One of the most common and anguish-filled birth defects is a cleft lip or palate (roof of the mouth). Not only do clefts disrupt the normality of a child’s facial appearance, they can also lead to problems with chewing, speech and the long-term health of teeth and gums.
A cleft is a tissue gap that occurs during fetal development, usually in the first trimester, in which parts of the baby’s face fail to unite. Why this occurs is not fully understood, but vitamin imbalances in the mother, exposure to radiation or other toxic environments, or infections are all believed to play a role.
Facial clefts are classified as either incomplete, in which there is some but not full tissue fusion, or complete, with no fusion at all. A cleft can be unilateral, affecting only one side of the face, or bi-lateral, affecting both sides. During infancy a cleft can adversely affect a child’s ability to nurse, and it sometimes disrupts breathing. As the child grows, speech patterns may be severely disrupted and their teeth and bite may not develop properly.
Fortunately, there have been dramatic advances in cleft repair over the past sixty years. It’s actually a process that can span a child’s entire developmental years and involve the expertise of a number of surgical and dental specialists. For a cleft lip, the initial surgical repair to realign and join the separated tissues usually occurs around three to six months of age; repair of a cleft palate (where the gap extends into the roof of the mouth) between 6 and 12 months.
Subsequent procedures may be needed in later years to refine earlier results and to accommodate the mouth’s continuing growth. At some point the treatment focus shifts to cosmetic enhancement (which can include implants, crown or bridgework) and periodontal health, to ensure gum tissues that support teeth and gums aren’t compromised by the effects of the cleft or its treatment.
At the end of this long process, something of a miracle may seem to occur: a young person’s once disfigured mouth transforms into a beautiful smile. It’s a chance for them to gain a normal life — and a new lease on physical, emotional and oral health.
For major-league slugger Giancarlo Stanton, 2014 was a record-breaking year. After the baseball season ended, he signed a 13-year, $325 million contract with the Miami Marlins — the biggest deal in sports history. But earlier that same year, Stanton suffered one of the worst accidents in baseball: He was hit in the face by an 88-mph fastball, sustaining multiple fractures, lacerations, and extensive dental damage.
After the accident, Stanton didn’t play for the remainder of the season. But now he’s back in Spring Training… and he’s got a not-so-secret weapon to help protect him against another injury: A custom-made face guard designed to absorb impacts and keep him from suffering further trauma.
As sports fans, we’re glad that Stanton was able to overcome his injury and get back in the game. As dentists, we’d like to remind you that you don’t have to be a major-league player to feel the harmful effects of a sports injury — and you don’t have to look far to find a way to protect yourself. In fact, you can get a custom-made mouthguard right here at the dental office.
Mouthguards have a long tradition in sports like football, boxing, and hockey. But did you know that far more Americans are injured every year playing “non-collision” sports like basketball, baseball — and even bicycling? And it doesn’t take a major-league fastball to cause a dental injury: The highest incidence of sports-related dental injuries occurs in 15-to-18-year-old males. In fact, about one-third of all dental injuries among children stem from various types of sports activities. These injuries may result in countless hours being lost from school and work, and cost significant sums for treatment and restoration.
Mouthguards have a proven track record in reducing dental and facial injuries: They are capable of absorbing the energy of a blow to the mouth, and dissipating it in a way that prevents damage to facial structures and teeth. But not all mouthguards are created equal: Custom-fabricated mouthguards, which are produced from an exact model of your mouth made right here in the dental office, offer by far the best protection. They fit better and safeguard the teeth more fully than any off-the-shelf or “boil-and-bite” type can. Plus, they’re more comfortable to wear. And let’s face it: No mouth guard can protect your teeth if you don’t wear it.
What’s more, some recent studies indicate that custom-made mouthguards may offer significant protection against concussion. An increasing awareness of the dangers that concussion may pose to athletes is one more reason why we recommend custom-made mouthguards to active people and their families.
To get his face guard, Giancarlo Stanton reportedly went to a specialist sporting-goods manufacturer in Illinois, and paid around $1,000. But you can get a custom-made mouthguard for yourself or your loved ones right at our office for a fraction of that price. And the peace of mind it can give you is… priceless.
If you have questions about custom-made mouthguards, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “An Introduction to Sports Injuries & Dentistry” and “Athletic Mouthguards.”
When a tooth is beyond repair due to disease or injury, it may be necessary to remove it. A “simple” tooth extraction is among the most common in dentistry and certainly not the agonizing procedure depicted in common lore.
They’re referred to as simple extractions because the shape of the tooth and root allows for a fairly straightforward and uncomplicated removal. An example would be the normally cone-shaped upper front tooth that doesn’t offer a lot of resistance during the extraction process.
The process itself is fairly straightforward. Teeth are held in place by the periodontal ligament, an elastic tissue made of tiny fibers that attaches the tooth to the supporting bone. These fibers can be dislodged from the tooth with some careful manipulation — in the hands of an experienced dentist there’s a deft “feel” to the fibers loosening. Once they’ve detached, it requires little effort to remove the tooth; with the aid of local anesthesia, you won’t feel anything but a little pressure.
