Common Bite Problems in Children and Adults

1. Crossbite
When upper teeth fit inside of lower teeth. Can be caused by misalignment of teeth (including baby teeth) or a misalignment of the bone; can affect a single tooth or groups of teeth.
Posterior crossbite: If the back teeth are affected, upper teeth are to the inside of bottom teeth.
Anterior crossbite: If the front teeth are in crossbite, the top teeth are behind the bottom teeth.
Possible consequences if not corrected: The jaw shifts to one side; lopsided jaw growth; wearing down of outer layer of the tooth called “enamel”.

2. Underbite
The lower jaw sits in front of the upper jaw.
Possible consequences if not corrected: Face has “bull dog” appearance; tooth wear; stress on jaw joints.

3. Open bite
Anterior open bite: Occurs when the back teeth are together, and the upper and lower front teeth do not overlap. This can result from excessive sucking, tongue thrusting or mouth breathing.
Posterior open bite: Occurs when the front teeth meet, but the back teeth do not.
Possible consequences if not corrected: Swallowing problems; tongue pushes through teeth when swallowing. Possible speech problems.

4. Deep biteWhen the bite is closed, the upper front teeth cover the bottom teeth too much.
Possible consequences if not corrected: Upper teeth can bite into lower gums; lower teeth can bite into the roof of the mouth. Possible gum disease, early enamel wear.

5. Crowding
Insufficient space for the teeth. This can be a result of big teeth or inadequate space in the jaw or both. This may result in teeth that overlap, are rotated, or take on a crooked/staggered appearance.
Possible consequences if not corrected: Hard to clean; possible cavities, especially in between the teeth; gum disease.

6. Spacing
Too much space between teeth. It can result from missing teeth, undersized teeth, oversized jaws, or a combination of these conditions.
Possible consequences if not corrected: Food gets stuck in open areas. Possible cavities, gum disease.

7. Protrusion

Front teeth that stick out (“buck” teeth). Teeth may appear protrusive because the upper jaw is too far forward, the lower jaw is too far back, the teeth grew in at an angle, or a combination of these conditions. Sometimes people who have protrusive front teeth also have a deep bite.

Possible consequences if not corrected: Upper teeth are prone to accidental breaking; hard to comfortably close the mouth and lips, leading to dried out oral tissues followed by tooth decay. Speech problems. Long, narrow face.

The fact is that if any of these common bite problems exist in a child’s mouth, they likely will not self-correct. Untreated problems tend to get worse with time. Many times, the bite problems are best treated while the child is still growing, so make an appointment with an orthodontist today. You don’t need to wait until your dentist refers you.

Teeth Whitening

Teeth whitening is one of the most popular cosmetic dentistry treatments offering a quick, non-invasive and affordable way to enhance a smile. Universally valued by men and women alike, whitening (or bleaching) treatments are available to satisfy every budget, time frame and temperament. Whether in the form of professionally administered one-hour whitening sessions at a dental office or cosmetic spa, or home-use bleaching kits purchased at your local drugstore, solutions abound.

Virtually everyone who opts for a teeth whitening solution sees moderate to substantial improvement in the brightness and whiteness of their smile. That said, it’s not a permanent solution to discoloration and requires maintenance or “touch-ups” for a prolonged effect.

In this article we break down everything related to teeth whitening, including the process of tooth discoloration, what causes staining, the various treatment options available, and their associated risks and costs.

Bleaching vs. Whitening: What’s the Difference?According to the FDA, the term “bleaching” is permitted to be used only when the teeth can be whitened beyond their natural color. This applies strictly to products that contain bleach — typically hydrogen peroxide or carbamide peroxide.

The term “whitening” on the other hand, refers to restoring a tooth’s surface color by removing dirt and debris. So technically speaking, any product that is used to clean the teeth (like a toothpaste) is considered a whitener. Of course, the term whitening sounds better than bleaching, so it is more frequently used — even when describing products that contain bleach.

The bleach preference for in-office whitening, where time is limited, is powerful and fast-acting hydrogen peroxide. When used in bleaching teeth, hydrogen peroxide concentrations range from approximately nine percent to 40 percent.

