What Causes Teeth to Move

Some would say you should add shifting and crowding teeth to the short list of certainties in life. However, movement of teeth is not unavoidable. So, let’s discuss why teeth move and prove or expel some myths you may have.

What we hear the most often from our patients (and even some dental professionals) is that the wisdom teeth caused the front teeth to shift and crowd. You’ve probably heard this yourself, right? Although wisdom teeth can cause problems with your molars, they aren’t the culprits for your crowded front teeth. We see crowded teeth with or without wisdom teeth present.

As orthodontists, our specialty is aligning crowded teeth into a beautiful smile. Believe me, we look at lots and lots of teeth of all ages every day! Crowding after braces happens for several reasons and ‘Why?’ is the most common question we get. Surprisingly, teeth are designed to slightly move when you bite down due to periodontal ligaments that hold teeth into place being sponges that soften forces applied to teeth. This gives you feedback on the food you eat and acts as tiny shock absorbers to protect your teeth. Therefore, anytime you are not wearing a retainer (which is daytime for most of us) your teeth actually move and shift slightly by design. The good news is that if you are wearing a retainer at night, it will realign your teeth back into their correct positions. This is also why your retainer might feel tight every time you put it on. The downside is that if you do not wear a retainer or night guard each night, your teeth will continue to gradually shift.

Several things make your teeth shift. Pressures from chewing and clinching will gradually shift and deepen your bite. Adding to that, swallowing exerts an inward pressure on your premolars and molars (back teeth) which eventually leads to constriction and a narrower dental arch. Ultimately, a smaller dental arch causes teeth to become crowded because they have less room to fit. For people with sleep apnea, these pressures on teeth are even more magnified.

Teeth constantly shift but the process takes many years for significant changes to happen and be noticed by patients. Starting to wear a retainer at night will stop the process going forward. However, if your teeth are slightly crowded, they are easy to re-align again with limited orthodontic involvement. I like to compare straightening teeth to a home remodel. It is going to take some effort, but the sooner you start, the sooner you get to enjoy your new and improved smile!

From easy touch-up cases to more advanced comprehensive treatments, we are happy to discuss your options for you or your child. We look forward to meeting you soon to review your concerns and make a plan catered to your beautiful new smile.

Dr. Lindhorst, Dr. Darsey, Dr. Theriot and the Heights Pediatric Dentistry and Orthodontics Team

Harmful Dental Habits and How to Break Them

We all have habits, some are good and some are not. And isn’t it frustrating that it’s so easy to create a habit, but so hard to break it?! Good dental habits include brushing your teeth twice a day, flossing, drinking lots of water and visiting the dentist for a check-up twice a year. Harmful dental habits include eating sugary snacks, sucking one’s thumb or a pacifier, biting nails, or grinding teeth. We all know we can cut back on the Skittles and Sour Patch Kids, but let’s talk about some of those other harmful habits and how to help break them!

Sucking is a natural instinct to help babies feel secure, find comfort and self-sooth. According to the American Academy of Pediatrics, pacifiers have also shown to have a protective effect against sudden infant death syndrome (SIDS). However, long-term nonnutritive sucking (past 18 months) can cause unwanted structural changes in the teeth and jaw called “malocclusion.” One example is pushing the top teeth forward creating an “open bite.” This can lead to the tongue thrusting forward and might result in a speech defect (or impairment) like a lisp. Another example is a narrowing of the palate or upper arch resulting in a “posterior crossbite.” This can lead to asymmetric growth of the teeth and face, airway constriction, teeth wear, TMJ problems, and more. These bite changes will likely require orthodontic intervention including palatal expanders or braces. According to the American Academy of Pediatric Dentistry, pacifier use beyond 12 months of age has been linked to an increase of acute otitis media (middle ear infections). We recommend eliminating pacifier habits by 12-18 months. We recommend eliminating thumb or finger sucking habits by age 6 because that’s about the time when permanent teeth start to emerge. The earlier the habit is stopped, the likelier the chance is that the teeth will shift and improve on their own.

Biting nails can cause chipping of the front teeth and shifting teeth out of alignment. Biting nails, thumb or finger sucking, and pacifiers all allow germs in the mouth. Washing hands often and disinfecting pacifiers frequently is recommended!

