“Orthodontic treatment” and “braces” almost seem like synonymous terms. But while braces certainly are orthodontic, it isn't the only tool in an orthodontist's toolkit.
A good example is a device is known as a Herbst appliance. It's used in situations where the upper jaw is outpacing the growth and development of the lower jaw during childhood. If not corrected, this could cause the top teeth to protrude abnormally beyond the lower teeth.
The Herbst appliance gently and gradually coaxes the lower jaw to grow in a more forward direction, thus “catching up” with the upper jaw. The top part of the device consists of two metal tubes hinged to small elastic bands, which are cemented to the cheek side of the upper back teeth (molars), one on either side of the jaw.
Two smaller tubes are attached in like fashion to the lower teeth, and then inserted into the larger tubes. As the lower jaw moves, the smaller tubes move within the larger to create pressure that gently pushes the jaw forward. Over time, this can sync the growth progress of both the upper and lower jaws, and reduce the chances of a poor bite.
For best results, a Herbst appliance is usually placed to coincide with a child's most rapid period of jaw growth, usually between 11 and 14. They could be placed as early as 8 or 9, however, in situations where the front teeth are already protruding well beyond the lips. In any event, the goal is to positively influence the growth of the lower jaw to alleviate or at least minimize the need for future orthodontic treatment.
As a fixed device, there's no need for a child or parent to tend to it as with other methods, like orthodontic headwear worn in conjunction with braces. A Herbst appliance can, however, alter the normal sensations associated with eating, swallowing and speaking, which may take a little adjustment time for the child. Wearers will also need to be extra vigilant with daily brushing and flossing because of a higher risk of tooth decay.
These, though, are minor inconveniences compared with the benefit of improved bite development. As such, a Herbst appliance could be a positive investment in your child's dental future.
If you would like more information on interceptive orthodontics, 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 “The Herbst Appliance.”
Unless you're 6 years old and on speed dial with the Tooth Fairy, a loose tooth isn't a good feeling. It's also a sign something is wrong in your mouth. If you don't take prompt action, you may lose that tooth for good.
To begin with, teeth are held in place by an elastic tissue known as the periodontal ligament. The ligament lies between the tooth and bone and attaches to both through tiny fibers. The thing to note about the ligament is that it does allow for tooth movement, which serves as a “shock absorber” against the forces generated while biting and chewing.
But that movement is normally so slight, you won't perceive it. If you do, chances are there's a problem with the ligament attachment, which may have been damaged due to trauma or disease.
A hard blow to the face could certainly damage both the teeth and their attachments. But it can also happen if one tooth extends out farther than the rest and absorbs more stress during chewing. You could encounter similar damage if you attempt DIY orthodontics or wear tongue jewelry.
The more common source of ligament damage, though, is periodontal (gum) disease, usually caused by dental plaque, a thin film of bacteria and food particles left on tooth surfaces. If not treated, the infection can advance deeper into the gum tissues (and eventually the supporting bone), causing the ligaments to weaken and detach. In fact, a loose tooth is often a sign of well-advanced gum disease.
If you notice a loose tooth, you should make an appointment with us as soon as possible. Our first step is to ascertain the underlying cause and initiate any needed treatment. We may also want to splint a loose tooth to adjacent teeth to prevent excessive movement while the ligaments heal and reform their attachment to the tooth.
There will be times when a loose tooth is beyond repair. In that case, it may be best to remove the tooth and install a life-like replacement like a dental implant. But that's not inevitable. If at all possible and practical, we'll try to save your loose tooth.
If you would like more information on loose permanent 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 Become Loose.”
Dentists remove millions of teeth each year, often because of tooth decay or gum disease. But disease isn't the only reason—a tooth extraction might make it easier to straighten a crooked smile.
Realigning teeth for therapeutic or cosmetic reasons is a regular undertaking in dentistry, but the process itself often differs from person to person. Each individual patient requires their own treatment plan taking into account factors like the kind of bite problem involved, the size of the jaw and the space available to move teeth.
This plan could indeed involve removing teeth. For example, an abnormally small jaw could cause crowding. Not only can crowding move teeth out of position, it may also leave little to no room for moving teeth. Although dentists can minimize crowding by influencing jaw development in early childhood, removing teeth for more space is usually the only option available to older adolescents and adults.
Similarly, teeth can fail to erupt properly and remain partially or fully submerged beneath the gums (known as impaction). There is an orthodontic method for pulling an impacted tooth fully onto the jaw, but only if the tooth isn't too far out of alignment. Otherwise, it may be better to remove the impacted tooth and then correct any gaps with braces or a dental implant.
