Posts for category: Dental Procedures
Teeth crowding is a difficult bite problem (malocclusion) that often involves the entire jaw structure to be evaluated. Normally occurring when the jaw doesn’t have adequate space for normal tooth eruption, teeth coming in later put pressure on other teeth, causing them to develop improperly.
Crowding also makes it difficult to realign teeth with braces because there’s simply not enough room for sufficient movement to take place. The solution may then be to consider the removal of some of the teeth to create enough space for orthodontic treatment.
Not just any tooth can be removed, however — we must first conduct a careful analysis to determine which can be removed to facilitate optimum movement of the remaining teeth without disrupting normal mouth function or affecting appearance. The teeth most frequently removed for this purpose are the bicuspids, located between the cuspids or eyeteeth (which are positioned directly under the eyes) and the molars, the largest teeth in the back of the mouth. Sometimes one premolar tooth on each side of the jaw can be removed without sacrificing future form or function.
There are a few important considerations we must keep in mind when extracting teeth for orthodontic reasons; perhaps the most important is preserving bone at the extraction site. Because continuing bone growth depends on the forces generated by teeth when we bite or chew, bone near a missing tooth socket will tend to diminish over time. If there’s insufficient bone during orthodontic treatment, it may result in gum recession and root exposure — not only damaging to the teeth themselves but also to a person’s smile appearance. To avoid this, we sometimes will consider inserting a bone graft, which will stimulate bone growth, into the empty socket immediately after extraction. While this isn’t commonly done, it’s being considered if the patient’s bone is thin and a concern during healing.
We must also consider how to accommodate other, unrelated tooth loss to assure the final result is visually appealing. It may be necessary in these cases to maintain the space at the missing tooth site for a future restoration once the orthodontics is completed. This takes planning as well as the use of restorations like dental implants, bridges or partial dentures.
Regardless of your bite issues, the field of orthodontics has the appliances and techniques to overcome even the most complicated condition. When necessary, using procedures like tooth extraction can help turn an unappealing, dysfunctional bite problem into a beautiful smile.
If you would like more information on orthodontic teeth extractions, 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 “Tooth Removal for Orthodontic Reasons.”
You're doing all the right things helping your child avoid tooth decay: daily brushing and flossing, regular dental visits and a low-sugar diet. But although occurrences are low, they're still getting cavities.
Some children still struggle with tooth decay even with proper dental care. If this is happening to your child, your dentist may be able to give them an extra preventive boost through topical fluoride.
Fluoride has long been recognized as a proven cavity fighter. Often added in small amounts to toothpastes and drinking water, fluoride strengthens tooth enamel against acid attacks that create cavities. With topical fluoride, a dentist applies a varnish, foam or gel containing a more concentrated amount of the chemical directly to the teeth.
The effectiveness of this method in reducing tooth decay is well-founded: A number of scientific studies involving thousands of children and adolescents found an average 28% reduction in occurrences of decay among those who received the treatment compared to those who didn't.
Still, many parents have concerns about the higher fluoride concentrations in topical applications. But even at this greater amount, fluoride doesn't appear to pose any long-term health risks. The most adverse effects—vomiting, headaches or stomach pain—usually occur if a child accidentally ingests too much of the solution during treatment.
Dentists, however, go to great lengths to prevent this by using guards to isolate the solution during an application. And in the case of a foam or gel application, parents can further lower the risk of these unpleasant side effects by not allowing their child to eat or drink for at least thirty minutes after the procedure.
The evidence seems to indicate that the benefits of regular topical fluoride applications for children at high risk outweigh the possible side effects. By adding this measure to your prevention strategy, you can further protect your child from this danger to their current and future dental health.
If you would like more information on tooth decay prevention for your child, 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 “Fluoride Gels Reduce Decay.”
You’re ready to have that missing tooth replaced with a dental implant or other life-like restoration. But we may first have to address another problem — moving the teeth around the missing tooth space back to where they should be.
That empty space is the primary reason those teeth are no longer in the right position. Through their attachment to the periodontal ligament that lies between them and the bone, teeth are able to move slightly over time in response to mouth changes. This same mechanism, however, may also cause teeth to “drift” toward each other across the empty space left by a missing tooth; too much drift and there won’t be enough room for the replacement tooth.
A fairly straightforward orthodontic treatment can restore drifted teeth to their original position to make room for the replacement. There is one situation, however, that can complicate this treatment — if you also have periodontal (gum) disease, a plaque-induced bacterial infection. During normal tooth movement bone dissolves (resorbs) in front of the tooth in the direction of movement, while new bone forms behind it to help stabilize the tooth in its new position. Gum disease, however, can weaken the bone around these teeth, inhibiting the natural rebuilding process of bone and connective tissue that could jeopardize the success of the orthodontic treatment.
