Category Archives: Oral Surgery

What Exactly Are Teeth Anyway?

A look at pulp, enamel, cementum, and dentinWith a few exceptions, teeth don’t heal by themselves. Every cartoon with an elderly character will show them taking out their false teeth. For many Americans, teeth simply don’t stand the test of time. They contain one of the few tissues in the body that is finite. Most people have heard of enamel from toothpaste ads, but that tissue is only 1 of the 4 that comprise a tooth. Enamel, dentin, cementum, and pulp are the four major tissues that round out a mouth full of pearly whites. Most of the previous blog entries talk about a specific dental disorder or problem and offer remedies to it. This one will be a bit of primer, a basic introduction to what teeth are, and what can go wrong for each part.

Dental pulp is soft tissue in the center of the tooth; it contains the nerve, blood and lymphatic vessels, and connective tissue. The pulp forms the main bulk, or core, of each tooth and extends almost the entire length of the tooth. It is covered by enamel on the crown portion and by cementum on the roots. The pulp consists of cells, tiny blood vessels, and a nerve and occupies a cavity located in the center of the tooth. If the pulp becomes infected, it is removed by root canal.

Cementum in the tooth

Cementum is the thin surface layer of bone like material covering the tooth’s root. It is yellowish and softer than either dentin orenamel. The fibers of the periodontal membrane, which holds the tooth in lace, are embedded in cementum. Deposition of cementum continues throughout life, especially in response to stresses. When the tooth’s crown is gradually worn down, new cementum is deposited on the roots so that the tooth can slowly rise to maintain a good bite.

Elephant Ivory is almost entirely made of Dentin.

Elephant tusks (Ivory) are solid dentin. Ivory was the preferred material for billiard balls, as dentin has an elastic quality

Dentin is the yellowish tissue that makes up the bulk of all teeth. It is harder than bone but softer than enamel and consists mainly of apatite crystals of calcium and phosphate. Sensitivity to pain, pressure, and temperature is transmitted via the tubes to and from the nerve in the pulp. Secondary dentine, is a less well-organized form of tubular dentine, is produced throughout life as a patching material where cavities have begun, where the overlying enamel has been worn away, and within the pulp chamber as part of the aging process.

Veneers are often the only solution to severely worn enamel.

Veneers are often the only solution to severely worn enamel.

Enamel is the hardest tissue in the body. It covers part of or the entire crown of the tooth. Enamel is not living and contains no nerves. The thickness and density of enamel vary over the surface of the tooth; it is hardest at the biting edges, or cusps. Normal enamel may vary in color from yellow to gray. The surface enamel is harder and contains more fluoride than the underlying enamel. It is very resistant to tooth decay. Enamel is also finite. Worn enamel is a symptom of most dental problems: erosion, attrition, abrasion, and the first part of the tooth to decay from cavities. A loss of enamel over time can lead to transparent and fragile teeth. Sensitive teeth can be relieved with desensitizing toothpastes, which often contain ingredients such as potassium nitrate, potassium chloride or potassium citrate seem to make the tooth less receptive to pain. In the case of severely worn enamel, veneers are often the only option.

This concludes the reading for dental anatomy 101. I hope that it provides a greater understanding to the past and future blog entries. And if you didn’t much care for the anatomy of your chompers, there is good news. With good dental hygiene, the dentist won’t have to bother you with any of these terms and explanations; you can just take a free toothbrush and be on your way.


Long in the Tooth

Aside from the usual worries like gum disease and cavities, there is a whole other realm of dental problems that most people may be unaware of. Teeth are finite, they will not last forever if they are not carefully preserved and protected. There are three major ways that teeth can wear away: attrition, abrasion, and erosion. With the proper knowledge and dental advice, tooth wear away won’t be a problem until you’re long in the tooth.

 

Tooth Wear AwayAttrition – Wear away of tooth surface by chewing, one of its primary causes is Bruxism.

