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Our 5 year old patient’s parents were concerned about her loud grinding at night and were asking about what to do so she’s not grinding her teeth away before the adult set comes in. While other dentists or pediatricians may say bruxism or teeth grinding is “normal” and that their child will eventually grow out of it, it is not normal and is actually a sign of an underlying airway disorder. Teeth grinding is the body’s physiological response to an airway problem and is considered sleep disordered breathing or (SDB). With SDB, airflow is interrupted and oxygen levels drop, and the body’s response is grinding or clenching their teeth to help open up the airway. Once the teeth are ground down, this can further lead to TMJ issues down the line which can be extremely painful. The main point is to intervene with a myofunctional appliance before this even has a chance to occur. The myofunctional appliance promotes the natural growth and development of the upper and lower jaws to promote nasal breathing, as well as expanding the airway and straightening teeth. As the jaw and airway develop, symptoms of SDB disappear. With an adequate airway, the body gets the oxygen it needs to help kids grow to their full potential. Myofunctional appliances not only address the root cause of SDB, they simultaneously straighten your child’s teeth (no need for braces!). Appliances help expand the arch to allow for proper spacing for adult teeth to grow in, while guiding the adult teeth to grow straight. Think of this as an interceptive appliance to straighten teeth, as opposed to braces doing the work after the teeth already grew in crooked.
“I like that smile better!” The patient was a great candidate to start wearing a myofunctional appliance to address her grinding. She looks forward to her dental appointments, and immediately points out which smile she likes better. The patient and her parents are ecstatic with her results after only 3 months. As seen in her pictures, her upper teeth almost completely covered her bottom teeth. Her jaw was also visibly shifted back, decreasing her airway space, and causing a crease to develop above her chin. After only 3 months, her jaw positioning and teeth positioning are ideal, the crease above her chin has disappeared, and the patient is thrilled with her new smile. Her facial development is apparent after having started treatment.
Pictures posted with permission from patient's Mom. :)
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 What's up, family? Just wanted to post another fun Invisalign case that is currently IN-PROGRESS! This orthodontic case is described as "Class 3 Malocclusion" - meaning this patient has an underbite, meaning his bottom teeth protrude ahead of his top teeth. A normal "Class 1" position (in basic terms) would have the upper front teeth slightly forward of the lower front teeth. POSITIVE FACTORS IN THIS CASE: This patient is a teenager, so that gives me more confidence that his teeth can move more easily. The older you are, the more SLOWLY teeth will move, which makes orthodontics a bit trickier. He is also extremely responsible - he follows all of our orthodontic rules, wears his appliances and his orthodontic elastics, which help to pull the lower teeth back.  This patient was prescribed Class 3 elastics. These are small but stretchy rubber bands that hook onto the aligners. This is considered an adjunct treatment to Invisalign, since aligners by themselves will NOT be able to correct this much of an underbite. Therefore, Class 3 elastics wearing is MANDATORY! To ensure enough wear time, this patient was required to wear the aligners plus elastics on his left and right for 20-22 hours per day, over a two week period for EACH TRAY. This is crucial to get the teeth to move as efficiently and predictably as possible.
After just 9 months of devoted aligner plus elastics wear, his underbite is already corrected! This case is not yet finished, however we simply could not wait to show off this patient's progress.
Remember: the key to successful Invisalign orthodontic treatment is to follow all the rules! Wear your aligners for the mandatory 20-22 hours per day, switch aligners as directed, use your elastics if they are prescribed, make each and every appointment time, and don't lose any aligners! HAVE A GREAT DAY AND SMILE! :)  "Please don't judge me, I haven't seen a dentist in many years!" This is a common quote we hear from many patients who come through our doors. My usual reply is that we never judge! Instead, we are thinking of many different ways we can to address your concerns and how we can help you smile your best. This case was so fun to restore. The story is that this kind patient (teeth pictured above) lost one of his front teeth, which was now being stabilized by a cantilever bridge supported by stainless steel window. Usually this is a temporary solution for a missing tooth, however the stainless steel had lasted over a decade! This patient was finally ready to replace it with a brand new bridge, as he disliked the esthetics (as you might guess!). One of the important factors for this case was that it was front teeth we were dealing with - we need careful treatment planning and prosthodontics, since one wrong move will completely ruin a smile! So we took careful models (lower left photo) along with fabricating a life-like temporary bridge (lower right photo) as we created his porcelain bridge.
