Is Your Dentist Actually DOING Anything When He Checks Your Teeth?

Dentistry, like many other professions, has an information gap between the consumer and provider.  When you get maintenance on your car and the mechanic looks you in the eye and says you need a new fan belt/transmission/Johnson Rod (Seinfeld anyone?) , you have to trust both his knowledge and his ethics inherently.  The same trust is needed with your doctor or dentist.  Our patients must believe we have their best interests in mind because it is difficult to completely convey our comprehensive oral health knowledge to the average person.  That does not mean we shouldn't always try, though.  Hence the information I provide in my blog posts, website, facebook page, and with each consult appointment I have with patients to discuss treatment options. 

There is a critical time, however, when dentists often don't have adequate time to bridge this information gap with our patients -- this is when we give exams during your routine cleaning appointments.  The purpose of these exams often baffles patients, as our visit is usually short, and some patients even go as far as declining the dental exam because they just don't see any value in it.  For that reason, I have decided to reveal exactly what your dentist is doing during that three minute exam and why it is important.

You may not realize this, but often your dental exam begins before the dentist even sees you.  When your hygienist has completed your cleaning and comes to get me in my office, I will receive an overview of your oral health condition.  I will review your digital x-rays on my computer and evaluate them for any decay, periodontal disease, compromised crowns or fillings, and other pathology.  After I have completed this review, I will then walk over to greet you in the hygiene room (and am often greeted with an anxious expression from someone uncomfortably reclined in the dental chair).  I realize this reclining position is an odd way to greet someone, so I always try my best to put you at ease. 

I'll then proceed to examine your entire mouth visually with my instruments and explorer.  The explorer is the "Captain Hook" instrument which basically allows me to feel for any decay in the various crevices of your teeth.  Specifically, I'm looking for areas of new decay on the tops and sides of your teeth, as well as checking the integrity of any fillings/crowns you have by feeling how they integrate with your tooth.  If a gap has appeared between a filling/crown and your tooth, there's probably decay there. 

Next, I'll examine any problem area of your gums and determine if additional periodontal treatment is necessary.  I'll then compare my findings to x-rays to validate what I see in your mouth.  I'll also use this time to reinforce any instruction concerning diet or oral hygiene the hygienist may have shared with you.

At this point I should have a pretty good determination of what, if anything, needs to be done and will discuss the options with you.  The hygienist will then schedule any follow-up appointments.  Sometimes the necessary work is extensive enough that I don't have adequate time to discuss everything with you during this cleaning appointment.  If that is the case, we will schedule a consultation appointment for a later date to discuss the necessary treatment in detail.  During this consultation appointment I will make sure you have all the information you need and all your questions are answered to your satisfaction.

While this entire dental examination process only takes a few minutes and can feel like just a bunch of poking and prodding, a lot of things are actually happening.  It is important to keep in mind that dentists are trained to find, diagnose, and treat all the ailments of the mouth.  Though skilled hygienists can spot many of these issues too, they will be the first to tell you a dentist needs to examine your mouth to catch all the areas of concern. 

Whenever a patient refuses the dentist's exam, we make it a point to note his/her chart that the suggestion for this exam was made but declined by the patient.  Why do we do this?  If, down the road, this same patient comes in with a dental problem and asks why it was not caught sooner, we will be able to respectfully discuss his/her decision to forgo the dental exam during previous cleaning appointments.

So - that's whats going on in that whirlwind of an encounter you sometimes have with your dentist during a cleaning appointment.  Now you know -- and you can consider that dental information gap just a little smaller!

Next blog topic: Six month checkups: Why they can save you considerable pain and money in the long-run.

Have a good one!

-DRS

My Interview with Bizymoms.com

Hey guys, today's post involves a little self-promotion (I hope you don't mind).  I was recently interviewd by Bizymoms.com for their local dentist section concerning root canal treatment.  My answers are pretty much a summary of my the various root canal treatmen blog posts, but for those of you who missed them and want to know the straight-skinny on what a root canal really is, check it out:

Root Canal Interview

-DRS

Do I Need to Floss? Really? I mean REALLY??

Hey readers! I apologize for the long lag between posts. I'm finding out that planning a wedding is an all consuming affair. I have a slow morning today patient-wise, though, so between looking for wedding venues, planning the guest list, and about a million other things, I've decided to tackle a truly interesting, cutting-edge, sexy dental topic...Flossing!

I know, I know, there's nothing cool about flossing. Or so you think.

• Did you know that floss has been found among the remains of our pre-historic ancestors? 
• Did you know the first "modern" floss thread was invented by Levi Spear Parmly (a dentist, naturally) in 1815 and was made of silk? 

