Common dental questions

When do I know if it is time to replace my toothbrush?

1.  If you cannot find it.
2.  If the bristles begin to flare to the sides.
3.  After your spouse polishes shoes with it.
4.  After your dog has chewed on it.
5.  When the color indicator strip begins to lose ½ its color.
6.  Every 4 to 6 months depending upon your usage.

(There are only 3 right answers)

What is the right way for my child to brush?

In the beginning, you will need to brush your child’s teeth for him/her. For the very young, just chewing on the brush proves beneficial. As the primary teeth erupt [usually around 6 months +/-) they require as much care as the adults. Since children usually mimic what they see, they will copy the care you show them and the importance you establish for this care.

Most children will obtain the best results with back and forth brushing. This is not the most reliable, but in the beginning it gets them started. They can graduate to more advance methods as their coordination improves.

What is fluoride and does it really protect my teeth?

Fluoride is a naturally occurring element, which was discovered as an advantageous element to prevent tooth decay when some children were found without tooth decay. Fluoride was found in relatively higher concentrations in the local drinking water of these areas. Texas is one state where naturally occurring fluoride exists. Africans use chewing sticks, which are high in fluoride, to decrease their incidence of decay. When used properly in small amounts, fluoride is a very safe material. The amounts found in local drinking water are safe and are less than are found in many naturally occurring water sources.

Fluoride becomes incorporated into the structure of the teeth. It provides additional strength and is slightly antibacterial in nature. It helps the most as the teeth are forming. 

Is it a bad idea to leave a baby with a bottle overnight?

It would depend upon what was in the bottle. If it is just water, that probably would not injure the baby’s teeth. If it is a sugar containing liquid, that is not a good idea. Allowing the baby to coat his/her teeth every night will dramatically increase the amount and extent of decay.

Is it OK for my child to suck his thumb?

There should be no problem, as long as your child does not suck his/her thumb too long. Signs that this may be a problem include front teeth that no longer meet. Usually a child should stop sucking a thumb by the time they go to school.

What is gingivitis and is it different from gum disease?

The term’s gingivitis, pyorrhea, periodontal disease and gum disease are synonymous. They are like saying car or automobile as they refer to the same thing. Gingivitis is the oral response to a bacterial infection. There are some systemic dysfunction’s, which allow an increased incidence of periodontal disease such as diabetes, trisomy 21, autoimmune diseases and others, but generally bacteria are the etiologic agents of the infection.

Healthy gingival tissues exhibit a balance between the type and number of bacteria present. Disease occurs when the balance is disrupted and more pathologic agent become predominant. Tissue swelling, redness, exudate and pain generally accompany the disease process. Left unaltered, the disease affects the bone support for the teeth. The exact sequence is not totally understood, but there is more bone loss than regeneration. This process of more loss than replacement directly correlates to the amount and duration of the infection, although there may be some individual differences. Unless the disease process is addressed, the bone loss continues. Interventions may vary from practitioner to practitioner. Many new non-surgical methods are being used in place of conventional surgery or following surgery. The ultimate goal is to enable the patient to control the disease and maintain his/her teeth.

My dentist keeps telling me I need to replace my missing teeth. If I am not in pain, why should I spend the money to replace teeth I don’t need?

Suppose you were going to buy a new car and there were two models exactly alike, except one was $2,000.00 less. The only difference between the two cars is the dealer took one tooth out of one of the cars gears. There are multiple teeth in the gears and they only took one small tooth from the gears. Which car would you buy?

Suppose further that you bought the $2,000 cheaper model. Would you expect the cars to last the same period of time? Most probably not! You would probably find that just one missing tooth could cause multiple other problems with your car. The same can be true of your mouth.

