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     We recently launched our practice website and discovered that web-searches of my name lead to this blog.  If you would like to visit our website to learn more about my treatment philosophy, background, or to download our new-patient forms, please visit blasebraces.com.  (You can also find us at blazebraces.com for those of you who prefer that spelling of my last name!)
     In forthcoming weeks you will be also be able to visit us on our office Facebook page for updates on contest winners and other office news!

Open bites: easy to find but hard to fix!

I would venture to say that an open-bite is the most difficult bite to predictably correct for most orthodontists. By "predictably" I mean that it is impossible to forecast whether an open-bite correction will stay corrected after the braces are removed, EVEN IF RETAINERS ARE WORN NIGHTLY.  There certainly are bite problems that are difficult to correct in general (severe deep bites, severe crowding), more complicated than average (impacted teeth, skeletal problems requiring jaw surgery), or that require significant dental work after the orthodontics (missing teeth or severely worn teeth requiring crowns, veneers and implants).  Open-bites remain the correction with the least chance for long-term stability.

The following three examples show the before and after images of open-bite patients.

Started with tooth contacts limited to last molars only.  Still has no contact between the incisors, but has overlap of the front teeth.  This patient still has a mild "tongue-thrust."


Here we had complete closure.  I saw her today and her bite remains closed.  I'm always happy to take "credit" but this has more to due with the patient's "good luck!"

 This adult had the most extensive treatment plan of my orthodontic career.  She had surgery to BOTH jaws in order to achieve this result.  Her bite remains stabile, but I think this is probably 90% due to the skill of the surgeon (Dr. Michael Gunson in Santa Barbara, CA)!  Additionally, the patient wears her retainers religiously.

18th Annual Skating Party

We had our 18th annual skating party on the Thursday before Thanksgiving and had a fabulous turnout.  Thank you all who attended and added to the enthusiasm of the event!  Dr. Blase DID win the adult race (for the 17th time), but as you can see in the photo, it was a battle coming out of the final turn -- and he was VERY sore the next two days, and suspects that his winning ways are coming to an end!  Kind of like the Steelers this year!  :-(

As usual we had 32 door prize winners in the 3 hours of skating and cake-eating ... and only our second broken arm in all this time!  Oops!  I just saw her yesterday and she's already out of her cast. We look forward to next year's event, so save the date -- Nov. 18th, 2010!

Oil painting of Yellow Labrador

I did this painting a few weeks ago in appreciation for the continued hospitality of the Wing family.  It is a portrait of Baxter, whose proud owners currently live in San Diego and have allowed us to stay in their guest room numerous times this fall while attending our son's home soccer games at the University of San Diego.

Albert Pujols portrait

Jim Steward has been a friend since we worked at McDonald's together in the mid-70's.  He is now a co-owner of an ad agency in St. Louis and as such works with the Albert Pujols Foundation.  For those of you unfamiliar with baseball, Pujols is perhaps one of the greatest players in Major League history and just finished his ninth year of play, all with the St. Louis Cardinals.  During that time he has never hit below .314 and he has been the National League MVP twice.  He has also become well known for his charitable efforts in his home country, the Dominican Republic through his foundation.

I had lunch with Jim this spring and he asked if I might try and paint a portrait of Albert for his dinner-auction event to be held this Dec. 5th in St. Louis.  I told him that I'd try, but if he didn't like it he could line his bird cage with it!  I just mailed the finished canvas yesterday.

It may not actually be used in this year's auction due to its late arrival (my fault!), but Jim thought they might make some copies of it and have Albert autograph those for larger contributors to his foundation, then use it in next year's event.  It will be fun to find out where it ends up, but in any case, I learned a lot and am pleased with the result.

This final photo is of a smaller version I painted for my son, Charles.  I tried a couple of different things with the background and the name on the left.  Having the two side by side reminded me of the seek and find games where you try and find the 10 items that are different.  Well, there are probably 10,000 slight differences between the two, so don't bother looking!

Dr. Blase's oil painting efforts!

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Wisdom Teeth: most do NOT need to be removed!

Do you need your 3rd molars (wisdom teeth) extracted?

