Making Tooth Pain Go Away

Pain Pain Go Away



I will sometimes get phone calls from patients who are in pain and for whatever reason can't come in. Normally you can tell them to take pain killers or call in a prescription. Sometimes this is not possible. So, how does a person stop the pain of a toothache? Sometimes you can use an ice pack and put it on the area, this is what we do when we take out teeth. It works really well and you don't have to take anything . A really great way to control tooth pain is to soak a small ball of cotton(about the size of a pea) and place it on the tooth in question. Clove oil is a natural

anesthetic . Dentists use it in sedative fillings when they can't finish a treatment and don't want to have the patient in pain. It is non-toxic, doesn't cause stomach upset and is all natural. It will work wonders and give you relief in a pinch.

Wire Act

With the advent of wire free braces people ask me if wire braces are still done.
The answer is yes. While removable braces may be unseen (for the most part) and very popular because of that , wires still have a place. The biggest use is in children and adolescents. Removable braces can be misplaced or damaged. In adults the teeth can't be moved in the right direction by removable braces. The downsides to the wires are they are noticeable, they can irritate the lips and cheek, and your hygiene has to be very good or you end up with discoloration or cavities. The things that wired braces have going for them is they don't involve the patient so much, work in situations where removable braces won't work. These two are the most valid reasons .They really have been sidelined by the clear braces but in certain niches they work extremely well.

Spring Cleaning (Cruddy Buildup on the Back of Lower Front Teeth)

The Buildup of Tartar (really calculus but if I mention it people
think I am going to talk about Descartes and math. Which
is probably slightly more boring than Dentistry) on the
back of the lower front teeth are due to a combination of factors.
First there is a Salivary duct under the tongue that does nothing
but squirt saliva on the backs of these teeth.
Then there is gravity which allows the saliva to pool on
the floor of the mouth. Last but not least it is hard to reach
with a toothbrush, manual or electric.Enter the Sulcabrush.
It will clean the back of the bottom teeth like a charm.
A couple of passes in the morning and you are set! It will
make the cleaning
at the dentist so much easier because you are keeping it
off instead of once, twice a year.

I was reading the other day and an article caught my eye . It was about how the maker of Mevacor,a cholesterol medicine, was trying to suppress the suppliers of Red Yeast Rice Extract.. It turns out that Red Yeast Rice Extract (RYRE) has the same cholesterol lowering substances as Mevacor. Mevacor is the name of a prescription pharmaceutical used to lower cholesterol This Substance is Monacolin K also known as lovestatin when used in Mevacor. The RYRE is of course much cheaper than Mevacor.

I've seen this before where a pharmaceutical company uses a naturally occurring substance and in an effort to protect their profit want to "owm" natural substances.

Well anyway looking into RYRE is not such a bad thing to do as a first step if you are looking to control high cholesterol.

Teeth Stain and how to get it off

Most people will not notice that their teeth are becoming discolored. It happens so gradually that it is unnoticed day to day. When a person does finally notice or gets told about their stained teeth they then go to the dentist to have them bleached. Bleaching is a harmless treatment in which hydrogen peroxide jelly is used to remove the stain that collects over the years. It cleans deep into the tooth . It does not damage the teeth and can be done in the office (in about an hour) or at home. Then the process happens all over again. There are ways to get off this merry-go-round. One way is to bleach at home. I would recommend a dentist made tray and a person wears it for a couple of hours every four to six months. The upside is the teeth stay white. The downsides teeth can become sensitive. Another issue is you have to keep buying more gel.

If a person doesn't want to do this can brush their teeth with baking soda. This will remove the stain sitting on the tooth. Salt works , but, if you have high blood pressure then this is not for you.Diatomaceous Earth powder is good stuff too. All of these things will gently scrub your teeth without being too abrasive

Don't under any circumstances use lemon juice or any other acid. It doesn't matter if it is natural or not. These caustic liquids make your teeth whiter but do it by removing the calcium. So whiter yes but also softer.

