Do Wisdom Teeth Cause Crowding?

do wisdom teeth cause teeth to shift or crowding

Do Wisdom Teeth Cause Crowding?

25 May 2023 | By Dr. Eric Meyer

Our third molars—if you were unfortunate enough to have them all, like me—were given the name “wisdom teeth” because they are the last teeth to erupt around the age of 17 to 25…when we are supposedly wiser.

We have long been told that our wisdom teeth cause our front teeth to shift or crowd when they come in. The theory is that as these molars erupt they “push” the teeth in front of them, squeezing them into a crowded position. Is this really the case?

A bevy of evidence exists that does not support this theory (see a few, references 2-7 below).

In reality, whether you have third molars or not, the overwhelming majority of evidence finds that overtime crowding is natural and to be expected (we’ll save this for another post). These studies reported there was no significant difference in crowding over time between individuals with and without wisdom teeth.

With that being said, there are plenty of reasons to consider extraction of wisdom teeth, as they may cause much greater problems down the road than crooked teeth, such as pain, infection, and tooth loss related to dental decay and periodontal problems. We often encourage extraction of wisdom teeth that appear to have a poor position or lack of space to erupt.

So how do we prevent any shifting of your teeth from happening?

If you had orthodontics in the past and you want to maintain your straight smile…wear your retainers as long as you can (at least at night)!

As always, have a great week!

-Dr. E

Renton T, Wilson NH. Problems with erupting wisdom teeth: signs, symptoms, and management. Br J Gen Pract. 2016;66(649):e606-e608. doi:10.3399/bjgp16X686509
Kaplan, R.G., 1974. Mandibular third molars and postretention crowding. American journal of orthodontics, 66(4), pp.411-430.
Ades, A.G., Joondeph, D.R., Little, R.M. and Chapko, M.K., 1990. A long-term study of the relationship of third molars to changes in the mandibular dental arch. American Journal of Orthodontics and Dentofacial Orthopedics, 97(4), pp.323-335.
Bishara, S.E., 1999. Third molars: a dilemma! Or is it?. American Journal of Orthodontics and Dentofacial Orthopedics, 115(6), pp.628-633.
Okazaki, K., 2010. Relationship between initial crowding and interproximal force during retention phase. Journal of Oral Science, 52(2), pp.197-201.
Al-Balkhi, K.M., 2004. The effect of different lower third molar conditions on the re-crowding of lower anterior teeth in the absence of tight interproximal contacts one-year post orthodontic treatment: a pilot study. J Contemp Dent Pract, 5(3), pp.66-73.
Southard, T.E., Southard, K.A. and Weeda, L.W., 1991. Mesial force from unerupted third molars. American Journal of Orthodontics and Dentofacial Orthopedics, 99(3), pp.220-225.

The Power of Growth Modification in Orthodontics

orthodontics and dentofacial orthopedics

The Power of Growth Modification in Orthodontics

17 February 2023 | By Dr. Eric Meyer

Kids are reflections of their parents. Maybe they have mom’s eyes or dad’s nose. “A chip off the ol’ block”, right? Well, they may have also inherited dad’s underbite or mom’s overbite, in addition to other characteristics.

Genetics play a major role in the growth and development of a child.

That’s not to say growth can’t be modified or influenced by environmental factors, such as orthodontics and dentofacial orthopedics. In orthodontics this would involve therapy to normalize growth and improve imbalances in the position of the upper and lower jaws.

Expanders, for example, increase the width of the upper jaw—perfect for children with constricted upper jaws and side crossbites.

Headgear can effectively correct imbalances in the position of the upper jaw, like restricting or enhancing it’s growth. In a child with deficient growth of the upper jaw, ‘protraction facemask’ (also known as reverse-pull headgear), brings the upper jaw forward and out of an ‘underbite’. This works by opening the sutures of the facial complex as the child is growing, however, the sutures must first be open.

This is why it is crucial to start this therapy at an earlier age before the sutures fuse completely with time.

