Calling someone "long in the tooth" is an unflattering way of saying they're getting old. The phrase refers to the effects of gum recession, in which the gums pull away from the teeth and cause them to appear longer. The problem, which makes the teeth vulnerable to disease as well as look unattractive, is a common problem for older people.
The most common cause for gum recession is periodontal (gum) disease. Bacteria and food particles, which make up dental plaque, trigger an infection. The deposits of plaque and calculus (hardened plaque) continue to fuel the infection as it continues to weaken gum tissue attachments.
As a result, the gums begin to lose their attachment to the teeth and pull away, exposing the root areas normally covered by the gums. Unlike the enamel-protected crowns (the parts of teeth you can see), the root is covered by a thin layer of material called cementum.
Although cementum offers less protection than enamel, this normally isn't a problem because the gums also act as a barrier against bacteria and other harsh aspects of the mouth environment. But without gum coverage, the root area becomes vulnerable to disease and is more prone to painful sensitivity.
Because gum disease is the main culprit, you can reduce your chances of gum recession by keeping your teeth clean of plaque through brushing and flossing, and regularly undergoing professional cleanings. If gum disease does occur, it's important to seek treatment as soon as possible: The earlier it's treated the more likely that any recessed gum tissues can regenerate.
If the recession is extensive, however, you may need clinical intervention to assist with its regrowth. This can be done by grafting tissue at the site that then serves as scaffold for new tissue to grow upon. Though effective, these microsurgical techniques are quite complex and involved.
So, if you suspect you have gum disease or recession, see your dentist as soon as possible for a full examination. It may be possible to restore your gums and enhance your smile.
If you would like more information on protecting your gum 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 “Gum Recession.”
Roughly 75% of American adults are missing at least one tooth, mostly from disease, trauma or extraction for other dental reasons. A few missing teeth, though, never erupted in the first place.
It’s a rare occurrence, but sometimes people are born without certain teeth, usually back molars or premolars that may not be as visible. Occasionally, though, it’s the more visible upper lateral incisors positioned on either side of the central incisors (the two front teeth on either side of the midline of the face).
Missing incisors can lead to poor bites and create difficulties for speech development and nutrition. But these highly visible (or in this case, “invisible”) teeth can also detract from an otherwise attractive smile.
There are ways, however to correct a smile with missing lateral incisors. Here are 3 of those ways.
Canine substitution. We can fill the vacancy created by the missing incisors by orthodontically moving the canines (the “eyeteeth,” normally next to them) into the space. Braces can close the gap in a conservative way, while possibly correcting any existing bite problems. Because canines are larger than incisors, its often necessary to re-contour them and restore them with a crown, veneer or bonding material to look more natural.
Fixed bridge. A second way to fill the space is with a dental bridge. A bridge consists of a series of crowns fused together in a row. The middle crowns replace the missing teeth; the end crowns cap the natural teeth on either end of the gap, which establishes support for the bridge. Another variation is a cantilever bridge in which only one natural tooth is capped for support. With either type, though, the capped teeth will be permanently reduced in size to accommodate the crowns.
Dental implants. This popular restoration is also a favorite for correcting missing incisors. Implants provide a life-like and durable replacement for missing teeth, while not requiring any alterations to existing teeth as with a bridge. But they are more expensive than the other options, and they require adequate space between the adjacent teeth for insertion, as well as healthy bone for proper placement and anchorage. This is also an option that must wait until the jaw has fully matured in early adulthood.
If you would like more information on treating congenitally missing 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 “When Permanent Teeth Don't Grow: Treatment Options for Congenitally Missing Lateral Incisors.”
The Millennials, those born around the turn of the Millennium in 2000, are entering adulthood. Like any generation, they have their collective promise—and problems. An example of the latter seems to involve their teeth: an estimated one in three people between the ages of 18 and 34 have some form of tooth decay.
If a recent survey is correct, that may be a result of poor oral hygiene practices. The absence of a consistent, daily habit of brushing and flossing to remove disease-causing dental plaque is the number one cause for dental disease. But a survey of 2,000 millennials found only three in ten brushed their teeth at least once a day with many often skipping brushing for two or more days a time.
Interestingly, more than half of the survey also reported an aversion to dental visits. That will likely need to change if these trends in poor hygiene continue, as aging millennials will eventually need extensive treatment for tooth decay and its close counterpart periodontal (gum) disease to save their teeth. Dental professionals recommend a different dental care track: stop dental disease before it develops. And the key to that is a simple but powerful daily brushing and flossing routine.
This routine should involve brushing teeth up to twice and flossing at least once a day. Brushing should be done with gentle strokes, but include all exposed tooth surfaces (about two minutes to perform a thorough job). Flossing is less popular than brushing, but it’s essential for removing plaque between teeth your brush can’t reach. To make it easier, you can use pre-threaded floss or a water flosser that removes plaque with a stream of water.
To round out your prevention strategy, you should see a dentist at least twice a year for professional cleanings of hardened plaque deposits (calculus), as well as overall monitoring of your dental health. And if dental visits make you anxious, your dental professional has a number of ways to help you relax.
One thing’s for sure: like any other generation, millennials prize both good health and an attractive smile. Adopting a solid oral hygiene lifestyle will do the most to achieve both.
On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.
“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”
Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.
Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.
A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.
Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.
So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.
If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”
Many people learn they have periodontal (gum) disease after noticing gum swelling, soreness or bleeding. But what you can see or feel may be only the tip of the iceberg — the damage may extend much deeper.
Gum disease is caused mainly by dental plaque, a thin film of bacteria and food particles built up on teeth due to ineffective brushing and flossing. Infection of the visible gums is only the beginning — left untreated, it can advance well below the gum line and even infect supporting bone.
One critical concern in this regard is the areas where the roots of a tooth separate from each other, known as furcations. Here an infection known as a furcation invasion can cause the bone to weaken and dissolve.
This usually occurs in stages (or classes) we can detect through manual probing and/or with x-rays. In the earliest stage, Class I, we might only notice a slight pocket in the gums with no significant bone loss. In Class II, though, the pocket between the roots has become a horizontal opening of two or more millimeters, indicating definite bone loss with increased pocket depth getting “under” the crown of the tooth. Class III, the last and most serious stage, describes an opening we can probe under the crown all the way to the other side of the tooth; the bone loss now extends “through and through” the furcation.
The basic goal of gum disease treatment is to remove plaque and calculus (tartar) from all tooth and gum surfaces. But removing plaque below the gum line, especially “into” the furcations, can be challenging. We will need instruments called scalers to clean root surfaces, assisted sometimes by ultrasonic equipment to vibrate plaque loose. With furcations we may also need to employ surgery to aid gum or bone tissue regeneration or to make the area easier to access for future cleaning.
Of course, the best way to protect against furcation invasions is to prevent gum disease in the first place. Be sure to brush and floss daily and visit us for thorough dental cleanings and checkups at least every six months.
And don’t delay contacting us if you see any signs of teeth or gum problems. The sooner we can identify gum disease, the more likely we’ll be able to prevent it from doing serious damage to your gums, bone and teeth.
If you would like more information on treating gum disease, 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 “What are Furcations?”
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