One went over the handlebars of his mountain bike. Another got an elbow going for a lay-up. For a third, it was that tricky maneuver on her new snowboard...

These are just a few of the ways that kids' teeth can be injured. (No doubt, parents can think of plenty more.) The good news is that modern dentistry offers more options than ever for treating the injury and restoring the appearance and function of the teeth.

Teeth that are fractured or dislodged are a serious condition that requires immediate, comprehensive treatment. The majority of dental injuries, however, are less severe: most often, they involve chipped teeth. If chips occur in the upper front teeth — as some 80% of dental injuries do — even small flaws can have a big affect on the appearance. And, especially in the teenage years, appearance can mean everything.

In many cases, small chips in the teeth can be repaired effectively using a procedure called “bonding.” In this treatment, we use a tooth-colored material made by mixing a plastic matrix and a glass-like filler, which provides adequate strength and aesthetic qualities similar to the natural teeth. In fact, this composite material can be matched to an individual's tooth color so accurately that it's hard to notice any difference.

Composite resins can be successfully bonded to most healthy teeth — and they offer some advantages over other restoration methods, particularly for children and teenagers. The bonding procedure avoids making tiny “undercuts” in the natural substance of the tooth, while metal fillings need to “lock in” to the tooth's structure. This means that bondings generally require less tooth preparation, which usually makes bonding a quick and relatively easy method of restoration.

It's true that, over time, some bonded restorations may not stand up to the tremendous biting forces of the jaw as well as porcelain restorations — but in young people whose permanent teeth have large pulp (nerve) chambers, the removal of too much tooth structure could compromise the long-term health of the tooth. Later on, we can look at performing a different type of restoration.

If you have questions about cosmetic bonding or sports-related dental injuries, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “An Introduction to Sports Injuries & Dentistry.”

Kristin Cavallari's flawless smile has been featured on TV, film and magazine covers. But the 25-year-old actress and reality-show personality didn't always have a perfect set of teeth. In fact, she told Dear Doctor magazine — where readers recently voted to crown her with the “Smile of the Year” award — that her dental treatments began the same way many do: with orthodontics in sixth grade.

“I had the ‘spaghetti catcher,’ which is what everyone used to call it,” she reminisced. But by that, she didn't mean a strainer — she's talking about what dentists call a “palatal expander.”

In case you're not familiar with this orthodontic device, a palatal expander takes advantage of the natural growth patterns of a child's upper jaw to create additional space for the top set of teeth. How does it work? Basically, it's similar to braces: By applying gentle pressure, the appliance creates changes in the jaw. Unlike braces, however, it's invisible — it fits between the upper teeth, close to the roof of the mouth.

During the three to six months a child wears the palatal expander, it pushes the left and right halves of the upper jawbone apart, and then maintains and stabilizes the new, wider spacing. Since the palatal bones don't fuse until after puberty, tightening it a little bit each day for the first few weeks provides a quick and painless method of making the upper jaw a bit roomier. And that can be a very good thing. Why?

There are lots of reasons. For one, it can relieve the condition called “crowding,” when there is not enough space in the upper jaw to accommodate the proper alignment of the permanent teeth. In the past, teeth often had to be extracted in that situation. It may even allow “impacted” teeth — ones which are blocked from erupting by other teeth — to come in normally.

It can help treat a “crossbite,” when the back top teeth come down to bite inside (instead of outside) the lower back teeth. It also generally shortens the total time a child needs for orthodontic treatment. That's good news for any teenager — even if their own day-to-day “reality show” isn't featured on TV!

If you would like more information about palatal expanders, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Palatal Expanders” and “Early Orthodontic Evaluation.”

Dental plaque (a film of bacteria that forms on your teeth) is known to be the main cause of periodontal (gum) disease. When the bacteria settle on your teeth they form a whitish film called biofilm. Those that are not removed cause formation of “pockets,” areas of separation between the teeth and their surrounding gums, in which plaque hardens into deposits known as calculus or tartar. The purpose of having your teeth cleaned regularly by a trained professional hygienist is to remove deposits of plaque and calculus. Removal of hard deposits on your teeth is called “scaling.” This can be done either by using hand-held scalers or by newer technology: ultrasonic power scalers.

Let's take a look at the strengths and weaknesses of both types of instruments.

Power Scalers

How they work: These instruments use the energy of ultrasonic vibration to crush and remove hard, calcified deposits of calculus. They also create shockwaves that disrupt bacterial cells. Use of these tools includes washing and flushing the pockets and any exposed root surfaces with water.

Pros: They are as effective as manual instruments for calculus removal in shallow gum pockets and significantly more effective in pockets greater than 4mm. They are very effective in removing calculus from root surfaces and from within periodontal pockets. Their small tips can penetrate deeper into periodontal pockets than manual instruments and are more comfortable to experience, and they are more effective for cleaning difficult nooks and crannies. Coolant sprays flush the area and remove bacteria and their by-products. They require less time than manual instruments.

