Dental Q & A
Q:I am 32 years old and have crowded and crooked front teeth. Is there a way to fix them without having to wear braces?
A: Yes, there are a few ways to correct your smile without having to wear braces or retainers. Among your options are Porcelain Veneers and Enamel Shaping. In mild cases of crowding, the more conservative approach is Enamel Shaping, which involves modifying the shape of your teeth by removing or contouring enamel to create the illusion that your teeth are more balanced in their appearance. This process does not require anesthesia, and the results are noticeable immediately. Keep in mind that the removal of enamel is an irreversible process, and may also require additional bonding to enhance the appearance of your teeth.
Porcelain Laminate Veneers, in my opinion, are the restoration of choice to correct poorly shaped or slightly crooked teeth for those individuals who do not wish to experience orthodontics.
Veneers are thin, custom-made shells made of tooth-colored materials which are bonded to the prepared teeth to enhance the esthetics of one’s smile. This, too, is an irreversible process because a small amount of enamel is usually removed to accommodate the thickness of the porcelain shell.
Veneers are used, with tremendous success, for treating gaps and dark spaces between teeth, for teeth that are stained, and for teeth that are worn or eroded at the gum line due to hard tooth brushing.
Many of the actors and entertainment personalities who appear to have “picture perfect” teeth have used veneers as a more permanent way to whiten and straighten their teeth. The procedure usually requires 2 or 3 appointments, and the results will make a dramatic difference in the way you look and feel about yourself.
Q:What can I do to prevent my baby from developing cavities? At what age should I start making dental appointments?
A:Parents and caregivers should realize that a baby’s teeth are susceptible to developing cavities from the moment they appear in the mouth. As a result, oral care should begin soon after the baby is born, and their gums should be cleaned with a clean, damp cloth or wet gauze pad after each feeding. As early as 4 months or as late as 12 months of age, the upper and lower front teeth first begin to appear.
You may begin brushing your child’s teeth the moment these teeth emerge. Never let your baby or toddler fall asleep with a bottle, unless it contains only pure water and then only after the bottle is rinsed out well before being filled. A bottle containing milk, formula, fruit juices, etc., is likely to cause decay. A pacifier coated with a sugary substance is also likely to cause cavities. This condition is referred to as Baby Bottle Tooth Decay, or Nursing-Bottle Syndrome. The teeth most likely to be affected are the upper front teeth, but other teeth can become damaged as well.
The good news is that it is preventable. Make sure to schedule your child’s first visit to the dentist by the first birthday. It is best if your child’s first experience occurs at a time before invasive dental work becomes necessary. A ride on the dental chair, magic tricks with “Mr. Thirsty” and visiting the toy chest should make your child’s visit pleasurable and non-threatening.
The first visit should also include the counting of teeth while your child looks at what is happening in a hand held mirror. Speak positively about dental visits, and make it something to look forward to. It is important to establish a positive relationship between your child and the dentist by starling early and continuing to see the dentist for regular check-ups. And don’t forget to share this valuable knowledge with anyone else who may be helping to care for your child.
Q:What are the advantages of having a tooth-colored filling over a silver filling? Is it true that silver fillings may cause health risks?
A: The composite resin (tooth-colored) fillings have come a long way in recent years. Their strength and longevity are now comparable to that of the silver fillings, but with much-enhanced esthetics. The dentist has the capability to match the filling exactly to the shade and color of your tooth such that no one else will ever know you had a cavity. Another advantage of these tooth-colored restorations is that the preparation is relatively conservative. Only decay is removed, and the filling is then bonded to the area that has been prepared.
Silver fillings do not have the same bonding capacity, and therefore rely on mechanical retention to hold the filling in place. As a result, good tooth structure is taken away to create the ideal depth and undercuts required to achieve adequate retention. Another advantage of composite restorations is that they are typically less sensitive to hot or cold, as metal tends to conduct temperature more readily. Since 1990, when “60 Minutes” ran a story on the alleged risks of dental amalgam (Silver-Mercury fillings), there has been a tremendous amount of media coverage.
Reports were made claiming that there have been miraculous “cures” for a variety of medical conditions after these types of restorations are removed, and that dental amalgam is a potential source of mercury toxicity. Mercury constitutes approximately 50% of dental amalgams, and trace amounts of mercury vapor escape in the process of chewing.
