Q&A with orthodontist Dr Anton Bass- ANSWERS BACK

[RachelMumsnet]

We're joined this week for a Q&A with specialist orthodontist Dr Anton Bass, who'll be answering your questions on all aspects of orthodontics for children, teenagers and adults. Orthodontics is a specialised field of dentistry which not only focuses on straightening teeth, but the development of the teeth, jaws and face, which all contribute to a nice smile. Dr Anton Bass is a graduate in Dentistry from Guy's Hospital, London and received his specialist Orthodontic training at the University of Pennsylvania in the United States, where he obtained a Master's degree in Clinical Orthodontics and certification by the American Board of Orthodontics. In 2001, he joined his father at Bass Orthodontics, a well established family practice, having been there for over 30 years and is amongst the first specialist Orthodontic practices in London's West End. Although he treats patients of all ages, he has particular interests in early preventative treatment, adult and 'invisible' treatment. Please send your questions to Dr Anton Bass on everything from prevention being better than cure to it never being too late for straight teeth, before 5pm on Monday 19th September and we'll be linking to his answers on 28th September.

I'm in a similar position to meala.

We didn't see the dentist when I was growing up. I now have a severe overbite and a lot of teeth in a small mouth. I did see an orthodontist about treatment who said that I would need corrective jaw surgery.

At the time I was hoping for the overbite to be corrected through braces so didn't pursue it. However, I have a few questions now. Who would carry out jaw surgery? Would it be available on the nhs? How long is the recovery time?

My dentist advised against the op but my teeth really get me down. My teeth look massive and I don't have a comfortable closed mouth.

Thanks

another teeth grinding question.....can braces help? DD's orthodontist says that they may help her bruxism - but at huge cost (£3k +) and also the time - a brace for 18 mo, plus a retainer for a further 2 years. SHe actually has nice teeth, except that they are being worn down.

Im reluctant to go down the route of "maybe". Our dentist has doubts, but suggests we have a nightguard made instead (c. £400). WHat would you advise?

Hi Dr Bass, thanks for coming.

I have two questions, one about my ds and one about myself.

Ds chews almost exclusively on one side. He can chew on the other, and will try to do so if I ask him to, but it seems difficult for him. Not physically, but intellectually - he has to think about it while chewing, whereas chewing on his 'usual' side is instinctive. Will his unilateral chewing affect the development of his jaw or wear his teeth unevenly? Should I persist in getting him to chew on both sides? Ds is 10.

About myself: I have a gap where a second premolar broke nearly 11y ago after a root canal treatment. It was not possible to crown it. The enervated root remains in my jaw, and just the base of the tooth pokes out of the gum. At some point I would like to have an implant. Is there any urgency? I think that the neighbouring incisors may have moved apart a bit since the tooth broke, which I was given to understand would not happen if the root was left in situ.

Thank you for your time Dr Bass.

My DD (1.5), fell at a play group yesterday and banged her mouth quite badly. She burst her lip, but what I am most worried about is a cut/abrasion above her top front tooth, sort of at the joint between gum and lip. There was also bleeding at the top of her front tooth in the gum line. However, the tooth was not wobbly, and she has not shown any reluctance to eat or bite food.

I am worried that her tooth may go black or that she may have damaged her adult teeth. How likely are these scenarios, and what would be the timescale on her tooth going black?

I am currently cleaning her teeth with great care, swabbing the cut with mouthwash on a cotton wool bud and trying to avoid giving her food which is difficult to bite or chew. Any other advice would be appreciated.

Hi Dr B

DH and I have both got horribly crowded mouths. All of my 4 year old's deciduous teeth have erupted and they are already crowded and a bit wonky. Our dentist says she's sure he will need orthodontic work in the future. His sister is only 12 months but the 6 teeth she has so far are HUGE so it doesn't look good for her either. I am hoping that because they aren't thumbsuckers like me their teeth won't be as unsightly as mine.

What factors cause this problem - obviously it is genetic by nature but is it to do with the absolute size of the teeth, or just the relative size of the jaw? And what controls tooth eruption - is it something that happens secondary to growth or is it an independent process?

Hi Dr B
My 18 yr old daughter still has two milk teeth!

An OPT revealed that both have '? retracted roots' and there are no adult teeth. Both milk teeth are malformed and have fillings. The dentist thought their malformation was due to an illness during pregnancy and fissure sealed them but fillings were required at the very next visit.

What would you advise for her?

I have 3 kids who are going to beggar me over the next 10-20 years fixing their teeth so I'd much appreciate some advice.

