OPEN BITE

Definition

Anterior openbite is generally defined as a condition where the upper incisor crowns fail to overlap the lower incisor crowns when the mandible is brought into full occlusion (Mizrahi 1978, Moyers 1975, Shapiro 2002, Beckman 1998). Hence an openbite could range from a mild case of ‘edge- to-edge’ incisor relationship to a severe skeletal openbite with only the molars in contact.

Simple openbites are usually confined to the teeth and alveolar process whereas complex openbites are based primarily on vertical skeletal dysplasias.

Openbite will occur during transition from primary to permanent dentition, and is considered to be a transient stage of normal dento-alveolar growth and development.

Incidence

Most openbites will resolve during the mixed dentition without treatment; however complex openbites that extend distal to the incisors and persist beyond the mixed dentition phase are more problematic. True anterior openbite in the British population varies from 0.4% to 3% at age 10 years, maintaining an incidence of 2% by 15 years of age (Haynes 1972, Robert and Goose 1979, Todd 1973). Wide racial variation occurs, with 16.3% of African-Americans having openbite at age 11 years (Cooke 1980). Kelly and Harvey
in 1977 stated that 3.5% of Caucasian and 16.3% of African Americans have an openbite. Thirty percent of adult Class III cases have an anterior openbite (Ellis and McNamara 1984), with others suggesting that most openbites are skeletal (Subtelny and Sakuda 1964).

A relatively high 32.3% of children in special needs schools were found to have an anterior openbite malocclusion (Gershater 1972).

Aetiology

Broadly speaking, anterior openbite, like any other malo- cclusion, can be either hereditary or environmental in origin, with aetiological factors acting pre- or post-natally on the tissues of the oro-facial region. Anterior openbites are usually multi-factorial in origin, determined by a combination of many factors operating within the inherent pre- determined growth potential of each particular patient.

Aetiological factors include:

1) Heredity
2) Environmental Factors –
a) Thumb, finger or foreign body sucking
b) Abnormal tongue function
c) Trauma or pathology to one or both condyles
d) Neurologic disturbances Iatrogenic factors, e.g. extruding molars during treatment
e) Airway pathology. An oral breathing pattern is generally considered to be an aetiological factor

Classification and Diagnosis

In describing a skeletal openbite, Schendel et al (1976) coined the term “long face syndrome” in which there is excessive height of the maxilla and a relatively large mandibular plane angle. Proffit characterised patients with skeletal openbite and an increased total face height manifested entirely in the lower facial third as having “long face syndrome”. Due to dental compensation, patients with increased lower facial height may not necessarily have an anterior openbite.

Clinical Presentation

There is great variation in the dental and skeletal morphology in patients with openbites (Cangialosi 1984)

Skeletal Open bite

Extra-oral features of patients with a skeletal openbite often include a long face, lip incompetence, an anterior openbite, steep mandibular plane angle, marked antegonial notching, increased anterior facial height and decreased posterior facial height. These cases may also present with a Class II malocclusion and mandibular deficiency due to posterior and downward rotation of the mandible. Intra-oral features include dental crowding with upright lower incisors, maxillary constriction with buccal segment crossbites, occlusion confined to molar contact and gingival hypertrophy in the anterior segments due to mouth breathing.

Dental Openbite

These patients generally exhibit normal facial features with only intra-oral abnormalities related to the aetiology, eg. Thumb sucking, tongue function/posture. The openbite is generally confined to the incisor region and maybe asymmetric. In cases of digit sucking the maxillary arch may also be narrow with proclination of the upper incisors and retroclination of the lower incisors. In patients with a forward tongue posture proclination and spacing of the upper and lower incisors is often seen.

Treatment Options

1. No active treatment

Clinicians may wait for self correction, particularly during the mixed dentition where skeletal growth appears normal and where no obvious habits are present. About 40-80% of mixed dentition openbites will self-correct in the teenage years (Kantowicz and Korhaus 1929, Anderson 1963, Worms 1971).

2. Habit control

Passive management can include education, motivation and passive appliance treatment such as tongue cribs (Fig. 3) or tongue spurs.

3. Growth modification and active orthodontic treatment

The aim of active treatment is often a combination of impeding posterior tooth eruption, reducing/redirecting vertical growth and extrusion of the anterior teeth. Appliances such as bite blocks, high pull headgear, chin cups and appliances employing magnets have been used. Fixed appliances must be managed carefully to avoid iatrogenic molar extrusion. Segmental arch wire techniques can be used for differential vertical control. More recently, mini- screws and skeletal anchorage plates (Fig. 4) have been used for molar intrusion.

