The basics for treating tooth decay have changed little since the father of modern dentistry Dr. G.V. Black developed them in the early 20th Century. Even though technical advances have streamlined treatment, our objectives are the same: remove any decayed material, prepare the cavity and then fill it.
This approach has endured because it works—dentists practicing it have preserved billions of teeth. But it has had one principle drawback: we often lose healthy tooth structure while removing decay. Although we preserve the tooth, its overall structure may be weaker.
But thanks to recent diagnostic and treatment advances we’re now preserving more of the tooth structure during treatment than ever before. On the diagnostic front enhanced x-ray technology and new magnification techniques are helping us find decay earlier when there’s less damaged material to remove and less risk to healthy structure.
Treating cavities has likewise improved with the increased use of air abrasion, an alternative to drilling. Emitting a concentrated stream of fine abrasive particles, air abrasion is mostly limited to treating small cavities. Even so, dentists using it say they’re removing less healthy tooth structure than with drilling.
While these current advances have already had a noticeable impact on decay treatment, there’s more to come. One in particular could dwarf every other advance with its impact: a tooth repairing itself through dentin regeneration.
This futuristic idea stems from a discovery by researchers at King’s College, London experimenting with Tideglusib, a medication for treating Alzheimer’s disease. The researchers placed tiny sponges soaked with the drug into holes drilled into mouse teeth. After a few weeks the holes had filled with dentin, produced by the teeth themselves.
Dentin regeneration isn’t new, but methods to date haven’t been able to produce enough dentin to repair a typical cavity. Tideglusib has proven more promising, and it’s already being used in clinical trials. If its development continues to progress, patients’ teeth may one day repair their own cavities without a filling.
Dr. Black’s enduring concepts continue to define tooth decay treatment. But developments now and on the horizon are transforming how we treat this disease in ways the father of modern dentistry couldn’t imagine.
Shingles is a painful viral infection that could potentially recur in sufferers for years. It causes painful skin rashes, general nerve pain, fever and fatigue. In extreme cases, it can cause blindness if the eyes become infected. And because it’s highly contagious, it could affect your dental treatment.
Formally known as herpes zoster, shingles is a recurrent form of chicken pox. If you contracted chicken pox in childhood, the shingles virus could lay dormant for several years. In fact, most people who contract shingles are over 50.
Because it acutely affects the nerves around the skin, the disease’s most common symptom is a belted or striped rash pattern that often appears on one side of the body and frequently on the head, neck or face. While the severity of symptoms may vary among patients, shingles can be a significant health threat to certain people, especially pregnant women, cancer patients or individuals with compromised immune systems.
In its early stages, the shingles virus can easily pass from person to person, either by direct contact with the rash or by airborne secretions that others can inhale. Because it’s highly contagious, even a routine teeth cleaning could potentially spread the virus to dental staff or other patients. Because of the significant health threat it potentially poses to some people, your dental provider may decline to treat you if you’re showing symptoms of the disease.
To stay ahead of this, let your dentist know you’re experiencing a shingles episode if you have an upcoming dental appointment, in which case you may need to reschedule. In the meantime, you should seek medical attention from your physician who may prescribe antiviral medication. Starting it within 3 days of a shingles outbreak can significantly reduce your pain and discomfort as well as its contagiousness.
And if you’re over sixty or at risk for shingles, consider getting the shingles vaccine. This readily available vaccine has proven effective in preventing the disease and could help you avoid the pain and disruption this viral infection can bring to your life.
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.”
Orthodontics shares a principle with the classic tug of war game: if you want things to move in the right direction you need a good anchor. Anchors help braces and other appliances apply constant pressure to misaligned teeth in the direction they need to go to correct a malocclusion (poor bite).
Orthodontic treatments work in cooperation with an existing oral mechanism that already moves teeth naturally in response to biting forces or other environmental factors. The key to this mechanism is an elastic tissue known as the periodontal ligament that lies between the tooth and the bone. Besides holding teeth in place through tiny attached fibers, the ligament also allows the teeth to move in tiny increments.
Braces’ wires laced through brackets affixed to the teeth exert pressure on them in the desired direction of movement –the periodontal ligament and other structures do the rest. To maintain that pressure we need to attach them to an “anchor”—in basic malocclusions that’s usually the back molar teeth.
But not all malocclusions are that simple. Some may require moving only certain teeth while not moving their neighbors. Younger patients’ jaws and facial structures still under development may also need to be considered during orthodontic treatment. That’s why orthodontists have other anchorage methods to address these possible complications.
One example of an alternate anchorage is a headgear appliance that actually uses the patient’s skull as the anchor. The headgear consists of a strap running around the back of the head and attached in front to orthodontic brackets (usually on molar teeth). The pressure it exerts can trigger tooth movement, but it can also help influence jaw development if an upper or lower jaw is growing too far forward or back.
Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed.
Using these and other appliances allows orthodontists to customize treatment to an individual patient’s particular malocclusion. With the right anchor, even the most complex bite problem can be transformed into a beautiful and healthy smile.
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 “Orthodontic Headgear & Other Anchorage Appliances.”
About one-quarter of people have teeth that never developed. While most of these congenitally missing teeth are wisdom teeth, they can also include premolars or lateral incisors (the teeth right next to the two front teeth, the central incisors).
Missing teeth can have an adverse effect on smile appearance. But that’s not all: because each type of tooth performs a specific function, one or more missing teeth can lead to bite problems and disruption of dental function. In the case of missing lateral incisors, the canines (eye teeth) normally positioned beside and toward the back of the mouth from them may begin to drift into the empty space and grow next to the central incisors. This can result in greater difficulty chewing and a smile that “doesn’t look right.”
To correct this situation, we must often first attempt to orthodontically move any out of place teeth to their normal positions. This re-establishes the space needed for the missing teeth to be replaced, which we can then restore with prosthetic (artificial) teeth. If the permanent restoration of choice involves dental implants, we’ll usually need to wait until the completion of jaw development around early adulthood. In the mean time, we can use a retainer appliance to hold the teeth in their new positions with prosthetic teeth attached to fill the empty space for a better smile appearance in the interim.
The real issue is timing—beginning orthodontic treatment when appropriate to a person’s oral development, as well as completing the implant restoration when the mouth has matured sufficiently. There are other considerations such as bone volume, which may have diminished due to the missing teeth. At some point we may need to consider grafting to build up the bone sufficiently to support dental implants.
This all may entail a team approach by various specialties like orthodontics, periodontics and implantology. Working together and coordinating within a timely schedule, a mouth and smile marred by undeveloped teeth can be transformed.
If you would like more information on treating smiles with underdeveloped permanent 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 “When Permanent Teeth Don’t Grow.”
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