Dental implants have soared in popularity thanks to their life-likeness, functionality and durability. But these prized qualities have also created an ironic downside—people are much more likely to replace a tooth with an implant rather than go through the time and effort to preserve it.
We say downside because even though an implant is as close to a real tooth as we can now achieve in dentistry, it still can't rival the real thing. It's usually in your long-term health interest to save a tooth if reasonably possible. And, there are effective ways to do so.
Most dental problems arise from two common oral diseases. One is tooth decay, caused by contact with acid produced by bacteria living in dental plaque. We can often minimize the damage by treating the early cavities decay can create. But if we don't treat it in time, the decay can advance into the tooth's pulp chamber, putting the tooth in danger of loss.
We can intervene, though, using root canal therapy, in which we drill into the tooth to access its interior. We clean out the decayed tooth structure, remove the diseased pulp tissue and fill the empty chamber and root canals to seal the tooth and later crown it to further protect it from re-infection.
Periodontal (gum) disease also begins with bacteria, but in this case the infection is in the gum tissues. Over time the ensuing inflammation locks into battle with the plaque-fueled infection. This stalemate ultimately weakens gum attachment, the roots and supporting bone that can also increases risk for tooth loss.
We can stop a gum infection through a variety of techniques, all following a similar principle—completely removing any accumulated plaque and tartar from the teeth and gums. This stops the infection and starts the process of gum and bone healing.
You should be under no illusions that either of these approaches will be easy. Advanced tooth decay can be complex and often require the skills of an endodontist (a specialist in root canals). Likewise, gum disease may require surgical intervention. But even with these difficulties, it's usually worth it to your dental health to consider saving your tooth first before you replace it with an implant.
If you would like more information on how best to treat a problem tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Save a Tooth or Get an Implant?”
Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.
Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.
TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.
There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.
Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.
For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.
One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.
The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.
If you would like more information on trigeminal neuralgia, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”
Boston Bruins defenseman Zdeno Chara had a rough Stanley Cup final against the St. Louis Blues this past June. Not only did the Bruins ultimately lose the championship, but Chara took a deflected puck shot to the face in Game Four that broke his jaw.
With the NHL season now over, the 42-year-old Bruins captain continues to mend from his injury that required extensive treatment. His experience highlights how jaw fractures and related dental damage are an unfortunate hazard in hockey—not only for pros like Chara, but also for an estimated half million U.S. amateurs, many in youth leagues.
Ice hockey isn't the only sport with this injury potential: Basketball, football (now gearing up with summer training) and even baseball players are also at risk. That's why appropriate protective gear like helmets and face shields are key to preventing injury.
For any contact sport, that protection should also include a mouthguard to absorb hard contact forces that could damage the mouth, teeth and gums. The best guards (and the most comfortable fit) are custom-made by a dentist based on impressions made of the individual's mouth.
But even with adequate protection, an injury can still happen. Here's what you should do if your child has an injury to their jaw, mouth or teeth.
Recognize signs of a broken jaw. A broken jaw can result in severe pain, swelling, difficulty speaking, numbness in the chin or lower lip or the teeth not seeming to fit together properly. You may also notice bleeding in the mouth, as well as bruising under the tongue or a cut in the ear canal resulting from jawbone movement during the fracture. Get immediate medical attention if you notice any of these signs.
Take quick action for a knocked-out tooth. A tooth knocked completely out of its socket is a severe dental injury. But you may be able to ultimately save the tooth by promptly taking the following steps: (1) find the tooth and pick it up without touching the root end, (2) rinse it off, (3) place it back in its socket with firm pressure, and (4) see a dentist as soon as possible.
Seek dental care. Besides the injuries already mentioned, you should also see a dentist for any moderate to severe trauma to the mouth, teeth and gums. Leading the list: any injury that results in tooth chipping, looseness or movement out of alignment.
Even a top athlete like Zdeno Chara isn't immune to injury. Take steps then to protect your amateur athlete from a dental or facial injury.
If you would like more information about dealing with sports-related dental injuries, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Athletic Mouthguards” and “The Field-Side Guide to Dental Injuries.”
There are a few mouth conditions so rare most of us have never heard of them. Geographic tongue would fall into this category, affecting only one to three percent of the population. Even so, these irregular reddish patches resembling land masses on a map (hence the name) might be alarming at first glance—but they pose no danger and usually cause very little discomfort.
Geographic tongue is also known as benign migratory glossitis. As its clinical name implies, the unusual red patchy areas (often surrounded by a grayish white border) aren't cancerous nor contagious. The patches also appear to change shape and move around ("migrate") the tongue.
The reddish appearance comes from the temporary disappearance of tiny bumps on the tongue surface called papillae, which can leave the tongue smooth to the touch in affected areas. The lost papillae may reappear again a few hours or days later, and may occasionally disappear again. While it's not painful, you can experience a stinging or burning sensation emitting from these patchy areas.
We're not sure how and why geographic tongue erupts, but it's believed high emotional or psychological stress, hormonal imbalance or certain vitamin deficiencies might be factors in its cause. There may also be a link between it and psoriasis, a condition that can cause dry, itchy patches on the skin.
If you're one of the rare individuals who has episodes of geographic tongue, the good news is it's harmless, only mildly uncomfortable and usually temporary. The bad news, though, is that there's no known cure for the condition—but it can be managed to ease discomfort during outbreaks.
It's been found that highly acidic and spicy foods, as well as astringents like alcohol or some mouthrinses, can increase the level of discomfort. By avoiding these or similar foods or substances, you can reduce the irritation. Your dentist may also be able to help by prescribing anesthetic mouthrinses, antihistamines or steroid ointments.
For the most part, you'll simply have to wait it out. Other than the mild, physical discomfort, the worst part is often simply the appearance of the tongue. But by watching your diet and other habits, and with a little help from us, you can cope with these irritations when it occurs.
If you would like more information on geographic tongue and similar oral issues, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Geographic Tongue: No Cause for Alarm.”
"Mom, my tooth hurts" isn't something you look forward to hearing your child say. But tooth pain is as common as other childhood ailments, so you may have to face it. Here are a few simple steps to make it easier.
First, ask your child where in the mouth it hurts and, if they can, tell you how long it's been hurting. Children's memories aren't always accurate, but you can still get a general idea that you can communicate with your dentist if you take them in.
Next, look in their mouth for anything out of the ordinary: gum swelling or bleeding, or dark spots on the teeth indicative of tooth decay. Look also for hard food particles like popcorn kernels caught between the teeth, which could be causing the pain. Gently floss between the teeth (even if you can't see anything) to remove any caught particles.
You'll also want to help ease their pain. You can apply an ice pack against the painful side of the jaw. Don't place ice directly on the skin, but use a container or cloth alternately against the jaw for a minute or so, and then away for a minute. You can also give them a dose of mild pain reliever like ibuprofen or acetaminophen appropriate for their age and weight—but never rub aspirin or other pain relievers on the gums, which tend to be acidic and can burn the skin.
Finally, you'll need to decide if you need to see a dentist and how soon. It might not be necessary with situations like the trapped food particles, but most of the time it's wise to have your dentist perform an examination for an accurate diagnosis and appropriate treatment. As to how soon, try to see the dentist immediately if the pain has continued from one day to the next or has kept your child up overnight. Otherwise, book an appointment for as soon as the dentist advises, even if the pain subsides.
A toothache at any age is never pleasant, but especially for children. Knowing these steps will help ease their discomfort and get them the relief and treatment they need.
If you would like more information on dental care for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child's Toothache: Have a Dental Exam to Figure out the Real Cause.”
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