Orthodontics shares a principle with the classic tug of war game: if you want things to move in the right direction you need a good anchor. Anchors help braces and other appliances apply constant pressure to misaligned teeth in the direction they need to go to correct a malocclusion (poor bite).
Orthodontic treatments work in cooperation with an existing oral mechanism that already moves teeth naturally in response to biting forces or other environmental factors. The key to this mechanism is an elastic tissue known as the periodontal ligament that lies between the tooth and the bone. Besides holding teeth in place through tiny attached fibers, the ligament also allows the teeth to move in tiny increments.
Braces’ wires laced through brackets affixed to the teeth exert pressure on them in the desired direction of movement –the periodontal ligament and other structures do the rest. To maintain that pressure we need to attach them to an “anchor”—in basic malocclusions that’s usually the back molar teeth.
But not all malocclusions are that simple. Some may require moving only certain teeth while not moving their neighbors. Younger patients’ jaws and facial structures still under development may also need to be considered during orthodontic treatment. That’s why orthodontists have other anchorage methods to address these possible complications.
One example of an alternate anchorage is a headgear appliance that actually uses the patient’s skull as the anchor. The headgear consists of a strap running around the back of the head and attached in front to orthodontic brackets (usually on molar teeth). The pressure it exerts can trigger tooth movement, but it can also help influence jaw development if an upper or lower jaw is growing too far forward or back.
Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed.
Using these and other appliances allows orthodontists to customize treatment to an individual patient’s particular malocclusion. With the right anchor, even the most complex bite problem can be transformed into a beautiful and healthy smile.
If you would like more information on 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 “Orthodontic Headgear & Other Anchorage Appliances.”
Sleep — you'll spend a third of your life in its blissful embrace. But it isn't a luxury: you need it as much as nutrition and exercise. An occasional bad night's sleep leaves you irritable and drowsy; a bad night's sleep every night could endanger your health.
One of the most common causes for chronic poor sleep is obstructive sleep apnea. This occurs when the airway becomes blocked and you stop breathing temporarily. The blockage may be due to an oversized tongue, tonsils or uvula, an abnormal jaw or chin structure, or nasal polyps and congestion. When your brain notices you're not breathing, it rouses you just enough to relieve the blockage. These incidents can occur and end in seconds several times a night without you being aware of it.
This interrupts your normal sleep patterns, including the critical rapid eye movement (REM) of deep sleep that occurs at different times during the night. The results of not getting enough REM sleep are quite unhealthy: besides irritability and reduced concentration, poor REM sleep is linked to depression, headaches, decreased sex drive, acid reflux, high blood pressure or the onset of diabetes. Your night time experience — as well as your sleep partner's — won't be pleasant either as you may experience night time sweating and snoring.
Fortunately, sleep apnea can be treated. Our first considered treatment is a custom-fitted night guard you wear while you sleep that holds the tongue back from the airway. If your apnea is more severe, you may need to consider continuous positive airway pressure (CPAP) therapy, which uses a machine to pump pressurized air through a mask you wear while sleeping to force the airway open. You might also benefit from surgery to remove excess soft tissue obstructing the airway.
If you or your family has noticed any of these symptoms mentioned, make an appointment to see us — we're trained to look for oral signs in the mouth that may indicate sleep apnea. The sooner we can implement a treatment strategy, the sooner you'll begin experiencing a good night's sleep and better health.
If you would like more information on sleep apnea and what to do about it, 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 “Sleep Disorders & Dentistry.”
Chronic pain can turn your life upside down. While there are a number of disorders that fit in this category, two of them—fibromyalgia and temporomandibular disorders (TMD)—can disrupt your quality of life to the extreme. And it may be the two conditions have more in common than similar symptoms—according to one study, three-fourths of patients diagnosed with fibromyalgia show symptoms of TMD.
To understand why this is, let’s take a closer look at these two conditions.
Fibromyalgia presents as widespread pain, aching or stiffness in the muscles and joints. Patients may also have general fatigue, sleep problems, mood swings or memory failures. TMD is a group of conditions that often result in pain and impairment of the temporomandibular joints that join the jaw with the skull. TMD can make normal activities like chewing, speaking or even yawning painful and difficult to do.
Researchers are now focusing on what may, if anything, connect these two conditions. Fibromyalgia is now believed to be an impairment of the central nervous system within the brain rather than a problem with individual nerves. One theory holds that the body has imbalances in its neurotransmitters, which interfere with the brain’s pain processing.
Researchers have also found fibromyalgia patients with TMD have an increased sensitivity overall than those without the conditions. In the end, it may be influenced by genetics as more women than men are prone to have either of the conditions.
Treating these conditions is a matter of management. Although invasive techniques like jaw surgery for TMD are possible, the results (which are permanent) have been inconclusive in their effectiveness for relieving pain. We usually recommend patients try more conservative means first to lessen pain and difficulties, including soft foods, physical therapy, stretching exercises and muscle relaxant medication. Since stress is a major factor in both conditions, learning and practicing relaxation techniques may also be beneficial.
In similar ways, these techniques plus medication or cognitive-behavioral therapy that may influence neurotransmission can also help relieve symptoms of fibromyalgia. Be sure then that you consult with both your physician and dentist caring for both these diseases for the right approach for you to help relieve the effects of these two debilitating conditions.
If you would like more information on managing TMD or fibromyalgia, 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.”
In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?
“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.
How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.
With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.
In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.
While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.
Which method is best for you? Don’t try using paranormal powers to find out: Come in and talk to us. If you would like more information about tooth replacement, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Crowns & Bridgework,” and “Dental Implants.”
Athletes in contact sports are at significant risk for traumatic injury to their teeth and mouth. It’s estimated 600,000 emergency room visits each year involve a sports-related dental injury.
Athletic mouthguards have become the premier safeguard against sports-related oral injuries. First worn by professional boxers in the 1920s, mouthguards are now required for use by various sports associations and leagues — from amateur youth to professional — for a number of sports. The National Collegiate Athletic Association (NCAA), for example, requires their use during play for hockey, lacrosse, field hockey and football. The American Dental Association recommends mouthguards for 29 sports or exercise activities.
But do mouthguards actually prevent injury? To answer that question in a scientific manner, the Journal of Sports Medicine published an evidence-based report in 2007 on mouthguard effectiveness for preventing or reducing the severity of oral-facial injuries and concussions. While the report objectively analyzed many of the problems and issues associated with mouthguards (like materials, design and durability), it concluded the risk of an oral-facial injury was nearly two times greater without the wearing of a mouthguard.
That being said, most dentists and other professionals in sports safety would advise not all mouthguards are alike. The stock, “off the shelf” mouthguard found in many retail stores with limited size offerings is the least expensive, but also least protective, of mouthguard types. Mouth-formed or “boil-and-bite” protectors, which are softened in boiling water and then bit down on by the player to form the fit, are better than the stock version — however, they often don’t cover all of the player’s back teeth.
The best option is a custom-designed guard made by a dentist for the individual patient. Although relatively expensive (costs range in the hundreds, compared with $25 or less for a stock guard), they provide the highest recognized level of mouth protection.
The bottom line: a mouthguard is a must-wear part of any uniform for any sport that involves contact or high velocity objects of play. If you or a family member is a contact sport athlete, it’s essential you protect your teeth and mouth with a custom-fit, high quality mouthguard.
If you would like more information on mouthguards, 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 “Athletic Mouthguards.”
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