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Orthodontics

Gina Pinamonti DDS

2011-05-01 11:25:00

Question: What is the difference between a DDS and a DDM and who is more qualified to treat all areas of dentistry competently?

Answer: It is wise to be concerned about the qualifications of those caring for the oral health of your family. It is also easy to be confused by all of the different areas of specialty within the field. Dentistry is much more than filling cavities. Dentists are on the front line of oral health and are often the first person to spot serious oral conditions, such as cancer of the mouth. Dentists with the DDS or DMD degree are qualified to provide the highest level of oral care to your family. There is no difference between Doctor of Dental surgery (DDS) and Doctor of Dental Medicine (DMD) and is just a choice of naming convention made by the school awarding the degree. The program content for both degrees is quite similar and the training students receive on either program is similar. Here are some other dental definitions from the American Dental Association that may be helpful to know: Definition of Dentistry: Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law. DDS/DMD Definitions: DDS — doctor of dental surgery DMD — doctor of dental medicine Indicates the degree awarded upon graduation from dental school to become a general dentist. There is no difference between the two degrees; dentists who have a DMD or DDS have the same education. Additional post-graduate training is required to become a dental specialist, such as an orthodontist, periodontist or oral and maxillofacial surgeon. Definitions of Recognized Dental Specialties: Approved by the Council on Dental Education and Licensure, American Dental Association. Dental Public Health: Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. Endodontics: Endodontics is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. Oral and Maxillofacial Pathology: Oral pathology is the specialty of dentistry and discipline of pathology that deals with the nature, identification and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical or other examinations. Oral and Maxillofacial Radiology: Oral and maxillofacial radiology is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region. Oral and Maxillofacial Surgery: Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Orthodontics and Dentofacial Orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Pediatric Dentistry: Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. Periodontics: Periodontics encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. Prosthodontics: Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.

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Orthodontics

Gina Pinamonti DDS

2011-03-01 10:26:00

Question: I am an athletic coach and we occasionally see injuries with our players. Of course, we do all that we can to prevent injuries, with appropriate protective gear, but it is helpful to know what to do. One of the areas that I am finding we have a gap in our knowledge concerns dental injuries. Can you give us an idea of what to do should an injury occur?

Answer: Thank you for your concern for your players. Sports injuries account for a significant portion of dental injuries every year; most of them are preventable by wearing appropriate mouth and face guards. If an injury such as having a tooth knocked out, does occur, it is important to seek help as soon as possible. Here are the American Dental Association’s recommendations for dental emergencies: Knocked-out (avulsed) tooth: It is important to make an effort to find the tooth for possible reimplantation into the socket. Once found, hold the tooth on the crown or top of the tooth and very gently rinse the tooth in water. Do not remove any tissue or fragments. Push the tooth in the socket. Remember there will be bleeding and swelling in the socket and this will cause hydraulic pressure creating resistance as you push it into place. Hold it there and get to the dentist immediately. If it is not possible to put the tooth in the socket, put it in milk and drive to the dentist within an hour if possible. Time is critical for successful reimplantation. Broken tooth- Rinse the mouth with warm water. Use cold compresses on the outside of the cheek to reduce swelling. Go to your dentist to get the missing enamel replaced for your comfort. Tongue or lip wounds- Clean the area gently with a clean cloth and apply cold compresses to reduce swelling. To reduce tongue bleeding, pull it forward and apply pressure with gauze. If the bleeding cannot be controlled, take the injured party to the hospital emergency room. Possible broken jaw- Apply cold compress, and get to the hospital immediately.

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Orthodontics

Gina Pinamonti DDS

2011-02-01 14:24:00

I am a very dedicated runner that competes nationally and internationally. More and more frequently, I am hearing other runners talk about using performance mouth guards to give a competitive edge, where I have always thought of mouth guards as a protective device for contact sports. Is this something that is truly beneficial beyond the protective factor and is it beneficial in all sports? Are there different types and makers?

