While crooked teeth are usually responsible for a malocclusion (poor bite), the root cause could go deeper: a malformed maxilla, a composite structure composed of the upper jaw and palate. If that’s the case, it will take more than braces to correct the bite.
The maxilla actually begins as two bones that fit together along a center line in the roof of the mouth called the midline suture, running back to front in the mouth. The suture remains open in young children to allow for jaw growth, but eventually fuses during adolescence.
Problems arise, though, when these bones don’t fully develop. This can cause the jaw to become too narrow and lead to crowding among the erupting teeth and a compromised airway that can lead to obstructive sleep apnea. This can create a cross-bite where the upper back teeth bite inside their lower counterparts, the opposite of normal.
We can remedy this by stimulating more bone growth along the midline suture before it fuses, resulting in a wider maxilla. We do this by installing a palatal expander, an appliance that incrementally widens the suture to encourage bone formation in the gap, which over time will widen the jaw.
An expander is a metal device with “legs” extending out on both sides and whose ends fit along the inside of the teeth. A gear mechanism in the center extends the legs to push against the teeth on both sides of the jaw. Each day the patient or caregiver uses a key to give the gear a quarter turn to extend the legs a little more and widen the suture gap. We remove the expander once the jaw widens to the appropriate distance.
A palatal expander is an effective, cost-efficient way to improve a bite caused by a narrow jaw, but only if attempted before the bones fuse. Widening the jaw after fusion requires surgery to separate the bones — a much more involved and expensive process.
To make sure your child is on the right track with their bite be sure to see an orthodontist for an evaluation around age 6. Doing so will make it easier to intervene at the proper time with treatments like a palatal expander, and perhaps correct bite problems before they become more expensive to treat.
If you would like more information on treating malocclusions, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
A woman as gorgeous and funny as Sofia Vergara surely planned to be a model and actress from the get-go, right? Wrong! Sofia’s first career choice actually was to be… a dentist! That’s right, the sexy star of TV’s Modern Family actually was only two semesters shy of finishing a dental degree in her native Columbia when she traded dental school for the small screen. Still, dental health remains a top priority for the actress and her son, Manolo.
“I’m obsessed,” she recently told People magazine. “My son thinks I’m crazy because I make him do a cleaning every three months. I try to bribe the dentist to make him to do it sooner!”
That’s what we call a healthy obsession (teeth-cleaning, not bribery). And while coming in for a professional cleaning every three months may not be necessary for everyone, some people — especially those who are particularly susceptible to gum disease — may benefit from professional cleanings on a three-month schedule. In fact, there is no one-size-fits-all approach to having professional teeth cleanings — but everyone needs this beneficial procedure on a regular basis.
Even if you are meticulous about your daily oral hygiene routine at home, there are plenty of reasons for regular checkups. They include:
- Dental exam. Oral health problems such as tooth decay and gum disease are much easier — and less expensive — to treat in the earliest stages. You may not have symptoms of either disease early on, but we can spot the warning signs and take appropriate preventive or restorative measures.
- Oral cancer screening. Oral cancer is not just a concern of the middle aged and elderly — young adults can be affected as well (even those who do not smoke). The survival rate for this deadly disease goes up tremendously if it is detected quickly, and an oral cancer screening is part of every routine dental visit.
- Professional teeth cleaning. Calcified (hardened) dental plaque (tartar or calculus) can build up near the gum line over time — even if you brush and floss every day. These deposits can irritate your gums and create favorable conditions for tooth decay. You can’t remove tartar by flossing or brushing, but we can clear it away — and leave you with a bright, fresh-feeling smile!
So take a tip from Sofia Vergara, and don’t skimp on professional cleanings and checkups. If you want to know how often you should come in for routine dental checkups, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor articles “Dental Hygiene Visit” and “Dental Cleanings Using Ultrasonic Scalers.”
Chronic jaw pain and limited jaw mobility are two common symptoms of a group of conditions known as temporomandibular joint disorders (TMJD or TMD). Several effective treatments have developed over the years, despite the fact that the underlying causes for TMD remain an elusive quarry for medical researchers.
But we may now have a promising new lead in understanding TMD: a possible link between it and other systemic inflammatory diseases. In recent study researchers interviewed over 1,500 people with TMD about various aspects of their lives. Nearly two-thirds reported at least three or more other inflammatory health conditions like fibromyalgia, chronic headaches or rheumatoid arthritis.
These statistics suggest a relationship between TMD and these other conditions. Further exploration of these possible links could result not only in a greater understanding of TMD but better treatment strategies for it and the other related conditions.
In the meantime, though, what can you do if you're currently dealing with TMD?
As of now the approaches with the best results continue to be conservative, non-invasive techniques we've used for several years. Thermal therapies like hot or cold compresses to the jaw area, for example, are quite effective in providing pain relief, and muscle relaxant drugs have proven beneficial for improving jaw mobility.
More radical approaches like jaw surgery have also come into prominence. But there's a caveat here: a significant number of people find their conditions don't improve or may even worsen. In the study previously mentioned, only 38% of respondents who had undergone jaw surgery saw any range of improvement (from slight to significant); by contrast, 28% indicated no change in symptoms and 46% said they were worse off.
It's important, then, that you thoroughly discuss your condition with your dentist, verifying first that you have TMD.Â Together you can develop a treatment plan to relieve pain and restore jaw function. If your dentist or surgeon suggests surgery, consider seeking a second opinion before choosing this more radical approach.
Hopefully, further research into the causes and relationships of TMD with other health conditions will yield still better treatments. In the meantime, you may still find relief and improve your quality of life with the proven techniques available now.
If you would like more information on treatments for chronic jaw pain, 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 “Chronic Jaw Pain and Associated Conditions.”
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
Although your smile wouldn't be the same without them, there's more to your gums than their looks. Besides helping to hold your teeth in place, they're also an important protective barrier for their roots.
Unfortunately, gums aren't immune to disease, especially periodontal (gum) disease. This bacterial infection, triggered by built-up dental plaque on teeth due to insufficient oral hygiene, can cause the gum tissues to detach from teeth and shrink back (recede). This can make your teeth more sensitive to hot or cold foods and beverages, as well as put them at even greater risk for tooth decay.
To treat gum recession, our first priority is to stop any ongoing gum disease through aggressive plaque removal. Depending on severity, this could require clinical procedures like scaling or root planing to remove plaque and tartar (hardened plaque deposits) at or below the gum line. This is especially crucial for improving gum tissue healing and stimulating potential reattachment.
Revitalizing gum tissues this way naturally has a better chance of occurring if we're able to prevent recession before it reaches the roots. If that does happen and we have sufficient gum tissue attachment remaining, we may need to give the gum tissue a helping hand through gum grafting surgery. There are a number of techniques depending on the circumstances, but they all use either tissue from another location in the patient's mouth or prepared tissue from another human donor. This type of surgery requires great skill and expertise, not to mention an aesthetic sense, to achieve a result that's both functional and attractive.
Other than daily brushing and flossing, the most important thing you can do for gum health is to see us as soon as you notice any signs of gum problems like swelling, bleeding or tooth sensitivity. The sooner we can diagnose and begin treating the problem, the less likely any gum recession will have a long-term impact on your health.
If you would like more information on gum health, 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 Recession.”
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