What makes an attractive smile? Of course, shiny, straight and defect-free teeth are a big factor. But there’s another equally important element: all your teeth have come in.
Sometimes, though, they don’t: one or more teeth may remain up in the gums, a condition known as impaction. And if they’re in the front like the upper canines (the pointed teeth on either side of the front four incisors) your smile’s natural balance and symmetry can suffer.
Impaction usually happens due to lack of space on a small jaw. Previously erupted teeth crowd into the space of teeth yet to come in, preventing them from doing so. As a result the latter remain hidden within the gums.
While impaction can interfere with the smile appearance, it can cause health problems too. Impacted teeth are at higher risk for abscesses (localized areas of infection) and can damage the roots of other teeth they may be pressing against. That’s why it’s desirable for both form and function to treat them.
We begin first with an orthodontic examination to fully assess the situation. At some point we’ll want to pinpoint the impacted teeth’s precise location and position. While x-rays are useful for locating impacted teeth, many specialists use cone beam CT (CBCT) technology that produces highly detailed three-dimensional images viewable from different vantage points.
If the tooth is in too extreme a position, it might be best to remove it and later replace it with a dental impact or similar restoration once we’ve completed other necessary orthodontic treatment. But if the tooth is in a reasonable position, we might be able to “move” the tooth into its proper place in the jaw in coordination with these other tooth-movement efforts to make room for it.
To begin this process, an oral surgeon or periodontist surgically exposes the tooth crown (the normally visible portion) through the gums. They then bond a small bracket to the crown and attach a small gold chain. An orthodontist will attach the other end to orthodontic hardware that will exert downward pressure on the tooth to gradually bring it into normal position.
Dealing with impacted teeth of this nature is often part of a comprehensive effort to correct the bite. If we’re successful, it could permanently transform both the smile and overall dental health.
If you would like more information on treating impacted teeth, 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 “Exposing Impacted Canines.”
Your gums aren’t just for show—they also play an important role in supporting and protecting your teeth. Healthy gums are essential for healthy teeth.
Your gums can take a lot from daily chewing or other environmental factors. Unfortunately, disease or trauma can weaken their resilience. This weakening could lead to gum recession.
Gum recession occurs when the tissues covering a tooth begin to lose their attachment and shrink back (recede). As a result, the tooth appears “longer” as more of it that’s normally below the gum line becomes visible. Not only is gum recession unattractive, it also exposes more of the tooth to disease-causing bacteria.
The most common cause for gum recession is periodontal (gum) disease, an infection arising from the accumulation of a thin bacterial biofilm on the teeth called plaque. Infected gums become inflamed, a normal defensive response to isolate diseased or damaged tissues from the rest of the body. Chronic inflammation, however, weakens affected tissues over time and results in bone loss.
Other factors can also contribute to gum recession. A tooth that didn’t erupt properly and has come in away from the center of its protective bony housing can impede adequate gum coverage. Your gum tissue thickness, which you genetically inherit, can also increase the risk of gum recession. People with thinner gum tissues are more susceptible to recession than with thicker tissues.
You can also damage your gums (ironically) while trying to care for them. Over-aggressive brushing over time may traumatize the gums to the point that they recede. While it’s essential in removing disease-causing dental plaque, brushing only requires a gentle scrubbing action covering all portions of tooth surfaces. The brush bristles and mild abrasives in the toothpaste do most of the work of plaque removal.
To minimize the chances of gum recession, you should practice proper oral hygiene and visit your dentist regularly for professional cleanings and checkups. And you might also consider orthodontics for improperly positioned teeth that could not only improve your smile, but also your gum health.
And by all means see your dentist if you notice any signs of gum infection like swollen, reddened or bleeding gums. The sooner you begin gum disease treatment, the less likely your gums will recede in the future.
If you would like more information on recognizing and treating gum recession, 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 “Gum Recession: Getting Long in the Tooth.”
There’s more to teeth than meets the eye. Hidden beneath the visible crown are the tooth’s roots set within the jawbone, secured and protected by the gums from bacteria and infection. But if the gums shrink back (recede), the roots become exposed and susceptible to disease, especially at the points where multiple roots branch from each other, areas called furcations.
It all begins with periodontal (gum) disease caused by built-up bacterial plaque from insufficient brushing and flossing. The infection triggers inflammation that over time weakens gum tissues. They begin to detach from the teeth, which can eventually lead to gum recession and root exposure.
This also causes bone loss, especially at the furcations. We can detect any loss (known as a furcation invasion) and how far along it may be with x-ray imaging or by manually probing with an instrument called a periodontal probe.
There are three general classes measuring furcation invasions. In the earliest, Class I, we can feel the invasion as a slight groove; in Class II, it increases to two or more millimeters across. In Class III the bone loss extends from one side of the root all the way to the other (a “through and through”).
