The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
Have you heard about interceptive orthodontics? This type of early intervention could benefit perhaps 10â??20% of children who need orthodontic treatment, making a positive impact on tooth and jaw development, facial symmetry, and overall self esteem. In case you’re not familiar with it, here are the answers to some common questions about interceptive orthodontic treatment.
Q: What’s the difference between interceptive orthodontics and regular orthodontics?
A: Standard orthodontic treatment typically involves moving teeth into better positions (usually with braces or aligners), and can be done at any age. Interceptive orthodontics uses a variety of techniques to influence the growth and development of teeth and jaws, with the aim of improving their function and appearance. Because it works with the body’s natural growth processes, interceptive treatment is most effective before the onset of puberty (around age 10-14), when growth begins to stop. It is generally not appropriate for adults.
Q: What are the advantages of early treatment with interceptive orthodontics?
A: When it’s done at the right time, interceptive treatment offers results that would be difficult or impossible to achieve at an older age without using more complex or invasive methods — for example, tooth extraction or jaw surgery. That’s why the American Association of Orthodontists, among other professional organizations, recommends that all kids have their first orthodontic screening at age 7.
Q: What are some common issues that can be treated with interceptive orthodontics?
A: One is crowding, where there is not enough room in the jaw to accommodate all the permanent teeth with proper spacing in between. A palatal expander can be used to create more room in the jaw and avoid the need for tooth extraction. Another is a situation where the top and bottom jaws don’t develop at the same rate, resulting in a serious malocclusion (bad bite). A number of special appliances may be used to promote or restrict jaw growth, which can help resolve these problems.
Q: How long does interceptive orthodontic treatment take?
A: Depending on what’s needed, a child might wear a device like a palatal expander or another type of appliance for 6-12 months, followed by a retainer for a period of time. Or, a space maintainer may be left in place for a period of months to hold a place for a permanent tooth to erupt (emerge from the gums). Interceptive treatment ends when a child’s jaw stops growing.
Q: Will braces still be needed after interceptive treatment?
A: Often, but not always, the answer is yes. However, interceptive treatment may shorten the period of time where braces need to be worn, and can help prevent many problems later on.
If you have additional questions about interceptive orthodontics, please contact our office or schedule a consultation. You can learn more in the Dear Doctor magazine article “Early Orthodontic Evaluation.”
When it comes to our children’s safety, there isn’t much nowadays that isn’t under scrutiny. Whether food, clothing, toys and more, we ask the same question: can it be harmful to children?
That also includes tried and true healthcare practices. One in particular, the routine x-ray, has been an integral part of dental care for nearly a century. As a means for detecting tooth decay much earlier than by sight, it has without a doubt helped save billions of teeth.
But is it safe for children? The reason to ask is because x-rays are an invisible form of electromagnetic radiation that can penetrate human tissue. As with other forms of radiation, elevated or frequent exposure to x-rays could damage tissue and increase the future risk of cancer.
But while there is potential for harm, dentists take great care to never expose patients, especially children, to that level or frequency of radiation. They incorporate a number of safeguards based on a principle followed by all healthcare professionals in regard to x-rays called ALARA, an acronym for “as low as reasonably achievable.” This means dentists and physicians use as low an exposure of x-ray energy as is needed to achieve a reasonable beneficial outcome. In dentistry, that’s identifying and treating tooth decay.
X-ray equipment advances are a good example of ALARA in action. Digital imaging, which has largely replaced film, requires less x-ray radiation for the same results than its older counterpart. Camera equipment has also become more efficient, with modern units containing lower settings for children to ensure the proper amount of exposure.
Dentists are also careful how often they take x-ray images with their patients, only doing so when absolutely necessary. As a result, dental patients by and large experience lower dosages of x-ray radiation in a year than they receive from natural radiation background sources found every day in the environment.
Dentists are committed to using x-ray technology in as safe and beneficial a way as possible. Still, if you have concerns please feel free to discuss it further with your dental provider. Both of you have the same goal—that your children have both healthy mouths and healthy bodies for the rest of their lives.
If you would like more information on x-ray safety for children, 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 “X-Ray Safety for Children.”
