Dr. Stafford is joined by Dr. Lauren Manning, a Prosthodontist with Advanced Dentistry. Her specialty address comprehensive, complex scenarios that often require teeth to be restored or replaced.
Topics discussed in this episode:
What is a Prosthodontist?
Congenitally missing teeth
What to do about those missing teeth
How long can a baby tooth be kept when it doesn’t not come out naturally?
Dental ankylosis
Importance of a dental care team
Learn more about Dr. Manning and Advanced Dentistry HERE.
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Dr. Stafford: Hi, this is Dr. Michelle Stafford here at World of Smiles with our podcast, Mixed Dentition. And today my guest star is Dr. Lauren Manning.
Dr. Manning: Hi.
Dr. Stafford: And she is my first person to be repeat-
Dr. Manning: Yes.
Dr. Stafford: ... on the podcast.
Dr. Manning: Going for a three-peat.
Dr. Stafford: So thanks for coming in again.
Dr. Manning: Thanks for having me.
Dr. Stafford: And for, I think we should start with, for our audience that perhaps didn't hear the first time around, can you define prosthodontist? So you're a specialized dentist?
Dr. Manning: Yes.
Dr. Stafford: So myself, I'm a pediatric dentist specialist. You are a prosthodontist specialist.
Dr. Manning: Hashtag overachiever.
Dr. Stafford: Yes. Hashtag overachiever.
Dr. Manning: A little bit more than dental schools.
Dr. Stafford: Yes.
Dr. Manning: So finished four years of dental school, went to four years, for me, for residency. And that's where I learned how to do more comprehensive complex rehabilitation. So patients who are either missing a lot of teeth, or have worn down their teeth, or potentially were born without some teeth, will come in to see me and we will restore and replace. Restore the teeth that are there and replace the teeth that are missing, so we do it in a more, I would say, comprehensive, complex type scenarios.
Dr. Stafford: Nice, yeah.
Dr. Manning: So as this relates to kids, I sometimes, not, I wouldn't say frequently, but definitely a couple of times a month, see children who are congenitally missing a tooth.
Dr. Stafford: Yes.
Dr. Manning: So I wanted to talk to you about that as a prosthodontist, because I kind of manage them and talk to parents and then eventually they make it over to you to talk about options.
Dr. Manning: Yeah. So it's really helpful as the prosthodontist to get involved in the treatment as early as possible, because a lot of these kids have spaces where either the baby tooth is still there because the permanent tooth didn't come in, so they didn't actually lose the baby tooth. But that baby tooth is too small compared to what the permanent tooth should look like. So there's a spacing or a discrepancy between the space that's there.
Dr. Manning: The other thing is a lot of times an orthodontist is also involved to help set the stage for what the smile should look like if all the teeth were present. So it's really nice to be a part of the treatment, even though we're not actually doing treatment for a while on kids that are missing their permanent teeth. That way we can work out what the spacing should be, can communicate with other people involved in treatment, can talk to parents about what's to come and what's to be expected, so that way it's not a big shock when they're actually ready to go through the process of replacing that tooth.
Dr. Stafford: That's great.
Dr. Manning: And there's a couple of different ways that it can be done. When someone's in braces, there can be a fake tooth that's kind of added to the wire. So it looks like they have a tooth there,
Dr. Stafford: Especially when it's one of their front teeth.
Dr. Manning: Exactly.
Dr. Stafford: It's very common for our listeners out there. It's very common to be missing, if you're missing a tooth, for it to be a lateral tooth or not the very first front tooth, but the side tooth.
Dr. Manning: In fact, I think that's the most common missing tooth [crosstalk 00:03:14]
Dr. Stafford: Missing tooth...
Dr. Manning: That there is.
Dr. Stafford: Followed by a premolar on the bottom, the mandibular premolar.
Dr. Manning: Exactly.
Dr. Stafford: Is the next missing tooth. So depending on which two, if you're missing the treatment plans a little bit different.
Dr. Manning: It is a little bit different. Particularly when it's when it's a front tooth cause we all like to have nice smiles and nobody wants to go a while without having a front tooth.
Dr. Stafford: Right.
Dr. Manning: What's critical with missing teeth from birth if you will, are the teeth that just don't develop is you can't really replace that tooth say with an implant. So the little titanium post that goes into the bone that serves as a root of the tooth, and then putting the nice pretty crown on top of that, you can't do that until you're done growing.
Dr. Stafford: Right.
Dr. Manning: And so a lot of kids go through middle school and high school not having a tooth there.
Dr. Stafford: That's hard.