However, research conducted by the ADA (American Dental Association) and the scientific community has concluded that there are no serious health risks associated with Silver fillings, and that its removal has not been shown to have any beneficial effects for a patient’s specific medical condition. In my practice I utilize mostly the composite resin fillings, not because of health concerns with Amalgam, but rather because they are more conservative in terms of reducing tooth structure and because they are much more esthetically pleasing.
A:Absolutely. A lack of certain nutrients can become a factor in periodontal disease by making it more difficult for the mouth to resist infection. Periodontal disease is a condition where the infected gums gradually pull away from the teeth, deepening the surrounding pockets, allowing the infection to destroy the supporting bone. This results in the loosening of the teeth and their eventual loss if left untreated.
Vitamins and minerals play a crucial part in helping the body combat bleeding and swollen gums, loosening of teeth, decay and bad breath. More specifically, vitamins and minerals help to form antibodies, help fight bacteria and infection and aid in the response of the immune system.
So what recommendations should a dentist make to his or her patients regarding diet and nutrition? The first suggestion should be to eat a well balanced diet and take the necessary nutritional supplements. Keep in mind that food storage, food processing, freezing and thawing, and cooking depletes the majority of nutrients from foods that were originally nutritious.
There are many other factors that affect the way vitamins and minerals are absorbed into our system. Stress, smoking, alcohol, drugs (pharmaceutical and recreational), pollution and various medical conditions can act to prevent one from receiving the benefits of a well-balanced meal.
Remember that disease tends to occur less frequently in a healthy, well-balanced body.
Q:I have recently heard that chemotherapy and radiation therapy can have very bad side effects in the mouth. My father was recently diagnosed with cancer, what should I recommend to him?
A: Side effects in the mouth from chemotherapy or from radiation to the head and neck can be very serious, as these therapies not only kill cancer cells, but may also harm normal cells, including those in your mouth. Complications common to both types of therapy include: Painful mouth and gums, ulcerations, rampant decay, dry mouth, burning sensations in your tongue, change in taste, and difficulty eating, talking and swallowing. Suffering individuals are also more likely to develop infections, which can delay or force the cessation of cancer treatment.
The most important piece of advice that you could recommend to your father, or to any person diagnosed with cancer, is to visit their dentist at least two weeks before starting their chemotherapy or radiation therapy. The dentist will perform a complete exam, take all necessary films, and address all mouth problems before they can become a possible source of infection or decay.
Fluoride rinses are not enough to prevent tooth decay. Instead, a fluoride gel placed inside a custom-made mouth tray is recommended. Individuals who develop dry mouth are more prone to tooth decay due to the decreased levels of saliva that they can produce. In order to minimize the harmful effects of dry mouth, one should avoid sugary substances such as candy or soda (unless sugar-free), chew on ice chips, sip water frequently, suck on sugar-free candy, or chew sugar-free gum to stimulate salivary flow.
Many times, as a result of cancer therapy, people develop jaw stiffness and a limited opening of their mouth. To prevent this, exercise the jaw muscles three times a day by opening and closing the mouth as far as possible (without causing pain) 20 times. Results are best after using warm, moist compresses or by performing the exercises in a warm to hot shower.
Other beneficial recommendations include brushing the teeth, gums and tongue gently, using an extra-soft toothbrush that had its bristles softened in warm water. Floss gently everyday, but stay clear of those areas that are sore or bleeding. Avoid using toothpicks, tobacco products and alcohol. Stay away from hard, crunchy or spicy foods that can irritate your mouth.
Avoid alcohol-containing mouth
rinses, but rather use a baking soda and salt solution (1/4 teaspoon of baking soda, 1/8 teaspoon salt in 1 cup warm water) followed by a plain water rinse.
Remember, don’t delay, even if cancer therapy has started, make sure that the oncologist works in a team approach with the dentist.
Q:My friends and family have told me on numerous occasions that I have bad breath. I stopped eating garlic and onions, I rinse with Listerine, and I always carry mints and breath spray with me, but nothing seems to work. What should I do?
