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.
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.”
There are plenty of options today for replacing missing teeth, including dental implants. But if the teeth have been missing for some time, complications can arise that limit your restorative options.
The most consequential possibility is bone loss. Bone has a life cycle: old cells dissolve (resorb), and are then replaced by new cells, stimulated to grow by the forces applied to the teeth during chewing. But the bone won't receive this stimulation if a tooth is missing — so growth slows down, which causes the bone volume to diminish with time.
Another complication can occur involving other teeth around the open space. These teeth will naturally move or “drift” out of their normal position into the missing tooth space. As a result we may not have enough room to place a prosthetic (false) tooth.
If either or both of these complications occur, we'll need to address them before attempting a restoration. Bone loss itself could eliminate dental implants as an option because they require a certain amount of supporting bone for correct placement. Bone loss could also make correcting misaligned teeth difficult if not impossible.
It might be possible, though, to regenerate lost bone with a bone graft. The graft is placed, sometimes along with growth stimulating substances, within the diminished bone area. It then serves as a scaffold upon which new bone can form.
If the bone becomes healthy again, we can then attempt to move any drifted teeth back to where they belong. Besides braces, there's another treatment option especially popular with adults: clear aligners. These are a series of removable, clear plastic trays that, like braces, exert gradual pressure on the teeth to move them. Patients wear each individual tray for about two weeks, and then switch to the next tray in the series to continue the process.
Unlike their traditional counterparts, clear aligners can be removed for cleaning or for special occasions. More importantly, they're much less noticeable than traditional braces.
Once any problems with bone health or bite have been addressed and corrected, you'll have a fuller range of options for replacing your missing teeth. With a little extra time and effort, you'll soon be able to regain a smile you'll be proud to display.
Academy Award-winning actress Kathy Bates knows how important it is to present your best face to the world — and one of the most important features of that face is a beaming smile. But there came a point when she noticed something was a little off. “I've always had good teeth, but it seemed to me as I was getting older that they weren't looking as good,” Kathy explained in a recent interview with Dear Doctor magazine.
That's when she decided it was time to take action. Kathy had orthodontic treatment when she was in her fifties, and she keeps her smile bright with tooth whitening treatments. She uses a kit provided by her dentist with a safe, effective whitening solution.
Of course, a bright, healthy smile looks great anywhere — whether you're on the red carpet or “off the grid.” And you don't have to be a Hollywood star to have professional whitening treatments. In fact, teeth whitening is one of the most popular and affordable cosmetic treatments modern dentistry offers.
The basic options for professional teeth whitening include in-office bleaching or take-home kits. Both types of dentist-supervised treatments offer a safe and effective means of getting a brighter smile; the main difference is how long they take to produce results. A single one-hour treatment in the office can make your teeth up to ten shades lighter — a big difference! To get that same lightening with at-home trays, it would take several days. On the plus side, the take-home kit is less expensive, and can achieve the same results in a bit more time.
It's important to note that not all teeth can be whitened with these treatments. Some teeth have intrinsic (internal) stains that aren't affected by external agents like bleaches. Also, teeth that have been restored (with bonding or veneers, for example) generally won't change color. And you can't necessarily whiten your teeth to any degree: Every tooth has a maximum whiteness, and adding more bleach won't lighten it beyond that level. Most people, however, find that teeth whitening treatments produce noticeable and pleasing results.
What about those off-the-shelf kits or in-the-mall kiosks? They might work… or they might not. But one thing's for sure: Without a dentist's supervision, you're on your own. That's the main reason why you should go with a pro if you're considering teeth whitening. We not only ensure that your treatment is safe — we can also give you a realistic idea of what results to expect, and we will make sure that other dental problems aren't keeping you from having a great-looking smile.
How often does Kathy Bates see her dentist for a checkup and cleaning? “I go about every four months,” she noted. “I'm pretty careful about it.” And if you've seen her smile, you can tell that it pays off. If you would like more information about teeth whitening, please contact us or schedule an appointment. You can learn more in the Dear Doctor magazine articles “Important Teeth Whitening Questions Answered” and “Teeth Whitening.”
One of the biggest concerns we hear from parents is about their child's thumb sucking habit. Our advice: if they're under age 4, there's no need for concern — yet. If they're older, though, you should be concerned about the possible effect on their bite.
Thumb sucking is a universal habit among infants and toddlers and is related to their swallowing pattern during feeding. As they swallow, their tongue thrusts forward to create a seal with the lips around the breast or a bottle nipple. Many pediatricians believe thumb sucking replicates nursing and so has a comforting effect on infants.
Around age 4, though, this swallowing pattern begins to change to accommodate solid food. The tongue now begins to rest at the back of the top front teeth during swallowing (try swallowing now and you'll see). For most children, their thumb sucking habit also fades during this time and eventually stops.
But for whatever reason, some children don't stop. As the habit persists, the tongue continues to thrust forward rather than toward the back of the top front teeth. Over time this can place undue pressure on both upper and lower front teeth and contribute to the development of an open bite, a slight gap between the upper and lower teeth when the jaws are shut.
While late childhood thumb sucking isn't the only cause for an open bite (abnormal bone growth in one jaw is another), the habit is still a prominent factor. That's why it's important that you start encouraging your child to stop thumb sucking around age 3 and no later than 4. This is best accomplished with positive reinforcement like rewards or praise.
If they've continued the habit a few years after they should have stopped, we may also need to check to see if their swallowing mechanism has become stunted. If so, we may need to use certain exercises to retrain their tongue to take the proper position during swallowing.
While you shouldn't panic, it's important to take action to stop thumb sucking before it becomes a long-term problem. A positive, proactive approach will help avoid costly orthodontic problems later in their lives.
If you would like more information about thumb or finger sucking, 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 “How Thumb Sucking Affects the Bite.”
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