Posts for: November, 2019
One in 700 babies are born each year with a cleft lip, a cleft palate or both. Besides its devastating emotional and social impact, this common birth defect can also jeopardize a child's long-term health. Fortunately, incredible progress has occurred in the last half century repairing cleft defects. Today's children with these birth defects often enter adulthood with a normal appearance and better overall health.
A cleft is a gap in the mouth or face that typically forms during early pregnancy. It often affects the upper lip, the soft and hard palates, the nose or (rarely) the cheek and eye areas. Clefts can form in one or more structures, on one side of the face or on both. Why they form isn't fully understood, but they seem connected to a mother's vitamin deficiencies or to mother-fetus exposure to toxic substances or infections.
Before the 1950s there was little that could be done to repair clefts. That changed with a monumental discovery by Dr. Ralph Millard, a U.S. Navy surgeon stationed in Korea: Reviewing cleft photos, Dr. Millard realized the “missing” tissue wasn't missing—only misplaced. He developed the first technique to utilize this misplaced tissue to repair the cleft.
Today, skilled surgical teams have improved on Dr. Millard's efforts to not only repair the clefts but also restore balance and symmetry to the face. These teams are composed of various oral and dental specialties, including general dentists who care for the patient's teeth and prevent disease during the long repair process.
Cleft repairs are usually done in stages, beginning with initial lip repair around 3-6 months of age and, if necessary, palate repair around 6-12 months. Depending on the nature and degree of the cleft, subsequent surgeries might be needed throughout childhood to “polish” the original repairs, as well as cosmetic dental work like implants, crowns or bridgework.
In addition to the surgical team's skill and artistry, cleft repair also requires courage, strength and perseverance from patients and their parents, and support from extended family and friends. The end result, though, can be truly amazing and well worth the challenging road to get there.
If you would like more information on repairing cleft birth defects, 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 “Cleft Lip & Cleft Palate.”
You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.
The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.
But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.
Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.
His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.
One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.
In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.
Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.
If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”
The U.S. Centers for Disease Control and Prevention calls it “one of the ten most important public health measures of the 20th Century.” A new vaccine? A cure for a major disease? No—the CDC is referring to the addition of fluoride to drinking water to prevent tooth decay.
Fluoride is a chemical compound found in foods, soil and water. Its presence in the latter, in fact, was key to the discovery of its dental benefits in the early 20th Century. A dentist in Colorado Springs, Colorado, whose natural water sources were abundant with fluoride, noticed his patients' teeth had unusual staining but no tooth decay. Curious, he did some detective work and found fluoride in drinking water to be the common denominator.
By mid-century, fluoride was generally recognized as a cavity fighter. But it also had its critics (still lively today) that believed it might also cause serious health problems. Ongoing studies, however, found that fluoride in tiny amounts—as small as a grain of sand in a gallon of water—had an immense effect strengthening enamel with scant risk to health.
The only condition found caused by excess fluoride is a form of tooth staining called fluorosis (like those in Colorado Springs). Fluorosis doesn't harm the teeth and is at worst a cosmetic problem. And it can be avoided by regulating the amount of ingested fluoride to just enough for effectively preventing tooth decay.
As researchers have continued to learn more about fluoride, we've fine-tuned what that amount should be. The U.S. Public Health Service (PHS), which sets standards for fluoride in drinking water, now recommends to utilities that fluoridate water to do so at a ratio of 0.7 mg of fluoride to 1 liter of water. This miniscule amount is even lower than previous recommendations.
The bottom line: Fluoride can have an immense impact on your family's dental health—and it doesn't take much. Excessive amounts, though, can lead to dental staining, so it's prudent to monitor your intake. That means speaking with your dentist about the prevalence of fluoride in your area (including your drinking water) and whether you need to take measures to reduce (or expand) your use of it.
If you would like more information on how best fluoride benefits your family's 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 “Fluoride & Fluoridation in Dentistry.”