Cosmetic Tooth Enamel Replacement Procedures Bulimia Birth Defects Acid Erosion Soda Pop Carbonic Acid Damage Boca Raton Florida FL




Dr. Mitchell Pohl 2900 N. Military Trail Suite 105 Boca Raton 33431 South Florida Dentistry (561) 368-3440 Office Tour	Deteriorated Enamel - Replacement and Rehabilitation Anatomies of Enamel Loss: Trauma - Genetics - Disease - Acids Healthy tooth structures are made up of a layer of enamel that completely envelops the tooth. This protective material ranges from approximately 2.5 to 3.0 millimeters thick, typically on the biting surfaces. It is the most mineralized and hardest tissue in our bodies. A common cause of enamel loss or deterioration that nearly everyone experiences at one time or other is due to caries... or simple cavities. Left untreated however, as some of us may already know.. can lead to complete destruction of a tooth structure. In the example of caries based enamel loss, good oral health habits including routine brushing, flossing and use of flourides can control and even arrest this type of enamel erosion. Tooth Enamel Remineralization Patients with weak enamel surfaces, usually a predisposed condition, may be prescribed special remineralizing products and toothpastes by their dentists. For more extreme degrees of enamel loss due to other factors, explained below, may require the use of laminates that mimic the cosmetic and protective properties of natural enamel. Extreme Deterioration Soda Pop Acids This first case is representative of what can happen when consumption of carbonated, caffeinated soda pop is not monitored closely. Our patient, a computer programmer, casually drank a six pack a day of Mountain Dew soda throughout his workday. Literally every tooth sustained some degree of acid erosion. Many structures were replaced with crowns while other, less damaged teeth were treated with porcelain onlays, inlays and veneers. The second photo is a similar case of overconsumption of carbonated soft drinks but with even more devastation. Nearly the same age of patient, same occupation but different preference of soda pop brand. Despite the severity and seemingly hopeless degree of destruction, the creative use of feldspathic porcelain products can provide a wonderful functional and cosmetic replacement for enamel surfaces and tooth structures that are assumed to be beyond repair. Our third photo pictured here is the treatment outcome for the worst case scenario shown above. Dr. Pohl, with the aid of stone models, articulation studies and precision wax up modeling was able to recreate normal dental function with an impressive cosmetic outcome. Watch a Miami WPBF TV News Video broadcast about Soda Pop Consumption and Enamel Damage that features Dr. Pohl and one of these patients. Citric Acid (Lemon Sucking) Erosion Another popular cause for failing enamel is frequent, direct contact of critic acids on enamel surfaces. Acids tend to have an etching effect. In this case of excessive lemon wedge sucking (a habit that can be easily acquired through above average consumption of many iced tea and alcoholic beverages), the etching process is quite pronounced. Notice how the etching damage is clearly defined, indicating a "biting behavior" into a lemon wedge. Looking more closely at the incisal (biting) edges of the upper arch teeth, excessive wear and loss of tooth height (vertical dimension) has been sustained. As the hard enamel surfaces continued to fail, the more porous underlying dentin also eroded. Combining these events with daily chewing and eating... bites and occlusion will readily collapse. The patient, a middle aged woman, underwent reconstructive procedures that restored, most importantly, the normal tooth height required for optimal dental function. With careful articulation analysis and diagnostic wax up modeling, the patient and Dr. Pohl were able to select from a variety of porcelain products that recreated the smile and appearance our patient had been missing for quite some time. Physical Trauma The crack or fissure across the anterior tooth on this patient is quite obvious. Damage was also sustained within the jaw bone, causing three tooth sructures to drop down and distort the anterior occlusal plane (biting surfaces of front teeth). Dr. Pohl performed a combination of reconstructive dentistry procedures and periodontal surgeries to save the damaged teeth enamel and more importantly, the jawbone structures to restablish the patient's normal occlusal plane. Adult Erosion Sometimes erosion can occur over extended periods of time due to infrequent maintenance treatments that dentists provide to patients who maintain a focus on good oral health habits. Preventive treatments, changes in diet and prophylactic oral health habits that taught to us as we move through adulthood are not learned by patients who avoid the routine dental check ups we should all have. As a result, many of us may adopt our "own" methods of treatment... such as overbrushing, to treat a symptom that is indicative of an entirely different need. In the adjacent photo it can be seen that this patient had a number of functional and cosmetic treatment needs. Shifting teeth, orthodontic alignment, multiple diastemas, chipped incisal (biting) edges, significant discoloration and enamel erosion were treated over an extended period of time. Bulimia, GERD and Purging These conditions, typified by the emergence of strong and caustic acids from the stomach tend to affect tooth structures from the lingual side (on the inside, or tongue side of the mouth). Enamel damage accruing from these disorders tend to be less noticeable but nonetheless more devastating since the teeth that sustain the greatest amount of physical forces will deteriorate rapidly as the protective enamel is etched away by the strong acids. Dr. Pohl uses a variety of porcelain products to reestablish the protective attributes of healthy enamel and enamel replacements. 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