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There are certain questions we all think about when we are told we need to wear orthodontic braces…..Will it hurt?….How will I be able to brush and floss?….Can I still eat my favorite foods?….How long will I have to wear them?

For millions of adults and children they might have a far different reaction……I have allergies to metals….Will I be able to have the orthodontic treatment without an allergic reaction?

Types Of Metal Used In Orthodontics

As many of us know, orthodontic braces are made up of brackets, wires, and bands. These orthodontic components are composed of various types of metal. This gives the orthodontic braces its inherent strength to do the job of moving your teeth into proper positioning over time. There are generally a few types of metal used in orthodontics and these can include:

-Stainless Steel

-Nickel Titanium

-Full Titanium

-Gold Plated Stainless Steel

What If I am allergic to certain metals? What choices will I have?

-Ceramic Braces – These are an excellent choice, not only for people with a nickel or metal allergy, but for people who are looking for a more esthetic orthodontic option. Ceramic braces are clear and are able to blend in with the teeth much more easily than traditional metal orthodontic braces. Ceramic braces allow for tooth movement without causing a reaction. Ceramic braces are not quite as strong as the traditional metal orthodontic braces so additional care is required as well as additional trips to the orthodontist for broken parts.

-Gold Plated Braces - These are especially comforting to many with a nickel allergy as they add extra security against an allergic reaction. The gold is able to form a stable bond between the teeth and the brackets and will also blend very nicely against ones teeth to soften the esthetics. These have become more popular for many simply becuase they feel they look better than traditional options but they do come with added cost.

-Titanium Braces - These appear very similar to the traditional stainless steel orthodontic braces. Titanium has an added advantage (besides being nickel free) that they are often considered to be more flexible than traditional stainless steel braces. This will allow them to be more flexible upon chewing and placing forces on them. This makes them a more durable option for many.

-Plastic (Polycarbonate) Braces - The main advantages to these are that they are completely metal free and can be made to be practically invisible on the teeth. This is a great option for allergy sufferers but also for many adults who do not want a mouth full of metal. The main disadvantage of these is they tend to not be as strong as traditional braces so added care is needed as well as allowance for extra visits when things break.

-Invisalign- This is a clear plastic removable appliance. It is changed periodically to slowly move teeth into position. It is nice because it is very cosmetic, and can be removed for photos.  The main negatives are, they are easy to lose, and movement is limited. Therefore, it takes more time to receive less results overall.

Other Potential Orthodontic Allergies

Other potential risks for allergies exist in the use of elastic ligatures (also called rubber bands) during orthodontic treatment. These rubber bands contain latex which might pose an issue for those with latex allergies. Luckily, in modern dentistry companies have developed latex free rubber bands using the same colors as the traditional ones.

Also, the metal used for a particular patient should be the same metal used throughout orthodontic treatment with no deviation. This ensures that there is no cross contamination as it would become quite difficult to pinpoint the exact issue when and if it arises further into treatment.

Orthodontic Allergies Conclusion

Communication is the key in dealing with any dental issue but especially for those with a history of allergies. If you suspect you have any type of allergy let the dentist know. It might be a good idea to get allergy tested prior to beginning orthodontic treatment if there is any doubt. Any allergy should not be taken lightly if there is any chance it could impact treatment. This will ensure a smooth transition and trouble free orthodontic treatment.

Cosmetic dentistry has become such a common term that almost every dentist calls themselves a “cosmetic dentist”. The American Dental Association does not recognize

Cosmetic Dentistry Marielaina Perrone DDS

Cosmetic Dentistry As An Art

cosmetic dentistry as a specialty in dentistry. The fact is, that even though cosmetic dentistry is not officially recognized,  it does take extra skill, experience, and training. A good cosmetic dentist is concerned with both the esthetic outcome as well as the functional outcome working together in harmony.

Common procedures used in cosmetic dentistry include teeth whitening, porcelain crowns, dental implants, limited tooth movement, gum sculpting, dental bonding, and porcelain veneers. With the exception of teeth whitening, all of the other procedures require extra skill on the part of the cosmetic dentist. The goal in any cosmetic dentistry procedure is to have the final product look and feel as natural as possible. This includes proper treatment  planning before and skilled preparation during the procedure. Choosing the ideal procedures, utilizing the highest quality materials, and pairing with the best dental laboratories are what makes for ideal cosmetic dentistry results. Being able to correct or fix any issues that might arise are just as important.

Cosmetic Dentistry Case Example

Patient came to the dentist with a  list of things she did not like about her teeth. She did not like spaces between teeth, wanted whiter teeth, and also had a badly decayed tooth in the upper molar area.

Step 1 – Fully explain your wants and needs. You and your cosmetic dentist need open lines of communication. An agreement should be reached about what can and cannot be done based on time, budget, and  function.

Step 2 -Full treatment planning records need to be taken. Pre operative x-rays, study models, and digital photographs. These are essential for a good cosmetic dentistry outcome.