While braces are a tried and true method for achieving a more attractive smile, they may also give rise to problems with dental disease. This is because their hardware — the brackets and bands that serve as tracks for the tensioning wires — make it more difficult to access the tooth and gum surfaces to clean away plaque. This thin film of food remnant may then become a haven for bacteria that cause gum disease or tooth decay.
One of the more common conditions to occur while wearing braces is gingivitis. This is an initial inflammation of the gum tissues caused by bacterial plaque that hasn’t been removed by brushing or flossing. As the inflammation grows unchecked, the infection could advance deeper into the tissues to become a more serious form of gum disease that threatens the survival of affected teeth.
Difficult as it may be for those wearing braces, the best way to avoid gingivitis is through more thorough oral hygiene practices. Fortunately, there are many hygiene products that can help you get around many of the access difficulties posed by braces. Smaller toothbrushes known as interproximal brushes and floss threaders, small aids that thread dental floss under braces wires, can access the spaces between teeth more readily than conventional brushes or floss. Water flossers (which use water under pressure to remove plaque between teeth) and motorized toothbrushes can further increase efficiency. We can also reduce bacterial growth in the mouth if need be with prescription-strength antibacterial mouthrinses.
If, however, gingivitis or gum overgrowth (another common occurrence during orthodontic treatment) continues to be a problem, we may need to take other actions including surgery. In extreme cases, the braces may need to be removed to adequately treat the gums and allow them time to heal before proceeding with orthodontics.
Extra care with daily hygiene and regular dental checkups and cleanings in addition to your orthodontic visits will help keep gum problems at bay while you’re wearing braces. Taking this extra care will stop or minimize the effect of disease as you continue on to the ultimate goal of your orthodontic treatment — a more beautiful smile.
Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.
“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.
Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.
Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.
Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.
Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.
So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!
For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”
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.”
People mainly identify orthodontics with braces. But while they’re a major part of it, braces aren’t the only way this important dental specialty can make a difference in a person’s bite.
For example, orthodontics can help guide the development of a younger patient’s facial structure that could head off future upper teeth misalignment. The area of focus is the upper jaw and palate (the roof of the mouth) that jointly make up a structure called the maxilla. The maxilla is actually formed by two bones fused together in the center of the palate along what is known as the midline suture running from front to back in the mouth.
The two bones remain separated until puberty, which helps accommodate rapid structural growth during childhood. But problems can arise if the upper jaw is too narrow, causing a “cross-bite” where the lower back teeth bite abnormally outside the upper ones. This can crowd upper permanent teeth and cause them to erupt improperly.
Using a technique called palatal expansion we can correct this abnormality if we act before the maxillary bones fuse. The technique employs a custom-made appliance called a palatal expander that attaches to the posterior teeth of the upper arch. Expanders have two halves joined by a small screw device to increase tension against the teeth to widen the jaw. A parent or the patient (if old enough) increases the tension by using a special key to turn the adjustment screw a tiny amount each day. This may cause minor discomfort that normally eases in a few minutes.
The patient wears the device until the jaw expands to the desired width and then allows the bones to stabilize in the new position. This can sometimes create a small gap between the upper front teeth, but it often closes on its own or it may require braces to close it.
While palatal expanders are not for every case, they can help normalize development and improve the bite, and thus preclude more extensive orthodontic treatment later. But time is of the essence: after the maxilla has fused, surgery will be necessary to separate them and widen the palate. It’s important then not to delay if your child could benefit from this effective treatment.
If you would like more information on palatal expanders and other orthodontic treatments, 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.”
While children are less likely than adults to experience periodontal (gum) disease, the same can't be said for tooth decay. One aggressive form of decay called early childhood caries (ECC) can have a profound effect on a child's dental development and future health.
That's why dentists who treat young children often use a variety of preventive measures to reduce the risk of ECC and other dental diseases. One popular method is dental sealants, dental material coatings applied to the biting surfaces of teeth that fill in the naturally occurring pits and crevices. These areas are highly susceptible to plaque formation, a bacterial biofilm of food particles that tends to accumulate on teeth. It's the bacteria that live in plaque that are most responsible for the formation of tooth decay.
Roughly one third of children between the ages of 6 and 11 have received some form of dental sealant. It's a quick and painless procedure applied during a routine office visit. The dentist brushes the sealant in liquid form on the teeth, and then hardens it with a special curing light. It's common for children to begin obtaining sealant protection as their molars begin to come in.