We cemented the bridge to the patient's delight! He and his wife were very happy with the final result! 
There could be several reasons for this appearance. The first of which is the material of the crown. Many caps or crowns are made of porcelain fused to a metal base. The porcelain is designed to mimic natural teeth, however it is layered on top of metal for better strength and support. When there is gum recession, some of the metal layer can be exposed and appears as a dark line along the gum line. Another reason for the dark line could be if the tooth previously had trauma or a root canal done before getting the crown done and gum recession exposed some of the natural tooth. The natural tooth under the crown may be discolored, however this does not always indicate the presence of decay or a cavity. A clinical exam would need to be done to determine the health of the tooth structure under the crown. Lastly, the black line could be decay or a cavity. Although the cap is a false tooth to cover the natural tooth, it does not mean the natural tooth will be immune to cavities. With proper home care (brushing twice a day, flossing once a day) and regular check up visits (at least every 6 months), patients with crowns can ensure their longevity. Some patients will complain of bad breath or halitosis around their old crowns. Indeed bacteria and decay trapped under crowns needing to be replaced will cause an odorous breath. At our office, while porcelain/metal crowns are sometimes indicated, almost 99% of our crowns are made of zirconia, porcelain, or ceramic. With today’s technology, these materials can be very strong, eliminating the need for a metal base. This will also make sure you won’t get the dark metal color showing through around the gum line. With our office’s 3D scan technology (our office loves to keep up with the newest technology), when indicated, we can match a new crown to a previous tooth’s look so your retainer will still fit and your bite will feel just like your old tooth! Take a look at the pictures below to see what may be hiding under old crowns that are due to be replaced.  This particular crown (porcelain fused to metal base) served our patient almost 20 years, which is about 20,000 meals! It was finally time for an upgrade to a brand new zirconia crown. Hopefully our patient can get another 20,000 meals out of the new one.   After the old cap is removed, all the decay is removed, and adequately built back up with a build-up filling to fill in all the gaps where decay was. The build-up filling will also protect the nerve inside the tooth if it is alive, or protect the root canal treatment which was done. Then we do a 3D scan of the natural tooth so a brand new custom made crown can be made.   Our dental lab was given instructions to match the patient's new tooth to their old tooth (to fit their retainer) using the 3D scan seen above.
The final crown restoration will be uploaded after our patient comes back in for its cementation!
Our very compliant patient's results after 6 months of wearing her myofunctional appliance. Myofunctional therapy/myofunctional appliance wear is a minimally invasive, and more holistic approach to treating children with maloccolusion (misalignment of teeth like crowding or excessive spacing) in the dental office. It is used to treat patients who are mouth breathers, have a tongue thrust, thumb sucking habits, or other tongue or cheek muscle habits. These are known as incorrect myofunctional habits. A few symptoms of incorrect myofunctional habits are snoring and teeth grinding during sleep. Myofunctional therapy can be used to treat the cause of these symptoms.
