“This Enamel is Not That Enamel!”

Let me start by saying that – for some of you – this post may seem a bit silly. However, I get questions in my office about enamel View definition in a new window, the white coating of our teeth that the outer layer is made of. Some people confuse the definition “enamel.” Is this enamel the same as that enamel? What is enamel, and how can you keep the different types straight?

The enamel (A) of a tooth meeting the dentin layer (B).

Tooth enamel is the hardest and most highly mineralized material in a mammal’s body. 92- 96% of enamel consists of minerals (hydroxyapatite, a phosphate and calcium salt) with the remaining part being water and organic material. Enamel makes up the shiny hard outer layer of a tooth for protecting dentin and pulp View definition in a new window, while at the same time carrying out the function of chewing and grinding our food. When you brush your teeth in the morning and at night (and after every meal – hint hint!), you are in fact brushing enamel. The normal color of enamel varies from light yellow to grayish white. At the edges of teeth where there is no dentin underlying the enamel, the color sometimes has a slightly blue tone. Since enamel is semitranslucent, the color of dentin and any restorative dental material underneath the enamel strongly affects the appearance of a tooth.

One day I was asked “why can’t we use bathtub enamel to fix tooth decay, since it is a cavity View definition in a new window on the enamel?” Well, in an effort to permeate some inquiring  minds, here are a few other types of enamel – which should never be confused with tooth enamel! Vitreous enamel is the colorful result of fusing powdered glass to a decorative object (usually metal, glass or ceramic View definition in a new window tile) by firing, usually between 750 and 850 degrees Celsius. The powder melts and hardens to a smooth, durable vitreous coating used in aesthetic applications, such as decorative work. This technique of applying enamel to add color or texture was originally mastered by the ancient Egyptians! Enamel paint is a type of liquid paint that gives a brilliant glossy shine when cured, and is especially useful in attention-grabbing mediums (such as street signs, door painting and road markers). The term “enamel paint” can also mean an object that is covered in an oil-base paint, but recently has come to include latex-and-water based paints.

Yes, it’s true that there are several different uses of the word “enamel,” but don’t confuse the brilliant white enamel of your teeth with enamel paint or decorative enamel!


“Smile Make Over Alert?”

Being able to smile is a beautiful thing – we all deserve a beautiful one! Some of us might need some work to obtain a dazzling smile, and cosmetic dentistry has been very popular and reaching that dazzle. Just don’t let your dream turn into a nightmare while pursuing your smile make over!

If you are planning on having any elective cosmetic work done, make sure your physician is familiar with different cosmetic options and has a good training background. The most common cosmetic dentistry problems can be prevented if you do your homework, including unsatisfactory cosmetic outcomes or clinical and technical shortcomings! These problems can lead to a not so happy nor healthy smile, altered speech, gum irritation, increased tooth sensitivity , chipping, loose teeth and even breakage of porcelain (from insufficient bonds between natural teeth and porcelain veneers View definition in a new window from an overly trimmed tooth structure or bite issue). These errors end up needing additional work (like crowns, root canals or gum surgery) and can be painful and infuriating.

It is important when considering any kind of cosmetic work – dentistry or otherwise – that you evaluate your own needs, and knowing your own health as a foundation for your own future.  The consequences of only looking at cosmetic dental procedures without the health side can put your long term oral health at risk.  If you have a fairly healthy mouth with well-aligned teeth, it may be easier to get satisfactory cosmetic results with the average cosmetic dentist . If you have seriously mis-aligned teeth, gum disease or lots of dental work / TMJ View definition in a new window problems (or are prone to cavities), you have a much more sensitive oral cavity View definition in a new window and must be very careful with who you choose to be your cosmetic dentist. Also, you may require multiple steps in order to attain a healthy, long lasting result.

It is also important to have a well thought-out plan before the procedures starts as good communication with your cosmetic dentist and technician is key. Not only is it necessary to be able to convey your desires clearly, but it is also best to go through the proper diagnostic steps to analyze the problem, plan the treatment scientifically with a mock-up or wax-up procedure and set up the detailed 3-D blueprint of your smile makeover before proceeding with dental reconstruction work. Make sure your dentist and ceramist are well experienced by asking other patients what kind of work you can expect and by checking into his or her credentials, education and training background (www.aacd.com is a good reference site).  Look at pictures of past cases the dentist has worked on, and get a feel of what kind of sincerity and caring attitude the dental team will be able to provide you, in order to help make your important decision. Make sure you ask questions about what will make the procedure a long term success before proceeding the work.

