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|Understanding the important tenets of dental health|
|Saturday, 30 June 2012 16:55|
STUDIES have shown that six out of every ten persons with crooked teeth could have had their condition prevented, had their parent or guardian insisted that the dental care provider do the right thing.
Besides children and adolescents, adults are frequently to be blamed for the numerous problems they encounter associated with wrong tooth position when professional help is sought to correct this.
Obviously, this is difficult, as, generally, patients are not certain what the correct treatment they need is. And that is why this column was started exactly twenty years ago. The public needs to be educated on the important tenets of dental health.
The permanent teeth that are most frequently lost in childhood are the first molars. These are the first permanent teeth of a person. If the child’s second molars have not yet erupted, they can be an excellent replacement.
For example, if a child’s six-year molar is extracted because of gross decay before the eruption of the second permanent or 12-year molar, the developing second molar will drift forward into the space of the first, depending on which tooth was lost, upsetting the position of all molars in that arch.
To prevent super eruption of the opposing molar, it should be extracted at the same time, thereby allowing the upper and lower second molars a chance to replace the first molars.
This also provides room for the third molars to erupt without difficulty. Even if the second molars do not replace the first molars perfectly, the condition will still be better than if only one first molar is extracted.
Teeth do not always extrude into open spaces. In a young person, there is a high probability of tooth movement into spaces vacated by extracted teeth. The older the patient, the less likely it is to occur, and then it is not always harmful.
There is the example of a patient in his mid-fifties who had all his upper teeth and a lower partial denture replacing a few lost molars. The partial denture fits with the appliance. Having been warned by his former dentist of the dire consequence of super eruption of unopposed molars without the partial denture, he continued to wear it, despite the constant annoyance.
When he explained his inability to adjust, a more sympathetic dentist suggested that he try doing without the partial, since he had enough teeth to chew with. Twenty-five years later, he was still grateful for the suggestion. The other teeth had held up, and the unopposed upper molars, which were stabilized in bone, did not extrude downward. This kind of non-treatment is very successful, because it does no harm, and relieves the patient of discomfort, but it is not very popular among many dentists, because it provides them with less economic satisfaction. I believe the patient’s wellbeing is far more important than my earning.
Assuming all the first and second molars are in normal occlusion, and the lower first molar is extracted sometime during adolescence, the second molar frequently drifts, and tilts forward into the space.
The bicuspid in front of the space is less likely to drift backward, because it is held in place by occluding with the upper teeth. At this early age, the upper first molar super erupts slightly down into the space below until further movement is prevented by contact with the shifting lower teeth in adjacent spaces.
Quite often, the teeth stabilizes at this point, but it is not uncommon for small spaces to remain, which collect food particles and plaque, causing further tooth decay and periodontal breakdown. Thus, it is desirable to prevent shifting of other teeth, by replacing the missing tooth soon after extraction. But there should be at least a two-month delay to allow the tooth socket to heal, so that the artificial tooth (pontic) will fit snugly against the gum ridge.
If the tooth is replaced immediately after extraction, the gum may shrink away from the pontic, but this problem can easily be solved later. Immediate dentures, which I only do for anterior teeth, should only be done in persons whose social standing and/or occupation necessitate their not ever being seen in public without teeth. In these cases, the dentures are made before the extractions are done, and so I am the only one who would see them without teeth in the dental clinic.
But what if the extraction was many years ago, and the teeth have already shifted so that the space is small, and the situation has stabilized. What if the adjacent teeth are sound, with only small fillings, or perhaps no filling at all? What if the bone support is strong and there is no periodontal breakdown around these teeth? What if you do not miss the tooth until your dentist reminds you of the small space, and recommends a fixed bridge?
Before consenting to a replacement bridge, consider the case of leaving well enough alone. If you face the circumstances described above, a bridge may be unnecessary, and should not be done. Notwithstanding, a clinical examination by your dentist is pivotal to the final and definitive decision.
More Dentist Speaks
- Preventive orthodontics
- Preventive maintenance and the Rule of Thoroughness
- When in doubt, find out
- Challenges in dentistry
- Beware the lower molars!
- Gum disease and stress
- Oral health: More than a pretty smile
- Root canals
- ORAL HEALTH EDUCATION
- THE DENTIST ADVISES : The fundamentals of implant dentistry
- Sensitivity and gum loss
- Headaches are such a pain!
- Stains come in all colours
- Unsupervised self-medication
- The trouble with gum disease
- Eating right
- Death by a simple toothache
- Small head, soft bristles should do the trick
- Promoting healthy bacteria from infancy