Answer: You have likely seen pro athletes in contact sports slip a guard in their mouth before they play. These mouthpieces are primarily to protect the teeth from loss or injury and differ from performance mouth guards. Performance mouth guards are designed to increase strength, performance, and endurance by decreasing stress and encouraging better breathing. They also have some protective advantage. Performance mouth guards decrease the stress to the jaw muscles endured when athletes unknowingly clench or grind during intense physical activity. A recent study conducted by the University of Minnesota linked jaw clenching to the increase of stress hormones that can inhibit physical performance. This advantage has come to the attention to many athletes across a wide range of sports. While the technology is high tech, the premise is actually simple. The mouth guards, which are fitted by an orthodontist or dentist, prevent grinding, help properly align the jaw and improve breathing. Improved breathing increases the oxygen to the muscles, which also improves performance. Performance mouth guards are made by several companies. Under Armour Performance Mouthpieces incorporate bite technology to reduce stress on the jaw and studies have shown they enhance performance. For non-contact sports or exercise such as golf, distance running or weight lifting, the mouthpiece is designed to cover only the lower teeth. Mouthguards that cover the upper jaw only are available and are perfect for anyone who needs to speak while playing. The basketball player or quarterback will be confident that they can be understood while speaking and breathing will be easy because the custom mouthguards stay in place. Mouthguards with maximum coverage of upper and lower teeth are indicated for high contact sports like football, hockey or karate. These high tech variations of custom fit Under Armour Performance Mouth guards are available at your local orthodontist and no referral is needed for an appointment. If you would like to have more information please call 620-231-6910.

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Orthodontics

Gina Pinamonti DDS

2010-12-01 14:26:00

Question: I brush everyday and the dentist says I still have “gingivitis”! What is gingivitis anyway?

