Are your teeth crowded?
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Are your teeth crowded?

Are your teeth crowded?

Did anyone else feel a little letdown by Avengers: Endgame?  

— minor spoilers ahead (but the movie was released last year, if you really cared about how this movie ended, you would have seen it by now) —

I liked the movie but it was over three hours long and so many of the characters were just crammed into the final battle with a few lines of dialogue/jokes.  It was a great moment when the dusted characters came back but it kind of unravels from that point. There were scenes where I could not distinguish the characters because there were dozens of superheroes in every shot.  

It was both awesome fan service and major overload.  The crowding of the characters in the final battle was a problem for me.  But Avengers: Endgame was a great ending to this phase of the Marvel Cinematic Universe and I had a lot of fun watching it.  

Where am I going with this?

Once in awhile, a patient will ask me if their crowded teeth are a problem.  These patients specify that they are not concerned with aesthetics, they just want to know if there are health risks to having crowded teeth.

Like a superhero movie that is supposed to be loaded with superheroes, crowding is not necessarily a bad thing.  

Sometimes the crowding is mild.  

Sometimes only the bottom teeth are crowded and the top teeth cover those when a patient smiles.

Many patients have some crowded teeth but their smiles are still amazing and there are rarely any foods they cannot chew.

Not all crowded teeth need to be straightened.  I would encourage patients to consider treating crowded teeth only if clinical problems occur or if they are unhappy with their smile.

These are some of the notable conditions we see in the oral health of patients in areas where the teeth are crowded:

Bad Breath

Crowded teeth are more difficult to keep clean because the toothbrush and floss cannot easily remove the build up sitting in the overlapping areas.  This built up plaque will cause an odor because it contains food particles and bacteria feeding on these food particles.

Stained Teeth

Food and drinks such as red wine, tea, coffee, chocolate, blueberries can stain our teeth even when the teeth are perfectly smooth.  The staining can be much worse when teeth are covered in built up plaque and tartar. The staining is also harder to remove (at home and at the dentist) when teeth are crowded because some areas are just not accessible by toothbrush, floss or scaling instruments.

Gingivitis

Not only will the built up plaque cause bad breath, it will also cause inflammation of the gums.  This inflammation can be seen as a red swelling along the gumline which tends to bleed during brushing and flossing.

In the photo above, there is a contrast between the gums along the top teeth and the bottom teeth.  The healthy gums around the top teeth are a pale pink and look very “tight” to the teeth. The gums around the bottom teeth are darker red and more swollen.

Gum Recession

When teeth are not aligned, they will push against the adjacent teeth and put undue stress on the surrounding gum tissue.  This stress will eventually result in gum recession and expose the roots of teeth. The bacteria in the built up plaque can spread below the gumline and eventually break down the supporting tissue to worsen the gum recession.

Chipped or Worn Teeth

Crowded teeth also cause problems with how the top and bottom teeth bite together.  In the picture below, the blue curve represents a smooth, even surface for the top teeth to bite against.  When teeth are crowded, the blue curve becomes more jagged and the peaked areas are more prone to chipping when the teeth bite together.

These are some of the common problems we see in patients with crowded teeth.  Most of these problems can be alleviated by good oral hygiene habits at home and regular visits to the dentist.  

If orthodontic treatment is sought, patients still need to perform good oral hygiene during treatment because the metal braces or invisalign attachments are all places where food and plaque can accumulate. It would be awful to go through braces while having bad breath and gingivitis the entire time and then to have cavities on the teeth after they’re finally straight.

I hope this was helpful!

Phuong Luu, DDS

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