Roughly 75% of American adults are missing at least one tooth, mostly from disease, trauma or extraction for other dental reasons. A few missing teeth, though, never erupted in the first place.
It’s a rare occurrence, but sometimes people are born without certain teeth, usually back molars or premolars that may not be as visible. Occasionally, though, it’s the more visible upper lateral incisors positioned on either side of the central incisors (the two front teeth on either side of the midline of the face).
Missing incisors can lead to poor bites and create difficulties for speech development and nutrition. But these highly visible (or in this case, “invisible”) teeth can also detract from an otherwise attractive smile.
There are ways, however to correct a smile with missing lateral incisors. Here are 3 of those ways.
Canine substitution. We can fill the vacancy created by the missing incisors by orthodontically moving the canines (the “eyeteeth,” normally next to them) into the space. Braces can close the gap in a conservative way, while possibly correcting any existing bite problems. Because canines are larger than incisors, its often necessary to re-contour them and restore them with a crown, veneer or bonding material to look more natural.
Fixed bridge. A second way to fill the space is with a dental bridge. A bridge consists of a series of crowns fused together in a row. The middle crowns replace the missing teeth; the end crowns cap the natural teeth on either end of the gap, which establishes support for the bridge. Another variation is a cantilever bridge in which only one natural tooth is capped for support. With either type, though, the capped teeth will be permanently reduced in size to accommodate the crowns.
Dental implants. This popular restoration is also a favorite for correcting missing incisors. Implants provide a life-like and durable replacement for missing teeth, while not requiring any alterations to existing teeth as with a bridge. But they are more expensive than the other options, and they require adequate space between the adjacent teeth for insertion, as well as healthy bone for proper placement and anchorage. This is also an option that must wait until the jaw has fully matured in early adulthood.
If you would like more information on treating congenitally missing 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 “When Permanent Teeth Don't Grow: Treatment Options for Congenitally Missing Lateral Incisors.”
One of the key elements in a child’s development is their first set of teeth. Although primary (“baby”) teeth last only a few years, they’re critically important for enabling a child to eat solid foods, speak and smile.
But they also provide one more important benefit—they hold the space in the jaw reserved for the permanent teeth developing just under the gums until they erupt. But if a child loses a primary tooth prematurely because of disease or injury, other teeth may drift into the vacant space and crowd it out for the intended permanent tooth. It may then come in misaligned or remain stuck within the gums (impaction).
To avoid this, we try to treat and preserve a diseased primary tooth if at all practical. For a primary molar, one of the large teeth in the back of the mouth, this might include capping it with a stainless steel crown.
Why a metal crown? Primary molars normally don’t fall out until around ages 10-12, so it may be years for a younger child before their permanent molars erupt. All during that time these particular teeth will encounter heavier biting forces than teeth in the front.
A steel crown is often the best solution for a molar given their longer lifespans and encountered biting forces. The crown’s metal construction can stand up to these forces while still protecting the tooth from re-infection from decay. And because molars are typically outside of the “smile zone” occupied by more visible front teeth, the crown’s metal appearance isn’t usually an aesthetic issue.
Crowning a molar usually takes one visit, a dentist typically performing the procedure with local anesthesia and possibly a mild sedative like nitrous oxide gas (“laughing gas”). After removing any decayed structure from the tooth, the dentist will then fit a pre-formed crown over the remaining structure, sized and shaped to match the original tooth as close as possible.
A stainless steel crown is a cost-effective way to added needed years to a primary molar that could otherwise be lost prematurely. Preserving it may help a child avoid bite problems and expensive future treatments.
If you would like more information on dental care for primary 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 “Stainless Steel Crowns for Kids: A Safe and Effective Way to Restore Primary Molars.”
Among dental restorations, implants are the closest prosthetic we have to real teeth. They not only replace the visible crown, but the titanium post imbedded in the jawbone adequately substitutes for the tooth root. Because of their unique design, implants are not only life-like, they’re highly durable and could potentially last for decades.
But while their success rate is remarkably high (more than 95% exceed the ten-year mark), they can fail. Ironically, one possible cause for implant failure is periodontal (gum) disease. Although an implant’s materials are themselves impervious to disease, the tissues and underlying bone that support the implant aren’t. If these natural tissues become infected, the secure hold the implant has can weaken and fail.
A gum infection usually begins with dental plaque, a thin biofilm of bacteria and food particles that builds up on tooth surfaces. Certain strains of bacteria within plaque can infect the gums. One particular form of the disease known as peri-implantitis starts as an initial infection and ensuing inflammation of gum tissues around an implant. The disease can quickly spread down to the bone and destroy the integration between the bone and the implant that helps keep the implant in place.