Answer: Most everyone brushes their teeth daily, but more often than not there are places where their tooth brushing is just not getting the job done. I believe that tooth brushing is a life skill that needs to be taught at a young age and reviewed frequently and refined over the course of a person’s life. When children are young they do not understand what they are supposed to be accomplishing and they do not have the muscle coordination to control their tooth brush very well. Parents should brush their children’s teeth until their dentist says the child has the skills to keep their teeth clean and cavity free. As the permanent teeth come in and though out life people may have crowded or misaligned teeth or dental changes such as braces, crowns or caps and bridges. As these dental changes occur, their approach to completely cleaning off all of the plaque from their teeth will need to be altered and again our skills need to be reviewed at dental checkups every six months. The secret to dental health starts with understanding the goal of brushing and flossing: plaque removal. Plaque is a thin layer of bacteria that sticks to the teeth. When the dentist or hygienist cleans your teeth the thin film will start to reform on teeth within 10 minutes. That should speak volumes on why brushing more than once a day is very important. If plaque remains on your teeth longer than 12 hours it will become hard and more difficult to remove with your tooth brush. That is why we brush twice daily so we PREVENT the plaque from becoming more difficult to remove. When plaque remains on your teeth it becomes an irritation to the gingival tissue or gums. The gum tissue will become red and swollen and might even bleed. This is known as gingivitis. UNFORTUNATELY, gingivitis does not hurt. If it did hurt I believe people would take it more seriously and take immediate steps to fix it. The good news is that gingivitis is reversible or you can fix it by removing the problem: plaque. But if you do not feel the gingivitis, if you miss the red area when you brush and leave the irritating plaque in the same place day after day, how can you fix the problem? You need to see the dentist or hygienist and have them review with you all of the areas where there is gingivitis and have them work with you on your tooth brushing skills to make sure you can physically remove the plaque every day. This may sound silly, but after working with dental patients for 18 years I have noticed a pattern. In most cases, I can tell if the patient is right handed or left handed by where they have gingivitis. Almost everyone brushes their side teeth better than the front teeth. Brushing on the sides is an easier motion for the arm. The tongue side of the lower front teeth is doubly difficult to clean because it is hard to get the tooth brush bristles along each tooth without deliberate vertical positioning of the tooth brush, and they are bathed by saliva that helps the plaque turn to tartar and stick. But the tell-tale sign that gives away which hand is used to brush is the red gums around the dirtiest teeth in the mouth and they are on the side of the person’s dominant hand. The right handed person puts the tooth brush in the mouth on the left side, flies back and forth from side to side, front to back, top to bottom, and then back to the left, then another figure 8 sweep and again they end up on the left. The front surface of the lower left teeth are usually quite clean. As the tooth brush comes around the front of the mouth it must be flipped to clean the right side. Our lips are in the way so the brush will enter along the side teeth on the right, completely skipping the lateral incisors and canine teeth which are the second and the third tooth from the middle of the mouth. This happens on both the top and the bottom teeth. Once I point this out, everyone in the room starts to think about how they approach brushing and heads start to nod. People understand and recognize they have a similar haphazard pattern. The left handers just reverse it. Now, I can start to educate anyone who will listen. Place fluoridated tooth paste on a soft tooth brush and put it to the farthest tooth back on the upper left. Make ten small circles getting the bristles under the gum line that makes a pocket or turtle neck of tissue around each tooth to completely remove all the plaque hiding there. The tooth brush might hit the jaw bone so do not open too wide in the back. Next move forward one tooth and repeat. Yes, your tooth brush bristles will touch neighboring teeth, but that is a bonus. When you have brushed ten circles per tooth on all of your teeth on the left or when you cannot go any farther in the front because of the lips on the right, then you have a choice of what to do next. You can either flip your tooth brush and start to the left of the middle of the front teeth or you can go to the last tooth on the right side and move forward with ten circles per tooth. This is repeated on the lower teeth and on each surface of the tooth; the front side, the tongue side, and the chewing surfaces. If there are any irregularities in your mouth such as crooked teeth or braces you will need to be sure to brush each surface of those objects because they hold plaque on their edges. The plaque bacteria produce acid that breaks down the enamel. It will soften and become white. Fluoridated toothpaste and complete plaque removal can remineralize the soft enamel and make it strong and hard again. (see 2nd photo) If the plaque is left alone then it will break through the enamel into the dentin and become a cavity. Once the bacteria are in the dentin they can grow much faster and eventually end up in the blood supply of the root canal of the tooth. Our bodies cannot remove the bacteria from the root canal so it will break into the bone. An abscess will result if the cavity is closed by food or material otherwise the infection will drain into the mouth where a putrid smell can occur and the pain is not as bad as the closed abscess. So elbow grease and ingenuity is also important and can save you a lot of trouble. All of these tips will make the obligatory two minutes of brushing fly by and you actually will accomplish the purpose of brushing: plaque removal. Complete plaque removal will require excellent, thorough brushing and flossing as well. Flossing is required because the tooth brush bristles cannot get between the teeth to remove plaque. If this approach to complete plaque removal is repeated daily the gingivitis should resolve. If the gingivitis is left alone then the bacteria in the gum line around the teeth will increase the amount of inflammation of the gum tissue making a deeper pocket and there will be an environment for more harmful bacteria to grow and they will start to destroy the bone that hold the teeth in the mouth. That process is called periodontal disease and the bone loss is not reversible, but permanent. This disease will lead to tooth loss if left alone. So this evening before bed when you get ready to give a tooth brush fly-by to your teeth, slow down and count to ten over and over again brushing each surface of each tooth thoroughly. End the day with the pride of complete plaque removal from every surface on every tooth above and below your gums. As you drift off into a deep sleep, know that there will be an abundance of those sweet smelling bacteria repopulating the crevasses of your pearly whites to greet you in the morning. This morning you will be different. You will be ready to clean your teeth with purpose and you will be better for it. The red line at the top of the teeth is gingivitis. This person’s plaque does have a yellow color to it, but most plaque is white or tooth colored. He reported he brushed earlier that day. The front teeth are just flown by and missed. If this were to continue he would not have front teeth to worry about by 25! This patient is right handed. When she was a child she did not brush well and she has damage to the enamel where her gum line was as a teenager. The plaque resting at the gum line produced acid that broke down the enamel, but not enough to break through and create a cavity. She remineralized her enamel with fluoride toothpaste and proper brushing. The enamel above the white marks is normal because the plaque was removed daily. Today her teeth are healthy, but the stains will not go away.

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Orthodontics

Gina Pinamonti DDS

2010-11-01 13:31:00

Question: My front teeth are so far away from my lower teeth I cannot bite them together. What can be done for an adult who did not have the benefit of braces when they were younger and growing?

