Wisdom Teeth

Did you hear about 3rd molars on NPR‘s Marketplacehttps://www.marketplace.org/2016/09/19/world/wisdom-getting-your-wisdom-teeth-removed  537686712_abdedba5e6_z

Dave Boudreau’s photo


Someone asked me about this post and I realized I should have gone into more detail.  There are usually a few reasons why you might want to get your “wisdom teeth” or 3rd molars out or “extracted.”  One of them is pain.  The other is pathology.  The 3rd molar could be causing a problem if it is unerupted.  The 3rd molars can also damage the 2nd molars (teeth you want to keep).  If you don’t understand why your doctor is mentioning getting the 3rd molars out, then ask.  Ask them to show you.  Don’t be shy – your doctor wants to make sure you understand and doesn’t want you to walk away with questions on your mind.  If you want to do some “heavy” reading, Dr. Raymond P. White, Jr., my mentor at UNC, is one of the world’s foremost authorities on the topic.  Here’s one of his articles from 2011 in the Orthodontic Journal AJODO http://www.ajodo.org/article/S0889-5406(11)00494-X/abstract Happy reading!!

Clear Retainers!!

Remember when you had to wear the metal retainer when you were a kid? Now you don’t! You can get a clear one like this! Maybe your older retainer doesn’t fit. If so, give us a call! We make metal or clear retainers for kids and adults.
If you’re in #Raleigh, and you’re not wearing retainers, your teeth are moving… get some new retainers here 🙂

We’re near @NCStateVetMed horses!! (also animals with big teeth!!!)

So lucky to be located near the NC State University Ncsu Vet School @NCStateVetMed!! Hope to “trot” by there and pet them again soon!!! I’m wondering if they need any orthodontic assistance?? 🙂

Raleighwood here we come!!

We’ve moved to Raleigh!! We’re now located at 2310 Myron Drive, Raleigh, NC 27607. We’re in a great new building and we hope you will come by for a new patient consult! We see patients of all ages for many different bite problems. Have a question about your bite? Call to make an appointment today: 919-469-9609.

Naipoki update!! (p.s. she doesn’t have tusks yet!!)

Naipoki Aug2013

This is so cool! We’re getting ready to renew our fostering of Naipoki and they sent us a little update of what she’d been up to!! It would be cool to visit there one day. Hope she’s keeping her teeth clean!!! (Apparently she won’t get tusks until about 3 years old!) She’s at the SheldrickWildlifeTrust.org

We’re gonna need a bigger toothbrush!

Speaking of teeth…. This crazy creature, the Gomphotherium, had tusks on the upper and lower jaws!!! Check it out!!! This photo is from the American Museum of Natural History.



If you look closely, between the tusks, you can see what looks like a human set of teeth.  So cool.

We adopted an elephant!!

We’re pretty excited about our newly adopted ELEPHANT!!!! Meet Naipoki!! She’s got HUGE teeth!!!  (Go to the bottom of the page “SELECT AN ORPHAN” and click on her name.) https://www.sheldrickwildlifetrust.org/asp/fostering.asp


She’s bigger than this now.  This is a picture from when she was first rescued from a well in Kenya.

Moms and dads, are you paying too much for the tooth fairy?

Moms and dads, are you paying too much for the tooth fairy?  #ToothLoss #ToothFairy http://www.usatoday.com/money/perfi/basics/story/2012-09-03/tooth-fairy-kids-money/57561778/1

You have questions about extractions. We have answers!

You have questions about extractions.  We have answers!


Many times the reason for needing extractions is based on tooth crowding.  If there is moderate to severe crowding, then including extractions as part of the treatment should be considered.  There are some people that are “border line” in their need for extractions.  There are also patients whose treatment and health will be detrimentally affected if extractions are not done.


While it may seem easy for someone to tell you to have teeth extracted, you might ask them if they have had braces and if they had teeth removed.  In my case, I’ve had both, so I know what you can expect from both.


In some cases, choosing not to extract teeth is detrimental.  One of the reasons extractions are recommended is the jaw is too small to align (straighten) the teeth.  Another way of saying this is the bone is too small for all of the teeth to fit.  If the orthodontist attempts to fit teeth into a bone that is too small, the teeth suffer because they have less bone to protect them.  Think of the tooth root like a tree root.  If a tree root doesn’t have dirt all around it, it is weakened.  The same happens with a tooth root; less bone around the root means the tooth is weakened.  There is not an unlimited amount of bone to keep teeth supported and anchored.


