Braces and Mouthguards

In over 20 years of practice, I have seen teeth or jaw accidents with almost every sport. Whether you play basketball, football, baseball, soccer, Lacrosse, hockey or any other sport involving a ball, you need to wear a mouth guard. If you have braces on, there is a special type of mouth guard recommended. It is a tray-type that fits over the braces and allows continuous movement of the teeth to take place. The kind of mouth guard you get at the sports store that you heat up and bite into is not appropriate for braces. Your orthodontist probably has these available in the office.
If you have trauma to your teeth while wearing braces, it is important to contact your orthodontist right away to let her assess the damage. If the braces are knocked loose, this needs to be repaired. If the teeth are knocked out of position, an oral surgeon may need to be involved in the care. Radiographs will be taken to check the roots of the teeth and the surrounding bone. Trauma can lead to nerve damage of the teeth. This can be evident right away or it may take months. Sensitivity to hot and cold or a color change may indicate nerve damage.
Take care of your teeth. They are meant to last a lifetime – So wear your mouth guard!


Oral Hygiene and Braces

Your dentist tells you how important it is to brush and floss regularly   to limit the amount of plaque formation on your teeth. But when you have braces, there are some new challenges. There are a lot of hiding places with braces on! It is not the tool that is the most important thing, it is the technique and what works best in your hands.
It is important to angle your toothbrush in between the braces and the gum tissue moving it in small circular motions to remove the plaque and food and to massage the gum tissue. I recommend brushing every time you eat something because anytime you leave food caught in your braces, the bacteria that live in your mouth eat it and produce acid. This acid causes soft spots which lead to decay. There is a small interdental brush that can be used to go under the wires and hooks where a regular toothbrush may miss. Waterpik water flossers are helpful to loosen the food prior to brushing. There is also a special type of Glide Floss Threaders for orthodontic patients which have a stiff end to guide underneath the wire. Flossing should be done at bedtime so that the food is not left in between your teeth overnight.
Wearing braces without proper oral hygiene can result in white spots around the braces where the food and plaque were left on the teeth for long periods of time. Brushing and flossing may be more challenging with braces but the final result is worth the effort.
Also, don’t forget to continue to see your dentist for regular check ups while you have your braces on!

What is TMJ?

The TMJ refers to the temporomandibular joint which is the joint that connects the lower jaw to the skull right in front of the ear. Some people experience popping, pain or even locking in this joint. Often it follows trauma such as a sports injury or car accident where the jaw has been bumped, but not always. Others symptoms related to this could be headaches, muscle tightness in the face or neck, tenderness in the joint or sore teeth.  Stress plays a role because of the  tendency to clench or grind your teeth during those times. Click TMJ problems (TMD) to learn more.

As an orthodontist, I can fabricate a mouthguard which is a hard acrylic removable splint which attaches to the top teeth and is worn at night and during high stress times. It is accurately adjusted to mimic a perfect functioning bite. Wearing this barrier between the teeth relieves stress on the joints, helps relax the muscles and protects the teeth from wearing down the enamel.

If there is damage in the joint itself, an arthroscopic procedure may be necessary to repair the tissue. A tear, scar tissue build up, or arthritic changes could be the cause of the symptoms and require surgical intervention by an oral surgeon. A splint is usually required to be worn during the healing process.

If you are experiencing any of these symptoms, contact your orthodontist for an evaluation.

The Wisdom About Wisdom Teeth

Wisdom teeth, or 3rd molars, develop behind the 12 year molars.  There are very few people who have room for the 3rd molars to erupt. As an orthodontist, I look for the developing 3rd molars on the panoramic radiograph before we begin treatment.  At this time, they are usually in the bud stage, but evident. There are some people who maybe missing 1 or more of the 3rd molars. This pattern is seen in families.

The most common age to have 3rd molars removed is between the ages of 16-18. However, there are some ready by age 14 and some not until they are in their 20’s. It is best to wait until the bone covering the teeth is resorbed so that the procedure is easier on the patient. Most people have to have them surgically removed because there is insufficient room for their eruption.

