Johansen Dental Blog

Posts for category: Oral Health

PrimaryTeethareCriticaltoFutureDentalHealthandWorthPreserving

Ask any kid and they'll tell you just how valuable "baby" teeth really are—out of the mouth, of course, and under their pillow awaiting a transaction with the Tooth Fairy. But there's more to them than their value on the Fairy Exchange Market—they play a critical role in future dental health.

Primary teeth provide the same kind of dental function as their future replacements. Children weaned from nursing can now eat solid food. They provide contact points for the tongue as a child learns to speak. And they play a role socially, as children with a "toothsome" smile begin to look more like what they will become when they're fully mature.

But primary teeth also serve as guides for the permanent teeth that will follow. As a future tooth develops below the gum line, the primary tooth preserves the space in which it will erupt. Otherwise, the space can be taken over by other teeth. This crowds out the intended tooth, which may erupt out of position or remain impacted below the gum line.

In either case, the situation could create a poor bite (malocclusion) that can be quite costly to correct. But if we can preserve a primary tooth on the verge of premature loss, we may be able to reduce the impact of a developing malocclusion or even prevent it.

We can help primary teeth last for their intended lifespan by preventing tooth decay with daily oral hygiene or clinically-applied sealants and topical fluoride. If they do become infected, it may be worth the effort to preserve them using procedures similar to a root canal treatment.

If a tooth can't be preserved, then we can try to reserve the empty space for the future tooth. One way is a space maintainer, which is a stiff wire loop attached to metal band bonded around an adjacent tooth. This keeps other teeth from drifting into the space until the permanent tooth is ready to erupt, at which time we can remove the appliance.

Your child may be anxious to get another tooth to put under their pillow. But helping that primary tooth go the distance will be more than worth it for their future dental health.

If you would like more information on the care and treatment of baby 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 “Importance of Baby Teeth.”

DentalInjuryIsJustaTemporarySetbackforBasketballStarKevinLove

The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.

In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?

The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.

Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.

So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”

Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.

If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”

PreservingthePulpisPriorityOnewithaNewlyEruptedPermanentTooth

The change from primary teeth to permanent is an announcement to the world that a boy or girl is "growing up." "Growing up," though, is still not "grown"—the new teeth are still in a period of development that can affect how we treat them if they're injured or diseased.

While a new tooth erupts with all its anatomical layers, the middle dentin is somewhat thinner than it will be after it matures. The pulp, the tooth's innermost layer, produces new dentin and gradually increases the dentin layer during this early development period. While the pulp continues to produce dentin over a tooth's lifetime, most of it occurs in these early years.

To prevent or stop any infection, we would normally perform a root canal treatment in which we remove the pulp tissue and fill the empty pulp chamber and root canals. This poses no real issue in an older tooth with mature dentin. Removing the pulp from an immature tooth, though, could interrupt dentin development and interfere with the tooth's root growth. Besides a higher risk of discoloration, the tooth could become more brittle and prone to fracture.

That's why we place a high priority on preserving a younger tooth's pulp. Rather than a root canal treatment, we may treat it instead with one of a number of modified techniques that interact less with the pulp. Which of these we use will depend on the extent of the pulp's involvement with the injury or disease.

If it's unexposed, we may use a procedure called indirect pulp therapy, where we remove most of the tooth's damaged dentin but leave some of the harder portion intact next to the pulp to avoid exposure. If, though, some but not all of the pulp is damaged, we may perform a pulpotomy: here we remove the damaged pulp tissue while leaving the healthier portion intact. We may then apply a stimulant substance to encourage more dentin production to seal the exposure.

These and other techniques can help repair an injured young tooth while preserving most or all of its vital pulp. Although we can't always use them, when we can they could give the tooth its best chance for a full life.

If you would like more information on caring for your child's 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 “Saving New Permanent Teeth after Injury.”

AMinorProcedureCouldMakeBreastfeedingEasierforYouandYourBaby

The American Academy of Pediatrics and other healthcare organizations recommend breastfeeding as the best means for infant feeding. While bottle feeding can supply the nutrition necessary for a baby's healthy development, breastfeeding also provides emotional benefits for both baby and mother.

But there might be an obstacle in a baby's mouth that prevents them from getting a good seal on the mother's breast nipple—a small band of tissue called a frenum. This term describes any tissue that connects a soft part of the mouth like the upper lip or tongue to a more rigid structure like the gums or the floor of the mouth, respectively.

Although a normal part of anatomy, frenums that are too short, thick or inelastic can restrict a baby's lip or tongue movement and prevent an adequate seal while nursing. The baby may adjust by chewing rather than sucking on the nipple. Besides a painful experience for the mother, the baby may still not receive an adequate flow of breast milk.

Bottle-feeding is an option since it may be easier for a baby with abnormal frenums to negotiate during nursing. But the problem might also be alleviated with a minor surgical procedure to snip the frenum tissue and allow more freedom of movement.

Often performed in the office, we would first numb the frenum and surrounding area with a topical anesthetic, sometimes accompanied by injection into the frenum if it's abnormally thick. After the numbing takes effect, we gently expose the tissue and cut it with either surgical scissors or a laser, the latter of which may involve less bleeding and discomfort. The baby should be able to nurse right away.

If you wait later to undergo the procedure, the baby may already have developed compensation habits while nursing. It may then be necessary for a lactation consultant to help you and your baby "re-learn" normal nursing behavior. It's much easier, therefore, to attempt this procedure earlier rather than later to avoid extensive re-training.

While there's little risk, frenum procedures are still minor surgery. You should, therefore, discuss your options completely with your dental provider. Treating an abnormal frenum, though, could be the best way to realize the full benefits of breastfeeding.

If you would like more information on treating tongue or lip ties, please contact us or schedule an appointment for a consultation.

By Johansen Dental
April 08, 2019
Category: Oral Health
Tags: mouthguards  
AprilIsNationalFacialProtectionMonth

April brings the perfect weather to get outside and play. Fittingly, April is also National Facial Protection Month. Whether you prefer softball or basketball, skateboarding or ultimate frisbee, don't forget your most important piece of equipment: a mouthguard to protect your face and your smile!

In an instant, a blow to the mouth can cause a dental injury that is painful to endure and expensive to treat. In just about any sporting activity, your mouth could come into contact with a piece of equipment, another person or the ground. That's why the American Dental Association and the Academy for Sports Dentistry recommend using a mouthguard when participating in any of over 30 activities, including some that aren't typically considered contact sports, like volleyball and bike riding.

Common sense, observation and scientific research support the use of mouthguards during sporting activities—but are the ones you get from your dentist really any better than the kind you can grab off the shelf at a sporting goods store or drugstore? The answer is yes!

In a 2018 experiment, researchers created a model of the human head to test how direct impact affects the teeth, jaws and skull. They compared the effects of impact when using no mouthguard, when using a custom-made mouthguard available from the dentist, and when using a stock mouthguard. They also tested mouthguards of different thicknesses. The results? The experimenters determined that any mouthguard is better than no mouthguard and that custom mouthguards available from the dental office are more effective than off-the-shelf mouthguards in protecting teeth, jaws and skull from impact. They also found that the thicker the mouthguard, the better the protection.

Although custom mouthguards are more expensive than the kind you can buy at the corner store, the difference in protection, durability, comfort and fit is well worth the investment. We consider your (or your child's) individual needs, take a precise model of your mouth and provide you with a custom-fit mouthguard of the highest quality material.

Don't ruin your game. A mouthguard can go a long way in protecting your teeth and mouth from injury. If you would like more information about a sports mouthguard, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Mouthguards” and “An Introduction to Sports Injuries & Dentistry.”