A: First of all you should realize that you are not the only one who struggles with this condition. It has been said that bad breath is so common that it is difficult to decide which is normal: individuals who have bad breath or those who do not have it. Bad breath, also referred to as oral malodor or halitosis, is so common a problem that it is estimated that close to a billion dollars are spent on products to combat this widespread condition. Of the 50% of the adult population affected, 90% of the odors were found to be of oral causes and therefore become the responsibility of the dentist to diagnose and treat these individuals.
Many products found in commercial markets simply try to control oral malodor by masking it with minty and fruity scents. Mint candies, gums and most mouthwashes are not powerful enough on their own to combat the foul smelling volatile sulfur compounds, the molecules primarily responsible for oral malodor. At this moment I’m sure that many of you readers are breathing into your hand to see if you may be one of those affected individuals. Don’t bother. One problem associated with bad breath is the inability to self-diagnose. A person with a normal sense of smell usually becomes desensitized to its own stimulants. The majority of individuals with halitosis are often unaware they even have bad breath unless someone around them happens to mention it.
So what can be done? The most effective way to manage oral malodor is by maintaining proper oral hygiene, regular dental cleanings, and diligent brushing of the tongue. Remember, your tongue is the most retentive surface in your mouth, and is quite adept at harboring bacteria within its Velcro-like surface.
Other oral factors that can cause bad breath include food impacted between teeth, faulty restorations, throat infections, food and bacteria caught within the crypts of your tonsils, and unclean dentures. Some non-oral causes may include: post nasal drip, diabetes mellitus, kidney failure, infections of the upper respiratory tract, and, of course, foods such as garlic and onions, which are rich sources of volatile sulfur compounds. Reduced salivation, or dry mouth, has been shown to make one’s halitosis more readily perceived.
Dry mouth resulting from mouth breathing or as a side effect of many medications can also be a common cause of bad breath. Sugar-free sour candies may help to stimulate the flow of your saliva, and walking around with a water bottle will help keep your mouth moist. Remember, mints and mouth rinses will mask odor only for a brief duration. If you want to eliminate bad breath, consult with your dentist
Q:Lately I have been waking up with headaches, and my jaw makes a popping sound when I open. Is this TMJ related? If so, what causes this, and what can I do to treat it?
A: Well, it sounds as if you are among the sixty million Americans who have been diagnosed with TMJ syndrome. The TMJ (temporomandibular joint) is a joint that attaches the lower jaw to your skull. The symptoms that you are describing may be a result of the TMJ not functioning properly, due to one or more of the following having been adversely affected: your chewing muscles, joints, ligaments or surrounding bones. It is difficult to pinpoint the exact cause of one’s TMJ syndrome. It may be the result of a traumatic accident or a disease such as arthritis.
The most common causes, however, are clenching and grinding of one’s teeth, which can tire and strain the chewing muscles, causing them to go into spasm and cause pain. An improper bite can also result in TMJ dysfunction. Among the symptoms are: headaches (usually upon awakening), tenderness or fatigue of the jaw muscles, earaches, and pain or difficulty when chewing, yawning or opening wide. Clicking or popping sounds are very common signs, and in some extreme cases (not yours), the jaw can actually get stuck in the open or closed position.
Most cases of TMJ disorders can be treated conservatively and successfully. Only a small number of cases require surgical correction, usually with those individuals who have suffered a traumatic injury. The first step is to eliminate the pain and muscle spasms. In mild cases, such as yours, this can be done with moist heat packs, a non-chewy diet, and muscle relaxants (if necessary).
The next step would be to try and become aware of the potential sources of stress and tension that could lead to clenching and grinding. A conservative therapeutic device that may work well for you is a corrective bite plate (made by your dentist), that will help to relax the muscles, thus preventing headaches, pain and spasm. Selective filing of an uneven bite to correct the “high” spots is a final attempt to treat TMJ conservatively, because the removal of tooth structure is an irreversible process.
Q:I am 40 years old, and just had my lower first molar tooth extracted. What would happen if I just left the space?
A: The loss of a back tooth can affect your dental health, your physical appearance and the way you chew, speak, sing and smile. When a tooth is lost, the adjacent teeth may tilt towards that empty space, or the teeth in the opposing jaw may drift up or down towards that space. Tipped teeth are more difficult to maintain, and are therefore more prone to decay. In addition, the surrounding bone and gum tissues may break down, resulting in an increased risk for gum disease. You may find yourself favoring the opposite side of your mouth when you chew, causing additional stress to your teeth and gum tissues.
