Why do you get an overjet?

Sometimes teeth can move forward from thumb sucking or pen chewing and even from teeth grinding at night.

Teeth grinding or clenching is caused by the cheek muscles that press onto the teeth, pushing the side teeth in and causing the front teeth to move forward.

If left untreated, the upper teeth can continue to push forward and upwards causing the front teeth gum to shrink/recede.

Also as the upper teeth move forward, they lose contact with the lower teeth and the lower teeth may drift upwards.

Do I need teeth out?

In most cases where the overjet is 7mm or more we recommend 2 upper teeth are removed. This happens quite frequently in children and so young or old adults should not be surprised that they too may need teeth removed.

Will extractions affect my face?

Patients with a large overjet sometimes have a long narrow face and or protruding upper or both upper and lower lips.

Extraction teeth and moving the teeth back will allow the lips to be a resting angle, and also to be flatter.

If you have very thin lips then extractions may not be advised, but with full lips, extractions will help improve the facial proportions.

Will extractions affect me later in life?

Remember most teenagers have 4 premolar teeth extracted for fixed braces, and they do not have any problems later in life.

Adult extractions are quite common with orthodontics, and much safer than interdental stripping (IPR).

The lower teeth therefore prevent the upper teeth from being moved orthodontically back.

This lady had a narrow arch and the upper teeth were sticking out. She had fixed braces as a teenager, did not wear the retainers and the teeth moved forward.

The patient was not happy with her profile but did not want a quick solution, she wanted the best solution that fitted around her teeth. She felt that her upper lip stood out and her lower lip was trapped under the upper teeth.

Her lower teeth were slightly angled forwards and the lower jaw was set back. The overjet was 12mm.
This is common in patients who have a shorter lower jaw or a longer upper jaw.

The upper teeth could have been tipped back but there would only be a slight change in the profile and overjet.
We recommended Invisalign with 2 upper premolar extractions, and the patient agreed.

2 teeth were removed at the clinic and plastic fake teeth were placed inside the aligners.

The patient collected 6 aligner packets at a time and came in every 60 days for a check up.

The aligners were changed every 10 days and taken out only for eating, brushing teeth and the odd social event.

Invisalign was used as the orthodontic treatment of choice and it took 15 months to finish the treatment.

The upper teeth were reshaped at the end although the UL1 could have been reduced more.

The patient received straightened teeth and a more relaxed profile. The lower lip no longer rested underneath the front teeth, and her lips became more relaxed and in a natural position.

Jaw surgery was not needed.

In summary what looked like a surgical case ended up as an Invisalign extraction case.

#invisalign #clear braces # clear aligners # straight teeth #braces

O post Using Invisalign to reduce the facial profile apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

In most cases there is not enough space for the wisdom teeth to grow, so they erupt at awkward angles and then get stuck.

This impaction can cause gum inflammation, infection, pain and swelling.

In certain cases the patient cannot open their mouth due to the infection.

In the image above the LL8 is impacted and this leads to food trapping and dental decay of the tooth next door.

The LL7 suffers from a severe cavity and will need root canal treatment or even an extraction.

Sometimes the wisdom tooth itself get decayed and causes extreme pain.

It can be difficult to floss between a buried wisdom tooth and the tooth infront.

But a poor diet with lots of sweet foods and drinks will accelerate tooth decay especially around the molars.

Dental pain can appear when it is too late to save the tooth and the tooth next door.

On a radiograph, dental decay is seen as a dark shadow or hole in the tooth.

As many wisdom teeth are positioned deeper than the second molars, then the decay in the seconds is deep and close to the nerve. Some teeth will need root canal treatment or even extraction.

Final advice is to brush and floss the molars, get a dentist to check with radiographs for any signs of infection, decay or even cysts.

In our opinion the first sign of a wisdom tooth problem should be actioned with an extraction soon after, as we have found wisdom teeth; once a problem, always a problem.

#wisdom teeth #toothache #dental extraction

O post Why you should get your wisdom teeth x-rayed part 2 apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

The dental arch is defined as the space within which the teeth sit in a comfortable uncrowded position. The width of the arch is usually wider than the depth, but this can vary amongst humans with disproportionate jaw length etc.

The arch can narrow over time owing to teeth clenching muscle action, tongue thrust, thumb sucking or even orthodontic relapse. This can lead to tooth crowding.