Crazy stuff! Now that I've got you interested in this fascinating spool of dental thread let me tell you why you should use it...

Wait...

I can just feel you nodding off at the thought of that...

Quick fact: The second best selling game of all time is Jenga. Jenga is a Swahili word, meaning "to build."

Do I have your interest again? Great. Let's begin. The purpose of floss is to rid the tight spaces between your teeth of plaque. And since plaque is basically a naturally forming slime of hostile bacteria, removing it on a regular basis will improve your oral health immensely in two major ways. First, this plaque can contain the type of bacteria that causes tooth decay, and unless it is cleaned regularly it can and will cause cavities between your teeth. Second, flossing along with proper brushing will prevent gingivitis.

"Hey doc, I've always wondered. What exactly is gingivitis?"

Well, I'm glad you asked!  Gingivitis is an inflammation (redness and puffiness) of your gums caused by, you guessed it, dental plaque. On its own gingivitis is not that bad. However, left untreated it greatly increases a person's risk for periodontitis, or the inflammation of the bone beneath your gums. Periodontitis is a much more difficult "itis" to treat, is tougher to reverse, and will cause this tooth-supporting bone to disintegrate over time. If too much of this bone is lost, a person's teeth will get looser and looser until they literally wiggle right out of the mouth.  Surprising? Well, it's true and all too common.

"But doc, I never floss and I haven't had cavities in years. I think I'll hedge my bets?"

I understand your reasoning, but as a dentist I can honestly say that cavities often come in bunches.  You can go years without one and take your oral hygiene for granted until a dentist tells you eight cavities are brewing between your teeth or worse, these teeth begin to hurt.  Furthermore, periodontitis is a slow, silent disease that tends to truly manifest itself in the second half of a person's life.  By this point, though, much irreversible damage has already been done.  Yet all this damage could have been prevented years earlier by flossing for 20 seconds a day.

So floss everyday! If it hurts your gums to floss and you see bleeding, that's OK. It just means your have some gingivitis. Grit your teeth and get through it. After a week of flossing, lo and behold, the pain and bleeding will be gone. That means you've cured yourself of gingivitis. That means you are a go-getter, a problem solver. I trust fixing the economy, the oil spill, childhood obesity, and pollution should be no sweat for the likes of you. Go get 'em tiger!

-DRS

A Story about Nelson Neglectful

Here's a story about an all too common situation we encounter as dentists.  Hopefully, it provides some insight into what we face as practitioners:   

A rarely seen patient or new patient named "Nelson Neglectful" appears in my chair one day in pain or with a broken tooth, and he wants me to fix it.  I tell him, "Of course I will, that's what I'm here for," and I do right by him.  But when I'm all finished, I take a quick look at the rest of Nelson's mouth and see problems, problems, and more problems.  Whether its more restorations, root canals, or crowns -- Nelson needs work.  Badly.  So I sit him up in the chair.  Maybe I hand Nelson a mirror or take some pictures to help him visualize my point, but essentially I look him straight in the eye and explain to him that he will have consistent, recurrent dental problems and pain in the future if he doesn't start seeing me on a regular basis.  Otherwise he'll experience massive tooth loss.  He is at the decision point, a major fork in the road.  Its not too late, but it will be soon.  Nelson nods, seeming to understand, and then leaves my chair to make another appointment...and promptly cancels, disappearing into the ether... 

...but sometimes he doesn't.  There's Nelson on my schedule!  There's Nelson in my chair!  He listened, he cares about his oral health...Yippee!  Lets get to work.  Diet control -- cut out the sugar!  Hygiene control -- floss is your new best friend!  Dental Phobia control if its necessary -- we're here to help!  MASSIVE cavity control.  We are fixing it.  Nelson is taking control of his problem.  Then, mysteriously, he disappears... AGAIN.  Why?  Nelson's previously neglected insurance benefits suddenly ran out.  It doesn't matter that my front desk took the time to explain these benefits to him, it still comes as a shock.  Apparently, his oral health is only important enough that he will address it if its not an out of pocket expense.

This story isn't referring to the patient who has true financial difficulties.  We are in tough times, and sometimes sacrifices have to be made.  Its also not referring to the high anxiety patient who has dental phobia.  Nelson Neglectful is the patient who just puts his/her dental health at the bottom of life's list.  An expensive cell-phone plan, some cool shoes, just about anything is more important than putting some money aside for much needed dental treatment.  It breaks my heart that I can't get through to this kind of patient.  I've seen what becomes of them down the line.  Nelson Neglectful, now "Tony Toothless," looks up from my chair with somber eyes and inevitably laments, "Man, I wish I had taken better care of my teeth."