Is there any evidence to support this type of growth modification? Lots of it! A recent study (Hino et al.)¹, using 3D x-rays, showed that on average the upper jaw moved forward 3 mm. In orthodontics every millimeter matters and we will gladly take 3 mm. Imagine if the child is at the right age and compliant—you may be able to double that and save surgical treatment in the future.

I’ll leave you with this example of a child starting with an underbite. This kid corrected his underbite by himself in 9-10 weeks with this appliance!

As always, have great day!

-Dr. E

Hino CT, Cevidanes LH, Nguyen TT, De Clerck HJ, Franchi L, McNamara JA Jr. Three-dimensional analysis of maxillary changes associated with facemask and rapid maxillary expansion compared with bone anchored maxillary protraction. Am J Orthod Dentofacial Orthop. 2013 Nov;144(5):705-14. doi: 10.1016/j.ajodo.2013.07.011. PMID: 24182587; PMCID: PMC3972125.

Gummy Smiles

What do Gummy smiles and fine wine have in common?

17 November 2022 | By Dr. Eric Meyer

What do Gummy smiles and fine wine have in common?

You’ll know the answer shortly. But first how much gingiva is appropriate to show when smiling? Everyone knows the timeless fable of “Goldilocks and the Three Bears.” Not too little, not too much, but juuuuust right. The same goes for the amount of gums you display when smiling. Too much is considered a ‘gummy smile’. None at all makes for an ‘older’ appearing smile. A little bit of gingival display is natural for a kid or young adult and shows youthfulness.

Many factors go into a person’s smile including lip length, lip mobility, tooth length, tooth position, and age to name a few.

Lip Length

A person with shorter lips and thinner lips is more likely to display more of their gums and teeth. How do we fix it? Although soft tissue surgery can be completed to reposition the lips and the muscles controlling the lips, a more conservative option may be lips fillers, especially in patients with thin lips.

Lip mobility

A person with greater mobility of their lips and facial muscles will reveal more gingiva as they raise their lips and contract facial muscles. How do we fix it? Some patients opt for botox, which temporarily relaxes facial muscles and hides a gummy smile.

Tooth length

As teeth erupt the gums should recede showing more of the crown of tooth. For some patients this does not happen, leading to the appearance of shorter crowns. How do we fix it? Expose the entire crown of the tooth with a soft tissue recontouring (gingivectomy) or boney recontouring (crown lengthening).

Face height

This more so relates to the position of your upper jaw when looking from the front. Some individuals have excessive downward growth of their upper jaw. If the lips and soft tissue do not follow it can lead to a gummy smile. How do we fix it? If severe enough, a patient may need jaw surgery to correct the increased vertical growth of the upper jaw. A conservative approach may include moving the teeth upward if surgery is a no-go.

Age

Ever wonder why most elderly people only show their lower teeth when they talk or smile? In reality, the soft tissue of our face will droop downward—for lack of better words—as we get older. You can’t fight gravity! This is why it’s not all that bad to have a gummy smile as a kid or young adult knowing that it will be better as you get older…like a bottle of fine wine!

Concerned about your gummy smile? Come see the smile doctors at Dubuque Orthodontics 🙂

-Dr. E32

Straight talk: What to know about retainers

Straight Talk: What to know about retainers

3 October 2022 | By Dr. Eric Meyer

We are now into October, which officially marks the start of spooky season. Sure, those ghosts and goblins set to roam the streets on Halloween are scary, but what’s more scary than finishing orthodontic treatment and seeing your teeth slowly shift back to the original position from lack of retainer wear. Here’s what you need to know about retainers after orthodontics treatment:

Types of retainers: removable vs. fixed

Removable retainers can be taken in and out and, thus, depend on the patient to wear as directed. These may be clear (Invisalign style) or acrylic/wire (old school). In general, most patients are given clear retainers, although the retainers with the wire resting on front the teeth may be made at the patient’s request or in certain circumstances.

Fixed retainers are a small wire that is bonded to the tongue side of the front teeth. Since these are not removeable they can be difficult to keep clean, but work well in holding those front teeth, especially in cases with severe malalignment or spacing at the beginning of treatment. Occasionally, fixed retainers may break in which teeth can shift if not addressed or even noticed by the patient.