So how do we break these habits? We have lots of tips andtricks! For pacifiers, options include limiting use to sleepy or stressful times, taking it away cold turkey, gradually cutting the tip off to break the satisfaction of seal, exchanging the pacifier for another object to hold for comfort such as a blanket or stuffed animal, or giving the pacifier to the “Paci Fairy” in exchange for a toy or reward. For thumb sucking, we recommend to first start with positive reinforcement. This might be in the form of rewards like incentives or a sticker chart. If this doesn’t work, then try deterrents such as painting a harmless bitter polish called Mavala on the finger(s). If that doesn’t work either then try a gentle physical barrier like character gloves (i.e. Spiderman or princesses), an elbow bandage to resist the arm-bending reflex, or a T-guard. The T-guard is a commercially available plastic barrier that is strapped to the hand. If all of these approaches are unsuccessful then we can place a special appliance in the mouth to help stop the habit. A nail biter can try the Mavala polish, keep cuticles moistened with lotions or oils, keep nails filed and/or painted, or play with a fidget toy for distraction.

If you have any questions or need help breaking one of these habits, come see us! Our team is well trained to discuss these habits with you and help guide you through the process of breaking the habit for good!

Dr. Lindhorst, Dr. Darsey, Dr. Theriot and the Heights Pediatric Dentistry and Orthodontics Team

Morning Appointments for Young Kids

We absolutely love our patients! We work hard to make sure that we give them the best possible experience in our office and that they will grow up to be comfortable in any dental setting. However, there are many factors that make that happen and we often need parental support in achieving them.

One of the most important considerations is as simple as bringing little kids to us early in the morning. We highly recommend having young children come even for cleaning appointments before their full day of school. Attending school can be stressful. The stimulation of playing, learning, and navigating social situations exhausts even us adults, and for kids can make a difference between a successful dental visit and a tearful one. As parents ourselves, we are keenly aware of the difficulty of evening routines at home with our kids due to the exhaustion and overstimulation of the day. We understand that in a dental office we are putting kids in stressful situations. We recline their chairs, shine big lights in their faces, check their teeth with sharp instruments and take x-rays that can be uncomfortable in their little mouths. And these procedures are just for a regular cleaning appointment! We work very hard on earning kids’ trust and convincing them that dental visits are easy and that they are safe. Having a child who has had a full day of stress prior to seeing us can set us up for failure and make kids, parents and us sad.

Some little ones who come to our office in the afternoon and have a very difficult time handling routine cleanings get rescheduled for the morning and then do very well. After several successful morning appointments, we are perfectly happy seeing younger kids later in the day, ut three and four o’clock appointments are still difficult for them. In addition, our teenagers from middle school and high school truly need those appointments as missing school is very difficult for them at that age.

If children are coming for appointments other than simple cleanings, such as fillings or crowns, we highly recommend sticking to the morning time even if they already do well for routine checkups. Those appointments are nerve wrecking even for adults and being well rested is crucial to success. After appointments that require no oral sedation, kids can immediately head back to school. If oral conscious sedation is used, kids cannot have any food before the appointment, and they must stay home for the rest of the day as the medicine wears off. Due to requiring an empty stomach and our team needing to monitor kids until the medications wear off with an afternoon phone call, these appointments are only allowed on or before 10am in our office.

Both our clinical experience and extensive research show that young kids do much better in the morning for any stressful situations. We understand dental appointments are not easy and can bring on a lot of anxiety. Our team does everything in our power to make them fun, easy, and exciting, but there is little we can do once children come to us already tired. Please call us with any further questions and we look forward to seeing our beautiful little ones with smiles on their faces first thing in the morning!

If you have any questions, call us at Heights Pediatric Dentistry & Orthodontics, 713-861-4000!

Dr. Lindhorst, Dr. Darsey, Dr. Theriot and the Heights Pediatric Dentistry and Orthodontics Team

X-Rays in Pediatric Dentistry & Orthodontics

As pediatric dentists and orthodontists, we are aware and respectful of radiation for our young patients. However, we also are unable to diagnose and treat properly without certain x-rays. Here is our guide to the pediatric dental and orthodontic x-ray schedule that is supported and recommended by American Academy of Pediatric Dentistry.

We do not usually take any radiographs before 3 years of age. At that time, we take a set of baseline x-rays that help us see both possible decay and early development of permanent dentition under baby teeth. After this initial set, we personalize frequency of x-rays based on our patient’s risk factors. Children with teeth not touching in the back

(open contacts), ones with great home oral care, ones with a healthy diet, no previous cavities, and no other risk factors will only get two x-rays called bitewings (cavity detecting ones) every 18 to 24 months. However, children with a higher risk for cavities starting between the teeth such as back molars touching, a diet that exposes teeth to sugar and acid and/or poor oral hygiene will get those two x-rays more often, in some cases every six months. Radiation from these x-rays is minimal and we will be happy to discuss details of how we moderate even that small of an exposure using thyroid collars, lead jackets, and state of the art technology.

