Orthodontics relies on certain mechanics in the mouth to move teeth to better positions. As the specialty has advanced, we've become ever more precise in moving teeth with braces, the “workhorse” of orthodontics, and other specialized appliances and techniques.
But although cooperating effectively with the mouth's natural ability for tooth movement is crucial for success, there's another aspect to consider if that success will be long-term: the growth and development of oral and facial structure. And not just development during childhood and adolescence: indeed, facial structure continues to change throughout a lifetime, including the senior years. Research has shown that although the rate of growth slows over time, it doesn't stop even for someone 80 years or older.
Our emerging understanding in this area has had an important impact on how and when we perform orthodontic treatment. As we develop a treatment strategy for an individual patient we consider not only the immediate outcome of a treatment, but also how it may change their facial appearance in the future. By taking continuing facial growth into consideration, we're more likely to achieve a new smile appearance that remains attractive later in life.
A key factor is to be sure we're initiating treatments at appropriate ages. We may detect developing bite problems as early as age 6, which might prompt preventive treatment at that time to diminish or even eliminate the problem. But it may also be prudent to wait on full-scale orthodontic treatment until late childhood or puberty. Furthermore, some form of orthodontic treatment might need to continue into early adulthood to ensure the most optimal outcome.
By taking a longer view of the treatment process, we're better able to work within the natural growth and development taking place now and in the future. As a result, a person is more likely to enjoy an attractive and youthful appearance even in their later years.
If you would like more information on aging factors for cosmetic enhancement, 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 “Understanding Aging Makes Beauty Timeless.”
Placing a dental implant within the jawbone requires a surgical procedure. For most people it’s a relatively minor affair, but for some with certain health conditions it might be otherwise. Because of their condition they might have an increased risk for a bacterial infection afterward that could interfere with the implant’s integration with the bone and lead to possible failure.
To lower this risk, dentists for many years have routinely prescribed an antibiotic for patients considered at high-risk for infection to take before their implant surgery. But there’s been a lively debate among health practitioners about the true necessity for this practice and whether it’s worth the possible side effects that can accompany taking antibiotics.
While the practice still continues, current guidelines now recommend it for fewer health conditions. The American Dental Association (ADA) together with the American Heart Association (AHA) now recommend antibiotics only for surgical patients who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions.
But patients with prosthetic joint replacements, who were once included in the recommendation for pre-surgical antibiotics, are no longer in that category. Even so, some orthopedic surgeons continue to recommend it for their joint replacement patients out of concern that a post-surgical infection could adversely affect their replaced joints.
But while these areas of disagreement about pre-surgical antibiotics still continue, a consensus may be emerging about a possible “sweet spot” in administering the therapy. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.
Because pre-surgical antibiotic therapy can be a complicated matter, it’s best that you discuss with both the physician caring for your health condition and your dentist about whether you should undergo this option to reduce the infection risk with your own implant surgery. Still, if all the factors surrounding your health indicate it, this antibiotic therapy might help you avoid losing an implant to infection.
If you would like more information on antibiotics before implant surgery, 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 “Implants & Antibiotics: Lowering Risk of Implant Failure.”
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.”
Like a second New Year’s Day, the month of September offers its own chance to make a brand new start: It’s back-to-school season! This can be an exhilarating time—a chance to meet new friends, face new challenges and set new goals. It’s also a great time to get started on the things that can keep your children healthy all year long…like a routine visit to the dental office.
Preventive dental visits are one of the most important ways to help keep a smile in top condition—not just for kids, but for people of any age. They are also one of the best values in health care, because so much can be accomplished in such a short time. What exactly happens at a routine visit? Here’s a brief run-down:
- A professional teeth cleaning clears sticky plaque and hardened tartar from places where your brush can’t reach. These deposits can harbor the bacteria that cause tooth decay and gum disease, and removing them helps prevent more serious problems from getting started.
- A complete dental exam involves a check for cavities, but it’s also much more: It includes screening for gum disease, oral cancer, and other potential maladies. X-rays or other diagnostic tests may be performed at this time; any changes can be observed, and the need for preventive or restorative treatments can be evaluated.
- The growth and development of children’s teeth is carefully monitored, from the first baby teeth to the third molars. If orthodontic work or wisdom teeth removal could benefit your child, this is a great time to discuss it. Adults may also benefit from ongoing evaluation for gum recession and other potential issues.
- Keeping your teeth and gums healthy also depends on how you take care of them at home. A routine office visit is a great opportunity to “brush up” on proper techniques for tooth brushing and flossing, and to ask any questions you may have about oral hygiene.
So if you have youngsters starting a new school year—or if you’re looking to make a fresh start toward good oral health yourself—make it a point to stop in to the dental office for a routine visit this season!
If you would like more information about maintaining good oral health, please contact us or schedule an appointment. You can learn more by reading the Dear Doctor magazine articles “Top 10 Oral Health Tips For Children” and “Dental Hygiene Visit: A True Value in Dental Healthcare.”
Shingles is a painful viral infection that could potentially recur in sufferers for years. It causes painful skin rashes, general nerve pain, fever and fatigue. In extreme cases, it can cause blindness if the eyes become infected. And because it’s highly contagious, it could affect your dental treatment.
Formally known as herpes zoster, shingles is a recurrent form of chicken pox. If you contracted chicken pox in childhood, the shingles virus could lay dormant for several years. In fact, most people who contract shingles are over 50.
Because it acutely affects the nerves around the skin, the disease’s most common symptom is a belted or striped rash pattern that often appears on one side of the body and frequently on the head, neck or face. While the severity of symptoms may vary among patients, shingles can be a significant health threat to certain people, especially pregnant women, cancer patients or individuals with compromised immune systems.
In its early stages, the shingles virus can easily pass from person to person, either by direct contact with the rash or by airborne secretions that others can inhale. Because it’s highly contagious, even a routine teeth cleaning could potentially spread the virus to dental staff or other patients. Because of the significant health threat it potentially poses to some people, your dental provider may decline to treat you if you’re showing symptoms of the disease.
To stay ahead of this, let your dentist know you’re experiencing a shingles episode if you have an upcoming dental appointment, in which case you may need to reschedule. In the meantime, you should seek medical attention from your physician who may prescribe antiviral medication. Starting it within 3 days of a shingles outbreak can significantly reduce your pain and discomfort as well as its contagiousness.
And if you’re over sixty or at risk for shingles, consider getting the shingles vaccine. This readily available vaccine has proven effective in preventing the disease and could help you avoid the pain and disruption this viral infection can bring to your life.
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