If all goes normally, we have most of our permanent teeth as we enter puberty. Except, though, when it doesn't—sometimes incoming permanent teeth don't fully erupt, often because there's not enough room for them on the jaw. This can leave all or part of a tooth still up inside the gum and bones.
This condition is known as impaction, and it can cause problems with a person's bite and their smile. This is especially true of the upper canines, those pointed teeth located just under the eyes. Without them present, a person's smile can look oddly different. Moreover, it can worsen their bite and increase the risk of trauma and disease for nearby teeth.
Fortunately, there may be a way to coax impacted canines into erupting into their proper position on the jaw. It will involve, though, some minor surgery and orthodontic intervention to accomplish that feat.
First, though, a patient with missing canines should undergo a thorough orthodontic evaluation. This exam will reveal not only what may be going on with the missing teeth, but how the whole bite has been affected. Knowing the big picture will help direct the next treatment steps.
After pinpointing the impacted teeth's exact position (usually through x-rays or cone beam CT scanning), we then decide whether it's feasible to attempt to expose the teeth. Sometimes, a tooth's position is so out of place that it may be best to remove it and consider a dental implant or other restorative measures.
If it is in a workable position, then the impacted teeth would be exposed surgically (usually by an oral surgeon or periodontist). The surgeon would then bond a small bracket to the exposed tooth and then attach a small chain.
After suturing the incised gum tissues back in place, the chain extending outward from the gums would then be looped over orthodontic hardware attached to other teeth. This will place downward pressure on the upper canine tooth, and over several months prod it to fully erupt.
This may sound like an elaborate procedure, but it's fairly routine and predictable. As a result, a patient can finally get the full benefit of all their teeth, enhance their dental health and transform their smile.
If you would like more information on dealing with impacted teeth, 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 “Exposing Impacted Canines.”
As we get older, we become more susceptible to chronic health conditions like diabetes, heart disease or arthritis. We can also begin to see more problems with our teeth and gums.
Whether it's ourselves or an older loved one, oral health deserves a heightened focus as we age on prevention and prompt treatment. Here's what you can do to protect you or a family member's teeth and gums during the aging process.
Make accommodations for oral hygiene. Keeping your mouth clean of disease-causing plaque is important at any age. But it may become harder for someone getting older: Manual dexterity can falter due to conditions like arthritis or Parkinson's Disease. Older adults with decreased physical ability may benefit from larger gripped toothbrushes or those modified with a bicycle handle. Electric power brushes are another option, as are water irrigators that can do as effective a job of flossing as threaded floss.
Watch out for “dry mouth.” Older adults often develop chronic dry mouth due to saliva-reducing medications they might be taking. It's not just an unpleasant feeling: Inadequate saliva deprives the mouth of acid neutralization. As a result, someone with chronic dry mouth has a higher risk for tooth decay. You can reduce dry mouth by talking with your doctor about prescriptions for you or a family member, drinking more water or using saliva boosting products.
Maintain regular dental visits. Regular trips to the dentist are especially important for older adults. Besides professional cleanings, dentists also check for problems that increase with aging, such as oral cancer. An older adult wearing dentures or other oral appliances also needs to have them checked periodically for any adverse changes to fit or wear.
Monitor self-care. As long as they're able, older adults should be encouraged to care daily for their own teeth. But they should also be monitored in these areas, especially if they begin to show signs of decreased mental or physical abilities. So, evaluate how they're doing with brushing and flossing, and look for signs of tooth decay or gum disease.
Aging brings its own set of challenges for maintaining optimum dental health. But taking proactive steps and acting quickly when problems arise will help meet those challenges as they come.
If you would like more information on dental care for older adults, 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 “Aging & Dental Health.”
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
Chronic jaw pain can be an unnerving experience that drains the joy out of life. And because of the difficulty in controlling it patients desperate for relief may tread into less-tested treatment waters.
Temporomandibular disorders (TMDs) are a group of conditions affecting the joints connecting the lower jaw to the skull and their associated muscles and tendons. The exact causes are difficult to pinpoint, but stress, hormones or teeth grinding habits all seem to be critical factors for TMD.
The most common way to treat TMD is with therapies used for other joint-related problems, like exercise, thermal (hot and cold) applications, physical therapy or medication. Patients can also make diet changes to ease jaw function or, if appropriate, wear a night guard to reduce teeth grinding.
These conservative, non-invasive therapies seem to provide the widest relief for the most people. But this approach may have limited success with some patients, causing them to consider a more radical treatment path like jaw surgery. Unfortunately, surgical results haven't been as impressive as the traditional approach.
In recent years, another treatment candidate has emerged outside of traditional physical therapy, but also not as invasive as surgery: Botox injections. Botox is a drug containing botulinum toxin type A, which can cause muscle paralysis. Mostly used in tiny doses to cosmetically soften wrinkles, Botox injections have been proposed to paralyze certain jaw muscles to ease TMD symptoms.
Although this sounds like a plausible approach, Botox injections have some issues that should give prospective patients pause. First, Botox can only relieve symptoms temporarily, requiring repeated injections with increasingly stronger doses. Injection sites can become painful, bruised or swollen, and patients can suffer headaches. At worst, muscles that are repeatedly paralyzed may atrophy, causing among other things facial deformity.
The most troubling issue, though, is a lack of strong evidence (outside of a few anecdotal accounts) that Botox injections can effectively relieve TMD symptoms. As such, the federal Food and Drug Administration (FDA) has yet to approve its use for TMD treatment.
The treatment route most promising for managing TMD remains traditional physical and drug therapies, coupled with diet and lifestyle changes. It can be a long process of trial and error, but your chances for true jaw pain relief are most likely down this well-attested road.
If you would like more information on treating jaw disorders, 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 “Botox Treatment for TMJ Pain.”
You already know the basics for healthy and attractive teeth and gums: brush and floss every day; and have your teeth cleaned and checked by a dentist every six months. But there are also some lesser known things you can do to improve what you're already doing—and some of them may go against popular wisdom.
Here then are 3 counter-intuitive tips for turbo-boosting your teeth and gum health.
Avoid brushing too hard and too often. While it may not seem like it, “The more, the better” isn't necessarily a good thing when it comes to brushing your teeth. Vigorous brushing several times a day could actually damage both your teeth enamel and your gums, eventually leading to problems like sensitive teeth. So, easy does it on the brushing pressure—let the mild abrasives in your toothpaste do the work removing disease-causing dental plaque. Likewise, avoid brushing more than twice a day.
Wait on brushing right after eating. If your first instinct right after a meal is to head to the sink to brush your teeth, curb your enthusiasm. Your enamel is actually in a slightly softened state right after eating and drinking because of an increase in mouth acid (especially if you've consumed sodas, sports drinks or juices). Saliva restores the mouth's pH balance and helps remineralize enamel in about an hour. If you brush before then, you could be sloughing off microscopic bits of enamel—an eventual problem if this is a regular habit.
Stop snack “grazing.” If you're one of those that likes to munch on food throughout the day, you could be thwarting your overall efforts to maintain good dental health. Remember saliva? As mentioned, it effectively neutralizes acid in a few minutes. But continuous snacking maintains a constant high level of acid in the mouth—saliva has little chance to catch up. As a result, your mouth stays acidic, which can lead to higher risk of dental disease. If possible, limit your snacking to mealtimes.
These tips might be surprising, but they're based on sound science and research. Incorporating them into your regular, ongoing dental care, could increase your chances of healthy teeth and gums.
If you would like more information on how best to clean and care for your teeth, 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 “10 Tips for Daily Oral Care at Home.”
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