Whitening toothpaste and rinses are a waste of time and money? They don't work. If you are bleaching the teeth get gel from a reputable source. I have heard charcoal works but I think it does because of it's slight abrasiveness. I don't believe it works because of any intrinsic properties.

If you have an occasion to attend, I have had patients who had job interviews come in for a scrubbing. They didn't want to bleach but wanted clean teeth.

What is Holistic Dentistry?

People often ask me "what do you do?" When I tell them that I am a holistic dentist.The next question is what is that?

A good definition is the one given by Dr Weill. He says that "Holistic dentistry, also known as biological dentistry, takes into account a person’s entire state of physical and emotional health. Holistic dentists use natural therapies (often in combination with conventional ones) to prevent, diagnose, and treat diseases of the oral cavity." This is a pretty broad definition. I find it sad that it is the definition of a certain kind of dentist. Shouldn't all dentist (and health practitioners in general) approach patient care that way?

To the above definition I would add minimally invasive to boot. Removing and replacing mercury fillings carefully. Performing root canals, preventing cavities, and gum disease. These are all things that dentists should do but most don't.

It is doing Dentistry with an eye on what you use and taking into account the whole patient.Again pretty much common sense.

In my practice we emphasize prevention strongly.That I have to mention this is just a sign of the state of dentistry. We monitor our patient's closely. I would prefer to prevent a problem than to cure one. Decay and gum disease can be prevented. They can be reversed in some situations and sometimes they have to be managed.

Diet has a huge impact on the health of the patient not to mention the oral cavity. If a patient returns and returns with decay then something in their life is not being dealt with.

Exercise, medications, life/work balance, systemic health. These are some of the things we ask about and investigate.

I guess it is a rejection of drill and fill. It is a realization that companies are out to make money that is their nature. This is not a repudiation of capitalism and this is definitely not the place I comment on the structure of economics and society. It is a statement of fact. The statement recognizes that companies are not for your betterment, but to sell you things, period. Since "I am piggy and I have the conch", The Lord of the Flies mentality prevails and the I really don't trust them to think about what they put in their products and the government seems to steer clear of regulation. I feel that people need an advocate as to what should be used.. So this is Holistic Dentist.

Two Step permanent replacement of a missing tooth without drilling, needle in two easy steps

Two step

The other day I was talking to a patient about what to do with a loose tooth. It was a upper front tooth and she didn't want to touch the teeth on either side. The teeth that were on either side had nothing wrong with them and we didn't want to cut them down to put a bridge there. If you cut down teeth to put a bridge on, the chances of needing a Root Canal in the future goes up by 25%. We then talked about implants which are a great option if a patient wants to replace a tooth without involving adjacent teeth. The argument against is having to wear something that comes out while the implant integrates. There is a method of putting in an implant and putting on a temporary crown while the implant heals. The downside? The success rate is a little lower. We finally decided to use a Maryland Bridge. This treatment allows you to glue a fake tooth in the space the same day we took the tooth out. It is permanently glued. If you want to place an implant, the Maryland Bridge will be glued in place and when the implant is ready then the bridge can easily be removed and a temporary crown placed on the implant. Walk in with a permanent tooth walk out with a permanent tooth. The process is simple. You take an impression of the tooth that needs to come out. The lab makes the Maryland Bridge. Next appointment the tooth comes out and the bridge is cemented in place.
No muss no fuss and done with a two step.