Cons: A contaminated mist may form so that the hygienist needs to wear protective equipment. The vibration of the ultrasonic instruments may make it difficult to feel if the root surface is completely smooth and free of calculus. Power scalers affect some heart pacemakers.

Conventional Hand-held Scalers

How they work: These depend on the skill and knowledge of the hygienist to manipulate them and scrape away calculus (tartar) from teeth and within pockets.

Pros: They are equally effective for plaque and calculus removal from shallow gum pockets. They do not interfere with electronic equipment like heart pacemakers. They can be used more easily on teeth in which there are areas of demineralization (areas where minerals have been removed from the tooth's enamel, making it more vulnerable to decay). They are easier on the tooth's surface and are thus better for use with porcelain or composite restoration, or sensitive teeth.

Cons: They take longer to complete a cleaning. Sometimes they cause more discomfort than ultrasonic scalers.

In most cases the choice of scalers is not really an either/or situation. Most experts say that the best results come through using both types of instruments. As a result, cleanings can be done with effective and efficient outcomes and greater patient comfort.

Contact us today to schedule an appointment to discuss your questions about dental cleanings. You can also learn more by reading the Dear Doctor magazine article, “Dental Cleanings Using Ultrasonic Scalers.”

You may think snoring is a minor problem, but it can be a lot more than that. Just ask hoops star Shaquille O'Neal, whose rambunctious snoring bothered his girlfriend enough for her to suspect a health problem. Her observations eventually led to Shaq's diagnosis of moderate Obstructive Sleep Apnea (OSA), which occurs when the soft tissue structures at the back of a person's throat, including the tongue, partially close off the upper airway and prevent air from moving into the lungs during sleep. Sometimes airflow can be blocked completely for 10 or more seconds.

When air flow is reduced, blood oxygen levels drop. This leads to brief waking episodes known as “micro-arousals,” which can happen sometimes more than 50 times an hour. The sleeper might not even be aware of this, even while gasping for air. Micro-arousals prevent the person from ever reaching deep, restful sleep.

Besides suffering from excessive daytime sleepiness, studies show sleep apnea patients are at higher risks of heart attacks, congestive heart failure, high blood pressure, brain damage and strokes. People with sleep apnea also have a higher incidence of work and driving-related accidents.

OSA can be treated in a few different ways. On the advice of his doctor, Shaq opted for a Continuous Positive Airway Pressure (CPAP) machine, which generates pressurized air delivered through a face mask worn while sleeping. The force of the pressurized air opens the airway (windpipe) in the same way as blowing into a balloon does.

For people with milder OSA, or who find they can't tolerate wearing a mask during sleep, an oral appliance supplied by a dental professional might be the answer. Oral appliances are worn in the mouth and are designed to gently reposition the jaw and move the tongue forward away from the back of the throat. Success rates of 80% or more have been reported using oral appliances, depending on the severity of the OSA.

If you would like more information on sleep apnea, please contact us or schedule an appointment for a consultation. You can learn more about sleep apnea by reading the Dear Doctor magazine article “Snoring & Sleep Apnea.” Dear Doctor also has more on “Sleep Disorders & Dentistry.”

People always wonder when it is appropriate to contact their dentist. To answer this, we have put together the following list to provide some guidelines for you and your family. However, your calls are always welcome! Our goal is simply to give you some clear scenarios that illustrate when you should give us a call or come in to our office.

For Bite Related Problems

1. Early or late loss of baby teeth.
2. Difficulty in chewing or biting.
3. Mouth breathing.
4. Finger sucking or other oral habits.
5. Crowding, misplaced, crooked or even missing teeth.
6. Jaws that shift, jaw joints that “pop” or “click” or are uncomfortable.
7. Any change causing speech difficulty.
8. Cheek or tongue biting.
9. Protruding teeth — large overbite.
10. Teeth that meet in an abnormal way or don't meet at all.
11. Facial imbalance or asymmetry.
12. Grinding or clenching of teeth.

For Injuries And Immediate Care

1. Knocked out permanent tooth: Call us immediately. You need to take action within 5 minutes of the injury for best results.
2. Injuries to lips, cheeks, tongue or gums that appear to require stitches: Call us for instructions as soon as possible.
3. Tooth injury — if a tooth has shifted from its original position: Call us to tell us you are on your way to our office and see us within 6 hours of the injury.
4. Chipped or broken tooth that is still in its original position: See us within 12 hours of the injury.
5. A knocked out baby tooth: Call us as soon as possible.
6. Bleeding without any significant tears in tissue that could require stitches: Call us for instructions.

What To Do Now

If any of the above describe you or another member of your family, then contact us today to discuss your questions or to schedule a consultation. You can also learn more about treating dental injuries by reading the Dear Doctor article, “The Field-Side Guide To Dental Injuries.”