Many people make the mistake of only visiting the dentist when they feel they have a problem. However, instead of coming in for only “crisis treatment,” visiting your dentist regularly & receiving preventive treatment will save you time & money in the long run.
What patients don’t realize is that most dental problems don’t start to hurt until they reach an advanced stage. For example, a cavity can be detected three to four years before any symptoms appear but usually isn’t because early tooth decay does not hurt, & therefore the patient sees no need to go to the dentist. However, pain happens only once the decay reaches the nerve of the tooth. At that point, a root canal & crown are usually necessary, where if the problem was detected earlier, only a small filling would have been required.
Dental Insurance: What You Should Know
Since insurance maximums have not kept pace with inflation (the average maximum benefit paid by insurance carriers was the same in 2003 as it was in 1960!), a Blueprint or Direct Reimbursement plan can be the solution to making needed dental services affordable & within reach.
A Blueprint is a full & complete plan, customized to your wants & needs. To help you achieve your ultimate goal of overall oral health, this plan allows you to phase in treatment over a period of time.
Direct Reimbursement is a simple reimbursement plan that allows you to choose treatment with little paperwork & without preliminary authorizations. It can save you money & allows you to purchase plans that provide cost-effective services for employees.
Dentures, which are removable artificial teeth, can be either partial (replace only a few missing teeth) or complete (replace a full set of missing teeth). There are two types of dentures: conventional dentures, which are placed after the teeth have been removed & the tissues have had time to heal, & immediate dentures, which are placed immediately after the teeth are removed with no healing time. An over-denture is a different kind of denture that fits over a small number of remaining teeth or implants.
When you first get dentures, it takes a little time to get used to them. They may feel awkward or loose until your cheek & tongue muscles learn to hold them in place. When first getting used to dentures, you may notice slipping when you laugh, smile or cough. This is caused by air getting under the base & moving it; you will eventually be able to better control these movements once you get more practice wearing them.
It may be a good idea to secure new dentures with an adhesive when you are just getting used to them. However, with all the recent advances in dentures, you normally do not need to use any type of adhesive with properly fitting dentures. Once you get used to wearing dentures, if you still feel they are loose, this is a sign they do not fit correctly, & you should see your dentist for a fit adjustment.
Eating also can be a challenge in the beginning. Starting with soft foods cut into small pieces & working your way up to returning to your normal diet is a good method to help you become used to chewing with your dentures. Avoid biting down on hard or crunchy foods, like whole apples, hard pretzels or crusty bread, as your dentures can break due to the angle where the denture surface comes into contact with the hard surface. Other than these types of food, biting is limited only by the stability of the dentures themselves. Insufficient bone structure, old or worn dentures & a dry mouth can decrease stability.
Sometimes dentures may feel sore or irritated, & it is important to see your dentist for regular fit adjustments to relieve this discomfort. Regular visits to your dentist are also important to assess whether your dentures need to be adjusted, relined or remade due to gum or bone shrinkage or normal wear over a period of time.
Dental Pain: What to Do
The most common oral diseases are those of the hard tissues (caries of enamel, dentine & cementum) & soft tissues & supporting bone (gingivitis, periodontitis) & are usually easily treated by a thorough dental examination & radiographs performed by a dental practitioner. However, other conditions, such as the ones asterisked below, can cause acute, recurring pain that may need the assistance of a pain management clinic.
Common acute dental pain conditions include:
Dental pulpitis (“toothache”) is an aching, throbbing pain that usually worsens following food or fluid intake. It is commonly caused by dental caries or a leaking dental restoration & may also result from a crack in the tooth if the patient experiences a sharp pain when pressure is applied to the tooth cusps. If the pulpal inflammation continues for any length of time & is followed by acute abscess (swelled jaw & painful throbbing), it is likely the cause of pain is an acute infection.
Gingivitis & periodontitis are two common gum diseases. Where gingivitis (bleeding gums caused by plaque buildup) is usually painless, periodontitis can cause an occasional, dull pain.
Pericoronitis is infected tissue that causes periodic pain & usually occurs with an impacted or erupting lower third molar.
Premature contact (“high bite”) is a recent tooth restoration that is “higher” than the normal occlusion, causing a sharp pain that may dull after a period of time.
Exposed cementum or dentine is caused by excessive or incorrect brushing that results in the exposure of the tooth root surface (a thin layer of cementum overlaying dentine) & causes tooth sensitivity to cold fluids or air.
Alveolar osteitis (“dry socket”) occurs several days after a tooth extraction when the blood does not clot well & leaves the bone & the nerve endings exposed. The pain is experienced as a deep ache in the extraction socket.
*Post endodontic surgery pain is severe aching pain following endodontic treatment, such as root canal therapy or apicetomy. Most patients’ pain improves over a few weeks; however, a few endodontic patients develop persistent, chronic pain.
*Maxillary sinusitis is a continuous aching pain in the maxillary teeth that usually worsens when bending forward. Similar symptoms are commonly found in TMD or neuropathic pain.
