Dental implants are widely considered by both dentists and patients as the premier choice for replacing missing teeth. Unfortunately, implants aren’t the appropriate choice for teenagers with missing teeth.
That’s because their jaws won’t fully finish most of their growth and development until early adulthood. An implant placed too early could become misaligned as the jaw matures. The best approach for a teenager is a temporary restoration until they’re old enough for an implant.
There are a couple of good options. One is a removable partial denture (RPD), prosthetic (false) teeth set in an acrylic base that mimics gum tissue at the locations of the missing teeth. RPDs, which stay in place by way of metal clips that fit over other teeth, are easy to wear and maintain.
On the downside, an RPD can break if you bite into something too hard. They can lose their fit and may need to be replaced with a new one. And, some teens aren’t quite keen on wearing a “denture.”
Another option is a bonded or Maryland bridge, a kind of fixed bridge. We bond dental material to the back of a prosthetic tooth with portions of the material extending out from either side of it.Â We then bond these extending tabs to the back of the teeth on either side of the prosthetic tooth to hold it in place. Unlike traditional bridges, we can eventually remove it without any permanent alterations to the teeth it’s attached to.
Before we undertake a bonded bridge, though, we must make sure the gums and bone of the surrounding teeth are free from periodontal (gum) disease and are healthy and strong enough to support the bridge. We also need to be sure the patient doesn’t have a deep bite or a teeth grinding habit, which could cause the teeth to make contact with the tabs and break them.
The patient also needs the maturity to responsibly perform diligent oral hygiene: this type of bridge has a tendency to build up disease-causing plaque, so brushing twice and flossing once every day is critical. Not doing so increases the risk of tooth decay or periodontal (gum) disease, which could complicate a future implant.
We can discuss these options after a thorough dental examination of your teenager. Either way, we’ll be able to restore your teen’s smile until we can undertake a more permanent restoration.
Ever since childhood, when her career as a model and actress took off, Brooke Shields has enjoyed worldwide recognition — through advertisements for designer jeans, appearances on The Muppet Show, and starring roles in big-screen films. But not long ago, that familiar face was spotted in an unusual place: wearing a nasal anesthesia mask at the dentist's office. In fact, Shields posted the photo to her own Instagram account, with the caption “More dental surgery! I grind my teeth!” And judging by the number of comments the post received, she's far from alone.
In fact, researchers estimate that around one in ten adults have dental issues that stem from teeth grinding, which is also called bruxism. (Many children also grind their teeth, but it rarely causes serious problems, and is often outgrown.) About half of the people who are teeth grinders report problems like persistent headaches, jaw tenderness and sore teeth. Bruxism may also result in excessive tooth wear, and may damage dental work like crowns and bridges; in severe cases, loosened or fractured teeth have been reported.
Researchers have been studying teeth grinding for many years; their findings seem to indicate that it has no single cause. However, there are a number of factors that play a significant role in this condition. One is the anatomy of the jaw itself, and the effect of worn or misaligned teeth on the bite. Another factor relates to changes in brain activity that occur during the sleep cycle. In fact, nocturnal (nighttime) bruxism is now classified as a sleep-related movement disorder. Still other factors, such as the use of tobacco, alcohol and drugs, and a high level of stress or anxiety, can make an individual more likely to experience bruxism.
What can be done for people whose teeth grinding is causing problems? Since this condition may have many causes, a number of different treatments are available. Successful management of bruxism often begins by striving to eliminate the factors that may cause problems — for example, making lifestyle changes to improve your health, creating a soothing nighttime environment, and trying stress-reduction techniques; these may include anything from warm baths and soft music at bedtime, to meditation and mindfulness exercises.
Several dental treatments are also available, including a custom-made occlusal guard (night guard) that can keep your teeth from being damaged by grinding. In some cases, a bite adjustment may also be recommended: In this procedure, a small amount of enamel is removed from a tooth to change the way it contacts the opposite tooth, thereby lessening the biting force on it. More invasive techniques (such as surgery) are rarely needed.
A little tooth grinding once in a while can be a normal response to stress; in fact, becoming aware of the condition is often the first step to controlling it. But if you begin to notice issues that could stem from bruxism — or if the loud grinding sounds cause problems for your sleeping partner — it may be time to contact us or schedule an appointment. You can read more about bruxism in the Dear Doctor magazine article “Stress and Tooth Habits.”
Millions of Americans regularly use ibuprofen to manage minor pain and swelling. As with other fields in healthcare, the drug is a mainstay in dentistry especially for post-procedural discomfort. But ibuprofen and similar drugs also have side effects that can lead to serious health problems. So, should you be concerned about its safety?
For most people, ibuprofen is safe and effective — but only if used properly. Like aspirin, ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces pain and inflammation by blocking the effect of substances called prostaglandins, released by injured or damaged tissues. NSAIDs differ in mechanism from pain relievers like steroids or narcotics and don’t have the same side effects, especially the addictive qualities and impaired consciousness potential of narcotics like morphine or codeine. While these more potent drugs are usually reserved for serious injuries or illnesses, NSAIDs like ibuprofen are ideal for mild to moderate pain following routine dental work.
