Until recently, the standard treatment for tooth decay remained essentially the same for nearly a century: Remove any decayed structure, then prepare and fill the cavity. But that singular protocol has begun to change recently.
Although "drilling and filling" saves teeth, it doesn't fully address the causes of decay. In response, dentists have broadened their approach to the disease—the focus now is on an individual patient's particular set of risk factors for decay and how to reduce those.
At the heart of this new approach is a better understanding of oral bacteria, the true cause of decay. Bacteria produce acid, which can erode tooth enamel and create a gateway into the tooth for decay to advance. We therefore want to lower those risk factors that may lead to bacterial growth and elevated acidity.
One of our major objectives in this newer approach is to reduce plaque, a thin film of food particles used by bacteria for food and habitation. Removing plaque, principally through better oral hygiene, in turn reduces decay-causing bacteria.
Plaque isn't the only mechanism for bacterial growth and acidity. Appliances like dentures or retainers accumulate bacteria if not regularly cleaned. Reduced saliva flow, often due to certain medications or smoking, limits this fluid's ability to buffer acid and acid reflux or acidic beverages like sodas, sports or energy drinks can disrupt the mouth's normal pH and increase the risk for enamel erosion.
Our aim, then, is to develop a long-term strategy based on the patient's individual set of oral disease risk factors. To determine those, we'll need to examine their medical history (including family), current health status and lifestyle habits. From there, we can create a specific plan targeting the identified risk factors for decay.
Some of the elements of such a strategy might include:
- Daily brushing and flossing, along with regular dental cleanings;
- Fluoride dental products or treatments to strengthen enamel;
- Changes in diet and excess snacking, and ceasing from any tobacco use;
- Cleaning and maintaining appliances, as well as monitoring past dental work.
Improving the mouth environment by limiting the presence of oral bacteria and acid can reduce the occurrence of tooth decay and the extent of treatment that might be needed. It's a more nuanced approach that can improve dental health.
If you would like more information on tooth decay prevention and 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 “Tooth Decay: How to Assess Your Risk.”
In one respect, celebrities are no different from the rest of us—quite a few famous people love to collect things. Marie Osmond collects dolls (as well as Johnny Depp, reportedly); Leonardo DiCaprio, vintage toys. And, of course, Jay Leno has his famous fleet of cars. But Victoria Beckham's collection is unusually "familial"—she's kept all of her four children's "baby" teeth after they've fallen out.
Best known as Posh Spice of the 1990s group Spice Girls and now a fashion designer and TV personality, Beckham told People Magazine that she has an "entire bucket" of her kids' primary teeth. And, she recently added to it when her nine-year old daughter lost another tooth earlier this year.
You may or may not want to keep your child's baby teeth, but you'll certainly have the opportunity. Children start losing their first set of teeth around age 6 or 7 through early puberty. During the process, each tooth's roots and gum attachment weakens to the point that the tooth becomes noticeably loose. Not long after, it gives way and falls out.
Although a baby tooth doesn't normally need any help with this, children (and sometimes parents) are often eager to accelerate the process. A loose tooth can be annoying—plus there's often a financial incentive via the "Tooth Fairy!"
First off, there's not much harm in a child wiggling a loose tooth—it may even help it come out. It's also possible to help the tooth safely detach sooner by taking a small piece of tissue, folding it over the tooth and giving it a gentle downward squeeze. If it's loose enough, it should pop out.
If it doesn't, don't resort to more forcible measures like the proverbial string and a door—just wait a day or two before trying the gentle squeeze method again. Once the tooth comes out, the empty socket may bleed a bit or not at all. If heavy bleeding does occur, have the child bite down on a piece of clean gauze or a wet tea bag until it stops. You may also have them eat softer foods for a few days to avoid a resumption of bleeding.
Beyond that, there's little else to do but place it under your child's pillow for the Tooth Fairy. And if after their "exchange" with that famous member of the Fae Folk you find yourself in possession of the erstwhile tooth, consider taking a cue from Victoria Beckham and add it to your own collection of family memories.
Wearing braces can ultimately give you a healthier and more attractive smile. In the short-term, though, your gums in particular may be in for a rough ride.
While we're all susceptible to gum disease, braces wearers are more likely to encounter it. This stems from two related factors: the difficulty braces pose to oral hygiene; and the potential irritation of soft tissues by the braces themselves.
The main cause for any form of gum disease is dental plaque, a thin bacterial film that accumulates on teeth. Removing plaque through brushing and flossing greatly reduces the risk of any dental disease. But braces wires and brackets make it difficult to brush and floss—as a result, some plaque deposits may escape cleaning, which makes a gum infection more likely.
To exacerbate this, braces hardware can irritate the gums and cause swelling and tissue overgrowth, also known as hyperplasia. The one-two punch of ineffective hygiene with hyperplasia are why braces wearers have a higher incidence of gum problems compared to the general population.
