My fourteen year old son has not lost any of his baby molars yet. Is this normal? I thought a fourteen year old would not have any baby teeth left at all

When we talk about children losing baby or primary teeth we generally speak in relation to averages. The average age for losing primary molars is eleven to twelve years of age. Many children and adolescents will shed their primary molars earlier or later than this and there can be other contributing factors involved.
You may think that fourteen is an abnormal age to be in this position, but being in dental practice myself, I can assure you that this is not as uncommon as you may believe. I have seen many cases over the years with individuals where some of the permanent teeth do not develop at all. If this is the case, then the baby tooth that precedes it will not exfoliate when it is supposed to or maybe not ever. The four teeth that replace the primary molars are known as premolars (meaning before the molars) or bicuspids. It may be possible that your son has not developed some or all four of these permanent premolars under the primary molars. A dental x-ray (radiograph) will confirm whether or not this is the diagnosis. However, it is rare that all the premolars remain undeveloped, and if that is the case then maybe one or two is not present, but it is unlikely that the other two will be absent also, although not impossible.
If in fact these premolars are present, an x-ray will confirm that and also display the stage of development of these teeth. Permanent teeth will generally erupt when their roots are approximately two-thirds formed. If the permanent root development is slower, this will delay eruption.
On occasion primary teeth will not come out due to a condition known as alkalosis. Alkalosis is a dental situation in which the roots of primary teeth lose their
normal attachment to the bone (small ligaments) and become fused directly
to the bone. The cause of this is not known, but it is seen fairly often,
Particularly in lower primary molars. It is rumored that children who grind their teeth experience alkalosis most often. If this condition is present, the baby teeth practically become bonded into the jaw bone and it is very difficult or impossible for them to exfoliate on their own or even to be extracted by a dentist or oral surgeon. In this case the permanent teeth will never erupt until the preceding baby tooth is absent and they may, in the meantime, try a different path of eruption and end up in the wrong place.
If the x-ray exhibits a lack of permanent premolars, then I advise to maintain the primary molars for as long as possible. The reason for this is so that occlusion (bite) can remain stabilized until all other adult teeth have erupted and until all craniofacial growth is completed. If these baby molars cannot be maintained for a long period of time due to root desorption, decay, trauma or anything else, your dentist can explain to your son, all treatment options available for tooth replacement.
I have patients in my own practice that have retained primary molars and other teeth and some are into their fifties and sixties without a problem. So if this is the diagnosis, it is not?the end of the world?. There are many treatment modalities and options.

I would not jump to conclusions until an x-ray is completed. Most likely he is a bit behind schedule with his dental development. One trip to your dentist will undoubtedly answer your question and set your mind at ease.

The members of the Essex County Dental Society want to raise awareness about oral cancer and educate the public on methods of prevention and the importance of early detection. During Dental Health Month, I thought it would be appropriate if you could address this important issue. Dr. Andrea Silverman, President, Essex County Dental Society