Abrasion – When brushing too vigorously wears away the tooth surface. (Usually evident where the gum and tooth meet)

Erosion – When acid wears away the tooth’s structure.

Attrition is a disorder usually brought on by stress, it also known as Bruxism. A mouth guard for nighttime use is usually recommended to prevent further deterioration. Severe attrition may only be able to treat with extensive too replacement, through either caps or crowns.

Abrasion is another one. This disorder is usually seen where the tooth meets the gum in a wedge or aAttrition on teeth v shaped mark. A hard bristle tooth brush is one of the biggest contributing factors to abrasion victims, although a hard brushing with a soft bristled brush can be just as harmful. Tooth abrasion can be repaired by bonding a tooth colored filling to the damaged area. The recommended way to brush your teeth is to place the brush at a 45 degree angle toward the junction of the gum and tooth and move the brush in a gentle circular motion. To make sure you’ve brushed properly try discoloring tablets, bright pink tablets that are chewed before brushing. Any place that hasn’t been brushed properly will be slightly tinged pink.

Erosion's effect on teeth.Tooth erosion is caused by acid. Teeth and acid do not mix. Acid is the bacterial by-product that causes cavities. Food and drink that are highly acidic can cause the enamel and the dentine to break down. The acid dissolves the calcium in the tooth. All soft drinks are acidic, including any carbonated: soda, diet soda, sports drinks, diet sports drinks, and sparkling mineral water. Soft drinks are a major cause of tooth erosion and the degree of erosion directly correlates to the amount and frequency of soft drink consumption. Other acidic foods include: citrus fruits, fruit juices, pickles, vinegar, and yogurt. Stomach acid is very powerful, strong enough to dissolve any food along with whatever tooth and bone fragments that might accidentally be ingested. When stomach contents are regurgitated acid comes into contact with the teeth. Any condition that causes repetitive vomiting will result in tooth erosion. The dentist is often the first one to the notice the problem because the back of the tooth is more susceptible to erosion. When a tooth is sufficiently eroded, the enamel will give way and expose the dentine, which can result in pain and increased sensitivity to: sweet, hot, and cold food or drinks. Erosion is a serious problem. If the nerves or blood vessels have been affected, those teeth will require a root canal and a replacement crown. To prevent tooth erosion, it is important to limit your exposure to acidic food and drink. It is also shown that chewing sugar-free gum can dilute acidity by increasing saliva flow.

Ask the dentist about tooth wear away. An early diagnosis and treatment regimen can be the difference between a $10 mouth guard, and a Cadillac’s worth of oral surgery.

Dental Mouth Guard


Do I Need a Root Canal?

People often have the misconception that root canal therapy is a painful experience and mistakenly believe that having an infected tooth removed is a preferable choice. Also known as endodontic (“endo” – inside; “dont” – tooth) treatment, a root canal will relieve the severe pain that is caused when the tooth nerve has become inflamed. Unfortunately, extracting an infected tooth can introduce many additional problems that could be avoided with a root canal.

A root canal may be necessary if a deep cavity or trauma to the tooth has occurred, causing the inside pulp to become infected or inflamed. Often, pressure develops inside the core of the tooth which is the source of sharp, lingering pain when biting down or when exposed to temperature changes, particularly from hot foods and liquids. Sometimes, a dull ache may be present and the gum may be sensitive to pressure. Left untreated, an abscess may develop and infection can spread from the tooth to the surrounding bone, and even into the bloodstream.

