Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
Parents have been dealing with their children's teething pain for as long as parents and children have been around. Along the way, the human race has developed different ways to ease the discomfort of this natural process of dental development. While most are good, common-sense measures, one in particular needs to be avoided at all costs—applying topical oral products to the gums containing Benzocaine.
Benzocaine is a topical anesthetic often found in oral products like Anbesol, Orajel or Topex to help ease tooth pain or sensitivity. The agent can be found in gel, spray, ointment or lozenge products sold over-the-counter. As an analgesic, it's considered relatively safe for adults to use.
But that's not the case with infants or younger children. Researchers have found a link between Benzocaine and methemoglobinemia, a potentially fatal blood condition. Methemoglobinemia elevates the amount of a hemoglobin-like protein called methemoglobin, which in high concentrations can lower oxygen levels being transported to the body's cells through the bloodstream.
Because of their smaller anatomy and organ systems, younger children can have severe reactions to increases in methemoglobin, which can range from shortness of breath or fatigue to seizures, coma or even death. That's why you should never use products with Benzocaine or similar numbing agents to ease teething pain. Instead, follow these common sense practices:
- Give your child chilled rubber teething rings, wet washcloths or pacifiers to chew or gnaw on. The combination of cold temperatures and pressure from biting on them will help ease the pain. Just be sure the item isn't frozen, which could cause frost burns to soft tissues.
- For temporary relief from soreness, gently massage your baby's gums with a clean, bare finger or with it wrapped in a clean, wet cloth. The massaging action helps counteract the pressure of the incoming tooth.
- For intense episodes of teething discomfort, ask your healthcare provider about using an over-the-counter pain reliever like acetaminophen or ibuprofen. Be sure you use only the recommended dose size for your child's age.
Teething is in many ways like a storm—it too shall pass. Be sure you're helping your baby weather it safely.
There's ample evidence tobacco smoking increases your risk for tooth decay and periodontal (gum) disease. But the same may be true for electronic cigarettes (E-cigs): Although millions have turned to “vaping” believing it's a safer alternative to smoking, there are growing signs it might also be harmful to oral health.
An E-cig is a device with a chamber that holds a liquid solution. An attached heater turns the liquid into a vapor the user inhales, containing nicotine, flavorings and other substances. Because it doesn't contain tar and other toxic substances found in tobacco, many see vaping as a safer way to get a nicotine hit.
But a number of recent research studies seem to show vaping isn't without harmful oral effects. A study from Ohio State University produced evidence that E-cig vapor interferes with the mouth's bacterial environment, or oral microbiome, by disrupting the balance between harmful and beneficial bacteria in favor of the former. Such a disruption can increase the risk for gum disease.
Other studies from the University of Rochester, New York and Universit? Laval in Quebec, Canada also found evidence for vaping's negative effects on oral cells. The Rochester study found astringent flavorings and other substances in vaping solutions can damage cells. The Quebec study found a staggering increase in the normal oral cell death rate from 2% to 53% in three days after exposure to E-cig vapor.
Nicotine, E-cig's common link with tobacco, is itself problematic for oral health. This addictive chemical constricts blood vessels and reduces blood flow to the mouth's tissues. This not only impedes the delivery of nutrients to individual cells, but also reduces available antibodies necessary to fight bacterial infections. Regardless of how nicotine enters the body—whether through smoking or vaping—it can increase the risk of gum disease.
These are the first studies of their kind, with many more needed to fully understand the effects of vaping on the mouth. But the preliminary evidence they do show should cause anyone using or considering E-cigs as an alternative to smoking to think twice. Your oral health may be hanging in the balance.
While retainers are often viewed as a nuisance, they’re crucial to protect the gains made with bite correction. Without them, all of the progress achieved through braces or clear aligners could be lost.
Here’s why: The same elastic gum tissue called the periodontal ligament that holds teeth in place also allows them to move incrementally in response to changes in the mouth. That’s why we can move teeth with braces or aligners, which put pressure on the teeth toward a desired direction of movement while the periodontal ligament does the rest.
But the mechanics can also work in reverse: With pressure relieved when the braces are removed, the teeth could revert to their original positions through a kind of “muscle memory.” The light pressure provided by a retainer is enough to keep or “retain” teeth in their new positions.
The best known retainer is a removable appliance. Initially, a patient wears it continuously and only takes it out during oral hygiene. Wear duration may later be reduced to night time only and eventually not at all, depending on a patient’s individual needs.
While effective, removable retainers do have some downsides. Like braces, they’re visible to others. And because they’re removable, they’re frequently misplaced or lost, leading to the added expense of a new one.
An alternative is a bonded retainer, a thin piece of wire attached to the back of the newly moved teeth to keep them in place. Because it’s behind the teeth it’s not visible—and there’s no misplacing it because only a dentist can take it out.
A bonded retainer is a good option, especially if a patient is immature and not as diligent about wearing or keeping up with their appliance. But it can make flossing difficult to perform, and if they’re removed or broken prematurely, the teeth could revert to their former positions.
If you decide to go with a bonded retainer, be sure you get some tips from your dental hygienist on how to floss with it. And if you decide later to have it removed early, be sure to replace it with a removable retainer. Either of these two options can help you keep your new and improved smile.
If you would like more information on bonded retainers, 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 “Bonded Retainers.”
The monarchs of the world experience the same health issues as their subjects—but they often tend to be hush-hush about it. Recently, though, the normally reticent Queen Elizabeth II let some young dental patients in on a lesser known fact about Her Majesty's teeth.
While touring a new dental hospital, the queen told some children being fitted for braces that she too “had wires” once upon a time. She also said, “I think it's worth it in the end.”
The queen isn't the only member of the House of Windsor to need help with a poor bite. Both Princes William and Harry have worn braces, as have other members of the royal family. A propensity for overbites, underbites and other malocclusions (poor bites) can indeed pass down through families, whether of noble or common lineage.
Fortunately, there are many ways to correct congenital malocclusions, depending on their type and severity. Here are 3 of them.
Braces and clear aligners. Braces are the tried and true way to straighten misaligned teeth, while the clear aligner method—removable plastic mouth trays—is the relative “new kid on the block.” Braces are indeed effective for a wide range of malocclusions, but their wires and brackets make it difficult to brush and floss, and they're not particularly attractive. Clear aligners solve both of these issues, though they may not handle more complex malocclusions as well as braces.
Palatal expanders. When the upper jaw develops too narrowly, a malocclusion may result from teeth crowding into too small a space. But before the upper jaw bones fuse together in late childhood, orthodontists can fit a device called a palatal expander inside the upper teeth, which exerts gentle outward pressure on the teeth. This encourages more bone growth in the center to widen the jaw and help prevent a difficult malocclusion from forming.
Specialized braces for impacted teeth. An impacted tooth, which remains partially or completely hidden in the gums, can impede dental health, function and appearance. But we may be able to coax some impacted teeth like the front canines into full eruption. This requires a special orthodontic technique in which a bracket is surgically attached to the impacted tooth's crown. A chain connected to the bracket is then looped over other orthodontic hardware to gradually pull the tooth down where it should be.
Although some techniques like palatal expanders are best undertaken in early dental development, people of any age and reasonably good health can have a problem bite corrected with other methods. If you are among those who benefit from orthodontics, you'll have something in common with the Sovereign of the British Isles: a healthy, attractive and straighter smile.
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