Tooth crowding due to arch collapse can create unsightly smiles, gum problems, tooth wear and even the odd fracture of a tooth.

Arch collapse can cause teeth to drift upwards, inwards, outwards and downwards.

The drift causes other teeth to fall into the space created. This can lead to bite issues, food trapping, gum disease and even decay.

Some patients have airway issues with arch collapse as the tongue tends to sit further back and patients are known to snore.

Invisalign is a great tool to reverse arch collapse and create a great smile.

In this case, a young male aged 25 presents with dental crowding and anterior tooth wear. The lower teeth are not seen much as they have drifted upwards and this has lead to a deep bite with upper teeth wear and tooth shortening.

He also had a deep bite that can lead to tooth wear and joint problems.

Some patients may want a quick fix with dental veneers and we certainly can recommend them in suitable cases. What we do not recommend however are stick on composite bondings as they can fall off and also make the teeth look bulky and non translucent.

The young patient wanted a noninvasive treatment without fixed braces.

We agreed Invisalign treatment and the idea was to expand the dental arches outwards, lower anteriors downwards and the upper anteriors upwards.

By tilting teeth into an upright position, we can increase the dental arch width and straighten the arch. This creates the pleasing effect of a wider smile with teeth aligned into an acceptable position.

The deep bite can also be addressed by the pushing forward and downwards of the lower incisors and the up and outwards movement of the upper incisors.

After 1 year of treatment we levelled off the incisor edges and the patient was very pleased. In fact 98% of Forma patients are pleased!

Take a look for your self.

We provided 3 upper and 3 lower Invisalign Vivera retainers and free tooth whitening.

The patient rang us up after 11 years and asked for new triple retainers, proving that his teeth were stable and in good health.

#invisalign#braces#clear aligners

O post What is Expanding the dental arch and why? apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

The E line

The E line is an imaginary line drawn from the nose tip to the chin. In the ideal face the upper and lower lips sit just behind the E Line, with the lower lip being fuller being closer.

Changes in the positions can be seen in patients who have :

1 Upper jaw being forward or backward

2 Lower jaw being forward or backward

3 Small or big nose

4 Full or flat lips

5 Teeth protrusion

All except teeth protrusion would involve a surgical intervention to correct or early fixed orthodontics with headgear etc. However teeth problems appear quite late into adulthood and many long or old adults would not wear fixed braces with head gear.

Bimaxillay protrusion

Bimaxillary proclination is a dental term used when both upper and lower teeth are angled forwards causing the lips to procline forward.

It is most common amongst African and Asian populations.

It is usually due to the increased length of the bone that holds the teeth, the dentoalveolar process, but can be sometimes due to tongue thrust as well.

It can also be seen where the lips are full but loose/incompetent which can allow the forward tilting of the teeth.

The lip profile can be seen to have a reduced angle between the base of the nose and the upper lip. The lips can be seen to be actively trying to close the mouth.

Sometimes a patient may have difficulty in having a relaxed pose with the lips together due to the proclination.

In a study carried out in 2007, Chinese participants preferred a flatter smile than a bimaxillary protruded smile.

In another study larger than average teeth that do not fit in the dental arch, can lead to proclination and also crowding.

Patients can inadvertantly ask for smile makeovers or veneer treatment hoping that the protrusion can be reduced, but without gross tooth destruction it is ill advised.

Most adult patients would like this type of malocclusion corrected orthodontically, but would not want fixed braces if at all possible.

Invisalign orthodontics solution

Invisalign clear aligners can be of great help in reducing this dental problem.

Space needs to be created to allow retraction of the teeth.

This can be done either by:

Pulling back all the teeth is possible if the wisdom teeth have been removed.

The amount of space at the back may be limited by the lower jaw.

Stripping the enamel between teeth contacts; this can only give 4-5 mm backward placement. But some patients prefer this option.

The best option is the removal of 2 upper and 2 lower premolars. This can give a total of 5-10m of space allowing the front teeth to be angled backwards to near vertical.

The spaces are closed during the process with the Invisalign aligners. At each aligner stage the space is reduced and the teeth crowding also less.

Extractions allow you to have maximum profile reduction and change in crowding without damaging the enamel of the teeth.

With the extraction of 4 premolars we were able to reduce the crowding and the profile. Notice the reduction of the lip profile and the nasolabial angle.