I wish I could get through to Nelson before he becomes Tony.  Any ideas?

-DRS

Snoring Problems? A Dental Appliance May be the Solution

The night before my application interview at my future dental residency in Richmond, VA, I was pretty nervous.  And when I get nervous, I have trouble sleeping.  Lack of sleep the night before some important event is nothing new for me, but usually I eventually fall asleep and the effects are annoying but tolerable.  On this night, though, I got no sleep whatsoever.  Why?  Sharing the small hotel room with me was a friend/colleague of mine who was also interviewing for a residency position.  And this friend (lucky for me) snored at an incredibly high decibel.  Think of the loudest, oldest, rustiest chainsaw being revved up over, and over, and over again all...freaking...night.  Needless to say he was the worst snorer I'd ever heard, and I was miserable.  Around 3:00 AM I was so bored and distraught I actually recorded his snoring on my cellular phone to play back for him that next day.  Obviously, the interview wasn't fun for me, but he and I were both accepted to the residency.  When I played his snoring back to him, though, he was pretty surprised at how bad it was.

Skip forward to four months later.  This same friend of mine and I (now busy dental residents) had to once again share a hotel room for a dental conference.  Obviously, I was dreading the experience.  However, this time when we hit the sack there was nary a peep from his corner of the room.  I was pleasantly shocked and slept like a baby.  When morning came I saw the reason for this transformation: my friend was wearing some sort of mouth-guard.  When I asked him about the device he smiled and told me that listening to my recording had spurned him to action.  He decided to enroll in a sleep study and learned that his snoring resulted from a  form of mild sleep apnea.  This same sleep apnea was preventing him from achieving sound, quality sleep.  Not to mention disrupting the sleep of anyone in a 5 mile radius!  Anyways, to fix the problem, he had one of our dental instructors fabricate an oral appliance (the mouthguard I saw him wearing) which positioned his lower jaw in such a way that his airway stayed open throughout the night.  Poof!  The sleep apnea all but disappeared.  He told me he was amazed at how refreshed he has started feeling after using the device, and that he couldn't believe how much of an improvement it has made.

Snoring and/or sleep apnea can be a major problem for some people.  Amazingly, the solution in the form of a dental oral appliance is not well known.  It definitely worked for my friend, and I know he continues to use this device to this day.  His newly acquired fiance can attest to that!  A few of the better known brands of these appliances are the TAP , the SomnoDent and the Silent Nite, but there are others.  So if you have a snoring problem and you would like to seek a solution, try telling your local Northford Family Dentist about it.  The solution may lie with one of these devices

-DRS

Energy Drinks...Did You Know They Cause Tooth Decay?

When I find multiple cavities in an otherwise healthy older adult patient, the first question I ask is, "Do you sip on sugared coffee or soda throughout the day?"  More often than not, the answer is, "YES!  I love my coffee/soda/juice!"  From there we will discuss how to curb that addiction to reduce tooth decay.  Lately, though, I've noticed the same question directed towards a younger patient will often garner a response to the tune of, "Eww, I don't like coffee.  I drink Red Bull (or any other energy drink) to wake up.  I love it!"  That response raises red flags in my mind because it seems these unhealthy beverages are becoming more and more popular with the younger generation.  What's worse, they are murder on your teeth.  The combination of acid and sugar in these beverages is a perfect storm for rapid, rampant tooth decay, and let me tell ya, the results ain't pretty.  Here's a good article I found discussing the oral effects of these drinks and others in more detail.  Pay special attention to the conclusion where it discusses ways to combat tooth decay/acid erosion.  I'll vouch that all the suggestions are representative of the most up-to-date research available:


Juices, tea and energy drinks erode teeth


-DRS

Are Silver Fillings Bad?

Recently, Dr. Connolly (the owner/dentist of Northford Family Dental) received the following e-mail from one of his patients concerning the use of amalgam restorations, or silver fillings, in dentistry:


Hi Dr. Connolly,

I hope this finds you well.  This is [Patient's Name], long time patient.

I was writing to ask your opinion about mercury used in amalgam fillings.  I'm 31, and had a few fillings put in over 20 years ago.

Should I be worried or consider having them replaced?

My best to you and your family.


