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Posts for category: Dental Procedures

GetAheadofaDevelopingCross-BitewithThisEarlyInterventionMeasure

Applying braces or clear aligners to move misaligned teeth is only part of an orthodontist's overall mission to eliminate poor bites (malocclusions). Sometimes a malocclusion isn't caused by the teeth at all—the size of the jaw is the problem!

One type in particular, a cross-bite, often happens because the upper jaw has developed too narrowly. As a result, many of the upper teeth fit inside the lower, the opposite of normal. But a tool called a palatal expander can alleviate the problem if it's applied at an early enough age.

The device works because the upper jawbone initially forms as two halves that fit together along a center line in the roof of the mouth (the palate) running from the back of the mouth to the front. These two bone halves remain separate during childhood to facilitate jaw growth, but eventually fuse around puberty.

Consisting of two sets of wire arms joined together by a hinge mechanism in the middle, the expander device is positioned up against the palate. The orthodontist extends each arm to press against the inside of the back teeth, then adds more outward pressure by turning the mechanism in the middle with a small key. During wear, the patient or caregiver will turn the mechanism in the same way to keep up the pressure on the two sides of the jaw.

This continual pressure keeps the two bones moving away from each other and maintaining a center gap between them. In response, more bone forms on the two halves to fill the gap. In time, the newly formed bone should widen the jaw enough to correct any developing malocclusion.

Timing is everything with a palatal expander—if not used before the jaw bones fuse, the patient will need a surgical procedure to separate the bones to pursue treatment. To catch the problem early enough, children should have an orthodontic evaluation on or before they turn six. An orthodontist may be able to identify this or other emerging bite problems and intervene before it becomes worse. Taking this approach can help save you and your child more expensive orthodontic treatment down the road.

If you would like more information on correcting poor bites, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”

WhyemBigBangTheoryemActressMayimBialikCouldntHaveBraces

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”

By Dr. Nishi Vakharia, DDS
February 27, 2019
Category: Dental Procedures
Tags: dental treatment  
TreatingaYoungPermanentToothRequiresaDifferentApproach

Soon after the primary (baby) teeth begin to give way, the teeth a child will have the rest of their lives start erupting into the mouth. But while they’re permanent, they’re not as strong and developed as they will be in adulthood.

That’s why we treat young permanent teeth differently from older adult teeth. For example, a decayed adult tooth may need a root canal treatment; but this standard treatment would often be the wrong choice for a child’s tooth.

The reason why involves the pulp, the innermost layer of a tooth, which plays a critical role in early development. Young permanent teeth continue to grow in sync with the jaws and facial structure. Most of this growth is in the dentin, the layer between the enamel and pulp, which increases proportionally to the other layers as the tooth matures. The pulp generates this new dentin.

A root canal treatment completely removes the diseased tissue of the pulp. This isn’t a major issue for a mature tooth because it no longer needs to generate more dentin. But it can have long-term consequences for an immature tooth whose growth may become stunted and the roots not fully formed. The tooth may thus become brittle and darkened, and might eventually require removal.

Because of these potential consequences, a root canal treatment is a last resort for a young permanent tooth. But there are modified alternatives, depending on the degree of pulp exposure or infection. For example, if the pulp is intact, we may be able to remove as much soft decayed dentin as we can, place an antibacterial agent and then fill the tooth to seal it without disturbing the pulp. If the pulp is partially affected, we can remove that part and place substances that encourage dentin growth and repair.

Our main goal is to treat a young tooth with as little contact with the pulp as possible, so as not to diminish its capacity to generate new dentin. Avoiding a full root canal treatment if at all possible by using these and other techniques will help ensure the tooth continues to develop to full maturity.

If you would like more information on dental care for children, 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 “Saving New Permanent Teeth after Injury.”

By Dr. Nishi Vakharia, DDS
February 17, 2019
Category: Dental Procedures
Tags: local anesthesia  
LocalAnesthesiaTakesthePainOutofMostDentalWork

Long ago dental work could be painful and stressful—often for both patient and practitioner. Thankfully, that time is long past: today, most procedures are painless in large part due to local anesthesia.

Local anesthetics are numbing substances applied to specific areas of the body like the teeth and gums to temporarily block pain during a procedure. And because they only affect a localized area of the body, you remain conscious and alert throughout the procedure.

To achieve the level of numbing necessary for dental work, we often need to deaden the gums using a needle to deliver the anesthetic. But then this poses a secondary pain concern—the needle stick itself.

Again, topical anesthesia comes to the rescue in the form of a swab, patch or spray applying an anesthetic directly to the top layer of the gums at the injection site. This numbs the area and prevents you from feeling the needle stick. It's highly probable, therefore, that from start to finish you won't feel any discomfort during your dental work except perhaps for a little pressure.

Local anesthesia truly is a game changer for dental care—and not just for the patient. A dentist who's concerned about their patient's comfort level may work hurriedly to complete a procedure. But if their patient is relaxed, the dentist can work calmly and methodically. The result is better, more focused care.

For all its improvements in the patient experience, though, there has been one consistent complaint—the numbness that often lingers for a while after the procedure is over. But there have been advances in recent years that have helped reduce this irritation: new anesthetic agents (even some that can reverse the anesthetic effect) and fine-tuned dosages can help keep residual numbing to a minimum.

Not all procedures like routine teeth cleanings or enamel shaping require anesthesia. But when it's appropriate, local anesthesia can make your next dental visit much more pleasant.

If you would like more information on how anesthesia benefits your 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 “Local Anesthesia for Pain-Free Dentistry.”

CompositeResinCouldAmpupYourTeethsAttractivenessinJustOneVisit

It might not rise to the level of a miracle, but cosmetic dentistry can achieve some amazing outcomes with unattractive teeth. A skilled and experienced dentist can turn "ugly ducklings" into beautiful "swans." And that achievement might not be as in-depth or expensive as you might think, thanks to the increased use of dental materials called composite resins.

Composite resins are pliable, tooth-colored materials we apply directly to tooth surfaces. They're most often used with broken, chipped or misshapen front teeth—the composite material replaces the missing tooth structure.

Composite resins have been around for decades, but haven't been widely used because they didn't have the strength of dental porcelain. In recent years, though, dentists have perfected techniques for bonding and shaping composites to teeth that have increased their durability. With just the right skill and artistry, composites can look like natural teeth.

We can correct many tooth flaws using composite resins right in our office. After roughening up the outer enamel surface of the tooth and performing other steps to aid bonding, we begin applying liquid resins to form a base layer that we then harden with a special light source. We continue to add layers to increase the color depth and shape of the restoration, before finally polishing it to resemble natural teeth.

Composite restorations are ideal for moderate tooth structure loss, but may not be appropriate for heavily worn, previously root canal-treated or fractured teeth. These and other kinds of flaws may require a different solution such as a dental porcelain restoration with veneers or crowns. Where composites can be used, though, they provide an affordable option that doesn't require an outside dental lab for fabrication—we can often perform it in one visit.

If you'd like to consider a composite resin restoration for a less than perfect tooth, see us for a complete examination and consultation. If your situation appears to be compatible for using this particular technique, composite resins could change your smile for the better in just a few minutes.

If you would like more information on how we can improve your 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 “Artistic Repair of Front Teeth with Composite Resin.”