It is a wonderful thing to have a great smile, but maintaining it will be just important. Proper home care and regular professional check-ups are musts – proper diet and healthy habits will keep your smile beautiful for a long time! Finally, wear a night guard View definition in a new window if you are prone to bruxism as they can help maintain the structure of your oral system.


“What Are Your Teeth Made Of?”

What are your teeth made of? What is in that precious white enamel View definition in a new window? What is inside your teeth? Teeth play a very important role in our mental and physical health. The function of our teeth not only play a role in allowing speech, but also help us to cut and chew food as the first step in our digestion system.

It is only natural to be curious about what teeth are made of and how they function within our mouth. The root anchors the tooth below the gum’s surface into the jaw bone, while the crown View definition in a new window of the tooth extends out past the gum. The outermost hard shiny layer of the tooth is called enamel, and is the hardest substance in the body and functions as a food grinder. 92- 96% of enamel consists of minerals (hydroxyapatite, a phosphate and calcium salt) with the remaining part being water and organic material .

Lying just beneath the hard, shiny enamel surface of every tooth is the dentin layer. This layer of the tooth is composed mainly of calcified bony-like tissue (mostly hydroxylapatite), and like bone it contains collagen, water and other organic components (and is soft in consistency). Throughout the dentin View definition in a new window layer are tiny passageways into the deep pulpal layer, connected to the enamel layer – these passages are known as tubules. Unlike enamel, dentin continues to modify throughout a person’s entire life. Dentin can grow or reform in response to a change in tooth conditions, such as tooth decay or attrition.

The innermost layer of the tooth is known as the pulpal layer. This inner sanctum of every tooth consists of nerves and blood vessels.  This pulp View definition in a new window benefits the teeth in several ways: primarily, the pulp keeps the organic components of the teeth healthy and properly supplied with moisture and nutrients. The pulp also conduces senses such as heat, cold and trauma from the teeth into the body’s nervous system.

The important thing to remember about your tooth structure is that it is subject to change – when bacteria and other substances (like alcohol, smoke or even sugary liquid) is introduced into your oral environment, prompt cleaning (with a toothbrush and floss) is necessary to prevent premature decay. Once decay passes through the enamel layer into the dentin, decay will progress rapidly, even when not easily detectable from visual inspection. Only when the enamel has caved in and broken down does a cavity View definition in a new window become visible. If the cavity was not treated early and the underlying dentin layer has already decayed (which can actually extend deep into the pulpal tissue), root canal therapy may be necessary, requiring a post and crown to restore the tooth. Ultimately, prevention is the best solution. Proper home care and regular dental check-ups can detect problems early, and are usually fixed easily.


“What about eating disorders?”

“I am scared! Am I going to loose my teeth?”

I looked at Jenny, as I have with many similar pretty young ladies, and really felt for her.

“Jenny, you will be fine – you are here to make sure you can have a healthy and beautiful smile. It is challenging, but work with me – together we can get your mouth back in shape.” And we did.

Jenny is not alone. Among the susceptible figure-conscious young female group, eating disorders are quite common, and teeth erosion is a side effect of the acidic oral environment resulting from either purging or a poor diet.

Eating disorders, including bulimia (binge eating followed by self-induced vomiting), anorexia and poor dieting habits carry side effects which are detrimental to your bodily and mental well being – they can also rot your teeth. Studies have shown that up to 2.1% of males and 7.3% of females purge (self-induced vomiting) at least once a week, and the numbers are even higher for adolescents.

Tooth surface loss from erosion caused by chemicals such as dietary, gastric or environmental acids typically wear away tooth enamel, which leads to sensitive teeth, caries or gum disease. If untreated, these effects can exacerbate leading to teeth grinding and gastric reflux disease. Soft tissue lesions, malnutrition,  a suppressed immune system, low self-esteem, an addictive personality (smoking, drinking or drugs), peptic ulcers and esophagitis are common among people who suffer from bulimia and anorexia. Oral damage from such disorders can include a severe breakdown of the teeth or their supporting structures which can affect the facial muscular system, negatively affecting your daily quality of life; the effort to restore a damaged mouth can become extremely challenging and costly.

