Indianapolis Crown Specialist Blog
Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.
That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!
Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.
Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”
One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.
Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.
Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”Â Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
Transforming your smile doesn’t necessarily require complex treatments like orthodontics, dental implants or porcelain veneers. Sometimes a little brightness can mean all the difference in the world.
Bleaching (or teeth whitening) is a proven method for dealing with tooth discoloration and staining. Nearly all whitening products, whether home or professional, contain the bleaching agent carbamide peroxide or its breakdown product hydrogen peroxide. These agents effectively diminish staining deep within a tooth (intrinsic) or on the enamel surface (extrinsic), although intrinsic staining will require a more invasive office procedure.
If you have extrinsic staining you have three basic options: dental office bleaching, a retail home kit or a kit purchased from a dentist. Again, you’ll find the same basic bleaching agents in each of these versions. The difference will be the concentration: home kits contain about 10% agent by volume, while the office application will be a much higher range of 15% to 35% (which may also employ specialized lights or lasers to increase the bleaching effect). As a result, an office bleaching may take only a visit or two to achieve the desired brightness while a home kit about two or three weeks.
Whitening is a more economical route for smile enhancement of otherwise sound teeth than other measures. But there are other considerations you should weigh before undergoing a procedure. Whitening isn’t a permanent fix — the brightness will diminish over time, optimally six months to a year in what dentists call the “fade rate.” You can slow this process by avoiding or limiting foods and habits that cause staining.
If you have other dental work — crowns, bridgework or fillings — it may be difficult to achieve a tint level that matches these restorations, especially at home. And while whitening is relatively safe (as long as you’re using your kit as directed), you may experience tooth sensitivity, gum irritation or other minor oral side effects.
Before you decide on whitening, visit us first for a complete dental examination. From there we can advise you on whether whitening is a good smile enhancement choice for you.
If you would like more information on teeth whitening, 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 “Teeth Whitening.”
While crooked teeth are usually responsible for a malocclusion (poor bite), the root cause could go deeper: a malformed maxilla, a composite structure composed of the upper jaw and palate. If that’s the case, it will take more than braces to correct the bite.
The maxilla actually begins as two bones that fit together along a center line in the roof of the mouth called the midline suture, running back to front in the mouth. The suture remains open in young children to allow for jaw growth, but eventually fuses during adolescence.
Problems arise, though, when these bones don’t fully develop. This can cause the jaw to become too narrow and lead to crowding among the erupting teeth and a compromised airway that can lead to obstructive sleep apnea. This can create a cross-bite where the upper back teeth bite inside their lower counterparts, the opposite of normal.
We can remedy this by stimulating more bone growth along the midline suture before it fuses, resulting in a wider maxilla. We do this by installing a palatal expander, an appliance that incrementally widens the suture to encourage bone formation in the gap, which over time will widen the jaw.
An expander is a metal device with “legs” extending out on both sides and whose ends fit along the inside of the teeth. A gear mechanism in the center extends the legs to push against the teeth on both sides of the jaw. Each day the patient or caregiver uses a key to give the gear a quarter turn to extend the legs a little more and widen the suture gap. We remove the expander once the jaw widens to the appropriate distance.
A palatal expander is an effective, cost-efficient way to improve a bite caused by a narrow jaw, but only if attempted before the bones fuse. Widening the jaw after fusion requires surgery to separate the bones — a much more involved and expensive process.
To make sure your child is on the right track with their bite be sure to see an orthodontist for an evaluation around age 6. Doing so will make it easier to intervene at the proper time with treatments like a palatal expander, and perhaps correct bite problems before they become more expensive to treat.
If you would like more information on treating malocclusions, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
If you’ve lost some teeth you may eventually want to replace them with dental implants. Implants by far are the restoration of choice due to their life-likeness and durability. But those advantages don’t come cheaply — implants can be expensive especially for multiple teeth.
If you’re forced to wait financially for implants, you still have other intermediary options like a removable partial denture (RPD). The conventional RPD has a rigid acrylic base colored to resemble gum tissue supported by a metal frame with attached prosthetic (false) teeth at the missing teeth locations. They’re held secure in the mouth through metal clasps that fit over the remaining teeth.
But these conventional RPDs can sometimes be uncomfortable to wear and don’t always cover the bottom of the gum completely. If this is a concern, you might consider an alternative: flexible RPDs. The base of this RPD is made of a form of flexible nylon rather than acrylic plastic. They’re much more lightweight but still fit securely in the mouth with thin plastic extensions rather than metal clasps. The base can also be more easily formed to cover areas where gum tissue may have receded.