Before Cosmetic Dentistry Marielaina Perrone DDS

Cosmetic Dentistry – Before

Step 3 – Options for treatment should be presented. Discuss options and develop an agreed upon treatment plan. In the pictured case, the mouth was healthy (except for decayed molar) and free of periodontal disease. Patient was shown what the final treatment could look like. Such visual cues can be very helpful in decision making. In this case the treatment plan decided upon included:

-Removal of an extremely decayed molar, and replacement with a dental implant.

-Porcelain Veneers to correct shape, size, color, and spacing of the front six upper teeth.

-Teeth Whitening – This will allow the patient to whiten the teeth to a more desirable color, so that the new porcelain veneers, and implant crown can be matched to a more visually appearing, cosmetic color.

Step 4 – Patient has badly decayed molar removed and is referred to periodontist for implant consultation and placement. Following placement of dental implant patient will wait 4-6 months for healing and bone strengthening to occur before final porcelain crown can be placed.

Step 5 – Begin Teeth Whitening. This procedure can either be done in office (in one hour), or the patient can complete teeth whitening at home over the course of 2-4 weeks. This step is important as the final porcelain veneers and porcelain crown will be fabricated to match the new, lighter, final shade following teeth whitening.

Step 6 – Following teeth whitening, porcelain veneers procedure can begin. Porcelain veneers (also referred to as porcelain laminates) are super thin, custom fabricated

After Cosmetic Dentistry Marielaina Perrone DDS

After Cosmetic Dentistry

shells of tooth colored porcelain designed to cover the front surface of teeth to improve your smile’s overall aesthetic appearance. These shells are adhesively bonded to the front of the teeth changing their color, shape, width, and/or length. At end of this appointment patient will be sent home in temporary veneers while the laboratory can fabricate the custom porcelain veneers.

Step 7 – Placement and bonding of final veneers. This is a critical step in this case as the porcelain veneers must not only line up properly to close gaps but also be the right color and shape.

Step 8 – Placement of porcelain crown following healing of the dental implant.

Step 9 – Happy Smile!

Cosmetic Dentistry Conclusion

There you have the steps involved in a typical cosmetic dentistry case. Sometimes there are extra visits if any issues arise but if planned for properly the patient should know exactly what to expect in terms of the cosmetic dentistry treatment schedule as well as finances. Cosmetic dentistry can transform an ordinary smile into one that makes the patient smile bright for a long time to come.

Interceptive Orthodontics is a phased type of orthodontics. Growth is utilized to correct developmental occlusion problems. Staging the treatment can correct immediateInterceptive Orthodontics Marielaina Perrone DDS problems and future issues. Interceptive orthodontics simply means diagnosing and treating malocclusions as soon as they are detected. The American Academy of Orthodontics now says all children should have an orthodontic assessment no later than the age of seven.

In the past, orthodontic treatment did not begin until around age 12-14. This is when all the permanent teeth are already erupted or very close to it. It was also common for your dentist to remove  permanent teeth to correct the bite and allow for room for the final phase of tooth movement. Modern orthodontists now advocate a way to keep permanent teeth, with phased  interceptive orthodontics. In interceptive orthodontics, children are treated at much earlier ages (usually between age 7-11 years old) to take advantage of continuing growth. Patients at this age tend to be more receptive to, and compliant with treatment. Interceptive orthodontics allows for fewer teeth to be extracted and also allows for  better end results.

Why Does My Child Need Interceptive Orthodontics?

Parents and patients need to understand that when interceptive orthodontics is performed there is usually more than one phase of of treatment. Phase two will begin when all the permanent teeth are in place. Going through phases allows for the second phase to be shorter in duration, since the major corrections happened in the interceptive orthodontics phase. Sometimes interceptive orthodontics are needed to correct problems related to skeletal development, and sometimes it is needed as a direct result of oral habits.

-Correction of Thumb Sucking and Pacifier Habits. Persistent thumb sucking, and extended use of a pacifier effect the development of the mouth. Thumb sucking, and pacifier use after the age of three could result in:

- a reshaped jawbone given its soft and pliable nature

- mis-aligned teeth growing out of position

- narrower dental arches

-extreme tongue thrust habits

- protruding front teeth which may be more susceptible to injury

- “open bites” that would require extensive orthodontic treatment to straighten

Some developmental issues requiring interceptive orthodontics include:

-constricted palate, causes misalignment of back teeth commonly called crossbite

-crowding of teeth

-uneven development of upper and lower jaw

Interceptive Orthodontics Marielaina Perrone DDS

Examples of Interceptive Orthodontics:

-Expansion of the upper jaw to eliminate a crossbite

-Expansion of one or both jaws to create space for overly crowded teeth

-Early removal of specific baby teeth to facilitate the proper eruption of permanent teeth

-Maintaining space for permanent teeth after the premature loss of a baby tooth

-Reducing the protrusion of upper incisors to decrease the likelihood of fracture from trauma

What are the advantages of interceptive orthodontics?

Some of the most direct results of interceptive treatment are:

-Creating room for crowded, erupting teeth

-Creating facial symmetry by influencing jaw growth

-Reducing the risk of trauma to protruding front teeth

-Preserving space for unerupted teethLas Vegas Cosmetic Dentist Marielaina Perrone DDS

-Expanding the palate to properly position back molars

-Reducing the need for tooth removal

-Reducing treatment time

Is your child a candidate for Interceptive Orthodontics?

