Why no pain does NOT mean no problem

Why no pain does NOT mean no problem.

Image: Bigstock.com

Problems in the mouth and damage to the teeth can come in many forms and not all problems present with a primary symptom of pain.

The dentist does not only check your teeth.

  • A dentist will visually inspect a patient when they come in. Looking for swollen glands, lymph nodes, cold sores, lesions or abnormalities on the lips. After which they may palpate some of the nodes, glands and muscles that can be felt on the outside of the body.
    • By doing this we can highlight any abnormalities that may indicate undiagnosed conditions.
  • They will conduct both a soft and hard tissue check.
    • As well as checking the teeth a clinician will look at the cheeks, lips, tongue, palate (soft and hard), tonsils and adenoids.
    • Dentists are on the lookout for lesions, lumps or abnormalities that may indicate something more sinister. These do not always occur alongside pain and often a patient will be unaware of their existence.
    • Check that the
  • The dentist will also check the teeth looking for decay “holes”, until decay becomes more severe it can often be painless. However, decay is not the only condition that effects the teeth others include:
    • Erosion – the teeth are worn away due to an acidic oral environment.
    • Attrition – tooth on tooth wear often caused by clenching and grinding.
    • Abrasion – mechanical wear often caused by brushing too hard or with a hard or medium toothbrush.
    • Discolouration – sometimes an indication that the tooth/nerve is “dying”, a sign of trauma on the tooth, or sometimes overuse of whitening products (white spots).

Often pain can be prevented or lessened when conditions can be identified early during a routine check-up.

How does my dentist know I’m grinding or clenching my teeth when I don’t?


How does my dentist know I’m grinding or clenching my teeth when I don’t?

Image: Bigstock.com

Many people do not know that they grind or clench their teeth throughout the day or night. Often during the night people will not notice their own habit of clenching or grinding and as not all conditions are accompanied by the sound of grinding it may not be brought to the attention of another person in the household until a significant amount of damage has been done to the teeth.

For a clinician there are many signs that indicate a patient is either currently clenching and grinding or has a history of doing so, these include:

  • Wear on the incisal/occlusal (biting) surfaces of the teeth
    • Tooth on tooth wear is referred to as attrition or bruxism this wear can range from being mild due to occasional grinding or clenching to severe where there may be a loss of vertical height of the teeth. Loss of height of the teeth can affect a person’s appearance and the way someone eats and speaks.
    • A flat biting edge or chipping on the edges to the teeth are a common outcome of attrition.
  • Linear alba
    • This is keratinised (thicker) tissue that is formed at the side of the cheek due to the muscles at the side of the mouth forcing the tissue between clenching or grinding teeth. Over time the soft tissue will become harder to prevent trauma to the cheeks.
  • Scalloped tongue
    • When active clenching and grinding is occurring often the sides of the tongue will show a scalloped shape around the edge due to being forced next to the teeth as they bite heavily together.
  • Muscles of mastication
    • Muscles can become sore or tired due to not receiving adequate rest and the intensity of the motions that each muscle goes through while clenching and grinding.
    • The muscles can even change shape with prolonged clenching and grinding, which may affect the appearance of the face.
  • Radiographic evidence
    • When viewed on an x-ray some teeth may show a widened space between the tooth and their supporting structures.
  • Head or neck ache
    • Due to the tension in the muscles when clenching and grinding people may find that they wake up or develop headaches throughout the day or night.
  • TMJ (jaw joint) problems
    • Prolonged or severe attrition may have a lasting effect on the jaw joint making it painful or difficult to open the mouth.

Treatment of grinding depends on frequency, severity, age and medical history. Unfortunately for children grinding is difficult to treat due to mixed dentition. In adults a dentist may recommend a grinding/bruxism splint to mitigate the effect of it has on the teeth. If left unchecked the damage due to grinding and clenching can lead to very extensive dental work required to rectify the bite and appearance of the teeth.

Why do you see a dentist for a toothache?

Why do you see a dentist for a toothache?

Image: Bigstock.com

Often when one has an ache in their bodies, they will see a doctor (general practitioner) to find out the best course of action, however is that the case when you have a toothache?

While it seems logical to visit a doctor to treat the immediate symptoms of pain due to a toothache, unfortunately the underlying cause of that pain cannot be treated in that setting. This may allow the tooth to give you further problems in the future and in most cases will generally be referred on to a dental practitioner.

There are many causes for a toothache such as gingivitis/periodontitis, decay, clenching/grinding, dental abscess’, sinusitis etc. and a doctor may provide medication to help to treat the pain whether by suggesting/prescribing pain management or the prescription of antibiotics.

