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Canker Sores
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Canker Sores and Cold Sores Many people suffer from canker and cold sores. In this article I will try to tell you how to differentiate between the two, how to treat them and what to be careful of. Canker Sores Canker sores, on the other hand, erupt inside the mouth on the soft tissue of the cheeks, inside the lips, (not outside like a cold sore), under the tongue or back in the throat. The origin of canker sores is not known. No one virus or bacteria seems to be responsible for the outbreak, in fact, some researchers feel that there is an auto immune response involved. That is, you become "allergic" to yourself and your body causes a sore at that site. They are frequently associated with stress, both physical stress, like being tired or run down, and emotional stress. Cold sores are similar in this respect. Canker sores can also be brought on by trauma. This can mean something a simple as biting your lip or bumping your cheek with the toothbrush. Some people get canker sores as a reaction to a common ingredient in toothpaste. Most toothpastes contain sodium lauryl sulfate (SLS). It is a detergent that is responsible for the foaming action of the toothpaste. If you have frequent bouts with canker sores, try switching to a non-SLS containing toothpaste such as Rembrandt©. If the canker sores that you get are particularly severe, occur frequently or cause scarring, you should talk to your dentist. Like cold sores there is no cure for canker sores. Many people have a way of treating them that works for them. Among the medications that I recommend are Zilactin© and Apthasol©. Zilactin© is an over the counter medication. It comes in a small tube. You dry the area and then apply a film of Zilactin© to the area. It frequently burns a little as it is applied. It then dries to form a white film over the area. This film helps protect the lesion from irritating foods and rubbing in your mouth. It can be applied as often as needed. Apthasol© is a prescription medication made specifically for the treatment of canker sores. It is getting mixed reviews on its success, but if you have exhausted all other medications then it would be worth a try. Topical steroids like Kenalog in Orabase© used to be a popular treatment. However, steroids are rapidly absorbed in the oral cavity and have a wide range of systemic effects. Steroids should always be used with caution and under the supervision of your dentist. The things to remember are, cold sores: highly contagious, generally on the outside of your mouth, multiple small blisters, use Denavir©. Canker sores: not contagious, on the soft tissues inside your mouth, larger ulcer like lesions, use Zilactin© or other over the counter remediesf. Cold sores are viral in origin. They usually are smaller than canker sores and typically form on the outside of you mouth, on you lip or in your nose. Most people experience a "prodrome" or tell tale feeling that they are going to get a cold sore. Frequently that is a burning or itching. The cold sores, usually multiple in nature, develop quickly after the prodrome as blisters. The blisters pop and then weep fluid. This fluid is full of virus particles and is very infective. Be very careful with yourself and others at this stage of the cold sore. If the fluid gets into an opening on your skin or any tissue surface, it can cause cold sores to develop at that site. This is how people get cold sores in their nose, in their nail beds, (Herpes Whitlow) or even in their eyes. Herpetic infections of the eyes can be very serious, sometimes leading to blindness and the loss of the eye. If the fluid, and thus the virus particles, are transferred to an infant, the infant will then come down with an acute outbreak of cold sores and can become very ill. The typical cold sores in the oral cavity are caused by the Herpes Type I virus. Genital herpes is usually caused by the Herpes Type II virus. However, if the fluid from a mouth cold sore, (Type I virus), is transfer to the genitals, the result will be genital herpes. If the virus type were to be checked by a lab test, it would test as Type I virus, it would just be in the location for the Type II virus. Similarly, genital herpes can be transmitted to the oral environment. The bottom line is, when you have a herpetic, (cold sore) outbreak, be very careful about transferring the virus to someone else or some where else. In the past there was very little that you could do for cold sores. Now there is a drug available that can help lessen the severity and duration of the outbreak. It is called Denavir©, chemical name pencyclovir. It must be applied regularly and should be started as soon as the patient feels the cold sore coming on, (at the prodrome). There is no cure for cold sores and someone who gets them will always get them, so be very careful and try not to pass them on to others. The virus is very hardy and can exist for a long time on environmental surfaces. Winter is a time when many people get chapping and cracking at the corners of their mouth. This is called angular chelosis. It used to be contributed to the pooling of moisture and chapping of the corners of the mouth. Now it is thought to be associated with the accumulation of yeast organisms in the crease at the corner of your mouth. The yeast organisms set up an infection which keeps the area chronically cracked open and raw. If you suffer from this condition and normal moisturizers like Vaseline© don't clear up the condition within a couple of weeks or if it seems to recur frequently, you might want to ask your dentist for a prescription for Nystatin Ointment. This is an antifungal agent which, when applied for 2 or 3 weeks usually clears up the condition nicely. Dry mouth is caused by many common medications. If your mouth is dry it's important to keep it lubricated and moist not only for your comfort, but to prevent rampant decay. There are many things that you can do depending on the severity of your condition. The easiest thing to try to chew gum or suck on a small hard candy. Be very careful that the candy or gum doesn't contain any sugar. The presence of sugar in your mouth for a long time coupled with the lack of the rinsing action of your saliva will cause severe decay very rapidly. Gum chewing also causes you to swallow more air, which can lead to gas pressure and bloating. In addition, some artificially sweetened products use sweeteners (xylitol) that can have the same effect when used in excess. The next level of treatment would be to use an artificial saliva or saliva substitute. Ask your pharmacist about which brand they carry. Most saliva substitutes are mixtures of lubricating agents like glycerin and flavoring additives to make your mouth feel fresh and clean. Salivart® is a popular brand, as is Optimoist® by Colgate®. A family of dry mouth products is made by a company called Biotene®. This family of products includes a gum, a toothpaste, an artificial saliva called Oralbalance® and a non alcohol, non sodium lauryl sulfate containing mouthwash. People who have low salivary flow can be very sensitive to the alcohol in mouthwash. It can cause pain and burning. Try different products until you find one you like.If your dry mouth is severe or unrelated to medications you are taking, it could be a result of a medical condition, the most common one being Sjogren's Syndrome. Be sure to consult with your dentist if you have dry mouth to try and determine the cause and to help you deal with the condition.