A myofunctional appliance is an alternative to braces, which is less expensive, and less painful. More importantly, not only does this treatment straighten teeth, it also helps your child’s face develop to its full potential. This type of treatment is aimed to treat the cause of malocclusion and jaw development, rather than the symptoms (as traditional orthodontics do). While braces/Invisalign can straighten teeth, if the initial cause of the malocclusion is not addressed, the patient’s teeth will relapse back to their maloccclusion. The earlier a child begins treatment to address the causes of malocclusion, the better retention they will have of their straight teeth and the more successful their treatment will be. A tell tale sign of incorrect myofunctional habits is the pediatric patient with bags under their eyes. This indicates a mid-face deficiency and lack of growth. The presence of under eye bags, or venous drainage, is due to the cheek bones failing to grow forward. They instead grow down and back, leading to a "long-face" appearance. This development also acts to narrow the airway, which leads to snoring and teeth grinding. The earlier incorrect myofunctional habits are corrected, the less problems the patient will have later in life. By age 5, majority of children in the US will already show signs of malocclusion and the need for orthodontic treatment. By age 14, 90% of facial development is complete. Though orthodontics can still make the teeth look straight, it cannot significantly change the shape of the face as myofunctional therapy would. Give our office a call to see if your child would be a good candidate for myofunctional therapy.
Typical appearance in snoring/grinding little patients: chipped teeth or sharp and jagged edges from grinding, crowding/tight teeth which leads to the patient being more cavity prone (as seen on the bottom front), deep bite appearance in which the top teeth almost completely cover the bottom teeth, and an under-developed lower jaw. In crowding cases like this, we can start treatment when they are as young as 4 years old. We absolutely can! Our dentists are able to perform an exam to determine if your child would be a good candidate for a myofunctional appliance. Proper appliance wear would help treat the cause of the snoring and grinding symptoms. Your child would get a good nights sleep, while also protecting their precious first set of teeth and promoting proper facial development.
Snoring and grinding are tell tale signs of sleep disordered breathing or improper nasal breathing (mouth breathing). When the patient’s airway is narrow, they will breathe predominantly through the mouth rather than through the nose. It is also a sign of poor facial development. Many children breathe through their mouths. Mouth breathing exposes the tonsils to toxins, allergens, and pollutants and can stress out the nervous system. Mouth breathing also disrupts the feedback to the upper jaw, leading to the downward, backward growth pattern seen in long-faced children with eye bags. Conversely, nasal breathing cleans, warms and humidifies the air and causes a relaxation response. Myofunctional therapy can be used to open the airway by posturing the jaw and tongue positioning. This treatment helps regulate the airway and allow adequate oxygen flow and proper growth and development of the jaws and facial structure.  Since the lockdown order of March 2020 due to the COVID-19 pandemic, there has been a significant increase in grinding and clenching teeth nationwide. These behaviors are related to stress. At our office, we have been prescribing nightguards for patients who were never diagnosed as grinders/clenchers before. Our patients who already had nightguards have ground right through them and have needed replacements.
Many of our patients have started coming in with symptoms of grinding/clenching such as sore jaw in the morning, headaches, tightness in the jaw/temples, ear aches, tender teeth when biting, chipped teeth/fillings/crowns, torn up inside of the cheeks from cheek biting, sensitivity to cold/sour. It is important to protect your teeth, because it's the only set you've got! If anyone has told you they have heard you grinding your teeth at night, or if you are experiences any of the above symptoms, it is important that you get fitted for a nightguard. We do not recommend any OTC/DIY nightguards, and have seen negative results from patients who have gone that route. Some patients have noticed their teeth moving or becoming wiggly from ill-fitting nightguards, or appliances that are not equilibrated to the opposing teeth. This can lead to tooth mobility, trauma, and potentially tooth devitalization or tooth loss. At your next appointment, let your dentist know if you think you may be grinding/clenching your teeth.  