While retainers are often viewed as a nuisance, they’re crucial to protect the gains made with bite correction. Without them, all of the progress achieved through braces or clear aligners could be lost.
Here’s why: The same elastic gum tissue called the periodontal ligament that holds teeth in place also allows them to move incrementally in response to changes in the mouth. That’s why we can move teeth with braces or aligners, which put pressure on the teeth toward a desired direction of movement while the periodontal ligament does the rest.
But the mechanics can also work in reverse: With pressure relieved when the braces are removed, the teeth could revert to their original positions through a kind of “muscle memory.” The light pressure provided by a retainer is enough to keep or “retain” teeth in their new positions.
The best known retainer is a removable appliance. Initially, a patient wears it continuously and only takes it out during oral hygiene. Wear duration may later be reduced to night time only and eventually not at all, depending on a patient’s individual needs.
While effective, removable retainers do have some downsides. Like braces, they’re visible to others. And because they’re removable, they’re frequently misplaced or lost, leading to the added expense of a new one.
An alternative is a bonded retainer, a thin piece of wire attached to the back of the newly moved teeth to keep them in place. Because it’s behind the teeth it’s not visible—and there’s no misplacing it because only a dentist can take it out.
A bonded retainer is a good option, especially if a patient is immature and not as diligent about wearing or keeping up with their appliance. But it can make flossing difficult to perform, and if they’re removed or broken prematurely, the teeth could revert to their former positions.
If you decide to go with a bonded retainer, be sure you get some tips from your dental hygienist on how to floss with it. And if you decide later to have it removed early, be sure to replace it with a removable retainer. Either of these two options can help you keep your new and improved smile.
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.”
You might be a bit apprehensive if your dentist recommends a root canal treatment, especially if it's your first. That's understandable: Popular culture has portrayed the root canal as an unpleasant experience.
But as a routine dental procedure, root canal treatments have been responsible for saving millions of decayed teeth. And, with local anesthesia, the procedure is painless. In fact, a root canal treatment stops pain that often results from advanced tooth decay.
So, let's take the mystery out of the root canal. Here's the 411 on this vital but often misunderstood dental procedure.
Why the name “root canal”? The terms for the procedure—root canal therapy, root canal treatment or simply “root canal”—arise from one of the principal parts of the tooth involved, root canals. These are tiny passageways that lead from the tooth's innermost layer, the pulp, to the tooth roots. While treatment often focuses on decay or diseased tissue within the pulp, the root canals can be infected too and must be included in the later filling process.
Who can perform a root canal? All general dentists are trained in basic root canal procedures. Depending on your tooth's condition, your family dentist may be able to perform it. But if your tooth has an intricate root canal network or some other complication, you may need an endodontist, a specialist in interior tooth and root treatments. Endodontists can perform advanced root canal techniques and have the specialized equipment to handle intricate cases.
What happens during a root canal? Although details may vary depending on the type of tooth and extent of decay, there's a basic process for all root canal procedures. After numbing the tooth and surrounding tissues, the dentist drills into the tooth to access the inner pulp chamber and root canals, then removes the diseased tissue and disinfects the empty chamber and canals. After preparing the canals, the dentist then fills the empty spaces. This, and subsequent sealing and crowning, protects the tooth from future decay.
After the procedure you may have some minor soreness for a few days, which is usually manageable with mild pain relievers like ibuprofen or acetaminophen. This discomfort will diminish with time, and your tooth will have a new lease on life.
If you would like more information on root canal 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 “Root Canal Treatment.”
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
Tooth decay is one of two dental diseases most responsible for tooth loss (gum disease being the other). In the absence of treatment, what starts as a hole or cavity in a tooth's outer layers can steadily advance toward its interior.
Most people associate cavities with the crown, the part of a tooth you can see. But cavities can also occur in a tooth's roots, especially with older adults. Root cavities pose two distinct difficulties: They can lead to more rapid decay spread than crown cavities within a tooth; and they're harder to detect.
Tooth roots are ordinarily covered by the gums, which protects them from bacterial plaque, the main cause for decay. But roots can become exposed due to receding gums, a common problem with seniors who are more susceptible to gum disease.
Unlike the enamel-covered crowns, tooth roots depend on gum coverage for protection against bacteria and the acid they produce. Without this coverage, the only thing standing between tooth decay and the roots is a thin material called cementum.
If decay does enter a tooth's interior, saving it often requires a root canal treatment to remove decayed tissue in the inner pulp and root canals, and then replacing it with a filling. But if we're able to discover a root cavity in its early stages, we may be able to fill it like a crown cavity.
The best strategy, though, is to prevent root cavities from forming. This starts with a dedicated daily regimen of brushing and flossing to remove dental plaque. If you're at high risk for root cavities, we may also recommend antibacterial mouthrinses and other aids.
Regular dental visits are also a must: a minimum of twice-a-year dental cleanings to remove stubborn plaque and calculus (hardened plaque) deposits. For added protection against root cavities, we can also apply fluoride varnish to strengthen teeth. And regular visits are the best way to detect any cavity in its early stages when treatment is less invasive.
A heightened risk of dental problems like root cavities are a part of the aging process. But partnering together, we can lower that risk and increase the longevity of your teeth.
If you would like more information on root cavities, 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 “Root Cavities.”
Half of all children will injure at least one tooth before adulthood. That's why we're joining with other health professionals this June to promote National Safety Month. As dentists, we want to call particular attention to potential dental injuries and what parents and caregivers can do to help their child avoid them.
The source for a dental injury usually depends on a child's age and development level. Younger children learning to walk and run are more apt to fall, and may hit their mouth on hard or sharp surfaces. Later on, most dental injuries tend to come from contact during sports play or other physical activities.
Your prevention strategy should therefore adjust to your child's age and activity level. If you have an infant starting to walk, for example, don't allow them to move around carrying a bottle, cup or other hard object that could be a source of injury if they fall. Also, keep an eye out for hard furniture or sharp-edged surfaces as they toddle around.
If you have a highly mobile toddler, discourage them from climbing and jumping on furniture, tables or other hard surfaces. If feasible, pad these surfaces and sharp edges to minimize the force of impact from a collision.
To prevent sports-related mouth injuries in older children and teens, your primary defense is an athletic mouthguard. Mouthguards cushion and absorb much of the force generated during hard sports contact. They should be worn for any physical activity with a potential risk for mouth injury, including practice sessions and informal play like a pick-up basketball game.
A type of athletic mouthguard known as “boil and bite” is readily available in retail sporting goods stores. After purchase, it is softened in very hot water; the wearer then places it in their mouth and bites down to form a permanent impression. Boil and bite mouthguards offer protection, but they can be bulky and uncomfortable to wear.
For a higher level of protection along with a more accurate and comfortable fit, a custom mouthguard created by a dentist is a more desirable option. These are based on a detailed impression of the wearer's bite, so the fit can't be beat. Both types of mouthguard need upgrading periodically in young wearers to accommodate dental development as they age.
Accidents can happen, but there's much you can do to reduce the likelihood of injury to your child's teeth. Protective measures and equipment—as well as a watchful eye—can go far to help them emerge from these active, early years dentally unscathed.
If you would like more information about dental safety, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Top 10 Oral Health Tips for Children” and “Athletic Mouthguards.”
This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.