Posts for: October, 2018

ARetainerHelpsyouKeepYourNewSmileaftertheBracesComeOff

It’s a big moment after months of wearing braces to finally get a glimpse of your new smile. The crooked teeth and poor bite are gone — and in their place are beautiful, straight teeth!

If you’re not careful, though, your new look might not last. That’s because the natural mechanism we used to straighten your teeth may try to return them to their previous poor positions.

Contrary to what many people think, teeth aren’t rigidly set within the jaw bone. Instead, an elastic, fibrous tissue known as the periodontal ligament lies between the teeth and the bone and attaches to both with tiny fibers. Though quite secure, the attachment allows the teeth to move in very minute increments in response to growth or other changes in the mouth.

Orthodontic appliances like braces or clear aligners put pressure on the teeth in the direction we wish them to move. The bone dissolves on the side of the teeth where pressure is being applied or facing the direction of movement and then builds up on the other side where tension is occurring.

The ligament, though, has a kind of “muscle memory” for the teeth’s original position. Unless it’s prevented, this “memory” will pull the teeth back to where they used to be. All the time and effort involved with wearing braces will be lost.

That’s why it’s important for you to wear an appliance called a retainer after your braces have been removed. As the name implies, the appliance “retains” the teeth in their new position until it’s more permanently set. For most people, this means wearing it for twenty-four hours in the beginning, then later only a few hours a day or while you sleep.

The majority of younger patients eventually won’t need to wear a retainer once bone and facial growth has solidified their teeth’s new position. Older adults, though, may need to wear one from now on. Even so, it’s a relatively slight inconvenience to protect that beautiful, hard-won smile.

If you would like more information on retainers, 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 “The Importance of Orthodontic Retainers.”


By Dr. Dulat
October 20, 2018
Category: Oral Health
Tags: jaw pain   tmj disorders  
TrytheConservativePathtoJawPainReliefFirst

If you have chronic jaw pain, you know how difficult eating, speaking or even smiling can be. Many sufferers will do anything to gain relief, even surgery. But before you go down that road, consider the traditional conservative approach to temporomandibular disorders (TMD) management first—it could provide the most relief with the least risk of side effects.

The temporomandibular joints connect the lower jaw to the skull on either side of the head. These ball and socket joints also contain a cushioning disk to facilitate movement. This disk is believed to be the primary focus for jaw pain problems known collectively as TMD.

Doctors now believe injury, stress, metabolic issues, jaw anatomy defects or similar factors trigger the chain reaction of muscle spasms, pain and soreness that can erupt during a TMD episode. A TMD patient may experience pain within the jaw muscles or joints themselves, clicking sensations, or an inability to open the jaw to its full range.

TMD therapy has traditionally followed an orthopedic path—treating jaw joints like any other joint. In recent years, though, a more aggressive treatment model has emerged that promotes more invasive techniques like orthodontics, dental work or jaw surgery to relieve discomfort. But the track record for this model, especially concerning jaw surgery, remains hazy at best and offers no guarantee of relief. These techniques are also irreversible and have even made symptoms worse in some patients.

It’s usually prudent, then, to try conservative treatments first. This can include pain and muscle relaxant medication, jaw exercises, stretching and massage, and dietary changes to reduce chewing force. Patients with teeth grinding habits may also benefit from a bite guard worn at night to reduce the biting force during sleep and help the joints relax.

By finding the right mix of treatments, you may be able to find significant relief from TMD symptoms with the conservative approach. If not, you might then discuss more invasive options with your dentist. But even if your dentist recommends such a procedure, you would be wise to seek a second opinion.

TMD can definitely interfere with your quality of life and peace of mind. But there are ways to reduce its effects and make for a happier life.

If you would like more information on managing chronic jaw pain, 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 “Seeking Relief from TMD.”


IncreaseBoneMassforDentalImplantsthroughGrafting

Losing a tooth from disease or accident can be traumatic. The good news, though, is that it can be replaced with a life-like replica that restores your smile. One of the most popular and durable solutions is a dental implant, which replaces not only the root of the tooth but the crown as well.

But there's a possible wrinkle with implants — for accurate placement there must be a sufficient amount of bone around it. This could be a problem if you've been missing the tooth for sometime: without the stimulus provided by a tooth as you chew, older bone cells aren't replaced at an adequate rate. The bone volume gradually diminishes, as up to 25% of its normal width can be lost during the first year after tooth loss. A traumatic injury can damage underlying bone to an even greater extent.

There is a possible solution, but it will require the services of other specialists, particularly a periodontist trained in gum and bone structure. The first step is a complete examination of the mouth to gauge the true extent of any bone loss. While x-rays play a crucial role, a CT scan in particular provides a three-dimensional view of the jaw and more detail on any bone loss.

With a more accurate bone loss picture, we can then set about actually creating new bone through grafting procedures. One such technique is called a ridge augmentation: after opening the gum tissues, we place the bone graft within a barrier membrane to protect it. Over time the bone will grow replacing both the grafting material and membrane structure.

Once we have enough regenerated bone, we can then perform dental implant surgery. There are two options: a “one-stage” procedure in which a temporary crown is placed on the implant immediately after surgery; or a “two-stage” in which we place the gum tissue over the implant to protect it as it heals and bone grows and attaches to it. In cases of pre-surgical bone grafting, it's usually best to go with the two-stage procedure for maximum protection while the bone strengthens around it.

Necessary preparation of the bone for a future dental implant takes time. But the extra effort will pay off with a new smile you'll be proud to display.

If you would like more information on special situations with dental implants, please contact us or schedule an appointment for a consultation.