About one-quarter of people have teeth that never developed. While most of these congenitally missing teeth are wisdom teeth, they can also include premolars or lateral incisors (the teeth right next to the two front teeth, the central incisors).

Missing teeth can have an adverse effect on smile appearance. But that’s not all: because each type of tooth performs a specific function, one or more missing teeth can lead to bite problems and disruption of dental function. In the case of missing lateral incisors, the canines (eye teeth) normally positioned beside and toward the back of the mouth from them may begin to drift into the empty space and grow next to the central incisors. This can result in greater difficulty chewing and a smile that “doesn’t look right.”

To correct this situation, we must often first attempt to orthodontically move any out of place teeth to their normal positions. This re-establishes the space needed for the missing teeth to be replaced, which we can then restore with prosthetic (artificial) teeth. If the permanent restoration of choice involves dental implants, we’ll usually need to wait until the completion of jaw development around early adulthood. In the mean time, we can use a retainer appliance to hold the teeth in their new positions with prosthetic teeth attached to fill the empty space for a better smile appearance in the interim.

The real issue is timing—beginning orthodontic treatment when appropriate to a person’s oral development, as well as completing the implant restoration when the mouth has matured sufficiently. There are other considerations such as bone volume, which may have diminished due to the missing teeth. At some point we may need to consider grafting to build up the bone sufficiently to support dental implants.

This all may entail a team approach by various specialties like orthodontics, periodontics and implantology. Working together and coordinating within a timely schedule, a mouth and smile marred by undeveloped teeth can be transformed.

If you would like more information on treating smiles with underdeveloped permanent 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.”

Today’s dental care has advanced leaps and bound over the last century. But these advances are tiny steps compared to what many believe may be coming in the next few decades. This optimism arises from our growing understanding of deoxyribonucleic acid (DNA), the chain-like molecule that houses the genetic instructions for the growth, function and reproduction of every cell in the body.

As researchers unlock the secrets of this vast genetic blueprint unique to each individual the possible applications from this knowledge are astounding. Here are just a few possibilities that could one day impact everyone’s oral health.

Preventing tooth decay. This rampant disease, triggered by bacteria (particularly Streptococcus mutans), can cause extensive damage in otherwise healthy teeth. There’s already some indications from the study of genomics that we may be able to stop or at least hinder this disease in its tracks. Already we’re seeing advances in gene therapy that might be able to inhibit the growth of Strep mutans and reduce its colonies in the mouth.

Growing new teeth. Composed of various layers, a natural tooth is part of a dynamic system of bone and gum ligaments that allow movement, protection and nourishment. Although dental implants are the closest and most advanced artificial approximation we now have to them, implants still can’t fully measure up to the function and capabilities of a natural tooth. But further insight into the genetic code may one day allow us to reproduce a living replacement tooth for a lost one.

Harnessing saliva for detecting disease. The impact of genomics related to the mouth could impact more than just the mouth itself. Researchers have discovered that saliva contains genetic information similar to blood, urine and other bodily fluids with markers for various disease conditions. Unlike other fluids, though, saliva is relatively easy to collect. The key is new equipment and testing protocols to take advantage of the information already available in a single drop of saliva.

These examples illustrate the range of possibilities for better health in the future: a reduction in dental disease early in life; new and better ways to restore missing teeth; and quicker ways to diagnose dangerous health conditions.

If you would like more information on new developments 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 “The Future of Dentistry: A Sneak Preview of Your Dental Future.”

Along with periodontal (gum) disease, tooth decay poses one of the two greatest threats to your teeth. Cavities are just the start: if decay invades the pulp, the tooth’s innermost layer, the infection created can continue to advance through the root canals to the supporting bone. This worst case scenario could cost you your tooth.

But we can stop this advanced decay in its tracks with a procedure called a root canal treatment. A root canal essentially removes all the infected tissue within the tooth and then seals it from further infection. And contrary to its undeserved reputation for being painful, a root canal can actually stop the severe tooth pain that decay can cause.

At the beginning of the procedure, we deaden the affected tooth and surrounding tissues with local anesthesia—you’ll be awake and alert, but without pain. We then isolate the tooth with a dental dam of thin rubber or vinyl to create a sterile environment around it to minimize contamination from bacteria found in saliva and the rest of the mouth.

We then drill a small hole through the enamel and dentin to access the interior of the tooth. With special instruments, we remove and clean out all the diseased or dead tissue in the pulp chamber and root canals. After disinfecting the empty spaces with an antibacterial solution, we’ll shape the root canals to make it easier to perform the next step of placing the filling.

