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.”
Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.
“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.
Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.
Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.
Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.
Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.
So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!
For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”
September is National Gum Care Month. Did you know that advanced periodontal disease is the number one cause of tooth loss among adults? Periodontal disease refers to any disease that affects the structures that hold the teeth in place, including gums, ligaments and bone. In its earliest stage, called gingivitis, the gums become inflamed. When it progresses to periodontitis, both soft and hard tissues that hold the teeth in place are affected, threatening the integrity of the teeth. Some people are more susceptible to periodontal disease than others. Here are some common risk factors:
Poor oral hygiene. Plaque buildup is the primary cause of gum disease. When life gets busy, we may be less diligent about our oral care. This allows bacteria in the mouth to form a biofilm (plaque), which causes inflammation of the gums.
Heredity: Some people are genetically more predisposed to gum disease. Look at your family history. Have any of your relatives had gum disease or lost their teeth?
Pregnancy. Gums are sensitive to hormone fluctuations, and it is not uncommon for pregnant women to experience an inflammation of the gums known as “pregnancy gingivitis.” Gingivitis — characterized by red, swollen gums that bleed easily — is the beginning stage of gum disease.
Age: The chance of developing gum disease increases with age. Over 70% of Americans 65 and older have periodontitis, an advanced form of gum disease, according to the U.S. Centers for Disease Control and Prevention. This may be influenced by other diseases, medications that cause dry mouth, or other causes of plaque buildup.
Diet: Eating too many simple carbohydrates (those found in sugar, white bread, white rice and mashed potatoes, for example) is linked to chronic inflammation in the body, which increases the risk of gum disease.
Smoking: Smoking is a significant risk factor for the development and progression of gum disease. Since nicotine constricts blood vessels, smokers may not see the typical symptoms such as red, puffy, bleeding gums, so the disease may cause damage before smokers realize there is a problem with their gums.
Diabetes: Uncontrolled diabetes puts you at higher risk of periodontal disease. Not only can diabetes make gum disease worse, gum disease can make diabetes symptoms worse.
Our aim is not to scare you but to help you become aware of factors that can increase your risk of gum disease. Many of these factors are not under your control. However, you can do your part to prevent gum disease by staying on top of the things you can control. Let us know about any new medications you are taking, eat a balanced diet rich in complex carbohydrates and other nutrients and, if relevant, manage your diabetes and explore programs that will help you quit smoking.
Fortunately, good oral hygiene and regular professional cleanings can turn early gum disease around, so if you have any of the risk factors that contribute to periodontal disease, be extra diligent about your oral hygiene routine. And make sure you come in for regular dental checkups and cleanings. If you show signs of gum disease, we may recommend that you come in for more frequent cleanings.
During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.
Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.
For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.
When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.
But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.
Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.
So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…
If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”
Biting the inside of your cheek is high on the list of minor but painfully irritating occurrences like paper cuts or tongue scalding from hot coffee. A mouth bite, though, has an additional tormenting feature — there's a good chance you'll bite the same spot again.
This kind of repeated mouth injury results in an enlargement of the soft tissue that has been traumatized. They're often diagnosed and referred to as a traumatic fibroma. When you bite your cheek, lips or tongue, you create a small wound that usually heals quickly. This healing process, though, can be interrupted if you bite the area again, which can then cause excess scar tissue to form.
The fibrous scar tissue, made up of a protein called collagen, is similar to a callous. You can often feel it with your tongue — a knot of tough skin that protrudes from the otherwise flat cheek wall. Because of this prominence, it tends to get in the “line of fire” during eating or biting, so you'll bite it again — and again. If this cycle continues, then even a more prominent scar tissue forms that you're more likely to bite again.
The wound will heal most of the time, unless you continually bite it. If it becomes a nagging problem, we can surgically remove the lump. After numbing the area with local anesthesia, we'll either use a laser or scalpel to remove it. The area is easy to fix and will flatten out the cheek surface. The entire procedure takes fifteen minutes or less and in a few days to a week you won't even notice it had been there.
While the vast majority of these lesions are harmless, it's still standard protocol to biopsy the removed tissue: a pathologist examines it under a microscope for cancer cells. This is a routine part of any medical practice and not a cause for alarm.
If you've had a lump for awhile that you always seem to be biting, see us for an examination. With a simple procedure, we may be able to remove that irritation once and for all.
If you would like more information on treating mouth lumps and other sores, 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 “Common Lumps and Bumps in the Mouth.”
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