Posts for: April, 2014
Periodontics is a branch of dentistry that specializes in the supporting structures around the teeth, including the gums and bone, as well as the ligaments that join these structures to the tooth roots. From the Latin peri (“around”) and the Greek odont (“tooth”), periodontics serves one purpose: to keep these supporting structures healthy.
This specialty is critical when it comes to periodontal disease. The term actually refers to a category of inflammatory diseases that affect the periodontal tissues. The inflammation arises from the body's response to bacterial plaque that has collected at the gum line because of poor oral hygiene. It begins as gingivitis (inflammation of the gums), but if left untreated can develop into periodontitis, which results in bone loss. If left to continue, eventual tooth loss occurs.
Proper oral hygiene and regular cleanings are your best defense against developing periodontal disease in the first place. Once the disease gains a foothold in the area below the gum line, routine brushing and flossing will not be enough. To defeat the disease will require more aggressive treatment.
This usually begins in our office with oral hygiene instruction, scaling and root planing or debridement to rid the root surfaces of plaque and calcified deposits, also referred to as tartar or calculus. This may be followed up with a surgical procedure to remove any remaining pockets that were too deep to resolve with conservative treatment.
Another option we may add to your oral hygiene routine is the use of an anti-microbial mouthrinse, usually containing a 0.12% solution of chlorhexidine. We may also prescribe the use of a topically-applied antibiotic such as tetracycline to stop the infection and promote tissue healing.
Once the disease is arrested, it's important that you continue good oral hygiene practices. Vigilance and prevention are critical to keeping these all important structures around your teeth healthy and functioning.
If you would like more information on the diagnosis and treatment of periodontal disease, 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 “Treating Difficult Areas of Periodontal Disease.”
“We all scream for ice cream,” the saying goes. But what if eating ice cream — or any very cold or hot food — literally makes you want to scream because your teeth hurt so much?
What causes sensitivity in teeth?
Understanding the anatomy of a tooth helps explain what happens when a tooth becomes sensitive to heat and cold. A tooth is composed of three types of tissue: a hard outer shell of enamel, the body of the tooth composed of the dentin, and an interior tissue of the pulp.
Enamel: The enamel forms the outside of the crown, the part of the tooth you normally see. Made of densely packed crystals of calcium, it is resistant to wear. It is not living tissue, and does not contain nerves, but it is capable of transmitting temperature like hot and cold.
Dentin: Inside the tooth's crown and root is a living tissue called dentin, which is a porous structure similar to bone. It is composed of microscopic tubules containing living cells, which are encased in a hard substance made of calcium crystals.
Pulp: The living dentin transmits sensation through to the pulp, which is in the center of the tooth and contains the tooth's blood vessels and nerves.
A tooth's enamel normally protects the dentin from exposure to extremes of temperature and pressure. If you wear away the enamel and expose the dentin, it will pass sensation through to the nerves in the pulp more directly. The result can range from a twinge to an excruciating pain.
Sensitivity can be caused by:
- Overzealous tooth brushing resulting in enamel wear and consequently dentin exposure and wear.
- Enamel and dentin erosion by acids in the foods and beverages you eat and drink.
- Tooth decay — the most common cause of sensitivity. Decay destroys enamel and dentin inflaming and infecting the living tissues of the pulp, which become increasingly painful.
What can you do to make your teeth less sensitive?
- Use a soft bristle tooth brush, and brush the affected teeth gently to remove all bacterial plaque. We can advise you on safe and effective brushing techniques.
- Use toothpaste that contains fluoride. Fluoride strengthens tooth surfaces and makes them more resistant to sensitivity and decay.
- Ask us about professionally applied fluoride varnishes or filling materials that can cover and replace sensitive or lost tooth structure.
Of course, if the problem is caused by tooth decay, make an appointment with us to remove the decay and place a filling in the sensitive teeth.
People who fly or scuba dive know firsthand how changes in atmospheric pressure can affect the body: as minor as a popping in the ears, or as life-threatening as decompression sickness. Pressure changes can also cause pain and discomfort in your teeth and sinuses — in fact, severe pain could be a sign of a bigger problem.
Barotrauma (baro – “pressure;” trauma – “injury”), also known as a “squeeze,” occurs when the unequal air pressures outside and inside the body attempt to equalize. Many of the body's organs and structures are filled with air within rigid walls; the force created by equalization presses against these walls and associated nerves, which in turn causes the pain.
The sinus cavities and the middle ear spaces are especially sensitive. Each of these has small openings that help with pressure equalization. However, they can become swollen or blocked with mucous (as when you have a head cold), which slows equalization and contributes to the pain.
It's also possible to experience tooth pain during pressure change. This is because the back teeth in the upper jaw share the same nerve pathways as the upper jaw sinuses — pain originating from the sinuses can be felt in the teeth, and vice-versa. In fact, it's because of this shared pathway that pressure changes can amplify pain from a tooth with a deeper problem, such as a crack, fracture or a defect in dental work.
Besides problems with your teeth, the severe pain could also be related to temporo-mandibular joint dysfunction (TMD), which is pain or discomfort in the small joint that connects your lower jaw to your skull. There are a number of causes for this, but a common one for scuba divers is an ill-fitted regulator mouthpiece that they are biting down on too hard while diving. A custom-fitted mouthpiece could help alleviate the problem.
If you've been experiencing tooth pain during pressure change events, you should see us for an examination before you fly or dive again. There might be more to your pain — and correcting these underlying problems could save you extreme discomfort in the future.
If you would like more information on the effects of atmospheric pressure changes on teeth, 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 “Pressure Changes Can Cause Tooth & Sinus Pain.”