The mouth is a crowded place with nerves, blood vessels and sinus cavities sharing common space with the teeth and gums. Although important in their own right, these structures can also hinder treatment for complex dental situations like dental implant surgery or impacted teeth.
Treating these and similar situations depends on getting an accurate depiction of “what lies beneath.” Conventional x-rays help, but their two-dimensional images don't always give the full picture. There's another way—cone beam computed tomography (CBCT).
Similar to CT scanning, CBCT uses x-ray energy to take hundreds of “sliced” images that are then re-assembled with special software to create a three-dimensional model viewable on a computer screen. CBCT is different, though, in that it employs a scanning device that revolves around a patient's head, which emits a cone-shaped beam of x-rays to capture the images.
A dentist can manipulate the resulting 3-D model on screen to study revealed oral structures from various angles to pinpoint potential obstacles like nerves or blood vessels. The detailed model may also aid in uncovering the underlying causes of a jaw joint disorder or sleep apnea.
CT technology isn't the only advanced imaging system used in healthcare. Another is magnetic resonance imaging (MRI), which excites hydrogen atoms in water molecules. This produces different vibration rates in individual tissue structures, which are then translated into detailed images of these structures. Unlike CT or CBCT, MRI doesn't use x-ray energy, but rather a magnetic field and radio waves to produce the atomic vibrations.
But while providing good detail of soft tissues, MRI imaging doesn't perform as well as CBCT with harder tissues like bone or teeth. As to the potential risks of CBCT involving x-ray radiation exposure, dentists follow much the same safety protocols as they do with conventional x-rays. As such, they utilize CBCT only when the benefits far outweigh the potential x-ray exposure risks.
And, CBCT won't be replacing conventional x-rays any time soon—the older technology is often the more practical diagnostic tool for less invasive dental situations. But when a situation requires the most detailed and comprehensive image possible, CBCT can make a big difference.
If you would like more information on advanced dental diagnostics, 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 “Getting the Full Picture With Cone Beam Dental Scans.”
Teenagers can have the same smile-disrupting tooth flaws as adults. But not all cosmetic treatments available to adults are appropriate for teenagers—at least not until they get a little older. Dental veneers fall into that category.
A veneer is a thin porcelain shell custom-made by a dental lab, and bonded by a dentist to the face of a tooth to mask chips, stains, gaps or other imperfections. Because they're less invasive than other measures, veneers are highly popular as a cosmetic dental solution. They do, however, usually require some enamel removal so that they'll appear more natural.
This enamel removal typically won't impact an adult tooth other than it permanently requires it to have veneers or other restorations after alteration. But there is a risk of damage to a teenager's tooth, which hasn't fully developed.
Adolescent teeth usually have a larger pulp chamber (filled with an intricate network of nerves and blood vessels) than adult teeth. And because the enamel and dentin layers may not yet be fully developed, the pulp is much nearer to the tooth's surface.
We must be very careful then in removing enamel and dentin for veneers or we may penetrate the pulp and risk damaging it. Alternatively, there is the possibility of no-prep veneers which are very conservative but often are unable to be done because of the need to often remove tooth structure to make the veneers look natural.
Another cosmetic problem can occur if we place veneers on a patient's teeth whose jaws and mouth structures are still growing. Eventually, the gums could recede and an unsightly gap form between the veneer and the adjacent natural tooth.
Fortunately, there are other techniques we can use to improve a tooth's appearance. Mild chipping can be repaired by bonding composite resin material to the tooth. Some forms of staining may be overcome with teeth whitening. These and other methods can address a teenager's smile appearance until their teeth are mature enough for veneers.
Whether or not a tooth is ready for veneers will depend on its level of development, something that can often be ascertained with x-rays or other diagnostic methods. And if a tooth has already undergone a root canal treatment, there isn't as much concern. In the meantime, though, it may be better for your teen to wait on veneers and try other techniques to enhance their smile.
If you would like more information on dental restoration for teenagers, 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 “Veneers for Teenagers.”
“Orthodontic treatment” and “braces” almost seem like synonymous terms. But while braces certainly are orthodontic, it isn't the only tool in an orthodontist's toolkit.
A good example is a device is known as a Herbst appliance. It's used in situations where the upper jaw is outpacing the growth and development of the lower jaw during childhood. If not corrected, this could cause the top teeth to protrude abnormally beyond the lower teeth.
The Herbst appliance gently and gradually coaxes the lower jaw to grow in a more forward direction, thus “catching up” with the upper jaw. The top part of the device consists of two metal tubes hinged to small elastic bands, which are cemented to the cheek side of the upper back teeth (molars), one on either side of the jaw.
Two smaller tubes are attached in like fashion to the lower teeth, and then inserted into the larger tubes. As the lower jaw moves, the smaller tubes move within the larger to create pressure that gently pushes the jaw forward. Over time, this can sync the growth progress of both the upper and lower jaws, and reduce the chances of a poor bite.
