Posts for: May, 2017
Primary (baby) teeth might not last long, but their impact can last a lifetime. Their first set of teeth not only allows young children to eat solid foods, but also guide permanent teeth to form and erupt in the proper position.
Unfortunately, primary teeth aren't immune to tooth decay. If the decay is extensive, the tooth may not last as long as it should. Its absence will increase the chances the permanent teeth won't come in correctly, which could create a poor bite (malocclusion) that's costly to correct.
If a primary tooth is already missing, we can try to prevent a malocclusion by installing a “space appliance.” This keeps nearby teeth from drifting into the empty space intended for the permanent tooth. The best approach, though, is to try to save a primary tooth from premature loss.
We can often do this in much the same way as we would with a permanent tooth — by removing decayed material and filling the prepared space. We can also perform preventive applications like topical fluoride or sealants that strengthen or protect the tooth.
It becomes more complicated, though, if the pulp, the interior of the tooth, becomes decayed. The preferred treatment for this in a permanent adult tooth is a root canal treatment. But with a primary tooth we must also consider the permanent tooth forming below it in the jaw and its proximity to the primary tooth. We need to adapt our treatment for the least likely damage to the permanent tooth.
For example, it may be best to remove as much decayed structure as possible without entering the pulp and then apply an antibacterial agent to the area, a procedure known as an indirect pulp treatment. We might also remove only parts of the pulp, if we determine the rest of the pulp tissue appears healthy. We would then dress the wound and seal the tooth from further infection.
Whatever procedure we use will depend on the extent of decay. As we said before, our number one concern is the permanent tooth beneath the primary. By focusing on the health of both we can help make sure the permanent one comes in the right way.
If you would like more information on caring for children's primary teeth, 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 “Root Canal Treatment for Children's Teeth.”
Most children's permanent teeth erupt on a fairly predictable schedule. Sometimes, though, one or more teeth might not develop as they should — or at all.
These absent teeth pose functional problems for chewing and hygiene, which can affect long-term dental health. But they can also have a disruptive effect on an otherwise attractive smile if the missing teeth are the upper lateral incisors in the most visible part of the smile.
You normally find this pair of teeth on either side of the upper central incisors (the two front-most teeth). On the other side of the lateral incisors are the canine or eye teeth, known for their pointed appearance. Without the lateral incisors, the canines tend to drift into the space next to the central incisors. This can produce an odd appearance even a layperson will notice: only four teeth where there should be six!
It's possible to correct this abnormality, but it will take time and expense. The first step is usually to move the teeth in the upper jaw with braces to their correct position. This puts teeth where they should be and also opens space between the canines and central incisors so we can eventually replace the missing teeth with dental implants.
But the key to all this is timing. It's usually appropriate to undertake tooth movement with braces during late childhood or adolescence. But implants shouldn't be installed until the person's jaw fully matures, usually in early adulthood. An implant placed before then could eventually become misaligned.
To accommodate the time between bite correction and implant placement, the patient can wear a retainer appliance that will keep the newly created space open. We can also attach artificial teeth to the retainer to camouflage the empty space.
It usually takes a team of a family dentist, an orthodontist and a surgeon to see this kind of “smile makeover” project through, possibly over several years. But the gains in better aesthetics and health are well worth the time and expense.
If you would like more information on replacing non-developing teeth, 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 “When Permanent Teeth Don't Grow.”
Sleep apnea is more than an annoyance. This chronic condition not only interferes with your alertness during the day, it may also contribute long-term to serious issues like cardiovascular disease.
Sleep apnea occurs when your airway becomes temporarily blocked during sleep. Of the possible causes, one of the most common is the tongue, which as it relaxes may cover and block the back of the throat. This lowers the body's oxygen level, which in turn alerts the brain to wake you to clear the airway. You usually go immediately back to sleep, unaware you've wakened. This can happen several times a night.
Although older people are at higher risk, anyone can have sleep apnea, even children with enlarged tonsils or adenoids. If you or a loved one regularly experiences fatigue, brain fog, irritability or loud snoring, sleep apnea could be the culprit. You'll need a complete medical examination to properly diagnose it.
If you do indeed have sleep apnea, there are a number of ways to treat it depending on its severity. One prominent way is with a Continuous Positive Airway Pressure (CPAP) machine that produces a higher air pressure in the mouth to force the tongue forward and keep the airway open.
