Dental information
Dental Emergencies
TOOTH KNOCKED OUT
If someone has a tooth knocked entirely out of their mouth onto the floor or ground during a game, you will hear conflicting advice about what should be done. Here's what you need to know.
The root of the tooth is covered with live cells that need to be kept alive. Those cells will start dying in 4 MINUTES if the tooth is not put back into the socket!
Before putting the tooth back in the socket, RINSE THE DIRT OFF using any non-toxic liquid on hand. Ideally water or milk, but even soda pop, or the victims own saliva.
Put the tooth back in the socket. CONFIRM THAT THE TOOTH IS FACING THE CORRECT DIRECTION!
Once in the socket, the tooth is likely going to misaligned with the other teeth due to the blow deforming the tooth socket. It's also helpful if someone were to use a little force to attempt to MOVE THE TOOTH somewhat back toward proper alignment. Often the nerves in area will still be a bit numb from the trauma, so the victim is able to tolerate some force on the tooth.
TOOTHACHE
Everyone should have respect for the potential for pain and infection that can occur from teeth. The pain can come on very rapidly, and can be severe. Any head and neck infection also has the potential to be become life threatening. Your options will always be better if you contact the dentist sooner than later. For our office, leave your name, number, and message on the voice mail after hours. We will be checking messages periodically, and will call you back. We get multiple calls daily on weekends and holidays, so don't think that you are being a bother. Just call!
INFECTION
If substantial infection has set it, the site may have become so acidic that local anesthesia would be unable to effectively numb the area. You may need to take an antibiotic for a day or more before any work should be attempted.
Typically, antibiotics will be able to kill all the bacteria involved in a dental infection. However, they can be very helpful by temporarily reducing the degree of infection, and open a window of opportunity where the tooth can be successfully anesthetized and treated.
If you take an antibiotic, GET THE TOOTH TREATED! An untreated tooth will always harbor some bacteria that will reinfect the site. The antibiotic will have killed the susceptible bacteria, and some of the bacteria that remain will include resistant types. When the infection repopulates, it will include a greater number of resistant bacteria. You can be creating a superinfection! Therefore, DO NOT TAKE MULTIPLE DOSES OF ANTIBIOTICS on your own!
The same bacterial resistance issue can also be occurring in your stomach and intestines. Take a quality PROBIOTIC, but wait at least one hour after taking the antibiotic, so the antibiotic has time to be absorbed out of your stomach.
Dentists generally start with an antibiotic that you will be able to tolerate, and is likely to control your infection. However, if the antibiotic doesn't seem to be improving the infection within about 48 HOURS, then you need to contact the dentist so they can consider switching to a different antibiotic that may be more effective against those bacteria that resisted the first antibiotic. You don't want to give a difficult bacterium time to gain the upper hand.
Enamel Regeneration
Every day, dental office staff see CAVITIES that will require injections, fillings, and crowns to restore. Now there are new materials that can stop, and even reverse, the decay process BEFORE CAVITIES FORM.
Before cavities form, enamel is DECALCIFIED by acids from bacterial plaque. Decalcifications appear WHITE.
On xrays, DECALCIFICATIONS look dark. Initially, the enamel surface remains intact and HARD.
DECALCIFICATION starts when plaque acids dissolve rod-shaped, calcium-phosphate CRYSTALS of the enamel, making it POROUS. As the acids penetrate deeper, the enamel becomes increasingly porous. As long as the outer enamel surface remains intact and HARD, there is still time to reverse the process.
A strong consensus of studies confirms that a formulation of amino acid PEPTIDES (CURODONT REPAIR FP, Switzerland) can mimic the natural PEPTIDE BIOMATRIX that grew your enamel during childhood. For studies: https://professional.vvardis.us/literature/
Bacterial ACID IONS inside an ENAMEL PEPTIDE MONOMERS absorbing through
DECALCIFICATION. The outer surface the porous enamel surface, and into the
is porous, but remain intact and hard. decalcified lesion.
The PEPTIDES link together to form a Calcium-phosphate CRYSTALS start to
BIOMATRIX that is capable of attracting grow on the BIOMATRIX surface,
calcium and phosphate ions from saliva. gradually REGENERATING ENAMEL.
Fresher Mouth
Do you know anyone who could benefit from a fresher mouth or breath? It can be socially very difficult. Although most people don't know what to do, it's usually easy to fix. For people who keep their teeth clean and don't have gum disease, research has shown that the greatest source of mouth odor is from the tongue.
