Posts for: December, 2018
As permanent teeth gradually replace primary (“baby”) teeth, most will come in by early adolescence. But the back third molars—the wisdom teeth—are often the last to the party, usually erupting between ages 18 and 24, and the source of possible problems.
This is because the wisdom teeth often erupt on an already crowded jaw populated by other teeth. As a result, they can be impacted, meaning they may erupt partially or not at all and remain largely below the gum surface.
An impacted tooth can impinge on its neighboring teeth and damage their roots or disrupt their protective gum attachment, all of which makes them more susceptible to tooth decay or periodontal (gum) disease. Impacted teeth can also foster the formation of infected cysts that create areas of bone loss or painful infections in the gums of other teeth.
Even when symptoms like these aren’t present, many dentists recommend removing the wisdom teeth as a preemptive measure against future problems or disease. This often requires a surgical extraction: in fact, wisdom teeth removal is the most common oral surgical procedure.
But now there’s a growing consensus among dentists that removing or not removing wisdom teeth should depend on an individual’s unique circumstances. Patients who are having adverse oral health effects from impacted wisdom teeth should consider removing them, especially if they’ve already encountered dental disease. But the extraction decision isn’t as easy for patients with no current signs of either impaction or disease. That doesn’t mean their situation won’t change in the future.
One way to manage all these potentialities is a strategy called active surveillance. With this approach, patient and dentist keep a close eye on wisdom teeth development and possible signs of impaction or disease. Most dentists recommend carefully examining the wisdom teeth (including diagnostic x-rays and other imaging) every 24 months.
Following this strategy doesn’t mean the patient won’t eventually have their wisdom teeth removed, but not until there are clearer signs of trouble. But whatever the outcome might be, dealing properly with wisdom teeth is a high priority for preventing future oral health problems.
If you would like more information on wisdom teeth and their potential impact on 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 “Wisdom Teeth: Coming of Age May Come with a Dilemma.”
Around 20 million people—mostly women after menopause—take medication to slow the progress of osteoporosis, a debilitating disease that weakens bones. But although effective, some osteoporosis drugs could pose dental issues related to the jawbones.
Osteoporosis causes the natural spaces that lie between the mineral content of bone to grow larger over time. This makes the bone weaker and unable to withstand forces it once could, which significantly increases the risk of fracture. A number of drugs have been developed over time that stop or slow this disease process.
Two of the most prominent osteoporosis drugs are alendronate, known also by its trade name Fosamax, and denosumab or Prolia. While originating from different drug families, alendronate and denosumab work in a similar way by destroying specialized bone cells called osteoclasts that break down worn out bone and help dissolve it. By reducing the number of these cells, more of the older bone that would have been phased out lasts longer.
In actuality this only offers a short-term benefit in controlling osteoporosis. The older bone isn’t renewed but only preserved, and will eventually become fragile and more prone to fracture. After several years the tide turns negatively for the bone’s overall health. It’s also possible, although rare, that the bone simply dies in a condition called osteonecrosis.
The jawbones are especially susceptible to osteonecrosis. Forces generated by chewing normally help stimulate jawbone growth, but the medications in question can inhibit that stimulus. As a result the jawbone can diminish and weaken, making eventual tooth loss a real possibility.
Osteonecrosis is most often triggered by trauma or invasive dental procedures like tooth extractions or oral surgery. For this reason if you’re taking either alendronate and denosumab and are about to undergo a dental procedure other than routine cleaning, filling or crown-work, you should speak to your physician about suspending your medication temporarily. Dentists often recommend a suspension of three to nine months before the procedure and three months afterward.
Some research indicates this won’t worsen your osteoporosis symptoms, especially if you substitute another treatment or fortify your skeletal system with calcium and vitamin D supplements. But taking this temporary measure could help protect your teeth in the long run.
If you would like more information on the effect of osteoporosis treatment on 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 “Osteoporosis Drugs & Dental Treatment.”
At the first-ever Players Weekend in August 2017, Major League Baseball players wore jerseys with their nicknames on the back. One player — Cleveland Indians shortstop, Francisco Lindor — picked the perfect moniker to express his cheerful, fun-loving nature: “Mr. Smile.” And Lindor gave fans plenty to smile about when he belted a 2-run homer into the stands while wearing his new jersey!
Lindor has explained that he believes smiling is an important part of connecting with fans and teammates alike: “I’ve never been a fan of the guy that makes a great play and then acts like he’s done it 10,000 times — smile, man! We’ve got to enjoy the game.”
We think Lindor is right: Smiling is a great way to generate good will. And it feels great too… as long as you have a smile that’s healthy, and that looks as good as you want it to. But what if you don’t? Here are some things we can do at the dental office to help you enjoy smiling again:
Routine Professional Cleanings & Exams. This is a great place to start on the road toward a healthy, beautiful smile. Even if you are conscientious about brushing and flossing at home, you won’t be able to remove all of the disease-causing dental plaque that can hide beneath the gum line, especially if it has hardened into tartar, but we can do it easily in the office. Then, after a thorough dental exam, we can identify any problems that may be affecting your ability to smile freely, such as tooth decay, gum disease, or cosmetic dental issues.
Cosmetic Dental Treatments. If your oral health is good but your smile is not as bright as you’d like it to be, we can discuss a number of cosmetic dental treatments that can help. These range from conservative procedures such as professional teeth whitening and bonding to more dramatic procedures like porcelain veneers or crowns.
Tooth Replacement. Many people hide their smiles because they are embarrassed by a gap from a missing tooth. That’s a shame, because there are several excellent tooth-replacement options in a variety of price ranges. These include partial and full dentures, bridgework, and dental implants. So don’t let a missing tooth stop you from being Mr. (or Ms.) Smile!
If you’d like more information about oral health or cosmetic dentistry, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Impact of a Smile Makeover.”