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.”
For major-league slugger Giancarlo Stanton, 2014 was a record-breaking year. After the baseball season ended, he signed a 13-year, $325 million contract with the Miami Marlins — the biggest deal in sports history. But earlier that same year, Stanton suffered one of the worst accidents in baseball: He was hit in the face by an 88-mph fastball, sustaining multiple fractures, lacerations, and extensive dental damage.
After the accident, Stanton didn’t play for the remainder of the season. But now he’s back in Spring Training… and he’s got a not-so-secret weapon to help protect him against another injury: A custom-made face guard designed to absorb impacts and keep him from suffering further trauma.
As sports fans, we’re glad that Stanton was able to overcome his injury and get back in the game. As dentists, we’d like to remind you that you don’t have to be a major-league player to feel the harmful effects of a sports injury — and you don’t have to look far to find a way to protect yourself. In fact, you can get a custom-made mouthguard right here at the dental office.
Mouthguards have a long tradition in sports like football, boxing, and hockey. But did you know that far more Americans are injured every year playing “non-collision” sports like basketball, baseball — and even bicycling? And it doesn’t take a major-league fastball to cause a dental injury: The highest incidence of sports-related dental injuries occurs in 15-to-18-year-old males. In fact, about one-third of all dental injuries among children stem from various types of sports activities. These injuries may result in countless hours being lost from school and work, and cost significant sums for treatment and restoration.
Mouthguards have a proven track record in reducing dental and facial injuries: They are capable of absorbing the energy of a blow to the mouth, and dissipating it in a way that prevents damage to facial structures and teeth. But not all mouthguards are created equal: Custom-fabricated mouthguards, which are produced from an exact model of your mouth made right here in the dental office, offer by far the best protection. They fit better and safeguard the teeth more fully than any off-the-shelf or “boil-and-bite” type can. Plus, they’re more comfortable to wear. And let’s face it: No mouth guard can protect your teeth if you don’t wear it.
What’s more, some recent studies indicate that custom-made mouthguards may offer significant protection against concussion. An increasing awareness of the dangers that concussion may pose to athletes is one more reason why we recommend custom-made mouthguards to active people and their families.
To get his face guard, Giancarlo Stanton reportedly went to a specialist sporting-goods manufacturer in Illinois, and paid around $1,000. But you can get a custom-made mouthguard for yourself or your loved ones right at our office for a fraction of that price. And the peace of mind it can give you is… priceless.
If you have questions about custom-made mouthguards, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “An Introduction to Sports Injuries & Dentistry” and “Athletic Mouthguards.”
Over the last century and a half millions of people have had a tooth cavity filled with “silver” amalgam. Perhaps you’re one of them. The use of this effective and durable filling has declined in recent years, but only because of the development of more attractive tooth-colored materials.
At the same time there’s another issue that’s been brewing in recent years about this otherwise dependable metal alloy: the inclusion of mercury in amalgam, about half of its starting mixture. Various studies have shown mercury exposure can have a cumulative toxic effect on humans. As a result, you may already be heeding warnings to limit certain seafood in your diet.
So, should you be equally concerned about amalgam fillings — even going so far as to have any existing ones removed?
Before taking such a drastic step, let’s look at the facts. To begin with, not all forms of mercury are equally toxic. The form causing the most concern is called methylmercury, a compound formed when mercury released in the environment combines with organic molecules. This is the form certain large fish like salmon and tuna ingest, which we then ingest when we eat them. Methylmercury can accumulate in the body’s tissues where at high levels it can damage various organ systems.
Dental amalgam, on the other hand, uses elemental mercury. Dentists take it in liquid form and mix it with a powder of other metals like silver, tin and copper to create a pliable paste. After it’s placed in a prepared cavity, the amalgam hardens into a compound in which the mercury interlaces with the other metals and becomes “trapped.”
Although over time the filling may emit trace amounts of mercury vapor, it’s well below harmful levels. You’re more likely to encounter “un-trapped” mercury in your diet than from a dental filling. And scores of studies over amalgam’s 150-year history have produced no demonstrable ill effects due to mercury.
Although it now competes with more attractive materials, amalgam still fills (no pun intended) a necessary role. Dentists frequently use amalgam in less visible back teeth, which encounter higher chewing pressures than front teeth. So, if you already have an amalgam filling or we recommend one to you, relax — you’re really in no danger of mercury poisoning.
Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand.Â Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.
Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.
A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.
Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.
If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.
If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”
You may not be nervous at all about visiting the dentist. But put yourself in a child’s place — a routine dental visit could be an anxious experience for them, and even more so if it involves dental work.
Dental professionals recognize this and go to great lengths to make children’s visits as pleasant as possible. It’s common among pediatric and family dentists to see child-friendly exam rooms and a well-trained staff experienced with interacting with children.
While this helps, some children still struggle with anxiety. Dentists have one other technique that can ease a child’s nervousness: conscious sedation. This technique involves the use of pills, inhaled gas or intravenous drips to help patients relax.
Sedation is different from general anesthesia, which uses drugs to render a patient unconscious so they won’t experience pain. A sedated patient remains in a conscious but relaxed state: they can still breathe independently and, with the most moderate form of oral sedation, be able to respond to touch or verbal instructions.
Oral sedation may also be accompanied by other methods like nitrous oxide gas that also aid with physical discomfort. Many drugs used often have an amnesiac effect — the patient won’t remember details about the procedure, which could contribute to less anxiety in the future.
Typically, a child receives an oral sedative just before the procedure. Most drugs are fast-acting and leave the child’s system quickly afterward.Â A staff member monitors their vital signs (pulse, respirations, blood pressure, etc.) during the procedure and after in recovery. They’ll remain in recovery until their vital signs return to normal levels and then be able to go home. They should stay home the rest of the day under adult supervision, but should be alert enough the next day to return to their normal activities.
Relieving anxiety is an important tool to ensure your child receives the dental care they need. It also creates a positive experience that could encourage a young patient to continue regular dental care when they reach adulthood.
If you would like more information on conscious sedation for children, 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 “Sedation Dentistry for Kids.”
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