To guard against this, patients with braces need to be extra vigilant about keeping their teeth and gums clean of plaque. It may be helpful in this regard to use specialized tools like interproximal brushes with narrower bristle heads that are easier to maneuver around braces.
And rather than using traditional flossing thread, orthodontic patients may find it easier and more effective to use pre-loaded flossing picks or an entirely different method called oral irrigation. The latter involves a handheld wand that directs a stream of pulsating water between teeth to loosen and flush away plaque.
It's also important for patients to see their dentist as soon as possible for any gum swelling, bleeding or pain. The dentist can determine if it relates to gum disease, hyperplasia or a combination of both, and recommend treatment. In extreme cases, it may be necessary to remove the braces until the gums heal, so catching and treating any gum problem early is a priority.
Regardless of the risk for gum disease, orthodontic treatment is still well worth the investment in your health and appearance. Practicing effective oral hygiene and keeping a watchful eye on your gums will help further lower that risk.
If you would like more information on oral care during 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 “Gum Swelling During Orthodontics.”
Dentists extract millions of teeth each year, mostly because of disease. But sometimes a healthy tooth is removed to gain a more favorable, long-term dental health outcome.
An example of this is extracting teeth for the sake of orthodontic treatment. This is often beneficial when treating bite problems caused by crowding, a condition in which not enough space on the jaw exists to accommodate all of the teeth coming in. When this happens, the limited space can force teeth out of their proper alignment.
Crowding also complicates correcting the bite problem with braces: As with the eruption phase, there's no available room for orthodontic movement. One solution that may arise after a detailed examination is to open up space on the jaw by removing some of the teeth.
Planning this kind of tooth extrication requires careful forethought with the end in mind—ultimately, the dental providers involved want the resulting appearance after braces to look as natural as possible. For that reason, dentists usually choose teeth for extraction that are outside of the "smile zone" (the teeth visible while smiling) like premolars and molars.
Additionally, dentists are concerned about bone loss after extracting the teeth. Bone often diminishes around empty tooth sockets, especially if those sockets were damaged during extraction. This loss in bone can weaken the jaw structure and cause significant problems while moving teeth with braces.
To avoid this, dentists take great care during tooth removal not to damage the socket. Additionally, they may place a bone graft within the socket immediately after removing the tooth, especially if the space will remain vacant for a significant period of time. A bone graft serves as a scaffold upon which new bone cells can form and accumulate.
After the extractions, the orthodontist may then proceed with correcting the bite. Patients may also need some form of prosthetic teeth to fill in the spaces while wearing braces. Often prosthetic teeth can be incorporated with the braces for a more natural look. After braces, any remaining gaps may require further restoration, either with dentures, bridges or, later in adulthood, dental implants.
Complex bite problems like crowding pose unique challenges in correcting them. But using techniques like tooth extraction can help achieve a successful and satisfactory outcome.
If you would like more information on treatments for 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 “Tooth Removal for Orthodontic Reasons.”
In addition to daily oral hygiene and regular dental visits, a tooth-friendly diet can boost your kid's dental health and development. You can help by setting high standards for eating only nutritious foods and snacks at home.
But what happens when they're not home—when they're at school? Although public schools follow the Smarts Snacks in Schools initiative sponsored by the U.S. Department of Agriculture, those guidelines only recommend minimum nutritional standards for foods and snacks offered on campus. Many dentists, though, don't believe they go far enough to support dental health.
Besides that, your kids may have access to another snack source: their peers. Indeed, some of their classmates' snacks may be high in sugar and not conducive to good dental health. Your kids may face a strong temptation to barter their healthy snacks for their classmates' less than ideal offerings.
So, what can you as a parent do to make sure your kids are eating snacks that benefit their dental health while at school? For one thing, get involved as an advocate for snacks and other food items offered by the school that exceed the USDA's minimum nutritional standards. The better those snacks available through vending machines or the cafeteria are in nutritional value, the better for healthy teeth and gums.
On the home front, work to instill eating habits that major on great, nutritional snacks and foods. Part of that is helping your kids understand the difference in foods: some are conducive to health (including for their teeth and gums) while others aren't. Teach them that healthier foods should make up the vast majority of what they eat, while less healthier choices should be limited or avoided altogether.
Doing that is easier if you take a creative, playful approach to the snacks you send with them to school. For example, if you send them to school with their own snacks, add a little excitement like cinnamon-flavored popcorn or cheese and whole wheat bread bites in different shapes. And make it easier for them with bite-sized snacks like grapes, baby carrots or nuts.
You can't always control what snacks your kids eat, especially at school. But following these tips, you may be able to influence them in the right direction.
If you would like more information on helping your child develop tooth-friendly snacking habits, 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 “Snacking at School.”
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