There are three components, which comprise and determine how your mouth functions. These are the teeth, jaw joints and muscles of mastication. Potential and actual damage may occur if removal of one tooth allows the remainder of the teeth to alter their position. This affects not only the teeth, but it may also affect the muscles, causing head or facial pain, and jaw joint dysfunction. Uncontrollable shifting of the bite can be a very serious consequence. Many people suffer with temporomandibular joint dysfunction because of the loss of just one tooth and the bite shifting. This can result in some headaches, neck pain, facial or ear pain, or referred pain to associated areas.

What is a root canal and why would I need one?

Inside the tooth is a small chamber, which contains some minor blood vessels and small nerves. If this tissue dies or becomes infected, it is usually very tender to the touch. The infected tissue must be removed and replaced with a substance, which will not become re-infected. After the root canal is completed, the tooth is crowned for long term stability and function.

This is a relatively painless procedure and a very reliable one as well. This enables the professional to assist the patient in maintaining his/her dentition because the tooth would otherwise have to be removed.

Our son fell and chipped his tooth. My husband says to forget it, as it is just a baby tooth. When should I take my child to the dentist?

If a baby tooth is injured it needs to be examined. The baby tooth is subject to decay just like adult teeth and they hold the space for the permanent teeth that will follow. Premature loss can cause problems that are expensive to correct. Usually, take your child to the dentist around 2 to 3 years of age.

Sometimes I get a "clicking or popping noise" or just general soreness in my jaw. Is this a problem, and what can I do about it?

 Clicking usually occurs when the cartilage is dislocated from its proper position. Without intervention, this process usually becomes worse and deteriorates.

Treatments often consist of wearing a diagnostic appliance called an orthotic that keeps the jaw from becoming dislocated. If the repositioning with the orthotic maintains a stable relationship, permanent corrections can be provided. Orthodontic corrections to a stable relationship are provided in the Feature section of Inside Dentistry, Case Review: Class II, Division 2 and Class III cases.

I don’t like my smile. Is there anything I can do?

Your smile is like the picture window through which people see you. If you are uncomfortable with your smile, there are certainly things that can be done. Replacement of stained, broken, repaired or missing teeth is possible with porcelain crowns. Removable appliances such as partials or dentures also improve esthetics. Orthodontic corrections are an excellent way to align the teeth so they look and function better.

How does orthodontic treatment work?

Conventional orthodontics applies forces to the teeth and the bone that supports the teeth adapts and reforms, allowing the teeth to be moved. Conventional orthodontic dental movements may or may not support the best jaw position, however. Newer methods first establish the best jaw joint and muscular relationship and then move the teeth to support the association.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar

Myths About Root Canal Treatment

Root canal is usually painful
Most people fear that a root canal treatment is usually associated with pain during treatment. Your dentist or endodontist will give a local anesthesia to numb the area around the tooth. If you are very apprehensive and tense you may need sedation, such as nitrous oxide. This eliminates the pain that is caused due to the procedure. If you have pain while the procedure is being done, tell your dentist about it. Your dentist will adjust the technique to avoid causing pain again or give more anesthesia if required.

As my tooth's nerves are removed, I won't feel any pain
Some people think that after the root canal treatment they won’t feel any pain in the treated tooth. However this is not true. Even though the pulp of the tooth is removed the nerves that surround your tooth can feel pressure and touch. These sensations are transmitted by the nerves in the surrounding tissue. In addition after the procedure you can have soreness in the concerned tooth for two to three days. You may be prescribed pain relievers such as acetaminophen or ibuprofen to ease the discomfort.

Why should I get a root canal treatment if the tooth may have to be taken out eventually?
A tooth after root canal treatment can last for the rest of your life with proper care. To increase the longevity of your teeth maintain good oral hygiene. To maintain healthy teeth and gums brush with fluoride toothpaste (twice a day) and floss everyday. Go for regular dental checkups and professional cleanings. Root canal treatment has helped to save several teeth that would or else need extraction.

