The removal of the frenum of the lips is called frenectomy. This surgical procedure is mostly performed in the upper lips. A frenum that is attached to the top of the alveolar crest could cause diastema and orthodontic problems. That is why a frenectomy should be performed. In these cases it is called a labial frenectomy.
When the frenum is short it puts too much tension to the gingiva and should be removed. Here is a short video describing the frenectomy dental intervention:
The supernumerary wisdom teeth can cause orthodontic problems during its eruption. This is a rare dental condition but it is associated with pain and tooth crowding. Having supernumeraries in this area of the mouth also effects the hygiene because the tooth crowded areas are hard to brush with a regular toothbrush.
The dental implants are devices made of titanium that resemble the tooth anatomy. They support the dental restorations and are meant to replace the missing teeth. They can support restorations like complete and partial dentures, crowns and dental bridges, can also be used as a part of the orthodontic treatment. All the dental implants are designed to resemble the roots of the teeth. They are also called endosseous implants since their purpose is to integrate in the mandibular or maxillary bone structure. The metal that they are made of is titanium. This metal is very good accepted by the body and does not cause any allergic reactions. It allows the bone tissue to grow around the titanium post and integrate with the bone structure – osseointegration. This term refers to the fusion of the implant surface with the surrounding mandibular or maxillary bone.
Except the root-form implants we have described there are several other type of dental implants. However they have plenty of disadvantages compared to the regular endosseous implants. These are blade endosseous implants and subperiosteal implants. The first type of implants have the shape of a flat blade and the second type are placed uder the periost of the bone – a framework that is attached to the bone surface connected with titanium screws.
What are the dental implants made of?
Some of the dental implants are made of pure titanium but in the past several years dentists have upgraded the mechanical qualities of the material by adding two additional metals to form the perfect alloy – aluminium and vanadium. This is the so called Titanium 6AL-4V alloy containing 90% Titanium, 6% Aluminium and 4% Vanadium. The osseointegration of the dental implants Ti-6AL-4V is the same as the ones made by pure titanium but the qualities of the both materials deffer. These made by Titanium 6AL-4V alloy have higher tensile strength and fracture resistance which is more important considering the functionality of the implants.
The osseointegration potential of the dental implants can be upgraded by increasing the surface of the implant by sandblasting or adding additional structures that increase the surface(that’s why the root-form dental implants look like screws – in order to increase their surface and achieve better osseointegration and fracture resistance). Other ways to improve the osseointegration of the implant is etching, plasma spraying and anodizing.
Taurodontism comes from the Latin word “taurus” which means a “bull” and “dens” which means “a tooth”. Actually taurodontism means bull-like teeth. It affects the molars and as you can see at the pictures below the teeth have enlarged vertical size at the expense of the roots. Usually the area where the enamel meets the cement of the teeth is constricted but taurodontic teeth does not have such a constriction.
What causes taurodontism
There is a structure called Hertwig’s root sheath which maps the shape of every tooth. The abnormal function of Hertwig’s root sheath leads to abnormalities in shaping the teeth. The furcation is located apically. There are some clinical researches that show the presence of only one root in molars (usually they have to be two or three). The shape of the tooth is different and research studies shows that the taurodontic crowns may be pyramidal, cuneiform or fused.
Taurodontism is more commonly diagnosed in patients with permenent dentition. There is a prevalence of 6% for mandibular first molars. In certain races in South Africa there is a prevalence in this dental condition. Some syndromes are connected to taurodontism too – amelogenesis imperfecta (AI), the tricho-dento-osseous syndrome, ectodermal dysplasia.
Typical for the taurodontism is the enlarged pulp that can be seen on the x-rays and the lack of constriction in the cervical area of the teeth. The mineralization is not affected.
Sometimes the patients complain of white spots on their front teeth. Such condition may be hereditary but most of the times are due to some other factors that we will discuss in this article.