It’s important, then, to first treat and bring the gum disease under control to restore health to both the gums and bone. It’s also just as important during orthodontic treatment to prevent another infection flare-up through renewed brushing and flossing and regular office cleanings and checkups. Choosing clear aligners over traditional braces to move the teeth could also help — unlike fixed braces that often make oral hygiene difficult, clear aligners can be removed to allow easier cleaning of teeth and gums.
Depending on your situation, the process for preparing your mouth for a tooth replacement can involve several procedures and healing time. But the end result — a brand new tooth that looks amazing — will be something to smile about.
Everyone has to face the music at some time — even John Lydon, former lead singer of The Sex Pistols, arguably England’s best known punk rock band. The 59-year old musician was once better known by his stage name, Johnny Rotten — a brash reference to the visibly degraded state of his teeth. But in the decades since his band broke up, Lydon’s lifelong deficiency in dental hygiene had begun to cause him serious problems.
In recent years, Lydon has had several dental surgeries — including one to resolve two serious abscesses in his mouth, which left him with stitches in his gums and a temporary speech impediment. Photos show that he also had missing teeth, which, sources say, he opted to replace with dental implants.
For Lydon (and many others in the same situation) that’s likely to be an excellent choice. Dental implants are the gold standard for tooth replacement today, for some very good reasons. The most natural-looking of all tooth replacements, implants also have a higher success rate than any other method: over 95 percent. They can be used to replace one tooth, several teeth, or an entire arch (top or bottom row) of teeth. And with only routine care, they can last for the rest of your life.
Like natural teeth, dental implants get support from the bone in your jaw. The implant itself — a screw-like titanium post — is inserted into the jaw in a minor surgical operation. The lifelike, visible part of the tooth — the crown — is attached to the implant by a sturdy connector called an abutment. In time, the titanium metal of the implant actually becomes fused with the living bone tissue. This not only provides a solid anchorage for the prosthetic, but it also prevents bone loss at the site of the missing tooth — which is something neither bridgework nor dentures can do.
It’s true that implants may have a higher initial cost than other tooth replacement methods; in the long run, however, they may prove more economical. Over time, the cost of repeated dental treatments and periodic replacement of shorter-lived tooth restorations (not to mention lost time and discomfort) can easily exceed the expense of implants.
That’s a lesson John Lydon has learned. “A lot of ill health came from neglecting my teeth,” he told a newspaper reporter. “I felt sick all the time, and I decided to do something about it… I’ve had all kinds of abscesses, jaw surgery. It costs money and is very painful. So Johnny says: ‘Get your brush!’”
We couldn’t agree more. But if brushing isn’t enough, it may be time to consider dental implants. If you would like more information about dental implants, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implants” and “Save a Tooth or Get an Implant?”
The longer many health problems go on, the worse they become. Treating them as early as possible could stop or slow their development.
That holds true for poor bites: while we can certainly correct them later in life, it's often better to "intercept" the problem during childhood. Interceptive orthodontics attempts to do this with treatments that influence how the jaws and other mouth structures develop during childhood. Many of these techniques are usually best implemented before puberty.
For example, some very complex problems called cross bites can occur if the upper jaw grows too narrowly. We might be able to stop this from happening by using an orthodontic appliance called a palatal expander during the childhood years. It works because the bone at the center of the palate (roof of the mouth) has a gap running back to front until the early teens when the gap closes.
We fit the palatal expander up under and against the palate, then extend out metal arms from a center mechanism to the back of the upper teeth that exert outward pressure on them. This widens the center gap, which the body continually fills with bone as the device gradually exerts more pressure. Over time this causes the jaw to widen and lessens the cross bite. Timing, though, is everything: it's most effective before the gap closes.
Another way to aid jaw growth is a Herbst appliance, a hinged device that alters the movement of the jaws. As a child wears it, a Herbst appliance draws the lower jaw forward to develop more in that direction. Like the palatal expander, it's best used before significant jaw growth occurs.
These are just two examples of techniques and tools that can guide structural growth and prevent bite problems. Because they're most effective in the early years of oral development, your child should undergo an orthodontic evaluation as early as age 6 to see if they need and can benefit from an interceptive treatment.
Interceptive orthodontics can stop or at least slow a growing bite problem. The effort and expense now could save you much more of both later on.
If you would like more information on interceptive orthodontics, 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 “Interceptive Orthodontics: Timely Intervention can make Treatment Easier.”