Check Engine Light: Dealing with Dental Emergencies

Dental emergencies can happen anytime to anyone.  Typically they happen when the dentist office is closed which is highly inconvenient to the patient.  Being prepared for dental emergencies and what to do in certain situations can mean the difference in saving or losing a tooth.

First let's discuss what is constituted as a "TRUE" dental emergency.

• Trauma sustained to a tooth from an accident
• Excessive swelling of the face
• Difficulty breathing or swallowing
• Fever
• Bleeding

We often get calls on Friday afternoons (or occasionally on weekends) from patients who have had an ongoing tooth ache or broken tooth for weeks (or even months) who now are now in state of extreme pain and do not want to go through the weekend in pain. Procrastination is not your friend.  Ignoring prolonged tooth pain (hoping it will go away) or a broken tooth is like ignoring the engine warning light on your car. It ultimately results in complete failure and the costs to repair rise exponentially.   With routine maintenance, your car will function and be reliable.  Run it out of oil and you'll have serious problems.

The same principles apply to your teeth.  Routine maintenance with your dentist alerts you to possible problems and affords you the ability to get issues taken care of before they become an "emergency", saving you pain and money. With that being said, we are aware that problems arise out of the blue, or trauma to a tooth results as an accident.

What should you do if you experience a true dental emergency?  

• Call your dentist at the first sign of an issue:  tooth pain, loss of filling, broken tooth
• Swelling: go to the emergency room if you are experiencing problems breathing or swallowing.  See your dentist right away.
• Tooth knocked out: keep moist at all times.  If you can put the tooth back in the socket without touching the root, that's ideal.  If not place the tooth between your cheek and gums or in milk and get to the dentist right away.
• Cracked tooth: rinse with warm salt water, cold compress may help with swelling.  See the dentist right away.
• Inflamed gums:  try flossing to remove food particles that may be lodged between teeth. Rinse with warm water.  If it persists see your dentist.
• Tooth ache: DO NOT place an aspirin on aching tooth or gum as it may burn the gum tissue.  Contact your dentist.
• Broken Jaw:  After hours go directly to the emergency room at the hospital.  Many times they have oral surgeons on call.  Otherwise see your dentist ASAP and he/she will give you a referral to an oral surgeon.

It will never cost less or hurt less than it does today!

8 Ball in the Corner Pocket: Winning Against Periodontal Disease

In the dental world, an 8 and a pocket aren't a good sign.  It's a sign of a serious disease of inflammation and bone loss called Periodontitis and it's not a game you want to play.

When people visit their dentist for a cleaning, the hygienist typically will probe the gums for a reading.  The numbers patients want to hear is 1-3 (healthy gum tissue).  4 indicates gingivitis (inflamed and bleeding gums), the beginning of periodontitis but still a reversible condition.  Numbers higher than 5 indicate the gums are separating from the teeth and can also be evidence of bone loss.

Bone Loss

The image on the left shows complete bone loss between two teeth.  Interestingly, patient came in every four months for a regular adult cleaning.  This happened in a very short amount of time which is not typical.  For many patients the type of bone loss would take years.

Periodontal disease is irreversible, however it is possible to improve and control the disease with needed treatments and excellent home care.

How are these pockets created?  Many factors can lead to gum disease: not brushing/flossing, other medical conditions such as Diabetes, medications causing dry mouth, etc.

Ultimately it starts as gingivitis.  The gums become inflamed and bleed due to bacteria in our mouth feeding off the plaque and tarter buildup.  The bacteria continue to feed until the inflammation causes the gums to pull away from the teeth.  Eventually the bacteria reach the jaw bone and continue eating away at the bone.

What are the risks?  Periodontal disease has been linked to other diseases such as heart disease.  Constant inflammation in the body is a sign of overall infection.  Since there are no fences in our body, the source of the inflammation (bacteria) is allowed to move to other sites in the body.

How do you control Periodontitis?  In most cases, patients will undergo Periodontal Scaling and Root Planing.  This treatment gets below the gum and begins cleaning out the bacterial infection between the gums and the teeth.  This allows the gums to heal and reconnect with the teeth.  Unfortunately bone loss is not reversible.  If there has been extensive bone loss, teeth can become mobile (loose) and gums can recede. Gum grafting surgery may be necessary.

Once scaling and root planing is complete, the patient will need to receive a periodontal maintenance more frequently than those who have healthy gums, typically every 3 to 4 months.

It will never cost less or hurt less than it does today!

Beware of Bleeding Gums!!

Bleeding gums are an indication of a condition of inflammation and infection called gingivitis. Gingivitis is the beginning stage of a more serious gum disease called Periodontitis, in which the gum tissue pulls away from the teeth creating pockets.  We'll discuss that a little more later.  For now, gingivitis is a reversible condition.

Gingivitis typically occurs when patients are not brushing and flossing regularly.  The gum tissue is aggravated by the plaque and tarter buildup that bacteria feed off of.  There are other causes for inflamed and sore gums including blood thinners.  Be sure to tell your dentist that you are taking blood thinners before having treatment.

