SECTION 2 Cosmetic Dentistry
Most of us will have 32 permanent teeth develop during our lifetime. This has been considered a normal complement of teeth. Some people, however, do not develop a full set of 32 teeth. It is quite common for people to be missing one or more of the third molars (wisdom teeth). And as the jaw dimension of modern human beings has decreased in size, there is no room for the proper placement of the third molars in a mouth, and they must be extracted.
Not as common, but not at all unusual, is a condition in which certain permanent front teeth never develop. When permanent teeth do not develop, they are considered to be congenitally missing. The term for this condition is congenitally missing teeth. When this happens, it is frequently one or both of the upper lateral incisors, which are the smaller teeth on either side of the two top front teeth. Less often the permanent canines or premolars do not develop.
The problem that results from congenitally missing teeth involves the space where the tooth (teeth) should have been. The teeth nearest the space shift into different positions to fill in the gap, often resulting in a crowded smile—when in fact, some teeth are missing!
The problems resulting from missing permanent teeth can be reduced or eliminated with early detection and a plan for future treatment. The usual treatment involves orthodontics to move the permanent teeth into better position or keep the permanent teeth in the correct location. Because we treat missing lateral incisors so often, the treatment routine is well established. The best esthetics, the most natural look, will be achieved by leaving the adjacent permanent central incisors and canine teeth in their customary places.
When there are missing lateral incisors, it is likely that we will recommend a bridge, a dental implant, or moving the canines into their positions. This will keep the bone in the missing tooth space at the proper level. We will then recommend moving the canines back into their proper positions. This may sound like extra treatment, but it is needed to keep the bone at the proper height for future tooth replacement treatment.
The sequence of treatment is orthodontics as early as necessary to maintain the space. The further the teeth have shifted from this original position, the more orthodontic treatment will be necessary. Then, while the child and mouth are growing, a removable replacement tooth is made. This appliance is worn until the teeth are ready to receive the implant or bridge, after age 18 or so when the mouth and dental structures are more mature.
When the permanent teeth further back in the mouth are missing, it is common for baby teeth to be retained in these spaces. Sometimes the baby teeth can last for years, but they do not have the root structure to remain stable over a lifetime. Because the retained baby teeth are meant for a small mouth, they do not have the right size, shape, or function as the permanent teeth. When lost, they can be replaced with implants or a bridge. Your own particular situation will determine the best course of treatment.
Fluoride is the dental marvel of our lifetime and a definite benefit to the oral health of our nation. But too much of a good thing can cause problems! Fluorosis of the teeth and mottled enamel can occur when there is too much fluoride ingestion while the teeth are forming. Prescription fluoride supplements of the proper dose are normally given to children who have less than the desired level in their diets. A child can get too much fluoride if it’s available from multiple sources. Children with access to a public water system containing fluoride may also be prescribed fluoride supplements, or they may swallow fluoride-containing toothpastes, mouth rinses, or certain fruit drinks, which may increase their fluoride intake above recommended levels. Fluorosis is a condition in which teeth form with unsightly dark spots on them. Some medications and illnesses can cause a similar problem. These dark spots, most often seen on the permanent teeth, are not more prone to decay, just unattractive. Several or all of the teeth can be affected. The color change (usually brown-orange or flat or opaque white) can be mild, moderate, or severe.
Generally speaking, three solutions are possible. Sometimes the stain is very superficial and can be merely polished off. It does not return. There is no pain involved in this procedure. The enamel is simply polished and made smooth again.
Many times it is quite easy to whiten the brown spots to match the surrounding tooth color. This is most often an in-office procedure (as opposed to whitening yellow teeth, which can be done at home with custom-made tooth-whitening trays). Strong whitening chemicals are placed on the dark area and activated by light or heat or both. Several applications (in the same visit) are done, and the stain usually disappears in one visit!