Tooth Talk

New trends and techniques in dentistry.

Dr. Mary Viechnicki-PotterSomething to Smile About

Patients come to Dr. Mary Viechnicki-Potter for various reasons. Some were born with a less-than-perfect smile. For others, though, the damage is the result of eating disorders.

“About 10 years ago, when I started practicing dentistry, eating disorders were more of an unspoken topic,” says the Haverford-based cosmetic dentist. “You didn’t see as much literature about it as you do now. It’s become much more of an epidemic over the past few years.”

These days, eating disorders are affecting children as young as middle school. “My daughter is in fifth grade, and I always have conversations with her about making healthy choices,” she says.

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In bulimics, the destruction is evident on both the back and front of teeth. Every time a bulimic vomits, stomach acid wears away enamel. Once the enamel is gone, it corrodes the dentin layer beneath. “Dentin wears away 10-15 times faster than enamel,” says Viechnicki-Potter. “Once the dentin begins to deteriorate, the process really escalates.”

Anorexics lack the vitamins and calcium necessary for a healthy smile. “I’ve suffered from anorexia and bulimia since I was 14 years old,” says one of Viechnicki-Potter’s patients, a 36-year-old Allentown woman. “My teeth were falling out from all the cavities I had. I was in constant pain with toothaches and had to have several root canals. The teeth that weren’t falling out were really stained.”

After she finally resolved her eating disorder in her late-20s, her teeth were a constant reminder. At 29, she turned to Viechnicki-Potter. “I was embarrassed, but she put me right at ease,” says the patient, whose smile is now fully restored. “She wasn’t at all judgmental.”

Another of Viechnicki-Potter’s patients was a 37-year-old man who struggled with bulimia. “He never divulged to me how long he’d been doing it, but his teeth eroded down to a mere 4 millimeters,” she says.

After a full mouth reconstruction that included 20 crowns, the length of his new teeth measured a healthy 9.5 millimeters. “I can rehabilitate the mouth of any patient,” she says. “But before I do that, the patient has to make a commitment to make a lifestyle change, and stop what they’re doing and get better.”

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Viechnicki-Potter is on the medical committee of A Chance to Heal, a Jenkintown-based group established to prevent eating disorders through education and advocacy. She speaks to children and adults at schools and hospitals about eating disorders and their devastating effect on teeth. “I feel responsible to do what I can to help prevent others from going through it,” she says.

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Dr. Edward WoehlingYour Loss

Periodontal disease is an infection that affects the tissues and bones supporting the teeth. Left untreated, it can lead to tooth loss. The bacteria in plaque produce toxins and enzymes that irritate the gums and cause inflammation that can compromise the area where the teeth attach to gums and bone.

“Our goal is to maintain your dental health and preserve your teeth,” says Dr. Edward Woehling, a periodontist at Bryn Mawr Periodontal Associates.

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Among the warning signs of periodontal disease: gums that bleed easily; red, swollen or tender gums; gums that have pulled away from teeth; persistent bad breath; pus between teeth and gums; loose or separating teeth; a change in the way teeth fit together when you bite; or a change in the fit of partial dentures.

And it can lead to more serious conditions, including cardiovascular disease, diabetes, respiratory disease, plus preterm and low-birth-weight babies. Any illness that has an inflammatory component can be worsened by periodontal disease. “It affects your whole system,” says Woehling. “Oral health has become an integral part of a person’s overall health.”

The good news is that it’s treatable. Woehling advises patients to schedule deep cleanings at least twice a year, if not quarterly. The procedure should include scaling (cleaning tartar and plaque below the gum line) and root planning (removing hardened plaque and smoothing irregular areas of the root surface). Brushing and flossing daily is the easiest way to prevent periodontal disease, along with regular dental appointments. Baby boomers who haven’t followed a routine maintenance plan over the years are at an increased risk, as are smokers.

If the worst does happen and you lose a tooth, dental implants are the most efficient solution. Bridges or dentures require filing down or removing adjacent healthy teeth, implants do not.

“New procedures reduce a lot of the complexities and pain historically associated with dental implants,” says Woehling.

Dr. May O’KeeffeGetting It Straight

These days, some of us who once considered ourselves lucky to not have to endure those “metal mouth” comments are now considering braces as adults. “I’m hearing a lot of, ‘It’s my turn now’ from the parents of my patients,” says Dr. May O’Keeffe, an orthodontist in King of Prussia.

The reasons so many adults are turning to orthodontia vary. Proper treatment can straighten crooked teeth or close unsightly gaps. But many come out of necessity. “Their dentist might’ve said they had to get an implant or a bridge redone, and to make those restorative treatments more ideal, you have to move the teeth into their proper positions,” says O’Keeffe.

These days, traditional metal brackets are just one option. Another, ceramic brackets, aren’t as noticeable in pictures or from a distance. Whatever choice they make, patients must be prepared to live with it for 18-24 months. “Adults are surprised when I tell them how long treatment is,” says O’Keeffe. “They watch these extreme makeover shows and expect a quick fix.”

Among the major technological advancements of the past few years, SureSmile employs a wire custom-bent by machine, as opposed to the orthodontist doing the bending. “This takes away the human inefficiencies of wire bending, so you can make treatment more precise,” says O’Keeffe.

And the more precise the fit, the faster the braces come off. In fact, SureSmile can reduce treatment time by up to 40 percent.

Lingual braces are placed behind the teeth, making it virtually impossible for anyone to tell you have them. The technique first hit the market more than 20 years ago, but recent computer technology has made the customizing process easier and more effective.

Another popular option, Invisalign, uses a series of clear, custom-made aligners to straighten teeth without braces, metal wires or brackets. And the patient can actually remove the aligners. “With adults, the compliance is less of an issue—especially since they’re the ones paying for it,” says O’Keeffe, who adds that Invisalign is ideal for patients with crowding and spacing issues.

No matter what treatment you choose, a retainer is a certainty. “They’re really important,” says O’Keeffe.

But the hassle is worth it. “What I love to see are the patients who always have their hands by their mouth covering their smiles,” says O’Keeffe. “After treatment, they feel free to show off their smile.”

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