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Besides providing great patient treatment, great dentists learn to work on their businesses / practices and to provide vision, leadership and love.
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Just what makes you want to be a dentist, anyway?
Where do you find your motivation each day when you walk into your practice?
These are important questions to ask ourselves -- and to address as we progress through our careers.
Where do you find your motivation each day when you walk into your practice?
These are important questions to ask ourselves -- and to address as we progress through our careers.
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The problems of missing and ectopic second bicuspids
Severely ectopic LR5 had to be removed. © 2018
3 Facts for your consideration:
5 Things that can throw the system off:
Lower: the “c” exfoliates and the 3 erupts the “d” and “e” exfoliate about the same time and the 4 and 5 erupt without the 6-year molar having time to mesialize.
5 Things you do to reduce the risk of FIVEs not jiving. (Which will help provide better chance of the necessary factors above.)
- The “5’s”, or second bicuspids are statistically the third most-commonly congenitally anomalous teeth, misshapen, ectopic eruptive positions, and missing. (The first two are wisdom teeth and upper laterals.)
- The predecessor primary/baby tooth, the “e” tooth, is typically 2-3 or more mm wider mesio-distally than the 5’s.
5 Things that can throw the system off:
- Missing permanent 5’s.
- One or more bicuspids in poor developmental/eruptive position
- Eruption sequence out of order, so space is lost early, OR held too long by a primary tooth, most often the “e”.
- Ectopic position after eruption, often rotations, sometimes as much as 90∘
- There is no space for lower 12-year molar eruption, and 5’s are crowded out.
- Profile is protrusive, and if all teeth remain in the arch, the protrusion is unesthetic.
- All permanent teeth are present.
- All permanent teeth must be in relatively good eruptive position.
- The sequence of primary tooth exfoliation is ideally...
Lower: the “c” exfoliates and the 3 erupts the “d” and “e” exfoliate about the same time and the 4 and 5 erupt without the 6-year molar having time to mesialize.
5 Things you do to reduce the risk of FIVEs not jiving. (Which will help provide better chance of the necessary factors above.)
- Clear the path (extract primary teeth that are in the path)... as early as the panoramic demonstrates an ectopic trajectory is obvious... ascertain LLA (lower lingual arch, Nance or upper lingual arch)... is in place to avoid any mesialization of the 6 year molars (save the precious “e” space)
- Use a UAW (Utility Arch Wire) to create space
- If severely ectopic trajectory, removal may be needed at some point
- Utilize various orthodontic techniques to derotate a rotated bicuspid as soon as it erupts, before the interosseous and interdental fibers develop
- Include in a comprehensive orthodontic treatment plan, the removal of a bicuspid that will facilitate successful eruption and successful occlusion of other teeth, including the 12 year molars, or removal of bicuspids when it will facilitate the most beautiful profile.
No space for 7’s and protrusive profile: plan to extract L5’s. © 2018 Dr Chris Baker.
UAW’s to create arch length for 3,4,5’s. © 2018 Dr Chris Baker. All rights reserved.
Unerupted L5; parents don’t want to remove now; hope for eruption. Completed ortho, removed braces… 5 is holding bone for implant. © 2018 Dr Chris Baker
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Relationships are transformational for your dental practice. Deal with your patients with absolute love in your heart.
"If words come out of the heart, they will enter the heart. If they come from the tongue, they will not pass beyond the ears." - Suhrawardi
"If words come out of the heart, they will enter the heart. If they come from the tongue, they will not pass beyond the ears." - Suhrawardi
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Missing upper 2's, missing lower 5's, ectopic canines. © 2018 Dr Chris Baker
The Panoramic radiograph. You may be surprised to discover the amazing information you can find about a child patient in that x-ray. Can you name five really important findings in a panoramic on an early mixed dentition patient?
Can you name six? Seven? Let’s go for double that figure! (And we won’t include decay, as it’s not the best diagnostic tool of decay. Well, on second thought, maybe we will include some possible decay-related findings at the end of our discussion.)
The panoramic should be taken when any permanent teeth are erupting. Often those first eruptions are the lower incisors, or the six-year molars, but no matter what teeth, take the pano then. (You may find opportunity to change the child’s life because of the secrets that x-ray holds.)
Start by counting/identifying all teeth (Sounds pretty tame and familiar so far!) :
Here’s an important opportunity to do outstanding diagnosis for your patient, and be paid for your care. You’re in dentistry to care for people, and in business to make a living.
Can you name six? Seven? Let’s go for double that figure! (And we won’t include decay, as it’s not the best diagnostic tool of decay. Well, on second thought, maybe we will include some possible decay-related findings at the end of our discussion.)
The panoramic should be taken when any permanent teeth are erupting. Often those first eruptions are the lower incisors, or the six-year molars, but no matter what teeth, take the pano then. (You may find opportunity to change the child’s life because of the secrets that x-ray holds.)