This is a very common question, and if you ask ten dentists about this issue, I wouldn't be surprised if you heard ten different responses.  While the use of mercury-filled amalgam restorations is a controversial topic, a dentist's opinion on the "amalgam debate" should ultimately stem from the most current scientific literature.  The American Dental Association is constantly reviewing this literature and modifies its stance on the subject accordingly.  Currently, the ADA claims "Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness" in an official statement that also summarizes the results of the most credible scientific literature on the topic.  However, this is a complex issue dealing with very personal subject matter, so there tends to be varying philosophies regarding amalgam and its use.  Consequently, I was pleased by Dr. Connolly's response, since it is exactly what I tell my own patients.  Quite a coincidence since we have never discussed this issue with each other: 

Dear [Patient's name],

We don't place amalgam fillings in our practice.  That being said,  probably 50% of the dentists  in the United States do continue to use the material.

Mercury Toxicity is generally the focus of concern about Dental Amalgam.  The greatest amount of Mercury released  from Amalgam  occurs when the amalgam is placed.  The second greatest release of Mercury occurs when the Amalgam is removed.  All Dental Restorations have a lifetime. It makes sense to me to replace your Restorations when they fail, with another material. I would not recommend that you replace them before they fail.

Finally, while concern is justified, it's important to put concern in context. Billions of Amalgam Fillings have been placed over the last century. Where are the hospitals full of patients suffering from Mercury Toxicity? If you have any other questions feel free to call.

Dr Joseph Connolly
4/14/10

I agree with everything Dr. Connolly has stated.  However, though Dr. Connolly does not place amalgam in this practice, I will...on rare occasions.  You can count on one hand the number of amalgam restorations I have placed in the last year. 

The reason I place them?  Amalgam fillings are better suited than composite resin fillings (white fillings) for very large cavities.  When I say large, I mean replacing a cusp of a tooth or more with filling material:

Using silver fillings in this situation is a last resort, though, because these large cavities are best treated by a laboratory fabricated inlay, onlay, or full coverage crown.  So, if a patient declines my suggestion of using one of these stronger restoration options, I will have a frank discussion with him/her about the advantage of an amalgam restoration (silver filling) for the long-term prognosis of the tooth.  If the patient refuses the silver filling after our discussion, I will happily place a white one, knowing the patient understands the risk for future problems with this particular tooth. 

As always, it is important patients are informed enough to weigh the risks/benefits of their treatment.  I believe the benefit of a stronger, mercury containing silver restoration outweighs the risk of future decay or tooth fracture associated with placing a large white filling.  Not everyone has the same risk/benefit philosophy though, so it's important each patient has the facts so he/she can make the decision.


I hope this post helps clarify the concerns patients have regarding silver fillings.  Even if you don't agree with my philosophy on the matter, at least you now know the reasoning behind it.


-DRS

America's Oral Health Dilemma

Recently I volunteered at the Mission of Mercy (MOM) project for the second year in a row.  MOM is a volunteer based free dental clinic administered for 2-3 days each year in various states across the U.S.  Fillings, extractions, root canals -- most basic dental procedures are performed continuously at this clinic on a GRAND scale. 

You may be wondering...who shows up for free dental care?  Is there a large demand for free dental services?  What insights can we glean from this experience regarding the state of America's oral health?

Having volunteered at the MOM Project in both Virginia and Connecticut, I saw a common troubling theme which is this:

People from all walks of life are not receiving adequate dental health care and they are suffering because of it

Cavities and periodontal disease were rampant among many of the patients we saw, illustrating years of oral health neglect and lack of care.  These patients had multiple problematic teeth in various states of decay.  Over 2,000 patients were treated in two days at the CT MOM Project, and much of this care was urgent and necessary to alleviate patients in chronic pain.  The patients I saw crossed all professions - blue collar, white collar, college students, single guys, housewives, children.  The patients crossed  all education levels and came from scattered areas of CT. 

As I filled or extracted each troublesome tooth, I recalled an old Bugs Bunny cartoon I'd seen where Bugs attempted to stop a leak in a large dike by sticking his finger in it.  But, to his dismay, as soon as he plugged the first hole a second appeared next to it.  Once he plugged the second hole another appeared, and so on and so forth.  Unfortunately, while treating these patients, I felt like Bugs with his leaks; though I've solved the immediate problematic tooth there are many other teeth about to cause pain for these patients.  Which brings us to the problem -- many of these patients will likely wait another year for a MOM dentist to plug those leaks. 

To loosely quote a wise friend of mine - the experience was akin to treating a gunshot wound with a Band-Aid!  My efforts are helping the immediate problem (pain) but ultimately the real issues causing these patients' pain (lack of care, inadequate oral health) are not being addressed. 

Don't get me wrong, the MOM project does a LOT of good, and I will continue to volunteer for it.  However, I doubt anyone volunteering with MOM, seeing patient after patient with mouths destroyed by disease, has any disillusions regarding this project --  it's no secret that our efforts simply buff some scratches out of the rusted jalopy that is America's oral health care system.  It's a problem that needs to be fixed on a fundamental level.  I am not a policy maker, though, and I admit I do not know where to begin.

