Dr. Halpin on Dental Health & Beauty

PM: It seems that every dentist claims to be a cosmetic dentist. Dr. H: To some extent, every dentist is because we can all attempt to restore, that is place fillings and crowns with tooth-colored materials. When a patient is concerned with his or her smile, not only the teeth but the entire mid and lower face should be analyzed.
	Dr. David Halpin with  Office Manager, Carmen Grant

PM: What is facial orthopaedics and its relation to orthodontics? 

Dr. H: My objective in orthodontics is a well proportioned face as well as straight teeth. For that reason, I evaluate the dental arches and the face in three dimensions: transverse, anterior-posterior and vertical. Through orthopaedics, which is the alignment of the upper and lower jaw bones, that orthodontics has its most attractive, healthiest and most stable result. In most cases, this is done non-surgically and usually without tooth extraction even for adults.

PM: You don’t have to extract teeth for orthodontics? 

Dr. H: Teeth do not need to be extracted to solve a crowding problem. 

PM: What are the benefits of starting treatment in children? 

Dr. H: Early treatment is recommended after age four when problems such as thumb-sucking, mouth breathing, narrow jaws, excessive overbite and deep bite are recognized. Early treatment may prevent fracture of protruded incisors, crowding of erupting teeth, and need for future jaw surgery. Also, early treatment may aid in psychological development that is appearance related.

PM: In your opinion, how would you quantify a beautiful smile? 

Dr. H: Firstly, the face should be symmetrical with a straight profile. The teeth should support the lips so they are full. The occlusion should be fairly flat in both an anterior-posterior and lateral view with a minimal overbite and overjet. The incisal edge of the upper teeth should follow the upper border of the lower lip and the upper gum line should parallel the lower border of the upper lip. The smile should be broad enough to see at least ten upper teeth. The relative facial and dental proportions should coincide with the golden ratio (1:1.618). The incisal embrasures should be progressively larger from mesial to distal, that is from the midline moving back, the teeth should have the proper torque and tip.

PM: I didn’t know so much was involved! 

Dr. H: And I haven’t yet mentioned straightness or the parameters of color. Any dental office can bleach natural teeth. 

PM: How can a patient get a beautiful healthy smile? 

Dr. H: After we establish the proper position of the jaws, the dental team either aligns teeth orthodontically or fabricates crowns and veneers to coincide with the new jaw positions.

PM: So you can approach treatment differently? 

Dr. H: Yes, and often combine alignment with crowns and/or veneers. 

PM: We heard you offer Invisalign. Tell us about it please. 

Dr. H: It is a bracket-free and wire-free orthodontic system for permanent teeth which uses a series of clear, removable trays which are progressively changed every two weeks until the teeth are aligned. 

PM: Can all your orthodontic patients be treated with Invisalign? 

Dr. H: If jaw alignment and/or reposturing is required such as significant arch widening and posterior teeth eruption then the patient isn’t a candidate. However, once these are corrected, then perhaps Invisalign can be used to align the teeth to achieve the end result.

PM: What is TMJ and what is its relevance to dentistry? 

Dr. H: The temporomandibular joints (TMJ), located immediately in front of the ears, are the hinges connecting the lower face (mandible) to the skull (temporal bone). The lower jaw and skull are connected by numerous muscles and ligaments. These are ball-socket type of bony hinges with “lifesaver” shaped cartilage between them. In a healthy joint, when the lower jaw opens and closes the discs stay in between. This is without discomfort and without noise. The patient should be able to get the thickness of three fingers between upper and lower front teeth when opened as wide as possible. The muscles of the head, neck and shoulders function relatively pain-free.

PM: What is TMD? 

Dr. H: Temporomandibular disorder (TMD) is the condition referring to a problematic TMJ. This is usually because it is too far posterior and superior (back and up). This occurs often in patients with narrow upper arch and deep overbite.

Approximately 80% of North American adults have an excessive overbite. Often, these patients have other signs of malocclusion (bad bite) such as worn, chipped or notched teeth, scalloped tongue and missing back teeth. The protective cartilage disc can become displaced resulting in the top part of the lower jaw bone pressing on the nerves and blood vessels at the back of the socket. This causes pain. When opening and closing the jaw, clicking, popping, or grating noises can be heard. Patients are advised to seek treatment to avoid worsening the problem. Severe cases can cause muscle pain, neck aches, ear aches, certain headaches, sometimes of migraine proportions, ringing in the ears, “plugged” ears, difficulty in opening the mouth or chewing, dizziness and chronic fatigue.

PM: Besides malocclusion of a deep overbite, what else can cause TMD? 

Dr. H: Trauma such as auto accidents, sports injuries, clenching or grinding of the teeth (bruxism), birth trauma, being in traction and missing back teeth. 

PM: In aesthetic crown and veneer cases, is the role of TMJ a consideration?

Dr. H: Absolutely YES. The dental team must determine what caused the need for this treatment. Often it’s because of an improper TMJ relationship and improper bite relationship which caused the problem. Without considering TMJ, these crowns and veneers could break soon and cause more trouble. Full-mouth dental prosthetics should be done to establish a healthy neuro-muscularly balanced, comfortable TMJ position. 

PM: Could you tell us about sleep apnea and snoring? 

Dr. H: Snoring is partially obstructed breathing. Sleep apnea is a complete breathing cessation for 10 seconds or longer. It is often caused by an upper airway obstruction which is Obstructive Sleep Apnea (OSA). Virtually all people with sleep apnea snore, but not all snorers have sleep apnea. OSA poses a significant health risk in that it can lead to irregular heartbeat, high blood pressure, heart attacks and strokes. Its signs and symptoms include, besides snoring, daytime sleepiness, nighttime gasping, morning headaches, fragmented sleep, impotence and irritability. Children can also suffer from OSA. Often they are highly allergic, mouth breathers with runny noses, and darkness under the eyes. Other signs are bed wetting, irritability, difficulty in concentrating in school and hyperactivity. 

PM: How is Obstructive Sleep Apnea treated? 

Dr. H: There are different approaches such as nighttime respirator called a Continuous Positive Air Pressure (CPAP) machine while sleeping on one’s side. Also, there’s the surgical approach and then the nighttime dental appliances which prevent the lower jaw and tongue from obstructing the airway. 

PM: Thank you for your explanations of these dental concerns.

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