Altered Passive Eruption: Hard Tissue

Teeth are composed of two basic, visible parts—the root portion and the crown (enamel-covered) portion. The term crown does not refer to the type of tooth replacement fabricated by a dental laboratory. Rather, it is the part of the tooth that is normally seen when you speak.

The present-day esthetic dental philosophy, demonstrated by people who have beautiful teeth and smiles, shows that there must be a certain amount of enamel-covered tooth visible for an attractive smile. The ratio is about 1.6:1, length to width. Teeth that are shorter than this look progressively less attractive. They look short and stubby. If they are actually worn down from a clenching or grinding problem, this is a different type of problem. But it may not be that the teeth themselves are too short. It could be that there is not enough of the crown of the tooth that can be seen. The remainder that should be seen is covered with gum or gum and bone tissue. This is known as altered passive eruption. It is not entirely clear why this happens. It may become obvious as early as age 14. The teeth may have a pleasing color and be very straight, but they still leave something to be desired because they are too small and too much gum shows when you smile.

This can be a severe cosmetic problem when coupled with the type of lip line that frames the teeth. A low lip line will probably hide most or all of the gum covered part of the tooth, so there is less of a need to correct the defect. A medium or high lip line, especially a high lip line, will show all of the tooth and gum. As the lip line gets higher, the attractiveness of the smile goes down. The situation can be so severe that the patient will train his or her muscles to artificially hold the upper lip stiff or cover the mouth with a hand when smiling. In this way, the short teeth or the great expanse of gum tissue will be hidden from view. It can cause significant psychological problems.

The solution can be easy or complicated, depending on the exact nature of the problem. If there is only a small amount of gum tissue to be removed from a single tooth or multiple teeth, and there is a medium lip line, then the tissue is easily removed with a laser or electrosurgical cutting device. Scalpels and stitches are not needed in small cases. As more gum must be removed and more tooth is exposed, there may be some underlying bone that must be reshaped. Bone removal will be followed, about 2 months later, by the soft tissue removal mentioned earlier. The first surgery must heal long enough for the tissue to reach its final position before the second can be completed. Remember, you are looking at differences of several millimeters to a fraction of a millimeter that will cause the case to be a success or failure. A two-step procedure is better than a one-step procedure.

The biting edges (enamel and/or dentin) of one or more teeth may be reshaped if there is a need not only to lengthen the teeth but also to make it appear that they have actually been placed higher in the smile line. This is for top teeth, of course. If a great deal of tooth must be reshaped to accomplish the desired effect, root or dentin may be exposed, making the tooth sensitive. These teeth will need to be covered with porcelain veneers or crowns to achieve the proper esthetics. Even if only a little amount of tooth is reshaped, the veneers or crowns may be indicated to get the exact appearance you want. We will discuss this with you before you begin treatment. It is important that you know what is being done, how long it will take to complete, and what you will look like when it is finished,

We will make the veneers or crowns and reshape the teeth. We will determine what can be done. We may also do the soft tissue contouring. This is most common. For procedures that involve a reshaping of the bone, you may be referred to our periodontist. Since we will do the restorative treatment, we know exactly where the soft tissue should be. We are the cosmetic specialists. We will establish the final position of the gum line. In extreme cases, the problem will be corrected with a combination of the above-mentioned procedures and orthognathic surgery to reposition the jawbone and teeth. This can be done by our oral surgeon. With a comprehensive examination, we can tell you what is appropriate for you. You do not have to live with an unattractive smile because you have short-looking teeth due to showing too much gum tissue. These problems can be corrected. Let us know what you do not like about your smile or teeth. More than likely, the smile you now have can be made into something you will like to show off.

