As dentists, we often see other mouth problems besides those with teeth and gums. One of the most common is cracking around the corners of the mouth. Although usually not serious, it can be irritating and uncomfortable.
Medically known as angular cheilitis (literally “an inflammation of the angles of the lip”), it’s also called perleche, derived from the French lecher, “to lick.” The latter moniker aptly describes the tendency of sufferers to compulsively lick the sores to relieve irritation, which actually can make things worse.
Perleche has a number of possible causes, mostly from in or around the mouth (although systemic diseases or medications can cause it on rare occasions). It’s often found among younger people who drool during sleep or older people with deep wrinkles along the sides of the mouth that increase the chances of dryness and cracking. Long-term wind or cold exposure, ill-fitting dentures or a lack of back teeth (which help support facial structure) may also contribute to the condition.
Patients with perleche can also develop yeast infections from a strain called candida albicans. The infection can spread through the whole mouth, significantly increasing the chances of physical discomfort.
Treating perleche often involves topical ointments with inflammation-reducing steroids and zinc oxide, which has antifungal properties, to provide an environmental barrier during the healing process. If a yeast infection occurs, we may treat it with oral or topical antifungal medication like Nystatin for the whole mouth and chlorhexidine rinses, which has antibacterial properties.
It also helps to adopt a few preventive measures that can minimize the occurrence of perleche. If you wear dentures, for example, cleaning them often (including, if necessary, with chlorhexidine) and leaving them out at night reduces bacterial and fungal growth. We can also see if your dentures are fitting properly. Replacing missing teeth provides better facial support and could minimize wrinkling around the mouth. And, of course, keeping up daily brushing and flossing helps ensure a healthy and disease-free mouth.
If you’re experiencing cracked mouth corners, let us know at your next appointment. With our help and of other medical professionals we may be able to give you relief from this irritating condition.
If you would like more information on gaining relief from angular cheilitis, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Cracked Corners of the Mouth.”
You're not just a patient to your dentist—you're also a partner for achieving your best oral health possible. And it takes what both of you do to achieve it.
No doubt your dentist always strives to bring their "A Game" when providing you care. You should carry the same attitude into your personal oral hygiene—to truly master the skill of brushing.
Like its equally important counterpart flossing, brushing isn't mechanically complicated—you need only a minimum of dexterity to perform it. But there are nuances to brushing that could mean the difference between just adequate and super effective.
The goal of both brushing and flossing is to clean the teeth of dental plaque, a built-up film of bacteria and food particles most responsible for dental diseases like tooth decay and periodontal (gum) disease. Brushing removes plaque from the broad front and back surfaces of teeth, while flossing removes it from between teeth where a toothbrush can't reach.
While a lot of cleaning tasks require bearing down with a little "elbow grease," that's unnecessary with brushing—in fact, you may increase your risk of gum recession if you brush too vigorously or too often. All you need is to apply a gentle, circular motion along all tooth surfaces from the gum line to the top of the tooth—a thorough brushing usually takes about two minutes, once or twice a day.
Your equipment is also important. Be sure your toothbrush is soft-bristled, multi-tufted and with a head small enough to maneuver comfortably inside your mouth. Because the bristles wear and eventually lose their effectiveness, change your brush about every three months. And be sure your toothpaste contains fluoride to help strengthen your enamel.
One last tip: while it may sound counterintuitive, don't brush immediately after a meal. Eating increases the mouth's acidity, which can temporarily soften the minerals in tooth enamel. If you brush right away you might slough off tiny bits of softened enamel. Instead, wait an hour before brushing to give your saliva time to neutralize the acid and help re-mineralize your enamel.
Unlike your dentist partner, your role in caring for your teeth doesn't require years of training. But a little extra effort to improve your brushing proficiency could increase your chances for a healthy mouth.
If you would like more information on best practices for personal oral hygiene, 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 “10 Tips for Daily Oral Care at Home.”
Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.
“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.
Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.
Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.
Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.
Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.
So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!
For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”
Losing a tooth can be traumatic, but a dental implant can dramatically turn that experience around. Providing functionality, life-like appearance and durability, implants stand out as the premier restoration for lost teeth.
For adults, that is. An older child or teenager with a missing tooth may need to wait a few more years for an implant. The reason: jaw development. A person's jaws, particular the upper jaw, continue to grow with most growth completed by early adulthood. Natural teeth with their periodontal attachments develop right alongside the jaw.
But because an implant attaches directly to the jawbone, its position is fixed: it won't change as the jaw grows and may gradually appear to sink below the gum line. That's why we wait to place an implant until most of jaw maturity has occurred after full jaw maturity. For females, we try to wait until 20 years of age and for males, usually 21 years of age. These are guidelines as some people mature faster and some slower, so a discussion with your dentist or surgeon is necessary to make an educated decision.
While we wait, we can install a temporary replacement for a child's or teenager's lost tooth, usually a partial denture or fixed modified ("Maryland") bridge. The latter affixes a prosthetic (false) tooth in the missing tooth space by attaching it to the back of natural teeth on either side with bonded dental material. It differs from a traditional bridge in that these supporting teeth aren't permanently altered and crowned to support the bridge.
During the time before implants we should understand that the area where the implant will be placed will undergo some bone deterioration, a common consequence of missing teeth. Forces generated as we chew travel through the teeth to stimulate renewing bone growth all along the jawbone. But with a lost tooth the chewing stimulation ceases at that part of the bone, slowing the growth rate and leading to gradual bone loss.
Fortunately, the titanium posts of dental implants stimulate bone growth as bone cells naturally grow and adhere to their surfaces. Before then, though, if the bone volume is diminished, we may need to graft bone material to stimulate bone growth that will enlarge the jaw bone enough for an implant to be placed.
It usually isn't a question of "if" but "when" we can provide your child with an implant for their missing tooth. In the meantime, we can prepare for that day with a temporary restoration.
If you would like more information on dental restorations for teenagers, 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 “Dental Implants for Teenagers.”
As a new permanent tooth develops, the roots undergo a process of breakdown and growth. As older cells dissolve (a process called resorption), they’re replaced by newer cells laid down (deposition) as the jaw develops. Once the jaw development ends in early adulthood, root resorption normally stops. It’s a concern, then, if it continues.
Abnormal root resorption most often begins outside of the tooth and works its way in, beginning usually around the neck-like (or cervical) region of the tooth. Also known as external cervical resorption (ECR), the condition usually shows first as pink spots where the enamel is being undermined. As these spots continue to erode, they develop into cavity-like areas.
While its causes haven’t been fully confirmed, ECR has been linked to excessive pressure on teeth during orthodontic treatment, periodontal ligament trauma, teeth-grinding or other excessive force habits, and bleaching techniques performed inside a tooth. Fortunately, ECR is a rare occurrence, and most people who’ve had these problems won’t experience it.
When it does occur, though, it must be treated as quickly as possible because the damage can progress swiftly. Treatment depends on the size and location of the resorption: a small site can often be treated by surgically accessing the tooth through the gum tissue and removing the offending tissue cells. This is often followed with tooth-colored dental material that’s bonded to the tooth to replace lost structure.
A root canal treatment may be necessary if the damage has extended to the pulp, the tooth’s interior. However, there’s a point where the resorption becomes too extensive to save the tooth. In these cases, it may be necessary to remove the tooth and replace it with a dental implant or similar tooth restoration.
In its early stages, ECR may be difficult to detect, and even in cases where it’s been diagnosed more advanced diagnostics like a CBCT scanner may be needed to gauge the extent of damage. In any case, it’s important that you have your teeth examined on a regular basis, at least twice a year. In the rare chance you’ve developed ECR, the quicker it’s found and treatment begun, the better your chances of preserving the tooth.
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