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My daughter had her wisdom teeth taken out last year. Since then she gets ear pain and her jaw locks. Could the two be related?
The issues described are consistent with symptoms for Temporo-Mandibular Joint Disorder or what people refer to as TMJ or TMD. Our jaw joint is very complex and therefore is susceptible to problems. TMJ/TMD is most often associated with pain in a person's jaw joint due to tight, overworked muscles of the mouth. The jaw joints sits right in front of our ears and when put under tension from tight, sore muscles does not function smoothly, therefore resulting in locking of the jaw. The TMJ/TMD problem is associated with long-term and/or extreme clenching and grinding. Clenching and grinding are often a result of stress we have in our lives. Removal of the wisdom teeth can be stressful on the person and also the jaw joint so it likely was not the cause but could have contributed to the problem occurring quicker than it would have otherwise. Treatment for TMJ/TMD requires an evaluation by your dentist as it is a condition that can have many different variables and therefore different types of treatment. Often, TMJ/TMD can be treated successfully with a custom occlusal guard designed and fabricated by your dentist. I would recommend you have your daughter evaluated by her dentist soon as this problem can continue to get worse and can become very painful. In the meantime treat it as you would any other injured joint by resting (not chewing gum, soft foods that do not require overworking of the muscles, use of anti-inflammatory medication like ibuprofen, rest and ice or heat on the painful areas. In my practice, I see many patients with TMJ/TMD and have continued to see a steady increase in the number of patients with TMJ/TMD. Modern day lives are becoming increasingly more stressful and as a result we are seeing a rise in the associated problems in the head, neck and jaw regions.
In the news it came out that flossing wasn't necessary. How do you feel about it?
The recent news release regarding flossing has gathered a great deal of attention. The American Academy of Periodontology (Periodontists are specialist dentists that treat diseases of the gum and bone) recommends daily flossing and brushing twice daily as part of your regular oral hygiene routine. Regular visits to your dentist for examinations is important to identify potential problems (i.e. gingivitis, periodontist, cavities, etc.) early so preventative measures or treatment can be done to address any issues you may have. The accumulation of plaque bacteria occurs on all surfaces of our teeth and requires efficient removal by physical disruption with proper brushing and flossing. Essentially we have 5 surfaces to a tooth that can be cleaned, 2 of which are between our teeth. For most people, our teeth are oriented closely and have very narrow spaces in between teeth. When we floss a "snap" occurs as the thin piece of floss is maneuvered between the teeth. The "snap" that occurs gets cleans the bacteria off of the side of our teeth where the bristles of a toothbrush cannot reach. If the bacteria is not cleaned off of the teeth it continues to accumulate in higher numbers and increases problems like gingivitis, periodontist and cavities. Therefore, if the spacing of someone’s teeth is too narrow for a toothbrush to clean and that person does not floss, allowing the bacteria to proliferate, than they will have problems. Further, if left untreated, periodontal disease can worsen, leading to tooth loss and increased risk for other systemic disease such as diabetes and heart disease. The bottom line is, flossing allows for the removal of plaque bacteria and debris from areas in the mouth that brushing alone cannot reach.
Can a Waterpik replace flossing?
While the Waterpik is better than nothing, it cannot replace flossing. Bacteria form a biofilm on the teeth called plaque that sticks very tenaciously to the teeth. Plaque especially likes to accumulate in the very tiny space just beyond the contact between 2 adjacent teeth (which is what causes the small snap people experience when they floss). The tiny space between their teeth and the tenacious sticking of the plaque make it impossible for the irrigation action of the Waterpik to remove all of the plaque. However, the physical action of floss breaking through the contact of the teeth and scraping the sides of the teeth is sufficient enough to disrupt and remove the plaque from in between your teeth.
When do you recommend bringing a child in for their first dental visit?
The American Academy of Pediatric Dentistry recommends your infant go to the dentist for the first time at the age of 12 months. Studies shows starting your child off early at the age of one year old and going every 6 months greatly reduces early childhood cavities. The first couple appointments are intended to look at the teeth of the child, educate the parent(s) and get the child used to the environment so they are not frightened as they get older.
My 5 year old son has an abscess on his tooth. Is the only option to pull it out? I am concerned with the hole in his mouth that will be there for the next 6-7 years.
The literature shows there are two options to treat an abscessed baby tooth. One option is extraction and the other is to do root canal therapy (a root canal) on the baby tooth. However, doing a root canal on a baby tooth is very difficult and can be very expensive, so it is not often done. If a baby tooth is pulled a space maintainer appliance must be inserted by your dentist to maintain the space and prevent the adjacent and opposing teeth from collapsing in on the space (which would require braces to fix). I understand your concern for your son having a "hole" in his mouth but keep in mind kids are often in various stages of losing, missing and getting in teeth so it usually goes unnoticed.
My 4 year old daughter intermittently complains her tooth hurts. It's always the same area. She/we brush well twice daily and she flosses at night. Is this something that needs to get checked out or just 4 year old complaining?