Treatment of the problem, besides education and being supportive to the person suffering from the disorder, involves precise dental management; controlling the oral environment, drinking water or healthier juice instead of diet soda, eating healthier (as opposed to binge eating and purging) are all part of the solution. Getting prescription strength fluoride View definition in a new window from your dentist to harden and desensitize your teeth and maintaining your oral hygiene by brushing and flossing at least twice a day is also crucial. if you regurgitate or vomit, rinse your mouth out right away. Adding baking soda to your brushing can also neutralize the acidic environment.

Regarding dental treatment, additive composite View definition in a new window bonding View definition in a new window to cover exposed dentin View definition in a new window or to replace lost tooth surface is a possibility. Getting a custom-fitted night guard to prevent further loss of tooth structure from bruxism and maybe veneers View definition in a new window or crowns to restore your mouth to ideal health are other possibilities. Of course, a professional assessment would be the first step of the process. The earlier you start treating the problem the better. A healthy mouth is essential for a healthy life.


“How Do Teeth Grow?”

Sure, we develop two sets of teeth (baby and permanent) over the course of our lives, and they are made of enamel View definition in a new window and dentin View definition in a new window. But what do you really know about tooth development?

Tooth development is a complex process by which form from embryonic cells, grow and emerge into the mouth. The key to a healthy oral environment in which teeth can thrive, enamel, dentin, cementum View definition in a new window and periodontium must all develop properly at the right time during fetal development. Baby (primary) teeth begin to develop at the 6 – 8 week mark in the womb. Adult (permanent) teeth develop at the 20 week mark in the womb. Formation of tissues within the branchial arch is the process that actually initiates tooth development. During pregnancy, proper prenatal care is essential for the future smile of the young life.

There are four stages your teeth develop into before becoming fully fledged teeth. The first stage, the bud stage, is characterized by the appearance of a tooth bud with no clear cell arrangement. This stage occurs when the fetus is approximately 6 weeks old. The second stage, the cap stage, is when cell arrangement becomes evident. Extracellular substances are produced resulting in an aggregation of these cells, as the tooth bud takes on the appearance of a cap, and becomes the enamel (dental organ). This is also the stage when supporting structures of the tooth are developed. The third stage, the bell stage, is characterized by a bell-shaped dental organ. The bulk of the tooth’s biological development and maturation take place during this stage. The final stage, the crown View definition in a new window stage, is when tissues (like enamel and dentin) are hardened and important cellular changes occur, including adding new material to the outer developing surface of the  tooth. Dentin formation, called dentinogenesis, is the first discernable sign of the crown stage, and occurs before enamel can be formed. Enamel formation, called amelogenesis, occurs after dentinogenesis. Environmental influences (like if the child suffers from fever, or is taking tetracycline antibiotics) can cause discoloration of permanent teeth.

Tooth eruption, which occurs between 6 months and two years of age, is the process of tooth development when teeth break the gum layer and become visible. Primary teeth stay in the mouth until around 6 years of age, at which point they are gradually replaced by permanent teeth. The first set of permanent teeth come in behind the twenty primary teeth at age 6. Sealant View definition in a new window can be placed on to these teeth to prevent tooth decay. The last primary teeth will exfoliate around age 12 to be replaced by second bicuspids. This is called the mixed stage, when both primary and permanent teeth are present. Orthodontic View definition in a new window treatment can be performed at the mixed stage; the most common age to receive braces is between 9 and 12.

The 3rd molars erupt around age 16 to 18. This is the stage when people are supposed to be wiser, so they are called wisdom teeth! Due to evolution, only one out of every 25 people have a jaw size that can accommodate all 32 teeth, so most of us need to have our wisdom teeth removed (lest problems be created with crowding or crooked teeth, which can lead to tooth decay and gum problems). Most of us have 28 teeth; with proper care, all 28 teeth can be kept throughout our life!

If you end up missing one or more permanent teeth, proper restorations should be made to assure the adequate support of your facialmuscular system to maintain its health. Such restorations will also help to prevent oral conditions from deteriorating due to shifting or tilted teeth (causing difficulty in maintaining healthy oral conditions). There are options for missing tooth problems; be sure to consult with your dental professional!