My Blog
By Wortham Dental
October 02, 2021
Category: Oral Health
Tags: loose tooth  
YouNeedtoActFasttoSaveaLooseTooth

Some things in life are almost guaranteed to make you go, "Uh, oh"—your car won't start, your a/c goes out, or, worse yet, you get an unexpected letter from the IRS.

Here's another: One of your teeth is loose. And, if you don't act quickly, that loose tooth may soon become a lost tooth.

But first, we need to find out why it's loose. It's usually due to one of two types of injury related to your bite. One type is called primary occlusal trauma. This results from your teeth encountering higher than normal biting forces. This often happens if you habitually gnash or grind your teeth together outside of normal functions like eating or speaking.

The other type is secondary occlusal trauma. In this case, the supporting gum tissues and bone have been weakened or lost by disease, with the gum tissues possibly becoming detached. Without this support, even normal biting forces could loosen a tooth.

Our treatment approach for a loose tooth may differ depending on which of these is the cause. For primary occlusal trauma, we want to reduce the biting forces that have contributed to loosening the tooth. One way to do this is to create a mouthguard that when worn prevents teeth from making solid contact during grinding episodes.

For secondary trauma, we want to first focus on treating any gum disease responsible for weakening the gum tissues. Once we have it under control, the gums and bone tissues can heal and possibly regain and strengthen their attachment with the tooth.

At the same time, we may also need to stabilize a loose tooth to prevent its loss. This usually involves splinting, whereby we use neighboring healthy teeth to support the loose tooth. One way to do this is to attach a metal strip across the backs of the loose tooth and its more stable neighbors, or by way of a channel cut through the top biting surfaces of the teeth.

If a loose tooth regains its attachment with the gums and bone, it may stabilize and any splinting can be removed. If not, splinting may become a permanent solution. Either way, prompt treatment can help us save your loose tooth.

If you would like more information on treating loose 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 “Loose Teeth: Biting Forces Can Loosen Teeth.”

WhatChrissyTeigensInaugurationNightCapMishapCouldMeanForYou

Inauguration night is usually a lavish, Washington, D.C., affair with hundreds attending inaugural balls throughout the city. And when you're an A-List celebrity whose husband is a headliner at one of the events, it's sure to be a memorable night. As it was for super model Chrissy Teigen—but for a slightly different reason. During the festivities in January, Teigen lost a tooth.

Actually, it was a crown, but once she told a Twitter follower that she loved it “like he was a real tooth.” The incident happened while she was snacking on a Fruit Roll-Up (those sticky devils!), and for a while there, husband and performer John Legend had to yield center stage to the forlorn cap.

But here's something to consider: If not for the roll-up (and Teigen's tweets on the accident) all of us except Teigen, her dentist and her inner circle, would never have known she had a capped tooth. That's because today's porcelain crowns are altogether life-like. You don't have to sacrifice appearance to protect a tooth, especially one that's visible when you smile (in the “Smile Zone”).

It wasn't always like that. Although there have been tooth-colored materials for decades, they weren't as durable as the crown of choice for most of the 20th Century, one made of metal. But while gold or silver crowns held up well against the daily grind of biting forces, their metallic appearance was anything but tooth-like.

Later, dentists developed a hybrid of sorts—a metal crown fused within a tooth-colored porcelain shell. These PFM (porcelain-fused-to-metal) crowns offered both strength and a life-like appearance. They were so effective on both counts that PFMs were the most widely used crowns by dentists until the early 2000s.

But PFMs today make up only 40% of currently placed crowns, down from a high of 83% in 2005. What dethroned them? The all-ceramic porcelain crown—but composed of different materials from years past. Today's all-ceramic crowns are made of more durable materials like lithium disilicate or zirconium oxide (the strongest known porcelain) that make them nearly as strong as metal or PFM crowns.

What's more, coupled with advanced techniques to produce them, all-ceramic crowns are incredibly life-like. You may still need a traditional crown on a back tooth where biting forces are much higher and visibility isn't an issue. But for a tooth in the “Smile Zone”, an all-ceramic crown is more than suitable.

If you need a new crown (hopefully not by way of a sticky snack) or you want to upgrade your existing dental work, see us for a complete exam. A modern all-ceramic crown can protect your tooth and enhance your smile.

If you would like more information about crowns or other kinds of dental work, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Crowns & Veneers.”

HeadOffaCrossbiteatthePassWithThisOrthodonticAppliance

At what age should you begin treating a poor bite? Many might say with braces around late childhood or early adolescence. But some bite problems could be addressed earlier—with the possibility of avoiding future orthodontic treatment.

A crossbite is a good example. In a normal bite, all of the upper teeth slightly cover the lower when the jaws are shut. But a crossbite occurs when some of the lower teeth, particularly in back, overlap the upper teeth. This situation often happens when the upper jaw develops too narrowly.

But one feature of a child's mouth structure provides an opportunity to intervene and alter jaw development. During a child's early years, the palate (roof of the mouth) consists of two bones next to each other with an open seam running between them. This seam, which runs through the center of the mouth from front to back, will fuse during puberty to form one continuous palatal bone.

