At your child's latest dental visit, you found out one of their primary (“baby”) teeth has become decayed and in danger of loss. Of course, you may think, it's only a primary tooth — it's going to come out sooner or later.
But a primary tooth lost “sooner” rather than “later” can create long-term negative consequences for your child's dental health. For the sake of the future permanent tooth, the best treatment strategy could be to put forth the effort and expense to save it.
Besides its role in eating and chewing, a primary tooth's most important function is as a “trailblazer” for the permanent tooth developing below it. A primary tooth doesn't normally loosen and let go until the new permanent tooth is ready to erupt. Until then they hold the new tooth's space in the jaw.
But if the primary tooth is lost prematurely, nearby teeth can drift into and crowd the space so that the permanent tooth comes in out of position. This can result in a malocclusion, or poor bite.
Depending on the state of your child's jaw development, it may be advisable to attempt saving the tooth through a filling or, in the case of deep decay, a modified root canal treatment. If the tooth can't be saved, then placing an orthodontic appliance known as a space maintainer might be necessary. Cemented to a tooth next to the empty space, this appliance has a looped band of metal that butts against the tooth on the other side of the gap, and prevents both teeth from drifting into the space.
Intervening for a decayed primary tooth can seem a waste of time and money since it has a limited lifespan to begin with. But for the health of its companion permanent tooth, as well as possibly avoiding orthodontic treatment, it could be well worth it for your child's long-term dental health.
If you would like more information on dental care for your child, 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 “Importance of Baby Teeth.”
Although usually an orderly process, some permanent teeth don't come in as they should. In fact, they may not come in at all and remain hidden in the gum — a situation called impaction. This creates multiple problems for function, health and, in the case of front canines, appearance.
Canines are the longer and more pointed teeth on each side of the front-most incisors. They help tear and cut food during chewing, a function impaction eliminates. Besides a higher risk for developing abscesses (isolated areas of infection) and cysts, they can also put pressure on neighboring teeth and damage their roots or cause them to erupt abnormally.
Dentists often remove impacted wisdom and other back teeth to lessen these potential problems. Removing canines, though, has additional considerations: besides compromising ideal chewing function, missing canines often create an unattractive smile.
But before considering removal, there's another technique we might be able to use to save the canines and actually draw them down through the gums to their correct position. It's usually part of an overall orthodontic plan to correct a poor bite (malocclusion).
After pinpointing their exact position with x-rays or CT scanning, a surgeon surgically exposes the impacted canines' crowns through the gums. They then bond small brackets to the crowns and attach a small gold chain to each bracket. They fasten the other end of the chains to orthodontic hardware that exerts downward pressure on the impacted teeth. Over several months this pressure can help move the teeth into their normal positions.
Unfortunately, this technique isn't always advisable: one or more of the impacted teeth may be in a difficult position to attempt it. It's usually best in these situations to remove the teeth, usually sooner rather than later for the sake of neighboring teeth.
Fortunately, with today's advanced restorative techniques, we can eventually replace the canines with dental implants, although that's best undertaken after the patient enters adulthood. In the meantime, we can utilize orthodontic means to preserve the open space and provide a temporary restorative solution.
Whatever route taken, these teeth don't have to become a source of problems, especially for your appearance. Whether through orthodontics or restorative dentistry, impacted canines don't have to ruin your smile.
If you would like more information on various orthodontic 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 “Exposing Impacted Canines.”
One of the biggest concerns we hear from parents is about their child's thumb sucking habit. Our advice: if they're under age 4, there's no need for concern — yet. If they're older, though, you should be concerned about the possible effect on their bite.
Thumb sucking is a universal habit among infants and toddlers and is related to their swallowing pattern during feeding. As they swallow, their tongue thrusts forward to create a seal with the lips around the breast or a bottle nipple. Many pediatricians believe thumb sucking replicates nursing and so has a comforting effect on infants.
Around age 4, though, this swallowing pattern begins to change to accommodate solid food. The tongue now begins to rest at the back of the top front teeth during swallowing (try swallowing now and you'll see). For most children, their thumb sucking habit also fades during this time and eventually stops.
