Posts for: May, 2018

WemayNeedtoRemoveoneorMoreTeethBeforeApplyingBraces

“To gain something, sometimes you have to give up something else.”

No, that isn't the latest viral meme on the Internet. It's actually a practical consideration that could arise in orthodontics.

In this case, the “something” to gain is a straighter, more attractive smile; the “something” you may have to part with is a few teeth. This may be necessary if there are too many teeth on a dental arch for its capacity, a situation called crowding. A lack of space is the main reason teeth come in misaligned.

Before we can correct this, we'll need to free up space to allow for tooth movement by removing one or more of the existing teeth. The ideal candidates are those that are near to the teeth we wish to move but not highly visible. The first bicuspids are the most frequent choices for removal: they're located behind the cuspids or eyeteeth (the pointed teeth right under the eyes).

Ideally, we'll remove the target teeth some time before we apply braces to give the gums a chance to heal. At the same time we want to preserve the bone that once supported the teeth we've extracted. This is because when we chew the forces generated by the teeth stimulates bone replacement growth. When a tooth is no longer there the supporting bone doesn't receive this stimulation and may ultimately reduce in volume.

We may try to prevent this by placing a bone graft in the empty socket immediately after removing the tooth. The graft serves as a scaffold to encourage new bone to grow. Hopefully when we're ready to apply braces, the bone will be strong and healthy to handle the movement of the teeth.

As the teeth move under the influence of braces, they'll begin to fill up the space created by tooth removal. Once it's completed, the extracted teeth won't be missed — the other teeth now straightened will completely fill out the smile.

The different steps in this process must be carefully planned and executed precisely, and it will take months or even years to complete. In the end, though, this complicated bite problem can be corrected and replaced with an attractive, straight smile.

If you would like more information on correcting a poor bite, 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 “Tooth Removal for Orthodontic Reasons.”


WhattoDoForMouthInjuriesYourChildMightEncounter

Famed educator Maria Montessori once said, “Play is the work of the child”—and most kids take their “work” very seriously. But their avid enthusiasm might also raise the risk of blunt force injuries, particularly to the mouth.

While you should certainly take steps to protect their mouth (like a custom-made guard for contact sports), you can’t completely erase the risk. You should know, therefore, what to do in case of a mouth injury.

The lips, tongue, and other soft oral tissues often get the brunt of any contact injury, ranging from minor bruising and swelling to severe cuts that require medical attention. First, clean the area as thoroughly as possible to remove trapped dirt or debris in the wound. If bleeding occurs, apply continuous gentle pressure with a clean cloth or gauze for 10-15 minutes until it stops, and cold compresses for any swelling. If the wound looks deep or severe, take them to an emergency room.

Blunt force can also impact teeth in a variety of ways. If part of a tooth chips, attempt to find the pieces and see a dentist as soon as possible—they may be able to bond the pieces back to the tooth. If a tooth gets moved out of place, call your dentist immediately or go to an emergency room after hours.

If a permanent tooth gets completely knocked out, find it and rinse off any debris with clean water. Then, place it gently back into its socket, or alternatively between the child’s cheek and gum or in a glass of cold milk. You’ll need to see a dentist as soon as possible to have the tooth replanted. With this kind of injury, time is of the essence.

A hard impact can also fracture the jawbone, which may be suspected if the face appears distorted or the teeth can’t make contact with each other when the jaws are shut. Control any bleeding, apply cold compresses or mild pain relievers to ease any pain or swelling, and go to an emergency room immediately.

A traumatic injury can heighten everyone’s emotions, including yours. You can avoid your emotions turning into panic, though, by following these common sense guidelines to help your child get through this unfortunate event.

If you would like more information on handling children’s dental problems, please contact us or schedule an appointment for a consultation.


3ThingsYouNeedtoKnowaboutEasingAnxietyOverDentalVisits

Although dental visits are routine for most people, it’s a different experience for a few. About one in ten adults have high anxiety or fear of going to the dentist and may avoid it altogether—even when they have an acute situation.

If you’re one of those with dental visit anxiety there’s good news—we may be able to help you relax and have a more positive experience. Here are 3 things you need to know about reducing your anxiety at the dental office.

It starts with the dentist. While every patient deserves a compassionate, understanding dentist, it’s especially so if you suffer from dental visit anxiety. Having someone who will listen to your concerns in a non-judgmental way is the first step toward feeling more comfortable in the dentist’s chair. It also takes a sensitive practitioner to work with you on the best strategy for relaxation.

Relaxation often begins before your visit. There are various degrees of sedation (which isn’t the same as anesthesia—those methods block pain) depending on your level of anxiety. If you experience mild to moderate nervousness, an oral sedative an hour or so before your appointment could take the edge off and help you relax. Oral sedatives are also mild enough for use with other forms of sedation like nitrous oxide gas, and with local anesthesia.

High anxiety may require deeper sedation. If your level of anxiety is greater, however, we may recommend IV sedation to induce a much more relaxed state. The sedation drugs are delivered directly into your blood stream through a small needle inserted into a vein. Although you’re not unconscious as with general anesthesia, we can place you into a “semi-awake” state of reduced anxiety. The drugs used may also have an amnesiac effect so you won’t remember details about the procedure. This can help reinforce positive feelings about your visit and help reduce future anxiety.

If you’re anxious about dental visits, make an appointment with us to discuss your concerns. We’re sure we can work out a strategy to reduce your anxiety so you can receive the dental care you need.

If you would like more information on sedation therapy, 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 “IV Sedation in Dentistry.”