For a predictable outcome, a dental implant should be placed as soon as the bone and gum tissues following a tooth extraction have healed. But what happens if the tooth has been missing for months or years? You might then run the risk of not having enough bone to properly place an implant.
This can happen because of a disruption in the growth cycle of living bone tissue. As older bone cells dissolve (resorption), new bone develops to take its place. This is a dynamic process, as the amount and exact location of the new growth is in response to changes in the mouth, particularly from forces generated by the teeth as we chew. If, however, this stimulation transmitted to the bone no longer occurs because the tooth is missing, the bone will tend to dissolve over time.
In fact, within the first year after a tooth loss the associated bone can lose as much as a quarter of its normal width. This is why we typically place bone grafting material in an empty socket at the same time as we extract the tooth. This encourages bone growth during the healing period in anticipation of installing a dental implant or a fixed bridge. If, however, the bone has diminished to less than required for a dental implant, we must then use techniques to encourage new bone growth to support a future implant.
One such technique for restoring bone in the back of the upper jaw is to surgically access the area through the maxillary sinus (a membrane-lined air space within the bone structure of the face) positioned just over the jawbone to place grafting material. During surgery performed usually with local anesthesia, the surgeon accesses the sinus cavity, lifts the tissue membrane up from the sinus floor and applies the grafting material on top of the bone. Eventually, the new bone growth will replace the grafting material.
If successful, the new bone growth will be sufficient to support an implant. Thanks to this renewed growth, you’ll soon be able to enjoy better function and a transformed smile provided by your new implant.
If you would like more information on forming new bone for implants through sinus surgery, 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 “Sinus Surgery.”
Watching your newborn develop into a toddler, then an elementary schooler, a teenager, and finally an adult is one of the most exciting and rewarding experiences there is. Throughout the years, you’ll note the passing of many physical milestones — including changes that involve the coming and going of primary and permanent teeth. Here are some answers to frequently asked questions about children’s dental development.
When will I see my baby’s first tooth come in?
The two lower front teeth usually erupt (emerge from the gums) together, between the ages of 6 and 10 months. But your baby’s teeth may come earlier or later. Some babies are even born with teeth! You will know the first tooth is about to come in if you see signs of teething, such as irritability and a lot of drooling. The last of the 20 baby teeth to come in are the 2-year molars, so named for the age at which they erupt.
When do kids start to lose their baby teeth?
Baby teeth are generally lost in the same order in which they appeared, starting with the lower front teeth around age 6. Children will continue to lose their primary teeth until around age 12.
What makes baby teeth fall out?
Pressure from the emerging permanent tooth below the gum will cause the roots of the baby tooth to break down or “resorb” little by little. As more of the root structure disappears, the primary tooth loses its anchorage in the jawbone and falls out.
When will I know if my child needs braces?
Bite problems (malocclusions) usually become apparent when a child has a mixture of primary and permanent teeth, around age 6-8. Certain malocclusions are easier to treat while a child’s jaw is still growing, before puberty is reached. Using appliances designed for this purpose, orthodontists can actually influence the growth and development of a child’s jaw — to make more room for crowded teeth, for example. We can discuss interceptive orthodontics more fully with you at your child’s next appointment.
When do wisdom teeth come in and why do they cause problems?
Wisdom teeth (also called third molars) usually come in between the ages of 17 and 25. By that time, there may not be enough room in the jaw to accommodate them — or they may be positioned to come in at an angle instead of vertically. Either of these situations can cause them to push against the roots of a neighboring tooth and become trapped beneath the gum, which is known as impaction. An impacted wisdom tooth may lead to an infection or damage to adjacent healthy teeth. That it is why it is important for developing wisdom teeth to be monitored regularly at the dental office.
If you have additional questions about your child’s dental development, please contact us or schedule a consultation. You can also learn more by reading the Dear Doctor magazine articles “Losing a Baby Tooth” and “The Importance of Baby Teeth.”
While it's possible for a teenager to lose a tooth from decay, it's more common they'll lose one from an accidental knockout. If that happens to your teenager, there are some things you should know to achieve a good outcome.
Our top concern is to preserve the underlying bone following tooth loss. Like other tissues, bone has a life cycle: older cells dissolve and are absorbed by the body (resorption), then replaced by new cells. The biting pressure generated when we chew helps stimulate this growth. But bone around a missing tooth lacks this stimulation and may not keep up with resorption at a healthy rate.
This can cause a person to lose some of the bone around an empty tooth socket. To counteract this, we may place a bone graft at the site. Made of bone minerals, usually from a donor, the graft serves as a scaffold for new bone growth. By preventing significant bone loss we can better ensure success with a future restoration.
