Posts for: December, 2019
Every year many parents learn their “tweenager” or teenager needs their bite corrected, often with specialized orthodontics. Imagine, though, if these families could go back in time to when their child’s poor bite was just developing to stop or slow it from forming.
Time travel may still be science fiction, but the approach suggested isn’t. It’s called interceptive orthodontics, a group of techniques and procedures performed during the early stages of jaw development. The focus is usually on getting abnormal jaw growth back on track, enough so that a poor bite won’t form.
The upper jaw, for example, may be growing too narrow, reducing the amount of available space for tooth eruption. If it isn’t corrected, teeth can erupt out of position. To correct it, an orthodontist places a palatal expander in the roof of the child’s mouth (palate). The appliance applies gentle pressure against the inside of the teeth, which stimulates the jaws to develop wider.
The expander works because of a separation in the bones at the center of the palate, which later fuse around puberty. The pressure applied from the expander keeps this gap slightly open; the body then continues to fill the widening expansion with bone, enough over time to widen the jaw. If you wait until puberty, the gap has already fused, and it would have to be reopened surgically to use this technique. Ideally, then, a palatal expander should be employed at a young age.
Not all interceptive techniques are this extensive—some, like a space maintainer, are quite simple. If a primary (baby) tooth is lost prematurely, teeth next to the empty space tend to drift into it and cause the intended permanent tooth to erupt out of place due to a lack of space. To prevent this an orthodontist places a small wire loop within the space to prevent other teeth from moving into it.
These are but two examples of the many methods for stopping or slowing a developing bite problem. To achieve the best outcome, they need to be well-timed. Be sure, then, to have your child undergo an orthodontic evaluation around age 6. If an interceptive orthodontic approach is needed, it could eliminate the need for more extensive—and expensive—treatment later.
Osteoporosis is a major health condition affecting millions of people, mostly women over 50. The disease weakens bone strength to the point that a minor fall or even coughing can result in broken bones. And, in an effort to treat it, some patients might find themselves at higher risk of complications during invasive dental procedures.
Over the years a number of drugs have been used to slow the disease’s progression and help the bone resist fracturing. Two of the most common kinds are bisphosphonates (Fosamax) and RANKL inhibitors (Prolia). They work by eliminating certain bone cells called osteoclasts, which normally break down and eliminate older bone cells to make way for newer cells created by osteoblasts.
By reducing the osteoclast cells, older bone cells live longer, which can reduce the weakening of the bone short-term. But these older cells, which normally wouldn’t survive as long, tend to become brittle and fragile after a few years of taking these drugs.
This may even cause the bone itself to begin dying, a relatively rare condition called osteonecrosis. Besides the femur in the leg, the bone most susceptible to osteonecrosis is the jawbone. This could create complications during oral procedures like jaw surgery or tooth extractions.
For this reason, doctors recommend reevaluating the need for these types of medications after 3-5 years. Dentists further recommend, in conjunction with the physician treating osteoporosis, that a patient take a “drug holiday” from either of these two medications for several months before and after any planned oral surgery or invasive dental procedure.
If you have osteoporosis, you may also want to consider alternatives to bisphosphonates and RANKL inhibitors. New drugs like raloxifene (which may also decrease the risk of breast cancer) and teriparatide work differently than the two more common drugs and may avoid their side effects. Taking supplements of Vitamin D and calcium may also improve bone health. If your physician still recommends bisphosphonates, you might discuss newer versions of the drugs that pose less risk of osteonecrosis.
Managing osteoporosis is often a balancing act between alleviating symptoms of the disease and protecting other aspects of your health. Finding that balance may help you avoid future problems, especially to your dental health.
If you would like more information on osteoporosis and 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 “Osteoporosis Drugs & Dental Treatment.”
When a woman learns she's pregnant, her first thought is often to do everything possible to protect the new life inside her. That may mean making lifestyle changes like avoiding alcohol or quitting smoking.
Some women may also become concerned that their regular dental visits could pose a risk to their baby. But both the American Congress of Obstetricians and Gynecologists and the American Dental Association say it's safe for pregnant women to undergo dental exams and cleanings—in fact, they're particularly important during pregnancy.
That's because pregnant women are more susceptible to dental infections, particularly periodontal (gum) disease, because of hormonal changes during pregnancy. The most common, occurring in about 40% of expectant mothers, is a form of gum disease known as pregnancy gingivitis. Women usually encounter this infection that leaves the gums tender, swollen and easy to bleed between the second and eighth month of pregnancy.
Untreated, pregnancy gingivitis could potentially advance below the gum line and infect the roots. It could also have an unhealthy effect on the baby: some studies show women with severe gum disease are more prone to give birth to premature or underweight babies than women with healthy gums.
But it can be stopped effectively, especially if it's treated early. Regular dental checkups and cleanings (at least every six months or more frequently if your dentist recommends) can help an expectant mother stay ahead of a developing gum infection.
With that said, though, your dentist's approach to your care may change somewhat during pregnancy. While there's little concern over essential procedures like gum disease treatment or root canal therapy, elective restorations that are cosmetic in nature might best be postponed until after the baby's birth.
So, if you've just found out you're pregnant, let your dentist know so they can adjust your care depending on your condition and history. And don't be concerned about keeping up your regular dental visits—it's a great thing to do for both you and your baby.
If you would like more information on dental care during pregnancy, 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 Care During Pregnancy: Maintaining Good Oral Hygiene Is More Important Than Ever.”