By contrast, the bleach of preference for at-home teeth whitening is slower-acting carbamide peroxide, which breaks down into hydrogen peroxide. Carbamide peroxide has about a third of the strength of hydrogen peroxide. This means that a 15 percent solution of carbamide peroxide is the rough equivalent of a five percent solution of hydrogen peroxide.

An Examination of Tooth Enamel
Most of us start out with sparkling white teeth, thanks to their porcelain-like enamel surface. Composed of microscopic crystalline rods, tooth enamel is designed to protect the teeth from the effects of chewing, gnashing, trauma and acid attacks caused by sugar. But over the years enamel is worn down, becoming more transparent and permitting the yellow color of dentin — the tooth’s core material — to show through.
During routine chewing, dentin remains intact while millions of micro-cracks occur in the enamel. It is these cracks, as well as the spaces between the crystalline enamel rods, that gradually fill up with stains and debris. As a result, the teeth eventually develop a dull, lackluster appearance.
Teeth whitening removes the stains and debris, leaving the enamel cracks open and exposed. Some of the cracks are quickly re-mineralized by saliva, while others are filled up again with organic debris.

Tooth Discoloration: Extrinsic vs. Intrinsic Staining
There are two categories of staining as it relates to the teeth: extrinsic and intrinsic.

Extrinsic stains are those that appear on the surface of the teeth as a result of exposure to dark-colored beverages, foods and tobacco, and routine wear and tear. Superficial extrinsic stains are minor and can be removed with brushing and prophylactic dental cleaning. Stubborn extrinsic stains can be removed with more involved efforts, like teeth whitening. Persistent extrinsic stains can penetrate into the dentin and become ingrained if they are not dealt with early.

Intrinsic stains are those that form on the interior of teeth. Intrinsic stains result from trauma, aging, exposure to minerals (like tetracycline) during tooth formation and/or excessive ingestion of fluoride. In the past, it was thought that intrinsic stains were too resistant to be corrected by bleaching. Today, cosmetic dentistry experts believe that even deep-set intrinsic stains can be removed with supervised take-home teeth whitening that is maintained over a matter of months or even a year. If all else fails, there are alternative cosmetic solutions to treat intrinsic staining, such as dental veneers.

Inlays and Onlays: The Indirect Filling Options

Inlays and onlays are dental restorations used by a select number of dentists. In certain cases, they are a more conservative alternative to full coverage dental crowns. Also known as indirect fillings, inlays and onlays offer a well-fitting, stronger, longer lasting reparative solution to tooth decay or similar damage. These restorations are beneficial from both an esthetic and functional point of view.

Inlays and onlays can often be used in place of traditional dental fillings to treat tooth decay or similar structural damage. Whereas dental fillings are molded into place within the mouth during a dental visit, inlays and onlays are fabricated indirectly in a dental lab before being fitted and bonded to the damaged tooth by your dentist.

The restoration is dubbed an “inlay” when the material is bonded within the center of a tooth. Conversely, the restoration is dubbed an “onlay” when the extent of the damage requires inclusion of one or more cusps (points) of the tooth or full coverage of the biting surface.

The Benefits of the Conservative Approach

Superior Fit: They offer a conservative preparation that preserves as much healthy tooth as possible. They are a great choice if you have minimal to moderate tooth decay that extends into a flossing area, offering an excellent alternative to full coverage crowns.

Tooth Color: Boasting esthetic longevity, they are not likely to discolor over time as tooth-colored resin fillings often do.

Tooth Structure Safeguard: They preserve the maximum amount of healthy tooth structure while restoring decayed or damaged areas, helping to ensure functional longevity.

Easy Tooth Cleaning: Because the fit is tailored at all edges and the preparation minimal, your tooth can be easier to clean than it would be with full coverage restorative alternatives such as a dental crown. Composite fillings can shrink during the curing process, whereas prefabricated porcelain or gold inlays/onlays will not (ensuring a precise fit).

Tight Space Fulfillments: If you have a cavity between your teeth, consider an inlay rather than a direct composite filling. They are better at sealing teeth to keep out bacteria; they are easy to clean, will not stain and offer exceptional longevity.

Strength and Stability: They are extremely stable restorative solutions for the treatment of decay. The superior fit and durable material make them a stable choice that can actually strengthen a damaged tooth.

Weak Tooth Protector: An onlay can protect the weak areas of the tooth. The procedure does not require the complete reshaping of the tooth.

