Question: What can happen as a result of avoiding Dental care?

Answer: What starts as a small cavity can become very serious if left untreated. Some people wait until the pain they have is enough to exceed their avoidance tendency. This fear of pain is one of the major reasons why patients fail to seek help from a dentist until their emergency becomes to severe. At that point, what should have been a simple cavity now becomes a more involved root canal or extraction. Additionally, a patient who avoids routine dental cleanings and gum maintenance can wind up with severe gum disease ( Periodontal Disease), which causes gum recession, bone loss, tooth mobility and the eventual loss of teeth. Swellings and infections may result from neglecting these cavities and gum tissues, and what would have been unnecessary costs and procedures will now be necessary to restore the mouth back to a better state of health and function.

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Question: What causes a toothache?

Answer: A toothache occurs when the nerve within the tooth gets damaged or inflamed. This is usually caused by bacteria from the tooth decay communicating with the nerve of the tooth. These cavities are usually brought about by a combination of poor oral hygiene coupled with eating a lot of sticky, sugary and starchy foods. This bacteria feeds on the sugars and starch left over from poor brushing and flossing. As a result acids are produced that will slowly eat away at the good tooth structure until the nerve becomes damaged, causing the toothache. Another way the nerve can get damage is from dental trauma (i.e. sports injury, rough play or fights, severe teeth grinding, or extensive dental work on hypersensitive teeth).

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Root Canal Therapy is when the Endodontist removes the inflamed or infected pulp (nerve), carefully cleans and shapes the nerve canals of the tooth’s root and then seals the prepared space. Most treatment is performed in one or two appointments ranging from 30-90 minutes each (depending on the number of canals). Once treatment is completed, you may be instructed to return to your dentist for a more permanent restoration. This restoration of the tooth is an important part of the treatment because it seals the cleaned canals from the oral environment, protects the tooth and restores it to function.

Root Canal Therapy (Endodontic treatment) is necessary when the nerve (pulp) becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities, repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

There are several indications for a need for treatment including prolonged sensitivity to heat or cold, spontaneous pain, discoloration of the tooth, and swelling or tenderness of the tooth or adjacent gums. Transient sensitivity to cold may just be due to exposed root surfaces or heavy teeth grinding. If the cold sensation lingers, and radiates up to give you a headache, chances are there has been irreversible damage to the nerve.

Sometimes there are no symptoms, and diagnosis is made from a routine x-ray. Other times root canal treatment is recommended as a result of the bacteria from the decay extending into the nerve (pulp) of the tooth.

Happy New Year! Start this year off on the right foot with some helpful tips on keeping your teeth their best.

Proper Home Care involves the combination of having an adequate diet, exercising proper brushing and flossing techniques, and utilizing additional adjuncts such as tongue scraping and rinses. A summary of these various facets of home care is summarized below:

Diet

Any food or snack that can become trapped within pits and groves of your teeth or between your teeth can become harmful if not cleaned properly. Chewy candy (i.e. Taffies, caramels, jellybeans, and licorice) are among the biggest cavity culprits. However, you may be surprised to know that nuts, raisins and dried fruits can also cause a lot of damage, since they too get readily stuck in and around the teeth.

The complex carbohydrates such as pretzels and potato chips get broken down into the same sugars that are found in cakes and cookies. Any food debris left on the tooth creates an acid attack in the mouth to break it down. The less likely the food is to dissolve or rinse away, the longer the acid attacks will be. Chocolate, which is full of sugar, is actually not as bad for your teeth as dried fruit and nuts, because chocolate dissolves quickly. However, you can prolong any acid attack by eating or drinking things slowly over a longer period of time.

Additionally, if you can’t get to a brush right away, you should rinse well with water, and can chew sugar-free gum for 5 minutes to help neutralize the acids in your mouth and lift out the debris from within the grooves of your teeth. This is especially important in those individuals with a dry mouth.

Brushing

It is recommended that everyone brush at least twice each day with a soft-bristled brush or electric brush. The first time should be in the morning, after breakfast, so your child’s teeth are clean before leaving for school. It defeats the purpose of brushing if you give your child their sugary vitamin after they brush, or give them their breakfast to nibble on the bus, because these substances will stay lodged in the top grooves of their molars and in between their teeth for hours to come, contributing to the formation of cavities.

The most important time to brush is right before you go to sleep at night so that nothing is left on or in between your teeth when you are sleeping. The reason is that when you are awake, your saliva helps to bathe and rinse your teeth, but while asleep, you do not salivate that much, and your teeth are more susceptible to developing cavities from the debris left on them.

Additionally, if you have the chance to brush after other meals or snacks, it would be advisable. And don’t forget to brush their teeth after they are given medicine, as the acids contained in medicines may break down the tooth enamel.

An electric brush has a few advantages over a manual brush. First it generates more brush strokes per second; making it more effective for the amount of time it is being used. Keep in mind that while it is recommended to brush for 2 minutes, the average person only brushes for 30 seconds. With an electric brush it is easier to clean behind the back teeth. Many of these electric brushes have certain extra bells and whistles such as a digital timer so you know when 2 minutes is up, and an indicator light to show if you are pressing too hard. There is usually less trauma to the gums and teeth when brushing with an electric brush since many over-zealous manual toothbrush users bang into their gums with the wrong technique, or scrub too hard.

