Friday 9 December 2011

Crooked teeth? Don't blame wisdom teeth!



There are very few of us lucky enough to have lower front teeth which form a perfect curve.
Most people think that crookedness and overlapping of lower front teeth in their late teens or even early twenties, are the fault of erupting wisdom teeth. If you have had braces done, you may even think that you had a relapse and blame your orthodontist.

Crowded/ crooked lower front teeth

If you think about it, it is not really possible for lower wisdom teeth (which develop slowly in the bone with no firm support) to push fourteen other teeth with roots firmly and vertically implanted in the bone so that the incisors in the middle twist and overlap.
Unfortunately, this is a normal maturation event and affects most people to some extent.  

Wisdom teeth are not so mighty




The lower jaw continues to grow forward after the upper jaw stops growing
How does the lower jaw grow during the late teens?

The lower jaw continues to grow for a while even after the upper jaw stops growing. As the bone grows forward, the lower teeth naturally move forward too. Now the lower front teeth don’t really want to slam into the stationary upper front teeth! Being small and somewhat delicate, they try to avoid a face-off with the big upper front teeth. Commonly, they may compromise by moving or tilting backward. At the same time, the larger lower back teeth have moved forward as well and they cannot go too far back. In their earnest rush to avoid a collision, the well-meaning lower front teeth get crunched for space and have to huddle together in a small space. In fact, sometimes upper front teeth flare out to increase space.


Many scientists consider growth-related changes as having a considerably bigger influence than that of the erupting wisdom teeth on the lack of space present for lower front teeth.  Early extraction of wisdom teeth will not lead to a reduction or solve the problem of lack of space. In the best case it will help to ensure that it doesn’t get worse.







My advice to you:
You may sometimes be told to have your wisdom teeth extracted prior to getting braces. Perhaps you may also be advised to remove wisdom teeth which have not given you any pain and show no sign of causing disease. In this case, remember- your wisdom teeth are innocent until proven guilty! Be sure to discuss in detail with your doctor the reasons why this has been advised, and make an informed decision.





For those with an academic interest:
Lower incisor crowding is multi-factorial and the influence of wisdom teeth on this phenomenon is controversial. Several aspects of bone and soft tissue growth are responsible. I have listed some studies here which debate this topic.
Current controversies in late incisor crowding 
Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults
The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth

Saturday 5 November 2011

Tooth-colored or Silver Fillings?


Dental Amalgam and Composite Resin are two of the most commonly used dental restoration materials.
Dental Amalgam or traditional silver fillings are strong, durable and economical. Dental Amalgam is a compound formed by combining silver and other metals with mercury. Mercury makes up approximately half of this compound. It binds the metals and holds them together forming a strong filling material. After many years of research, mercury continues to be irreplaceable in dental amalgam. While there is no conclusive proof that mercury as a constituent of amalgam is harmful, mercury by itself is very toxic.
Composite Resin or tooth-colored fillings are newer materials which can match different shades of teeth. The type most commonly used today is made of microscopic glass or porcelain particles embedded in an acrylic matrix. Composites are sometimes assumed to be weaker than amalgam and were initially used only to fill front teeth. In the last decade, newer composite resins have been introduced into the market, which are highly resistant to attrition and comparable to or even better than amalgam. In modern dentistry, composite resins are replacing amalgam as the material of choice for fillings.

Amalgam replaced by Composite


In India, traditional amalgam fillings are still very popular due to their longevity and low cost. These involve simpler dental techniques and less demanding skill levels. Many urban dental practices employ both amalgam and composite resin fillings.


My Choice:

I spent my years in dental school placing innumerable amalgam fillings, subsidized by the government for a community that is unable to afford composite fillings. The most obvious problem is they are…well, ugly :) I have seen no evidence of mercury leakage causing toxicity or that amalgam fillings have in any way been detrimental to health. I found that amalgam fillings have a remarkable clinical performance and am told their strength is unsurpassed.

That said, mercury is a known poison and is classified as a hazardous waste material. It is illegal to dispose of mercury or dental amalgam in the garbage. We are supposed to avoid skin contact with both amalgam and mercury. Yet, it can legally be placed in a patient’s mouth. I no longer feel it necessary to risk placing silver amalgam in my patients’ teeth, especially when I have access to the newly improved composites- which when properly placed look just like the natural tooth and also strengthen the tooth.