Dental Health Month (aka Oral Health Month) is held every April and it represents a time that Canadians can all ?celebrate the smile?. This celebration has been in existence since the 1950?s when it was held on special weeks or days. The dental health month that we know today and celebrate throughout the month of April, developed in the 1980 as part of a dental awareness program.
Dental Health Month has been extremely successful in increasing public dental awareness and knowledge about all oral and dental related topics, including oral cancer. Dental health professionals and dental associations have been spreading the word and other information via advertising, contests, displays and numerous other special promotions. Our main goal here is to help teach Canadians to keep their oral health and teeth? Good for Life?.
I personally feel that there is no better evidence of good dental care than a lovely smile and no better evidence of good dental practices than people who are proud of their smiles! If dental health month could be celebrated my way, there would be dentists and their counterparts on every corner handing out toothbrushes tied to helium balloons with smiles on them. There would be airplanes flying banners that get everyone interested in their smile, and displays at the local malls and sport complexes with mountains of interesting and enthusiastic information. There may even be an interesting article in the local newspaper (ha).
Every smile is a winner whether it’s the smile on kid’s faces when they run in a playground, the smiles of parents and grandparents as they watch their children and grandchildren play, or the smile of a jockey on a winner.
I am extremely excited about Dental Health Month, but what interests me most is the possibility of the public becoming aware of their health. It?s all about raising awareness about health issues, a good time for ?spring cleaning?. Remember that oral health is directly linked to overall health. Nutrition and digestion for the entire body begins with the mouth. In simple terms, your mouth is a window to the rest of your health. Get your mouth and health in order. Your dentist is your partner in prevention and can see things that you can’t see and may even help diagnose things that you weren’t aware of.
The Ontario Dental Association says ?stick out your tongue at your dentist and it could save your life!? This is one of the main messages being delivered during Oral Health Month. Oral cancer is a very serious and often aggressive disease that commonly is asymptomatic. Go to your dentist for an oral cancer screening exam, especially if you are a smoker. This disease spreads very rapidly and kills more than a thousand Canadians every year and dentists are the health care providers that play the most critical role in detection, diagnosis and treatment. There are approximately three thousand cases diagnosed each year. Early detection is essential to dramatically increasing survival rates, and if you have oral cancer and if it is detected early, your dentist can save your life.
We hear a lot about cancer where we live, but it is not widely known that oral cancer has a greater mortality rate than both breast cancer and prostate cancer. The screening your dentist does is a quick, easy and painless way to ensure you have a healthy mouth. Dentists have the education, expertise and frequent opportunity, through regular checkups, to identify signs and symptoms of a wide range of medical conditions associated with the mouth. In other words, no other individual health care professional is in such a unique position to detect oral cancer or any other disease that shows signs in the mouth, and start the patients treatment and recovery process.
Do you have a sore on your lips or mouth that does not heal? A lump on the lip, mouth or throat? A white or red patch on the gums, tongue or lining of the mouth? Unusual bleeding, pain or numbness in the mouth? A sore throat that doesn’t go away, or a feeling that something is caught in your throat? Difficulty or pain with chewing or swallowing? Swelling of the jaw that causes dentures to fit poorly or become uncomfortable? A change in your voice and/or pain in the ear? Any of these are signs and symptoms that a problem may exist.
So stick out your tongue at your dentist and get a clean bill of dental health so we can see miles of smiles!

I have been hearing so much in the past couple of years about dental waterline contamination. What is all the talk about and do I have to worry about catching something when I go to the dentist?-Visitor JJ

There has been much more attention given to topics related to dental waterlines in the past few years than before and at times the media has gotten involved. Dentists and their staff use water in almost everything they do, including on their patients during dental treatment. Water passes through devices such as air/water syringes, high-speed hand pieces (drills), and ultrasonic teeth cleaners.
The possible problem that individuals are concerned about is that the thin lines that carry water to these instruments develop a biofilm inside as a result of colonization of bacteria. This is what the whole controversy is about.
Microscopic bacteria are naturally formed in most water systems, and when they group with fungi, a biofilm is formed. Biofilms can be defined as thin layers of naturally occurring water bacteria and fungi that establish themselves on nearly all surfaces of water delivery systems. When I say water delivery systems I am not only talking about dental waterlines but also about faucets, showers and other plumbing fixtures in your home. As a matter of fact, these bacteria often exist even if water is bottled or filtered.
There are many misinterpretations with respect to these biofilms. Exposure to them is part of the natural, daily contamination with germs that we encounter without a problem. We don’t even realize the actual exposure levels. There is no real scientific data relating illness to biofilms in dental water lines. The risk of obtaining an infection from dental waterlines is probably very low, although we don’t know for certain.
One?s ability to defend themselves from any daily exposure to common bacteria depends on their health status, especially the strength of their immune system. Those with HIV or AIDS, those receiving chemotherapy for cancer, or even severe diabetics are a few who have lowered immune systems. They are therefore more vulnerable to attack from these biofilms or any type of bacteria, even from colonized dental water lines. If you smoke, are a heavy drinker, are very young or very old, you are more at risk. My personal opinion is that you are exposed to fewer germs and bacteria in a dental office than in your everyday activities.
Most dentists are aware of the public concern about this topic and as a result they have installed systems on their dental units that allow them to filter and flush out all related waterlines on a daily basis with solutions that destroy these bacteria aggregations and thus decrease the chance of contamination. Also your dentist can run the drill before and after each use to flush out any bacteria. Some offices are even running their dental equipment off of independent water supplies other than city water. This is another attempt to keep bacteria to a minimum and I am sure it helps the overall problem.
People have been visiting dentists for decades and there has never really been any big controversies related to contaminated water lines but dentists today are taking necessary precautions anyway, just as they do with the rest of the modern sterilization procedures that they practice