For best results, a Herbst appliance is usually placed to coincide with a child's most rapid period of jaw growth, usually between 11 and 14. They could be placed as early as 8 or 9, however, in situations where the front teeth are already protruding well beyond the lips. In any event, the goal is to positively influence the growth of the lower jaw to alleviate or at least minimize the need for future orthodontic treatment.
As a fixed device, there's no need for a child or parent to tend to it as with other methods, like orthodontic headwear worn in conjunction with braces. A Herbst appliance can, however, alter the normal sensations associated with eating, swallowing and speaking, which may take a little adjustment time for the child. Wearers will also need to be extra vigilant with daily brushing and flossing because of a higher risk of tooth decay.
These, though, are minor inconveniences compared with the benefit of improved bite development. As such, a Herbst appliance could be a positive investment in your child's dental future.
If you would like more information on interceptive orthodontics, 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 “The Herbst Appliance.”
Since his breakout role as Dr. Doug Ross in the 90's TV drama ER, George Clooney has enjoyed a blockbuster career as an award-winning actor, director and producer. He's still going strong, as seen in the recent film The Midnight Sky, which Clooney directed and starred in. This sci-fi drama set a record as the most-watched movie on Netflix for the first five days after its late December release. And although now well into middle age, Clooney still possesses a winsome charm epitomized by his devil-may-care smile.
But he didn't always have his enigmatic grin. Early on, his struggles pursuing his burgeoning acting career triggered a stressful habit of grinding his teeth. This took a toll, as his teeth began to look worn and yellowed, giving his smile—and him—a prematurely aged appearance.
Clooney's not alone. For many of us, our fast-paced lives have created undue stress that we struggle to manage. This pent-up stress has to go somewhere, and for a number of individuals it's expressed through involuntary grinding or gritting of the teeth. This may not only lead to serious dental problems, but it can also diminish an otherwise attractive smile.
There are ways to minimize teeth grinding, the most important of which is to address the underlying stress fueling the habit. It's possible to get a handle on stress through professional counseling, biofeedback therapy, meditation or other relaxation techniques. You can also reduce the habit's effects with a custom-made oral device that prevents the teeth from making solid contact during a grinding episode.
But what if teeth grinding has already taken a toll on your teeth making them look worn down? Do what Clooney did—put a new “face” on your teeth with dental veneers. These thin layers of porcelain are bonded to teeth to mask all sorts of blemishes, including chips, heavy staining and, yes, teeth that appear shortened due to accelerated wearing. And they're custom-designed and fashioned to blend seamlessly with other teeth to transform your smile. Although they're not indestructible, they're quite durable and can last for years.
Veneers can correct many mild to moderate dental defects, but if your teeth are in worse shape, porcelain crowns may be the answer. A crown, which bonds to a prepared tooth to completely cover it, allows you the advantage of keeping your natural tooth while still enhancing its appearance.
Although different in degree, both veneers and crowns require permanently altering the teeth, such that they will require a dental restoration from then on. But if you're looking for an effective way to transform your worn or otherwise distressed teeth into a beautiful smile, it's a sound investment.
Just like George Clooney, your smile is an important part of who you are. We can help you make it as appealing as possible with veneers or other dental enhancements. Call us today to get started on the path to a more attractive smile.
If you would like more information about dental veneers and other smile enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Veneers.”
Dentists remove millions of teeth each year, often because of tooth decay or gum disease. But disease isn't the only reason—a tooth extraction might make it easier to straighten a crooked smile.
Realigning teeth for therapeutic or cosmetic reasons is a regular undertaking in dentistry, but the process itself often differs from person to person. Each individual patient requires their own treatment plan taking into account factors like the kind of bite problem involved, the size of the jaw and the space available to move teeth.
This plan could indeed involve removing teeth. For example, an abnormally small jaw could cause crowding. Not only can crowding move teeth out of position, it may also leave little to no room for moving teeth. Although dentists can minimize crowding by influencing jaw development in early childhood, removing teeth for more space is usually the only option available to older adolescents and adults.
Similarly, teeth can fail to erupt properly and remain partially or fully submerged beneath the gums (known as impaction). There is an orthodontic method for pulling an impacted tooth fully onto the jaw, but only if the tooth isn't too far out of alignment. Otherwise, it may be better to remove the impacted tooth and then correct any gaps with braces or a dental implant.
There's also a situation on the opposite side of the spectrum that could benefit from teeth removal—when one or more permanent teeth fail to form, known as congenitally missing teeth. This can cause gaps in the smile or a “lopsided” appearance where a tooth on one side of the jaw is present while its counterpart on the opposite side of the jaw is missing.
The missing tooth can be replaced by an implant, bridge or other restoration. But another option may be to remove the existing counterpart tooth, and then close the gaps. This can result in a much more attractive smile that might be simpler and less costly than replacing the missing tooth.
Again, the decision to remove teeth to improve smile appearance depends on the patient and their particular dental condition. But in the right situation, it could make straightening a smile easier and more effective.
If you would like more information on 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 “Removing Teeth for Orthodontic Treatment.”
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