Osteoporosis is a serious bone weakening disease in older adults that can turn a minor fall into a major bone fracture. But the condition could also impact dental treatment—triggered ironically by the drugs used to treat osteoporosis rather than the disease itself.
From the Latin for “porous bone,” osteoporosis causes bone to gradually lose mineral structure. Over time the naturally-occurring spaces between mineralized portions of the bone enlarge, leaving it weaker as a result.
Although there's no definitive cure for osteoporosis, a number of drugs developed over the last couple of decades can inhibit its progress. Most fall into two major categories, bisphosphonates and RANKL inhibitors.
These drugs work by inhibiting the normal growth cycle of bone. Living bone constantly changes as cells called osteoblasts produce new bone. A different type, osteoclasts, clear away older bone to make room for these newer cells. The drugs selectively destroy osteoclasts so that the older bone, which would have been removed by them, remains for a longer period of time.
Retaining older cells longer initially slows the disease process. But there is a downside: in time, this older bone kept in place continues to weaken and lose vitality. In rare instances it may eventually become detached from its blood supply and die, resulting in what is known as osteonecrosis.
Osteonecrosis mostly affects two particular bones in the body: the femur (the long bone in the upper leg) and the jawbone. In regard to the latter, even the stress of chewing could cause osteonecrosis in someone being treated for osteoporosis. It can also occur after tooth extractions or similar invasive procedures.
If you're taking a bisphosphonate or RANKL inhibitor, you'll want to inform your dentist so that the necessary precautions can be taken before undergoing dental work more invasive than routine cleanings or getting a filling or crown. If you need major dental work, your dentist or you will also need to speak with your physician about stopping the drug for a few months before and after a dental procedure to minimize the risk of osteonecrosis.
Fortunately, the risk for dental problems while undergoing treatment for osteoporosis is fairly low. Still, you'll want to be as prepared as possible so that the management of your osteoporosis doesn't harm your dental health.
If you would like more information on osteoporosis and dental 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 “Osteoporosis Drugs & Dental Treatment.”
Unless you're 6 years old and on speed dial with the Tooth Fairy, a loose tooth isn't a good feeling. It's also a sign something is wrong in your mouth. If you don't take prompt action, you may lose that tooth for good.
To begin with, teeth are held in place by an elastic tissue known as the periodontal ligament. The ligament lies between the tooth and bone and attaches to both through tiny fibers. The thing to note about the ligament is that it does allow for tooth movement, which serves as a “shock absorber” against the forces generated while biting and chewing.
But that movement is normally so slight, you won't perceive it. If you do, chances are there's a problem with the ligament attachment, which may have been damaged due to trauma or disease.
A hard blow to the face could certainly damage both the teeth and their attachments. But it can also happen if one tooth extends out farther than the rest and absorbs more stress during chewing. You could encounter similar damage if you attempt DIY orthodontics or wear tongue jewelry.
The more common source of ligament damage, though, is periodontal (gum) disease, usually caused by dental plaque, a thin film of bacteria and food particles left on tooth surfaces. If not treated, the infection can advance deeper into the gum tissues (and eventually the supporting bone), causing the ligaments to weaken and detach. In fact, a loose tooth is often a sign of well-advanced gum disease.
If you notice a loose tooth, you should make an appointment with us as soon as possible. Our first step is to ascertain the underlying cause and initiate any needed treatment. We may also want to splint a loose tooth to adjacent teeth to prevent excessive movement while the ligaments heal and reform their attachment to the tooth.
There will be times when a loose tooth is beyond repair. In that case, it may be best to remove the tooth and install a life-like replacement like a dental implant. But that's not inevitable. If at all possible and practical, we'll try to save your loose tooth.
If you would like more information on loose 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 Become Loose.”
In any given year, 4 million tweens and teens are in the process of having their teeth straightened with braces or clear aligners. It's so common we tend to consider orthodontic treatment for young people as a rite of passage into adulthood.
But it doesn't necessarily have to be that way—it might be possible to stop or at least minimize a poor bite before it fully develops. That's the goal of interceptive orthodontics—treatments that head off or “intercept” a bite problem early.
The goal isn't necessarily to reposition misaligned teeth, but to correct a problem that can lead to misalignment. Here are some examples.
A narrow jaw. A narrowly developing jaw can crowd incoming teeth out of their normal positions. For the upper jaw, though, we can take advantage of a temporary separation in the bones in the roof of the mouth (palate) with a device called a palatal expander. Placed against the palate, the expander exerts outward pressure on the teeth and jaw to widen this separation. The body fills in the gap with bone to gradually widen the jaw.
Abnormal jaw alignment. It's possible for a jaw to develop abnormally during childhood so that it extends too far beyond the other. Using a hinged device called a Herbst appliance, it's possible to interrupt this abnormal growth pattern and influence the bones and muscles of the jaw to grow in a different way.