A toothache may be indicative of many things from minor gum disease to more serious conditions. Therefore the type & nature of the pain are important factors in determining & pinpointing the source of the pain. Most toothaches can usually be categorized under one of these five types of pain:
Sharp pain, which usually follows contact of the tooth with hot or cold liquids, is likely caused by a hole in the tooth or filling through which the liquid travels & stimulates the nerve. The pain will stop within a few seconds to a minute during the early stages of decay. The problem is usually fixed with drilling & filling the tooth but can be relieved in short notice with a temporary filling that stops the stimulation of the nerve.
Dull pain usually results from chemicals released from immune system cells in response to bacteria that are attacking living nerve cells. The chemicals stimulate the nerves, causing an aching pain that is not prompted by a stimulus, such as a cold drink. Pain also worsens in bed at night because blood pressure increases in the tooth when lying down. Treatment usually involves root filling the tooth, which cleans away the dead pulp tissue & bacteria, or tooth extraction for severe decay.
Sharp pain only when biting generally happens when there is a small fracture in the enamel of a tooth, which allows the tooth to flex during biting & stimulate the nerve. The pain normally involves only one cusp, usually a molar.
Sharp pain when brushing near the gums happens when gums recede with age & wear & expose the root surface of a tooth. The thin layer of cementum that covers the root quickly dissolves, exposing the dental tubules & resulting in pain when brushing. The problem may be solved by either brushing with Sensodyne toothpaste or having a dentist apply a special fluoride varnish to protect the root surface.
Ibuprofen is the best over-the-counter drug for dental pain. However, if the pain is persistent, avoid chronically taking painkillers & seek a dentist to remedy the situation. Putting aspirin on the gum next to the painful tooth will not remedy the pain & may result in a chemical burn on the gums if left in contact for too long. Also avoid giving aspirin to children, especially those under 12, to prevent a possible reaction in those who suffer from Reyes syndrome.
Dental Swelling: What to Do
Gum swelling, whether it is one area of the gums surrounding a tooth or the entire gums, is quite common & can be due to anything from minor causes, like hypersensitivity to chewing gum, reactions to prescription medications, or a stuck popcorn kernel, to more serious ones, such as gum disease or health problems.
Gum or periodontal disease is quite common, & research shows nearly one in three US adults between the ages of 30 & 54 have some form of it. The most minor type of periodontal disease is gingivitis. Signs of gingivitis include red, swollen gums that bleed easily when brushing or flossing. It is caused by a buildup of plaque & can be taken care of with professional cleaning followed by continued attentive oral care at home. However, sometimes gum swelling does not indicate a problem within the mouth, but rather a more serious health condition, such as leukemia or diabetes.
In either case, it is best to receive a complete examination from your dentist or periodontist as soon as you experience swollen gums, bleeding while brushing or flossing or any other abnormal symptoms in your mouth.
Dental Implants: Are They Right for Me?
What is a dental implant?
Dental implants are the most natural way to replace a missing tooth. Made of titanium metal, the implants are surgically embedded in the jawbone as a substitute that takes the place of a root of a tooth. Through a process called osseointegration, the bone grows around the implant, fusing the two together & providing a secure anchor for crowns, bridges or dentures.
What is the process like?
Before any work can be done, the doctor must perform a thorough assessment of the patient’s medical & dental history as well as a full-mouth examination, including specific x-rays. The doctor then uses this information to map out a complete treatment plan. Once this is done, the patient undergoes local anesthesia & surgical insertion of titanium metal implants into the jawbone. After a period of healing, which varies according to the type of implant & quality & quantity of bone, crowns, bridges or dentures can be firmly attached to the implant.
How many implants should be placed?
Many factors, such as quality & quantity of the patient’s bone, the existing anatomy of the bone & the patient’s financial budget, must be taken into consideration during the treatment planning to determine the number of implants a patient should receive. To ensure lasting success, enough implants need to be placed to support the teeth, & the traditional ratio is one implant per each tooth replaced. If the number of implants is limited in efforts to save the patient money, keep in mind implants that fail because there are not enough to securely hold the teeth in place can be even more costly in the long run. In these cases, instead of sacrificing the overall success of the procedure, avoid implant treatment altogether or alter the type of restoration according to the patient’s financial constraints.
Gum Disease: Silent & Deadly
Because gum disease is often painless & requires specific examination procedures to detect it, a patient may unknowingly have it for years. Unless it is in an advanced stage, gum disease cannot be detected with just a visual oral examination. The dentist must perform a special examination that measures the pockets (the space between tooth & gum) with a periodontal probe to discover early-stage gum disease. Other signs of gum disease include bleeding gums, redness of gum tissue, gum swelling around teeth, bad breath, receding gums & loose teeth.
The procedure to correct the problem is short, simple & painless. It is important to detect & treat gum disease in its early stages to prevent tooth loss & disfigurement.
Children’s Dental Care
Decayed teeth – bottle caries
Many children who are put to bed with a bottle containing milk, juice or other sugary liquids are at risk of a type of tooth decay called bottle caries. Some signs of bottle caries include the appearance of brown teeth with fragmented edges & upper front teeth that break easily.
