What makes an attractive smile? Of course, shiny, straight and defect-free teeth are a big factor. But there’s another equally important element: all your teeth have come in.
Sometimes, though, they don’t: one or more teeth may remain up in the gums, a condition known as impaction. And if they’re in the front like the upper canines (the pointed teeth on either side of the front four incisors) your smile’s natural balance and symmetry can suffer.
Impaction usually happens due to lack of space on a small jaw. Previously erupted teeth crowd into the space of teeth yet to come in, preventing them from doing so. As a result the latter remain hidden within the gums.
While impaction can interfere with the smile appearance, it can cause health problems too. Impacted teeth are at higher risk for abscesses (localized areas of infection) and can damage the roots of other teeth they may be pressing against. That’s why it’s desirable for both form and function to treat them.
We begin first with an orthodontic examination to fully assess the situation. At some point we’ll want to pinpoint the impacted teeth’s precise location and position. While x-rays are useful for locating impacted teeth, many specialists use cone beam CT (CBCT) technology that produces highly detailed three-dimensional images viewable from different vantage points.
If the tooth is in too extreme a position, it might be best to remove it and later replace it with a dental impact or similar restoration once we’ve completed other necessary orthodontic treatment. But if the tooth is in a reasonable position, we might be able to “move” the tooth into its proper place in the jaw in coordination with these other tooth-movement efforts to make room for it.
To begin this process, an oral surgeon or periodontist surgically exposes the tooth crown (the normally visible portion) through the gums. They then bond a small bracket to the crown and attach a small gold chain. An orthodontist will attach the other end to orthodontic hardware that will exert downward pressure on the tooth to gradually bring it into normal position.
Dealing with impacted teeth of this nature is often part of a comprehensive effort to correct the bite. If we’re successful, it could permanently transform both the smile and overall dental health.
If you would like more information on treating impacted teeth, 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 “Exposing Impacted Canines.”
If you're considering dental implants to replace one or more missing teeth, you'll need to undergo a minor to moderate surgical procedure (depending on the number of implants) to install them. Depending on your current health status and medical history, you may need antibiotics before or after the procedure to help ensure a successful outcome.
Although implants have a high success rate (over 95%), they can still fail — and bacterial infection is a major culprit. Installing implants requires surgically accessing the bone through the gum tissues; you may also need other invasive procedures like tooth extraction or bone or gum tissue grafting. These disruptions to the soft tissues can introduce bacteria into the bloodstream.
In certain individuals, this can increase infection risk not only around the implant but also in other parts of the body. You may be at higher risk, for example, if you have serious health problems like cardiovascular disease or diabetes, a weakened immune system, you use tobacco or you're over or under normal weight. The American Dental and American Heart Associations both recommend antibiotics before dental implant surgery as a preventive measure against infection if you have a prosthetic heart valve, a history of infective endocarditis, a heart transplant or some congenital heart conditions.
For other patients with low to moderate risk for infection, there's vigorous debate on administering antibiotics before implant surgery. There are some side effects to antibiotic use, ranging from diarrhea to allergic reactions, and an increased concern in general to the developing resistance of many infectious agents due to the prevalent use of antibiotics. Many dentists and physicians are becoming more discriminate in the patients for which they prescribe antibiotics before surgical procedures.
It really comes down, then, to your particular case: not only the specific procedures you need but also your general health. After weighing these factors against the possible benefits for protecting your health and improving your odds of a successful outcome, we'll recommend whether antibiotic treatment for implants is right for you.
If you're ready to put the "pizzazz" back into your smile, your dentist may be able to help. It's possible your dull, dingy smile could be transformed with teeth whitening.
Teeth whitening or bleaching is a technique that applies a solution with a bleaching agent (usually up to 35% hydrogen peroxide in an office setting) to the teeth to whiten them. Although there are Do-It-Yourself home whitening kits you can use, there are a few good reasons why you should first consider a whitening procedure in a dental office setting.
To begin with, you should first have your teeth examined by a dentist to determine why they're discolored. Certain foods and beverages we consume or tobacco habits are the usual culprits causing stains on the enamel, the outermost tooth layer. These are the kinds of stains targeted by most whitening solutions.
But the interior of a tooth can also become discolored for reasons like trauma, past dental work or tetracycline use at an early age. If your staining is internal (intrinsic) rather than external (extrinsic) reducing that discoloration will require an invasive procedure only a dentist can perform—a home kit won't be able to do the job.
Another reason for having your teeth whitened by your dentist (even extrinsic staining) involves your time and the degree of brightness you'd like. Because dentists use stronger bleaching solutions (home kits usually use a weaker solution of 10% carbamide peroxide) it takes fewer sessions than home kits to achieve results—and they may last longer. In addition, dentists have more control over the level of brightness to match your expectations of a more subdued, natural look or a dazzling "Hollywood" smile.
