Month: June 2014

Does “Root Canal” Hurt?

The short answer to the question “Does Root Canal Therapy Hurt” is absolutely No.  The procedure itself should not hurt if performed under anesthesia.  The patient may not be able to get numb for the procedure because of bacteria secreting toxins that changes the chemistry in the tissue that prevent the proper action from the anesthetics.

For a longer answer, we can look into what kind of discomfort might be experienced by the patient and the cause of those discomfort.  My goal of this article is to educate the public about this common dental emergency procedure and to help people to cope with the fear of going to the dentist.

There are two major sources of discomfort experienced by the patient during the root canal therapy procedure.  One kind of discomfort is of nervous origin.  It can be the pain/discomfort from not having enough anesthesia.  Another kind of discomfort comes from the physical distress from undergoing the procedure, such as from opening the jaw for an extended time, stretching of the cheek and retracting of the tongue.

The nervous pain is due to the problem of patient not being able to get enough anesthesia from the injected anesthetics.  There are many possibilities of why patient cannot get numb.  It can be due to the anesthetics not penetrating to the location where the nerve is located or there is not enough anesthetics to sufficiently numb the nerve.  This usually can be easily corrected by letting the dentist to readjust the site of injection so that the anesthetics can get to the right place or, if there is not enough anesthetics, dentist can give additional anesthetics to the area.  However, there are times that the patient might still not be able to get numb even after the dentist does the necessary steps of injecting the anesthetics.  The chemistry of the body tissue might have changed due to the presence of bacteria when the patient is having dental infection.  Sometimes the infection might affect only one smallest part of the nerve within the tooth and the dentist won’t be able to find out until the tooth has been worked on in the middle of the treatment.  Most of the time, the tooth can be anesthetized if the dentist administers additional anesthetics, but in some rare instances if the patient still cannot get numb, the dentist might tell the patient to come back after a week of taking the antibiotics.

During the root canal therapy procedure, the patient might have physical distress from the technical aspect of the procedure.  The patient’s jaw might get tired from opening wide for extended time.  Or patient might have discomfort from having the cheek stretched.  Most of this is due to the technical aspect of the root canal therapy.  The patient might need to open for extended time because root canal therapy consists of multiple steps which requires the most concentration from the dentist and it takes time to thorough treat the infection within the infected nerve canal in the tooth.  Sometimes if the patient cannot open wide enough, it might add difficulty for the dentist to be able to see and reach the nerve canals in the tooth.  And also, sometimes the patient would express their distress in their body movement.  So even though we cannot change the technical aspect of the procedure and we cannot change how wide the patient can open their mouth, we can educate patient about the procedure and let them more tolerable to the procedure.  A calm patient will definitely contribute to the outcome of the root canal therapy.

In summary, the root canal therapy is not a painful procedure.  Under proper anesthesia and proper physical coping, the patient should have a pleasant experience of undergoing the dental procedure.  The fear of going to the dentist is due to the lack of understanding of the dental problems and the dental procedures.  I hope people to find that the root canal therapy is not “scary” so they can get the necessary dental treatment to save their teeth.

 

Written by Daniel Tee, DDS, MS

Practicing Emergency Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Baby Bottle Syndrome

Nursing Bottle syndromeTooth decay in children and infants are often referred to as Baby Bottle Syndrome. It happens when sweetened liquid (such as juice, milk, and pacifiers dip into the sweetener) clings onto the teeth for prolonged period of time and bacteria lived off from these sugar and secrete acidic metabolic  byproducts that damage the tooth structure.

Many parents would allow the baby to sleep with the bottle of milk or juice.  Also, they would give the child pacifiers dip into sugar water.  These would promote tooth decay because during sleep, the salivary flow would decrease and there is not enough saliva to wash away these sugar from the teeth.

Baby teeth are important because they are needed to chew food for proper nutrition.  Also, they are important for speaking and smiling.  The baby teeth are there to serve as placeholders for adult teeth when the adult teeth starts to come in.  Without these baby teeth, the adult teeth would come in improper position and the adult teeth become crooked.  Decayed or damage teeth can affect development of speech learning.  Decayed teeth can also become painful.

There are many methods to avoid baby bottle syndrome:

1.  Use and teach proper oral hygiene to child. Use dampened cloth to wipe the baby teeth after ingestion of food, milk or sweetened liquids.

2.  Floss the baby teeth

3.  Clean and massage the gum area.

4.  Make sure your child has proper fluoride exposure such as fluoridated drinking water, fluoride-containing toothpaste, etc.  Also go to the dentist for checkup and to give your child fluoride treatment on teeth.

5.  Don’t let your child to sleep with bottle of milk or sweetened liquids.

6.  Don’t dip pacifiers into sugar water.

 

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Periodontal Probing

Periodontal probing is the measurement of the gum pockets for evaluating the periodontal disease status.  It is done with a periodontal probe which is a instrument with depth marking and it is inserted into the gum pocket to measure its depth.  The depth of the gum pocket corresponds to the loss of attachment of the gum tissue to the surface of tooth.  It indicates the periodontal disease status.