The short version:

Sometimes, but NOT to prevent your teeth from shifting, and NOT generally because you were told that they are "impacted." So unless there is a clear dental-health problem, then you may pretty much leave them alone and have your dentist check them periodically. If they have not erupted, there is rarely any orthodontic justification for third molar extraction.

Examples of possible dental-health problems:
1. A tip of a lower 3rd molar is erupted, it has no room to erupt further, and a pocket or infection of the tissue overlapping the molar is present.
2. A 3rd molar has erupted at an unusual angle or position (ectopic eruption).
3. The molars have erupted but are in such a position in the mouth that the patient frequently bites their cheek.
4. The 3rd molar is decayed and the decay cannot be physically removed by the dentist due to insufficient access.
5. There is a cyst or damage to an adjacent tooth.

The long version:

The almost universal "need" for 3rd molar extraction is slowly going the way of the tonsillectomy phenomenon of my youth in the 1960's. It used to be almost a right of passage to have your tonsils out in grade school. Now is generally requires far more medical proof before a patient is subjected to the discomfort, risks, and expense of such a procedure.

Historically, wisdom teeth have been blamed as the cause of lower incisor crowding. However, we have known in the orthodontic literature for over 20 years that when comparing people born without wisdom teeth with those who've had them removed and with a third group of patients who still "own" theirs have the same average amount of shifting with the passage of time.

Therefore, tooth shifting is an age-related problem. This is why the orthodontic community switched recommendations with respect to retainer wear. Rather than asking each patient to wear retainers "for two years," or "until you are 18," or "until you get your wisdom teeth removed," for at least the past 25 years we in the profession state in our informed-consent forms that you must use your retainers both consistently AND for the rest of your life. This usually means night-times only and as the years go by, less and less nights per week.

Probably the best summary on the topic that I have found discussing the myths surrounding wisdom teeth was written by Jay Friedman, DDS, MPH (Master of Public Health) in the September 2007 issue of the American Journal of Public Health (vol 97, No 9). He has 28 citations if you are interested in seeing some of the original research. His concluding paragraph reflects my feelings on the subject:

"The evidence is compelling that prophylactic extraction of third molars is a significant public health hazard. It is a silent epidemic of iatrogenic injury that warrants avoidance of the extraction of any third molar in the absence of a pathologic condition or a specific problem."

Another interesting observation was made by Dr. Lindauer in the July 2007 issue of the American Journal of Orthodontics and Dentofacial Orthopedics. He stated:

"Opinions about the role of third molars in causing crowding of the anterior dentition were significantly related to year of graduation for both orthodontists and oral/maxillofacial surgeons. Generally, orthodontist became less likely to believe that third molars caused crowding and were less likely to recommend their removal prophylactically when they graduated more recently from orthodontic programs. This agrees with most recent literature on the topic that suggests little association between the eruption of third molars and crowding of the anterior teeth. Surgeons were more likely to believe that third molars caused crowding and more likely to recommend their removal to prevent crowding if they graduated in the 1970s or 1980s than earlier or later graduates."

It may be another two generations of dentists and oral surgeons before this becomes our universally acknowledged societal and professional perspective. Meanwhile, I will continue to do my part to let those patients under my care know that the presence of third molars does NOT necessarily mean that they will HAVE to be removed!

Julia's gone

Julia is my oldest child of two. She left for college four years ago and this is the painting I did for her to display in her dorm room. She chose against bringing her teddy bear to college since its arm had nearly worn off over the years. I included books by two of her favorite authors from then, Mercedes Lakey and J.K.Rowling.

She graduated this past May from Duke and is currently working on her Master's in Business Systems at the Fuqua School of Business at Duke University. We talk frequently, but I still miss her presence in my daily life.

About six years ago I took a beginners drawing class at The Drawing Studio here in Tucson anticipating the day when the kids would be gone. I knew that I would need something more than golf and practicing orthodontics to keep active and "engaged" in my life without them around. About a year later I started taking oil painting classes and I have enjoyed "most" of the hours I've spent painting since. I will include photos of more of my work in future posts.