We instinctively know when a smile looks normal—and when it doesn't. It could be that something simply looks out of place like crooked teeth. But we might also notice when something is missing—as with one or both of the canine teeth.
The canine teeth align just under the eyes and are recognizable by their pointed ends. When they're missing, the smile looks “incomplete.” But “missing” in this case could mean “invisible”—the teeth are there, but hidden within the gums because they failed to come in properly and became impacted. This often happens on a smaller jaw where other teeth have crowded into the space intended for them.
Fortunately, we may have a remedy, and not just for appearance's sake—any impacted tooth can cause health problems, from gum abscesses to root damage of neighboring teeth. Although this might necessitate their surgical removal, we might also be able to coax them through the gums into better position in the jaw, if they're in a reasonably good position. This could result in both a boost to a patient's oral health and a more normal looking smile.
First, though, a patient will need to undergo a thorough bite evaluation by an orthodontist. Besides pinpointing the impacted teeth's precise location with x-rays or CT technology, an orthodontist will also want to assess the positions and condition of the rest of the teeth. If the conditions are right and there's enough room in the jaw, the orthodontist may recommend drawing the impacted canines into proper alignment in the jaw.
The process starts when an oral surgeon exposes the impacted teeth by surgically cutting through the gum tissue. They then attach a small bracket to the tooth with a tiny metal chain attached, the other end of which is looped over orthodontic hardware attached to other teeth. The tension on the chain by the hardware gradually nudges the teeth downward out of the gums. This is usually done in coordination with other measures to fully correct the bite.
If the procedure is successful, bringing the canines out of impaction reduces the problems those teeth could cause the person's oral health. But just as important, it can restore normality to their smile.
If you would like more information on treating impacted teeth, 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.”
Forty years have passed since the first reported case of Acquired Immune Deficiency Syndrome (AIDS), and it and the human immunodeficiency virus (HIV) that causes it are still with us. About 1.2 million Americans are currently infected with HIV, with 50,000 new cases diagnosed each year.
The emergence of antiretroviral drugs, though, has made it possible for many with HIV to live normal lives. Even so, the virus can still have a profound effect on health, including the teeth and gums. Because of its effect on the immune system, HIV+ patients are at greater risk for a number of oral conditions, like a fungal infection called candidiasis ("thrush").
Another common problem is chronic dry mouth (xerostomia), caused by a lack of saliva production. Not only does this create an unpleasant mouth feel, but the absence of saliva also increases the risk for tooth decay and periodontal (gum) disease.
The latter can be a serious malady among HIV patients, particularly a severe form of gum disease known as Necrotizing Ulcerative Periodontitis (NUP). With NUP, the gums develop ulcerations and an unpleasant odor arising from dead gum tissue.
Besides plaque removal (a regular part of gum disease treatment), NUP may also require antibiotics, antibacterial mouthrinses and pain management. NUP may also be a sign that the immune system has taken a turn for the worse, which could indicate a transition to the AIDS disease. Dentists often refer patients with NUP to a primary care provider for further diagnosis and treatment.
Besides daily brushing and flossing, regular dental cleanings are a necessary part of a HIV+ patient's health maintenance. These visits are also important for monitoring dental health, which, as previously noted, could provide early signs that the infection may be entering a new disease stage.
It's also important for HIV+ patients to see their dentist at the first sign of inflamed, red or bleeding gums, mouth lesions or loose teeth. Early treatment, especially of emerging gum disease, can prevent more serious problems from developing later.
Living with HIV-AIDS isn't easy. But proper health management, including for the teeth and gums, can help make life as normal as possible.
If you would like more information on dental care and HIV-AIDS, 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 “HIV-AIDS & Oral Health.”
Between the final game of the World Series in late October and spring training in February, major league baseball players work on their skills preparing for the new season. Reporters on a Zoom call to the New York Yankees' training camp wanted to know what star outfielder Aaron Judge had been doing along those lines. But when he smiled, their interest turned elsewhere: What had Aaron Judge done to his teeth?
Already with 120 homers after only five seasons, Judge is a top player with the Yankees. His smile, however, has been less than spectacular. Besides a noticeable gap between his top front teeth (which were also more prominent than the rest of his teeth), Judge also had a chipped tooth injury on a batting helmet in 2017 during a home plate celebration for a fellow player's walk-off home run.
But now Judge's teeth look even, with no chip and no gap. So, what did the Yankee slugger have done?
He hasn't quite said, but it looks as though he received a “smile makeover” with porcelain veneers, one of the best ways to turn dental “ugly ducklings” into “beautiful swans.” And what's even better is that veneers aren't limited to superstar athletes or performers—if you have teeth with a few moderate dental flaws, veneers could also change your smile.
