Setting the dental record straight

Avoiding multiple health and social problems caused by unsightly teeth at all ages

THERE ARE MANY reasons to take care of those pearly whites — at any age. Maybe an elementary student is picked on for her crooked teeth. Maybe a young athlete is in a sporting accident and needs emergency dental care. Maybe grandma wants a winning smile for her grandchildren. Or, perhaps a business professional wants to make a presentation without feeling self-conscious about a discolored tooth.

Avoiding these problems begins with good dental hygiene, even at an early age. So, Dr. Archana Antony, an associate with Central Florida Health Care at 201 Magnolia Ave. in Winter Haven, teaches the basics of brushing twice a day, flossing daily, and avoiding excess sugar. “The moment they come in, we educate them about the importance of having that healthy smile,” she says. Parents should brush a young child’s teeth, even while they are learning the process. “The reason behind this is because their hand and eye coordination are not fully developed ’til seven- or eight years old,” she explains.


When permanent teeth come in around age seven, children’s mouths may become overcrowded. Front teeth may protrude, and other children may be cruel.

“I distinctly remember being [called] Bugs Bunny or Bugs,” says a Bradenton orthodontist, Dr. Steven Tinsworth, who developed problems in the second grade.

“Baby teeth fall out in front around six to eight years old and the replacement front teeth are always larger than the baby incisors they replace,” Dr. Tinsworth explains. “The space for these larger teeth is not yet available and so front teeth erupt protrusive or rotated to fulfill the definition of the common ‘ugly-duckling’ phase.”

Though he wasn’t beaten up, he was picked on. In the end, it may have affected his decision to become an orthodontist. He acknowledges that, while height and weight are factors, children with good-looking teeth get more positive attention. And, a recent study shows that children with poor oral health might be the targets for more negative attention, such as bullying.

The American Journal of Orthodontics and Dentofacial Orthopedics reports that unsightly teeth in 11- to 12-year-olds can be associated with bullying. A study reveals missing teeth, irregular spacing, the shape or color of teeth, or prominent front teeth are the most likely physical features that increase the likelihood of bullying.

The report was based on a Jordanian study, described in the publication Adjo-Do, involving sixth graders with a high prevalence of bullying. Many were bullied because of dental or facial appearance.


Dr. Tinsworth has seen others suffer, too. “Appearances count a lot. Careers and relationships are oftentimes pinned upon much of that,” he says. “We think of this bullying as a school kid issue, but those same discriminations are often prejudices reflected in more subtle ways as older teens or in the adult work world,” explains Dr. Tinsworth, who also belongs to the Manatee Dental Society.

Dentists realize it’s important to protect that smile; an ugly one can catch people off guard. “It’s an immediate kind of freeze because you’re expecting something different,” says Dr. Tinsworth, past president of the Florida Association of Orthodontists and a member of the American Association of Orthodontists. “I’ve had men in their late 30s, who were rising up the corporate ranks speak with hand over mouth,” he observes, “then undergo orthodontic treatment.”

Keeping teeth straight and in good working order enhances chewing and nutrition, improves articulation, and results in healthier gums, teeth, and bone. Teeth also are easier to clean. And it’s true whether the person is young or in their senior years.


“Patients with missing teeth, particularly front teeth, eventually lose the support that teeth offer to the lips and face. As a result, they feel aged and unattractive,” explains Dr. William Nerestant, a Lakeland dentist who offers implants, cosmetic dentistry, and other services.

“The effects of not being able to comfortably share the daily experience of eating with loved ones, combined with the perceived unattractive appearance, erodes the patient’s self confidence and self-esteem,” he elaborates.

When problems occur, modern dentistry brings new options, like dental implants, which can replace one tooth or a mouthful. “When a patient chooses to have dental implants, whether it is to replace a lost front tooth or to transition from dentures, they replace more than the lost teeth. They trade off the inherent problems as well, like denture adhesive, difficulty eating, and diminished self esteem,” Dr. Nerestant says.

Bone grafts can help when there is not enough bone to support the implant. “Bone grafting is a highly successful procedure in most cases,” Dr. Nerestant states. “Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.”

“As dental implants become more and more recognized as the standard of care, we are finding more insurance companies are allocating benefits toward services related to dental implants,” says Dr. Nerestant, of Lakeland’s Midtown Dental.

Midtown Dental offers a free consultation and its own version of insurance: a Dental Savings plan, specifically for those without dental insurance. “The plan has no limit,” he continues, “and it also covers dental implants.”


Dental insurance may not cover the cost of fixing crooked or missing teeth. With orthodontists, there is typically an upfront fee and monthly payments, Dr. Tinsworth reports. However, patients are encouraged to check with their dental insurance provider and their dentist’s office to ensure the right coverage or optimal payment plan.

When a child loses a tooth in an accident, the tooth may be saved if it’s put back into the mouth in 20 minutes, Dr. Antony points out. “We want to save the [permanent] tooth if at all possible.”

The tooth should be kept in saliva, milk, or a commercial, sterile saline like that used for eyes or ears. Even if the tooth is found in dirt, it should be wiped rather than rinsed in water. “You have to do something. Clean it, then put it back in,” she explains. The child should then be taken to a dentist or an emergency room as soon as possible. Even if the tooth is damaged, it may be used for a number of years. “You don’t give implants [fixed, replacement teeth] on a young kid while their mouth is still growing,” Dr. Antony advises. “The main thing is trying our best to see if we can save that tooth. There are so many options.”


As dentistry continues to advance, so do preventive measures for patients. Three-dimensional imaging is making it possible to diagnose problems like constriction of the airway that may affect not only teeth but oxygenation to the brain, which is part of a child’s learning and development. “New technology is providing information and allowing the recognition of things we were not even aware of,” Dr. Tinsworth says. “I think dentistry is going to continue to be a growing area of knowledge and impact” on the overall health of patients’ lives at all ages.



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