Your child's permanent teeth come in gradually, starting just as they begin losing their primary ("baby") teeth and not ending until late adolescence or early adulthood. That's when the third molars or "wisdom teeth" close out the process.
Because of their late arrival, wisdom teeth have a high potential for dental problems. With a greater chance of crowding or obstruction by other teeth, wisdom teeth often get stuck fully or partially below the gums and bone (impaction) or erupt out of position. In one study, 7 in 10 people between the ages of 20 and 30 will have at least one impacted wisdom tooth at some time in their lives.
It's not surprising then that wisdom teeth are among the most extracted teeth, to the tune of about 10 million per year. Besides those already diseased or causing bite problems, many are removed preemptively in an attempt to avoid future problems.
But wisdom teeth usually require surgical extraction by an oral surgeon, which is much more involved than a simple extraction by a general dentist. Given the potential consequences of surgical extraction, is it really necessary to remove a wisdom tooth not creating immediate problems?
That's not an easy question to answer because it's often difficult to predict a wisdom tooth's developmental track. Early on it can be disease-free and not causing any problems to other teeth. But as some researchers have found, one in three wisdom teeth at this stage will later develop disease or create other issues.
For many dentists, the best approach is to consider extraction on a case by case basis. Those displaying definite signs of problems are prime for removal. But where there are no signs of disease or other issues, the more prudent action may be to keep a watchful eye on their development and decide on extraction at some later date.
More than likely, your dentist will continue to have an ongoing discussion with you about the state of your child's wisdom teeth. While extraction is always an option, wisdom teeth that aren't yet a problem to dental health may be best left alone.
A lot of cosmetic dental procedures focus on how teeth look: whether they're stained, chipped or otherwise disfigured. But a true smile makeover requires looking beyond individual teeth appearance and asking if they're properly aligned. Your teeth may be beautiful in and of themselves, but they could detract from your smile if they're not straight.
Orthodontics—the dental specialty dedicated to correcting poor bites—can be just as important to your smile appearance as veneers, crowns or other restorations. Cosmetic enhancement, though, isn't an orthodontist's only priority: a poor bite can interfere with dental function and oral hygiene, so repairing it and making sure the teeth "bite" together correctly is just as important to your health.
Your first step is to undergo a comprehensive orthodontic exam. Its purpose is two-fold: to diagnose the nature of your particular bite problem; and to determine if your mouth is healthy enough to undergo the necessary treatment to correct it. From here, your orthodontist will propose a treatment plan to correct your particular bite problem.
Although a number of orthodontic appliances may be used, the most likely tools employed will be either fixed braces or removable clear aligners. Both of these use the mouth's natural ability to move teeth by applying subtle pressure on the teeth and supporting periodontal structures for a period of time.
While braces are effective, if you're an adult or teenager and nothing in your bite situation would preclude their use, you may choose clear aligners. Aligners are a sequence of plastic mouth trays that are computer-generated based on the patient's mouth impression. Patients wear the trays in succession, each slightly smaller than the previous one, until they complete the series.
People often prefer aligners over braces for a couple of reasons. Unlike fixed braces, you can take them out of your mouth for eating, cleaning or special occasions. And because they're clear, they're nearly invisible to others and so less embarrassing than metal braces.
Whichever method, you'll be under the supervision of a trained dentist or orthodontist who will monitor your progress and make treatment adjustments as necessary to keep you on course. It takes a lot of skill to make sure the bite fits together correctly. Remember, the plastic aligner is always between your teeth. Making sure your teeth come together is something a dentist must supervise or else it may not allow your teeth to fit together properly. In the end, you could have an entirely new smile that's healthier and more attractive—let's just make sure the bite is correct as well.
If you would like more information on gaining a straighter, more attractive smile, 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 “The Magic of Orthodontics: The Original Smile Makeover.”
As Spring turns to Summer, millions of students will depart high school in the time-honored rite of passage called graduation. At the same time, quite a few of these graduates will be experiencing another maturity milestone: the eruption (coming in) of their last permanent teeth.
Typically, these are the back third molars, better known as “wisdom teeth,” emerging on either end of both the top and bottom jaws sometime between the ages of 18 and 24. Their arrival heralds the end of a long development process that began in infancy.
But this auspicious event can give rise to dental problems. Because they’re the last to come in, wisdom teeth often erupt in an environment crowded by earlier teeth. Depending on jaw size and other factors, there may not be enough room for a normal eruption.
Wisdom teeth can thus erupt out of position, creating a poor bite (malocclusion). Or they might not erupt at all—becoming stuck fully or partially within the gums and bone, a condition known as impaction. Impacted teeth can also cause problems for the adjacent teeth, damaging the roots of the second molars or disrupting the surrounding gum tissue, making them more susceptible to periodontal (gum) disease.
