YourChildsImpactedFrontTeethcanbeSaved-butDontWaittooLong

Children's permanent teeth normally erupt over several years after first forming below the gum line. All their permanent teeth should come in by the time they reach early adolescence.

Unfortunately, this process doesn't always happen as it should. If the erupting teeth become crowded due to a poor bite (malocclusion), teeth still to come in may not have enough room to fully erupt. They become impacted, a condition in which the visible crown remains partially or completely submerged below the gum line.

Impacted teeth create consequences for other teeth and dental health overall. They more readily cause abscesses (a localized infection within the gum tissue) and can damage the roots of nearby teeth. Impacted front canine (eye) teeth can interfere with bite function and their visual absence mars an otherwise attractive smile.

If your child's canine teeth have failed to erupt properly, there is a way to help them fully come in if you act before their mouth structure fully matures. The first step is an orthodontic evaluation of their entire bite. This will determine if there's enough space to move other teeth to make room for the impacted canines.

If so, we would then find the exact position of the impacted teeth using x-rays and possibly cone beam CT scanning for a detailed three-dimensional image. The teeth could be in a variety of positions, such as angled toward the roof of the mouth or cheek or buried high in the jawbone. If the teeth are too far out of position the best course of action may be to remove them and replace them later with a dental implant.

If the impacted teeth, though, are in a feasible position for retrieval, we first expose each tooth through the gums with a minor surgical procedure and bond a small bracket to it. We then attach a small gold chain to the bracket that loops over an orthodontic appliance attached to other teeth. The appliance will exert pressure over several months to pull the tooth into proper position.

If successful, your child will gain the use of these important teeth and a more attractive appearance. But don't delay — this desired outcome will become much harder if not impossible to attain as their teeth and jaws continue to develop.

If you would like more information on treating 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.”

By Nathan C. Steele, DMD
March 21, 2020
Category: Dental Procedures
Tags: braces   retainer  
WhyaBondedRetainerMightbeaBetterChoiceAfterBraces

A lot of time and effort goes into straightening your smile. But there’s a possibility it might not stay that way—and all that hard work could be lost. The same natural mechanism that enables your teeth to move with braces could cause them to revert to their old, undesirable positions.

So for a little while (or longer for some people) you’ll need to wear a retainer, an appliance designed to keep or “retain” your teeth where they are now. And while the removable type is perhaps the best known, there’s at least one other choice you might want to consider: a bonded retainer.

Just as its name implies, this retainer consists of a thin metal wire bonded to the back of the teeth with a composite material. Unlike the removable appliance, a bonded retainer is fixed and can only be removed by an orthodontist.

Bonded retainers have several advantages. Perhaps the most important one is cosmetic—unlike the removable version, others can’t see a bonded retainer since it’s hidden behind the teeth. There’s also no keeping up with it—or losing it—since it’s fixed in place, which might be helpful with some younger patients who need reminding about keeping their retainer in their mouth.

There are, however, a few disadvantages. It’s much harder to floss with a bonded retainer, which could increase the risks of dental disease. It’s also possible for it to break, in which case it will need to be repaired by an orthodontist and as soon as possible. Without it in place for any length of time the teeth could move out of alignment.

If you or a family member is about to have braces removed, you’ll soon need to make a decision on which retainer to use. We’ll discuss these options with you and help you choose the one—removable or bonded—that’s right for you.

If you would like more information on bonded retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Bonded Retainers: What are the Pros and Cons?

By Nathan C. Steele, DMD
March 11, 2020
Category: Oral Health
Tags: oral health   gum disease  
HeresWhatYouCanDotoAvoidGumDisease

Here's an alarming statistic: Nearly half of adults over 30—and 70% over 65—are affected by periodontal (gum) disease. It's sobering because if not caught and treated early, gum disease can lead to not only tooth loss but also an increased risk of heart attack or stroke.

Gum disease most often begins with dental plaque, a thin film of bacteria and food particles that builds up on tooth surfaces mainly from poor oral hygiene. Undisturbed plaque can become a breeding ground for bacteria that cause gum infections.