I refer my patients to an oral surgeon who puts the patient to sleep for the procedure. The next few days there will be some swelling, some possible bruising and a soft diet will be required. Sometimes the 3rd molars are rotated or tilted toward the 2nd molars. It is better to have them removed   to prevent possible misalignment of the teeth due to pressure from the back.

A good rule of thumb is to have your wisdom teeth evaluated to see if there is enough room for their normal eruption or have them removed by the time you finish High School. I am always surprised when I see someone who has fully erupted wisdom teeth in their mouth.

What Are Some Types of Early Orthodontic Treatment?

It is important to have your child evaluated by an orthodontist at an early age to detect developing problems with the eruption of the teeth or the growth of the jaws.

On example of an early growth problem is an overbite. This usually involves the underdevelopment of the lower jaw. It is possible for an orthodontist to do some growth modification during the growing years to help maximize the growth of the lower jaw to catch up with the upper jaw. It is helpful to provide health information about the child’s growth potential from the pediatrician and to gather information about the height and age of puberty of both parents.

An underbite is another example and it could be an overdevelopment of the lower jaw, an underdevelopment of the upper jaw or a combination of the two. This can be determined by a clinical examination and cephalometric radiograph which allows the orthodontist to measure the jaws. A family history is also helpful because this type growth pattern has a strong hereditary component and can be expressed in different degrees of severity.  The use of a reverse pull facemask worn by the child when he is at home and while he sleeps can help encourage the growth of the upper jaw and slow down the growth of the lower jaw in this early stage of  development. If left untreated, there is a chance this type growth pattern could require surgical intervention post growth.

Another type bite that should be treated early is a crossbite. This can involve the back teeth on one or both sides and is due to a narrow upper jaw in comparison to the lower jaw. There is a suture line down the middle of the palate that is not fused until about age 11 so an expander can be used to widen the palate and correct  the crossbite.

Evaluating a child early can alleviate some problems and  lessen the severity of developing problems.

At What Age Should My Child See an Orthodontist?

The American Association of Orthodontists recommends that a child see the orthodontist for an initial evaluation at age 7. Usually, by this time, the 6 year molars have erupted and the incisors have been lost. An early evaluation allows the orthodontist to check for developing problems with the growth of the jaws or the formation and eruption of the teeth.

Some of the problems detected early could include:

1. A thumbsucking or fingersucking habit

2. Crowded or blocked out permanent teeth

3. An overbite ( Due to an underdeveloped lower jaw)

4. An underbite ( Due to an overdeveloped lower jaw or underdeveloped upper jaw)

5. A crossbite involving the front or back teeth

6. Missing or extra permanent teeth

The correction of some of these problems early may alleviate or lessen the severity of the problem later. The orthodontist would make measurements of the teeth and face, take a medical history and take a panoramic radiograph. From this information,she could determine if any early intervention is necessary. When in doubt, ask your orthodontist.

Help! I Can’t Get My Child to Stop Sucking His Thumb

Have you ever seen a picture of a baby sucking his thumb in the womb? Sucking is a natural behavior of a newborn and is often done to help comfort themselves as a toddler but most children stop on their own between the ages of 2 and 4. If your child continues to suck past this age, it is important for you to encourage them to stop. Prolonged sucking can affect the growth of the jaws and the position of the teeth. The pressure caused by sucking can shape the palate causing a high, narrow arch and the thumb itself can flare the upper teeth and inhibit the growth of the lower jaw.

As an Orthodontist, I can fabricate an appliance to block the thumb and prevent the suction. We call it a “reminder appliance” and it is especially helpful for the child who continues to suck his thumb when he sleeps.  I had a patient several years ago who was still sucking his thumb at age 16. He had to have a combination of orthodontics and orthognathic surgery to correct to correct the bite and the position of the jaws.

The habit appliance is usually effective within the first few weeks but we leave it in approximately 3 months to make sure the habit has ceased.

A good “Rule of Thumb” is to make sure the habit is corrected before the upper permanent incisors erupt.