I recommend children see a dentist by their first birthday and routinely see children at the age of 9 months to one year of age. If your daughter has not been to a dentist yet I would highly recommend you see a dentist. Children have a relatively high threshold for pain so her complaining may be a sign of a problem. I would not ignore her complaints and get her to a dentist right away. Baby teeth are prone to getting cavities quickly. Sugary and acidic foods contribute to an accelerated rate of decay (i.e. Soda, fruit juice, candy, gummy vitamins, etc.).
My son has an under-bite. He's 21 months. When will they need to start correcting it?
At 21 months your son has a great deal of jaw growth and development to go. Depending on the severity, your son will require some form of orthodontia (braces) to fix. The Orthodontist will use methods of treatment to help slow and reduce the development of the mandible (lower jaw) while allowing the maxilla (upper jaw) to "catch up" in development so the under-bite is corrected. If the under-bite is severe he may also require surgery and orthodontia to correct. I often will refer my patients with an under-bite to the Orthodontist around the age of 8-9 years old, depending on their rate of tooth development. The current treatment philosophy for most Orthodontist is to treat the patient when all of their baby teeth are lost, which occurs on average around the age of 10-11 years old.
When should I start brushing my daughter's teeth? She is 7 months and has 3 of them.
I recommend you start brushing your daughter's teeth right away. Bacteria adhere and attach to teeth as soon as they break the skin and begin to erupt into the mouth. At 7 months children often like to chew on their toothbrush, which works well in getting the bristles around the teeth to help clean off the bacteria. I would use a small, soft bristled, infant toothbrush which you can often get from the store. Also, now is a good time to begin looking for a dentist for your daughter as the American Academy of Pediatric Dentistry recommends children begin seeing the dentist at the age of one.
My 7 year old still has all of their baby teeth and now I can see an adult bottom tooth growing and pushing up his baby tooth.
Seven years old is late to lose baby teeth but still within the range of normal. Having the lower anterior (front) permanent teeth erupt behind the primary (baby) teeth is fairly common and is also referred to as "shark teeth". It is not something to be overly concerned about. One of two outcomes can arise from this situation: The primary tooth will be lost naturally and pressure from the tongue will push the permanent tooth into the proper orientation over time; or the primary tooth will not be lost naturally and may need to be extracted (pulled) at some point, which is a relativity easy procedure. I would recommend you have your child be evaluated and monitored by your dentist, who will be able to let you know if the tooth does need to be extracted. Be prepared for the other permanent teeth to do the same thing when they begin to erupt. If the primary tooth or teeth need to be extracted your child will require local anesthetic (numbing) in that area and may need to be sedated, depending on their tolerance level. I have successfully extracted teeth in these situations with no sedation, only local anesthetic, with a positive experience for the child many times in the past.
My child has two yellow spots on their front two teeth. They have been like that since they came in around five months (now 23 months old). We have not seen a dentist yet, and my child cannot sit still for longer than two minutes.
From what is described it sounds like your child has hypocalcification/hypomaturation of their baby teeth. During the developmental process for teeth, certain environmental factors can alter the maturation process causing an underdevelopment of the tooth structure. Hypocalcification/hypomaturation can predispose teeth to cavities because they are not as strong and therefore as resistant to cavities as teeth that develop normally. The most common factor, that can alter maturation of teeth, is often frequent or prolonged illnesses in your child, like the flu, ear infections, etc. I would recommend you set up an appointment with a Dentist who has experience treating children and to have your child evaluated. I would also recommend you establish a regular visit interval for every 6 months. A Dentist can determine if there is a problem, how severe the problem is and what can be done to prevent further problems. The majority of children below the age of three are unable to sit still for very long. The Dentist will have a process for evaluating the child, often with your help, which does not take very long. The first couple appointments are intended to look at the teeth of the child, educate the parent(s) and get the child used to the environment so they are not frightened as they get older. By continuing with regular visits your child will begin to get continually more comfortable with going to the dentist. As your child gets more comfortable with his dental visits they will receive more preventative, diagnostic care.
Can I request filling rather than caps for my child, it seems like they cap kid’s teeth more than do fillings?
Primary (baby) teeth are treated with crowns (caps) more frequently than secondary (adult) teeth. The reason crowns are placed instead of restorations (fillings) is that primary teeth decay more quickly and therefore develop bigger cavities than secondary teeth. When cavities exceed a certain size for a given tooth the remaining tooth structure may be too weak to support a restoration. When a cavity exceeds a certain threshold the recommended treatment is a crown because it stabilizes the weakened tooth, providing a treatment with a better long term prognosis. You always have the right to request treatment and ask for an explanation from your dentist for why he/she recommends a given treatment and the risks and benefits of the different treatments. My team and I work hard to educate our patients and parents to help prevent cavities from occurring, or becoming large, prevention is always the best form of treatment.
