Thanks to treatments like chemotherapy and radiation, your chances of surviving cancer are greater than ever. These treatments, however, often produce unwelcome side effects. Treating throat or oral cancer, for example, could damage your mouth's salivary glands or bone.
Saliva is essential to oral health, providing antibodies to curb the growth of disease-causing bacteria and neutralizing acid, which can erode enamel. But salivary glands damaged during cancer treatment may not be able to produce enough saliva. The resulting “dry mouth” creates an environment conducive to bacterial growth and elevated acid levels.
You can help reduce the effects of dry mouth during your treatment (and after, if the damage is permanent) by drinking more water or by using substances that stimulate saliva. Cutting back on acidic foods and beverages will also help lower your mouth's acidity. And be sure to keep up daily oral hygiene and regular dental visits.
The more ominous threat to oral health during cancer treatment, though, is osteoradionecrosis. This occurs when radiation targets specific areas of bone. The bone can lose blood supply and living cellular tissue, which inhibit its ability to heal or replenish itself. If this occurs in the jawbone of teeth that may be lost, the bone tissue could be adversely affected during healing.
Depending on your treatment needs, your risk for osteoradionecrosis might be unavoidable if teeth are to be lost. It's important we discuss that risk because it could impact future dental treatment. In the worst case, before cancer treatment, we may not be able to save affected teeth and your restorative options might be limited.
If your risk of osteoradionecrosis is minimal, though, we may be able to restore any resulting damaged or missing teeth with a wide range of options like dental implants or crowns before or after your cancer treatment.
As with other aspects of health, taking care of your teeth and gums while undergoing cancer treatment can be challenging; some problems may be unavoidable. But with a proper dental treatment plan during and after chemotherapy and radiation, we can minimize those problems and help to eventually restore your smile.
“To gain something, sometimes you have to give up something else.”
No, that isn't the latest viral meme on the Internet. It's actually a practical consideration that could arise in orthodontics.
In this case, the “something” to gain is a straighter, more attractive smile; the “something” you may have to part with is a few teeth. This may be necessary if there are too many teeth on a dental arch for its capacity, a situation called crowding. A lack of space is the main reason teeth come in misaligned.
Before we can correct this, we'll need to free up space to allow for tooth movement by removing one or more of the existing teeth. The ideal candidates are those that are near to the teeth we wish to move but not highly visible. The first bicuspids are the most frequent choices for removal: they're located behind the cuspids or eyeteeth (the pointed teeth right under the eyes).
Ideally, we'll remove the target teeth some time before we apply braces to give the gums a chance to heal. At the same time we want to preserve the bone that once supported the teeth we've extracted. This is because when we chew the forces generated by the teeth stimulates bone replacement growth. When a tooth is no longer there the supporting bone doesn't receive this stimulation and may ultimately reduce in volume.
We may try to prevent this by placing a bone graft in the empty socket immediately after removing the tooth. The graft serves as a scaffold to encourage new bone to grow. Hopefully when we're ready to apply braces, the bone will be strong and healthy to handle the movement of the teeth.
As the teeth move under the influence of braces, they'll begin to fill up the space created by tooth removal. Once it's completed, the extracted teeth won't be missed — the other teeth now straightened will completely fill out the smile.
The different steps in this process must be carefully planned and executed precisely, and it will take months or even years to complete. In the end, though, this complicated bite problem can be corrected and replaced with an attractive, straight smile.
If you would like more information on correcting a poor bite, 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 “Tooth Removal for Orthodontic Reasons.”
Before you consider cosmetic changes to your smile, ask yourself one question: how's your bite? How your teeth are positioned and aligned doesn't just affect their function — it also affects your appearance. A proper bite is foundational to a beautiful smile — and it deserves your attention first.
Here are 3 important steps for addressing your bite problem on your way to a more attractive smile.
Get an orthodontic evaluation. Only a dentist or orthodontist can determine if your teeth are properly aligned and working well with each other — and if not, why. With their knowledge and expertise they'll be able to tell you what specific bite problem (malocclusion) you have and the best treatment to correct it to support any future cosmetic enhancement.
Consider your tooth-movement options carefully. If you have a malocclusion, your dentist or orthodontist may recommend correction before undertaking other cosmetic work. In most cases, you'll have two choices. The first is traditional metal braces, which uses wires held in place and anchored by brackets cemented to the teeth. They're effective, but must be fixed in place and aren't considered attractive. The other choice is clear aligners, which use custom removable plastic trays worn in sequence to gradually move teeth. They're easier for oral hygiene and are hardly noticeable to others, but may not work in every bite situation.