Immediate dental treatment for a suspected endodontic infection is always the best course of action, and the treatment is relatively pain free and is performed under a local anesthetic administered by the dentist. First, the dentist will have to x-ray the suspicious tooth to diagnose the problem and will sometimes test the tooth to determine whether the nerve is in the process of dying. Once it has been determined that an infected tooth requires a root canal, and the tooth and surrounding area are numb, a small opening is made into the tooth, just as if one were having a filling placed. The infected, dying nerve and blood vessels are removed and the root canals are smoothed, cleaned, disinfected and filled with a rubber material. Some patients feel slight tenderness around the tooth for a day or two, but generally aspirin or ibuprofen will provide sufficient relief. After the nerve has been removed a tooth is no longer living, and the lack of blood supply causes it to become brittle over time. Your dentist will almost always advise you to have a crown placed on an endodontically treated tooth to protect it.
Most of the time a root canal can be performed in a single appointment and the crown will require two more visits to complete. The end result is that you will have kept your natural tooth and restored it to full function. Because bone loss and shifting of the remaining teeth often result when a tooth is extracted, the root canal avoids these complications as well.If you are confronted with the recommendation to have root canal treatment, or if you are experiencing unexplained pain when chewing or to temperature, don’t hesitate to inquire about your options or ask for further information about endodontic treatment to restore your smile and comfort. Have you had a positive experience with root canal therapy? We would like to hear your comments… and they may even help alleviate the concerns of others.


Diabetes and Periodontal Disease

Diabetes and periodontal disease are two common chronic diseases that are reaching epidemic proportions in America; and in fact current research indicates that the two diseases actually directly influence each other. Periodontal disease effects more than half of all adults; and according to recent statistics released by the American Diabetes Association, 25.8 million children and adults in the United States are diabetic. Another 79 million people are pre-diabetic, meaning that they are at risk for developing this serious disease which can affect many major organs including the heart, blood vessels, nerves, eyes and kidneys. Scientists understand a great deal about both diseases and they are learning more all the time… considering the number of people at risk and the potentially life threatening consequences of developing either of these conditions, isn’t it a good idea to know your risks and to understand how the two diseases are linked?

What is Diabetes?

Diabetes is a complicated disease which involves the inability of the body to make the hormone insulin (Type I) or to use the insulin that it makes (Type II). Insulin is necessary to move glucose, also known as “blood sugar” from the blood stream into the cells, to be used for energy that sustains life. When cells do not receive adequate glucose, the body stops functioning…and if too much glucose accumulates in the blood, a variety of severe health complications can occur. Furthermore, people with diabetes are at higher risk for infections and they tend not to heal as well as people without the disease because their immune systems don’t function as effectively.

Type one diabetics are born with the disease, and are treated with replacement insulin. However, type II diabetes generally develops slowly over time as insulin receptors are damaged or destroyed, thought to result from chronic inflammation. Periodontal disease is jointly caused by the by-products of oral bacteria and the body’s inflammatory response to those bacteria. The common thread appears to be inflammation, but how does the diabetes-periodontal disease relationship work? Researchers have determined that there are several reasons for the association.

  • Chronic inflammation occurs in the body for a variety of reasons including untreated periodontal infections and even excessive body fat, and the long standing inflammation causes tissue damage. This process is how the gums and bone surrounding the teeth are destroyed in periodontitis. Similarly, inflammation damages the part of the cell that allows insulin to work (the insulin receptor) making cells “insulin resistant”. As the body’s cells become increasingly resistant to insulin, type II diabetes develops. Untreated, the process continues: damaged tissue itself causes more inflammation, so one disease provokes the other.
  • High blood sugar inhibits and slows circulation. The body heals itself of infections by using specialized cells and substances transported in the blood to the site of an infection. Sluggish circulation impairs this natural healing ability, which makes the gum tissues more susceptible to infections and much more difficult to treat.
  • High glucose levels in saliva promote growth of bacteria that cause periodontal disease.
    • Untreated periodontal disease can actually increase blood sugar and make it more difficult to control; and a study in the Journal of Periodontology found that if Type II diabetes is poorly controlled, patients are more likely to develop periodontal disease.

