By Lanier Periodontics
July 18, 2019
Category: Oral Health
Tags: oral hygiene   floss  
FlossFirstorLastHereareReasonsforEitherApproach

A certain news story a few years ago notwithstanding, dentists still recommend flossing along with brushing to adequately remove disease-causing plaque. If there is any controversy at all about flossing, it's whether you should perform it before brushing or after. Each perspective has good reasons.

"Brush First" proponents say their way encourages the formation of a daily hygiene habit, a must for preventing disease. That's because brushing can remove most of the plaque built up on the teeth, while flossing can then remove what's left. If you floss first, though, you'll have to plow through the sticky film with the floss, which can be an unpleasant experience. Facing that every day could make a person less enthusiastic about developing a hygiene habit.

But it's not just about the sensation: depending on the person, the plaque buildup could be so much that the floss becomes clogged with it. You're then moving the plaque rather than removing it. Brushing a lot of the plaque out of the way first will increase the cleaning power of your floss.

The "Floss First" team, though, is undaunted with their own take on the matter. Flossing can loosen up any stuck debris between teeth, making it easier for brushing to clear it away. It can also expose plaque-covered areas between teeth to allow better contact with the fluoride in your toothpaste. And, the amount of plaque you're pulling out in certain areas during flossing could tip you off to beef up your brushing efforts on those areas of heavier plaque accumulation.

One of the prime reasons for flossing first, though, goes back to the comfort factor and human nature. To be honest, for most people flossing isn't as much "fun" as brushing. If you put it off until after brushing, you're more likely not to do it if you find it unpleasant. Doing it first gets the less likeable task out of the way, so you can then do the more likeable one, brushing.

Which approach is best for you? It's really a personal decision, one you can discuss with your dentist. Try both ways, and see which one seems better. But whether you floss first or last, do floss to really reduce your risk for dental disease.

If you would like more information on best oral hygiene practices, 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 “Brushing and Flossing: Which Should be Done First?

By Lanier Periodontics
July 08, 2019
Category: Dental Procedures
CrazyLittleThingCalledHyperdontia

The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.

The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.

Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces).┬áSome people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.

Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.

After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.

Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.

If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”

ReplacingaBackToothMayHelpYouAvoidFutureDentalProblems

Considering the costs, many people view replacing a back tooth as less important than a more visible front tooth. They’re rarely seen, so who will notice?

You might, eventually. A missing back tooth can set off a chain reaction of problems that can affect your overall dental health. Besides playing an important role in chewing food, back teeth also redistribute most of the chewing force away from the front teeth. Their absence can also affect the bite: adjacent teeth to the missing one will tend to migrate toward the open space, causing them to tip and rotate into an improper position. This can cause an increase in tooth mobility, excessive wear and erosion, and endanger their survival in the long run.

To avoid these and other problems you should consider some form of replacement. Most dentists prefer a dental implant for its life-like appearance and durability, and because its titanium post has a natural affinity with bone. Bone cells will grow around and permanently adhere to the implant, which may stop and even reverse bone loss in some cases.

Implants, though, require a certain amount of bone structure initially to anchor and position properly. If you have inadequate bone and don’t want to bone graft the area, the next best option is a fixed bridge, in which the missing tooth is replaced with an artificial crown known as a pontic. The pontic is fused between two support crowns that are permanently affixed to the natural teeth on either side of the missing tooth (also known as abutments). While fixed bridges restore function and inhibit tooth migration, they require the natural tooth supporting the bridge to be reduced to accommodate the crowns placed on them. This permanently alters them and places them at higher risk for future nerve damage, gum disease and decay.

One final option is a removable partial denture (RPD). Although RPDs restore function and improve appearance, their movement within the mouth may place additional stress on the teeth that hold them in place. This movement over time could damage or loosen them.

We can discuss which option is best for you after a complete dental exam. The important thing, though, is to replace the back tooth as soon as possible — doing nothing could cost you much more in the long run.