My child is now eight years old and her teeth are already crowded. We asked our dentist when she should see an orthodontist for braces and he said twelve is a good age for most kids. Is this usually the age for braces and can they be put on earlier if we want and will braces work for an adult like myself? ? Jill in Lasalle, On

This question about your daughter is one that I entertain on a regular basis in my own practice. There really is no simple answer to that question because it is situation specific. If you notice a problem with your child’s teeth at any age, it is acceptable to have an orthodontic evaluation.
Common obvious problems may include but are not limited to crowded teeth and a distinctive overbite. Sometimes even if minor abnormalities exist, treatment won’t be needed or begin until adolescence. In general it is a good idea to have an orthodontist see your child around the age of seven. At this point in development, the first permanent molars are usually erupted and several other permanent teeth may have come in. The orthodontist can tell clinically and radio graphically whether problems may be developing or not.
Even if braces aren’t placed, the orthodontist often can make current treatment recommendations that will help the future situation. These immediate options could possibly decrease the amount of time that orthodontic appliances are going to be required for later and may also decrease the cost of treatment. The exact recommendations will vary from child to child, but a consultation around the age of seven or even eight is an excellent option and will also educate parents to a certain degree.
Problems that are very easy to correct at an earlier age, may require much more extensive treatment later if ignored and may be financially devastating also. I have even seen a child as young as four years old that required orthodontic intervention. Early detection may even help achieve a better end result especially due to the fact that corrections are easier while the jaws are still growing. After growth is completed, although not impossible, orthodontics is a more difficult task.
The thing to remember is that orthodontic problems are very difficult for a parent to recognize because they mostly do not cause pain. Basically you are not alerted if something is wrong. Orthodontists are experts in straightening teeth but in addition to that they are highly trained in understanding the concept of growth and development of the jaws, mouth and face. They know and understand how things should be.
I find that most young children do not end up needing treatment until approximately the age of twelve, but like previously stated, this age will vary. Problems to look for early on may include thumb sucking, front teeth that don’t meet when biting, protruded teeth, overlapping or crowded front teeth, or permanent teeth that aren’t coming in after the primary teeth have fallen out.
If you have any concerns, ask your dentist for a referral now just to get the facts. In answer to your question about yourself, you are never too old to get braces. Even though it is easier to do at young age, healthy teeth can be moved at any age!

It has been years since I have seen a dentist and one of my New Years resolutions is to start taking care of my teeth and going to the dentist because I don’t want to lose my teeth and end up with dentures. If I cannot get up enough courage to go, will I end up with dentures like my grandparents and what can I do at home to prevent this? -T.T.

If you travel back in time to when your grandparents were the age that you are now, most likely one or both of them were even wearing dentures at that time. You most likely even thought that was the way it was supposed to be and that at some point you would actually reach that juncture.
Well Tom, the good news on this New Year is that it is not true and that is not the way it has to be, unless you want it and I don’t think that is the case. The fact is that teeth can last a lifetime, as long as they are properly maintained. This is true even if genetics plays a role in your dental health, which it often does. The process can be as simple as following a healthy diet, practicing proper oral hygiene, accessing fluoride-related preventative products and making regular visits to your dentist.
Dentistry has changed significantly since our grandparents? and great-grandparents? day when dental treatment was comprised of two main modalities. Those options probably were ? fill or pull?. The main focus now is prevention and maintenance. Today we as dental practitioners focus not on the teeth alone, like in the past, but indirectly on everything related to the soft and hard tissues of the head and neck and to your overall health.
Before fluoride was available, dentists spent such large amounts of time filling and extracting teeth that there was no time for anything else. Patients didn’t even know the difference due to ignorance and indifference as a result of that lack of knowledge. Fluoride that was not available in water systems decades ago is now assisting us tremendously with respect to prevention and allowing dentists everywhere to spend time educating their patients and offering services that were never even heard of years ago. Services like cosmetic dentistry, dental implants and gum disease treatment are only a few of the ones I am referring to. Subsequently there are fewer individuals losing teeth to gum disease and therefore less wearing dentures.
As dentists we can’t take all the credit. A more knowledgeable public, one who understands the importance of good old brushing and flossing is the main contributing factor. As low-tech as these sounds, it is still the most advanced method of prevention.
As far as what you can start doing now right at home and after you see your dentist, begin by making sure that you always brush at least twice a day, after breakfast and before bed preferably. When buying a toothbrush, always purchase a soft or ultra-soft bristle type and direct the brush at a forty-five degree angle placing the bristles inside the cuff of the gum where it joins the tooth. Without too much force gently brush back and forth rolling up and out.
Brushing can remove plaque from three out of five surfaces of teeth, but proper flossing can clean the other two surfaces. Purchase a type that feels most comfortable to you, whether waxed or untaxed, flavored or not. Place it between your teeth against the tooth being flossed and slide it up and down against the side and just below the gum line to remove plaque.
Ask your dentist or hygienist about rubber-tipping to stimulate the gingival and about other methods of oral hygiene and irrigation. The fact is that teeth can last a lifetime, as long as they are properly maintained. Start the year out right with your dental health.

