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.
There’s been a growing awareness about the effects of gluten, a protein found in grains like wheat, rye and sometimes oats, on certain people. An estimated 1 in 133 Americans have Celiac Disease (CD), a gluten-related disorder that causes the body’s immune system to work against itself. And if you have CD, you could eventually face dental problems like enamel pitting and erosion.
When a person with CD consumes gluten, their immune system mistakenly identifies the protein as malicious and attacks it. The attack occurs in the membranes that line the digestive system, which in the process destroys cilia, tiny hair-like structures that aid in food absorption. This disrupts the body’s normal absorption of nutrients, which can lead to a number of systemic conditions including intestinal cancer.
Because of the lack of nutrients, your teeth’s enamel may develop defects. You may begin to see dull spots or pitting, or chalky grooves in its normally shiny surface: this is a sign you’ve lost surface enamel crystals (decalcification). You may also be more susceptible to outbreaks of aphthous ulcers (canker sores).
Because symptoms can be misdiagnosed or go unnoticed, it may be years before you know you have CD. You can, however, get a definitive diagnosis through a blood test for gluten antibodies, which is then confirmed with a biopsy of a tissue specimen from the intestine.
While there’s ongoing research for CD-related medication, there’s currently only one recognized treatment for it — remove gluten from your diet. This is much harder than it sounds, and requires knowing what you can and can’t eat, along with strict monitoring of food package labeling. Thankfully, the world is becoming better educated in this respect as more food manufacturers are clearly labeling products containing gluten and restaurants are providing gluten-free menu options.
Once you have dietary controls in place, your dental issues can be treated as any other person, with one exception: none of the products used in treatment like polishing paste or fluoride gels should contain gluten, and must be verified before using.
CD is a serious condition that could even become life-threatening. Knowing you or someone in your family has it will help you protect both your overall health and your teeth.
If you would like more information on the gluten’s effect on dental health, 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 “Gluten & Dental Problems.”
As a cancer patient, you know how important radiation and chemotherapy are to overcoming the disease. But these treatments often come at a price to other aspects of your health, including your teeth and gums if the treatment target includes the head or neck regions.
Radiation and chemotherapy are effective because they target and destroy cancer cells. Unfortunately, they may also kill non-cancerous, healthy cells; in the mouth, for example, they can damage the cells in the salivary glands and disrupt their ability to produce adequate saliva flow, leading to xerostomia (dry mouth).
This could seriously affect your teeth’s protective enamel shell. As we eat or drink, our mouth’s pH level can become too acidic. Acid is your enamel’s primary enemy because it causes the minerals in the enamel to soften and dissolve (de-mineralization). Saliva neutralizes acid and replaces much of the enamel’s minerals.
Without adequate saliva flow, the enamel will tend to erode over time. You can further aggravate the situation if you routinely consume acidic foods and drinks, like sipping energy drinks or soda during the day. Once the enamel is gone it can’t be replaced naturally, and the teeth will be in serious danger of tooth decay and eventual loss of function and appearance.
To avoid these consequences you should take steps during cancer treatment to reduce your risk for xerostomia or other unhealthy mouth conditions: limit your consumption of acidic foods and beverages; use mouth rinses to counteract acidity and inhibit bacterial growth; and promote saliva flow through medication.
It may be, though, that enamel erosion and subsequent tooth damage is unavoidable. In this case, you may need to consider restorative options with artificial crowns or other cosmetic enhancements — not only to improve your appearance but also to protect your natural teeth from further damage.
Before considering the latter, you should undergo a complete dental examination to assess your condition and make sure you have adequate bone and gum support, and any dental disease under control. From here, we can go about restoring the attractive smile that may have faded during your battle with cancer.
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
From the moment your child's first tooth appears, usually between six and nine months, you need to be concerned about Early Childhood Caries (ECC). This particular form of tooth decay can have a devastating effect on primary (baby) teeth and lead to their premature demise. Losing one before its time could adversely affect how the future permanent tooth comes in.
You can help prevent ECC with daily brushing and cleaning, regular dental visits (beginning around their first birthday) and limiting the sugar they eat. Here are 3 more things to consider for boosting your prevention efforts.
Breastfeeding. Pediatricians generally recommend breastfeeding if possible for a baby's overall health, including dental development. And although breast milk contains fermentable carbohydrates that boost bacterial growth, it no more promotes tooth decay than similar foods and beverages. That said, though, once the child begins to eat and drink other foods and beverages, the combination of sugars in them and breast milk could increase the bacteria that causes ECC. This is another good reason to wean the child from breast milk as they begin to eat more solid foods.
Bottles and pacifiers. It's quite common for parents and caregivers to soothe a fussing or crying baby with a bottle filled with formula, milk or juice for sipping, or even a pacifier dipped in jam, sugar or some form of sweetener. But these practices can create an environment that promotes high acid production from bacteria feeding on the sugars. Instead, avoid giving them a “prop-up” bottle filled with liquids containing sugar and try to limit bottle use to mealtimes. And provide them pacifiers without sugary additives if you use them.
Medicines. Children with chronic illnesses or other needs often take medication containing sugar or with antihistamines that reduce the flow of acid-neutralizing saliva. If the medications can't be altered, then it's extra important for you to practice diligent, daily hygiene to reduce the effect of higher mouth acid.
If you would like more information on dental disease prevention in babies and young children, 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 “Age One Dental Visit: Why it's Important for Your Baby.”
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