If I don’t have any pain, I don't really need a root canal
It is very much possible that your tooth that needs root canal therapy may not have pain. But remember that absence of pain does not mean that your tooth is healthy. Like an infection of the pulp of the tooth may not cause pain initially. But without treatment it can cause pain and swelling. In some cases untreated infection can cause pus accumulation at the root tip in the jawbone, forming an abscess. Untreated abscess can extend and destroy the bone around the tooth and cause pain. After examination if your dentist recommends root canal treatment get it done even if there are no symptoms.

In root canal therapy the roots of my tooth are removed, or my whole tooth is removed
A tooth has outer enamel, the dentin (main body of the tooth) and soft tooth pulp (in the center of the tooth and in canals also called root canals). Nerves and blood vessels enter the tooth through the end of the root (called the apex) and then pass through a canal inside the root to the pulp chamber. In root canal treatment, the tooth pulp which may be inflamed or infected is removed. After removing the diseased pulp tissue, the space is cleaned, shaped and filled. In root canal therapy the roots of the tooth or the whole tooth is not removed.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar

Restoring the Tooth After Root Canal

After the root canal procedure your tooth may need to be restored. This gives your tooth natural shape and appearance. In the front teeth a composite filling material is used to restore the tooth. The molars and premolars need a crown. Before the crown is made your dentist will make a base or foundation to reinforce the tooth and support the crown. The base to reinforce the tooth is called a core. A post may be needed to hold the core in place. The post is a rod made of metal. Your dentist may take out a little root filling material from the root canals to make space for the post. The crown is prepared in a dental laboratory. Material used to make crown are porcelain, metal, or a combination of the two. The crown is cemented onto the base or foundation.

Root canal procedure can fail. Reasons for failure of root canal include

All the infection from a canal was not removed
All  the canals were not cleaned or desinfected
Tooth gets infected again if there is a leakage around an old filling or crown from which the bacteria can enter the tooth.
The procedure to do a repeat root canal treatment is the same but it is more complicated and time consuming than the first one because the restorative material has to be removed before the second root canal.

Most of the failed root canal treatments have infection that are difficult to eliminate.
You may need endodontic surgery, either in place of or after retreatment. If a second root canal is not possible endodontic surgery apicoectomy may be needed. During apicoectomy, the root tip, or apex, and the infected tissue are removed. Then filling is done to seal the end of the root. An apicoectomy is performed using an operating microscope. That's why apicoectomy is also called endodontic microsurgery. Apicoectomy may be needed if the tooth remains infected after retreatment. The success rate for apicoectomy is approximately 80% to 90%. If the tooth remains infected after apicoectomy also it will have to be extracted.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar

All about Dental Sealants and how they help prevent Tooth Decay

At times your dentist may place a plastic coating on the chewing (occlusal) surface of the permanent back teeth (the molars and premolars). This plastic coating is known as sealant and it helps to protect the teeth from decay.

Why are dental sealants used on teeth?

The chewing (occlusal) surface of the permanent back teeth (the molars and premolars) has grooves or "fissures." Food particles get deposited in the narrow grooves and it can be difficult to clean them as the fissures can be deep and narrower than even a single bristle of a toothbrush. Plaque (a sticky substance that is formed when bacteria present in the mouth get deposited along with saliva, food particles and other natural substances on the surface of the teeth) gets accumulated in them. The bacteria in plaque break the sugar (carbohydrate) in food and lead to formation of acid in the mouth and can lead to tooth decay if it is not removed. The dental sealants protect the grooved and pitted areas by creating a smooth surface by covering the fissured area.

When are dental sealants applied?

In children a dentist may apply sealant as soon as the molar teeth come fully into the mouth (erupt) to protect them from caries. Application of dental sealant on the chewing (occlusal) surfaces of these teeth helps to protect the tooth from caries.

Can dental sealants be used only on the chewing surface of molar and premolar permanent teeth?

Dental sealants are mostly used to cover the chewing (occlusal) surfaces of the back permanent teeth (the molars and premolars) as they have grooves or pits. The sealant helps to protect these teeth for decay. They may be placed on other teeth if they have grooves or pits.