My daughter has an overbite but not a severe one, my biggest concern with her is overcrowding and weak teeth. She has always been a slow teether, her baby teeth took months apiece to come through, she started teething at 3 months old but the teeth only came through the week of her 1st birthday (8 of them in 2 days ) and now we're having the same issue with her losing them. She's lost 2 so far, one took 3 months to fall out, the other 6 months and two others which have been loose for longer than 6 months are refusing to fall out. With the two bottom ones which have come, they grew up behind the loose tooth before it fell and whilst one moved forward the more recent one doesn't have any space to move into, the gap simply isn't big enough. Is this something that should be dealt with now (she's 6.5) or is it simply a case of waiting to see how bad the situation gets and her having braces as a teen? Also, her baby teeth were extremely translucent and white, very weak looking.... these new teeth seem to be the other extreme, almost yellow looking.... is this something to worry about?

DS1 is a grinder (actually all three of them are but it's most extreme with him), I brought him to the school dentist (we're in Ireland) as the quicks of his front teeth are visible and he's complaining about pain, they're ground down to approximately 1/2 - 2/3 of their original length, and was told: 'I've seen worse, there's nothing to be done other than to pull them if he grinds them down too far' Surely this can't be the only solution, is there a mouth guard of some kind he could be fitted for? Is it worth bringing him to a private orthodontist and asking for help? And how likely is he to damage his adult teeth the same way? (he's 5 now and dd lost her first baby tooth at 5.5, and he was younger getting his as a baby)

My youngest is 2 and he has a huge overbite. He's already had minor surgery for tongue tie and is non verbal, his upper lip is tied too. The overbite and badly formed jaw have been mentioned a lot, one consultant told me 'I'd start saving for orthodontist fees now' and on his statement report there was mention of future surgery. What sort of surgery are they talking about? What age can we start dealing with this issue, can anything be done while he's a child or do we have to wait for his full set of adult teeth to come through?

Sorry it's an essay but I feel constantly worried about this and dentists round here don't seem to give a damn about children's teeth unless they're rotten/dead

Hi
I have two questions, one about my DS and one about me.

My DS is 6 and a half and has already lost 6 baby teeth and has 3 adult teeth through. What key signs would indicate that he is likely to have a problem with maloclusion and at what stage would these be identified? I had a lot of orthodontic treatment starting quite young and had adult teeth removed from the bone at about 7 or 8 years old.

After about 8 years of orthodontic treatment I had a straight even smile. A few years ago I had a wisdom tooth removed from my top jaw - I asked for this as it had a hole in it and was difficult to reach to brush properly. I've never been sure if this was a wise decision as no one every gave me a long term plan with my teeth and told me whether wisdom teeth were expected and planned for or not. Last year I had root canal work and had a tooth crowned, this cause some movement in the lower arc. My dentist did not warn me about this first and when I last went she said I needed to wait until everything settled down. Everything has settle now but one of my bottom front teeth is misaligned. Does this require more orthodontic treatment to get back to how it was before? Is this normal after a crown?

Thanks

hello I have a query about children with special needs.My dd is nearly 6 and has not yet lost any teeth.Currently no problems and our nhs dentist has given her a clean bill of health,from what he could see,she bit the poor bloke last time!! (it can be tricky looking in her mouth and indeed teeth cleaning at times!!).She has microcephaly and I know that a lot of children can have dental issues as they get older and their adult teeth develop,so my question is is there such a thing as a specialist orthodontist who deals with such children and how would i go about finding one???Many thanks.

I would like to say thank you - your father did my orthodontics and I probably wasn't very appreciative at the time (as a normal stroppy teenager and being told to have baby teeth extracted when I was 8). My teeth are still in great condition and still straight at 32. This is partly due to the permanent retainer bar on the back of my bottom teeth which my hygienist comments very favourably on every time I see her as it is easy to clean because it is only attached to my canines. And my dentist refused to remove it when I suggested it about 7 years ago, which was a great call. My DH's teeth are a real mess due to recrowding and not cleaning properly when he had his orthodontics (done by someone else) and I am grateful to your team who took the time to make sure I was cleaning properly while I had my treatment. So please pass on my thanks to your dad!

How 'perfect' will my daughter's smile be? she is 14, still has lots of baby teeth to lose, but also has lots of adult teeth missing thanks to a congenital condition. She is missing at lest four in the cleft line, two on each side. I know lots can and will be done, but can we image a perfect, Hollywood smile, or will she always have slightly 'off' teeth?

Hello!

DD is 13 and been wearing a removable appliance (is that the term?) for a couple of years. The Top one has done the joband her teeth are nice and straight now. The bottom one was to move her bottom jaw forward but it hasn't made any difference at all. The last 2 appointments she was just told to wear it all the time. She tends to take it out during her sleep though - she'll go to sleep with it in then have to hunt around in the mornings.

