It's difficult to measure how x-ray imaging has transformed dentistry since its use became prominent a half century ago. As equipment and methods standardized, the technology revolutionized the way we diagnose tooth decay and other mouth-related issues.
One of the more useful of these methods is called the bitewing x-ray. The term comes from the shape of the device a patient holds between their teeth with the film attached on the side toward their tongue. We direct the x-ray beam to the outside of the patient's cheek, where it passes through the teeth to expose on the film. Its particular design provides clearer images since the patient's bite helps keep the film still and distortion-free, making it easier to view signs of early tooth decay.
Bitewing x-rays usually consist of four films, two on either side of the mouth, necessary to capture all of the teeth (children with smaller jaws, however, often only require one film per side). How frequently they're conducted depends on a number of factors, including the patient's age: children or young adolescents are usually filmed more frequently than adults, usually every six to twelve months. Frequency also depends on a patient's particular decay risk — the higher the risk the more frequent the x-ray.
Regardless of how often they're performed, a similar application principle applies with bitewing x-rays as with any other radiological method: As Low As Reasonably Achievable (ALARA). With the ALARA principle in other words, we're looking for that sweet spot where we're able to detect the earliest stages of dental disease with the least amount of radiation exposure.
Bitewings fit this principle well: a patient receives only a fraction of the radiation exposure from a four-film bitewing as they do from a daily dose of environmental radiation. Factor in new digital technology that reduces exposure rates and bitewings pose virtually no health risk to patients, especially if conducted in a prudent manner.
The benefits are well worth it. Thanks to bitewing x-rays we may be able to diagnose decay early and stop it before it causes you or your family member extensive tooth damage.
Moving teeth through orthodontics may involve more than simply wearing braces. There are many bite conditions that require extra measures before, during or after traditional orthodontic treatment to improve the outcome.
One such measure is extracting one or more teeth. Whether or not we should will depend on the causes behind a patient's poor dental bite.
Here, then, are 4 situations where tooth extraction before orthodontics might be necessary.
Crowding. This happens when the jaw isn't large enough to accommodate all the teeth coming in. As a result, later erupting teeth could erupt out of position. We can often prevent this in younger children with space maintainers or a palatal expander, a device which helps widen the jaw. Where crowding has already occurred, though, it may be necessary to remove selected teeth first to open up jaw space for desired tooth movement.
Impacted teeth. Sometimes an incoming tooth becomes blocked and remains partially or fully submerged beneath the gums. Special orthodontic hardware can often be used to pull an impacted tooth down where it should be, but not always. It may be better to remove the impacted tooth completely, as well as its matching tooth on the other side of the jaw to maintain smile balance before orthodontically correcting the bite.
Front teeth protrusion. This bite problem involves front teeth that stick out at a more horizontal angle. Orthodontics can return the teeth to their proper alignment, but other teeth may be blocking that movement. To open up space for movement, it may be necessary to remove one or more of these obstructing teeth.
Congenitally missing teeth. The absence of permanent teeth that failed to develop can disrupt dental appearance and function, especially if they're near the front of the mouth. They're often replaced with a dental implant or other type of restoration. If only one tooth is missing, though, another option would be to remove the similar tooth on the other side of the jaw, and then close any resulting gaps with braces.
Extracting teeth in these and other situations can help improve the chances of a successful orthodontic outcome. The key is to accurately assess the bite condition and plan accordingly.
If you would like more information on orthodontic options, 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 “Removing Teeth for Orthodontic Treatment.”
Straightening your smile doesn't happen overnight—it can involve months or even years of orthodontic treatment. And although the end result is well worth it, the long process can make it difficult to keep your gums healthy, especially while wearing braces.
Gum swelling in particular is a common problem for braces wearers with two potential sources. First, orthodontic hardware makes it difficult to keep teeth clean of dental plaque, a thin bacterial film that can cause gum disease. Plaque and its hardened counterpart tartar can trigger a gum infection, which in turn triggers inflammation. As a result, affected gums appear swollen and red, and can easily bleed.
Gum tissues may also react to braces pressing against them and develop hypertrophy (or hyperplasia), an increase in individual tissue cell growth. If this overgrowth occurs, it may not get resolved until after your braces have been removed.
As long as the hypertrophy doesn't appear to have weakened gum attachment with the teeth, it's usually not a big concern. But what is a concern is that hypertrophy could increase a braces wearer's difficulties with oral hygiene and give rise to a true gum infection that could endanger dental attachment. Advanced cases could require surgical correction or removal of the braces altogether to adequately treat the infection.
The best way to avoid a worst case scenario is to be as diligent as possible with daily brushing and flossing. Fortunately, there are several tools that can make it easier with braces. Interproximal brushes, tiny brushes that can fit into the narrow spaces between the teeth and the braces, can be used in conjunction with your regular toothbrush.