Daily brushing and flossing can remove most of this plaque buildup, but you also need to get professional dental cleanings at least twice a year. This is because any plaque you missed brushing and flossing can interact with saliva and harden into calculus or tartar. This hardened plaque can't be dislodged through brushing and flossing alone, but requires special instruments used by dental professionals to remove it.

You should also be aware of other risk factors you may have that increase your chances of gum disease and take action to minimize them. For instance, you may have a higher genetic propensity toward gum disease. If so, you'll need to be extra-vigilant with personal hygiene and watch for any signs of disease.

Tobacco use, especially smoking, can double your chances of gum disease as well as make it difficult to notice any signs of disease because your gums will not bleed or swell. Quitting the habit can vastly improve your odds of avoiding an infection. Your disease risk could also be high if you have a diet heavy in sugar, which feeds bacteria. Avoiding sugary foods and eating a more dental-friendly diet can lower your disease risk.

Oral hygiene and managing any other risk factors can greatly reduce your risk for gum disease, but it won't eliminate it entirely. So, be sure you seek professional dental care at the first signs of swollen, reddened or bleeding gums. The sooner you undergo treatment for a possible gum infection, the better your chances of avoiding extensive damage to your teeth, gums and supporting bone.

The risk for gum disease goes up as we get older. But by following good hygiene and lifestyle practices, you can put yourself on the healthier side of the statistics.

If you would like more information on gum disease care and treatment, 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 “How Gum Disease Gets Started.”

By Nathan C. Steele, DMD
March 01, 2020
Category: Dental Procedures
Tags: celebrity smiles   veneers  
HowVeneersRestoredHowieMandelsWinningSmile

You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.

The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.

But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.

Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.

His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.

One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.

In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.

Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.

If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”

By Nathan C. Steele, DMD
February 20, 2020
Category: Oral Health
Tags: oral health   gum disease  
ThisFebruaryShowaLittleLovetoBothYourHeartandYourGums

It’s February and time for a little heart love. And not just the Valentine’s Day kind: February is also American Heart Month, when healthcare providers promote cardiovascular health. That includes dentists, because cardiovascular health goes hand in hand with dental health.

It just so happens that February is Gum Disease Awareness Month too. If that’s a coincidence, it’s an appropriate one: Although different in nature and health impact, heart disease and gum disease are linked by a common thread: chronic inflammation.

Inflammation (or tissue swelling) in and of itself is beneficial and often necessary. When cells in the body are injured or become diseased, the immune system isolates them from healthier cells through inflammation for the protection of the latter. Once the body heals, inflammation normally subsides.

But conditions surrounding both heart disease and gum disease often prevent a decrease in inflammation. With heart disease, for example, fatty deposits called plaque accumulate within blood vessels, impeding blood flow and triggering inflammation.

A different kind of plaque plays a pivotal role with gum disease. Dental plaque is a thin biofilm that builds up on tooth surfaces. It’s home to bacteria that can infect the gums, which in turn elicits an inflammatory response within those affected tissues. Unless treated, the infection will continue to grow worse, as will the inflammation.

The bad news is that these two sources of chronic inflammation are unlikely to stay isolated. Some recent studies indicate that cardiovascular inflammation worsens gum inflammation, and vice-versa, in patients with both conditions.

The good news, though, is that treating and managing inflammation related to either condition appears to benefit the other. Patients with cardiovascular disease can often reduce their inflammation with medical treatment and medications, exercise and a heart-friendly diet.

You can also ease gum disease inflammation by undergoing dental plaque removal treatment at the first signs of an infection. And, the sooner the better: Make a dental appointment as soon as possible if you notice swollen, reddened or bleeding gums.

You can lower your gum disease risk by brushing and flossing daily to remove accumulated plaque, and visiting us at least twice a year for more thorough dental cleanings and checkups. If you’ve already experienced gum disease, you may need more frequent visits depending on your gum health.

So this February, while you’re showing your special someone how much you care, show a little love to both your heart and your gums. Your health—general and oral—will appreciate it.

If you would like more information about gum health, please contact us or schedule a consultation.





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Nathan C. Steele, DMD

(908) 526-2113
17 Monroe Street Bridgewater, NJ 08807