If you have any questions about altered passive eruption, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Dental Detectives: What Fossil Teeth Reveal About Ancestral Human Diets

When scientists want to know what our ancient ancestors ate, they can look at a few things: fossilized animal bones with marks from tools used to butcher and cut them; fossilized poop; and teeth. The first two can tell us a lot, but they're hard to come by in the fossil record. Thankfully, there are a lot of teeth to fill in the gaps.
"They preserve really well," explains Debbie Guatelli-Steinberg, a dental anthropologist at Ohio State University. "It's kind of convenient because teeth hold so much information."
The structure of a tooth and even the amount of enamel, for example, hint at what the teeth are adapted to eat.
Look at molars: Thick enamel on a molar is good for crushing foods. It suggests an animal used its teeth to grind seeds or crush the marrow out of bones. Thin enamel on a molar, while delicate, causes sharp edges — perfect for slicing and tearing foods like leaves and fruits.
However, these are just clues to some of the things the animal could have been eating, not what it ate every day, says Peter Ungar, an anthropologist at the University of Arkansas.

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"If you eat Jell-O almost every day of the year, but sometimes you need to eat rocks ... you want teeth that can eat rocks," he explains. So, teeth are usually adapted for the toughest component of an animal's diet, not what it eats on a daily basis.
To see what an animal was actually eating, Ungar studies something called dental microwear, the marks left behind by food on teeth. As we chew on say, a celery stick, hard particles — either bits of silica from the plants' cells or sand and grit from the surrounding environment — are dragged across and pressed into our teeth. When we chomp down on something hard, like a nut, the crushing force leaves microscopic pits behind. When we tear through tough grasses — which may not sound appetizing now, but it's likely some of our ancestors did eat them — by moving our teeth side-to-side, the teeth get tiny, microscopic scratches.
"I call it a foodprint," Ungar says.
These foodprints can paint a pretty good picture of what an animal ate in the weeks leading up to its death — a sort of last meal. A study of such microwear revealed that Australopithecus afarensis, our 4 million-year-old ancestor best known by the famous fossil of Lucy, probably ate tough grasses and leaves. And it looks like early members of our genus, Homo — like Homo habilis, which lived 2.4 million years ago or Homo erectus, which even overlapped with humans about 100,000 years ago — were omnivores like us. They ate a variety of foods like meat, plants, fruits, "Anything they wanted!" says Ungar.
So we can tell what an animal was adapted to eat and what it ate shortly before it died. But to know what it ate for longer periods, scientists have to look deeper — to just below the surface of a tooth — for certain molecular signatures left behind from daily meals.
As our teeth grow in early childhood and adolescence, they incorporate certain molecules from the food we eat. The same was true for our ancestors. Paleoanthropologists studying ancient diets are especially interested in carbon molecules in our ancestors' teeth, because they come from plants and stick around for a long time.
Some groups of plants use mostly one form, or isotope, of carbon. Plants with C3 isotopes are usually found in fruits and leaves — things that grow in forests. Plants with C4 isotopes, like grasses and sedges, grow in savannas.
Data from isotopes confirmed that Lucy's species switched from forest foods to savanna foods about 3.5 million years ago. That transition from forests to grasslands may have played a key role in human evolution, explains Matt Sponheimer, a paleoanthropologist at the University of Colorado, Boulder. Some researchers even think that adding more grass to our diets gave our ancestors more foods to eat and places to live as the early climate changed causing Africa's forests to shrink.
Our understanding of what our ancestors ate has become more complex and richer with time, as scientists have applied newer, more advanced techniques to study teeth. When Mary Leakey dug the 2 million-year-old human ancestor Paranthropus boisei out of Olduvai Gorge in Tanzania in 1959 year, she noticed the fossil's wide, thick molars. The skull had huge cheekbones to accommodate strong chewing muscles and powerful jaws, suggesting the species was well-suited for crushing nuts. So, Paranthropus boisei was nicknamed Nutcracker Man.
But when Peter Ungar and others examined Nutcracker Man's teeth, they barely found any foodprints, so they decided he likely ate soft foods like fruits.

An analysis of Nutcracker Man's tooth isotopes revealed C4 carbon, which comes from savannas, not fruit-filled forests.
Today, researchers think that Paranthropus boisei ate a varied diet with lots of different foods, but he mostly ate tough grasses and sedges.