Immediately after the tooth is removed, we commonly insert bone grafting material in the socket to minimize bone loss until a permanent replacement like a dental implant can be installed after tissue healing. We then place sterile gauze over the site for a few minutes to control bleeding and, depending on the size of the wound opening, we may also place a few stitches to close it. We then give you instructions for caring and cleaning the site over the next few days, and prescribe antibiotics to reduce the chance of infection and anti-inflammatory drugs for any discomfort.
Although a simple extraction is a routine procedure, it’s important to perform a proper assessment of the tooth and the surrounding bone beforehand, including x-rays to determine the tooth’s exact shape and position. If we discover a complication that makes a simple extraction impractical (like multiple roots at acute angles), we may then refer you to an oral surgeon for a more complicated surgical extraction.
It’s our hope you’ll have your natural teeth for as long as you live. But if you must have one removed, you can rest assured it’s a common — and uneventful — experience.
If you would like more information on tooth extraction, 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 “Simple Tooth Extraction.”
Can having a great smile help land you a high-level business position, a TV show, and a bride? Maybe — at least if you go by the example of Bill Rancic.
The 42-year-old Chicago native is well known as the first winner of NBC-TV's The Apprentice, a reality show where contestants vied for a job with Donald Trump's organization. Shortly after his selection as Trump's newest hire, Rancic met his future wife, Giuliana, when she interviewed him for E! News. Flash forward a few years, and the couple is now hosting their own reality TV show on Style network.
So how much has Bill's winning smile helped?
“I think a great smile says a lot about a person — especially in our professions,” Bill recently said in an interview with Dear Doctor magazine. He also mentioned that having a few cosmetic dental treatments helped him close the deal.
As a child, Bill wore braces to correct an overbite. For both kids and adults, orthodontic treatment is often the first step toward getting the smile of your dreams. The practice of orthodontics has changed dramatically in the past 20 years and there are now a number of choices available in lieu of traditional metal braces.
Not Your Father's Braces
For those who need to maintain a “professional” image, tooth-colored braces offer a less noticeable way to straighten your teeth. Lingual braces are another option that's suitable in some situations. These are truly invisible: bonded on the tongue side of the teeth, they can't be seen from the front.
Or, you may be able to forego braces altogether and use a series of clear plastic aligners to gradually bring your teeth into alignment. Not only are these difficult to notice, but they can be completely removed for short periods of time — at important board meetings, for example.
Red-Carpet Tooth Whitening
More recently, Rancic had tooth whitening treatments. Depending on the degree of lightening needed, these can range from custom-fitted bleaching trays that you wear at home under the supervision of a dentist, to in-office whitening treatments that work in far less time. Both can be effective in lightening your teeth by six shades or more.
But if you need the ultimate in whitening, veneers may be the best option. These are fingernail-thin coatings, made of pearly-white porcelain or composite material, that are placed directly on the tooth surfaces. Realistic and durable, they can provide a “Hollywood white” smile that's ready for the red carpet.
Did Bill's cosmetic dental work really improve his life? We can't say for sure — but as his wife Giuliana recently told Dear Doctor, “First impressions are very important, and having a beautiful smile will help anyone make a great impact on others.” So perhaps it worked on her!
If you would like more information on how cosmetic dental treatments can improve your smile, please contact us or schedule an appointment for a consultation. You can learn more about this topic in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Important Teeth Whitening Questions Answered.”
There’s no question that x-ray imaging has transformed how we diagnose and treat dental problems. But traditional x-rays have at least one limitation — they are two-dimensional portraits that can only provide a portion of the information available. If you could view the interior of teeth or other mouth structures in three dimensions, you would have access to more detail about their conditions.
Computerized axial tomography (CAT) scanning has brought that third dimensional view to physicians generally and, in more recent years, to dentists. The latest development in this technology is known as Cone Beam Computed Tomography (CBCT). A CBCT emits a spiral of x-rays that form a cone-shaped beam that is caught on detectors. Using digital geometry, the CBCT then generates a three-dimensional image by precisely “layering” this large series of two-dimensional images caught by the detectors on top of each other.
CBCT is already making a significant impact in dentistry and its related specialties. Dentists now can visualize with amazingly precise detail the three-dimensional anatomy of the teeth, jaws, facial bone and other structures in the head and neck area. Orthodontists can examine the growth stages of a patient’s teeth eruption to better prepare treatment strategies. Oral surgeons can determine the precise location of impacted teeth and their exact proximity to nerves and sinuses. And, periodontists who specialize in gum disease and treatment can better determine the level of bone loss and gum attachment for more accurate diagnoses and effective treatment.
While a CBCT delivers a higher dose of x-rays than a traditional panoramic radiograph, it actually delivers a lower dosage than a digital standard 18 film full mouth series or than conventional medical CT scanners. The field of view also determines the level of x-ray exposure — the smaller the field of view (and more concentrated the x-rays) the higher the dosage and the better detail of anatomy.
The good news, though, is that a low dosage CBCT scan can still provide a level of detail that can provide dentists with a very accurate view of anatomical features, including bone density and mass, in three dimensions. That capability can vastly elevate the accuracy of diagnoses and lay the groundwork for effective dental treatment.
If you would like more information on the uses of CBCT scanning to help you maintain dental health, 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 “CAT Scans in Dentistry.”
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