What is a Periodontist?
Each person’s smile is different… but every attractive smile has two things in common: A full set of pearly white teeth, and the right amount of healthy pink gum tissue to show them off. For the most part, your general dentist is the healthcare provider who takes care of your teeth—checking for signs of a problem, providing treatment when needed, and making sure you get regular professional teeth cleanings. But who should you see when your gums need some extra help? That’s a job for a periodontist.
Periodontists are the dental professionals who focus on prevention, diagnosis and treatment of diseases that affect the gums, as well as other structures that support the teeth. Among other things, they can recognize and treat the early stages of gum inflammation before it gets out of hand; perform minor surgery to resolve complicated cases of periodontitis (severe gum disease); use lasers or gum grafting techniques to restore the appearance of a smile; and even place dental implants in the jaw, when a tooth can’t be saved.
Periodontists are sometimes called “the plastic surgeons of dentistry.” Like conventional plastic surgeons, they can use various techniques to remodel soft tissue, and even reshape bone in the jaw. But periodontists aren’t just concerned with outward appearances; maintaining healthy, disease-free gums is a key part of good oral health. And when you consider that gum disease is the leading cause of tooth loss in adults, you can see how important healthy gums really are.
How Periodontists Are Trained
The field of periodontics is one of the nine specialty practice areas recognized by the American Dental Association (ADA). In order to qualify as a periodontist, a candidate must have successfully completed four years at an accredited dental school. Following this, he or she receives an additional three years of education and clinical training in an approved post-graduate program for periodontology.
General dentists can provide regular in-office tooth cleanings, and give instruction on effective at-home oral hygiene—two common measures that can help prevent gum disease. But sometimes, that just isn’t enough. Periodontists are often called upon to treat advanced or complicated cases of gum disease. Their special training and experience enables them to diagnose the underlying conditions causing the disease, and offer a number of effective treatments and restorative procedures. They also work in conjunction with general dentists, tailoring a comprehensive plan that can resolve a patient’s present gum disease—and keep it from recurring in the future.
How Periodontists Treat Gum Disease
Periodontists have a wide array of tools available to fight gum disease. Treatment generally starts with the least invasive and costly measures, which are non-surgical procedures. These include scaling and root planing, where special hand-held instruments are used to clean the root surfaces of the teeth. Lasers are sometimes used in this procedure, and some patients also receive antimicrobial medications. The removal of dental plaque and hardened calculus (tartar) from tooth surfaces that lie under the gums is sometimes enough to resolve a patient’s gum disease—especially when followed up with a conscientious maintenance program.
If periodontal disease has progressed to the point where gum tissue no longer fits snugly against the teeth, minor gum surgery may be needed. A small “flap” may be opened in the gum tissue, enabling infected tissue and bacteria to be removed from an infected “pocket” under the gums; healthier gum tissue can then begin naturally reattaching to bone. This “pocket reduction” surgery is an effective treatment which, in many cases, stops the progression of periodontal disease.
Gum disease can erode bone in the jaw and damage the tissues that surround and support your teeth; left untreated, it may eventually lead to tooth loss. To help reverse the damage, your periodontist may recommend various regenerative procedures. Bone grafts, gum grafts and tissue-stimulating growth factors can be used to repair damage to these tooth-supporting structures, and help you preserve your natural teeth.
Periodontists Offer Other Treatments
When teeth can’t be saved, many periodontists can provide today’s premier tooth-replacement system: the dental implant. Placed into the jawbone in a minor surgical procedure, these prosthetic teeth are natural-looking and fully functional tooth replacements that can last for the rest of your life.
Periodontists also offer a number of treatments that can improve the appearance of your smile and resolve some dental problems. If you have gum recession, for example, gum graft surgery can be used to cover the exposed roots of teeth with healthy gum tissue—your own tissue, or processed material from a donor. This can give you a better-looking smile, and may also reduce tooth sensitivity and protect against tooth decay in this area.
Crown lengthening surgery can be used as part of a tooth restoration procedure, or to change the appearance of a “gummy” smile—one where there seems to be too much gum and too little tooth. In this procedure, excess gum tissue is reshaped to allow more of the natural tooth (or teeth) to show.
When to See a Periodontist
Research has shown that effective brushing and flossing, along with regular professional teeth cleaning, helps prevent tooth decay and gum disease. But sometimes, even people who are very attentive to their oral hygiene can’t keep gum disease from getting started. When that occurs, it’s time to see a periodontist. Your general dentist may recommend a visit to the gum specialist if he or she notices a problem—but you don’t usually need a referral to schedule a consultation. In addition, you can talk to a periodontist about improving the look of your smile with some periodontal plastic surgery.