To fill all the root canals and pulp chamber, we typically use a rubber-like material called gutta-percha. Because it’s thermoplastic (“thermo”—heat; “plastic”—to shape), we can compress it into and against the walls of the root canals in a heated state to fully seal them. This is crucial for preventing the empty tooth interior from becoming re-infected. Afterward, we’ll seal the access hole with its own filling; later, we’ll bond a permanent crown to the tooth for additional protection and cosmetic enhancement.

After the procedure you may have some temporary minor discomfort usually manageable with aspirin or ibuprofen, but your nagging toothache will be gone. More importantly, your tooth will have a second chance—and your dental health and smile will be the better for it.

If you would like more information on treating tooth decay, 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 “A Step-By-Step Guide to Root Canal Treatment.”

When they’re introducing a new movie, actors often take a moment to pay tribute to the people who helped make it happen — like, you know, their dentists. At least that’s what Charlize Theron did at the premiere of her new spy thriller, Atomic Blonde.

"I just want to take a quick moment to thank my dentists," she told a Los Angeles audience as they waited for the film to roll. "I don’t even know if they’re here, but I just want to say thank you."

Why did the starring actress/producer give a shout-out to her dental team? It seems she trained and fought so hard in the action sequences that she actually cracked two teeth!

“I had severe tooth pain, which I never had in my entire life,” Theron told an interviewer from Variety. At first, she thought it was a cavity — but later, she found out it was more serious: One tooth needed a root canal, and the other had to be extracted and replaced with a dental implant — but first, a bone grafting procedure was needed. “I had to put a donor bone in [the jaw] to heal,” she noted, “and then I had another surgery to put a metal screw in there.”

Although it might sound like the kind of treatment only an action hero would need, bone grafting is now a routine part of many dental implant procedures. The reason is that without a sufficient volume of good-quality bone, implant placement is difficult or impossible. That’s because the screw-like implant must be firmly joined with the jawbone, so it can support the replacement tooth.

Fortunately, dentists have a way to help your body build new bone: A relatively small amount of bone material can be placed in the missing tooth’s socket in a procedure called bone grafting. This may come from your own body or, more likely, it may be processed bone material from a laboratory. The donor material can be from a human, animal or synthetic source, but because of stringent processing techniques, the material is safe for human use. Once it is put in place your body takes over, using the grafted material as a scaffold on which to build new bone cells. If jawbone volume is insufficient for implants, it can often be restored to a viable point in a few months.

Better yet, when grafting material is placed in the tooth socket immediately after extraction, it can keep most of the bone loss from occurring in the first place, enabling an implant to be placed as soon as possible — even before the end of a movie’s shooting schedule.

Will Atomic Blonde prove to be an action-movie classic? Only time will tell. But one thing’s for sure: When Charlize Theron walks down the red carpet, she won’t have to worry about a gap in her smile.

If you have questions about bone grafting or dental implants, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implant Surgery” and “Immediate Dental Implant.”

On your way to a more attractive smile, you’ll have to deal with some inconveniences while wearing braces like avoiding certain foods or habits or dealing with possible embarrassment about your new “metal smile.” But there’s one consequence of wearing braces that could dramatically affect your dental health: the difficulty they pose for keeping your teeth clean of dental plaque.

Dental plaque is a thin film of bacteria and food particles that if allowed to build up on tooth surfaces could trigger tooth decay or periodontal (gum) disease. Brushing and flossing thoroughly every day helps prevent this buildup.

Unfortunately, metal brackets and wires can get in the way and cause you to miss areas while performing these hygiene tasks. This could cause plaque buildup in those isolated areas that could trigger an infection. And if you (or someone you love) are also a teenager, the natural adolescent surge in hormones can increase your infection risk.

If while wearing braces you notice your gums are reddened, swollen or bleeding when you brush, these are all signs of infection and the body’s inflammatory response to it. The longer the infection continues, the weaker the tissues become, causing them to gradually detach from the teeth. Along with bone deterioration (another effect of the disease), this can ultimately lead to tooth loss.

To prevent this from happening, you’ll need to be as thorough as possible with daily brushing and flossing. To help make it easier, you can use special tools like an interproximal brush that can maneuver around the braces better than a regular brush. For flossing you can use a floss threader to more readily guide floss between teeth or a water flosser that uses a pressurized stream of water rather than floss thread to remove plaque.

This extra cleaning effort while wearing braces can greatly reduce your disease risk. But you’ll still need to keep an eye out for any symptoms like swollen or bleeding gums, and see your dentist as soon as possible. If the symptoms become severe you may need your braces removed until the disease can be brought under control. The health and future vitality of your teeth and gums is what’s of primary importance.

If you would like more information on dental care while wearing braces, 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 Swelling During Orthodontics.”