The Procedure

Typically, an inlay or onlay procedure is completed in two dental visits.

During your first visit, your dentist must prepare the damaged tooth. A molded impression of the tooth is then taken and sent to a dental laboratory, where the restoration is fabricated.

Inlays and onlays can be made from gold, porcelain or resin materials. The difference is in the appearance of the finished restoration. A fitted, provisional restoration (sometimes known as a temporary or “temp” for short) in the shape of the final restoration can be created during this visit to protect the tooth while the final restoration is being fabricated.

Your dentist might discuss with you the best type of material to use. If esthetics is not a concern (for example, with back molars), gold is the best option. Porcelain offers the best esthetics and are often used in the “smile line” areas. Resin materials may be the best option for people who grind their teeth and/or those with a misaligned bite (malocclusion).

During your second visit, the provisional temporary is removed and your inlay or onlay is placed.

They are extremely stable restorations that seldom fail. Your dentist will check all margins to ensure a smooth fit with tight adjacent contacts. Your dentist will also check your bite to ensure that there are no occlusion-related problems affecting the margins of the restoration. Once fitted, the restoration is bonded onto the tooth and the margins are polished.

What Does the Future Hold?

The materials used to fabricate inlays and onlays continue to evolve and become more natural and tooth-like in terms of structure, how they wear and their longevity. Their use for restorative purposes is not likely to be replaced by another treatment any time soon due to the combination of excellent functional longevity and esthetic naturalness associated with inlays and onlays. In fact, maintaining tooth color over the course of your lifetime may be further enhanced as the materials continue to improve, adding to the esthetic value of the restoration.

Selecting The Right Dentist

There is no formal training offered for porcelain inlays and onlays in dental school and the number of continuing education courses is limited. As a result, there are a relatively small number of dentists who perform this type of procedure. If you want porcelain, it’s important that you make sure your dentist is able to offer that material type.

Some dentists receive training while working closely with their dental laboratory where the technicians are very willing to provide feedback on the best design. Some dentists have technology in their office that allows them to send images of your damaged tooth to a technician so that they can discuss optimal treatment options during your consultation. Dental technicians may also assist with treatment planning for upcoming cases by communicating in real-time with your dentist while you are in the chair.

How Much do They Cost?

• The average cost for inlays is $250 to $1,500, and for onlays, between $350 and $1,500, on average. This cost can be impacted by a variety of factors, including:
• The dentist performing the procedure. Some dentists have more experience than others and so their fees may reflect their experience and training.
• Your location – the cost of inlay and onlay services can vary in different locations.
• The tooth or teeth being worked on – back teeth are more difficult to prepare and work on than front teeth.
• The type of material used – gold can be more expensive than other materials (depending on the gold market) and porcelain can be more expensive if fabricated by a highly skilled technician.
• The size of the inlay or onlay – larger onlays cost more than smaller inlays.

Dental insurance companies place inlays and onlays in either the ‘basic’ or ‘major’ service category.

The basic category provides coverage for dental fillings, cleanings and other routine dental services. Your dental insurance may have a pre-set limit for basic services, or a percentage (say 80 percent) of the usual and customary inlay/onlay fees for your area.

If your dental insurance company places them in the major category (like full coverage dental crowns), it could mean that you will be reimbursed at the 50 percent coverage rate.

Typically, a dental office that provides inlay and onlay services will know the reimbursement rates offered by your insurance company because they have had many dealings with local insurance carriers. As always, keep in mind that reimbursement rates vary between carriers and in different areas of the country. You can ask your dental provider to submit for a pre-treatment estimate from your insurance company to get a better idea of your insurance benefit.

Bonding vs Crowns

No matter how well you take care of your teeth, chips happen. Tooth chipping is an issue that many people deal with at one time or another in their life. Fortunately, repairing a chipped tooth can be relatively straightforward and minimally invasive. There are a variety of restorative options to consider, including fillings, veneers, bonding and crowns. In this feature, we evaluate dental bonding versus dental crowns.

How They Work

Bonding refers to the permanent attachment of dental materials to your teeth using adhesives and high-intensity curing light. Dental bonding comes in two primary forms: direct composite bonding (repairing chips, cracks or filling cavities) and adhesive bonding (used with crowns, bridges, veneers, inlays/onlays, etc.).

