Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
You might be a bit apprehensive if your dentist recommends a root canal treatment, especially if it's your first. That's understandable: Popular culture has portrayed the root canal as an unpleasant experience.
But as a routine dental procedure, root canal treatments have been responsible for saving millions of decayed teeth. And, with local anesthesia, the procedure is painless. In fact, a root canal treatment stops pain that often results from advanced tooth decay.
So, let's take the mystery out of the root canal. Here's the 411 on this vital but often misunderstood dental procedure.
Why the name “root canal”? The terms for the procedure—root canal therapy, root canal treatment or simply “root canal”—arise from one of the principal parts of the tooth involved, root canals. These are tiny passageways that lead from the tooth's innermost layer, the pulp, to the tooth roots. While treatment often focuses on decay or diseased tissue within the pulp, the root canals can be infected too and must be included in the later filling process.
Who can perform a root canal? All general dentists are trained in basic root canal procedures. Depending on your tooth's condition, your family dentist may be able to perform it. But if your tooth has an intricate root canal network or some other complication, you may need an endodontist, a specialist in interior tooth and root treatments. Endodontists can perform advanced root canal techniques and have the specialized equipment to handle intricate cases.
What happens during a root canal? Although details may vary depending on the type of tooth and extent of decay, there's a basic process for all root canal procedures. After numbing the tooth and surrounding tissues, the dentist drills into the tooth to access the inner pulp chamber and root canals, then removes the diseased tissue and disinfects the empty chamber and canals. After preparing the canals, the dentist then fills the empty spaces. This, and subsequent sealing and crowning, protects the tooth from future decay.
After the procedure you may have some minor soreness for a few days, which is usually manageable with mild pain relievers like ibuprofen or acetaminophen. This discomfort will diminish with time, and your tooth will have a new lease on life.
If you would like more information on root canal treatment, 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 “Root Canal Treatment.”
If all goes normally, we have most of our permanent teeth as we enter puberty. Except, though, when it doesn't—sometimes incoming permanent teeth don't fully erupt, often because there's not enough room for them on the jaw. This can leave all or part of a tooth still up inside the gum and bones.
This condition is known as impaction, and it can cause problems with a person's bite and their smile. This is especially true of the upper canines, those pointed teeth located just under the eyes. Without them present, a person's smile can look oddly different. Moreover, it can worsen their bite and increase the risk of trauma and disease for nearby teeth.
Fortunately, there may be a way to coax impacted canines into erupting into their proper position on the jaw. It will involve, though, some minor surgery and orthodontic intervention to accomplish that feat.
First, though, a patient with missing canines should undergo a thorough orthodontic evaluation. This exam will reveal not only what may be going on with the missing teeth, but how the whole bite has been affected. Knowing the big picture will help direct the next treatment steps.
After pinpointing the impacted teeth's exact position (usually through x-rays or cone beam CT scanning), we then decide whether it's feasible to attempt to expose the teeth. Sometimes, a tooth's position is so out of place that it may be best to remove it and consider a dental implant or other restorative measures.
If it is in a workable position, then the impacted teeth would be exposed surgically (usually by an oral surgeon or periodontist). The surgeon would then bond a small bracket to the exposed tooth and then attach a small chain.
After suturing the incised gum tissues back in place, the chain extending outward from the gums would then be looped over orthodontic hardware attached to other teeth. This will place downward pressure on the upper canine tooth, and over several months prod it to fully erupt.
This may sound like an elaborate procedure, but it's fairly routine and predictable. As a result, a patient can finally get the full benefit of all their teeth, enhance their dental health and transform their smile.
If you would like more information on dealing with impacted teeth, 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 “Exposing Impacted Canines.”
Half of all children will injure at least one tooth before adulthood. That's why we're joining with other health professionals this June to promote National Safety Month. As dentists, we want to call particular attention to potential dental injuries and what parents and caregivers can do to help their child avoid them.
The source for a dental injury usually depends on a child's age and development level. Younger children learning to walk and run are more apt to fall, and may hit their mouth on hard or sharp surfaces. Later on, most dental injuries tend to come from contact during sports play or other physical activities.