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Why Should Wisdom Teeth be Removed? One of the most frequently performed procedures of oral surgeons is to remove a patient’s third molars or wisdom teeth. I frequently get questions from patients wondering why they, or their child, need to have these teeth removed. Parents are understandably hesitant to have their children have to undergo the extractions and they frequently have not had theirs out and are doing fine, so they naturally wonder why their children should have theirs removed. Wisdom teeth or third molars normally erupt around the age of eighteen. ( Incidentally, they don't cause the crowding of the lower anterior teeth, see my comment about that in the "Ask The Doctor" section.) Because of an evolutionary trend towards a smaller jaw, most people don't have room for them in their mouth. The tooth either doesn't erupt at all, an impacted wisdom tooth, or it only erupts partially, a partially impacted wisdom tooth. Both fully and partially impacted wisdom teeth can be further categorized as hard tissue impacted, meaning that they are covered with bone, or soft tissue impacted, meaning they are covered with gum tissue. There are two problems inherent with impacted wisdom teeth. They can become cystic and they can be an area of weakness in the jaw where fractures can occur. Let's talk about cysts first. When teeth are developing in the jaw they are enclosed in an eruption sac. This sac can start to expand and develop into a cyst. It doesn't happen frequently, but it can happen. In my twenty plus years of practice, I have seen it happen about 20 or 30 times, at least once a year. That's a significant percentage of patients. If it does happen, then the wisdom tooth has to be removed, by the time it is discovered there frequently has been extensive destruction of bone in the jaw. To have a wisdom tooth removed at age 17 or 18 is uncomfortable, but not that difficult, to have a cyst removed at 40 or 50 is a big deal, perhaps resulting in a week off of work and considerable discomfort, sometime an adjacent tooth is also lost due to the bone destruction. To have a cyst removed in an 80 year old is a huge problem, especially if the patient’s health is compromised in other ways. We are now seeing the first generation of adults going into their retirement years with most of their teeth. I believe that they should strive to have their mouths as stable and disease free as possible. The second problem associated with impacted wisdom teeth is jaw fractures. When a tooth isn't erupted in the jaw, it resides inside the eruption sac in a hole in the bone. This hole make the jaw weak in that area. If a person receives a blow to the jaw, in an accident or a fall, then frequently the jaw will break through the impaction site. This means that the tooth will have to be removed before the jaw can be set and it makes recovery longer and more difficult. Partially impacted wisdom teeth are even more problematic. A partially impacted tooth is subject to gum disease, decay and infection. Because of their location so far back in the mouth, most people have a hard time keeping their wisdom teeth clean. If you can't clean them, you will undoubtedly get gum disease and decay there. I've talked in previous articles about the dangers of gum disease, especially their relationship to systemic disease, (see periodontal disease in the "Systemic Health" section). The decay and gum disease can endanger other teeth and lead to multiple tooth loss. An even bigger problem is that of infection. Because the partially impacted tooth is hooded with gum tissue, the tooth under the gum tissue can't be kept clean. The bacteria builds up and leads to pericoronitis, or infection of the gum tissue around the impacted tooth. Once the infection occurs, there is an 80% recurrence rate. You continue to get the infection over and over again. The tooth will have to be extracted. As before, is it better to get it extracted when you are 18, or 80? Are you willing to gamble that you will be one of the few people who won't have a problem with those impacted teeth? The odds aren't good, get them extracted while you are young, strong, resilient and healthy. Partially impacted wisdom teeth are even more problematic. A partially impacted tooth is subject to gum disease, decay and infection. Because of their location so far back in the mouth, most people have a hard time keeping their wisdom teeth clean. If you can't clean them, you will undoubtedly get gum disease and decay there. I've talked in previous articles about the dangers of gum disease, especially their relationship to systemic disease, (see periodontal disease in the "Systemic Health" section). The decay and gum disease can endanger other teeth and lead to multiple tooth loss. An even bigger problem is that of infection. Because the partially impacted tooth is hooded with gum tissue, the tooth under the gum tissue can't be kept clean. The bacteria builds up and leads to pericoronitis, or infection of the gum tissue around the impacted tooth. Once the infection occurs, there is an 80% recurrence rate. You continue to get the infection over and over again. The tooth will have to be extracted. As before, is it better to get it extracted when you are 18, or 80? Are you willing to gamble that you will be one of the few people who won't have a problem with those impacted teeth? The odds aren't good, get them extracted while you are young, strong, resilient and healthy. Fluoride is a naturally occurring element that, when ingested or applied to teeth, prevents dental decay. It is one of the most heavily studied additives in the world and is very safe and effective. Fluoride was first discovered in the drinking water out west. People in certain areas had a condition known locally as "Colorado Brown Stain". People who were affected by this condition had discolored teeth, but had an extremely low rate of dental decay. Research was done and it was found that the water they were drinking had very high levels of fluoride in it. Scientists found that if the amount of fluoride in the water was dropped below a certain level the staining problem would disappear but the anti-cavity benefits would remain. Thus the beginning of fluoride research and the addition of fluoride to water supplies. Grand Rapids, Michigan was one of the first cities in the United States to be fluoridated. This occurred in the 1950's and is today commemorated by a statue in the city. Fluoride has been one of the most studied public heath measures ever. Its use is endorsed by the American Dental Association, The American Medical Association, The United States Public Health Service, The World Health Organization, The U.S. Surgeon General's Office and The American Cancer Society , among others. A complete list of all of the organizations endorsing the use of fluoride can be found in The American Dental Association's Fluoride Facts webpage. There is a very good and unbiased discussion of fluoride at the American Dietetic Association website. You can also view a wealth of information at the American Dental Association Fluoride Information webpage. Your children should receive systemic fluoride, that is fluoride that is ingested, up to age 16. That can be automatically accomplished if your water supply is fluoridated. If you live in Rochester Hills or if your community has Detroit City water, then your water supply is fluoridated. If you have your own well or if you live in the City of Rochester, then your child's fluoride intake should be supplemented. Because of the heavy mineral content in the Rochester area, there is sometimes some naturally occurring fluoride in the water. A study done by the State of Michigan in the 1960's show that many of the wells tested in the Oxford, Lake Orion, Rochester area had some level of fluoride in them. You can easily have your water tested by contacting the State of Michigan Department of Environmental Quality. There has been a paradigm shift regarding fluoride supplements. The latest studies indicate that fluoride doesn’t work systemically as we previously thought, but rather works by bathing the teeth in fluoride as you drink the fluoridated water. Likewise, the fluoride drops our children used to ingest or the tablets they chewed worked by directly contacting the teeth, not via the bloodstream. In view of this, the best way to supplement for deficient fluoride in the water supply is to drink bottled fluoridated water. We are recommending that children in non-fluoridated areas drink a small, ½ pint, bottle of fluoridated water daily. Bottled fluoridated water is available from Dannon© and also generically, often called “nursery water”. We have found that it is readily available locally from most supermarkets. Another useful application for fluoride is becoming more apparent as we see more adults entering their senior years with there teeth. In the past many adults didn't have teeth or had only a few in their senior years. Now, thanks to the hard work of your dental professionals, most people keep their teeth for life. As we observe this group of adults, we see a higher incidence of root surface decay. Root surface decay is caused by a different set of organisms and progresses differently than regular dental decay. Root surface decay can be prevented very nicely with brush-on, prescription strength fluoride applications like Colgate's Prevident®. I find myself writing prescriptions for this on an increasing basis. For people with a slightly elevated rate of decay or children with braces, an over the counter fluoride rinse can be a very useful adjunct to their oral hygiene regime. These are available as Act®, Fluoriguard® and Listermint with Fluoride®. Many store brands of fluoridated mouthwashes and fluoridated toothpastes have now applied for, and received, the American Dental Association's Seal of Approval. Look for it and don't use a fluoridated product unless it has the ADA Seal. Fluoride is a difficult element to work with and unless the formulation is proper, the fluoride may not be active and available to do any good. If you have more questions on fluoride ask us at your next visit or e-mail me a question.
