Posts for: September, 2016
Orthodontic treatment is a big investment. But given the benefits for future good health and a more attractive smile, it's well worth it.
In the here and now, though, braces wearers face a different threat to their dental well-being — dental disease. Wearing braces can actually increase the risk of disease and make it more difficult to fight.
Tooth decay and periodontal (gum) disease, the two most common forms of dental disease, usually arise from plaque, a thin film of bacteria and food particles on tooth surfaces. The bacteria produce acid, which erodes enamel and makes the teeth susceptible to decay. Certain bacteria can also infect the gums and eventually weaken their attachment to teeth. Thorough brushing and flossing everyday removes this disease-triggering plaque buildup.
But braces' hardware can make brushing and flossing more difficult. The brackets attached to the teeth and wires laced through them make it more difficult for floss and brush bristles to access all the areas around the teeth. Plaque can build up in certain spots; it's estimated braces wearers have two to three times the plaque of a person not wearing braces. Acid can also remain in contact with some of the enamel surface for too long.
It's important, therefore, if you wear braces to make a concerted effort to brush and floss thoroughly. Besides improving technique and taking more time, you might also consider additional aids. You can obtain toothbrushes specially designed for use with braces, as well as floss holders or threaders that make it easier to access between teeth. Another flossing alternative is an oral irrigator that sprays water under pressure between teeth is an alternative to flossing.
As a precaution against acid damage, we can boost enamel protection with additional fluoride applied to your teeth. We may also prescribe antibacterial rinses to keep the bacteria population low.
Above all, be sure to look out for signs of disease like swollen or bleeding gums or pain. As soon as you sense something out of the ordinary, be sure and contact us.
If you would like more information on keeping your teeth disease-free while wearing braces, 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 “Caring for Teeth During Orthodontic Treatment.”
There's something universal about thumb sucking: nearly all babies do it, and nearly all parents worry about it. While most such worries are unfounded, you should be concerned if your child sucks their thumb past age of 4 — late thumb sucking could skew bite development.
Young children suck their thumb because of the way they swallow. Babies move their tongues forward into the space between the two jaws, allowing them to form a seal around a nipple as they breast or bottle feed. Around age 4, this “infantile swallowing pattern” changes to an adult pattern where the tip of the tongue contacts the front roof of the mouth just behind the front teeth. At the same time their future bite is beginning to take shape.
In a normal bite the front teeth slightly overlap the bottom and leave no gap between the jaws when closed. Â But if thumb sucking continues well into school age, the constant pushing of the tongue through the opening in the jaws could alter the front teeth's position as they erupt. As a result they may not fully erupt or erupt too far forward. This could create an open bite, with a gap between the upper and lower teeth when the jaws are closed.
Of course, the best way to avoid this outcome is to encourage your child to stop thumb sucking before they turn four. If, however, they're already developing a poor bite (malocclusion), all is not lost — it can be treated.
It's important, though, not to wait: if you suspect a problem you should see an orthodontist for a full evaluation and accurate diagnosis. There are even some measures that could discourage thumb sucking and lessen the need for braces later. These include a tongue crib, a metal appliance placed behind the upper and lower incisors, or exercises to train the tongue and facial muscles to adopt an adult swallowing pattern. Often, a reward system for not sucking their thumbs helps achieve success as well.
Thumb-sucking shouldn't be a concern if you help your child stop before age 4 and keep an eye on their bite development. Doing those things will help ensure they'll have both healthy and straight teeth.
If you would like more information on thumb sucking, 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 “How Thumb Sucking Affects the Bite.”
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.”
If you're considering dental implants to replace one or more missing teeth, you'll need to undergo a minor to moderate surgical procedure (depending on the number of implants) to install them. Depending on your current health status and medical history, you may need antibiotics before or after the procedure to help ensure a successful outcome.
Although implants have a high success rate (over 95%), they can still fail — and bacterial infection is a major culprit. Installing implants requires surgically accessing the bone through the gum tissues; you may also need other invasive procedures like tooth extraction or bone or gum tissue grafting. These disruptions to the soft tissues can introduce bacteria into the bloodstream.
In certain individuals, this can increase infection risk not only around the implant but also in other parts of the body. You may be at higher risk, for example, if you have serious health problems like cardiovascular disease or diabetes, a weakened immune system, you use tobacco or you're over or under normal weight. The American Dental and American Heart Associations both recommend antibiotics before dental implant surgery as a preventive measure against infection if you have a prosthetic heart valve, a history of infective endocarditis, a heart transplant or some congenital heart conditions.
For other patients with low to moderate risk for infection, there's vigorous debate on administering antibiotics before implant surgery. There are some side effects to antibiotic use, ranging from diarrhea to allergic reactions, and an increased concern in general to the developing resistance of many infectious agents due to the prevalent use of antibiotics. Many dentists and physicians are becoming more discriminate in the patients for which they prescribe antibiotics before surgical procedures.
It really comes down, then, to your particular case: not only the specific procedures you need but also your general health. After weighing these factors against the possible benefits for protecting your health and improving your odds of a successful outcome, we'll recommend whether antibiotic treatment for implants is right for you.
After a long struggle with dental disease, you have finally lost the last of your remaining teeth.Â Like over a quarter of Americans in their 60s and 70s, this unfortunate development can have a profound impact on your health and self-image.
While there are a number of advanced methods for replacing lost teeth, there's one tried and true option that's centuries old — the removable denture. It's the option millions of people have chosen to lessen the impact of missing teeth.
Fashioned properly, removable dentures restore the form and function you once had with your natural teeth. The prosthetic (false) teeth are precisely placed in an acrylic, gum-colored base that closely follows the contours of your gums. Because they're removable, they're fairly easy to clean and maintain.
They do have a disadvantage, though, and it's related to bone health after tooth loss. Like other living tissues, bone has a life cycle: as older cells die, new cells form to take their place. The forces your teeth generate when you chew stimulate new bone growth. But without teeth to provide this stimulation, new bone won't keep up the pace of replacement at a healthy rate. As a result you may gradually lose bone, as much as a quarter of its normal width within a year of losing a tooth.
Dentures don't transmit any stimulation to the gum and bone from chewing. Furthermore, the compressive forces transmitted to the gum and underlying bone tissue contributes to bone loss. As the bone continues to diminish, your denture fit becomes looser to the point you will eventually need them relined with new acrylic material or have a new set made.
There is another alternative when patients loose all of their teeth: an implant-supported removable denture. Dental implants can be used to keep the dentures more secure and can also slow or even halt bone loss where the implants are placed. In this case we strategically place a few implants to serve as supports for a removable denture. The denture has connection points that join up with the implants to hold it more securely in place. As few as two implants are needed in the lower jaw, while the upper jaw does better with three or four implants.
Losing all your teeth can be traumatic, but there are effective ways to overcome it. With new technology, the traditional restoration of removable dentures may be the vehicle for achieving that.
If you would like more information on restoring missing teeth with 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 “Removable Full Dentures.”