I recently visited my dentist and asked him about changing some of my old silver fillings, especially on the bottom. They are very large and aside from me not liking the way they look, he said some of them have new cavities starting around them. He recommended what he called inlays and onlays. What exactly are these and are they better than regular fillings?? Mary L.

When you have damage or decay to your teeth or are replacing old restorations that are large, an inlay or only may be an excellent choice. They are often used to restore teeth that are missing more than half of the natural tooth structure on the biting surface. What I mean is that in some situations, there is not an adequate amount of tooth to hold a filling with any degree of predictability and another avenue must be explored.
Sometimes a crown is recommended. This is a complete covering that can protect and strengthen your tooth. Many times it may not be necessary to use a restoration as advanced as a crown, so an only would be a better treatment option or a great alternative. So inlays and on lays are utilized mostly at times when the restoration is too large for a filling yet a crown is not required to support the tooth. They may actually increase the strength of a tooth.
Inlays and on lays are like large fillings that are made ?indirectly? outside of the mouth by a dental lab technician. The lab technician fabricates them from a mold or impression taken by your dentist. This is why they are called indirect restorations as opposed to fillings that are completed directly in the mouth. Fillings performed in one dental visit are known as direct restorations. Inlays and onlays usually take two appointments to be completed, but can take three if custom shading is further required. The final restoration has an ideal shape and contact with the adjacent tooth, and the occlusion or biting properties with opposing teeth are very accurate.
Any shrinkage of the inlay or onlay occurs in the lab and not in the mouth and is corrected in the bonding process to the tooth. This minimizes stress put on the tooth due to polymerization shrinkage from regular composite (white) fillings, and thus reduces the chance of postoperative sensitivity (usually temporary) to biting and temperature.
An inlay covers more of the inside part of a tooth, thus the name inlay. An onlay covers and fills some of the inside of the tooth but covers some of the outer part of the tooth also. It can replace one or more missing cusps of a tooth and is bonded on the tooth in addition to inside the natural clinical crown. Some dentists refer to an only as a partial crown. It is very helpful in restoring strength post-operatively if a tooth is structurally compromised from fracture or anything else.
Traditionally inlays and inlays’ were made of gold but today most individuals choose porcelain ceramic and resin materials. The tooth colored ceramic options are more popular and the fact that they are bonded in place as opposed to cemented, helps allow the procedure to restore strength close to that of the original virgin tooth.
If esthetics are a concern to you, porcelain inlays and on lays are a pleasing esthetic alternative and with toady’s technology can be made to look almost exactly like your natural tooth. The difference will be practically unnoticeable. If you choose this as a treatment option, you will no doubt have the good fortune of being satisfied!

I took my daughter to the doctor because her tongue is burning off and on and looks real abnormal at times. He said she probably has geographic tongue and that it is nothing to worry about. What is it and is he right?? JJJ.

