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.”
Although normally benign, a cold sore outbreak can be irritating and embarrassing. Understanding why they occur is the first step to minimizing outbreaks.
The typical cold sore (also known as a fever blister) is caused by the Herpes Simplex Virus (HSV) Type I, medically known as “Herpes Labialis” because it occurs on or around the lips. This virus is not to be confused with HSV Type II, which causes a genital infection. Unlike most viruses, HSV Type I can cause a recurring sore outbreak in certain people. Most viruses tend to occur only once because the body produces anti-bodies to prevent further attack; it’s believed HSV Type I, however, can shield itself from these defenses by hiding in the body’s nerve roots.
These cold sore outbreaks often occur during periods of high stress, overexposure to sunlight or injuries to the lip. Initially you may have an itch or slight burning around the mouth that escalates into more severe itching, redness, swelling and blistering. The sores will break out for about a week to ten days and then scab over and eventually heal (unless they become infected, in which case the healing process may go longer). You’re contagious between the first symptoms and healing, and so can spread the virus to other people.
In recent years, anti-viral prescription medications have been developed that can effectively prevent HSV outbreaks, or at least reduce the healing time after an occurrence. The most common of these are acyclovir and valcyclovir, proven effective with only a few possible mild side effects. They can be taken routinely by people with recurring cold sores to suppress regular outbreaks.
While HSV Type I cold sores are more an aggravation than a health danger, it’s still important for you to see us initially for an examination if you encounter an outbreak. It’s possible for a more serious condition to masquerade as a cold sore or blister. A visit to us may also get you on the right track to reducing the frequency of outbreaks, as well as minimizing discomfort when they do occur.
If you would like more information on the treatment of cold 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 “Cold Sores.”
When you visit us for your regular checkup we're examining more than your teeth and gums. We're also checking to see if you're having problems with soft tissues in and around your mouth.
Besides canker sores, rashes or other types of abnormalities, our exam may uncover strange looking lesions known as lichen planus on the inside of the mouth. These purple-tinted bumps or rash-like discolorations are named for their similarity in appearance to lichen fungi found on trees or rocks. Although these mouth sores may look odd, they're fairly rare and usually do not cause concern.
Most people don't even know they have lichen planus until it's discovered during a dental exam. If there are any symptoms, it's usually a feeling of roughness, tenderness or itching. They may increase your sensitivity to spicy or acidic foods, but rarely cause extreme pain. If they're located around the gums, you may also notice a little soreness after brushing or eating.
To confirm it is lichen planus, we need to perform a biopsy. During this procedure, we remove a tiny amount of the affected tissue and have it examined microscopically. We do this not only to determine the correct diagnosis, but also to rule out more serious problems like pre-cancerous lesions or oral cancer.
Thankfully, though, this worst case scenario is quite rare, and although the condition can't be cured, there are some things you can do to keep any discomfort to a minimum. If the lesions are irritating, we recommend using a soft toothbrush with gentle brushing action. You may also want to limit or avoid spicy or acidic foods like citrus, tomatoes, hot peppers and caffeinated drinks. Managing stress can also help. For some extreme conditions, we can prescribe a topical steroid to help relieve discomfort.
If you notice any of the above symptoms, be sure to contact us or point it out at your next appointment. Once we know what we're dealing with, we can take steps to treat you.
If you would like more information on different types of mouth 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 “Lichen Planus.”
It's no secret that many of Hollywood's brightest stars didn't start out with perfectly aligned, pearly-white teeth. And these days, plenty of celebs are willing to share their stories, showing how dentists help those megawatt smiles shine. In a recent interview with W magazine, Emma Stone, the stunning 28-year-old star of critically-acclaimed films like La La Land and Birdman, explained how orthodontic appliances helped her overcome problems caused by a harmful habit: persistent thumb sucking in childhood.
“I sucked my thumb until I was 11 years old,” she admitted, mischievously adding “It's still so soothing to do it.” Although it may have been comforting, the habit spelled trouble for her bite. “The roof of my mouth is so high-pitched that I had this huge overbite,” she said. “I got this gate when I was in second grade… I had braces, and then they put a gate.”
While her technical terminology isn't quite accurate, Stone is referring to a type of appliance worn in the mouth which dentists call a “tongue crib” or “thumb/finger appliance.” The purpose of these devices is to stop children from engaging in “parafunctional habits” — that is, behaviors like thumb sucking or tongue thrusting, which are unrelated to the normal function of the mouth and can cause serious bite problems. (Other parafunctional habits include nail biting, pencil chewing and teeth grinding.)
When kids develop the habit of regularly pushing the tongue against the front teeth (tongue thrusting) or sucking on an object placed inside the mouth (thumb sucking), the behavior can cause the front teeth to be pushed out of alignment. When the top teeth move forward, the condition is commonly referred to as an overbite. In some cases a more serious situation called an “open bite” may develop, which can be difficult to correct. Here, the top and bottom front teeth do not meet or overlap when the mouth is closed; instead, a vertical gap is left in between.
Orthodontic appliances are often recommended to stop harmful oral habits from causing further misalignment. Most appliances are designed with a block (or gate) that prevents the tongue or finger from pushing on the teeth; this is what the actress mentioned. Normally, when the appliance is worn for a period of months it can be expected to modify the child's behavior. Once the habit has been broken, other appliances like traditional braces or clear aligners can be used to bring the teeth into better alignment.
But in Stone's case, things didn't go so smoothly. “I'd take the gate down and suck my thumb underneath the mouth appliance,” she admitted, “because I was totally ignoring the rule to not suck your thumb while you're trying to straighten out your teeth.” That rule-breaking ended up costing the aspiring star lots of time: she spent a total of 7 years wearing braces.
Fortunately, things worked out for the best for Emma Stone: She now has a brilliant smile and a stellar career — plus a shiny new Golden Globe award! Does your child have a thumb sucking problem or another harmful oral habit? For more information about how to correct it, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “How Thumb Sucking Affects the Bite.”
For a healthy pregnancy, it helps to have healthy teeth and gums. In fact, the American College of Obstetricians and Gynecologists (ACOG) encourages its members to advise expectant moms to see their dentist. But maintaining oral health can be more challenging when you’re expecting. For one thing, hormonal changes make you more susceptible to periodontal (gum) disease, which has been linked to “systemic” (general body) health problems including preterm labor and low birth weight.
Periodontal (gum) disease results from the buildup of bacterial plaque on tooth surfaces in the absence of good oral hygiene. It typically starts as gingivitis — inflammation and redness around the gum margins and bleeding when brushing and flossing. If the infection progresses, it can attack the structures supporting the teeth (gums, ligaments, and bone) and may eventually result in tooth loss. And if the infection enters the bloodstream, it can pose health risks elsewhere in the body. Studies suggest that oral bacteria and their byproducts are able to cross the placenta and trigger an inflammatory response in the mother, which may in turn induce early labor.
TLC for Your Oral Environment
Brushing twice daily with fluoride toothpaste and flossing or using another interdental cleaner at least once daily is your first-line defense again bacteria buildup. Professional cleanings are also important to remove hardened plaque (calculus) that brushing and flossing may miss. And regular checkups can catch problems early to avoid or minimize adverse effects. Periodontal disease and tooth decay aren’t always painful or the pain may subside, so you won’t always know there’s a problem.
Dental emergencies such as cavities, root canals and tooth fractures should be treated promptly to address pain and infection, thereby reducing stress to the developing fetus. Of course, if you know you need a cavity filled or a root canal prior to becoming pregnant, that’s the optimal time to get treated!
If you would like more information about dental care during pregnancy, please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “Pregnancy and Oral Health.”
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