You have a toothache… or do you? That's not a facetious question — sometimes it's difficult to determine if it's your tooth that hurts, your gums or both. It's even difficult at times to pinpoint which tooth may be hurting.
This is because the pain can originate from a variety of causes. Determining the cause is the first step to not only alleviating the pain, but also treating the underlying condition. Those causes generally follow one of two paths: either the problem originates within a tooth and spreads to the gums and other tissue, or it begins with infected gum tissues and can spread to the teeth.
We refer to the first path as endodontic, meaning it originates from within a tooth. Most likely the tooth has decayed (also referred to as a cavity), which if untreated can progress, allowing bacteria to infect the tooth pulp (living tissue inside the tooth that contains nerve fibers). Pain results as the nerves become inflamed and sensitive, though often varying in quality (sharp or dull) or frequency (constant or intermittent); outside stimuli, like temperature or pressure, may also trigger pain.
Although likely originating with one tooth, it may be difficult to pinpoint which one is actually causing it; you might even feel pain in your sinus cavity radiating upward from the tooth. An untreated infection will continue to spread to surrounding soft tissue, or result in a painful abscess, an infected pocket of bacteria between the tooth and gums.
The other path is periodontal, meaning the infection originates in the gum tissues. A thin layer of dental plaque known as biofilm develops and sticks to teeth at the gum line, which can lead to infection of the gum tissue, which then becomes inflamed and painfully sensitive. The untreated infection can then progress along the tooth and invade the pulp through the accessory root canals.
Knowing the source of an ache will determine the best course of treatment, whether a root canal, root planing, or a combination of these or other procedures. It's also the best, most efficient way to relieve you of that unpleasant mouth pain.
If you would like more information on the various causes of tooth pain, 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 “Confusing Tooth Pain.”
The old saying, “If it ain't broke, don't fix it,” doesn't really apply when discussing your wisdom teeth. It's great if they are not bothering you, but don't wait for problems to develop before you take action. This may seem counter-intuitive, but you should know that the best time to have your wisdom teeth removed is when they are not causing problems.
Why do wisdom teeth cause problems?
Wisdom teeth are so-called because they appear at ages 17 to 25, the age of supposedly attaining wisdom. They are also known as third molars and are farthest back in your jaws. For some people they come through the gum-line only partially, or they may not erupt into the mouth at all. Unerupted they have the potential to cause problems associated with the neighboring teeth and surrounding gums.
You may have heard of “impacted” wisdom teeth. This means that they are impacted or forced against neighboring structures, teeth or bone that prevent them from coming into the mouth in correct biting position. Since they are your last teeth to come in, space for them may be severely limited. They may push into the teeth that are already in place, becoming stuck as they try to erupt. When wisdom teeth are trapped like this below the gum line and are pushing against neighboring teeth, these molars can cause problems such as infections, cysts, or gum disease.
My wisdom teeth seem OK, so why remove them?
The dilemma is that if you wait until you feel pain connected with your wisdom teeth, their neighboring teeth may already be in trouble.
Another reason to remove these back teeth before they cause problems is that it's a good idea to have your surgery while you are young. Younger, healthy patients with no infections at the site have the best chance of having their wisdom teeth extracted without complications, with an easier recovery and uneventful healing.
Of course, each situation is different. Make an appointment with us for an examination and a consultation to discuss the risks and benefits of removing your wisdom teeth. For more information read the article “Removing Wisdom Teeth” in Dear Doctor magazine.
Today's cosmetic dentist can bring amazing transformations to their patient's smiles. That's because we now have a versatile array of materials and processes that precisely replicate the appearance of natural teeth.
Two of the most useful are porcelain veneers and crowns. Although different in structure and function, veneers and crowns both utilize a material known as dental porcelain, a ceramic material that can be shaped to resemble an individual patient's natural tooth shape, with the same color, hue saturation and translucence as the original or surrounding teeth.
As the name implies, veneers are a thin layer of dental porcelain that adheres to the outer surface of a tooth, essentially as a replacement for enamel. They solve a number of esthetic issues patients have with their teeth, especially those in front: poor color, shape and contours; broken teeth; poor tooth position; and staining that can't be removed with conventional bleaching. They most often require minimal tooth preparation, as only 1 mm or less of tooth enamel needs to be removed. Occasionally, no tooth reduction is required.
