My Blog

By Paul David Epstein, D.M.D. & Associates, P.C.
May 12, 2018
Category: Dental Procedures
Tags: partial denture  
APartialDentureCanRestoreaSmileMarredbyaFewMissingTeeth

Dentures in one form or another have been around for centuries. Although dental implants have earned a well-deserved prominence of late, the denture still remains a viable tooth replacement option.

What's more, dentures aren't reserved for total tooth loss only. Even if you've lost just a few of your teeth, we can fit you with a removable partial denture (RPD). Although mainly considered a temporary solution for missing teeth, some people depend on an RPD for many years due to finances or other issues.

The traditional RPD consists of a rigid acrylic plastic base that resembles gum tissue supported by a metal framework, with prosthetic (false) teeth precisely placed to fill the space of the missing teeth. They're held in place with metal clasps that extend from the metal framework to fit over the remaining natural teeth.

Although they're an effective restoration, traditional RPDs have a few drawbacks. Some people find them uncomfortable to wear or have an allergy to the acrylic plastic. They also have a propensity to stain from beverages like tea, coffee or wine.

But there's a more recent version called a flexible RPD that addresses these and other concerns. It's made of a pliable nylon that's durable, yet comfortable to wear. Rather than metal clasps, they're secured in place with thin, finger-like nylon extensions that fit into the small, natural depressions in the crowns of the teeth around the gum line.

Flexible RPDs are also highly adaptable to appear life-like in many situations. We can fashion the nylon base to cover areas around natural teeth where the gums may have receded due to gum disease.

They do, however, have a few downsides. Unlike traditional dentures, they're difficult to reline or repair. Like any oral appliance, they can suffer from wear and neglect, so you must properly clean and maintain them. And, like any RPD their best role is as a temporary bridge rather than a permanent restoration.

In the meantime, though, you can count on a flexible RPD to restore your ability to eat and speak proficiently, as well as smile with confidence. It's a great affordable way to address a few missing teeth.

If you would like more information on dentures as a restoration option, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Flexible Partial Dentures.”

By Paul David Epstein, D.M.D. & Associates, P.C.
May 02, 2018
Category: Dental Procedures
JulianneHoughSharesaVideo-andaSong-AfterWisdomTeethComeOut

Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.

That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!

Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.

Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”

One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.

Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.

Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”  Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.

If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”

By Paul David Epstein, D.M.D. & Associates, P.C.
April 22, 2018
Category: Dental Procedures
Tags: porcelain veneers  
ChangeYourSmilefortheBetterwithPorcelainVeneers

Are you tired of those stained, chipped, slightly crooked or—in a word—unattractive teeth? We have an effective solution for you: cover them with life-like porcelain veneers.

As the name implies, a veneer is a thin layer of dental porcelain custom-made to match your tooth’s shape and color and permanently bonded to the outside enamel. With its translucent, light-reflective quality similar to tooth enamel, dental porcelain looks completely natural. Veneers are well suited for minor to moderate imperfections, and can even be used to correct slight gaps between teeth.

We begin the process by performing a comprehensive dental exam to begin planning the exact shape and color of your new veneers. We can now do much of this planning with computer imaging, which may also give you the chance to see how your veneers will look on you after treatment.

We often will also need to prepare the teeth to accommodate the veneers when we bond them. Although the alterations shouldn’t be anywhere near as extensive as with a porcelain crown, we will still often need to remove some of the enamel layer so the veneer won’t look bulky. Even though we’ll remove as little as possible, if needed it will still permanently alter your teeth—so they’ll require some form of restoration from then on.

Once we’ve prepared the teeth, it’s then time to create the veneers. This is typically done by a dental laboratory technician through a manual process that may take several weeks. Increasingly, though, equipped dental offices are now able to generate their veneers in-house with computer-aided design/computer-aided manufacture (CAD/CAM) milling technology.

Once the veneers are ready, they’re bonded securely to the teeth with a detailed process that helps ensure they’ll endure biting and chewing forces for a long time. Still, you’ll need to avoid biting into hard objects or using your teeth for such things as cracking nuts. If you have a clenching or grinding habit, we may also recommend you wear a night guard to prevent excessive forces against not just your veneers but your teeth as well.

By taking good care of them, your new veneers can give you many years of service. Most of all, they can transform your embarrassing appearance into a smile you’re proud to show.

If you would like more information on porcelain veneers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Porcelain Veneers.”

