My Blog
By Elizabeth DeAguirre DDS
January 23, 2022
Category: Dental Procedures
RemovingTeethCouldAidOrthodonticTreatment

There's usually more to straightening a smile than simply applying braces. That's why an orthodontist takes the time first to learn all they can about a patient's bite and, depending on what they find, take other actions before treating with braces or clear aligners. One such action might be removing one or more teeth.

That might at first seem out of place with our intended goal of straightening teeth. But there are situations where subtracting teeth can benefit bite correction. Here are a few scenarios where a dental extraction might be necessary before orthodontics.

Crowding. When a jaw is failing to grow to a normal width, teeth erupting later may not have sufficient room and thus come in misaligned. It's possible to help widen the jaw during early growth development through a device called a palatal expander, but it's best attempted before puberty. Later, it may be easier to open up more room for tooth movement on a crowded jaw by removing select teeth.

Impacted teeth. Impaction occurs when a tooth doesn't properly erupt and remains totally or partially submerged below the gum line. Although in some situations we may be able to coax an impacted tooth down onto the jaw, it may be easier to extract it, along with the matching tooth on the other side of the jaw for balance. We can then move the teeth or use other restorations to close the gap.

Jaw abnormalities.  A bite problem may in reality be a jaw problem: For example, a lower jaw set too far back may not be aligning properly with the upper jaw causing the bite to skew. Jaw surgery could correct this alignment, but those procedures can be highly invasive. An alternative is to remove a couple of select upper teeth, then use braces to move the remaining teeth back. This can result in a less noticeable overbite.

Orthodontics not only enhances your appearance, it can also a improve your oral health. Extracting one or more teeth may be a necessary prerequisite to straightening your smile.

If you would like more information about straightening a 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 “Removing Teeth for Orthodontic Treatment.”

By Elizabeth DeAguirre DDS
January 13, 2022
Category: Dental Procedures
Tags: celebrity smiles   crown  
WhatChrissyTeigensInaugurationNightCapMishapCouldMeanForYou

Inauguration night is usually a lavish, Washington, D.C., affair with hundreds attending inaugural balls throughout the city. And when you're an A-List celebrity whose husband is a headliner at one of the events, it's sure to be a memorable night. As it was for super model Chrissy Teigen—but for a slightly different reason. During the festivities in January, Teigen lost a tooth.

Actually, it was a crown, but once she told a Twitter follower that she loved it “like he was a real tooth.” The incident happened while she was snacking on a Fruit Roll-Up (those sticky devils!), and for a while there, husband and performer John Legend had to yield center stage to the forlorn cap.

But here's something to consider: If not for the roll-up (and Teigen's tweets on the accident) all of us except Teigen, her dentist and her inner circle, would never have known she had a capped tooth. That's because today's porcelain crowns are altogether life-like. You don't have to sacrifice appearance to protect a tooth, especially one that's visible when you smile (in the “Smile Zone”).

It wasn't always like that. Although there have been tooth-colored materials for decades, they weren't as durable as the crown of choice for most of the 20th Century, one made of metal. But while gold or silver crowns held up well against the daily grind of biting forces, their metallic appearance was anything but tooth-like.

Later, dentists developed a hybrid of sorts—a metal crown fused within a tooth-colored porcelain shell. These PFM (porcelain-fused-to-metal) crowns offered both strength and a life-like appearance. They were so effective on both counts that PFMs were the most widely used crowns by dentists until the early 2000s.

But PFMs today make up only 40% of currently placed crowns, down from a high of 83% in 2005. What dethroned them? The all-ceramic porcelain crown—but composed of different materials from years past. Today's all-ceramic crowns are made of more durable materials like lithium disilicate or zirconium oxide (the strongest known porcelain) that make them nearly as strong as metal or PFM crowns.

What's more, coupled with advanced techniques to produce them, all-ceramic crowns are incredibly life-like. You may still need a traditional crown on a back tooth where biting forces are much higher and visibility isn't an issue. But for a tooth in the “Smile Zone”, an all-ceramic crown is more than suitable.

If you need a new crown (hopefully not by way of a sticky snack) or you want to upgrade your existing dental work, see us for a complete exam. A modern all-ceramic crown can protect your tooth and enhance your smile.

If you would like more information about crowns or other kinds of dental work, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Crowns & Veneers.”

By Elizabeth DeAguirre DDS
January 03, 2022
Category: Dental Procedures
Tags: wisdom teeth  
DecidingtheFateofWisdomTeethMoreNuancedThaninthePast

If you're of a certain age, there's a good chance you've had your third molars—wisdom teeth—removed. At one time, extracting these particular teeth was a common practice, even if they hadn't shown any signs or symptoms of disease or dysfunction. But now, if you have a son or daughter coming of age, your dentist may recommend leaving theirs right where they are.

So, what's changed?

Wisdom teeth have longed been viewed as problematic. As the last of the permanent teeth, they often erupt on a jaw already crowded with other teeth. This can cause them to come in out of position—or not at all, remaining partially or totally submerged (impacted) beneath the gums.

