Straight Teeth, Healthy Gums

 

So You're Saying I Can Straighten My Teeth and Make my Gums Healthier at the Same Time...?

As we know, fixed braces can create numerous plaque-retention sites which increase a patient's risk to develop demineralizations or "white spots", cavities, or gum infections. The risks are real-whether the braces are on the front of your teeth or on the inside (lingual braces). (1)

Recent clinical trials at the University of Florida and the University of Washington show that periodontal response, or gum health, improves during orthodontic treatment with Invisalign®. (2) This is due to the fact that patients can remove the aligners to brush and floss normally. They also found in surveying the patients that these patients spent more time brushing and flossing, and cleaning the inside of the aligners to keep them invisible.

The other benefit of Invisalign® is the additional splinting effect, which is greater than that of fixed braces. The teeth that are not moving are held stationary without receiving a net force. So tooth mobility-which is normal and necessary during orthodontic treatment- is minimized.(2)

See the video below that dramatizes the health benefits that can be yours when you decide to try Invisalign® therapy. See you next month!

                                 

References:
(1)Miethe R.R., Vogt S. "A Comparison of the periodontal health in patients during treatment with Invisalign(R) system and with fixed orthodontic appliances." J Orofac Orthop 1999;115:83-8.

(2)Boyd, R.L. "Improving Periodontal Health through Invisalign Treatment" Access 2005; 24-26

It's Allergy Season!

It's allergy season...how are your children breathing? Is it allergies, or is it something else?


It's April, and Spring allergy season is well underway in Kent County, Delaware. This month's blog post is looking at breathing in our younger patients from an anatomic perspective.

A recent study published (Iwasaki et al., American Journal of Orthodontics and Dentofacial Orthopedics; February 2013 Vol 143 Issue 2, pgs. 235-245) by researchers at Kagoshima University, Kagoshima, Japan demonstrated the benefits of orthodontic expansion therapy for younger patients. The purpose of the study was to clarify the effect of orthodontic expansion therapy on the position of the tongue and the airway space in children with nasal airway blockage.

The study included patients ages 9 to 11 years old who had a Class II jaw relationship with no previous orthodontic treatment, no jaw discrepancies, and no enlarged adenoids or tonsils. They were divided into two groups; a control group and a group who received expansion therapy. The airway volume was measured in four areas before and after expansion for both groups; the mouth, in the nasal area, upper throat (retropalatal) and lower throat (oropharyngeal).

After expansion, the measurements showed the mouth airway region decreased significantly for the control group, whereas the three other areas increased. In the control group, two areas increased in volume, and two areas did not change. Overall there was no significant difference for mouth airway volume between the two groups after orthodontic expansion.

The effect of orthodontic expansion is this: the tongue improvement in posture and going to a higher position in the mouth. But in some patients, the low tongue posture did not improve because the nasal obstruction remained even after orthodontic expansion.

So, for our OSL patients who present for treatment (which may include expansion therapy): Orthodontic expansion enlarges the airway both with and without improvement in nasal obstruction. Some patients will need additional intervention, and we will continue to refer for allergy, or ENT evaluations.

To our patients and friends of OSL - here's to a great spring, and many good nights sleep...

See you next month!

Why NOT Consult an Orthodontist..? Part 2

Last month I introduced a few scenarios we encounter that can contraindicate a patient beginning orthodontic treatment. This month, I will present two more:

3. Homecare and Dental Hygiene, Periodontal disease prevention

Whether you plan on having conventional braces or Invisalign® aligners, you must practice good homecare and have healthy gums. Invisalign® is removable so it does make it easier to brush and floss with little technique change. Braces require a little more effort than you are currently practicing.

Every patient I consult with is evaluated, and we take photographs to review together. Ask any of our OSL patients-they will confirm it! We want to make it easy for you but ultimately you need to be consistent in your daily life.

Another part of your homecare is your diet; avoid sodas, sports drinks, and sweets to prevent cavities- if you consume them. The risks to you include permanent scars and gum damage that may require more dental treatment than you had planned. Water is your best option.