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The TMJ or the Temporal-Mandibular Joint (the jaw joint) is a very complicated area and much has been written about it, both on the internet and in print. TMJ therapy and treatment is a very controversial area and you can only believe a small portion of what you hear or read. Be careful when accepting treatment on your jaw joint and always be sure that you understand the treatment proposed, that it sounds logical, that you know that it will do you some good and you know how much it will cost you. Jaw joint problems are frequently described as TMJ syndrome or TMD, (Temporal-Mandibular Dysfunction). To say that you have TMJ is a misnomer because that means that you have a Temporal-Mandibular Joint, which almost everyone has. It is more accurate to say that you have TMJ disorder, syndrome or dysfunction, or just, "I have jaw pain." Because this area is so controversial and complex I will try to simplify it. Some "authorities” might disagree with me over my simplification, but it will help you understand the jaw joint better. There are two broad categories of jaw pain, that caused by muscles and that caused by bone or cartilage problems. In general, muscle pain is the more common and more easily treated of the two categories. Most jaw pain of muscular origin is caused from overuse of the jaw and the muscles. Just as the muscles in your arm or back get tired and sore if you over work them, the muscles of your jaw joint will do the same. However the difference between TMJ pain and other muscle pain is that TMJ pain is often referred. That is, your brain doesn't' know how to tell you that the muscles inside you skull hurt and so it refers that pain to other areas of your face and neck. People with this kind of pain often say that their whole face hurts or their ear hurts, (we get many referrals from Ear, Nose and Throat physicians because people often go to them first thinking they have an ear infection.) Some people say that it feels like a band is around their head. Another common complaint is that people will have trouble opening their jaw or their jaw will lock closed, (locking open is probably not a muscular problem but a cartilage problem, more on that later.) People with this kind of pain will often, upon questioning, admit to a period of high stress or to habits that stress their jaw muscles, like gum chewing or clenching their teeth. Frequently, although not always, there will be evidence of tooth grinding, (some people don't grind, they just clench, clenching won't wear the teeth and won't produce the telltale noise as is often described by the patient’s spouse: "I can hear him grinding his teeth at night." Treatment for TMJ pain of muscular origin is often accomplished with a bite guard or night splint. Sometimes ice packs and /or anti-inflammatory medications are also used. Although the style for the bite guard varies from dentist to dentist, it is generally a horse shoe shaped wafer of plastic that is worn over the upper or lower teeth. Generally the plastic is a hard plastic, not soft like a football mouth guard, although even this is controversial. I was taught that hard plastic was best, and that people tend to "bounce" on a soft splint, which will exacerbate their muscle problem. Some dentists do use a soft splint, however. The theory behind the bite splint is two fold. First it distributes the stress of the clenching over a wider area of teeth. You can't just grind on one spot or find a particular tooth to clench on. Secondly, and I think more importantly, is that the splint opens the muscle beyond its working length. We all know that when we are picking something up, we are stronger when our arm is partially bent then if the arm is completely extended. That is because muscles have a "working length" at which they are most efficient. Just as your arm muscles have an optimum working length, so do your jaw muscles. If you open them up beyond that working length, then they can't exert as much force. So by wearing the bite splint you allow the muscles to rest or at least, not to work as hard. For most people, the bite splint is best worn at night. It's hard to speak with it in and it is visible in a patient's mouth, so most people don't want to wear it during the day. However, for patients with severe muscle spasms or for people whose daily activities allow it, the splint can be worn during the day. For instance, some of my patients grind their teeth while they work at their computers. Some of my patients who travel a lot grind and clench while they drive or fly to their meetings. Some people clench while they study. For these people, it may be helpful to wear the splint during these occasions. Be sure not to try and bypass your dentist and go out and by a football mouth guard to wear to bed. It probably won't work and it could severely damage your jaw joint. It is very important that the bite is balanced on the splint. A soft mouth guard from the store can't be "equilibrated" or adjusted to match your bite. Your back teeth will probably hit first and that could allow you to set up a lever in your mouth, with the back teeth as a fulcrum, and cause you to "lever" your jaw joint out of position. Sometimes people who have this pain develop a pattern of discomfort that could be described as "chronic pain syndrome". These people have major, debilitating pain that doesn't respond well to normal conservative therapy. They should receive treatment at a chronic pain clinic, especially one associated with a major university. Often the treatment is multi-disciplinary, involving physicians, dentists and psychiatrists. The treatment might take many months or years and can involve treatment with stronger pain medications or anti-inflammatory medicines, muscle relaxants and antidepressants. (The relationship between antidepressant medications and chronic pain is just being investigated and is not well understood, it is not necessarily related to clinical depression, but perhaps linked to levels of certain neurotransmitters in the brain.) The other category of jaw pain is caused by bone or cartilage problems. Sometimes arthritis can make the joint stiff and sore just as other joints in your body can be affected by arthritis. Bone spurs in the joint can cause locking and pain. But most of the problems related to bones and cartilage is related to the cartilage disc that is present between the bones of the joint. If the bones put pressure on the disc or if the disc is forced or slips out of position, then the jaw can't function correctly.Many people have clicks or popping noises in their jaw. I was taught that most people tolerate these noises well and if it is just noise and not pain or restriction of motion, then it is probably best not to treat the noise. Other people disagree with this statement and think that any noise should not be tolerated. Just be sure that if you have treatment for jaw noise, you have a reasonable assurance that the treatment will be safe and effective. This treatment of a misplaced disc is the most controversial area of all. Some people claim to be able to treat it effectively, some people say it can't be cured, it can only be treated, some people say that it can't even be treated very effectively. If you have this kind of a problem, be sure that you receive treatment form someone who really knows what they are doing. I think one of the best avenues for treatment is through a major university like The University of Michigan. Be sure that unless you have exhausted all other means of treatment, you don't allow any nonreversible treatments to be done on you. Some people will treat these problems through full mouth rehabilitation. This means that most, if not all, of the teeth are crowned or capped. This can work if the diagnosis is correct and if the person doing it is skilled and meticulous about the dentistry. But it must only be done after careful diagnosis of the problem. It frequently is done in such a manner that until the dentist knows it is going to work it is reversible. For instance, the dentist might place temporaries or a temporary splint in place first in order to see if full mouth reconstruction is going to solve the problem or make it worse. To conclude this discussion just let me reiterate a few points: this area is a complicated and controversial one, if the pain is severe or long lasting, think about a referral to a university setting or a pain clinic. Get a second opinion if you are confused or unsure of the diagnosis. And most of all, try to use treatments that are non-invasive and reversible, (like bite splint therapy.) If you are confused or have questions , feel free to e-mail me.
