What is a bad bite?

A bad bite refers to the misalignment of teeth. When teeth do not come together correctly, they are termed bad bite, or "malocclusion."

What causes a bad bite?

It is often caused by genetics, environmental factors, oral habits or multifactorials. For example, you may have an overjet, commonly known in lay term as "over bite," where your front teeth stick out. With this bite, your lower lip, caught behind the upper teeth, wedges both top and bottom teeth and makes the upper teeth stick out further. If you have a tongue habit, your tongue can push your front teeth out further. The misalignment of your teeth and jaw can make the bite worse over time.

3 types of bad bite:

In orthodontics, there are 3 main types of bad bite. There are also subdivision bites but for simplicity, lets discuss the 3 main ones. They are categorized based on how the top and bottom jaws relate to each other.

• Class I bite is referred to both upper and lower jaws being proportionate in length. There is no issue with the jaw; instead, the bite problem is associated with the teeth. The teeth are either not straight or they can be crowded, spaced, rotated, overlapped, twisted or tipped.
• Class II bite refers to a long upper jaw or a short lower jaw. The jaw position affects the appearance of the front incisors. With a Class II bite, the upper front teeth fit far outside the lower front teeth. 
• Class III bite refers to a long lower jaw or a short upper jaw. Often the upper jaw grows too short and the lower jaw grows too long. With a Class III bite, the lower front teeth fit far outside the upper front teeth.

Who should correct a bad bite?

A bad bite should be corrected by an orthodontist. Orthodontists are dental specialists who have undergone an additional 2-3 years of specialized study in the field of malocclusions to correct and treat bite and jaw problems. They are trained to diagnose all problems associated with the teeth, the jaw, the airway, the facial musculature, and temporal mandibular joints. Some bite problems may need both orthodontics and surgical interventions. Although your general dentist may offer orthodontic treatment, he or she does not have the added training and may not be able to correct complex orthodontic cases.

Dr. Nancy Phan is an orthodontist and has been practicing orthodontics exclusively for over 10 years. When you schedule an orthodontic consultation, she will go over your bite problem and suggest treatment options. Orthodontic records can be taken at that time to further collect data, diagnose problems, analyze details and establish a treatment plan. Once a treatment plan is completed, treatment will then be rendered.

When you have a bad bite, you need more than tooth alignment. You need correction of teeth, bite, jaw and facial alignment to achieve that harmonious and beautiful smile! You can check our website www.CareOrthodontics.com for other beneficial information.

Does my child need early orthodontic treatment?

Even though our office offers complimentary orthodontic consultations to children, some parents do not take advantage of this offer. Some parents say, “Why early treatment when my child can wait?” or “Would it cost me more to do early treatment?” These are valid questions, until you know the reasons for early treatment and significant benefits that come with it.

Many orthodontic problems may be diagnosed and treated early to prevent further complications. The American Association of Orthodontists recommends an orthodontic evaluation at age 7. Dr. Phan recommends that children be screened for any bite or jaw growth problems between ages 7-9.

Screening does mean your child always requires orthodontic treatment. Screening allows you to recognize the severity of an orthodontic problem, if there is any. In our office, 20-25% of children benefit from early treatment. The remaining 75-80% do not require early treatment.

Early orthodontic treatment may also be referred to as Phase I treatment, interventional orthodontic treatment, interceptive orthodontic treatment, or limited orthodontic treatment. These terms indicate early correction of a bite problem.

What are examples of early bite problems?

• Severe over bite – where the lower teeth cause cuts on the upper gum
• Severe over jet – where the upper jaw and teeth stick out too far, risking enamel fracture
• Under bite issues- where the lower jaw sticks out too far
• Cross bite issues – where the upper and lower jaws misalign, leading to uneven facial growth
• Mouth breathing habit – causing dry mouth and inflamed gums
• Thumb and finger sucking habit – causing open bite
• Speech impediment – affecting language development
• Early loss of baby teeth – delayed eruption of permanent teeth
• Difficulty chewing or biting – affecting digestion and well-being
• Super crowded teeth – affecting eruption of permanent teeth
• Uneven bite – affecting facial appearance and self-image

Why do they need correction?  

