Posts for: October, 2016
We treat most malocclusions (bad bites) with braces or clear aligners. But not all malocclusions are alike — some can require extra procedures to achieve successful results.
One such example is when incoming teeth crowd other teeth and cause them to erupt abnormally. The crowding also reduces the space needed to move the misaligned teeth to better positions. To make more room we'll often remove some of the teeth before undertaking orthodontics.
The key is to extract the right teeth. The best candidates are those whose absence will have minimal effect on both appearance and dental function. That's commonly the bicuspids, located right on the edge of the “smile zone” (the teeth most visible when we smile) between the cuspid (eye) teeth and the back molars.
Once we choose and remove the teeth our next concern is to protect the bone at the extraction site.Â The bone in our jaws benefits from the pressure created when we bite or chew. This stimulates new bone cells to form and replace older cells. Without it, as when we have a missing tooth, the amount of bone can diminish over time and affect the success of any future orthodontics.
To prevent this, we take care not to damage the gums and bone removing the tooth. We may also install a graft under the empty socket to encourage bone growth.
If we've removed teeth outside the smile zone, the resulting orthodontics will move teeth into the opened space. In the end, you won't even notice they're gone. Teeth lost or congenitally missing in the smile zone, though, may eventually require a replacement tooth. A dental implant is the best choice, but it should be put on hold for a younger person until their jaw has fully developed.
In the meantime, we can install a spacer or a temporary restoration to hold the empty space and prevent other teeth from drifting into it. This can be incorporated into braces or aligners, or with a removable partial denture or a temporary modified bridge.
Extracting teeth to aid orthodontics first requires a well-laid plan that could encompass several years. The end result, though, can be well worth the time and effort — better function and a new, attractive smile.
If you would like more information on the process of straightening 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 “Tooth Removal for Orthodontic Reasons.”
Your dentures have served you well over the years. Lately, though, you’ve noticed the fit loosening in the lower denture. It’s not a new problem: you’ve had them refitted a few times already. But now it seems to be growing worse and you’re having more trouble chewing food or speaking clearly.
The problem isn’t all wear and tear with your dentures — the bone in your jaw is shrinking. A denture applies forces that are compressive. Natural teeth produce forces when we chew that travel through the tooth root and stimulate the bone to grow. Without teeth, there’s no such force to stimulate the bone. As a result, new bone cells don’t replace older cells at a healthy rate and bone volume diminishes over time. Because traditional dentures are supported by the gum ridges, the constant compressive forces on the gums can also contribute to bone loss.
As mentioned, we can refit dentures by lining them with new acrylic material. Eventually, though, it may be necessary to consider a new set of dentures that match the altered contours of your jaw. But continuing bone loss might lead to the same fate for your new dentures as your previous pair.
There’s a relatively new alternative, though, that could provide greater denture stability and help deter bone loss: implant overdentures. They’re actually a union between a traditional denture and a dental implant, a tooth replacement approach introduced over thirty years ago.
With this option, two strategically-placed implants are surgically inserted into the jaw bone. We then manufacture a denture (or retrofit your current dentures, if possible) with fittings that connect to the implants. Once in the mouth, the dentures gain their main support from the implants rather than the gum ridge, which relieves pressure on the bone. And because the titanium implant has a natural affinity with bone, new bone will grow and attach itself to it, increasing its stability and stopping bone loss.
Although more expensive than traditional dentures, implant overdentures are more affordable than individual teeth replaced by implants and are very cost-effective over time. What’s more, they can restore the comfort and confidence to eat, speak and smile that you once enjoyed when you had your own teeth.
If you would like more information on implant-supported dentures, 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 “Implant Overdentures.”
Oral appliances run the gamut from night guards and retainers to full or partial dentures. Millions of people depend on them for restoring or maintaining dental health.
Today's user-friendly appliances reflect the latest advances in technology. But that doesn't mean you can simply "place them and forget them." Their longevity depends on taking care of them.
The most important aspect of appliance care is keeping them clean. Although bacteria have no effect on an appliance's materials, they can accumulate on its surfaces and raise the risk your natural teeth and gums will be infected. To reduce that risk you should clean your appliance every day.
The best way is with a countertop ultrasonic cleaner. These units emit high frequency sound vibrations that loosen plaque (a thin film of bacteria and food particles) from even the appliance's tiniest crevices. Most units cost between $40 and $60, and pose less of a scratching risk to the appliance's surfaces than manual cleaning.
If you'd prefer to use a brush, there are some dos and don'ts to follow. You can use a cleaner especially designed for your appliance, but less expensive mild dish detergent or hand soap (with an antibacterial agent) will work too. Don't use toothpaste — most contain an abrasive ingredient for removing plaque from enamel that could leave microscopic scratches on your appliance. Use a soft-bristle toothbrush (but not the one you use for your natural teeth) or one designed for your appliance.
While boiling kills bacteria, the high heat can soften and warp the plastic material in an appliance. This could alter how the appliance fits in your mouth, making them loose and uncomfortable to wear. You should also avoid bleach: it can whiten acrylic or nylon designed to mimic the red color of real gum tissue.
Unless we've advised you otherwise, don't wear the appliance around the clock, a practice that raises the chances of bacterial accumulation. And be sure you also brush and floss your natural teeth every day.
Keeping both your mouth and your appliance clean helps ensure the best oral health possible — and that your appliance will last longer.
If you've had periodontal (gum) disease, you've no doubt experienced gum inflammation, bleeding or pain. But your gums may not be the only mouth structures under assault — the disease may be damaging the underlying support bone.
Although easing soft tissue symptoms is important, our primary focus is to protect all your teeth's supporting structures — the gums, the attaching ligaments and, of course, the bone. To do so we must stop the infection and reduce the risk of reoccurrence.
Stopping gum disease depends on removing its source — plaque, a thin biofilm of bacteria and food particles accumulating on tooth surfaces, due to poor oral hygiene. We must remove it mechanically — with hand instruments known as scalers or ultrasonic equipment that vibrates the plaque and calculus (hardened plaque deposits) loose.
It's not always a straightforward matter, though, especially if the diseased gum tissues have pulled away from the teeth. The slight natural gap between teeth can widen into voids known as periodontal pockets; they fill with infection and can extend several millimeters below the gum line. We must thoroughly cleanse these pockets, sometimes with invasive techniques like root planing (removing plaque from the roots) or surgical access. You may also need tissue grafting to regenerate gum attachment to the teeth.
One of the more difficult scenarios involves pockets where roots divide, known as furcations. This can cause cave-like voids of bone loss. Unless we treat it, the continuing bone loss will eventually lead to tooth loss. Besides plaque removal, it may also be prudent in these cases to use antimicrobial products (such as a mouthrinse with chlorhexidine) or antibiotics like tetracycline to reduce bacterial growth.
Perhaps the most important factor is what happens after treatment. To maintain gum health and reduce the chances of re-infection, you'll need to practice diligent daily hygiene, including brushing, flossing and any prescribed rinses. You should also keep up a regular schedule of office cleanings and checkups, sometimes more than twice a year depending on your degree of disease.
If you would like more information on treatments for gum disease, 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 “Treating Difficult Areas of Periodontal Disease.”