In a healthy tooth, a coating of enamel protects the crown — the part above the gum line — and a layer of cementum protects the tooth root below the gum line. Enamel and cementum are inert (nonliving) substances that do not respond to stimuli such as heat or cold; however, dentin, the living tissue below them, does. Dentin contains numerous microscopic tubules that readily transmit stimuli toward the nerve-filled center of the tooth (pulp tissue). Loss of protective enamel or cementum leaves dentin exposed to all sorts of stimuli in the oral environment, which can trigger “dentinal hypersensitivity” — anything from a mild twinge to shooting pain.
Fortunately, there are many options for treating hypersensitivity. The key to selecting the most appropriate one(s) is determining the cause(s). Some of the more common reasons for sensitivity due to dentin exposure include:
- Enamel erosion caused by an “acid attack” related to external (extrinsic) causes — i.e., consumption of acidic beverages/food — or internal causes — i.e., regurgitation of stomach acids due to gastroesophageal reflux disease [GERD] or the eating disorder bulimia
- Using an overly abrasive brush or toothpaste, brushing incorrectly or too frequently, or brushing too soon after an “acid attack” — all of which can result in a loss of enamel
- Tooth decay (dental caries or cavities)
- Tooth fracture or chipping: tooth grinding (bruxism) is a common cause
- Worn fillings
- Gum recession, due to age or improper tooth brushing, that exposes the tooth root
- Gum disease, which can result in gum recession
Sensitivity can also occur following a procedure like treating a cavity. Normally it subsides within a couple of weeks or so but if it continues there may be another underlying cause.
Whatever the source(s) of your discomfort, our office can get to the bottom of it and recommend an effective course of treatment that meets your personal needs!
If you would like more information about tooth sensitivity, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sensitive Teeth.”
A consistently dry mouth is not only uncomfortable and unpleasant but also probably more serious than you think. Dry mouth, medically known as xerostomia (“xero” – dry; “stomia” – mouth) affects millions of people, but few understand why it happens or why it is important.
What Causes Dry Mouth?
It is normal to awaken with a dry mouth because saliva flow decreases at night. But if your mouth is persistently dry throughout the day, it may be a result of habits such as smoking, alcohol or too much coffee drinking or even dehydration. It is also a common side effect of some medications. Xerostomia is not a disease in itself, but it could be a symptom of salivary gland or other systemic (general body) disease.
Why is Saliva Important?
A persistently dry mouth can be a problem. Not only does it feel unpleasant and lead to bad breath, it can also significantly increase your risk for tooth decay. Saliva lubricates your mouth for chewing, eating, digestion and even speaking. Saliva also has important antibacterial activities. Most importantly normal healthy salivary flow neutralizes and buffers acids in the mouth to protect the teeth from the acids produced by bacteria on the teeth that cause decay, and by acids in sodas, sports drinks and juices that can erode tooth enamel.
Not only does saliva neutralize acids but with its high mineral content it can actually reverse de-mineralization — the process by which acids attack enamel and remove calcium from the enamel surface. Healthy saliva actually re-mineralizes the outer layers of tooth enamel, but the process can take 30-60 minutes. That's why it's important not to snack on sugars or drink sodas between meals — one an hour and your mouth is acidic all the time.
Individuals without enough saliva are especially at risk for root decay and fungal infections, and they are also more likely to lose tooth substance through abrasion and erosion.
What Can We Do for a Dry Mouth?
If your mouth is usually dry, make an appointment with us to assess the causes of the problem. However it may be more serious with medical implications. The solution may be as simple as drinking more water and using good daily oral hygiene, or it may necessitate prescription medication to promote more saliva flow.
Contact us today to schedule an appointment to discuss your dry mouth and what we can do to help. For more information read the article in Dear Doctor magazine “Tooth Decay – How To Assess Your Risk.”
It’s indisputable that fluoride has revolutionized dental care. Decades of research have overwhelming shown this natural, enamel-strengthening chemical has decreased tooth decay.
Too much fluoride, though, can cause enamel fluorosis, a permanent staining of tooth enamel. In its mildest form, the teeth develop faint whitish streaks; in more severe cases, the staining is noticeably darker and the teeth appear pitted. The teeth themselves aren’t damaged, but the unsightly staining could require cosmetic treatment. Children under age 9 (when permanent teeth enamel matures) are especially at risk of fluorosis due to over-fluoridation.
Because of fluoride’s prevalence in hygiene products and many drinking water supplies, it’s not always easy to know if your child is receiving too much. There are two areas, though, that bear watching.
First, you should limit the serving quantity of fluoride hygiene products, particularly toothpaste. Children tend to swallow rather than spit out toothpaste after brushing, so they ingest more fluoride. We recommend a small “smear” of toothpaste on the brush for children under two, and a pea-sized amount for children two to four.
