Dentists remove millions of teeth each year, often because of tooth decay or gum disease. But disease isn't the only reason—a tooth extraction might make it easier to straighten a crooked smile.
Realigning teeth for therapeutic or cosmetic reasons is a regular undertaking in dentistry, but the process itself often differs from person to person. Each individual patient requires their own treatment plan taking into account factors like the kind of bite problem involved, the size of the jaw and the space available to move teeth.
This plan could indeed involve removing teeth. For example, an abnormally small jaw could cause crowding. Not only can crowding move teeth out of position, it may also leave little to no room for moving teeth. Although dentists can minimize crowding by influencing jaw development in early childhood, removing teeth for more space is usually the only option available to older adolescents and adults.
Similarly, teeth can fail to erupt properly and remain partially or fully submerged beneath the gums (known as impaction). There is an orthodontic method for pulling an impacted tooth fully onto the jaw, but only if the tooth isn't too far out of alignment. Otherwise, it may be better to remove the impacted tooth and then correct any gaps with braces or a dental implant.
There's also a situation on the opposite side of the spectrum that could benefit from teeth removal—when one or more permanent teeth fail to form, known as congenitally missing teeth. This can cause gaps in the smile or a “lopsided” appearance where a tooth on one side of the jaw is present while its counterpart on the opposite side of the jaw is missing.
The missing tooth can be replaced by an implant, bridge or other restoration. But another option may be to remove the existing counterpart tooth, and then close the gaps. This can result in a much more attractive smile that might be simpler and less costly than replacing the missing tooth.
Again, the decision to remove teeth to improve smile appearance depends on the patient and their particular dental condition. But in the right situation, it could make straightening a smile easier and more effective.
If you would like more information on orthodontic treatments, 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 “Removing Teeth for Orthodontic Treatment.”
Getting dental implants is going to require surgery. But don't let that concern you—it's a relatively minor procedure.
Currently the “gold standard” for tooth replacement, an implant consists of a titanium post surgically imbedded in the jawbone. We can affix a life-like crown to a single implant or support a fixed bridge or removable denture using a series of them.
Because placement will determine the restoration's final appearance, we must carefully plan implant surgery beforehand. Our first priority is to verify that you have adequate jawbone available to support an implant.
Additionally, we want to identify any underlying structures like nerves or blood vessels that might obstruct placement. We may also develop a surgical guide, a retainer-like device placed in the mouth during surgery that identifies precisely where to create the holes or channels for the implants.
After numbing the area with local anesthesia, we begin the surgery by opening the gum tissue with a series of incisions to expose the underlying bone. If we've prepared a surgical guide, we'll place it in the mouth at this time.
We then create the channel for the insert through a series of drillings. We start with a small opening, then increase its size through subsequent drills until we've created a channel that fits the size of the intended implant.
After removing the implant from its sterile packaging, we'll directly insert it into the channel. Once in place, we may take an x-ray to verify that it's been properly placed, and adjust as needed. Unless we're attaching a temporary crown at the time of surgery (an alternate procedure called immediate loading), we suture the gums over the implant to protect it.
Similar to other dental procedures, discomfort after surgery is usually mild to moderate and manageable with pain relievers like acetaminophen or ibuprofen (if necessary, we can prescribe something stronger). We may also have you take antibiotics or use antibacterial mouthrinses for a while to prevent infection.
A few weeks later, after the bone has grown and adhered to the implant surface, you'll return to receive your new permanent crown or restoration. While the process can take a few months and a number of treatment visits, in the end you'll have new life-like teeth that could serve you well for decades.
If you would like more information on dental implants, 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 “Dental Implant Surgery.”
Even masterpiece paintings need an appropriate frame. Likewise, our gums help bring out our teeth's beauty.
But gums are more than enhancements for our smile appearance—they're also critical to good oral health. In recognition of National Gum Care Month, there are a couple of reasons why you should look after your gums just like you do your teeth.
For one, the gums are primarily responsible for holding teeth in place. With healthy gums, the teeth won't budge even under chewing stress (although this attachment does allow for micro-movements). Diseased gums, however, are another story: Advancing gum disease weakens gum attachment, causing teeth to loosen and eventually give way.
The gums also protect the root end of teeth from pathogens and oral acid, just as enamel protects the crown. Gum disease can also foul up this protective mechanism as infected gums have a tendency to shrink away from the teeth (also known as gum recession). This exposes the roots to an increased risk for disease.
So, taking care of your gums is an essential part of taking care of your teeth. And, the basic care for them is the same as for your pearly whites: daily brushing and flossing and regular dental cleanings. These habits remove the buildup of dental plaque, a thin film of food and bacteria that cause gum disease.
It's also important to keep a watchful eye for any signs of gum abnormalities. Be on the alert for unusual gum redness, swelling and bleeding. Because these may be indicators of an infection already underway, you should see us for an examination as soon as possible.