I have a child with special needs/rare condition that requires them to each a high calorie diet. No matter how many times I brush their teeth it seems like we are always needing to fix a cavity. So far my child has had back teeth pulled and three caps and it looks horrible.
This situation is challenging. I would recommend your child be given a fluoride supplement, if you do not have adequate fluoride in your water, to make permanent teeth more resistant to cavities when they erupt. After your child eats or drinks anything try to give water to help dilute the mouth and if applicable do not give any food at night after dinner (especially not through the night). I recommend avoiding fruit juices and giving fresh fruit instead. In certain situations I recommend the brushing with a prescription anti-bacterial rinse (called Peridex) for my special needs patients. Talk to your dentist about your unique situation and come up with a game plan for things you can do to try to prevent cavities for your child.
My child is 15 months old and when we brush his teeth at home he won't even open his mouth most of the time. How can we see a dentist if he won’t open his mouth and what can we do at home to make brushing teeth less of a fight?
I treat many children in my practice and have had a number of them resistant to letting us look in their mouth. We approach all our patients, especially our nervous and young patients, in a compassionate, nurturing way to establish trust and help them feel more comfortable. We explain everything we are going to do with the parents and child. Depending on the child we may show what we will do to "count their teeth" on our stuffed dinosaur with teeth so the child can see will happen to them. We also educate the parents on ways to brush their kid’s teeth, especially when they are resistant, and discuss if any changes need to be made to diet, brushing, etc. to prevent cavities. The first few appointments often are only exams with the help of the parents and over time the child gets more and more comfortable coming to see us and before we know it the children often are excited to come see us and do great in the dental chair getting their teeth cleaned and looked at by the dentist.
What is the average age babies get their molars?
Babies have two types of molars their first molars and second molars. The first molars erupt on average between the ages of 13-19 months while the second molars erupt on average between the ages of 23-33 months.
What is the best toothpaste and mouth rinse to use for my children who are 8 and 5?
In regard to toothpastes for your children and most children, I recommend any kind of over the counter toothpaste they seem to like the most that contains fluoride. Toothpaste companies are trying to market their products as being superior to other but the two most important things with toothpaste is 1) your child brushes well at least twice a day for two minutes or more (hence the reason I say whatever kind they like because they will be more likely to brush if they like the toothpaste), 2) the toothpaste contains fluoride which is what helps protect our teeth from cavities. With regard to a mouth rinse, I often do not recommend a mouth rinse as they are not needed if the person is brushing and flossing well. Some parents would like to have the added protection of a mouth rinse, so to those parents I recommend ACT fluoride rinse. Never use Listerine as it has a high alcohol content that irritates and dries the mouth, which can cause problems. In my practice, if a child or adult is considered high risk (i.e. has 3 or more teeth with cavities beginning to form in the teeth) I prescribe a high concentration fluoride toothpaste, Colgate Prevident, to be used.
My Two year old is still using a pacifier and now some of the front teeth have become a little misshapen by it. Will this fix its self?
This commonly occurs with children who have habits like sucking on a pacifier, finger(s) and/or thumb. When the child creates a seal around the object and sucks on the object than it pushes on the teeth causing movement (same concept as braces applying a force to teeth to cause movement), which displaces the teeth. Even if your child stops sucking his thumb, the baby teeth will not move back into place. Weening off is good as the sucking pressure can also cause a narrowing of his upper teeth arch. If the upper arch is narrowed than they will likely need what is called a palatal expander when they are older to widen the palate back to a normal dimension. The good news is that if they do not continue the pacifier habit when the permanent teeth erupt they will not have the same displacement. Most kids begin to get their permanent front teeth around the age of 6-6.5 years old. The sooner you can ween off the pacifier the better but displaced baby teeth do not necessarily mean the permanent teeth will be displaced.
My 3 yr old son keeps pushing the bottom of his jaw out like he has an underbite. He holds his mouth in this underbite when he is thinking, drawing, watching TV, playing, and randomly through out the day.
Your son's protrusion (forward positioning) of the mandible (lower jaw) could either be due to a habit he has developed or due to a discrepancy with his bite. There is really no way to stop him from doing what he is doing. He is unlikely to develop any issues with his TMJ at his age and will likely outgrow his habit. I see many children, who grind and protrude their mandibles that outgrow their habit with no issues other than some mildly worn teeth.
My child has a two teeth that are attached at the top and split at the bottom (as a normal tooth would look). Is this normal and should I worry about it?
From what you describe your son has one of two alterations that resulted in his “split” tooth. It is important know that both types of alterations are nothing to be concerned about. One possibility is galled germination, which two “joined” tooth crowns (the portion of the tooth above the gum line) form from a single root. The second possibility is called fusion in which two separate teeth fuse together so you have two roots and two crowns. Both alterations are not common but I have seen multiple patients with each alteration in my career. Formal diagnosis of which alteration is the cause requires a radiograph (x0ray of the area and a clinical examination by his dentist. No treatment is indicated and the alteration often is not replicated in the permanent dentition (adult teeth).