While periodontal therapy may take many forms, it has the same goals: to restore diseased or damaged tissues to good health; to improve the appearance and function of every part of your smile; and to allow you to keep your natural teeth for as long as possible.
Periodontics is the dental specialty focusing exclusively in the inflammatory disease that destroys the gums and other supporting structures around the teeth. A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal, or disease, and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. As specialists in periodontal disease, they are experts in the latest techniques for diagnosing and treating periodontal disease. They are also trained in cosmetic periodontal procedures.
Periodontists treat cases ranging from mild gingivitis to more severe periodontitis. Periodontists offer a wide range of treatments, such as scaling and root planing (the cleaning of infected root surfaces), root surface debridement (the removal of damaged tissue), and regenerative procedures (the reversal of lost bone and tissue). When necessary, periodontists can also perform surgical procedures for patients with severe gum disease. Additionally, periodontists are trained in the placement, maintenance and repair of dental implants.
What is the Difference between a Dentist and a Periodontist?
One main difference between dentists and periodontists has to do with your gums.
When your teeth need a cleaning or an X-ray, you probably schedule an appointment with your friendly Los Angeles family dentist, right? And you probably do the same thing when you need a cavity filled or if your teeth have become discolored. But there are times when your Los Angeles family dentist can’t help you, simply because the work you need done requires more than a simple tooth extraction. That’s where the difference between a dentist and a periodontist comes in to play.
But what exactly IS a periodontist? And how does s/he differ from your Los Angeles family dentist? Periodontists have extended education in the periodontium which focuses on the soft tissue (gums) and bone. A general dentist can treat gum disease through routine cleanings, scaling and root planning (deep cleanings), and antibiotic medications. Periodontists are needed for advanced cases of gum disease call periodontitis which are out of the realm of treatment a general dentist.
One main difference between dentists and periodontists has to do with your gums. Periodontists are the ones who usually diagnoses gum disease (like gingivitis) and periodontitis – the technical term for a disease that affects the gum AND the bones. But a periodontist also works towards treating (and with your help, preventing) any disease of the soft tissue, so you could see one if your mouth is sore.
Understanding the Difference between a Dentist and a Periodontist
So how do you know when you need a periodontist vs. a dentist? We’ve compiled a list of basic things for which to see your Los Angeles family dentist. Please note that your Los Angeles dentist may recommend a periodontal visit for concerns that don’t necessarily appear on this list, if s/he thinks it’ll help you.
Visit the Dentist for:
- Checkups to Ensure Proper Oral Health
- Bi-Monthly Cleanings
- Standard X-Rays
- Filling Cavities
- Root Canals
- Standard Tooth Extractions
- Crowns or Bridges
- Some Cosmetic Procedures (Veneers, Bonding, Whitening, Etc.)
- Pediatric Care
- Non-Surgical Periodontal Care
Visit the Periodontist For:
- Deep Pocket Cleanings
- Bone Grafting
- Soft Tissue Removal
- Root Planing
- Implant Replacement
- Crown Lengthening
- Hard Tissue Recontouring
Periodontist Vs. Dentist
Unlike the standard Los Angeles family dentist, a periodontist focuses on soft tissue and bone disease. Periodontistis often presents with bleeding, tender or swollen gums, loose teeth, and mouth pain. But since the main difference between a dentist and a periodontist is the soft tissue specialty, your dentist might not be able to help you if your gums are in bad shape. Severe cases of periodontitis can lead to health problems like diabetes and heart disease – even cancer. Pregnant women with unhealthy gums and teeth often deliver babies with low birth weights. Some medical professionals have even found a correlation – though in truth, they’re not quite sure why – between Alzheimer’s and poor oral health.
Periodontists are dental practitioners who specialize in the prevention and treatment of diseases of the tooth-supporting tissues – the periodontium. Although all dentists receive training in the diagnosis and treatment of mild to moderate periodontal disease, it is usual practice to refer severe or complex cases to a periodontist, who will have undertaken additional training and acquired special expertise in the area.
Within the field of periodontology, there is also a range of different specialties which focus on particular types of treatment; for example, some dentists may focus their practice on providing implant therapy to replace missing teeth.
Periodontitis is a pretty insidious disease. And while most Los Angeles dentists are trained to treat gum disease non-surgically, advanced cases are usually recommended to some who specializes in it.
