Posts for: September, 2019
A poor bite (malocclusion) could be more than simply teeth out of alignment. There could be complex causes for the malocclusion, possibly involving the facial bone structure.
An example of this is the development of a cross-bite due to problems with the upper jaw and palate (the roof of the mouth), jointly called the maxilla. The maxilla is in fact formed by two bones fused together in the center of the palate in what's called the midline suture. The suture doesn't completely fuse until after puberty.
Sometimes a maxilla's development doesn't follow a normal track. The upper jaw doesn't widen as it should, which leads to the cross-bite where the upper back teeth abnormally bite inside the lower teeth. The upper front teeth continue to bite normally in front of the lower front teeth. This also can have profound influence on breathing, causing sleep apnea.
We can correct this by using an orthodontic appliance called a palatal expander before the midline suture fuses. The expander gradually widens the upper jaw to its normal width and thus eliminates the cross-bite.
Positioned at the roof of the mouth, the expander has metal arms that extend from a central hinge to exert pressure on the inside of the upper teeth. The patient or a caregiver uses a small key to turn a mechanism that extends the arms toward the teeth a tiny amount each day. This gradually widens the jaw, while at the same time stimulating bone growth at the midline suture. Eventually the gap fills with bone to solidify the new width as the suture fuses.
It's important to undertake this treatment before fusion. If you wait until after puberty, you will need to separate the bones first to attempt it. The overall impact and cost is much less if you act promptly in the early years.
Palatal expansion may not be the right treatment in every case, so we'll need to perform a thorough orthodontic exam first. If, however, we do determine it can help, using an expander can improve function, correct future breathing problems and make possible a more attractive future smile.
If you would like more information on orthodontic treatment options, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
Applying braces or clear aligners to move misaligned teeth is only part of an orthodontist's overall mission to eliminate poor bites (malocclusions). Sometimes a malocclusion isn't caused by the teeth at all—the size of the jaw is the problem!
One type in particular, a cross-bite, often happens because the upper jaw has developed too narrowly. As a result, many of the upper teeth fit inside the lower, the opposite of normal. But a tool called a palatal expander can alleviate the problem if it's applied at an early enough age.
The device works because the upper jawbone initially forms as two halves that fit together along a center line in the roof of the mouth (the palate) running from the back of the mouth to the front. These two bone halves remain separate during childhood to facilitate jaw growth, but eventually fuse around puberty.
Consisting of two sets of wire arms joined together by a hinge mechanism in the middle, the expander device is positioned up against the palate. The orthodontist extends each arm to press against the inside of the back teeth, then adds more outward pressure by turning the mechanism in the middle with a small key. During wear, the patient or caregiver will turn the mechanism in the same way to keep up the pressure on the two sides of the jaw.
This continual pressure keeps the two bones moving away from each other and maintaining a center gap between them. In response, more bone forms on the two halves to fill the gap. In time, the newly formed bone should widen the jaw enough to correct any developing malocclusion.
Timing is everything with a palatal expander—if not used before the jaw bones fuse, the patient will need a surgical procedure to separate the bones to pursue treatment. To catch the problem early enough, children should have an orthodontic evaluation on or before they turn six. An orthodontist may be able to identify this or other emerging bite problems and intervene before it becomes worse. Taking this approach can help save you and your child more expensive orthodontic treatment down the road.
If you would like more information on correcting poor bites, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
Even with picture perfect teeth, you may still be unhappy with your appearance. The problem: too much of your upper gums show when you smile.
There’s no precise standard for a “gummy smile”—it’s often a matter of perception. As a rule of thumb, though, we consider a smile “gummy” if four or more millimeters of upper gum tissue show while smiling. In any event if you perceive you have a gummy smile, it can greatly affect your self-confidence and overall well-being.
The good news is we can often correct or at least minimize a gummy smile. The first step, though, is to find out why the gums are so prominent.
There are a few possible causes: the most obvious, of course, is that there’s more than normal gum tissue present. But the cause could be the front teeth didn’t fully erupt in childhood and so the gums appear more prominent. Other causes include the upper lip moving too far upward when smiling (hypermobile) or an elongated upper jaw that’s out of proportion with the face.
Finding the exact cause or combination of causes will determine what approach we take to minimize your gummy smile. If too much gum tissue or not enough of the teeth show, we can use a surgical procedure called crown lengthening to expose more of the crown (the visible part of a tooth), as well as remove excess gum tissues and reshape them and the underlying bone for a more proportional appearance.
A hypermobile upper lip can be treated with Botox, a cosmetic injection that temporarily paralyzes the lip muscles and restricts their movement. But for a permanent solution, we could consider a surgical procedure to limit upper lip movement.
Surgery may also be necessary for an abnormal jaw structure to reposition it in relation to the skull. If, on the other hand it’s the teeth’s position and not the jaw causing gum prominence, we may be able to correct it with orthodontics.
As you can see, there are several ways varying in complexity to correct a gummy smile. To know what will work best for you, you’ll need to undergo an orofacial examination to determine the underlying cause. It’s quite possible there’s a way to improve your smile and regain your self-confidence.
If you would like more information on improving a gummy smile, 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 “Gummy Smiles.”