A few months into wearing braces you may notice your gums are swollen. It's likely you've developed periodontal (gum) disease.

Gum disease is a bacterial infection that usually begins with dental plaque. This thin, accumulated biofilm on teeth is filled with bacteria that cause dental disease. The more of it that remains on your teeth, the higher your risk for a gum infection.

In addition to regular dental cleanings, the best way for a person to reduce their gum disease risk is to remove plaque on a daily basis through brushing and flossing. Unfortunately, wearing braces complicates this: The brackets and wires affixed to your teeth can get in the way of your toothbrush and regular dental floss. As a result, you can easily miss plaque hidden around these bits of hardware.

Aside from gum disease, the braces themselves can irritate your gums. This irritation inflames the gums and may even cause more tissue to grow. Compound this overgrowth with a possible gum infection and it's no wonder your gums are severely swollen.

To lessen the chances of swollen gums with braces, you'll need to beef up your daily hygiene efforts. Simply put, it will typically take more time than normal to thoroughly clean around your braces. A few specialized tools, though, might make it easier.

An interproximal brush with a narrower head than a regular toothbrush is useful for accessing tight places around brackets. And a floss threader or a water flosser (which uses pressurized water to loosen and remove plaque) may help you better maneuver around wires to remove plaque between teeth.

Keeping your teeth clean as possible will certainly help you avoid gum swelling due to disease. But swelling from tissue overgrowth may not be resolved until your braces come off. In severe cases, it may even be necessary to remove the braces to treat the gums before resuming orthodontic treatment.

In any case, be as thorough as possible with your oral hygiene efforts during orthodontics and see your regular dentist for cleanings every six months. When you have completed orthodontic treatment, cleanings every six months are usually recommended. It's the best way to keep your gums healthy while you're wearing braces.

If you would like more information on dental care while wearing braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gum Swelling During Orthodontics.”

Once consigned to an extraordinary divine intervention, the term "miracle" is often used today for anything out of the ordinary. But even if the usage has become a little worn, there are things that, though not of supernatural origin, may still deserve the description. In that regard, today's surgical techniques to correct lip or palate clefts and the impact they can have on lives is well-nigh miraculous.

Before the 1950s, though, there was little that could be done to correct these kinds of birth defects. That all changed, though, with a "bolt from the blue" discovery by a military doctor over a half century ago. During Cleft & Craniofacial Awareness & Prevention Month this July, we recognize that doctor's breakthrough insight and the vast progress since then in cleft reconstruction surgery.

Affecting more than 4,000 babies each year, clefts develop during early pregnancy as portions of the face, typically the lips or extending into the palate, don't completely unite with each other. As a result, gaps (clefts) occur where the tissues should be uniform, forming on one side of the face or both.

Clefts can have a harmful effect on a baby's ability to feed or even breathe, and they can interfere with speech development as the child gets older. But what may cause the most emotional pain is the alteration of a person's normal appearance, which may inhibit their ability to socially interact with others.

But a child today with a lip or palate cleft can reclaim a more normal appearance through a series of surgical repairs. The genesis for this began when a U.S. Naval surgeon named Ralph Millard stationed in Korea in 1950 noticed something when studying photographs of his cleft patients. He realized there was no missing tissue with a cleft—all the "parts" were still there and only needed to be "rearranged" surgically.

Today's surgeons do just that, having built modern cleft correction on Dr. Millard's original procedures. And although it involves multiple procedures and often a team of surgeons, dentists and orthodontists, the end result is life-changing.

As amazing as these results may be, cleft correction is a process that can take years, taxing the stamina of both patients and their families. But with ample support, a child with a cleft now has a chance to enter adulthood with a normal smile and appearance. If anything deserves the title "miracle," surely cleft reconstruction surgery does.

If you would like more information about cleft treatment and reconstruction, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Cleft Lip & Cleft Palate.”

During the COVID-19 quarantines, stir-crazy celebrities have been creating some “unique” home videos—like Madonna singing about fried fish to the tune of “Vogue” in her bathroom or Cardi B busting through a human-sized Jenga tower. But an entertaining Instagram video from Kevin Bacon also came with a handy culinary tip: The just-awakened film and TV actor showed fans his morning technique for cutting a mango to avoid the stringy pulp that gets between your teeth. After cutting a mango in half, he scored it lengthwise and crosswise to create squares and then turned the mango inside out for easy eating.

With his mango-slicing video garnering over a quarter-million views, the City on a Hill star may have touched a nerve—the near universal annoyance we all have with food stuck between our teeth. Trapped food particles aren't only annoying, they can also contribute to a bacterial film called dental plaque that's the top cause for tooth decay and gum disease.

Unfortunately, it's nearly impossible to avoid stuck food if you love things like popcorn, poppy-seed muffins or barbecue ribs. It's helpful then to have a few go-to ways for removing food caught between teeth. First, though, let's talk about what NOT to use to loosen a piece of stuck food.