Tongues are covered with papillae -- like a cut-pile carpet. Some tongues have tall papilli, with deeper valleys between the papillae. When the valleys are too deep, they harbor species of bacteria that survive only in the absence of oxygen. They are called anaerobes, and are the odor producing bacteria. Don't underestimate the ability of these tongue bacteria to cause overwhelming odor. You need 3 items to get rid of them:
TONGUE SCRAPER
Favorite tongue scraper to date is from Oolitt, available direct or from Oxyfresh.com. Try them all, but this is hard to beat.
TONGUE BRUSH
Buy a specialized tongue brush at the drugstore or online. It needs to be low profile (short stiff bristles), so that it can reach to the back of the tongue without unnecessary gagging. It needs to to be wide, so the wide tongue can be brushed quickly.
EFFECTIVE MOUTHRINSE
Oxygenating mouthrinses using stabilized chlorine dioxide will instantly kill odor causing bacteria. Oxyfresh Power Rinse Oxyfresh.com) and Closys Mouthrinse (drugstores). Crest Pro Health, with cetylpyridinium chloride, may also be effective.
TECHNIQUE
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Scrape the top and sides of the tongue to remove the bulk debris. Rinse debris off the tongue scraper between each stroke.
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Wet the tongue brush with the mouthrinse, then brush the tongue. This introduces oxygen between the papillae, and loosens deep debris.
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Rescrape the tongue to remove the loosened debris
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Hold mouthrinse in your mouth for 2 minutes, then expectorate
Kids Care
TEETHING
Teething is a normal experience for infants and children, but it can be painful. Many well-meaning parents and caregivers who want to ease a child’s pain might turn to products that could be harmful. Soothing children’s gums with prescription or nonprescription medicines containing benzocaine or lidocaine – or homeopathic tablets and other products – might seem like good options. The U.S. Food and Drug Administration warns that these products can be dangerous to children and can lead to serious injury, and even death.
The American Academy of Pediatrics (AAP) recommends alternative ways for treating teething pain, including rubbing infants’ gums with a clean finger, or providing a teething ring made of firm rubber to chew on. On average, infants begin teething around age 4 to 7 months and have a total of 20 “baby teeth” by 3 years of age. According to the AAP, occasional symptoms of teething include mild irritability, a low-grade fever, drooling, and an urge to chew something hard.
Topical medications (used on the surface of the gums) containing benzocaine or lidocaine offer little to no benefit, and are associated with serious risks when used for teething pain in children. These include creams, gels, and homeopathic teething tablets.
Benzocaine, a local anesthetic (a drug that temporarily numbs), is the active ingredient in several nonprescription oral health care products, including Anbesol, Cepacol, Chloraseptic, HurriCaine, Orabase, Orajel, and Topex. These products should not be used for teething pain in children because they can be dangerous. Using benzocaine products can lead to a serious, and sometimes fatal, condition called methemoglobinemia, in which the oxygen-carrying capacity of red blood cells is greatly reduced.
Topical oral viscous lidocaine solution – a prescription drug used to treat certain types of mouth pain – also should not be used to treat teething pain in infants and young children. It can cause grave harm, such as heart problems, severe brain injury and even death. In addition, topical oral viscous lidocaine solution can cause seizures in infants and young children when too much is applied, or it is accidentally swallowed.
The FDA also has received reports of death and serious injuries to infants and children, including strangulation and choking, caused by teething jewelry, such as amber teething necklaces.
What You Can Do to Ease Teething Pain:
If a child’s gums are swollen and tender, gently rub or massage the gums with your finger, or give the child a firm (not liquid-filled) teether made of rubber to chew on. Make sure the teething ring is not frozen. If the object is too hard, it can hurt the child’s gums. Be sure to supervise children so they don’t accidentally choke on the teething ring.
FIRST VISIT
Ideally, your baby should be seen as soon as they show teeth. At their first visit, the HAPPY VISIT, we will look at your baby or child's teeth as much as they will permit. Our primary goal is that your baby or child is comfortable and happy during the visit. There are some important points of information to cover, Only after the child is comfortable with the hygienist looking into the mouth would the child be scheduled for a tooth cleaning visit.
SDF
If your child is very young but has multiple cavities that need treatment, an option to avoid sedation dentistry is to place SDF (silver diamine fluoride) directly on the decay. If the home care is improved going forward, the SDF can arrest the decay, so the lesions do not tend to progress, That way, needed dental work can be postponed until your child is older, and better able to tolerate dental work.
We also have the option of nitrous oxide for light sedation as needed.