O post Proclined teeth and the Eline apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

COVID-19 has an impact on health-care professionals, including dentists, dental hygienists, and dental assistants. COVID-19 virus has been found in saliva, which puts the dental professional at risk. Furthermore, recently released statistics showing that the virus can live on up to three days on plastic and stainless-steel items, four hours on copper surfaces, and up to three hours suspended in a fine mist. The information assimilated in this document will help those in the dental profession reduce the risk of exposure to and from patients.

Practice safe infection control protocols

• Use preprocedural rinse of peroxide. The concentration of any rinse used should be at least 0.5%. Over-the-counter peroxide is typically 3%, so it would need to be diluted. Rinse at the beginning of the appointment for 60 seconds and again after the appointment.
• At this time, the ADA and CDC are only recommending peroxide to destroy the virus. While chlorine dioxide and chlorhexidine have been shown to kill some viruses, at this time, the American Dental Association and the Centers for Disease Control and Prevention have not endorsed their use for destroying COVID-19.
• ALWAYS wear appropriate personal protective equipment (PPE) when working directly with patients.This includes safety glasses, gowns, lab jackets, face shields, gloves, and a mask appropriate for the task.

Patient screening

• Front desk staff should call and screen patients prior to their scheduled appointments. Additionally, staff should screen patients when arriving for their appointments.
• Reschedule any patient who discloses they have had flu-like symptoms that include a high fever, dry cough, or difficulty breathing. Or if they have been in contact with anyone who has tested positive for COVID-19 within the last three weeks or 21 days.

General housekeeping

• Avoid direct handshaking, hugging, or greetings that require direct contact.
• Provide hand-sanitizer in all operatories, at the front desk, and in all bathrooms.
• Disinfect common areas including entry doors, throughout the day. Diluted household bleach will kill the virus.
• Wash hands often and refrain from touching your face—eyes, nose, and mouth.

O post Making patients safe when Dentistry reopens apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Invisalign works by providing staged aligners, that should be changed every 10-14 days. You should also be reviewed for spacings, buttons and misfitting during the process. Unfortunately with dentistry and the public in lockdown, we need to decide wether the Invisalign process should be continued or put on hold.

Luckily for many of you, Forma Smile have given you all your aligners. For some new starters you may only have 2-3 aligners and for some ex Finest Dental patients, you may have been given a limited number of aligners by FD.

Advice on staging

There are four types of patients as stated, but to be more clear :

1 Patients who have had no buttons added yet; our advice is to stop at aligner 2 ( or the last aligner without attachments) and wait until we can book you in. You can wear your last aligner just at night as a holding brace.

2 Patients who have yet to start treatment; our advice is that we must wait until Covid is over to start your treatment.

3 Patients who are in the middle of treatment or near the end ; our advice is to email and tell us what number aligner you are on, and we can advise on wether you needed spaces or just to carry on.

4 Patients who had reviewed their scans and the aligners are on order; we are waiting for shipments and we can ship the first aligners to you before any buttons/attachments are bonded.

In light of the crisis any new orders are being processed with at least 3-4 aligners with no buttons or spacings, which would give you Invisalign treatment for 6-8 weeks. This should take us out of the Covid crisis.

Advice on diet

As many of us are in lockdown, we have all day to sit at home and visiting the fridge/larder becomes very tempting. I personally am in a perpetual cycle of eating and exercising.

Aligners need to be removed for eating and drinking anything sugary or fizzy. If you feel you cannot manage aligner therapy and all the consumption, then perhaps put aligner therapy on hold and just wear the current aligner at night.

For those with the more active outlook, you may see this lockdown as a great way to continue aligner therapy; but be careful about tooth decay if you are eating or drinking more often.

Try your hand at cooking healthy meals with more vegetables or salads at the table. I for one make more Indian vegetable curries now and hardly eat meat. My daughters think I am a flexitarian!

Advice on hygiene

We always recommend flossing 2-3 times a day and the use of the Philips electric tooth brush. This regime will keep your teeth and gums clean, but also keep the aligners clean. Do not use hot/warm water (or even the dishwasher) on the aligners, as they will surely distort.

Sometimes soaking them in an oral antiseptic solution will also help.

Advice on personal health

Lockdown means no visits to the gym, parks or swimming centres. It also means long periods of sitting down.

In this quiet period of self reflection exercise can break the mood and get you healthy again.

