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What to do when your child is missing a permanent tooth/teeth?

July 2nd, 2018

Most of the time with children when a baby tooth is lost around 11 or 12, its loss is followed by the eruption of its permanent replacement. However, in about 5-10% of the population, the adult/permanent tooth never forms. The best way to confirm that an adult tooth is missing is via a panoramic x-ray.

The type of treatment and when to start it depends on the age of your child and other variables that may come into play like which adult tooth is missing, the crowding of the teeth and your child’s overall bite. These options can be to keep the baby tooth as long as possible, replace it in the future with an implant/crown or bridge or close the resulting space with orthodontic treatment. Just because a tooth is a baby tooth does not necessarily mean it cannot last a long time, and in the right situations, research out of the University of Iowa has shown that patients who retain their baby teeth (with no permanent replacement), 80% were able to keep the baby tooth well into their adulthood.

In other patients where and when the missing adult tooth will need to be replaced, orthodontic treatment is usually delayed until your child is a mid to late teenager if the replacement option is an implant and crown. If the replacement option is a bridge to replace the missing adult tooth, then orthodontic treatment could begin sooner and then followed with the bridge placed by your general dentist.

And finally in some cases, simply removing the retained baby tooth and orthodontically closing the resulting space may be the best option depending on the typical associated variables like which tooth is missing, overall crowding and your child’s bite. There can be many options for a missing tooth/teeth, so that’s why an orthodontist needs to be consulted so that your child can be accurately examined. With a thorough exam by an orthodontic specialist, you can be given a treatment plan that is customized to your child’s individual problems and your family’s needs.

Note: Dr. Edward Altherr is a board-certified orthodontist in private practice serving Apex, NC, and the surrounding towns/cities of Cary, Holly Springs, Morrisville and Fuquay-Varina. Dr. Altherr’s training in orthodontics was at the prestigious University of North Carolina at Chapel Hill’s program where we studied under many great orthodontic icons like Dr. William Proffitt and Dr. Camilla Tulloch. During his orthodontic training, Dr. Altherr’s research and further focus was on the orthodontic treatment of the mixed-dentition (mix of baby and adult teeth in kids between 6 and 14 yo). With his research and over 16 years of clinical orthodontic experience as of 2018, Dr. Altherr is considered an expert in mixed-dentition orthodontics and other areas of orthodontics like temporary skeletal anchors. This web blog is for educational purposes only. Dr. Altherr is licensed only in the state of North Carolina, and cannot diagnose and recommend orthodontic treatment over the phone or internet.

Braces or Invisalign as an Adult

March 29th, 2018

Adults comprise about 20% of most orthodontic practices’ patients across the US. Obstacles and/or questions that sometimes have prevented adults in the past from even obtaining a consult with an orthodontist have been the length of the overall time in treatment because they are busy with jobs and kids, the cost or am I too old or will I be the only adult amongst kids?

Over the years, our adult patients have been pleasantly surprised that the length of recommended treatment by Dr. Altherr is not years upon years like what they may remember as a teen or from what they’ve heard. The reasons why treatment times are shorter are from technological improvements and the fact that some adults only concern is straightening their front teeth, which may only require 6 months or less of treatment. Our oldest adult patient was in their 70’s, so some would say it’s just a number. Finally, we have some mornings where we see only adults.

We appreciate our adult patients because they are usually more invested and involved in their treatment primarily because they are paying for it (and not mom and dad). Therefore, adults are more compliant than kids with their oral hygiene and other things like wearing rubber bands or retainers.

The most common observation that we hear from our adult patients is the temporary irritation to their cheeks and lips from the braces in the first 2 weeks of treatment. After that, the irritation is not an issue because the lips/cheeks toughen up, and there essentially is no irrigation with clear aligner therapy like Invisalign.
So, we hope this information has helped. If so, please call us today for your complimentary exam with Dr. Altherr.

Is there a difference between a general dentist who provides orthodontic treatment versus an orthodontist?

September 21st, 2017

The simple and quick answer is YES. And why is this important?  We will explain.

After the four years of dental school where a dental student receives very limited training and experience in orthodontics, an orthodontist receives 2-3 years of additional training in orthodontics (braces and Invisalign) only during their residency at a university.  Orthodontists like Dr. Altherr also were required to do research for a Master’s degree while also receiving usually over 5,000 hours of true, hands-on clinical training and experience to expose them to every type of potential problem involving one’s bite and their smile.  University training is important since many laypeople can be confused by some general dentists who advertise that they have received certification in this or that type of orthodontic treatment.  Please keep in mind that the for-profit orthodontic courses that most general dentists attend are roughly 8 hours per day over the course of a 2-3 day weekend.  Let’s compare the time involved for one’s training in orthodontics: 16-24 hours or over 5,000 hours; no contest, we agree.

