Posts for: December, 2013

By Michael C Scheske, DDS, PC
December 30, 2013
Category: Dental Procedures
Tags: orthodontics  
RemovingCertainTeethcanBenefitOrthodonticTreatment

Not only can orthodontic treatment transform your smile, it can also restore function to your teeth and mouth that will improve both your oral and general health. But any treatment to straighten misaligned teeth requires careful planning. Depending on the exact nature of your misalignment, there may be some additional steps we would need to perform before undertaking orthodontic treatment.

One common need is space to help relieve overcrowding. To make room for tooth movement, often a tooth may need to be removed if the crowding is excessive. The most likely candidates are the first bicuspids, teeth located between the cuspids (or eyeteeth, located in line under the eyes) and the second premolar located in front of the molar teeth. The removal of these first premolars won't have a great effect on future form or function. Under the gentle pressure exerted by the braces, neighboring teeth will move and fill in the open space. Today's orthodontist goes to great lengths to avoid removing any teeth; in severe overcrowding, though, this is an acceptable way to create needed space.

Damaged teeth in need of replacement may also be removed before orthodontics and certainly more desirable — if any tooth needed to be removed, you would always choose a damaged tooth first. The object is to first preserve the underlying bone and close the space to avoid replacing that tooth or, if not possible, maintain the correct amount of space for any future restoration.

As living tissue, bone constantly reshapes in response to its environment. If it no longer senses a tooth (or the forces exerted by a tooth when biting or chewing), the bone will slowly disappear through a process known as bone resorption. To counteract this process, we may graft material (like processed donor bone) into the socket to encourage and maintain bone growth. This creates a platform for future tooth replacements like implants or bridgework after orthodontic treatment.

After orthodontics, it may also be necessary to install some type of “placeholder” (temporary bridgework or partial denture) in the area of missing teeth. Keeping the teeth from migrating into the space will improve the chances that any permanent restoration like an implant or fixed bridgework will look natural — as if it belonged there the entire time.

A complete dental examination will indicate whether any teeth need to be removed before undergoing orthodontic treatment. If necessary, taking this strategic step will help ensure we achieve the best result — a winning smile.

If you would like more information on tooth removal and other options to enhance orthodontics, 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 “Tooth Removal for Orthodontic Reasons.”


By Michael C Scheske, DDS, PC
December 20, 2013
Category: Oral Health
ThickorThinYourGumsNeedtobeProtected

While hygiene and regular dental care go a long way to reduce your risk of oral disease and disorders, you’re still subject to your heredity. Everything from tooth alignment to the shape of your jaws is determined by your genes.

So is the biological structure of your gum tissue. Aside from minute variations, gum tissue structure falls into two broad categories — “thin” or “thick,” which refer to the actual thickness of the tissue and the underlying bone. The tooth’s appearance is the best indicator of which type you may have: those with more triangular-shaped tooth (often called scalloped) have thin gum tissue; a person with a squarer appearance (flat) has thick gum tissue. People of Asian descent tend to have thin/scalloped tissue while those with European or African heritage tend to have thick/flat tissues.

Thick gum tissue isn’t superior to thin, or vice-versa. In fact, each type is susceptible to certain types of diseases or adverse conditions.

Thin tissues are more susceptible to the occurrence of receding gums. Caused mainly by periodontal disease and toothbrush abrasion, the gum tissue recedes and exposes more of the unprotected tooth surface that should be below the gum line. This increases the risk of decay and tooth loss. Patients with thick tissue, on the other hand, have a higher risk of developing a condition known as “pocketing.” As the thicker gum tissue becomes inflamed from dental plaque, it loses its attachment to the teeth and forms a small pocket. The end result is possible bone and tooth loss.

There’s not much you can do about which type of gum tissue you have, for which you can thank (or blame!) your ancestors. But there’s something you can do to reduce your risk of periodontal disease. First and foremost, you should practice good daily hygiene, brushing with a soft-bristled tooth brush and gentle flossing. It’s also important to maintain regular cleanings and checkups in our office; not only will this ensure complete plaque and tartar removal, but gives us a better chance to detect either receding gums or pocketing early. Earlier detection can mean better treatment outcomes — and a saved smile.

If you would like more information on genetic types of periodontal tissues, 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 “Genetics & Gum Tissue Types.”


TreatingAccessoryRootCanalsImprovestheChancesforaSuccessfulToothRecovery

Without a doubt, an effective root canal treatment can extend the life of a tooth for many years. But sometimes even a well-maintained tooth can fall prey to disease months or even years after a root canal treatment. While there are a number of reasons to account for this failure, a common one is so tiny it could have easily been missed during the first treatment.

A root canal is an open space within the tooth that contains the pulp. The pulp is a connective tissue with a network of nerve fibers connected to the root that alert the brain to environmental changes involving the tooth. It is most important during the tooth’s early development, but becomes less important as we age. The pulp is susceptible to infection from tooth decay or periodontal (gum) disease, which if left untreated can threaten the tooth’s survival. During a root canal treatment, we enter these spaces, clear out the diseased pulp and fill the canal with a bio-compatible filling; we then seal it off to deter further decay.

The treatment could ultimately fail, though, because of accessory or lateral canals missed during the procedure. Like a tree with smaller branches growing out of its larger limbs, accessory canals are smaller access ways that branch off of the main root canals. These accessory canals, which can occur anywhere along a main canal, can be quite small and not easily detected during an initial root canal treatment. They are especially susceptible to infection due to gum disease if they open into the periodontal membrane, the main attachment point between teeth and bone.

If we suspect the presence of accessory canals (either initially or after ensuing problems following a root canal treatment), this could require the skills of an endodontist, a dentist who specializes in the treatment of a tooth’s interior. Accessory canals are treated in much the same way as larger canals, but may require an endodontist’s specialized microscopic equipment and filling techniques. Effective treatment of these smaller accessory canals will certainly improve the chances of a successful, long-term outcome for the tooth.

If you would like more information on root canal treatments, 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 “Accessory Canals.”












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Union, MO 63084
(636) 583-8100

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