• In a growing child, every effort should be made to help the maxilla and mandible grow at similar speeds. Uneven jaw growth leads to an unfavorable facial profile and requires jaw surgery later in adulthood.
• By manipulating jaw dimension in a growing child, it is possible to reverse the genetic causes of this trait.
• By aligning the jaws, it is possible to achieve a more balanced and symmetrical face.
• By correcting deviated jaw growth, it is possible to reverse facial asymmetry.
• By stopping dysfunctional habits, such as finger sucking or tongue thrusting, it is possible to prevent speech, mastication, and bite problems.
• By creating space, it is possible to prevent impaction of permanent teeth.
• By correcting a malocclusion, it is possible to avoid psychological impacts caused by school bullies or child teasing.

What are the benefits of early treatment? 

Early intervention eliminates harmful oral habits, creates space for ease of permanent teeth eruption, reduces the extra pain associated with surgical requirements, and reduces the risk of jaw surgery in adulthood. Early treatment plays an important role in the prevention of serious bite problems, guides jaw alignment, develops final occlusion, and improves facial aesthetics.

Early detection of jaw and bite problems provides a great opportunity for effective treatment planning, financial planning, and simple treatment. When indicated, early treatment, also known as Phase I treatment, reduces the severity, treatment length and treatment cost of Phase II treatment. Many times, a more severe orthodontic problem can be corrected using a fixed or removable orthodontic appliance.

Call for a consultation.

You can schedule a consultation for your child to evaluate their bite and receive the best advice to care for your child’s smile by calling our office at (408) 971-2885. Please visit our website, www.CareOrthodontics.com, for other beneficial information.

Treatment options for sleep apnea

What is sleep apnea?

Sleep apnea is a condition when your breathing stops during your sleep, sometimes occurring 20-30 times per hour. Each time you stop breathing, the lack of oxygen available to supply to the brain causes you to wake up to restart the breathing process. The continuous process of wake-sleep, wake-sleep cycles prevent you from achieving deep sleep and causes you to feel constant drowsiness and fatigue during the day.

What are the risk factors?

Sleep apnea can occur with any age and gender. However, it is more common in males over age 40. There is higher risk for individuals with obesity, smoking, drinking, and family history.

Should it be treated?

Sleep apnea should be treated immediately. If left untreated, it can lead to high blood pressure, risk of heart failure, and stroke. It interferes with sedation and surgical recovery. Due to unintentionally falling asleep during the day, it negatively affects work and school. It also leads to higher risk of injury while operating heavy machinery.

How is sleep apnea treated?

Treatment for sleep apnea depends on the severity and type of apnea. Basic treatments involve behavior management, such as instructing patients to lose weight, stop smoking, stop drinking, and sleep on their side instead of their back.

Intervention treatment may include an oxygen machine. A medical device called a CPAP machine (Continuous Positive Airway Pressure) is commonly used to treat moderate to severe sleep apnea. It delivers a continuous stream of oxygen to the patient, and has been proven to lower blood pressure and reduce heart problems [Source: WebMD].

Many people find that the machine works effectively at delivering air flow. However, the drawbacks include wearing a face mask that can be cumbersome and uncomfortable, and the mask can cause sore spots and irritation to the skin. The machine can be noisy, which can wake a person up at night. It is also an expensive machine. Some patients find themselves waking up at night to take the oxygen mask off.

An alternative treatment is oral appliance therapy. The oral device works best for mild and moderate cases of sleep apnea and avoids the drawbacks of an uncomfortable machine. The treatment involves fabricating and fitting a custom-made appliance to position the mouth open and unobstructed in order to maintain an open airway. This appliance is fabricated by an orthodontist and is used to prevent throat blockages. The oral appliance must fit comfortably so that it does not cause sore spots and the person can breathe comfortably.

