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Posts for tag: orthodontic treatment

BeontheAlertforWhiteSpotsonTeethWhileWearingBraces

While wearing braces is the path to a healthier and more attractive smile, it can be a difficult journey. One of your biggest challenges will be keeping your teeth clean to avoid a higher risk of tooth decay.

Tooth decay starts with dental plaque, a thin film of bacteria and food particles that accumulates on teeth. Daily brushing and flossing clear this accumulation. But the hardware of braces makes it difficult to access all tooth surfaces, and can even become a haven for plaque.

One sign in particular of tooth decay while wearing braces is the appearance of chalk-like spots on the teeth known as white spot lesions (WSLs). WSLs occur because the minerals in the enamel beneath them have begun to break down in response to decay. The spots can eventually cause both structural and cosmetic problems for a tooth.

The best approach to WSLs is to prevent them from developing in the first place. You'll need to be extra vigilant with daily oral hygiene while wearing braces to reduce plaque buildup. To help with the increased difficulty you might consider using a special toothbrush designed to maneuver more closely around orthodontic hardware. You may also find using a water flosser to be a lot easier than flossing thread.

Preventing tooth decay and WSLs also includes what you eat or drink to reduce the effects of enamel de-mineralization. The bacteria that cause decay thrive on sugar, so limit your intake of sweetened foods and beverages. And to avoid excessive demineralization cut back on acidic foods as well.

If despite your best preventive efforts WSLs still form, we can take steps to minimize any damage. For one, we can give your enamel a boost with fluoride applications or other remineralization substances. We can also inject a tooth-colored resin beneath the surface of a WSL that will make it less noticeable.

With any of these and other treatments, though, the sooner we can treat the WSL the better the outcome. Practicing good hygiene and dietary habits, as well as keeping an eye out for any WSL formations, will do the most to protect your new and improved smile.

If you would like more information on preventing dental disease while wearing braces, 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 “White Spots on Teeth During Orthodontic Treatment.”

EarlyOrthodonticTechniquesCouldStopGrowingBiteProblems

The longer many health problems go on, the worse they become. Treating them as early as possible could stop or slow their development.

That holds true for poor bites: while we can certainly correct them later in life, it's often better to "intercept" the problem during childhood. Interceptive orthodontics attempts to do this with treatments that influence how the jaws and other mouth structures develop during childhood. Many of these techniques are usually best implemented before puberty.

For example, some very complex problems called cross bites can occur if the upper jaw grows too narrowly. We might be able to stop this from happening by using an orthodontic appliance called a palatal expander during the childhood years. It works because the bone at the center of the palate (roof of the mouth) has a gap running back to front until the early teens when the gap closes.

We fit the palatal expander up under and against the palate, then extend out metal arms from a center mechanism to the back of the upper teeth that exert outward pressure on them. This widens the center gap, which the body continually fills with bone as the device gradually exerts more pressure. Over time this causes the jaw to widen and lessens the cross bite. Timing, though, is everything: it's most effective before the gap closes.

Another way to aid jaw growth is a Herbst appliance, a hinged device that alters the movement of the jaws. As a child wears it, a Herbst appliance draws the lower jaw forward to develop more in that direction. Like the palatal expander, it's best used before significant jaw growth occurs.

These are just two examples of techniques and tools that can guide structural growth and prevent bite problems. Because they're most effective in the early years of oral development, your child should undergo an orthodontic evaluation as early as age 6 to see if they need and can benefit from an interceptive treatment.

Interceptive orthodontics can stop or at least slow a growing bite problem. The effort and expense now could save you much more of both later on.

If you would like more information on interceptive orthodontics, 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 “Interceptive Orthodontics: Timely Intervention can make Treatment Easier.”

DealingwiththeRealityofIncreasedDiseaseRiskwithBraces

Wearing braces is all about the future: you undergo many months of treatment to gain a lifetime of better mouth function and a more attractive smile.

In the meantime, though, you'll have to deal with a few new realities during treatment: restrictions on foods, limitations with mouth function, and (perhaps) embarrassment over your new “metallic” smile.

There's one reality, though, that trumps all others in importance: your risk for developing dental disease increases significantly during orthodontic treatment. The brackets and wires of your braces make it more difficult to remove bacterial plaque, the main cause of dental disease, which allows places for disease-causing bacteria to thrive. To combat this, you'll need to step up your hygiene efforts to remove daily plaque.

One sign your efforts might not be getting the job done is red, swollen or bleeding gums. Although gums can swell in reaction to the braces themselves, it's often because plaque-induced periodontal (gum) disease has infected the gum tissues.