How important is it to get baby checked out once teething starts and some have erupted? Is it necessary to start "brushing" teeth now when baby only has two bottom teeth, with two top ones coming in?
I recommend you start brushing your child's teeth right away. Bacteria adhere and attach to teeth as soon as they break through the gums and begin to erupt into the mouth. At a young age, children often like to chew on their toothbrush, which works well in getting the bristles around the teeth to help clean off the bacteria. I would recommend you brush your child's teeth using a small, soft bristled, infant toothbrush which you can often get from the store. Also, now is a good time to begin looking for a dentist for your baby as the American Academy of Pediatric Dentistry recommends children begin seeing the dentist at the age of one. Baby teeth are prone to getting cavities quickly. Sugary and acidic foods contribute to an accelerated rate of decay (i.e. Soda, fruit juice, gummy vitamins, etc.). Studies show, starting your child off early at the age of one year old and going every 6 months greatly reduces early childhood cavities. The first couple appointments are intended to look at the teeth of the child, educate the parent(s) and get the child used to the environment so they are not frightened as they get older.
How do I get my toddler/little kid/big kid to floss?
The more frequently you attempt to floss, the more quickly the child starts to acclimate to flossing. I also recommend using the flossers with a fun shaped handle, like an animal. I find positive reinforcement also works well in encouraging your child to both floss and brush.
What approach, if any, does Merrimack Smiles recommend when it comes to fluoride supplements for children?
When discussing fluoride for children there are two routes for the administration of fluoride, systemic and topical. Topical application comes in the form of toothpaste and fluoride treatments from your dentist. Topical application helps protect the teeth from the daily attack of bacteria to help prevent cavity formation on erupted teeth. Systemic administration comes in the form of either an adequately fluoridated water and/or fluoride supplements prescribed by your child's dentist (according to the level of fluoride in your water source) to meet the recommendation of the American Academy of Pediatric Dentistry. Systemic administration is important for permanent teeth as they develop and make the teeth more resistant to cavities when they erupt. If the children are not getting adequate fluoride from the water source than I will prescribe fluoride supplements (either in liquid or chewable form) for the child and the dosage is relative to the age of the child. Most sources of water, both well and city, do not have adequate fluoride levels so a fluoride supplement is indicated.
Should I use fluoride toothpaste when brushing my 10 month old's teeth? We only use a very small amount but should I worry about him swallowing it?
The use of a fluoridated toothpaste depends on whether or not he is getting water from a source that is fluoridated. The Center for Disease Control has an area on their website (http://www.cdc.gov/oralhealth/) that lists what water sources are fluoridated or not. When discussing fluoride for children there are two routes for the administration of fluoride, systemic and topical. Topical application comes in the form of toothpaste and fluoride treatments from your dentist. Topical application helps protect the teeth from the daily attack of bacteria to help prevent cavity formation on erupted teeth. Systemic administration comes in the form of either an adequately fluoridated water and/or fluoride supplements prescribed by your child's dentist (according to the level of fluoride in your water source) to meet the recommendation of the American Academy of Pediatric Dentistry. Systemic administration is important for permanent teeth as they develop and make the teeth more resistant to cavities when they erupt. I personally do not recommend the use of a fluoridated toothpaste until the child can spit because there is no way to know how much fluoride the child is consuming and too much fluoride can cause problems. I would recommend you discuss the issue further with your dentist after checking your water source on the CDC website to determine if your son is getting any fluoride from your water.
What is the difference between topical and systemic fluoride applications?
When discussing fluoride for children there are two routes for the administration of fluoride, systemic and topical. Topical application comes in the form of toothpaste, fluoride treatments from your dentist and fluoride rinses such as mouthwashes like Act. Topical application helps protect the teeth from the daily attack of bacteria to help prevent cavity formation on erupted teeth. Systemic administration comes in the form of either an adequately fluoridated water and/or fluoride supplements prescribed by your child's dentist (according to the level of fluoride in your water source) to meet the recommendation of the American Academy of Pediatric Dentistry. Systemic administration is important for permanent teeth as they develop and make the teeth more resistant to cavities when they erupt. If the children are not getting adequate fluoride from the water source than I will prescribe fluoride supplements (either in liquid or chewable form) for the child and the dosage is relative to the age of the child. Most sources of water, both well and city, do not have adequate fluoride levels so a fluoride supplement is indicated. I would not recommend you stop using the fluoride supplement until all of your children’s' permanent teeth have erupted.
If I have a lot of fillings will it give me tinnitus?
I have not identified anything in the literature that associates fillings and tinnitus. On occasion tinnitus can be associated with Temporal-mandibular joint disorder (TMD) in which case your dentist may be able to address and treat. If you are experiencing tinnitus it often is associated with the inner part of the ear and/or the neurology associated with your ear. The best place to start with tinnitus would be an Ear Nose and Throat specialist physician.
I have a bridge and was wondering if a cavity can be fixed without breaking the bridge.