A recent survey of more than 1,000 adults found that when removing something caught between our teeth, we humans are a creative lot. The makeshift tools that survey respondents said they've used in a pinch included twigs, safety pins, screwdrivers and nails (both the hammer and finger/toe variety). Although clever, many such items are both unsanitary and harmful to your gums and tooth enamel, especially if they're metallic or abrasive.

If you want a safe way to remove unwanted food debris, try these methods instead:

Brush your teeth: The gentle abrasives in toothpaste plus the mechanical action of brushing can help dislodge trapped food.

Use dental floss: A little bit of dental floss usually does the trick to remove wedged-in food—and it's easy to carry a small floss container or a floss pick on you for emergencies.

Try a toothpick. A toothpick is also an appropriate food-removing tool, according the American Dental Association, as long as it is rounded and made of wood.

See your dentist. We have the tools to safely and effectively remove trapped food debris that you haven't been able to dislodge by other means—so before you get desperate, give us a call.

You can also minimize plaque buildup from food particles between teeth by both brushing and flossing every day. And for optimally clean teeth, be sure you have regular dental office cleanings at least twice a year.

Thanks to Kevin Bacon's little trick, you can have your “non-stringy” mango and eat it too. Still, you can't always avoid food getting wedged between your teeth, so be prepared.

If you would like more information about effective oral hygiene practices, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”

We instinctively know when a smile looks normal—and when it doesn't. It could be that something simply looks out of place like crooked teeth. But we might also notice when something is missing—as with one or both of the canine teeth.

The canine teeth align just under the eyes and are recognizable by their pointed ends. When they're missing, the smile looks “incomplete.” But “missing” in this case could mean “invisible”—the teeth are there, but hidden within the gums because they failed to come in properly and became impacted. This often happens on a smaller jaw where other teeth have crowded into the space intended for them.

Fortunately, we may have a remedy, and not just for appearance's sake—any impacted tooth can cause health problems, from gum abscesses to root damage of neighboring teeth. Although this might necessitate their surgical removal, we might also be able to coax them through the gums into better position in the jaw, if they're in a reasonably good position. This could result in both a boost to a patient's oral health and a more normal looking smile.

First, though, a patient will need to undergo a thorough bite evaluation by an orthodontist. Besides pinpointing the impacted teeth's precise location with x-rays or CT technology, an orthodontist will also want to assess the positions and condition of the rest of the teeth. If the conditions are right and there's enough room in the jaw, the orthodontist may recommend drawing the impacted canines into proper alignment in the jaw.

The process starts when an oral surgeon exposes the impacted teeth by surgically cutting through the gum tissue. They then attach a small bracket to the tooth with a tiny metal chain attached, the other end of which is looped over orthodontic hardware attached to other teeth. The tension on the chain by the hardware gradually nudges the teeth downward out of the gums. This is usually done in coordination with other measures to fully correct the bite.

If the procedure is successful, bringing the canines out of impaction reduces the problems those teeth could cause the person's oral health. But just as important, it can restore normality to their smile.

If you would like more information on treating impacted teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”

Temporomandibular joint disorder (TMD) is an umbrella term for a number of chronic jaw problems. These conditions cause recurring pain for 10 to 30 million Americans, especially women of childbearing age.

But even after decades of treatment and research, a full understanding of TMD's underlying causes eludes us. That doesn't mean, however, that we haven't made progress—we have indeed amassed a good deal of knowledge and experience with TMD and how best to treat it.

A recent survey of over a thousand TMD patients helps highlight the current state of affairs about what we know regarding these disorders, and where the future may lie in treatment advances. Here are a few important findings gleaned from that survey.

Possible causes. When asked what they thought triggered their TMD episodes, the top answers from respondents were trauma, stress and teeth clenching habits. This fits in with the consensus among experts, who also include genetic disposition and environmental factors. Most believe that although we haven't pinpointed exact causes, we are over the target.

Links to other disorders. Two-thirds of survey respondents also reported suffering from three or more other pain-related conditions, including fibromyalgia, rheumatoid arthritis and chronic headaches. These responses seem to point to possible links between TMD and other pain-related disorders. If this is so, it could spur developments in better diagnostic methods and treatment.

The case against surgery. Surgical procedures have been used in recent years to treat TMD. But in the survey, of those who have undergone surgery only one-third reported any significant relief. In fact, 46% considered themselves worse off. Most providers still recommend a physical joint therapy approach first for TMD: moist heat or ice, massage and exercises and medications to control muscle spasms and pain.

These findings underscore one other important factor—there is no “one size fits all” approach to TMD management. As an individual patient, a custom-developed action plan of therapy, medication, and lifestyle and diet practices is the best way currently to reduce the effects of TMD on your life.

If you would like more information on TMD management and treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Chronic Jaw Pain and Associated Conditions.”