Gum disease is an aggressive infection. If it isn't stopped it can damage the gums and underlying bone that support your teeth — damage that could eventually lead to tooth loss. To stop it, we must remove plaque from all tooth and gum surfaces, even below the gum line. In some advanced cases it may even be necessary to remove the braces to better treat the disease.

That's why preventing gum disease through effective hygiene is so important. Besides continuing routine visits with your family dentist, you should also brush and floss every day to remove plaque. Be sure you're brushing above and below the braces. It may be helpful to use an interproximal brush specifically designed to maneuver around these tight spaces. You can also use a floss threader or a water irrigator to make the job of flossing easier.

If you do notice gum redness, swelling or bleeding, don't delay — call your dentist at once. An examination will determine if you have gum disease and to what degree, which will guide treatment. The sooner this happens, the less the impact on your dental health and your orthodontic treatment.

If you would like more information on dental care while wearing braces, 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 “Gum Swelling During Orthodontics.”

YoumayNeedOrthodonticWorkBeforeGettingaDentalImplant

For whatever reason, you’ve put off replacing a missing tooth for awhile. Now you want to fill that empty gap in your smile with a dental implant restoration.

But if your tooth’s been missing for a long time, there could be a problem with space. This is because the teeth on either side of the space may have gradually drifted into it, leaving no room for the implant. You could need orthodontic work first to return these teeth to their proper position.

We could use braces, metal orthodontic devices with wires threaded through brackets bonded to the teeth that are then anchored, usually to back teeth. The orthodontist uses elastics or springs as well as possibly incrementally tightening of the wire against the anchors. These techniques create pressure or tension on the teeth for the desired direction of movement. The teeth’s natural mechanism for movement does the rest.

But while effective, braces can be quite noticeable, an embarrassing thought for many adults having to wear them over several months of treatment. But there may be an alternative: clear aligners, a succession of slightly different plastic trays usually worn in two-week intervals. Sequentially wearing each tray gradually moves the teeth to their desired positions.

Though not appropriate for all bite situations, clear aligners have a number of benefits when they can be used. They’re nearly invisible to others and can be removed for hygiene tasks or rare special occasions. What’s more, the orthodontist may attach a temporary prosthetic (false) tooth to the trays to camouflage the missing space during treatment.

There’s one other issue you may have to deal with: if your tooth loss was related to periodontal (gum) disease, the gums and underlying bone may be in poor condition. In fact, substantial bone loss could rule out an implant altogether. But we may be able to remedy both gum and bone deficiencies through grafting or plastic surgery. It may be possible to regenerate enough bone to support the implant; and surgically repairing your gums will help ensure the implant appears natural.

If you have problems like these, don’t give up on your restoration goal just yet. With some orthodontic and dental work ahead of time, we may still be able to make implants a reality for you.

If you would like more information on restoring your smile after losing teeth, please contact us or schedule an appointment for a consultation.

DrawingImpactedTeethintotheOpencanRestoreaSmile

You don’t have to be a dental professional to appreciate a beautiful smile. Likewise, you’ll also know when something’s not quite right with one.

Such can be the case when a tooth fails to erupt properly, causing most or all of the crown to remain below the gum line, a condition known as impaction. Upper canines (or “eyeteeth,” for their location in the arch under the eyes) are especially susceptible to impaction: located on either side of the lateral incisors, which are on either side of the central incisors (the two center front teeth).

The upper canines are important both for function and appearance. Working with their lower counterparts they help cut through food as we chew, so you lose some of that efficiency when they don’t erupt properly. Impacted teeth are susceptible to abscesses and cysts, and can impinge upon and damage the roots of other teeth. And just as importantly, their absence also disrupts the smile as nearby teeth tend to move or “drift” toward the open space.

Rather than remove the impacted canines as is often done with back teeth, it may be more advantageous for both function and appearance to “coax” them into full eruption. This requires first pinpointing their exact location below the gums using x-rays or cone beam 3-D imaging.

If the teeth are in reasonably good position we must first prepare them for orthodontic treatment by surgically exposing the crown from the gums and bonding a small bracket to it. We then attach a small gold chain to the bracket that extends outside of the gums when we suture them back into place. The chain is attached to orthodontic hardware that exerts pressure on the impacted tooth for several months to “pull” it out into the arch.

This procedure has the best chance of success if undertaken before the end of jaw development in early adulthood. Otherwise, it may be better to remove the impacted canines and replace them with dental implants, followed by orthodontic treatment of other teeth to restore their proper position and bite relationships. In either case, your impacted upper canines don’t have to be a problem — we can restore both your mouth function and your smile.

If you would like more information on impacted teeth and treatment options, 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.”