The biggest concern for the use of an NSAID is its tendency to thin the blood, especially if used continuously over several weeks; this can make bleeding control more difficult after an injury. Prolonged overuse has also been linked to erosion of the stomach lining leading to ulcers or bleeding, kidney failure, early miscarriage and repeat heart attacks for patients with cardiovascular disease.
With this in mind, we recommend that adults take no more than 2,400 milligrams of ibuprofen during one twenty-four hour period for short-term pain relief unless otherwise recommended by a doctor. Research has shown that a single 400-milligram dose of ibuprofen is safe and effective for relieving even severe post-operative pain for about five hours in most people. On the other hand, we don’t recommend a NSAID during pregnancy or for people with a history of intestinal bleeding or heart attacks.
Taking into account your medical history and the procedure you’ll be undergoing, we will recommend the best pain management medication for your situation. In most cases, ibuprofen will be an effective means to reduce your discomfort level and, taken properly, will not pose a danger to your overall health.
If you would like more information on dental pain management, 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 “Treating Pain with Ibuprofen.”
Have you started orthodontic treatment recently? Are you having a little trouble getting used to your braces? If so, you are not alone: Everybody goes through an adjustment period during which they momentarily wonder if they’ll really ever get used to this. Don’t worry — you will! And we’ve never heard anyone say, on the day their braces come off and their new smile is revealed, that they aren’t glad they went the distance. Just ask Houston Rockets all-star center Dwight Howard, who discussed his own orthodontic treatment in a recent interview.
“I’m sure I was no different than anyone else who has ever had braces,” he told Mediaplanet. “At first I hated them so much… That changed once I got used to them and I actually grew to love them.” What’s Howard’s advice? “Do exactly what your orthodontist says and know that the outcome is well worth it in the end.” We couldn’t agree more! Here are some tips for wearing braces comfortably:
- Hard & Chewy Foods: If you love fresh fruits and vegetables, that’s great; there’s no reason to give them up, just the really hard ones. You don’t want to bite into an apple or carrot or any other hard foods like bagels and pizza that have any “size” to them. Small pieces may be ok as long as they can’t bend your wires. Chewy, sticky candy should really be avoided completely. Same with soda, sports drinks and so-called energy drinks because they contain acids that promote tooth decay and can cause a lot of damage around the braces.
- Effective Oral Hygiene: Keeping your teeth clean is more important than ever, but also more challenging than ever. It’s easy for food to get stuck under wires and around brackets, but failing to remove it can cause tooth decay, gum irritation and soreness. Therefore, the cleaner your teeth and your braces are, the healthier you will be. Use interdental cleaning brushes and/or a floss-threader to get behind your wires. A mouthrinse can also help strengthen teeth and keep bacteria in check. If you have any questions about how to clean between your teeth, please ask for a demonstration at your next visit.
- Pain Relief: Some soreness at the beginning of orthodontic treatment is normal. To relieve it, you can use an over-the-counter pain reliever and/or a warm washcloth or heating pad placed on the outside of the jaw. If brackets or wires are rubbing against the inside of your cheeks or lips, try applying wax to these areas of your braces. If this does not offer enough relief, we may be able to trim the end of a poking wire. Call us if you need help with this.
Our goal is to make your orthodontic treatment as comfortable as possible on the way to achieving your all-star smile. If you have questions about adjusting to braces, contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Caring for Teeth During Orthodontic Treatment.”
Dental implants can do more than replace individual teeth — a few well-placed implants can support other restorations like a fixed bridge. The natural integration that occurs between the bone and the implant's titanium post creates a strong, durable hold for both implant and the supported restoration.
But if a bone-implant connection weakens, the implant could be in danger of failing. This can occur because of periodontal (gum) disease caused by dental plaque, a thin film of built-up food particles and bacteria on the teeth. Untreated, the infection can ultimately spread from the gums to the bone and cause it to diminish in volume. If the bone loss occurs around an implant the threaded surface of the post may be exposed, inviting more plaque buildup. This can trigger more bone loss and eventually implant failure.
That's why you must brush and floss daily to remove plaque on and around your fixed bridge just as you do your natural teeth. Brushing around a bridge could be difficult with a traditional brush, so you may want to use an interproximal brush designed for just such situations. Be sure any utensil you use contains only plastic parts — metal creates microscopic scratches in the restoration materials that could harbor plaque.
You should also floss between the bridge and gums as well as between any natural teeth. While this can be difficult with traditional flossing methods, there are some tools to make it easier.
One is a floss threader, a small tool with a loop on one end and a stiff plastic edge on the other. With floss threaded through the loop, you gently guide the edged end between the bridge and gums. Once it passes through, you wrap the two ends of the floss with your fingers as you would normally and work it along each side of the nearest implants.
You can also use pre-cut floss sections with stiffened ends to pass through the gap, or an oral irrigator that loosens and flushes away plaque with a pressurized water stream. Just be sure you flush debris away from the gum and not toward it.
Keeping all surfaces of your implant-supported bridgework clean of plaque is necessary for its longevity. Be sure you also visit your dentist regularly for more thorough cleanings.
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