Misaligned teeth are more difficult to keep clean of bacterial plaque, which in turn raises the risk of tooth decay or gum disease. Impacted teeth can put pressure on the roots of neighboring teeth, which further increases the risk for disease or bite problems.

To avoid these common problems associated with wisdom teeth, dentists often remove them as a preemptive measure. Given their size and possible root complexity, this is no small matter: Removing them usually requires oral surgery, making wisdom teeth extraction one of the top oral surgical procedures performed each year.

Today, however, many dentists are taking a more nuanced approach to wisdom teeth. While they still recommend removal for those displaying signs of disease or other problems, they may advise leaving them in place if the teeth are healthy, not interfering with their neighbors, and not affecting bite development.

That's not necessarily a final decision, especially with younger patients. The dentist will continue to monitor the wisdom teeth for any emerging disease or problems, and may put extraction back on the table if the situation merits it.

The key is to consider each patient and their dental needs regarding wisdom teeth on an individual basis. If warranted, removing the wisdom teeth may still be warranted if will help prevent disease, keep bite development on track and optimize oral health overall.

If you would like more information on wisdom 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 “Wisdom Teeth: Coming of Age May Come With a Dilemma.”

By Elizabeth DeAguirre DDS
December 24, 2021
Category: Dental Procedures
Tags: dental implants  
DoYouHaveEnoughSupportingBoneforanImplant

Upgrades can be exciting—moving on to a larger house, the latest smartphone, or maybe a new car. And, the same can apply with tooth replacements: Maybe you're ready now to upgrade your existing restoration to a dental implant, the most advanced tooth replacement method now available.

But you might encounter a speed bump in your plans: whether or not you have enough bone available for an implant. Here's why your bone may not be adequate.

Like any other cellular tissue, bone has a life cycle: older cells die and newer cells form to take their place. This process stays on track because of the forces generated when we chew, which stimulates new growth.

But that stimulus disappears when a tooth goes missing. This slows the bone growth cycle to the point that bone volume can gradually dwindle. You could in fact lose up to a quarter of bone width in just the first year after losing a tooth.

And, you'll need adequate bone to provide your implants with sufficient strength and stability, as well as the best possible appearance alongside your other teeth. If you don't have enough bone, we must either enhance its current volume or opt for a different restoration.

Fortunately, we may be able to do the former through bone augmentation or grafting. With this method, we place a graft of bone tissue in the area we wish to regenerate. The graft becomes a scaffold upon which new bone cells build upon. It's possible for grafting to produce up to 5 mm in additional width and 3 mm in height to supporting bone.

We can also use this method to prevent bone loss by placing a graft immediately following a tooth extraction. Some studies show the graft can help preserve bone up to 10 years, giving patients time to consider or prepare for a dental implant.

 There are circumstances, though, where bone loss has been too extensive to make up enough ground to place an implant. If so, there are other effective and life-like restorations to replace missing teeth. But there's still a good chance augmentation can restore the bone you need for a new smile with dental implants.

If you would like more information on dental implant restorations, 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 “Dental Implants After Previous Tooth Loss.”

By Elizabeth DeAguirre DDS
December 14, 2021
Category: Oral Health
Tags: sleep apnea  
YourDentistMayBeAbleToProvideYouWithaSleepApneaSolution

Morning tiredness, brain fog and snoring are just some of the indicators of a medical condition known as sleep apnea. And, it's worse than waking up on the wrong side of the bed—over time, sleep apnea could increase your risk for heart disease or other life-threatening conditions.

Sleep apnea occurs when air flow becomes restricted during sleep, usually by the tongue blocking the airway. As oxygen levels begin to fall, the brain signals the body to wake up to "fix" the air flow problem.

As this arousal may only last a second or two, you may not remember it when you awaken in the morning. But it can happen numerous times a night, depriving you of the deep sleep your body needs for rest and repair.

Fortunately, there are ways to treat sleep apnea. In extreme instances, you may need surgery to correct anatomical defects causing the condition. For most cases, though, the most common treatment is continuous positive airway pressure (CPAP) therapy, which consists of a portable pump delivering pressurized air through a face mask that keeps the throat open while you sleep.

Used by millions of patients, CPAP can be quite effective. Some patients, though, feel uncomfortable using a CPAP machine for various reasons. If you're one of those unhappy CPAP campers or you would like to consider a possible alternative, your dentist might have the answer: oral appliance therapy (OAT).

An OAT device is worn in the mouth during sleep to prevent the tongue from falling back against the back of the throat and blocking the airway. There are various forms of OAT appliances, but they're all custom-made by a dentist to fit an individual patient's mouth. They work best for mild to moderate sleep apnea in which the tongue is the primary culprit in airway blockage.

If you suspect you may have sleep apnea, you should undergo a complete examination by a doctor or dentist to confirm it. If you've been diagnosed with mild to moderate sleep apnea, talk to your dentist about an OAT device. You may find OAT can provide you the relief you need for a better night's sleep.

If you would like more information on oral treatments for sleep apnea, 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 “If You Snore, You Must Read More!





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