SPECIAL TECHNIQUE FOR SHOTS
If a young child needs to have a tooth numbed, we use the following technique very successfully.
You want to be confident that the visit will go smoothly. Children are intuitive geniuses, and will be aware of your level of anxiety. If the child isn't overly anxious before sitting in the chair, most of the time they will make it through the appointment. Sometimes NITROUS OXIDE will help.
In the few cases where the child becomes overly anxious, the best choice at that point is to keep our interaction with the child happy, and simply reschedule the appointment. That is the safety valve! Having a safety valve accomplishes two very important things. First, you can relax about the visit. Second, your child will not ever have to deal with a fear-producing dental visit. The fact that a child may become anxious in a new environment is not traumatizing to the child. Making a big deal over their anxiety can be traumatizing. It's best for them to establish from the start that dental offices are great places to go. This investment in time and trouble for the adults is an investment that will pay dividends for the rest of the child's life. So don't feel bad or apologetic if we scrap the appointment. It's the right thing to do. On the next visit, the child will feel more familiarized, and will recall that all the adults acted in a friendly manner until he/she left the last time.
An anesthetic PATCH is placed by the tooth for 5 minutes
We show the child a "wand that will make the tooth go to sleep". The wand is for the anesthetic, and does not appear threatening. It does not look like a syringe or needle. It will be vibrating. If they want, they can touch it, and feel the vibration. Then we have them approve touching it to their lip. They can feel that it vibrates and doesn't feel bad. After that, they're nearly always OK with the wand.
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The child lets us touch the wand against their cheek near their tooth.
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Once they are satisfied that the wand is OK in their mouth, we start to numb the gums by the tooth. IN MOST CASES, CHILDREN DO NOT NOTICE ANY DISCOMFORT, OR TOLERATE WHAT THEY FEEL. In the rare event that they do, we know that the appointment will effectively be over, and they will have to reschedule at a later date.
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Once the tooth is numb without any incident, kids usually do great with the other parts of the visit.
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Adults that are needle-phobic request this protocol
SIMPLE STRATEGY TO FORM GOOD NUTRITION HABITS FOR KIDS
Expand the list of healthy foods your child will eat without food battles:
1. Plan the menu with one favorite item they'll want more of, and one item they don't yet like
2. Place very small portions of each food item on the plate--small enough so you know the child will still be hungry when done
3. SIMPLE FOOD RULE: You can have seconds of anything you want, but you have to finish your plate first
FLUORIDE
From 2000 - 2012, the National Institute of Health conducted the largest fluoride study ever, which concluded that the beneficial effects were only from topical exposure of fluoride directly onto the surfaces of the teeth. It was found that there was no benefit from ingesting fluoride.
The two main changes are as follows:
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Children do not need to swallow fluoride drops or tablets.
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Adults can benefit from topical fluoride too, like ACT, Fluorigard, or Up&Up Fluoride mouthrinses available from drugstores, groceries, and Target.
The government fluoridates water in many areas. The study did not conclude that ingesting fluoride is harmful. Fluoridated water is used as an affordable method to control dental decay because it topically contacts the teeth, and is dramatically effective.
Some are concerned with fluoride competing with iodine in the thyroid gland. To date, the majority of researchers have not yet seen this or other potential issues as a reason not to use fluoride. If you don't want to ingest fluoridated water in your area as a precaution, you may want to filter it out with reverse osmosis, or drink bottled water.
Home Care to Prevent Cavites
Bacteria form destructive plaque on everyone's teeth daily. When the bacteria have multiplied, they are able to clump together in a sticky mass (the plaque), such as along the protective gumline areas. Their acidic waste is contained against your tooth where fluids cannot break through the sticky plaque to dilute it. The acids start binding and removing the Calcium Phosphate mineral from the crystaline structures making up the mineral portion of the teeth. Tooth deminerialization proceeds.
Fortunately, once the plaque is broken up by brushing and flossing, calium phosphate in our saliva reattaches to the open positions in the crystalline latice, and remineralization proceeds.
If you have not had a cavity during the past few years, there are some simple things you can do to keep the tooth reminerization balance in your favor.
Don't feed your bacteria too often. About 1 minute after bacteria are exposed to carbohydrates, they have ingested them and are excreting acidic waste. About 10 minutes after that, they double in number. If you put anything in your mouth except water between meals, your bacteria will double in number each time. 3, 4, or even 5 discrete meals daily are manageable for the teeth. Even healthy snacks feed your bacteria.
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Avoid prolonged exposure to acids. Sip or swish ALKALINE WATER occasionally during the day to elevate your oral pH.