The only other x-rays taken between three and seven years of age are ones required for possible trauma or infections of teeth. These x-rays and their frequency are based on the recommendations of the AAPD, incidents themselves and their severity.

Once patients reach around seven years of age and their front teeth as well as last molars are permanent, they are due for panoramic x-rays. This x-ray does not diagnose cavities but shows us growth and development of oral structures that is not visible on any of the previous radiographs. On a panoramic x-ray we can see temporomandibular joints, bone pathology, all adult teeth developing underneath baby teeth, their direction, extra or missing teeth as well as anything that could prevent them from future eruption. This x-ray is crucial to deciding on timing of orthodontic treatment and many other dental treatment decisions. If everything looks healthy on this x-ray, we will repeat it when all permanent teeth erupt at twelve years of age and once more around age seventeen to check for wisdom teeth development and a possible referral to oral surgeons.

As children get older, frequency of cavity diagnosing x-rays can be more spaced out as permanent teeth have thicker enamel and take longer to develop cavities. However, permanent teeth are more important since they need to serve our patients for the rest of their lives. Therefore, we take all potential cavity developing habits more seriously and follow up on x-rays as necessary. Most of our teenage patients need bitewings only once a year or even once every two years. However, poor oral hygiene, developing cavities, or an acidic and sugary diet will call for higher frequency.

Our orthodontic team periodically needs panoramic x-rays, cephalometric (side view of the jaws) x-rays, or even 3D scans, to ensure proper movement of teeth during orthodontic treatment. Those x-rays are usually indicated prior to treatment and further frequency is prescribed by the orthodontist as needed.

If you have any questions or concerns about x-rays, their necessity, indications, and radiation, please contact our office anytime!

If you have any questions, call us at Heights Pediatric Dentistry & Orthodontics, 713-861-4000!

Dr. Lindhorst, Dr. Darsey, Dr. Theriot and the Heights Pediatric Dentistry and Orthodontics Team

Positive Dental Experience for Kids

The dental office is a scary place for so many people. Part of our mission at Heights Pediatric Dentistry and Orthodontics is to ensure that our sweet patients never fear going to the dentist.

However, a child’s perception of the dentist is controlled largely by parents before we even have a chance to work our magic. We count on parents to be our partners instead of introducing preconceived fears. During our appointments we explain everything we do prior to initiating any treatment. We use words that accurately explain every step without instilling fear. We work hard with our little patients to prepare them for everything we will do, but if you want to do some preparations at home, here are some guidelines.

First and foremost, we think that the language we use to prepare the children for their appointment is crucial to their experience. Please avoid words such as shot, hurt, drill, or pull. Instead, we use the terms painting sleepy juice, tooth feeling different or having a pillow for a tooth nap, tooth whistle or tiny toothbrush, and wiggle out the tooth.

If your child is coming in for an exam and cleaning, please tell them that we are going to take some pictures of his or her teeth, and then we will brush and count the teeth.

If a filling or similar procedure needs to be done, please tell your child that we need to wash out the sugar bugs with a tiny toothbrush that sprinkles water. We will have them wear the “funny nose” to make them feel happy. We need to let the tooth take a nap by painting sleepy juice around it. It will feel like a pillow for the tooth and will go away after they get home. Finally, we will put a white star in the tooth and shine it up.

In case of an extraction, please tell your child that sleepy juice will be painted around that tooth; we will then wiggle the tooth out and place a band aid over it.

After dental treatment is done, try to be positive and reinforce how great your child did. Instead of asking “Did it hurt?” or “Was it bad?” please tell them “You did great! I’m so proud of you for being brave!” This will make them feel successful and confident.

Thank you for helping your children develop a positive attitude toward dentistry! We promise that it will pay off in the future and they will never “hate” the dentist. Should you have any questions, please don’t hesitate to call our office anytime.

If you have any questions, call us at Heights Pediatric Dentistry & Orthodontics, 713-861-4000!

Dr. Lindhorst, Dr. Darsey, Dr. Theriot and the Heights Pediatric Dentistry and Orthodontics Team