My Blog

Posts for tag: orthodontic treatment

By Richard Taylor, DMD
August 26, 2019
Category: Dental Procedures
LadyGagaWasntBornThisWay

Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"

"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.

The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.

Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.

Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).

The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.

Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.

So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.

If you have questions about orthodontic treatment, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Orthodontics For The Older Adult.”

ALittleOrthodonticMagicCouldHelpanImpactedToothErupt

Bite problems aren't limited to teeth simply out of position. The problem could be some teeth aren't there—visibly, that is. They still exist below the gums and bone, but they've been crowded out and blocked from erupting. We call this condition impaction.

Any tooth can become impacted and affect the bite, but a person's smile suffers more if it involves visible front teeth. This is especially so if the teeth in question are upper canines or "eye teeth"—the smile doesn't look normal without these pointed teeth on either side of the central and lateral incisors.

Impacted teeth can also contribute to more than a cosmetic problem: they're more susceptible to abscesses (pockets of infection) or root damage both to themselves or neighboring teeth. To minimize these potential health issues, we'll often remove impacted teeth surgically (as is often done with wisdom teeth).

But because of their important role in not only appearance but also bite function, we may first try to assist impacted canines to fully erupt before considering extraction. It takes a bit of orthodontic "magic," but it can be done.

Before we can make that decision, though, we want to precisely locate the impacted teeth's positions and how it may affect other teeth. This initial evaluation, often with advanced diagnostics like CT scanning or digital x-rays, helps us determine if the impacted teeth are in a workable position to save. If they're not, we may then need to consider removing them and ultimately replacing them with a dental implant or similar restoration.

But if their position is workable and there are no other impediments, we can proceed with helping them erupt. To do this we'll have to first expose them by creating a small opening in the gums through minor surgery. We then bond a small bracket to the tooth, to which we'll attach a small chain that we then attach to orthodontic braces. This enables us to exert continuous pressure on the tooth.

Over time, the pressure coaxes the tooth to erupt. We may still need to apply other forms of orthodontics and cosmetic procedures, but using this procedure to rescue impacted canines can produce a healthier and more attractive smile.

If you would like more information on treating complex bite problems, 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.”

BeontheAlertforWhiteSpotsonTeethWhileWearingBraces

While wearing braces is the path to a healthier and more attractive smile, it can be a difficult journey. One of your biggest challenges will be keeping your teeth clean to avoid a higher risk of tooth decay.

Tooth decay starts with dental plaque, a thin film of bacteria and food particles that accumulates on teeth. Daily brushing and flossing clear this accumulation. But the hardware of braces makes it difficult to access all tooth surfaces, and can even become a haven for plaque.

One sign in particular of tooth decay while wearing braces is the appearance of chalk-like spots on the teeth known as white spot lesions (WSLs). WSLs occur because the minerals in the enamel beneath them have begun to break down in response to decay. The spots can eventually cause both structural and cosmetic problems for a tooth.

The best approach to WSLs is to prevent them from developing in the first place. You'll need to be extra vigilant with daily oral hygiene while wearing braces to reduce plaque buildup. To help with the increased difficulty you might consider using a special toothbrush designed to maneuver more closely around orthodontic hardware. You may also find using a water flosser to be a lot easier than flossing thread.

Preventing tooth decay and WSLs also includes what you eat or drink to reduce the effects of enamel de-mineralization. The bacteria that cause decay thrive on sugar, so limit your intake of sweetened foods and beverages. And to avoid excessive demineralization cut back on acidic foods as well.

If despite your best preventive efforts WSLs still form, we can take steps to minimize any damage. For one, we can give your enamel a boost with fluoride applications or other remineralization substances. We can also inject a tooth-colored resin beneath the surface of a WSL that will make it less noticeable.

With any of these and other treatments, though, the sooner we can treat the WSL the better the outcome. Practicing good hygiene and dietary habits, as well as keeping an eye out for any WSL formations, will do the most to protect your new and improved smile.

If you would like more information on preventing dental disease while wearing braces, 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 “White Spots on Teeth During Orthodontic Treatment.”

AnchorageToolsHelpOrthodontistsCorrectComplexBiteProblems

While braces are often the stars for straightening smiles, they're not the only cast members in an orthodontic production. Orthodontists occasionally turn to other appliances if the bite problem is challenging. Whatever the tool, though, they usually have something in common—they use the principle of anchorage.

To understand anchorage, let's first consider the classic kid's game Tug of War. With teams on either end of a rope, the object is to pull the opposing team across the center line before they pull you. To maximize your pulling force, the player at the back of your rope, usually your stoutest member, holds steady or "anchors" the rest of the team.

Like a Tug of War team, braces exert force against the teeth. This stimulates the supporting periodontal ligament to remodel itself and allow the teeth to move. The braces use the teeth they are attached to as anchors, which in a lot of cases are the back teeth. By attaching a thin wire to the brackets or braces on the teeth, the orthodontist includes all the teeth on the arch, from one end to the other. Anchored in place, the wire can maintain a constant pressure against the teeth to move them.

But not all bite situations are this straightforward. Sometimes an orthodontist needs to influence jaw growth in addition to teeth movement. For this purpose, they often use orthodontic headgear, which runs around the back of the head or neck and attaches to orthodontic brackets on the teeth. It still involves an anchor but in this case it's the patient's own skull.

In some situations, an orthodontist may feel he or she needs more anchorage as the teeth alone may not be enough. For this, they might establish a separate or additional anchor point using a temporary anchorage device (TAD). A TAD resembles a tiny screw that's inserted into the jawbone near the tooth intended for movement. The orthodontist can then attach the TAD to braces hardware using some form of elastics. After treatment, they remove the TAD.

These are just a couple examples of specialized tools an orthodontist can use for bite correction. Thanks to them and similar devices, even the most complex bite problem can be overcome to create a healthier and more attractive smile.

If you would like more information on correcting a poor bite, 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 “Orthodontic Headgear & Other Anchorage Appliances.”

GetAheadofaDevelopingCross-BitewithThisEarlyInterventionMeasure

Applying braces or clear aligners to move misaligned teeth is only part of an orthodontist's overall mission to eliminate poor bites (malocclusions). Sometimes a malocclusion isn't caused by the teeth at all—the size of the jaw is the problem!

One type in particular, a cross-bite, often happens because the upper jaw has developed too narrowly. As a result, many of the upper teeth fit inside the lower, the opposite of normal. But a tool called a palatal expander can alleviate the problem if it's applied at an early enough age.

The device works because the upper jawbone initially forms as two halves that fit together along a center line in the roof of the mouth (the palate) running from the back of the mouth to the front. These two bone halves remain separate during childhood to facilitate jaw growth, but eventually fuse around puberty.

Consisting of two sets of wire arms joined together by a hinge mechanism in the middle, the expander device is positioned up against the palate. The orthodontist extends each arm to press against the inside of the back teeth, then adds more outward pressure by turning the mechanism in the middle with a small key. During wear, the patient or caregiver will turn the mechanism in the same way to keep up the pressure on the two sides of the jaw.

This continual pressure keeps the two bones moving away from each other and maintaining a center gap between them. In response, more bone forms on the two halves to fill the gap. In time, the newly formed bone should widen the jaw enough to correct any developing malocclusion.

Timing is everything with a palatal expander—if not used before the jaw bones fuse, the patient will need a surgical procedure to separate the bones to pursue treatment. To catch the problem early enough, children should have an orthodontic evaluation on or before they turn six. An orthodontist may be able to identify this or other emerging bite problems and intervene before it becomes worse. Taking this approach can help save you and your child more expensive orthodontic treatment down the road.

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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”