Answer: There are a lot more possibilities today for someone to get that perfect smile they have always wished they had. Most cases are straight forward. The road to straight teeth is a straight line, but sometimes the jaws just do not fit together and no matter how straight the teeth are they will never fit together in their normal jaw position. Quite often the upper jaw and the lower jaw bones do not line up correctly and the orthodontist can use auxiliary appliances to influence the teeth to more closely approximate ideal, but there are cases that are outside the norm. In order for the orthodontists to make sure they give the patient the best occlusion or “bite” possible, braces must be accompanied by surgically repositioning the jaw bones. The majority of the jaw imbalances in the United States are where the upper teeth appear to stick out too far and the lower jaw and chin are way behind. This jaw relationship is usually a lack of lower jaw growth and those patients can be treated surgically by repositioning the lower jaw forward. Lower jaw surgery will improve the function of the teeth, reduce the prominence of the upper front teeth, the chin will balance the face more, the nose usually appears smaller and the skin under the chin will become tighter. When the lower teeth stick out ahead of the upper teeth, in an underbite, surgical treatment usually moves the upper jaw forward. Because the lower jaw continues to grow as long as the patient is growing tall, and that can be late in men, surgery is done when the patient is an adult or at least when growth has ceased. The surgical movement of the upper jaw forward allows the lower teeth to fit under the upper teeth. This makes eating easier, especially when biting into a sandwich. The cheek bones appear more prominent, the nasal airway becomes larger and the eyes have more lower lid support making the person look more rested. The previous descriptions of jaw surgical needs are just skimming the surface. There are multiple ways to correct the facial imbalance other than what has been mentioned here and there are multiple variations of the jaw imbalance problems, such as the narrow upper jaw and teeth that fit inside the lower teeth; the open bite where only back teeth can touch and the front teeth do not work together; and the facial asymmetrical growth where one side is much smaller or out of proportion with the other not only front to back but sided to side. Jaw imbalances are prepared for surgically corrected orthodontics in similar manners. The orthodontist will work with a maxillofacial oral surgeon to create a plan to correct the facial imbalance. The patient is informed about the entire process, risks and limits of the braces and surgery are presented to the patient, a pre-determination is sent into the patient’s health insurance, expected results are explained and once all is accepted the treatment can begin. Braces are applied to the teeth, they are aligned over their respective bones and in most cases the patient’s bite will become worse in preparation for surgically fitting the jaws together. When the dental casts of the patient’s teeth appear to fit well, the orthodontist will send the patient back to the oral surgeon. The surgeon will make sure everything looks good from their perspective or ask for adjustments to be made by the orthodontist, re-submit the insurance and make sure all is in order for the surgery. The surgical procedure is usually completed in the hospital or surgical center. The patient will stay overnight and in most cases is released the next day at the discretion of the oral surgeon. The patient remains under the care of the oral surgeon for about 6 weeks. They usually do not have their mouth wired closed anymore because the bones are fixed with plates or screws and they are more stable. The jaws are guided to healing positions with rubber bands and a wafer thin plastic splint. After one week, the patient is feeling much better and in usually two weeks they are resuming their normal routines. In four to six weeks, the patient returns to the orthodontist who will continue to finish the treatment with the jaws in the new position. This could take a few months to a year depending on the amount of muscle pull or relapse that occurs after surgery. The goal for the surgically assisted orthodontic treatment is a functional bite. The benefits of the surgical corrections is improved facial balance, improved facial esthetics, many times more room for the tongue, and many times improved airway. But most of all you will see a new air of confidence in the patient who has realized their dream of the beautiful smile they now have.

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Orthodontics

Gina Pinamonti DDS

2010-10-01 11:22:00

Question: I see kids in braces at a very young age these days. What is the exact age when kids can begin wearing braces?

Answer: That is a very common question asked by parents. The short answer is that every child is different and should be evaluated by the time the permanent teeth start to come in, around 7 years old, or sooner. At that point the permanent first molars have erupted and the bite is established. This will indicate how the upper and lower jaws relate to each other. Ideally the upper front teeth should be slightly ahead of the lower teeth, but more often than not, the upper teeth are too far forward. If the child is experiencing repeated injury to the front teeth, teasing or low self esteem, then early treatment could be indicated, otherwise treatment could be put off until more permanent teeth are present. For those people who have the lower teeth in front of the upper teeth early treatment is very important. The lower jaw continues growing until the patient stops growing tall. If we can get the upper teeth in front of the lower teeth before 8 years of age then the jaws can grow in improved harmony reducing the chances for very involved orthodontic treatment when older. In addition to the bite and jaw relationship the initial exam will also evaluate other things which play a role in the type of future treatment and when treatment will begin. Things such as facial growth, crowding or missing teeth, improper swallow or tongue-thrusting and finger or thumb-sucking can hinder proper jaw development and tooth alignment, as well as affecting facial appearance. When the orthodontist evaluates the patient, if the condition does not necessitate early treatment, often called phase 1 treatment, your orthodontist will schedule follow-up exams to evaluate the development. The orthodontist will continue to monitor the patient’s growth and progress at varied intervals from 6 months to a year. In the vast majority of cases, braces or full treatment is appropriate between 11 and 15 years old to utilize the patient’s growth. As an adult treatment is still possible, we just do not have the growth to help with treatment. Many parents seek an early orthodontic consultation because there is something they do not like, such as an overbite or a thumb or finger habit. Early evaluation is key. Many people mistakenly believe that orthodontics must begin only after the permanent teeth come in. The truth is, many orthodontic problems are more easily treated well before that time and early treatment can eliminate the need for more drastic measures during future treatment. Something as simple as selective removal of certain baby teeth can improve the pattern of tooth eruption. In some cases, early treatment can correct problems that may not be possible once the face and jaws finish growing. While the bone is still growing, it is possible to use orthodontic appliances to apply force to the jaw to guide growth. Once the growth has ceased, the same opportunity no longer exists, making early evaluation even more important. Over all, the most important step you can take in your child's orthodontic care is early evaluation.

