Author Archives: rgangwisch

Pulpitis

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man with toothache

Ouch!

Ever woken up to a toothache? Chances are it was caused by pulpitis, an inflammation of the dental pulp, a collection of nerves and blood vessels inside your tooth. A mild pulpitis can cause symptoms of cold sensitivity. If the condition is allowed to progress, then it can lead to lots of pain and suffering. The most common cause of pulpitis is decay. Bacteria can get down inside a cavity and form acids and toxins that can injure the pulp (nerve). If allowed to continue unchecked, it can lead to much discomfort and to pulpal death. Another cause of pulpitis can be exposed roots. Normally a tooth has an enamel coating, but if the gums begin to recede, then cementum and dentin can be exposed. Dentin has microscopic tubules that lead to the nerve. Bacteria can get into these tubules and can cause sensitivity. For temporary relief of pulpitis until you can get to a dentist, the best thing is an anti-inflammatory such as Ibuprofen. Pharmacies may have toothache drops which have oil of cloves in it or temporary filling material (zinc oxide and eugenol) to plug the hole. Once at the dental office, if decay is the cause of the pulpitis, then the dentist many times can simply remove it and place a filling. If the pulpitis is due to receded gums, then the dentist can apply a desensitizing agent on the root surface to help alleviate the pain.

Periapical X-Rays

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Sample of a Periapical X-RayA periapical x-ray is a closeup of a particular tooth or teeth. If your dentist recommends one, by all means, have him take it. I recommend periapical x-rays to my patients anytime they say that they are having pain in a particular area, if there is deep decay in a tooth or if there is a problem or defect that is apparent on a bitewing x-ray (the x-ray that is used to detect cavities and gum disease) but cannot be seen in it’s entirety. When viewing a periapical x-ray, the dentist will look at the bone around the root, the height of the bone for periodontal (gum) defects, intactness of the root and for any other pathology (disease process) that could be visible. If a darker area exists on the x-ray around the tip of the root, then that could mean that there is a dead nerve inside the tooth. Dark areas up the side of the root could mean a possible root fracture. Dark areas at the crest of the bone (the portion closest to the crown of the tooth, i.e. the part of the tooth that you see) is usually an indication of bone loss due to gum disease. Pathological conditions can show up as either light or dark areas. This could be indicative of a tumor or cyst. That’s why it is so important to allow your dentist to take a periapical x-ray if he recommends it.

Orthodontic Retainers

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Orthodontic Retainers

Orthodontic Retainers

So you’ve spent a couple of years being metal mouth with your braces and the time has finally come to get them off. That’s the good news-now-here’s the bad. You have to wear a retainer for the rest of your life. Orthodontic retention is just as important as the actual treatment. This is because the muscle forces are always there trying to push the teeth back into their original position. It’s a constant battle-the good guys against the bad guys-and the only way to win is by wearing the retainer regularly. When the braces are taken off, the bone that holds the teeth is in a state of flux. The teeth are quite loose because the pressure that is applied by the braces erodes the bone on the pressure side and stimulates new bone on the other side. However, the new bone growth is slow to catch up, therefore, loose teeth. The retainer must be worn full time until the bone can heal with the teeth in their new postion. The good news is that this full time period doesn’t last forever. Once the orthodontist decides that the teeth are stable enough, you can go to the night time wear. But from that point on, you must sleep with it in forever, or risk undoing all of that time, effort and money to straighten them.

Bisphosphonates and Osteonecrosis in the Mouth

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An example of bisphosphonate related osteonecrosis

Bisphosphonate Related osteonecrosis

Medications to help reduce the effects of osteoporosis have been a great help to the sufferers of the disease. Unfortunately, as there is with most medications, there are side effects. The main oral concern of these side effects is a malady called bisphosphonate-related osteonecrosis,BON, which is essentially localized bone death. After oral or periodontal (gum) surgery, wound healing can be compromised to the point that raw, denuded bone can be present and continues to be a nagging problem for the sufferer. It was a condition that was common in cancer patients who received radiation treatment. However, with the advent of the osteoporosis medications, this affliction became more common. The good news is that those receiving oral medications versus intravenous were significantly less likely to be affected by BON. The most popular of these medications go under the brand names of Fosamax, Uredic, Boniva and Zometa. If any type of oral surgical procedure is contemplated, the dentist must be made aware that the patient is taking a bisphosphonate drug.  Since there is no treatment available for BON, a decision must be made weighing the risk versus the benefits of doing the surgery.

Gum Disease and Heart Disease

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It is becoming more and more apparent that there’s is a link between gum disease and heart disease. The link appears to have to do with inflammation. Chronic diseases such as diabetes, cardiovascular disease, Alzheimer’s disease and periodontal (gum) disease all have an inflammatory component. The general feeling at this time is that inflammatory components of gum disease can worsen plaque buildup in the arteries leading to the heart. The plaque buildup narrows the inside of those arteries, thus, restricting the blood flow.

Another theory is that bacteria that is present in periodontal (gum) pockets gets into the blood stream and attaches to the coronary arterial plaques. This theory says that that could contribute to clot formation. Studies have shown that people with periodontal disease are more than twice as likely to have coronary artery disease.