The treatment of pain before seeing a dentist can occasionally make accurate diagnosis of a tooth difficult and may delay treatment until a correct and detailed diagnosis can be made (often when the tooth exhibits signs of pain again).

Why does my dentist want to take x-rays?

Why does my dentist want to take X-rays?

Dental x-rays are an extremely vital tool for diagnosing treatment. Image: bigstock.com

Radiographs/x-rays are a valuable diagnostic tool when seeing a dentist to check your current oral condition. There are several types of x-rays used in a dental setting the most common of which include:

Bitewings

Taking routine x-rays (every two years) allows the practitioner to check areas that are not otherwise visually accessible. This x-ray shows the crowns of both the upper and lower teeth but does not extend down to the root tips of either.

This may benefit the patient in several ways:

  • They highlight areas that need attention or more focused cleaning such as demineralisation of the enamel between the teeth. By pointing out areas such as this a practitioner aims to prevent any progression of disease in these areas. This allows practitioners to watch suspicious areas rather than immediately filling small areas of demineralisation on teeth that may otherwise be controlled with good oral hygiene.
  • Series of bitewings provide a timeline of disease, changes are watched and tracked over time if there were a sudden change in an otherwise stable mouth a time frame of the disease progression can aid in narrowing down the cause or change in lifestyle that has affected the patient. This allows the practitioner to ask more targeted questions and give more practical and personalised advice relating to a patient’s oral health.
  • Prevent larger fillings or more major works from being necessary; in some areas of the mouth or due to the structure of some people’s enamel, decay will not be apparent until it has become quite severe. Having x-rays allow the dentist to advise on  decay when it is in it’s early stages hopefully before more major work is necessary.

These radiographs usually include a device or a plate with a wing/tab on which to bite onto once placed on the inside of the teeth. These single image dental x-rays are very low exposure, 2x images are approximately less than 0.0025mSv of radiation which is equivalent to less than half a day of natural background radiation.

In a stable mouth, bitewings can be taken every two years but for patients with high decay or rapid changes dentists may advise that yearly bitewings would be beneficial.

Periapicals

This is another in chair dental x-ray however it will target a specific tooth showing clinicians the tooth from the tip of the crown to the very apex of the root of the tooth.

The benefit of having a periapical before treatment is that:

  • The practitioner is able to support a diagnosis with radiographic evidence. Some conditions such as a root fracture, a dental abscess or internal resorption are not necessarily able to be seen by visually inspecting the mouth and do require a periapical x-ray to properly diagnose these conditions.
  • Shows root formation and attachment to bone. Everyone is individual and there are some people that have roots that are shaped differently to others or some teeth that may fuse to the bone. Before treatment it is important for practitioners to know these details before commencing with some procedures that may be affected by this.
  • To check the quality of treatment. Dentists may take a periapical during or after invasive treatment such as a filling or root treatment to be sure that the quality of the work is high and provides the best treatment possible for the patient.

These radiographs are not taken routinely and are generally requested when a patient or practitioner has a concern regarding a particular tooth. They are the same low dose radiation exposure as a single bitewing x-ray.

OPG or Panoramic

This 2-dimensional dental x-ray shows the full mouth including all the teeth the jaw and the palate giving a good overview of the general health of the mouth. An approximate

These x-rays can track many things and can benefit a patient by:

  • Showing eruption patterns in children/adolescents with mixed dentition or for checking the eruption of the third molar (wisdom teeth).
  • Give an overview of the periodontium (bone that surrounds the teeth). Using these x-rays clinicians can check for any periodontal disease that affects the bone before damage has become too severe.
  • Check for fractures in the underlying structures of the jaw or palate.
  • An OPG will quite often be used to assess for the adequacy of the bone before referring for a more detailed x-ray when looking at implants.

Clinicians are more discerning when referring for OPG/panoramic x-rays as their radiation exposure is higher than a single x-ray at approximately 0.014mSv which is equivalent to less than 3 days’ worth of natural background radiation exposure.

Other x-rays may include:

  • A Lat Ceph – to check the profile view of the teeth and bone structure, usually used when referring for orthodontic treatment.
  • A CBCT (Cone beam CT) – to check for the viability of implants or for information that cannot be obtained from single two-dimensional images such as root resorption or precise positioning of teeth.
  • TMJ x-rays – check the jaw joint for any abnormalities in the case of pain, severe clicking or crunching of the joint.