Can dental sealants be used on teeth of adults?

Yes sealants can be placed on teeth of adults as well. But they are used less often in adults. They are used in adults if they have deep grooves and fissures that do not already have fillings or dental sealants.

What do dental sealants look like?

Various types of sealant are present. They can be clear, white or have a slight tint depending on the type of dental sealant that is used.

How are dental sealants placed?

Your dentist will first clean your teeth with a paste and brush, then rinse and dry your tooth/teeth. An acidic solution will be placed on the tooth to make a fine rougher surface than the surrounding tooth enamel (this rough surface promotes the dental sealant to attach to the tooth). After drying the tooth your dentist will place the liquid dental sealant on the tooth and it is hardened by using a light. After the sealant hardens on the tooth you can chew on the tooth again.

How long does a dental sealant last?

Dental sealants have been proven to be effective in preventing decay on chewing (occlusal) surfaces. They can last for years and can be reapplied if needed.

Is fluoride needed after dental sealant is placed?

Yes, as the sealants protect only the surface they are applied on where as fluoride protects all the surfaces of the tooth from decay and cavities.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar

What to Eat After Dental Surgery?

Good diet and nourishment is of utmost significance especially when a person is recuperating from a dental surgery. If one knows what to eat and eats the appropriate diet, it guarantees quick recovery and also reduces the possibility of excessive dry socket and blood loss. Post oral surgery phase is a very critical stage and must not be managed without the supervision of dental specialists. In case the patient has been prescribed some antibiotics, he may have to exclude dairy products from his diet chart. In fact, for a couple of days following the surgery the patient should go in for either drinking beverages such as tea or water or foods that are soft.

In the post dental surgery period, a person needs to know what to eat and must include sufficient amount of fibre and protein in the diet. Liquids should also form a predominant part of the diet. Good dietary liquids include nourishing fruit and vegetable juices, milkshakes, energy drinks, instant breakfast drinks and fruit smoothies.
Immediately after oral surgery, oatmeal, soft scrambled eggs, soft fruits, well cooked rice and cream of wheat should be included in the diet of the patient.
Avoid carbonated or aerated beverages, hot fluids and spicy food after oral surgery.
The patient must eat those food items that do not cause irritation to one’s surgery spot. Foods such as puddings, yoghurt, custard, vegetable broth, ice-creams, applesauce, cream soups, and mashed potatoes are soothing to the spot of surgery.

Anything that needs to be sucked should be stringently avoided as this can hinder the blood clot formation in the mouth, resulting in excessive bleeding.
Though meat and the dairy products are an excellent source of protein and energy, they need to be avoided. Instead, you can eat mashed potatoes, soft cheeses and tofu. Moreover, food items including canned fish, poached fish, hummus, meat loafs, mashed pinto beans and shredded meat are supposed to be included in the diet as they do not require much of chewing. Peanut butter, seed and nut oils are also recommended.

What to eat after dental surgery is an important query that needs to be addressed to every patient. The latest innovations in the field of medicine and pharmacy have made the surgical methods and process less agonising and more tolerable on the part of the patient. As the patient is under the influence of medication when he returns home, he must ensure that he sticks to the prescribed painkillers and must not eat anything without the approval of the doctor.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar

Why are they called “wisdom” teeth?

Third molars have been referred to as “teeth of wisdom” since the Seventeenth Century and simply “wisdom teeth” since the Nineteenth Century. The third molars generally appear much later than other teeth, usually between the ages of 17 and 25 when a person reaches adulthood. It is generally thought among linguists that they are called wisdom teeth because they appear so late, at an age when a person matures into adulthood and is “wiser” than when other teeth have erupted.