Direct composite bonding is typically performed in a single visit and serves as a less expensive solution for minor tooth issues such as chips or cracks. In contrast, adhesive bonding is not the primary restorative tool. Rather, it simply serves as the “glue” that holds that restoration in place.

Bonding requires rubber dam isolation of the teeth to prevent moisture leaks. A gentle phosphoric acid solution is applied to the teeth (acid etching) to help strengthen the bond. The acid is removed after 15 seconds and the bonding material applied. Once in place, a high-intensity curing light seals the bond.

Minor sensitivity might be felt after placement but should be short-lived. Keep in mind that composite bonding materials are prone to chipping, so avoid chewing on pens, ice, fingernails or other hard objects.

Crowns are tooth restorations used to preserve the functionality of damaged teeth. Also referred to as “caps,” dental crowns are most commonly used to protect a cracked or chipped tooth, restore structure functionality the following decay, or even replace a pre-existing crown. The custom-designed crown (typically gold, all-ceramic or porcelain fused to metal) encases the damaged tooth, protecting it from further damage.

Tooth impressions can be taken during an initial crown consultation. Treatment planning will be discussed, including the type of anesthesia to use and whether a temporary crown will be needed. If your dentist uses a dental laboratory for fabrication, the impression will be sent there and a temporary crown will be placed. If your dentist offers chairside CAD/CAM, the crown will be milled in office and no temporary crown or return visit will be needed.

As with bonding, you are advised to avoid chewing hard objects after having a crown placed. People who habitually clench or grind their teeth may be advised to use the aid of a mouth guard while sleeping to protect crown longevity.

Are you a Candidate?

Bonding candidacy is not overly selective. In fact, chances are you’ve had dental bonding at one point or another (having a cavity filled or a crown attached, etc.). During your consultation, your dentist will conduct an oral health evaluation to ensure that you do not have any underlying concerns that might preclude you from undergoing treatment; issues such as tooth decay or gum disease must be treated prior to performing dental bonding. Bonding may not be an option if your teeth are severely damaged or disfigured. Large cracks, chips or gaps may require a more involved restorative measure such as crowns or veneers.

Your dentist may suggest that you have teeth whitening before bonding in order to better match the composite material with the tooth color. After whitening, you will need to wait upwards of 21 days before undergoing bonding treatment in order to ensure a durable bond.

Dental crown candidacy is determined by your dentist after a thorough oral health evaluation. Tooth health must be such that it can support the crown. If the underlying tooth or root is beyond repair, then extraction may be required and a bridge or implant option employed instead of a straightforward crown. This can be considerably more expensive than standard crown placement. As with bonding candidacy, general oral health must also be evaluated before crown placement. Gum disease, decay or other underlying oral health concerns must be treated to accommodate crown placement.

Cost of Bonding vs Crowns

The cost of any dental treatment can vary from case to case — bonding and crowns included.

Dental bonding, in particular, is difficult to price because the cost of adhesive bonding is rolled into the cost of whatever restorative procedure it is being used for. In other words, dental crown placement requires adhesive bonding, so the cost of crowns includes bonding.

That said, the cost of direct composite bonding can range between $350 and $600 per tooth. The cost of indirect bonding associated with something like veneers can range between $700 and $1,500 per tooth.

The cost of dental crowns is easier to estimate and ranges between $1,000 and $3,500. When cared for appropriately, a dental crown will last 10 to 15 years.

Can Baby Teeth Predict Autism?

Baby teeth (also called primary teeth) are present from birth and begin to come in between six months to a year. Aside from being teeny tiny and adorable, baby teeth offer a great introduction to child dental health. From brushing and flossing to early visits with a pediatric dentist (and perhaps the odd bit of cash from the tooth fairy), baby teeth play an important role in child development. Perhaps even more than previously thought thanks to new research out of the Icahn School of Medicine at Mount Sinai in New York City. Researchers believe that baby teeth could be key to predicting autism risk. It’s all down to how two specific elements (zinc and copper) are metabolized.

According to one of the study’s lead authors, “we have identified cycles in nutrient metabolism that are apparently critical to healthy neurodevelopment, and are dysregulated in autism spectrum disorder.” Essentially, they’ve been able to identify an abnormality in the metabolic process of autistic children by studying their baby teeth and comparing the results with those of healthy children. And it could open the door to a whole new way of approaching the fight against autism.