But for whatever reason, some children don't stop. As the habit persists, the tongue continues to thrust forward rather than toward the back of the top front teeth. Over time this can place undue pressure on both upper and lower front teeth and contribute to the development of an open bite, a slight gap between the upper and lower teeth when the jaws are shut.
While late childhood thumb sucking isn't the only cause for an open bite (abnormal bone growth in one jaw is another), the habit is still a prominent factor. That's why it's important that you start encouraging your child to stop thumb sucking around age 3 and no later than 4. This is best accomplished with positive reinforcement like rewards or praise.
If they've continued the habit a few years after they should have stopped, we may also need to check to see if their swallowing mechanism has become stunted. If so, we may need to use certain exercises to retrain their tongue to take the proper position during swallowing.
While you shouldn't panic, it's important to take action to stop thumb sucking before it becomes a long-term problem. A positive, proactive approach will help avoid costly orthodontic problems later in their lives.
If you would like more information about thumb or finger 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.”
For over three decades, veneers have helped mask dental imperfections like chipping, staining or gaps and improve the appearance of millions of teeth. As the name implies, this thin layer of porcelain covers a tooth's visible surface and accurately mimics the texture, color and translucence of natural teeth.
Veneers could be just the solution you need for a more attractive smile. But before you begin treatment, be sure you have these 3 essentials in place to ensure a successful outcome.
True expectations. While the transformation of a tooth's appearance with a veneer can be astounding, veneers in general do have their limitations. You need an adequate amount of the tooth's structure present for a veneer to properly adhere — if not, you may need to consider a porcelain crown instead. Likewise, gaps and other misalignments may be too great for a veneer to cover: in that case, you should consider orthodontics. A thorough examination beforehand will determine if veneers are the best option for you.
An artisan team. Every veneer is custom made to match an individual patient's tooth shape and color, handcrafted by a skilled dental technician. There's also an art to the dentist preparing the tooth beforehand and then properly positioning the veneer for bonding to achieve the most attractive result. Be sure, then, that your veneer "team" comes highly recommended by others.
The best materials. The first porcelains were powdered glass ceramics mixed with water to form a paste. Technicians shaped the paste in successive layers and as it oven-cured it took on the beautiful translucence of natural teeth. Unfortunately, this type of porcelain could be brittle and prone to shattering when subjected to heavy biting forces. In recent years, though, we've begun to use ceramics reinforced with other materials like Leucite for added strength. Today, the materials dentists use have much better durability.
If you would like more information on porcelain veneers, 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 “Porcelain Veneers.”
Thanks to treatments like chemotherapy and radiation, your chances of surviving cancer are greater than ever. These treatments, however, often produce unwelcome side effects. Treating throat or oral cancer, for example, could damage your mouth's salivary glands or bone.
Saliva is essential to oral health, providing antibodies to curb the growth of disease-causing bacteria and neutralizing acid, which can erode enamel. But salivary glands damaged during cancer treatment may not be able to produce enough saliva. The resulting “dry mouth” creates an environment conducive to bacterial growth and elevated acid levels.
You can help reduce the effects of dry mouth during your treatment (and after, if the damage is permanent) by drinking more water or by using substances that stimulate saliva. Cutting back on acidic foods and beverages will also help lower your mouth's acidity. And be sure to keep up daily oral hygiene and regular dental visits.
The more ominous threat to oral health during cancer treatment, though, is osteoradionecrosis. This occurs when radiation targets specific areas of bone. The bone can lose blood supply and living cellular tissue, which inhibit its ability to heal or replenish itself. If this occurs in the jawbone of teeth that may be lost, the bone tissue could be adversely affected during healing.
Depending on your treatment needs, your risk for osteoradionecrosis might be unavoidable if teeth are to be lost. It's important we discuss that risk because it could impact future dental treatment. In the worst case, before cancer treatment, we may not be able to save affected teeth and your restorative options might be limited.
If your risk of osteoradionecrosis is minimal, though, we may be able to restore any resulting damaged or missing teeth with a wide range of options like dental implants or crowns before or after your cancer treatment.
As with other aspects of health, taking care of your teeth and gums while undergoing cancer treatment can be challenging; some problems may be unavoidable. But with a proper dental treatment plan during and after chemotherapy and radiation, we can minimize those problems and help to eventually restore your smile.
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