Orthodontic Tips September 12, 2014


“My bottom teeth are loose Doctor. What should I do?”

You need braces and a TMJ splint at the same time.

Give your patients the option of saving their teeth even though the future looks bleak.

This picture is an anterior view of a healthy 59 year old woman with a deep bite, TMJ dysfunction and lower incisor crowding and mobility. In fact, all of the lower incisors have only 5mm of bone around their roots and tooth 31 had mobility of 3. Her bruxing habit was Continue reading

Orthodontic Tips August 26, 2014

Orthodontic Tips August 26, 2014

Deep bites are a life-long problem.

And, these problems get worse with each passing year.

Send this patient for orthodontic treatment before the deep bite causes an irreversible situation.

This picture is from a 41 year old male. His issues range from periodontal bone loss from the crowding; bruxing and clenching issues and TMJ problems from the deep bite; to sleep apnea from the reduced intra-oral volume caused by the lingually tipped teeth and the deep Continue reading

Orthodontic Tips August 7, 2014

Tooth brushing pic

Tooth brushing with braces is difficult!

Push the bristles under the wire.

Plaque hides under the wire and around the braces. So the only way to get the plaque out is to push the bristles of the tooth brush under the wire. In order to do that the brush needs to lie flat on the labial surface of the teeth before you push the bristles under the wire.

Access this first from the occlusal, and then flip the brush over and access under the wire from the gingival. Both access points are necessary to really get the teeth clean. Continue reading

Orthodontic Tips July 31, 2014

Low level laser2
I can hardly open my mouth!

This sounds like a closed lock TMJ dysfunction.

A new patient came to our office today with a closed lock TMJ dysfunction.
This problem is right in the “sweet spot” for my swing (to paraphrase baseball jargon).

Her problem was worse on the right side.

First we used our low level laser to break the spasm in her jaw muscles. My staff did the laser care to break muscle spasms on the Masseter muscles and the Temporalis muscles. Then she used it directly on the jaw joint, first closed and then opened. Then the staff person used the low level laser to support the lymphatic system on the submandibular lymph glands and the subclavicular lymph glands. Continue reading

Orthodontic Tips July 22, 2014

Orthodontic Tips July 22, 2014

Doctor, I’m hitting my teeth harder on the right. Something is wrong with my bite.

Watch the dental midlines for habit related occlusal problems.

This morning one of my TMJ cases came in with the complaint that he was hitting too hard on the right side when he was wearing the splints.
I put some articulating paper between the upper and lower splints to mark the occlusal contacts. Occlusal markings were present on both sides. However, to let the patient know Continue reading

Orthodontic Tips June 24, 2014

Five SmilesOrthodontic Tips June 24, 2014

Where is the right place to put lateral incisors in the smile?

Anywhere the patient wants them….

There are guidelines, but the bottom line is not clear.

As dentists we choose to create a smile that pleases. The studies that impress me the most show that the incisal edges of the maxillary anterior teeth should parallel the arc of the lower lip. The Damon courses emphasize that the maxillary centrals and cuspids should be at one level and the lateral incisors slightly more gingival. Continue reading

Orthodontic Tips June 16, 2014

Orthodontic Tips June 16, 2014
Arch incoordination
Arch coordination.

Is it a concern?

Yes it is and this is why. “Poor occlusion.”

This patient came to see me last week. She was hoping to have her teeth straightened without any extractions. Her maxillary dental arch is over-wide and her lower arch is severely crowded. The extra width causes a lack of cuspid guidance on the left side. Also, Continue reading

Orthodontic Tips June 2, 2014

Orthodontic Tips June 2, 2014

Events seem to come in threes.

This month I saw two dual bite patients. I guess there is another one on the way.

A dual bite is a situation where maximum dental intercuspation (MI) is not the same tooth and jaw position as centric relation (CR).

The patient may be asymptomatic for many years while their jaw muscles and ligaments are young and flexible. However, at some point their jaw system can no longer compensate for this poor bite resulting in TMJ distress, bruxing habits or sleeping disorders. Continue reading

Orthodontic Tips May 27, 2014

Orthodontic Tips May 27, 2014
Cavites under braces
Cavities under braces are a real danger.

What can we do about it?

There are three things to do about it: and there are three times to do it.

The three things are the same as the three actions for pediatric dentistry: Tell, Show, Do.

The three times to do it are when the braces go on, during the orthodontic treatment, and again during the orthodontic treatment.

Tell: Instruct the new orthodontic patient how to brush their teeth. The danger area is gingival third of the tooth so the bristles of the brush need to be pushed into that area to get rid of plaque there. Continue reading