How Baby Teeth Helped

When it comes to baby teeth there isn’t all that much to know. We only have them for a few years before the permanent teeth erupt, and if we’re lucky, we might be able to exchange them for a small payday courtesy of the tooth fairy. But it turns out that baby teeth have a far more elaborate (and helpful) story to tell.

During development in the womb and throughout childhood, baby teeth form a new layer every single day. This is important because the chemicals circulating throughout the body are imprinted on these layers, documenting exposure levels to things like zinc and copper. And because this layering is a daily process, the imprinting offers a chronological record of exposure that is essential for understanding the effects that abnormal metabolic cycles can have on neurological development. 

Researchers used lasers to sample the layers of baby teeth collected from Swedish twins — one of whom was autistic. Through comparison of their reconstructed exposures, it was determined that the autistic sibling had vastly different levels of copper and zinc in their teeth. What’s not clear is whether the metabolic abnormality has a causative role in the development of autism, or whether the excess zinc and copper is a traceable byproduct of the condition.

The findings were substantiated by three additional studies: one looking at non-twin siblings living in New York City, and two evaluating two pairs of unrelated children from the United Kingdom and Texas. In each case, the zinc and copper abnormalities tracked with the initial Swedish study.

This is the first study of its kind to be able to identify a biomarker for predicting autism with an impressive 90 percent accuracy.

Rewriting the Diagnostic/Treatment Process for Autism

When you consider the fact that approximately 1 in 68 U.S. children is identified as autistic by the U.S. Centers for Disease Control and Prevention, this research has groundbreaking potential in the understanding of how autism develops; and how it might be prevented.

Although autism experts are quick to point out that this research is in its infancy and unlikely to have any immediate clinical application, it does suggest that such biomarkers could be used to develop new diagnostic testing protocols for early postnatal life. I.e. predicting a child’s risk for autism far earlier than the current diagnostic protocols allow, and potentially opening the door to early treatment that can counter its progression.

According to researchers, if autism spectrum disorder (ASD) is diagnosed at a younger age, parents can take advantage of the early introduction of therapies.” What’s more, the methodologies of this study could have implications that extend beyond the diagnosis and treatment of autism, helping to predict other neurodevelopmental disorders.

Composite vs. Porcelain Veneers

Composite vs. Porcelain Veneers – Choosing the Right Material

Choosing to have dental veneers placed is the first step to improving the aesthetics of your teeth and getting that winning smile you’ve longed for. Determining what material to go with is the second.

Composite resin and porcelain are the most commonly used materials in the veneer fabrication process. In the hands of an experienced cosmetic dentist, both materials can beautifully transform your smile. But how do you know which type is right for you? This comes down to your specific needs and which factors are most important to you (cost, treatment time, etc.). Let’s evaluate some of the differences between composite and porcelain veneers.

Advantages of Composite Veneers

Composite veneers have a number of advantages over porcelain, chief among which is cost. On average, porcelain veneers are twice as expensive as composites, which is very important for some people given that most treatments are not covered by insurance, meaning you are likely paying out-of-pocket for treatment. The cost of veneers varies based on a number of factors, but composites cost on average between $250 and $1,500 per tooth. This can add up quickly in a smile makeover.

Another advantage that composite veneers have over porcelain is the fact that composites can typically be fabricated while you wait, making it a same-day treatment. Direct composite veneers (also referred to as composite bonding) are actually sculpted on your teeth rather than in an offsite lab. The tooth-shaded resin is applied to teeth directly (hence the name) where it can be shaped and sculpted by the dentist. The shaped resin is hardened using a high-intensity light, after which additional layers of resin can be applied and sculpted as needed to elicit the desired aesthetic outcome. Once finished, the resin must be polished in order to elicit a more natural, tooth-like appearance. The composite procedure therefore tends to be much less invasive and noticeably quicker than porcelain.

Arguably the biggest advantage that composite veneers have over porcelain is reversibility. Porcelain requires reshaping of your natural teeth in order to fit the veneer. When it comes to composites, minimal prep work is required on your natural teeth, meaning that they are not permanently altered to such an extent that the composite material cannot be removed and replaced as needed.