Teeth from more recent fossils reveal more because they have more isotopes preserved in them. For example, the nitrogen in the teeth of Neanderthals can reveal whether the protein they ate came from plants or animals. It's one of many reasons researchers think Neanderthals hunted large mammals, though scientists have also found fossilized plants stuck in Neanderthal teeth.
Researchers were even able to use isotopes to find out when one Neanderthal started weaning her baby. As teeth grow, they lay down layers of enamel. And barium, a molecule children get from breast feeding mothers, builds up in baby teeth until the mother stops nursing. By comparing barium in a Neanderthal tooth with levels in donated present day baby teeth, the scientists were able to find out that the Neanderthal baby had been weaned at about seven months.
We can even use teeth to tell if someone moved between places with dramatically different foods or soils. Since wisdom teeth are the last adult teeth to come in, comparing them to an early emerging canine tooth can give scientists a dietary snapshot across time. Say someone was born in Africa and moved to a new continent as a preteen, while wisdom teeth were still growing. A comparison of the isotopes in the teeth would reveal the story of that migration.
There's still a lot to learn from teeth, and a lot of fossil teeth still being discovered, says Sponheimer. And as the tools to study them get more sophisticated, teeth are providing a richer picture of "who we are and how we came to be," he says.

By: Erin Ross, NPR
http://www.npr.org/sections/thesalt/2016/10/25/497094756/dental-detectives-what-fossil-teeth-reveal-about-ancestral-human-diets

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Dental Sealants Prevent Cavities and More Kids Need Them, CDC Says

There's a quick and easy way to prevent 80 percent of cavities, but most kids don't get it, federal health officials said Tuesday. The treatment, dental sealants, works well, but only 60 percent of kids who need sealants get them, the Centers for Disease Control and Prevention says.

                       

    

Dentist inspecting boys mouth before treatment. Universal Images Group / UIG via Getty Images

One good solution: doing it at school. But states often lack the funding to pay for such programs, and often bureaucratic requirements about having dentists on site can hold them up, also, the CDC said.

"Many children with untreated cavities will have difficulty eating, speaking, and learning," said CDC director Dr. Tom Frieden.

"Dental sealants can be an effective and inexpensive way to prevent cavities, yet only one in three low-income children currently receive them. School-based sealant programs are an effective way to get sealants to children."
The CDC says that 20 percent of kids and teenagers have untreated dental decay by the time they are 19. Kids with constant toothaches cannot eat properly and have trouble paying attention at school.

Related: Do Kids Need Dental Sealants?

Even though they are endorsed by the CDC and the American Dental Association, only 43 percent of 6- to 11-year-old children have a dental sealant, federal surveys show.

"Low-income children were 20 percent less likely to have sealants than higher-income children," the CDC's Susan Griffin and colleagues wrote in a report released Tuesday.                    

"School-age children without sealants have almost three times more cavities than children with sealants," the CDC added.

"Applying sealants in school-based programs to the nearly 7 million low-income children who don't have them could save up to $300 million in dental treatment costs."

That's because a filling costs more. In addition, once a tooth has been drilled to put in a filling, it's never as stable again.
But many states struggle to pay for such programs, the CDC team found.

"Federal funding of state oral health programs is largely com­petitive and varies widely by state," they wrote. "Many state and local school-based sealant programs cover part of their expenses by Medicaid billing."

And Medicaid, the joint state-federal health insurance plan for children and low-income people, is already badly stretched in most states.
One big expense is paying a dentist to oversee the program, the CDC found. One solution: Allow lower-paid professionals to administer sealant programs. At least one state has already done so.

"For example, in South Carolina, school-based sealant programs managed and staffed by dental hygienists deliver sealants in approximately 40 percent of high-need schools," Griffin and colleagues wrote.

"CDC currently provides funding to 21 state public health departments to coordinate and implement school-based and school-linked sealant programs that target low-income children and those who live in rural settings," the agency added.

It said the federal government plans to do more. It will classify pediatric dental services as an essential health benefit to be covered by dental insurance as part of the Affordable Care Act, for instance, and match state Medicaid and CHIP costs for sealants.
The sealants are plastic-based coatings that get into the cracks and crannies of molar teeth, stopping food and bacteria from starting the chemical reaction that leads to cavities.
 Studies show they are safe and stop tooth decay, even when they are layered over an existing pre-cavity.

"Studies on sealant effectiveness indicate that sealants delivered in clinical or school settings prevent about 81 percent of decay at two years after placement, 50 percent at four years, and can continue to be effective for up to nine years through adolescence," the CDC said.

