James P. Edmonds, DDS
Lauren Sherman, DDS
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Posts for tag: orthodontic treatment

By Edmonds and Sherman Dental
October 12, 2018
Category: Dental Procedures
4SignsYourChildMayHaveaPoorBite

Although tooth decay is a major problem to watch for in your child’s teeth, it isn’t the only one. As their teeth transition from primary (“baby”) to permanent, you should also be on the lookout for a developing poor bite or malocclusion.

Although the signs can be subtle, you may be able to detect an emerging malocclusion, starting usually around age 6, if you know what to look for. Here are 4 signs your child may be developing a poor bite.

Excessive spacing. This is something that might be noticeable while the child still has their primary teeth. If you notice an excessive amount of space around the front teeth, the sizes of the jaws and the teeth may be disproportional.

Abnormal overlapping. The upper teeth normally just cover the bottom teeth when the jaws are closed. But a malocclusion may be forming if the lower teeth cover the upper (underbite), the upper teeth extend too far over the lower (deep bite) or there’s space between the upper and lower front teeth (open bite).

Different overlapping patterns. Watch as well for some of the teeth overlapping normally while others don’t, a sign of a cross bite. For example, the back upper teeth may cover their counterparts in a normal fashion while the lower front teeth abnormally overlap the top front. The roles here between front and back teeth can also be reversed.

Abnormal eruptions. Permanent teeth normally follow a pattern when erupting, but certain factors could disrupt the process. For example, a jaw that’s developed too small can cause crowding as incoming teeth vie for space; as a result, some permanent teeth may erupt out of their proper position. Likewise, if a baby tooth is out of its normal position or prematurely lost, the permanent tooth may erupt out of position too.

The good news with each of these developing bite problems is that we can correct them or at least minimize their future effect if caught early. So if you notice any of these signs or anything else out of the ordinary, see an orthodontist as soon as possible. It’s also a good idea to have your child undergo a thorough orthodontic evaluation around age 6.

If you would like more information on bite problems in 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 “Problems to watch for in Children Ages 6 to 8.”

By Edmonds and Sherman Dental
August 13, 2018
Category: Dental Procedures
HowtoTreattheProblemofTeeththatNeverDeveloped

About one-quarter of people have teeth that never developed. While most of these congenitally missing teeth are wisdom teeth, they can also include premolars or lateral incisors (the teeth right next to the two front teeth, the central incisors).

Missing teeth can have an adverse effect on smile appearance. But that’s not all: because each type of tooth performs a specific function, one or more missing teeth can lead to bite problems and disruption of dental function. In the case of missing lateral incisors, the canines (eye teeth) normally positioned beside and toward the back of the mouth from them may begin to drift into the empty space and grow next to the central incisors. This can result in greater difficulty chewing and a smile that “doesn’t look right.”

To correct this situation, we must often first attempt to orthodontically move any out of place teeth to their normal positions. This re-establishes the space needed for the missing teeth to be replaced, which we can then restore with prosthetic (artificial) teeth. If the permanent restoration of choice involves dental implants, we’ll usually need to wait until the completion of jaw development around early adulthood. In the mean time, we can use a retainer appliance to hold the teeth in their new positions with prosthetic teeth attached to fill the empty space for a better smile appearance in the interim.

The real issue is timing—beginning orthodontic treatment when appropriate to a person’s oral development, as well as completing the implant restoration when the mouth has matured sufficiently. There are other considerations such as bone volume, which may have diminished due to the missing teeth. At some point we may need to consider grafting to build up the bone sufficiently to support dental implants.

This all may entail a team approach by various specialties like orthodontics, periodontics and implantology. Working together and coordinating within a timely schedule, a mouth and smile marred by undeveloped teeth can be transformed.

If you would like more information on treating smiles with underdeveloped permanent 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.”

By Edmonds and Sherman Dental
August 03, 2018
Category: Oral Health
HowtoReduceToothWhiteSpotsWhileWearingBraces

When your braces finally come off, you’ll hopefully be astounded by what you see –once-crooked teeth replaced by a more attractive smile. But you might also see something you didn’t expect: noticeable white spots on some of your teeth.

These spots called white spot lesions (WSLs) appear lighter than the surrounding tooth enamel due to mineral loss just beneath the surface. This happens because bacterial or food acids have contacted the enamel surface for too long and dissolved the underlying calcium and other minerals. This results in a small discolored and chalky-like area in the enamel.

WSLs are common during orthodontics because wires and brackets create hard to reach places for brushing and flossing, which can accumulate bacterial plaque. The bacteria produce acid, which weakens the enamel at these places. The tiny white spots that result are more than just unattractive—they can become entry points into the tooth for decay. That’s why they should be dealt with as soon as possible—and preferably before they’re created.

To that end, you’ll need to do as thorough a job as possible brushing and flossing while undergoing orthodontic treatment. To improve your thoroughness try using an interproximal toothbrush that can maneuver more closely around braces hardware than a regular brush. You can also improve your flossing with a floss threader or a water flosser, a device that sprays pressurized water to loosen and flush away plaque.