In some severe cases, surgical treatment may be required to permanently change the position of the jaw. The mandible can be advanced to open the airway. The maxilla can be widened with a palatal expander in order to widen airway spaces.

If you or someone you love suffers from sleep apnea, talk to your physician to be referred to a sleep apnea specialist. The specialist may conduct a sleep study to diagnose the extent of the problem and recommend the appropriate treatment. If you are diagnosed with obstructive sleep apnea (OSA), you can schedule a consultation with an orthodontist to see if oral appliance therapy may be helpful to treat your sleep apnea. We can custom create an oral device for you to help open your airway and improve breathing.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a beautiful and healthy smile. We create beautiful smiles with Care!

Sources and Citations:

1. http://www.progressivebraces.com/sleep-apnea-appliance-snore-appliance
2. http://www.dentistryiq.com/articles/2013/11/using-oral-and-dental-devices-to-treat-snoring-and-sleep-apnea.html
3. http://www.webmd.com/sleep-disorders/sleep-apnea/continuous-positive-airway-pressure-cpap-for-obstructive-sleep-apnea

What is the difference between snoring and sleep apnea?

What is snoring?

Snoring occurs when you make hoarse sounds during sleep. It is caused by the vibration of the soft palate. It presents due to narrowing and laxity of airway tissues. Snoring does not restrict the airway and it does not cause sleep disturbances.

Studies estimate that 30% to 50% of the U.S. population experience snoring. Light snoring can be a minor annoyance. Excessive, loud and habitual snoring can disturb your loved one. Snoring does not cause breathing or sleep disturbances. However, it can progress into upper airway resistance syndrome, which causes sleep disturbances and becomes sleep apnea. Snoring can be a sign of sleep apnea. Snoring can increase a person's risk for stroke. [Source: Lee et al.]

In summary, as long as there is no airway restriction, then the term “snoring” is used. It is important that you recognize the differences between snoring and sleep apnea.

What is sleep apnea?

Sleep apnea is a condition when your breathing stops during your sleep, sometimes occurring 20-30 times per hour. Each time you stop breathing, the lack of oxygen supply available to the brain causes you to wake up in order to restart the breathing process. The continuous process of wake-sleep, wake-sleep cycles prevent you from achieving deep sleep and causes you to feel constant drowsiness and fatigue during the day.

Sleep apnea is defined as restriction of the airway passage for a minimum time leading to oxygen saturation drop. Apnea is a complete or almost complete blockage of the airway for a certain time.

What are the signs of sleep apnea?

Snoring is one symptom of sleep apnea. However, snoring does not always indicate sleep apnea. It may be a social inconvenience but may not cause cessation of breathing, and may not require immediate treatment. Currently, 1.2 million Americans suffer from sleep apnea.

To diagnose sleep apnea, look for these symptoms:

• Choking or gasping that follows loud snores at night
• Breathing cessation episodes
• The need to wake up frequently with shortness of breath
• Sore throat and dry mouth after waking
• Insomnia or difficult sleeping
• Headaches, drowsiness, and irritability upon waking in the morning
• Falling asleep unintentionally during the day

What are the different types of sleep apnea?

The types of sleep apnea are usually diagnosed by a sleep apnea specialist in a sleep lab.

There are 3 types of sleep apnea:

1. Obstructive sleep apnea (OSA) is the common type. It occurs due to a physical blockage, typically caused by the tongue, uvula and soft palate, which collapse and block the airway in the back of the throat.
2. Central sleep apnea (CSA) is a less common type. It occurs due to lack of proper signals from the brain sent to the breathing muscles.
3. Complex sleep apnea is a less common type. It is a combination of obstructive and central sleep apnea. [Source: Dental IQ]

 

Medical and dental conditions associated with sleep apnea

• People who have high blood pressure, frequent heartburn and hypothyroidism have high associations with sleep apnea.
• People who have heavy clenching, grinding, bruxing, temporal mandibular joint symptoms and frequent headaches have high associations with sleep apnea. [Source: Health checklist]

If you have these conditions, along with disruptive sleep patterns, you should see your physician to get diagnosed with sleep study tests to rule out sleep apnea.