At this stage a patient is in danger of losing the tooth, so we’ll have to act promptly. This means first removing accumulated dental plaque and calculus (tartar) to stop the infection and allow the gums to heal. With severe damage, we may need to assist healing with bone and gum tissue grafting, in which we place donor grafts to serve as scaffolding for the appropriate tissue to grow upon.
You can help prevent this situation by practicing effective daily hygiene and visiting your dentist for thorough cleanings at least twice a year (or more if recommended). And at the first signs of a gum infection—swollen, reddened or bleeding gums—make an appointment as soon as possible to have it checked. The sooner we can detect and treat gum disease, the less likely a furcation invasion or worse will be in your future.
When they’re introducing a new movie, actors often take a moment to pay tribute to the people who helped make it happen — like, you know, their dentists. At least that’s what Charlize Theron did at the premiere of her new spy thriller, Atomic Blonde.
"I just want to take a quick moment to thank my dentists," she told a Los Angeles audience as they waited for the film to roll. "I don’t even know if they’re here, but I just want to say thank you."
Why did the starring actress/producer give a shout-out to her dental team? It seems she trained and fought so hard in the action sequences that she actually cracked two teeth!
“I had severe tooth pain, which I never had in my entire life,” Theron told an interviewer from Variety. At first, she thought it was a cavity — but later, she found out it was more serious: One tooth needed a root canal, and the other had to be extracted and replaced with a dental implant — but first, a bone grafting procedure was needed. “I had to put a donor bone in [the jaw] to heal,” she noted, “and then I had another surgery to put a metal screw in there.”
Although it might sound like the kind of treatment only an action hero would need, bone grafting is now a routine part of many dental implant procedures. The reason is that without a sufficient volume of good-quality bone, implant placement is difficult or impossible. That’s because the screw-like implant must be firmly joined with the jawbone, so it can support the replacement tooth.
Fortunately, dentists have a way to help your body build new bone: A relatively small amount of bone material can be placed in the missing tooth’s socket in a procedure called bone grafting. This may come from your own body or, more likely, it may be processed bone material from a laboratory. The donor material can be from a human, animal or synthetic source, but because of stringent processing techniques, the material is safe for human use. Once it is put in place your body takes over, using the grafted material as a scaffold on which to build new bone cells. If jawbone volume is insufficient for implants, it can often be restored to a viable point in a few months.
Better yet, when grafting material is placed in the tooth socket immediately after extraction, it can keep most of the bone loss from occurring in the first place, enabling an implant to be placed as soon as possible — even before the end of a movie’s shooting schedule.
Will Atomic Blonde prove to be an action-movie classic? Only time will tell. But one thing’s for sure: When Charlize Theron walks down the red carpet, she won’t have to worry about a gap in her smile.
If you have questions about bone grafting or dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Immediate Dental Implant.”
Because the mouth is one of the most sensitive areas of the body, we go to great lengths to eliminate pain and discomfort associated with dental work. Anesthesia, both local and general, can achieve this during the actual procedure—but what about afterward while you’re recuperating?
While a few procedures may require prescription opioids or steroids to manage discomfort after a procedure, most patients need only a mild over-the-counter (OTC) pain reliever. There are several brands available from a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs like aspirin or ibuprofen work by blocking the release of prostaglandins into the body, which cause inflammation in tissues that have been damaged or injured.
Unlike their stronger counterparts, NSAIDs have fewer side-effects, cost less and aren’t addictive. And unlike opioids NSAIDs don’t impair consciousness, meaning patients can usually resume normal activities more quickly.
But although they’re less dangerous than opioids or steroids, NSAIDs can cause problems if taken at too strong a dose for too long. Its major side effect is interference with the blood’s clotting mechanism, known as “thinning the blood.” If a NSAID is used over a period of weeks, this effect could trigger excessive external and internal bleeding, as well as damage the stomach lining leading to ulcers. Ibuprofen in particular can damage the kidneys over a period of time.
To minimize this risk, adults should take no more than 2400 milligrams of a NSAID daily (less for children) and only for a short period of time unless directed otherwise by a physician. For most patients, a single, 400 milligram dose of ibuprofen can safely and effectively relieve moderate to severe discomfort for about 5 hours.
Some patients should avoid taking a NSAID: pregnant women, those with a history of stomach or intestinal bleeding, or heart disease (especially if following a daily low dose aspirin regimen). If you have any of these conditions or similar concerns, be sure you discuss this with your dentist before your procedure for an alternative method for pain management.
If you would like more information on managing discomfort after dental procedures, 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 “Treating Pain with Ibuprofen.”
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