Geographic Tongue is a very common condition of the tongue and probably a lot more common than you and your daughter realize. It is also known as ?benign migratory glossaries? or ?erythematic migrants?. It is relatively harmless and often it goes unnoticed because it is mostly asymptomatic.
Geographic Tongue usually appears as slightly depressed smooth (sometimes rough or crater-like) patches on the surface of the tongue. The outside border or outer edges of the tongue however are usually white in color. It is described as geographic due to the fact that the lesions appear like a map of an unknown country or like a bunch of islands. It has been reported to be more common in individuals with diabetes, psoriasis and that have deep fissures (grooves) in their tongue. If symptoms exist they usually manifest as a slight irritation or burning sensation that becomes exaggerated with spicy or hot foods. It sometimes even occurs in oral tissues other than the tongue.
We don’t really know what causes Geographic Tongue, but we do know that it appears in at least three percent of the population and is twice as often noticed in adult females than males or children. Histological studies describe an inflammation-like appearance, and it has been suggested that genetics may play a role in the etiology or cause.
Some affected patients have been found to have zinc deficiencies but any definitive cause is non-existing. Hormones may play a role because women taking oral contraceptives have the worst geographic tongue on day 17 of their cycle (British Dental Journal-Aug 1991). Stress seems to be a factor, for occurrence is greater at these times.
There is usually no loss of sense of taste or dexterity but increased loss of the tongues sense of touch has been noted. The appearance and common belief that infection exists, is what causes concern and leads affected individuals to seek treatment. It will disappear occasionally quickly and sometimes months later. Treatment is available if it is decreasing your daughter’s quality of life by way of certain steroids, usually topical. However, some of the stronger steroids may produce side effects that outweigh the benefits of the therapy. Treatment does not permanently cure this condition but provides significant improvement of symptoms. Her dentist should be able to provide you with information about treatment. Just be comfortable with the fact that Geographic Tongue is harmless and will resolve on it?s own after outbreaks, even without treatment.

I finally can afford to have a couple of dental implants put in my mouth to replace teeth lost twelve years ago. My dentist said that he is referring me to an oral surgeon for a bone graft and implant surgery. Why would I need a bone graft and what is it all about?? Bill in Walkersville

In the years following the extraction of teeth, bone in your jaws where the teeth previously existed tends to resort or shrink naturally. If you later want to place dental implants at these sites, it is often impossible without a graft of bone from somewhere else to re-establish what is missing. Basically you may now be, after twelve years, left with a situation where the quality and quantity of bone in those areas does not warrant implant placement.
The graft can increase the amount of bone in the area(s) and improve the shape of the alveolar jaw bone to make it more suitable. Also the chances of success for the titanium dental implants will rise. If there is not an adequate amount of healthy bone to support the implant, it may fail.
Bone grafting not only gives us the opportunity to place implants of proper width and length, but also allows an opportunity to restore esthetics and function. It is a surgical procedure that can sometimes be done right in the dental office, but it is most often completed by oral surgeons in their office or in a hospital setting.
Bone loss can also be caused from trauma, periodontal disease, infections or cysts. There are numerous techniques available today and there are several choices with respect to the bone graft material that can be utilized. The materials can basically be categorized into five different types.
The Auto graft (autogenously) is the most common and most successful. This involves transplanting bone from one site of your body to your jaw. The site the bone is taken from is usually called the donor site. On the other hand, the site that receives the graft is known as the recipient site. Usual donor sites are your chin or back areas of your jaw itself. If these are not sufficient, then larger amounts can be taken from the iliac crest of one of your hips or from your shin bone (tibia).
The Allograft (allergenic) is a graft between you and another individual. The source for this is usually cadaver bone. There are issues involved with this including thorough screening to prevent cross infection if diseases exist, but larger amounts of bone can easily be sought after.
The Xenograft is a tissue graft between two different species. An example would be getting bone from a monkey.
The Allopath involves the use of synthetic bone, not from humans or animals.
Lastly there are Growth Factors which are natural proteins found in our bodies that can be used to stimulate bone growth. These are known as BMP?S or bone morphogenic proteins. Their use is a potential future substitute for autogenous grafting, but they currently are not often utilized outside of clinical studies.
Your surgeon will select a bone grafting material base on your specific situation and will discuss all options with you.

I am a thirty-nine year old male. I recently visited my dentist for a routine check-up and cleaning and he discovered four wart-like growths on my tongue. He referred me to an oral surgeon to have them removed and sent for biopsy, but he thinks they are most likely genital warts. What are genital warts, how does someone get them, and how will the surgeon get rid of them?? M.S.