 

Smoking is the number one environmental risk factor for gum/periodontal disease, so I encourage you to quit.

Periodontal disease is preventable, and the best prevention is starting treatment with excellent homecare. Learn to floss, use your toothbrush for 2 minutes each time for thorough cleanings.

4. The time commitment ....to get the results you want

According to the American Association of Orthodontists, the average treatment takes about 22 months to complete. About 1 in 5 patients are adults. There are a series of appointments that need attending over this span of time. Seeing a local orthodontist saves you time getting to these appointments. Each appointment allows me to assess your progress, adjust your appliances, time to review instructions and answer questions you may have.

At OSL, we review a patient's time, the plan and work to make it convenient, but patients also need to make sure they are ready to focus on what is needed. Whether they are in school or in work, they make a commitment to proceed and we make it with them. 98% of our patients finish on time or early, which is accomplished by thorough planning and discussions before the treatment begins.

Two OSL patients are shown below-along with the number of months in treatment, and number of appointments needed to finish treatment:

18 appointments over 23 months from start to finish

11 appointments, over 18 months from start to finish

Orthodontic Treatment can contribute to good dental health for adults and children. At OSL, we work with our local dentists and our patients to ensure the orthodontic experience is what we all would want. 

References:

1. AAOmembers.org/Press/Orthodontic-Treatment.cfm
2. "Making Orthodontic Treatment More than Just Straight Teeth" Robert Boyd, Med, DDS

Why NOT consult an Orthodontist..? Part 1

This month, and next month, I hope to save you time (and money) and provide some evidence to support the title premise. Believe it or not orthodontic treatment is not for everyone. It may seem like I’m turning away potential patients, but you’ll soon see that doctors really want what’s best for their patients.

 

1. Bone preservation medications- Prescription meds such as Actonel®, Boniva®, Fosamax® and others are used to protect against osteoporosis and reduce the risk of bone fractures. These same meds actually inhibit your teeth from straightening and affect bone healing. I have consulted with patients and their physicians about possible “drug holidays.” With this, our patients see some straightening, and then a treatment slow down to where the patients’ teeth stop moving altogether.

 

What can you do?

Knowing you will achieve at best an incomplete orthodontic result, most of our patients choose or are encouraged to look at cosmetic options such as veneers or crowns, and to speak to their dentist about this option. PLUS- you may see the improvement you are looking for sooner than you would with orthodontic treatment! J

2. Piercings and other oral habits-

Habit (Def.)-an acquired mode of behavior that has become nearly or completely involuntary

If repeated with enough intensity, frequency and duration, oral habits can move teeth, and not in a way you would like.

Children can stop a finger habit with encouragement and time, and if necessary a fixed appliance can be inserted and act as a reminder to stop. This is important in growing children due to the possible distortion of the developing jaws.

  Photo courtesy of the Journal of Clinical Orthodontics

 

Tongue thrust habits are seen in children and adults, and can affect the treatment results. Awareness of the habit is the first step to reduce the habit, and some exercises can reduce or eliminate the habit.

 

Oral piercings can lead to oral habits. In the figure above you can see her teeth the day her tongue was pierced- no space present. She habitually pushed the bar into the teeth and forced the teeth apart, and stripped the gum tissue. The treatment to correct this involved removing the piercing, then 4 months of periodontal/gum therapy and then orthodontic treatment.

 Photo courtesy of the American Association of Orthodontists

What can you do?  

Stop the habit. Sometimes an appliance to interrupt the habit is indicated.

Remove the oral piercing, let the area heal. Then consult Dr. Steckel if alignment correction is needed.

 

Until Part II, here’s to your health and super smiles!

References:

1.   Zahrowski, J.J. “Bisphosphonates: An Orthodontic Concern”; presented at the AAO Annual Session Washington D.C. May, 2010.

2.   Sawsan T., Guigova, I., Preston, C.B. “Midline Diastema Caused by Tongue Piercing”  Journal of Clinical OrthodonticsVol 44, No.7: Pages 426-428, 2010

3.   “Problems to Watch for in Growing Children” AAO publication July 2012.

