We treat most malocclusions (bad bites) with braces or clear aligners. But not all malocclusions are alike — some can require extra procedures to achieve successful results.
One such example is when incoming teeth crowd other teeth and cause them to erupt abnormally. The crowding also reduces the space needed to move the misaligned teeth to better positions. To make more room we'll often remove some of the teeth before undertaking orthodontics.
The key is to extract the right teeth. The best candidates are those whose absence will have minimal effect on both appearance and dental function. That's commonly the bicuspids, located right on the edge of the “smile zone” (the teeth most visible when we smile) between the cuspid (eye) teeth and the back molars.
Once we choose and remove the teeth our next concern is to protect the bone at the extraction site.Â The bone in our jaws benefits from the pressure created when we bite or chew. This stimulates new bone cells to form and replace older cells. Without it, as when we have a missing tooth, the amount of bone can diminish over time and affect the success of any future orthodontics.
To prevent this, we take care not to damage the gums and bone removing the tooth. We may also install a graft under the empty socket to encourage bone growth.
If we've removed teeth outside the smile zone, the resulting orthodontics will move teeth into the opened space. In the end, you won't even notice they're gone. Teeth lost or congenitally missing in the smile zone, though, may eventually require a replacement tooth. A dental implant is the best choice, but it should be put on hold for a younger person until their jaw has fully developed.
In the meantime, we can install a spacer or a temporary restoration to hold the empty space and prevent other teeth from drifting into it. This can be incorporated into braces or aligners, or with a removable partial denture or a temporary modified bridge.
Extracting teeth to aid orthodontics first requires a well-laid plan that could encompass several years. The end result, though, can be well worth the time and effort — better function and a new, attractive smile.
If you would like more information on the process of straightening 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 “Tooth Removal for Orthodontic Reasons.”
Now in your adult years, you feel you’ve functioned pretty well even with a few misaligned teeth. You may also think having them straightened at this point may not be worth the effort and expense.
But there are solid reasons — beyond, of course, the psychological and social benefits gained from a new smile — why straightening teeth even as an adult can be a wise investment. Orthodontics not only enhances your appearance but may also improve your long-term oral health.
Restores proper oral function. Teeth that are aligned properly will tend to function properly. Although you can still chew, speak and smile with teeth that aren’t quite aligned properly, over time you’ll put more stress on both the teeth and the jaws, which could lead to more wear than what normally occurs with aging. By re-aligning teeth to a more normal position you could be extending the life of your teeth and reducing your risk of other functional problems.
Reduces the risk of periodontal (gum) disease. Some people with misaligned teeth are more susceptible to periodontal disease. Besides difficulties with bacterial plaque removal (a must to avoid gum disease), a person with misaligned teeth can also encounter more defects involving bone and gum tissues like gum recession that can contribute to the progression of gum disease. By straightening teeth (and performing plastic periodontal surgery if needed), we can reduce this risk dramatically — as long as we’re performing periodontal treatment for existing gum disease before and during orthodontics.
Facilitates tooth replacement. When we lose a tooth, the mouth’s natural mechanism is to move remaining teeth to fill the void left by the lost tooth. This can make it difficult to position a dental implant or similar tooth replacement in a functional and aesthetically appealing way. By applying orthodontics to move drifting teeth back into their proper place, we restore the best condition for achieving success with a tooth replacement.
The best way to know how much you could benefit from orthodontic treatment is to visit us for a full dental evaluation. From there, we can help you decide if treatment for straightening misaligned teeth is right for you.
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 “Why Straighten Teeth.”
You don’t have to be a dental professional to appreciate a beautiful smile. Likewise, you’ll also know when something’s not quite right with one.
Such can be the case when a tooth fails to erupt properly, causing most or all of the crown to remain below the gum line, a condition known as impaction. Upper canines (or “eyeteeth,” for their location in the arch under the eyes) are especially susceptible to impaction: located on either side of the lateral incisors, which are on either side of the central incisors (the two center front teeth).
The upper canines are important both for function and appearance. Working with their lower counterparts they help cut through food as we chew, so you lose some of that efficiency when they don’t erupt properly. Impacted teeth are susceptible to abscesses and cysts, and can impinge upon and damage the roots of other teeth. And just as importantly, their absence also disrupts the smile as nearby teeth tend to move or “drift” toward the open space.
Rather than remove the impacted canines as is often done with back teeth, it may be more advantageous for both function and appearance to “coax” them into full eruption. This requires first pinpointing their exact location below the gums using x-rays or cone beam 3-D imaging.
If the teeth are in reasonably good position we must first prepare them for orthodontic treatment by surgically exposing the crown from the gums and bonding a small bracket to it. We then attach a small gold chain to the bracket that extends outside of the gums when we suture them back into place. The chain is attached to orthodontic hardware that exerts pressure on the impacted tooth for several months to “pull” it out into the arch.
This procedure has the best chance of success if undertaken before the end of jaw development in early adulthood. Otherwise, it may be better to remove the impacted canines and replace them with dental implants, followed by orthodontic treatment of other teeth to restore their proper position and bite relationships. In either case, your impacted upper canines don’t have to be a problem — we can restore both your mouth function and your smile.
If you would like more information on impacted teeth and treatment 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 “Exposing Impacted Canines.”
Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"
"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.
The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.
Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.
Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).
The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.
Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.
So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.
If you have questions about orthodontic treatment, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Orthodontics For The Older Adult.”
When designing your new smile, we have a lot of options for changing how individual teeth look: from whitening discolored teeth to replacing missing teeth with life-like dental implants. But the problem may not be how your teeth look — in fact, individually they may look perfect. If they’re not straight, though, your smile won’t be as attractive as it could be.
We can address a poor bite (malocclusion) through the dental specialty of orthodontics. By moving misaligned teeth we may be able to transform your smile without any other dental work, or it could serve as a more solid foundation for other cosmetic enhancements. To find out if orthodontics can make a difference for you, you should begin with an initial visit to your general dentist. A thorough dental examination will enable them to tell you if correcting your bite could be a good option for you. If it is, they’ll most likely refer you to an orthodontist, a specialist in treating malocclusions.
The orthodontist will also perform an evaluation and get as complete a picture as possible of your particular bite problems. This examination will also include checking jaw growth and development in younger patients, how the affected teeth align with other teeth, and if your current bite is having any effect on the jaw joints. This will provide a good overview of not only the malocclusion but how it affects the rest of your mouth.
With this detailed analysis, they can then advise you on the best course of treatment. Most malocclusions can be corrected with braces or, increasingly, clear aligner trays. In certain situations, though, more specialized approaches may be needed, such as isolating only certain teeth for movement.
While orthodontic treatment takes time and can be expensive, the end result can be amazing: an improved bite that not only enhances your appearance but improves function and long-term health. Along with other cosmetic enhancements to your teeth and gums, orthodontics can give you a new sense of confidence in your smile.
If you would like more information on improving your smile with 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 “The Magic of Orthodontics.”