"Sealants delivered in clinical or school settings prevent about 81 percent of decay at two years after placement."

 The American Dental Association (ADA) agrees, and says many people don't know that dental insurance often pays for them.

"Dental sealants are one-third the cost of a filling, so their use can save patients, families, and states money," the Pew Charitable Trusts, an independent, public service-oriented nonprofit, says in a statement. "Sealant programs based in schools are an optimal way to reach children — especially low-income children who have trouble accessing dental care."
 One worry that parents may have is about BPA, a chemical found in the sealants that is increasingly linked with health risks. The ADA says the benefits of sealants far outweigh any perceived risk.

"The potential amount of BPA patients could be exposed to when receiving sealants is minuscule, and it's less than the amount a person receives from breathing air or handling a receipt," the ADA says.

By: Maggie Fox, NBC News
http://www.nbcnews.com/health/kids-health/dental-sealants-prevent-cavities-more-kids-need-them-cdc-says-n668266

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Doctors, Dentists Seek New Ways to Reach Millennial Patients

Kate Morgan, 25, hasn't seen a doctor for a checkup since before she went to college, when she saw her pediatrician at age 18.

"Nothing's bothering me, I don't have any symptoms, why go see a doctor?" reasoned Morgan, who recently moved from Voorhees, N.J. to Hummelstown, Pa. When she has needed medical care, she either went to the emergency department or visited an urgent care clinic.
For now she has insurance under her dad's policy, but that's ending with her 26th birthday next week. She works multiple part-time jobs, so she can't get employer-based insurance.

"I have no idea how the health insurance marketplace works or if I can afford it," she said. "I haven't looked into it because it's kind of daunting."
Morgan is not alone. According to the 2015 Investing in the Health and Well-Being of Young Adults report, only 55 percent of Americans ages 18 to 25 visited a doctor's office in 2009 and only 34 percent visited a dentist.
There are lots of reasons: feeling invincible, difficulty navigating the health care system, concerns about costs and co-pays, and the inconvenience of making an appointment and seeing a doctor or dentist. Under the Affordable Care America Act (also known as Obamacare), everyone who can afford it is legally obligated to get health insurance or pay a penalty. One of the main reasons some major insurers have cited for leaving the exchanges is the lack of young, healthy people signing up, leaving the exchanges full of older and less healthy people who cost more to cover.

 

How often

How often a person should get a physical exam depends on whom you ask, said Janice Hillman, an adolescent-medicine physician at Penn Medicine.
"A medical provider will say once a year for an annual physical," she said. "But if you ask insurance, they'll say 18-34 year olds are your ideal patient population because they're never sick, so well-checks should be every two years and three years with some insurance plans."
But it's about more than an insurance quagmire. The millennials (19-35 year-olds) are a lost generation for health care, Hillman said. They hate to, as they see it, waste time and money; they don't place as much store as their elders on having a personal relationships with a provider; and they go to the internet for answers. When they do get sick, they choose retail clinics and emergency rooms for the convenience.
"Most millennials cannot believe that our outdated, inefficient system says, 'You're sick today, come in two weeks when I have an appointment for you,'" Hillman said. "So they go where they can be seen at the time and place of their choosing."
The health care system is taking notice. Online apps such as DocASAP and Zocdoc; telemedicine, where doctors work with patients via phone and web; and an increase in physician assistants who can examine, diagnose and treat patients, are gaining popularity. ERs are developing parallel tracks so they can accommodate true emergencies as well as patients who use the ER as a primary care office. Many doctors and hospital systems are communicating with patients through text messages, the favorite tool of the tech-savvy generation.

"The millennials want efficiency, value, to be treated with respect, and customer service, and we have to listen," said Hillman.