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What do you do when you have a toothache, break a tooth or loose a temporary or a filling and you're out of town? Read on and we'll help you out. First remember that this is advice based on theoretical occurrences, I can't tell for sure what might happen to your teeth. This advice isn't to be construed as providing a diagnosis. Always see a dentist if you are able to. Only a licensed dentist can truly know how to treat your teeth. There are three categories of things that can happen to your teeth while you're out of town, pain (including swelling), broken teeth, and lost fillings or temporaries. We'll cover each one individually. First, the most serious and upsetting, pain and /or swelling. If you have pain you should try to get to see a dentist. Determine if the pain is from your gum or your tooth, (often felt as pain in the jaw or bone around the tooth. Pain in the tooth usually means a cavity or a tooth in need of root canal therapy. Pain in the gum could mean a gum infection, treatable with antibiotics. If it's just cold sensitivity it isn't as serious. Spontaneity means trouble. If you have a spontaneous toothache, (a toothache that comes and goes by itself) and wakes you up in the night or if it keeps you from going to sleep, then you probably have a tooth that needs root canal therapy. This is also true if the ache isn't relieved by over the counter medications like ibuprofen (Advil®, Nuprin® or Motrin IB®). If you are in the U.S. then contact one of your business associates, the hotel for their list of dentists on call or call the local dental society for advice on who to see. Try to get the dentist to treat the tooth, that is, don't just let them medicate you with antibiotics or pain medications if what you really need is root canal therapy. Pain from a tooth who's nerve is dying isn't controlled well by pain pills. The pain will increase in severity until it is unbearable. Try to get the dentist to at least start the root canal therapy. Sometimes the dentist might even be able to complete it. If you are out of the country then you may have to be more careful in who you see. Get a recommendation from the hotel management, look at the office beforehand to be sure it is clean and has sterile instruments. Some counties don't perform root canal therapy up the standards of the U.S. You might want to get pain relieving treatment and then head for home. You may be able to call your dentist at home for advice. I've taken calls from my patients in Europe, Asia, Mexico and Central America in order to try and help them out. Broken teeth aren't quite as big a problem. Unless it is a catastrophic crack, which is unusual, the tooth normally won't start to give you a true toothache. It may be hypersensitive to cold, it may rub your tongue sore, but if it's just a break and not related to a large spot of decay, you'll be fine until you get home. Smooth the the sharp edge of the tooth with an emery board, a diamond style emery board works especially well. Then use paraffin wax, bee's wax or sugarless gum to cover the break. Usually, if you can cover the cold sensitive spot and smooth off the sharpness, you'll be okay. If you lose a temporary you are also probably in not too bad of shape. There are two types of temporaries, those for fillings and inlays, and those for crowns and onlays. The first type goes into a hole in the tooth, the second type goes around the tooth on the outside of it. If you lost a filling or inlay temporary, you can use wax or sugarless chewing gum to fill the hole and prevent sensitivity and food impaction. Just clean the debris out of the hole, dry it the best you can with cotton or a small piece of cloth and push the softened wax or gum into the hole. If you lost a crown or onlay temporary, you can put it back onto the tooth if it's still in one piece. First, clean out the debris inside of the temporary and outside the tooth. Try the temporary on to see which way it fits and to see if it seats. Be careful not to break it. If it goes down easily and seems to want to stay in place without adhesive, stick it in and leave it. Just be careful not to swallow it when you are eating. If it seems to want to come out, you may be able to "re-cement " it with denture adhesive like Polygrip or Fix-O-Dent. Put just a small amount of adhesive into the dry temporary, dry off your tooth and put the temporary back in place. Be careful not to use too much and not to force the temporary too hard. Denture adhesives, especially the gel types, are very thick, and might prevent the temporary from seating all the way. Use just a little and seat the temporary slowly. If you are using powdered adhesive, then wet the inside of the temp slightly, shake a small amount of powder into the temp, then shake the excess out of the temp. The result is a thin layer of powder inside the temp, a lot like the same effect you get when you grease a cake pan and then dust it with flour. Again carefully press the temp into place and you'll be all set. Check your bite carefully, if the bite is high on any kind of temporary then you will irritate the tooth and it will get sore and hypersensitive. If you have a problem with a tooth while you are out of town be sure to address it as soon as possible, don't let the problem fester and get worse. If you can, see a dentist. If you are unable to see a dentist, try one of these measures to see if it will help you out.
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| Periodontal
Disease Matters of the Heart Successful Aging© Real Age© Detecting Carotid Artery Calcifications Herbal Medicines |
Periodontal Disease Periodontal disease (commonly known as gum disease) is the leading cause of tooth loss in adults. It is a chronic infection causing the gum tissue and bone to lose their attachment to the root of your tooth. Now the American Heart Association has a new alert: the same bacteria responsible for periodontal disease are now known to affect the coronary arteries of the heart by layering them with plaque. Researchers can only account for about 70% of the cases of heart disease by using the normal risk factors such as high blood pressure, obesity or high cholesterol. Although scientists are not exactly sure of the mechanism, it seems that the presence of bacteria in your mouth, either directly seeding into your blood stream or you body's immune system reaction to the presence of that bacteria, start the process that results in artery blocking plaques in your heart. Early detection and treatment of periodontal disease can help you keep your teeth for a lifetime and can also reduce your risk for heart disease. It is more important than ever to be tested for gum problems. Ask your dentist if you have been tested for periodontal disease. Testing for periodontal disease is a relatively simple process of measuring the depth of the groove around you tooth. These measurements are recorded on a chart where they can be assessed. Each year the charting is repeated and the results compared to the previous year. Periodontal disease is not completely curable at this point in our lives. However, it can be treated and periodontal health can be maintained through detection, periodontal therapy, and proper home care. There is also increasing evidence relating periodontal disease to diabetes,
respiratory disease and pre-term, low birth weight babies. The evidence
for problems with pregnancy is very strong. If you are pregnant or thinking
about becoming pregnant, be sure to have a thorough professional dental
cleaning and examination. Be sure the doctor checks for periodontal
