The braces are finally off! But to keep your new, straighter smile you'll need to wear a retainer for some time. That's because the same structural mechanism used to move your teeth could undo what we've just accomplished.
That mechanism resides in an elastic tissue called the periodontal ligament that lies between the teeth and the bone and attaches to both with tiny fibers. While the ligament holds the teeth securely in place, it also allows for slight movement in response to bite changes. Braces "pull" the teeth in the desired new direction, and the ligament responds.
But with that pressure gone after the braces' removal, a kind of "muscle memory" can set in that moves the teeth back towards their original positions. A retainer, a dental appliance worn on the teeth, exerts just enough pressure to "retain" or keep the teeth from regressing.
Retainers are effective, but the most common type has a feature that poses potential problems: it can be removed by the wearer. Because of this, less disciplined patients might be tempted not to wear their retainer as directed. There's also a higher risk of losing one and incurring additional cost to replace it.
But there is another type, the bonded retainer, which stays permanently in the mouth until removed by an orthodontist. It's composed of a thin piece of metal that's firmly attached to the back of the teeth with dental composite material. Not only does a bonded retainer solve the problems mentioned before, it also can't be seen from the outside like a removable retainer.
A bonded retainer does have one disadvantage: because it can't be removed, it can obstruct the teeth during brushing and flossing and require more effort. You won't have as much difficulty with a removable retainer keeping teeth and gums clean. You can overcome this disadvantage, though, with specialized tools like a water flosser or a floss threader to make hygiene easier.
To choose which type of retainer is best for you or your family member, have a talk with your orthodontist. And if you choose a bonded retainer and later have it removed, be sure to switch immediately to a removable one if your orthodontist advises. With either retainer, you'll be able to preserve that hard-earned smile for years to come.
If you would like more information on bonded retainers, 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 “Bonded Retainers: What are the Pros and Cons.”
We all know that a child's baby teeth don't last forever. So if those little teeth develop problems, like severe decay, chips or cracks, it doesn't much matter—right? Wrong! National Children's Dental Health Month, observed in February, is the perfect occasion to remember why baby teeth need the same meticulous care as adult teeth:
- Baby teeth perform the exact same jobs adult teeth do, only in little mouths. Without healthy teeth, a child can't eat comfortably, speak properly or smile with confidence. Given that the last baby tooth doesn't fall out until around age 12, children need to rely on these "temporary" teeth for a long time!
- While there often are no symptoms of early tooth decay, badly decayed baby teeth can become painful—and the problem may get worse quickly. Untreated tooth decay can lead to suffering and expense that could have been avoided with relatively simply dental treatment.
- Baby teeth help guide adult teeth into the right position. Each baby tooth helps hold the right amount of space open for the next tooth that will grow in. When a baby tooth is lost before the permanent replacement is ready to grow in, orthodontic problems can result.
As you can see, good dental health has a big impact on a child's quality of life and health—in both the present and the future. That's why it's important to treat childhood dental disease and injuries promptly and properly. Regular dental exams are the best way to keep on top of your child's dental health. If a cavity is discovered at a routine exam, prompt treatment can keep the decay from spreading to the root canals.
If your child plays sports, ask us about a custom-made mouthguard. This small device can protect your child's teeth from serious injury. And if a baby tooth does get knocked out, let us know. It may be best to fit your child with a very small dental device called a space maintainer, which will hold that empty space open until the permanent tooth beneath it grows in.
If you would like more information about children's dental health, please contact us or schedule an appointment a consultation. You can also learn more by reading the Dear Doctor magazine article “Importance of Baby Teeth.”
Biting the inside of your cheek is high on the list of minor but painfully irritating occurrences like paper cuts or tongue scalding from hot coffee. A mouth bite, though, has an additional tormenting feature — there's a good chance you'll bite the same spot again.
This kind of repeated mouth injury results in an enlargement of the soft tissue that has been traumatized. They're often diagnosed and referred to as a traumatic fibroma. When you bite your cheek, lips or tongue, you create a small wound that usually heals quickly. This healing process, though, can be interrupted if you bite the area again, which can then cause excess scar tissue to form.
The fibrous scar tissue, made up of a protein called collagen, is similar to a callous. You can often feel it with your tongue — a knot of tough skin that protrudes from the otherwise flat cheek wall. Because of this prominence, it tends to get in the “line of fire” during eating or biting, so you'll bite it again — and again. If this cycle continues, then even a more prominent scar tissue forms that you're more likely to bite again.
The wound will heal most of the time, unless you continually bite it. If it becomes a nagging problem, we can surgically remove the lump. After numbing the area with local anesthesia, we'll either use a laser or scalpel to remove it. The area is easy to fix and will flatten out the cheek surface. The entire procedure takes fifteen minutes or less and in a few days to a week you won't even notice it had been there.
While the vast majority of these lesions are harmless, it's still standard protocol to biopsy the removed tissue: a pathologist examines it under a microscope for cancer cells. This is a routine part of any medical practice and not a cause for alarm.
If you've had a lump for awhile that you always seem to be biting, see us for an examination. With a simple procedure, we may be able to remove that irritation once and for all.
If you would like more information on treating mouth lumps and other sores, 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 “Common Lumps and Bumps in the Mouth.”
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
Like other healthcare providers, dentists have relied for decades on the strong pain relief of opioid (narcotic) drugs for patients after dental work. As late as 2012, doctors and dentists wrote over 250 million prescriptions for these drugs. Since then, though, those numbers have shrunk drastically.
That’s because while effective, drugs like morphine, oxycodone or fentanyl are highly addictive. While those trapped in a narcotic addiction can obtain drugs like heroine illicitly, a high number come from prescriptions that have been issued too liberally. This and other factors have helped contribute to a nationwide epidemic of opioid addiction involving an estimated 2 million Americans and thousands of deaths each year.
Because three-quarters of opioid abusers began their addiction with prescription pain medication, there’s been a great deal of re-thinking about how we manage post-procedural pain, especially in dentistry. As a result, we’re seeing a shift to a different strategy: using a combination of non-steroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen and acetaminophen, instead of a prescribed narcotic.
These over-the-counter drugs are safer and less costly; more importantly, though, they don’t have the high addictive quality of an opioid drug. A 2013 study published in the Journal of the American Dental Association (JADA) showed that when two NSAIDs were used together, the pain relief was greater than either drug used individually, and better than some opioid medications.
That’s not to say dentists no longer prescribe opioids for pain management following dental work. But the growing consensus among dental providers is to rely on the double NSAID approach as their first-line therapy. If a patient has other medical conditions or the NSAIDs prove ineffective, then the dentist can prescribe an opioid instead.
There’s often hesitancy among dental patients on going this new route rather than the tried and true opioid prescription. That’s why it’s important to discuss the matter with your dentist before any procedure to see which way is best for you. Just like you, your dentist wants your treatment experience to be as pain-free as possible, in the safest manner possible.
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