Why does this matter or why is it important?  It really is like seeing your family physician for heart surgery.  In a severe emergency, if you and your family doc were on an island, could he or she try to treat some sort of heart issue?  Possibly, but in a real world, day-in and day-out basis, where you and they are not on an island, should they?  No.  They simply don’t have the experience and training to successfully perform the specialty procedure(s) with any degree of predictability, and in a timely manner.  Another analogy to describe this difference for your home- one usually would not hire an electrician to unclog a toilet?  Usually a plumber would be hired who is specifically trained and experienced to deal with plumbing problems.

In a 2-3 year orthodontics residency after the 4 years of dental school, a resident is usually expected to start and finish around 50 patients with various problems so that they can get hands-on experience in a controlled clinical setting.  After graduating from dental school, there are continuing education (CE) courses available which allow dentists to further their education and expand the range of services that they can provide to their patients. All practicing dentists and dental specialists are required to obtain a minimal amount of CE per year.  Some of these CE courses are provided at universities, but most are for-profit courses done on weekends in hotels where the only requirement is attendance and payment of the enrollment fee.  These weekend courses may not even allow the general dentist to perform a single orthodontic procedure on a real patient before trying to perform such on an actual patient.  Furthermore, weekend courses have no way of evaluating how orthodontic treatment progresses over time and the weekend instructor is not in the general dentist’s office to help and provide guidance afterwards.

If it sounds too good to be true, it probably is, and just because one can do something, doesn’t mean that they should.  Before you let any dental provider treat you orthodontically (braces or Invisalign), do your research online or ask around town.  If you are in your dental provider’s office, specifically ask them if they are an orthodontic specialist, where they did their orthodontic residency and if they ever had braces as a teem, who provided their orthodontic treatment- their family dentist or an orthodontist?  Most would answer, their orthodontist.

Note from the Author: Dr. Edward R. Altherr, is a board-certified orthodontist who is in the private practice of orthodontics in Apex, NC.  He was trained and had taught orthodontics at the University of North Carolina at Chapel Hill. Dr. Altherr has over 15 years of specialty orthodontic practice and 2-3 years of general dental practice.  This blog is for informational purposes only, and is provided to help you understand currently accepted orthodontic problems and concepts.

Where are my child's teeth?

August 16th, 2017

Did your child lose a baby tooth some time ago and there is not an adult (permanent) tooth? There are usually two main reasons why this  happens and some other less common ones.

The first main reason for a permanent tooth to not erupt is there needs to be enough space. The front adult teeth are usually much wider than the front baby teeth. This can sometimes catch parents by surprise when a child’s teeth were perfect before the baby teeth started to fall out.  Ideally, the baby teeth should not look perfect, and there should be spaces between all of the front teeth. If there is not enough space when the baby teeth are lost, your child may need orthodontic treatment to assist with their permanent teeth erupting.

A second common reason for a permanent tooth to not come in after a baby tooth has been lost is that the adult tooth underneath is erupting in the wrong direction.  This is called ectopic eruption.  This is not unusual, especially with adult teeth like the lower second bicuspids and molars and the upper canines.  The first step for this problem is typically removing the above baby tooth as soon as the problem is diagnosed. If the eruption path does not change, then orthodontic treatment will be needed to guide the tooth in its correction position.  Why does an adult erupt in the wrong direction?  We do not have this answer currently for most ectopic eruption cases.

There are a few other less common reasons why an adult tooth doesn’t erupt.   First, an adult tooth can never form or develop, and be congenitally missing.  This frequently occurs with upper lateral incisors and lower premolars.  One theory proposed is that as we continue to evolve as a species, the genetic drive for more teeth is no longer needed, so more people are not having the full complement of thirty-two (32) teeth.  Second, a tooth can become “glued” to the surrounding bone and not erupt.  This is called ankylosis.  Why this occurs?  Sometimes, we do not know, but past trauma to the tooth can contribute to this fusion or if a tooth stays in its jaw bone a long time, then it can become ankylosed.  In most situations, these teeth cannot be moved and orthodontics is needed to correct the associated problems.  Finally, an adult tooth can have primary failure of eruption (PFE) which is a condition where a tooth does not erupt.  All normal teeth have a thin layer of tissue around their roots, but a tooth with PFE does not have this tissue and can’t erupt.  Again, orthodontic treatment is needed to correct this problem.  Why this occurs, we do not know.

Bottom line- If your child lost a baby tooth and no adult replacement one has come in, you should consider having an orthodontist examine your child.  An orthodontist is a dental specialist who usually has three (3) years of additional training after the four years of dental school in diagnosing and treating the problems specifically described in this blog.

Note from the Author: Dr. Edward R. Altherr, is a board-certified orthodontist who is in the private practice of orthodontics in Apex, NC.  He was trained and had taught orthodontics at the University of North Carolina at Chapel Hill. Dr. Altherr has over 15 years of specialty orthodontic practice and 2-3 years of general dental practice.  This blog is for informational purposes only, and is provided to help you understand currently accepted orthodontic problems and concepts.

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