You can probably still find bargains on Amazon or Ebay, but many of us do not have a great income coming in, so perhaps an economical purchase is advised.

Luckily I had ordered an exercise bike on Ebay before Covid. I bought an ex gym club bike, worth probably £1000 for as little as £200. For some of you who want a gym standard bike going cheap the ebay site equip4gyms in Wales was where I bought my bike from (shipping takes about 1 week). It has a rest for my Ipad so I can exercise and watch Money Heist or even a seminar.

I also have an outdoor bike and I make sure that at least once a day or two I go for a bike ride as well.

A daily walk/run is also recommended before you get down to your Netflix series or knitting, as is the fad in my house.

Always be careful not to out do your self and pace your exercise with care.

For any further information please email us

admin@forma.co.uk

or tel 02074369672

O post Invisalign during the Covid crisis apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

A sense of loss

Being a registered patient means that you have no access problems when you have a dental problem; you are recognised by the receptionist and the dentist and nurse know you very well.
The dentist has maintained your oral health, patched up or maintained your lifelong teeth.
Even when a new dentist arrives, you are comfortable in the knowledge that the dental record will tell all.
Much like your prized car, your dental health was looked after with great care.

It is rare for a clinic to close down, and when it does you feel abandoned.
Please do speak with anyone if you feel alone and lost, even a family member may have wise and comforting words for you.
You can contact us by email if you need advice.

You and 2000+ other patients may need to register with another dentist. Some patients may just abandon dental care completely.
Many clinics are already fully booked and it may take you a while for you to register with another dentist.

Trying to carry on

You may have paid in full or by instalments and are in the middle of treatment. Where can you go to get the remainder fo your treatment done?
It can be difficult for a dentist to pick up treatment midway, they may have another opinion or a different dental treatment plan in mind.
Usually the dentist is compassionate and understands your situation. He/she may just want to charge for what treatment was left to do.
Sometimes you have paid for crowns or veneers to be fitted and are in temporaries. It can be difficult for you because you cannot just turn up at Accident and Emergency.
Many patients would have already paid for these once and do not want to pay again.
The problem is that temporaries are a short term solution and you must get permanents fitted soon.
Dental implants once placed can be left indefinitely until a crown is placed.
Many patients may have already paid in full however for the implant and crown.

Financial loss

If you have paid by a credit card then the bank may be able to get your money back.
If you have taken finance, contact the finance company for advice. They may advise stopping the payments for now.
The finance company will be able to trigger their insurance policy for monetary loss and help reimburse you.
Under the consumer credit act if a service is not provided then the finance company may have to investigate but ultimately reimburse you.
Trying to get a refund from a closed down clinic may be difficult because the clinic probably closed down because of financial problems.

In current treatment 

If you are in pain, have had recent surgery or need stitches out then please contact another dental surgery and let them help. Sitting on a dental problem will only make it worse.
It may be difficult to get crowns fitted without having new impressions taken. Maintain a good diet, be careful with temporaries and have a soft diet.

Invisalign patients

Invisalign patients should try to stay on the current aligner if they needed teeth spacings or attachments bonded. If they are just changing aligners then please change to the next one if the old aligner was a good fit. If the delay is long then contact Invisalign and see about transferring the treatment to another Invisalign provider.
If you feel that the aligner is getting tired then just wear it at night as a retainer until you can resume treatment. You may change to the next one if the old one is beyond tired.
You should not progress through the aligners as you may have required spaces to be made.
We will be happy to help patients in the middle of Invisalign treatment and we can liase with Invisalign on your behalf.

Dental Implants

Patients in the middle of treatment or require implants etc. but are not in any pain should maintain good oral hygiene. Implants do not need immediate attention as there is a waiting time for the bone and soft tissues to mature. You may be desperate to get the crown fitted but hopefully you are wearing a temporary denture or crown. An antiseptic mouthwash helps keep the mouth clean.
Do seek immediate help if you are worried, have a swelling or are in pain. Sometimes all you need is a reassuring word.
If the finance company allows it then you may be able to transfer to Forma as an ongoing treatment case.

Further advice

All is not lost. If you have lost a lot of money try to see if your household insurance has a legal department who can try to get your money back, either from the clinic or the finance company.
Citizens Advice I feel are limited in knowledge in these situations, but they are worth a phone call.

If we have not covered your situation and need help, please do email us directly.

O post Finest Dental: What to do when a clinic closes apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.