In the end, the main difference between dentists and periodontists is the course of their studies. And the best way to spend time with your dentist (vs. a periodontist) is by forming good oral hygiene habits. Brushing your teeth twice a day, flossing between meals and scheduling regular visits with your Los Angeles family dentist should prevent you from having to see a specialist, because taking care of your teeth means taking care of your gums.
A periodontist is one of the least understood types of dentists. This professional deals in gum diseases, working to give patients healthier mouths. Whenever you feel like your gums are sensitive or you notice bleeding, you need a periodontist. Otherwise, you risk gum disease or the pain experienced with every bite, and other extreme mouth conditions. Here’s our guide on periodontists, what they do, and why patients sometimes need one.
The Basics of Periodontology
Periodontology isn’t a word that you hear very often. As such, you may not understand its meaning. In simplest terms, you want pink gums. They’re the sign of a healthy mouth. A periodontist is a person who helps you in situations when your gums aren’t in optimal condition.
Of course, gums aren’t the only focus for periodontists. These professionals also work on other parts of the mouth, ones you don’t think about often – but use regularly. For example, the part of the jawbone that supports your teeth is the alveolar process. Any issues with this part of the jaw could lead to tooth loss, especially in women. That’s because it’s the bone portion that hosts tooth sockets. When your alveolar process deteriorates or breaks, you need a periodontist to reset it and secure your teeth.
Similarly, the cementum is the tissue that connects your teeth and gums. It’s a calcified substance with a simple purpose. Cementum protects the roots of your teeth. To do this, it connects the alveolar bone with the teeth via the periodontal ligament. Commonly known as the PDL, this ligament is supportive in nature and 70 percent water in composition. The rest of it is cells and fibers. When your PDL is unhealthy, the attached tooth doesn’t erupt correctly, which means it doesn’t grow right.
All about Los Angeles Periodontists
A periodontist is a master of many trades. This type of dentist must anticipate future gum and tooth issues, treat current ones, and repair prior ones. The job of a periodontist is to protect all the support structures of your teeth. These professionals train to make sure that your gums, jawbone, and connective gum tissue are operating at optimal capacity. When a periodontist notices a problem with any of these elements, the need for action is immediate.
When left untreated, gum damage can cause you to lose a tooth or, in extreme situations, suffer a gum or jaw disease that could require the removal of a part of your jawline. That’s why periodontists have a reputation as the plastic surgeons of dentistry. These professionals often work to correct soft tissue issues in your mouth before they become a larger problem. Prevention is a key part of this job, but surgery is also needed in many instances.
The worst cases of periodontitis require this surgery. The advanced stages of gum disease are worrisome. They are sometimes early warning signs of cancer, especially in adult males. A periodontist protects a person’s well-being by diagnosing and treating these early issues. The dentist will also test for cancerous cells. Should the patient lose one or more teeth, the periodontist will also suggest a course of action to hide the situation. Replacement implants are usually the best option, and this process is generally quick and painless.
To become a periodontist, a person receives regular dental school training. After the person completes this process, they must receive three years of specialized training. The specialization focuses on gum and tooth health. During this time, the periodontist will learn how to add implants, perform jaw and gum surgery, and treat cancerous gums. So, a periodontist is a dentist who receives multiple years of additional training to do more specialized types of mouth healthcare.
How Does a Periodontist Appointment Work?
The start of your first periodontist appointment is just like any other dental visit. You’ll check in at the front desk and then wait for your turn. When you get called back to the exam room, the dentist will review your medical charts. You should alert your caregiver if you have any allergies to medicines. You should also inform the periodontist if you have heart problems, diabetes, or any other condition like pregnancy that could impact treatment options.
You may need to get x-rays during your appointment. The periodontist wants to have the most current medical information before making any decisions. The dentist will check the records and x-rays and then do a routine check of your mouth, jaw and gums. Afterward, you’ll receive an update the state of your mouth. The periodontist will tell you if you need any procedures done. If not, the professional will suggest some dental practices you should do daily to improve your situation.
A periodontist is one of the most important kinds of dentists. You may never need to visit one, but if you do, you’ll know that this person has the specialized training needed to treat your gums and mouth.
A periodontist is a dentist who is an expert in the treatment of oral inflammation, and who knows how to prevent, diagnose, and treat periodontal disease. Periodontists receive extensive training in these areas, and are familiar with the latest techniques for diagnosing and treating periodontal disease.