We can make either removable or fixed, but we do prefer removeable in most cases as patients are better able to keep things clean.

Can retainers be worn too long?

No. In fact, we recommend most patients wear their retainers at night for the rest of their lives. We typically start patients on day and nighttime wear then transition to nighttime only.

My teeth have shifted since I completed orthodontics

If you have noticed that your teeth have shifted after some time, don’t sweat it! Contact our office and we will consider options, such as making a new retainer or realigning those teeth that shifted. We offer both clear aligners (Invisalign style) and braces to get you back to where you started.

Keys to Retainers

Wear as directed. For retainer wear there is no “one size-fits-all”. Follow your orthodontists instructions to keep your smile straight.
Keep them clean. They’ll last longer and stay clearer. A toothbrush and soft soap will do the trick.
Handle with care. If it’s not in your face, it’s in your case!
Contact us if you lose your retainer or the retainer does not fit. We may be able to adjust them or make new ones.

As always, have a great day and enjoy the fall weather!

-Dr. E

Does my child need early orthodontic treatment?

Does my child need early orthodontic treatment?

8 August 2022 | By Dr. Eric Meyer

When it comes to early orthodontic treatment, we prefer to wait until a child has lost all of their baby. However, some kids benefit greatly from an early phase of treatment while in the the mixed dentition (typically ages 7-10). This means the child has a glaring issue that can really lead to greater problems down the road if left untreated.

Another term for early treatment is “interceptive orthodontics.” Why, because we want to intercept problems before they turn into headaches. We’ll get to a few examples shortly.

The American Association of Orthodontists recommends seeing an orthodontist around age 7. This allows an orthodontist to evaluate a child in the early stages of growth and diagnose problems related to growth, tooth development, and tooth eruption, among other things.

So what do we look for in kids who need an early phase of treatment? Common problems, among others, may include:

Tooth related

Side (posterior) crossbite – the top back teeth overlap inside the bottom back teeth
Front (anterior crossbite – commonly called an “underbite, where the lower front teeth overlap in front of the upper front teeth
Severe crowding and malalignment
Excessive spacing, often accompanied by protruding front teeth (that stick out)
Space maintenance – when baby teeth are lost prematurely, a small appliance holds the space for us
Extra teeth, missing teeth, or impacted teeth

Growth and development related

A deficient upper jaw or a strong lower jaw contributing to an underbite
A strong upper jaw or deficient lower jaw contributing to excessive space between the top and front teeth
Asymmetric growth of the jaws due to crossbites or facial trauma
Craniofacial anomalies, such as cleft lip and palate

Treating these issues early on and many others will allow for a positive influence on the growth of the child, avoid impaction of teeth, lower the risk of trauma to the front teeth, and in the case of extra or missing teeth, plan for the future. Although a small investment, this early treatment will save you time, money, and unnecessary procedures later on. For more detailed information on early treatment click here to see a description of common problems and how they are solved with early treatment. For a free exam for your child feel free to contact us 🙂

-Dr. E

Oral hygiene during orthodontic treatment

8 September 2022 | By Dr. Eric Meyer

What we love about orthodontics is we have the ability to transform smiles and in doing so improve the lives of our patients. Part of achieving our goal for a healthy, stable, functional, and esthetic smile is good oral hygiene from patients. Although, we deliver the treatment we can’t do it without your help!

As you may have guessed, braces make cleaning your teeth a little more difficult. This is why we want our patients to have excellent brushing and flossing habits. Every patient receives oral hygiene instruction at the start of treatment and continuous feedback on how they are doing with cleaning their teeth throughout treatment.

What we aim to avoid are white spot lesions and cavities during treatment. White spots are the first signs of the weaking of the outer layer of the tooth due to plaque buildup from poor oral hygiene. Plaque loves to accumulate around the brackets and especially at the gumline, making it extremely important to brush all surfaces of your teeth, as well as along the gumlines. White spot lesions are extremely difficult to correct and may even be irreversible if large enough. With continued poor brushing and flossing habits, the white spots eventually turn into cavities, which need to be fixed by your dentist.

