While we often associate tooth decay with cavities forming in a tooth’s visible or biting surfaces, the occurrence of this all too common disease isn’t limited to those areas. Cavities can develop in any part of a tooth exposed to bacteria.
Gum recession, the shrinking back of the gums from the teeth, can cause such exposure in areas normally covered by the gums. Because these areas are usually more vulnerable to infection when exposed, cavities can develop at or right below the gum line. Because of their location it can be difficult to fill them or perform other treatments.
One way to make it less difficult is to perform a crown lengthening procedure. While the term sounds like we’re increasing the size of the tooth, we’re actually surgically altering the gums to access more of the affected tooth surface for treatment. It’s typically performed in a dental office with local anesthesia by a general dentist or a periodontist, a specialist in the gums.
During the procedure, the dentist starts by making small incisions in the gums to create a tissue “flap” that can be lifted out of the way. This exposes the underlying bone, which they then reshape to support the gum tissue once it’s re-situated in its new position. The dentist then sutures the gums back in place. Once the gums heal, the decayed area is ready for treatment.
Crown lengthening is also useful for other situations besides treating cavities. If a tooth has broken off at the gum line, for example, there may not be enough remaining structure to support a crown. Crown lengthening can make more of the underlying tooth available for the crown to “grab” onto. It’s also useful in some cases of “gummy smiles,” in which too much of the gum tissue is visible in proportion to the tooth size.
Because crown lengthening often involves removing some of the bone and is thus irreversible, you should discuss this procedure with your dentist in depth beforehand. It could be, though, this minor procedure might make it easier to preserve your teeth and even make them look more attractive.
Your teen is about to embark on an orthodontic journey to a straighter, more attractive smile. But although you're excited about the outcome, you both may be steeling yourselves for a few years of "life with braces."
But maybe not—your teen may be able to take advantage of a different kind of corrective appliance: clear aligners. This 21st Century teeth movement method has a number of advantages over braces. For teens, though, there's one big one that could have a huge impact on their social life—clear aligners are nearly invisible to other people.
Clear aligners consist of a series of clear, removable, computer-generated trays based on photographs, models and x-rays of an individual patient's teeth and bite. Each of the trays is slightly different from the previous one in the series, and by wearing each one for about two weeks before moving on to the next, the aligners gradually move the teeth to the desired new positions.
Besides reducing embarrassment often associated with wearing metal braces, clear aligners have other benefits. Unlike braces, they can be removed for eating, easier oral hygiene or for rare special occasions (although for best effectiveness, they should be worn for 20 to 22 hours each day). Recent developments like added elements that help target certain teeth for movement or "power ridges" for more controlled and efficient force have increased the range of bite problems they can be used to correct.
While this means clear aligners can be used for many bite problems, in some severe cases braces and other orthodontic treatments might still be necessary. And because they're not fixed like braces (only the orthodontist can remove them) the patient must have the maturity and self-discipline to wear them consistently.
Your teen will need to undergo a thorough orthodontic examination to see if clear aligners are a viable option for them. If so, it could make the next few treatment years less stressful for both of you.
If you would like more information on clear aligners, 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 “Clear Aligners for Teens: User-Friendly Orthodontics.”