What is an immediate denture? When a patient has many teeth that are non-restorable and require removal, this type of denture can be placed IMMEDIATELY after extraction of the teeth. This means that the patient will not have to leave the office with teeth missing. This is in contrast to removing teeth, waiting 4-6 months for bone healing and stabilization, followed by denture fabrication. Advantage: Your new teeth are ready on the day of surgery, and you may eat with it - simpler, smaller foods at first Disadvantage: The bone is healing underneath and is changing its anatomy following surgery, which may affect the fit of the denture over time. The patient above is an 81-year old with extensive history of smoking and poor hygiene. His lower teeth have been compromised by severe periodontitis (gum disease) and gross caries (cavities). He already has an upper complete denture. The prognosis of the lower teeth is deemed NON-RESTORABLE. Recommended treatment is full lower teeth extraction in conjunction with a lower immediate denture.  Impressions of his upper and lower jaw were taken, which are sent to our dental laboratory. They then create stone models of his dentition.  The lab creates a try-in denture, in which some of the teeth are set in wax and acrylic to try in the patient's mouth and confirm fit. This try-in denture fit the patient's upper teeth and his bite perfectly.  After confirming the fit of the try-in denture, the lab removes all teeth on the stone model, which simulates the planned tooth removal. They set the REMAINING teeth onto the denture and fabricate the FINAL denture to be delivered on surgery day.  Surgery day. After extracting all the non-restorable teeth, the lower immediate denture is immediately placed. This patient will leave our office with a full set of teeth!  Post-operative instructions:
1. Sleep with the denture in place to compress the surgery site and help with healing/recovery 2. NO SMOKING FOR AT LEAST 3 DAYS - to prevent dry socket formation and reduce chance of infection 3. Eat soft, simple foods that are easy to consume, like soup or mashed vegetables 4. Sore, painful spots may develop, like a new pair of shoes that are too tight. Continue to use the denture so that a sore spot becomes visible; your dentist will now know exactly where to adjust the tight spot 5. It takes practice getting comfortable with your denture. Practice speaking and eating so your mouth and tongue can adjust  As most of us know, we are born with baby (primary) teeth, which give way for our adult (permanent) teeth. This is how the tooth fairy stays in business when parents put their kids' baby teeth under the pillow! However, what most parents need to know are that baby teeth are important placeholders for the adult teeth. Baby teeth shouldn't fall out (exfoliate) at ANY time, they need to fall out at SPECIFIC times to allow the adult teeth to grow and emerge (erupt) from the gums properly.  As stated above, baby teeth maintain the space required to allow the adult teeth enough room to grow. This is why spacing between baby teeth is great, since adult teeth are bigger and need space to enter. However, sometimes baby teeth exfoliate earlier than expected. There is a genetic component, as well as hygiene and diet component.  This patient is a 6-year old who lost his 2nd primary molar unexpectedly, leaving a large gap. As the chart above shows, this tooth should not exfoliate until he is at least 10 years old! Because he is still growing, his bone and teeth are constantly changing and moving, which means the big permanent 1st molar in the back (his adult tooth) is going to tip forward and close the gap. Why is this bad? It means the permanent 2nd premolar will be blocked underneath because there won't be enough room to grow. He will have orthodontic problems as he ages if the tooth remains blocked.  What should parents do when this happens? Timing is everything. The adult tooth will immediately start to close the gap, so children need to see the dentist ASAP.
In this case, we placed a device called a space maintainer - it maintains the gap to stop the tooth from tipping and allows space for the permanent tooth to grow. We cemented this device with a blue orthodontic cement for ease of visibility. This device can be removed when the permanent tooth below erupts, or when the baby tooth itself exfoliates in the future. TIP FOR PARENTS: Please keep an eye on your child's teeth! Early intervention in their dental health means a more beautiful, healthier smile as they grow!  Happy new year!
As we move along into this new year, we feel it's important for everyone to follow through on their new year's resolutions. Exercising more, eating more vegetables, more vacations - these are all great ideas. But let's not forget about our teeth! Here are some new year's resolutions for a healthier mouth and a greater smile: 1. Brushing and flossing DAILY!
2. Less sugary food and drinks
3. Cut down on smoking
4. Improving your smile
Good luck on all of your resolutions! We hope this is the best year ever for you! |
Photo used under Creative Commons from Michael Dunn~!
