Most of us are quite familiar with what traditional braces look like. But occasionally we see more complex-looking devices being worn by young orthodontic patients: thicker wires that extend outside the mouth, with straps that may go behind the neck or over the chin. What are these devices, and why are they sometimes needed?

In general, orthodontic appliances with external parts braced by the head, neck or chin are referred to as “headgear.” These devices may be used to handle a number of particular orthodontic situations, but they all have one thing in common: They provide the additional anchorage needed to move teeth into better positions.

It may come as a surprise that teeth, which seem so solid, can actually be moved fairly easily over time. This is because teeth are not fixed directly into bone, but are instead held in place by a hammock-like structure called the periodontal ligament. Using a light, controlled force — such as the force of springy wires and elastics in traditional braces — teeth can be moved slowly through the jaw bone, like a stick being pulled through sand.

Of course, to pull a stick through sand, you need a firm anchorage — your legs, for example, bracing against a rock. Most of the time, the back teeth, with their large, multiple roots, provide plenty of support. But sometimes, the back teeth alone aren’t enough to do the job.

If a very large space between teeth is being closed, for example, the back teeth might be pulled forward as the front teeth are pulled back; this could result in poor alignment and bite problems. In other cases, the front teeth may need to be pulled forward instead of back. The back teeth can’t help here; this is a job for headgear.

Some types of headgear have a strap that goes behind the head or neck; they use the entire head as an anchorage. Other types, called “reverse pull” headgear, have a strap that comes over the chin or the forehead; they can pull teeth forward. Headgear can even influence the proper growth of facial structures — that’s why it is usually seen on preteens, whose growth isn’t yet complete.

Headgear is usually worn for 12 hours per day, for a limited period of time. In some cases, rather than headgear, appliances called “temporary anchorage devices” (TADS) may be recommended. These are tiny screws that are implanted into the jawbone in a minimally invasive procedure, and serve a similar function.

While it may not look pretty, orthodontic headgear is capable of moving teeth into their proper positions in a relatively short period of time — and ending up with a great-looking smile is what orthodontics is all about.

If you have questions about orthodontic headgear, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine article “Moving Teeth With Orthodontics.”

Not long ago, musician, businessman, and actor 50 Cent (AKA Curtis James Jackson III) joined the growing ranks of celebrities (like Demi Moore and LeAnn Rimes) who have sent out tweets from the dental chair. The rapper, who has had extensive cosmetic work done on his teeth, even live-tweeted an action shot of his dentist giving him an oral exam!

Some might consider this too much information — but we're happy whenever people are reminded of the importance of regular dental checkups. In fact, the “routine” dental exam is truly one of the most useful procedures (and one of the best values) in dental care. Let's “examine” some reasons why that's so.

For one thing, coming in to our office when you don't have a specific problem gives us the chance to talk to you about any concerns you may have in regard to your mouth — or your health in general. In fact, many of the questions we ask and the exam procedures we perform give us an opportunity to detect potentially deadly diseases. For example, simply monitoring your blood pressure may identify a risk for heart disease; or an examination of the oral tissues may reveal the first signs of oral cancer. Both conditions are treatable if caught early on.

Of course, at a dental exam we always look closely at your teeth for signs of cavities. We also check your gums for inflammation or bleeding, which could indicate gum disease. X-rays or other diagnostic tests are performed when necessary. Generally, the sooner we can diagnose and treat any problems we may find, the better (and less costly) the outcome tends to be.

A typical checkup also includes a thorough, professional teeth cleaning with specialized tools, performed by our skilled dental hygienists. This not only makes your mouth look and feel sparkly clean — it also removes the built-up hard deposits (called tartar or calculus) that can lead to bad breath or gum disease.

Once the exam and cleaning are done, we have a good idea of the general state of your dental health. We can then give feedback on your oral hygiene techniques, assess your risk for disease, and make recommendations tailored to your individual needs. And we can do all this in about half an hour.

So talk about it, tweet about it — but don't neglect it! Along with regular brushing and flossing, routine dental checkups are the best way for you to maintain good oral hygiene — and prevent future dental problems.

If you would like more information about the benefits of regular dental exams, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “The Dental Hygiene Visit.”

When we refer to periodontal (gum) disease, we’re actually talking about a family of progressive, infectious diseases that attack the gums and other tissues attached to the teeth. Caused primarily by bacterial plaque left on tooth surfaces from inefficient oral hygiene, gum disease can ultimately lead to tooth loss.

There’s only one way to stop the infection and restore health to diseased tissues — remove all of the offending plaque and calculus (hardened plaque deposits) possible from tooth and gum surfaces, including below the gum line at the roots. The basic tools for this task are specialized hand instruments called scalers or ultrasonic equipment that vibrates plaque loose. A series of cleaning sessions using these tools could stop the infection and promote healing if followed with a consistent, efficient daily hygiene habit.

There are times, however, when the infection has progressed so deeply below the gum line or into the tissues that it requires other procedures to remove the plaque and infected tissue. One such situation is the formation of an abscess within the gum tissues, a pus-filled sac that has developed in response to infection. After administering local anesthesia, the abscess must be treated to remove the cause and allow the infectious fluid to drain. The area is then thoroughly flushed with saline or an antibacterial solution.

The gum tissues are not completely attached to the tooth surface for a small distance creating a space. These spaces are called periodontal pockets when they are inflamed and continue to deepen as the disease progresses. These inflamed and sometimes pus-filled pockets form when tissues damaged by the infection detach from the teeth. If the pockets are located near the gum line, it may be possible to clean out the infectious material using scaling techniques. If, however, they’re located four or more millimeters below the gum line a technique known as root planing may be needed, where plaque and calculus are shaved or “planed” from the root surface. As the disease progresses and the pockets deepen, it may also be necessary for surgical intervention to gain access to the tooth roots.

To stop gum disease and promote soft tissue healing, we should use any or all treatment tools at our disposal to reach even the most difficult places for removing plaque and calculus. The end result — a saved tooth — is well worth the effort.

If you would like more information on treating periodontal disease, 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 “Treating Difficult Areas of Periodontal Disease.”