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Sodas & sport drinks not only feed your bacteria, they are packed with their own acid with pH's approaching battery acid. They can also give you osteoporosis. Many lemon harvesters stripped much of the enamel from their teeth by keeping a fresh lemon in their mouth for hours. We are not against lemons, but we don't like hours-long acid exposures either.
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Rinse with fluoride before bedtime. ACT (J&J), Fluorigard (Colgate), or Up & Up (Target) fluoride rinses area readily available. Do not confuse with mouthwashes, sold on same shelf. After you have flossed, brushed, and drank your evening water, then swish with the fluoride rinse a few seconds. Spit out all the rinse, and then go to sleep. The residue from the rinse will still be on the teeth. It will harden the teeth for an hour or two. This is a powerful and simple way to reduce your cavities.
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Effectively break up the bacterial plaque daily. Do this with an electric toothbrush, preferably a sonic brush. Focus your brushing on the gumline areas of the teeth -- where the plaque accumulates.
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Floss the plaque from the other protected area, which is between the teeth.
FLOSSING
The secret to effective flossing is pulling a very long segment of floss from the dispenser. It should be about 2 feet long. Simultaneously wrap either end around your favorite finger of your right and left hands until you have many turns around each finger, and the fingers are now connected by about 5" of remaining floss. Now the floss will not slip off the fingers, even though you're not holding it. You cannot floss if you're having to hold the floss in a pinch-grip. Now your other fingers are free to direct and control the floss. With a little practice you will be able to floss every space in 2 minutes.
If flossing is that efficient, you will be likely to do it nightly. With tension on the floss, pop the floss through the tight contact area between the teeth. Push the floss against the back tooth, and then scrape it up and down 2 or 3 times on the tooth. Next, pull the floss forward against the forward tooth, and scrape it up and down 2 or 3 times. (Pushing and pulling tends to wrap the floss around the tooth somewhat so the floss contacts more of the tooth.) Then pop the floss out, and move on to the next contact.
If your teeth are too tight, and the floss shreds, try Glide (Crest) floss, or others designed to limit shredding. The dentist can also adjust an overly tight contact.
DRY MOUTH
Dry mouth is the single worst condition for cavities. People that frequently have dry mouth can get cavities so rapidly that it's discouraging. Most people don't realize that their saliva is the single most protective item for their teeth. It fights bacteria with antibodies and white blood cells, and it remineralizes enamel to repair acid damage. Saliva substitutes or water do not do that, although drinking water will help you produce more saliva.
If you have dry mouth because of chronic nasal congestion, then you need to insist that your MD fix the problem so you can avoid constant dental work. Many allergies can be reduced, and some eliminated. Nasal passages can be opened.
Those with dry mouth need to do it all. In addition to the above techniques, ask your dentist for a prescription toothpaste and prescription antibacterial mouthrinse. There are also effective prescription salivary stimulants.
If nasal congestion is not a problem, but you mouthbreathe anyway, buy a chin strap for under $30 online or from the drugstore that will help keep your mouth closed.
Tooth Whitening
WHITER TEETH
The single most effective way to whiten teeth is using custom trays made by vacuum-forming a soft plastic over models of your teeth. The trays are then used at home with a whitening gel. While some people may experience temporary sensitivity after whitening, multiple careful studies have shown that whitening does not damage the teeth. Whitening gels are hydrogen peroxide based, which is a natural biological substance that your own body produces daily.
People are able to whiten teeth much more with home trays more than with other techniques for several reasons:
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The application of the whitening gel can be done many times over a long period of time so that the whitening is gentle and incremental.
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The trays fit very closely to the teeth so that they are unobtrusive to wear. People usually won't even notice if you have them in. They are easy to wear repeatedly.
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After all costs are averaged in, tray whitening is very close in cost to the best over-the-counter whitening options. Once you have your trays, the refill syringes are not expensive. Syringes with quality gels and desensitizers can be purchased from dental offices, but whitening gels from drugstores or online can also be effective. Tray whitening is half the cost of in-office whitening. In-office whitening can whiten the teeth more in a single session, but a week or two of home tray whitening can provide equal results.
TECHNIQUE
A small dab of whitening gel is syringed onto the tray surface that will touch a front surface of a tooth. You don't need very much gel. The smallest syringes should last 5-7 sessions, and much larger syringes are available. After the trays are placed over the teeth, use a finger pressure against the tray to spread the gel evenly over the tooth surface. Wear for 15 minutes only on your first time to confirm if the teeth or gums become sensitive. If OK, can whiten for 30 minutes per session. I recommend only 2 - 3 sessions weekly. Any month that you are whitening on this schedule, your teeth will usually get lighter.