A manual toothbrush can be very effective with the right technique, and conversely, an electric toothbrush can be virtually useless with the wrong technique. If using a manual brush, use small, vibratory strokes on a 45 degree angle so that the bristles get in the pockets between the teeth and gums. Avoid the up and down or circular motion, as that can just traumatize the gums. If you are using an electric brush, try to spend at least 2 full seconds on each tooth surface (inside, outside and top), making sure to angle the brush between the teeth and having the bristles go between the tooth and the gums. Spin brushes are just a watered down version of an electric brush the may attract the attention of your child with its various themed versions.

Whether you use a manual brush or an electric, make sure you always change your brush or brush head every three months, or sooner if you just had a cold so you don’t reinfect yourself.

Flossing

It is very important to floss your teeth at least once per day (preferably before you go to sleep) to remove food debris and plaque from in between your teeth where your toothbrush couldn’t reach. Plaque causes tooth decay and can lead to gum disease. Another great reason to floss is that recent studies have shown that flossing helps to prevent a heart attack or stroke.

When flossing, be sure to take out a piece about 18 inches long, and gently wrap it around your middle fingers so that you have full control and dexterity holding the floss between your thumb and index finger. Then, starting at the base of the gums, work the floss in a circular motion scrapping the plaque away from the gums. Don’t forget to wrap the floss around the corner line angles of the tooth where plaque builds up.

Toothpastes

Toothpastes coupled with the proper brushing action is an effective way to remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes cavities, gum disease, and eventual tooth loss if not controlled. Tooth pastes also contain fluoride, which makes the entire tooth structure more resistant to tooth decay. Toothpastes also help to remove superficial stains and help to leave your mouth with a clean, fresh feeling. It doesn’t matter what kind of toothpaste you use, as long as it contains fluoride.

Other Dental Aids

Other dental aids that work very well are pre-brushing rinses, such as Plax, and post brushing antiseptic mouthwashes designed to help kill germs between your teeth. Water Jet Irrigators, such as Waterpiks, are effective for cleaning in between teeth, especially when one does not have the dexterity for flossing properly. Proxybrushes (brushes designed to remove plaque and debris in open areas between the teeth) and Stimudents (very thin wooden toothpick made of orange-wood) are also great adjuncts to removing debris that gets trapped between the teeth.

Tongue scraping

Your tongue is the most retentive surface in your mouth, and is quite adept at harboring bacteria within its Velcro-like surface. It is the anaerobic bacteria and volatile sulfur compounds trapped in these surfaces that give off the oral malodor.

Tooth brushing alone does not clean our mouths, and mouth rinses only mask the bad breath for a short period of time. It has been found that 90% of halitosis (bad breath) originates from the mouth, with 80% coming from the posterior third of the tongue. Brushing the posterior of the tongue will stimulate a gag reflex. The only definite way to remove those volatile sulfur compounds is to scrape the tongue with a tongue scraper designed to reach that area.

Question: How long should one have to live with sensitive teeth?

Answer: Minor amounts of sensitivity can often be controlled with sensitivity toothpastes, fluoride gels or other types of desensitizing agents. However, if the amount of discomfort that you get from this sensitivity is causing you to change your life style or is a constant source of distress, you should address this sensitivity more definitively. First, you should see your dentist to determine the cause of your sensitivity (i.e. exposed root areas, teeth grinding, fracture, cavities, etc.). Second, take note of what causes the sensitivity (i.e. hot, cold, air, sweets, etc.) and its duration (does it linger, or does it go away after the stimulus is removed). Often times your dentist can put a layer of bonding over an exposed root, make you a night guard for grinding, or repair a cavity or minor tooth fracture. If the sensitivity still persists, a more involved treatment may be indicated.

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If you have a question that you would like answered, download the Dental Expert App to your iPhone, iTouch, or iPad and look for it updated here!

The Dental Expert App has had more than 35,000 downloads so far! One of it’s great features is the “Ask the Expert” function which allows you to send your question directly to Dr. Lazare.

Hundreds of people have submitted questions already, and to get the answers out, before the updates become available, they will be answered here, on our Blog. Here is a question that many people are curious about:

Question: Why do teeth turn yellow?

Answer: Teeth can turn yellow for a variety of reasons, including:

• Aging (years of cumulative stain and the wear of the outer, white enamel layer of the teeth over time)

• Heavy consumption foods and beverages that are more likely to stain (including: red wine, dark teas, coffee, vegetable juices, hot chocolate, soy sauce, etc.)

• Smoking

• Poor oral hygiene (which creates a thick coat of a yellowing plaque or tartar)

• Heavy Grinding (which can wear away the enamel to reveal the yellower layer of tooth structure beneath)

Please note that the most common cause of this yellowing is due to poor brushing, which builds up this plaque and tartar, which is more likely to hold the stain than the tooth’s enamel. Once the teeth are cleaned, the yellow often disappears. Whitening is only effective for brightening the enamel itself, and will not do anything for teeth that are not properly cleaned.

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If you have a question that you would like answered, download The Dental Expert App to your iPhone, iTouch, or iPad and look for it updated here!