disease. Infective endocarditis (IE) is a rare but debilitating and deadly disease. The bacteria causing this disease enter the bloodstream from various points including the oral cavity, urinary or gastrointestinal tracts. These bacteria lodge in the heart valves, inflame the middle layer of the walls of the heart and cause ulcerations in the inner wall of an artery. In 1955 the use of antibiotics for the prevention of IE following dental procedures was implemented. Have you wondered why the change in the American Heart Association’s recommendation of antibiotic dosage for at-risk patients? The 1997 Guidelines recommend antibiotic protection before any dental procedure that may cause bleeding. The current regimen is a single dose of 4 (500-mg) capsules of Amoxicillin one hour before treatment. Studies show the bacterial increases resulting from dental procedures are of short duration. The highest concentration of bacteria occurs within the first 30 seconds. Within 15 to 30 minutes after the completion of the dental procedure, the blood becomes sterile. Based on this information, the follow-up dose was eliminated. Erythromycin is no longer recommended for penicillin-allergic individuals; instead, clindamycin, cephalexin, cefadroxil, azithromycin, or clarithromycin are the suggested alternatives. Visit the American Heart Association’s website to view the guidelines of recommended antibiotic premedication as it relates to dental procedures. Successful aging is the title of a book by Robert L. Kahn, Ph.D. Dr. Kahn is a Professor Emeritus in the School of Public Health at The University of Michigan. In his book, he says that only 1/3 of adults age successfully. He defines successful aging as minimizing the risk of disease and disability, maintaining physical and mental function and having what he calls," a continuing engagement with life." He lists 6 myths of aging. They include, "to be old is to be sick", "you can't teach an old dog new tricks", "the horse is out of the barn", "the secret of successful aging is to choose your parents wisely", "the lights may be on, but the voltage is low" and "the elderly don't pull their own weight". He maintains that people control their own destiny to a large extent and can age successfully if they will take certain action steps. He believes that it's never too late, that how well we age is up to us and we are to a large part overfed, under exercised and uninspired. Read his book and change your lifestyle. You too can learn to "age successfully." Books on Aging Successfully: Be An Outrageous Older
Man - by Bard Lindeman. This is the title of another book that might interest you. It is by Michael Roizen, M.D., a physician from The University of Chicago. He maintains that you can add up to 30 years on your life by including some simple behavioral changes in your life. In his book he asks you questions about your lifestyle and habits. He then adds or subtracts years to your life to determine your "real age". He was recently on the Today Show© on NBC and during the interview they asked 5 questions that they felt were the easiest things to do that added the most onto our life. One of the questions was, "Do you floss and brush your teeth every day?" If so then you gained 3 years in your lifespan. If you brushed but didn't floss you lost 1/2 year, if you had periodontal disease then youlost 2 1/2 years. He then went on to talk about the relationship between periodontal disease and the health of the rest of your body. Imagine that! Just by flossing you gain 3 years. Other important things in increasing your longevity were, eating fish on a regular basis, exercise, (even just walking) and your degree of social support, which is the number of friends and relatives that you can use to help reduce the stress in your life. You can take his entire test on-line at the Real Age Website. In order to take the test at the Real Age site you need to register with them, I read their privacy statement and it seems innocent enough. They say that the information gleaned from there readers will be used for research purposes only and to improve their website. They say that they will never release your name to a third party. If you are hesitant about registering at their website, you can take the test at Today Show©, this link will take you to the article about the interview and this link will take you to the test. Detecting Carotid Artery Calcifications A study released in February of 1999 shows that carotid artery calcifications can be observed on a routine dental panoramic x-ray. These are those large x-rays that a dentist takes to see all of your upper and lower jaws at the same time. The machine spins around your head as you stand or sit at the machine. The study, by University of Michigan radiology professor Dr. Sharon Brooks and D. Andrew Lewis, D.D.S., shows that calcifications in the carotid artery frequently show up as white spots in a particular area of a panoramic x-ray. Since this study was published last year in The Journal of General Dentistry, we have been reviewing all patients’ films for signs of calcifications. Since that time we have found over 12 cases that required investigation by the patient's physician. That's over one case per month. The study shows that about 4.6% of people over the age of 55 will have a positive detection for this condition. You have a higher chance of having carotid artery calcifications if you have any of the following risk factors, hypertension (high blood pressure), diabetes, if you smoke, if you are a male, or if you have hyperlipidemia (high cholesterol). Check with your dentist and ask if they have checked your panoramic x-ray for signs of carotid artery calcification. If your dentist is unsure what to look for, refer them to The Journal of General Dentistry, published by The Academy of General Dentistry, January-February 1999, pages 98-103. It could save your life. There is also an abstract of many studies that have been done on this subject at the National Library of Medicine website. Herbal Medicines: the Good, the Bad and the Ugly Herbal remedies are just starting to be investigated in this country. I recently took a class from a University of Michigan physician who is also an herbalist. In fact, she calls herself a "wild crafter"; she gathers, dries and compounds her own herbs. The following information is from that class, presented by Sara Warber, M.D. She lectures in The Department of Internal Medicine, is an Assistant Professor in the Department of Family Medicine and the Co-Director of The University of Michigan Complimentary and Alternative Medicine (CAM) Research Center. Data from the New England Journal of Medicine and the Journal of The American Medical Association shows that somewhere between 33% and 43% of all Americans use alternative therapies and that 50% of all women use them. That data is from 1990, it's no doubt much greater now. However, only 28% of those people using alternative methods informed their doctors. This can create a huge problem for your physician or dentist. There are many side effects from herbals. Some can modify the action of another drug. Symptoms that you are experiencing could come from the herbal that you are taking. Be sure to tell your health care provider what herbals you use. People think of herbal therapies not as medicines but as some miracle cures that have no side effects. We know that isn't the case. Every compound that has an action on the body has side effects caused by that compound's actions on other organs. You can't put something into your body and expect it to only affect one organ. Remember that some of our most useful drugs, and some of our most potent poisons, originally came from herbs. Strychnine, heroin and cocaine are all herbals. Just because something is "natural" doesn't mean that it is without risk. Click HERE for a table that some of the more popular herbs and the results of studies investigating them. The table is a compilation of data from Dr. Warber, Consumer Reports Magazine and various websites. Remember; don't take herbals without advising your doctor. My purpose in providing this information isn't to recommend herbal therapy but, rather, to inform you of the consequences of taking them and remind you of the importance of having your physician involved.
