LoudMouth: Making Noise About Dentistry
Fire the Laser!
Most people hear the word laser and instinctively want to use air quotation marks and queue up their best Doctor Evil impression. Admittedly, I indulge this impulse from time to time as well, but recently I find myself more often touting laser benefits to my patients than using it as a punch line. Now that we have two different types of lasers in the office, the spectrum of services that we can offer has broadened substantially. I could easily drone on and on about every great advantage of laser dentistry, but for now I want to focus on those that alleviate painful problems.
Aphthous ulcers and canker sores can be rather uncomfortable and difficult to treat. In most cases, patients were usually recommended to use some sort of medicated solution or ointment and wait anywhere from 7-14 days for these troublesome lesions to run their course. Now, using our all-tissue laser, these lesions can be treated if caught early to greatly reduce discomfort and time before they resolve. The “laser bandage” essentially removes surface inflammation, or in the case of viral lesions actually eradicates infected cells, and creates a protective layer over the lesion, similar to a scab over a skin wound. This treatment jump-starts the healing process in addition to typically providing immediate relief. Just last week we had a child in tears from several sores that “forgot he even had them” a day later.
Another common issue faced by many patients is pain in the TMJ, or jaw joint. There are a wide variety of reasons why patients may experience pain in this area and an equally broad spectrum of different treatment options to alleviate these symptoms. Very frequently, an appliance can be made, medications can be prescribed, and occasionally a combination is recommended to correct the underlying causes of the discomfort. We are seeing more frequently, however, that relief can be provided using low level laser therapy to stimulate healing cells to activate in this area. This is accomplished with our diode, or soft-tissue, laser and is especially effective for patients who experience jaw discomfort after long procedures. Most patients will notice an improvement after one 5 minute application, though some will require multiple rounds of treatment. Though this type of treatment is not designed to replace the more traditional methods, it has proven to be a valuable addition to our tool belt to help keep patients comfortable.
These two palliative treatments represent a small fraction of the many ways modern dental lasers can improve the way we treat patients in our office. To learn more, check out our laser education page or come visit us in the office!
When a Dental Emergency Becomes a Medical Emergency
One of the most challenging tasks that I am faced with on an almost daily basis is helping patients understand that their dental issues need to be addressed prior to the development of symptoms. All too often, patients tell me “but Doc, that tooth isn’t bothering me, so I’m just going to wait until it starts hurting to get it fixed.” There are a couple issues with this line of thinking that bear discussion. For starters, I would be remiss if I didn’t acknowledge that finances are a major driving force in most patients’ decision-making processes. That said, most treatment that is completed in a timely fashion after it was initially recommended is often less costly to the patient. A perfect example of this is a tooth that simply needs a filling due to a moderately deep cavity. As compared to other restorative treatments, a filling is about as cost-efficient as it gets, and often times a tooth requiring a filling will not elicit any symptoms. Usually, once the tooth starts barking at the patient, the cavity has likely progressed to the point where more extensive (read: costly) treatment is required.
Financial implications aside, when small problems like cavities are left to expand, they can reach the point at which they begin to cause infection. Generally speaking, an oral infection usually is usually contained around its source as the immune system attempts to block its expansion into surrounding tissues. That said, if left untreated, infections will spread according to the path of least resistance. Luckily, in most cases, infection will spread through the bone and out through the gums towards the cheek. Many patients will notice a “pimple” on their gums, which may pop or drain, typically alleviating some discomfort in the process. Some patients run into more significant problems when the infection ends up penetrating through the tongue side of the bone (typically in the lower jaw). In this situation, the infection will often spread alongside the bone towards the throat rather than through the gums. At this point, a life-threatening condition called Ludwig’s angina can occur as the swelling from the infection begins to constrict and potentially obstruct the airway. This is a problem that usually requires a trip to the emergency room and extensive surgery.
One might think that given these grave consequences which can occur from an infection of a lower tooth, someone with an infection of an upper tooth would be in the clear. That’s right, you saw it coming: this is not the case. The other major side effect of a dental infection results from the spreading of this infection into the bloodstream. The veins in the mouth and lower face form a network that communicates with the venous system inside the skull (read: next to the brain). Therefore, it stands to reason that the passage of any infectious particles into these veins has the potential to work its way into the brain, causing major issues including brain abscess or cavernous sinus thrombosis.
Hopefully by this point, I’ve made it clear that if you develop one of these infections, you don’t want to let it spread. So how can we prevent that? Too often I’m asked “well if I have an infection can’t I just take an antibiotic?” Yes and no. Yes, an antibiotic will cause a dental infection to calm down for some amount of time, which typically decreases discomfort and the likelihood of expansion. That said, the source of infection is within the tooth, where antibiotics do not have an effect. Generally there are two different treatment options for an infected tooth: root canal or extraction. Check out our education pages for more information on these treatments, or come see me in the office for a deeper explanation!