    Many of the risk factors that are associated with Type II diabetes can be minimized through healthy lifestyle changes; and fortunately the same is true of periodontal disease. Good home care practices and regular dental checkups are the keys to good oral health, especially for people diagnosed with or at risk for diabetes. Eliminate tobacco use as well… research has shown that diabetic smokers may be 20 times more likely than diabetic non-smokers to develop periodontal disease! The major risk factors for developing Type II Diabetes include:

    • High blood pressure
    • High blood triglyceride (fat) levels
    • High-fat diet
    • High alcohol intake
    • Sedentary lifestyle
    • Obesity or being overweight

    Many people feel overwhelmed by everything they need to learn when they are first diagnosed with diabetes, but they quickly realize that they must take steps to manage their condition every day. Excellent oral care is an essential step in that process, and the good news is that your dental team understands its important role.

    Research at Columbia University has demonstrated that dentists can often identify patients with undiagnosed diabetes based on what they observe about the conditions in the mouth during a checkup. So, if you are at risk or suspect you might have the symptoms of either diabetes or periodontal disease, please take the risk seriously and speak to both your dentist and physician … it could save your life. If you have already been diagnosed with either condition then you should know that your dentist is committed to working with you and the rest of your medical team to maintain optimal health and quality of life.


    Losing Sleep? Your Dentist Can Help Prevent the Deadly Effects of Sleep Apnea

    Are you chronically sleepy during the day? Excessive snoring and waking up feeling unrefreshed are common symptoms of Obstructive Sleep Apnea (OSA), a sleep disorder in which interruptions in breathing occur because the airway becomes narrowed or blocked by excess tissue when throat muscles relax. Episodes of apnea (not breathing) can occur as often as every few seconds during sleep causing frequent waking, and as you might expect, some serious long term consequences including cardiovascular disease and even death.

    About 4% of middle aged adults and 3-12% of children suffer from this treatable condition, and it is particularly common among overweight people. Most are not aware that the problem exists until family members either witness periods of apnea (not breathing), or raise concerns about symptoms such as heavy snoring. Unfortunately, difficulty staying alert during waking hours may lead to accidents or injury before the diagnosis of Obstructive Sleep Apnea is made.

    The most common treatment for OSA is a Continuous Positive Airway Pressure (CPAP) machine. Worn when sleeping, the CPAP is a type of respirator consisting of a snug fitting face mask and pressurized air flow that keeps the throat open, allowing patients to breathe more easily and consistently. The benefits of treatment can be life changing… and life saving. Unfortunately, many patients with Obstructive Sleep Apnea have difficulty getting accustomed to wearing a CPAP mask, and give up after a short time because they find it intrusive.

    There are several other ways to treat Obstructive Sleep Apnea, and if you think you may be experiencing some of the symptoms of this potentially serious sleep disorder you should bring it to the attention of your physician immediately. You should also be aware that your dentist may play an important role in treating your condition, especially if you are one of the people for whom a CPAP machine is not effective.

    Surgery may be a recommended treatment is some cases, and could involve repositioning of the jaw by an oral and maxillofacial surgeon, or perhaps removal of excess tissue in the throat (including tonsils or adenoids) by an ear nose and throat specialist (otorhinolayryngologist). One of the more common and effective solutions for mild to moderate sleep apnea is an oral appliance, custom crafted by a dentist with specialized training in sleep medicine. These FDA approved devices resemble orthodontic retainers, but are designed to reposition the lower jaw (Mandibular Advancement Device), elevate the soft palate, and increase muscle tone of the tongue (Tongue Retaining Device), thus keeping the airway unblocked during sleep.

    The effects of Sleep Apnea are not only dangerous, research has indicated that they truly invade reduce the overall quality of nearly every aspect of life. The first step towards getting a better night’s sleep is to have a thorough examination by a physician specifically trained to diagnose and treat sleep disorders. Depending on the seriousness of your condition, your doctor may request that you participate in a sleep study, which will provide your health care team with precise data about your breathing and sleeping habits. The results of the sleep study will assist in determining which treatment options are likely to be most beneficial to you.

    If you have been losing sleep, you can rest assured that our office will work with you and your medical team to ensure that you obtain an accurate diagnosis and treatment for this condition.


    Are You at Risk for Oral Cancer?