The loss of a tooth may also result in the failure to maintain the natural shape of your face, due to the lack of lip and cheek support in that area.
The outcome may be an older appearance due to a sinking of your mouth in the region where the tooth was lost. Missing teeth can and should be replaced. Speak to your dentist to explore the many options you have, including implants and fixed bridges, which come very close to duplicating the function and appearance of your natural teeth.
Q:My daughter wants to have her tongue pierced. As a concerned parent, I want to be able to advise her of the harm that she may be inflicting upon herself by undergoing this kind of procedure. What are the dental complications of having oral piercings?
A: For starters, the piercing of oral structures has a higher than normal risk of infection due to the vast amounts of bacteria that thrive in the mouth. Unfortunately, as body piercing becomes more en vogue, and as individuals run out of body parts to pierce, many are now turning to the mouth, lips and tongue as places to adorn their jewelry. Common symptoms following the piercing of intraoral structures include pain, swelling, infection and an increased salivary flow.
Other potential complications include the cracking or fracturing of teeth and restorations; the interference with chewing, swallowing or speaking; and the development of nerve sensitivity as a result of the galvanic currents that arise from the metal jewelry contacting the metal fillings in one’s mouth.
It is important to point out that a large portion of the population of individuals who choose to pierce their lips, checks and tongue will more than likely undergo one or more of the above listed adverse conditions. I have seen a number of patients who have required a root canal or tooth extraction due to the damage caused by their oral piercings.
And it is not unheard of to encounter serious secondary infections or even airway obstruction from excessive swelling. My advice is to think long and hard before subjecting one’s self to this form of art and self-expression.
Q:I just bought a home water filter system for my family. Can water filters reduce the benefits a fluoridated water system would otherwise offer to my children’s teeth?
A:The answer to your question is YES. Some types of water treatment systems that are installed in one’s home can decrease the fluoride levels, thus potentially reducing the cavity-preventing effects of a water supply that has been optimally fluoridated.
It has been documented that the reverse osmosis systems and distillation units remove significant amounts of fluoride. However, studies have also shown that water softeners do not cause a significant loss in fluoride levels. The concentration of fluoride found in your water will depend on the type and quality of the water filter you purchased, the current status of the filter and its age.
For questions about the level of fluoride in your water supply or to arrange to have your filtered water tested, contact your local and state public health departments. Your dentist should also be contacted to determine if your children are candidates for fluoride supplementation, as it is available by prescription only. Those individuals who drink bottled water as their primary source of water may also be depriving themselves of the benefits of fluoride, as many brands fall short of the optimum levels of 0.7-1.2 ppm.
Q:Whenever I bite down on the right side of my mouth, I feel a sharp pain. My dentist said that I may have cracked a tooth, but I don’t remember biting into anything hard. What could have caused my tooth to crack? And what can I do for it?
A: There are many factors that could have caused your tooth to crack without you even realizing it. Clenching, grinding and unnatural chewing motions can place abnormal stresses on a tooth, leading to a crack. Teeth with large fillings, along with teeth that have lost significant amounts of tooth structure due to aging or wear, are more susceptible to cracking.
Even subjecting tooth enamel to extreme variations in temperature, such as drinking hot tea and then sipping ice water, can cause teeth to crack. Of course, traumatic accidents and biting into hard objects or foods are obvious causes of tooth distress.
How do you know when your tooth has cracked? Well, many times the crack is not detectable on a x-ray, as it may be small and appear as a hairline fracture running vertically along the tooth. The best way to detect a crack is from your symptoms.
If you have sensitivity to cold, heat, air, sweet, sour, or to sticky foods, take note where it is coming from so that you may be able to help your dentist diagnose the origin of your problem. Cracked teeth usually hurt more upon the release of your bite than from the pressure of biting itself.
Don’t be alarmed just because your tooth may be sensitive. Not all sensitivity comes from a cracked tooth, and not all cracked teeth are causes for concern. Tiny cracks are often encountered, and usually do not require any dental treatment. Other times, bonding, onlays, veneers and crowns may be necessary to restore a cracked tooth. A tooth that is found to be severely cracked may require root canal therapy or even an extraction. Schedule an appointment with your dentist so that together you can diagnose the origin of your discomfort, and determine which treatment modality will best serve your condition.