Nightguards and Grinding

The statistics are not good. Some studies show that an estimated 20 percent of the population during waking hours and 8 percent during sleep grind. Grinding professionally known as Bruxing and its close cousin Clenching cause a lot of pain, suffering , and cracked teeth among other things.The symptoms can range from none and the only reason you know is that the person you share a bed with tells you make noise grinding (Described sometimes as two bricks rubbing together) or the dentists notices wear marks on your teeth (known as wear facets)to debilitating migraine like headaches. The treatments can range from soft diet and NSAIDs(anti inflammatory drugs) to narcotics (with all the dependency baggage and the loss of efficacy).The first step is soft diet, Nsaids and fabrication of a Nightguard. Stress reduction cut down on caffeine. These are mostly straightforward.Night Guards come in different types. The NTI covers only the front 2-4 teeth small and unobtrusive.The standard night guard is a U shaped mouth guard looking device which covers the chewing surfaces of one arch of the mouth. Then there are others that cover just the chewing surfaces.These appliances keep the teeth from touching.that is their function I even have some patients that must wear them during the day. These are made to be more comfortable and discrete.It is not well understood what the cause of grinding is. It was thought that stress was the cause. The problem is that not all people under a lot of stress grind and clench. Not everyone who grinds will grind all the time . They might grind in stretches and then stop. It might have something to do with Dopamine. I read an article in the New York Times years ago which did a pretty good job describing grinding .

NTI covers Only Front four lower teeth

Standard Night Guard

This is a picture I found on the internet illustrating what happens when you have GERD, more commonly known as Reflux. This when the stomach acid backs up into the esophagus( tube from mouth to stomach). It is all to common to have a patient come into the dental chair telling me that they have tooth  sensitivity and they wake up in the morning with congestion.  They might have really good hygiene but constantly have cavities.  These could be signs of GERD.  I tell them to take a Tablespoon of apple Cider Vinegar every morning.  They have to brush their teeth with baking soda and use MI Paste(super concentrated Calcium gel). This usually clears up the problem.  Just to make sure I send them to a GI specialist.

Effects of Poor Dental Health on Your Body

   I love this graphic about oral disease.  Sometimes dentists and patients talk about the mouth as if it is not connected to anything else.  Here is what can be effected by not cleaning well/regularly.

Oil Pulling

Oil pulling is the process of swishing an oil such as sesame or coconut in the mouth to prevent decay and gum disease.  It is said to treat diabetes and heart disease.It is an ayurvedic practice that has been around for thousands of years.   The research is a little thin ,but, theoretically it should work.  There is a link between Heart disease and gum disease.  Diabetes is tougher to link to being helped by Oil Pulling  First off lets be serious and realize that a double blind large scale study is never going to be done.  No one is going to pay a researcher a ton of money to investigate a substance that is inexpensive to buy. That being said there is no reason it shouldn't work for the mouth.  Both of these oils have antibacterial properties and coconut oil might have antifungal effects.  If exposing your mouth to xylitol can prevent cavities(see earlier post) then using other substances probably will work as well. I guess the trick s finding out which ones work,  which ones don't work, and which ones do harm. So if you swish oils around your mouth everyday and it has an enormous effect awesome, if it only  a slightly beneficial effect good.  It is an easy enough thing to do and if combined with good oral hygiene keeps you out of the dental/ medical office then it is a win.  Therefore I would give it a thumbs up,I wonder what the other four dentist would say?

Keep Your Mouth Shut

It's funny I've heard the saying "close your mouth or you'll catch flies".  I never really thought that  keeping your mouth closed would have medical implications. Perhaps if you were a member of the mob.  Now that I am a dentist I realize that mouth breathers usually have permanent gingivitis.While this is not as bad as it sounds it still gives the person  red and bleeding gums.  This is the extent to which I was taught mouth breathing affected people.
   It now seems that mouth breathing has other and more serious considerations. There is a strong correlation between  breathing rate and a number of diseases Asthma being one.  It also has effects on posture- the head and neck are extended creating muscle stress. The abdomen and diaphragm are impacted.  Which causes a loss of muscle strength.  There is Long Face syndrome which is pretty much what the name implies... a long face which was thought to be genetic but the culprit is mouth breathing. It also turns out that nasal (through the nose) breathing supplies more oxygen to the blood than mouth breathing. This is a brief overview a more indepth analysis of breathing is found by reading Patrick McKeown and the seminal works of Konstantin Buteyko.

The End of Root Canals!?

