When you think orthodontics, you may instantly picture braces or clear aligners worn by teenagers or adults. But there’s more to orthodontics than correcting fully developed malocclusions (poor bites). It’s also possible to intervene and potentially reduce a malocclusion’s future severity and cost well beforehand.
Known as interceptive orthodontics, these treatments help guide jaw growth in children while mouth structures are still developing and more pliable. But timing is critical: waiting until late childhood or puberty could be too late.
For example, we can influence an upper jaw developing too narrowly (which can cause erupting teeth to crowd each other) with an expander appliance placed in the roof of the mouth. The expander exerts slight, outward pressure on the upper jaw bones. Because the bones haven’t yet fused as they will later, the pressure maintains a gap between them that fills with additional bone that eventually widens the jaw.
Functional appliances like the Herbst appliance influence muscle and bone development in the jaws to eventually reshape and reposition them. The Herbst appliance utilizes a set of metal hinges connected to the top and bottom jaws; when the patient opens and closes their jaws the hinges encourage the lower jaw to move (and eventually grow) forward. If successful, it could help a patient avoid more invasive treatments like tooth extraction or jaw surgery.
Some interceptive objectives are quite simple in comparison like preserving the space created by a prematurely lost primary tooth. If a child loses a primary tooth before the incoming permanent tooth is ready to erupt, the nearby teeth can drift into the empty space. Without enough room, the permanent tooth could erupt out of position. We can hold the space with a simple loop device known as a space maintainer: usually made of acrylic or metal, the device fits between adjacent teeth and prevents them from drifting into the space until the permanent tooth is ready to come in.
Interceptive orthodontics can have a positive impact on your child’s jaw development, now and in the future. For these techniques to be effective, though, they must begin early, so be sure your child has a complete orthodontic evaluation beginning around age 7. You may be able to head off future bite problems before they happen.
Everyone has to face the music at some time — even John Lydon, former lead singer of The Sex Pistols, arguably England’s best known punk rock band. The 59-year old musician was once better known by his stage name, Johnny Rotten — a brash reference to the visibly degraded state of his teeth. But in the decades since his band broke up, Lydon’s lifelong deficiency in dental hygiene had begun to cause him serious problems.
In recent years, Lydon has had several dental surgeries — including one to resolve two serious abscesses in his mouth, which left him with stitches in his gums and a temporary speech impediment. Photos show that he also had missing teeth, which, sources say, he opted to replace with dental implants.
For Lydon (and many others in the same situation) that’s likely to be an excellent choice. Dental implants are the gold standard for tooth replacement today, for some very good reasons. The most natural-looking of all tooth replacements, implants also have a higher success rate than any other method: over 95 percent. They can be used to replace one tooth, several teeth, or an entire arch (top or bottom row) of teeth. And with only routine care, they can last for the rest of your life.
Like natural teeth, dental implants get support from the bone in your jaw. The implant itself — a screw-like titanium post — is inserted into the jaw in a minor surgical operation. The lifelike, visible part of the tooth — the crown — is attached to the implant by a sturdy connector called an abutment. In time, the titanium metal of the implant actually becomes fused with the living bone tissue. This not only provides a solid anchorage for the prosthetic, but it also prevents bone loss at the site of the missing tooth — which is something neither bridgework nor dentures can do.
It’s true that implants may have a higher initial cost than other tooth replacement methods; in the long run, however, they may prove more economical. Over time, the cost of repeated dental treatments and periodic replacement of shorter-lived tooth restorations (not to mention lost time and discomfort) can easily exceed the expense of implants.
That’s a lesson John Lydon has learned. “A lot of ill health came from neglecting my teeth,” he told a newspaper reporter. “I felt sick all the time, and I decided to do something about it… I’ve had all kinds of abscesses, jaw surgery. It costs money and is very painful. So Johnny says: ‘Get your brush!’”
We couldn’t agree more. But if brushing isn’t enough, it may be time to consider dental implants. If you would like more information about dental implants, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implants” and “Save a Tooth or Get an Implant?”
Braces utilize the mouth’s existing teeth-moving mechanism by applying pressure in the direction of the desired movement. This is done with a wire laced through metal brackets affixed to the outside of the teeth that’s then usually anchored to brackets on the back teeth to maintain constant tension.
This anchorage set-up alone, however, may not work effectively with all bite situations, which might require other points of anchorage. That’s where these other tools in the orthodontist’s toolkit can come in handy.
Headgear. These appliances not only aid with moving teeth but they also help influence the proper growth of facial structures (as when one of the jaws is too far forward or too far back). Because of this influence on jaw growth you’ll only find them used with pre-teens. The most typical application is a strap running around the back of the head or neck (or sometimes over the chin or forehead) that attaches in the front to brackets usually bonded to the molars. In this case the back of the patient’s skull serves as the anchor point.