Oral Health for Older People

Oral health for older people

Oral Health for Older People | Image Shutterstock.com

Oral health includes not only natural teeth but also dentures and the soft tissues (including the lips cheeks tongue and roof of the mouth). Regardless of one’s age oral health is an important factor in everyday life; good oral health promotes good general health; more self-confidence and a better quality of life.

The messages for a healthy mouth apply for all ages: Eat well, Drink well, Clean well, Play well, Stay well.

There are some barriers that may prevent us from caring for our oral health in the best way possible; these include:

  • Education
    • There is a lot of research being done into the effects of oral health on the whole body.
    • A lot of bacteria are contained in the mouth and may affect respiratory infections, your capacity to heal and can impact on some diseases.
    • Poor oral health has been linked to cardiovascular/heart disease often increasing the severity of the disease.
    • Recently evidence has indicated a link between poor oral health and the progression of Alzheimer’s and is believed to speed up the progress of the disease.
    • Even patients with dentures can be susceptible to oral disease and in fact have an increased risk of fungal infections. Dental check-ups are still advised to check for any suspicious lesions or infection and for maintenance on the dentures as required.
  • Motivation
    • Everyone has days where they are tired, unmotivated and not feeling like the best version of ourselves. On these days it is still important to include oral health in our daily hygiene routine.
    • Try and find an easy and effective way to keep your teeth in good shape with a regular routine.
  • Dexterity
    • As we age dexterity can become an issue for some people but can be overcome with a few tricks such as; using a tennis ball over the end of a manual toothbrush or switching to an electric toothbrush, the handle will be easier to grip and manoeuvre around the mouth.
    • Use a mouth rinse such as peroxyl, the foaming agent in the mouth rinse is able to lift debris from tissue and between some tricky to reach areas when rinsed vigorously in the mouth for a period of one minute.
  • Access to the right tools
    • It is hard to sometimes determine or access the best tools for cleaning our teeth and dentures, there are some key implements that patients may own to care for their mouth:
      • Toothbrush/Denture brush
      • Toothpaste
      • Denture soaking tablets
      • Floss or interdental brushes
      • Mouth rinse
    • Teeth should be brushed two times a day for at least 2 minutes and optimally dentures should be taken out of the mouth to allow the tissues to recover overnight, where this is not possible taking them out during down time is advised to avoid inflammation and fungal infection.
    • Each of these has a role in oral health and it is important to check with your dental professional as to which combination is best for you.
  • Access to appropriate care
    • It is sometimes difficult to make time for a dental visit or see the necessity for one when there is not a problem. Be proactive and try to see a dentist to get regular checks for any problems as they are beginning and before they cause pain. Fixing these problems at an early stage may also reduce the need for more extensive work on the tooth.
    • There can be difficulty to get transport to and from the dentist. Check for the local community transport to be able to make a time to see the dentist. Reception are able to try and accommodate your preferred time and day – talk to them for any help you need to get to the dentist.

Choosing the right toothbrush

There are many different options of toothbrushes currently on the market. The most important things to look at before purchasing is: toothbrush head size and bristle softness.
Always look for a toothbrush with a smaller head – this will enable you to get to the back teeth and the hard to reach places a bit easier. Soft or ultra-soft bristles are also advisable, anything harder than this could potentially cause damage to the enamel tooth structure particularly if used with the incorrect technique.
A powered/electric toothbrush is a good alternative to a manual toothbrush. It can do a better job of cleaning the teeth, especially for those who have difficulty brushing or who have limited manual dexterity.

Charcoal, friend or foe?

A recent trend in oral health has been that of using charcoal to accompany or even replace toothpastes however there are some risks associated with it’s use.
Charcoal is very abrasive and as a result can affect the surface of the teeth by beginning to wear away the shiny and protective outer layer (enamel) of the tooth. This damage can lead to abrasion wear facets, a matte/scuffed looking enamel and sensitivity. As well as wearing away the enamel of the tooth abrasion can also wear away the gums and cause recession, making the tooth appear longer and possibly exposing the neck of the tooth which is generally darker in colour than the enamel and more open to sensitivity.
In some cases charcoal may have a negative effect in the mouth including discolouration of non-natural material such as filling material. Some people, especially those that experience minor abrasions and ulcers may find that their soft tissue is also affected by charcoal as it may cause some irritation to these areas.
Studies are being currently being conducted and early results are showing that on a microscopic level the abrasives in charcoal products are doing significantly more damage to the surface enamel of the teeth than a standard toothpaste. There have been no proven studies to show whether clinically the charcoal in these products are effective in tooth whitening, oral hygiene and prevention.

