Posts for: March, 2019
After your son or daughter's dental exam, you expect to hear about cavities, poor bites or other dental problems. But your dentist might suggest a different kind of problem you didn't expect—an eating disorder.
It's not a fluke occurrence—a dental exam is a common way bulimia nervosa or anorexia nervosa come to light. That's because the teeth are often damaged by the behaviors of a patient with an eating disorder.
Most of this damage occurs because of purging, the practice of induced vomiting after eating. During vomiting stomach acid can enter the mouth and "wash" against the back of the teeth. After repeated episodes, the acid dissolves the mineral content of tooth enamel and causes it to erode. There's also a tell-tale pattern with eating disorders: because the tongue partially shields the back of the lower teeth while purging, the lower teeth may show less enamel erosion than the upper.
Hygiene practices, both negligent and too aggressive, can accelerate erosion. Anorexics often neglect basic grooming and hygiene like brushing and flossing, which increases the likelihood of dental disease. Bulimia patients, on the other hand, can be fastidious about their hygiene. They're more likely to brush immediately after purging, which can cause tiny bits of the enamel immediately softened by the acid wash to slough off.
In dealing with a family member's eating disorder, you should consider both a short and long-term approach to protect their dental health. In the sort-term the goal is to treat the current damage and minimize the extent of any future harm. In that regard, encourage them to rinse with water (mixed optionally with baking soda to help neutralize acid) after purging, and wait an hour before brushing. This will give saliva in the mouth a chance to fully neutralize any remaining acid. Your dentist may also recommend a sodium fluoride mouth rinse to help strengthen their tooth enamel.
For the long-term, your goal should be to help your loved one overcome this potentially life-threatening condition through counseling and therapy. To find out more about treatment resources near you, visit the National Eating Disorders Association website at nationaleatingdisorders.org. Taking steps to treat an eating disorder could save not only your loved one's dental health, but also their life.
If you would like more information on eating disorders and dental health, 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 “Bulimia, Anorexia & Oral Health.”
A “gummy” smile, in which the upper gums are too prominent, is a common condition. There are several causes for gummy smiles — determining which one is the first step to having your appearance changed.
Although perceptions vary from person to person, most dentists agree a gummy smile shows 4 mm or more of gum tissue, and the amount is out of proportion with the length of the crown (the visible tooth). Teeth normally erupt through the gums during childhood and continue development until early adulthood, shrinking back from the tooth until stabilizing in place.
This typically produces a crown length of about 10 mm, with a “width to length” ratio of about 75-85%. But variations can produce differences in the relationship between teeth and gums and the width to length ratio of the teeth. The teeth may appear shorter and the gums more prominent. Worn teeth, caused by aging or grinding habits, may also appear shorter.
If tooth to gum proportionality is normal, then the cause may be upper lip movement. When we smile, muscles cause our lips to retract 6-8 mm from the lip’s resting position. If the amount of movement is greater (meaning the lip is hypermobile), it may show too much of the gums. The upper jaw can also extend too far forward and cause the gums to appear too prominent.
There are a number of ways to improve gummy smiles, depending on the cause. Periodontal plastic surgery known as crown lengthening removes and reshapes excess gum tissue to reveal more of the tooth. Lip hypermobility can be reduced with Botox injections (to paralyze the muscles) or in some cases with surgery to reposition the muscle attachments. Orthognathic surgery can be used to surgically reposition an overextended upper jaw. Other cosmetic enhancements such as orthodontics, bonding or porcelain restorations can also prove effective.
The first step is to obtain an accurate diagnosis for your gummy smile. From there, we can devise the best treatment approach to bring your smile back into a more attractive proportion.
If you would like more information on minimizing 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.”
Some moviegoers have been known to crunch popcorn, bite their fingers or grab their neighbor’s hands during the intense scenes of a thriller. But for one fan, the on-screen action in the new superhero film Black Panther led to a different reaction.
Sophia Robb, an 18-year-old Californian, had to make an emergency visit to the orthodontic office because she snapped the steel wire on her retainer while watching a battle scene featuring her Hollywood crush, Michael B. Jordan. Her jaw-clenching mishap went viral and even prompted an unexpected reply from the actor himself!
Meanwhile, Sophia got her retainer fixed pronto—which was exactly the right thing to do. The retention phase is a very important part of orthodontic treatment: If you don’t wear a retainer, the beautiful new smile you’re enjoying could become crooked again. That’s because if the teeth are not held in their new positions, they will naturally begin to drift back into their former locations—and you may have to start treatment all over again…
While it’s much more common to lose a removable retainer than to damage one, it is possible for even sturdy retainers to wear out or break. This includes traditional plastic-and-wire types (also called Hawley retainers), clear plastic retainers that are molded to fit your teeth (sometimes called Essix retainers), and bonded retainers: the kind that consists of a wire that’s permanently attached to the back side of your teeth. So whichever kind you use, do what Sophia did if you feel that anything is amiss—have it looked at right away!
When Black Panther co-star Michael B. Jordan heard about the retainer mishap, he sent a message to the teen: “Since I feel partly responsible for breaking your retainers let me know if I can replace them.” His young fan was grateful for the offer—but even more thrilled to have a celebrity twitter follower.
If you have questions about orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Bonded Retainers.”