 

The loss of attachment occurs when there is inflammation of the gum tissue.  When there is a bone loss around a tooth, the periodontal probing can also indicate the amount of bone loss.  The amount of bone loss can also be confirmed by the bitewing radiographs.

For new patient who comes in for comprehensive exam, I would establish a baseline periodontal probing measurement and record those measurements in patient’s chart.  Each tooth is probed at six different site.  Three on the facial side of the tooth; another three on the lingual side of the tooth.  The recorded gum pocket depths are written on the periodontal chart.  The following is a periodontal chart:

Periodontal disease, gum treatment

Periodontal disease, gum treatment

 

The patient has only one missing teeth.  The teeth are numbered from 1 to 32.   There are three dates on the chart.  The initial baseline measurements show probing depth ranging from 1 to 5 mm.  Depth from 1 to 3mm is considered normal depth for typically healthy gum tissue.  Depth from 4 to 5 mm indicates some incipient periodontal problem.  From the initial measurements, it shows that the patient used to have incipient stage of periodontal disease.  Thus I perform the periodontal treatment called Scaling and Root Planing.

 

Then patient would come in for periodontal maintenace once every 3 months.  Subsequent visits I re-measure the gum pockets and the patient shows significant improvement in the health of gum tissue.  There are reduction of pocket depths.  In the most recent visit, patient has almost all of his teeth return to normal range.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Oral Health Affects Systemic Health

Proper oral hygiene does not only prevent cavities; proper oral hygiene can benefit your overall systemic health.

Research shows that oral health is closely related to the systemic health.  For example, periodontitis affects other vital organs in the body and contributes to diseases, like the cardiovascular disease, diabetes, breathing problems, osteoporosis, arthritis, etc.  From a research conducted by University of North Caroline, researchers show that patients with periodontitis are more likely to die from heart attack than those patients without periodontitis.  Also, the patients with periodontitis would be more likely to die from stroke than those patients without periodontitis.

Periodontitis is one of the most common infection in the world.  Our mouth is a entry way for bacteria.  Bacteria in the mouth can cause infection to the gum.  They can also travel through the blood stream and infect other vital organs, such as the heart, in the body.

Periodontitis can affect the diabetes status.  With proper treatment of periodontitis, it can help decrease the diabetic index.

For good overall heatlh, oral hygiene plays a vital role.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Missing Posterior Molar Teeth Can Start Series of Dental Problems

It is common that people have one or two missing teeth and sometimes people would ignore restoring those missing posterior molar teeth, because people would think it is at the back and nobody can see their missing teeth.  Also, people chose not to restore them because of cost of replacing them and they believe they are chewing fine with their remaining teeth.

Tooth Split

Tooth split due to excessive biting pressure. The patient has missing posterior molar teeth and mainly use the small premolars to chew.  Excessive biting pressure cause the premolar to fracture.

However, posterior teeth are especially important for chewing.  Lack of posterior molar teeth can dramatically decrease a person’s chewing efficiency.  Also the lack of posterior molar teeth can put additional stress on the rest of remaining other teeth.  I will show a photo of a patient who recenlty come to my office.  She has missing posterior molar teeth on both side of her mouth.  She mainly only chew with the premolars and anterior teeth which are relatively small and are not designed to handle the stress in chewing and grinding food.  Thus, with times, the right upper premolar tooth becomes fractured.  The photo shows that the tooth has a fracture line down thru the mid-section of the tooth.  Upon clinical examination, the fracture actually goes deep down to the mid root and this tooth cannot be repaired and needs to be extracted.

Another problem with missing teeth is that the teeth around the missing tooth area would start to shift in position.  The other teeth may collapse into the empty space.  The bite will be in disharmony and excessive wear and tear will happen to the other teeth.  Opposing teeth would start to come down and eventually they would touch the gum.  The opposing teeth will be affected and may have the risk of losing them, in addition to the already missing teeth.

Teeth Collapse

Upper teeth start to drift downward and eventually would come out of the bone socket.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

 

Cosmetic Dentistry — Facial Golden Ratio, the Key to Beauty

In Comsetic Dentistry, Golden Ratio is one of the most important guide in designing dental restorations to improve a person’s smile.

If a person’s face is even, and has proper proportions, we would say this person is healthy looking and maybe further to say he/she is attractive.  In the Renaissance period in Europe, Greek artists use the “Golden Ratio” to create sculptures of gods/goddesses and architects use the “Golden Ratio” to design buildings.  Now, the scientists rediscover this golden ratio to be one of the most important factors in determining beauty.

Golden Ratio is a number of 1.6.  For example, if the ratio of the length and the width of a face is 1.6, then this face is usually perceived as more attractive.  Teeth can influence the length of a face.  When some teeth are broken or missing, the lower jaw will become closer to the upper arch at its maximum closure.  Thus, the face will appear to become shorter.  Furthermore, if there is lack of teeth support, the cheek would become collapsed and appear sunken in.  The lip and cheek would appear to have more wrinkles and this make a person to looking old.

