Braces at my Age? Yes!

Remember how you were interested in how many cavities you had when you were young (or maybe not so interested)? Now you have weathered periodontal disease, worn teeth, crowns, bridges, partials, often losing some teeth along the way. So it's not the same as it was. And just as we need to remodel our houses at times from the bottom up, we have to sometimes rebuild our bites.

As we age, the importance of comprehensive treatment planning increases. Where we were at one time accustomed to having the dentist fix one tooth at a time, that doesn't work as well as it did when we were younger because of the general deterioration that often occurs as the years pass.

In developing a comprehensive treatment plan, we often look at the changes that have occurred in tooth to tooth relationships. Teeth drift into spaces created by teeth that have been missing. So the teeth start to lean over. And just as the Leaning Tower of Pisa is not particularly stable, a slanted tooth may not be able to tolerate the generally vertical forces from chewing and the multiple forces that occur when we grind our teeth.

Sometimes teeth are never in the right position to begin with, but we live with it. The problem is that unfavorable tooth positions over time can result in loose teeth as the body can no longer bounce back from the adverse stresses that the teeth and the underlying bone can no longer tolerate.

As we age, teeth often become more crowded, particularly in the front. People often ask me why their teeth are more crowded in the front now, when they never used to. The answers are sometimes difficult to come by, but the fact is that teeth tend wo move toward the center as we age, causing crowding that we never had when we were younger.

Therefore, an important part of a comprehensive dental treatment plan is to look at these factors and make sure that our teeth are in the best possible position for appearance and for function.

If teeth are out of alignment, the treatment is now easier and quicker than ever before. You've probably seen commercials for a technique that uses a series of clear plastic trays that move teeth without anyone even seeing that your teeth are being moved. And if traditional braces are desired, there is a periodontal surgical technique that can be used at the beginning of orthodontic treatment to make the treatment up to four times faster than traditional braces called "Periodontally Assisted Osteogenic Orthodontics."

The point is clear. Proper tooth alignment can help your teeth be more comfortable and more functional. Orthodontic tooth alignment is worth assessing as part of any full dental treatment plan.

What to Look for in a Dental Exam

There is no shortage of new, innovative, dental techniques to enhance your dental experience, your ability to chew, and your smile. But today, let’s get back to basics and talk about what you should look for in a dental examination.

We grew up understanding that if there is a cavity, it needs to be fixed. This is “single-tooth” dentistry. However as we’ve grown older, we may have lost teeth, crowned teeth, broken teeth, had gum disease, gum recession, etc., etc. Changes in tooth relationships occur as a result. It’s for those reasons that our dental examinations should be more detailed. A full oral care plan should be developed even if it may be months or years before you complete the plan. A good plan can save money and help preserve your dental health.

Here’s a checklist of my recommendations:

□ A full periodontal examination including periodontal probing, gum recession, thickness of the gum tissue, and tooth mobility

□ A full dental examination which looks at tooth decay, worn fillings and crowns that may be leaking, cracks and microfractures, and loss of enamel at the gum line.

□ Full mouth dental x-rays. I want to be a bit careful here. Dental radiation for these x-rays is extremely small. However, it is still radiation. The more your disposition to dental disease, the more important x-rays become.

The three examinations above should give you and your dentist an understanding as to the long-term risk for each tooth. After all, you don’t want to spend a lot of money on a tooth that has a high risk of being lost.

□ Bite relationship. Not only should you know how your teeth line up, you should also know which teeth touch and which teeth don’t. For the most part, all teeth should touch when you close your mouth.

□ Joint and muscle assessment. Does your jaw pop or grind when you open or close your mouth. Why? And what can be done to reduce the chances of more joint damage.

□ Study models. For complex cases, impressions are made of your teeth and models of your mouth made so that your dentist can look at your mouth from every different direction.

The more complex your case, the more these diagnostic elements are important. Specialized diagnostic instruments to test the vitality of the nerve of the tooth, or specialized x-rays such as the Cone Beam CT Scan which provides a three dimensional view of your bone may also be indicated.

The relatively small cost in doing a good, careful, diagnostic evaluation can easily be saved in the treatment planning process that you and your dentist make together. A little bit of planning can go a long way toward decreasing your costs and improving your results in effective, comprehensive dental treatment.