The primary goal of dental care is to preserve teeth. But there are circumstances in which removing a tooth, even a relatively healthy one, could prove best in the long run.
A malocclusion (poor bite) related to crowding might fit such a circumstance. Crowding occurs when the size of the jaw is too small for the teeth coming in. With not enough space, some teeth could erupt out of their proper positions. Removing certain teeth frees up space to eventually allow braces or other orthodontic devices to re-align the teeth.
The teeth most frequently removed are the first bicuspids, located between the cuspid (the "eyeteeth" directly under the eyes) and the back teeth, and the second premolar. Removing these won't normally affect appearance or functionality once orthodontic or cosmetic treatments are complete.
Because of the mechanics of jaw development it might be necessary to perform these extractions several years before orthodontic treatment. This could create another potential problem: the time lag could adversely affect bone health.
This is because bone, as living tissue, has a life cycle with cells forming, functioning and then dissolving, and new cells taking their place. When teeth are chewing or in contact with each other they generate force that travels through the tooth roots to the bone and stimulates cell growth at a healthy replacement rate.
But when a tooth is missing, so is this stimulation. This slows the replacement rate and eventually leads to decreased bone volume. Too much bone loss could create obstacles for orthodontic treatment or a future dental implant.
To avoid this, the dentist will often place a bone graft with processed bone mineral within the empty tooth socket right after extraction. The graft serves as a scaffold for bone cells to grow upon. The graft (plus any other added growth boosters) can help maintain a healthy level of bone volume to facilitate future orthodontic or restorative treatments.
Since targeted extraction for orthodontics is time-sensitive, you should have your child's bite evaluated by an orthodontist by age 7 to see if any action is necessary. The earlier a malocclusion is detected, the more likely a more attractive and healthy smile will be the ultimate outcome.
If you would like more information on correcting poor bites, 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 “Tooth Removal for Orthodontic Reasons.”
Spring means different things to different people—but to baseball fans, it means just one thing: the start of another thrilling season. All 30 Major League Baseball teams begin play this month, delighting fans from Toronto to Texas and everywhere in between.
The boys of spring carry on an age-old tradition—yet baseball is also changing with the times. Cigarette smoking has been banned at most ballparks for years; smokeless tobacco is next. About half of the MLB venues now prohibit tobacco of any kind, including “snuff” and “dip.” What’s more, a recent contract agreement bars new Major League players from using smokeless tobacco anywhere.
Why all the fuss? Because tobacco isn’t safe to use in any form. People who use smokeless tobacco get just as much highly addictive nicotine as cigarette smokers. Plus, they get a mouthful of chemicals that are known to cause cancer. This puts them at higher risk for oral cancer, cancer of the esophagus, pancreatic cancer and other diseases.
A number of renowned ballplayers like Babe Ruth, Curt Flood and Bill Tuttle died of oral cancer. The death of Hall of Famer Tony Gwinn in 2014 focused attention on tobacco use in baseball, and helped lead to the ban. Gwynn was convinced that his addiction to smokeless tobacco led to his getting oral cancer.
Yet tobacco isn’t the only cause of oral cancer. In fact, the disease is becoming more common in young people who do not smoke. That’s one more reason why it’s so important for people of all ages to keep to a regular schedule of routine dental exams. These visits offer a great opportunity to detect oral cancer in its earliest, most treatable stages.
So as you watch your favorite team, take a tip from the professional athletes’ playbook. If you don’t use tobacco, don’t start. If you do, now is a good time to quit. For help and support, call an expert at 1-800-QUIT-NOW or visit smokefree.gov.
If you have any questions about oral cancer, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Diet and Prevention of Oral Cancer.”
You might not be aware how much force your jaws generate while you eat or chew. But you can become aware in a hurry when part of your inside cheek or lip gets in the way.
What may be even worse than the initial painful bite are the high odds you’ll bite the same spot again—and again. That’s because of a feature in the skin’s healing process.
As a surface wound heals, it often forms a cover of fibrous tissue consisting of the protein collagen. This traumatic fibroma, as it’s called, is similar to a protective callous that develops on other areas of damaged skin. In the process, though, it can become “taller” than the surrounding skin surface, which increases the chances of another bite.
This second bite often results in more fibrous tissue formation that rises even higher from the skin surface, which then becomes more likely to be bit again. After repeated cycles, the initial wound can become a noticeable, protruding lump.
These kinds of sores are typically not cancerous, especially if they’ve appeared to form slowly over time. But they can be a nuisance and the occasion of sharp pain with every subsequent bite. There is, though, an effective way to deal with it—simply have it removed.
While it involves a surgical procedure—an oral surgeon, periodontist or dentist with surgical training usually performs it—it’s fairly minor. After numbing the area with a local anesthetic, the dentist will then completely excise the lesion and close the resulting gap in the skin with two or three small sutures (it could also be removed with a laser). The wound should heal within a few days leaving you with a flat, flush skin surface.
The tissue removed is usually then biopsied. Although it’s highly unlikely it was more than an annoying sore, it’s still common procedure to examine excised tissues for cancer cells. If there appears to be an abnormality, your dentist will then see you to take the next step in your treatment.
More than likely, though, what you experienced was a fibroma. And with it now a thing of the past, you can chew with confidence knowing it won’t be there to get in the way.
If you would like more information on dealing with common 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 article “Common Lumps and Bumps in the Mouth.”
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
Periodontal (gum) disease can cause a number of devastating effects that could eventually lead to tooth loss. However, you may be more prone to a particular effect depending on the individual characteristics of your gums.
There are two basic types of gum tissues or “periodontal biotypes” that we inherit from our parents: thick or thin. These can often be identified by sight — thinner gum tissues present a more pronounced arch around the teeth and appear more scalloped; thicker tissues present a flatter arch appearance. While there are size variations within each biotype, one or the other tends to predominate within certain populations: those of European or African descent typically possess the thick biotype, while Asians tend to possess the thin biotype.
In relation to gum disease, those with thin gum tissues are more prone to gum recession. The diseased tissues pull up and away (recede) from a tooth, eventually exposing the tooth’s root surface. Receding gums thus cause higher sensitivity to temperature changes or pressure, and can accelerate tooth decay. It’s also unattractive as the normal pink triangles of gum tissue between teeth (papillae) may be lost, leaving only a dark spot between the teeth or making the more yellow-colored root surface visible.
While thicker gum tissues are more resilient to gum recession, they’re more prone to the development of periodontal pockets. In this case, the slight gap between teeth and gums grows longer as the infected tissues pull away from the teeth as the underlying bone tissue is lost. The resulting void becomes deeper and more prone to infection and will ultimately result in further bone loss and decreased survivability for the tooth.
Either of these conditions will require extensive treatment beyond basic plaque control. Severe gum recession, for example, may require grafting techniques to cover exposed teeth and encourage new tissue growth. Periodontal pockets, in turn, must be accessed and cleaned of infection: the deeper the pocket the more invasive the treatment, including surgery.
Regardless of what type of gum tissue you have, it’s important for you to take steps to lower your risk of gum disease. First and foremost, practice effective daily hygiene with brushing and flossing to remove bacterial plaque, the main cause of gum disease. You should also visit us at least twice a year (or more, if you’ve developed gum disease) for those all important cleanings and checkups.
If you would like more information on hereditary factors for gum disease, 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 “Genetics & Gum Tissue Types.”
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