Keys to doing your part

Continue seeing your dentist every 3-6 months for regular check ups and cleanings.
Brush after eating and drinking (unless it is water). If you do not have access to a toothbrush we recommend at least rinsing with water or a mouthrinse. We have travel toothbrushes at our office, so don’t hesitate to ask for one! This or a small bottle of mouthrinse will be very easy to store in a backpack or locker at school. For both toothpaste and mouthrinses, look for Fluoride on the bottle–this ingredient is great for strengthening your teeth and preventing cavities.
Floss after once a day using floss threaders or floss picks made specifically for patients with braces. Another great tool is a Water Pik, a small handheld device in which you direct a stream of water to rinse around the brackets and wires. We highly recommend these for patients with orthodontic appliances that are fixed, such as expanders, pendulums, herbst, and more.
Avoid sugary, crunchy, sticky, chewy and hard foods such as caramels, taffy, hard candy, popcorn, pizza crusts, nuts, etc. Eating ice, chewing on pencils or pens and biting into whole apples can cause damage to your appliances. Avoid sugary beverages as if possible and brush or rinse after consumption.
Compliance is key. With your help with appliances, rubberbands, appropriate diets, and taking care of your teeth and gums your treatment will go much quicker!

Lastly, for patients in clear aligner therapy, such as Invisalign, oral hygiene is just as important as with braces. What makes this treatment modality great is that you have the ability to remove the clear trays to easily floss and brush. However, patients must always brush before replacing the trays, otherwise they will trap everything under the trays. As the clear aligners cover every surface of your teeth this is easiest way to get cavities during treatment.

At the end of the day we want you to have a healthy, stable, functional and esthetic smile. However, we don’t want to do that at the cost of destroying teeth with cavities! So do myself and yourself a favor and keep those pearly whites clean before, during, and after treatment! For questions about oral hygiene feel free to come to our office, call us, and visit our resources web page.

-Dr. E

What to know about “black triangles”

What to know about "black triangles"

22 August 2022 | By Dr. Eric Meyer

Black triangles, also known as “open gingival embrasures,” are the spaces found below the contacts of adjacent. As the gum tissue does not fill in that space it appears as a dark triangle following the taper of the teeth in contact. These tend to be very annoying, as they are not only unesthetic, but they also trap food. Ever feel like you’re always checking your phone camera to see if you have some food between your teeth? Not fun, right?

What causes black triangles?

To get all “science” on you for a moment, the results of a classic 1992 study by Tarnow et al. showed that “when the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was 6 mm, the papilla was present 56% of the time…”

What this means is that you have to have a certain height of bone beneath the contact points of adjacent teeth to support the gum tissue. These pesky spaces are the result of inadequate bone levels between teeth. As bone levels fall around teeth the gumline follows which creates the open embrasure we see as a dark triangle.

The bone level is affected by many things. For example, poor oral hygiene results in poor periodontal health and reduced bone levels. Another example is crowding, or crooked teeth. These teeth generally have lower contact points, that are closer to the bone. When these teeth are straightened the contact points rise, however, the bone level remains the same and a black triangle appears. A reduced periodontium can also be apart of aging. As we get older our bone levels around our teeth may drop and contribute to black triangles.

How do you fix black triangles?

Adding bone between teeth would be the most ideal way, but grafts typically do not lead to a stable results. So, we have to come up with other ways.

Restoration by a dentist to build up teeth and “fill in” the black triangle with restorative material.
Orthodontics with Interproximal reduction (or filing) between teeth, which drops the contact point and pushes the gum tissue into the black triangle as the result space is closed.
Orthodontics to correct the malignment of teeth causing a higher than normal contact point.
Injections with hyaluronic acid to increase the volume of the gum tissue, which has found to work only temporarily.
Soft tissue gum graft, which is difficult and may not completely resolve the black triangle.