Start by counting/identifying all teeth (Sounds pretty tame and familiar so far!) :
- Missing teeth. Count ‘em. Every single one. Be sure. Most often upper lateral incisors, and bicuspids, but maybe any incisor, any tooth actually. While severe “anodontia” is typically related to Ectodermal Dysplasia, and other developmental disorders, any permanent tooth can be missing even without identifiable developmental disorders "with names.”
- Extra teeth. Supernumerary teeth can be anywhere. One of my patients had one that looked like a canine, but about the size of a primary canine, in the floor of the nose, over the bicuspid root area.
- Malformed and unusual teeth. While ectopic and unusual trajectories of eruptive paths can cause dilacerations, there may be malformed crowns as well. Note any taurodontic primary molars that may hinder exfoliation, dilacerated roots that may hinder eruption, or if the dilacerated root is next to a missing tooth space, it could prevent implant later. Notice now. Notice incisors with talon lingual cusps/dens evaginates, and shovel-shaped incisors with scooped out lingual surfaces which may be more at risk of decay at the cuspal interfaces, and may create occlusal issues in contact with the lower incisors.
- Variations in sizes of teeth. Notice particularly large lateral incisors as well as peg or small laterals which may also interfere with occlusal harmony.
- Fused or possibly fused teeth; or geminated teeth.
- Ectopic teeth positions, which can portend huge difficulties in getting the teeth into the arch later, or even contribute to transpositions of teeth, and certainly to extended orthodontic treatment. If normal eruption does not occur, ectopic teeth may need to be orthodontically moved over larger than normal distances, and past other tooth roots. This predisposes both the ectopic teeth as well as the teeth in the path of the movement to potential damage, including root resorption, loss of vitality, alveolar bone loss and gingival and per problems, and some ankylose,
- Stage of exfoliation and eruption
- Poorly resorbing roots on primary teeth - is it due to ectopic position of succedaneous permanent tooth? Is the permanent successor missing?
- Submerged primary molars - actually probably due to an ankylosis or other failure of the tooth to undergo normal eruptive growth with the adjacent teeth.
- Crowding. Eruption issues to come. Opportunity to clear the path of eruption and prevent more complex problems and need for extended treatments.
- Third molar positions. While not usually evident in the earliest mixed dentition panoramic x-ray, often are notable within a year or two. Horizontal and severe ectopic positions may affect the eruption of the twelve year molars, and should be monitored for need for early removal to allow eruption of the twelve year molars.
- Twelve year molars that do not have the space to erupt in the mandible. As human jaws get smaller, and teeth do not, we are seeing more 12 year molars that will never be able to clear the mandibular ramus, like many third molars. Not frequent, but more and more so.
- Class II or III occlusion (at least as screening, to be evaluated further.)
- Atypical incisive papilla alveolar bone area. Again, screening, to be confirmed with diastema, low and deep pull frenum, etc.
Here’s an important opportunity to do outstanding diagnosis for your patient, and be paid for your care. You’re in dentistry to care for people, and in business to make a living.
Missing LL5, and severely ectopic LR 5, which had to be removed. © 2018 Dr Chris Baker
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Using the right systems is the "secret sauce" to successfully implement an orthodontic program in a general or pediatric dental practice.
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The best treatment of the patient, doctor, is still YOUR responsibility.
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Sometimes effective child patient management is not 'politically correct.'
Let me explain...
Let me explain...
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You’ve undoubtedly heard the question, “Doctor, what can we do about her bad breath?”
Jenny’s mom asked me that question a worried look on her face. “I’ve talked to the pediatrician, and nothing is wrong. But, she is being teased about it, and we notice it at home too. Can you help us?”
And you’ve undoubtedly run through the conventional wisdom of telling them to check with their pediatrician or doctor about any upper airway infections, congestion, allergies, and about any GI tract illness, including GERD -- and be sure they brush and floss well every day.
Past that, you have suggested mouthwash. Maybe.
Mouthwash? Not. A. Good. Idea... because many-to-most mouthwashes have alcohol which dries the oral cavity and may worsen the situation. Of course there are products created for just this situation, the 'BB' (Bad Breath) that embarrasses the patient and/or parents. Those may work, though are often expensive and do not get to the etiology of the problem.
About 25% of the population has chronic BB, apparently not related to the above etiologies. A study of Army recruits found that only 17% did NOT have halitosis.
What could be the reason for BB?
Once you have ruled out the respiratory tract and GI tract (including gingivitis/perio disease) as sources, and the patient’s medical reports do not show other systemic diseases or challenges, the etiology is… GET READY…FOR…IT…
PROBABLY… an unhealthy and highly pathogenic MICROBIOME.
Bad bugs in the gut.
BB (Bad Breath) is caused by BB (bad bugs).
The trillions of microbes we call the microbiome is the community of coexisting microorganisms found in and on the human body. According to studies, the number of microbes is actually from three to ten times the number of cells in the human body. This includes the red blood cells, which are about 25 trillion, or 84% of the total cells of the body.
These microbes include bacteria, fungi and viruses (as well as other simple organisms called archaea and protists (algae and amoebae), that coexist with body cells. They are crucial for the immune system, and for hormonal and metabolic balance. Many are necessary “good bugs” that work with the body for health.