Unfortunately, relapse is usually a major concern in the treatment of anterior openbites. For example Lopez- Gavito (1985) in a sample of 41 patients with an original openbite of 3mm or more reported, 10 years post retention, 36% relapse of openbites. No single parameter of dentofacial form was reliable in predicting stability.

It should be stressed that relapse following conventional orthodontic therapy of skeletal openbites can be considerable. This highlights the need for accurate diagnosis, prudent treatment planning and adequate explanation to patients in such cases.

4. Surgical Management

Surgical treatment is generally undertaken after active growth is complete to minimise relapse. This may involve measures as simple as extraction of posterior teeth, however in more severe cases posterior impaction of the maxilla is indicated. Maxillary impaction allows forward and upward rotation of the mandible, thereby decreasing the lower anterior facial height and providing closure of the anterior openbite. Other surgical movements of the maxilla and/or mandible can also be planned as required as part of the surgical treatment plan. A common surgical combination is a LeFort I osteotomy of the maxilla with a bilateral sagittal split osteotomy (BSSO) of the mandible.

Hoppenreijs et al (1996), in a study of 6 year post operative results, found 20% relapse in 267 patients treated using LeFort I intrusion with or without BSSO. McCance et al (1992), in a study of 1 year post operative results of surgically corrected Class II and III openbite cases using LeFort I and BSSO procedures, reported stable results in Class II cases and a 23% relapse in Class III cases.

Openbite patients can often be the most challenging cases to manage effectively. The importance of appropriate diagnosis and treatment planning cannot be over-emphasised if a pleasing, stable and acceptable long term result is to be achieved. It is also important that the clinician understand dento-facial growth and development in addition to the effects of the appliances and mechanics that are to be employed to avoid unwanted iatrogenic side-effects.

Originally published on Australian Society of Orthodontists (ASO)

OPEN BITE

Unknown Tuesday, January 12, 2016

FACIAL TRAUMA

FACIAL TRAUMA

The dental specialist performs the proper treatment of facial injuries. These professionals must be well versed in emergency care, acute treatment and long term reconstruction and rehabilitation not just for physical reasons but emotional as well. Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Dr. Lee meets and exceeds these modern standards. He is trained, skilled and uniquely qualified to manage and treat facial trauma. He is on staff at local hospitals and deliver emergency room coverage for facial injuries, which include the following conditions:

• Facial lacerations
• Intra oral lacerations
• Avulsed (knocked out) teeth
• Fractured facial bones (cheek, nose or eye socket)
• Fractured jaws (upper and lower jaw)

THE NATURE OF MAXILLOFACIAL TRAUMA

There are a number of possible causes of facial trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

SOFT TISSUE INJURIES OF THE MAXILLOFACIAL REGION

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Dr. Lee is a well-trained oral and maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations.

BONE INJURIES OF THE MAXILLOFACIAL REGION

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary, are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.

INJURIES TO THE TEETH AND SURROUNDING DENTAL STRUCTURES

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.

Source: Oyster Point Oral and Facial Surgery

FACIAL TRAUMA

Unknown Sunday, January 10, 2016

BONE GRAFTING

MAJOR AND MINOR BONE GRAFTING

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.

Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.

MAJOR BONE GRAFTING

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.

SINUS LIFT PROCEDURE

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

RIDGE EXPANSION

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Source: Oyster Point Oral and Facial Surgery

BONE GRAFTING

Unknown Saturday, January 9, 2016

Growing multiple new teeth from single tooth germ

Researchers from the RIKEN Center for Developmental Biology, working with colleagues from the Tokyo Medical and Dental University, have found a way to -- literally -- multiply teeth. In mice, they were able to extract teeth germs -- groups of cells formed early in life that later develop into teeth, split them into two, and then implant the teeth into the mice's jaws, where they developed into two fully functional teeth.

Teeth are a major target of regenerative medicine. According to Takashi Tsuji, the leader of the team, approximately 10 percent of people are born with some missing teeth, and in addition, virtually all people lose some teeth to either accidents or disease as they age. Remedies such as implants and bridges are available, but they do not restore the full functionality of the teeth. Growing new teeth would be beneficial, but unfortunately humans only develop a limited number of teeth germs -- the rudimentary cell groups from which teeth grow.