How to reverse gingivitis:

1. Brush twice daily (invest in an electric toothbrush)
2. Floss daily
3. Eat a well balanced diet low in starches and sugars
4. Drink plenty of water (if you must have a sugar drink, don't sip on it, allow yourself 20 minutes then either brush, rinse with Xylitol mouth wash, or Xylitol gum/mints)
5. Eliminate tobacco

It will never cost less or hurt less than it does today!

There's a Desert in My Mouth - The Facts About Dry Mouth

Wikipedia's definition of a desert:  A desert is a barren area of land where little precipitation occurs and consequently living conditions are hostile for plant and animal life.

It's also an excellent definition for patient's who suffer from dry mouth.  There is little saliva production making it difficult to swallow, eat or speak.  It also creates a hostile oral environment.

First let's talk about what causes dry mouth.  Many physicians fail to disclose to patients that the medications they are prescribing can have dry mouth as a side effect.  You should alert your physician right away, whatever you do, don't stop taking the prescription without the consent of the doctor.  Diseases and conditions such as Diabetes can also lead to dry mouth, as well as stress!

What oral risks are associated with a dry mouth?

• Bad breath
• Gum disease
• Decay

Where is the oasis in the desert?  Some tips on living with dry mouth:

• Sipping on room temperature water all day
• Sugarless drinks
• Include a beverage with meals
• Xylitol products such as gum, mints, or melts and oral mist spray
• Avoid smoking and drinking alcohol
• Alcohol-free mouth rinse (Xylitol is preferable)
• Room humidifier as you sleep

It will never cost less or hurt less than it does today!

The Daily Grind: Effects of Clenching and Grinding

It is probably one of the most common issues we see in the dental office daily.  Patients who clench or grind their teeth are at a higher risks for dental problems than those who don't.  What you need to know: bruxism (grinding of teeth) can lead to serious problems.

• Misalignment of teeth - can lead to gum disease
• Headaches
• Failed restorations (crowns, fillings, bridges)
• Cracked tooth syndrome

What are the causes of bruxism?  Stress can be the leading culprit.  It's important to identify stressors and try to eliminate them if possible.  Neurological disorders, such as Parkinson's and Huntington's disease can also be the reason someone is a bruxer.  

We are very surprised that many of our patients do not know that they are a clencher or grinder.  Tooth wear is one of the best indicators.  This is discovered during regular cleanings and checkups.  We are able to help patients save their teeth by fabricating a custom made bite splint to wear at night.  This bite splint can save the patient thousand of dollars in restorations, as well as other painful conditions.

It will never cost less or hurt less than it does today.

HPV: Linked to Oral Lesions

What are some signs or symptoms that you may oral HPV?  Lesions on your tongue, soft palate, or tonsils could be an indication of oral HPV.  It is one of the most common types of infections among teens and women aged 25 years and younger who are sexually active.  Though these are not the only people who are at risk for oral HPV.

HPV is mainly spread through skin-to-skin contact.  There are several different types of HPV and determining which type you have is important.  Regular check ups with Dr. Gilmore can help identify potentially harmful lesions.  Biopsies are done to determine whether the lesion is benign or malignant.  

However, HPV 16 (which also causes cervical cancer), typically attacks at the base of the tongue which is difficult to see visually.   There are no screening test available, such as swabbing (as available to women at their annual pap) due to how far down the back of the throat you'd have to swab.

Men are twice as likely to get HPV 16 than women and it's more common among white males than black.  A doctor should be seen as soon as symptoms appear: a lump in the neck, a sore throat or ear pain that persists for two weeks or if you begin to talk as if something were burning in the back of your throat.

It will never cost less or hurt less than it does today.

The Tooth About Cavities

Tooth decay, sounds painful!  However, for most people, they don't even know they have a cavity forming because the initial stages of tooth decay aren't painful.  As the cavity grows your tooth may become hot or cold sensitive.  Once the decay reaches the nerve canal you may experience severe pain.

What is tooth decay?  Tooth decay is a process that involves a balance of the mineral loss and replacement in a tooth over time in response to daily acid attacks resulting from food consumption, plaque, medications, etc.  I know this sounds rudimentary, but the bacteria that's found in our mouth feeds off the foods we eat (especially sugary foods) and essentially excrete acids which in turn break down the enamel (protective coating) of the tooth.

Every time you eat or drink there is an acid attack on your teeth that occurs.  Building a critical defense against plaque and acids are a critical part of your oral health.

How to prevent tooth decay?  

• Avoid snacking or sipping on sugary food and drinks during the day.  Specific foods cling to your teeth, sugars and starches especially. 
• Fluoridated water can be beneficial over bottled water.   
• Xylitol products (natural sugar with bacteria fighting properties) - Strive for 5 - Five 1g exposures a day has been proven to reduce cavities by 85% in some patients.
• Sealants on teeth prior to decay starting is an invaluable way to protect teeth.
• Most importantly, regular cleanings and checkups

It never costs less or hurts less than it does today!