When a child falls asleep with a bottle in his mouth, the liquid pools around the upper teeth. During sleep, the mouth produces less saliva & there is not enough to flush out any liquid or sugar remaining on the teeth. This creates an ideal environment for bacteria to grow, which in turn reacts with the sugar in the liquid to form an acid that eats the tooth enamel & causes decay.
The best way to help prevent decay is to remove the bottle & wipe the child’s gums & teeth with a soft cloth before putting the child to bed. Also, children should receive a dental examination at no later than 18 months.
Dental decay – cavities:
Although fluoride, regular brushing & flossing lower the chance of developing cavities, these methods are not fully effective at reaching the most decay-prone areas of the teeth. The grooves & depressions on the chewing surfaces of the back teeth are still left susceptible to decay-causing bacteria & should be painted with a plastic-like coating called a sealant to prevent cavities from forming in this area.
Since sealant application is simple, fast & painless & studies have shown that sealants can reduce tooth decay by as much as 90% to 100%, the American Dental Association recommends applying them to each adult back tooth as soon as it comes in. At around six or seven-years-old, the first adult back teeth erupt, & all are usually present & should be sealed, by age 13.
Please call our office with any questions about the benefits of using sealants to prevent decay.
Prevent tooth decay:
Fluoride is a key ingredient to preventing tooth decay. Some local water systems do contain fluoride but may not contain enough to be effective in preventing decay. (You may call your local water district to determine whether or not your water contains fluoride.) In this case, or in the case your water is not fluoridated at all, fluoride supplements are necessary to provide you with the proper dose of fluoride needed to reduce dental decay.
Children should receive a dental examination at no later than 18 months, & if fluoride supplements are necessary, they should be administered shortly after birth until around the age of 12, when the second permanent molars erupt.
Please call our office with any questions, or if you need more information.
Dental Care for Seniors
Seniors tend to have less saliva & take more medication, both of which dramatically affect their oral health. Some health conditions, as well as particular medications, can cause “dry mouth.” Saliva is important to lubricate, flush out plaque & neutralize the acid plaque produces. Plaque buildup accelerates tooth decay & gum infections cause the teeth’s bone support to weaken. As a result, daily brushing, a healthy diet & using fluoride is more important than ever.
Other oral changes seniors face are darker teeth due to long-term plaque exposure & changes in the dentin in the tooth, receding gums that uncover roots susceptible to decay & darker, decaying fillings from deterioration over time.
Dentures that do not fit correctly or are not properly cleaned, illness & some medications can also exacerbate oral problems.
Please call our office if you have any questions or for more information regarding senior oral health problems & care.
Teeth Whitening: Is it Right for You?
Teeth bleaching whitens teeth that have been darkened with age or stained by coffee, tea or tobacco. It has over a 90% success rate & can last up to five years, depending on personal habits, such as smoking or drinking coffee or tea. Results can vary in certain cases like teeth stained from smoking, taking certain medications, or fluorosis, a condition in which there is too much fluoride present. Also, bleaching will not lighten fillings or other artificial materials used in crowns, porcelain veneers, etc. Although bleaching is tough on stains but gentle on your teeth, if you have sensitive teeth, periodontal disease, teeth with worn enamel or if you’re pregnant or breastfeeding, your dentist may discourage treatment.
Replacing Silver Fillings with Tooth-Colored Fillings
Silver fillings, called amalgams, are used to fill the space where decay has been removed from a tooth. However, the filling is not airtight & over time the amalgam corrodes & leaks, blackening the silver & often the tooth as well.
The other alternative is composite fillings, which are made out of material similar to porcelain & actually bond to the tooth, creating a strong, tight seal. Patients tend to feel less self-conscious about composite fillings because they are stain resistant & matched to the color of their natural teeth & therefore hardly noticeable. Also, they are often less sensitive than their silver counterparts. Patients with smaller cavities as well as those allergic to metal are ideal candidates for composite fillings.
Please call our office for more info or with any questions concerning the benefits of replacing silver amalgam fillings with more natural, tooth-colored composite fillings.
Why Have Crowns?
One reason to get crowns is in order to restore the appearance of your teeth & face. Prior to preparing a cap, the dentist needs to restore a tooth that is severely cracked or decayed. Furthermore, since teeth support face muscles, anything less than a full tooth may affect your appearance.
Secondly, since a crown is the same size & shape as natural teeth, it will keep your jaw & bite aligned as well as prevent other teeth from shifting. Also, when a tooth is missing, other teeth tend to take on a greater share of the work of biting & chewing. A crown can help ease the burden for these other teeth & prevent unnecessary wear.
Root Canal Therapy
Although root canal therapy may seem scary to most patients, there are three main reasons for it: to stop a toothache, to prevent bacteria & pain from spreading to the jaw & to preserve the original tooth rather than replacing it with a denture or bridge.
The root canal is a channel filled with pulp (the living tissue inside the tooth made up of blood vessels, nerves & complex cells) that runs from the tooth’s root up to its top surface. A crack or decay in the tooth allows bacteria to get to the pulp, which irritates it & causes it to inflame. This inflammation of the pulp tissue decreases blood flow & creates pressure inside your tooth, causing pain.