By Renee Feldsher DMD
January 14, 2015
Category: Dental Procedures
Tags: oral surgery   orthodontics  
ExposingandPreservingImpactedCanineTeeth

The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.

At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.

Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.

Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.

At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.

If you would like more information on the effects and treatment of impacted 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 “Exposing Impacted Canines.”

FlossingAnImportantPartofTVDesignerNateBerkusOralHealthRoutine

As one of America's most beloved go-to guys for inspiration on the latest interior design trends, Nate Berkus has written a highly successful book, Home Rules: Transform the Place You Live Into a Place You'll Love; he is a contributing editor to O Magazine; and he is currently hosting his own television program, The Nate Berkus Show. He is also recognized for his eye-catching smile.

During a recent interview with Dear Doctor magazine, Berkus opened up about the facts behind his trademark smile. While his smile is all-natural — he never wore braces or had any cosmetic work done — he gives credit to his childhood dentist for the preventative healthcare he received as a young boy. “I'm grateful for having been given fluoride treatments and sealants as a child,” he said. Nate also shared the important flossing advice he learned from his dentist that he still follows today: “Floss the ones you want to keep.”

Why is flossing so important?

Flossing is crucial because it remains the most effective method for removing plaque from between teeth, where the toothbrush can't reach. It is also an important part of keeping your gums healthy so that you can avoid periodontitis (gum disease). You should floss at least once a day either before or after you brush your teeth. If you see blood after flossing, it may indicate that you have periodontitis, or it may mean that you are flossing too harshly. Remember, you need to use a delicate hand and a proper technique when brushing and flossing to avoid damaging your teeth and gums.

To learn more about flossing, including step-by-step instructions with photos, you can continue reading the Dear Doctor magazine article “Flossing — A Different Approach.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination, review your brushing and flossing techniques, and discuss any questions you have as well as treatment options. As needed, we will work with you to teach you the proper brushing and flossing techniques so that you feel confident before you leave our office. And to read the entire interview with Nate Berkus, please see the Dear Doctor magazine article “Nate Berkus.”

By Renee Feldsher DMD
December 19, 2014
Category: Dental Procedures
Tags: wisdom teeth  
ExtractingWisdomTeethNowMayPreventDentalProblemsLater

The reason for extracting a tooth may be all too obvious — the tooth is too decayed or damaged to attempt saving. The reason for extracting a wisdom tooth, on the other hand, may not be so apparent: from the perspective of pain or reduced function, you may not notice a thing. Our recommendation to remove a wisdom tooth is based primarily on what may be occurring out of view below the gum line and its potential threat to adjacent teeth.

Teeth grow and develop below the gum line in the jaw, and then push their way through the gums as they appear in the mouth (eruption). After a normal eruption, the enamel-covered crown is visible above the gum line; the remaining tooth root (about two-thirds of the tooth’s length) resides below the gum line. Because wisdom teeth, or third molars, erupt rather late between ages 17 and 25, they may lack the room to erupt properly due to crowding from other teeth that have already erupted. This can cause the wisdom tooth not to erupt fully through the gums, leaving the crown trapped below the gum line, a condition known as impaction. For the tooth, impaction increases the chances of infection, cyst formation and gum disease around it.

An impacted wisdom tooth can also cause problems for the adjacent teeth as well. The impacted tooth may begin to press against the roots of other teeth; the resulting pressure can damage the other roots, increasing the risk for disease or future tooth loss. A person may not even know they have this problem since there’s often little to no noticeable pain or symptoms.

It may seem counterintuitive, but the best time to remove a wisdom tooth is when it’s not causing immediate problems. There will be, however, signs found during examination (particularly x-rays or CT scan) that future problems are in the making. By extracting an impacted wisdom tooth at the appropriate time, we can avoid more serious problems in the future and improve oral health.

If you would like more information on wisdom teeth and your oral health, 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 “Removing Wisdom Teeth.”

