Posts for: July, 2018
It’s a big moment after months of wearing braces to finally get a glimpse of your new smile. The crooked teeth and poor bite are gone — and in their place are beautiful, straight teeth!
If you’re not careful, though, your new look might not last. That’s because the natural mechanism we used to straighten your teeth may try to return them to their previous poor positions.
Contrary to what many people think, teeth aren’t rigidly set within the jaw bone. Instead, an elastic, fibrous tissue known as the periodontal ligament lies between the teeth and the bone and attaches to both with tiny fibers. Though quite secure, the attachment allows the teeth to move in very minute increments in response to growth or other changes in the mouth.
Orthodontic appliances like braces or clear aligners put pressure on the teeth in the direction we wish them to move. The bone dissolves on the side of the teeth where pressure is being applied or facing the direction of movement and then builds up on the other side where tension is occurring.
The ligament, though, has a kind of “muscle memory” for the teeth’s original position. Unless it’s prevented, this “memory” will pull the teeth back to where they used to be. All the time and effort involved with wearing braces will be lost.
That’s why it’s important for you to wear an appliance called a retainer after your braces have been removed. As the name implies, the appliance “retains” the teeth in their new position until it’s more permanently set. For most people, this means wearing it for twenty-four hours in the beginning, then later only a few hours a day or while you sleep.
The majority of younger patients eventually won’t need to wear a retainer once bone and facial growth has solidified their teeth’s new position. Older adults, though, may need to wear one from now on. Even so, it’s a relatively slight inconvenience to protect that beautiful, hard-won smile.
If you would like more information on retainers, 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 Importance of Orthodontic Retainers.”
Although dental implants are best known as single tooth replacements, they can actually play a role in multiple or complete tooth loss (edentulism) restorations. While replacing multiple teeth with individual implants is quite expensive, there’s another way to incorporate them in a restoration at much less cost — as supports for bridges.
In this case, only a few strategically placed implants are needed to support restorations of multiple crowns fused together into a single unit. Implant-based bridges consist of two main types: the first type is a fixed bridge, which is permanently attached to the implants and can’t be removed by the patient. It’s often the preferred treatment for patients who’ve lost most or all of their teeth but have not yet experienced significant bone loss in the jaw.
This choice, however, may not be the best option for patients with significant bone loss. In these cases, there’s a second type of fixed bridge: an implant-supported fixed denture. This type of fixed denture provides support for the lost bone support of the lips and cheeks. If a fixed bridge is not possible due to finances or inadequate bone support to place 4 to 6 implants, a removable denture (also known as an overdenture) that’s supported and held in place by implants is the next best alternative. Unlike a fixed bridge, an overdenture can be removed by the patient for cleaning purposes, and will require less investment than a fixed bridge.
For people with bone loss, the overdenture does more than restore chewing and speech function. Because bone loss can diminish support of the facial structures — actually shorten the distance between the chin and the tip of the nose — an overdenture provides additional bulk to support these structures to improve appearance. Depending on what the patient needs for facial support, overdentures for the upper jaw can be designed as “full palates,” meaning the denture plastic completely covers the upper jaw palate, or open in which the plastic doesn’t completely cover the palate.
Besides the condition of your teeth, gums and bone, your own personal preferences and financial ability will also play a role in which option is best for you. After considering all these factors, we can recommend which of these types of implant-based restorations will fit your needs. With either bridge, fixed or removable, you’ll certainly benefit from the improvement to both your mouth function and your smile.
If you would like more information on implant-supported bridges, 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 “Fixed vs. Removable.”
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”