When a bridge is completed, essentially, crowns are placed on either side of a space where a tooth is missing. Crowns are like caps covering the top portions of our teeth. Often when a cavity develops around a bridge it forms at the junction where the tooth and crown meet. The cavity grows up under the cap and the only way the dentist can confidently remove all of the cavity, and prevent even bigger issues down the road, is to remove the entire bridge. Removal of a bridge requires the bridge to be destroyed. Talk to your dentist about other options to replace the missing tooth or if a bridge is the best solution. If possible I often recommend sectioning the bridge to remove and replace the crown on the tooth with a cavity and replacing the missing tooth with a dental implant. By going with an alternative treatment than a bridge you can avoid this problem from occurring again in the future. Dental implants have their limitations and may not be an option for you. Your dentist can provide you with more details regarding your situation and potential options.
Can I request filling rather than caps for my child, it seems like they cap kid’s teeth more than do fillings?
Primary (baby) teeth are treated with crowns (caps) more frequently than secondary (adult) teeth. The reason crowns are placed instead of restorations (fillings) is that primary teeth decay more quickly and therefore develop bigger cavities than secondary teeth. When cavities exceed a certain size for a given tooth the remaining tooth structure may be too weak to support a restoration. When a cavity exceeds a certain threshold the recommended treatment is a crown because it stabilizes the weakened tooth, providing a treatment with a better long term prognosis. You always have the right to request treatment and ask for an explanation from your dentist for why he/she recommends a given treatment and the risks and benefits of the different treatments. My team and I work hard to educate our patients and parents to help prevent cavities from occurring, or becoming large, prevention is always the best form of treatment.
I had 2 teeth filled in July, and a couple of weeks ago they developed a very sensitive reaction to anything even remotely cold. Is there anything I can do to help this?
Temperature sensitivity is normal when you experience a quick "zing" with no lasting/lingering pain. However, if your tooth throbs after exposure to hot, cold or starts to hurt spontaneously with no stimuli (e.g. wakes you up from your sleep at night) than this may indicate you will need root canal therapy (root canal). Other factors can be causing your tooth to hurt. Anything that can introduce inflammation around your tooth can make it more sensitive to chewing, temperature, flossing or all of the above. The most likely cause for your sensitivity is either normal tooth sensitivity experienced after treatment has been done to a tooth or your bite may be off and will require a quick adjustment. I often will place a fluoride varnish on a temperature sensitive tooth to provide insulation and allow the tooth to calm down and adjust to the new filling that has been placed.
I'm on blood thinners and just lost a filling. Will I need to contact my doctor and stop taking the drugs before having the filling replaced?
Replacing a filling will not require you to cease taking your anti-coagulation (blood thinner) medication. The only time your Doctor would have concerns for treatment with your anti-coagulation medications is if surgery was involved.
I realize that a root canal involves "killing" the tooth/nerves. Why do I still have pain coming from that tooth sometimes? It is capped and I have had it for about 6 years.
A root canal involves removal of the nerve and pulp of a tooth. When a root canal has been performed it is supposed to remove the internal nerves of the tooth that respond to hot, cold and sweets. However, if you still have pain coming from the tooth this is not normal and the source of the pain can come from two possible sources. One source could be from the internal portion of the tooth and is the result of an incomplete root canal in which an aberrant nerve was not likely treated with the original root canal. If the original root canal was incomplete an additional "retreat" of the root canal is warranted and you should have the tooth treated by an endodontist (a dentist who specializes in root canals). The other source of the pain could be from nerves outside of the tooth in the bone and tissue surrounding the tooth (called the periodontium). If the periodontium is the source the reason is likely an issue with the bite originating from too much pressure on the crown from the bite not being properly adjusted. If the bite discrepancy is the issue than the dentist who did the crown should be able to adjust the bite and address the issue. I would recommend calling your regular general dentist and set up an appointment to address and diagnose the tooth to determine the origin of the pain. The bottom line is that you should not still have pain and something is wrong with the tooth that needs to be addressed.
I had a dental office talk me into putting crowns on two teeth I have that were cracked but not causing me any pain. Since putting the crown on one of them hurts with hot and cold and when food gets stuck around it. Does this mean I’ll now need a root canal? Can they use the same crown or will I have to pay all over for a crown and now a canal?
