Moving teeth through orthodontics may involve more than simply wearing braces. There are many bite conditions that require extra measures before, during or after traditional orthodontic treatment to improve the outcome.
One such measure is extracting one or more teeth. Whether or not we should will depend on the causes behind a patient's poor dental bite.
Here, then, are 4 situations where tooth extraction before orthodontics might be necessary.
Crowding. This happens when the jaw isn't large enough to accommodate all the teeth coming in. As a result, later erupting teeth could erupt out of position. We can often prevent this in younger children with space maintainers or a palatal expander, a device which helps widen the jaw. Where crowding has already occurred, though, it may be necessary to remove selected teeth first to open up jaw space for desired tooth movement.
Impacted teeth. Sometimes an incoming tooth becomes blocked and remains partially or fully submerged beneath the gums. Special orthodontic hardware can often be used to pull an impacted tooth down where it should be, but not always. It may be better to remove the impacted tooth completely, as well as its matching tooth on the other side of the jaw to maintain smile balance before orthodontically correcting the bite.
Front teeth protrusion. This bite problem involves front teeth that stick out at a more horizontal angle. Orthodontics can return the teeth to their proper alignment, but other teeth may be blocking that movement. To open up space for movement, it may be necessary to remove one or more of these obstructing teeth.
Congenitally missing teeth. The absence of permanent teeth that failed to develop can disrupt dental appearance and function, especially if they're near the front of the mouth. They're often replaced with a dental implant or other type of restoration. If only one tooth is missing, though, another option would be to remove the similar tooth on the other side of the jaw, and then close any resulting gaps with braces.
Extracting teeth in these and other situations can help improve the chances of a successful orthodontic outcome. The key is to accurately assess the bite condition and plan accordingly.
If you would like more information on orthodontic options, 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.”
Porcelain veneers are excellent for restoring otherwise sound teeth that are stained, chipped or slightly misaligned. But the question for many is, are they long-lasting?
Just as the term is used in building construction, a dental veneer is a thin covering of material that’s bonded to the outside of a tooth to conceal blemishes. Very thin layers of dental porcelain (a form of hardened glass colored to match a patient’s natural teeth) are created by a dental lab technician to achieve the preferred shape and size of the patient’s tooth. Unlike crowns or other restorations, veneers require very little tooth preparation to accommodate them.
As to their longevity: if cared for properly, a veneer could last for twenty years or more. While the veneer itself isn’t subject to the effects of dental disease, the tooth and the gums that support it are. Shrinking gum tissues as a result of periodontal (gum) disease, for example, could have a negative effect on the veneered tooth and subsequently the veneer. It’s important, then, that you properly practice daily brushing and flossing, along with keeping up regular office cleanings and checkups.
There’s one other important consideration: while porcelain veneers can withstand normal biting forces, if they’re subjected beyond their tolerance they could shatter. You should be careful not to subject your veneered teeth to an abnormal biting force, such as biting down on an extremely hard object. If you tend to grind your teeth at night, wearing a night guard can minimize the force created from the grinding.
It’s possible to repair and re-bond a loose or slightly chipped veneer. In some cases, though, severe damage may require a replacement. Still, by using common sense about what you bite down on and taking proper care of your teeth and gums, you can minimize the chances of damage and enjoy many years of a more attractive smile.
If you would like more information on porcelain veneers, 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 “Porcelain Veneers: How Long will Your Porcelain Veneers Last?.”
If you press your tongue against your teeth, unless something is badly wrong they won't budge. In fact, your teeth are subjected to a fair amount of pressure each day as you chew and eat, and yet they remain firmly in place.
But there's a deeper reality—your teeth do move! No, it's not a paradox—the gum and bone tissues that hold your teeth in place allow for slight, imperceptible changes in the teeth's position. Their natural ability to move is also the basis for orthodontics. Here are 3 more facts you may not know about your teeth's natural ability to move.
Teeth are always on the move. Teeth are held firmly within the jawbone by an elastic gum tissue called the periodontal ligament and a thin layer of bony-like material called cementum. In response to pressure changes, though, the bone dissolves on the side of the teeth in the direction of pressure and then rebuilds behind it, solidifying the teeth's new position, a process that happens quite slowly and incrementally. And it will happen for most of us—some studies indicate more than 70% of people will see significant changes in their bite as they age.