The news is filled with advances of all sorts.  Smart phones have more computing power than the computers used to put men on the moon.  Cars are smarter than the mainframes used at MIT in the fifties. Face, hand, arm transplants used to be science fiction, now while not routine, are not uncommon.
    Dentistry has also come a huge way in a short period of time.  Digital x rays, scanning teeth instead of impressions with purple gooey stuff that not only makes you gag, but tastes disgusting. Just around the corner is three D printing of fillings.
  What is on the horizon is the end of the Root canal.  Looked at it objectively, a root canal is really no ones idea of a great treatment. Cleaning out the nerve knowing that you will never be able to get it all out.  Doing a procedure that I can't see what I'm doing, with a ton of anomalies and deviations. Then having a dead tooth that can't tell you if anything is wrong.  Don't misunderstand, it is a great procedure in that you get to save teeth that would need to be extracted.  Hopefully I can look back and put root canal in the category of "it was the best we could do at the time".  Research in stem cells has been going on in dentistry.  Instead of removing the nerve and putting in a filler researchers are trying to use stem cells to regenerate the nerve.  This is a whole new world where instead of doing something that is almost as good, you get to have a tooth that is as good as new.

Stop Cavities Chew Gum

People want to know-What can I do to prevent cavities?  Well, there is the brushing and flossing of teeth.  That's kind of obvious though.  There is eating candy. I know this sounds counter intuitive, Even crazy.   If the candy has Xylitol as a sweetener though, then eat away. Xylitol prevents decay and slows down the progress sometimes even reversing a cavity that is already present.  First off what is Xylitol? It is a sweetener derived from  fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse, and birch. It has 33% less calories than sugar and is the only sweetener that reduces decay, remineralizes tooth, and helps prevent ear aches. If an expecting mother eats it regularly the child has a lower rate of cavities. It has no deleterious effect on the developing baby.  It is best as a hard candy but can be chewed in a gum.  It has been studied extensively and shows no side effects in clinical doses.  Children are more than happy to eat it. It has no problems with long term use.  It is pretty much a win- win, which is a rare thing in dentistry.



Sources: Wikipedia, Dentaltown

White Spots on Your Teeth

There are a number of reasons that there are white spots on your teeth.  It can range from an issue called fluorosis, which means that a person has had too much fluoride and it has affected the tooth structure.  What people forget is that many mouth washes have fluoride, major metropolitan areas have fluoride in the water,toothpastes, bottled water and on top of that some dentists do fluoride treatments after a cleaning.  These things make it easy to get white spots on the teeth when you are a kid and the teeth are growing.  There are other types of white spots- after wearing braces with wires, around the brackets, which were glued to the teeth  people will get white spots. These spots are due to poor oral hygiene around the brackets. Poor oral hygiene will also cause white lines at the gum line of the teeth.
    These are the common causes of white spots that can be reversed easily and with minimal invasiveness.  What it requires is scrubbing the teeth, cleaning them with a gel and then using a calcium paste to force calcium back into the tooth, repeat if needed. It's Simple and  effective.  If this method doesn't work then you can move onto more invasive techniques like composite(bonding), veneers(porcelain facings) or decide that the spots aren't so bad after all.
    There is one last type of white spot that hasn't been covered. Sometimes when a person gets a cavity the tooth can turn a dull white.  This gives the patient and dentist no option but to treat the decay.

News Flash-Your nose ....it's on your face!!

