Early Treatment

Stubborn Teeth!

June 14th, 2017

Dr. Theresa here today to write about an intriguing subject: impacted teeth.  For the sake of simplicity, I will only focus on one of the most commonly impacted teeth, Maxillary (upper) canines.  Canines are commonly referred to as the “i-teeth.”  An impacted tooth means it has finished developing, but is unable to erupt.

What makes the upper canines become impacted?  There are multiple theories, and none of them have been officially proven.  So we will discuss the most realistic ones.

First, the size of the teeth could be larger than the space available in the jaw (simply called ‘crowding.’)  When this happens, there is not enough space for the canine to erupt into the mouth which inevitably traps the canine in the bone.

Second, the baby canine tooth does not fall out at the appropriate time.  If the baby canine remains in the mouth too long then the permanent canine does not have a chance to erupt into the mouth.  Remember, there is a ‘normal’ permanent tooth eruption sequence (more on that below).

Third, the canine can develop sideways (horizontal), but no one has a reasonable explanation as to why.

Lastly, the development of one of the adjacent teeth can affect the upper canine eruption path.  Usually this would be the Lateral Incisor (one of your front teeth), and in the cases with impacted canines the incisor would be peg shaped and smaller than ideal.  I put this theory in because we have seen a recent string of patients with extremely small upper incisors whose canines are impacted.

Is there a way to avoid canine impaction?  In most cases yes there is, but it does require an orthodontic visit around age 7.  For those avid readers of our blog (all 6 of you—thank you by the way!), we had a post about the ideal time to visit the orthodontist.  Here is the link.  So what are we, as orthodontists, looking for?

We begin by making sure there is progress with losing baby teeth and gaining permanent teeth.  We also take a special X-ray to determine the canine location.  The X-ray also assesses the development of all teeth, and whether the baby teeth are inhibiting normal permanent tooth eruption.  In regards to the upper canines, they normally erupt into the mouth around age 11.

If the baby canines are not loose by age 10 AND you haven’t seen an orthodontist, it is our recommendation that you discuss the situation with your dentist.  We are also happy to take a look at any time.

As previously mentioned, early intervention can prevent or decrease the severity of an impacted canine.  The goal of early intervention is to guide the proper tooth eruption, and to ultimately make any treatment as comfortable as possible.

We hope that everyone has a great start to their Summer!

Age 7 is perfect for a visit!

March 1st, 2017

Dr. Theresa here.  For my first blog post, I wanted to touch on a common question.  'When should I bring my child in to see the orthodontist?'

The American Association of Orthodontist (AAO) recommends that every child see an orthodontist at age seven.  Here is a link if you want.  The immediate follow-up question is 'does every 7 year old need treatment?'  Not at all.

At this initial evaluation we note which permanent teeth are present and the relationship of the jaws with one another.  We take photos and a panoramic X-ray (PAN) and sit down to explain our findings.

In dental school and orthodontic residency we spent an excessive amount of time learning the ‘correct’ tooth loss and eruption sequences.  There are charts and graphs, and plenty of test questions on the subject.  But what did we find when we began practicing?  No child follows the sequence exactly!  Instead we have to think through the process for each child.  And that is why we spend the time to ensure you, the parent, understand your child’s mouth.

Fortunately, most of the time we will recommend routine 6-month checkups where we will continue to monitor growth and development of your child.  We recommend early treatment only when there is a sound, research driven reason.  That will be covered in a later post.  If early treatment is necessary, it will improve your child’s self-esteem, reduce the chance of trauma, and potentially decrease the complexity of treatment in the future.

So if your dentist doesn’t mention an orthodontic evaluation around age 7, please have an orthodontist take a look.  It could prevent a much more difficult (a.k.a. invasive) road later in life.

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