Every day the forces you generate when you bite or chew can exert enormous pressure on your teeth. And day after day your teeth remain stable and secure, thanks to an intricate system of periodontal ligaments, attaching gum tissue and bone. The latter element is especially important — healthy bone makes healthy teeth.
And vice-versa — the same biting forces are transmitted through the tooth root to the bone via the periodontal ligament to stimulate new bone growth to replace older bone that has dissolved (resorbed). If a tooth’s missing, however, the bone doesn’t receive that stimulation, and the resorbed bone isn’t replaced at a healthy rate. In fact, you can lose up to a quarter of bone width in the first year alone after tooth loss.
And this can cause a problem when you’re looking to replace that missing tooth with what’s considered the best restorative option available: dental implants. Known for their life-likeness and durability, implants nonetheless need sufficient bone to anchor properly for the best outcome. Without it, implants simply aren’t practical.
But that doesn’t have to be the end of the story: it’s quite possible to regenerate enough bone to support implants through bone grafting. Bone material from the patient (or another donor, human, animal or synthetic) is placed under the gum at the missing tooth site to serve as a scaffold for new growth. The new bone growth will eventually replace the graft material.
The size of the graft and extent of the procedure depends of course on the amount of bone loss at the site. Loss can be kept to a minimum, though, if the graft is placed immediately after a tooth extraction, a common practice now. After a few months, the bone created through the graft is sufficient for supporting an implant and gives you the best chance for a beautiful outcome.
If you’re considering an implant for a missing tooth, you should schedule a consultation appointment with us as soon as possible. After a thorough dental exam, we’ll be able to tell you if bone grafting to support implants is a good idea for you. It adds a little more time to the overall implant process, but the results — a new, more attractive smile — will be well worth it.
If you would like more information on bone regeneration, 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 “Can Dentists Rebuild Bone?”
When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.
“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”
The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”
A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.
It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.
So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
Before we discuss cosmetic options for transforming your smile, and before any preparations for treatment, there’s one question that needs to be answered: What do you want to be different about your smile?
There’s a common misconception that cosmetic changes to the teeth and gums — a “smile makeover” — is primarily a technical achievement based on rigid principles of beauty. Patients believe they must defer to their dentists for what will look best. But that’s not the entire picture: what’s often lost in the understanding is that it’s your smile — the smile at the end of the process you must be comfortable showing with confidence.
In this regard, there are two types of patients, with no right or wrong view — simply what a patient perceives as the smile they want. Some want the “perfect” smile — the greatest level of regularity between teeth shape, size and alignment and the maximum level of brightness. Others are more comfortable with a “natural” smile, a more subtle look with just enough change to create something new and different. The latter may even desire a less than perfect look that doesn’t “fix” all their imperfections — the ones they believe give their face “character.”
Knowing to which side you lean is important at the outset. It’s then important for you to communicate those expectations with us. While we’re focused on the technical aspects of treatment — tooth length, the lineup of teeth with other facial features or the gum-to-lip distance — only you can express what’s going to be a beautiful yet comfortable smile for you. By meshing the technical requirements with your personal desires, we’re able to formulate a makeover plan that fits you.
It all begins with a comprehensive examination to determine the exact health state of your mouth, and it may be necessary to first perform dental work to improve it. From there we can discuss what is and isn’t possible to change the appearance of your teeth and gums. In the end, we want the same result as you — a beautiful smile you’re happy and confident to show the world.
If you would like more information on smile makeovers, 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 “Great Expectations: Is what you get what you want?”
Wearing orthodontic braces brings challenges to daily life. During treatment a patient will need to avoid certain foods and habits, take more time to brush and floss properly, and may endure occasional discomfort. But the effect of metal braces on appearance can be especially difficult, especially for peer-conscious teens.
Clear aligners, though, offer an alternative to braces that could make some of these challenges easier, particularly with your appearance. Aligners are clear plastic trays that fit over the teeth to move them. They can be removed by the wearer for easier brushing and flossing or for special occasions. Best of all, they're much less noticeable than metal braces.
Clear aligners were developed thanks to advances in digital technology. An orthodontist uses a computer application incorporating the data from photographs, x-rays or CT scans of a patient's teeth and jaws to produce a series of clear plastic trays. The patient then wears each tray for about two weeks before changing to the next tray in the sequence.
The trays apply pressure much like metal braces to gradually move teeth to the desired position on the jaw. Each tray is slightly smaller in size than the previous tray in the sequence, so that the progression of tooth movement continues with each succeeding tray. The treatment time is about the same as with conventional braces.
This new orthodontic tool works well for many common bite problems, but until recently they've been limited in scope. But new designs in trays and attachments called buttons added to teeth to provide more leverage have greatly increased their use for more complex bite issues.
Clear aligners also have one other disadvantage, ironically due to one of their principal benefits, removability. Although they can be taken out, they must be worn consistently to achieve results. Some younger patients may not have the maturity level and discipline to responsibly wear their aligners as they should.
That's one issue you'll need to discuss with your orthodontist if you're considering clear aligners for your teen. But if they can maintain wearing consistency, and they have a bite problem that can be corrected with aligners, both you and your teen may find this choice more agreeable and attractive than braces.
If you would like more information on clear aligners, 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 “Clear Aligners for Teens.”
Contrary to what you might think, a knocked out tooth doesn’t inevitably mean tooth loss. Time is of the essence — the shorter the interval between injury and replanting the tooth, the better the tooth’s long-term survival. The longer the interval, on the other hand, the less likely the tooth can survive beyond a few years. That phenomenon is due to the mouth’s natural mechanism for holding teeth in place.
The tooth root maintains its attachment with the jaw bone through an intermediary tissue known as the periodontal ligament. Tiny fibers from one side of the ligament securely attach to the tooth root, while similar fibers attach to the bone on the opposite side of the ligament. This maintains stability between the teeth and bone while still allowing incremental tooth movement in response to mouth changes like tooth wear.
While the ligament fibers will attempt to reattach to a replanted tooth’s root, the longer the tooth is out of the socket the less likely the fibers will fully reattach. An “ankylosis” may instead form, in which the root attaches directly to the jaw bone without the periodontal ligament. In this situation the body no longer “recognizes” the tooth and begins to treat it like a foreign substance. In all but the rarest cases, the tooth root will begin to resorb (dissolve); at some point (which varies from patient to patient) the attachment becomes too weak for the tooth to remain in place and is lost.
Ideally, a knocked out tooth should be replanted within 5 minutes of the injury (for step-by-step instructions, refer to The Field-Side Guide to Dental Injuries available on-line at www.deardoctor.com/dental-injuries). Even if you pass the 5-minute window, however, it’s still advisable to attempt replanting. With a subsequent root canal treatment (to remove dead tissue from the inner tooth pulp and seal it from infection), it’s possible the tooth can survive for at least a few years, plenty of time to plan for a dental implant or similar tooth replacement.
If you would like more information on treatment for a knocked out tooth, 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 “Knocked Out Tooth.”
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