What the Heck is a Root Canal?
In honor of Root Canal Awareness week, I wanted to do my part and help further the understanding of this common procedure. Most people, upon hearing the term “root canal”, instinctively cringe at the notion of the dental procedure of nightmares and butt of many “I’d rather have a root canal than…” jokes. But for those who have actually undergone this treatment, most would attest that the actual process itself was nowhere near as bad as they may have feared. As this is a very routine and common treatment that many people will experience over the course of their lives, a better understanding of the notorious root canal will help to dispel some rumors that accompany this dental procedure.
RUMOR: Root canals are not really necessary.
VERDICT: Technically, somewhat true. Root canals are most frequently recommended when one of two instances occurs: decay reaches the pulp (nerve) of the tooth causing it to become contaminated and infected if left untreated, or when the pulp dies or becomes non-vital. When either of these situations presents, there is potential for infection or inflammation to pass from the inside of the tooth to the bone, which usually results in a toothache. The root canal process involves accessing canals that pass through the roots of the tooth which house the pulp, removing all remnants of pulp tissue, cleansing and shaping the canals, applying medicaments if needed, and sealing the canals with a rubber-like material called gutta percha. In most cases, a post and crown are required after the root canal treatment has been completed.
But wait, I said that root canals not being necessary was somewhat true. Well, the other option is removal of the tooth. Once the pulp becomes infected or irreparably inflamed, it becomes the source of any infection or inflammation that may spread to the surrounding bone. The root of the problem (pun intended) is within the tooth, so either a root canal can be completed to clean out, seal, and save the tooth, or the tooth can be extracted, taking the source of the problem with it. So there, I did not lie.
RUMOR: If a tooth is infected, antibiotics will fix this instead of a root canal.
VERDICT: While antibiotic regimens may be used in conjunction with the root canal process, this rumor could not be further from the truth. As previously mentioned, the source of infection is within the tooth, where antibiotics cannot take effect. If infection has progressed to the bone surrounding the tooth, antibiotics will help temporarily mitigate the infection and often decrease any symptoms (read: pain) associated with this issue; however, this should be viewed as a band-aid. In the absence of root canal or extraction, the symptoms (read again: pain!) will return with time.
RUMOR: Root canals hurt!
VERDICT: Usually, root canals are conducted in order to take a patient out of pain. Once the canals are accessed, the remainder of the procedure involves very fine instrumentation with a serious of small files. Occasionally, teeth that have severe infection can be stubborn with becoming adequately numb, but there are often ways to get around this. Although it is not outside the realm of possibility to have some discomfort with this procedure, most frequently root canals are generally a comfortable procedure.
Hopefully dispelling some of these root canal rumors has provided some additional peace of mind as related to this very common dental procedure. Surely, this blurb does not cover this subject in its entirety, so feel free to come in and ask us any other questions that might come up!
The Cavity Conundrum: Why Even the Best Patients Can Still Get Cavities
Every so often during a routine check-up, I encounter patients who clearly take good care of their teeth yet still have cavities present. This situation puts both the patient and me in an awkward position: I have to impart this news to someone who is holding up their end of the bargain with regard to home care, and the patient is left searching for the reason he or she has a cavity. In the same token, I’ll occasionally see patients who show some degree of disregard for maintaining a clean, healthy mouth yet show no evidence of cavities. If a sense of befuddlement is setting in, you’re not alone. While the aforementioned scenarios seem to be oxymoronic, they occur more often than you’d think. The reality of the matter is that the process of cavity development (a.k.a. dental caries or tooth decay) is very much multifactorial.
There are three main components that are required for the decay process to begin: a tooth, dental plaque, and a food source. I suppose the first piece of this puzzle is somewhat self-explanatory, but it stands to reason that no tooth = no cavity. Plaque consists of a complex micro-civilization of bacteria that are present throughout the mouth in all individuals, healthy or not. This film of bacteria can form in as little as four hours after a dental cleaning and can only be mechanically removed with a toothbrush, floss, or professional cleaning. Within the plaque microenvironment, several types of bacteria are implicated as repeat offenders in the cavity process. These strains consume dietary sugars (note that many starches are broken down into simple sugars by salivary enzymes) and release acid as a by-product. This acid spreads over the tooth surface where the plaque resides, causing demineralization of the tooth’s enamel which eventually facilitates bacterial penetration into the tooth.