Orthodontics works with the process. Orthodontic appliances like braces or clear aligners apply targeted pressure in the direction the orthodontist intends the teeth to move—the natural movement process does the rest. In the case of braces, a thin metal wire is laced through brackets bonded to the front of the teeth and then anchored, typically to the back teeth. The orthodontist incrementally tightens the wire against its anchors over time, encouraging tooth movement in response to the pressure. Clear aligners are a series of removable trays worn in succession that gradually accomplish the same outcome.
Watch out for the rebound. That nice, straight smile you've gained through orthodontics might not stay that way. That's because the same mechanism for tooth movement could cause the teeth to move back to their former positions, especially right after treatment. To avoid this outcome, patients need to wear a retainer, an appliance that holds or "retains" the teeth in their new positions. Depending on their individual situations and age, patients may have to wear a retainer for a few months, years or from then on.
If you would like more information on orthodontic 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 “The Importance of Orthodontic Retainers.”
If while watching a Seattle Seahawks game you thought you saw wide receiver D. K. Metcalf sucking on a “binky,” your eyes weren’t deceiving you. Well, sort of not—he’s actually been known to wear a mouth and lip guard shaped like a child’s pacifier.
Metcalf isn’t the only pro football player customizing this essential piece of safety equipment. Broncos running back Ronnie Hillman has been seen sporting “vampire fangs.” And Odell Beckham Jr., wide receiver with the Cleveland Browns, has a series of interchangeable guards with various designs and colors.
You may say, “That’s the NFL, so of course players have the money and fame to dress up their mouthguards with a little flair.” But custom mouthguards aren’t out of reach for the average athlete—in fact, it’s actually a sound idea. Not so much for expressing personality, but for the comfort and protective advantages that a custom mouthguard may have over retail varieties.
Usually made of high-resistant plastic, an athletic mouthguard absorbs blows to the face and mouth during hard contacts in sports like football, basketball and hockey. Mandated by many organized sports associations, mouthguards can prevent dental and facial injuries like chipped or knocked out teeth, gum abrasions or jaw fractures. There’s even some evidence they reduce the risk of concussion.
Many amateur players use what is known as a “boil and bite” mouthguard, available in retail sporting goods stores. They’re softened first, usually in hot water, and then placed in the mouth and clenched between the jaws to obtain a somewhat individualized fit.
Although they do provide some level of protection, a boil and bite mouthguard can’t match the accuracy of a custom mouthguard produced by a dentist based on impressions and measurements of an individual player’s mouth. As a result, custom mouthguards can be made thinner than many boil and bite guards, increasing their comfort while being worn. More importantly, their accurate fit enhances their protective capabilities.
As you might imagine, custom mouthguards are more expensive than their retail counterparts, and with younger athletes whose mouth structures are still growing, it may be necessary to upgrade a custom guard after a few seasons. Still, the cost of a custom mouthguard may be well worth the superior protection it provides for your own little star athlete. And although it may not necessarily look like a binky or vampire fangs, a custom mouthguard could make their playing experience safer and more comfortable.
You don’t have to be a dental professional to appreciate a beautiful smile. Likewise, you’ll also know when something’s not quite right with one.
Such can be the case when a tooth fails to erupt properly, causing most or all of the crown to remain below the gum line, a condition known as impaction. Upper canines (or “eyeteeth,” for their location in the arch under the eyes) are especially susceptible to impaction: located on either side of the lateral incisors, which are on either side of the central incisors (the two center front teeth).
The upper canines are important both for function and appearance. Working with their lower counterparts they help cut through food as we chew, so you lose some of that efficiency when they don’t erupt properly. Impacted teeth are susceptible to abscesses and cysts, and can impinge upon and damage the roots of other teeth. And just as importantly, their absence also disrupts the smile as nearby teeth tend to move or “drift” toward the open space.
Rather than remove the impacted canines as is often done with back teeth, it may be more advantageous for both function and appearance to “coax” them into full eruption. This requires first pinpointing their exact location below the gums using x-rays or cone beam 3-D imaging.
If the teeth are in reasonably good position we must first prepare them for orthodontic treatment by surgically exposing the crown from the gums and bonding a small bracket to it. We then attach a small gold chain to the bracket that extends outside of the gums when we suture them back into place. The chain is attached to orthodontic hardware that exerts pressure on the impacted tooth for several months to “pull” it out into the arch.
This procedure has the best chance of success if undertaken before the end of jaw development in early adulthood. Otherwise, it may be better to remove the impacted canines and replace them with dental implants, followed by orthodontic treatment of other teeth to restore their proper position and bite relationships. In either case, your impacted upper canines don’t have to be a problem — we can restore both your mouth function and your smile.
If you would like more information on impacted teeth and treatment options, 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.”
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