Additionally, when there is less bone around the tooth, there is also less gingiva (aka gum) around the tooth.  For example, If you put a 10” flagpole in the ground only 1” deep, then it will probably tip over.  If you put that same 10” flagpole in the ground 5” deep, then it will be sturdy.  To keep “sturdy” teeth, we need bone and gums around the teeth.  When attempting to fit teeth in a larger “semi-circle,” the amount of bone around the teeth could be reduced – and this is based on the amount of bone already available.


So, unfortunately, teeth can come out of the bone.  And orthodontists want to take care to make sure teeth have enough bone and enough gingiva/gum.


One of the signs that teeth done have enough bone is the “washboard” effect on the lower front teeth.  This can be a clue that the teeth are not fully surrounded by bone (like a tree root), and may have reduced bone on the front of these teeth.  Put your finger on the gum of your lower front teeth and move your finger from right to left and back.  Is your finger going up and down like a wave?  If your answer is yes, you’re feeling tooth roots and possibly teeth that have less bone.


Another sign is what is called “Reduced Attached Gingiva,” which exhibits itself sometimes in the lower front teeth.  It is a reflection that a patient’s gingiva is not as “sturdy” as gingiva that is healthy.  If a patient who has moderate to severe crowding has this type of gingiva before orthodontics and chooses not to have extractions, then he/she is more likely to have this increase in severity during orthodontics.  Having Reduced Attached Gingiva get worse is not optimal and may require a tissue graft from a periodontist either during or after orthodontics.


If a tooth has gingival recession, there is less gingiva surrounding the tooth.  If a tooth has recession before orthodontics, and during orthodontics teeth are “flared” to create room for all of the teeth (instead of extracting), the recession could get worse.  When crowded teeth are aligned, the teeth are moved forward and outward.  Teeth can be tipped too far, puncturing the bone and creating holes in the bone and damaging to the tooth.


There is another reason why an orthodontist might suggest getting teeth out: to avoid jaw surgery.  Sometimes the skeleton is also a component of the dental problem.  An “overbite” or an “underbite” may be improved by removing teeth while avoiding jaw surgery.  Removing teeth has a quicker recovery time and is less traumatic.


Getting a healthy tooth taken out can sound a little kooky.  Do your research.  Talk to your orthodontist.  Having teeth out may be a better option than trying to squeeze them in, causing long term problems.

What Orthodontists Don’t Tell You: The Top 10

What Orthodontists Don’t Tell You: The Top 10

I recently came across an article with this title and was intrigued because I wanted to make sure I was informing my patients properly.

Below I discuss the items mentioned in the article.

1. “There are some people who can give you braces who are not real orthodontists.”  I have a degree in Dentistry and a Masters of Science degree in Orthodontics.  I am a board eligible orthodontist who completed a three year orthodontic residency.  I do not practice general dentistry, which allows me to concentrate fully on orthodontic issues that my patients have.

2. “The last payment is not really your last.”  Before we start treatment, I discuss all the expected needs of the treatment.  We also discuss that if any additional items are needed (for example when a patient has a skeletal problem and is growing out of the improvements we’ve already made with orthodontics), we will address that.  Before we start orthodontics, I let the patient and parents know if I am leaning towards a need for something additional.  Retainers needed after braces are included in our treatment.

3. “There are different “types” of treatment.”  There are different schools of thought on some types of orthodontic treatment.  As with most things, there are traditional proven successful methods and there are some methods that may or may not have science behind them.  UNC-Chapel Hill’s Orthodontic Residency Program, where I trained, is arguably the best orthodontic residency in the country – where residents are educated to look for research-based answers and options for treatment.  The educational program at UNC is not afraid to address some types of treatment that may not be evidence-based treatments, teaching the residents to rely on data-driven outcomes.

4. “Not everyone needs braces at seven years old.”  I tell all of my patients the pros and cons of getting treatment.  I also discuss whether their concerns are solely aesthetic or what might happen if they don’t opt for treatment.  Most people don’t need treatment at the age of 7, but we see children of that age  and younger often to determine if the problem they might be having is something they need to take care of soon, or if their problem can wait until they have more permanent teeth, or at all.

5. “The costs of orthodontics can be negotiated.”  I don’t want healthcare to be degraded to the status of an outdoor flea market.  Do you want your orthodontist to be the best, well-trained practitioner?  I do not know exactly what my fellow colleagues in orthodontists are charging for various treatments, but I can tell you that I feel our treatment costs are fair and are not excessive.  We have different forms of payments plans to help people with their treatment goals.  Our practice also has some characteristics that others may not – check us out at www.partrickorthodontics.com.

6. “Teeth are not guaranteed to stay straight.”  I address this with every patient when we talk about orthodontic treatment and how important retainers are.  We have a saying in orthodontics about retainers, “Nighttime for a lifetime.”  If you wear your retainers, the chances of your teeth changing are very low.  [There are very few patients who have extenuating circumstances at the end of treatment, but they are aware of their particular circumstances.]