Teeth can be sensitive after having treatment where crowns are done. Temperature sensitivity is normal when you experience a quick "zing" with no lasting/lingering pain. However, if your tooth throbs after exposure to hot, cold or starts to hurt spontaneously with no stimuli (e.g. wakes you up from your sleep at night) than this may indicate you will need root canal therapy (root canal). Other factors can be causing your tooth to hurt. Anything that can introduce inflammation around your tooth can make it more sensitive to chewing, temperature, flossing or all of the above. If your new crown is hitting too heavy when you bite, which you may or may not notice, than it can cause significant inflammation and therefore pain in your jaw and tooth. If your bite is not right often a simple adjustment by your dentist can fix the problem. If food is getting stuck around your crown, particularly in between your teeth the crown may not have the proper contours and food sticking around your tooth can cause inflammation and pain. If the pain is coming from inflammation around your tooth than you would not require root canal therapy. However, sometimes cracks in our teeth can allow bacteria to get into the inside of our tooth where the blood supply and nerves of a tooth are located, called the pulp. If bacteria get into the pulp they cause a tooth infection and is an internal source of pain. To remove the infection root canal therapy is required, which can be done through your new crown and often does not require a new crown. You would need to have a filling placed after the root canal therapy to fill the hole created through the middle of the crown so the root canal therapy can be done. Often the filling done is called a post and core which allows the dentist to bond a post into one of your roots which is also bonded to the filling, tooth and crown to increase strength and stability of the tooth. Post and cores for a tooth are similar to the use of rebar in concrete to add strength and reinforcement. In rare occasions, cracks in a tooth can propagate deeper into a tooth causing a vertical root fracture, which is one of the main reasons dentists recommend crowns when they see significant cracking of a tooth. When a tooth undergoes a vertical root fracture there is no long-term treatment option for the tooth so an extraction is indicated and treatment to replacing the missing tooth. As you can see there are many things that can cause pain in a tooth but often it is simply normal sensitivity or an issue with the bite being off requiring a quick bite adjustment. I recommend you call your dentist office and schedule an appointment to have the tooth examined to determine the origin of the pain.
I had a very bad experience at my last dentist and now the only way I can go is if I am put out completely, do many dentists do this and if so which ones?
Unfortunately I have treated quite a few patients who have had bad experiences and developed extreme fear for the dentist. Very few general dental offices provide the deep sedation that "put you out completely". Deep sedation can only be provided by Oral Surgeons or Anesthesiologists which requires the dentist to bring someone like that into the office or treat you in a hospital setting. However, there are lighter forms of sedation which do not "put you out completely" but rather sedate you to a level that alleviates your extreme anxiety/phobia while allowing you to still be awake. The lighter form of sedation is called conscious sedation and involves you taking a medication class called benzodiazepines. Another form of anxiety relief can come from nitrous oxide. Not all offices provide the lighter form of sedation but if they do provide sedation they will state it on their website. I see a great deal of patients with severe dental anxiety/phobia and use both of the anxiety alleviating forms I mentioned previously. Additionally, I find the best form of anxiety relief is establishing a good sense of trust with my patients. Dental anxiety is associated with a bad, often painful, experience, in which trust for dentists is lost to varying degrees. I would recommend you talk to people you know and go to a dentist referred to as being caring and trustworthy. When you meet with the dentist explain your bad experience so they best know how to treat you to alleviate your anxiety. Once you have one or more positive experiences with the dentist you will begin to develop trust again and your fear will either decrease or go away completely. I would not recommend you avoiding going to a dentist because problems can occur, often causing dental infections and pain, which will only increase your fear for the dentist.
What is your suggestion for someone that has a severe phobia of the dentist?
For patients with severe dental phobias I recommend several things. One is that you find someone with whom you think you can trust over time. Dental phobias arise from a past experience that is remembered very vividly in which the patient had a terrible dental experience often with a great deal of pain. Finding a dentist who is compassionate and understands how to treat patients with a severe dental phobia is key. The dentist needs to establish a relationship with the patient and over time develop at least a basic level of trust from the patient. Some patients require anxiolytic (anxiety reducing) medications to help them get through appointments. Anxiolytic medications commonly used are nitrous oxide (happy gas), Xanax, Valium or Halcion. I treat many patients with dental phobias and dental anxiety in my practice and have been successful in doing so by providing a team of compassionate individuals that compliment my caring nature to provide a comfortable environment. I provide a comfortable environment and establish trust with all of my patients by educating them about what to expect, what I am doing as I am providing treatment and going slower and allowing frequent breaks so the patient does not feel rushed or overwhelmed. Most people think they are the only person with a dental phobia, talk to your friends and family, you will be surprised how many others have a fear of the dentist. Those who have a phobia can often recommend a dentist who is good at treating patients with fear for the dentist. I would not avoid the dentist because the longer you go without seeing a dentist the more problems that occur and the worse it can get, which only feeds into the phobia itself. Preventive care goes a long way in preventing bad things from happening.
Is there an over the counter whitening product that is "safe" to use?
There are many types of over the counter whitening products like toothpastes, mouth rinses and whitening strips. The active ingredient in most whitening products is either hydrogen peroxide or carbamide peroxide (which gets broken down into hydrogen peroxide and another by product). There have not been any long term studies on the safety of frequent exposure of your mouths tissues to hydrogen peroxide. However, in moderation I have not seen any major issues with the use of whitening products. Mild problems associated with any whitening product include tooth sensitivity and mild tissue irritation. Thus far it appears that over the counter whitening products are relatively safe to use.
How do you get rid of or help geographic tongue?
