Wisdom Teeth Roundup

As summer blitzes by, one of the most-asked questions by my patients visiting from college is, "what should I do about my wisdom teeth?"

The short version here is that you either want your wisdom teeth all the way in or all the way out.  If they erupt only partially, there's a risk of getting a cavity or a gum infection because food and plaque can get trapped where you can't clean it properly.

Wisdom teeth are best evaluated between the ages of 15-17. 

If it's obvious that there's no room for them, having them out younger tends to be a little easier because the roots aren't as long.  However, it also helps when they're closer to the surface;  a good rule of thumb is they're ready when the roots are 1/3 to 1/2 formed.
As long as the wisdom teeth aren't causing any discomfort and aren't too close to the nerve in the jaw, you generally have a window between ages 15-19 where there isn't a significant difference between when you chose to have them out. 

Here's a 16 year-old with roots about 1/3rd formed.  This is a great time to get them evaluated by an oral surgeon.

Does everyone absolutely have to have their wisdom teeth out?  
 
No.
If you have space so that your wisdom teeth might erupt all the way in, I'd just monitor them and see if you can keep them clean.  Careful brushing around the wisdom teeth as they erupt and rinsing with a gentle over-the-counter gum medicine like Peroxyl can help reduce the risk of cavities or infection while they erupt.

Here's a 15 year-old whose wisdom teeth look to be erupting vertical and who might have space.  My advice to her was to wait and see.

If I don't get my wisdom teeth out, will it make my lower teeth crowd when I'm older?  
 
Not necessarily.
As we age, our lower front teeth naturally continue to move forward and up.  It's a slow process, but the normal tendency is for them to become more crowded anyway.
There are patients with no wisdom teeth who still get relapse crowding of their lower front teeth.  And, there are patients with completely horizontal wisdom teeth who have perfectly straight teeth.

Relapse crowding could be a separate blog post all on its own. 

But to sum up:

1)  Relapse crowding are the severity of your original crowding, how it was treated, and how was it retained.  If you try to fit too many teeth into a jaw that's too small, you have a higher risk of relapse.  Extraction treatment creates space, so it tends to lessen this tendency. 
2)  After treatment, the type of retainer and consistently its worn play a huge role.  Bonded wires are the most stable, metal wires + hard acrylic are next, and the cheap plastic tray-style are the least effective. 
3)  The longer you keep and wear your retainers, the more stable your lower front teeth tend to be.
4)  As a distant fourth, wisdom teeth _might_ contribute to crowding, but the effects are nearly impossible to measure and are far less significant than #'s 1-3.

Is it really painful to get your wisdom teeth out?
 
If you're having them done by a good oral surgeon under general anesthesia, the experience is quite literally:

…Okay, I'm lying in a weird chair and they're giving me a mask.  It smells like pine needles.  I'm supposed to count down from 10…9...
…
…
…Uh.  I'm waking up in another room now?

In most cases, you actually feel pretty good the day you get them out. However, swelling increases over the first 72 hours so you have to plan ahead and know that you're going to feel worse before you feel better.  Extractions vary by complexity, so there are some that are more uncomfortable than others.  Your surgeon should be able to give you an idea of where you fall on the routine to difficult spectrum.

The quick secrets to recovering from wisdom teeth:
1)  Ice is your friend.  The better you follow the 10 minutes on/10 minutes off regimen, the better you control your swelling.  Less swelling = less discomfort
2)  Plan to take it easy for at least a couple of days and follow your oral surgeon's instructions carefully.
3)  Be sure to keep the healing sockets clean, but be gentle when irrigating.  You do not want to get an infection in the socket!
4)  If warm salt water rinses aren't your thing (blech), the aforementioned Peroxyl rinse is a nice alternative. (No, I'm not sponsored by them or anyone for that matter.)


I have three quick examples of good, not-so good, and just plain idiotic.

One of my sisters had her wisdom teeth out on a Friday afternoon.  I sat on her all weekend while watching DVDs, resting, and icing.  She was fine by Monday.

The other sister had her wisdom teeth out…and felt good enough that she decided to go do something with her friends.  She swelled up like a chipmunk.

And then there's me.  Supposed dental professional who should know better.  One of my patients begged me to fill in a spot on his bass fishing team for the Northern California Club Classic.  They were short a man and would be disqualified otherwise.  And so it was that I woke up at 3am the day after my extractions and went fishing in 40 degree weather with heavy winds.  We ended up winning the tournament by two ounces…and at the victory barbecue, my mouth was swollen shut to the point where I couldn't even eat baked beans. 

So there you have it, folks.  Have a good oral surgeon evaluate your teeth between age 15-17, remember that ice is your friend, and don't go fishing afterwards like your favorite orthodontist did. 