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Orthodontics

Gina Pinamonti DDS

1969-12-31 18:00:00

Question: My child has a cavity in a back baby tooth and my dentist wants to fill it. He will lose it anyway so what is the harm in just pulling it?

Answer: The harm of early extraction or pulling of a back baby tooth will result in crowding if the permanent tooth is not close to erupting. Many times baby teeth will need to be pulled for various reasons. When those baby teeth are in the back, a space maintainer will need to be placed. The space maintainer will hold the space the baby tooth was holding. The primary teeth are very important even though they will be replaced by adult teeth. The baby teeth need to be functional for some time because they are replaced slowly, from about six years of age to the early teens. There are 20 baby or primary teeth that will be replaced by adult teeth. These primary teeth are place holders for the permanent teeth underneath them. If the primary teeth are lost early or if they have big cavities, then the neighboring teeth will drift into the space created by the lost tooth structure and crowd out the underlying permanent tooth as shown in the photographs below. Fixing this crowding problem could require extensive orthodontic treatment with braces and/or removal of the blocked permanent adult tooth. The unwanted movement can be prevented by placing a space maintainer immediately after the removal of the baby tooth. As illustrated in the photographs below, the space maintainer will hold the space until the permanent tooth is in the mouth. The easiest way to keep your child’s mouth healthy and prevent cavities from happening is to make brushing fun and for the adult to brush the child’s teeth regularly until the dentist says they are capable to keep their mouth cavity free. From an early age make it a point each day to have your children see you brushing your teeth and enjoying it. Make positive remarks to your reflection in the mirror, not to your children, as you inspect your work. Comment on how nice your mouth tastes after brushing and how great your gums feel after flossing. Remark that your mouth is the gateway to the rest of your body and if you don’t keep your mouth healthy how can anything else be healthy? Allow your kids to catch you being a good brusher and flosser. Remember responsibility cannot be taught, it must be caught. Your children already know how great you are. Let them see what great pride you take in your mouth and they will want to be just like you. Then ask them to show you their brushing skills. Ask them if they can see well enough in the mirror to inspect their own teeth just like you do. Have them open their mouth as wide as possible and check for plaque. Call plaque “Cavity Bugs” or some other catchy name you can come up with. Make a big deal about brushing the Cavity Bugs away and how glad you are that you were able to get them off before they make a hole in the tooth. In the photo below you will see a pretty, clean smile, but when the child opens you will see why brushing and flossing is so important. Cavities have been growing rampantly and the child will not have any idea that is not normal. These baby teeth will need to be filled if possible or removed. If they are removed then a space maintainer will be needed. Most importantly the child will need help with flossing to keep this from happening again on the permanent adult teeth. In the x-ray image you will see the adult teeth that will replace the baby teeth. This is the x-ray of the child above. You can see the dark areas that occur with cavities and the crowding that has resulted in the space lost with the loss of tooth structure. It is very important to have your children see the dentist every six months and have radiographs taken yearly to check between the teeth to prevent the spread of cavities. Dr. Gina Pinamonti is an orthodontist in Pittsburg, KS. practicing since 1998. She is a graduate of Pittsburg State University. She completed her dental training at the University of Missouri-Kansas City School of Dentistry graduating with honors. She completed her Orthodontic and Dentofacial Orthopedic residency in 1998 from UMKC as well. Dr. Pinamonti is a member of the ADA, American Association of Orthodontists, Kansas Dental Association and the vice president of the Kansas Association of Orthodontists. For more information please call 620-231-6910 or visit www.smileoutloud.com.