Gummy Smile
A "gummy smile," or excess gingival display, is a condition where too much pink tissue can be seen when a person speaks or smiles. Approximately 7% of men and 14% of women have excess gingival display in full smile. A gummy smile is usually associated with an enlarged upper jaw, a short upper lip, short upper front teeth, or a forward position of the front teeth. This condition may also result from disproportionate lip length or tooth height.
A gummy smile can be corrected by orthodontic treatment, periodontal surgery, jaw surgery, or a combination of these procedures. In general, active treatment time with orthodontic appliances ranges from 1 to 3 years. The actual time depends on the growth of the patient's mouth and face, the cooperation of the patient, and the severity of the problem. Custom-made appliances are designed by the orthodontist according to the problem being treated. They may be removable or fixed (cemented and/or bonded to the teeth), and made of metal, ceramic or plastic. By placing a constant, gentle force in a carefully controlled direction, braces can slowly move teeth through their supporting bone to a new desirable position.
Crossbite
An individual with a crossbite will have teeth that are out of place when the mouth is closed. In most instances, this means that one set of your teeth will either fall inside or outside of the opposing set. For example, your upper teeth may sit inside of the lower teeth when the jaw is closed. Many of the causes of crossbite are apparent in childhood or early adulthood. Two of the biggest causes of crossbite are heredity and delayed loss of baby teeth. Both of these situations could cause the teeth to be out of the proper position. Misaligned teeth can cause premature wear and muscular problems in the jaw.
Treatment for crossbite depends upon the severity of the problem and the age of the patient. Children are often easier to treat because their teeth are still in the process of developing. In addition, children are more accepting of the idea of wearing braces. Orthodontics, however, is used to properly align the teeth of both children and adults. In extreme cases, surgery may be required to align the jaws. Temporomandibular joint disorder is another problem that can develop from jaw problems. Over time, orthodontic treatment is the best solution for individuals with crossbite.
Crowding
If your teeth are crooked, turned, or overlapped, you are not alone-virtually 90% of the population has an orthodontic condition known as crowding. Generally caused by genetics (eg, a relatively small jaw or relatively large teeth) or by habits such as nail biting and thumb sucking, crowding is easily fixed with orthodontia.
Typical treatment for crowded teeth involves the placement of highly detailed orthodontic "braces" on all the upper and lower teeth. In adolescents or adults, braces may be worn between two and three years, depending on how crowded or misaligned the teeth are. Once the teeth are stable in their alignment, the braces are removed, and a fixed retainer is placed on the back of the lower teeth to hold them in place; the upper teeth are held with a removable retainer. Retainers are worn for two or more years depending on the severity of the original condition. The lower retainer should be worn as long as possible, as the highest chance of relapse occurs with the lower front teeth.
When crowding is detected early in children (when baby teeth are still present), a functional appliance or braces can be placed so that when the baby teeth fall out, the appliance/braces hold back the rest of the molars, acting as a "spacer." The patient is instructed to turn the appliance's screw each night, which slowly widens the upper jaw in order to make room for the impending adult teeth. Expansion is normally a four to six month procedure.
Tongue Thrust
Swallowing occurs 24 hours per day and about 2000 times each day. Each time you swallow, one to six pounds of pressure is applied to the inside structures of the mouth. Normally when a person swallows, the middle section of the tongue is placed on the roof of the mouth. When the tongue is placed between and behind the teeth, this pressure pushes the teeth apart and out, causing distortions of the face and teeth. This abnormal swallowing motion is known as "tongue thrust." This condition is most common in children with prior severe thumb sucking habits.
Myofunctional therapy (with a speech therapist) is a popular method of treating tongue thrust. In severe cases, a special appliance may be prescribed with or without braces. The appliance is clear and has two heavy wires curving back onto the roof of the mouth behind the upper front teeth. These wires do not interfere with the tongue as long as the tongue is in the proper swallowing position. If the mouth is opened during the swallow (tongue thrust position), the motion brings down the wires into the path of the tongue and the thrusting motion is prevented. The appliance may also be used in combination with vertical elastic bands to again reinforce the habit.
Open bite
Open bite is an oral condition that occurs when certain teeth, usually your front teeth, do not make contact with each other. Open bite gives the illusion that a person's mouth is never really closed, because there is always space between the teeth. One problem with an open bite is that the back molar enamel wears faster because these are the only teeth that touch. Some patients have chewing difficulties because they cannot incise food with their front teeth.
There are a number of circumstances that could be responsible for open bite. Thumb sucking and tongue thrusting are habits that can have an affect on the development of open bite. Speech problems such as lisping can also cause open bite. Genetics can create a situation where the upper and lower jaw is unaligned. Your dentist should be able to spot these causes and refer you to an orthodontist for proper treatment.
Open bites should be treated early. If open bites persist too long, they are difficult to correct and sometimes require jaw surgery.
Spacing
In orthodontics, spacing means exactly what it sounds like: there is too much space between your teeth. This condition is the exact opposite of crowding, and is known clinically as "diastema." Spacing occurs in approximately 5% to 10% of the population. Like crowding, spacing may be caused by genetic factors. For example, if you inherit a large jaw from your mother, but small-sized teeth from your father, you probably will have too much space in your mouth! Spacing may affect all of your teeth, or just a portion of them. In addition, chronic thumb sucking as a child can also create or widen spaces between the teeth.
Many patients choose to close spaces for cosmetic reasons to bolster self-confidence and self-esteem. In other cases, spacing may significantly affect your ability to bite or chew. Some spaces require braces to close, while others should be closed with bonding or veneers from your family dentist. Drs. Dunegan or Hughes will recommend the best method for you.