Although usually an orderly process, some permanent teeth don't come in as they should. In fact, they may not come in at all and remain hidden in the gum — a situation called impaction. This creates multiple problems for function, health and, in the case of front canines, appearance.
Canines are the longer and more pointed teeth on each side of the front-most incisors. They help tear and cut food during chewing, a function impaction eliminates. Besides a higher risk for developing abscesses (isolated areas of infection) and cysts, they can also put pressure on neighboring teeth and damage their roots or cause them to erupt abnormally.
Dentists often remove impacted wisdom and other back teeth to lessen these potential problems. Removing canines, though, has additional considerations: besides compromising ideal chewing function, missing canines often create an unattractive smile.
But before considering removal, there's another technique we might be able to use to save the canines and actually draw them down through the gums to their correct position. It's usually part of an overall orthodontic plan to correct a poor bite (malocclusion).
After pinpointing their exact position with x-rays or CT scanning, a surgeon surgically exposes the impacted canines' crowns through the gums. They then bond small brackets to the crowns and attach a small gold chain to each bracket. They fasten the other end of the chains to orthodontic hardware that exerts downward pressure on the impacted teeth. Over several months this pressure can help move the teeth into their normal positions.
Unfortunately, this technique isn't always advisable: one or more of the impacted teeth may be in a difficult position to attempt it. It's usually best in these situations to remove the teeth, usually sooner rather than later for the sake of neighboring teeth.
Fortunately, with today's advanced restorative techniques, we can eventually replace the canines with dental implants, although that's best undertaken after the patient enters adulthood. In the meantime, we can utilize orthodontic means to preserve the open space and provide a temporary restorative solution.
Whatever route taken, these teeth don't have to become a source of problems, especially for your appearance. Whether through orthodontics or restorative dentistry, impacted canines don't have to ruin your smile.
If you would like more information on various orthodontic 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 “Exposing Impacted Canines.”
Most children's permanent teeth erupt on a fairly predictable schedule. Sometimes, though, one or more teeth might not develop as they should — or at all.
These absent teeth pose functional problems for chewing and hygiene, which can affect long-term dental health. But they can also have a disruptive effect on an otherwise attractive smile if the missing teeth are the upper lateral incisors in the most visible part of the smile.
You normally find this pair of teeth on either side of the upper central incisors (the two front-most teeth). On the other side of the lateral incisors are the canine or eye teeth, known for their pointed appearance. Without the lateral incisors, the canines tend to drift into the space next to the central incisors. This can produce an odd appearance even a layperson will notice: only four teeth where there should be six!
It's possible to correct this abnormality, but it will take time and expense. The first step is usually to move the teeth in the upper jaw with braces to their correct position. This puts teeth where they should be and also opens space between the canines and central incisors so we can eventually replace the missing teeth with dental implants.
But the key to all this is timing. It's usually appropriate to undertake tooth movement with braces during late childhood or adolescence. But implants shouldn't be installed until the person's jaw fully matures, usually in early adulthood. An implant placed before then could eventually become misaligned.
To accommodate the time between bite correction and implant placement, the patient can wear a retainer appliance that will keep the newly created space open. We can also attach artificial teeth to the retainer to camouflage the empty space.
It usually takes a team of a family dentist, an orthodontist and a surgeon to see this kind of “smile makeover” project through, possibly over several years. But the gains in better aesthetics and health are well worth the time and expense.
If you would like more information on replacing non-developing 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 “When Permanent Teeth Don't Grow.”
Your teenager is about to take a big step toward better health and a more attractive appearance — orthodontic treatment. You both know the benefits: better chewing function, lower risk of dental disease, and, of course, a straighter and more beautiful smile.
But your teen might also dread the next couple of years of wearing braces. And it's hard to blame them: although they're effective, wearing braces restricts eating certain snacks and foods, they require extra time and effort for brushing and flossing, and they're often uncomfortable to wear. And of high importance to a teenager, they may feel embarrassed to wear them.
But over the last couple of decades a braces alternative has emerged: clear aligners. This form of bite correction requires fewer food restrictions, allows greater ease in hygiene, and is considered more attractive than braces. In fact, most observers won't notice them when a wearer smiles.
Clear aligners are a series of clear plastic trays created by computer that are worn in a certain sequence. During wear each tray exerts pressure on the teeth to gradually move them in the desired direction. The patient wears a single tray for two weeks and then changes to the next tray in the sequence, which will be slightly different than the previous tray. At the end of the process, the teeth will have been moved to their new positions.