If you have any other questions, please feel free to drop me a line on the office Facebook page.

Bleaching Basics

Just about every adult and many teen patients ask me about bleaching when they're about to get their braces off.  In honor of prom season, here's a review:

How does it work?

Imagine that your teeth actually looks like a giant honeycomb.  Enamel is essentially a bunch of stacked tubes that form a giant wall.  Over time, these tubes can get clogged with pigment.  As these tubes get clogged, they block the transmission and reflection of light through your teeth.  This results in a darker or yellower appearance.

Food and drink which contain lots of dark pigment can accelerate this process.  The classic culprits here are things like coffee, tea, red wine, cola, and dark berry juices.

Oral bleaching products essentially act like chemical pipe-cleaners that help clear out the pigment from your enamel tubes.

They all work by the same mechanism of action;  it's just that the more expensive, prescription-only, and in-office productions have a much higher concentration of bleach.

In order of efficacy, least to most:

Over-the-counter (white strips/paint-on products) < bleaching trays < in-office

What about side effects?

The most common side effect is temperature sensitivity.  By cleaning out the clogged tubes, it's like unplugging a tooth's "ears";  sensations are no longer muffled and the nerves can become temporarily hyper-sensitized to changes in the surrounding environment. 

The flip side to the more effective bleaching products is that the power comes at a price;  they also tend to cause more sensitivity.

There was a time I tried a sample of take-home bleach from a dental convention.  The instructions said to line the trays and put them in while sleeping.  Around midnight, I woke up and felt like my teeth were on fire.  Just the slight breeze from breathing made them throb.  Not fun.

As a secondary side effect, there can also be localized irritation of the gums, especially if you already have gum disease or recession.

How do I counter the side effects?

If you have recession (exposed root surfaces), or gum disease, you'll want to talk with your dentist before starting any type of bleaching program.  It's best to make sure that your teeth and gums are safe for bleaching.  You might need to skip it entirely, or be very selective and careful about how you go about it.

As a general rule of thumb, I recommend starting with a short duration;  15-20 minutes when using over-the-counter strips or take-home trays.  If you're not sensitive, you can slowly increase the duration of your bleaching sessions.

If you are sensitive, then keep the sessions short.  You can also try taking days off to let the teeth rest in between.  For really sensitive teeth, using concentrated fluoride after bleaching sessions can help.  We give our patients a prescription fluoride gel and tell them to alternate bleaching versus fluoride days. 

Any other tips?

As I discussed before, there are certain types of food/drink that are more likely to stain your teeth.  For the best results, you'll want to try to avoid those while bleaching and for a week or two after you stop to let your teeth recover.  I had a patient once who started bleaching right after her braces came off…and we were all shocked when she came back with brown teeth.  Turns out that she was in the habit of drinking several large glasses of pomegranate juice each day.  The bleach opened up the tubes in her teeth - then she promptly filled them with pomegranate pigment and made them darker.  Fortunately, her teeth re-whitened as soon as she cut out the juice and resumed bleaching.

How long will bleaching last?

It depends on your diet and cleaning habits as well as what type of bleaching product you used.    On average, most whitening applications last between six months to two years.  If you're extremely careful about avoiding high-stain food/drink, you might get more mileage.

If there's anything I didn't cover, or you have any additional questions, feel free to send me a message via our office Facebook page.  Happy Bleaching!

Why be an orthodontist?

Why Orthodontics?

A college patient asked me the other day, "Why exactly did you want to go into orthodontics anyway?"  He's about to declare majors and has been looking at his various career options.

The question gave me a brief pause.  It's something I hadn't really thought about since I had applied to dental school and then my orthodontic residency…both of which are starting to be a few years longer ago than I like to think about.

I grew up visiting and then working summers in my father's orthodontic office.  (He claims he didn't try to brainwash me when I was in the crib - to this neither of us confirm nor deny.) 

What struck me is that it seemed like he was friends with everyone.  Young, teenaged, or adult, and both active or in retainers, my dad had a good time visiting with all of his patients.  Orthodontics is a bit unique in that the work takes years to complete.  It means that you get to watch your younger patients grow up;  sometimes from elementary school all the way to college and beyond.  For your adult patients, treatment often takes longer because the case is more complex or the teeth just move slower.  But at the end, you really feel like you've accomplished something together.

Ultimately, I told my patient, "You work hard, but you feel like you're making a positive difference in people's lives.  And when you're done, you've often built a friendship that lasts beyond their time in treatment."

This blog is meant to highlight the more casual and fun side of an orthodontic office.  Most of the posts will come from stories in the clinic, or questions asked by patients.  If there's something you've always wanted to know, but never found the right time to ask, feel free ask in the comments. (or FB message, or email)

Thanks for visiting.