While crooked teeth are usually responsible for a malocclusion (poor bite), the root cause could go deeper: a malformed maxilla, a composite structure composed of the upper jaw and palate. If that’s the case, it will take more than braces to correct the bite.
The maxilla actually begins as two bones that fit together along a center line in the roof of the mouth called the midline suture, running back to front in the mouth. The suture remains open in young children to allow for jaw growth, but eventually fuses during adolescence.
Problems arise, though, when these bones don’t fully develop. This can cause the jaw to become too narrow and lead to crowding among the erupting teeth and a compromised airway that can lead to obstructive sleep apnea. This can create a cross-bite where the upper back teeth bite inside their lower counterparts, the opposite of normal.
We can remedy this by stimulating more bone growth along the midline suture before it fuses, resulting in a wider maxilla. We do this by installing a palatal expander, an appliance that incrementally widens the suture to encourage bone formation in the gap, which over time will widen the jaw.
An expander is a metal device with “legs” extending out on both sides and whose ends fit along the inside of the teeth. A gear mechanism in the center extends the legs to push against the teeth on both sides of the jaw. Each day the patient or caregiver uses a key to give the gear a quarter turn to extend the legs a little more and widen the suture gap. We remove the expander once the jaw widens to the appropriate distance.
A palatal expander is an effective, cost-efficient way to improve a bite caused by a narrow jaw, but only if attempted before the bones fuse. Widening the jaw after fusion requires surgery to separate the bones — a much more involved and expensive process.
To make sure your child is on the right track with their bite be sure to see an orthodontist for an evaluation around age 6. Doing so will make it easier to intervene at the proper time with treatments like a palatal expander, and perhaps correct bite problems before they become more expensive to treat.
If you would like more information on treating malocclusions, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
Although it’s a natural part of dental development, teething is no picnic for your baby. This process in which each of their twenty primary teeth gradually erupt through the gums usually begins around their sixth to ninth month and may not end until around age three.
These periodic tooth eruptions can cause your baby to bite, gnaw, drool or rub their ears. Teething can also disrupt sleeping patterns, decrease appetite and cause gum swelling and pain that can turn your otherwise happy baby into an unhappy one.
Managing these teething episodes is one of the most common topics parents bring up with their dentists. Since teething is supposed to happen, there’s no need for medical intervention unless the child is also experiencing diarrhea, rashes, fever or prolonged irritability associated with teething episodes. In most cases, the best you can do is to make your child more comfortable. Here are a few things to help you do just that.
Provide cold items for gnawing. Rubber teething rings, wet wash cloths or pacifiers that have been chilled can give your child something to gnaw on and ease the pressure of sore gums while the chilled temperatures help numb pain. Be sure, though, that the items aren’t frozen because extremely cold temperatures can burn the skin.
Gum massage. You can massage your child’s gums with one of your fingers during a teething episode to counteract the throbbing pressure coming from the erupting tooth. Just be sure your finger is clean and don’t use any numbing agents unless advised by your dentist or pediatrician.
OTC medication. You can ease mild to moderate teething pain with over-the-counter pain relievers like acetaminophen or ibuprofen in dosages appropriate for your child’s age. But don’t apply rubbing alcohol to the gums or massage in any pain reliever—both practices can burn the skin. And, as mentioned before, only apply numbing agents like Benzocaine with the advice and supervision of a healthcare professional.
Besides these practices, be sure to keep up regular dental checkups to monitor the teething process and ensure all is going normally. And remember: though it may seem harrowing at times, the teething process won’t last forever.
If you would like more information on easing the effects of teething, 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 “Teething Troubles: How to Help Keep Your Baby Comfortable.”
While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.
“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.
Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.
Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).
For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.
Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.
If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”
Dental anxiety is a common problem: it’s estimated that one in two Americans admits to some level of nervousness about seeing the dentist. On the extreme side of this statistic about 15% of the population even avoid or postpone dental care because of it. While comedy shows routinely make fun of people’s fear of the dentist, the consequences of not receiving needed dental care due to dental anxiety are no laughing matter.
Fortunately, visiting the dentist doesn’t have to be a nerve-wracking, butterflies-in-the-stomach experience. Here are 3 ways to make sure your next visit is more pleasant.
The right dentist. Dental care is more than technical—it’s also personal and relational. The most important element for reducing dental visit anxiety is a provider you’re comfortable with and that you trust. It’s especially important for high anxiety patients to find a dentist who also has compassion for how they feel and won’t judge them—instead, working with them to find just the right combination of techniques and possible medications that encourage relaxation.
Oral sedation. For many people nervous about dental visits the answer could be prescribed sedation medication taken an hour or so before their appointment. Typically a mild sedative, the dose is just enough to help them relax. It’s also often coupled with other methods like nitrous oxide or local anesthesia for a pain-free and unstressed experience.
IV sedation. For people with high levels of anxiety, it’s often beneficial to increase the level of sedation. One of the best ways to do this is with an intravenous flow of medication that will place a person in a deeper state of relaxation. Although this method requires careful vital sign monitoring during the procedure, it’s often the best way to calm patients with high anxiety so they can receive the dental care they need.
Working with your dentist, you can develop just the right mix of these and other methods for making your dental visits easier. No matter what your level of anxiety, you don’t have to avoid the dentist nor needed dental care.
If you would like more information on reducing anxiety during dental visits, 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 “IV Sedation in Dentistry.”
What do a teenager with a poor bite, a senior citizen with multiple missing teeth or a middle-aged person with a teeth grinding habit all have in common? They may all depend on a dental appliance for better function or appearance.
There’s a wide variety of removable dental appliances like clear aligners or retainers for orthodontic treatment, dentures for tooth loss or night guards to minimize teeth grinding, just to name a few. But while different, they all share a common need: regular cleaning and maintenance to prevent them from triggering dental disease and to keep them functioning properly.
The first thing to remember about appliance cleaning is that it’s not the same as regular oral hygiene, especially if you have dentures. While they look like real teeth, they’re not. Toothpaste is a no-no because the abrasives in toothpaste designed for tooth enamel can scratch appliance surfaces. These microscopic scratches can develop havens for disease-causing bacteria.
Instead, use liquid dish detergent, hand soap or a specific cleaner for your appliance with a different brush from your regular toothbrush or a specialized tool for your particular appliance. Use warm but not very hot or boiling water: while heat indeed kills bacteria, the hot temperatures can warp the plastic in the appliance and distort its fit. You should also avoid bleach—while also a bacteria killer, it can fade out the gum color of appliance bases.
Be sure you exercise caution while cleaning your appliance. For example, place a towel in the sink basin so if the appliance slips from your hands it’s less likely to break hitting the soft towel rather than the hard sink. And while out of your mouth, be sure you store your appliance out of reach of small children and pets to avoid the chance of damage.
Cleaning and caring for your appliance reduces the risk of disease that might affect your gums or other natural teeth. It will also help keep your appliance working as it was designed for some time to come.
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