"We wondered," says Tsuji, "about whether we might be able to make more teeth from a single germ." To demonstrate that it might be feasible, the group focused on the fact that teeth development takes place through a wavelike pattern of gene expression involving Lef1, an activator, and Ectodin, an inhibitor. To manipulate the process, they removed teeth germs from mice and grew them in culture. At an appropriate point in the development process, which turned out from their experiments to be 14.5 days, they nearly sliced the germs into two with nylon thread, leaving just a small portion attached, and continued to culture them. The hope was that signaling centers -- which control the wave of molecules that regulate the development of the tooth -- would arise in each part, and indeed this turned out to be true. The ligated germs developed naturally into two teeth, which the team transplanted into holes drilled into the jaws of the mice. The teeth ended up being fully functional, allowing the mice to chew and feel stimulus, though they were only half the size of normal teeth, with half the number of crowns -- a result that could be expected given that the researchers were using already developed germs.

Significantly, they were able to manipulate the teeth using orthodontic methods, equivalent to braces, and the bone properly remodeled to accommodate the movement of the teeth.

Looking to the future, Tsuji says, "Our method could be used for pediatric patients who have not properly developed teeth as a result of conditions such as cleft lip or Down syndrome, since the germs of permanent teeth or wisdom teeth could be split and implanted. In the future, we could also consider using stem cells to grow more germs, but today there are barriers to culturing such cells, which will need to be overcome." The research was published in the Dec. 17, 2015(London time) edition of Scientific Reports, an online journal of the publishers of Nature.

Source: medicalnewstoday.com

Growing multiple new teeth from single tooth germ

Unknown Friday, January 8, 2016

Impacted Teeth

EXPOSURE AND BRACKETING OF AN IMPACTED TOOTH

An impacted tooth simply means that it is “stuck” and can not erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems (see “Impacted wisdom teeth” under “Procedures”). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eye tooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth which have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tight together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eye teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment

The older the patient, the more likely an impacted eye tooth will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray along with a dental examination be performed on all dental patients at around the age of 7 years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or are some adult teeth missing. Are there extra teeth present or unusual growths that are blocking the eruption of the eye tooth? Is there extreme crowding or too little space available causing an eruption problem with the eye tooth? This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require a referral to an oral surgeon for extraction of over retained baby teeth and/or selected adult teeth that are blocking the eruption of the all important eye teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance the impacted eye tooth will erupt with nature’s help alone. If the eye tooth is allowed to develop too much (age 13-14), the impacted eye tooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).

WHAT HAPPENS IF THE EYE TOOTH WILL NOT ERUPT WHEN PROPER SPACE IS AVAILABLE?

In cases where the eye teeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted eye teeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eye tooth has not fallen out already, it is usually left in place until the space for the adult eye tooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eye tooth exposed and bracketed.

In a simple surgical procedure performed in the surgeon’s office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after surgery (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it! Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.

These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from surgery once. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they get impacted than the posterior molar teeth. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.

Recent studies have revealed that with early identification of impacted eye teeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eye tooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eye tooth will have erupted enough that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. In the long run, this saves time for the patient and means less time in braces (always a plus for any patient!).

WHAT TO EXPECT FROM SURGERY TO EXPOSE AND BRACKET AN IMPACTED TOOTH:

The surgery to expose and bracket an impacted tooth is a very straight forward surgical procedure that is performed in the oral surgeon’s office. For most patients, it is performed with using laughing gas and local anesthesia. In selected cases it will be performed under I.V. sedation

if the patient desires to be asleep, but this is generally not necessary for this procedure.

You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all after these cases. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be beeped after hours if any problems should arise after surgery.

Source: Oyster Point Oral and Facial Surgery

Impacted Teeth

Unknown Thursday, January 7, 2016

CLEFT LIP AND PALATE

CLEFT LIP AND PALATE


During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections do not meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.

A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.

A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.

CLEFT PALATE

The palate is the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face have developed individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes a baby with a cleft palate may have a small chin and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin sequence.

Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in about one out of every 800 babies.

Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development. In most cases, surgery is recommended. When surgery is done by an experienced, qualified oral and maxillofacial surgeons such as Dr. Lee, the results can be quite positive.

CLEFT LIP TREATMENT

Cleft lip surgery is usually performed when the child is about 10 years old. The goal of surgery is to close the separation, restore muscle function and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.

CLEFT PALATE TREATMENT

A cleft palate is initially treated with surgery safely when the child is between 7 to 18 months old. This depends upon the individual child and his / her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.

