- Braces (Orthodontia)
Braces are applied to teeth for various reasons, including poorly aligned jaws, crooked, crowded and missing teeth, or a bad bite (also called malocclusion).
Various things can cause teeth to become crooked or jaws misaligned, including thumb-sucking or a traumatic injury. Some conditions are inherited.
Children between the ages of 10 and 14 are typical candidates for braces because their facial structures are still developing. Adult braces usually entail additional procedures because their faces have already fully developed.
Orthodontics is a field of dentistry that deals with corrections involving jaw and teeth alignment. An orthodontist is a specialist who diagnoses and applies braces.
Braces employ the use of wires and are usually one of three types:
- Old-fashioned, conventional braces, which employ the use of metal strips, or bands.
- Metal or plastic brackets that are cemented or bonded to teeth.
- Brackets that attach to the back teeth (also called "lingual" braces).
Orthodontic procedures, also called "orthodontia," are complex processes.
In most cases, a dentist will need to make a plaster cast of the individual's teeth and perform full X-rays of the head and mouth.
After orthodontic appliances are placed, they need to be adjusted from time to time to ensure that they continue to move the teeth into their correct position.
Retainers are used following braces to ensure that teeth remain in position.
Aesthetic and Comfort Issues
Advances in technology have vastly improved appearance issues with orthodontia.
Braces today are made from extremely lightweight and natural-colored materials. The materials that braces attach to-brackets-are bonded to the surfaces of teeth but can be later removed.
People can expect to wear braces for about two years-less or more in some cases. Adults are usually required to wear braces for longer periods of time.
Because orthodontic appliances need to be adjusted from time to time to ensure they continue to move the teeth into their correct position, they can create pressure on the teeth and jaws. This mild discomfort usually subsides following each orthodontia adjustment.
People who wear braces must be diligent in ensuring that food particles and other debris do not get trapped in the network of brackets and wires. In addition, brackets can leave stains on enamel if the area surrounding them is not cleaned on a daily basis.
Daily oral hygiene such as brushing, flossing and rinsing are a necessity. Some people with orthodontic appliances can benefit from using water picks, which emit small pressurized bursts of water that can effectively rinse away such debris.
Another caveat: Braces and sticky foods don't mix. Crunchy snacks and chewy substances should be avoided at all costs because they can cause orthodontia to be loosened or damaged.
Space maintainers are nifty devices that can help teeth grow in normally following premature tooth loss, injury or other problems.
The devices can help ensure that proper spaces are maintained to allow future permanent teeth to erupt.
If your child loses a baby tooth early through decay or injury, his or her other teeth could shift and begin to fill the vacant space. When your child's permanent teeth emerge, there's not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking.
The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses some of these intricate structures on the chewing surfaces of your teeth.
Enter sealants, which are thin coatings applied to the chewing surfaces designed to prevent the intrusion of bacteria and other debris into the deep crevices on the tops of your teeth.
Sealants actually were developed about 50 years ago, but didn't become commonly used until the 1970s. Today, sealants are becoming widely popular and effective; young children are great candidates for preventative measures like sealants because in many cases, decay has not set in. Even on teeth where decay is present, sealants have been shown to fight additional damage.
Sealants are applied by first cleaning the tooth surface. The procedure is followed by "etching" the tooth with an abrasive substance, which allows the sealant to better adhere. After the sealant is applied, a warm light source is directed to the site to promote faster drying. Sealants usually need re-application every five to 10 years.
- Missing Teeth
Fixed bridges and implants are often used to replace missing teeth and to correct some kinds of bite problems.
Crowns and bridges are the most effective procedure for replacing missing teeth or bite problems.
Bridges are natural-looking dental appliances that can replace a section of missing teeth. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth.
Bridges are sometimes referred to as fixed partial dentures, because they are semi-permanent and are bonded to existing teeth or implants. Some bridges are removable and can be cleaned by the wearer; others need to be removed by a dentist.
Porcelain, gold alloys or combinations of materials are usually used to make bridge appliances.
Appliances called implant bridges are attached to an area below the gum tissue, or the bone.
Crowns are synthetic caps, usually made of a material like porcelain, placed on the top of a tooth.
Crowns are typically used to restore a tooth's function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.
Crowns are also used to attach bridges, cover implants, prevent a cracked tooth from becoming worse, or an existing filling is in jeopardy of becoming loose or dislocated. Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.
A tooth must usually be reduced in size to accommodate a crown. A cast is made of the existing tooth and an impression is made. The impression is sent to a special lab, which manufactures a custom-designed crown. In some cases, a temporary crown is applied until the permanent crown is ready. Permanent crowns are cemented in place.
Crowns are sometimes confused with veneers, but they are quite different. Veneers are typically applied only to relatively small areas.
Caring For Your Crowns
With proper care, a good quality crown could last up to eight years or longer. It is very important to floss in the area of the crown to avoid excess plaque or collection of debris around the restoration.
