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ThisOrthodonticDeviceCouldStopaPoorBiteFromDeveloping

“Orthodontic treatment” and “braces” almost seem like synonymous terms. But while braces certainly are orthodontic, it isn't the only tool in an orthodontist's toolkit.

A good example is a device is known as a Herbst appliance. It's used in situations where the upper jaw is outpacing the growth and development of the lower jaw during childhood. If not corrected, this could cause the top teeth to protrude abnormally beyond the lower teeth.

The Herbst appliance gently and gradually coaxes the lower jaw to grow in a more forward direction, thus “catching up” with the upper jaw. The top part of the device consists of two metal tubes hinged to small elastic bands, which are cemented to the cheek side of the upper back teeth (molars), one on either side of the jaw.

Two smaller tubes are attached in like fashion to the lower teeth, and then inserted into the larger tubes. As the lower jaw moves, the smaller tubes move within the larger to create pressure that gently pushes the jaw forward. Over time, this can sync the growth progress of both the upper and lower jaws, and reduce the chances of a poor bite.

For best results, a Herbst appliance is usually placed to coincide with a child's most rapid period of jaw growth, usually between 11 and 14. They could be placed as early as 8 or 9, however, in situations where the front teeth are already protruding well beyond the lips. In any event, the goal is to positively influence the growth of the lower jaw to alleviate or at least minimize the need for future orthodontic treatment.

As a fixed device, there's no need for a child or parent to tend to it as with other methods, like orthodontic headwear worn in conjunction with braces. A Herbst appliance can, however, alter the normal sensations associated with eating, swallowing and speaking, which may take a little adjustment time for the child. Wearers will also need to be extra vigilant with daily brushing and flossing because of a higher risk of tooth decay.

These, though, are minor inconveniences compared with the benefit of improved bite development. As such, a Herbst appliance could be a positive investment in your child's dental future.

If you would like more information on interceptive orthodontics, 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 Herbst Appliance.”

AsAntetokounmpoKnowsEvenanNBAStarCanBeSidelinedbyaToothache

The NBA's reigning MVP Giannis Antetokounmpo may seem unstoppable, but he proved no match for a troubled tooth. Antetokounmpo, the self-proclaimed “Greek Freak,” missed one of the final three 2020 regular season games for a dental issue that resulted in last-minute oral surgery. According to a Milwaukee Bucks spokesperson, the star underwent “a root-canal like procedure.”

Root canal therapy, often simply called “a root canal,” may be needed when there is an infection inside the tooth. When dental pulp becomes inflamed or infected, excruciating pain can result. Pulp is the soft tissue that fills the inside of the tooth. It is made up of nerves, blood vessels and connective tissue. During root canal treatment, the pulp is removed, the space inside the tooth is disinfected, it is filled with a special material, and then the hole is sealed up.

A root canal is nothing to fear. It relieves pain by getting rid of infection and is so effective that over 15 million of them are performed in the U.S. each year. This routine procedure generally requires only local anesthetic, and your mouth should be back to normal within a day or two after treatment. Antetokounmpo can attest to that, as he returned to play the next day.

However, delaying root canal treatment when you need it can have serious consequences. If left untreated, an infection inside the tooth continues to spread, and it may move into the gums and jaw and cause other problems in the body. So, how do you know if you may need a root canal? Here are some signs:

Lingering sensitivity to hot or cold temperatures. One sign of nerve damage inside your tooth is pain that is still there 30 seconds after eating or drinking something hot or cold.

Intense pain when biting down. You may feel pain deep within your tooth, or in your jaw, face or other teeth. The pain may be hard to pinpoint—and even if it improves at times, it usually comes back.

A chipped, cracked or discolored tooth. A chip or crack can allow bacteria to enter the tooth, and the tooth may darken if the tissue inside is damaged.

A pimple on the gum. A bump or pimple on the gum that doesn't go away or keeps coming back may signify that a nearby tooth is infected.

Tender, swollen gums. Swollen gums may indicate an infection inside the tooth or the need for periodontal treatment.

And sometimes there is no pain, but an infection may be discovered during a dental exam.

Tooth pain should never be ignored, so don't put off a dental visit when you have a toothache. In fact, if a bad toothache goes away, it could mean that the nerves inside the tooth have died, but the infection may still be raging. Also, be sure to keep up with your regular dental checkups. We may spot a small problem that can be addressed before it becomes a bigger problem that would require more extensive treatment.

Remember, for dental issues both large and small, we're on your team! If you would like more information about tooth pain, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Tooth Pain? Don't Wait!” and “Root Canal Treatment: What You Need to Know.”

By Okun Dentistry
March 24, 2021
Category: Oral Health
Tags: loose teeth  
SeeYourDentistASAPIfYouHaveaLoosePermanentTooth

Unless you're 6 years old and on speed dial with the Tooth Fairy, a loose tooth isn't a good feeling. It's also a sign something is wrong in your mouth. If you don't take prompt action, you may lose that tooth for good.

To begin with, teeth are held in place by an elastic tissue known as the periodontal ligament. The ligament lies between the tooth and bone and attaches to both through tiny fibers. The thing to note about the ligament is that it does allow for tooth movement, which serves as a “shock absorber” against the forces generated while biting and chewing.