If we find gum disease, we can begin immediate treatment in the form of comprehensive plaque removal. If the disease has advanced to the root, we may need to access this area surgically to remove any infection. So, the sooner we're able to diagnose and treat an infection, the less likely that scenario will occur.
Ironically, something meant to protect your gums could also damage them. You can do this with excessive and overly aggressive brushing. Putting too much "elbow grease" into brushing, as well as doing it more than a couple of times a day, could eventually cause the gums to recede. Instead, apply only the same degree of pressure to brushing as you would while writing with a pencil.
As we like to tell our patients, take care of your mouth, and your mouth will take care of you. Something similar could be said about your gums: Take care of these essential soft tissues, and they'll continue to support and protect your teeth.
Along with fessing up to cherry tree surgery and tossing silver dollars across the Potomac River, George Washington is also famously known for wearing wooden dentures. Although we can't verify the first two legends, we can confirm Washington did indeed wear dentures, but not of wood—hippopotamus ivory and (yikes!) donated human teeth—but not wood.
Although they seem primitive to us today, Washington's dentures were the best that could be produced at the time. Still, the Father of Our Country suffered mightily from his dentures, both in physical discomfort and social embarrassment. Regarding the latter, our first president's dentures contorted his lips and mouth in an unattractive way, faintly discernable in Gilbert Stuart's famous portraits of our first president.
If only Washington had lived in a later era, he might have been able to avoid all that dental unpleasantness. Besides better versions of dentures, he might also have benefited from an entirely new way of replacing teeth—dental implants. Just four decades after this state-of-the-art restoration was first introduced, we now recognize implants as the "Gold Standard" for tooth replacement.
In recognition of Dental Implant Month in September, here are 4 reasons why dental implants might be the right tooth replacement choice for you.
Life-like. While other restorations provide a reasonable facsimile of natural teeth, implants take like-likeness to another level. That's because the implant replaces the root, which then allows for a life-like crown to be attached to it. By positioning it properly, implants and the subsequent crown can blend seamlessly with other teeth to create an overall natural smile appearance.
Durable. Implants owe their long-term durability (more than 95% still functioning after ten years) to a special affinity between bone and the titanium post imbedded in the jaw. Bone cells readily grow and adhere to the implant's surface, resulting over time in a more secure hold than other restorations. By the way, this increased bone growth around implants can help slow or even stop progressive bone loss.
Low impact. Dental bridges are another well-regarded tooth replacement option, but with a major downside: The natural teeth on either side of the missing teeth gap must be crowned to support the bridge. To prepare them, we must permanently alter these teeth. Implants, though, don't require this form of support, and so have a negligible effect on other teeth.
Versatile. Although implants are a practical choice for individual tooth restorations, multiple teeth replacements can get expensive. Implants, though, can also be incorporated into other restorations: Four to six implants can support an entire removable denture or fixed bridge. Implant-supported restorations are more durable than the traditional versions, while also encouraging better bone health.
If you need to replace teeth and would like to consider dental implants, see us for a complete examination. You may be an ideal candidate for this "best of the best" dental restoration.
Our primary aim as dentists is to preserve teeth. There are times, however, when preserving a tooth is no longer worth the effort and we must recommend removing it. Fortunately, extracted teeth can be replaced with a functional and attractive restoration.
Today's top tooth-replacement option is the dental implant. Composed of a titanium metal post imbedded into the jawbone, a single dental implant can replace an individual tooth or a series of implants can support other restorations for multiple teeth. Besides being incredibly life-like, dental implants are highly durable and can last for decades.
But dental implants aren't an optimal choice for everyone. Their cost often matches their status as the premier tooth replacement method. And because they require a minimum amount of bone for proper implantation, they're not always feasible for patients with extensive bone loss.
But even if dental implants aren't right for you, and you want a fixed restoration rather than dentures, you still have options. What's more, they've been around for decades!
One is a bonded crown, which works particularly well for a tooth excessively damaged by decay, excessive wear or fractures. After removing all of the damaged portions and shaping the remaining tooth, we cement a life-like crown, custom created for that particular tooth, over the remaining structure.
Besides improving appearance, a crown also protects the tooth and restores its function. One thing to remember, though, is although the crown itself is impervious to disease, the remainder of the natural tooth isn't. It's important then to brush and floss around crowned teeth like any other tooth and see a dentist regularly for cleanings.
Dental bridges are a fixed solution for extracted teeth. It's composed of prosthetic teeth to replace those missing bonded together with supporting crowns on both ends. These crowned teeth are known as abutments, and, depending on how many teeth are being replaced, we may need to increase the number of abutments to support the bridge.
Although durable, crowns or bridges typically don't match the longevity of an implant. And, implants don't require the permanent alteration of support teeth as is necessary with a bridge. But when the choice of implants isn't on the table, these traditional restorations can be an effective dental solution.
If you would like more information on crown or bridge restorations, 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 “Crowns & Bridgework.”
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