Temporary anchorage devices (TADs). Orthodontists sometimes wish to isolate the teeth to be moved from nearby teeth that shouldn’t be. For example, they may want to move front teeth back to close a space without the back teeth moving forward. In this case, it may be necessary to create a separate anchorage point in the jaw. This can be done with TADs, which are made of either biotolerant (stainless steel, chromiumâ??cobalt alloy), bioinert (titanium, carbon), or bioactive (hydroxyapatite, ceramic oxidized aluminum) materials and shaped like mini-screws. Orthodontists insert them into the bone and then attach them to the braces using elastics (rubber bands). After completing orthodontic treatment they’re easily removed.
Elastics. We’ve already mentioned them, but elastics deserve their own category because they can be used in various kinds of anchorage. They play an important role, for example, in cross-arch anchorage that maintains tension between the upper and lower jaws. They can also be used to help move one or more groups of teeth — or isolate certain teeth from moving. They truly are flexible (no pun intended) in their uses for fine-tuned tooth movement.
All these devices can be used in various combinations to match and correct whatever bite situation a patient may have. The end result is straighter and better-functioning teeth — and a more attractive smile.
If you would like more information on orthodontic treatment, 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 “Orthodontic Headgear & Other Anchorage Appliances.”
Is having good oral hygiene important to kissing? Who's better to answer that question than Vivica A. Fox? Among her other achievements, the versatile actress won the “Best Kiss” honor at the MTV Movie Awards, for a memorable scene with Will Smith in the 1996 blockbuster Independence Day. When Dear Doctor magazine asked her, Ms. Fox said that proper oral hygiene was indeed essential. Actually, she said:
"Ooooh, yes, yes, yes, Honey, 'cause Baby, if you kiss somebody with a dragon mouth, my God, it's the worst experience ever as an actor to try to act like you enjoy it!"
And even if you're not on stage, it's no fun to kiss someone whose oral hygiene isn't what it should be. So what's the best way to step up your game? Here's how Vivica does it:
“I visit my dentist every three months and get my teeth cleaned, I floss, I brush, I just spent two hundred bucks on an electronic toothbrush — I'm into dental hygiene for sure.”
Well, we might add that you don't need to spend tons of money on a toothbrush — after all, it's not the brush that keeps your mouth healthy, but the hand that holds it. And not everyone needs to come in as often every three months. But her tips are generally right on.
For proper at-home oral care, nothing beats brushing twice a day for two minutes each time, and flossing once a day. Brushing removes the sticky, bacteria-laden plaque that clings to your teeth and causes tooth decay and gum disease — not to mention malodorous breath. Don't forget to brush your tongue as well — it can also harbor those bad-breath bacteria.
While brushing is effective, it can't reach the tiny spaces in between teeth and under gums where plaque bacteria can hide. But floss can: That's what makes it so important to getting your mouth really clean.
Finally, regular professional checkups and cleanings are an essential part of good oral hygiene. Why? Because even the most dutiful brushing and flossing can't remove the hardened coating called tartar that eventually forms on tooth surfaces. Only a trained health care provider with the right dental tools can! And when you come in for a routine office visit, you'll also get a thorough checkup that can detect tooth decay, gum disease, and other threats to your oral health.
Bad breath isn't just a turn-off for kissing — It can indicate a possible problem in your mouth. So listen to what award-winning kisser Vivica Fox says: Paying attention to your oral hygiene can really pay off! For more information, contact us or schedule an appointment for a consultation. You can read the entire interview with Vivica A. Fox in Dear Doctor's latest issue.
If you or a family member has problems with teeth alignment or your bite, you may be considering braces. This tried and true method can straighten out most smiles — but there's more to braces than you may realize.
For one thing, orthodontic treatment wouldn't work if it weren't for the natural mechanism for tooth movement that already exists in the mouth. It may seem your teeth are rigidly set in the jawbone but that's not how they maintain their attachment: that's the job of an elastic connective tissue known as the periodontal ligament that lies between the tooth and the bone. The ligament has tiny fibers that attach to the tooth on one side and to the bone on the other to actually hold the teeth in place, much like a hammock secured between two posts.
The ligament attachment also allows the teeth to move incrementally in response to environmental factors or the aging process. We harness this natural movement ability with braces to move teeth to a more desirable position. We first attach small brackets to the front crowns of the teeth (the visible portion) and then string arch wires through them. We then attach the wires to anchor points where we can adjust the amount of tension they're exerting through the brackets against the teeth. By gradually increasing that tension, the teeth respond as they would when any force is applied against them and begin to move.
By precisely controlling that movement we can transform a patient's smile. But we believe the advantages are more than cosmetic: the teeth will function better and will be easier to care for and keep clean. These benefits, though, have to be balanced with heightened risks for root resorption (something that occurs only about 10% of the time) in which the ends of the roots can shrink, or loss of mineral content in teeth enamel where the hardware makes it more difficult to remove bacterial plaque. These risks can be reduced by closely monitoring dental health during the entire treatment process and through stepped up efforts in daily oral hygiene.
The starting point for deciding on an orthodontic treatment is a thorough dental examination with x-rays or CT scan imaging. Once we have a complete picture of your misalignment problems and any other extenuating circumstances, we can recommend a treatment plan just for you.
If you would like more information on orthodontic treatment, 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 “Moving Teeth with Orthodontics.”
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