Several variables determine how effectively you can tolerate this constant attack on your teeth. For starters, everyone has a different bacterial population in each of their mouths, meaning that some people will have higher or lower concentrations of the aggressive acid producers. Naturally, those with more prevalent acid-producing plaque will be more cavity-prone and vice versa. Even for more susceptible individuals, simply having potent plaque does not condemn them to a life of tooth decay. Saliva, which contains various minerals, is a critical component in the protective mechanism that resists cavity formation. Certain minerals in saliva can at the very least partially neutralize the acid produced by oral bacteria, while others can even help to remineralize enamel. Given these benefits, it stands to reason that any impairment of saliva production or flow would have a detrimental effect on a cavity-prone individual. Dry-mouth, or xerostomia, is often seen as a side-effect of many medications and as a result of head and neck radiation therapy for cancer treatment. Cavity prevention in these individuals is frequently a challenge for both the patient and myself.
Now that we’ve established what can make someone cavity-prone, we can briefly discuss what options are available to tip the scales away from cavity development. For starters, impeccable home care is always paramount. When done properly, brushing and flossing will decrease the amount of plaque present to cause cavity formation. As in our first example, though, sometimes this alone is insufficient. Diet is important as well, so limiting sugars, simple and complex, and acids will always be helpful by providing less food source for any plaque that is present. There are also several products available to offer a preventive boost. Any product containing Recaldent, like MI Paste and Trident Xtra Care, or high levels of fluoride, like Prevident 5000 or various fluoride rinses, will help remineralize and strengthen enamel to better resist acid attack. For dry-mouth patients, there are a variety of products available, including Biotene products, which can alleviate some of these effects. Some of these products are only available by prescription or from a dentist, so stop by and ask me more about them!
Demystifying Dental X-Rays
One of the most common requests that my staff and I receive when patients come in for routine check-ups is if we can proceed without taking x-rays. The rationale is always one of two options: 1) “I don’t want to pay for x-rays” or 2) “I am concerned with the amount of radiation that I am receiving”. I will not delve into the first reason much because these x-rays are often covered in full by most dental insurances. In the absence of this coverage, I can only influence to a certain degree a patient’s desire to diagnose small problems so that they can be treated before they snowball into more advanced issues. What I aim to clarify are the risks and benefits to these frequently used diagnostic aids.
In my last post I discussed the panoramic x-ray and how it can have benefits that reach far beyond the scope of traditional dentistry. Here I will focus on bitewing and periapical (PA) x-rays that are routinely taken on a basis typically ranging from once every six to eighteen months. Bitewings in their most frequent use show several posterior teeth (molars and premolars) in each film and are primarily used for diagnosing cavities and bone levels in between the teeth. PA’s as part of a routine check-up often supplement the bitewings in the anterior, providing similar information on the front teeth as well as potential infections that can show up at the ends of the roots of the teeth. Some patients, particularly those with periodontal (gum) disease or extensive dental problems, may also require PA’s of the molars and premolars as part of a full mouth series. These issues often cannot be diagnosed by simply looking inside the mouth until they have progressed substantially and may at that point necessitate additional treatment. Below are examples of a bitewing and PA showing some of the issues I’ve just discussed.
Now that we have established a better understanding of the benefits of these routine x-rays, we can further analyze the risks associated with them. First of all, we live in a digital age. Everything is computerized, and so, too, are dental x-rays. Not only do digital x-rays yield drastically improved diagnostic capability, but they also reduce the amount of radiation approximately 90% as compared to film x-rays. If your dentist still uses film x-rays, it is either time for him or her to get with the times or for you to find out why he or she has not yet gone digital. For those individuals who are still concerned with the radiation resulting from even digital x-rays, consider the following: each digital bitewing x-ray carries an effective radiation dose equivalent to that of 5.6 hours of background radiation just from living on Earth, NOT even in direct sunlight. During the normal series that we take once annually, consisting of four bitewings and three anterior PA’s, there is less than a day and a half worth of background radiation. This amounts to 1.1% of the EPA annual radiation limit for a member of the general public and 0.011% of the annual dose at which a lifetime risk of cancer is evident.
Having now seen the potential benefits of using these common dental x-rays as compared to the comparatively small risks associated with their use, it is my sincere hope that any concerns about radiation from routine dental visits are laid to rest. As always, I welcome questions, so feel free to ask me at your next dental visit!
One Simple X-Ray That Saved Someone’s Sight
For most patients, one dental visit each year often entails some series of radiographs, or x-rays, that according to their dentists are necessary to diagnose cavities in between the teeth. These images are also useful in visualizing, to a degree, any bone loss due to periodontal disease, but what purpose do additional radiographs that are not used to evaluate potential problems with the teeth serve? What is this panoramic radiograph and why do dentists want to take one if it does not tell them anything about teeth?