A dentist can also help you navigate special circumstances like matching and managing natural teeth whiteness with dental restorations (which don't bleach) or special whitening situations like a single discolored tooth.
Even if you eventually decide to go the home kit route, consulting with a dentist first can still prove helpful. You'll get expert advice on products, tips on how to apply them and how to prolong the whitening effect. Whichever way you go, home kit or dentist, you can gain a brighter, more confident smile with teeth whitening.
If you would like more information on teeth whitening, 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 “Important Teeth Whitening Questions…Answered!”
Academy Award-winning actress Kathy Bates knows how important it is to present your best face to the world — and one of the most important features of that face is a beaming smile. But there came a point when she noticed something was a little off. “I've always had good teeth, but it seemed to me as I was getting older that they weren't looking as good,” Kathy explained in a recent interview with Dear Doctor magazine.
That's when she decided it was time to take action. Kathy had orthodontic treatment when she was in her fifties, and she keeps her smile bright with tooth whitening treatments. She uses a kit provided by her dentist with a safe, effective whitening solution.
Of course, a bright, healthy smile looks great anywhere — whether you're on the red carpet or “off the grid.” And you don't have to be a Hollywood star to have professional whitening treatments. In fact, teeth whitening is one of the most popular and affordable cosmetic treatments modern dentistry offers.
The basic options for professional teeth whitening include in-office bleaching or take-home kits. Both types of dentist-supervised treatments offer a safe and effective means of getting a brighter smile; the main difference is how long they take to produce results. A single one-hour treatment in the office can make your teeth up to ten shades lighter — a big difference! To get that same lightening with at-home trays, it would take several days. On the plus side, the take-home kit is less expensive, and can achieve the same results in a bit more time.
It's important to note that not all teeth can be whitened with these treatments. Some teeth have intrinsic (internal) stains that aren't affected by external agents like bleaches. Also, teeth that have been restored (with bonding or veneers, for example) generally won't change color. And you can't necessarily whiten your teeth to any degree: Every tooth has a maximum whiteness, and adding more bleach won't lighten it beyond that level. Most people, however, find that teeth whitening treatments produce noticeable and pleasing results.
What about those off-the-shelf kits or in-the-mall kiosks? They might work… or they might not. But one thing's for sure: Without a dentist's supervision, you're on your own. That's the main reason why you should go with a pro if you're considering teeth whitening. We not only ensure that your treatment is safe — we can also give you a realistic idea of what results to expect, and we will make sure that other dental problems aren't keeping you from having a great-looking smile.
How often does Kathy Bates see her dentist for a checkup and cleaning? “I go about every four months,” she noted. “I'm pretty careful about it.” And if you've seen her smile, you can tell that it pays off. If you would like more information about teeth whitening, please contact us or schedule an appointment. You can learn more in the Dear Doctor magazine articles “Important Teeth Whitening Questions Answered” and “Teeth Whitening.”
When you look at the top row of a normal smile, you'll see symmetrical pairs: the central incisors in the middle, flanked by the lateral incisors and the canine (or eye) teeth on the outside of them.
Sometimes, though, teeth may not form as they should: in fact, it's one of the more common congenital defects with one in five people having missing or deformed teeth, often the upper lateral incisors. In the latter case, it's not uncommon for the eye teeth to drift into the missing lateral incisors' spaces next to the central incisors. This creates a smile even a layperson can tell is off.
There is a way to treat this with orthodontics and cosmetic dentistry that will transform that person's smile while restoring better mouth function too. It's often a long process, however, that's best begun early and must be precisely timed with dental development.
Using braces, we move the drifted teeth back to their proper positions, which will make room for a future dental restoration. It's usually best to begin this treatment during late childhood or early adolescence. The next step is to fill the newly-created space with prosthetic (false) teeth.
Dental implants are an ideal choice since they're durable and life-like, and won't require permanent alteration of adjacent teeth. They do, however, require a certain amount of bone volume at the site to support them; if the volume is insufficient we may have to place a bone graft to stimulate new growth.
It's also best not to install implants until the jaw has finished development, usually in the late teens or early adulthood. In the interim between tooth repositioning and implants we can customize a retainer or other removable appliance with a false tooth to occupy the space. This not only enhances the smile, it also prevents the repositioned teeth from drifting back.
These steps toward achieving a new smile take time and sometimes a team of specialists. But all the effort will be rewarded, as a person born without teeth can have a new smile and improved oral health.
If you would like more information on treating dental development deficiencies, 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 “When Permanent Teeth Don't Grow.”
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