While not as prevalent as adults, teenagers can have missing teeth, usually from injury or from never having been formed. Fortunately, life-like dental implants can replace missing teeth. But unfortunately for teens, implants aren't usually a good option—yet.
That's because a teenager's jaws are still growing, and will continue until early adulthood. Dental implants don't adjust to this growth like natural teeth and will eventually look out of place. It's best, then, to consider a temporary restoration for a teenager. And, there are two excellent options: one removable and one fixed.
The first is a removable partial denture (RPD). Like a full denture, an RPD has an acrylic base that resembles gum tissue, to which prosthetic (false) teeth are attached to match the positions of the missing teeth. It's usually held in place with metal or nylon clips that slide under part of the natural teeth at the gum line.
RPDs are versatile and durable. But they're not designed to be worn indefinitely, so they can be damaged if subjected to excessive biting forces like biting into something hard. And, peer-pressured teens may also feel self-consciousness about wearing a “denture.”
The other option is a bonded bridge. It's similar to a traditional bridge, except how it's supported in the mouth. A traditional bridge gains its support from the crowns on each end attached to natural teeth, which must be permanently altered for them. By contrast, a bonded bridge has strips of dental material extending from both sides of its back that are bonded to the back of the adjacent natural teeth.
With the bonding material behind the bridge, it can't be seen—and the natural teeth won't require permanent alteration. But a bonded bridge is usually more costly than an RPD and less secure than a traditional bridge. And not every teen is a viable candidate for one: issues like how the teeth fit together and if the teen has a tooth grinding habit could be strikes against this fixed option.
Your dentist can help you sort out the best of these options for your teen. If cared for and maintained properly, either restoration can buy you time until your teen is ready for dental implants.
If you would like more information on restoring a teenager's smile, 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 “Temporary Tooth Replacement for Teens: What Are the Options?”
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
The journey to a straighter smile with braces can be difficult. One of the biggest dangers you'll face is an increased risk of periodontal (gum) disease.
Gum disease is caused by dental plaque, a thin film of bacteria and food particles on tooth surfaces. To curtail plaque growth, you must brush and floss daily and visit your dentist regularly for more thorough cleanings. If you don't, accumulated plaque can trigger an infection with potentially disastrous consequences for your dental health.
But wearing braces can make you more vulnerable to gum disease. The braces and wires can get in the way of brushing and flossing. To add to the difficulty, the gums often react to being in close proximity to braces, causing their tissues to swell or overgrow. And if the patient is a teenager, the normal hormonal surge that occurs during these years could compound this vulnerability even more.
To prevent an infection, you'll need to practice extra diligence cleaning your teeth with brushing and flossing. It takes more time and effort, but it's worth it to lower your disease risk. To help even more, consider using tools like specialized brushes that can maneuver better around hardware and floss threaders that can get floss under wires. You might also consider a water flosser, which uses pressurized water to remove plaque between teeth.
In addition to your orthodontic visits, you should also maintain your regular cleaning schedule with your family dentist—or more often if they recommend. Besides cleaning, your dentist also monitors for signs of developing gum disease. They can also prescribe mouthrinses for controlling bacterial growth.
Even with diligent hygiene, your gums may still adversely react to the braces. This may not be a problem if your gum tissues don't appear to be detaching from the teeth. But your dentist or orthodontist may recommend you see a periodontist (a gum specialist) to help monitor that aspect of your care. In extreme cases, it may be necessary to remove the braces and allow the gums to heal.
Keeping your teeth clean and your mouth disease-free is no easy task while wearing braces. But it can be done—and with your dentist's help, you can achieve a straighter and healthier smile.
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.”
Say “bacteria,” especially in the same sentence with “disease” or “infection,” and you may trigger an immediate stampede for the hand sanitizer. The last thing most people want is to come in contact with these “menacing” microorganisms.
If that describes you, however, you’re too late. If you’re of adult age, there are already 100 trillion of these single-celled organisms in and on your body, outnumbering your own cells 10 to 1. But don’t panic: Of these 10,000-plus species only a handful can cause you harm—most are either harmless or beneficial, including in your mouth.
Thanks to recent research, we know quite a bit about the different kinds of bacteria in the mouth and what they’re doing. We’ve also learned that the mouth’s microbiome (the interactive environment of microscopic organisms in a particular location) develops over time, especially during our formative years. New mothers, for example, pass on hundreds of beneficial species of bacteria to their babies via their breast milk.
As our exposure to different bacteria grows, our immune system is also developing—not only fighting bacteria that pose a threat, but also learning to recognize benevolent species. All these factors over time result in a sophisticated, interrelated bacterial environment unique to every individual.
Of course, it isn’t all sweetness and light in this microscopic world. The few harmful oral bacteria, especially those that trigger tooth decay or periodontal (gum) disease, can cause enormous, irreparable damage to the teeth and gums. It’s our goal as dentists to treat these diseases and, when necessary, fight against harmful microorganisms with antibacterial agents and antibiotics.
But our growing knowledge of this “secret world” of bacteria is now influencing how we approach dental treatment. A generalized application of antibiotics, for example, could harm beneficial bacteria as well as harmful ones. In trying to do good we may run the risk of disrupting the mouth’s microbiome balance—with adverse results on a patient’s long-term oral health.
The treatment strategies of the future will take this into account. While stopping dental disease will remain the top priority, the treatments of the future will seek to do it without harming the delicate balance of the mouth’s microbiome.
If you would like more information on the role of bacteria in oral 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 “New Research Show Bacteria Essential to Health.”
After living with braces for a couple of years, the “big reveal” finally happens and you see your new smile for the first time. But then you’re told you have to wear another mouth appliance—around the clock to start and then just at night. After all the new smile excitement, wearing a retainer can be a little anticlimactic.
But this part of your orthodontic treatment is as important as the earlier tooth movement phase. That’s because your new “forever smile” doesn’t necessarily come with a “forever” guaranty. In fact, your teeth could quickly begin moving back to where they were before braces if you don’t wear a retainer.
The reason why is because of a tough but elastic gum tissue called the periodontal ligament. This ligament lies between the teeth and the jawbone, attaching to both through tiny extending fibers. The periodontal ligament actually does most of the anchoring work to hold your teeth in place.
The ligament is also why we’re able to move your teeth to different positions: As braces apply pressure to the teeth and jaw in the direction of desired movement, the ligament remodels itself to allow the teeth to take up these new positions.
The tissues involved, though, still retain a kind of “memory” of where the teeth used to be. This creates an immediate tendency for the teeth to revert to these old positions. To prevent this, we use a retainer that when worn keeps or “retains” the teeth in their new positions until they’ve stabilized and the old tissue “memory” fades.
There are different types of retainers, some removable and some fixed in place. Choosing the best one for a particular patient will depend on the complexity of the bite treatment, the patient’s age and level of self-responsibility and the preferences of the orthodontist. Whichever type of retainer you eventually use, it’s important you wear it to preserve all of the time and effort that went into transforming your smile.
Wearing a retainer might not be high on your “exciting things to do” list. But it’s the best way to guarantee you’ll enjoy your new smile for years to come.
If you would like more information on keeping your new smile after 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 “The Importance of Orthodontic Retainers.”
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