While flexible RPDs hold up better to wear and tear than their conventional counterparts, they must still be maintained like any other appliance. They can accumulate plaque (bacterial biofilm) responsible for tooth decay and periodontal (gum) disease, so daily thorough cleaning is a must. And if there fit becomes loose they can be more difficult to reline or repair than other types of dentures.
They also share a common weakness with other dentures — they can’t prevent and may even stimulate bone loss. As bone ages, old cells dissolve and new ones form to take their place. As we eat and chew our teeth transmit the forces generated through the teeth to the bone to stimulate it to grow. RPDs and other dentures can’t transmit this stimulus, so the bone replaces much slower to the point that the bone volume can diminish.
That’s why it’s best to consider any RPD as a temporary solution until you can obtain an implant for a more permanent and bone-friendly option. In the meantime, though, an RPD can provide you with a great solution for both form and function for missing teeth.
If you would like more information on RPD choices, 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 “Flexible Partial Dentures: An Aesthetic Way to Replace Teeth Temporarily.”
During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.
Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.
For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.
When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.
But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.
Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.
So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…
If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”
With college, a full-time job and an upcoming wedding to plan, Brooke Vitense had the hectic life of an average young woman in her twenties. But a chance discovery one morning would completely upend her normal life.
That morning Brook noticed white spots on the underside of her tongue while brushing her teeth. Not long after, she pointed out the spots to her dentist during her regular dental checkup. He recommended having the spots biopsied, just to be safe. She needed a wisdom tooth removed, so she scheduled the biopsy with her oral surgeon to coincide with the tooth extraction.
She soon forgot about the biopsy — until her dentist contacted her about the results. The lesions were pre-cancerous: he recommended she have them and a portion of her tongue removed surgically as soon as possible.
She underwent the procedure, but that wasn't the end of her ordeal. The follow-up pathology report indicated cancerous cells in the tissue excised during the procedure. To ensure elimination of any remaining cancerous cells they would need to remove more of her tongue as well as the lymph nodes from her neck.
Brooke survived her cancer experience and has since resumed her life. Her story, though, highlights some important facts about oral cancer.
Oral cancer is life-threatening. Although cases of oral cancer are rarer than other types of malignancies, the survival rate is low (50%). This is because lesions or other abnormalities are often dismissed as simple sores. Like any cancer, the earlier it's detected and treated, the better the chances for survival.
Anyone of any age can develop oral cancer. While most cases occur in older adults, young and otherwise healthy people like Brooke are not immune. It's important for everyone to make healthy lifestyle choices (good oral hygiene and nutrition, moderate alcohol use and avoidance of tobacco) and see a dentist whenever you see an abnormal sore or spot in your mouth.
Regular dental checkups are crucial for early detection. Had Brooke not seen her dentist soon after discovering the spots on her tongue, her survivability could have been drastically lower. Regular dental visits (and cancer screenings if you're at high risk) could mean all the difference in the world.
If you would like more information on the signs and treatment of oral cancer, please contact us or schedule an appointment for a consultation. You can watch Brooke's interview by visiting How a Routine Dental Visit Saved My Life
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.”
Treating advanced periodontal (gum) disease takes time. If you have this destructive disease, it wouldn’t be uncommon for you to undergo several cleaning sessions to remove plaque from tooth and gum surfaces. This built-up film of bacteria and food particles is primarily responsible for triggering and fueling gum disease.
These cleaning sessions, which might also involve surgery and other advanced techniques to access deep pockets of infection, are necessary not only to heal your gums but to preserve the teeth they support. With these intense efforts, however, we can help rescue your teeth and return your reddened and swollen gums to a healthy, pink hue.
But what then — is your gum disease a thing of the past?
The hard reality is that once you’ve experienced gum disease your risk of another occurrence remains. From now on, you must remain vigilant and disciplined with your oral hygiene regimen to minimize the chances of another infection. You can’t afford to slack in this area.
Besides daily brushing and flossing as often as your dentist directs, you should also visit your dentist for periodontal maintenance (PM) on a regular basis. For people who’ve experienced gum disease, PM visits are more than a routine teeth cleaning. For one, your dentist may recommend more than the typical two visits a year: depending on the severity of your disease or your genetic vulnerability, you may need to increase the frequency of maintenance appointments by visiting the dentist every two to three months.
Besides plaque and calculus (tartar) removal, these visits could include applications of topical antibiotics or other anti-bacterial substances to curb the growth of disease-causing bacteria in your mouth. You may also need to undergo surgical procedures to make particular areas prone to plaque buildup easier to clean.
The main point, though, is that although you’ve won your battle with gum disease, the war isn’t over. But with your own daily hygiene maintenance coupled with your dentist’s professional attention, you’ll have a much better chance of avoiding a future infection.
