Posts for: December, 2017
What makes an attractive smile? Of course, shiny, straight and defect-free teeth are a big factor. But there’s another equally important element: all your teeth have come in.
Sometimes, though, they don’t: one or more teeth may remain up in the gums, a condition known as impaction. And if they’re in the front like the upper canines (the pointed teeth on either side of the front four incisors) your smile’s natural balance and symmetry can suffer.
Impaction usually happens due to lack of space on a small jaw. Previously erupted teeth crowd into the space of teeth yet to come in, preventing them from doing so. As a result the latter remain hidden within the gums.
While impaction can interfere with the smile appearance, it can cause health problems too. Impacted teeth are at higher risk for abscesses (localized areas of infection) and can damage the roots of other teeth they may be pressing against. That’s why it’s desirable for both form and function to treat them.
We begin first with an orthodontic examination to fully assess the situation. At some point we’ll want to pinpoint the impacted teeth’s precise location and position. While x-rays are useful for locating impacted teeth, many specialists use cone beam CT (CBCT) technology that produces highly detailed three-dimensional images viewable from different vantage points.
If the tooth is in too extreme a position, it might be best to remove it and later replace it with a dental impact or similar restoration once we’ve completed other necessary orthodontic treatment. But if the tooth is in a reasonable position, we might be able to “move” the tooth into its proper place in the jaw in coordination with these other tooth-movement efforts to make room for it.
To begin this process, an oral surgeon or periodontist surgically exposes the tooth crown (the normally visible portion) through the gums. They then bond a small bracket to the crown and attach a small gold chain. An orthodontist will attach the other end to orthodontic hardware that will exert downward pressure on the tooth to gradually bring it into normal position.
Dealing with impacted teeth of this nature is often part of a comprehensive effort to correct the bite. If we’re successful, it could permanently transform both the smile and overall dental health.
If you would like more information on treating impacted teeth, 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 “Exposing Impacted Canines.”
If you’ve had a total joint replacement or similar procedure, you will want your surgeon to decide if you need to take an antibiotic before you undergo dental work. This is a precaution to prevent a serious infection known as bacteremia.
Bacteremia occurs when bacteria become too prevalent in the bloodstream and cause infection in other parts of the body, especially in joints and bone with prosthetic (replacement) substances. It’s believed that during invasive dental procedures bacteria in the mouth can enter the bloodstream through incisions and other soft tissue disruptions.
Joint infections are a serious matter and can require extensive therapy to bring it under control. Out of this concern, the use of antibiotics as a prophylactic (preventive measure) against bacteremia once included a wide range of patients for a variety of conditions and procedures. But after an in-depth study in 2007, the American Dental Association concluded that the risks for many of these patient groups for infection triggered by a dental procedure was extremely low and didn’t warrant the use of antibiotic premedication therapy.
As a result, recommendations for antibiotic therapy changed in 2009, eliminating many groups previously recommended for premedication. But because of the seriousness of joint infection, The American Academy of Orthopedic Surgeons still recommends the therapy for joint replacement patients about to undergo any invasive procedure, including dental work. It’s especially needed for patients who also have some form of inflammatory arthritis, a weakened immune system, insulin-dependent diabetes, hemophilia, malnourishment or a previous infection in an artificial joint.
The guidelines for antibiotic premedication can be complex. It’s best, then, to speak with both your orthopedic surgeon and us about whether you should undergo antibiotic therapy before you undergo a dental procedure. The ultimate goal is to reduce the risks of any disease and to keep both your mouth and your body safe from infection.
If you would like more information on the use of antibiotics in dental care, 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 “Premedication for Dental Treatment.”