My Blog

By David E. Shapiro, DMD
February 09, 2019
Category: Oral Health
Tags: topical fluoride  
TopicalFluorideisaSafeWaytoProtectYourChildsTeethfromDecay

We've known for decades that fluoride strengthens tooth enamel and lowers the risk for decay. And while adding it to toothpaste and drinking water are the more common ways for getting it into the body, an increasingly popular way—especially for children—is to apply fluoride directly to the teeth.

But is topical fluoride really worth the effort and expense? And, are there any side effects to treating teeth this way?

As to the first question, researchers have performed numerous studies measuring fluoride's effectiveness for preventing tooth decay. The Cochrane Oral Health Research Group recently reviewed studies on topical fluoride applications involving nearly 10,000 children and adolescents between the ages of 2 and 15. The combined average for all the studies showed a 28% reduction in decayed teeth for patients who received topical fluoride compared to those who didn't.

This was especially true for children at high risk for decay: directly applying fluoride gels, foams or varnishes to teeth reduces that risk substantially. But there are also side effects to this application. Fluoride in general has only one known safety concern, a condition known as fluorosis. Too much fluoride over time can cause heavy discoloration of the teeth. This does not affect the health of the teeth, but it can look unattractive and require cosmetic treatment to reduce its effect.

There's little to no risk for fluorosis with the controlled treatments offered by dentists; the fluoride solution remains on the teeth no more than a few minutes. But there is a possible side effect during treatment due to the relatively high dose of fluoride used. If the patient accidentally swallows some of the solution, the concentration of fluoride can cause stomach upset, vomiting or headaches.

Dentists minimize the chances for this by usually using the more difficult to swallow varnish form of topical fluoride on younger patients, and using trays or other barrier devices to isolate the fluoride solution from the rest of the mouth. Under professional supervision, it's rare for an accidental ingestion to occur.

The risks for these side effects are quite low, and the benefits of topical fluoride for reducing the chances for decay can more than outweigh them. Fluoride applications are one of many ways we can protect your child's current and future dental health.

If you would like more information on decay prevention techniques like topical fluoride, 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 “Fluoride Gels Reduce Decay.”

By David E. Shapiro, DMD
January 30, 2019
Category: Dental Procedures
3WaysOrthodonticTechniquesCouldPreventaPoorBite

While orthodontists can effectively correct most poor bites (malocclusions), some can be quite complex requiring much time and expense. But there's good news—we often don't have to wait on a malocclusion to fully develop if we catch it in time. Thanks to interceptive orthodontics, we may be able to intervene much earlier and eliminate or reduce the degree of difficulty with treatment.

Interceptive orthodontics is a group of techniques and devices used in early childhood to help deter a possible malocclusion. Here are 3 ways this approach could make a difference in your child's bite development.

Guiding jaw growth. On a normal-sized upper jaw, the permanent teeth usually have ample room to erupt. Not so with a smaller jaw: incoming teeth become crowded and may erupt out of alignment or too close to each other. Orthodontists often use a device called a palatal expander to aid an under-sized jaw in its development. The device fits along the roof of the mouth between the teeth and applies gradual outward pressure on them. This encourages the jaw to widen as it grows, thus providing more room for erupting teeth to come in properly and decrease the chances of obstructive sleep apnea in the future.

Reshaping and repositioning jaw bones. An overbite can occur when the jaws aren't properly aligned, often due to poor muscle and bone development. This is where devices like the Herbst appliance are useful. Its hinge mechanism encourages the lower jaw to grow further forward. The jaws can thus develop in a more normal way, minimizing the development of a malocclusion.

Maintaining space. Primary ("baby") teeth are important for dental development because they help guide future permanent teeth to erupt properly; they also keep nearby teeth from drifting into the intended space. But when a primary tooth is lost prematurely due to disease or trauma, the space can become vulnerable to this kind of "drift." With a simple mechanism called a space maintainer we can hold open the space created by a prematurely lost primary tooth until the permanent tooth is ready to erupt.