However, they are not a good solution where there is not an adequate amount of tooth structure to work with. In this case, a crown may be the best choice. A crown (or cap) covers the remaining tooth structure completely, reinforcing the remaining tooth structure 360°. This is an excellent choice for patients who have lost a large amount of tooth structure due to decay, trauma or grinding habits that have eroded the enamel.
To determine if you are a true candidate for either of these applications you should undergo a smile analysis in our office. During this process it's even possible to create a diagnostic mock-up — a “trial smile,” if you will — with temporary tooth-colored materials applied to your teeth and then photographed for your review.
The smile analysis helps us recommend the best solution for you and in turn will help you make an informed choice on the right application for you. Although either option may not be feasible in all situations, they may just be the right choice to change your smile for the better.
If you would like more information on how porcelain veneers and crowns can help transform your smile, 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 “Porcelain Crowns and Veneers.”
Root canal treatments are an important method for stopping the disease process within an infected tooth and ultimately saving it. However, one of the few side effects could have an aesthetic impact on your smile. Leftover blood pigments or the filling materials themselves can cause a darkening of the tooth — the tooth could eventually stand out in an unsightly way from surrounding teeth.
There is, however, one possible solution: a whitening technique known as internal or non-vital bleaching can lighten a darkened, non-vital tooth. For this procedure, we would insert a bleaching mix (usually sodium perborate mixed with hydrogen peroxide) into the pulp chamber of the darkened tooth for a short period of time. The chemical reaction of the mix whitens the tooth from within.
Our first step is to make sure by x-rays that the root canal filling in the tooth is still intact and still has a good seal. We then create a small opening in the rear of the tooth just above the root canal filling, irrigate it with water to remove any debris, and then add a special cement at the point where the root canal filling begins to seal it from any leakage of the bleaching solution into the root canal filling.
We then insert the bleaching solution into the empty pulp chamber. This is covered with a cotton pellet, which is then sealed in with a temporary filling. We repeat this application over a number of days until we see a noticeable change in the tooth color (normally after one to four visits). At this point, we would remove any residual solution and apply a permanent filling to seal the tooth.
This procedure can be performed instead of more extensive procedures such as veneers and crowns as a cover for the discolored tooth, or as a way to lighten teeth before applying a veneer or crown to help prevent discoloration from showing through. Either way, non-vital bleaching can help remove unsightly discoloration and restore vibrancy to your smile.
If you would like more information on internal or non-vital bleaching, 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 “Whitening Traumatized Teeth.”
Sports drinks have grown in popularity since University of Florida football trainers developed Gatorade® in the 1960s. They're widely viewed as a convenient fluid and nutrient replacement after strenuous workouts. Recently, another beverage has become wildly popular — the energy drink, whose high caffeine promises heightened concentration and physical ability.
While energy drinks have raised health concerns, sports drinks are widely regarded as safe. Both kinds of drinks, however, may be a cause for concern when it comes to your dental health.
While both are substantively different, they do have one thing in common — both beverages contain high levels of citric and other acids to improve taste and shelf life. This high acidity can have a detrimental effect on tooth enamel.
When the mouth becomes too acidic after eating or drinking (4 or lower on the pH scale), the tooth's outer protective enamel begins to erode, a process known as demineralization. Saliva with its neutral pH of 7 can neutralize this over-acidity in about thirty minutes to an hour after eating and the enamel will actually begin to remineralize. But when there's an overabundance of acid, as with these beverages, saliva's neutralizing ability becomes inhibited. The mouth remains too acidic for a longer period, resulting in greater erosion of the enamel.
Generally speaking, we don't recommend energy drinks at all. If, however, you occasionally take in a sports drink, add the following precautions, if possible: combine the drink with a mealtime and rinse your mouth with pH-neutral water to wash away residual acid from the sports drink; and wait an hour before brushing your teeth — since some demineralization occurs before saliva neutralizes the acid, you could brush away some of the softened enamel before it can remineralize.
Finally, consider this: pure, clean water is still the best hydrator in the world. Replenishing your fluids with it after exercise might also be the better choice for your dental health.
If you would like more information on the effects of sports and energy drinks on oral health, 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 “Think Before you Drink.”
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