There's also a situation on the opposite side of the spectrum that could benefit from teeth removal—when one or more permanent teeth fail to form, known as congenitally missing teeth. This can cause gaps in the smile or a “lopsided” appearance where a tooth on one side of the jaw is present while its counterpart on the opposite side of the jaw is missing.
The missing tooth can be replaced by an implant, bridge or other restoration. But another option may be to remove the existing counterpart tooth, and then close the gaps. This can result in a much more attractive smile that might be simpler and less costly than replacing the missing tooth.
Again, the decision to remove teeth to improve smile appearance depends on the patient and their particular dental condition. But in the right situation, it could make straightening a smile easier and more effective.
If you would like more information on orthodontic treatments, 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 “Removing Teeth for Orthodontic Treatment.”
Temporomandibular joint disorder (TMD) is an umbrella term for a number of chronic jaw problems. These conditions cause recurring pain for 10 to 30 million Americans, especially women of childbearing age.
But even after decades of treatment and research, a full understanding of TMD's underlying causes eludes us. That doesn't mean, however, that we haven't made progress—we have indeed amassed a good deal of knowledge and experience with TMD and how best to treat it.
A recent survey of over a thousand TMD patients helps highlight the current state of affairs about what we know regarding these disorders, and where the future may lie in treatment advances. Here are a few important findings gleaned from that survey.
Possible causes. When asked what they thought triggered their TMD episodes, the top answers from respondents were trauma, stress and teeth clenching habits. This fits in with the consensus among experts, who also include genetic disposition and environmental factors. Most believe that although we haven't pinpointed exact causes, we are over the target.
Links to other disorders. Two-thirds of survey respondents also reported suffering from three or more other pain-related conditions, including fibromyalgia, rheumatoid arthritis and chronic headaches. These responses seem to point to possible links between TMD and other pain-related disorders. If this is so, it could spur developments in better diagnostic methods and treatment.
The case against surgery. Surgical procedures have been used in recent years to treat TMD. But in the survey, of those who have undergone surgery only one-third reported any significant relief. In fact, 46% considered themselves worse off. Most providers still recommend a physical joint therapy approach first for TMD: moist heat or ice, massage and exercises and medications to control muscle spasms and pain.
These findings underscore one other important factor—there is no “one size fits all” approach to TMD management. As an individual patient, a custom-developed action plan of therapy, medication, and lifestyle and diet practices is the best way currently to reduce the effects of TMD on your life.
If you would like more information on TMD management and treatment, 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 “Chronic Jaw Pain and Associated Conditions.”
"Debit or credit?" "Buy or rent?" "Paper or plastic?" Decisions, decisions. It's great to have more than one good option, but it can also provoke a lot of thought in making the right choice. Here's another decision you may one day have to face: "Save my tooth or replace it?"
It's hard to pass up replacing a tooth causing you misery, especially when the alternative is a functional and attractive dental implant. But before you do, consider this important message the American Association of Endodontists relay during Save Your Tooth Month in May: Before you part with a tooth, consider saving it as the best option for your oral health.
Even an implant, the closest dental prosthetic we now have to a real tooth, doesn't have all the advantages of the original. That's because your teeth, gums and supporting bone all make up an integrated oral system: Each component supports the other in dental function, and they all work together to fight disease.
Now, there are situations where a tooth is simply beyond help, and thus replacing it with an implant is the better course of action. But if a tooth isn't quite to that point, making the effort to preserve it is worth it for your long-term health.
A typical tooth in peril is one with advanced tooth decay. Decay begins when acid softens tooth enamel and creates a cavity. At this stage, we can often fill it with a tooth-colored filling. But if it isn't caught early, the decay can advance into the tooth's interior pulp, well below the enamel and dentin layers.
This is where things get dicey. As decay infects the pulp, it can move on through the root canals to infect the underlying bone. If this happens, you're well on your way to losing the tooth. But even if the pulp and root canals have become infected, we may still be able to save the tooth with root canal therapy.
Here's how it works: We first drill a tiny access hole into the infected tooth. Using special instruments, we remove all of the infected tissue from within the pulp chamber and root canals. After a bit of canal reshaping, we fill the now empty spaces with a rubber-like substance called gutta percha. After it sets, it protects the tooth from any more infection.
Contrary to what you might think, root canals aren't painful, as your tooth and the surrounding tissue are completely anesthetized. In fact, if your tooth has been hurting, a root canal will stop the pain. Better yet, it could save a tooth that would otherwise be lost—a satisfying outcome to a wise decision.
If you would like more information about tooth decay treatments, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “A Step-By-Step Guide to Root Canal Treatment.”
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