Should it be treated?

A light snoring can be a minor annoyance to your spouse or family member but may not need treatment. Severe snoring can be a sign of sleep apnea and should be diagnosed and treated. Sleep apnea should be treated immediately. If left untreated, sleep apnea can lead to high blood pressure, risk of heart failure, and stroke. It interferes with sedation and surgical recovery. Due to unintentionally falling asleep during the day, it negatively affects work and school. It also leads to a higher risk of injury while operating heavy machinery.

In the next post, Dr. Nancy Phan will discuss different treatment options for sleep apnea.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a beautiful and healthy smile. We create beautiful smiles with Care!

1. http://www.dentistryiq.com/articles/2013/11/using-oral-and-dental-devices-to-treat-snoring-and-sleep-apnea.htm
2. Lee SA, Amis TC, Byth K, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008, 31:1207-1213
3. Bruce, Dan. Health history checklist for sleep-related breathing disorders. Dental Economics 03 2015, 80-84

3 effective methods to clean your retainers and Invisalign aligners

If you are wearing removable retainers such as Hawley, or clear retainers or aligners, you may notice they get white build-up. At first, the build-up may be soft and sticky due to plaque build-up. With time, this sticky layer turns into crusty, white build-up that is difficult to brush away.

Just as calculus builds up on teeth, caused by minerals in saliva, calculus deposits can form on retainers. With time, it is very hard to remove. Aside from the unattractive look, dirty retainers also smell like rotten fruit. Thus, it is important to keep retainers and aligners clean.

Below are 3 methods of cleaning retainers: 

1. Brush your retainers manually
2. Soak your retainers in a sonic cleansing system
3. Soak your retainers in homemade solutions

 

1. Brush your retainers manually

This method is the cheapest, most reliable, and most effective way of cleaning retainers and aligners. Every morning, a minimum of once a day, manually brush your retainers with liquid hand soap and a toothbrush. Use a denture toothbrush that has stiff bristles to help get rid of the white plaque. Then rinse with warm water. Store retainers or aligners in a case with the lid open to air dry and eliminate any damp, salivary smell. Use soap that contains an antibacterial agent to clean plaque. It will also have a deodorizing agent to eliminate the smell.

Make sure to store retainers dry and only if they are clean and free of build-up. If they are dirty and you don't have time to brush them in the morning, then you should store the retainers in a cup of distilled water. Dirty retainers will dry out with a white biofilm and harden into crusty white calculus that is very difficult to clean and remove.

If you are concerned about avoiding chemicals, then use water only to clean the retainers. It may take a little longer to manually scrub the retainer.

You can use toothpaste instead of soap to brush the retainers. However, most toothpaste contains about 20% of abrasives, such as silica compounds, triclosan, polymers, and pyrophosphates. These ingredients are used to polish the teeth, prevent biofilm formation, prevent stains, and prevent tartar formation respectively. These ingredients can create micro scratches on your retainers or make retainers look more dull over time.

 

2. Soak your retainers in cleaning tablets and a sonic cleaner

This method uses a proprietary system of sonic cleaner and tablets. It is convenient and works effectively, however, it is more expensive. You can purchase a portable sonic cleaning kit and cleaning tablets at a drug store or over the internet from websites such as dentalkit.com or smileshop.com.