In conclusion, black triangles are the result of reduced bone levels relative to the contact point of adjacent teeth. They can often be eliminated or reduced in size by restorative treatment, orthodontics, and periodontics. The best practice is prevention to avoid them with good oral hygiene including brushing and flossing! For more information on addressing black triangles feel free to contact us.

-Dr. E

References

Tarnow, Dennis P., et al. “The Effect of the Distance from the Contact Point to the Crest of Bone on the Presence or Absence of the Interproximal Dental Papilla.” Journal of Periodontology, vol. 63, no. 12, 1992, pp. 995–996., https://doi.org/10.1902/jop.1992.63.12.995.

Relapse: Help! My teeth have shifted!

Relapse: Help! My teeth have shifted!

25 July 2022 | By Dr. Eric Meyer

So you’re finally done with orthodontic treatment. You’ve spent the money and the time for your friendly orthodontist to take off those braces or finish those clear aligner trays. They give you a retainer with a set of instructions and you are the happiest person alive!

Days or months go by and your retainer is gone! Maybe your dog ate it? Perhaps the waiter threw it away with your napkin? Or you left it at that vacation destination, only to remember that night on flight back.

Give it time and your teeth will shift. The degree of relapse will vary from person to person. Some individuals will experience very little shifting, while others significant movement. It’s a matter of stability. My wise professor always told us, “the most stable malocclusion is the initial malocclusion.” What he meant was the greater we deviate from the initial alignment of your teeth the less stable the resulting outcome of treatment. Patient’s with very complex malocclusions and extremely difficult cases will need greater consideration in retention (in general). We may even consider a “fixed” retainer, which is a small wire glued to the tongue side of your teeth in the event you do not wish to have a removeable retainer. Regardless of where you started, you and I would prefer to keep things the way we left them when we finished treatment!

Your greatest fear may be going through another short phase of braces, but really this is a great time to consider a few clear aligners to get you back on track. Our retainers just so happen to be “Invisalign” style, clear retainers, so consider these “active” retainers. If you think that your teeth have shifted after orthodontic treatment come see us. We’d be happy to get you back to a straight smile! For more information on treating relapse with clear aligners click here or call us at 563-556-2353.

-Dr. E

Invisalign®: A clear alternative…

invisalign clear aligners at dubuque orthodontics

Invisalign®: A clear alternative...

18 July 2022 | By Dr. Eric Meyer

It’s the year of 2022.

Self-driving cars are not too far away, Elon Musk is sending re-usable rocket ships into outerspace, and we’re still moving teeth with metal? Not so fast! Align technology launches Invisalign® clear aligners in the late ’90s, howeverrrr, it’s first product is not even close to the efficiency and control that braces offer. Fast forward 20 years and the plastic is much better, the understanding of the force systems are well-studied, and features such as “attachments” (tooth colored bumps that are bonded to teeth) allow for added control.

So are we there yet? Although it’s come along way, studies have shown that Invisalign still lacks the control that braces offer with certain tooth movements, as well as cases with higher complexity. For example, moving roots is very difficult to do with the plastic trays. This is the kind of tooth movement that would be required in an extraction case where the roots need to move to close extraction spaces. We don’t have to worry about the predictability with wires and brackets. As you already know, braces are stuck to your teeth, so you don’t have a choice. With clear aligners, you are responsible for keeping the clear trays in (for 22 hours each day I might add).

On the other hand, clear aligners allow us to digitally move teeth and even avoid moving certain teeth. For example, if a patient wants to straighten their front teeth and has a great bite in their back teeth we can maintain them that way. That is much harder to do with braces where the outcome is not precisely controlled by a sophisticated computer software and almost all teeth get a bracket. What I really like about clear aligners is the fact that patients can much better floss and brush as they are removeable.

In summary, braces and clear aligners both have their own pros and cons. Not every patient is a candidate for clear aligners. In patients that are good candidates, Invisalign® works wonderfully. If you have a very complex case don’t worry, though! We can still predictably treat complex cases with a short phase of braces to work out the tough tooth movements, then finish with clear aligners. You get the best of both worlds!

For more information on Invisalgn®, click here, or call our office to schedule a free evaluation! 563-556-2353

-Dr. E