The white spots on the teeth are mainly a cosmetic issue but should be taken under serious consideration because it may be an early sign of initial tooth decay. The white spots are usually a result of enamel demineralization. This is how the caries begins – the acids from the bacteria that reside in the mouth and the acids from the food cause this loss of minerals. If the ph stays lower than 5.5 there is no balance between the demineralization and remineralization and loss of minerals is at place. This process can be seen on the tooth as opaque areas. These opaque areas have a white color and people complain of “white spots on their teeth”.
Having such hypocalcified spots does not mean that the patient’s hygiene is bad, sometimes can be caused by other factors like wearing braces for a long time. In these cases the hygiene is hard to be improved due to this plaque retention factor. The mineral loss can be caused by consuming too much acidic foods (citric fruits, drinking juices with low ph). People do not realize how acidic some foods may be. Let’s take for example Coca Cola. While drinking it you feel the sweet taste but that does not mean that it does not contain acidic components. As a matter of fact such juices and drinks are the most dangerous for the enamel, you feel they are sweet but they contain a huge amount of acids and sugar at the same time. Keep in mind that the cariogenic bacteria in the mouth use simple sugars for living and their final metabolic product are acids. In this way acids are delivered by the juice itself and from the bacterial terminal products of metabolism. These demineralized areas can be restored if the ph is raised over 6.5 ph.
The white spots can also be a result of hereditary conditions such as enamel and dentine hypoplasia. The mineralization of the tooth tissue is lower than usual but that is not a consequence of acidic foods or poor hygiene but other factors we will discuss later on.
Sometimes babies have teeth that are present in their mouth at the time of their birth. They are called natal teeth and their presence is very uncommon. According to National Institute of Health studies they appear in one of 2000-3000 babies. Usually this is the set of the lower central incisors. The babies born with teeth have to be monitored because this condition could cause some problems.
What to do with the natal teeth?
The doctors should decide what to do with the natal teeth. They can be extracted before the mother has started nursing. The natal tooth can hurt the mother’s breasts and also cause choking if the tooth is loose and at some point it falls in the baby’s throat. Don’t worry if your child has lost his natal tooth because he will still have his decidous and adult teeth and won’t affect their development and eruption. If the babies are born with a loose tooth it is better to be extracted.
Another decision the dentist can take is to keep the natal tooth. If it doesn’t have pointy and sharp edges and doesn’t bother the breastfeeding the tooth can be kept. Keep in mind that it is a retention factor and should be cleaned often. That can happen by rinsing or rubbing the gums with cloth soaked in hydrogen hydroxide. If the tooth is sharp it can be polished with a bur and other polishing brushes and disks. The baby can hurt the mother’s breast and even himself when sucking his own teeth.
It is very important for the clinician to be aware of the teeth eruption dates. Not only for the primary but also for the permanent teeth. In this way the diagnosis of the supernumerary tooth will be easier to place. The eruption dates can vary and depend on hereditary factors but there are certain periods in which the tooth eruption is considered as premature or delayed eruption. The baby teeth chart will help you orientate about the normal eruption dates. The presence of these conditions should alert the dentist to a potential problem.
Assessment of the oral soft tissues and dental check-up must be executed. After the assessment the dentist should write down all the information received during the intra-oral examination. The following factors should be included in the dental charting
Sometimes the patients complain about a weird change in the color of their gums. They come to us complaining about their bad outlook and want to solve this problem as soon as possible. This situation may happen very often in the regular dental practice since most of the patients are concerned only about the esthetic point of view. On the other hand the clinicians have a different way of evaluating these conditions and are mostly concerned about the function and anatomical health of the surrounding tissues. As a matter of fact both points of view meet in the right clinical decision when it comes to gum diseases.
The best way to evaluate the importance of the clinical case is by obtaining the medical history information- what the complaints are, the history of the complaint, past dental issues, social and family dental and medical history. The patients have noticed a significant change in the gingiva margin which is close to the tooth crown. They say “Doctor, my gums turned black and look awful. Is there an explanation for this color change and what can I do to restore their previous color?” When we observe a healthy gingiva its normal color is pink. Actually this pink color comes from the small arteries and capillaries in the gums.
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