Some are not good. These are the BB (bad bugs), and have been implicated in cardiovascular diseases, cancer, infections, diabetes, Alzheimer’s, even obesity and other serious illnesses.
Everyone routinely carries some pathogens or “bad bugs.” In healthy people, they co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers.
It hasn’t helped that we have become so “germ-conscious” that we’ve overdone it to the point of killing the “good bugs”, and letting the “bad bugs” overgrow. We use anti-bacterial soaps, and disinfecting wipes and lotions. Often more quickly able to "bounce back" from such an attack, the bad bugs have a heyday.
Additionally, nutrition and diet are critical parts of the body’s interaction with its environment, as frequent snacking and high carbohydrates and sugars help the pathogens overtake the friendly microbes.
When out of balance, one of the possible results in a human body is BB - halitosis.
Balancing and restoring the microbiome has the potential to make us much more healthy.
Start with probiotics, the supplemental “good bugs” that are packaged in liquid, capsule and chewable forms. In fact, for the patient with BB, the chewable can be fantastic.
Encourage the patient to reduce the intake of sugars and carbohydrates, on which the “bad bugs” feed, and to chew up three or four probiotic tablets a day. One brand is American Health Chewable tablets, and available on Amazon as well as at many health food stores.
It works! Amazing when we get to the etiology of the problem!
Jenny’s mom reports that she no longer has any problem with BB, now that she is limiting sugar and carbs and using Probiotics. She’s a happy girl! Likewise, no BB for my daughter, one of my assistants and a colleague, all of whom have successfully addressed their microbiome.
Got BB? Get Probiotics!
Jenny’s mom asked me that question a worried look on her face. “I’ve talked to the pediatrician, and nothing is wrong. But, she is being teased about it, and we notice it at home too. Can you help us?”
And you’ve undoubtedly run through the conventional wisdom of telling them to check with their pediatrician or doctor about any upper airway infections, congestion, allergies, and about any GI tract illness, including GERD -- and be sure they brush and floss well every day.
Past that, you have suggested mouthwash. Maybe.
Mouthwash? Not. A. Good. Idea... because many-to-most mouthwashes have alcohol which dries the oral cavity and may worsen the situation. Of course there are products created for just this situation, the 'BB' (Bad Breath) that embarrasses the patient and/or parents. Those may work, though are often expensive and do not get to the etiology of the problem.
About 25% of the population has chronic BB, apparently not related to the above etiologies. A study of Army recruits found that only 17% did NOT have halitosis.
What could be the reason for BB?
Once you have ruled out the respiratory tract and GI tract (including gingivitis/perio disease) as sources, and the patient’s medical reports do not show other systemic diseases or challenges, the etiology is… GET READY…FOR…IT…
PROBABLY… an unhealthy and highly pathogenic MICROBIOME.
Bad bugs in the gut.
BB (Bad Breath) is caused by BB (bad bugs).
The trillions of microbes we call the microbiome is the community of coexisting microorganisms found in and on the human body. According to studies, the number of microbes is actually from three to ten times the number of cells in the human body. This includes the red blood cells, which are about 25 trillion, or 84% of the total cells of the body.
These microbes include bacteria, fungi and viruses (as well as other simple organisms called archaea and protists (algae and amoebae), that coexist with body cells. They are crucial for the immune system, and for hormonal and metabolic balance. Many are necessary “good bugs” that work with the body for health.
Some are not good. These are the BB (bad bugs), and have been implicated in cardiovascular diseases, cancer, infections, diabetes, Alzheimer’s, even obesity and other serious illnesses.
Everyone routinely carries some pathogens or “bad bugs.” In healthy people, they co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers.
It hasn’t helped that we have become so “germ-conscious” that we’ve overdone it to the point of killing the “good bugs”, and letting the “bad bugs” overgrow. We use anti-bacterial soaps, and disinfecting wipes and lotions. Often more quickly able to "bounce back" from such an attack, the bad bugs have a heyday.
Additionally, nutrition and diet are critical parts of the body’s interaction with its environment, as frequent snacking and high carbohydrates and sugars help the pathogens overtake the friendly microbes.
When out of balance, one of the possible results in a human body is BB - halitosis.
Balancing and restoring the microbiome has the potential to make us much more healthy.
Start with probiotics, the supplemental “good bugs” that are packaged in liquid, capsule and chewable forms. In fact, for the patient with BB, the chewable can be fantastic.
Encourage the patient to reduce the intake of sugars and carbohydrates, on which the “bad bugs” feed, and to chew up three or four probiotic tablets a day. One brand is American Health Chewable tablets, and available on Amazon as well as at many health food stores.
It works! Amazing when we get to the etiology of the problem!
Jenny’s mom reports that she no longer has any problem with BB, now that she is limiting sugar and carbs and using Probiotics. She’s a happy girl! Likewise, no BB for my daughter, one of my assistants and a colleague, all of whom have successfully addressed their microbiome.
Got BB? Get Probiotics!
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One of the great myths believed by some pediatric dentists is that they need to avoid extracting baby teeth whenever possible.