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Permanent Tooth
Eruption |
Permanent Tooth Eruption Schedule The permanent teeth begin to erupt about the age of six. The first teeth to appear are the lower central incisors and the six year molars, the first molars. The lower central incisors frequently erupt behind the baby front teeth, so if you look in your child’s mouth and see two rows of teeth there, don’t panic, it’s normal. As the permanent teeth erupt more, the tongue will push them forward and they will in turn push the baby teeth out. This is the only area in the mouth where this is normal. The permanent first molars usually erupt without a problem. Most children have little, if any, discomfort during their eruption. In fact, it’s not at all common for parents and the child to not realize that they are in until the dentist points it out to them. Occasionally the gum tissue over the erupting molar will get sore and inflamed. If this happens you should have us examine your child to see if the condition needs to be treated. Sometimes we will prescribe a numbing agent or perhaps some Tylenol®. Additional treatment isn’t usually needed. Around seven the child will get their upper central incisors in, quickly followed by the lower lateral incisors then the upper lateral incisors. This will give the child eight permanent front teeth, (all of the incisors) and four permanent back teeth, (the first molars). Things will stay like this until the child is about nine. At this time the cuspids or canines, (also known as eye teeth), erupt. The final teeth to come in will be the bicuspids, (the two teeth behind the eye teeth), at age eleven and twelve respectively. In general, girls will get their teeth sooner than boys, although this is not always the case. You will also find that eruption dates can vary from child to child by as much as six to twelve months. So if your child isn’t getting their teeth as soon as some of their classmates, don’t worry, it’s probably normal. We will observe your child for signs of proper eruption and notify you if we feel that the eruption pattern is excessively delayed. Your child's first visit to the office should be at about age three. At that visit we will try to accomplish a complete exam and cleaning. We won’t, however, push the child beyond what they are ready for. If anything more than a ride in the chair scares them excessively, then that’s all we will do at that visit in order to gain their trust. If they will permit it, we will polish their teeth, floss them, and examine their teeth, gums and entire mouth. We will then review brushing techniques and give them a new brush to take home. Children’s teeth need to be brushed at least twice a day. The best schedule is in the morning after they have had their breakfast, and then again in the evening as the last thing they do before they go to bed. It is very important that they don’t go to bed with dirty teeth
or with a bottle of milk or juice. Because of the decrease in salivary
flow while they are sleeping the natural flushing and cleansing effect
of the saliva cannot occur and decay will progress rapidly. Sealants are a plastic covering that we put on your child’s teeth to fill up the grooves and prevent decay. We routinely seal only the molars. We seal the first molars around 6 or 7 years of age and the second molars at around 12 or 13 years. Baby teeth aren't usually sealed, the enamel on baby teeth is different and the sealant doesn't stick well. Bicuspids usually don't have deep enough grooves to warrant sealing them. However, we may elect to seal these teeth if the need arises. We will let you know when sealants need to be placed. For more information on sealants you might want to visit the American Dental Association's sealant web page. Normally orthodontic referrals occur around the age of nine. In some cases interceptive orthodontics needs to be started sooner. We carefully observe your child at each cleaning appointment to determine if an orthodontic treatment is needed. If so Dr. Duz takes care of some orthodontics in our office, more complex cases are referred to an orthodontist. Having orthodontics performed is important in many ways, not the least of which is the overall health of your child's mouth. Crowded teeth are difficult to clean. That leads to higher rates of decay and gum disease. Frequently, misaligned teeth can cause severe gum recession. Self esteem can also be severely affected if a child has crowded or protruding teeth. It is also much easier to achieve the desired results if the orthodontics is completed while the child is still growing. Orthodontics isn't merely a matter of cosmetics.
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Caring for the Older or Dependent Adult If you have a parent, friend or relative, living by themselves or in a facility of some kind, you need to care for their teeth. Even if the facility in which they reside says that they brush their teeth for them, the results are usually much less than adequate. The aides have many jobs to accomplish and they usually lack training in oral health care. Nothing is more frustrating to me than to examine an elderly patient and find that they have multiple spots of decay and extensive work or extractions to do. There are many reasons why older adults get decay. They are frequently on multiple medications that can dry out their mouth. Usually, they have many areas of gum recession which can expose the softer, easily decayed root surface. They often have missing teeth or large rough fillings which make cleaning their teeth difficult. They may lack the dexterity to clean their teeth properly because of a stroke or arthritis. And they may have an undependable memory so that they forget to brush their teeth. The pain threshold of older patients is commonly decreased so that they don’t feel the discomfort associated with the start of decay and may not even have a lot of pain when the tooth is abscessed or they are swollen. If they have dentures they can get large denture sores and not even know that they have them. Left untreated these denture sores can become infected and severely affect their systemic health. There are many things that you can do to help an older adult enjoy good oral health. The first is to be sure their teeth are being brushed properly. Ask them if they are brushing their teeth. If they are of good mind and you feel that they can accomplish this task for themselves then just monitor them and be sure they remember to brush. The single most important time is just before they go to bed. During sleep, the salivary flow diminishes. This prevents the natural cleansing action of the saliva from washing away food particles and rinsing away the sugars which cause decay. If they are capable of brushing, but physically unable to do a good job, and then try to find a way to make it easier for them. The first step might be an automatic brush. The Sonicare® is an excellent brush as is the Braun Oral –B® and the Teledyne Interplak®. Some people don’t like the feeling of the automatic brush, or maybe they can’t afford one. You can get large handled brushes, (they come in a right hand and left hand model) at Whole Foods and some other stores which can be much easier to hang onto for someone with arthritis. If you can’t find a commercially available large handled brush you can make one with layers of adhesive tape or by taping a layer of foam around the handle. If they are brushing but still getting decay, or as an added prevention against decay, a prescription strength brush on fluoride is very useful. Ask your dentist about Prevident 5000 plus®, a high strength prescription fluoride brush-on toothpaste. In our practice we are putting more and more patients on Prevident to deter root surface decay. If they can’t afford the expense of a prescription, then have them use an over the counter fluoride rinse like Fluoriguard®, Act or Listermint with fluoride®. Many of the "store brand" fluoride mouth rinses are applying to the American Dental Association for acceptance. Look for the ADA label. That insures that the product has been tested for efficacy and has submitted those test results to the ADA for review. If it doesn’t carry the seal, don’t use it, it may not do you any good and be a waste of money, for a list of accepted products go to the American Dental Society. If the elder patient is incapable of brushing for themselves then someone has to brush for them. As I mentioned before, don’t count on the facility to do it for you. Even if they say that it is being done, take a small flashlight and look in the elder person's mouth. You’ll probably see all kinds of food build up and plaque. Take it upon yourself to brush their teeth for them. You can use an automatic brush, a conventional tooth brush or you can use a toothbrush that I like that was developed specifically for caregivers. It’s called the Collis Curve®. The bristles are curved inwards towards themselves so that you brush almost all of the surfaces of the tooth at one time. It will make your job much easier. These brushes are available at our office, you can come in or e-mail us at dentistsonmain@worldnet.att.net and we will send them to you. The company that makes these brushes can be reached online at www.colliscurve.com. If the person for whom you are caring has full dentures, be sure to remove them when you visit and clean them. You can brush them with a conventional toothbrush or can use a denture brush. You don’t even have to use paste if you don’t want to; the important thing is that they are brushed to remove the plaque build up. Soaking them helps to freshen the taste and remove soaked on odors, but soaking won’t remove plaque. For that you must brush them, and then soak them if you like. It’s also important that a person with dentures see a dentist at least once and preferably twice a year to check the fit of the dentures and to check the mouth for denture sores, infections and other diseases including oral cancer. Dentures need to be relined occasionally, anywhere from every 3 to 5 years. If they are beyond relining then a new set may need to be made. Be careful about the dentures if the person is in a facility. Have the dentures marked with their name. Dentures are frequently lost in these types of facilities and other residents sometimes mistakenly take them thinking that they are theirs. If they end up in the lost and found there is no way to tell whose denture belongs to whom, unless they are marked. We will be glad to have this done for you for a small fee. (The denture has to go the dental laboratory and the name is put into the denture under a layer of clear plastic.) If you try to do it yourself with an engraving tool the roughness is liable to irritate the person's tissues and cause a denture sore. Because of a poor swallowing reflex, poorly fitting, worn out dentures or lack of teeth, some older adults suffer from severe cracking and chapping of the corners of their mouth. Many times this is related to a build up of yeast organisms in this moist area. See the article on angular chelosis for information on how to treat this condition. Many medications can cause dry mouth. Not only can dry mouth be uncomfortable, but it can also lead to rampant decay, and sore mouth. See the article above in "Your Oral Health" on dry mouth for tips on how to help your older or dependant adult treat their dry mouth.