Dr. Manning: So there's a couple of different things that we can do in the in between time to put a tooth there until they're done growing and are actually ready to have that implant done.
Dr. Manning: One of those things is a Maryland Bridge and so it's a little, it's a tooth that's bonded to the back of the two teeth or one of the teeth beside where the space is. And so the nice thing about it that we get feedback from a lot of our patients, is that it stays in their mouth. It's not something that has to come in and out. They don't have to worry about, you know they can floss around it and brush their teeth normally and kind of go about their lives.
Dr. Manning: And it's not necessarily a great permanent solution, but it's a really good in between fix for, for having a missing front tooth.
Dr. Stafford: Yes.
Dr. Manning: For a back tooth. A lot of the time we'll, we'll try to keep the tooth as long as possible.
Dr. Stafford: The baby tooth?
Dr. Manning: Exactly. Unless it's fused to the bone and it's not actually moving up. So what will happen is the chewing surface of the teeth becomes unlevel, and it looks a little more like a roller coaster then this nice flat plane.
Dr. Stafford: That's a good way to describe it, the rollercoaster.
Dr. Manning: Yeah. Yeah. And that can change the bite, it, people can't eat quite as well. And so that's when we kind of want to go in and actually think about removing that tooth and replacing it. Yeah.
Dr. Stafford: And there are parents, I mean I sometimes have kids and talk about, 'Oh your child's missing that premolar on the bottom'. And the parent's like, 'Oh I'm missing the same one. I still have my baby out there'. I'm sure you hear this all the time too. Yeah. How long do you think those premolars, the ones that are missing the baby molars, what's the latest research on that? How long they can kind of last? I've put you on the spot. But I know you love research [crosstalk 00:05:54]
Dr. Manning: Well a lot of it depends actually, cause it varies case to case. A lot of it depends on the health or how much intact tooth structure there is. Yes. So if that baby tooth had a large filling or had multiple fillings, then it's actually not going to last as long.
Dr. Stafford: Right. Exactly.
Dr. Manning: And again it kind of goes back to where that tooth is in rel, in relation to the teeth beside it. For people who were, I guess in situations where the tooth isn't fused, that tooth can last, you know, well into your twenties, thirties, sometimes even forties.
Dr. Stafford: Right.
Dr. Manning: And if there's not a reason to remove it, then we can leave it there and actually restore that baby tooth. We can build it back up. When it becomes a problem, say if it gets really loose or if it gets an infection, which is kind of the leading reason for, that the teeth would be removed at that late or that, that stage in the game, kind of that late in life. That's when you want to be a little more proactive and not just watch it or maintain it.
Dr. Stafford: Right.
Dr. Manning: So it's, it's kind of hard to say in terms of like the research, because it's also varying every clinical..
Dr. Stafford: There's a lot of variables.
Dr. Manning: It's, it's also different person to person. So it's kind of hard to find that, standardize group [crosstalk 00:07:14] like everybody's the same all throughout it.
Dr. Stafford: Well, I was talking to a dentist this past week again and he had it as a daughter who's missing it too. And I guess she's like in her 50s with it. We do the math like that is unusual.
Dr. Manning: It is unusual.
Dr. Stafford: They do not usually last that long. Yeah. Yeah. It's one of those things that when they are congenitally missing teeth, I like try and drive home floss, floss, floss.
Dr. Manning: Yes.
Dr. Stafford: Because as soon as they get a cavity...
Dr. Manning: It's all downhill from there. Yeah. Yeah. Maintaining, just keeping everything really healthy will certainly help prolong how long the tooth can stay there and the longer you wait, the more successful any treatment you're going to do down the road will be just because it doesn't need to be there for so long. I tell my patients like the average number of time that your teeth touch in five years is 1.2 million times. That's a lot of use.
Dr. Manning: If you think about like how often you're driving your car, like that's a lot of years, then you take your car in and have it.
Dr. Stafford: I love that statistic. Let's just talk about that again. 1.2 million in five years [crosstalk 00:08:18] Wow.
Dr. Manning: So a lot of the studies that are looking at materials, like if you're going to use porcelain or if you're going to use gold or whatever you're going to put, put in, when they mimic use in the mouth or years in the mouth, they make the teeth touch 1.2 million times to mimic five years of use.
Dr. Stafford: That's amazing.
Dr. Manning: That's like the standard, the standardized protocol there. That, it's crazy though when you think about it. It really is.
Dr. Stafford: That is amazing. Our team, they work hard for us.
Dr. Manning: They do.
Dr. Stafford: Take care of those teeth.
