Dental Arts of Wyomissing Blog
Posts for: July, 2019
Every year, thousands of children are born with a cleft palate, cleft lip or a combination of both. The advocacy group AmeriFace promotes the month of July as National Cleft & Craniofacial Awareness & Prevention Month to call attention to this potentially disfiguring defect—and to highlight treatments offered by dentists that can change the destiny of a child with a cleft defect.
Simply put, a cleft is a gap or opening in the palate (roof of the mouth) and/or upper lip. Cleft lips and palates result when structures that are forming in an unborn baby’s mouth and face don’t fuse together as they should during pregnancy. They can occur on either one side or on both sides of the face, in partial form (with some connecting tissue present) or completely open.
Clefts can cause severe disfigurement in a child, which may lead to a diminished self-image and disruption in relationships with others. A cleft can also compromise other aspects of a child’s health and life, including dental health, nutrition, respiratory function and speech development.
Doctors don’t always know why a particular baby is born with a cleft lip or palate, but clefts are thought to result from a combination of factors. Genetics most certainly plays a role, but there appear to be other influencing factors during pregnancy like nutritional deficiencies and fetal exposure to alcohol, radiation or toxic chemicals. In addition, having poorly controlled diabetes or being obese during pregnancy may increase the risk of the baby being born with cleft lip or cleft palate.
Managing known health conditions as well as striving for better prenatal nutrition and protection from environmental hazards may reduce the risks for cleft formation, even so, clefts do form. When they do, we can often effectively correct them, thanks to surgical procedures first developed by a military surgeon stationed in Korea in 1950.
While analyzing photos of cleft patients, Dr. Ralph Millard realized the tissue needed to repair a cleft was already present, but in a distorted form. He then experimented with surgical techniques that released the tissue so that it could be moved and fashioned into a normal appearance.
Dr. Millard’s original techniques remain the basis for today’s advanced procedures. Correction of a cleft lip or palate typically requires a series of procedures which can span the child’s developmental years. The first surgery usually occurs around 3-6 months of age, followed by later procedures to refine the earlier work. This process usually requires a team of dental specialists that includes oral surgeons, orthodontists and general dentists.
The road to restoration from a cleft birth defect can be a long one for children and their families, but the treatment methods developed over the last several decades can truly give them the gift of a normal life.
If you would like more information about cleft repair and other oral surgical procedures, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Cleft Lip & Cleft Palate: Common Birth Defects That Can Be Repaired Beautifully by Skilled Surgeons.”
Millions of microorganisms call your mouth home—and while most are friendly, some are not. An invasive procedure like implant surgery can disrupt the mouth's soft tissues and allow disease-causing bacteria to enter the bloodstream.
This isn't necessarily a major concern if your immune system is sound—your body will move quickly to quash any developing infection. But if your body's defense is weak or compromised by other health conditions, an ensuing infection could cause you problems. In the case of a dental implant, a localized infection around it could lead to its failure.
The bone normally grows and adheres to the surface of an implant soon after it's placed, giving it the added strength and durability for which implants are best known. A bacterial infection, though, could impede bone integration and weaken the implant's hold within the jaw.
One way to avoid this is by treating patients at high risk for infection with an antibiotic before the procedure. In one recent study, researchers concluded that patients receiving a 2-gram dose of amoxicillin an hour before implant surgery helped reduce the risk of future implant failure.
But before taking this route, the dentist must first decide whether antibiotic pre-treatment might be more detrimental than beneficial to an individual patient. Antibiotics can cause side effects in certain people ranging from diarrhea to allergic reactions. Healthcare providers must also be prudent with administering antibiotics for the good of society in general—overuse can potentially give rise to antibiotic-resistant bacteria.
A number of healthcare associations highly recommend antibiotic pre-treatment for any dental patient with prosthetic heart valves, a history of infective endocarditis, a heart transplant and similar heart conditions. They also recognize patients with conditions like prosthetic joints, weakened immune systems, diabetics or other serious health problems could also benefit from antibiotic pre-treatment, but leave it to the physician's discretion on whether or not it's appropriate for an individual patient.
If you're planning to undergo implant surgery or a similar procedure and are concerned about infection, speak with your dentist about whether you would qualify and benefit from antibiotic pre-treatment. If appropriate, taking an antibiotic beforehand could minimize your infection risk.
If you would like more information on pre-surgical antibiotic treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implants & Antibiotics: Lowering Risk of Implant Failure.”
Bite problems aren't limited to teeth simply out of position. The problem could be some teeth aren't there—visibly, that is. They still exist below the gums and bone, but they've been crowded out and blocked from erupting. We call this condition impaction.
Any tooth can become impacted and affect the bite, but a person's smile suffers more if it involves visible front teeth. This is especially so if the teeth in question are upper canines or "eye teeth"—the smile doesn't look normal without these pointed teeth on either side of the central and lateral incisors.
Impacted teeth can also contribute to more than a cosmetic problem: they're more susceptible to abscesses (pockets of infection) or root damage both to themselves or neighboring teeth. To minimize these potential health issues, we'll often remove impacted teeth surgically (as is often done with wisdom teeth).
But because of their important role in not only appearance but also bite function, we may first try to assist impacted canines to fully erupt before considering extraction. It takes a bit of orthodontic "magic," but it can be done.
Before we can make that decision, though, we want to precisely locate the impacted teeth's positions and how it may affect other teeth. This initial evaluation, often with advanced diagnostics like CT scanning or digital x-rays, helps us determine if the impacted teeth are in a workable position to save. If they're not, we may then need to consider removing them and ultimately replacing them with a dental implant or similar restoration.
But if their position is workable and there are no other impediments, we can proceed with helping them erupt. To do this we'll have to first expose them by creating a small opening in the gums through minor surgery. We then bond a small bracket to the tooth, to which we'll attach a small chain that we then attach to orthodontic braces. This enables us to exert continuous pressure on the tooth.
Over time, the pressure coaxes the tooth to erupt. We may still need to apply other forms of orthodontics and cosmetic procedures, but using this procedure to rescue impacted canines can produce a healthier and more attractive smile.
If you would like more information on treating complex bite problems, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”