A panoramic radiograph, or panorex, gives the dentist a broad overview of the mouth and its surrounding structures. While it is an exaggeration to suggest that this image does not provide information about the teeth, this is not the purpose or rationale behind use of this diagnostic tool. Surely, as the panorex is a broad overview of the mouth, it can bring to light larger dental issues and is particularly useful for evaluating the position of impacted wisdom teeth, but it does not have the resolution required to detect small cavities. Consider the difference between taking a panoramic photograph of a landscape and taking a photograph of one particular area of that same landscape using a telephoto lens. Two different pictures aimed towards portraying two different levels of detail.
This radiographic study is primarily used as a screening tool to search for issues in the jaw, lower portion of the head, and upper neck. The maxillary sinuses, which are located just above the upper molars, temporomandibular joint (TMJ, jaw joint), and lower orbit (eye socket) are all typically visible in this type of image. Issues such as tumors, cysts, bone infections, and fractures can often be seen in this type of x-ray. The early diagnosis of these problems can be critical to proper treatment and maintaining quality of life.
The image below portrays a cyst found within the patient’s maxillary sinus. After referral to an ENT specialist, further evaluation of this cyst revealed that it was expanding towards the eye and was within close proximity of compressing the patient’s optic nerve, which is responsible for relaying visual information from the eye to the brain. Successful surgery was completed to remove the cyst with no effects on the patient’s eyesight. Had this x-ray not been routinely taken at the time, it is entirely possible that vision would have been lost, or permanently impaired, in one eye. It bears mentioning that the patient was completely asymptomatic and had this x-ray taken as part of a routine screening.
Unfortunately, the frequency that most people elect to have this type of radiograph taken is largely dictated by their dental insurance plans, which typically allow for one per three to five years. Given the low risk and potential benefit of this x-ray, a strong argument can be made for more frequent use. With regard to the risk associated with radiation exposure, stay tuned for my next post, which will clarify radiation dosage and its potential effects on the body.
National Facial Protection Month and Preventing Dental Injuries
The spring brings blooming flowers, warm weather, and a new season of sports. Children, adolescents, and even adults who partake in physical activities are urged to be a little more protective of their faces and mouths throughout April. April is National Facial Protection Month, and a new season of baseball, softball and lacrosse can lead to a variety of facial injuries. Dental associations around the globe are spreading awareness and helping patients and individuals find the best solutions for their protection. It is estimated that two percent of children who participate in sports "eventually will suffer a facial injury severe enough to require medical attention." Some injuries are more serious than others, but most of the time the injury is around the mouth.
Preventing Dental/Oral Injuries
We routinely recommend custom sports mouth guards for the extra protection and stability that they offer. Depending on the level of contact expected in any given sport, these appliances can be custom tailored to fit each patient's needs. A properly made mouth guard is a deterrent against many dental injuries, including cracked or knocked out teeth. Wearing a fitted mouth guard will not have an impact on one's breathing or performance, nor will it alter one's speech when compared to the typical over-the-counter product.
There are numerous broadcasted athletic highlights available for viewing which portray esteemed players in their respective sports wearing protective mouth guards. There are, just the same, highlights of what can result from not wearing a mouth guard, as seen here. These professionals understand the advantages of wearing a guard to prevent an injury over having to repair or lose a broken tooth that was caused by an inadvertent action during gameplay. Risk of injury to the soft tissue of the mouth is also minimized greatly while wearing a mouth guard. If professional athletes understand the benefit and value of employing this level of protection, it stands to reason that this is a solid guideline for the rest of us.
Being National Facial Protection Month, it's not always about the mouth. There also exists great risk of injury to the head and eye areas. While we'll provide the mouth protection, supplementing protection by wearing a helmet should also be considered, which, when properly fitted, are proven to limit sustained head injury by up to 85 percent. There are many products available that offer facial protection, as well, ranging from eyewear to face shields. In general, when playing sports, our faces are exposed and vulnerable to injury, so don't take this too lightly. An errant hop on the baseball infield or a blindside hit to the head can result in minimal to no injury when proper precautions are taken.
Seeking Assistance or Treatment
If an injury is sustained through a sport or activity in Morris County, make an appointment with our dedicated dentists. Whether having experienced a dislodged tooth or another type of trauma, we offer comprehensive treatments that can provide full mouth restoration. Just remember, if you have a tooth fully knocked out, store it in your own saliva, do NOT scrub it, and get to a dentist as FAST as possible! Aside from helping with trauma, we are of course here for all of your oral health needs.
