Happy (and dentally safe) Halloween!

While dentists and orthodontists have a professional conflict with Halloween, we also know that holiday snacks are a fact of life.  Here are some suggestions to enjoy a fun and dentally safe Halloween:

Before going out trick-or-treating, try to ensure your children eat a good, hearty meal so there will be less temptation to gorge on candy. 

Tooth decay occurs when candy and other sweets mix with bacteria in the sticky plaque that constantly forms on teeth to produce acid, which can wear away enamel.  Chewy, sticky treats are particularly damaging because not only are they high in sugar, but they spend a prolonged amount of time stuck to teeth and are more difficult for saliva to break down.    Hard candies are tough on teeth as well because kids tend to suck on them at a leisurely pace for an extended period of time.

The majority of dentists who hand out candy choose chocolate because when it comes to teeth and sugar, it's really a matter of time. Chocolate dissolves quickly in the mouth and can be eaten easily, which decreases the amount of time sugar stays in contact with teeth.

At the end of the night, it's a good idea to remove the sticky, gummy and chewy choices from your child's candy haul.  And remember: the worst thing a kid can do is go to bed without brushing after gorging on the night's loot.

And last but not least, promote good oral health care habits to your children year-round by encouraging twice daily brushing with fluoridated toothpaste, daily flossing and regular dental checkups.

Happy Halloween!

Is Phase II always necessary after Phase I?

Because orthodontic care is not a “one size fits all” approach, not all patients need or will benefit from a two-phase orthodontic treatment.  Each patient has a unique problem that requires an unique, individualized treatment plan.  In fact, most children do not need Phase I orthodontic treatment and can actually wait until most or all permanent teeth are present.

When early orthodontic intervention is not necessary, careful monitoring of growth, development and observation of the eruption of the adult permanent teeth will allow me to make the call of when treatment start is ideal to obtain the best bite and smile possible in the timeliest manner.

After the completion of Phase I orthodontic treatment, usually a period of retention of the obtained results and observation will follow.  If no long-term risks are associated with not continuing with Phase II treatment, the orthodontist will make it optional and elective for the parents of a child who just underwent Phase I orthodontic treatment.  While this is not typical, it is quite possible.

For some kids that need Phase I orthodontic treatment, however, the problems that are being addressed are extensive, and full correction may not be attained until treatment moves on to Phase II.  The most common problems that usually do require two-phase orthodontic treatment are severe crowding being treated without extraction of permanent teeth, “underbites” and severe “overbites.”

What is “Phase II orthodontic treatment?”

Phase II orthodontic treatment follows early orthodontic intervention (a.k.a. Phase I) usually after a period of “rest and growth.” The goal of Phase II Treatment is to position all the permanent teeth as to maximize and protect their function as well as ensure long term health of the bite and chewing system.

Phase II treatment often does not require extraction of permanent teeth. It is best accomplished with full braces or Invisalign®, and usually lasts less that 2 years due to the improvements made in Phase I Treatment. This is especially relevant for patients as they enter their teenage years.

It is important to note that after Phase I orthodontic treatment most young patients typically have 16 new teeth that are erupting or will erupt in the next two or three years. These new teeth did not have brackets on them during Phase I simply because they were not in the mouth.

An orthodontist cannot determine how these teeth will erupt but can do everything within his or her skills to preserve or gain space for these erupting teeth. We are highly trained professionals but simply cannot control a patient's DNA. Actually, we work against DNA to create healthy and beautiful smiles that will last a lifetime.

How does two-phase orthodontic treatment benefit my child?

The benefits of early treatment are the creation of an environment that promotes unimpeded optimal eruption of the permanent dentition and more balanced chewing/biting and facial growth. This will consequently provide better chewing function, more pleasant dental and facial esthetics and make any needed further correction in a second phase of care more comfortable and timely.

The following is a list of potential benefits of Phase I early orthodontic treatment:
- Reduce of the need to extract permanent teeth through improvement of the width of the dental arches and preserving or gaining space for erupting permanent teeth
- Influence jaw growth in a positive manner thus reducing or eliminating the need for jaw surgery;
- Lower the risk of trauma to protruded front teeth;
- Correct harmful oral habits improve esthetics and self-esteem;
- Simplify and shorten treatment time for definitive orthodontic treatment (phase II);
- Increase stability of final treatment results;
- Reduce likelihood of impacted permanent teeth;
- Improve speech development;
- Guide permanent teeth into more favorable positions; and
- Improve compliance before the busy teenage years.

What kind of dental problems need early (Phase I) orthodontic treatment?

Problems that should be addressed through Phase I orthodontic treatment between ages 8-12 to avoid serious problems later include lack of space for eruption of all permanent teeth, crossbites (when one or some upper teeth fail to cover opposing lower teeth), and facial growth imbalances that cause severe overbites and underbites.

Some of the most direct results of interceptive treatment are:
- Reducing the need for tooth removal by creating room for crowded erupting teeth and reserving space for unerupted teeth;
- Creating facial symmetry by directing jaw growth;
- Reducing the risk of trauma to protruding front teeth;
- Reducing the risk of premature tooth wear and chipping of the teeth; and
- Elimination of habits that create bad bites.

It is important to note that after Phase I most patients typically will have 16 new teeth that will be erupting within the next couple of years. The way these teeth erupt will play an important role in determining the need or not of a second phase of treatment (Phase II).

What is “two-phase” orthodontic treatment?

Two-phase orthodontic treatment consists of two separate times a child receives orthodontic treatment. A first phase of treatment is done while the child still has some baby teeth. A second phase takes place when a child has most or all of their permanent teeth. Braces may or may not be used in the first phase of treatment, but are always used in the second phase.

Common reasons for initiating a first phase (Phase I) of treatment are:

- Preventing a problem from developing (preventive treatment);

- Interception of a developing problem before it becomes worse and harder to treat later (interceptive treatment);

- Guidance of the growth of the jaw bones that support the teeth (growth modification).

In my office I recommend a first phase of treatment when I determine that a child’s problem, if left alone, will create an unhealthy environment for the growth and development of his or her teeth, gums, jaws and face. This kind of treatment is timed to predictable stages of dental development to provide the greatest potential for improvement and correction of a child’s bad bite or to take advantage of a child’s growth and development for treatment purposes.

Health problems linked to periodontal disease – part 2

Here are some more of the general health consequences an untreated bad bite can lead to as the cause of gum and/or periodontal disease.

Pregnant women that have periodontal disease are seven times more likely to have a baby that is born prematurely or too small. Physicians ponder over the possible relationship between premature births and low birth weight babies with periodontal disease in the mother. The reasoning is that toxins given off by the bacteria have a bad effect on the baby and might trigger premature birth.

S. mutans is a bacteria that lives in the dental plaque. It is known that it causes cavities and churns out acids that erode teeth. Sometimes S. mutans can enter the bloodstream and travel to the heart halves causing dangerous endocarditis. Straight teeth collect less dental plaque.

Lastly, a study from Sweden concluded that exposure to inflammation early in life increases the risk of developing Alzheimer’s disease by a fourfold factor. One of the major sources of infections detected by this study was periodontal disease.

In conclusion, while we can’t say that straight teeth and good oral health can prevent certain types of cancer or Alzheimer’s disease, we can say that the constant inflammation resulting from the association between crooked teeth and periodontal disease may lead to severe consequences later in life.