Clear aligners aren't appropriate for all bite problems. When they are, though, they offer a couple of advantages over braces. Unlike braces, a wearer can remove the aligner to brush and floss their teeth or for rare, special or important social occasions. And, of course, their appearance makes them less likely to cause embarrassment while wearing them.
In recent years, design improvements have increased the kinds of bites aligners can be used to correct. For example, they now often include “power ridges,” tiny features that precisely control the amount and direction of pressure applied to the teeth. They've also become thinner and more comfortable to wear.
If you're interested in clear aligners as a treatment option, talk with your orthodontist about whether your teen is a good candidate. If so, they could make orthodontic treatment for achieving a more attractive and healthy smile less of an ordeal.
If you would like more information on clear aligners as an orthodontic option, 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.”
A few days before the Oscars, Vanity Fair magazine asked Academy Awards host Neil Patrick Harris to name his most treasured possession. Was it his Tony award statuette for best leading actor in a musical? His star on the Hollywood Walk of Fame? The stethoscope he wore while playing teenaged doctor Doogie Howser on TV? No, as it turns out, the 41-year-old actor’s most treasured possession is… his wisdom teeth. Yes, you read that correctly. “Oddly, I still have my four wisdom teeth,” Harris said. “I refuse to let them go or I’ll lose my wise parts.”
How odd is it for a 41-year-old to have wisdom teeth? Actually, not that odd at all. While it is true that wisdom teeth are often removed, there’s no one-size-fits-all approach to this. It all depends on whether they are causing problems now, or are likely to cause problems in the future.
The trouble wisdom teeth cause is related to the fact that they are the last molars to come in, and that molars are large in size. By the time wisdom teeth appear between the ages of 17 and 21, there often is not enough room for them in the jaw. Sometimes it’s because you may have inherited a jaw size that’s too small for your tooth size; and generally speaking, the size of the human jaw has evolved to become smaller over time.
If room is lacking, the adjacent molar (that came in earlier) can interfere with the path of eruption — causing the wisdom tooth to come in at an odd angle. The wisdom tooth can hit up against that other tooth, possibly causing pain or damaging the adjacent tooth. This is known as “impaction.” Sometimes the wisdom tooth breaks only partway through the gum tissue, leaving a space beneath the gum line that’s almost impossible to clean, causing infection. A serious oral infection can jeopardize the survival of teeth, and even spread to other parts of the body.
If a wisdom tooth is impacted, will you know it? Not necessarily. A tooth can be impacted without causing pain. But we can see the position of your wisdom teeth on a dental x-ray and help you make an informed decision as to whether they should stay or go. If removal is the best course of action, rest assured that this procedure is completely routine and that your comfort and safety is our highest priority. If there is no great risk to keeping them, as Neil Patrick Harris has done, we can simply continue to monitor their condition at your regular dental checkups. It will be particularly important to make sure you are reaching those teeth with your brush and floss, and that you keep to your schedule of regular professional cleanings at the dental office. All healthy teeth are indeed worth treasuring.
If you would like more information about wisdom teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
When it's time for your child to visit the dentist (we recommend around their first birthday), you may want them to see your family dentist. But you might also want to consider another option: a pediatric dentist.
The difference between the two is much the same as between a pediatrician and a family practitioner. Both can treat juvenile patients — but a family provider sees patients of all ages while a pediatrician or pediatric dentist specializes in patients who haven't reached adulthood.
Recognized as a specialty by the American Dental Association, pediatric dentists undergo about three more years of additional post-dental school training and must be licensed in the state where they practice. They're uniquely focused on dental care during the childhood stages of jaw and facial structure development.
Pediatric dentists also gear their practices toward children in an effort to reduce anxiety. The reception area and treatment rooms are usually decorated in bright, primary colors, with toys and child-sized furniture to make their young patients feel more at ease. Dentists and staff also have training and experience interacting with children and their parents to help them relax during exams and procedures.
While a pediatric practice is a good choice for any child, it can be especially beneficial for children with special needs. The “child-friendly” environment is especially soothing for children with autism, ADHD or other behavioral/developmental disorders. And pediatric dentists are especially adept in treating children at higher risk for tooth decay, especially an aggressive form called early childhood caries (ECC).
Your family dentist, of course, can presumably provide the same quality care and have an equally welcome environment for children. And unlike a pediatric dentist who will typically stop seeing patients when they reach adulthood, care from your family dentist can continue as your child gets older.
In the end it's a personal choice, depending on the needs of your family. Just be sure your child does see a dental provider regularly during their developing years: doing so will help ensure a lifetime of healthy teeth and gums.
If you would like more information on visiting a pediatric dentist for your child's dental needs, 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 “Why See a Pediatric Dentist?”
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