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By Richard Jaffe, DDS
January 03, 2018
Category: Dental Procedures
DrawingImpactedTeethintotheOpencanRestoreaSmile

You don’t have to be a dental professional to appreciate a beautiful smile. Likewise, you’ll also know when something’s not quite right with one.

Such can be the case when a tooth fails to erupt properly, causing most or all of the crown to remain below the gum line, a condition known as impaction. Upper canines (or “eyeteeth,” for their location in the arch under the eyes) are especially susceptible to impaction: located on either side of the lateral incisors, which are on either side of the central incisors (the two center front teeth).

The upper canines are important both for function and appearance. Working with their lower counterparts they help cut through food as we chew, so you lose some of that efficiency when they don’t erupt properly. Impacted teeth are susceptible to abscesses and cysts, and can impinge upon and damage the roots of other teeth. And just as importantly, their absence also disrupts the smile as nearby teeth tend to move or “drift” toward the open space.

Rather than remove the impacted canines as is often done with back teeth, it may be more advantageous for both function and appearance to “coax” them into full eruption. This requires first pinpointing their exact location below the gums using x-rays or cone beam 3-D imaging.

If the teeth are in reasonably good position we must first prepare them for orthodontic treatment by surgically exposing the crown from the gums and bonding a small bracket to it. We then attach a small gold chain to the bracket that extends outside of the gums when we suture them back into place. The chain is attached to orthodontic hardware that exerts pressure on the impacted tooth for several months to “pull” it out into the arch.

This procedure has the best chance of success if undertaken before the end of jaw development in early adulthood. Otherwise, it may be better to remove the impacted canines and replace them with dental implants, followed by orthodontic treatment of other teeth to restore their proper position and bite relationships. In either case, your impacted upper canines don’t have to be a problem — we can restore both your mouth function and your smile.

If you would like more information on impacted teeth and treatment options, 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.”

UnderstandingtheAgingProcessLeadstoMoreEffectiveOrthodontics

If you’ve ever looked at younger photos of yourself, you’re sure to notice differences with your present appearance. Of course, your basic features might appear much the same. But maybe your lips seemed a little thicker back then, or your nose a bit less prominent.

This is because your facial features don’t stop growing when you reach adulthood—they continue to change throughout your life. For example, lips reach their maximum thickness by around age 14 for girls or age 16 for boys; they’ll remain at that level of thickness for a few years before gradually thinning throughout adulthood. The nose will also continue to grow, becoming more prominent especially as changes in the lower part of the face can make the chin appear shorter.

Although each of us ages at different rates and in different ways, these general physical trends are somewhat predictable. That’s why we can use the knowledge of how our facial physiology changes with age to fine tune orthodontic or other cosmetic dental treatments. The most optimum approach is to consider treatment in the early stages of bite development during childhood or early adolescence.

This means we’re doing more than correcting a patient’s current bite: we’re also taking into account how tooth movement now might affect the jaw and facial structures later in life. By incorporating our understanding of age-related changes into our treatment we might be able to provide some hedge against the effects of aging.

This approach starts with early comprehensive dental care, preferably before a child’s first birthday, and an orthodontic evaluation at around age 6 to assess bite development. It may also be necessary to initiate interceptive treatment at an early age to lessen or even eliminate a growing bite problem to help ease the extent of future treatment. And if a bite requires correction, early evaluation can help create a timetable for effective treatment in later years.

Taking this approach can correct problems now affecting both dental health and appearance. But by acknowledging the aging process in our treatments, we can build the foundation for a beautiful smile well into the future.

If you would like more information on keeping an attractive smile throughout your life, please contact us or schedule an appointment for a consultation.

By Richard Jaffe, DDS
December 04, 2017
Category: Dental Procedures
Tags: braces   orthodontics  
4TipsforAvoidingDentalDiseaseWhileWearingBraces

Wearing braces takes time, but if all goes well the changes to your smile will be well worth it. In the meantime, though, you’ll have to contend with one particular difficulty—keeping your teeth clean of disease-causing, bacterial plaque.