The sonic cleaners cost from $10 to $50 per unit depending on if they are battery operated or have a power plug with an auto shut-off option. These units basically vibrate to shake off calculus and plaque build-ups. The cleaning tablets cost about $5 per monthly supply. There are many brand names, such as Retainer Brite, SonicBrite, DentaSoak, Efferdent, and Polident. These tablets have antibacterial agents, cleaning agents and deodorizing agents to eliminate the smell and clean retainers. [Source: Wikihow]

 

3. Soak retainers in homemade cleaning solutions

With this method, you will need to create your own ingredient mix. The ingredients can be vinegar, baking soda or hydrogen peroxide.

You can use 5% distilled white vinegar, used for home cooking. Mix 1 part vinegar to 3 parts warm water. Soak your retainers or aligners for 20 minutes. Then clean off with water to dissolve white plaque. Use vinegar sparingly, as long term use can degrade the plastic and change the color of acrylic.

If you have not been cleaning your retainers and the build-up is old, chunky, and crusty, then use 1 part vinegar to 1 part water and soak overnight. Brush off with a stiff brush in the morning. Vinegar works as a dissolving and antibacterial agent. Most of the time, you can get rid of about 75% of crusty calculus. You still need mechanical brushing to scrape of the remaining tenacious hard calculus. By brushing your retainers daily, you prevent hard mineral build-ups as described here.

Baking soda or hydrogen peroxide can be used in substitution for vinegar, also with dilution in water. These ingredients work as an antibacterial agent to neutralize acidic bacteria and clean soft plaque. In general, vinegar still does a better job at removing hard calculus.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a healthy and beautiful smile. We love to see you smile!

Am I too old for braces?

From time to time, we have grandparents who are interested in orthodontic treatment after having brought the grandkids into our office. We also have middle-aged adults who would like to get started with treatment or want re-treatment. Nowadays, there are more adults getting braces and Invisalign treatment than decades before. According the American Association of Orthodontists, currently 20% of orthodontic patients are adults, compared to less than 5% over 20 years ago. 

Reasons why it is easier for adults to wear braces these days:

• The metal brackets are thinner and smaller
• The clear, ceramic brackets are thinner, less brittle, less likely to cause stains
• Optional lingual braces are attached to the back of the teeth and are less noticeable
• Invisalign is a good alternative for adults who do not want to wear braces
• Socially, it is more acceptable to wear braces and more people are doing it than ever before

As more people are aware of the benefits of straight and healthy teeth, they are more motivated to obtain treatment. You don't have to live with negative consequences of physically limited oral health due to bad bite, uneven teeth, gingival recessed gum, or trapped plaque. You don't have to suffer the psychological setback of covering your unattractive teeth while smiling, and you don't have to fear that people will judge you negatively due to crooked teeth.

Here are the benefits of receiving orthodontic treatment:

• Less chance of food build-up, stain, and plaque accumulation with aligned teeth
• Less periodontal disease and gum recession when teeth are in proper occlusion
• Less trauma in occlusion when teeth are properly fitted
• It is much easier to brush and floss with straight teeth
• You chew food properly and avoid gastrointestinal problem with correction of improper bite
• You speak better and digest food better with correction of an open bite
• You show more self-confidence when you have a better smile
• When you smile more, you are more approachable to others, make more friends, attract the opposite sex, and perform better at job interviews.

Should you consider orthodontic treatment at your age?

You are never too old for orthodontic treatment. Even in your 70s or 80s, as long as there is normal bone metabolism and no periodontal disease, tooth movement can occur. However, here are some important differences to consider in adult orthodontics:

• By adulthood, bone growth has stopped. Therefore, there are no opportunities to manipulate jaw growth except for jaw surgery. With severe underbites, overbites, crossbites, or facial asymmetry, a combination of jaw surgery and orthodontic treatment may be necessary.
• Treatment may take longer in adults compared to adolescence. With age, teeth may move a little more slowly due to dense bone. With age, adults are more prone to root resorption and periodontal diseases. Thus, adults need to be more closely monitored and need more frequent cleanings. Adults need gum pockets checked every 4-6 months to ensure healthy periodontal structure.
• Adults often need more inter-discipline care and dental cosmetic treatments along with orthodontic treatment. Procedures such as veneers, porcelain crowns, teeth whitening, gum grafting, etc. are often indicated to restore size, shape, and function of teeth as a result of heavy grinding, bruxism, root-canal treatment, internal staining, or gum recession.