By Renee Feldsher DMD
December 04, 2014
Category: Oral Health
TVAnchorNancyODellDiscussesPregnancyandOralHealth

We've all heard of morning sickness, but did you know that it's also not unusual for pregnant women to experience oral discomfort? This is what Entertainment Tonight co-host Nancy O'Dell discovered when she was expecting her daughter, Ashby. In an exclusive interview with Dear Doctor magazine, Nancy described how her gums became extra-sensitive during pregnancy, leading her dentist to diagnose her with “pregnancy gingivitis” (“gingival” – gum tissue; “itis” – inflammation).

“While my dental health has always been relatively normal, pregnancy did cause me some concern about my teeth and gums,” Nancy said. “With my dentist's advice and treatment, the few problems I had were minimized,” she said.

It's especially important to maintain good oral hygiene during pregnancy with routine brushing and flossing, and regular professional cleanings. This will reduce the accumulation of the dental bacterial plaque that leads to gum disease. Both mother and child are particularly vulnerable to these bacteria during this sensitive time. Scientific studies have established a link between preterm delivery and the presence of periodontal (gum) disease in pregnant women. Also, the elevated hormone levels of pregnancy cause the tiny blood vessels of the gum tissues to become dilated (widened) and therefore more susceptible to the effects of plaque bacteria and their toxins. Gingivitis is especially common during the second to eighth months of pregnancy.

Excess bacterial plaque can occasionally lead to another pregnancy-related condition in the second trimester: an overgrowth of gum tissue called a “pregnancy tumor.” In this case, “tumor” means nothing more than a swelling or growth. Pregnancy tumors, usually found between the teeth, are completely benign but they do bleed easily and are characterized by a red, raw-looking mulberry-like surface. They can be surgically removed if they do not resolve themselves after the baby is born.

If you are experiencing any pregnancy-related oral health issues, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Nancy O'Dell, please see “Nancy O'Dell.” Dear Doctor also has more on “Pregnancy and Oral Health: Everything You Always Wanted To Know But Never Knew To Ask.”

By Renee Feldsher DMD
November 19, 2014
Category: Oral Health
Tags: oral health   dental health  
DentalHealthDoYouMaketheGrade

When it comes to our overall health, many of us think we’re pretty well-informed. But a recent survey quiz given by the American Dental Association (ADA) revealed something surprising: When it comes to dental health, most people could use plenty of “brushing up.” In fact, the average score on the true/false test was a barely passing D! Among the questions most people answered incorrectly were:

  • How often should you brush your teeth? (91 percent got it wrong)
  • At what age should you take your child to the dentist for the first time? (75 percent wrong)
  • How often should you replace your toothbrush? (65 percent wrong)
  • Can cavity-causing germs be passed from person to person? (59 percent wrong), and
  • Does sugar cause cavities?

We’ll come back to the last question in a moment — but first, let’s recap some basic dental health information.

While you might think it’s best to brush after every meal, the ADA recommends brushing just twice a day. That’s because excessive brushing can erode tooth enamel (especially if it has already been softened by acidic food or drinks), and can also expose and irritate the root of the tooth. But when you do brush, you should keep at it for at least two minutes each time!

Bring your child in to the dental office within six months after the first tooth appears — but no later than his or her first birthday! The age-one dental visit starts your child off right with proper preventive care and screenings, and sets the stage for a lifetime of good oral health.

Most people think it’s OK to change your toothbrush twice a year — but the ADA recommends that you get a new one every three months; that’s because stiff, frayed bristles just don’t clean your teeth and gums as well as they should. Likewise, most people don’t realize that the bacteria that cause cavities can be passed from one person’s mouth to another — by putting a child’s pacifier in your mouth or sharing a toothbrush, for example.

And speaking of cavities: Technically, they aren’t caused by sugar, as 81 percent of people thought. Tooth decay occurs when certain types of oral bacteria release an acidic byproduct that attacks the tooth enamel and creates small holes (cavities). This occurs after the bacteria have metabolized sugar in your diet. So while sugar doesn’t directly cause cavities, it does lead to tooth decay by feeding harmful bacteria. How about partial credit for that one?

If you have additional questions about your dental health, please call our office to schedule a consultation. For more information, see the Dear Doctor magazine article “Good Oral Health Leads to Better Health Overall.”





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