I prefer not to employ amalgam in my practice and have chosen to use only the best composites available.
Liquid Mercury
Amalgam replaced by Composite




Friday 7 October 2011

The Burden of Bad Breath




- Do people take a step back when they are talking to you?
- Has anyone ever offered you a breath mint?
- Is there often a bad taste in your mouth?
- Do you constantly have a whitish or yellowish film coated on your tongue?

If you answered yes to any of the above, bad breath is probably a chronic problem for you and its time to consider treatment. Bad breath can affect your social and professional relationships and undermine your confidence.

Bad breath or “halitosis” can be attributed to a multitude of causes such as tooth decay, gum disease, medications, sinus infections, gastric reflux disease, lung and kidney infections etc.
A relatively longer (yet unfortunately incomplete) list of causes can be found here.
Now, of course, a visit to your dentist is essential to determine whether bad breath is due to any of the more common oral causes. A detailed medical history will be taken to rule out other causes. Corrective measures can then be undertaken. Many simple home remedies exist too.


From my Clinic Diaries:

In the last one month, I co-incidentally had four patients all of whom visited me to complain of bad breath. No dental decay or other oral disease was found. Detailed history revealed no obvious causes. Interestingly, all four patients had one thing in common- they admitted to drinking inadequate quantities of water. Two of them brushed their teeth only once a day. 
Let me introduce you to them:




Patient A, a teenage girl, simply forgets to drink water. She rushes to and fro between three-four tuition classes everyday. She feels she has time to brush once a day in the morning only, as she sleeps at 1.30am.





Patient B, a high-powered male executive, is in office from 9am - 9pm. He claims he has no time to drink water with his busy schedule.





Patient C, a young lady, works in an air-conditioned company office. She hesitates to drink water as she will have to visit the toilet several times in a day, which she is convinced she has no time for.




Patient D, a middle-aged home manager, is too busy caring for her home and children. It slips her mind that she should reach out for a glass of water even when she is cooking up a meal in the kitchen. At night, she collapses with tiredness and can't summon up the strength to brush her teeth.





My advice to you:

- Please drink water! Lots and lots of water! :) You need to have atleast 6-8 glasses of water daily. Find the time to hydrate and be healthy. Water washes away left-over food particles, and moistens the mouth making it less hospitable to odor causing bacteria. Drinking water is also good for your general health and can prevent and cure a myriad of medical conditions.
To read some of the many benefits of drinking water, please click here
- Brush twice daily



Wednesday 21 September 2011

Chocolate: A not-so-guilty pleasure




Chocolate has been much maligned. It is accused of accelerating tooth decay and causing cavities. I love chocolate! My heart sings at the sight of chocolate :) 
The criminal activity of chocolate is overstated and I would like to come out in support of chocolate. While there is still much we do not understand about chocolate, research is emerging about its effects on our health.

The sugar in chocolate does contribute to cavities, but no more than the sugar in any other food. There is no definite proof that chocolate hastens tooth decay.

Sugars cause tooth decay. The longer and more frequently sugar is in contact with teeth, the more likely this will happen. Sticky foods that take a long time to eat are major offenders. It is the time for which the sugar is present that is important, not the amount.  


A research study conducted at Forsyth Dental Center, Boston found that chocolate, even that which contains caramel, is less sticky than you may think. Milk chocolate is cleared away from your teeth by saliva in less than two minutes and even caramel containing chocolate melts very quickly in your mouth and is swallowed. This leaves little time for bacteria to attack your teeth and cause cavities. Plus, if you brush regularly, you won't have a problem! Sticky foods include cookies, crackers, dry cereals (sugared cereal flakes, granola bars, etc) and potato chips. Bacteria form acids from these sticky foods and lead to tooth decay. Unbelievable? See the detailed publication.

Research also found very starchy food to be more dangerous than very sugary food. Starchy foods like potato chips and salted crackers break down slowly while sticking to your teeth, giving oral bacteria plenty of sugars to chew on, for a long time.

Sticky Foods that hasten tooth decay


A word of caution…
I think it is safe to say that chocolate is having its name cleared of several charges. Yet, chocolate is not a health food. For some, it may cause allergies or trigger migraines. It does have high sugar content. Let us acknowledge the fats and calories and eat it in moderation.
To keep your teeth healthy, brush twice a day with fluoridated toothpaste, floss and have your teeth checked once in six months. Oh, and stay away from those potato chips! :)


Extra Information:
Details of the beneficial effects of chocolate on our general health are still being researched. Cacao beans, not chocolate, are considered a super-food. For chocolate lovers who would like a quick summary, I recommend this article from a Harvard Medical School Health Publication.