Certain behaviors such as jaw clenching or bruxism (teeth grinding) significantly shorten the life of a crown. Moreover, eating brittle foods, ice or hard candy can compromise the adhesion of the crown, or even damage the crown.
- Root Canal Therapy
Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward until they reach the tip of the root.
All teeth have between one and four root canals.
Many tooth problems involve infections that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves and other tissues. When the infection becomes worse, it can begin affecting the roots. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems.
A diseased inner tooth brings a host of problems. Pain and sensitivity are some of the first indications of a problem, while inside, a spreading infection can cause small pockets of pus to develop, leading to an abscess.
Root canal therapy is a remarkable treatment with a very high rate of success. It involves removing the diseased tissue, halting the spread of infection, and restoring the healthy portion of the tooth. In fact, root canal therapy is designed to save a problem tooth; before the procedure was developed and gained acceptance, the only alternative for treating a diseased tooth was extraction.
When restoration procedures such as root canal therapy, crowns, or fillings are not enough to save a tooth, it may need to be pulled, or extracted.
Tooth extraction procedures today are far less painful than ever before, thanks to powerful anesthetics and sedatives. In many cases, a patient who has tooth pulled experiences little or no discomfort, and only minor bleeding.
Before a tooth is extracted, the area surrounding the tooth is numbed with a topical/and or injectable anesthetic such as Novocaine.
Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn't occur.
Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.
Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.
If wisdom teeth are causing a problem and are not pulled, they can sometimes become impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: severe discomfort, inflammation, and some kinds of infections.
Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one's ability to properly bite down, speak or eat.
If you experience any of the following symptoms, you may have an impacted wisdom tooth:
- Facial swelling
- Gum swelling
Post Op Instructions
Bleeding. Following extractions some bleeding is to be expected. If persistent bleeding occurs, place gauze pads over bleeding area and bite down firmly for one-half hour. Repeat if necessary. Biting on a wet Lipton tea bag for a few minutes is also effective.
Swelling. Ice bag or chopped ice wrapped in a towel should be applied to operated area — one-half hour on and one-half hour off for 4-5 hours.
Pain. For mild to average pain use any medication you would normally take for a headache or other pain. If a prescription for medication has been given to you, fill it at the pharmacy and start taking immediately. Remember to always take antibiotics until completion. All antibiotic pills must be taken as directed until the bottle is empty.
Food. Light diet is advisable during the first 24 hours. Stay away from spicy foods or acidic foods.
Bony Edges. Small sharp bone fragments may work up through the gums during healing. These are not roots; if annoying return to this office for their simple removal. If any unusual symptoms occur, call the office at once. The proper care following oral surgical procedures will hasten recovery and prevent complications
- Scaling and Root Planing
Advanced gum disease sometime requires the dentist to clean below the gum line to remove stubborn, crusty deposits called tartar or calculus, and to remove damage near the tooth root. This is done to prevent further damage and restore and stabilize the tooth.
For some patients, a local anesthetic is administered to the affected area. Then, a small scaling instrument and/or ultrasonic cleaning device are used to remove the deposits.
After cleaning, the root may need to be smoothed, or planed, to restore it as much as possible to its original shape. Planing also allows your gum tissue to better attach itself and heal properly.
- Flap Surgery
Some people have problems with gums that don't conform to their teeth as well as they should. Gums should be snug around the base of teeth so the teeth can be anchored firmly and grow properly.
Conditions such as prolonged or untreated gum disease can actually cause gums to separate from teeth and form opportunistic pockets for bacteria and other debris; decay can also cause further deterioration.
Left untreated, these pockets can lead to serious infections that cause bone loss, making tooth extraction very likely.
A procedure called pocket reduction, or flap surgery, was developed to correct this problem. The procedure involves scraping away hard deposits such as tartar or calculus and reshaping damaged bone, with the eventual goal of reducing the size of the pocket and allowing the tissues to firm up around the teeth.
A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.
Types of dentures
Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.
Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.
Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.
Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient's jaws during a preliminary visit.
An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.
An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.
Partial dentures are often a solution when several teeth are missing.
Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps.
How are dentures made?
The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient's final denture is placed, following any minor adjustments.
First, an impression of your jaw is made using special materials. In addition, measurements are made to show how your jaws relate to one another and how much space is between them (bite relationship). The color or shade of your natural teeth will also be determined. The impression, bite and shade are given to the dental laboratory so a denture can be custom-made for your mouth.
The dental laboratory makes a mold or model of your jaw, places the teeth in a wax base, and carves the wax to the exact form wanted in the finished denture. Usually a "wax try-in" of the denture will be done at the dentist's office so any adjustments can be done before the denture is completed.
