While braces are often the stars for straightening smiles, they're not the only cast members in an orthodontic production. Orthodontists occasionally turn to other appliances if the bite problem is challenging. Whatever the tool, though, they usually have something in common—they use the principle of anchorage.
To understand anchorage, let's first consider the classic kid's game Tug of War. With teams on either end of a rope, the object is to pull the opposing team across the center line before they pull you. To maximize your pulling force, the player at the back of your rope, usually your stoutest member, holds steady or "anchors" the rest of the team.
Like a Tug of War team, braces exert force against the teeth. This stimulates the supporting periodontal ligament to remodel itself and allow the teeth to move. The braces use the teeth they are attached to as anchors, which in a lot of cases are the back teeth. By attaching a thin wire to the brackets or braces on the teeth, the orthodontist includes all the teeth on the arch, from one end to the other. Anchored in place, the wire can maintain a constant pressure against the teeth to move them.
But not all bite situations are this straightforward. Sometimes an orthodontist needs to influence jaw growth in addition to teeth movement. For this purpose, they often use orthodontic headgear, which runs around the back of the head or neck and attaches to orthodontic brackets on the teeth. It still involves an anchor but in this case it's the patient's own skull.
In some situations, an orthodontist may feel he or she needs more anchorage as the teeth alone may not be enough. For this, they might establish a separate or additional anchor point using a temporary anchorage device (TAD). A TAD resembles a tiny screw that's inserted into the jawbone near the tooth intended for movement. The orthodontist can then attach the TAD to braces hardware using some form of elastics. After treatment, they remove the TAD.
These are just a couple examples of specialized tools an orthodontist can use for bite correction. Thanks to them and similar devices, even the most complex bite problem can be overcome to create a healthier and more attractive smile.
If you would like more information on correcting a poor bite, 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 “Orthodontic Headgear & Other Anchorage Appliances.”
Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.
Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.
TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.
There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.
Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.
For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.
One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.
The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.
If you would like more information on trigeminal neuralgia, 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 “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”
Every year, thousands of children are born with a cleft palate, cleft lip or a combination of both. The advocacy group AmeriFace promotes the month of July as National Cleft & Craniofacial Awareness & Prevention Month to call attention to this potentially disfiguring defect—and to highlight treatments offered by dentists that can change the destiny of a child with a cleft defect.
Simply put, a cleft is a gap or opening in the palate (roof of the mouth) and/or upper lip. Cleft lips and palates result when structures that are forming in an unborn baby’s mouth and face don’t fuse together as they should during pregnancy. They can occur on either one side or on both sides of the face, in partial form (with some connecting tissue present) or completely open.
Clefts can cause severe disfigurement in a child, which may lead to a diminished self-image and disruption in relationships with others. A cleft can also compromise other aspects of a child’s health and life, including dental health, nutrition, respiratory function and speech development.
Doctors don’t always know why a particular baby is born with a cleft lip or palate, but clefts are thought to result from a combination of factors. Genetics most certainly plays a role, but there appear to be other influencing factors during pregnancy like nutritional deficiencies and fetal exposure to alcohol, radiation or toxic chemicals. In addition, having poorly controlled diabetes or being obese during pregnancy may increase the risk of the baby being born with cleft lip or cleft palate.
Managing known health conditions as well as striving for better prenatal nutrition and protection from environmental hazards may reduce the risks for cleft formation, even so, clefts do form. When they do, we can often effectively correct them, thanks to surgical procedures first developed by a military surgeon stationed in Korea in 1950.
While analyzing photos of cleft patients, Dr. Ralph Millard realized the tissue needed to repair a cleft was already present, but in a distorted form. He then experimented with surgical techniques that released the tissue so that it could be moved and fashioned into a normal appearance.
Dr. Millard’s original techniques remain the basis for today’s advanced procedures. Correction of a cleft lip or palate typically requires a series of procedures which can span the child’s developmental years. The first surgery usually occurs around 3-6 months of age, followed by later procedures to refine the earlier work. This process usually requires a team of dental specialists that includes oral surgeons, orthodontists and general dentists.
The road to restoration from a cleft birth defect can be a long one for children and their families, but the treatment methods developed over the last several decades can truly give them the gift of a normal life.
If you would like more information about cleft repair and other oral surgical procedures, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Cleft Lip & Cleft Palate: Common Birth Defects That Can Be Repaired Beautifully by Skilled Surgeons.”
There is a primary principle dentists follow regarding tooth decay—treat it as soon as you find it. Something as simple and routine as filling a cavity could prevent future tooth loss.
But treating a cavity at or below the gum line could be anything but simple and routine. Older adults who may also be dealing with gum recession are more likely to have these kinds of cavities where the gums block clear access to it.
But there is a way to access gum-covered cavities with a minor surgical procedure known as crown lengthening. Crown lengthening is commonly used in cosmetic dentistry to expose more of the visible teeth when there's an overabundance of gum tissue or if the teeth are disproportionately small. We can use it in this instance to surgically relocate the blocking gum tissue out of the way of the cavity.
After numbing the area with local anesthesia, tiny incisions will be made in the gums to create a tissue flap. After reshaping the underlying bone to recreate normal anatomy but at a different level, this flap is then moved and sutured to a new position. This exposes enough tooth structure so that the cavity can be repaired after gum healing.
As with any minor surgery, there's a very slight risk of bleeding and/or infection with crown lengthening. If you undergo this procedure, you'll receive post-care instructions for the first few days afterward including avoiding strenuous activities, eating only soft foods and using an ice pack the day of surgery to help control swelling.
This versatile procedure can help save a tooth that might otherwise be lost due to decay. And, it might even improve your appearance.
If you would like more information on treatment options for tooth decay, 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 “Crown Lengthening: This Common Surgical Procedure Restores Function and Improves Appearance.”
Regular dental visits are an important part of teeth and gum health at any age, including young children. But the clinical nature of a dental office can be intimidating to children and create in them an anxiety that could carry over into adulthood and disrupt future care.
You can, though, take steps to "de-stress" your child's dental visits. Here are 3 ways to reduce your child's dental anxiety.
Start visits early. Most dentists and pediatricians recommend your child's first visit around age one. By then, many of their primary teeth have already erupted and in need of monitoring and decay prevention measures. Beginning visits early rather than later in childhood also seems to dampen the development of dental visit anxiety.
Take advantage of sedation therapy. Even with the best calming efforts, some children still experience nervousness during dental visits. Your dentist may be able to help by administering a mild sedative before and during a visit to help your child relax. These medications aren't the same as anesthesia, which numbs the body from pain—they simply take the edge off your child's anxiety while leaving them awake and alert. Coupled with positive reinforcement, sedation could help your child have a more pleasant dental visit experience.
Set the example. Children naturally follow the behavior and attitudes of their parents or caregivers. If they see you taking your own hygiene practices seriously, they're more likely to do the same. Similarly, if they notice you're uncomfortable during a dental visit, they'll interpret that as sufficient reason to feel the same way. So, treat going to the dentist as an "adventure," with a reward at the end. And stay calm—if you're calm and unafraid, they can be too.
If you would like more information on effective dental care for kids, 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 “Taking the Stress out of Dentistry for Kids.”
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