Water Pick

A Water Pick can be a helpful aid in oral hygiene. For orthodontic patients who have braces, it can be a big help to flush food particles that are trapped in the little nooks and crannies under the wires and brackets. For periodontal patients (those with advanced gum disease), it can be helpful to deliver chemotherapeutic agents deep into the pockets between the teeth and gums where the bone has been destroyed by the disease. It is important to not use the Water Pick at a high setting in order to avoid stripping away the gingival attachment (the portion that connects the gums to the teeth). Although a Water Pick can be a good adjunct, it is not a full alternative to using a toothbrush and floss. Plaque is formed by bacteria which converts sugar into a sticky substance. With the bacteria stuck to the teeth, they are free to form acids and toxins which are the cause of decay and gum disease. A Water Pick is not strong enough to clean the sticky plaque off the tooth surfaces, therefore, a brush and floss must be used.

Thumb-sucking (Part III)

There is no need to worry about your child’s  thumb-sucking habit during their pre-school years,  however, if they have not stopped by the time that the permanent teeth come in, then life long damage can occur. Many times, peer pressure in school alone can cause a child to stop the habit. However, an occasional child will still persist, especially at night while sleeping. Many methods have been proposed and tried to break the habit. No one technique works for every child. There are positive and negative ways. Using positive reinforcement can be very effective but requires a lot of work. You can get a calendar and stick a star on for everyday that the child doesn’t suck their thumb. So many days in a row can earn a reward. This requires lots of parental participation and is difficult to break nighttime sucking. Other methods include wrapping the thumb in tape or gauze or placing a sock over it while sleeping.

Thumb-sucking (Part II)

By not stopping a thumb-sucking habit by the time that the permanent teeth erupt, the child will not swallow properly. This causes a dreadful muscle imbalance which affects the direction and growth of the jaw bones and the final placement of the teeth. The upper arch tends to be long and narrow since the tongue tends to thrust forward with each swallow. The lower jaw will tend to be smaller because the tongue will usually be swallowing forward. Once the thumb-sucking habit is stopped, the orthodontic problems persist since the muscles are in imbalance. When orthodontic treatment is done, the muscle imbalance and swallowing issues must be addressed or else rapid relapse can occur. Things such as myofunctional therapy or tongue exercises are best instituted before any orthodontics is started. This will allow for a much more stable result.

Thumb-sucking (Part I)

Thumb-sucking is a natural reflex for babies. The habit can continue for the first few years of childhood without any permanent damage being done. However, if the habit is not discontinued by the time that the permanent teeth erupt, then the mouth can become permanently deformed. The classic look of a chronic thumbsucker is tiny prominent upper central incisors (or buck teeth) along with a receded chin. It’s possible that there can be a speech impediment also. It’s not really the pressure of the thumb physically pulling the teeth forward that causes the deformity. When the thumb is present when the child swallows, it redirects the tongue downwards away from its natural position in the roof of the mouth. When the thumb is not present, the tongue will continue to thrust forward causing the upper teeth to shift forward and the pressure from the cheeks will collapse the arches inward.

Ectopic Eruption (Part II)

Another common situation where a permanent tooth is not in its normal path of eruption is when the first molars (six year molars) are attempting to come in too far forward thus resorbing the roots of the baby tooth that is ahead of it. If this situation is allowed to continue, then it will cause the baby tooth to be lost prematurely. The offending permanent molar will then erupt too far forward, thus leaving no room for the bicuspid to erupt later. I have found that by pushing the molar back before the baby tooth is lost, then the baby tooth can be retained until its normal time to come out. The procedure is call distalization. I connect orthodontic bands on a couple of molar teeth and connect them to a spring. I then bond a hook on the chewing surface of the offending tooth and engage the spring. This pushes the tooth back into its normal position. I remove the spring and allow the tooth to erupt normally. The process takes from two to four months.

Orthodontic Evaluation during Dental Exam

An orthodontic evaluation during routine dental examination is very important for children. In many cases, early treatment of orthodontic problems can make subsequent phases much easier, less expensive, or may even eliminate the need for further treatment. Many parents think that one has to wait until all of the baby teeth come out and the permanent teeth are in before starting orthodontic treatment, however, many problems – such as lack of space or crossbites – can be corrected early while there are still baby teeth present. The results can be much more stable when done early. The muscle tone of the lips, cheeks, and tongue are still in a states of flux in a young child. The muscle tone usually doesn’t become set for life until all of the permanent teeth come in. That gives a little window of time that the size of the jaw can be changed and the result will be relatively stable, whereas, doing it later in will have a high rate of relapse.