While CPAP is effective, the pump, hose and face mask you must wear may become uncomfortable while you sleep. We may, however, be able to supply you with a less cumbersome device: a custom-made oral appliance you wear while you sleep. Similar to a retainer, this appliance mechanically pulls and holds the lower jaw forward, which in turn moves the tongue away from the airway opening.
This oral appliance won't work with all forms of sleep apnea, so you'll need an examination to see if you're a candidate. With more advanced conditions, you may even need surgery to reshape the airway or remove soft tissue obstructions around the opening.
Whichever treatment is best for your situation, it's well worth reducing your sleep apnea. Not enduring these nightly incidences of airway blockage will help ensure you're getting a good night's sleep — and enjoying a higher quality of health and life.
If you would like more information on treating sleep apnea, 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 “If You Snore, You Must Read More!”
There are plenty of options today for replacing missing teeth, including dental implants. But if the teeth have been missing for some time, complications can arise that limit your restorative options.
The most consequential possibility is bone loss. Bone has a life cycle: old cells dissolve (resorb), and are then replaced by new cells, stimulated to grow by the forces applied to the teeth during chewing. But the bone won't receive this stimulation if a tooth is missing — so growth slows down, which causes the bone volume to diminish with time.
Another complication can occur involving other teeth around the open space. These teeth will naturally move or “drift” out of their normal position into the missing tooth space. As a result we may not have enough room to place a prosthetic (false) tooth.
If either or both of these complications occur, we'll need to address them before attempting a restoration. Bone loss itself could eliminate dental implants as an option because they require a certain amount of supporting bone for correct placement. Bone loss could also make correcting misaligned teeth difficult if not impossible.
It might be possible, though, to regenerate lost bone with a bone graft. The graft is placed, sometimes along with growth stimulating substances, within the diminished bone area. It then serves as a scaffold upon which new bone can form.
If the bone becomes healthy again, we can then attempt to move any drifted teeth back to where they belong. Besides braces, there's another treatment option especially popular with adults: clear aligners. These are a series of removable, clear plastic trays that, like braces, exert gradual pressure on the teeth to move them. Patients wear each individual tray for about two weeks, and then switch to the next tray in the series to continue the process.
Unlike their traditional counterparts, clear aligners can be removed for cleaning or for special occasions. More importantly, they're much less noticeable than traditional braces.
Once any problems with bone health or bite have been addressed and corrected, you'll have a fuller range of options for replacing your missing teeth. With a little extra time and effort, you'll soon be able to regain a smile you'll be proud to display.
Refined sugar is a prime food source for disease-causing oral bacteria. As bacteria consume sugar they produce high levels of acid that over time can erode enamel and leave a tooth vulnerable for decay.
The solution to stopping this vicious process is simple: cut back on eating refined sugar. The reality, though, is a bit more complicated. Many of us seem genetically hard-wired with a “sweet tooth,” perhaps a remnant of our early ancestors' sense that sweet foods were a safe means to obtain energy.
Food manufacturers likewise don't help with making this dietary change — the number of items with added sugar has ballooned over the last several decades. We can trace a lot of this back to the unintended consequences of past government guidelines that called for removing fat from processed foods. But this also removed flavor, so manufacturers began adding sugar (under a myriad of names) to compensate.
Sugar consumption is now a hot health topic for its suspected connection with inflammatory diseases like diabetes and cardiovascular disease, as well as dental health. We now have a love-hate relationship with sugar — we want to show it the door but we can't quite bring ourselves to let it go.
The situation has created a market for artificial sweeteners. The amount and types of sugar alternatives has exploded since saccharine first emerged in the early 1960s. With these increased choices, though, there have also been increased concerns over their health impact, including in the mouth.
This concern has prompted numerous research studies. The conclusion: artificial sweeteners don't adversely affect the health of most people. And, from a dental perspective, artificial sweeteners can have a positive impact on teeth and gum health because unlike refined sugar they don't promote oral bacterial growth.
In fact, one particular sweetener may be even more beneficial to your teeth: xylitol. This sweetener, which comes from a sugar alcohol that oral bacteria can't digest, is often found in chewing gums, hard candies or mints. Â In effect, xylitol “starves out” bacteria to help prevent tooth decay.
From a dental perspective, replacing sugar with an artificial sweetener (especially xylitol) can be advantageous. And less sugar could mean more good news after your next dental checkup.
If you would like more information on artificial sweeteners, 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 “Artificial Sweeteners.”