Your prevention strategy should therefore adjust to your child's age and activity level. If you have an infant starting to walk, for example, don't allow them to move around carrying a bottle, cup or other hard object that could be a source of injury if they fall. Also, keep an eye out for hard furniture or sharp-edged surfaces as they toddle around.
If you have a highly mobile toddler, discourage them from climbing and jumping on furniture, tables or other hard surfaces. If feasible, pad these surfaces and sharp edges to minimize the force of impact from a collision.
To prevent sports-related mouth injuries in older children and teens, your primary defense is an athletic mouthguard. Mouthguards cushion and absorb much of the force generated during hard sports contact. They should be worn for any physical activity with a potential risk for mouth injury, including practice sessions and informal play like a pick-up basketball game.
A type of athletic mouthguard known as “boil and bite” is readily available in retail sporting goods stores. After purchase, it is softened in very hot water; the wearer then places it in their mouth and bites down to form a permanent impression. Boil and bite mouthguards offer protection, but they can be bulky and uncomfortable to wear.
For a higher level of protection along with a more accurate and comfortable fit, a custom mouthguard created by a dentist is a more desirable option. These are based on a detailed impression of the wearer's bite, so the fit can't be beat. Both types of mouthguard need upgrading periodically in young wearers to accommodate dental development as they age.
Accidents can happen, but there's much you can do to reduce the likelihood of injury to your child's teeth. Protective measures and equipment—as well as a watchful eye—can go far to help them emerge from these active, early years dentally unscathed.
If you would like more information about dental safety, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Top 10 Oral Health Tips for Children” and “Athletic Mouthguards.”
To anyone immersed in the “X-Men Universe” Hugh Jackman will always be Wolverine, a role he played in seven movies. But there’s more to this Australian actor than mutant bone claws and mutton chops that would make Elvis envious. Jackman has also starred in over 20 non-superhero films, including Les Misérables, for which he won a Golden Globe. He is also a Tony award-winning Broadway performer—with a winning smile.
With his famed character Logan/Wolverine fading in the rearview mirror, Jackman has returned to his musical roots. He will play Harold Hill in the Broadway revival of The Music Man, set to open in Fall 2020. And since May 2019 he’s been on world tour with Hugh Jackman: The Man. The Music. The Show., featuring Jackman and a supporting cast performing songs from favorite shows and films, including Les Misérables and the 2017 hit The Greatest Showman.
The Show, with 90 planned stops throughout Europe, North America and Oceania, is a decidedly different “universe” from the X-Men. As Wolverine, Jackman could get away with a scruffier look. But performing as Jean Valjean or the bigger-than-life P.T. Barnum, he has to bring a vastly different look to the role, which brings us to Jackman’s teeth…
Once upon a time, Jackman’s teeth were an unflattering gray—definitely not a good look for stage or film. So with the help of his dentist, Jackman set about upgrading his smile with teeth whitening. Teeth whitening is a great way to take a dull, stained smile and turn up the volume on its brightness—and attractiveness—a notch or two. A dentist applies a bleaching solution that stays in contact with the teeth for a few minutes. The process is often aided by special lighting.
A professional application is especially desirable if, like Jackman, you want “Goldilocks” brightness: not too little, not too much, but just right for you. Dentists can precisely control the tint level to get a brighter but more naturally looking white. Of course, you can also get a dazzling “Hollywood” smile if you so desire.
And although the effect of teeth whitening isn’t permanent, a dental application can last a while, depending on how well you manage foods and beverages that stain teeth. With a touchup now and then, you may be able to keep your brighter smile for years before undergoing the full procedure again.
One important note, though: This technique only works with outer enamel staining. If the discoloration originates from within the tooth, the bleaching agent will have to be placed internally, requiring access to the inside of the tooth. An alternative would be porcelain veneers to mask the discoloration, an option that also works when there is ultra-heavy enamel staining.
If you’re tired of your dull smile, talk with us about putting some pizzazz back into it. Teeth whitening could be your way to get a smile worthy of Broadway.
If you would like more information about teeth whitening, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Teeth Whitening” and “Whitening Traumatized Teeth.”
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