If you would like more information on tooth replacement, 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 “Replacing Back Teeth.”

AnchorageToolsHelpOrthodontistsCorrectComplexBiteProblems

While braces are often the stars for straightening smiles, they're not the only cast members in an orthodontic production. Orthodontists occasionally turn to other appliances if the bite problem is challenging. Whatever the tool, though, they usually have something in common—they use the principle of anchorage.

To understand anchorage, let's first consider the classic kid's game Tug of War. With teams on either end of a rope, the object is to pull the opposing team across the center line before they pull you. To maximize your pulling force, the player at the back of your rope, usually your stoutest member, holds steady or "anchors" the rest of the team.

Like a Tug of War team, braces exert force against the teeth. This stimulates the supporting periodontal ligament to remodel itself and allow the teeth to move. The braces use the teeth they are attached to as anchors, which in a lot of cases are the back teeth. By attaching a thin wire to the brackets or braces on the teeth, the orthodontist includes all the teeth on the arch, from one end to the other. Anchored in place, the wire can maintain a constant pressure against the teeth to move them.

But not all bite situations are this straightforward. Sometimes an orthodontist needs to influence jaw growth in addition to teeth movement. For this purpose, they often use orthodontic headgear, which runs around the back of the head or neck and attaches to orthodontic brackets on the teeth. It still involves an anchor but in this case it's the patient's own skull.

In some situations, an orthodontist may feel he or she needs more anchorage as the teeth alone may not be enough. For this, they might establish a separate or additional anchor point using a temporary anchorage device (TAD). A TAD resembles a tiny screw that's inserted into the jawbone near the tooth intended for movement. The orthodontist can then attach the TAD to braces hardware using some form of elastics. After treatment, they remove the TAD.

These are just a couple examples of specialized tools an orthodontist can use for bite correction. Thanks to them and similar devices, even the most complex bite problem can be overcome to create a healthier and more attractive smile.

If you would like more information on correcting a poor bite, 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 “Orthodontic Headgear & Other Anchorage Appliances.”

PeriodontalSurgerymaybeNeededtoHaltGumDiseaseandEncourageHealing

There’s only one way to effectively halt the progressive damage of periodontal (gum) disease — completely remove the bacterial plaque and hardened deposits (calculus) from above and below the gum line that are causing the infection. Although we can accomplish this in most cases with hand instruments called scalers, ultra-sonic equipment or both, some cases may require periodontal surgery to access and clean deeper “pockets” of infection.

As this damaging disease progresses, the supporting bone dissolves and the gum tissues will begin to detach from a tooth, leaving an open space known as a “periodontal pocket.” Besides plaque and calculus pus may also form as a result of the infection. All of this material must be removed from the pocket before healing and, hopefully, tissue reattachment can begin.

Shallow pockets near the gum line are usually accessed and cleaned with hand instruments. But deeper pockets (5 millimeters or greater in depth) may require a surgical procedure to completely clean the area also allowing for regenerative procedures to be done to regain attachment. This will reduce the depth of the periodontal pockets that will make them more accessible for future cleanings and maintenance. Flap surgery is a common type of such a procedure: a small opening (similar to the flap of a letter envelope) is surgically created in the gum tissue to expose the area of infection around the tooth root and bone.

There are also other types of periodontal surgery for repairing and stimulating regeneration of damaged gum tissues. Using grafts or other enhancements, these plastic surgical techniques are especially useful where gum tissues have receded above the natural gum line, leaving more of the underlying tooth below the enamel exposed to disease. These procedures have become more effective in recent years with the development of specialized technologies called “barrier membranes” and biologic growth factors. These materials have allowed bone grafts to be more successful as this technology is engineered for targeted tissue growth and repair, and then dissolve at an appropriate point in the regeneration process.

Periodontal surgery isn’t appropriate for every situation. Still, these procedures do play an important role for many patients to put a halt to the damage caused by gum disease.

If you would like more information on surgical procedures for 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 Surgery: Where Art Meets Science.”





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