A policy maker I am not...a dentist I am.  So, one message I can share is this:  The most efficient way to fight tooth decay is to prevent it from happening in the first place.  To be frank, many of the MOM patients I saw are doing EVERYTHING wrong concerning their oral health.  They enjoy their favorite vending machine candy bar with their favorite soda (or Red Bull) on a regular basis, don't brush regularly (if at all), and simply never see a dentist for a check-up. 

I'm not standing on my pulpit looking down, though.  I understand life is hectic and it's easy to let oral health maintenance fall by the wayside, especially when you don't understand the consequences of your actions.  And that's where I feel we need to begin.  By making people understand how much value there is in being diligent about their oral health -- by brushing regularly, skipping that soda, and getting regular cleanings -- we would be able to prevent these patients from slipping into a basically untreatable state of oral health. 

Prevention programs, in my humble clinical opinion, are the answer.  But I'm not a public health expert, and recognize the implementation of these programs is complex, as is positioning them to be successful.  There are programs that have made a difference.  The Give Kids a Smile program and the work done by South Park Inn in Hartford come to mind.  Obviously, more can and should be done.  In the meantime, the MOM project will be there, helping thousands of people.  I hope a day comes soon where we've found answers to this oral health dilemma that make the MOM project unnecessary.

-DRS
Northford Family Dental

What Parents Should do to Prepare their Children for the Dentist

It's a typical day in the life of a parent of a young child.  In other words, things are as hectic as ever.  Making school lunches, driving the kids to soccer practice, helping with homework, discussing the merits of wearing more than a single pair of pants all week, going to the DENTIST for a cleaning...*gulp*...this last one is often dreaded the most. 

For a child there is nothing fun about sitting still for 30 (long) minutes while strange adults poke and prod your teeth.  Parents feel like their child-rearing skills are directly reflected in their child's oral health.  They half expect the dentist to look up at them after an exam with an accusatory stare making a "tsk, tsk" noise as they shake their head in disgust.  Or, even worse, hear the dreaded word "cavity" cross the dentist's lips.  What can possibly be worse than that?

 

Well, as it turns out, many things.  But probably my greatest challenge concerning children's dental care is overcoming the psychological barriers instilled in the children (and parents, too).  I understand life is busy, it's tough to deny your children the foods they like, and even if you do they are often savvy enough to find sugary foods anyway.  

My philosophy is this: Parents who take their children to the dentist regularly are responsible, period.  So - if there are dietary, oral hygiene, or cavity issues, it's not reflective of poor parenting but of education.  A lot of people simply don't know what causes cavities and how to prevent them.  But, the most important piece of education I can share is this:

If your child has a cavity, please remember the following statement and repeat it to yourself over and over...and over again if you begin to waver:

 

"It's not a big deal."

 

This mentality is the single most important thing between a trouble free dental appointment and one that ends in crying and frustration (and by that I mean frustrated children and crying parents).  I treat most of the children at our practice and have noticed a definite pattern between an easy, efficient appointment for a child's filling or tooth extraction and one where a lot of  "resistance" emerges. 

Generally speaking, the bigger deal a parent makes out of the situation, the bigger deal a child will make out of it.  Parents want to be there for their children, understandably, and in doing so they can unknowingly project their own anxiety about dentistry onto their children.  As you know, children are remarkably perceptive.  If they hear their parents speak in length about what's going to happen, they will see this appointment as "a big deal," which, as you may remember, is what we don't want.  If the words "pain," "hurt," "sharp," or "drill" are used at any point, this appointment not only becomes "a big deal," it has the potential to become a catastrophe for everyone involved.  So, please choose how you discuss what is going to happen VERY carefully.

 

It doesn't end there, though, because like I said, children are remarkably perceptive and actions speak louder than words, so please keep the following in mind:

• Not only do parents need to speak casually about their child's upcoming appointment, they need to treat it like a visit to the barber or physician's office. 
• No rewards for good behavior should be discussed because then the child will believe what is about to happen is strange or difficult. 
• Don't discuss your personal dental experiences unless they are absolutely positive. 

Furthermore, don't even worry about not adequately preparing your child for the procedure...dentistry has come a long way since your were a kid.  Nine times out of ten the pinch of the needle is the only discomfort a child feels in my chair.  So if they don't think it's a big deal going in, they'll leave not thinking it's a big deal, won't be traumatized from the experience, will care more about their oral health, have great teeth, go to great schools, marry well, and be altogether successful.  Incredible!