The denture is completed at the dental laboratory using the "lost wax" technique. A mold of the wax-up denture is made, the wax is removed and the remaining space is filled with pink plastic in dough form. The mold is then heated to harden the plastic. The denture is then polished and ready for wear.
Getting used to your denture
For the first few weeks, a new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Your denture should easily fit into place. Never force the partial denture into position by biting down. This could bend or break the clasps.
At first, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Your denture can be adjusted to fit more comfortably. After making adjustments, you may need to take the denture out of your mouth before going to bed and replace it in the morning.
Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum. You may want to avoid chewing gum while you adjust to the denture.
Care of your denture
It's best to stand over a folded towel or a sink of water when handling your denture, just in case you accidentally drop it. Brush the denture (preferably with a denture brush) daily to remove food deposits and plaque, and keep it from becoming permanently stained. Avoid using a brush with hard bristles, which can damage the denture. Look for denture cleansers with the American Dental Association (ADA) Seal of Acceptance. Pay special attention to cleaning teeth that fit under the denture's metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay.
Hand soap or mild dishwashing liquid to clean dentures is also acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures. A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution.
Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.
Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Loose dentures can cause various problems, including sores or infections. Dentures that do not fit properly can be adjusted. Avoid using a do-it-yourself kit to adjust your dentures, as this can damage the appliance beyond repair. Glues sold over-the-counter often contain harmful chemicals and should not be used on a denture.
If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.
Over time, dentures will need to be relined, re-based, or re-made due to normal wear. To reline or re-base a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become loose and the teeth show signs of significant wear.
Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.
Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.
Some people worry about how dentures will affect their speech. Consider how your speech is affected when you have a number of your natural teeth missing.
Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures "click" while you're talking, speak more slowly. You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.
Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which causes constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.
People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth.
One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.
People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.
Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.
Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint. Traumatic injuries also can cause jaw dislocation.
In these cases, jaw surgery, may be required to correct the condition. Some jaw surgery can be performed arthroscopically.
- Maxillofacial Surgery
When facial reconstruction, including procedures involving the oral cavity, is called for, a specialist is needed. Surgical procedures of the neck and head area are performed by a maxillofacial surgeon.
Common maxillofacial procedures include denture-related procedures and jaw surgery.
Protruding chins, crooked or buck teeth or misaligned teeth are good candidates for maxillofacial surgery.
In some people, jaws do not grow at the same rate; one may come in larger than the other, or simply not be aligned properly with other bony structures in the skull. This can cause problems other than appearance issues; an improperly aligned jaw can cause problems with the tongue and lips, and speech and chewing problems as well. Jaw surgery can move jaws into their proper place.
Other kinds of maxillofacial surgery can correct problems with upper facial features such as the nose and cheek.
In addition to correcting jaw problems surgically, orthodontic appliances such as braces may be needed to restore bite relationship and ensure continued proper alignment of the jaw. In some cases, tiny wires or small rubber bands may be needed to keep the jaws in place and promote faster healing. In other cases, small "fixation" screws or plates may need to be inserted in the jaws to facilitate easy movement of the jaws following surgery.
People who have worn dentures for a long time can sometimes experience loss of gum tissue and even bone, mostly from the wear and tear of the appliance on the soft tissues of their mouth.
In extreme cases, maxillofacial surgery, including bone grafts, manipulation of soft tissues or even jaw realignment, may be performed to correct such problems.
- Cosmetic Dentistry
People choose aesthetic dental procedures/surgery for various reasons-to repair a defect such as a malformed bite or crooked teeth, treat an injury, or just improve their overall appearance. Whatever the reason, the ultimate goal is to restore a beautiful smile.
For these and many other reasons, aesthetic dentistry has become a vital and important part of the dental profession.
Common aesthetic dental procedures can be performed to correct misshaped, discolored, chipped or missing teeth. They also can be used to change the overall shape of teeth-from teeth that are too long or short, have gaps, or simply need to be reshaped.
Some of the more common procedures involve:
- Bonding - A procedure in which tooth-colored material is used to close gaps or change tooth color.
- Contouring and reshaping - A procedure that straightens crooked, chipped, cracked or overlapping teeth.
- Veneers - A procedure in which ultra-thin coatings are placed over the front teeth. Veneers can change the color or shape of your teeth. For example, veneers have been used to correct unevenly spaced, crooked, chipped, oddly shaped or discolored teeth.
- Whitening and bleaching - As the term implies, whitening and bleaching, a rapidly increasing procedure, are used to make teeth whiter.
- Implants - A procedure that gives another option for replacing a missing tooth or teeth. They are so well designed that they mimic the look and feel of natural teeth.
- Crowns - A procedure to cover and protect the tooth. While a crown can be used for many different reasons such as restoring a tooth that has been broken, has advanced decay or compromised in another way, it can also be used to improve the esthetics of your smile.
Which techniques should be used to improve your smile? A dental exam will take many factors into consideration, including your overall oral health.