KCDC Celebrates National Children’s Dental Health Month by Sponsoring ‘Give Kids a Smile’ Day
The earlier children begin to receive routine checkups for their dental hygiene, the healthier their teeth become. February is National Children’s Dental Health Month and dental professionals across the country are taking initiative to making sure children in our communities receive treatment that provides a beautiful, healthy smile through their childhood and into adulthood. Here at KCDC, we’re committed to your children’s dental health and ensure that their teeth are healthy on each and every visit to our office.
Friday, February 6, was Give Kids a Smile Day, and our dentists in North Jersey gave back to the kids of the community by providing free dental care to underprivileged children. We treated numerous kids on Friday and they left with a refreshed feeling, smiling from ear to ear. Our team provided children with free exams, cleanings, and sealants to those in need.
We are extremely pleased with the turnout of the event and the success we had, treating every child who walked through the door. We want to thank all of our sponsors who helped participate in the event, our entire staff, and Printed Ink for the value they added. We take great pride in our efforts and commitment to the community, and we made our best effort to provide a fun atmosphere for the kids.
The importance of regular dental checkups should not be overlooked. Daily brushing, flossing, and general care for the mouth will help children prevent cavities in their young mouths. Good oral health, in a child, sets the stage for continued health through adolescence and beyond. We supplied every child we treated on Friday, February 6 with a goodie-bag that included an oral hygiene kit and small prize.
As the month advances, our dentists will continue to provide children with the dental care they need to maintain a glowing smile. We are sticking to the 2015 slogan, “Defeat Monster Mouth” and hope parents will reinforce this at home! No matter what kind of treatment you or your children need, whether a cosmetic procedure, braces, or a routine checkup, make an appointment at our office and keep your mouths healthy.
“I Was Told I Need a Tooth Extracted…Now What?”
A myriad of dental patients each day are confronted with some of the least pleasant news one could receive at a dental office: “You need to have this tooth taken out.” Of course, this news affects different patients in different ways and surely depends on the location of the offending tooth. Certain patients may not lose much sleep over losing a molar, whereas virtually all patients will stress over being told that a front tooth is beyond repair. Understanding the rationale behind this and the process associated with restoring a patient to proper function and esthetics is paramount in reducing this stress and expediting a positive outcome.
Why Do I Need to Take It Out?
Before understanding the process of restoring the missing space, it is necessary to comprehend the rationale behind the recommendation to remove a tooth. There are several reasons why this may be the treatment of choice in a given scenario.
For starters, a badly broken tooth often necessitates extraction. Of course, this depends on how far towards (or beneath) the gums the tooth is broken. If the fracture is in the root of the tooth (the part held in the bone) that is usually an indication it needs extraction. Similarly, if there is excessive decay that extends deep below the gums, the removal of the decay would leave the tooth in a similar state as if it were fractured.
If the health and status of the bone and gums around the tooth is such that the tooth is not well-supported or strongly held within the bone, extraction may again be the right choice. Regardless of the scenario, you should discuss your options with your dentist. As with many things in life, there are many ways to skin a cat, but as dentists we are tasked with providing you with the pros and cons of whichever treatment options that we are presenting to you. More than anything else, BE INFORMED, and decide accordingly.
Ok, I’ll Take It Out, What’s Next?
The main determinant of how to proceed from the point where both dentist and patient agree to move forward with extracting the tooth is the restorative treatment plan. When considering fixed (stay in place, not removable) options, there is basically a decision between a fixed bridge and an implant. Generally speaking, nowadays an implant is preferred so that the teeth on either side of the tooth to be extracted do not require preparation (especially if neither needs restoration at the time).
Additionally, any problems that arise for either of the teeth supporting the bridge often require replacement of the entire bridge. An implant restoration looks and feels similar to the tooth it is replacing, and hygiene (most notably flossing) is much easier. The next decision primarily falls upon the dentist, who will determine if the bone and soft tissue at the site of extraction is sufficient to accommodate an implant immediately at the time of extraction. If possible, this shortens the overall time until the restoration of the implant (placement of the implant crown), which ranges from 2-6 months after placement. If an implant is not possible at the time of extraction, most often a bone graft will be placed in order to maintain the existing bone as best possible. Usually this adds an additional 3-6 months to the overall timetable.
To summarize, when a tooth needs to be extracted and the preferred restoration is an implant, your dentist will determine if the implant can be placed right away, or if you need grafting first. The implant, which is similar to a titanium screw, is usually left to integrate into the bone after placement. After this process has completed, a prosthesis (crown) will be made and attached to the implant.
For more information and graphical representations of this topic, visit www.kcdcmontville.com/implants.html.