With their increased popularity among dentists, researchers have conducted a number of studies to see whether dental sealants have a measurable effect reducing tooth decay. After reviewing the cases of thousands of children over several years, many of these studies seemed to show that children who didn't receive sealants were more than twice as likely to get cavities as children who did.
As evidence continues to mount for dental sealants' effectiveness protecting young children from decay, both the American Dental Association and the American Academy of Pediatric Dentistry now recommend it for all children. Not only can sealants help preserve children's teeth now, but they can reduce future costs for dental treatment that results from tooth decay.
If we could go back in time, we all probably have a few things we wish we could change. Recently, Dr. Travis Stork, emergency room physician and host of the syndicated TV show The Doctors, shared one of his do-over dreams with Dear Doctor magazine: “If I [could have] gone back and told myself as a teenager what to do, I would have worn a mouthguard, not only to protect my teeth but also to help potentially reduce risk of concussion.”
What prompted this wish? The fact that as a teenage basketball player, Stork received an elbow to the mouth that caused his two front teeth to be knocked out of place. The teeth were put back in position, but they soon became darker and began to hurt. Eventually, both were successfully restored with dental crowns. Still, it was a painful (and costly) injury — and one that could have been avoided.
You might not realize it, but when it comes to dental injuries, basketball ranks among the riskier sports. Yet it’s far from the only one. In fact, according to the American Dental Association (ADA), there are some two dozen others — including baseball, hockey, surfing and bicycling — that carry a heightened risk of dental injury. Whenever you’re playing those sports, the ADA recommends you wear a high-quality mouth guard.
Mouthguards have come a long way since they were introduced as protective equipment for boxers in the early 1900’s. Today, three different types are widely available: stock “off-the-shelf” types that come in just a few sizes; mouth-formed “boil-and-bite” types that you adapt to the general contours of your mouth; and custom-made high-quality mouthguards that are made just for you at the dental office.
Of all three types, the dentist-made mouthguards are consistently found to be the most comfortable and best-fitting, and the ones that offer your teeth the greatest protection. What’s more, recent studies suggest that custom-fabricated mouthguards can provide an additional defense against concussion — in fact, they are twice as effective as the other types. That’s why you’ll see more and more professional athletes (and plenty of amateurs as well) sporting custom-made mouthguards at games and practices.
“I would have saved myself a lot of dental heartache if I had worn a mouthguard,” noted Dr. Stork. So take his advice: Wear a mouthguard whenever you play sports — unless you’d like to meet him (or one of his medical colleagues) in a professional capacity…
Our bodies are constantly changing as we age. Although the most rapid development occurs during childhood and adolescence, our bones, soft tissue and bodily systems will continue to change, even as we enter old age.
That includes our mouth and facial structures. Over time change will result in a flatter facial profile: this will cause the nose to gain more prominence as the lower part of our face becomes shorter. The extent of our lip movement can also change with time, resulting in less of our teeth appearing when we smile. The teeth themselves will also wear, which can make them appear shorter.
These and other aging consequences should be taken into account in our dental care. We should consider their impact on the health and function of our teeth (the therapeutic aspect) and our appearance (the cosmetic aspect). Rather than less attention, the effects of aging often require a multi-layered approach to care. The foundation for this care, of course, isn’t laid when we reach our middle or later years, but with the regular and special treatments we receive when we’re young.
For example, the best time to address teeth alignment and bite is usually during early adolescence. Orthodontic treatment will certainly improve dental function and smile appearance in the short term; but improving the bite can also have implications later in life. By anticipating how the soft tissue and bone structure within the face and jaws will continue to develop, we can better determine the final teeth position we wish to achieve. This creates satisfying results in the present and a more stable platform for oral health in the future.
We can apply the same approach to other areas, like the position of the lower jaw. Using orthognathic surgery to reposition it will benefit jaw development throughout adulthood. Making these improvements can diminish the effects of aging later in life.
In essence, dental care is a life-long endeavor that begins when we’re very young and continues into our senior years. Properly caring for your teeth at any age is the key to enjoying good oral health for your entire life.
If you would like more information on the effects of aging on dental health, 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 “Understanding Aging Makes Beauty Timeless.”
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.