is delivered.  With this approach, you will never walk out of the office without teeth!

Immediate denture replaces all bad teeth at time of taking them out

Immediate denture is sometimes called a healing, temporary, or transitional denture, as that is its role.  Most of the time, after removal of teeth and delivery of the immediate dentures, your gum tissues will continue to heal and shrink, making your dentures loose, and become uncomfortable.  The teeth may have to be ground down to correct your bite, and you will have to learn to adapt with your new denture.  It is a normal process of immediate dentures.  Sometimes, you will prefer to have a new one made, usually within 6 months to a year, to improve the setup position or color of the teeth.  We will offer to reline your dentures to make them fit more comfortably for you during that time period of healing.

Sometimes a few front teeth need to be removed, an immediate partial denture can be made before removing bad teeth.  It is still considered a temporary partial denture.  That way, the patient walks out of the office with teeth and a new beautiful smile on the day of surgery. 

Dentures are very durable appliances and will last many years, but over time may have to be remade, repaired, or re-adjusted due to normal wear.  Even though you don't have any teeth remaining, you should see a dentist periodically to check for other problems with your bite, rocking dentures, and also for cancer screening.

There is another type of complete denture called implant supported overdenture. This type of denture uses implants and attachments as anchors to make your denture fit more tightly into your jawbone.  The denture will snap into place.  If you have found that you need to use adhesive or glue to hold your dentures in place, implant overdentures would be a solution for you!  Not only will they boost your self confidence, knowing that your dentures will be not fall out in public, overdentures can greatly improve the way you speak and chew.

Don't hesitate to ask Dr. Vuong for more options, depending on your needs and circumstances.

3 Steps To A Healthy and Beautiful Smile!

Have you always wanted a Healthy and Beautiful Smile? Now you can! Do you know that beautiful lips frame the smile, healthy gums support the teeth on a great foundation, beautiful straight white teeth give it a nice sparkle, and fresh breath makes it more attractive? Here are some simple steps that you can apply to give you the confidence to smile BIG! 

1. Healthy Lips, Gum, Clean Teeth, and Fresh Breath

Lips should be protected from sun and harsh weather damage. They should be conditioned with moisturizer to protect them from drying, chapping, and peeling. To achieve healthy gums, brush and floss daily to remove bacterial plaque to prevent gingivitis, periodontitis, and bad breath. Brushing the tongue is also recommended. Consider and limit your diet high in refined sugars. Drink plenty of water; watch out for sugar containing and carbonated beverages. Regular dental cleanings and checkups give your smile its best chance in maintaining optimum health. Problems caught in the early stages can be quickly treated or prevented. Cavities can contribute to bad breath, so get those taken care of as soon as possible. Clean, healthy teeth, and gums are the foundation to a beautiful smile! 

2. Straight Teeth 

Many people think that braces are mainly for kids and take 2-4 years to complete. Not anymore! Now, there is a choice! Dr. Vuong can straighten your smile in an average time of six months with our new 6 Month Braces. Ask us about this new treatment option that many of our patients are very excited about! 

3. Stunning White Teeth 

Teeth can be whitened with our Custom Take Home Whitening System that has been proven to lighten your teeth in 2 weeks, without the need for a "laser" light. The light has been clinically proven to be unnecessary. For even better result, close professional guidance can enhance the typical result that most patients are happy with! 

If you have missing teeth, or badly decayed teeth that are holding back your smiles, give us a call. There are options and solutions. We can help!

Removable Partial Denture For Missing Teeth

This patient came to Dr. Vuong not happy with the appearance of her current partial denture. It was also not fitting well, neither was it esthetically pleasing. She also had a lower partial denture which didn't fit at all and was painful when worn.  It was rocking during chewing. The bite was off.  For these reasons, she wasn't wearing the lower partial denture. She wanted new teeth so she could look and chew better!

There are many treatment options for missing teeth for a case such as this, from fixed partial dentures such as porcelain-fused-to-metal bridges, zirconia-framework fixed bridges, multiple implants to replace many of the missing teeth, precision attachment removable partial dentures, or traditional metal framework removable partial dentures. The final decision is usually made by the patient, guided by the outcomes that both the patient and the dentist want to achieve.

