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Posts for: March, 2021

RemovingTeethMightMakeItEasierToStraightenaSmile

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.”


ANewDentalPainManagementApproachReducestheNeedforNarcotics

Narcotics have long played an important role in easing severe pain caused by disease, trauma or treatment. Healthcare professionals, including dentists, continue to prescribe them as a matter of course.

But narcotics are also addictive and can be dangerous if abused. Although addictions often arise from using illegal drugs like heroin, they can begin with prescriptive narcotics like morphine or oxycodone that were initially used by patients for legitimate reasons.

As a result, many healthcare providers are looking for alternatives to narcotics and new protocols for pain management. This has led to an emerging approach among dentists to use non-addictive non-steroidal anti-inflammatory drugs (NSAIDs) as their first choice for pain management, reserving narcotics for more acute situations.

Routinely used by the public to reduce mild to moderate pain, NSAIDs like acetaminophen, ibuprofen or aspirin have also been found to be effective for managing pain after many dental procedures or minor surgeries. NSAIDs also have fewer side effects than narcotics, and most can be obtained without a prescription.

Dentists have also found that alternating ibuprofen and acetaminophen can greatly increase the pain relief effect. As such, they can be used for many more after-care situations for which narcotics would have been previously prescribed. Using combined usage, dentists can further limit the use of narcotics to only the most severe pain situations.

Research from the early 2010s backs up this new approach. A study published in the Journal of the American Dental Association (JADA) concluded that patients receiving this combined ibuprofen/acetaminophen usage fared better than those only receiving either one individually. The method could also match the relief power of narcotics in after care for a wide range of procedures.

The NSAID approach is growing in popularity, but it hasn't yet displaced the first-line use of narcotics by dental professionals. The hesitancy to adopt the newer approach is fueled as much by patients, who worry it won't be as adequate as narcotics to manage their pain after dental work, as with dentists.

But as more patients experience effective results after dental work with NSAIDs alone, the new approach should gain even more momentum. And in the end, it promises to be a safer way to manage pain.

If you would like more information on dental pain management, 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 “Are Opioids (Narcotics) the Best Way to Manage Dental Pain?


GumRecessionCanRobYouofYourSmileandYourDentalHealthToo

If it seems like your teeth are getting longer as you get older, it's unlikely they're magically growing. More likely, your gums are shrinking or receding from your teeth. Besides the negative effect on your appearance, gum recession exposes you and vulnerable tooth areas to harmful bacteria and painful sensitivity.

Although common among older adults, gum recession isn't necessarily a part of aging: It's primarily caused by periodontal (gum) disease, in which infected gum tissues can weaken and detach from the teeth. This, along with bone loss, leads to recession.

But gum disease isn't the only cause—ironically, brushing your teeth to prevent dental disease can also contribute to recession. By brushing too aggressively or too often (more than twice a day), you could eventually damage the gums and cause them to recede. Tobacco use and oral piercings can also lead to weakened or damaged gums susceptible to recession.

You can lower your risk of gum recession by abstaining from unhealthy habits and proper oral hygiene to prevent gum disease. For the latter, your primary defense is gentle but thorough brushing and flossing every day to remove harmful dental plaque. You should also see your dentist at least twice a year for professional dental cleanings and checkups.

If, however, you do experience gum recession, there are a number of ways to restore your gums or at least minimize the recession. To start with, we must treat any gum disease present by thoroughly removing all plaque and tartar (calcified plaque), which fuels the infection. This reduces inflammation and allows the gums to heal.

With mild recession, the gums may rejuvenate enough tissue to recover the teeth during healing. If not, we may be able to treat exposed areas with a tooth-colored material that protects the surface, relieves discomfort and improves appearance.

If the recession is more advanced, we may still be able to stimulate gum regeneration by attaching a tissue graft with a micro-surgical procedure. These types of periodontal surgeries, however, can require a high degree of technical and artistic skill for best results.

In any event, the sooner we detect gum disease or recession, the quicker we can act to minimize the damage. Doing so will ensure your gums are healthy enough to protect your teeth and preserve your smile.

If you would like more information on gum recession, 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 “Gum Recession.”




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