Posts for: October, 2020
Before we begin correcting a malocclusion (poor dental bite), we need to ask a few questions: How extensive is the malocclusion? How far must we move the teeth to correct it? How might the patient's jaw size impact treatment?
Answering these and other questions help us develop an effective treatment plan. And depending on the answers, we might need to look at other procedures before we install braces—like removing one or more of the teeth.
This isn't a subject to approach lightly: All teeth play an important role in dental function and smile appearance, and ordinarily we want to preserve teeth, not remove them. Sometimes, however, it may be a necessary action to achieve our goal of an improved dental bite.
For example, it might be necessary for correcting a malocclusion caused by severe teeth crowding. This occurs when one or both of the jaws hasn't grown to a sufficient size to accommodate all of the teeth erupting on it. As a result, some of the teeth could come in out of their proper alignment.
If caught early before puberty, we may be able to use other techniques to alleviate crowding, like a device called a palatal expander that influences an upper jaw to widen as it grows. If successful, it could provide later teeth more room to erupt in their proper positions.
But even if additional jaw growth occurs, it may not be enough to avoid a malocclusion or treatment with braces. Alleviating further crowding by removing teeth in little noticed areas could help with subsequent orthodontics.
Removing teeth may also be the answer for other problems like an impacted tooth, in which the tooth has not fully erupted and remains submerged in the gums. It's sometimes possible to use a technique to “pull” the tooth down where it should be; but again, that will still require jaw space that may not be available. The more effective course might be to remove the impacted tooth.
Whether or not tooth extraction will be needed can depend on a thorough orthodontic evaluation and full consideration of all the available options. Even though the ideal situation is to correct a bite with all teeth present and accounted for, it may be for the better good to sacrifice some.
If you would like more information on orthodontic techniques, 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 “Removing Teeth for Orthodontic Treatment.”
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
Little things add up. Like your three meals a day, which could total over 87,000 by the time you're eighty. If you average a full night's sleep every night, you will have whiled away over a quarter of a million hours in slumber by your diamond birthday. And if you're the typical American, you will also have spent over 900 hours (or nearly 40 days) brushing your teeth.
If that last example sounds like a lot, it's actually not: If it's a daily habit, that's about two minutes of brushing a day. But that little bit of time could have an incredible impact on your dental health over a lifetime. That's why dental providers commemorate October as National Dental Hygiene Month to call attention to just how important those 900-plus hours can be to a healthy mouth.
Brushing is important because of what a few strains of bacteria can do to your oral health. While most of your mouth's microscopic inhabitants do no harm (and some are even beneficial), the malevolent few cause tooth decay and gum disease, both of which could lead to tooth loss.
These bacteria live in and feed off of a thin biofilm of food particles called dental plaque. Over time, plaque and tartar (a hardened, calcified form) can build up on tooth surfaces. As it grows, so does the mouth's bacterial population and the risk for disease. In fact, just a few days of undisturbed plaque growth is enough time for a gum infection to get started.
Brushing your teeth removes this plaque accumulation, which reduces the bacterial levels in your mouth. A thorough brushing of all surfaces usually takes about two minutes, but it must be done every day to keep plaque at bay. So, yes, a little time spent brushing every day can be a big deal. That said, though, it's not the be-all and end-all of oral hygiene. You should also floss daily since plaque accumulates just as readily in the spaces between teeth where brushing can't reach. We, along with the American Dental Association, recommend brushing twice a day and flossing once a day for optimal oral health.
But no matter how proficient you are with brushing and flossing, you may still miss some spots. Be sure, then, that you also see us regularly for dental cleanings to thoroughly clean your teeth of plaque and fully minimize your risk of dental disease.
Oral hygiene only takes a little of your time each day. But it does add up—not only in the “days” you'll spend doing it, but in a lifetime of better dental health.
If you would like more information about getting the most out of your daily oral hygiene, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”