Erythema migrans, referred to as geographic tongue, does not have a specific known cause. Suspected causes include nutritional deficiencies, stress and hereditary origins. While the appearance of the tongue may be alarming to people, the condition is not harmful. Some cases of geographic tongue resolve on their own but may take years to do so. I would recommend you talk to your primary care physician to evaluate for nutritional deficiencies and consider taking a good quality multivitamin. Avoid any foods that are acidic or spicy as these may cause a stinging sensation with the tongue. If you have a prolonged burning sensation you may have Candidiasis and your dentist can treat this problem to address the burning.
What is the flap of skin/bump that sits behind the two front teeth and what does it do?
The bump behind your 2 front teeth is called the incisive papilla and is skin covering a nerve called the nasopalatine nerve, which provides sensation to the front part of your palate (roof of your mouth).
Do you have any tips or tricks to help me stop biting my inner cheeks and lips?
Your situation is common and the remedy can be complex. Most people who bite their inner cheeks and lips will do it subconsciously so it can be tough to stop since you do not aware of what you are doing. I have two recommendations that I have found work well for most of my patients. The first recommendation is to work on being very aware of your habit during the day and do your best to stop the biting immediately when identified. Try to keep space between your teeth (the only time your teeth should touch is when you are chewing food). The second recommendation is to talk to your dentist and have an occlusal guard fabricated or try an sports guard from the sporting goods store, which is to be worn when you are sleeping. A custom guard from your dentist can help protect your teeth, temporomandibular joint (jaw joint or TMJ) and muscles to reduce sensitivity, pain, clenching, grinding and headaches. A sports guard may only keep you from biting your cheeks and lips, but may be all you need to break your habit. Stop using the sports guard if you experience pain in your jaw, face or have more headaches, as these guards can cause these problems. Many people grind their teeth, bite their cheeks, lips and/or tongue when they are sleeping and unaware they are doing so. A guard provides protection for your teeth and provides enough overlap from your teeth to keep the tissue away from the impingement points so you physically cannot bite yourself. Some people may also wear their guard during the day to prevent themselves from biting their tissue if they cannot stop otherwise.
Why would my teeth be pitting, and what's the best way to fix it?
There are a few causes for pitting in teeth. One cause occurs when an issue occurs during the development of a tooth and the tooth does not develop completely. Another cause is from chronic (long-term) exposure to an acidic environment. An acidic environment can occur from Gastroesophageal Reflux Disease (GERD or chronic acid reflux) and/or acidic foods and drinks. The acidic environment causes degradation of the tooth structure. Pitting of teeth may or may not need any form of treatment to fix the problem. If the pitting is minor, not noticeable, and not sensitive with no cavity, then no treatment is required. If the pitting is noticeable and/or sensitive with no cavity it may need to be sealed. If the pitting has a cavity and is a significant problem it may need treatment with a filling, veneer or crown. I would recommend you be evaluated by a dentist to determine if treatment is required and to assess if there is a cause that can be addressed to prevent further problems.
Would cracks in teeth be noticed during a regular cleaning/checkup with X-rays? Or would they be noticed right before a filling was put in? Or is it possible they wouldn't be noticed until after the newly placed filling was removed due to pain starting as soon as the local wore off?
Cracks in teeth can be very obvious or subtle. Some cracks are larger and can be identified easily during a regular checkup or before a filling is put in. Some cracks are more subtle and can only be identified after a cavity or existing filling has been removed. Some cracks are very subtle and cannot be identified visually but only by specific tests or symptoms of the patient (i.e. pain after local anesthetic wears off). However, pain after a filling does not necessarily mean you have a cracked tooth. Pain can originate from the filling not having the proper anatomy and therefore causes an interference with your bite. Some discomfort and cold sensitivity is not uncommon after any dental work has been done. If you have a quick jolt of pain when you bite into something hard, like an almond or a tough piece of bread that can be an indication that you have a deeper crack in your tooth referred to as "cracked tooth syndrome". I would recommend you be evaluated by a dentist to identify if a crack is present and if so whether it is causing your pain. I also would recommend you find the cause of the crack as certain things, like clenching and grinding, can cause cracking of other teeth so protective measures can be taken to prevent future problems.
My daughter had her wisdom teeth taken out last year. Since then she gets ear pain and her jaw locks. Could the two be related?