 

This brings me to my final point, which may be the most important.  How YOU, as a parent act during the procedure plays a huge role in how well the procedure goes.  As recommended by pediatric dentists and child psychology experts, when a child is about four years old he/she can be separated from his/her parents without much problem.  While I realize that may sound too young, and a loving and concerned parent will often want to be there with their child during the procedure, think about the message that sends.  When you stand by their sides, holding their hands, offering soothing words through the procedure you are sending the message that, you guessed it, this is a BIG DEAL.

Parents usually can't hide their apprehension, and if a child in the dental chair sees this, his/her anxiety skyrockets which, in turn, triggers the parent to become truly fearful and ask the child if "it hurts".  Now, the child begins to panic because the concept of pain has entered the equation.  Anxiety feeds off of fear which turns to panic in a destructive tangle of emotion.  And while all this is going on, I'm trying to fill a cavity.  As you can imagine, it can be tough.  On the other end of the spectrum is the parent who either waits in the waiting room until the appointment is complete or is off to the side reading a magazine.  For them this procedure is no big deal, the children consequently are at ease, and we're usually finished in about twenty minutes.   

 

So what should you do?  If your child needs a filling, don't panic.  Remember the mantra.  Treat this procedure like a walk in the park.  Don't use words like, "pain," "hurt," or "drill."  Instead, let them know the needle may "pinch" for a second.  The dentist puts your tooth to "sleep" before he "cleans" or "fixes" the problem.  Stay positive.  Let your child know this makes him/her healthy, a big boy or girl, and above all else,

 

IS NO BIG DEAL!!!!!

 

-DRS
Northford Family Dental

Why does my Tooth Hurt? Signs you may need a rooth canal...

In my last post I discussed strong cold sensitivity and its relationship to the tooth's inner pulp, so now I'll continue along those lines and describe the pain associated with a tooth that needs a root canal.  The majority of the time this pain stems from a cavity, but it can also be caused by a cracked tooth or a deep filling. 

As a quick recap, here's a picture of a cross-section of a tooth (if you are reading this blog in facebook, click on the extended info tab, scroll down to root canal treatment and check out the first picture in the series):

 

In this picture you can clearly see the the inner pulp I've discussed in my previous posts, as well as the hard enamel and dentin shell encasing it.  It's this hard shell that causes the problems associated with root canal pain.  As bacteria get closer and closer to the pulp via a crack or a growing cavity, this pulp, like any part of your body, exhibits the immune response of inflammation and swelling.  Unlike the rest of your body, though, this swelling has nowhere to go due to the hard enamel covering and dentin.  The very thing designed to protect the pulp actually becomes a prison for it.  Consequently, pressure builds up inside of the tooth causing the pulpal nerves to go ballistic.  This pressure can manifest itself in the following stages of pain over the course of days, weeks, or even months:

1) Mild cold sensitivity

2) Strong cold or hot sensitivity (aching for over 15 seconds after a hot or cold stimulus touches the tooth)

3) Spontaneous pain in the offending tooth or non-localized pain (an aching) in the jaw, sometimes extending up to the ear

4) Pain with chewing or biting on the tooth

5) A dull ache near the root of the tooth (below the gumline)

These numbers signify the tooth's progression from initial bacterial infection in the pulp, to pulpal inflammation, and finally to the total destruction of the pulp.  The degree of pain will typically peak around numbers two or three, with the pain diminishing somewhat as the tooth enters the fifth stage.  Moreover, it's important to note this is only a general guideline, so some of these stages may be skipped or occur at the same time.  And sometimes a tooth may become completely infected by bacteria with no pain whatsoever!

So what does all this mean to you?  If you are experiencing any of the symptoms from numbers 2-5, see a dentist immediately.  Though there's a chance the pain may be related to something else, this is not something to be ignored because the pain can become intense and crippling.  Once this happens, only a root canal or the extraction of the tooth can relieve the pain. 

I recall reading a study on women who had experienced pain related to childbirth, pain related to cancer, and tooth pain due to pulp infection.  These women were then asked to rank the pain they felt in each situation from least to most painful.  Can you guess which one was consistently ranked the most painful?  Surprisingly, tooth pain was ranked the most severe.  With this in mind, please see a dentist ASAP if you think you may need a root canal.

Have a good one!

-DRS

    

How to Brush your teeth. Are you doing it right?

Believe it or not, most people don't brush their teeth properly in the sense that they consistently miss the same spots in their mouths.  Its all too common for me to see developing cavities forming along the cheek-side gumlines of upper and lower molars in otherwise healthy patients.  Those areas are hard to brush and easily missed, resulting in plaque that is given the time to mature and form a cavity.  Here's a great link on how to properly brush your teeth.  Do you think you are brushing right?