Alrighty, I am going to start this blog up...again.  Let me tell you doing this blogging thing is not as easy as it looks. Today's topic is the New York Times article "Rethinking the Twice-Yearly Dentist Visit".
    I am amazed at the confusion caused by the routine things in dentistry.  The article (paraphrased) says that a cookie cutter approach to treating patients might not be the best way to care for a patient. The reaction to this article ranges from "wow, I knew the dentist was ripping me off" to "Isn't science great and what will they discover next".
    First off, the origin of the twice a year cleaning is murky.  It either come from  "Amos and Andy in the middle of the last century" or a toothpaste jingle ,where you need to use this toothpaste and see your dentist twice a year.  It doesn't really matter where it comes from. What matters is that a one size fits all is a terrible way to treat a patient. I don't know when it happened, the patient devolved from being an individual  with needs, quirks,and desires to being a  widget that is plugged into a one size fits all regimen. Then out comes amazing new information! The patient is a person!
   The time between cleanings should be based on the patients needs and desires.  I have some patients that I see once every three years.  Why should I see them more often?  They don't need to have a cleaning and are not prone to getting cavities.  I am sure they have better things to do than going to the dentist.  I have other patients I see every three months.  Why? Because they need to.
    So, is the dentist ripping you off?  No,  how often you get a cleaning should be decided between you and you're dentist.  Wow, mind blowing. What will they think of next?

Implants Vs. Bridge

The topic today everyone is implants vs. bridge.  When you lose a tooth or teeth and are going to have it/them replaced how does a dentist pick the best treatment? Well, first are the teeth on either side virgin (untouched)  then implant is a good way to go, simply because cutting the teeth on either side of the space to place a bridge is like destroying the village to save the village. A good rule of thumb is- what a dentist can do is not better than what you were born with. Cutting down untouched tooth to support a missing fake tooth usually does not make a whole lot of sense.  If the teeth adjacent to the space have boneloss then implant again. Alright what if the teeth next to the space have large fillings and lots of bone support?  Well then you have to think, will they need crowns in the future?  Then a bridge is not such a bad option. You can cover the teeth with crowns and use those crowns to support the fake tooth(pontic)  The bridge doesn't require surgery, or waiting for integration- an implant has a waiting period of 3-6 months to allow the bone to attach to the implant called integration, so it takes a while to finish up the case. The work around for getting implant teeth faster is- immediate load implants which mean that the implants are placed and a provisional (temporary) crown is placed on the same day but not placed in the bite. Nice, walk in with a gap and walk out with a tooth then wait for the bone to heal and get the permanent crown cemented.  In this situation it is important to pick your cases carefully or else the the bone won't grow properly and the whole implant will come out. A permanent bridge goes from start to finish in weeks not months. As in everything else there are downsides to a bridge.  I think the biggest problem is the spot where a tooth was taken out.  When a tooth is pulled there is no tension on the bone so the bone starts to resorb(shrink) unfortunately the bridge tooth stays the same creating a gap  between the fake tooth (pontic) and gum.This is where food will get caught which brings me to the possibility of cavities because the fates of the teeth are now intertwined lose one supporting tooth(retainer) and the whole bridge might be lost.

Bleaching

Alright let's start this off with the question that I get asked the most- Will bleaching hurt my teeth? The answer is NO. Bleaching is basically an optical illusion. A persons teeth are a lot like Swiss cheese,stay with me here, the tooth has lots of microscopic pores these pores are filled with a jelly.  The tooth(Cheese) is pretty much impervious to stain, the jelly is what gets stained so the whole tooth looks darker.  Things with vibrant colors tend to stain more coffee, tea,red wine, etc. When you bleach you place a gel (carbamide peroxide)on the tooth.  This gel breaks down into air and water.  The microscopic bubbles of air cause the jelly in the tooth to break apart and voila' more light passes through and your teeth are magically whiter. So is it safe- yep it actually doesn't do anything to the teeth.  The process has been around for a long time (it was used by dentists to stop bleeding after gum surgery) and O.K.ed by the FDA in 1989.  Here are the down sides:  it is not permanent so you have to keep doing it, it can cause cold sensitivity using sensitivity toothpaste can really help, and lastly there is no easy way out whitening toothpastes and rinses don't work. Period. So whether you do it at home, in a dental office, or with something like crest strips they all function the same.  The other thing is dental work is not affected by bleaching so if you have white fillings or crowns in the front teeth the dental work won't get lighter.  So if you bleach you will need them replaced.  On the flip side if you need something done on your front teeth bleach first then have the color matched to the bleached teeth.