The major goals of surgery are to:

Close the gap or hole between the roof of the mouth and the nose.
Reconnect the muscles that make the palate work.
Make the repaired palate long enough so that the palate can perform its function properly.
There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to the surgery.

The cleft hard palate is generally repaired between the ages of 8 and 12 when the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.

WHAT CAN BE EXPECTED AFTER THE SURGERY?

After the palate has been fixed, children will immediately have an easier time in swallowing food and liquids. However, in about 1 out of every 5 children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large however, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a "fistula," and may need further surgery to correct.

Source: Oyster Point Oral and Facial Surgery

CLEFT LIP AND PALATE

Unknown Wednesday, January 6, 2016

Gum Disease

       Gum disease is an infection of the tissues that surround and support your teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know you have it. Also referred to as periodontal disease, gum disease is caused by plaque, the sticky film of bacteria that is constantly forming on our teeth.

Here are some warning signs that can signal a problem:

• gums that bleed easily
• red, swollen, tender gums
• gums that have pulled away from the teeth
• persistent bad breath or bad taste
• permanent teeth that are loose or separating
• any change in the way your teeth fit together when you bite
• any change in the fit of partial dentures

Some factors increase the risk of developing gum disease. They are:

• poor oral hygiene
• smoking or chewing tobacco
• genetics
• crooked teeth that are hard to keep clean 
• pregnancy 
• diabetes 
• medications, including steroids, certain types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

See your dentist if you suspect you have gum disease because the sooner you treat it the better. The early stage of gum disease is called gingivitis. If you have gingivitis, your gums may become red, swollen and bleed easily. At this stage, the disease is still reversible and can usually be eliminated by a professional cleaning at your dental office, followed by daily brushing and flossing.

Advanced gum disease is called periodontitis. Chronic periodontitis affects 47.2% of adults over 30 in the United States. It can lead to the loss of tissue and bone that support the teeth and it may become more severe over time. If it does, your teeth will feel loose and start moving around in your mouth. This is the most common form of periodontitis in adults but can occur at any age. It usually gets worse slowly, but there can be periods of rapid progression.

Aggressive periodontitis is a highly destructive form of periodontal disease that occurs in patients who are otherwise healthy. Common features include rapid loss of tissue and bone and may occur in some areas of the mouth, or in the entire mouth.

Research between systemic diseases and periodontal diseases is ongoing. While a link is not conclusive, some studies indicate that severe gum disease may be associated with several other health conditions such as diabetes or stroke.

It is possible to have gum disease and have no warning signs. That is one reason why regular dental checkups and periodontal examinations are very important. Treatment methods depend upon the type of disease and how far the condition has progressed. Good dental care at home is essential to help keep periodontal disease from becoming more serious or recurring. Remember:You don’t have to lose teeth to gum disease. Brush your teeth twice a day, clean between your teeth daily, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.

Source: American Dental Association (ADA).

Gum Disease

Unknown

5 Reasons Why Fluoride in Water is Good for Communities

1. Prevents tooth decay. Fluoride in water is the most efficient way to prevent one of the most common childhood diseases – tooth decay. An estimated 51 million school hours are lost each year due to dental-related illness, and one study has shown that children who live in communities without fluoridation are three times more likely to end up in the hospital to undergo dental surgery. 


2. Protects all ages against cavities. Studies show that fluoride in community water systems prevents at least 25 percent of tooth decay in children and adults, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
3. Safe and effective. For 70 years, the best available scientific evidence consistently indicates that community water fluoridation is safe and effective. It has been endorsed by numerous U.S. Surgeons General, and more than 100 health organizations recognize the health benefits of water fluoridation for preventing dental decay, including the Centers for Disease Control and Prevention, the American Medical Association, the World Health Organization and the American Dental Association. 
4. Saves money. When it comes to the cost of treating dental disease, everyone pays. Not just those who need treatment, but the entire community – through higher health insurance premiums and higher taxes. The average lifetime cost per person to fluoridate a water supply is less than the cost of one dental filling. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs.
5. It’s natural. Fluoride is naturally present in groundwater and the oceans. Water fluoridation is the adjustment of fluoride to a recommended level for preventing tooth decay. It’s similar to fortifying other foods and beverages, like fortifying salt with iodine, milk with vitamin D, orange juice with calcium and bread with folic acid.

If you have specific questions about your family’s fluoride needs, please contact your family dentist, pediatrician or physician.

Source: American Dental Association (ADA)

Unknown Monday, January 4, 2016