The issues described are consistent with symptoms for Temporo-Mandibular Joint Disorder or what people refer to as TMJ or TMD. Our jaw joint is very complex and therefore is susceptible to problems. TMJ/TMD is most often associated with pain in a person's jaw joint due to tight, overworked muscles of the mouth. The jaw joints sits right in front of our ears and when put under tension from tight, sore muscles does not function smoothly, therefore resulting in locking of the jaw. The TMJ/TMD problem is associated with long-term and/or extreme clenching and grinding. Clenching and grinding are often a result of stress we have in our lives. Removal of the wisdom teeth can be stressful on the person and also the jaw joint so it likely was not the cause but could have contributed to the problem occurring quicker than it would have otherwise. Treatment for TMJ/TMD requires an evaluation by your dentist as it is a condition that can have many different variables and therefore different types of treatment. Often, TMJ/TMD can be treated successfully with a custom occlusal guard designed and fabricated by your dentist. I would recommend you have your daughter evaluated by her dentist soon as this problem can continue to get worse and can become very painful. In the meantime treat it as you would any other injured joint by resting (not chewing gum, soft foods that do not require overworking of the muscles, use of anti-inflammatory medication like ibuprofen, rest and ice or heat on the painful areas. In my practice, I see many patients with TMJ/TMD and have continued to see a steady increase in the number of patients with TMJ/TMD. Modern day lives are becoming increasingly more stressful and as a result we are seeing a rise in the associated problems in the head, neck and jaw regions.
What is the best route to have all four wisdom teeth pulled; one at a time or all four at once?
If multiple teeth need to be extracted (pulled) I recommend you have them all done at the same time. With wisdom teeth, some people prefer to be sedated for the procedure and doing them individually will greatly increase the cost to the patient. When you have teeth extracted some post-operative soreness is to be expected and I have found that my patients experience less discomfort by getting all the extractions done at once as opposed to being sore multiple times. The only exceptions are for patients with severe medical issues which require the lease amount of surgery necessary at one time and for patients who cannot afford to have all the teeth extracted in one appointment. So for most people, it will be less expense with less sensitivity if you have all the teeth extracted compared to one tooth at a time.
In the news it came out that flossing wasn't necessary. How do you feel about it?
The recent news release regarding flossing has gathered a great deal of attention. The American Academy of Periodontology (Periodontists are specialist dentists that treat diseases of the gum and bone) recommends daily flossing and brushing twice daily as part of your regular oral hygiene routine. Regular visits to your dentist for examinations is important to identify potential problems (i.e. gingivitis, periodontist, cavities, etc.) early so preventative measures or treatment can be done to address any issues you may have. The accumulation of plaque bacteria occurs on all surfaces of our teeth and requires efficient removal by physical disruption with proper brushing and flossing. Essentially we have 5 surfaces to a tooth that can be cleaned, 2 of which are between our teeth. For most people, our teeth are oriented closely and have very narrow spaces in between teeth. When we floss a "snap" occurs as the thin piece of floss is maneuvered between the teeth. The "snap" that occurs gets cleans the bacteria off of the side of our teeth where the bristles of a toothbrush cannot reach. If the bacteria is not cleaned off of the teeth it continues to accumulate in higher numbers and increases problems like gingivitis, periodontist and cavities. Therefore, if the spacing of someone’s teeth is too narrow for a toothbrush to clean and that person does not floss, allowing the bacteria to proliferate, than they will have problems. Further, if left untreated, periodontal disease can worsen, leading to tooth loss and increased risk for other systemic disease such as diabetes and heart disease. The bottom line is, flossing allows for the removal of plaque bacteria and debris from areas in the mouth that brushing alone cannot reach.
Can a Waterpik replace flossing?
While the Waterpik is better than nothing, it cannot replace flossing. Bacteria form a biofilm on the teeth called plaque that sticks very tenaciously to the teeth. Plaque especially likes to accumulate in the very tiny space just beyond the contact between 2 adjacent teeth (which is what causes the small snap people experience when they floss). The tiny space between their teeth and the tenacious sticking of the plaque make it impossible for the irrigation action of the Waterpik to remove all of the plaque. However, the physical action of floss breaking through the contact of the teeth and scraping the sides of the teeth is sufficient enough to disrupt and remove the plaque from in between your teeth.
I want to get an electric toothbrush. What do you recommend?
Not all electric toothbrushes are equal in the effectiveness. The top two electric toothbrushes are the Sonic Care and Oral-B Pro. I personally like the oscillating action of the Oral-B pro and recommend the 5000 model as it has good features at a good price. I often recommend talking to your dentist when purchasing as they often have a better price than buying it anywhere else.
What grit of sanding paper would you recommend for filing down your own teeth 2000? and it best to wet sand or dry sand?
I would not recommend any at home dentistry, even sanding with a fine grit can cause damage to your teeth. See your dentist for any problems you may have to avoid exacerbation on an existing problem.
What are your thoughts on using bentonite clay and activated charcoal as a toothpaste instead of a fluoride based one.
I am not aware of any research that has been done to test the effectiveness of bentonite clay and/or activated charcoal when used as a cleaning agent for the teeth and mouth. Professionally I have treated a number of patients who do not wish to use fluoride and often use Tom’s of Maine toothpaste instead. I have found that if the patient is very diligent with their oral hygiene, brushing and flossing very effectively, they often have a low cavity rate and healthy mouths. Fluoride helps prevent cavities so not using it increases your risk for cavities. However, not using fluoride does not necessarily mean you will get cavities. Good hygiene, a healthy diet with limited sugars, acid, etc. with regular preventive appointments with your dentist are the most important factors for a healthy oral environment being healthy in general.