If you would like more information on preventing and treating gum disease, 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 “Periodontal Cleanings.”
It's no secret that many of Hollywood's brightest stars didn't start out with perfectly aligned, pearly-white teeth. And these days, plenty of celebs are willing to share their stories, showing how dentists help those megawatt smiles shine. In a recent interview with W magazine, Emma Stone, the stunning 28-year-old star of critically-acclaimed films like La La Land and Birdman, explained how orthodontic appliances helped her overcome problems caused by a harmful habit: persistent thumb sucking in childhood.
“I sucked my thumb until I was 11 years old,” she admitted, mischievously adding “It's still so soothing to do it.” Although it may have been comforting, the habit spelled trouble for her bite. “The roof of my mouth is so high-pitched that I had this huge overbite,” she said. “I got this gate when I was in second grade… I had braces, and then they put a gate.”
While her technical terminology isn't quite accurate, Stone is referring to a type of appliance worn in the mouth which dentists call a “tongue crib” or “thumb/finger appliance.” The purpose of these devices is to stop children from engaging in “parafunctional habits” — that is, behaviors like thumb sucking or tongue thrusting, which are unrelated to the normal function of the mouth and can cause serious bite problems. (Other parafunctional habits include nail biting, pencil chewing and teeth grinding.)
When kids develop the habit of regularly pushing the tongue against the front teeth (tongue thrusting) or sucking on an object placed inside the mouth (thumb sucking), the behavior can cause the front teeth to be pushed out of alignment. When the top teeth move forward, the condition is commonly referred to as an overbite. In some cases a more serious situation called an “open bite” may develop, which can be difficult to correct. Here, the top and bottom front teeth do not meet or overlap when the mouth is closed; instead, a vertical gap is left in between.
Orthodontic appliances are often recommended to stop harmful oral habits from causing further misalignment. Most appliances are designed with a block (or gate) that prevents the tongue or finger from pushing on the teeth; this is what the actress mentioned. Normally, when the appliance is worn for a period of months it can be expected to modify the child's behavior. Once the habit has been broken, other appliances like traditional braces or clear aligners can be used to bring the teeth into better alignment.
But in Stone's case, things didn't go so smoothly. “I'd take the gate down and suck my thumb underneath the mouth appliance,” she admitted, “because I was totally ignoring the rule to not suck your thumb while you're trying to straighten out your teeth.” That rule-breaking ended up costing the aspiring star lots of time: she spent a total of 7 years wearing braces.
Fortunately, things worked out for the best for Emma Stone: She now has a brilliant smile and a stellar career — plus a shiny new Golden Globe award! Does your child have a thumb sucking problem or another harmful oral habit? For more information about how to correct it, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “How Thumb Sucking Affects the Bite.”
There are a number of ways to improve unsightly teeth. You can, of course, replace them with dental implants — but not if they're still viable. You can crown them: however, you'll have to significantly reduce their structure for the crowns to fit over them.
There is another less invasive option for teeth with mild to moderate imperfections — you can cover them with porcelain veneers. As the name implies, a veneer is a thin covering of dental porcelain bonded to the outside surface of a tooth. They literally put a “new face” on chipped, stained or slightly gapped teeth.
You'll first need a dental examination to ensure your teeth are reasonably healthy and that you don't have any significant dental problems that could interfere with the veneers. We can then design your veneers' shape and color to achieve the look you desire. We can also create a temporary “trial smile” with acrylic replicas of your proposed veneers to give you a realistic impression of your future smile.
The next step is the possibility the teeth need to be prepared for the veneers. Although quite thin, veneers can still make the teeth look larger or bulky. To compensate, we remove some of the tooth enamel. Although much less than for a crown, this alteration is still permanent: your teeth will need some form of restoration from now on. There are also “no-prep” veneers, which require no tooth surface reduction.Â Ask us if this is an option.
We then make an impression of the teeth, which with other information will guide a technician at a dental laboratory to manually create your new veneers. This can take several weeks and requires a high degree of artistry to produce a custom product that will match your teeth.
Once they've arrived, we'll use a permanent bonding process to precisely attach them to your teeth.Â It will then be up to you to care for your veneers, especially not biting down on anything hard that could chip or crack them. You should also maintain regular dental visits and proper oral hygiene to keep your smile as bright and attractive as possible.
Although small in size, veneers can make a big impression. They can restore the smile you once had — or give you the look you've always wanted.
If you would like more information on porcelain veneers, 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 “Porcelain Veneers: Strength & Beauty as Never Before.”
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