Dr. Manning: Some people are harder on them than others. You know, I like nuts and corn nuts and all the crunchy things that aren't necessarily the best, but...
Dr. Stafford: Right.
Dr. Manning: You know, at at the same time, you got to live your life.
Dr. Stafford: Yeah, exactly. And I think as long as you're eating stuff that's more food. It's the candy and the chemical candy, like hard candies and sticky candies.
Dr. Manning: Rocks that melt.
Dr. Stafford: Oh yeah. Rocks that melt. That damage teeth the most?
Dr. Manning: It is.
Dr. Stafford: That's my little soapbox about it. And it's Halloween. I know it's Halloween coming up, so...
Dr. Manning: Just make sure you're brushing and flossing after you eat all that candy! [crosstalk 00:09:29]
Dr. Stafford: Brush extra and floss extra. Oh, that's great. Well, this has been very exciting to talk about the technical scientific term is ankylosis for a teeth that start to sink down into the bone. And scientifically, this is what I find also very interesting, we don't know exactly why the body starts to do that. There's some theories out there.
Dr. Manning: Yep.
Dr. Stafford: But we don't know exactly why.
Dr. Manning: I think one of the prevailing theories is that it's, it's an inflammation, so it's a resorptive or where the, the bone or the, the collagen ligament that's around the tooth that gives it its wiggle actually gets replaced with bone. And so it fuses to the root, and from a lot of teeth that experience trauma. So if a tooth has been knocked out or if it's been displaced because you're playing tee ball and got hit in the face with the ball or you take a spill, that's one of the things that can happen when the tooth is put back in because that area, those, those cells have been damaged.
Dr. Manning: And for some people who have a really low kind of inflammatory response, their body's not fighting themselves very hard. They're fine. And for other people, you know, it just tends to flare up and you wind up losing that, that little wiggle to the tooth. Right. And that's definitely when you, you want to start thinking about doing something to fix the problem because it,
Dr. Stafford: yes,
Dr. Manning: The, the bone won't continue to move with growth. So you wind up with uneven gum levels and the teeth aren't lined up quite properly. And when it fuses you can't move it, so...
Dr. Stafford: Braces will not move it once it's fused to the bone, so...
Dr. Manning: It's there.
Dr. Stafford: It's stuck.
Dr. Manning: Yeah.
Dr. Stafford: Well great. Well thank you for coming on our podcast today.
Dr. Manning: Thank you for having me.
Dr. Stafford: I appreciate you, and...
Dr. Manning: It's always fun to talk teeth, I love it.
Dr. Stafford: It's great. It's fun. It is fun. And you're my neighbor next door. So sometimes we get to talk about complicated cases for, especially these kiddos that are missing teeth or have had a big trauma or something like that, so...
Dr. Manning: Yeah, I think it's really important that patients, especially whether it's adults or children with kind of complicated needs to have a really good team in place. Cause you know, we, we can't do it all. I don't think any one person can really solve every larger problem. And so we worked with the pediatric dentists, we work with the orthodontist, we work with sometimes a root canal specialist in cases where there's trauma to teeth, to kind of all cohesively work together to kind of build, build the plan and make sure that each patient's getting the very best care we can give them. Yeah.
Dr. Stafford: Yeah.
Dr. Manning: Plus it's just more fun that way.
Dr. Stafford: It is more fun. And then you get all of these smart people working to get the best result.
Dr. Manning: Exactly. Exactly.
Dr. Stafford: It's why you're going to get the best treatment.
Dr. Manning: At least that's the goal.
Dr. Stafford: That's always the goal [crosstalk 00:12:25].
Dr. Manning: That's always the goal. And you know, it's also nice to get different perspectives because when you're working with people that are a specialist in their own field, they're going to have more information. And for parents of kids, you know, the kids aren't really going to know what's going on or what to expect or they show up to their appointment, they kind of go with the flow.
Dr. Manning: But parents I find are always very inquisitive and they want to know what the steps are going to be, how long treatment is going to take, what is the downtime going to be? Are they going to have to miss school? Those kinds of things. And so when there's multiple people on the plan or that are involved in treatment, they're getting more information so that they can feel better about the decisions that they're making on behalf of their children too.
Dr. Stafford: And the more information the better. For sure.
Dr. Manning: Always.
Dr. Stafford: Definitely.
Dr. Manning: Yeah.
Dr. Stafford: Great. Well, thanks again for coming on the show and we might have you back again for a third visit sometime.
Dr. Manning: I told you, I'm going for a three-peat here.
Dr. Stafford: Three-peat [crosstalk 00:13:19] and thank you to our audience for tuning in today and remember, fill the world with smiles.