But that movement is normally so slight, you won't perceive it. If you do, chances are there's a problem with the ligament attachment, which may have been damaged due to trauma or disease.

A hard blow to the face could certainly damage both the teeth and their attachments. But it can also happen if one tooth extends out farther than the rest and absorbs more stress during chewing. You could encounter similar damage if you attempt DIY orthodontics or wear tongue jewelry.

The more common source of ligament damage, though, is periodontal (gum) disease, usually caused by dental plaque, a thin film of bacteria and food particles left on tooth surfaces. If not treated, the infection can advance deeper into the gum tissues (and eventually the supporting bone), causing the ligaments to weaken and detach. In fact, a loose tooth is often a sign of well-advanced gum disease.

If you notice a loose tooth, you should make an appointment with us as soon as possible. Our first step is to ascertain the underlying cause and initiate any needed treatment. We may also want to splint a loose tooth to adjacent teeth to prevent excessive movement while the ligaments heal and reform their attachment to the tooth.

There will be times when a loose tooth is beyond repair. In that case, it may be best to remove the tooth and install a life-like replacement like a dental implant. But that's not inevitable. If at all possible and practical, we'll try to save your loose tooth.

If you would like more information on loose 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 Become Loose.”

By Okun Dentistry
March 14, 2021
Category: Dental Procedures
Tags: tooth decay  
FrequentSinusInfectionsTakeaTriptoYourDentist

If you suffer frequent sinus infections, you might want to see a dentist. No, really—your recurring sinusitis might stem from a decayed tooth.

Tooth decay can start as a cavity, but left untreated can advance within the tooth and infect the pulp and root canals. If it reaches the end of the root, it can cause the root tip and surrounding bone to break down.

A severe toothache is often a good indicator that you have advanced tooth decay, which can usually be stopped with a root canal treatment.  But a decayed tooth doesn't always produce pain or other symptoms—you could have a “silent” infection that's less likely to be detected.

A symptomless, and thus untreated, infection in an upper back tooth could eventually impact the maxillary sinus, a hollow air-filled space located just above your back jaw. This is especially true for people whose tooth roots extend close to or even poke through the sinus floor.

That “silent” infection in your tooth, could therefore become a “loud” one in the sinuses causing chronic post-nasal drip, congestion and, of course, pain. Fortunately, a physician or an ear, nose and throat (ENT) specialist might suspect a dental origin for a case of recurring sinusitis, a condition known as maxillary sinusitis of endodontic origin (MSEO).

Antibiotic treatment can clear up sinusitis symptoms short-term. It's unlikely, though, it will do the same for a dental infection, which may continue to trigger subsequent rounds of sinusitis. The best approach is for a dentist, particularly a specialist in interior tooth disease called an endodontist, to investigate and, if a decayed tooth is found, treat the source of the infection.

As mentioned earlier, the solution is usually a root canal treatment. During this procedure, the dentist completely removes all infected tissue within the pulp and root canals, and then fills the empty spaces to prevent future infection. In one study, root canal therapy had a positive effect on alleviating sinusitis in about half of patients who were diagnosed with a decayed tooth.

If your sinusitis keeps coming back, speak with your doctor about the possibility of a dental cause. You may find treating a subsequently diagnosed decayed tooth could alleviate your sinus problem.

If you would like more information on how your dental health could affect the rest of your body, 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 “Sinusitis and Tooth Infections.”

WeMayBeAbleToTreatSomeBiteProblemsEarly

In any given year, 4 million tweens and teens are in the process of having their teeth straightened with braces or clear aligners. It's so common we tend to consider orthodontic treatment for young people as a rite of passage into adulthood.

But it doesn't necessarily have to be that way—it might be possible to stop or at least minimize a poor bite before it fully develops. That's the goal of interceptive orthodontics—treatments that head off or “intercept” a bite problem early.

The goal isn't necessarily to reposition misaligned teeth, but to correct a problem that can lead to misalignment. Here are some examples.

A narrow jaw. A narrowly developing jaw can crowd incoming teeth out of their normal positions. For the upper jaw, though, we can take advantage of a temporary separation in the bones in the roof of the mouth (palate) with a device called a palatal expander. Placed against the palate, the expander exerts outward pressure on the teeth and jaw to widen this separation. The body fills in the gap with bone to gradually widen the jaw.

Abnormal jaw alignment. It's possible for a jaw to develop abnormally during childhood so that it extends too far beyond the other. Using a hinged device called a Herbst appliance, it's possible to interrupt this abnormal growth pattern and influence the bones and muscles of the jaw to grow in a different way.

Missing primary teeth. An important role for a primary (baby) tooth is to hold a place for the future permanent tooth. But if the primary tooth is lost too soon, other teeth can drift into the space and crowd out the intended permanent tooth. To prevent this, we can insert a space maintainer: This simple looped metal device prevents teeth from drifting and preserves the space for the permanent tooth.

Although these and other interceptive treatments are effective, some like the palatal expander do their best work within a limited age frame. To take advantage of interceptive orthodontics in a timely manner, parents should seek a bite evaluation for their child from an orthodontist around age 6. The earlier we detect a growing bite problem, the greater your chances for successful intervention.

If you would like more information on treating emerging bite problems early, 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 “Interceptive Orthodontics.”





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