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.”
Your tooth is in peril if its innermost layer, the pulp, becomes infected and inflamed. Deep tooth decay, repeated dental procedures or fractures can all expose the pulp and ultimately the roots to infection and lead to tooth loss.
But that scenario isn't inevitable — we can often save the tooth with a root canal treatment. By accessing the tooth's interior through a prepared hole, we're able to clean out the infected tissue in the pulp chamber and root canals, and fill the empty space with a special filling. We then cap the tooth with a custom crown to protect it from a re-infection.
Root canal treatments have a very high success rate — chances are good your tooth will survive for many years afterward. But there's a slight chance the tooth may become re-infected; in that case, a second root canal treatment may be in order.
In a few cases, though, a second root canal may not be advisable, and could even accelerate damage to the tooth. For example, if past dental work resulted in an extensive crown restoration, accessing the root canals the conventional way will require disassembling that restoration. This could weaken the tooth significantly.
We can approach the problem from a different route: instead of accessing the tooth's interior through the crown (the visible part of the tooth), we instead perform a surgical procedure called an apicoectomy, which accesses the tooth at the root end through the gums.
In this procedure we numb the area with local anesthesia and then make a small incision through the gums at the level of the affected root. After access, we remove any diseased tissue around the root and a few millimeters of the root tip itself. We then insert a small filling in its place to seal the canal and prevent further infection. In some cases we may also insert a graft to encourage bone growth and aid in healing.
Over time, the affected area will heal and return to normal function. Even if a traditional root canal treatment can't be used, an apicoectomy could be another option for saving your tooth.
If you would like more information on your options for preserving a problem tooth, 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 “Apicoectomy.”
Although tooth decay is a major problem to watch for in your child’s teeth, it isn’t the only one. As their teeth transition from primary (“baby”) to permanent, you should also be on the lookout for a developing poor bite or malocclusion.
Although the signs can be subtle, you may be able to detect an emerging malocclusion, starting usually around age 6, if you know what to look for. Here are 4 signs your child may be developing a poor bite.
Excessive spacing. This is something that might be noticeable while the child still has their primary teeth. If you notice an excessive amount of space around the front teeth, the sizes of the jaws and the teeth may be disproportional.
Abnormal overlapping. The upper teeth normally just cover the bottom teeth when the jaws are closed. But a malocclusion may be forming if the lower teeth cover the upper (underbite), the upper teeth extend too far over the lower (deep bite) or there’s space between the upper and lower front teeth (open bite).
Different overlapping patterns. Watch as well for some of the teeth overlapping normally while others don’t, a sign of a cross bite. For example, the back upper teeth may cover their counterparts in a normal fashion while the lower front teeth abnormally overlap the top front. The roles here between front and back teeth can also be reversed.
Abnormal eruptions. Permanent teeth normally follow a pattern when erupting, but certain factors could disrupt the process. For example, a jaw that’s developed too small can cause crowding as incoming teeth vie for space; as a result, some permanent teeth may erupt out of their proper position. Likewise, if a baby tooth is out of its normal position or prematurely lost, the permanent tooth may erupt out of position too.
The good news with each of these developing bite problems is that we can correct them or at least minimize their future effect if caught early. So if you notice any of these signs or anything else out of the ordinary, see an orthodontist as soon as possible. It’s also a good idea to have your child undergo a thorough orthodontic evaluation around age 6.
If you would like more information on bite problems in 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 “Problems to watch for in Children Ages 6 to 8.”
The vast majority of teeth and gum problems stem from two dental diseases: dental caries (tooth decay) and periodontal (gum) disease. But although these dental diseases are all too common in our society, there’s a good chance you can prevent them from harming your own dental health.
That’s because we know the primary cause for both of them—dental plaque, a thin film of bacteria and food particles that can build up on tooth surfaces usually as a result of poor oral hygiene. Remove this plaque build-up daily and you dramatically decrease your risk for disease.
The primary way to do this is with a daily habit of brushing and flossing. While regular dental cleanings remove plaque and tartar (calcified plaque) from hard to reach places, it’s your regular practice that removes the bulk of daily buildup. Interrupting plaque buildup helps keep disease-causing bacteria at bay.
That also means performing these two hygiene tasks thoroughly. For example, you should brush all tooth surfaces, especially in the rear and along the entire gum line (a complete brushing should take at least 2 minutes). And by the way, “thorough” doesn’t mean “aggressive”—a gentle circular motion is all you need. If you scrub too hard, you run the risk over time of damaging your gums.
And while many people discount flossing as a hard and unpleasant task, it’s still necessary: at least half of the plaque in your mouth accumulates between the teeth where brushing can’t reach effectively. If you find flossing too difficult, you can take advantage of tools to make the task easier. A floss threader will make it easier to get floss through your teeth; you could also use an oral irrigator, a device that emits a pressurized spray of water to loosen and flush away some plaque.
Along with dental visits at least twice a year, daily brushing and flossing is the best way to reduce your risk of both tooth decay and gum disease. Avoiding these two diseases will help ensure your smile is attractive and healthy throughout your life.
If you would like more information on preventing dental 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 “Daily Oral Hygiene: Easy Habits for Maintaining Oral Health.”
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.”
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