A brilliant smile can make a person more attractive.  In cosmetic dentistry, when we talk about a beautiful smile, we don’t just talk about lips.  Teeth can influence a person’s smile.  When you smile or talk with someone else, people can see your teeth.  A nice clean looking teeth can change your impression upon other people.  If your teeth is not crooked or stained. dentist can correct it with veneers.  Teeth with proper proportion will make your smile more attractive.

 

Written by Daniel Tee, DDS, MS

Practicing Cosmetic Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Tooth Cavity Disease Progression and Stages of Demineralization

Today I am going to talk about how a tooth develops cavity, from its early stage of enamel demineralization to full blown tooth cavity.

The tooth develops cavity because the bacteria in the mouth digests the food debris on the tooth surface and these bacteria would release some acidic byproduct as part of this digestion process.  These acidic byproduct would damage the enamel and slowly leach out the calcium within the enamel.  This is the first stage of tooth cavity disease process and is called enamel demineralization.

Acid erosion is a commonly cause for enamel demineralization.  (See Acid Erosion in this dental blog.)

When the enamel is demineralized, the tooth surface would appear chalky white.

Cosmetic Dentistry, enamel demineralization remedies, dental treatment

The right canine tooth (second to the left tooth on the photo) has chalky white spot on its surface.

Luckily the tooth at this stage can still be healed naturally.  The treatment would consist of avoiding food and beverages high in acidic content, improve oral hygiene and also most importantly is to receive fluoride treatment at the detnal office.  The fluoride treatment is to apply fluoride gel or varnish on the tooth.  Fluoride helps to strengthen the tooth and would help initiate remineralization process.  Remineralization is the reverse of demineralization.  Fluoride helps the calcium to rebuild the weakened enamel.

However, if the demineralization process get worse, the soften patch of enamel may become cavitated.   The middle tooth in the above photo illustrates how a cavity looks like.  This cavitation is a non-reversible process.  It would require dental intervention.  At this stage, the tooth needs to be fixed with the composite filling material by the dentist.  The dentist would have to clean out any decay or non-reversibly weakened tooth structure.  Then dentist would go through the steps in completing the filling.

A cosmetic veneer can also be used to mask out the large area of filled tooth structure.  Or if the defect is large, a crown is needed to restore the tooth.

 

Written by Daniel Tee, DDS, MS

Practicing Cosmetic Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Cosmetic Dentistry — Full Porcelain Crowns

Comsetic dentistry is a special branch in dentistry in which the aim is to improve the cosmetic appearance of a person’s smile.  The tooth may or may not be diseased or broken.  It could simply be that the tooth is discolored or the shape of the tooth is not harmonious to the rest of other teeth in the mouth.I enjoy doing cosmetic dentistry because I like the challenge of evaluating each individual case bring forth by the patient and deliver a pleasing result that could make some positive change to the patient’s life.

So let me present a recent cosmetic dental case.  This patient presents to my office with the two front chipped teeth.  She told me she has a heavy bite and may have habit of grinding.  Typically, a person with chipped front tooth could be getting either composite bonding, veneer or crown.  However, in this case, I suggest patient to go with the crown for full coverage strength and for esthetic purpose, I offer her full porcelain crown.  The porcelain is a strong type of porcelain called the lithium disilicate or by tradename of eMax.

This is how she presents with in her initial visit.  Her front two teeth are chipped.

Cosmetic Dentistry Chipped Front Teeth

As I am also a cosmetic dentist, I have to carefully design the crown so that the shape is harmonious with the other teeth and the bite has to be correct.  This is where the dentistry ends and where artistry begins.  I have numerous experiences in cosmetic dentistry and I am able to deliver a pleasing result.

This is how the final result looks like with her two new front crowns:

Cosmetic Dentistry Two Front Porcelain Crowns

Upper Front Two Crowns. (She still has some other planned dental work to be done on her lower teeth.)

 

 

Written by Daniel Tee, DDS, MS

Practicing Cosmetic Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Kidney Transplant and Periodontitis

I remembered some time ago I had a patient whose physician asked me to treat his periodontitis prior to his kidney transplantation.  His physician thought the patient had periodontitis.  This is a new trend that the patient had to be screen for various localized infection/disease prior to kidney transplantation and one of the localized infection that requires treatment is the dental periodontitis. (reference source)

The bacteria within the mouth can cause infection.  The presence of periodontitis can cause the increase of bacterial growth.  For the patient who has kidney disease, his/her immune system might be weak and can get infection easily.

For kidney transplantation, the medical surgeon would require patient to have dental checkup and treatment, and this includes the treatment for periodontitis.  The reasons for dental treatment is that after the kidney transplant, the patient would be administered with drugs to prevent rejection of the newly transplanted kidney by the body’s immune system.  These are immune-suppression drugs.  And these drugs would decrease immune system response to bacterial attack.  The patient would be more susceptible to bacterial infection during the immunal therapy after the transplantation.  Thus, the doctor would have to make sure that the patient has no existing bodily infection.  The dentist is asked to check for any dental infection and one of the common dental infections is periodontitis.  With patient’ dental periodontitis under active control, this lowers the likelihood of bodily infection from the dental cause.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.