That’s why it’s important for you to keep the implant and the tissues around it clean of plaque, just as you would the rest of your natural teeth. This requires daily brushing and flossing around the implant and other teeth, and visiting your dentist regularly for more thorough dental cleanings.
You should also be alert to any signs of disease, especially around implants: gum redness, swelling, bleeding or pus formation. Because of the rapidity with which peri-implantitis can spread, you should see your dentist as soon as possible if you notice any of these signs.
Preventing gum disease, and treating it promptly if it occurs, is a key part of implant longevity. Preserving your overall dental health will help make sure your implant doesn’t become a loss statistic.
Millions of microorganisms call your mouth home—and while most are friendly, some are not. An invasive procedure like implant surgery can disrupt the mouth's soft tissues and allow disease-causing bacteria to enter the bloodstream.
This isn't necessarily a major concern if your immune system is sound—your body will move quickly to quash any developing infection. But if your body's defense is weak or compromised by other health conditions, an ensuing infection could cause you problems. In the case of a dental implant, a localized infection around it could lead to its failure.
The bone normally grows and adheres to the surface of an implant soon after it's placed, giving it the added strength and durability for which implants are best known. A bacterial infection, though, could impede bone integration and weaken the implant's hold within the jaw.
One way to avoid this is by treating patients at high risk for infection with an antibiotic before the procedure. In one recent study, researchers concluded that patients receiving a 2-gram dose of amoxicillin an hour before implant surgery helped reduce the risk of future implant failure.
But before taking this route, the dentist must first decide whether antibiotic pre-treatment might be more detrimental than beneficial to an individual patient. Antibiotics can cause side effects in certain people ranging from diarrhea to allergic reactions. Healthcare providers must also be prudent with administering antibiotics for the good of society in general—overuse can potentially give rise to antibiotic-resistant bacteria.
A number of healthcare associations highly recommend antibiotic pre-treatment for any dental patient with prosthetic heart valves, a history of infective endocarditis, a heart transplant and similar heart conditions. They also recognize patients with conditions like prosthetic joints, weakened immune systems, diabetics or other serious health problems could also benefit from antibiotic pre-treatment, but leave it to the physician's discretion on whether or not it's appropriate for an individual patient.
If you're planning to undergo implant surgery or a similar procedure and are concerned about infection, speak with your dentist about whether you would qualify and benefit from antibiotic pre-treatment. If appropriate, taking an antibiotic beforehand could minimize your infection risk.
If you would like more information on pre-surgical antibiotic treatment, 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 “Implants & Antibiotics: Lowering Risk of Implant Failure.”
Pediatricians and dentists alike recommend beginning your child's regular dental visits at an earlier age rather than later. Most say children's first visits should happen around their first birthday.
Some may question whether that's necessary given the state of a child's dental development at that age. At that stage they normally have only a few primary teeth, which will eventually give way to their permanent set soon enough.
But regular dental visits can make a positive difference even at that early age. Here are 3 oral health areas that could benefit from seeing the dentist by Age One.
Protecting primary teeth from decay. It's true that primary teeth don't last long when compared to a normal lifespan. But during their short tenure, they do play a critical role in a child's health and development. Not only do they provide a child dental function for eating, speaking and smiling, they also preserve the space for the permanent teeth that will succeed them. Without them, permanent teeth can erupt out of position to form a poor bite (or malocclusion). That's why early dental care to prevent and treat decay in primary teeth helps them remain for as long as they should.
Detecting developing malocclusions. A malocclusion doesn't form overnight—there can be subtle signs of its development during early childhood. A dentist, especially a pediatric dentist or orthodontist, can often detect those signs before the malocclusion fully develops (one reason why every child should have an orthodontic evaluation around age 6). With early detection, an orthodontist can use interventional techniques that will lessen or even stop a malocclusion from forming. As a result, later orthodontic treatment may not be as extensive—or expensive—as it could have been.
Developing a healthy dentist-patient relationship. Dental anxiety is a real problem for many adults—in some cases it can be so severe they avoid professional dental care altogether. The roots of that dental fear often go back to unpleasant experiences during childhood. Starting dental visits when a child is very young appears to minimize the development of dental anxiety. A young child, especially visiting a "kid-friendly" dental clinic, will more likely view dental care as a routine part of life and will less likely be afraid.
If you would like more information on dental care for children, 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 “Age One Dental Visit: Why It's Important for Your Baby.”
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