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Posts for: October, 2018

TheTimelyUseofaPalatalExpanderCouldHelpCorrectaCross-Bite

While crooked teeth are usually responsible for a malocclusion (poor bite), the root cause could go deeper: a malformed maxilla, a composite structure composed of the upper jaw and palate. If that’s the case, it will take more than braces to correct the bite.

The maxilla actually begins as two bones that fit together along a center line in the roof of the mouth called the midline suture, running back to front in the mouth. The suture remains open in young children to allow for jaw growth, but eventually fuses during adolescence.

Problems arise, though, when these bones don’t fully develop. This can cause the jaw to become too narrow and lead to crowding among the erupting teeth and a compromised airway that can lead to obstructive sleep apnea. This can create a cross-bite where the upper back teeth bite inside their lower counterparts, the opposite of normal.

We can remedy this by stimulating more bone growth along the midline suture before it fuses, resulting in a wider maxilla. We do this by installing a palatal expander, an appliance that incrementally widens the suture to encourage bone formation in the gap, which over time will widen the jaw.

An expander is a metal device with “legs” extending out on both sides and whose ends fit along the inside of the teeth. A gear mechanism in the center extends the legs to push against the teeth on both sides of the jaw. Each day the patient or caregiver uses a key to give the gear a quarter turn to extend the legs a little more and widen the suture gap. We remove the expander once the jaw widens to the appropriate distance.

A palatal expander is an effective, cost-efficient way to improve a bite caused by a narrow jaw, but only if attempted before the bones fuse. Widening the jaw after fusion requires surgery to separate the bones — a much more involved and expensive process.

To make sure your child is on the right track with their bite be sure to see an orthodontist for an evaluation around age 6. Doing so will make it easier to intervene at the proper time with treatments like a palatal expander, and perhaps correct bite problems before they become more expensive to treat.

If you would like more information on treating malocclusions, 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: Orthodontics is more than just Moving Teeth.”


By David E. Shapiro, DMD
October 12, 2018
Category: Oral Health
Tags: oral health   gum disease  
BoostYourOverallHealthbyReducingGumInflammation

The human body’s immune system has amazing defensive capabilities. Without it a common cold or small wound could turn deadly.

One of the more important processes of the immune system is inflammation, the body’s ability to isolate diseased or injured tissue from unaffected tissue. Ironically, though, this vital component of the healing process could actually cause harm if it becomes chronic.

This often happens with periodontal (gum) disease, an infection of the gums caused by bacterial plaque built up on teeth due to inadequate hygiene, which in turn triggers inflammation. The infection is often fueled by plaque, however, and can become difficult for the body to overcome on its own. A kind of trench warfare sets in between the body and the infection, resulting in continuing inflammation that can damage gum tissues. Untreated, the damage may eventually lead to tooth and bone loss.

In treating gum disease, our main goal is to stop the infection (and hence the inflammation) by aggressively removing plaque and calculus (tartar). Without plaque the infection diminishes, the inflammation subsides and the gums can begin to heal. This reduces the danger to teeth and bone and hopefully averts their loss.

But there’s another benefit of this treatment that could impact other inflammatory conditions in the body. Because all the body’s organic systems are interrelated, what occurs in one part affects another especially if it involves inflammation.

It’s now theorized that reducing gum inflammation could lessen inflammation in other parts of the body. Likewise, treating other conditions like high blood pressure and other risk factors for inflammatory diseases could lower your risk of gum disease and boost the effectiveness of treatment.

The real key is to improve and maintain your overall health, including your teeth and gums. Practice daily brushing and flossing to remove plaque, and visit your dentist regularly for more thorough cleanings. And see your dentist at the first sign of possible gum problems like bleeding, redness or swelling. You’ll not only be helping your mouth you could also be helping the rest of your body enjoy better health.

If you would like more information on the relationship between gum disease and other systemic conditions, 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 Link between Heart & Gum Diseases.”


By David E. Shapiro, DMD
October 02, 2018
Category: Oral Health
Tags: oral hygiene  
GoodOralHygieneIsntJustforTeeth

In October, the American Dental Hygienists’ Association sponsors National Dental Hygiene Month to remind everyone that having good oral health is directly related to practicing good oral hygiene at home. This includes brushing twice each day with fluoride toothpaste and flossing at least once per day. But sometimes we forget that dental hygiene applies not just to your teeth but also to anything you regularly wear in your mouth. This includes removable dentures (full or partial), clear aligners, nightguards, mouthguards and retainers. If you (or your kids, or seniors you know) wear any of these, please review the three appliance-care tips below.

1. CLEAN IT. Just like natural teeth, an oral appliance worn every day needs daily brushing. But toothpaste isn’t an appropriate cleanser for these devices; it’s too abrasive. The grainy particles it contains are great for scrubbing plaque and bits of food from the hard enamel coating of teeth—but they can actually leave little nicks in the plastic of your oral appliance, creating areas for bacteria to hide. This can eventually cause odors and stains. Instead, clean appliances with liquid dish soap or denture paste. Buy a separate brush for your appliance—don’t use the same one that you use on your teeth. It can be a very soft regular toothbrush, nail brush or denture brush.

2. RINSE IT. After cleaning your appliance, rinse it thoroughly. But don’t use hot water—and never boil an oral appliance to sterilize it! Your device was custom-made for your mouth, and it needs to fit precisely to do its job. Hot water can warp the appliance and change the fit, possibly rendering it useless or even harmful. For example, a warped orthodontic aligner might not move teeth into the correct position. Remember: the goal is to kill bacteria, not your appliance!

3. STORE IT. Keep your appliance in a safe place—away from curious pets and toddlers. When you are not wearing it or cleaning it, your device should be packed away in its case or soaking overnight in water or a cleaning solution according to your original instructions.

If you have any questions about oral appliance care or oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “10 Tips for Cleaning Your Oral Appliance” and “10 Tips for Daily Oral Care at Home.”