Dr. Bob's Blog

Posts for category: Dental Procedures

WisdomTeethCanStillbeaProblemfortheWorldsYoungestBillionaire

According to Forbes Magazine, Kylie Jenner is the world's youngest billionaire at age 22. Daughter of Caitlyn (Bruce) Jenner and Kris Jenner, Kylie is the founder and owner of the highly successful Kylie Cosmetics, and a rising celebrity in her own right. But even this busy CEO couldn't avoid an experience many young people her age go through each year: having her wisdom teeth removed.

At around 10 million removals each year, wisdom teeth extraction is the most common surgical procedure performed by oral surgeons. Also called the third molars, the wisdom teeth are in the back corners of the jaws, top and bottom. Most people have four of them, but some have more, some have fewer, and some never have any. They're typically the last permanent teeth to come in, usually between ages 17 and 25.

And therein lies the problem with wisdom teeth: Many times, they're coming in late on a jaw already crowded with teeth. Their eruption can cause these other teeth to move out of normal alignment, or the wisdom teeth themselves may not fully erupt and remain fully or partially within the gums (a condition called impaction). All of this can have a ripple effect, decreasing dental function and increasing disease risk.

As Kylie Jenner has just experienced, they're often removed when problems with bite or instances of diseases like tooth decay or gum disease begin to show. But not just when problems show: It's also been a common practice to remove them earlier in a kind of “preemptive strike” against dental dysfunction. But this practice of early wisdom teeth extraction has its critics. The main contention is that early extractions aren't really necessary from a medical or dental standpoint, and so patients are unduly exposed to surgical risks. Although negative outcomes are very rare, any surgical procedure carries some risk.

Over the last few years, a kind of middle ground consensus has developed among dentists on how to deal with wisdom teeth in younger patients. What has emerged is a “watch and wait” approach: Don't advise extraction unless there is clear evidence of developing problems. Instead, continue to monitor a young patient's dental development to see that it's progressing normally.

Taking this approach can lead to fewer early wisdom teeth extractions, which are postponed to a later time or even indefinitely. The key is to always do what's best for a patient's current development and future dental health.

Still, removing wisdom teeth remains a sound practice when necessary. Whether for a high school or college student or the CEO of a large company, wisdom teeth extraction can boost overall dental health and development.

If you would like more information about wisdom teeth and their impact on dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Wisdom Teeth: To Be or Not to Be?

By Dr. Malenius
September 28, 2020
Category: Dental Procedures
DIYOrthodonticsisaRecipeforDentalDisaster

Do-It-Yourself (DIY) is a deeply held American trait for building, renovating or repairing things without the services of a professional. The Internet has only made this tradition easier: There are scores of videos showing people how to do things on their own like build a deck, fix a dryer or bake an award-winning soufflé.

But some things are best left to the experts, which if you tried to do using too little knowledge or a lot less training could turn out disastrous. A prime example is becoming your own orthodontist and using dubious home methods to straighten your teeth. If that sounds preposterous, the American Association of Orthodontists recently reported it does happen, with one in ten of their members saying they have treated patients who attempted their own smile-straightening projects.

Often found on social media, these methods usually involve household items like rubber bands or dental floss to straighten teeth. Like other forms of DIY, the object is to save money. In the end, though, these self-orthodontic methods could result in dental damage that could cost much more to repair (if indeed it's repairable) than what might have been spent with professional orthodontics in the first place.

Utilizing extensive training, experience and artistry, orthodontists work with the mouth's natural ability to move teeth in a precise manner for a planned outcome. They carefully consider each individual patient's jaw and facial structures, along with the severity and complexity of their bite problem, as they design and implement a treatment plan involving braces, clear aligners or other orthodontic appliances.

A rigged homemade device to move teeth can't adequately take these factors into account. As a result, you may be risking permanent gum and bone damage—and you may even lose teeth in the process. Even if repairable, such damage could require oral surgery, cosmetic dentistry or more extensive orthodontic procedures.

In the end, you're highly unlikely to be successful at DIY orthodontics—and you won't save any money. A healthy and beautiful smile is well worth the cost of professional, high-quality orthodontics.

If you would like more information on orthodontic options, please contact us or schedule an appointment for a consultation.

HughJackmanIsAllSmilesforHisNewBroadway-InspiredShow

To anyone immersed in the “X-Men Universe” Hugh Jackman will always be Wolverine, a role he played in seven movies. But there’s more to this Australian actor than mutant bone claws and mutton chops that would make Elvis envious. Jackman has also starred in over 20 non-superhero films, including Les Misérables, for which he won a Golden Globe. He is also a Tony award-winning Broadway performer—with a winning smile.

With his famed character Logan/Wolverine fading in the rearview mirror, Jackman has returned to his musical roots. He will play Harold Hill in the Broadway revival of The Music Man, set to open in Fall 2020. And since May 2019 he’s been on world tour with Hugh Jackman: The Man. The Music. The Show., featuring Jackman and a supporting cast performing songs from favorite shows and films, including Les Misérables and the 2017 hit The Greatest Showman.