How To Brush Your Teeth 

-DRS

www.northfordfamilydental.com

Dental Joke...CORNY

I think this may only be a joke that dentists find funny.  You be the judge and let me know what you think:

A man went to his dentist because he feels something wrong in his mouth. The dentist examines him and says, "that new upper plate I put in for you six months ago is eroding. What have you been eating?" The man replies, "all I can think of is that about four months ago my wife made some asparagus and put some stuff on it that was delicious ... Hollandaise sauce. I loved it so much I now put it on everything --- meat, toast, fish, vegetables, everything." "Well," says the dentist, "that's probably the problem. Hollandaise sauce is made with lots of lemon juice, which is highly corrosive. It's eaten away your upper plate. I'll make you a new plate, and this time use chrome." "Why chrome?" asks the patient. To which the dentist replies, "It's simple. Everyone knows that ... there's no plate like chrome for the Hollandaise!"

-DRS

Strong Cold Tooth Sensitivity - A Tale of Castles and Invaders

In part two of my 72 part series (just kidding) on tooth pain, I'll be discussing what's going on when your tooth is sensitive to cold...and I mean really sensitive. Major cold sensitivity is defined as pain that is intense and lingers for more than a few seconds. If you drink something cold and have to stop what you are doing to wince for a minute or two, that's major cold sensitivity. To explain what's going on, I'm going to try something a little different in this post: a tale about castles and invaders.

Note: The following analogy requires your imagination to be properly configured and switched to the "On" position.

In medieval times castles were built to help defend villages against invaders. When an invading army arrived on the scene, the entire village would retreat into the castle, the drawbridge would shut, and the castle's heavy brick and stone ramparts would deter the invaders...initially. However, if the invaders were persistent (and just about all were), they would set up a siege and pelt the castle walls with boulders from their catapults -- slowly turning them to dust. This siege could take months. In the end, though, the castle's defenses would inevitably fall, and the invaders would storm its inner sanctums and plunder everything. A lot of fighting and chaos would ensue.

Castle walls? Invaders? Is this the new Jerry Bruckheimer film? Let's break down the metaphor:

-The castle is actually a tooth.
-The villagers are the tooth's innermost nerves and blood vessels (see my last post if you don't understand this part).
-The invaders are the bacteria that cause tooth decay.

Once that bacteria arrives on your tooth and starts its siege, it slowly pelts away at your tooth's very strong outer walls (tooth enamel). But instead of using boulders to slowly destroy your tooth, it uses acids derived from the sugar you eat (think about this little war going on next time you are sipping a 64 oz Big Gulp of Mountain Dew). The destruction of the tooth's wall results in a cavity, and as the cavity grows it moves the bacteria closer and closer to the vulnerable inner part of your tooth. Sometimes, when it's close to the the tooth pulp, mild cold sensitivity will ensue. Regardless, eventually the cavity will break through and the chaos of the destruction of the village and its inhabitants (your pulp) will result in strong tooth sensitivity. In simpler terms, your pulp tissue is being destroyed by bacteria and is beyond the point of saving.

The severity of this pulp destruction due to bacterial infection manifests itself in multiple forms and degrees of pain, and I'll save that for my next post.

Back to the analogy; let's consider the heroic intervention of another army who happens upon this problem in the castle's hour of need, wipes out the invaders in one fell swoop, and leaves the castle repaired as best it can. That would be great, right? But alas, sometimes the army arrives too late, the walls are leveled, the village is plundered. The only thing the heroic army can do is destroy the invaders from within the castle, clean up the destruction, and repair the walls as best it can. Who is this gallant army? You guessed it, it's your neighborhood dentist! And that destruction of the invaders before they level the walls is a filling of course!

But what does a dentist do if this bacteria "levels your tooth's walls" and invades the pulp? That, my friends, requires a root canal - and the repair is a dental crown. Fortunately, the lack of a pulp (remember, all destroyed) actually makes no difference to the function of your tooth.

There you have it! Strong cold sensitivity explained! The moral of this tale? See your dentist if you experience this, as the pain could get worse. Why? That, as they say, is a tale for another post.

-DRS
Northford Family Dental

Disclaimer: All of the information presented in Dr. Sherberg's blogs cannot be used as the sole source of a dental diagnosis. Only a visit to the dentist can provide that.

Hilarious Dentist Names

Check out these apropos real dentist names. I can believe there's actually a Dr. Daryl B Payne! And Dr. Root was a professor at my residency!