This patient elected to have new removable partial dentures made.  We treated a few large cavities.  While this case has room for esthetic improvements, it is okay with this patient.  We worked with many limiting factors due to budget constraints. We had to use metal frameworks for rigidity and support of many missing teeth. We did two front crowns and made rest seats in them (places for partial framework to hook onto). We could have made crowns for her back teeth to bring out the arch for a more beautiful and wider smile.  Her bite was another complicated factor. Nevertheless, we achieved the result we both wanted!  You can see noticeable major improvements! Most importantly, the patient can now eat her favorite food without the partial dentures falling up and down or moving! :) 

Less lower teeth showing makes for a more pleasing smile... :) 

Many who have to wear partial dentures don't like metal hooks to show when they smile. They may have the entire partial denture made in plastic, which looks great but they can not eat and chew variety of food with it. In cases where the entire removable partial can not be made with the flexible plastic material, a metal framework is needed for rigidity and support so that it can take the work load when you chew. Here we could see that the metal hooks were needed, but we incorporated the plastic esthetic design into the framework so that it blends right in with the gum tissue color. There are many other advanced options, known generally as precision attachment partial dentures, however, the combination of metal framework and esthetic hooks is a very popular option for many of our patients.

February is National Children's Dental Month

February is the National Children's Dental Health Month! Have you considered the importance of a dental exam for your child before kindergarten enrollment? It is recommended that children visit a dentist before 1 year old or as soon as teeth are coming in. Although Dr. Vuong likes to see children starting at age 3 and up, we love kids and would be happy to make accommodations for your child's first dental visit! We can make that visit fun and memorable!

Do Cavities Have Holes In Them?

What is a cavity? What does it look like? Is it supposed to hurt? What happens when your tooth has big hole in it? 

Although this young person hasn't been to the dentist in 5-7 years, overall she has good teeth, healthy gums, and no pain at all. However, can you point out to me which teeth have cavities? Do you think these need to be treated as soon as possible? How deep do you think they are? Do you think there are cavities in between teeth as well? What would happen if this patient delays treatment?

Do all cavities have holes in them? It's okay for you to guess. Dentists are not guessing which of your teeth has a cavity or caries when they tell you that you have a cavity. It takes many years of reading X-rays, looking for signs of a cavity, and past experiences to diagnose them properly. When diagnosed, treatment should be done as soon as possible to receive the best prognosis and saving more of your tooth! You will be glad you did!

Cavities, sometimes called tooth decay, or caries, develop from breakdown of your enamel and soon the softer dentin layer of your teeth. Most of us blame cavities on eating too much sugars and candies, but it's only half true. Bacteria, normally present in your mouth environment, are the ones that feed on sugars and carbohydrates, and make acid as their waste product. The acid not only irritates your gums, causes gum bleeding, it also breaks down your teeth. Not all cavities have "holes" in them. You may have a cavity or decay under your existing fillings, or crowns. White fillings can turn black from recurrent decay or failure in bonding as they get older and stressed from daily use. Some older fillings break because they have decay underneath. When you can actually see a hole in your tooth, the decay is too big and you need to have that treated as soon as you can to prevent more damage. When your cavities are too big, you may not be able to do a filling anymore, you may need a root canal (when the cavity is too close to the nerve), a large buildup, and/or a crown. 

So could you point out which teeth have cavities here? We just finished the treatment for this patient. We will have taken out the wisdom teeth that had cavities in them. See the new photos. 

Close up view of the finished new white fillings.

Here's a picture of a very deep cavity in a molar. It doesn't really have a hole in it for you to feel that it is there. Though this patient is not aware of it because it is not sensitive or hurting yet, it is very advanced and even involves the contact areas between teeth that can be detected on X-rays called the Bitewing X-rays. Treating a cavity as soon as possible can prevent the need for root canal as the deeper cavity reaches close to the nerve inside. Flossing will prevent future problems in the restorations or fillings and ensure they will last much longer. 

Here I was using a different camera, and I have increased the contrast setting in these images to show the failed white filling that had significant amount of decay or softness underneath once the existing filling was removed. You can also see the crack line in the third image. The dark dentin was good tooth structure so that was not removed. We masked the darkness and filled the rest of the cavity, checked the bite, and made sure that all the margin was sealed tight. Failing filling or restoration treated early, more often than not, can prevent the need for root canal, which many people dread. Though this cavity was significantly much deeper, the patient reported no sensitivity. He was quite pleased to see that they all blended in nicely without the dark lines. No root canal! 