If you like your color, plan on applying the gel once monthly to hold the color. If you think they're too light, just skip your monthly maintenance session, and they will gradually darken.
SENSITIVITY
If your TEETH become sensitive from whitening:
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Put Sensodyne toothpaste into your whitening tray so that the Sensodyne will cover the sensitive teeth when the tray is seated over the teeth. Wear the tray 15 minutes or more before whitening, and repeat for 15 minutes after whitening.
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Reduce the whitening time from 30 minutes to 15 minutes.
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Ask for a lower concentration gel, keeping in mind that the carbamide peroxide gel is approximately half the strength of the hydrogen peroxide gel.
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Do not use trays again until your sensitivity is resolved. You don't want to overly irritate the live pulps of the teeth.
If your GUMS become sensitive from whitening:
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Have the tray scallop-cut around each tooth (you could do it with scissors) so the tray does not extend to cover any gum tissue
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After seating the trays on the teeth, wipe the gums with a damp towel to remove any gel that may have oozed out onto the gums
Implants
Typically, there is less discomfort after implant placement than after tooth removal.
Implants have a 90%+ success rate.
In those cases where implants fail, it's roughly that same as when teeth go bad.
BENEFITS
1. Halts the rapid and ongoing bone loss that occurs after tooth removal
2. Provides support against biting forces, which can become traumatic to other teeth, or your TMJ, when teeth are missing
3. Restored implant teeth are brushed and flossed at home the same as natural teeth, and also need cleaning by the hygienist
Implants can support all tooth replacements: crown, bridge, removable partial denture, or full denture.
If all your upper or lower teeth are bad, we can use them to replace all the teeth.
When teeth are missing, Try to place implants ASAP while there is still enough bone. To save costs, delay placing the tooth replacements. Implants can stay in place without a tooth added for as long as you need.
Root Canals
Root Canal Therapy (RCT) has a 90%+ success rate for preserving teeth. Thousands of carefully performed studies confirm that RCTs are safe, and effectively control pulpal infection.
In the early 1900s, some researchers theorized that bacteria from teeth that had root canals could cause infection in areas distant from the tooth through the transfer of bacteria through the bloodstream. This was called the "focal infection theory", and it led some dentists to advocate tooth extraction. This theory was discredited in the 1930s, though it still circulates on the internet.
Bacteremia (bacteria in the bloodstream) is caused by many everyday activities, including brushing and flossing the teeth. You have 10 trillion bacteria living in and on your body. In failing root canals, as in failing teeth, the effect of the bacteria will be greatest in the area around the tooth.
Wisdom Teeth
About 75% of people don't have enough space for their wisdom teeth, but 25% of people have sufficient space. You should plan to keep your wisdom teeth if you have space, and they're coming in straight. Wisdom teeth can function as another set of molars, and molars are your most valuable teeth. About 10% of people are missing one or more wisdom teeth.
If you do not have enough space for the lower (mandibular) wisdom teeth, then they should be removed preventatively before you turn 25 years of age. Generally, it is less traumatic to surgically remove the lower wisdom teeth once they are partly formed, but before they are completely formed. This is usually age 15 to 18. After that, they become more difficult to remove each year. After age 25, most dentists will not recommend removing them preventatively due to increased surgical complications. When lower wisdom teeth do not have enough space, they tend to develop a chronic infection around the tooth. This condition leads to loss of bone around the valuable molar beside the lower wisdom tooth, and eventually typically causes an acute infection of the gums that necessitates removal that is considerably more problematic that a preventative removal would have been. It is rare for upper wisdom teeth to experience similar problems.
Most people elect to have IV sedation and surgically remove all 4 wisdom teeth in one appointment. However, many elect to remove only the lower wisdom teeth to reduce overall tissue trauma, as well as to reduce cost.
Unlike the lower wisdom teeth, removal of the upper wisdom teeth typically becomes easier, less traumatic, and has lower post-op pain, if the teeth are given time to grow into the mouth. Once in the mouth, they're removed by "simple" extraction, instead of "surgical" extraction that requires cutting gum and bone. Simple extraction of the upper wisdom teeth is less traumatic, and less expensive, than when done surgically at the earlier time that is ideal for lower wisdom teeth.
Further costs can be saved by removing upper or lower wisdom teeth using local anesthesia (shots) instead of IV sedation. Local anesthesia is typically able to entirely numb the area to keep the procedure comfortable.