Missing primary teeth. An important role for a primary (baby) tooth is to hold a place for the future permanent tooth. But if the primary tooth is lost too soon, other teeth can drift into the space and crowd out the intended permanent tooth. To prevent this, we can insert a space maintainer: This simple looped metal device prevents teeth from drifting and preserves the space for the permanent tooth.
Although these and other interceptive treatments are effective, some like the palatal expander do their best work within a limited age frame. To take advantage of interceptive orthodontics in a timely manner, parents should seek a bite evaluation for their child from an orthodontist around age 6. The earlier we detect a growing bite problem, the greater your chances for successful intervention.
If you would like more information on treating emerging bite problems early, 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 “Interceptive Orthodontics.”
Kill Bill fans have been pressing for a third installment of the stylized revenge tale since Kill Bill, Volume 2 hit the theaters in 2004. Finally, filmmaker Quentin Tarantino is talking about the long-awaited Volume 3 as if it might soon become a reality. The third movie in the franchise would most likely focus on the now-grown daughter of the character played by Vivica A. Fox in the first two. Vivica recently made known that should Kill Bill, Volume 3 go into production, she thinks 24-year-old actress and singer Zendaya would be perfect for the role.
Although Zendaya is a few inches taller than Vivica, the two women have a few things in common. Besides being talented movie and television actresses who have won awards for their roles, they both have camera-ready smiles. And both Vivica and Zendaya can thank their dentists for helping their smiles be their best.
In 2016, Vivica told Dear Doctor magazine that her smile needed a boost, so she opted for dental veneers to correct gaps between her teeth—and she's very happy with them. “I love my veneers!” she exclaimed. Zendaya also had help in achieving her Hollywood-perfect smile. In 2011, early in her career on the Disney channel, she wore clear orthodontic aligners to straighten her teeth. To further perfect her smile, she visited her dentist for professional teeth whitening in 2016, inviting a film crew along to show how easy and effective in-office tooth whitening is.
But you don't have to be a celebrity to enjoy smile-enhancing dental treatments. They are great options for anyone who wants to improve the look of their smile.
Teeth whitening. If your teeth are looking yellowed, in-office whitening can make them up to 10 shades brighter in one visit! Some people prefer professional at-home whitening kits, which produce great results more gradually.
Bonding or veneers. For small chips and cracks, cosmetic bonding can cover flaws by adding layers of a tooth-colored material over the tooth. For bigger flaws, heavy discoloration or gaps between teeth as Vivica had, dental veneers may be the answer. These custom-made thin porcelain shells cover the front-facing surface of the tooth, hiding imperfections to give anyone a Hollywood smile.
Orthodontics. Crooked teeth can detract from the look of a smile. While traditional braces are an option, many people with mild to moderate alignment issues find removable clear aligners the perfect way to get the smile they desire with minimal impact on their daily activities. Clear aligners are very subtle and can be removed for eating and cleaning as well as for special occasions—or for filming scenes, as Zendaya knows.
Contact us or schedule an appointment for a consultation to see if professional teeth whitening, cosmetic bonding or veneers, orthodontics, or another dental treatment could enhance your smile. You can also learn more by reading the Dear Doctor magazine articles “Important Teeth Whitening Questions Answered” and “How Your Dentist Can Help You Look Younger.”
If your child has seen the dentist regularly, and brushed and flossed daily, there's a good chance they've avoided advanced tooth decay. But another problem might already be growing right under your nose—a poor dental bite (malocclusion).
A dental bite refers to the way the upper and lower teeth fit together. In a normal bite the teeth are in straight alignment, and the upper teeth slightly extend in front of and over the lower when the jaws are shut. But permanent teeth erupting out of position or a jaw developing abnormally can set the stage for a malocclusion.
Although the full effects of a malocclusion may not manifest until later, there may be signs of its development as early as age 6. If so, it may be possible to identify a budding bite problem and “intercept” it before it goes too far, correcting it or reducing its severity.
Here are 6 signs your school-age child could be developing a malocclusion.
Excessive spacing. If the spacing between teeth seems too wide, it could mean the size of your child's teeth are out of proportion with their jaw.
Underbite. Rather than the normal upper front teeth covering the lower, the lower teeth extend out and over the upper teeth.
Open bite. There's a space or gap between the upper and lower teeth even when the jaws are shut.
Crowding. Due to a lack of space on the jaw, incoming teeth don't have enough room to erupt and may come in misaligned or “crooked.”
Crossbites. Some of the lower teeth, either in front or back of the jaw, overlap the upper teeth, while the rest of the upper teeth overlap normally.
Protrusion or retrusion. This occurs if the upper front teeth or jaw appear too far forward (protrusion) or the lower teeth or jaw are positioned too far back (retrusion).
Besides watching out for the preceding signs yourself, it's also a good idea to have your child undergo a comprehensive bite evaluation with an orthodontist around age 6. If that does reveal something amiss with their bite, intervention now could correct or lessen the problem and future treatment efforts later.
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