The Show, with 90 planned stops throughout Europe, North America and Oceania, is a decidedly different “universe” from the X-Men. As Wolverine, Jackman could get away with a scruffier look. But performing as Jean Valjean or the bigger-than-life P.T. Barnum, he has to bring a vastly different look to the role, which brings us to Jackman’s teeth…

Once upon a time, Jackman’s teeth were an unflattering gray—definitely not a good look for stage or film. So with the help of his dentist, Jackman set about upgrading his smile with teeth whitening. Teeth whitening is a great way to take a dull, stained smile and turn up the volume on its brightness—and attractiveness—a notch or two. A dentist applies a bleaching solution that stays in contact with the teeth for a few minutes. The process is often aided by special lighting.

A professional application is especially desirable if, like Jackman, you want “Goldilocks” brightness: not too little, not too much, but just right for you. Dentists can precisely control the tint level to get a brighter but more naturally looking white. Of course, you can also get a dazzling “Hollywood” smile if you so desire.

And although the effect of teeth whitening isn’t permanent, a dental application can last a while, depending on how well you manage foods and beverages that stain teeth. With a touchup now and then, you may be able to keep your brighter smile for years before undergoing the full procedure again.

One important note, though: This technique only works with outer enamel staining. If the discoloration originates from within the tooth, the bleaching agent will have to be placed internally, requiring access to the inside of the tooth. An alternative would be porcelain veneers to mask the discoloration, an option that also works when there is ultra-heavy enamel staining.

If you’re tired of your dull smile, talk with us about putting some pizzazz back into it. Teeth whitening could be your way to get a smile worthy of Broadway.

If you would like more information about teeth whitening, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Teeth Whitening” and “Whitening Traumatized Teeth.”

ImplantsCanMakeItEasiertoRestoreMissingTeethinStages

A fair number of people with total tooth loss have arrived at this point after a long history of dental issues. It's quite likely they've had a series of bridges or partial dentures over the years to accommodate lost teeth at various times before moving to full dentures.

For many, it often seems easier to extract any remaining teeth at some point and simply move on to a total restoration. It's often better for oral health, however, to preserve any remaining teeth for as long as possible and update restorations as needed. Dental implants could make this type of staged restoration strategy much easier to manage.

Implants are tiny metal posts surgically imbedded in a patient's jawbone. Over time, bone cells grow and adhere to the implant's titanium surface, creating a strong and durable hold. Its most familiar application is as a replacement for an individual tooth.

But because of their strength and durability, this advanced dental technology is also used to support other restorations like bridges and partial or full dentures by way of a few strategically placed implants. And it's in that role that they can be useful in planning and implementing future restoration upgrades when needed.

Under this strategy, we add implants to supplement pre-existing implants from earlier restorations to support the updated dental work. For example, we might have previously placed an implant supporting a single tooth or a small bridge. When the need later arises for a partial denture, we can add additional implants to be used with the earlier one to support the new denture.

If the earlier implants have been well-placed, we need only to add enough implants necessary to support a full denture when the time comes. How many will depend on the particular type of denture: A removable lower denture may only require one additional implant with one already in place. A fixed upper or lower denture will require enough to bring the number to between four and eight.

Taking this long-term approach can be more cost-effective in the long-run. More importantly, it can make for a smoother path for the patient and help preserve remaining teeth for as long as possible.

If you would like more information on restoration options for lost 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 “Replacing All Teeth but Not All at Once.”

LingualBracesMightbeaBetterFitforYourActiveLifestyle

If you've decided to straighten your teeth, you've made a wise choice for both your dental health and your smile. Now you may be facing another decision—which method to use for bite correction.

Not too long ago people had only one choice—traditional braces all the way. But that changed with the introduction of clear aligners, a series of removable plastic trays worn one after the other to realign teeth. In all but a few situations, clear aligners accomplish the same outcome as braces but without the conspicuous appearance and, thanks to their removability, difficulty in brushing and flossing teeth.

And now, a recent innovation in orthodontics could give you a third option—lingual braces. These are braces fixed to the back of teeth adjacent to the tongue (hence the term “lingual”), rather than on the front as with traditional braces. They essentially perform the same action, only instead of “pushing” teeth like traditional braces, they “pull” the teeth to the target positions. Lingual braces may also ease certain disadvantages people find with traditional braces or clear aligners.

If you're into martial arts, for instance, you may encounter blows to the face that increase your injury risk while wearing traditional braces. Likewise, if you're highly social, clear aligners can be a hassle to take out and keep up with if you're frequently eating in public. Lingual braces answer both types of issues: They won't damage your lips or gums in the case of blunt force facial contact; and they remain out of sight, out of mind in social situations.

