Posts for category: Oral Health
Tooth decay is a primary cause of tooth damage and loss, with annual treatment costs in the billions of dollars. It arises mainly from oral bacteria, which proliferates in the absence of effective oral hygiene. There are, however, other risk factors besides poor hygiene that could make you more susceptible to this disease.
Many people, for example, have genetically inherited deeper grooves (fissures) and depressions (pits) than the average tooth anatomy. These may be harder to reach with a toothbrush and can become havens for bacterial plaque. Others may have health conditions that indirectly affect the mouth: bulimia or anorexia, psychological conditions that involve self-induced vomiting, or GERD, gastro-esophageal reflux disease, in which stomach acid could regurgitate into the mouth. These conditions could result in a highly acidic mouth environment.
Some medical and — ironically — dental treatments could also increase your tooth decay risk. Some medications can reduce saliva flow, which inhibits acid neutralization and re-mineralization of enamel. Retainers, braces, bite guards or other dental appliances may also reduce the saliva wash over teeth, and can make brushing and flossing more difficult.
There are also risk factors that result from our lifestyle choices. Eating a lot of foods rich in sugars and other carbohydrates, for example, or acidic beverages like soda, energy or sports drinks contributes to the rise of bacteria in our mouths.
There are ways to reduce the effects of these risk factors. In addition to a daily habit of effective brushing and flossing, you should also include semi-annual cleanings and checkups at our office a part of your routine. If you have genetic, medical or dental issues that are out of your control, we can discuss solutions, such as alternatives to medications or different techniques for cleaning around dental appliances. For lifestyle-related factors, you should consider removing the habit or modifying it: for example, snacking at specific times or drinking acidic beverages only at mealtime.
While tooth decay is a serious, destructive disease, it is highly preventable. Addressing all your risk factors, not just hygiene, will reduce your chances of having it.
If you would like more information on tooth decay prevention, 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 Decay: How to Assess Your Risk.”
Your temporomandibular joints (TMJ), located where your lower jaw meets the skull, play an essential role in nearly every mouth function. It’s nearly impossible to eat or speak without them.
Likewise, jaw joint disorders (temporomandibular joint disorders or TMD) can make your life miserable. Not only can you experience extreme discomfort or pain, your ability to eat certain foods or speak clearly could be impaired.
But don’t assume you have TMD if you have these and other symptoms — there are other conditions with similar symptoms. You’ll need a definitive diagnosis of TMD from a qualified physician or dentist, particularly one who’s completed post-graduate programs in Oral Medicine or Orofacial Pain, before considering treatment.
If you are diagnosed with TMD, you may then face treatment choices that emanate from one of two models: one is an older dental model based on theories that the joint and muscle dysfunction is mainly caused by poor bites or other dental problems. This model encourages treatments like orthodontically moving teeth, crowning problem teeth or adjusting bites by grinding down tooth surfaces.
A newer treatment model, though, has supplanted this older one and is now practiced by the majority of dentists. This is a medical model that views TMJs like any other joint in the body, and thus subject to the same sort of orthopedic problems found elsewhere: sore muscles, inflamed joints, strained tendons and ligaments, and disk problems. Treatments tend to be less invasive or irreversible than those from the dental model.
The newer model encourages treatments like physical therapy, medication, occlusive guards or stress management. The American Association of Dental Research (AADR) in fact recommends that TMD patients begin their treatment from the medical model rather than the dental one, unless there are indications to the contrary. Many studies have concluded that a majority of patients gain significant relief with these types of therapies.
If a physician or dentist recommends more invasive treatment, particularly surgery, consider seeking a second opinion. Unlike the therapies mentioned above, surgical treatments have a spotty record when it comes to effectiveness — some patients even report their conditions worsening afterward. Try the less-invasive approach first — you may find improvement in your symptoms and quality of life.
If you would like more information on treating TMD, 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 “Seeking Relief from TMD.”
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
Dental anxiety is a common problem: it’s estimated that one in two Americans admits to some level of nervousness about seeing the dentist. On the extreme side of this statistic about 15% of the population even avoid or postpone dental care because of it. While comedy shows routinely make fun of people’s fear of the dentist, the consequences of not receiving needed dental care due to dental anxiety are no laughing matter.
Fortunately, visiting the dentist doesn’t have to be a nerve-wracking, butterflies-in-the-stomach experience. Here are 3 ways to make sure your next visit is more pleasant.
The right dentist. Dental care is more than technical—it’s also personal and relational. The most important element for reducing dental visit anxiety is a provider you’re comfortable with and that you trust. It’s especially important for high anxiety patients to find a dentist who also has compassion for how they feel and won’t judge them—instead, working with them to find just the right combination of techniques and possible medications that encourage relaxation.
Oral sedation. For many people nervous about dental visits the answer could be prescribed sedation medication taken an hour or so before their appointment. Typically a mild sedative, the dose is just enough to help them relax. It’s also often coupled with other methods like nitrous oxide or local anesthesia for a pain-free and unstressed experience.
IV sedation. For people with high levels of anxiety, it’s often beneficial to increase the level of sedation. One of the best ways to do this is with an intravenous flow of medication that will place a person in a deeper state of relaxation. Although this method requires careful vital sign monitoring during the procedure, it’s often the best way to calm patients with high anxiety so they can receive the dental care they need.
Working with your dentist, you can develop just the right mix of these and other methods for making your dental visits easier. No matter what your level of anxiety, you don’t have to avoid the dentist nor needed dental care.
If you would like more information on reducing anxiety during dental visits, 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 “IV Sedation in Dentistry.”
Although normally benign, a cold sore outbreak can be irritating and embarrassing. Understanding why they occur is the first step to minimizing outbreaks.
The typical cold sore (also known as a fever blister) is caused by the Herpes Simplex Virus (HSV) Type I, medically known as “Herpes Labialis” because it occurs on or around the lips. This virus is not to be confused with HSV Type II, which causes a genital infection. Unlike most viruses, HSV Type I can cause a recurring sore outbreak in certain people. Most viruses tend to occur only once because the body produces anti-bodies to prevent further attack; it’s believed HSV Type I, however, can shield itself from these defenses by hiding in the body’s nerve roots.
These cold sore outbreaks often occur during periods of high stress, overexposure to sunlight or injuries to the lip. Initially you may have an itch or slight burning around the mouth that escalates into more severe itching, redness, swelling and blistering. The sores will break out for about a week to ten days and then scab over and eventually heal (unless they become infected, in which case the healing process may go longer). You’re contagious between the first symptoms and healing, and so can spread the virus to other people.
In recent years, anti-viral prescription medications have been developed that can effectively prevent HSV outbreaks, or at least reduce the healing time after an occurrence. The most common of these are acyclovir and valcyclovir, proven effective with only a few possible mild side effects. They can be taken routinely by people with recurring cold sores to suppress regular outbreaks.
While HSV Type I cold sores are more an aggravation than a health danger, it’s still important for you to see us initially for an examination if you encounter an outbreak. It’s possible for a more serious condition to masquerade as a cold sore or blister. A visit to us may also get you on the right track to reducing the frequency of outbreaks, as well as minimizing discomfort when they do occur.
If you would like more information on the treatment of cold sores, 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 “Cold Sores.”