Advantages of Porcelain Veneers

Although composite veneers have a number of advantages, there is one area in which they cannot compete with porcelain: durability. Porcelain is a far stronger material than composite resin (even with the improvements in resin materials over the years). Well-maintained porcelain veneers can last 10 to 15 years, compared to the five- to seven-year average lifespan of composites. It’s important to consider this tradeoff if you’re thinking of having veneers placed. That is, while composites may cost half as much as porcelain, they last only half as long. So which is the better value?

Most dentists agree that porcelain veneers offer the most natural, tooth-like aesthetics. Porcelain has a translucent quality that is quite similar to tooth enamel. It is also highly resistant to staining and chipping due to the strength of the material and the glaze that is applied after treatment. On the other hand, composite veneers are more porous and therefore susceptible to staining, meaning that you may need to adjust your diet in order to avoid certain stain-causing foods. Composite also needs to be polished in order to achieve a tooth-like esthetic. And even then it doesn’t quite compare.

The porcelain veneer procedure is more involved, and often requires temporaries be worn while you wait for the veneers to be sculpted in a lab. However more and more dentists are embracing chairside CAD/CAM technologies that help to speed up the process by allowing for on-site fabrication. If you are looking for a porcelain veneers solution, it’s important to evaluate the sort of technologies that your dentist has available. You could end up drastically reducing the overall treatment time. Lastly, porcelain veneers offer a viable treatment solution for all cases of worn enamel, wear and tear, genetic defects, uneven teeth, etc. Composites may not be a viable option for severe concerns. For example, significant discoloration or spacing issues may not be adequately treatable with composite veneers, making porcelain your only option. Your dentist will conduct a thorough oral health evaluation as part of your consultation to determine your options.

Composite or Porcelain… What’s the Verdict?

At the end of the day, the only way to determine whether a composite or porcelain veneer solution is right for you is to speak with your dentist about your aesthetic goals and to weigh your personal considerations. In other words, what is most important to you? If you’re looking for the most cost-effective solution, then a composite veneers treatment plan will probably be a good fit. However, if you have a severe aesthetic concern, or you’re looking for the most natural and durable treatment solution (and cost is not a consideration), then porcelain veneers will give you a fantastic result.

What Causes Tooth Staining?

Age: There is a direct correlation between tooth color and age. Over the years, teeth darken as a result of wear and tear and stain accumulation. Teenagers will likely experience immediate, dramatic results from whitening. In the twenties, as the teeth begin to show a yellow cast, whitening may require a little more effort. By the forties, the yellow gives way to brown and more maintenance may be called for. By the fifties, the teeth have absorbed a host of stubborn stains which can prove difficult (but not impossible) to remove.

Starting color: We are all equipped with an inborn tooth color that ranges from yellow-brownish to greenish-grey, and intensifies over time. Yellow-brown is generally more responsive to bleaching than green-grey.

Translucency and thinness: These are also genetic traits that become more pronounced with age. While all teeth show some translucency, those that are opaque and thick have an advantage: they appear lighter in color, show more sparkle and are responsive to bleaching. Teeth that are thinner and more transparent – most notably the front teeth – have less of the pigment that is necessary for bleaching. According to cosmetic dentists, transparency is the only condition that cannot be corrected by any form of teeth whitening.

Eating habits: The habitual consumption of red wine, coffee, tea, cola, carrots, oranges and other deeply-colored beverages and foods causes considerable staining over the years. In addition, acidic foods such as citrus fruits and vinegar contribute to enamel erosion. As a result, the surface becomes more transparent and more of the yellow-colored dentin shows through.

Smoking habits: Nicotine leaves brownish deposits which slowly soak into the tooth structure and cause intrinsic discoloration.

Drugs / chemicals: Tetracycline usage during tooth formation produces dark grey or brown ribbon stains which are very difficult to remove. Excessive consumption of fluoride causes fluorosis (discoloration marked by the appearance of faint white marks on the teeth) and associated areas of white mottling.

Grinding: Most frequently caused by stress, teeth grinding (gnashing, bruxing, etc.) can add to micro-cracking in the teeth and can cause the biting edges to darken.

Trauma: Falls and other injuries can produce sizable cracks in the teeth, which collect large amounts of stains and debris.