If you do develop WSLs, there are some things we can do to treat them. We can attempt to re-mineralize the affected enamel with the help of topical fluoride (either pastes or gels for home use or with an office application) or a re-mineralizing agent. We can also use techniques like microabrasion, which restores damaged areas beneath the surface, or inject a liquid, tooth-colored resin beneath the WSL’s surface to improve appearance and protect against decay.

If while wearing braces you do notice any white spots or other tooth discoloration let your dentist or orthodontist know right away. The sooner your dental providers can begin dealing with potential WSLs the better your chances for a healthy and beautiful outcome after braces.

If you would like more information on oral hygiene while wearing braces, 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 “White Spots on Teeth During Orthodontic Treatment.”

By Edmonds and Sherman Dental
October 09, 2017
Category: Dental Procedures
FAQInterceptiveOrthodonticsforChildren

Have you heard about interceptive orthodontics? This type of early intervention could benefit perhaps 10â??20% of children who need orthodontic treatment, making a positive impact on tooth and jaw development, facial symmetry, and overall self esteem. In case you’re not familiar with it, here are the answers to some common questions about interceptive orthodontic treatment.

Q: What’s the difference between interceptive orthodontics and regular orthodontics?
A: Standard orthodontic treatment typically involves moving teeth into better positions (usually with braces or aligners), and can be done at any age. Interceptive orthodontics uses a variety of techniques to influence the growth and development of teeth and jaws, with the aim of improving their function and appearance. Because it works with the body’s natural growth processes, interceptive treatment is most effective before the onset of puberty (around age 10-14), when growth begins to stop. It is generally not appropriate for adults.

Q: What are the advantages of early treatment with interceptive orthodontics?
A: When it’s done at the right time, interceptive treatment offers results that would be difficult or impossible to achieve at an older age without using more complex or invasive methods — for example, tooth extraction or jaw surgery. That’s why the American Association of Orthodontists, among other professional organizations, recommends that all kids have their first orthodontic screening at age 7.

Q: What are some common issues that can be treated with interceptive orthodontics?
A: One is crowding, where there is not enough room in the jaw to accommodate all the permanent teeth with proper spacing in between. A palatal expander can be used to create more room in the jaw and avoid the need for tooth extraction. Another is a situation where the top and bottom jaws don’t develop at the same rate, resulting in a serious malocclusion (bad bite). A number of special appliances may be used to promote or restrict jaw growth, which can help resolve these problems.

Q: How long does interceptive orthodontic treatment take?
A: Depending on what’s needed, a child might wear a device like a palatal expander or another type of appliance for 6-12 months, followed by a retainer for a period of time. Or, a space maintainer may be left in place for a period of months to hold a place for a permanent tooth to erupt (emerge from the gums). Interceptive treatment ends when a child’s jaw stops growing.

Q: Will braces still be needed after interceptive treatment?
A: Often, but not always, the answer is yes. However, interceptive treatment may shorten the period of time where braces need to be worn, and can help prevent many problems later on.

If you have additional questions about interceptive orthodontics, please contact our office or schedule a consultation. You can learn more in the Dear Doctor magazine article “Early Orthodontic Evaluation.”

WemayNeedtoRemoveoneorMoreTeethBeforeApplyingBraces

“To gain something, sometimes you have to give up something else.”

No, that isn't the latest viral meme on the Internet. It's actually a practical consideration that could arise in orthodontics.

In this case, the “something” to gain is a straighter, more attractive smile; the “something” you may have to part with is a few teeth. This may be necessary if there are too many teeth on a dental arch for its capacity, a situation called crowding. A lack of space is the main reason teeth come in misaligned.

Before we can correct this, we'll need to free up space to allow for tooth movement by removing one or more of the existing teeth. The ideal candidates are those that are near to the teeth we wish to move but not highly visible. The first bicuspids are the most frequent choices for removal: they're located behind the cuspids or eyeteeth (the pointed teeth right under the eyes).

Ideally, we'll remove the target teeth some time before we apply braces to give the gums a chance to heal. At the same time we want to preserve the bone that once supported the teeth we've extracted. This is because when we chew the forces generated by the teeth stimulates bone replacement growth. When a tooth is no longer there the supporting bone doesn't receive this stimulation and may ultimately reduce in volume.

We may try to prevent this by placing a bone graft in the empty socket immediately after removing the tooth. The graft serves as a scaffold to encourage new bone to grow. Hopefully when we're ready to apply braces, the bone will be strong and healthy to handle the movement of the teeth.

As the teeth move under the influence of braces, they'll begin to fill up the space created by tooth removal. Once it's completed, the extracted teeth won't be missed — the other teeth now straightened will completely fill out the smile.

The different steps in this process must be carefully planned and executed precisely, and it will take months or even years to complete. In the end, though, this complicated bite problem can be corrected and replaced with an attractive, straight smile.

If you would like more information on correcting a poor bite, 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 “Tooth Removal for Orthodontic Reasons.”