7. “These braces have been worn before by someone else.”  It is nearly impossible to “re-use” braces, because they are permanently distorted when they are removed from teeth.  In addition, we are vigilant in regards to recommended sterilization practices to ensure you have the same treatment we would like for ourselves.

8. “There are trendy options in braces and they may not be a good choice.”  There are some “trendy” braces options that parents and patients inquire about (for example clear braces or a braces “brand”).  If a patient inquires about these options, I am happy to let them know if this is a good option for them.  I am also confident in letting patients know the limitations of treatment (trendy or otherwise).  In fact, I take this obligation seriously, to inform patients about their options, even if these options are not interesting to the patient.  I want the patient to be informed and make choices based on the best information available.

9. “The braces may be on longer than originally planned.”  I give every patient a range of dates that their treatment should be completed.  Before starting I also discuss with them reasons why treatment might not be completed on time, so that we can discuss how we negotiate this problem should it arise.

10. “Braces can hurt.”  I describe the process involved in orthodontics to my patients, including when it will be uncomfortable.  Almost all patients are glad they decided to have their teeth straightened with a great smile and improved self-esteem.  I had braces as a young person, so I feel comfortable in discussing this process with patients, first person.  Orthodontists move teeth in bone, which causes pressure.  But it is not constant pressure for the duration of the treatment.  Usually the most discomfort is about a 3 day period when the braces are first put on and then the pressure subsides.  At each appointment we make changes to the braces, but the discomfort is not comparable to the first few days.  People feel pain differently from each other, so what  is uncomfortable to one patient may not bother another, and vice versa.

I hope this information above has been helpful.  If you have any questions or comments on this information or any other questions you might have about orthodontics, please contact us as 919-469-9609 or drpartrick@partrickorthodontics.com





Recently this article has been in the news and on patient’s minds.  “Dental X-Rays and Risk of Meningioma,” from Elizabeth B. Claus, et al from the journal Cancer, 2011.

Patients are always concerned about radiation.  Many people don’t realize this, but it is also a concern of the dentist.  There are a few comments I’d like to make about the article.

The article states that “the main outcome measure for the study was the association between a diagnosis of intracranial meningioma and self-reported bitewing, full-mouth, and panorex dental x-rays.”  The biggest problem with this is that it relies on what patients remember about what x-rays they had.  Some people can’t remember what they had for breakfast this morning, so making such an important claim based on what patients remember years ago is not the most reliable way to collect scientific data.  It is also possible that the patient unintentionally or harmlessly “remembers” more x-rays if they had a diagnosis of meningioma because they want to be able to link their disease to a cause.

The other important piece of information is this article is in the Conclusion: “Exposure to some dental x-rays performed in the past when radiation exposure was greater than the current era appears to be associated with an increased risk of intracranial meningioma.”  Unfortunately this bit of information doesn’t get much media coverage – that the amounts of radiation exposure, even twenty years ago, was more than current exposure amounts, based on improvements in technology.  If digital imaging is used, there is less radiation exposure than if film were used, making it healthier for the patient.

You may not know this, but we are exposed to radiation when we walk down the street, if you live in a brick house, or if you cook with natural gas.  An airplane flight across the country exposes a person to 3-5 mREM of radiation.  In comparison, digital x-rays for a full mouth series (18 x-rays) is about 6 mREM. (A mREM is a unit of radiation exposure.) [A full mouth series is a set of 18 x-rays that is taken usually at a new patient appointment.]

As a patient is it within your right to ask questions.  Asking  “Do I need these?” to the dental assistant or dentist is not inappropriate.  At that point maybe the dentist can give you some actual good data about your quandary instead of a study that has significant weaknesses.


Patient gets a computer generated jaw!!!


Patient gets a computer generated jaw!!!


Here is the information from the company that makes the jaw.  Really cool images here on how they’re doing it.




Below is more information about a woman who gets the world’s first 3D printed jaw transplant:

Doctors and engineers have joined forces to bring the world its first lower jaw transplant, using a prosthetic jaw made by a 3D printer. An 83-year-old Belgian woman underwent the operation last June, after suffering from an infection that rapidly ate away her jaw.

In order to keep breathing, chewing, talking and feeling in her jaw, the patient had no option other than the complete removal of her mandible (lower jaw).

Scientists at the University of Hasselt BIOMED Research Institute in Belgium developed a custom made implant using 3D printing of titanium powder. The design, processing and production of the implant were all done digitally, and the implant was ready in just a couple of hours. Weighing 107 grams, the prosthetic jaw was just a bit heavier than a natural lower jaw, but to no disadvantage. The implant was coated with “artificial bone” and polished, fitting the patient perfectly.