Actual Names of Practicing Dentists

Dr.Pullman, Dr.Filler, Dr.Fear, Dr.Rensch (pronounced wrench), Dr.Pick, Dr.Tusk,
Dr. Drewel (pronounced "drool"),Dr.Tucek (2thChk), Dr.Chu, Dr.Shugar, Dr.Pic,
Dr.Pang, Dr.Butcher, Dr.Harm, Dr.Hurter, Dr.Toothaker, Dr.Lynch,Dr.Root,
Dr.Nasti, Dr.Paine/Payne/Pain (15 entries but notably Dr.Daryl B Payne =
"There Will Be Pain"), Dr.Smiley, Dr.Schotz, Dr.Hale (pronounced "hell" in southern),
Dr.Bliss, Dr.Lancit, Dr.Gager, Dr. Eke

-DRS

Northford Family Dental

Great Article on the Effects of Grinding Your Teeth

I just read this great article on the causes and effects of chronic teeth grinding. From my perspective, I always tell patients its important to address this problem early since habitual grinding can do MAJOR damage to your teeth in the long term. Usually a dentist-made nightguard will prevent this damage from occuring. Enjoy:

http://www.fox4now.com/global/story.asp?s=11738317

-DRS

Why does my tooth Hurt? Mild Cold Sensitivity

Now that we've got tooth whitening covered, I'm going to begin a series of posts on the causes of tooth pain and sensitivity. It's important to understand these posts are meant to be informational only and are not substitutes for a formal dental exam and diagnosis. That being said, lets kick it off with mild cold sensitivity! Woo Hoo!

There are various reasons a tooth can become sensitive to cold temperature, but when you understand the basics of how a tooth is put together, you'll see they are all manifestations of the same underlying mechanism. Basically, in the center of everybody's tooth there is a soft bundle of nerves and blood vessels called the pulp. The majority (but by no means all) of dental pain comes from this pulp, and it can be very, very testy. If anything irritates these nerves in the pulp their only response is to signal pain. Hot, cold, trauma...all are interpreted as pain. They are pretty one sided in this regard. Furthermore, when something irritates the pulp, it can cause the blood vessels that compose it to become inflamed which, in turn, bothers these nerves and causes them to interpret even mild irritants as disproportionately painful. So, the pulp nerves signal pain, and the pulp blood vessels determine the tooth's threshold for pain.

Mild cold sensitivity is defined as sensitivity to cold that lasts only few seconds. If a tooth aches for a minute or longer after being exposed to something cold, something different is going on, and I'll discuss that in my next post. With that in mind, lets explore what causes mild cold sensitivity:

1) Decay - If a tooth has some decay, the proximity of the bacteria causing the decay to the center of the tooth irritates the blood vessels of the pulp which, in turn, lowers the tooth's threshold for pain.

2) Exposed root - If a tooth's root is exposed because of gum recession, the nerves of the pulp in this area are closer to the surface of the tooth and not protected by a layer of hard, insulating enamel. For this reason cold signals have a much easier time making their way to the pulp. Consequently, their effects will be exaggerated and the tooth will be sensitive. Often this sensitivity is transitory and will go away on its own -- desensitizing toothpaste can help here.

3) After a dental filling is placed - If the filling is deep and placed relatively close to the pulp, the trauma to the tooth from cleaning out all the decay can irritate the blood vessels of the pulp and consequently lower the tooth's threshold to pain. At some point in the near future (a few days to a few weeks) this sensitivity will subside.

4) Tooth has been fractured from biting on something wrong- If part of a tooth has broken off, the insulating enamel has been removed and cold sensations have a shorter distance to travel to the pulp. From there it's the the same mechanism as described in number 2 above.

5) Trauma to the tooth - If your tooth experiences blunt force trauma (through a fall, blow to the face, etc.), the blood vessels in the pulp will become irritated and lower a tooth's threshold for pain. This effect SHOULD be transitory, but tooth trauma is more complicated than this and will get its own post later.

6) Tooth is cracked - This reason is so complicated it merits its own post.

Those are the main reasons your tooth can be mildly cold sensitive. Please understand that all of these reasons require a dental consult to determine if any treatment is necessary. Think of this pain as an early warning signal that something is wrong. Often, a dentist can intervene at this stage with minor treatment. If the pain is ignored, future pain and the consequent treatment of it could be more involved. So - listen to your body and see your dentist!

Next post...strong cold sensitivity will be explained. Have a good one!

-DRS

New Dental Videos

Is the written word concerning your ever-present, ever-growing dental questions not enough? Check out our website at northfordfamilydental.com and click the dental video tabs to view dental videos that answer dental questions ranging from root canals to dental implants. Of course, feel free to contact me via our Facebook page or our website if you have any questions about anything discussed in the videos.

-DRS