 

Pediatrician

For some young adults, that means sticking with their pediatrician. The National Ambulatory Medical Care Survey analysis estimates that there were 700,000 visits to pediatricians by 19-28 year olds in 2002, 1.4 million in 2007 and 2.4 million in 2012.
The fact that they are seeing any doctor is good news, said Patience White, director at the Center for Health Care Transition Improvement, a group that studies the transition from pediatric to adult health care.
Karly O'Toole, 24, doesn't feel regular checkups are worth the trouble. "The doctor that I had is in West Chester and it's not easy to get there," said the Center City resident. An account executive still on her parents' insurance, she doesn't want to take time off from work or lay out the co-pay.
"It's more of a chore to me than it is a benefit. If I'm feeling okay, I don't feel the need to get a checkup."
O'Toole does see a specialist for a recurring heart issue and sees the gynecologist for birth control. But for anything else she'll consult her mom or the pharmacist, and if necessary, go to an urgent care facility. She eschews dentists.
Dental care recommendations include a cleaning every six months, four basic x-rays once a year and a full set of x-rays every four to five years, said dentist Jeff Cabot, owner of Queen Village Family Dentistry. But there's an obvious gap in the millennial age group, he said.
"Dentistry is best done on a routine basis," he said, noting that by the time there's pain, what could have been a simple filling might turn into a root canal or crown - or even systemic health problems.
"Gum disease increases your risk for heart disease, diabetes, low-birth-weight babies of pregnant mothers, and there's a connection with Alzheimer's disease because it's literally an infection that can travel through your entire body," he said.
Cabot chalks up the reluctance to young people feeling invincible, and also fear of the cost of dentistry.

"A lot of people think it's expensive but if you do it properly it can actually reduce your overall costs," he said.
That's what happened to Morgan. Though she was cavity-prone as a kid, until last year, she hadn't seen a dentist in seven years. When she finally did go, she needed extensive work. "Now I go regularly and am very much committed to dental care," she said.
"But I've yet to do the same with regular health care."

By: Terri Akman
http://www.philly.com/philly/health/20160918_Doctors__dentists_seek_new_ways_to_reach_millennial_patients.html

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Smile (Lip) Line

What is the lip line?
How many teeth you show when you smile or speak and how much of each tooth (length) is displayed when you smile broadly, or (at the opposite end of the spectrum) when your lips are at rest, are functions of where your upper lip attaches to your face and how old you are.

3 classifications

There are 3 classifications of "lip line" that dentists use - low, medium, and high. 

A low lip line is one in which very little of your teeth are visible when you talk or smile. Someone with a low lip line will show, at the most, a millimeter or two of the edge of the biting edge of the tooth. 

A medium lip line will allow most of the tooth, up to and including a millimeter or two of the gum tissue, to be visible. 

A person with a high lip line will show all the top front teeth and a significant amount of gum tissue when speaking or smiling.

High Lip Line

Changing your lip line
Dentists (and plastic surgeons) have not been very successful in surgically changing the low, medium, or high lip line. There are some dental "tricks" that can be used in limited situations to reduce the amount of gum display evident with a high smile line. Most of the corrective procedures to improve the esthetics of the situation require significant investments of both time and money. Periodontal (gum) surgery, alone or in conjunction with porcelain veneers or ceramic crowns, is more likely. In extreme cases the only option may be to surgically reposition the entire maxilla (with or without orthodontics). Conversely, the appearance of showing no teeth when talking or smiling is regarded as one associated with advanced aging.

There is another component to how much of your teeth show when your lips are at rest, and it has to do with gravity and time. Your face and lips are composed of soft tissue that is under a constant gravity challenge. Gravity always wins, given enough time. There skin and subskin tissues drop over the years. If, with your lips at rest, you showed about 3 mm of the biting edges of the top two front teeth when you were 20 years old, by the time you are 40, you may show only 2 mm of edge. Someone 50 years of age would show 1 mm, and at 60 years, maybe no tooth is seen when the lips are at rest. The tissues of the human face will drop about 1 mm every 10 years, beginning around age 40. As the facial tissues lose elasticity, they slowly drop. Obviously, some lucky people have better genetics and their faces will stay tighter and the tissue drop will be slower. Correcting the age-related facial tissue drop can be done with plastic surgery - the common face lift.

High, medium. and low lip lines

Genetics or Gravity? 
If you are reading this, then you have either asked questions about your smile and lip line or this issue has been addressed in the broader context of cosmetic dentistry procedures you require. After a thorough examination, we will explain what situation you have and what corrective measures are possible.

If you have any questions about your smile line, please feel free to call our office for a consultation at 512-250-5012.