Because of these and other issues, impacted wisdom teeth are among the most common type of teeth removed: an estimated 10 million each year. And many of these are removed before they show signs of disease or complications as a preemptive strike against developing dental problems.
Although unnecessary surgery should always be avoided, according to some research, there’s a one in three chance that erupting wisdom teeth that are not showing signs of trouble will eventually become problematic. And the earlier they’re removed, the lower the risk of post-extraction complications.
Wisdom teeth should always be evaluated on a case by case basis. Those with obvious signs of disease or complications do require prompt treatment, including possible extraction. Others that are asymptomatic can be monitored over time: If they’re tending to become problematic, we can adjust the treatment plan accordingly. Our goal is to ensure these particular teeth signaling the end of childhood won’t detract from dental health in adulthood, so a measured approach seems to be the best and safest one.
If you would like more information on treatment options for wisdom teeth, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Wisdom Teeth: Coming of Age May Come With a Dilemma” and “Wisdom Teeth: To Be or Not to Be?”
Teeth whitening or bleaching is one of the most affordable and least invasive ways of improving your smile. Although the effect fades with time, whitening can make dull and dingy teeth more attractive in short order.
Teeth whitening is also unique among cosmetic dental procedures in that you can do it yourself at home. While professional bleaching solutions are stronger and capable of greater brightness and longevity, you can still achieve good results with a DIY kit.
If you decide to whiten at home, though, there are a few things to keep mind for a desirable and safe outcome. Here are 3 tips for successful DIY teeth whitening.
Follow the directions. It's not a good idea, both for a successful and safe outcome, to stray away from a kit manufacturer's recommended directions. FDA-approved home kits usually contain 10% or less of carbamide peroxide (one of the more common bleaching agents). That may not seem very strong but it's adequate within the recommended time it remains on your teeth to achieve an effective whitening effect. Exceeding those directions could permanently damage your tooth enamel.
Make sure a home kit will work on your staining. Home whitening kits only affect outer staining on tooth enamel. But dental discoloration can also arise from inside a tooth, often because of trauma, tetracycline use, or as a side effect of a root canal treatment. This kind of internal staining requires a special procedure usually performed by an endodontist to reduce it. So, see your dentist first to make sure your teeth are healthy enough for whitening and that a home kit will work for you.
Get your dentist's advice on home kits. There are a number of whitening applications on the market you can choose, so ask your dentist for recommendations. They can also give you some helpful tips on the whitening process to ensure you'll be safe and successful in your efforts.
Here's a couple of other things to remember to enhance your teeth whitening experience: whether you whiten your teeth at home or with the dentist, be sure you continue to care for your teeth with daily brushing and flossing. And, if you limit your consumption of foods and beverages known to stain teeth, you'll help extend the duration of your brighter smile.
If you would like more information on teeth whitening procedures, 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 Whitening Safety Tips.”
Although cancer treatment has advanced steadily in recent decades, the most used therapies continue to be radiation and chemotherapy to eradicate cancerous cells. And while they often work, both can cause "collateral damage" in healthy tissues near the targeted cells.
This can create a number of indirect consequences for a patient's health, including in the mouth. The salivary glands, for example, can be damaged by radiation treatments aimed at the head or neck. The effect on these glands can interrupt the normal flow of saliva and cause xerostomia or "dry mouth."
Lack of adequate saliva causes more than an unpleasant, sticky mouth feeling. One of saliva's main functions is to neutralize acid that builds up naturally after eating. Without it, high acid levels can cause enamel and root surface erosion and lead to tooth decay.
Cancer treatment can also contribute to gastro-esophageal reflux disease (GERD). This disease causes stomach acid to bypass the natural tissue barriers of the esophagus and enter the mouth. As with dry mouth, the increased acid level from GERD can be just as devastating to enamel—and the damage will be permanent.
To minimize these effects on your dental health, it's important to take proactive steps before, during and after cancer treatment. If at all possible, have any needed dental work performed before you begin radiation or chemotherapy—it's better to start it with teeth and gums as healthy as possible.
During treatment, try to continue regular dental visits to monitor your oral health and receive any needed preventive or therapeutic treatments. Depending on your condition and the advice of your dentist, you may need to increase your visit frequency during this time. Your dentist can help with boosting your saliva production and strengthening your tooth enamel. But you should also practice daily brushing and flossing, drink plenty of water and seek treatment for any resulting GERD symptoms.
Even with the best efforts, though, your teeth and gums may still incur damage while treating your cancer. Fortunately, there are a wide array of materials and procedures that can effectively restore them to health. So, once your treatments are completed consult with a dentist on your options for improving the health and appearance of your teeth and gums.
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