“Computer technology will cause a veritable revolution in the medical world. We just need to learn to work with it,” Dr. Jules Poukens, University professor and part of the development team, said in a written statement. “Doctors and engineers together around the design computer and the operation table: that’s what we call being truly innovative.”

The surgery restored not just the function but also the contour of the face in the patient.

According to Xilloc Medical, the company that created the jaw, the day after the surgery the patient was already able to function normally with adequate speech, swallowing and movement. The patient needed antibiotics to heal properly after treatment.  Article


Space Between Teeth



Lately I have seen a number of patients with a problem that has a little mystery surrounding it.  It’s called a “tongue thrust.”  Some people don’t know that it’s rarely a problem when it’s only associated with swallowing.  The problem lies when the tongue is positioned on the front teeth – essentially “pushing” on the front teeth.  In this case, the force of the tongue is strong and can make the upper and the lower teeth move forward.  This also creates spaces between the front teeth as well as create an “open bite” where the upper and lower front teeth don’t touch each other.  Usually when this happens it is an unconscious habit.  It’s not an easy habit to break.  One of the ways to improve the problem is to position the tongue further back in the mouth, so that it doesn’t rest on the front teeth.  Orthodontists can help with this in a number of ways, but for starters they can help you figure out if you’re having this problem and unconsciously pressing your tongue on your teeth.  Half of resolving this problem is knowing you have it.  The other half is cessation and getting some help reducing the spaces that have opened because the tongue is pressing too hard.  Check out our new patient page at www.partrickorthodontics.com if you’re interested in getting evaluated.  Our consults are free!!


Do your teeth look like you’re in a horror movie?

Improving your dental hygiene – or how not to look like you’re in a horror movie!!

It’s not easy to keep your gums and teeth clean, especially when you have orthodontics.  The best way to do that is to floss once a day and brush at least twice a day.  If you have braces you’re going to want to brush after every meal.  (Lunch caught in the braces is not a good look once lunch is over.)  Electric toothbrushes get teeth cleaner.  Get one if you don’t have one.  You’ll notice a difference.  You can even do a “scientific study” to compare your manual toothbrush to an electric toothbrush – brush on the left side with the manual brush and on the right side with the electric.  You will notice a difference by the end of the day.  If after all this your gums look puffy, ask your dentist or orthodontist for more tips on how to keep gums healthy.  Plaque can look like a whitish “film” on your teeth, especially where the gum/gingiva touches the tooth, but it’s not always visible.  Red “indicating” tablets can tell you if there are areas you’re missing when you brush.  Here’s how to use the tablets: Brush your teeth.  Then chew up the tablet – then spit it out.  The places where plaque is grabbing onto the tooth is a darker red color.  The rest of teeth will look pinkish, but the plaque looks dark red.  The dark red areas with plaque are areas that were missed the first time you brushed.  This may be an area that gets often neglected.  Every dental visit you have will be a much more comfortable appointment for you if your gums aren’t swollen.  When gums are swollen they have gingivitis so they bleed.  Don’t let bleeding stop you from flossing – it’s a sign that you need to floss more often.  Gums that get flossed everyday do not bleed.  Take good care of your teeth and you’ll be able to chew foods like almonds and celery way into old age.  Email me with any questions you might have about daily dental care.  drpartrick@partrickorthodontics.com

Brown Teeth

Brown teeth can be a sign of an infection inside the tooth.  Have you ever seen someone with just one brown tooth?  Recently we noticed a celebrity who has a front tooth that is slightly discolored, so we thought we would post these two pictures to show you what they look like.  If a tooth has changed like the ones in the pictures below, it may be a sign that the tooth had a traumatic impact or a cavity (tooth decay).  This discoloration doesn’t have to be permanent – a dentist may be able to help.  Let us know if you need help finding a dentist in your area.



Social Benefit Of Braces

The results are in!! Braces provides a “social benefit.”  Ideal smile owners seem to have more athletic, social and leadership skills.  While we can’t guarantee you’ll be a better athlete, it’s worth a consultation to find out!!!

Click on the photos to see how you feel about the “before” and “after.”



They’re making teeth!

Wow!! They’re making teeth!! They’ve got a way to go - but just wow!!    The article talks about how they made some teeth from stem cells.  You can see from the lower right picture that there’s not much bone around the “implanted” tooth, but that’s more a problem with the jaw holding the tooth than a problem with a !!!!man made tooth!!!!!

Wow!! They’re making teeth!! They’ve got a way to go – but just wow!!    The article talks about how they made some teeth from stem cells.  You can see from the lower right picture that there’s not much bone around the “implanted” tooth, but that’s more a problem with the jaw holding the tooth than a problem with a !!!!man made tooth!!!!!