What Exactly Are Teeth Anyway?

With 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 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 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.

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.

 

Attrition – 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 a 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.

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.

Grinding and Clenching

Unexplained soreness of the jaw or neck muscles and persistent headaches could be an indication that you are suffering from bruxism, or grinding and clenching of the teeth.  The problem is treatable and more common that you may realize, even though most people are completely unaware that they do it.

Frequently, people who clench and grind their teeth do so during sleep, and learn about it from their sleep partner.    Sometimes bruxism is discovered when clients ask their dentist about pain or an odd sensation that their teeth are loose. However, the habit can create a long list of symptoms from mild to significant and can be quite destructive to the teeth themselves as well as to supporting structures, causing the gum recession and bone loss which can eventually cause teeth to be lost. Among people who chronically grind, fractured teeth and damage to the nerves which can require root canal therapy are common.  Unfortunately, this treatable behavior can exist for a long time before it is diagnosed, because many of the symptoms can be easily overlooked or ignored, and may be thought to have another cause.  Consider bringing to your dentist’s attention any of the following symptoms:

• Earache
• Headaches or Migraines
• Loose teeth
• Changes in the way your teeth fit together
• Sensitive teeth
• Tinnitus
• Gum recession
• Neck pain
• Insomnia
• Soreness of the jaw or neck

Bruxism is thought to run in families but it is also be a common response to stress, anxiety and depression. Other causes of the habit include bite problems, eating disorders, excessive alcohol use, and medical conditions such as Parkinson’s disease and obsessive compulsive disorder.  Ideally, treating bruxism involves managing or eliminating the cause but obviously, this is not always possible andtreatment for the behavior and its symptoms often focuses on interruption of the grinding, relieving stress on the jaw joint and and preventing damage to the teeth .

Careful examination of the teeth may reveal fine cracks, wear facets in the tooth anatomy, and otherwise unexplained changes in the bone around the teeth. These findings, along with a thorough medical history will help your dentist diagnose bruxism and suggest a treatment plan.  Most frequently, a hard plastic occlusal splint is custom made to fit the teeth. Worn while sleeping, this “nightguard ”  protects the teeth by covering their surface and enabling them to  glide easily.  The night guard is form-fitting, covers all of the upper teeth and  prevents them from shifting over time which ultimately prevents gradual changes in how teeth  fit together.  A different type of  FDA approved appliance called an NTI(Nociceptive Trigeminal Inhibition system)  fits only over the upper front teeth and prevents the back teeth from touching at all.  Other treatment options including biofeedback, hypnosis, dietary supplements and (rarely) Botox injections are less well known and have had mixed or questionableresults.

People who have been grinding their teeth for a long time may have significantly damaged their teeth;  in severe cases they can even be worn down to the gum line. The damage may have left teeth  sensitive and susceptible to cavities, and may have even caused changes in the shape of your face or the way you feel about your smile. The first step in addressing these issues is always to treat the  bruxism  so that no further damage occurs; and the good news is that there are several cosmetic options that can improve the function of your teeth as well as their appearance.      Your cosmetic dentist may suggest crowns, veneers or bonding as part of your complete treatment  plan.

Unexplained symptoms may not be as mysterious as you think… why not talk to your dentist about bruxism and what treatment options may be right for you?  You deserve a beautiful, pain-free smile!