Lately, science has added some credence to the idea that the third molar does indeed erupt when a person is “wiser”. Recent research has shown the brain continues to grow and develop right on through adolescence: in fact, most researchers believe the brain does not reach full maturity until the age of 25. Perhaps, then, our ancestors weren't so far off the mark — that the eruption of “wisdom teeth” is a sign that the carefree days of childhood have given way to the responsibilities of adulthood.

The old saying, “If it ain't broke, don't fix it,” doesn't really apply when discussing your wisdom teeth. It's great if they are not bothering you, but don't wait for problems to develop before you take action. This may seem counter-intuitive, but you should know that the best time to have your wisdom teeth removed is when they are not causing problems

Why do wisdom teeth cause problems?
For some people they come through the gum-line only partially, or they may not erupt into the mouth at all. Unerupted they have the potential to cause problems associated with the neighboring teeth and surrounding gums.

You may have heard of “impacted” wisdom teeth. This means that they are impacted or forced against neighboring structures, teeth or bone that prevent them from coming into the mouth in correct biting position. Since they are your last teeth to come in, space for them may be severely limited. They may push into the teeth that are already in place, becoming stuck as they try to erupt. When wisdom teeth are trapped like this below the gum line and are pushing against neighboring teeth, these molars can cause problems such as infections, cysts, or gum disease.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar

Root Canals, nothing to be afraid of…

Of all the terms you hear in a dentist’s office, to most people root canal is probably the scariest. So, what is a root canal? Simply put, a root canal is a treatment to repair and save a badly decayed or infected tooth. A root canal procedure involves removing the nerve and pulp, cleaning the inside of the tooth, and finally sealing the inside of the tooth. Think of it simply as a filling inside the tooth instead of on top of the tooth. Without treatment, the tissue around the tooth will become infected and abscesses may form.

The term “root canal” actually refers to the natural cavity within the center of the tooth. The soft area within the root canal is called the pulp or pulp chamber. The tooth’s nerve is also within the root canal.

Why does pulp and nerve need to be removed?
When a tooth’s pulp or nerve is damaged, it breaks down and bacteria begins to grow within the tooth. The bacteria, along with other decayed debris, can cause an infection, or even an abscessed tooth. An abscess is a puss filled pocket that forms at the ends of the tooth’s roots. In addition to an abscess, an infection in a root canal can also cause:

1. Swelling in the gums, and even spreading to the face, neck, or head.
2. Bone loss around the tip of the root.
3. A hole can be created in the side of the tooth with drainage leaking into the gums and even through the cheek into the skin.

What causes pulp or nerve damage in the first place?

The nerve and/or pulp can become inflamed, irritated, and infected due to several things. The most common causes are deep decay, repeated dental procedures on a single tooth, large fillings, a crack/chip in the tooth, or trauma to the face.

How do you know you need a root canal?

Some of the common signs that a root canal procedure may be needed are:

- Severe toothache when chewing or applying pressure.
- Extended sensitivity or pain to hot or cold temperatures.
- A darkening of the tooth, discoloration.
- Swelling and/or tenderness in the nearby gums.
- A reoccurring pimple on the gums.

How much pain is involved?

Root canals have a long standing reputation of being very painful, but actually most patients compare it to a filling, which is minimal pain.

For a few days after the procedure there may be sensitivity due to natural tissue inflammation, especially if there was pain and infection before the procedure. Most patients control this with simple over-the-counter medications and prescribed antibiotics. Most return to normal activities the next day.

Are there any alternatives?

Saving the natural teeth is always the best option, if possible. The only alternative is to extract the tooth and replace it with either a bridge, implant, or a removable denture to restore chewing function and prevent other teeth from shifting. These alternatives are not only more expensive, but also require more treatment time and additional procedures to adjacent teeth and supporting tissues.

Prevention

Prevention is very simple in theory; brush twice a day, floss at least once a day, and see your dentist regularly. Also, when playing sports, remember to where a mouth guard to avoid trauma.

  Dr. Claudio A. Sorrentino

  www.dentalpalermo.com.ar