Some periodontal needs can be managed by a general dentist, however, more and more patients are showing signs of periodontal disease. Research also suggests a link between periodontal disease and other chronic diseases of aging, therefore there may be a need for periodontal treatment that has an increased level of expertise by a trained specialist. Patients who have moderate or severe levels of periodontal disease can be managed by a partnership between their dentist and a periodontist.
Periodontists treat cases that are more problematic, such as those with severe gum disease or with a complicated medical history. Treatments include scaling and root planing (in which the infected surface of the root is cleaned) or root surface debridement (in which damaged tissue is removed). Periodontists also treat patients with severe gum problems using a range of surgical procedures. In addition, they are specially trained in the placement, maintenance, and repair of dental implants.
During the first visit, the periodontist typically reviews the patient’s complete medical and dental histories. It is extremely important for the periodontist to know if any medications are being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.
The periodontist will then examine the gums, check to see if there is any gum line recession, assess how the teeth fit together when biting, and will check the teeth to see if any are loose. The periodontist will also take a small measuring instrument (called a probe) and place it between the teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps the periodontist assess the health of the gums. X-rays may also be taken to observe the health of the bone below the gum line.
You’re used to going to the dentist & just seeing the doctor, the hygienist & maybe a dental assistant. But now you’ve been told you need to see a periodontist too. Now you’re thinking, “Perio-what?”
If you’ve never heard the word periodontist, don’t worry. To put it plainly, a periodontist is a dentist who specializes in caring for your gums & the other supporting tissues of your mouth. “Peri-” means “around” & “odont” means “tooth”. Periodontal means having to do with the tissues around your teeth & periodontitis means infection of the tissues around your teeth.
Dentist usually refer patients to a periodontist because they have periodontal disease, also known as gum disease. While general dentists are also qualified to treat periodontal disease, periodontists can offer more specialized care and attention, just like an orthodontist can offer more specialized braces options that most general dentists.
Dentists may also refer you to a periodontist if you have health factors that put you at higher risk of periodontal disease & it’s complications. Examples of such risk factors are pregnancy, diabetes, heart disease, chronic respiratory disease or having recently undergone cancer treatment or organ replacement surgery.
While a dentist may choose to treat your periodontal disease at their own practice at first, they may choose to refer you to a periodontist if they feel a specialist will be able to offer you a more successful outcome. By the way, when we say a more successful outcome when it comes to periodontal disease, we generally mean you’ll end up keeping most of your teeth.
As you may have realized from the explanation about terminology above, periodontal disease is a disease of the tissues around your mouth. Specifically this means your gums & the bone of your jaws, which are what hold your teeth in your mouth. If these both become diseased & weakened, your teeth can fall out. Having periodontal treatment (often called periodontal maintenance) from either a periodontist or your general dentist reduces the chance you will lose a tooth.
We know that some periodontal patients view going to see a periodontist for their treatment as an inconvenience, so we will do our best to pair you with a specialist who’s hours fit your busy schedule. However, if you find that you just can’t make the time to go to the periodontist, we’d much rather you see us for your periodontal maintenance rather than not doing it at all.
If you have any questions about your referral to a periodontist or your diagnosis of periodontal disease, please contact us!
How Long to Dental Implants Last?
Dental implants are one of the greatest innovations of modern dentistry. They are true prosthetic replacement teeth, consisting of an artificial titanium tooth root with a porcelain crown attached. Over 3 million Americans have dental implants, and that number is increasing by 500,000 people per year (source). With dental implants becoming a more and more popular solution to replace missing teeth, it’s fair to ask: how long do dental implants last?
The short answer is that dental implants can last a lifetime. Here’s the long answer.
Anyone who has had to have a crown or a bridge replaced or dentures re-fitted knows that not all dental restorations last forever. These three types of restorations can each fail for their own reasons. In the case of crowns and bridges, they can fail if the original tooth structure they’re attached to gets compromised due to decay. Most dentures eventually need to be refitted or replaced when bone loss causes the jaw to change shape.
Luckily, if you get dental implants, you don’t have to worry about the same risks. One of the reasons that implants are considered the best and most advanced option for replacing missing teeth is they are not subject to the same failure problems as standard crowns, bridges, or dentures. That isn’t to say that dental implants work perfectly all the time, but recent studies have shown that dental implants have a 98% success rate .
Many dentists conservatively estimate that implants will last about 25 years. The reason we can’t guarantee they’ll last a lifetime is there haven’t been very many long-term studies of dental implants yet.
