On the way to adulthood, permanent teeth steadily erupt until, if all goes normally, you have a full set of teeth. Sometimes, though, one or more teeth may fail to form. This not only can affect your dental health, but it could also diminish your smile.
For example, if the lateral incisors on either side of the central incisors (the two teeth front and center) don't develop, it could create a smile that's “not quite right.” But we can vastly improve such a smile in one of three unique ways.
The first is to fill the resulting gap through canine substitution. This is an orthodontic method in which we use braces to move the pointed canine teeth, which normally position on the other side of the missing laterals, closer to the central incisors. This choice is determined by the size of the canine teeth. If they are slim in width, they can be re-shaped to make them appear more like a lateral incisor, and the gums possibly reshaped as well around them through cosmetic surgery.
We can also install a dental bridge, an appliance that fills the missing lateral space with prosthetic teeth. A traditional bridge requires the teeth on either side of the gap to be reduced in size, which becomes a permanent alteration to accommodate these crowns. This is a disadvantage in a young person. We can also use a “bonded bridge” which uses adhesives to attach extended pieces (or “wings”) of dental material from either side of the prosthetic tooth to one or more supporting teeth. These wings are behind the permanent teeth. Though not as durable as a traditional bridge, it does avoid altering the support teeth.
Finally, we can replace the missing teeth with dental implants. In this method, we install titanium metal posts into the jawbone at the missing tooth locations and then attach a life-like crown to each one. Implants may be more costly than other restorative methods and can take several months to complete. But they are life-like, highly durable, and don't require any alteration to other teeth. A disadvantage is that you should wait until at least 19 years of age to consider this option. What many people do is use a temporary solution until the proper age to do a dental implant.
Each of these methods have their advantages and disadvantages, which should be thoroughly reviewed in consultation with your dentist. And each may also require other dental work, such as initial orthodontics to open adequate space for a restoration. But any of these methods for correcting a missing lateral tooth can be effective and help restore both a healthier mouth and a more attractive smile.
If you would like more information on treating congenital dental defects, 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 “When Permanent Teeth Don't Grow.”
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.
In the fight against dental disease and other conditions your general dentist is your first line of defense for prevention strategies and treatment. Sometimes, however, your condition may require the services of a dental specialist to restore health to your mouth.
A good example of this is an advanced case of periodontal (gum) disease. While your dentist and hygienist are quite skilled at removing plaque and calculus, there may be extenuating circumstances that may benefit from the knowledge and expertise of a specialist. In the case of gum-related issues that would be a periodontist, a dentist who specializes in the diagnosis and treatment of diseases or disorders related to the gums and bone that support teeth.
There are a number of reasons why you may be referred to a periodontist regarding your gum health. Besides advanced stages of the disease (loose teeth, periodontal pocketing or bone loss) that require surgery or other invasive techniques you may have a particular form that requires advanced treatment, or a secondary condition, like pregnancy or diabetes, which could impact your periodontal condition. There may also be a need for a periodontist’s consultation if you’re preparing for cosmetic restoration, most notably dental implants, that could have a bearing on your gum and bone health.
As your primary oral health “gatekeeper,” your general dentist is largely responsible for determining what you need to achieve optimal health. Likewise, your periodontist or other specialists for other problems will be equally committed to providing you the right care for your situation. Your general dentist and other specialists will work together to ensure that your condition will be cared for, and that you’ll continue to enjoy the highest level of oral health possible.
If you would like more information on the role of periodontics and other dental specialties in oral health, 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 “Referral to a Dental Specialist.”
For some time now, you’ve noticed things about your teeth and gums — your overall smile — that you would like to change. But you’re in unfamiliar territory: you don’t know where to begin.
Here, then, are a few basic cosmetic dentistry questions you should ask yourself and us to get you moving in the right direction.
Am I a candidate for cosmetic dentistry? Invariably, the answer is yes — there’s always a way to enhance your appearance, starting with basic hygiene or whitening. But whether you’re a candidate for a particular procedure will depend on a full examination of your mouth — a “smile analysis” — to assess its current condition and needs, and what cosmetic options would best fit those needs.
Are my expectations realistic? That will first depend on what we find with your smile analysis. It will, however, also include studying the bigger picture — how certain changes might affect not only your smile but your overall facial appearance. Your wants and desires are extremely important in this process, but they should also be balanced with a dose of reality — some things may not be in your best interest health-wise to undertake, or are not in keeping with basic aesthetic principles of beauty.
Will I be able to have an idea beforehand how the changes will look? We’ve come a long way in providing patients ways to preview their new smile before undertaking a procedure. It’s often possible to “see” your proposed smile through computer simulation, or in some cases “test drive” it with temporary (provisional) crowns or veneers. For restorations involving porcelain crowns, it may be possible to take your input and fine-tune the shape and color of the permanent crown before it’s completed.
What will it cost? This will depend on the treatment plan we develop. Some treatments like teeth whitening are relatively inexpensive, while procedures like dental implants or orthodontics are major investments. You should also consider the costs to your time — some treatments require only a single visit, while others may take months or even years to complete. Depending on your financial means and comfort level, cost will need to be factored into the final plan, as well as your expectations.
If you would like more information on cosmetic dentistry, 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 “Cosmetic Dentistry: A Time for a Change.”
When you floss (you do floss, right?), you probably notice a sticky, yellowish substance called plaque stuck to the thread. This thin film of tiny food particles and bacteria is the reason you floss and brush in the first place: Because it's the main trigger for tooth decay and gum disease, removing it decreases your risk for disease.
But this isn't the only form of plaque you should be concerned about. That same sticky substance can also interact with your saliva and harden into what's commonly known as tartar. Dentists, however, have a different term: They refer to these calcified deposits as calculus. And it's just as much a source of disease as its softer counterpart.
You might have noticed that this form of plaque has the same name as an advanced type of mathematics. Although dental calculus has little in common with algebra's cousin, both terms trace their origins back to the same linguistic source. The word “calculus” in Latin means “small stone;” it became associated with math because stone pebbles were once used by merchants long ago to calculate sales and trades.
The term became associated with the substance on your teeth because the hardened plaque deposits resemble tiny stones or minerals—and they can be “as hard as a rock” to remove. In fact, because they adhere so firmly it's virtually impossible to remove calculus deposits with brushing or flossing alone. To effectively eliminate calculus from tooth surfaces (including under the gum line) requires the skills and special dental tools of dentists or dental hygienists.
That's why we recommend a minimum of two dental cleanings a year to remove any calculus buildup, as well as any pre-calcified plaque you might have missed with daily hygiene. Reducing both plaque and calculus on your teeth fully minimizes your risk of dental disease. What's more, removing the yellowish substance may also brighten your smile.
That's not to say daily brushing and flossing aren't important. By removing the bulk of plaque buildup, you reduce the amount that eventually becomes calculus. In other words, it takes both a daily oral hygiene practice and regular dental visits to keep your teeth healthy and beautiful.
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