Flossing is also easier if you use a floss threader or a water flosser. The latter utilizes a pump to emit a pulsating jet of water to break loose plaque between teeth and flush it away. Clinical studies have shown the effectiveness of water flossers for removing plaque in braces wearers as opposed to not flossing at all.
A faithful daily hygiene practice and twice-a-year cleanings and checkups with your regular dentist can help minimize your chances of gum swelling. Doing so will help ensure you'll complete your orthodontic treatment on the way to healthier and more attractive smile.
If you would like more information on teeth and gum care while wearing 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 “Gum Swelling During Orthodontics.”
Orthodontic braces are a familiar sight, especially among tweens and teens: metal brackets and wires attached to the front of the teeth for all to see. Now imagine the opposite: much the same hardware, but now positioned out of sight on the back of the teeth.
It's not your imagination: It's the latest development in orthodontic technology called lingual braces. Developed simultaneously by two orthodontists in Japan and Beverly Hills, these appliances are placed on the tongue or “lingual” side of the teeth rather than the traditional labial or “lip-side.”
Generally, lingual braces can correct any bite problem labial braces can. The difference lies in how each method does its job: Traditional braces exert pressure or “push” against the teeth, while lingual braces “pull” the teeth into better alignment.
So, why choose lingual over labial? For one, they're “invisible” to others: all the hardware is on the backside of the teeth, out of sight. They're also not as readily exposed to blunt force facial trauma, which can damage traditional braces (a driving impetus for the Japanese doctor to develop them for his martial arts patients, and his American counterpart for a law enforcement patient working in a rough area).
Patients may also prefer lingual braces over removable clear aligners, another popular tooth-movement option. Fixed lingual braces achieve the same quality of “invisibility” as removable aligners, but without the inconvenience of removing them as patients must with aligners for eating, snacking or cleaning.
They can, however, be costly, running 15-35% more than labial braces. Patients may also have difficulty adjusting to them because they can affect speech and tongue comfort. However, any discomfort and initial regret with choosing lingual braces tends to fade as most patients grow more accustomed to them after a week or so.
There's one other “perk” to lingual braces—unlike patients with traditional braces who have to wait for their removal to see the finished bite correction, patients with lingual braces get an unobstructed view of their progress all during wear. That can definitely boost morale during the long treatment period!
Lingual braces haven't been around long, so not every orthodontist offers them. But the list is growing, and there soon may be a provider near you for this new teeth-straightening alternative.
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.”
Actor Zac Efron has one of the top smiles in a business known for beautiful smiles. Bursting on the scene in 2006 at age 18 in High School Musical, Efron has steadily increased his range of acting roles. He recently starred as Ted Bundy on Netflix, wearing prosthetics to match the notorious serial killer's crooked teeth.
With his growing fame, Efron's attractive smile has become one of his more memorable attributes. But it wasn't always so. Before Hollywood, Efron's smile was less than perfect with small, uneven teeth and a gap between his top front teeth. Before and after pictures, though, make it quite apparent that the actor has undergone a significant smile makeover.
While fans are abuzz on the 411 regarding his dental work, Efron himself has been hush-hush about his smile transformation. We won't join the speculation: Instead, here are a few possible ways you can get a more attractive smile like Zac Efron.
Teeth whitening. A single-visit, non-invasive teeth whitening procedure can transform your dull, stained teeth into a brighter, more attractive smile. Although the effect isn't permanent, it could last a few years with a professional whitening and good oral practices. Having it done professionally also gives you more control over the level of shading you prefer—from soft natural white to dazzling Hollywood bright.
Orthodontics. Like Efron, if your teeth aren't quite in proper alignment, straightening them can make a big difference in your appearance (and your oral health as well). Braces are the tried and true method for moving teeth, but you may also be able to choose clear aligner trays, which are much less noticeable than braces. And don't worry about your age: Anyone with reasonably good dental health can undergo orthodontics.
Bonding. We may be able to correct chips and other slight tooth flaws with durable composite resins. After preparing your tooth and matching the material to your particular color, we apply it directly to your tooth in successive layers. After hardening, the unsightly defect is no more—and your smile is more attractive.
Veneers. Dental veneers are the next step up for more advanced defects. We bond these thin, custom-made layers of dental porcelain to the front of teeth to mask chips, heavy staining and slight tooth gaps. Although we often need to permanently remove a small amount of tooth enamel, veneers are still less invasive than some other restorations. And your before and after could be just as amazing as Zac Efron's.
Improving one's smile isn't reserved for stars like Zac Efron. There are ways to correct just about any dental defect, many of which don't require an A-lister's bank account. With a little dental “magic,” you could transform your smile.
If you would like more information about how to give your smile a boost, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “The Magic of Orthodontics” and “Porcelain Veneers.”