Seating Orthodontic Bands

As the big day approaches to get ones braces on, there is usually a quick step that precedes that appointment. With modern technology, the newer braces can be made in small dots making them much more esthetic. These are bonded to the teeth by etching the enamel surface with acid. However, the molar teeth bear quite a bit of brunt of the bite, so bonding brackets onto those teeth can be frustrating because they can become debonded under normal chewing. Thus, many times it is helpful to go back to the old style bands for those molars. To seat the bands comfortably, there needs to be a small gap between the teeth. Therefore, separators must be placed ahead of time to create that space. A separator can be an elastic “donut” or a twisted wire. They are placed about a week before the big appointment. This will allow the bands to be slipped on with minimal fuss. They usually will make ones teeth sore for a day or two – nothing that a little ibuprofen wouldn’t take care of. But it is sure well worth it because otherwise, the bands would have to be forced on.

Making Room for Crowded Teeth

Crowded teeth are a very common problem affecting many people. To straighten these teeth orthodontically, a dentist needs to make room in the mouth to fit all of the teeth in a nice straight line. Many times, the crowding is so severe that teeth have to be removed to make room. However, it is preferable to keep all of the teeth (except for the wisdom teeth) if possible. This way, it is easier to get teeth to mesh properly. The other alternative is to reduce the size of the teeth.

Teeth are coated with enamel, the hard white substance that we see in our pearly whites. It has no nerve endings, just like hair and fingernails, so it can be smoothed and shaped without the need for local anesthetic. A quarter of a millimeter can be safely removed from each side in between the teeth without causing an increase in decay. That doesn’t sound like much, but when that small increment is added up over an entire arch of teeth, that can amount to a few millimeters which can be enough to allow for an adequate amount of space to makes ones teeth picket fence straight.

Clear Orthodontic Brackets

There is a lot of talk these days about “invisible braces” and for good reason.  For selected cases, they work great. They can be removed to eat and to brush and floss.  However, these type of “braces” do not work on many cases because of the complexity of the case. The invisible braces do not allow for fine control of tooth movement and some movements such as raising a tooth from it’s socket or doing a lot of rotation cannot be done with that method. Many adults and even some teens avoid orthodontic treatment because of the “metal mouth” stigma. For those who are not candidates for invisible braces, there is still hope to get their teeth straightened without having to wear a silver smile. Clear brackets are placed on the teeth as an alternative to the metal ones. These are made of an extremely hard, ceramic material. A metal wire still needs to be used, however, that is so thin that it is not very perceptible from a conversational distance. The ceramic brackets can be more difficult to work with and some orthodontists will charge more due to that. They can especially be problematic treatment wise when torque is placed on them and they can tend to crack due to their brittle nature. But if the only other acceptable treatment is no treatment, the clear braces are certainly a very acceptable alternative.

Invisible Braces (Invisalign®)

Invisalign Aligner

Invisalign Aligner

Invisible braces (such as Invisalign®) are a fantastic way to straighten one’s teeth. There is no “metal mouth” look. People can’t even tell that you are having orthodontics done. You can take the aligner out to eat so there are no restrictions of sticky or hard foods. You can also take them out to brush and floss your teeth. Oral hygiene is so much easier to do without all of the nooks and crannies to negotiate around with the brush. No more smiling with a big wad of lettuce hanging from your teeth. The process is started by making precise molds of the person’s teeth. A lab makes a 3-D computer image of the mold and a technician manipulates the teeth in tiny increments until the final result is achieved. A clear, thin, plastic aligner is contructed for every incremental step. As each aligner is worn, the teeth are slowly moved to their intended positions.

Invisible braces are not for everyone. They have a difficult time raising teeth out of the sockets, a movement called extrusion. They will also not be able to treat a tooth that is severly rotated. Teens can be treated with this method, however, all of the 2nd molars (12 year old molars) have to be fully erupted. With all of that being said, for patients who are candidates fo invisible braces, it can be an extremely satisfying experience.