 

Treatment with Invisalign

Invisalign® and your wedding..

Your wedding is one of biggest events of your life. How many times in your life are all of your friends and family gathered in one place, just for you? How often do you have such a large photo opportunity focused on you? Of course, you want to look your best during this event with a great smile to compliment your wedding dress (or suit). The answer: Invisalign®. You may have heard of this treatment option, and you probably have some questions.

 

What is Invisalign®?

Invisalign® is a series of removable aligners that many times are an alternative to braces. It was developed by Align Technologies, and Dr. Steckel has used this treatment option since 1999. She is also an Invisalign® Preferred Provider, meaning she is experienced and current in providing this treatment. The aligners are specifically designed to fit your teeth, and are practically unnoticeable while straightening your teeth.

 

How does it work?

Dr. Steckel consults with you to determine that Invisalign® will predictably work for you on the pre-wedding schedule you’ve planned. (See photos below of a recent bride’s experience.) If Invisalign® is right for you, impressions of your teeth are made to create the three-dimensional computer model Dr. Steckel uses plan your treatment. Dr. Steckel reviews your plan with you, and shows what each aligner will do, and then you start to wear your aligners.

 

How will I use Invisalign®?

You will be scheduled with Dr. Steckel and her OSL team typically every six to eight weeks. The average treatment plans involve about 20 or 30 aligners, and each aligner is worn for 2 weeks. Although we suggest you wear the aligners as much as possible, you can take them off for special occasions, like your weddingJ. They also can be removed for eating and drinking.  Make sure that you clean your teeth properly before reseating the aligners. For best results, the aligners should be worn for twenty-two hours each day.

 

“Here are some before and after photos before the treatment with Invisalign® and before the wedding.
She was very satisfied even though the treatment wasn’t finished by the time of her wedding.”

How effective is Invisalign®?

Invisalign® is effective in correcting gapped teeth, over bites, under bites, open bites, cross bites, and overcrowding. Note-Although Invisalign® has made breakthroughs to address more severe and complex cases, some cases may require traditional braces for treatment. If that is the case, have no fear, for today’s traditional or ceramic braces are smaller and more effective than ever before. They would be more apparent than Invisalign®, but they are still an available option. Other considerations: Some of our patients we’ve treated with Invisalign® had braces when they were younger. These patients usually report a preference for Invisalign® to straighten their teeth.

 

Here are some before and after photos of our Invisalign® patients, the first wanted to correct her spaced teeth and the second to correct her overbite and crowding:

Conclusion:

So, when you plan your wedding, remember that there is more than one treatment option improve your smile. Invisalign® can help you improve your smile and remain under-the-radar while you’re doing it.  Dr. Steckel’s advice- plan early and plan ahead, see your dentist for a check-up, then call us for an orthodontic consultation.

 

Treatable cases. (2012). Retrieved from http://www.invisalign.com/How-Invisalign-Works/Pages/Treatable-Cases.aspx

Steckel, S, (2012) Choices, Choices, Invisalign or Braces. Retrieved from Orthodontics on Silverlake blog. www.doverorthodontics.com

Steckel, S (2011) National Orthodontic Health Month. Retrieved from Orthodontics on Silverlake blog. www.doverorthodontics.com

DiMatteo, A. (2012). Invisalign: Invisible braces solution. Retrieved from http://www.yourdentistryguide.com/invisalign/

 

 

 

 

 

 

 

Sonicare® Toothbrush and Good Oral Health

Orthodontic patients at Orthodontics on Silverlake are usually in good dental health before they begin their treatment. In reviewing their medical history before treatment, I may find prescription meds that can cause dry mouth and/or eating habits that can be detrimental. Frequent meals can subject their teeth to more frequent plaque-inducing acids. So our patients get an education in oral health care, and they are asked to make a commitment to keeping their teeth clean throughout their active treatment. GOOD NEWS: This has been shown to have a lasting impact, long after the treatment is completed.(1)

 

I have found that patients using a Sonicare® toothbrush have an easier time maintaining their commitment.