Why are ‘baby’ teeth so important?

It can be difficult to get kids on board with brushing and taking care of their teeth and while they do lose their deciduous (baby) teeth the early habits and oral conditions can have an effect on the permanent adult teeth that follow them.
Teeth aid in a child’s ability to smile, speak, chew and gives structure to the face all of these things can affect a child’s social interactions and self-esteem. They are space maintainers for the permanent teeth so that they may hopefully be guided into the correct position in the mouth and promote correct oral health behaviours that will be used for a lifetime.
To aid the baby teeth it is important to look at several factors including:
Diet – while diet has an effect on oral hygiene it can also change when a child is severely affected by caries as children may be continuing to eat foods that have a negative impact on oral health or may turn to softer easier to chew foods. Be sure to monitor a child’s sugar intake as sugar is metabolised by the bacteria that is able to create decay.
Systemic disease – certain diseases such as diabetes can have an effect on oral health both at a young age and later in life. Building good habits at a young age will aid in allowing children to keep their teeth healthy and hopefully prevent need for major dental work.
Brushing and flossing – it is important to brush twice per day (morning and night), when plaque builds up on the teeth for prolonged periods of time it can begin to affect the enamel surface of the tooth. This change will first it will appear as a new white spot on the tooth (at this stage if it is kept clean it may not result in a cavity) and after this may further progress into a cavity. It is important to brush your child’s teeth from the appearance of the first baby tooth up until an age where they have the dexterity to brush alone. Assisted/shared brushing is advised even to the age of 8-9 often with the adult doing the nightly brush and the child being allowed to handle the morning one. After ceasing to brush it is still important to monitor the child/adolescence’s teeth so that a high standard of oral health can be achieved.
Behaviour – there are several behaviours that can affect the placement of the teeth and the promotion of jaw growth including sucking on a dummy or thumb, a tongue thrust, clenching and grinding and open mouth breathing. Each of these actions may have an effect on baby teeth but may also have long term consequences and effects on adult teeth that may require intervention at a later point.
Taking children for regular dental check-ups (especially when nothing is wrong) is an important step in building trust, pointing out any areas of concern early and creating a good hygiene habit for later life. Early dental visits can make intervention much easier on the child, parent and practitioner as they have previous good experiences to reflect back upon.

Why does my dentist ask for my medical history every visit?

Image: Bigstock.com

When first attending a new dental surgery, patients will be asked a series of questions regarding their health including things such as allergies, previous dental history, previous and current medical history including conditions and medications, smoking status and even dietary information.
All allergies are important to disclose as there may be products that are used in a patient’s mouth that contain surprising ingredients or agents that a patient may react to; this includes food, medication, preservatives, dyes, metals, minerals and compounds.
While some questions may seem trivial they play an important role in the dental experience. There are some conditions and surgeries for which a patient may be required to take antibiotic covers before any treatment these may include some heart conditions, joint replacements and prosthetics or as advised by a GP or specialist.
Oral disease can be affected by the state of one’s oral health and vice versa, poor oral hygiene has been linked as a contributing factor for conditions such as heart disease and Alzheimer’s and therefore may require some thorough attention. Alternatively, conditions and lifestyle choices such as diabetes, systemic disorders, radiation therapy, diet, alcohol intake and smoking status can affect the teeth, gums and tissues of the mouth and may explain some changes that are observed over subsequent appointments.
Medications play a significant role in the treatment of oral disease, there are a high number of medications that cause xerostomia (dry mouth) which can have a significant impact on some patients. Certain medications such as those to treat osteoporosis (such as Prolia) and blood thinners (such as Warfarin) may require treatment such as extractions to be delayed to lower the risk of bone necrosis or excessive bleeding.
All medical information is confidential and kept on record for the purposes of dental treatment.

What are veneers?

Veneers are a thin layer of material that sits on the front surface of the tooth to change it’s appearance. They can be used to improve the appearance of the teeth including colour, shape and position by coating the surface in a thin layer of porcelain or composite.
Porcelain veneers are prepared and fitted over two appointments, they are more robust, have a high lustre and require less maintenance however they may still chip or break with certain habits such as a heavy bite, fingernail biting and grinding.
Composite veneers are more cost effective and can be completed in a single appointment (depending on the number of teeth), they are colour matched to each patient’s needs using several shades of composite material for a great aesthetic result. This material requires some maintenance and polishing and is slightly more prone to chipping than porcelain.
To find out whether veneers are suitable for you feel free to make an appointment with us on (02) 4324 1181.