The other concern is your drinking water. Three-quarters of America’s water systems add fluoride, usually to a recommended level of 0.70 PPM (parts per million). To know if your water supply adds fluoride and at what levels, you can contact your local water utility or health department, or check the Center for Disease Control’s website for their “My Water’s Fluoride” program (http://apps.nccd.cdc.gov/MWF/Index.asp). This site will have information if your water system participates in the program.
If your area exceeds recommended levels or is at high risk for fluorosis, we recommend reducing the use of tap water in infant formula. Besides breast-feeding (human breast milk is low in fluoride), you can use either ready-to-feed formula, or mix powdered formula with water specifically labeled “de-ionized,” “purified,” “de-mineralized,” or “distilled.”
One thing you should not do is eliminate your use of products containing fluoride — this may increase your child’s risk of tooth decay. The consequences of decay can be serious and have a life-long effect — and far outweigh the risks of fluorosis staining.
If you would like more information on fluoride and your infant, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”
If your infant is extra cranky and seems to want to chew everything in sight, it's a good bet that the first tooth is on the way! For parents, this is cause for both celebration and concern. After all, no parent wants to see a child suffer even a little bit. Decades ago, when a teething infant showed signs of discomfort, a parent might have rubbed some whisky or other strong liquor on the child's gums — a misguided and dangerous practice. There are far safer, more effective ways to help your child through this exciting yet sometimes uncomfortable phase of development. Here are our top five teething remedies:
Chilled rubber teething rings or pacifiers. Cold can be very soothing, but be careful not to freeze teething rings or pacifiers; ice can actually burn the sensitive tissues of the mouth if left in place too long.
Cold, wet washcloths. These are great for gnawing on. Make sure the washcloth is clean and that you leave part of it dry to make it more comfortable to hold.
Cold foods. When your child is old enough, cold foods such as popsicles may soothe sore gums. However, make sure you confine them to mealtimes because sugars can cause tooth decay — even in very young children.
Gum massage. Massaging inflamed gums with your clean finger can help counteract the pressure from an erupting tooth.
Over-the-counter medicine. If teething pain persists, you can give your baby acetaminophen or ibuprofen, but check with a pharmacist or this office for the correct dosage. The medicine should be swallowed and not massaged into the sore areas, as this, too, can burn.
So when does it all begin? Some babies start teething as early as three months or as late as twelve months, but the typical time frame is between six and nine months. Usually the two lower front teeth erupt first, followed by the two upper front teeth. The first molars come in next, followed by the canines (eyeteeth). Most children have all 20 of their baby teeth by age 3.
If you have any questions about teething or the development of your child's teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Teething Troubles.”
Because its symptoms can be easy to overlook, gum disease is sometimes called a “silent” malady. But don't underestimate this problem! Untreated periodontal disease can progress into a serious condition, possibly leading to tooth loss and even systemic (whole-body) health issues. With proper preventive measures and appropriate treatment, however, the disease can be controlled.
The root cause of periodontal disease — actually, a group of related diseases, all of which affect the tissues surrounding the teeth — is the buildup of bacterial plaque (also referred to as biofilm) around the gums. While hundreds of types of bacteria live in the mouth, only a comparatively few are thought to be harmful. But when oral hygiene (namely, brushing and flossing) is inadequate, the environment in the mouth becomes favorable to those harmful types.
The disease often begins with inflammation of the gums called gingivitis. It symptoms include bad breath, bleeding gums, and soreness, redness, or tenderness of the gum tissue. However, in some people these early warning signs are ignored, or masked by the effects of harmful habits like smoking.
Gum disease is chronic; that means, if left alone, it will worsen over time. Periodontitis, as it progresses, causes damage to the ligament that helps hold the tooth in place, as well as bone loss. This may become increasingly severe, and ultimately result in the loss of the tooth. Severe periodontitis is also associated with whole-body (systemic) inflammation, which has been linked to an increased incidence of cardiovascular diseases, like stroke and heart attack.
But there's no reason to allow gum disease to progress to this stage! Prevention — that is, regular daily brushing and flossing as well as regular dental cleanings — is a primary means of keeping this problem at bay. Plus, every time you have a regular dental checkup, your gums are examined for early signs of trouble. Of course, if you notice the symptoms of gum disease, you should come in for a check-up as soon as you can.
There are a number of effective treatments for gum disease. One of the most conservative, routine ways are those regular dental cleanings we referred to earlier, usually called scaling and root planning. Using hand-held and ultrasonic instruments, the buildup of plaque (tartar) is carefully removed, sometimes under local anesthesia. A follow-up evaluation may show that this treatment, carried out on a regular schedule, is all that's needed. Or, it may be time for a more comprehensive therapy.
If you have concerns about gum disease, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Understanding Gum (Periodontal) Disease” and “Warning Signs of Periodontal (Gum) Disease.”
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