Orthodontics is not just for improving the appearance of the smile. Orthodontic treatment improves malocclusions.  Malocclusions occur as a result of tooth or jaw misalignment. Malocclusions affect the way you smile, chew, clean your teeth or even the way you feel about your smile. Recent studies have shown that malocclusions left untreated can result in problems as we age. Crowded teeth are much more difficult to brush and floss which may contribute to tooth decay and periodontal disease. Protruding teeth are more susceptible to accidental chipping. Crossbites can result in unfavorable growth and uneven tooth wear. Openbites can result in tongue-thrusting habits and speech impediments.

Interceptive Orthodontics Conclusion

In the end, orthodontics is not just about a pretty smile. It adds to ones function and ability to maintain healthy teeth throughout their lives.

Thumb sucking is a common habit and natural reflex for children. Sucking on thumbs, fingers, pacifiers or whatever they can get in their mouth may make babies feel secure and happy and help them learn about their world. Thumb sucking can continue as a child grows. They will use the thumb sucking to soothe themselves or help themselves fall asleep.

Is Thumb sucking normal?

Babies have a natural rooting and sucking reflex. This can cause them to put their thumbs or fingers into their mouths. Thumb sucking can sometimes can occur even before birth. Because thumb sucking is soothing to babies, some slowly develop a habit of thumb sucking when they are tired, anxious or simply bored. Some children who are thumb suckers will only suck their thumb, while some will need to hold an object they treasure, like a security blanket or soft stuffed animal.

Does Thumb sucking cause any problems?

Unfortunately thumb sucking can cause problems for children if it continues. Thumb sucking in children younger than 4 is usually not an issue for development. Children who suck their thumbs often or with increased aggressiveness after 4-5 years of age, or those who are still sucking their

effects of thum sucking

Effects of Thumb sucking

thumbs at age 6, are at risk for dental  or speech problems. Once the permanent teeth begin to come in and develop in the mouth, the persistent thumb sucking may cause top teeth to push out and upward, and bottom teeth to push inward. This tooth movement can cause development of a “buck tooth” appearance, an inability to close the front teeth (open bite), damage to the roof of the mouth, and subsequent speech issues. Pacifiers cause similar issues as thumb sucking but the habit of using the pacifier is a far easier habit to break, it can be thrown out, a finger can not. What determines if thumb sucking causes dental problems or not is the intensity and length of time of the thumb sucking. Checking a child’s thumb for damaged skin and calluses can help determine the aggressiveness of the thumb sucking habit. Many children simply rest their thumbs in their mouth. These children are far less likely to develop any long term issues from their version of thumb sucking. On the other hand, an aggressive thumb sucker may develop issues with their primary and permanent teeth (if they are still thumb sucking at that point when they erupt.

Speech problems caused by thumb sucking are related to the misaligned teeth, distorted palate, and tongue thrusting. The tongue does not have the ability to find the correct placement for proper enunciation, and the tongue muscle needs to be retrained. Tongue thrusting is the pushing forward motion of the tongue when swallowing, causing a continued pressure on the teeth even when not thumb sucking.Speech problems can include not being able to properly say S’s, T’s and D’s, lisping, and tongue thrusting when talking.

Children who are thumb suckers may need treatment for the following reason:

-They have not stopped thumb sucking on their own by age 4-5.

-Speech problems are becoming noticeable.

-If they are teased or feel embarrassed by their sucking.

Treatment

At home treatment by children can include:

-Gentle reminders from parents and loved ones. When you notice your child sucking their thumb, gently remind him or her to stop. You should always avoid criticizing or making fun of your child. This will only create stress.

-Positive reinforcement. Positive reinforcement goes a long way in this area. Provide small rewards when they are not sucking their thumbs for extended periods of time. A reward could be as simple as an extra trip to the park or a slightly later bedtime.

-Competing response. Parents should give their child encouragement to do a different activity when they feel the urge to suck their thumbs. Could be something like squeezing a pillow.

Parents should also take away the child’s security blanket or stuffed animal during certain times of day. This will limit the amount of sucking. Another option is putting gloves on the hands or placing band aids over the thumb in question. This can help the child by reminding them they should not suck their thumbs.

If home treatment does not work and you are worried or feel frustrated about your child’s thumb sucking you should talk with your child’s dentist or doctor. There may be other treatment options, such as behavioral therapy, special nail polish for thumbnail, thumb devices, or devices for the mouth (habit appliances). A dental habit appliance is only a good idea for children who have not been able to stop thumb sucking on their own and have asked for help. It is usually something non removable, blocking the roof of the mouth to make thumb sucking impossible. It is worn for a few weeks to months and then removed by the dentist.

thumb sucking nail treatment

Thumb sucking nail treatment

Remember that thumb-sucking usually is not a problem until a child starts kindergarten or later. Most children will cease the activity on their own if you give them enough time. Slowly but surely, most children begin to stop thumb sucking on their own around ages 3-6 years old. If you notice changes in your child’s primary teeth, or are concerned about your child’s thumb sucking consult your dentist.