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Now that you have finished the initial portion of your periodontal treatment, the root planning phase, you will begin the maintenance phase. It is very important that you follow our instructions, both in home care and frequency of maintenance visits, in order to help prevent the advancement of your gum disease. Remember that like diabetes, we can treat gum disease but we can’t cure it. Once you have been diagnosed with gum disease you can never go back to “routine” dental cleanings. In order to keep your gums in optimum health and try to prevent further bone loss and infection you must return for your periodontal maintenance visits every 3 months. Because of the bone loss that has occurred, the shape of the tooth that is visible above the gum line is different now. Ideally, the tooth that is visible above the gum line is egg shaped, it is totally convex. It has a natural shape that allows food to flow off of it. In fact, areas of the tooth are actually almost self cleansing because of that shape. However, when you lose bone around the tooth, the visible shape of the tooth becomes different. Now the tooth has a more complex shape. In addition to the convex surfaces, there are now also concave surfaces. These areas are not self cleansing and, in fact, are more likely to accumulate debris, tartar and plaque. These areas get dirty faster and are much more difficult to clean, both for you and for us. For this reason we do periodontal maintenance instead of a routine prophylaxis or dental cleaning. The hygienist has to use all her skills to clean the plaque and tarter out of these convex areas. She may irrigate with an antibacterial liquid in order to flush debris and bacteria out of periodontal pockets. She will be very meticulous to insure that all of the root surfaces that are exposed because of the disease are clean. It is imperative that you return every 3 months for these maintenance appointments in order to prevent the bacteria from building to the “critical mass”. This is because as soon as we have finished polishing your teeth, the bacteria start to accumulate on your teeth again. As more and more bacterial gather together in a “plaque” the composition of that plaque changes. The bacteria buried deep in the plaque are protected from you body’s natural defense mechanisms. Because your body can’t get at them to fight them off, the population of “bad bacteria” increases deep inside of the plaque. As the plaque matures it becomes more and more virulent and it starts to emit the toxins which are responsible for the progression of gum disease. This is called the “critical mass” and it occurs at about 3 months. By bringing you in before the plaque has reached critical mass we can help prevent the accumulation of toxins and the advancement of your gum disease. Gum disease is a chronic, progressive condition that can usually be controlled, but it takes meticulous home care and adherence to a rigorous schedule of periodontal maintenance. Be sure to return for your maintenance visit every 3 months.
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Reasons for |
You have been diagnosed with a cracked tooth. Cracked tooth syndrome is a description of the symptoms that can occur when you have a cracked tooth. Reasons for Cracked Teeth Teeth get cracked because of tooth grinding and clenching. People frequently clench and grind their teeth at night and might not be aware of the extreme forces that they are putting on their teeth. Large fillings aggravate the situation by acting as a wedge, splitting the tooth apart. Any tooth with a filling larger than 1/3 the distance between the cusp tips is at risk for a crack. Teeth without a filling can also get cracked. It isn’t as common, but it can occur. The hallmark of a cracked tooth is selective bite pressure sensitivity. That is, the tooth hurts when you bite on the right consistency of food, in the right direction. As the crack progresses, the tooth will become sensitive to softer and softer foods. A cracked tooth is also frequently chronically cold sensitive. Diagnosis of a cracked tooth is difficult because the crack can usually not bee seen, either visually or on x-ray examination. The diagnosis must be made based on the patient’s symptoms. An aid frequently used for diagnosis is the flexible bite stick. With the flexible bite stick the tooth is usually sensitive on the rebound, not upon biting down on the stick. There are three types of cracks. Shallow or simple, deep and catastrophic. Shallow or simple cracks don’t go far down inside the tooth. If allowed to proceed to completion, the simple crack would result in a cusp or other portion of the tooth breaking off. This is the most common type of crack. Deep cracks go down close to or into the nerve of the tooth. Teeth with deep cracks will eventually need to have root canal treatment. Catastrophic cracks split the tooth in two. They extend down through the root of the tooth. These teeth will have to be extracted. This is the least common type of crack. Because we cannot see the crack, we cannot determine what type of crack is present until after the tooth is treated. If the sensitivity doesn’t clear up after several months or the sensitivity turns into a true tooth ache, then root canal treatment should be considered. Treatment usually consists of placing a crown on the tooth. The crown acts like a band clamp around the tooth, holding the crack together and alleviating the sensitivity. In the case of a deep crack, root canal treatment may be needed. As previously discussed, root canal treatment should be considered if the ache worsens or doesn't clear.
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Veneers |
Whenever we perform treatment on a patient we give them a handout sheet explaining important information about their procedure. This section contains a collection of the post treatment information sheets that we distribute. Your doctor has just placed new veneers for you. Here are a few things to keep in mind when caring for your new veneers. Using Your Veneers You can eat and drink normally with your new veneers. You can bite apples, eat sandwiches and use your teeth as they should normally be used, but it is important that you don’t abuse your teeth. Don’t bite thread, chew on pencils or pens, don’t bite of tags from clothing, and don’t bite fishing line. Don’t chew ice. All of these types of things put tremendous end to end pressure on your teeth and veneers and can cause them to fracture. If you grind or clench your teeth at night you should always wear your bite guard or occlusal splint. If you grind or clench your teeth and don’t have a bite guard you should talk to us about getting one. Not only will it protect your veneers but it will also help protect your natural teeth and aid in taking the strain of clenching and grinding off of your TM joint. Care of Your Veneers Veneers are the Cadillac® of cosmetic restoration. Care for them as you would care for a Cadillac®. Brush at least twice a day, three times per day is better. Floss once a day. Properly cared for, veneers can last a long time. Your doctor has just delivered an occlusal guard or bite splint to you. Here is how you should use it and take care of it. Inserting and Removing the Guard In order to insert the guard, place it over your upper teeth. The front of the guard should be even with the front of your upper anterior teeth. Push up firmly and evenly on both sides, the guard should snap into position. To remove your occlusal guard position your index fingers at the edge of the guard on both sides near the back of your mouth. Pull both sides down firmly, the guard should drop out. Using your Occlusal Guard You can wear your guard whenever you want to. Most people find it convenient to wear it at night time while they sleep. For many people this is the time that they clench and grind the most and because they are sleeping they can’t prevent themselves from doing it. However, some people clench and grind during the daytime. They might do it while reading, or concentrating on a task or when doing a hard job. If you find yourself clenching in the daytime you can wear your guard then also. It just makes speaking difficult. Caring for your Guard When you remove the occlusal guard from your mouth, rinse it in cool water.
