The comments

Eileen Thomas says:

I am 65. I remember being told about my unerrupted canine 40 years ago but until this year i had totally forgotten. Then the tooth began to errupt .
So this morning I have had it extracted.
My teeth in my top jaw are almost all crowns.
Will I have problems with them?
Thank you

Dr Sylvain Chamberland, Orthodontiste says:

I don't think I can help you further at this point without having a clinical exam. I recommend that you visit Dr Briss once you are back to Boston.

Dr Sylvain Chamberland, Orthodontiste says:

If the surgeon placed the gum above the crown using an apically repositioned flap, don't worry. The gum will follow the canine as it erupts.

If he cut a window in the gingiva, it is not good, but a keratinized gingival graft can be done at the end of the ortho treatment.

I hope that help. You can send picture via my facebook professional page account.

Joann Fitzell says:

My daughter had both of her canine teeth impacted. She had surgery today to pull them from her gums. However, the surgeon did not leave any keritinized gum in place. He cut away all of the gum to expose the teeth and attach them to her braces. I'm concerned now that she will not have sufficient gum coverage as the teeth decend into place. Should I be concerned like this?

Ndr eva says:

On a 14 year old female with pituitary hyposecretion whith transversal discrepancy of 6mm could still use RME (Hyrax for example)without surgery?

Dr Sylvain Chamberland, Orthodontiste says:

The chincup does not limit or reduce mandibular growth. However, the the maxilla is protracted forward and downard, therefore the chin move down as the there is some opening of the mandibular plane.

Hongjin says:

Hello dr chamberland, nice article up there.
I have a question dr, does the chin cup in this protraction mask limits the forward growth of mandible? Or helps in directing it downward, like the chin cup therapy.

Gurmukh Singh Sahi says:

Thanks a lot .very quick .v simple....

Jennifer Liu says:

Dear Dr. Chamberland,

Thank you so much for your insight and referral. I am currently out of the country but have wanted to find another reputable doctor in Boston for a long time.

In the meantime, if this additional info makes anything more certain for you, kindly let me know: the few doctors I have seen have concluded it is a muscular problem and only recommended a splint once I started experiencing pain symptoms. I had a pernicious habit of jutting my chin/jaw forward to compensate for lack of projection. No CBCT has ever been taken to examine for condylar resorption. I am just concerned since even though the pain is intermittent, the overall trend over the last 1.5 years has been intensifying pain, spreading from my lower left jawline to my chin and right jawline. That is, the pain I'm sometimes in now is more severe than the pain I was sometimes in before. I have stopped that old habit as far as I know. I don't know if the worsening pain 1) is indicative of a different underlying cause other than muscular, at least the current underlying cause; and 2) will damage my joints and cause other symptoms like worse deviated opening, and if these are contraindicative of orthodontic treatment.

Again, you've provided an invaluable resource for those of us trying to do our homework and your time is so appreciated.

Sincerely, Jennifer

Dr Sylvain Chamberland, Orthodontiste says:

I think the important thing is to get a proper diagnosis of your TMJ pain. Is it arthrosis? Is it disk luxation with reduction? Is it mainly muscle pain?
You say that pain is intermittent and correlated with stress level. Chances are that you clench your teeth when the stress is high and it create compression (and inflammation) in the joint, then you have pain.
On the other hand, clicking in joint is not a contraindication of an orthodontic treatment. Your bite may be shifting because of the underlying malocclusion.
You seem to live in te area of Boston. I would recommend that you have a consultation with my very godd friend Dr David Briss.
Keep us informed.
Best regards
Dr Sylvain Chamberland

Jennifer says:

Dear Dr. Chamberland,

I am writing to you after coming across your PowerPoint presentations describing two-phase TMD and orthodontic treatment. Because of your uncommon experience with both TMD and orthodontics, I was hoping you might answer a question for me.

Basically: is "stabilizing" the TMD necessary before beginning orthodontic treatment? I have reached no consensus on this after consulting orofacial pain specialists (Mass General, Tufts, etc.) and orthodontists alike.

I have had clicking all my life. Feelings of bite awkwardness started in 2013. Pain symptoms began in 2014. I wore a splint for 4 months which helped 85%. My doctor weaned me off and told me just to wear it whenever I needed it. Since then, my pain is intermittent and correlated with my stress levels. That is, permanent "stabilization" of my TMD seems unlikely - I've accepted it as a chronic condition. On the other hand, I understand the rationale for stabilizing it in order for the success of subsequent orthodontic treatment: I wonder if the unresolved TMD pain will be compounded and unbearable with orthodontics, and I have noticeable deviated jaw opening. It seems that an orthodontist correcting the patient's bite is impossible when that bite is constantly shifting due to TMD.

I would just like to know if it would be a bad decision to proceed with orthodontics without more TMD treatment and leaving the symptoms as they are.

I would be deeply grateful for any time you could spare to help me, given your unique background. I felt lucky to have stumbled across you via the Internet!

Thank you very much.

Sincerely, Jennifer

Dr Sylvain Chamberland, Orthodontiste says:

Thank You Dr. Vu for the precision about the dosage of radiation

However, the supplementary information of Dr. Denis Forest say:

"Human beings are subjected to two great sources of radiation: natural and artificial radiation. In total, these two kinds of radiation nearly account for about 360 millirems (mRem) per year for non-smokers and 640 mRem for smokers."

The radiation we are subjected is from 2 sources: natural and artificial.

Therefore, the dosage of 360 mRem is likely greater than the dosage from natural radiation of 285 mRem.

You may be both right.

Best regards,

Dr Amine says:

thank you doctor

Dr Sylvain Chamberland, Orthodontiste says:

Yes you can.

amine says:

thanks Dr.Chamberland for this intresting demonstrations
I have a question if you allow me.
Can we apply facemask therapy simultaneously with Hyrax palatal expander when the expansion screw is activated?

Thanks a lot Dr Chamberland i realy need to know.

Dr Sylvain Chamberland, Orthodontiste says:

It depends on the patient anxiety and the surgeon.
Generaly, local anesthesia is sufficient. But some patients who have high anxiety may benefit from IV sedation.
Pain may last for a few days, 2-4 days. Soft diet may be recomemnded for 1 week.

Dr Sylvain Chamberland, Orthodontiste says:

Easy
Stop wearing it. Remove your barbel.

Dominique says:

What if the barbell of your tongue ring is tipping your tongue when you play with it a lot and the bottom is taring forward and taring the bottom entry hole. How can you make it stop shifting?

dave h says:

Palatally impacted canine open exposure surgery on 15 year old: does patient need IV sedation or would Valium and numb the area sufficient? How long will post op pain last and how long before eating normal food? Thanks.

Dr. Vu says:

"In total, the dosage from natural radiation is around 285 mRem per year (or 3 uSv per day)"

285 mRem = 2,850 uSv per year
2,850 ÷ 365 days = 7.8 uSv per day.

I think it should 7.8 uSv per day.

Thank you so much with this great topic. I learned alot. Have a happy new year!