The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
While pediatric dentistry has made great strides in making young patients’ dental visit experiences more relaxing, some children and teenagers still have difficulty with anxiety. Their anxiety in turn can make necessary care much harder to provide.
For difficult cases, many dental providers for children now incorporate a technique known as conscious sedation to help ease anxiety. With this technique, they’re able to perform procedures like cavity-filling or tooth-extraction that are more difficult with an anxiety-prone patient.
While general anesthesia creates a total loss of consciousness, conscious sedation uses precise medications to suppress consciousness at different levels ranging from light to deep suppression, and create a relaxed state for the patient. A child under sedation can still breathe normally and respond to certain stimuli, including touch and verbal commands. For only a light or minimal effect, a dentist normally administers the sedation drug as a pill the child takes orally. For deeper sedation, the medication is most likely delivered through a vein (intravenously).
Sedation reduces fear and anxiety but not necessarily pain, so it’s often accompanied by some type of anesthesia, either a local anesthetic delivered by injection to the procedure site or with a nitrous oxide/oxygen gas combination that’s inhaled through a mask worn by the patient.
Even though the child isn’t completely unconscious, one of the dentist’s staff will monitor vital signs (heart and respiration rates, blood pressure and blood oxygen level) throughout the procedure. This continues even after the treatment is over until the child’s vital signs return to pre-sedation levels. Once released, they will need a ride home and should rest for the remainder of the day. They can then return to school and resume other normal activities the next day.
With the advent of newer and safer drugs, conscious sedation is becoming a more widespread technique in both medicine and dentistry. Using it to ease a child’s anxiety increases the chances they’ll receive all the dental care they need without unpleasant memories of their visit that could follow them into later life.
If you would like more information on the role of conscious sedation for children, 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 “Sedation Dentistry for Kids.”
It’s often best health-wise to preserve even the most troubled tooth—including a child’s primary (“baby”) tooth. If that sounds like too much effort for a tooth that lasts only a few years, there’s a big reason why—if it’s lost prematurely, the incoming permanent tooth above it could erupt out of position.
Preserving a decayed primary tooth could include procedures similar to a root canal treatment, commonly used in adult permanent teeth with inner decay. However, we may need to modify this approach to protect the primary tooth’s pulp. This innermost layer plays a critical role in early dental development.
Because an adult tooth has reached maturity, removing diseased pulp tissue has little effect on its permanent health. But the pulp contributes to dentin growth (the layer between it and the outer enamel) in primary and young permanent teeth, so removing it could ultimately compromise the tooth’s long-term health.
Our goal then with a child’s tooth is to remove as much diseased tissue as possible while involving the pulp as little as possible. What techniques we use will depend on how much of the pulp has become infected.
For example, if decay has advanced to but hasn’t yet penetrated the pulp, we may remove all but a small amount of the decayed structure just next to the pulp to avoid its exposure. We may then apply an antibacterial agent to this remaining portion and seal the tooth to curb further infection.
If on the other hand the pulp has become infected, we may try to remove only the infected portion and leave the remaining pulp intact. We’ll only be able to do this, however, if we deem the remaining pulp healthy enough to remain infection-free after the procedure. If not, we may need to remove the entire pulp as with a traditional root canal. This option, though, is a last resort due to the possible effect on dentin growth and the tooth’s long-term health.
As you can see attempts to preserve a primary tooth can be quite involved. But if we can help it reach its full life span, it could mean better dental health for a lifetime.
If you would like more information on caring for primary 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 “Root Canal Treatment for Children’s Teeth.”
It’s true — thumb sucking beyond age 4 can cause bite problems for permanent teeth. But prolonged thumb sucking is just one of a number of possible contributing factors for a bad bite (malocclusion). A dentist must identify all the factors involved when a bad bite is present — their involvement is essential for a successful treatment outcome.
A fairly benign habit for infants and toddlers, thumb sucking is related to an “infantile swallowing pattern” young children use by thrusting their tongues forward between the upper and lower teeth when they swallow. Around age 4, though, they usually transition to an adult swallowing pattern in which the tongue rests on the roof of the mouth just behind the front teeth. Thumb sucking stops for most children around the same time.
Thumb sucking beyond this age, though, can put increased pressure on incoming permanent teeth pushing them forward. This could lead to an “open bite” in which the upper and lower teeth don’t meet when the jaws are closed. The tongue may also continue to thrust forward when swallowing to seal the resulting gap, which further reinforces the open bite.
Before treating the bite with braces, we must first address the thumb sucking and improper tongue placement when swallowing — if either isn’t corrected the teeth could gradually revert to their previous positions after the braces come off. Besides behavioral incentives, we can also employ a thin metal appliance called a “tongue crib” placed behind the upper and lower incisors. A tongue crib discourages thumb sucking and makes it more difficult for the tongue to rest within the open bite gap when swallowing, which helps retrain it to a more normal position.
An open bite can also occur if the jaws develop with too much vertical growth. Like thumb sucking and improper tongue placement, abnormal jaw growth could ultimately cause orthodontic treatment to fail. In this case, though, surgery may be necessary to correct the jaw structure.
With all these possible variables, our first step needs to be a thorough orthodontic exam that identifies all the cause factors for your child’s specific malocclusion. Knowing if and how thumb sucking may have contributed to the poor bite will help us design a treatment strategy that’s successful.
If you would like more information on the causes of poor tooth position, 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 Thumb Sucking Affects the Bite.”
How many actresses have portrayed a neuroscientist on a wildly successful TV comedy while actually holding an advanced degree in neuroscience? As far as we know, exactly one: Mayim Bialik, who plays the lovably geeky Amy Farrah Fowler on CBS' The Big Bang Theory… and earned her PhD from UCLA.
Acknowledging her nerdy side, Bialik recently told Dear Doctor magazine, “I'm different, and I can't not be different.” Yet when it comes to her family's oral health, she wants the same things we all want: good checkups and great-looking smiles. “We're big on teeth and oral care,” she said. “Flossing is really a pleasure in our house.”
How does she get her two young sons to do it?
Bialik uses convenient pre-loaded floss holders that come complete with floss and a handle. “I just keep them in a little glass right next to the toothbrushes so they're open, no one has to reach, they're just right there,” she said. “It's really become such a routine, I don't even have to ask them anymore.”
As many parents have discovered, establishing healthy routines is one of the best things you can do to maintain your family's oral health. Here are some other oral hygiene tips you can try at home:
Brush to the music — Plenty of pop songs are about two minutes long… and that's the length of time you should brush your teeth. If brushing in silence gets boring, add a soundtrack. When the music's over — you're done!
Flossing can be fun — If standard dental floss doesn't appeal, there are many different styles of floss holders, from functional ones to cartoon characters… even some with a martial-arts theme! Find the one that your kids like best, and encourage them to use it.
The eyes don't lie — To show your kids how well (or not) they are cleaning their teeth, try using an over-the-counter disclosing solution. This harmless product will temporarily stain any plaque or debris that got left behind after brushing, so they can immediately see where they missed, and how to improve their hygiene technique — which will lead to better health.
Have regular dental exams & cleanings — When kids see you're enthusiastic about going to the dental office, it helps them feel the same way… and afterward, you can point out how great it feels to have a clean, sparkling smile.
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