As the name implies, veneers are thin shells of porcelain bonded to the front of teeth to mask chips, cracks, discolorations or slight gaps between teeth. They may even help even out disproportionately sized teeth. Veneers are custom-made by dental technicians based on a patient's particular tooth dimensions and color.
Like other cosmetic techniques, veneers are a blend of technology and artistry. They're made of a durable form of dental porcelain that can withstand biting forces (within reason, though—you'd want to avoid biting down on ice or a hard piece of food with veneered teeth). They're also carefully colored so that they blend seamlessly with your other teeth. With the right artistic touch, we can make them look as natural as possible.
Although porcelain veneers can accommodate a wide range of dental defects, they may not be suitable for more severe flaws. After examining your teeth, we'll let you know if you're a good candidate for veneers or if you should consider another restoration. Chances are, though, veneers could be your way to achieve what Aaron Judge did—a home run smile.
If you would like more information about porcelain veneers, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Veneers: Strength & Beauty As Never Before.”
Wearing braces can pose challenges for your daily life and habits. One in particular is trying to keep your teeth and gums clean.
Braces or not, your oral hygiene needs to be thorough. Every day, your teeth accumulate a thin film of bacteria and food particles called dental plaque that can cause tooth decay or gum disease. It's essential to remove as much as possible each day by brushing and flossing.
That's a more difficult task with braces. The brackets and wires interfere with accessing many of your teeth's surfaces with a toothbrush or floss. As a result, braces wearers on average have a higher incidence of dental disease than non-wearers.
But while it's difficult to keep your mouth clean wearing braces, it's not impossible. Here are some tips and tools for making oral hygiene easier during orthodontic treatment.
A low-sugar diet. Besides items like chips that could damage your braces, you should also limit your consumption of foods and snacks with added sugar. This carbohydrate is a primary food source for disease-causing bacteria. Limiting sugar in your diet can help reduce plaque buildup.
The right toothbrush. Brushing with braces is easier if you use a soft multi-tufted brush with microfine bristles. The smaller bristles maneuver better around the braces than larger bristled brushes. You'll still need to make multiple passes above and below the wires to be sure you're brushing all tooth surfaces.
Flossing tools. Traditional flossing using just your fingers can be next to impossible to perform with braces. But a tool like a floss holder or threader can make it easier to get between teeth. You might also try a water flosser that removes plaque from between teeth with a pressurized spray of water.
Dental treatments. Your dentist can give your teeth extra protection while you're wearing braces with topically applied fluoride to strengthen enamel. Using mouthrinses with an antibacterial ingredient like chlorhexidine may also reduce harmful bacteria.
Be sure you also keep up regular visits with your family dentist while wearing braces, and especially if you begin to notice puffy and reddened gums or unusual spots on your teeth. The sooner any case of dental disease is detected, the less impact it will have on your dental health.
If you would like more information on dental care while undergoing orthodontic treatment, 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 “Caring for Teeth During Orthodontic Treatment.”
Preventing periodontal (gum) disease not only preserves your teeth and gums, it might also benefit the rest of your health. There's growing evidence that gum disease has links to other systemic diseases.
Gum disease usually starts with dental plaque, a thin film of bacteria and food particles, which triggers a bacterial gum infection. Left untreated, the infection advances and steadily breaks down the gums' attachment to teeth.
This can create large ulcerated areas that are too weak to prevent the passing of bacteria and toxins into the bloodstream and other parts of the body. There's growing evidence from epidemiology (the study of the spread and control of disease) that this bloodstream transfer, as well as the inflammation that accompanies gum disease, could affect other body-wide conditions or diseases.
Diabetes. This chronic condition occurs when the body can't adequately produce insulin, a hormone that regulates sugar (glucose) in the blood, or can't respond to it. Diabetes can inhibit healing, cause blindness or lead to death. Both diabetes and gum disease are inflammatory in nature, and there's some evidence inflammation arising from either condition may worsen the other.
Heart disease. Heart attack, congestive heart failure, stroke and other cardiovascular diseases are a leading cause of death. Like diabetes and gum disease, these heart-related conditions are also characterized by inflammation. There are also specific types of bacteria that arise from gum disease that can travel through the body and increase the risk of heart disease.
Arthritis. An autoimmune disease, rheumatoid arthritis causes debilitating pain, particularly involving the joints, and leads to decreased mobility. Interestingly, many newly diagnosed arthritis patients are also found to have some form of periodontal disease—the two diseases, in fact, follow a similar development track. Although this may hint of a connection, we need more research to determine if there are indeed links between the two diseases.
Regardless of any direct relationships between gum disease and other conditions, preventing and treating it can improve both your oral and general health. You can lower your risk of gum disease by practicing daily brushing and flossing and undergoing regular dental cleanings to remove plaque. And at the first sign of gum problems, see your dentist as soon as possible for early intervention—the earlier the better.
If you would like more information on oral health care, 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 “Good Oral Health Leads to Better Health Overall.”
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.