    According to the National Cancer Institute, about 36,500 new cases of oral and throat cancer will be diagnosed this year and 7,880 people will die from the disease, often because it is diagnosed too late. Here is sobering statistic reported by the Oral Cancer Foundation: among those newly diagnosed individuals, only a little over half will still be alive in 5 years… and these disturbing statistics have not improved very much in decades despite many new advances in our ability to detect and diagnose and treat the disease. How can this be? Unfortunately, the people who are at greatest risk may be least likely to have regular dental and medical checkups, for a variety of reasons ranging from health insurance to lack of awareness.

    How much do you know about your risk for this deadly and destructive disease?

    Lifestyle factors are chief among the major risk factors for oral cancers, and includes long term exposure to sun, such as would occur among people who spend their careers or leisure time outdoors. Heavy alcohol use is another lifestyle choice that increases risk; and tobacco use, regardless of its form accounts for about 75% of the cancers of the mouth, throat and lips that are diagnosed at 50 and older. When heavy alcohol use is combined with tobacco, the risk of developing oral cancer is 15 times greater!

    Speaking of age, most oral cancer has historically been discovered in people over age 60. The Center for Disease Control reports that it occurs more often in men than women, and black people seem to be at higher risk than other races… but no one is really immune. About 5% of oral cancers have no known cause; and new evidence has emerged that the Human Papilloma Virus (HPV-16), a common sexually transmitted disease present in about 40 million Americans is responsible for an increase in the number of oral cancers among young adults.

    Early signs of oral cancer are very often painless and difficult to detect without a thorough head and neck examination by a dental or medical professional. As a result the people who are inclined to put off dental visits – often those who have lost their dental insurance and postpone checkups for financial reasons – are most vulnerable. Oral cancer is treatable, but the tissues of the mouth and neck have a rich blood supply and numerous lymph nodes that enable undiagnosed oral cancer to spread to other parts of the body very quickly. Improving the average 50% survival rate depends upon the location and early detection of suspicious lesions – before they can spread.

    What to be concerned about:

    • A sore in the mouth – especially a painless one – that does not heal within two weeks
    • A lump or thickening in the cheek.
    • A white or red patch on the gums, tongue, tonsil, lip, or lining or floor of the mouth.
    • A sore throat or a feeling that something is caught in the throat.
    • Difficulty chewing or swallowing.
    • Difficulty moving the jaw or tongue.
    • Numbness of the tongue or other area of the mouth.
    • Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.
    • Chronic hoarseness.

    The American Cancer Society recommends that doctors and dentists examine the mouth and throat as part of a routine cancer-related checkup… and you should do a self examination periodically too: look in your own mouth with a flashlight or have someone do it for you:

    • · Remove dentures or partials
    • · Look and feel inside the lips and the front of gums
    • · Tilt head back to look at and feel the roof of your mouth
    • · Pull the cheek and both lips out to see the inside surfaces as well as the back of the gums
    • · Stick out your tongue as far as you can and look at all of its surfaces
      • Lift up your tongue to examine the floor of the mouth
        • · Feel for lumps or enlarged lymph nodes (glands) in both sides of the neck including under the lower jaw.

    Many people have some harmless, abnormal lesions in their mouth that never become cancerous, but it is important to be aware of them and bring them to the attention of the dentist for observation and diagnosis. A thorough head and neck examination is always a routine part of your regular dental checkup visit; it takes only a minute but it could save your life.


    Senior Oral Health: Smiles For A Lifetime

    Like the rest of the body, our mouth and likewise our oral health needs change as we get older; and just a few generations ago, oral disease and eventual tooth loss were expected parts of the aging process. Thanks to advancements in medicine over the past fifty years, adults expect to live longer healthier lives… and when seniors and the people who care for them are aware of their unique oral health needs, it is not unrealistic to expect to keep teeth in great shape for a lifetime of smiles!

    Normal or not?

    Changes in the skin, bones, circulation and immune system that affect the body also affect the mouth; and even the teeth undergo normal changes with age. Do you know what to expect?

