Looking in the mirror, you probably focus on your teeth and gums—i.e., your smile. Your dentist, though, will take the time to look deeper into your mouth, searching for anything out of the ordinary. That could be a type of mouth sore known as lichen planus.
Lichen planus are lesions that can appear on skin or mucus membranes, including inside the mouth. The name comes from their resemblance to lichens, a fungus found on trees or rocks (although the sore itself isn't fungi). As such, they often have a lacy pattern of lines emanating from purplish bumps.
Again, the first indication you have such a condition may come from your dentist. Sometimes, though, you may notice greater sensitivity to spicy or acidic foods and, if the gums are affected, irritation when you eat or brush.
If you find out you have lichen planus, don't be alarmed—it usually doesn't pose harm to your health and it's not contagious. Its appearance, though, could be mimicked by more harmful medical conditions, so your dentist will want to confirm the lesion observed is truly lichen planus.
It's routine, then, for your dentist to excise a small sample of the sore's tissue and send it to a pathology lab for biopsy. Although results will more than likely confirm lichen planus or some other benign lesion, it's better to err on the side of caution and ensure you're not dealing with something more serious.
If you are diagnosed with lichen planus, you may need to take steps to manage symptoms. In most people, the sore will go away on its own, although there's no guarantee it won't reappear sometime later. In the event it lingers, your dentist may prescribe a topical steroid to help ease any discomfort.
You can also minimize a future outbreak by practicing effective daily oral hygiene to reduce the bacterial populations that may contribute to the condition. And when you're symptomatic, try avoiding spicy or acidic foods like citrus, peppers or caffeinated beverages.
Lichen planus is more bothersome than harmful. Taking the above steps can help you avoid it or deal with it more effectively when it occurs.
If you would like more information on lichen planus, 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 “Lichen Planus: Mouth Lesions That are Usually benign.”
You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.
The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.
But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.
Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.
His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.
One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.
In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.
Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.
If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”
If you’ve noticed a small sore in your mouth, it’s possible you have a non-contagious disease known as lichen planus. Although usually benign, it’s still a good idea to have it examined and monitored.
The condition is so named because its lesions are similar in appearance to lichen, the algae and fungi organism often found on rocks and trees. It’s believed to be a type of autoimmune disease, in which the body treats some of its own cells as foreign and reacts adversely to them. Certain medications and substances may also cause a lichenoid reaction. Besides the inner cheeks, gums or tongue, lichen planus may also appear on other skin or mucous surfaces on the wrists, legs or fingernails.
When it appears inside the mouth it usually resembles a lacy pattern of white lines or ulceration. Gum tissues may become red and inflamed, with some soreness after brushing or eating. Although there’s no known cure for lichen planus, it rarely causes serious problems — in fact, you may not even be aware you have the condition unless pointed out during a dental exam. It may, in time, fade away.
If the lesions do become bothersome (painful, itchy or overly-sensitive), there are some ways to ease discomfort: brushing with a soft toothbrush (to minimize irritation), flossing, and avoiding acidic or spicy foods and beverages which have been known to cause flare-ups. Managing stress is also helpful, and a topical steroid may be prescribed for more severe outbreaks.
Perhaps the greatest concern with lichen planus, though, is it may resemble more serious conditions, particularly oral cancer. The only way to be certain that it is a benign condition is to perform a biopsy on some of the affected tissue. If you notice a problem, be sure to visit us for a complete examination. And regardless of whether you have the condition or not, regular oral cancer screenings, as well as limits on alcohol consumption and stopping use of tobacco, will also reduce your risk of oral cancer.
Odds are if you have a case of lichen planus it isn’t causing you any problems. If it does cause you discomfort, though, you can take steps to ease your symptoms.
We all need a good night's sleep, both in quantity and quality. That's why the Better Sleep Council promotes Better Sleep Month every May with helpful tips on making sure you're not only getting enough sleep, but that it's also restful and therapeutic. The latter is crucial, especially if you have one problem that can diminish sleep quality: nocturnal teeth grinding.
Teeth grinding is the involuntary movement of the jaws outside of normal functioning like eating or speaking. You unconsciously grind teeth against teeth, increasing the pressure of biting forces beyond their normal range. It can occur while awake, but it is more common during sleep.
The habit is fairly widespread in children, thought to result from an immature chewing mechanism. Children normally outgrow the habit, and most healthcare providers don't consider it a major concern.
But teeth grinding can also carry over or arise in adulthood, fueled in large part by stress. It then becomes concerning: Chronic teeth grinding can accelerate normal age-related tooth wear and weaken or damage teeth or dental work. It may also contribute to jaw joint pain and dysfunction related to temporomandibular disorders (TMD).
If you notice frequent jaw tenderness or pain, or a family member says they've heard you grind your teeth at night, you should see us for a full examination. If you are diagnosed with teeth grinding, we can consider different means to bring it under control, depending on your case's severity and underlying causes.
Here are some things you can do:
Alter lifestyle habits. Alcohol and tobacco use have been associated with teeth grinding. To reduce episodes of nighttime teeth grinding, consider modifying (or, as with tobacco, stopping) your use of these and related substances. Altering your lifestyle in this way will likely also improve your overall health.
Manage stress. Teeth grinding can be a way the body “lets off steam” from the accumulated stress of difficult life situations. You may be able to reduce it through better stress management. Learn and practice stress reduction techniques like meditation or other forms of relaxation. You may also find counseling, biofeedback or group therapy beneficial.
Seek dental solutions. In severe cases, there are possible dental solutions to reducing the biting forces generated by teeth grinding. One way is to adjust the bite by removing some of the structure from teeth that may be more prominent than others. We may also be able to create a bite guard to wear at night that prevents teeth from making solid contact with each other.
These and other techniques can be used individually or together to create a customized treatment plan just for you. Minimizing teeth grinding will help ensure you're getting the most out of your sleep time, while protecting your dental health too.
Restoring missing or unattractive teeth can often be a lengthy process. Months may elapse between initial teeth preparation and final placement to allow time for tissue healing and permanent crown manufacturing. During that period you will likely wear temporary (provisional) crowns to protect the teeth while improving function and appearance.
In the past, provisional crowns were fairly uniform. Today, though, there are provisional crowns available that conform exactly to a patient’s individual mouth. These crowns not only enhance function and appearance, they’re an excellent way to “try out” your new smile before the permanent restoration.
Customized provisional crowns are part of a concept known as “smile analysis.” A new smile involves more than restoring affected teeth: we also consider the overall health of your mouth, the shape of your face, and your own desires and expectations. Your final smile design is a joint collaboration between you, our office and the dental laboratory that will fashion the final restoration.
There are a number of techniques for creating customized provisional crowns. Some techniques involve bonding tooth-colored materials like composite resin directly to the teeth. Others use impression models of your teeth to create an outline or shell that’s filled with an acrylic material and then affixed to your teeth. The aim with any of these techniques is to produce a provisional crown that accurately reflects the final crown’s appearance.
With these types of provisional crowns, we can see how the new teeth will look (their color, shading, shapes and proportions) against the gums, and if they appear to be in balance and harmony with the entire face, including your lips, jaws and facial contour. We can also evaluate how well the new teeth function as you chew, speak or smile.
It takes some extra effort to prepare customized provisional crowns rather than the more uniform version. But this effort is well worth it: by helping us anticipate more accurately how your new restorations will appear and function, customized crowns help ensure your new smile is an attractive and satisfying one.
If you would like more information on temporary restorations, 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 “Concepts of Temporary Restorations.”
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