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What is the treatment for missing teeth? There are several ways that missing teeth can be managed. One option might be closure of the spaces with orthodontic treatment. Sometimes this can be nicely accomplished with the advantage of eliminating the need for prosthodontic treatment to replace the missing teeth. Many times however closure of the spaces may result in over-retraction of the front teeth which may be undesirable with regard to facial esthetics. In these cases orthodontic treatment is performed to properly consolidate and position the space(s) in preparation for prosthodontic treatment to replace the missing teeth. The best method for replacement of the missing teeth should be discussed with your general dentist. Some options may include a bridge which is an artificial tooth attached to the teeth adjacent to the missing teeth (often bonded) or implants (an artificial root implanted into the bone to which an artificial crown is attached). Removable appliances may also be used to replace the missing teeth but these appliances area usually of a temporary nature and "permanent replacements" are usually more natural feeling and comfortable. Permanent tooth replacements are generally not considered until a patient has completed their growth and until then removable appliances are often used to provide to provide a solution for esthetics. Why do some teeth become impacted? The impaction of teeth is often genetically determined. For instance there is a strong genetic influence on the impaction of upper cuspid teeth. Environmental factors such as crowding, early loss of baby teeth, over-retained baby teeth, and the presence of extra teeth may also significantly increase the risk for impacted teeth. What can be done for impacted teeth? In most cases impacted teeth can be properly positioned. This will most often require orthodontic treatment to create space for impacted tooth and to apply pressure to the tooth in the proper direction to guide it into position. Usually a surgical procedure is necessary to expose the impacted tooth and to apply an orthodontic attachment which will be used for the application of force to the tooth. In some cases the risk of impaction can be reduced by the early creation of space or the early removal of baby teeth which can give the potentially impacted tooth a better chance of properly erupting. Orthodontics tends to address skeletal or jaw problems more now than it did in the past. If you believe that the jaw structure is purely determined by genetic factors and that environment al influences play no significant role you will find little value in many of the early treatment performed today. If however you begin to understand that while the genetic pattern has a great deal of influence on the development of the jaws and the teeth it is not the sole determining factor you can see the value of early intervention in at some cases. The genetic pattern is influenced both positively and negatively by environmental factors that act on jaw and tooth development. A good example of this is the influence a strong, persistent thumb habit has on the development of an overbite. While a patient may or may not be genetically predisposed to excessive overbite the thumb is a strong negative influence. Likewise orthodontic appliances in some cases may provide a strong positive influence on the genetic growth pattern. Of course if you are going to try to influence child's growth you must be acting during the growth period and hence earlier treatments are necessary. In addition the rate of the extraction of permanent teeth is less today than it was 20 years ago and in an effort to try to reduce the number of patients in which extractions are indicated early treatment is used to attempt to create additional space for the developing teeth. The timing of treatment is not without controversy in orthodontics and of course as with all treatments this decision must be tailored to the individual patient. Does the application or removal of braces cause damage to the teeth? Typically braces are bonded to or cemented to the enamel surfaces of the teeth. In order to prepare the teeth for proper bonding a microscopic layer of the enamel is treated and slightly effected. When braces are removed typically the brace is separated from the bonding material or cement and then the bonding material is polished off of the tooth. Once again this may affect a microscopic outer surface layer of the enamel but this will not affect the health of the tooth and will not be evident to inspection with the eye. Therefore there is typically no change (other than microscopic) evident from the application or removal of the braces. Damage to the teeth during orthodontic treatment (marking of the teeth) is generally caused by inadequate removal of plaque from around the braces by the patient. The plaque, which is bacterial growth gives off acid as a by-product of the processing of sugars. It is this acid which demineralizes the enamel surface which results in white marks on the teeth or in extreme cases enamel breakdown (decay). Often the extent of the marks is not fully realized until the braces are removed since the area under the brace which is protected contrasts sharply with the adjacent demineralized area. For this reason it is imperative that the plaque be removed from around the braces during the course of orthodontic treatment.
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