So - where do we go from here? Give up and accept things? Or are there any other options?

hi
when my son was 10 he fainted and landed on his face. he didnt break any teeth but his two front middle teeth became discoloured. they were white to begin with but he now has two vivid very white patches in the middle of them making the rest f the two teeth look yellowy.
his dentist said he had bruised his teeth and nothing can be done about it. however he is being bullied for it at school and at nearly 14 he has had enough as it has gone on for nearly 4 years. is there anything we can do to make the teeth the same white shade all over?

hello, i suffer from cyclic vomiting syndrome and as a result my teeth are crumbling and manky. i brush properly twice a day with an electric toothbrush, i also use those little brushes to get inbetween my crooked teeth and i floss.
the bottom middle teeth are awful. despite being careful with my hygiene the gums have receded and they are thick with hard plaque. im terrified they are going to fall out.
when i have been sick i wait before brushing, at least half an hour and then i brush them gently and use an alcohol free mouthwash. i was using corsodyl for a long time but i found it made me feel more sick for some reason.
is there anything i can do differently to try and save my teeth?

hello,

I have 2 queries.

My eldest child (2years, 9months) sucks her bottom lip a lot, even when sleeping. She often asks for a dummy, which she hasn't had for approx 2 years. I'm now thinking, I should give her a dummy and then try to break that habit later as it will have less of an impact on her teeth. Any views?

My youngest (14 months) constantly sucks her thumb and has done since birth. Will this impact her teeth and should I be trying to stop this.

Thanks for any advice.

Hi

Where do you sit on the early intervention issue?

My dd had a removable brace for a year when aged 8 to widen her upper palate and correct a cross bite - we paid for it privately (ouch!) as we were advised that correcting it then would reduce the need for extractions when older.

Aged 11, her teeth are almost all in and she hasn't had to have the trauma of removing any. She may have to have a fixed brace for a short time to correct some rotation.

It strikes me that doing work earlier could cut down costs and upset for a lot of children!

Dr. Bass - I wrote a question further up about my 13 yo DD and her reluctance to wear her bionator. I've just been told by her orthodontist that she will have to move on to a Delaire mask with a fixed metal bit in her top jaw for 3-6 months. That's this for anyone who hasn't heard of it. And that there's no point doing it for any less than 16 hours per day. And that if this doesn't work (ie because she doesn't wear it enough) she will almost certainly need the jaw operation at 18.

So my first question still remains, but is all the more important now. How forceful should parents get in insisting that teenagers comply?

Hello
My DD aged 5 has an extended frenulum, with a very large gap between her two top baby teeth. Our dentist says it will need correcting, and she will then need orthodontic work when her adult teeth are in. There's not time scale yet for this. My question is if the frenulum is corrected early, is there any chance DD could avoid orthodontic work, or is it inevitable?

hi
when i was in southern ireland recently, my friend told me that all 12 y olds there are offered the chance to have their back teeth coated and as a result there has been a reduction in rot and removals....what do they use?....is it possible to get this done in england?... what are your thoughts?
thanks

pollywaddle.... it's fissure sealing they get. I had all mine done when younger and despite my junk food diet and lax oral hygiene as a teen I don't have a filling yet (27)

My 10 year son has a cross bite. How will this be treated, and have we left it too late? How long will it take to correct? Thanks for any advice!

Dr Bass

I hate my teeth! I have sucked my thumb since a baby and although I hardly ever suck it now (children make me so exhausted I fall asleep without needing to) I have an over bite and very crowded lower teeth. In the last year or so I feel constant pressure in my front lower teeth as one tooth is being pushed back by two adjacent teeth falling in. It is not yet painful but it is uncomfortable. I also notice that I have increasing pressure on my molars at the back - seem to wake up having bitten down hard on them. (Sorry, my tooth vocabulary is terrible - hope you understand what I mean).

From both an aesthetic and a pain/pressure point of view I think I need to do something about this. The cost is a real worry - what is the ball park figure I would be looking at? Is this something that can be corrected without surgery? And how do I find a really good orthodontist locally. The thought of having a good smile makes me feel quite tearful. I would really love to sort this out...

My nine year old has protruding front teeth and is teased about it. I've discussed with our dentist and her view is that 12 is about the right age to address this. Grateful if you would confirm that this is a normal approach. I guess it is about jaw/mouth development. Would you take account of the teasing as a reason for earlier intervention?

Pollywolly. Your dentist here in England will do fissure sealing. It used to be free but I had to pay for my eldest dd a few years ago. £20 a tooth!

Hello Dr Bass.
My youngest child, aged 3, sucks his two fingers almost constantly. I even have a scan pic of him doing it! How much damage could he be doing to the shape of his upper jaw and at which point should I really get tough on him to stop?
Thank you for all your advice.

I don't if you can help, yesterday I noticed a lump on the top of my mouth today I have noticed another one which became sore as I was eating dinner. Should I see a dentisit or a doctor.