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Dental information

Dental Emergencies

TOOTH KNOCKED OUT

If someone knocks a tooth entirely out of their mouth onto the ground, such as at an athletic event, you will hear multiple ideas of what to do with the tooth.

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 and then rinse it with any clean liquid on hand, or even the victims own saliva.

Put the tooth back in the socket.  Confirm that the tooth is facing the correct direction. 

If the tooth and socket is pushed back, is helpful if it were encouraged forward somewhat while the area is still numbed from the trauma

 

TOOTHACHE

Everyone should have respect for the potential for pain and infection that can occur.  The pain can come on very rapidly, and has the capability of equaling childbirth.  Infection can become dangerous because of the proximity to head and neck structures.  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, as we will be checking them 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 infection may have caused the area to become overly acidic so that the local anesthesia is unable to effectively numb the area.  It may be deemed necessary to take antibiotic for a day or more before any work should be attempted.

 

Antibiotics will generally not solve any dental problems.  Instead they can be used to knock the infection down, and create a window of opportunity where the tooth can be successfully anesthetized and treated.  

 

You never want to take antibiotics without definitively treating the tooth.  When you take the antibiotic, it will kill off the bacteria that are susceptible to it.  An untreated tooth will always harbor unkilled bacteria that will reinfect the site.  However, they will generally be the bacteria that were resistant to the antibiotic.  If you give the bacteria time to reinfect the site, this time it will be infected with resistant bacteria.

 

Dentists generally start with broad spectrum antibiotics that are well tolerated by most, and control most infections.  However, if the antibiotic doesn't seem to be improving the infection within 48 hours, then you need to contact the dentist so they can consider switching to a different antibiotic that may be more effective against your particular strain of bacteria.  You don't want to give a difficult bacterium time to gain the upper hand.

 

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

1)  Scrape the top and sides of the tongue to remove the bulk debris.  Rinse debris off the tongue scraper between each stroke.  

 

2) Wet the tongue brush with the mouthrinse, then brush the tongue.  This introduces oxygen between the papillae, and loosens deep debris.

 

3) Rescrape the tongue to remove the loosened debris

 

4) Hold mouthrinse in your mouth for 2 minutes, then expectorate

 

 

 

Kids Care

FIRST VISITS

We usually start to see children at age 3.  The first visit is frequently sitting on mom's lap after mom got her teeth cleaned.  Then the hygienist will interact with the child, and maybe see if she can take a peek in the mouth.  Whether or not that's successful, the primary goal of that first visit is that the child is happy with it.  Only after the child is comfortable with the hygienist looking into the mouth would the child be scheduled for a tooth cleaning visit.

 

 

SHOTS

If a young child needs to have a tooth numbed, we use the following technique very successfully.  It's very important that you have confidence that the visit will go smoothly, and it will.  Therefore, you won't have to be anxious. Children are intuitive geniuses, and are aware of adult anxiety on some level.  If the child isn't out of control before he/she sits in the chair, they will make it through the appointment without incident almost every time.  

 

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.

 

1. A special topical local anesthetic is placed on the site for 3-5 minutes

2. We show the child a "wand that will make the tooth go to sleep".  The wand is for the anesthetic, and does not appear threatenting.  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 aways OK with the wand.

3. The child lets us touch the wand against their cheek near their tooth.   

4.  Once they are satisfied that the wand is OK in their mouth, we start to numb the gums by the tooth.  THE CHILD CANNOT FEEL EVEN THE SLIGHTEST PINCH DURING THE NUMBING.  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.    

5.  Once the tooth is numb without any incident, kids usually do great with the other parts of the visit. 

6. Adults that are needle-phobic request this protocol

 

 

FLUORIDE

During the first 12 years of this century, the National Institute of Health conducted the largest fluoride study ever, headed by John Featherstone (UCSF).  The study 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:

1.  Children do not need to swallow fluoride drops or tablets.

2. Adults can benefit from topcial fluoride too (ACT or Fluorigard rinses available from your drugstore or grocery)

 

Please note that there are still many healthcare professionals, including pharmacists, pediatric dentists, pediatricians, etc that are not aware of this information.  It is being taught to new graduates of professional schools, but many healthcare professionals are unlikely to read an article on fluoride or dental treatments in their journals, or attend a continuing education course where these are the main topics.  Therefore, you have to be willing to diplomatically point this out to them as you encounter it.  


The government fluoridates the 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 reseachers 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.  

Preventing 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.  

 

 

1. 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.  


2. Avoid prolonged exposure to acids.  

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. 

 

 

3. Effectively break up the bacterial plaque daily.  

Brush with an electric brush, preferably a sonic brush.  Touch the brush to the tooth surface at the gumline.  That's where the plaque is.  This is not about massaging the gums.  

 

Floss the plaque from the other protected area, which is between the teeth.  Flossing may be more important than brushing.  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.

 

4.  Rinse with fluoride before bedtime.

ACT (J&J) or Fluorigard (Colgate) fluoride rinses area available in grocery and drug stores.  They are with the mouthwashes in the store, but they are used differently.  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 may be the most powerful and simple way to reduce your potential for decay.  

 

5. XYLITOL

Xylitol is a sweet substance produced in woody plants.  Acid-producing bacteria cannot consume Xylitol.  Xylitol mints are found online or in the health food section of your store.  Using Xylitol can reduce the number of acid-producing bacteria in your mouth.

 

 

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.  

Swish and spit with baking soda water every couple hours to counteract mouth acidity.  Make a solution by adding 3 teaspoons of baking soda (sodium bicarbonate) to a half-liter (16.9 oz) bottle of water.  Make a fresh solution every 4 days because it degrades.

 

If nasal congestion is not a problem, but you mouthbreathe anyway, buy a chin strap for under $30 online 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:

 

1. 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.

 

2. 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.

 

3. 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 mainenance session, and they will gradually darken.  

 

 

SENSITIVITY

If your TEETH become sensitive from whitening:

1. 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.

2. Reduce the whitening time from 30 minutes to 15 minutes.

3. Ask for a lower concentration gel, keeping in mind that the carbamide peroxide gel is approximately half the strength of the hydrogen peroxide gel.

4. 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:

1. 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

2. 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

 

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. 

Implants

Implants replace the "root" portion of the tooth that is below the gumline.  After implants are placed, tooth replacements are connected to the implant, and they replace the portion of the tooth above the gumline.  Implant placement is significantly less traumatic than the removal of the teeth they replace.

​The greatest benefit of implants is that of halting the loss of jaw bone where teeth are missing. Otherwise the body gradually dissolves jawbone where the teeth have been lost, bone which is needed to support tooth replacements of any type.

 

Tooth replacements are either Removable or Non-Removable.  REMOVABLES, like dentures and partial dentures, are less expensive. They snap onto the implants for stability, and for the elimination of unsightly clasps.  NON-REMOVABLES, like hybrid dentures and bridges, look and feel more like real teeth.

 

To go easy on the budget, implants can be placed to preserve the bone, but then let sit unused as long as necessary to save up for the tooth replacements.

 

​Implants need to be cleaned by the hygienist two or more times yearly, just like teeth