    A decline in the function of the immune system is a natural part of aging, but it is significant because it makes the body less capable of fighting infection. Everyone has both good and harmful bacteria in their mouth but as a result of the aging immune system, there is a gradual shift toward a greater number of the harmful bacteria which are responsible for gum disease, tooth decay and fungal infections such as yeast or thrush.

    • The Enamel: the outer shell of the tooth is the hardest substance in the body, and it is not replenished over time. Normal wear and tear over the life span causes it to be gradually worn away, which can expose the softer dentin underneath, making teeth more vulnerable to decay. Professional fluoride treatments may be recommended to strengthen the enamel. White fillings protect exposed dentin and cosmetically enhance your appearance… a stronger and more youthful smile is possible!
    • The Dentin: is the yellower, softer layer that underlies the enamel and covers the nerve of the tooth. Dentin is continually produced over the life of the tooth, and over time the tooth will naturally become darker and less sensitive to temperature. Older adults can and do have their teeth whitened with outstanding results. Usually, a cosmetic whitening procedure performed in the dental office is preferable to an over the counter product when the teeth have darkened significantly.
    • The Pulp: is the core of the tooth where the nerve and blood supply are found. The pulp shrinks as we age, making teeth less sensitive overall. Cavities may be much deeper and larger before they are felt. Many people mistakenly believe that dental checkups are less important as we get older but in reality, they are more important than ever!
    • The Bone: that supports the teeth should not change just because we get older. However, a person’s oral hygiene over their life span will directly impact the health of the bone over time. Periodontal (bone and gum) examinations are an important part of a routine dental checkup appointment for everyone. People who have had gum disease should have their bone level monitored more frequently, especially if they have difficulty fighting infections.
    • The Gums: lose collagen and connective tissue with age. Just like the skin of the rest of the body, the gums become thinner, more fragile, more susceptible to injury and infection, and may take longer to heal.

    Common problems

    Normal physiological changes may leave older adults vulnerable to oral complications… declining eyesight, failing memory and even arthritis may make self-care more challenging and those professional checkups much more critical. Chronic conditions such as diabetes, osteoporosis, and circulatory problems are often associated with aging and these can these have a major impact the health of the mouth as well. Regular checkups can alert your dentist to the possibility of underlying medical conditions that you may not be aware of; and just in case you still need to be convinced, here are some surprising facts about oral health problems commonly experienced by seniors:

    • Among those over 75 years of age, about 50% of have cavities on the roots of their teeth (root caries) and may not be aware of it. Untreated decay can progress into the pulp of the tooth causing pain and serious blood infections, such as septicemia.
    • About 25% of seniors ages 65 to 74 have severe periodontal disease. Research has linked this condition with other serious health problems such as diabetes, heart disease, stroke, respiratory illness and pneumonia in institutionalized patients.
    • Oral cancer is diagnosed most frequently in people over age 65. Each year 30,000 new cases of oral and throat cancers are diagnosed and about 8,000 individuals die from these diseases. Early cancers are treatable, but since they are usually painless they often remain undetected until they have reached the later stages. Do you know about your risk factors for oral cancer? There are many… including tobacco and alcohol use, but some oral cancers develop in people with no known risk factors at all. When was the last time you were examined by a dental professional?
    • Dry mouth is a major side effect of over 400 medications, many of which are taken by older adults. Blood pressure medications, cholesterol-lowering drugs, medicines for Alzheimer’s disease and antidepressants are just a few examples. Don’t underestimate the importance of this treatable condition… it contributes to tooth decay, gum disease, denture discomfort and it makes eating and speaking difficult or painful.

    No matter what your age, a healthy mouth is important for general health and quality of life… and many older adults are choosing to cosmetically enhance their teeth for a real self esteem boost! Your personal oral health needs might include preventive checkups, fixing or replacing teeth or a brighter and younger looking smile. Whatever the case may be, your dental team has the expertise and the products that will allow you to look your best and love your smile for a lifetime! What types of services would you be most interested in learning more about?