An orthodontist can take advantage of this separation if the jaw isn't growing wide enough with a unique device called a palatal expander. This particular oral appliance consists of four, thin metal legs connected to a central mechanism. The orthodontist places the expander against the palate and then uses the mechanism to extend the legs firmly against the back of the teeth on both sides of the jaw.

The outward pressure exerted by the legs also widens the seam between the two palatal bones. The body will respond to this by adding new bone to the existing palatal bones to fill in the widened gap. At regular intervals, the patient or a caregiver will operate the mechanism with a key that will continue to widen the gap between the bones, causing more expansion of the palatal bones until the jaw has grown to a normal width.

The palatal expander is most effective when it's applied early enough to develop more bone before the seam closes. That's why it's important for children to undergo bite evaluation with an orthodontist around age 6. If it appears a bite problem is developing, early interventions like a palatal expander could slow or stop it before it gets worse.

If you would like more information on interceptive orthodontics, 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.”

TemporarySmilesforTeensWaitingonDentalImplants

Here's some good news: Teenagers are less likely than adults to lose teeth to dental disease. But there's also a flip side. Teens can still lose teeth, more likely from traumatic injury.

Fortunately, there are several options for replacing lost teeth like dentures or bridges. But the choice considered best by most dentists and patients is a dental implant. An implant tooth looks and functions like the real thing—and it's durable, capable of lasting for years, if not decades.

But there's a hitch with teens getting an implant: Even though they may have all their permanent teeth by adolescence, their jaws are still growing and developing. Natural teeth, with their attachment to the jaws by way of a periodontal ligament, can keep pace with this growth—but implants can't.

That's because an implant doesn't have this attachment to gum tissue like natural teeth, but to the jawbone alone. Hence, an implant tooth can't keep up with jaw development, and may eventually look like it's "sunk" into the gums in relation to the teeth around it.

It's best, then, to wait until a teen's jaws have fully developed before attempting an implant. In the meantime, though, they don't have to endure a smile marred by missing teeth, but can replace them with a temporary restoration. The two most common options are a partial denture or a modified bridge.

The partial denture is a lightweight version that's quite affordable. Although not as durable as other types of dentures, the appliance is only intended to last until the patient is old enough for a permanent implant.

The modified bridge is a prosthetic tooth with strips of dental material extending behind it that are bonded to the backs of the teeth on either side to hold it in place. It's likewise not as durable as a traditional bridge, but it can fill the bill until time to place an implant.

Although this adds an additional step in a teen's restorative journey after losing a tooth, it's necessary—waiting to place an implant after jaw maturity will help ensure a long-lasting result. In the meantime, a temporary tooth replacement will help them to enjoy a normal smile.

If you would like more information on dental restorations for teens, 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 “Dental Implants for Teenagers.”

By Wortham Dental
August 23, 2021
Category: Oral Health
Tags: jaw pain  
ThinkTwiceBeforeYouUndergoBotoxTreatmentforChronicJawPain

There's still much about the underlying nature of chronic jaw joint dysfunction we have yet to unravel. Treating these conditions known as temporomandibular joint disorders (TMDs) may therefore require some experimentation to find what works for each individual patient.

Most TMD therapies are relatively conservative: eating softer foods, taking anti-inflammatory pain relievers or undergoing physical therapy. There have been some surgical techniques tried to relieve jaw pain and dysfunction, but these have so far had mixed results.

Recently, the use of the drug Botox has been promoted for relieving jaw pain, albeit temporarily. Botox contains tiny amounts of botulinum toxin type A, a poisonous substance derived from the bacterium Clostridium botulinum, which can cause muscle paralysis. It's mainly used to cosmetically smooth out small wrinkles around facial features.

Because of these properties, some physicians have proposed Botox for TMD treatment to paralyze the muscles around the jaw to reduce pain and discomfort. While the treatment sounds intriguing, there are a number of reasons to be wary of it if you have TMD.

To begin with, the claims for Botox's success in relieving jaw pain have been mainly anecdotal. On the other hand, findings from randomized, double-blind trials have yet to show any solid evidence that Botox can produce these pain-relieving effects.

But even if it lived up to the claims of TMD pain relief, the effect would eventually fade in a few weeks or months, requiring the patient to repeat the injections. It's possible with multiple Botox injections that the body will develop antibodies to fight the botulinum toxin, causing the treatment to be less effective with subsequent injections.

Of even greater concern are the potential side effects of Botox TMD treatment, ranging from headaches and soreness at the injection site to more serious muscle atrophy and possible facial deformity from repeated injections. There's also evidence for decreased bone density in the jaw, which could have far-reaching consequences for someone with TMD.

The best approach still seems to lie in the more conservative therapies that treat TMD similar to other joint disorders. Finding the right combination of therapies that most benefit you will help you better manage your symptoms.

If you would like more information on treatments for TMD, 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 “Botox Treatment for TMJ Pain.”





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