Don't slack on the retainer phase of treatment. The day will come when the braces or aligners come out of your mouth for good. But your realignment project isn't over — you'll need to wear a retainer appliance for a while. Re-aligned teeth can relapse to their former positions, so it's essential you wear a retainer to keep them where they've been moved. Without a retainer, all the time and effort invested in your bite will have been to no avail.
In a nutshell: get the big picture about your bite, choose the treatment best for you and follow through on every phase. The end result will be a solid platform for the smile you've always dreamed about.
If you would like more information on orthodontic treatments, 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 Magic of Orthodontics: The Original Smile Makeover.”
All treatments for periodontal (gum) disease focus on one goal — to remove any bacterial plaque and calculus (hardened plaque deposits) that are at the heart of the infection. Plaque is a thin surface film of food particles and bacteria that cause gum disease.
Plaque builds up on tooth surfaces due to inadequate oral hygiene. And as the disease progresses brushing and flossing won’t be enough — you’ll need our services and specialized equipment to fully remove the plaque and calculus. The basic technique is called scaling in which we remove plaque and calculus manually from tooth surfaces above and just a few millimeters below the gum line.
As the disease develops, though, the slight natural gap between teeth and gums may begin to increase to form voids known as periodontal pockets. Filled with infection, these pockets can extend below the gum line onto the roots of the tooth. If the pocket extends more than 4 millimeters, basic scaling may not be able to remove all of the plaque and calculus.
Periodontists (dentists who specialize in the treatment and care of gum tissues) can perform a surgical method to access these deeper areas. Known as flap surgery, this procedure aims not only to reach and disinfect periodontal pockets and root surfaces, but also repair damaged gum tissue and create a better environment for future hygiene and treatment.
As the name implies, we create an opening in the gum tissue with one side remaining attached to the gum structure — much like the flap of a paper envelope. Through this opening we’re able to reach areas to remove plaque and calculus, as well as install both bone grafts to regenerate lost bone and growth factors to stimulate tissue growth. Once finished, we stitch the flap back into place with sutures and, in many cases, place a moldable dressing to protect and hold the flap secure while the incision heals.
This relatively minor procedure can be performed with local anesthesia and requires only a few days of recuperation. The results, though, can provide long-term benefits — reduced infection, better bone and gum health, and a more conducive environment for future maintenance of health — that could save your teeth and your smile for many years to come.
If you would like more information on treatments for gum disease, 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 “Periodontal Flap Surgery.”
Your nightly snoring has become a major sleep disturbance for you and other family members. But it may be more than an irritation — it could also be a sign of sleep apnea, a condition that increases your risk for life-threatening illnesses like high blood pressure or heart disease.
Sleep apnea most often occurs when the tongue or other soft tissues block the airway during sleep. The resulting lack of oxygen triggers the brain to wake the body to readjust the airway. This waking may only last a few seconds, but it can occur several times a night. Besides its long-term health effects, this constant waking through the night can result in irritability, drowsiness and brain fog during the day.
One of the best ways to treat sleep apnea is continuous positive airway pressure (CPAP) therapy. This requires an electric pump that supplies constant pressurized air to a face mask worn during sleep to keep the airway open. But although effective, many patients find a CPAP machine clumsy and uncomfortable to wear. That's why you may want to consider an option from your family dentist called oral appliance therapy (OAT).
An OAT device is a custom-made appliance that fits in the mouth like a sports mouthguard or orthodontic retainer. The majority of OAT appliances use tiny metal hinges to move the lower jaw and tongue forward to make the airway larger, thus improving air flow. Another version works by holding the tongue away from the back of the throat, either by holding the tongue forward like a tongue depressor or with a small compartment fitted around the tongue that holds it back with suction.
Before considering an OAT appliance, your dentist may refer you to a sleep specialist to confirm you have sleep apnea through laboratory or home testing. If you do and you meet other criteria, you could benefit from an OAT appliance. There may be other factors to consider, though, so be sure to discuss your options with your dentist or physician to find the right solution for a better night's sleep.
If you would like more information on sleep apnea treatments, 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 “Oral Appliances for Sleep Apnea.”
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