The outcomes are just as good for adults. Even though many adults worry about the age to pursue orthodontic treatment, the majority are satisfied with the end results. They are happy that they invested the time and money in their smile and they can keep their healthy smiles for many more years to come!

At Care Orthodontics, we are here to help. If you have any questions about your bite and would like to consider treatment options, you can schedule an appointment for complimentary consultation with Dr. Nancy Phan at 408-971-2885. You can also find other beneficial information on our website at www.CareOrthodontics.com.

Does my child need a palatal expander?

Some parents are concerned when seeing many crooked teeth in their child’s mouth, and often ask if a palatal expander would be beneficial. The answer is, it depends. A child should be seen by an orthodontist to evaluate the size, shape, and bite of the mouth to determine if an expander is indicated.

What is an expander? It is a custom-fitted dental device that is made by 2 metal halves joined together by a small screw. When turned, the screw opens slowly to widen the width of the upper jaw.

  

When is palatal expander used? A palatal expander can be used on a child or an adult to correct a bad bite, sometimes referred as a "cross-bite." It is also used to widen the maxilla. Anatomically, the upper jaw and roof of mouth are together know as a maxilla. In some individuals the maxilla is narrower than normal and causes the upper teeth to fit abnormally inside the lower teeth when biting down known as a "cross-bite." A cross-bite may restrict the amount of space available for the permanent teeth to erupt. A cross-bite can also cause the lower jaw to shift lopsided when biting down creating facial asymmetry.

In a child, there is a window of opportunity to correct a cross-bite non-surgically. Since the maxilla is made up by 2 pieces of bones connected in the middle by a seam of cartilage, this cartilage is soft and can be stretched by a palatal expander. Once puberty hits, on average round age 12-14; this cartilage hardens into bone. The 2 pieces of maxilla bones fuse together and cease to expand. Any expansion has to be done through surgery.

In adults, jaw expansion works through jaw surgery via a cut through the roof of the jaw, then a palatal expander separates the bones, bone fills in the expansion gap, and finally bone healing occurs 3-4 months later to stabilize the new jaw.

Why is palatal expander used? The expander is used to correct a one-side cross-bite or two-side cross-bites and to widen the roof of the jaw. In a child, the expander fixes the bad bite, prevents unsymmetrical facial growth, prevents uneven wearing of teeth, and gains space to allow ease of eruption of permanent teeth. In adults, using an expander establishes balanced occlusion, prevents uneven enamel wear, and corrects facial asymmetry.

Does it hurt to wear an expander? Insertion of an expander does not hurt except for turning the appliance. One can feel some tight pressure around the base of the nose and the roof of mouth a few minutes after the expander has been turned. An expander does alter speech and swallowing for 1-2 weeks until the tongue adjusts to the new device.

How long is the expander turned? In general the expander is turned for 1 to 2 weeks while being monitored by an orthodontist. After that, the expander is left in the mouth for an average period of 6 months for bones and tissues to adapt.

In summary, a palatal expander is beneficial when indicated. Although it is non-invasive to separate the maxilla bone with an expander, it must be done before puberty. Discovering this type of malocclusion early is one of the many reasons the American Association of Orthodontists recommends a child to see an orthodontist by the age of 7. It is much easier for parents to have a consultation with an orthodontist to survey their child's bite problem, discuss options, and plan the course of treatment early than dealing with complicated options which may require pain and surgical intervention later on.

At Care Orthodontics, we are here to help. Dr. Nancy Phan can provide a complimentary consultation to answer your questions at (408) 971-2885. You can also find other beneficial information on our website at www.CareOrthdontics.com.