 

• My OSL team and I observe less stain on our patients' teeth, and this also was confirmed in a 2010 randomized, multi-center study of 179 adults (2).
• Another study looked at reducing gingivitis, gingival bleeding and plaque over time and they compared a manual toothbrush to a Sonicare® toothbrush. The Sonicare® toothbrush removed up to 4 times as much plaque than the manual toothbrush, and reduced the bleeding and gingivitis by 2 times.(3)
• The 2 minute timer in the brush is very motivating, and the mechanism and extent of plaque removal goes beyond manual scrubbing. (4)

 

We encourage patients to put a Sonicare® on their Christmas wish list this year (not kidding!). Every Sonicare® toothbrush purchased in our office in the month of December 2012 enters you into our drawing for one lucky parent or patient to receive their very own Sonicare® from all of us at OSL.

 

Good luck, Good health, and Happy Holidays! See you next month.

 

 

References:

1. Orthodontic Treatment Contributes to Good Dental Health for Adults/www.aaomembers.org/Press/Orthodontic

2. Colgan P, DeLaurenti M, et al Data on File 2010

3. Milleman K, Milleman J, Putt M et al, Data on File 2011

4. Hope CK, Wilson M. Am JDent 2002;15:7B-11B

Teeth Missing In Action...

....Congenitally Missing Lateral Incisors

One of several reasons I appreciate having been a general dentist for a few years and now working as a specialist with local general/restorative dentists is combining orthodontic treatment with esthetic dentistry for permanent finished results.

Typically, the youngest patient seen for an orthodontic consult is around the age of 7. At this consult a missing lateral incisor can be diagnosed at that young age. Closing the space where the tooth (if one is missing) or teeth (if both are missing) is an esthetic and viable procedure that provides longterm results that are completed in the patient's adolescence. Recent improvements in restorative dentistry including individual tooth bleaching, porcelain veneers and/or hybrid composite resin build-ups can yield results indistinguishable from natural dentitions. These improvements discussed can minimize potential problems with orthodontic space closure, when teeth are substituted into non-traditional positions. Longterm stability of the results is aided with a fixed retainer and removable back-up retainer.

 

Patient finished her orthodontic treatment at 17 years, with all of her natural teeth. No additional dental treatment needed.

 

Patient finished his orthodontic treatment at age 18 years with all of his natural teeth. No additional dental treatment needed.

Of course in treatment planning, it's important to identify alternative procedures, including discussing the cost-risk-benefit ratios of each option. Osseointegrated implants are frequently discussed to replace the missing tooth/teeth. Unfortunately the timeline for optimum longterm results adds potential problems to this treatment option. These timeline issues are realized when a patient finishes orthodontic treatment at age ~13, receives retainers, and waits at least 4 (female) and up to 7 years (male) for skeletal growth to cease. During this time wearing a retainer consistently is frequently not done. If this happens, orthodontic re-treatment is needed to realign the teeth and spaces before implants can be placed. (see photos)

 

Patient finished her orthodontic treatment at age 17 years, then went to a periodontist and dentist for 2 implants and 2 crowns to restore missing lateral incisors.

Top Left: Congenitally missing upper lateral incisors, Top Right: With retainer (flipper)

 Bottom: Final after implants and crowns

 

Patient in treatment congenitally missing upper lateral incisors. He will finish his orthodontic treatment at age 17 years. Retainer will have denture teeth attached. Implants/crowns will be done in another year to replace missing lateral incisors.

Teamwork and planning orthodontic with restorative dentistry can successfully treat patients with missing lateral incisors so the results look like an intact dentition. See you next month!

References
1. Tuverson DL. Orthodontic treatment using canines in place of missing lateral incisors. Am J Orthod. 1970;58:109-127
2. Zachrisson BU. Remodeling teeth by grinding. Am J Orthod. 1975;68:545-553
3. Rosa M., Zachrisson BU. The space closure alternative for missing maxillary incisors:an update. J Clin Orthod 2010;44:540-549
4. Thilander B, et al. Orthodontic aspects of the use of oral implants in adolescents: a 10 year follow-up study. Eur J Orthod. 2001; 23:715-731.