The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.
At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.
Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.
Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.
At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.
If you would like more information on the effects and treatment of impacted 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 “Exposing Impacted Canines.”
While gum recession is a common occurrence related to aging, it’s not just an “old person’s disease.” It can happen to anyone, even someone with a relatively healthy mouth. And this detachment and shrinking back of the gums from the teeth may not be a minor problem—your dental health is definitely at risk.
Here then are 4 things you should know about gum recession, and what you can do about it.
The most common cause: periodontal (gum) disease. A bacterial infection triggered by built-up dental plaque, gum disease weakens the gums’ attachment to teeth that leads to recession. To help prevent it, clean away plaque with daily brushing and flossing and visit a dentist regularly for more thorough plaque removal. If you already have gum disease, prompt treatment could stop the infection and reduce any resulting damage including recession.
…But not the only one. There are other factors that contribute to recession besides disease. In fact, it could be the result of “too much of a good thing”—brushing too hard and too frequently can damage the gums and lead to recession. You might also be more susceptible to recession if you’ve inherited thin gum tissues from your parents. Thin gums are at increased risk of recession from both disease and over-aggressive hygiene.
Best outcomes result from treating gum disease and/or recession early. The earlier we detect and treat a gum problem, the better the outcome. See your dentist as soon as possible if you see abnormalities like swollen or bleeding gums or teeth that appear larger than before. Depending on your condition there are a number of treatment options like plaque removal or techniques to protect exposed teeth and improve appearance.
Grafting surgery could regenerate lost gum tissue. While with mild cases of gum recession the gums may respond well to treatment and actually rejuvenate on their own, that might not be possible with advanced recession. We may, however, still be able to restore lost tissue through grafting. Using one of a number of techniques, a graft of donor tissue can foster new replacement growth. It’s a meticulous micro-surgical approach, but it could be a viable answer to extreme gum recession.
If you would like more information on gum recession, 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 “Gum Recession.”
It's no exaggeration — dental implants have revolutionized teeth replacement. Life-like and durable, implants are the closest thing in design and function to a natural tooth.
In fact, there's only one thing better than a dental implant — a real tooth. For function and long-term oral health, you can't beat what nature provided you in the first place. So before you finally decide to remove and replace that problem tooth, consider these other options for saving it.
Root canal therapy. Tooth decay can do more than cause cavities — it can work its way into the pulp, the innermost layer of a tooth. If it isn't stopped here, it could continue on to the roots and put the tooth in real danger of loss. A root canal treatment removes the infection from the pulp and root canals and replaces the space with a filling. A life-like crown is then bonded or cemented to the tooth to protect it from further infection.
Aggressive treatment for periodontal (gum) disease. This other dental disease is just as damaging as tooth decay. Caused by bacterial plaque, the gums around a tooth become infected and inflamed. As it moves deeper into the tissues and inflammation progresses, it can affect supporting bone causing it to dissolve. To prevent this potential bone loss, it's important to seek out and remove hidden pockets of plaque. This may require surgery to access the roots for plaque and calculus (tartar) removal, but it's well worth it to preserve the tooth.
Bone grafting. As mentioned before, gum disease can ultimately lead to bone loss. But even when bone loss has occurred (a substantial threat to a tooth's survival) we may be able to reverse it with bone grafting techniques. During this procedure we insert grafting material at the loss site along with substances that stimulate growth. The graft serves as a scaffold for new bone cells to grow upon. Over time the bone volume increases and helps stabilize a weak tooth.
Of course, your best option is to avoid dental disease in the first place with daily brushing and flossing and regular dental visits for cleanings and checkups. That and treating dental disease in its earliest stages will help ensure you'll have the best teeth possible — your own.
If you would like more information on options for treating diseased 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 “Save a Tooth or Get an Implant?”
While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.
“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.
Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.
Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).
For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.
Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.
If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”
Pregnancy is an exciting time in a woman’s life — but it can also generate a lot of questions about both the mother’s and the baby’s health. The realm of dental care is no exception.
Here are a few of the questions we frequently hear from expectant mothers, along with our answers.
Does the baby’s tooth calcium come from my teeth?
This question is frequently asked by mothers who may have had dental issues and are worried they’ll pass on these problems to their baby. Simply put, no — a baby developing in the womb derives minerals like calcium for their teeth and bones from the mother’s diet, not her teeth. What an expectant mother can do is be sure to eat a healthy, balanced diet rich in nutrients and minerals like calcium.
Am I at heightened risk for dental disease during pregnancy?
Pregnancy does cause significant increases in your body’s hormones, particularly estrogen. This can cause changes in the gum tissue’s blood vessels that may make you more susceptible to periodontal (gum) disease (commonly called “pregnancy gingivitis”). It’s also possible later in pregnancy to develop non-cancerous overgrowths of gum tissues called “pregnancy tumors.” The heightened risk for gum disease during pregnancy calls for increased vigilance in monitoring gum health.
What should I do to take care of my teeth?
It’s important to brush your teeth thoroughly twice a day with ADA-approved fluoridated toothpaste to remove plaque, a thin layer of bacteria and food remnants that adhere to teeth. You should also floss daily and consider using an anti-plaque/anti-gingivitis mouthrinse. And, of course, you should see us for regular office cleanings and checkups, or if you notice swollen, tender or bleeding gums, or other abnormalities.
Should I take prenatal fluoride supplements?
This sounds appealing as a way to give your baby a head start on strong tooth development. Studies on its effectiveness, however, remain slim and somewhat inconclusive — we simply don’t have enough data to make a recommendation. What does have a solid research record is the application of fluoride to teeth in young children just after they appear in the mouth — studies involving over a thousand teeth have shown 99% cavity-free results using topical fluoride applications with sealants.
If you would like more information on dental care during pregnancy, 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 “Expectant Mothers.”
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