This series of pictures shows what appeared to be a small cavity turned out to be very deep! These types of cavities are often missed during the exam when the grooves are not cleaned out, or the criteria used by one dentist are different from another. Some dentists may not consider this a cavity that needs treatment yet. To make matters more complicated, when a dentist diagnoses a cavity, patients may hesitate to get the treatment right away, and over time have forgotten that they ever have a cavity. 

As you can see, when these grooves are opened, the cavity looks very bad. By first opening the grooves, and using a slow speed handpiece and round bur (a safer way to remove the softer decay tooth than a high speed drill), Dr. Vuong cleaned out and checked for any remaining decay. Once cleaned out, a new filling can be done and verified that all the margins are sealed properly. When the bite is checked and proper steps are observed, this patient should experience little or any post-operative sensitivity at all. 

As shown in the examples above, the sooner the cavities are treated, the better it is, and you may avoid pain, sensitivity, or even root canal treatment. 

Alternative Treatment Option To Root Canal or Tooth Extraction

Are you having a toothache that needs root canal but tight on funds? Dr. Vuong can help! With mutual agreement, partial root canal treatment called a pulpectomy can be done to relieve pain, so that you can save money and complete the procedure in the near future, preferably within 4-6 months period. The sooner you can finish the procedure to seal the tooth from bacteria and re-infection, the better!  And it is important to restore the broken tooth with a crown to protect it from fracturing.  Even when the best root canal procedure is completed, but the patient fails to follow up with restoring it, the prognosis of that tooth decreases tremendously.

Understandably, pulpectomy is rarely presented to patients as a treatment option because it can be considered not a standard of care.  In some cases, pulpectomy may not completely alleviate pain or swelling, or it may cause more complication for which the dentist would have to continue with the treatment.  Or the patient simply fails to follow through.  With trust and mutual agreement between the patient and the dentist, and with the understanding that this treatment option is a temporary relief for pain, it would be a great benefit to someone in pain, who is motivated to save the tooth, and wants to work out a payment arrangement to get the treatment completed properly.  

When proper steps are taken and followed up, pulpectomy could be a good alternative solution rather than taking the tooth out, which will cost more to replace in the future. Of course, pulling that tooth out is the less expensive option if you still want to go that route. We can do that too!

The Importance of Keeping Children's Teeth Healthy

Did you know that many children do not lose all their baby teeth until they are about 10 or 11 years old? And that the first adult tooth to erupt is when they are around 6 years old? 

Look at the chart below, you can see that the presence of many baby teeth is crucial to keep adult teeth erupting in the right place, as mother nature has intended. When a child loses a baby tooth too soon, spaces may be lost, and adult teeth coming in at the wrong place. Sometimes, the bite can become quite complicated that will require many years of braces to correct. 

Source: Ash, M. Wheeler's Dental Anatomy Physiology and Occlusion 7th ed W.B.Saunders

Imagine a 5 years old child who has a toothache, and it is his first dental visit to the dentist. To the dentist's disappointment, the child has an abscessed baby tooth, let's say the upper 2nd baby molar that will require extraction. (In the above chart, the first blue tooth on the left of the upper arch at age 7 is the 2nd baby molar). What do you think will happen as a consequence for that early tooth loss? The adult molar will erupt and invade the space for the premolar tooth to erupt in its proper place!

When we take X-ray images of baby teeth and put on our big screen monitor, many kids get so excited to see their own adult teeth forming! Unfortunately, it wasn't the case here. This child came to us with a lot of pain and huge swelling for a few days! He had a big cavity in the baby tooth, which was not treated and became abscessed. It was not ready to come out yet, either on its own or for us to remove it.

Due to circumstance that the tooth could not be saved with baby root canal treatment, we took the tooth out. Care was taken not to damage the adult tooth underneath. Abscessed baby tooth can also damage the adult tooth underneath if it was not removed. 

Now what do you think will happen to the tooth (which is the adult molar) on the right side of the image? Will it tilt over and prevent that adult premolar tooth underneath to come out? So what can we do to prevent this from happening?

Keeping baby teeth healthy is very important for the health of adult teeth. Treating cavities early on to prevent abscess and the need to take out baby teeth is one way. However, the best way is to prevent cavities all together!