You need to brush it also. Brush it with your toothbrush and toothpaste
when you bush your teeth. Even though you brush it well, it will still
build up tarter and stain. Be sure that you bring it into the office with
you when you get your teeth cleaned and we can clean it for you and check
the bite on it. If it Cautions Your occlusal guard is carefully designed and adjusted to make your jaw feel more comfortable. If at any time your jaw feels worse rather than better, then you should contact us immediately for an appointment. If the guard makes any of your teeth sore, upper or lower, then be sure and let us know so that we can properly adjust it. Lastly, be sure to keep your dog away from your guard. Dogs delight in chewing them up and you will find yourself without a guard and having to buy a new one. Your doctor has just placed a new bridge for you. Here are a few things to keep in mind in order to keep your bridge, and the tooth under it, healthy. Chewing If your new bridge is porcelain, (white), then you must be sure to not ever chew excessively hard substances. You shouldn’t chew ice, hard candy, pencils or pens. Chewing hard things like these can not only break your bridge, but your natural teeth as well. Sensitivity It is normal to experience some sensitivity with your new bridge. Usually the sensitivity leaves anywhere from a few days to a few weeks after the bridge is placed. If it feels like the sensitivity is getting worse rather than better, or the sensitivity doesn't leave after a few weeks, be sure to call us for an appointment so that we can evaluate the tooth. Death of the Nerve Anytime a tooth is severely damaged, as when it is decay or fractured enough to require a bridge, the nerve can die in the tooth. This can happen as soon as a few days after the bridge is placed or years after the bridge is placed. However, the longer a tooth goes without giving you symptoms, the more likely it is that the nerve is going to be okay. Thus, a tooth that has been stable for 2 years is much less likely to die than one that has been recently worked on. The difference between normal sensitivity of a new bridge and that in which the nerve is dying is in the symptoms. If the tooth is sensitive to cold and it gives you a sharp pain which quickly subsides as the tooth warms up again, then the tooth is probably just sensitive. If, however, the tooth gives you a spontaneous ache, an ache that wakes you up in the night, or an ache that pounds with your heartbeat, then that is a sign that the nerve could be dying. If the nerve dies in a tooth then the tooth will require root canal therapy. Care of Your New Bridge Care for your new bridge as you care for your teeth. Be sure to brush at least twice a day and floss at least once a day. The bridge can last a long time if it is properly cared for. However, it can be lost quickly if it is neglected. Your doctor has just placed a new filling for you. Here are a few things to keep in mind in order to keep your filling, and your tooth healthy. Chewing Don’t chew on your new filling for 24 hours. The filling doesn’t immediately reach full strength. Using it too soon could cause the filling to fracture. Sensitivity It is normal to experience some sensitivity with your new filling. Usually the sensitivity leaves anywhere from a few days to a few weeks after the filling is placed. If it feels like the sensitivity is getting worse rather than better, or the sensitivity doesn't leave after a few weeks, be sure to call us for an appointment so that we can evaluate the tooth. Tooth Fracture Placing a filling in a tooth weakens the tooth. The larger the filling is the weaker the tooth becomes. This weakness can result in fracture of the tooth. If the tooth fractures then a filling may need to be placed in order to restore the tooth to proper function. Anytime a tooth is severely damaged, as when it is decayed and requires a filling, the nerve can die in the tooth. This can happen as soon as a few days after the filling is placed or years after the filling are placed. However, the longer a tooth goes without giving you symptoms, the more likely it is that the nerve is going to be okay. Thus, a tooth that has been stable for 2 years is much less likely to die than one that has been recently worked on. The difference between normal sensitivity of a new filling and that in which the nerve is dying is in the symptoms. If the tooth is sensitive to cold and it gives you a sharp pain which quickly subsides as the tooth warms up again, then the tooth is probably just sensitive. If, however, the tooth gives you a spontaneous ache, an ache that wakes you up in the night, or an ache that pounds with your heartbeat, then that is a sign that the nerve could be dying. If the nerve dies in a tooth then the tooth will require root canal therapy. Any posterior toot which has had root canal therapy requires a filling to restore. Care of Your New Filling Care for your new filling as you care for your teeth. Be sure to brush at least twice a day and floss at least once a day. The filling can last a long time if it is properly cared for. However, it can be lost quickly if it is neglected. You have been treated with Arrestin®, a tetracycline derived antibiotic. It was inserted into the groove between your tooth and gum in order to help treat a local occurrence of gum disease. The microspheres that enclose the antibiotic will slowly release the antibiotic over the course of about 14 days. After treatment with Arrestin® you shouldn’t have any awareness of the antibiotic being in place. You shouldn't have any pain or swelling. If you do be sure to call our office. The area where the antibiotic was placed will be evaluated at your next periodontal maintenance appointment. There won’t be any noticeable effect detectable in the area until at least 3-4 months after the treatment. In order for the treatment to be most effective be sure to follow these guidelines.
After an Extraction or Oral Surgery Control of Bleeding Maintain gentle pressure by biting on the gauze sponge that has been placed over the surgical area. Change the gauze sponge every 5-10 minutes. Keep steady, firm pressure on the site for 45 minutes. If bleeding persists, bite on a tea bag which has been gently moistened and wrapped in a piece of gauze. Repeat as often as needed. Call the office if the bleeding continues for more than 1 hour. Protection of the blood clot Do not rinse, spit or use a mouthwash for at least 24 hours. Do not drink liquids through a straw. The use of commercial mouthwashes during the healing period is not encouraged. Discomfort It is normal to experience some discomfort. If pain medication or antibiotics have been prescribed, take as instructed. If pain medications don't help or if our discomfort persists more than 1 day, call the office. Control of swelling Gently apply ice packs to the area for periods of 20 minutes on, 10 minutes off. Ice packs should be used for the first 24 hours only. Eating Adequate food and fluid intake following surgery and/or extractions is important. If you find that eating your regular diet is too difficult, you may supplement your diet with liquid nutritional substitutes such as Carnation Slender ®and /or vitamins. Allergic reactions If you experience a generalized rash, itching or hives, cal us immediately. Sutures Do not fail to return for suture removal if sutures were placed. Hygiene The toothbrush may carefully used in the area id the mouth involved by the surgical procedure. A clean mouth heals faster. In addition Avoid all excessive activity; it may cause bleeding from the site. Don't pick at the surgical area. Avoid alcoholic beverages and refrain from smoking until healing is well established. Do not hesitate to call if any questions arise, (248) 652-1010
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