Even though theses theories haven’t been thoroughly proven, it is still a good idea to make sure that you are free of gum disease. A thorough periodontal exam by a dentist is necessary to be certain that gum disease is not present. This is because symptoms are not usually present until the later stages of the disease when irreversible bone damage occurs and the teeth start loosening.

3D Dental X-Rays

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3D Cone Beam X-RayWe now have a piece of “Star Wars” technology at our disposal. 3D x-rays are now readily available to dentists. Called cone beam tomography, one can see jaw structures, tooth relationships and root canal anatomy. They are becoming the standard of care for implant surgery since it shows the relationship between the available bone and major structures such as nerves and sinuses. It’s indispensable for making sure that a dental implant does not impinge on the nerve that controls the lower lip. It can also help find some hidden bone around the sinuses allowing for placement without doing expensive bone grafts. In orthodontics, the relationship between the upper and lower jaw in conjunction with the rest of the skull can be determined readily with these x-rays. The3D view can aid a dentist in search for an elusive root canal or an extremely curved root.

Although the amount of radiation needed to produce these x-rays is reasonably minimal, the general feeling at this time is to not make them a routine procedure, especially in children who will probably be exposed to multiple sources of radiation throughout their lifetime.

 

Risks of Tooth Bleaching

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Teeth bleaching has become a very popular way of lightening one’s teeth. It is a great technique that can be done minimally invasive and for low cost. As with any dental procedure, it does come with some minor risks. The most common one is tooth hypersensitivity, in other words, that next cold drink could shoot you through the roof. We use an at-home bleaching technique which greatly lessens the sensitivity. The bleaching agent that we use has potassium nitrate in it which which significantly reduces the problems with cold food and drink. You can also use a toothpaste that is specifically made for hypersensitive teeth, such as Sensodyne.

Before Bleaching

Before Bleaching

After Bleaching

After Bleaching

Scanning electron microscope studies have shown no appreciable damage to the tooth enamel, however, there can be some roughening of composite resins which are used for the tooth colored fillings. It’s not significant enough to avoid bleaching altogether, although you may need to be prepared to have any large fillings in your front teeth replaced since they probably won’t match after the bleaching is done.

Contact with the gums can cause some irritation, especially with the stronger concentrations of bleaching agent. Make sure that the tray that holds the bleach has been properly contoured so as to not cover the gums and wipe any excess gel off the gums.

Teeth Grinding

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Worn Teeth From Night Grinding

Damage Due To Night Grinding

Damage Restored With Beautiful Porcelain Crowns

Damage Restored With Beautiful Porcelain Crowns

 

 

 

 

 

Teeth grinding is a very common problem. It’s not unusual for someone to not be aware that they are even doing it. It is more common at night since during the day, most people can catch themselves in the act. Stress is the most common reason for grinding. While sleeping (called nocturnal bruxism), it becomes an outlet for the normal stresses involved in everyday life. Another cause can be an uneven bite and the body’s reaction to try to even it out by subconsciously gnashing the teeth together in an attempt to even everything out.

Untreated teeth grinding can cause pain in the jaw joint (temperomandibular joint) and the surrounding muscles. It can also lead to premature extreme tooth wear necessitating major dental reconstruction.
To counter the problem, if the grinding is present during the daytime, I tell my patients to try to catch themselves doing it. If they find that they are clenching, then they should have “lips together, teeth apart”. This has been very successful for many of my patients. However, most of the grinding problems occur at night. In that case, it is best to build a nightguard, a plastic mouthpiece, to help prevent any further damage from occurring.

Gum Grafting

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Gum Graft

From: perio.org

 

 

 

 

 

 

Gum recession is a very common problem. It can cause cold sensitivity on the exposed roots. In severe cases, it can lead to bone loss causing the tooth to loosen and eventually loss of the entire tooth. The recession can be caused by improper tooth brushing, thin gum tissue, abnormal muscle pull, or trauma. The good news is that we now have surgical techniques that will allow the gum to be rebuilt close to the original level. The procedure involves harvesting a piece of gum tissue from the roof of the mouth, stripping the top layer of gum tissue in the affected area, then suturing the new piece in place. After a few weeks of healing, the tissue looks almost as good as the original. Aftercare is extremely important to keep the problem from recurring. Very careful use of a toothbrush in the area is a must.

The procedure is usually performed by a periodontist, a specialist in treating the gums. If you going to have this procedure done, ask the surgeon to make a surgical stent to cover the roof of your mouth. This area can be extremely painful if left exposed. The feedback that I have had from my patients is that they have been extremely grateful that the roof of their mouth was covered. This made their healing time much more uneventful.

Mercury in Dental Fillings

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Drops of mercuryThe element mercury in its pure form is toxic to humans. The good news is that when it is combined with silver into a compound called amalgam, it becomes inert. That makes it safe for using for dental filings. Using over 100 years of data, the American Dental Association has determined that it is safe for use. In fact, it is considered unethical for a dentist to recommend removing “mercury” fillings for health reasons. If a dentist tells you that you need all of your “poisonous” fillings replaced, it’s time to run out the door.

The newer tooth colored fillings are approved for use in back teeth. Although they don’t last as long as the silver fillings, they are still a very reasonable alternative to the metal ones and they look great. The cost of amalgam fillings is about 20% less than tooth-colored. At Gangwisch Dental Group, we normally use the composite (tooth-colored) materials, however, we will place the amalgam ones upon request.