Genital warts are caused by a virus known as human papillovirus or HPV. This particular virus has more than one hundred variations and there a few that cause genital warts.
The most common way of attaining these warts from an infected individual is through direct skin-to-skin contact with an infected area. This is usually via oral, vaginal or anal sex.
There are commonly no symptoms associated with these growths and they sometimes don?t appear until months or even years after contact. Occasionally they cause itching, burning, pain and bleeding. It is even possible to never develop warts and still be infected.
Genital warts in the mouth typically appear as bumps or raised lesions that are cauliflower-like in appearance. They may also appear fleshy or even dark and are sometimes extremely difficult to recognize.
Genital strains of HPV can be spread to your mouth but it is not that common. You can transfer human papillomavirus from your mouth to your partners mouth or genitals at any time that the virus is present, even when you don’t have visible lesions yourself. The virus likes to live in warm and moist places because they are more conducive for growth. Also, a decreased immune system for either party can increase the risk of infection.
HPV can become dangerous. It is more common in women and is the most common cause of cervical cancer. This virus can also cause cancer in men. Eighty percent of all cervical cancers are caused by HPV.
Treatment can decrease the risk and occurrence of cancer. Modalities include surgical removal, freezing with liquid nitrogen, burning off or removal by laser. Some topical medications can help. Your physician, dentist and or oral surgeon will determine which treatment option is best for you. It will most likely consist of local anesthesia, surgical removal and biopsy testing. After removal, be sure that the lesions don’t recur and take action immediately if others develop

My wife has two teeth missing. They are the ones right next to the front teeth. They never developed and she has been wearing a removable plate with two teeth on it for the past twenty years. Is this common and what the best way to replace them is. -George in Tilsonburg.

What your wife has is known as congenitally missing teeth (lateral incisors). It means that these merely did not develop at all when they were supposed to, resulting in empty spaces where permanent teeth should have been. This is not as unusual as you may think. The most common teeth to be congenitally missing are lateral incisors (next to the two front teeth), second premolars (two teeth behind the canines or eye teeth), and the wisdom teeth.
Congenitally missing teeth can occur in two variations, hypodontia and oligodontia. Hypodontia is characterized by the absence of six or fewer permanent teeth, while oligodontia is characterized by the absence of more than six permanent teeth.
Spaces left by missing teeth affect the rest of your teeth. These gaps can cause chewing problems, along with esthetic problems. If even one tooth is missing, other teeth may slowly shift out of place. This can change the way your teeth fit together (your bite), depending on where the missing teeth are. A poor bite may make your jaw sore. Your teeth may become harder to clean, leading to tooth decay and gum disease. And shifting teeth may change your smile.

In your case the three most common ways of replacing these missing teeth are a removable partial like she presently has, a fixed bridge or with dental implants. Her partial most likely is a removable replacement prosthesis fabricated from all acrylic or a metal base with acrylic and teeth on it.
A fixed bridge is one or more replacement teeth attached to the natural teeth next to them. The bridge can only be removed by a dentist. A bridge can be made of metal, tooth-colored porcelain, or a combination of the two. Your dentist will suggest the best material for your mouth. There are two main types of bridges: conventional and Maryland. A conventional bridge has replacement teeth that are attached to crowns. The crowns are placed over the natural teeth on either side of the space to be filled. A Maryland bridge has replacement teeth that are attached to the back of nearby natural teeth using a metal strip. This type of bridge may be an option if the teeth next to the bridge are in good condition and if the biting forces where the teeth are placed are not too powerful.
Dental implants are the closest relative to natural teeth. They are permanent false teeth anchored right into your jawbone. A titanium post is threaded right into the bone and a process known as osseointegration takes place. This means that the bone migrates and grows directly into the threads of the implant and causes it to be firm in place over time. Later a tooth colored porcelain crown is placed on the implant. They are more stable than dentures, and you’ll be able to eat almost anything with ease and comfort. Many patients find implants give them a more positive self-image and more confidence. The entire process takes about six to seven months but can be completed in less time with some types of implants. Dental implant treatment does require a greater investment of time and money, but it can be well worth it.
In my opinion, implant restorations have become the most optimal kind of replacement for congenitally missing lateral incisors. The central incisor and canine or cusped often erupt in less than optimal positions adjacent to the open lateral incisor space, and therefore preprosthetic orthodontic treatment is frequently required. Space closure, derogation and correction of root proximities may be needed to ensure proper space for implants and their esthetics. Good Luck!