Poor bites, also known as “malocclusions,” can have a dramatic impact on mouth function and appearance. Moving teeth to better positions will solve most of these bite problems — but not all.
A case in point is a malformed maxilla, the skeletal structure formed by the union of the upper jaw and the roof of the mouth (the palate). If the rear portion of the maxilla develops too narrowly, the back teeth will bite abnormally inside the lower teeth while the front teeth bite normally, creating what’s known as a crossbite. People with this kind of malocclusion often shift their lower jaw to one side to bite down completely.
This can be corrected without too much intervention if the problem is diagnosed while the person is young. This is because the maxilla is actually formed from two bones that don’t completely fuse together in the center of the palate until just after puberty. An orthodontic appliance known as a palatal expander takes advantage of this slight gap. The metal appliance is placed along the narrowed portion of the palate in the rear of the mouth: four metal “arms,” two on each side, attach to the inside of the back teeth with a tension device between them that extends the arms outward to put pressure against the teeth.
Every day the patient or a parent uses a special key to turn the tension device and cause it to expand slightly, placing additional outward pressure on the jaw. This will widen the gap in the center of the palate and new bone will grow to fill in the increased space. Over time this will cause the rear portion of maxilla to widen.
While effective, a palatal expander may not work in every case, and it must be done before the two bones fuse permanently. When it can be used, though, it’s a proven treatment that can restore proper bite function, as well as improve your child’s smile.
If you would like more information on palatal expanders to correct certain bite problems, 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.”
Fibromyalgia is a chronic condition that produces widespread pain and stiffness in the muscles and joints. The pain, muscle spasms and tingling it causes can disrupt sleep, alter moods and impair memory function.
Dealing with just this one condition can be overwhelming. But did you know 3 out 4 fibromyalgia patients also develop chronic pain and dysfunction involving their jaw joints? Known collectively as temporomandibular joint disorders (TMD), these jaw joint problems cause pain, muscle spasms and difficulty moving the jaws that can interfere with eating and speaking. TMD can also contribute to headaches and earaches.
Many researchers believe this prevalence of TMD among fibromyalgia patients stems from both conditions originating from the same primary cause—a malfunction within the central nervous system. In both cases, the brain and spinal cord may not be able to process pain signals in a normal fashion. This malfunction could also be generating and amplifying pain signals even when nerves are receiving no stimulation.
For decades now, the most effective treatment strategy for TMD has been to manage the symptoms with physical therapy and exercises, thermal therapy or medications. Relief for fibromyalgia has depended on medication and relaxation techniques like biofeedback therapy. But with the evidence of some connection between the two conditions, it may be helpful to coordinate treatment for both with a team approach involving all your healthcare providers, rather than treat them separately.
To that end, make sure both your dentist or physician treating you for TMD and your physician treating your fibromyalgia each know about the other condition. Consulting together, your healthcare team may find treatments (like certain drugs that counteract neurotransmitter imbalances) that might help reduce symptoms in both conditions. And cognitive-behavioral therapy, meditation and other therapeutic pain management techniques can help you cope with the pain.
Continued research into these two debilitating conditions and the possible links between them may have an effect on how we treat both. A holistic approach to treating them could be the wave of the future.
If you would like more information on the links between TMD and other chronic pain conditions, 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 “Fibromyalgia and Temporomandibular Disorders.”
You depend on your family dentist for most of your oral care. There are some situations, though, that are best handled by a specialist. If you or a family member has a deeply decayed tooth, for example, it might be in your long-term interest to see an endodontist.
From the Greek words, endo ("within") and odont ("tooth"), endodontics focuses on dental care involving a tooth's interior layers, including the pulp, root canals and roots. While general dentists can treat many endodontic problems, an endodontist has the advanced equipment and techniques to handle more complex cases.
The majority of an endodontist's work involves teeth inwardly affected by tooth decay. The infection has moved beyond the initial cavity created in the enamel and dentin layers and advanced into the pulp and root canals. The roots and underlying bone are in danger of infection, which can endanger the tooth's survival.
The most common treatment is root canal therapy, in which all of the infected tissue is removed from the pulp and root canals. Afterward, the empty spaces are filled and the tooth is sealed and crowned to prevent future infection. General dentists can perform this treatment, primarily with teeth having a single root and less intricate root canal networks. But teeth with multiple roots are a more challenging root canal procedure.
Teeth with multiple roots may have several root canals needing treatment, many of which can be quite small. An endodontist uses a surgical microscope and other specialized equipment, as well as advanced techniques, to ensure all of these inner passageways are disinfected and filled. Additionally, an endodontist is often preferred for previously root-canaled teeth that have been re-infected or conditions that can't be addressed by a traditional root canal procedure.
While your dentist may refer you to an endodontist for a problem tooth, you don't have to wait. You can make an appointment if you think your condition warrants it. Check out the American Association of Endodontists webpage www.aae.org/find for a list of endodontists in your area.
Advanced tooth decay can put your dental health at risk. But an endodontist might be the best choice to overcome that threat and save your tooth.
If you would like more information on endodontic dentistry, 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 “Why See an Endodontist?”
While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.
“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.
Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.
Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).
For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.
Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.
If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”
While the effectiveness of chemotherapy and radiation have contributed to rising cancer survival rates, they can still have an adverse effect on the rest of the body. That includes the mouth: these treatments can damage healthy tissues like the salivary glands. The decrease in saliva flow increases the risk of tooth decay or periodontal (gum) disease.
While overcoming cancer is certainly the patient’s main health priority, it’s important for them to tend to their oral health. The best approach often involves a three-way partnership between patient, dentist and family caregivers all doing their part to keep the patient’s teeth, gums and mouth healthy during cancer treatment.
Here’s what each “partner” can do to protect a cancer patient’s oral health during treatment.
The dentist. To minimize dental disease odds, patients should enter cancer treatment with their teeth and gums in the best shape possible. Before beginning treatment, then, the dentist can assess their oral health status and recommend a treatment plan for any existing disease or condition. The dentist can also monitor a patient’s oral health during the treatment period.
The patient. Patients can do the most to protect their oral health by removing disease-causing plaque buildup with daily brushing and flossing, as well as maintaining their regular schedule of dental cleanings (if possible). They should also attempt to reduce dry mouth, a potential consequence of cancer treatment, by consuming more water and using saliva boosters like Xylitol-sweetened gums and mints. A nutritious diet is also important for protecting oral health.
The caregiver. Many cancer patients depend on family or friends to aid them during treatment. One of the best things a caregiver can do is act as a liaison between the patient and their medical and dental providers. When it comes to oral health, caregivers should be on the alert for any mouth changes including tooth pain, gum swelling or bleeding, foul breath and other signs of disease.
Focusing on oral health can be a daunting challenge for patients during their fight with cancer. But with help from their other partners, they can come out of this fight with their teeth, gums and mouth in good health.
If you would like more information on oral care during cancer 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 “Oral Health During Cancer Treatment.”
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