Don’t worry, though—while keeping dental disease at bay with braces can be challenging, it is doable. Here are 4 tips for minimizing your chances of tooth decay or periodontal (gum) disease during orthodontic treatment.

Eat less sugar. Like any living organism, bacteria must eat—and they’re especially amenable to sugar. The more they have access to this favorite food source, the more they multiply—and the greater your risk of tooth decay or gum disease. Eating fewer sugary foods and snacks and more dental-friendly ones helps restrict bacteria populations in your mouth.

Brush thoroughly. Brushing with braces can be difficult, especially in areas blocked by orthodontic hardware. You need to be sure you brush all tooth and gum surfaces around your braces, including above and below the wire running through the brackets. A soft multi-tufted microline bristle brush is a good choice for getting into these hard to reach places. Brushing around braces takes more time, but it’s essential for effective plaque removal.

Use flossing tools. Flossing is important for removing plaque from between teeth—but, unfortunately, it might be even more difficult to perform with braces than brushing. If using string floss proves too daunting consider using a floss threader or a similar device that might be easier to maneuver. You can also use a water irrigator, a hand-held device that sprays water under pressure to loosen and flush away between-teeth plaque.

Keep up regular dental visits. While you’re seeing your orthodontist regularly for adjustments, you should also see your general dentist at least every six months or more. Besides dental cleaning, your dentist also monitors for signs of disease and can prescribe preventive measures like antibacterial mouth rinses. Of course, if you see abnormalities, like white spots on your teeth or red, puffy or bleeding gums, contact your dentist as soon as possible. The sooner a problem can be addressed the less impact it may have on your orthodontic treatment and overall oral health.

If you would like more information on caring for teeth and gums while wearing braces, 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 “Caring for Teeth During Orthodontic Treatment.”

By Richard Jaffe, DDS
November 26, 2017
Category: Dental Procedures
DontBreakItLikeBeckham

During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.

Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.

For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.

When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.

But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.

Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.

So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…

If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”

By Richard Jaffe, DDS
November 11, 2017
Category: Oral Health
Tags: teething  
WeathertheStormofTeethingwithTheseComfortTips

Teething is a normal part of your baby’s dental development. That doesn’t make it less stressful, though, for you or your baby.

This natural process occurs as your child’s primary teeth sequentially erupt through the gums over a period of two or three years. The first are usually the two lower front teeth followed by the two upper front ones, beginning (give or take a couple of months) between six and nine months. By the age of three, most children have all twenty of their primary teeth.

The disruption to the gum tissues can cause a number of unpleasant side effects including gum swelling, facial rash, drooling, disrupted sleep patterns and decreased appetite. As a result a child can become irritable, bite and gnaw to relieve gum discomfort or rub their ears. Every child’s experience is different as well as their degree of pain and discomfort.

As a tooth is about to erupt, you may notice symptoms increasing a few days before and after. The symptoms will then subside until the next tooth begins to erupt. In a way, teething is much like a storm—you mostly have to ride it out. However, that doesn’t mean you can’t lessen your child’s discomfort during the teething episode.

For one thing, cold, soft items like teething rings, pacifiers or even a clean, wet washcloth your child can gnaw on will help relieve gum pressure. Chilling the item can have a pain-numbing effect—but avoid freezing temperatures, which can burn the tissues. You can also massage the gums with a clean finger to relieve pain. But don’t rub alcohol on their gums and only use numbing agents (like Benzocaine) for children older than two, and only with the advice and supervision of your healthcare provider. The use of acetaminophen or ibuprofen might also be used under the advice of your doctor.

If you notice your child has diarrhea, extensive rashes or fever, contact your physician immediately—these aren’t normal teething symptoms and may indicate something more serious. And be sure to consult with us if you have any other questions or concerns.

Teething can be a difficult time for your baby and family. But with these tips and a little “TLC” you can keep their discomfort to a minimum.

If you would like more information on caring for your baby’s developing 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 “Teething Troubles: How to Help Your Baby be Comfortable.”





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