These and other techniques can help stop bad bites from developing in young children, minimizing or even eliminating the need for future orthodontic treatment. That means a healthier mouth for your child and less impact on your wallet.

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 “Interceptive Orthodontics: Timely Intervention can make Treatment Easier.”

By David E. Shapiro, DMD
January 20, 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.”

By David E. Shapiro, DMD
January 10, 2019
Category: Oral Health
Tags: gum recession  
RecessedGumsCouldEndangerYourTeeth

A "toothy grin" might be endearing, but not necessarily healthy. More of the teeth showing may mean your gums have pulled back or receded from the teeth. If so, it's not just your smile that suffers—the parts of teeth protected by the gums could become more susceptible to disease.

There are a number of causes for gum recession. Some people are more likely to experience it because of genetically thinner gum tissues. Over-aggressive brushing could also contribute to recession. But the most common cause by far is periodontal (gum) disease, a bacterial infection triggered by dental plaque accumulating on teeth mainly as a result of inadequate hygiene.

There are some things we can do to help heal and restore recessed gums, most importantly treating gum disease. The number one goal of treatment is to uncover and remove all dental plaque from tooth and gum surfaces, which can take several sessions and sometimes minor surgery if the infection has reached the tooth roots. But removing plaque and tartar (calcified plaque) is necessary to stop the infection and allow the gums to heal.

For mild recession, this may be enough for the gums to regain normal coverage. But in more severe cases we may need to help rejuvenate new tissue with grafting surgery. In these highly meticulous procedures a surgeon uses microscopic techniques to position and attach donated tissue to the recession site. The graft serves as a scaffold on which new tissue growth can occur.

While these treatments can be effective for reversing gum recession, they often require time, skill and expense. It's much better to try to prevent gum recession—and gum disease—in the first place. Prevention begins with daily brushing and flossing to prevent plaque buildup, as well as regular dental visits for more thorough cleanings. Be on the lookout too for any signs of a beginning gum infection like swollen, reddened or bleeding gums and see your dentist as soon as possible to minimize any damage to your gums.

Caring for your gums is equally as important as caring for your teeth. Healthy gums equal a healthy mouth—and an attractive smile.

If you would like more information on preventing gum recession, 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 “Gum Recession.”

LingualBracesOfferaLessVisibleAlternativetoTraditionalBraces

We’re all familiar with tried and true traditional braces and perhaps with newer clear aligners for realigning teeth. But there’s an even more novel way that’s quickly becoming popular: lingual braces.

This type of braces performs the same function as the traditional but in an opposite way. Rather than bonded to the front of the teeth like labial (“lip-side”) braces, these are bonded to the back of the teeth on the tongue (or “lingual”) side. While labial braces move teeth by applying pressure through “pushing,” lingual braces “pull” the teeth to where they need to be.

Although lingual braces are no better or worse than other orthodontic methods, they do have some advantages if you’re involved in sports or similar physical activities where mouth contact with traditional braces could cause lip or gum damage, or if your work or lifestyle includes frequent snacking or eating, which requires continually removing clear aligners. And like aligners, lingual braces aren’t noticeable to the outside world.

But lingual braces typically cost more: as much as 15-35% more than traditional braces. They can initially be uncomfortable for patients as the tongue makes contact with the hardware. While most patients acclimate to this, some don’t. And like traditional braces, it’s hard to effectively brush and floss your teeth while wearing them. This can be overcome, though, by using a water flosser and scheduling more frequent dental cleanings while you’re wearing them.

For the most part, lingual braces can correct any poor bite (malocclusion) correctable with labial braces. The treatment time is also comparable, ranging from several weeks to a couple of years depending on the malocclusion. And, as with any other orthodontic method, you’ll need to wear a retainer once they’re removed.

Lingual braces have only been available in a limited fashion for a few years, but their availability is growing as more orthodontists train in the new method. If you’re interested in the lingual braces approach, talk to your orthodontist or visit www.lingualbraces.org to learn more.

If you would like more information on lingual braces, 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 “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”





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