Before considering lingual braces, though, keep in mind that they may cost 15-35 percent more than traditional braces. They also take time for some people to get used to because of how they feel to the tongue. And, they're not yet as widely available as traditional braces, although the number of orthodontists who have received training in the new method is increasing.

If you'd like to know more about lingual braces and whether they're right for you, speak to your dentist or orthodontist. You may find that this new option for improving your dental health and your smile fits your lifestyle.

If you would like more information on lingual braces, 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 “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”

WhyAlfonsoRibeiroIsGratefulforRootCanalTreatment

As the host of America's Funniest Home Videos on ABC TV, Alfonso Ribeiro has witnessed plenty of unintentional physical comedy…or, as he puts it in an interview with Dear Doctor–Dentistry & Oral Health magazine, "When people do stuff and you're like, 'Dude, you just hurt yourself for no reason!'" So when he had his own dental dilemma, Alfonso was determined not to let it turn onto an "epic fail."

The television personality was in his thirties when a painful tooth infection flared up. Instead of ignoring the problem, he took care of it by visiting his dentist, who recommended a root canal procedure. "It's not like you wake up and go, 'Yay, I'm going to have my root canal today!'" he joked. "But once it's done, you couldn't be happier because the pain is gone and you're just smiling because you're no longer in pain!"

Alfonso's experience echoes that of many other people. The root canal procedure is designed to save an infected tooth that otherwise would probably be lost. The infection may start when harmful bacteria from the mouth create a small hole (called a cavity) in the tooth's surface. If left untreated, the decay bacteria continue to eat away at the tooth's structure. Eventually, they can reach the soft pulp tissue, which extends through branching spaces deep inside the tooth called root canals.

Once infection gets a foothold there, it's time for root canal treatment! In this procedure, the area is first numbed; next, a small hole is made in the tooth to give access to the pulp, which contains nerves and blood vessels. The diseased tissue is then carefully removed with tiny instruments, and the canals are disinfected to prevent bacteria from spreading. Finally, the tooth is sealed up to prevent re-infection. Following treatment, a crown (cap) is usually required to restore the tooth's full function and appearance.

Root canal treatment sometimes gets a bad rap from people who are unfamiliar with it, or have come across misinformation on the internet. The truth is, a root canal doesn't cause pain: It relieves pain! The alternatives—having the tooth pulled or leaving the infection untreated—are often much worse.

Having a tooth extracted and replaced can be costly and time consuming…yet a missing tooth that isn't replaced can cause problems for your oral health, nutrition and self-esteem. And an untreated infection doesn't just go away on its own—it continues to smolder in your body, potentially causing serious problems. So if you need a root canal, don't delay!

If you would like additional information on root canal treatment, please contact us or schedule a consultation. You can learn more by reading the Dear Doctor magazine articles “A Step-By-Step Guide to Root Canal Treatment” and “Root Canal Treatment: What You Need to Know.”

ImplantsMakeDenturesMoreSecureComfortableandBone-Friendly

Even in the 21st Century, losing most or all of your teeth is still an unfortunate possibility. Many in this circumstance turn to dentures, as their great-grandparents did, to restore their teeth. But today's dentures are much different from those of past generations—and dental implants are a big reason why.

The basic denture is made of a gum-colored, acrylic base with artificial teeth attached. The base is precisely made to fit snugly and comfortably on the patient's individual gum and jaw structure, as the bony ridges of the gums provide the overall support for the denture.

Implants improve on this through two possible approaches. A removable denture can be fitted with a metal frame that firmly connects with implants embedded in the jaw. Alternatively, a denture can be permanently attached to implants with screws. Each way has its pros and cons, but both have two decided advantages over traditional dentures.

First, because implants rather than the gums provide their main support, implant-denture hybrids are often more secure and comfortable than traditional dentures. As a result, patients may enjoy greater confidence while eating or speaking wearing an implant-based denture.

They may also improve bone health rather than diminish it like standard dentures. This is because the forces generated when chewing and eating travel from the teeth to the jawbone and stimulate new bone cell growth to replace older cells. We lose this stimulation when we lose teeth, leading to slower bone cell replacement and eventually less overall bone volume.

Traditional dentures not only don't restore this stimulation, they can also accelerate bone loss as they rub against the bony ridges of the gums. Implants, on the other hand, can help slow or stop bone loss. The titanium in the imbedded post attracts bone cells, which then grow and adhere to the implant surface. Over time, this can increase the amount of bone attachment and help stymie any further loss.

An implant-supported denture is more expensive than a standard denture, but far less than replacing each individual tooth with an implant. If you want the affordability of dentures with the added benefits of implants, this option may be worth your consideration.

If you would like more information on implant-supported restorations, 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 “Overdentures & Fixed Dentures.”

TheRealTruthBehindEdHelmsMissingToothinTheHangover

Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.

In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.

Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.

Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.

If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.

The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.

Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.

If you would like more information about restoring missing teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Dental Implants.”