Dental implants in their modern form were invented a little more than 50 years ago. In 1965, a Swedish scientist named Per-Ingvar Brånemark placed the first dental implant in the mouth of a man named Gösta Larsson. When Larsson died in 2006 at the age of 75, his original implants were still in place. They had lasted over 40 years!
Just like your natural teeth, the health and longevity of a dental implant depend on looking after your oral health. Dental implants are cared for just like natural teeth with daily brushing and flossing and regular dental checkups. Smoking can make it much more likely for dental implants to fail, as can pre-existing gum disease (periodontal disease). These health factors should be taken into account before a patient decides to have dental implants placed. If you’re interested in replacing missing teeth with dental implants, come see us and start a conversation!
A periodontist is an “Oral Health Specialist” with formal residency training in the diagnosis, treatment and prevention of periodontal (gum) disease and other oral health problems. Periodontists are specially trained to save teeth when possible. Periodontists are also specially trained to replace missing teeth when they are lost using dental implants. Periodontists are experts in the treatment of all forms of periodontal disease, including gingivitis, periodontitis, and gingival (gum) recession. Periodontists are also experts at Oral Plastic Surgery and regenerating lost gum and bone around teeth.
The American Dental Association recognizes periodontics as one of the nine specialties of dentistry. Periodontists receive extensive training, including three years of additional education beyond dental school.
By choosing a periodontal specialist for your care, you will benefit from the latest diagnostic procedures for treating periodontal disease and placing dental implants tailored to your needs. Periodontists also perform Oral Plastic Surgery to modify the appearance of the gums which can improve the smile. The following are some examples of what periodontists are trained to do.
When to See a Periodontist
When to See a Periodontist
A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored. Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants. Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.
Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.
Referrals from General Dentists and Self Referral
There are several ways treatment from a periodontist may be sought. In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.
If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:
- Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
- Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
- Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease. As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost altogether.
- Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
- Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections. The bacteria infection can spread through the blood stream and affect other parts of the body.
Diagnosis and Treatment
Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.
- Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.
- Moderate periodontal disease – If the gum pockets reach 4-6mm in length, a more extensive scaling and root planing cleaning might be required. This cleaning is usually performed under local anesthetic.
- Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planing will always be performed as the initial nonsurgical treatment. In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.
- Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.
Ask your periodontist if you have questions about periodontal disease, periodontal treatment or dental implants.
Dental Implant Procedure Explained by Los Angeles Periodontist
Dental implants are one of the most popular dental procedures, but few understand what goes into a dental implant procedure. Before any dental procedure, it is important to understand exactly what is being done to your teeth and mouth, so let’s break down exactly what a dental implant procedure entails.
What are Dental Implants?
Dental implants are the best way to replace missing or damaged teeth, providing a long-term and healthy solution. The dental implant will look, chew, feel and function just like normal teeth, making the issues and ailments that come with a missing tooth disappear. You can smile with confidence again with dental implants.
What is the Dental Implant Procedure?
The dental implant procedure is safe and predictable if performed by a dental implant specialist or periodontist. Here are the crucial steps in the dental implant procedure.
Develop a Dental Implant Individualized Treatment Plan
It is important to go into the dental implant procedure with a plan to meet your specific goals and situation. Every person is different and each missing tooth site has different surrounding anatomy, so it is important to carefully evaluate and create a customized plan specific to each individual. Our team will inspect your mouth, analyze your situation, and come up with a treatment plan that is best for you.
Place The Titanium Tooth Root Implant
Once the treatment plan is established, it is time to start the dental implant procedure. The first step is inserting the titanium root into the missing tooth area, fusing the implant post to the bone socket. Once placed, the jawbone will slowly grow around the dental implant root, anchoring it in place and securing it to the jaw. This is why healing time varies with each individual as every person heals at a different rate.
Attach the Abutment to the Dental Implant Root
Once the jawbone has finished growing around the implanted titanium root, it is time to attach the abutment. The abutment is a tiny connector that attaches the titanium root to a new replacement tooth.
Model Tooth for the Dental Implant Procedure
In order to make a new tooth or new set of teeth specific to your mouth, a mold must be made of your teeth. Dentists will make an impression of your bite and create a model that shows the size, shape, type, and arrangement of your teeth. The new tooth is fabricated based on this model.
Attach Crown to the Abutment and Tooth Root
Now that you have an accurate replacement tooth, it is time to place it into your mouth. The replacement tooth, called a crown, is attached to the abutment and put firmly in place. The color of the crown is made to match the teeth around it, and just like that, you have a beautiful new tooth!