By Paul David Epstein, D.M.D. & Associates, P.C.
April 12, 2018
Category: Oral Health
Tags: aspirin  
MakeSureYourDentistKnowsYoureTakingDailyAspirin

Aspirin has been a popular pain reliever and fever reducer for over a century. Its effect on the clotting mechanism of blood, however, has led to its widespread and often daily use in low dose form (81 mg) to help reduce the chances of heart attack or stroke in cardiovascular patients. While this has proven effective for many at risk for these conditions, it can complicate dental work.

Aspirin relieves pain by blocking the formation of prostaglandins; these chemicals stimulate inflammation, the body’s protective response to trauma or disease. Aspirin reduces this inflammatory response, which in turn eases the pain and reduces fever. It also causes blood platelets to stop them from clumping together. This inhibits clotting, which for healthy individuals could result in abnormal bleeding but is beneficial to those at risk for heart attack or stroke by keeping blood moving freely through narrowed or damaged blood vessels.

Even for individuals who benefit from regular aspirin therapy there are still risks for unwanted bleeding. Besides the danger it may pose during serious trauma or bleeding in the brain that could lead to a stroke, it can also complicate invasive medical procedures, including many in dentistry. For example, aspirin therapy could increase the rate and degree of bleeding during tooth extraction, root canal or other procedures that break the surface of soft tissue.

Bleeding gums after brushing is most often a sign of periodontal (gum) disease. But if you’re on an aspirin regimen, gum bleeding could be a side effect. A thorough dental examination will be necessary to determine whether your medication or gum disease is the root cause.

It’s important, then, to let us know if you’re regularly taking aspirin, including how often and at what dosage. This will help us make more accurate diagnoses of conditions in your mouth, and will enable us to take extra precautions for bleeding during any dental procedures you may undergo.

If you would like more information on the effects of aspirin and similar medications on dental treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Aspirin: Friend or Foe?

By Paul David Epstein, D.M.D. & Associates, P.C.
April 10, 2018
Category: Oral Health
Tags: jaw pain   tmj   tmd  

Your jaw moves constantly. You eat, speak, breathe, and change facial expressions with your mandibles and the two joints on either side ofjaw pain your head. Called the temporomandibular joints, these hinge-like mechanisms operate the bone, muscles and connective tissues of your jaw in three dimensions. If something malfunctions, jaw pain often results. Dr. Paul David Epstein expertly evaluates and treats jaw pain in Burlington, MA. Sufferers of TMJ, or TMJ/TMD, as it is called, can feel well again.

Symptoms of TMJ/TMD in Burlington, MA

Commonly, your jaw hurts if you suffer from temporomandibular joint dysfunction. It may feel warm to the touch, stiff and swollen. You may hear weird popping, grinding or clicking sounds as you eat or simply open and close your mouth. In extreme cases, you may not be able to open or close your mouth. Ear aches, tinnitus (a buzzing or high-pitched squealing noise) and headaches often accompany TMJ/TMD.

Causes of TMJ/TMD

Women between the ages of 18 and 44 seem most prone to jaw pain. However, besides age and gender, heredity poses risk for TMJ/TMD, as the condition appears to run in families.

Other causes of jaw pain include:

  • Stress
  • Uneven dental bite
  • Chronic teeth clenching or grinding (bruxism)
  • Arthritis
  • Trauma (a blow to the head)
  • Osteoporosis

How Dr. Epstein can help

If you have jaw pain, contact Paul David Epstein DMD & Associates. During a one-on-one consultation, Dr. Epstein will review your symptoms, take digital X-rays and other kinds of imaging as needed and do a complete oral examination. Based on his findings, he'll present a care plan aimed at the root causes of your jaw pain.

Relief often comes with a combination of treatment modalities, and most of them are very simple. Surgery, orthodontic correction or bite alteration with dental crowns are good options but only when more conservative measures don't work. As such, Dr. Epstein likely will recommend:

  • A soft diet to reduce the pressures associated with biting and chewing
  • Stretching exercises
  • Ice or heat to relieve pain
  • Muscle relaxants
  • Over-the-counter ibuprofen to reduce inflammation
  • A customized acrylic bite guard to cushion teeth

End your jaw pain

Yes, you can. For more information, or to arrange your TMJ/TMD consultation with Dr. Epstein, call his office at in Burlington, MA, (781) 273-1152.





This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.