Because of its lifelikeness, functionality and durability, dental implants are considered the best of the restoration options that can be considered to replace a missing tooth. But placing an implant during the teen years is problematic because the jaws are still growing. If we place an implant prematurely it will appear to be out of alignment when the jaw fully matures. Better to wait until the jaw finishes development in early adulthood.
In the meantime, there are a couple of temporary options that work well for teens: a removable partial denture (RFP) or a fixed modified bridge. The latter is similar to bridges made for adults, but uses tabs of dental material that bond a prosthetic (false) tooth to the adjacent natural teeth to hold it in place. This alleviates the need to permanently alter the adjacent natural teeth and buy time so that the implant can be placed after growth and development has finished.
And no need to worry about postponing orthodontic treatment in the event of a tooth loss. In most cases we can go ahead with treatment, and may even be able to incorporate a prosthetic tooth into the braces or clear aligners.
It's always unfortunate to lose a tooth, especially from a sudden accident. The good news, though, is that with proper care and attention we can restore your teenager's smile.
If you would like more information on how to treat lost teeth in teenagers, 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 for Teenagers.”
There are instances when a general dentist will remove (extract) a problem tooth. At other times, though, the same dentist may refer a patient needing an extraction to an oral surgeon. Why the difference?
The procedure performed by a general dentist is referred to as a “simple tooth extraction.” “Simple” doesn’t mean easy and requiring no skill or expertise — it certainly does. In this case, the term refers to the anatomy of the tooth being extracted, particularly its roots.
Teeth that respond well in a simple extraction have an uncomplicated root system. The path of removal, usually with a single root involved, is fairly straight and without extreme angles. In the hands of a skilled and experienced dentist, it can be removed with little to no discomfort.
Dentists actually must use finesse to remove a tooth from its socket. The tooth is held in place with tiny collagen fibers that extend from a tough, elastic gum tissue known as the periodontal ligament, which lies between the teeth and the bone. With some manipulation, a dentist can loosen these fibers, which then makes removing the tooth much easier. All of this can usually be performed with local anesthesia.
Of course, to determine if a tooth can be removed this way, we must conduct a thorough dental examination first, including x-ray imaging to determine the exact nature and location of the roots. If the exam reveals the root system is more complex, or that there are defects to the bone or the tooth that could make a simple extraction difficult (resulting, for example, in not removing the crown and root in one piece), then the tooth may need to be removed surgically.
Such situations require the skill and resources of an oral surgeon. These specialists perform a number of surgical procedures related to the mouth and face; as procedures go, extraction is among the most routine. Using local anesthesia and post-operative pain management, undergoing a surgical extraction involves only minimal discomfort and a very short recovery time.
After examining your tooth we’ll recommend the best course for extraction, whether simple or surgical. In either case, we’ll see that your problem tooth is extracted as efficiently and painlessly as possible.
If you would like more information on tooth extractions, please contact us today to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Simple Tooth Extraction?”
Perhaps you haven’t thought of it quite this way, but saliva is one of the true wonders of the human body. This unassuming fluid performs a variety of tasks to aid digestion and help protect your mouth from disease. And you hardly notice it — except when it’s not there.
That’s the case for millions of people in America who have a chronic condition called xerostomia or “dry mouth.” This happens when the salivary glands don’t secrete enough saliva, normally two to four pints daily.
Of course, we can experience mouth dryness when we first wake up (saliva flow ebbs while we sleep), feel stressed, use tobacco, or consume alcohol and certain foods like onions or spices. It becomes a problem, though, when periods of low saliva become chronic. Without its preventive capabilities, you’ll be at much higher risk for dental diseases like tooth decay or periodontal (gum) disease.
Chronic dry mouth can occur for various reasons: systemic diseases like cancer or autoimmune deficiencies can cause it, as well as radiation or chemotherapy treatments. One of the most common causes, though, is medication, both over-the-counter and prescription. The surgeon general identifies over 500 known drugs that may inhibit saliva production, including some antihistamines, diuretics and antidepressants. It’s often why older people who take more medications than younger people suffer more as a population from dry mouth.
Because of its long-term health effects, it’s important to try to boost saliva flow. If your mouth is consistently dry, try to drink more fluids during the day. If you suspect your medication, see if your physician can prescribe a different drug. It also helps to drink a little water before and after taking oral medication.
We may also recommend medication or other substances that stimulate saliva or temporarily substitute for it. Xylitol, a natural alcohol sugar that also inhibits bacterial growth, can help relieve dryness. You’ll often find it in gums or mints.
Chronic dry mouth is more than a minor irritation — it can lead to more serious conditions. In addition to these tips, be sure to also keep up your regular dental visits and maintain a daily schedule of oral hygiene to prevent dental disease.
If you would like more information on overcoming dry mouth, 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 “Dry Mouth: Learn about the Causes and Treatment of this Common Problem.”
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