Current Dental Topics

A dental cavity is the most common cause of a toothache. A cavity is a hole in the outermost layers of the tooth. These layers, the white enamel and the yellow dentin layer below, serve to protect the inner living tooth tissue, called the pulp. The pulp is where the nerves and blood vessels reside. Cavities are caused when bacteria in the mouth convert simple sugars into acid. The acid and saliva dissolve the enamel and dentin.

Often a cavity is not noticed by a patient until they deepen and collect food debris. The pulp of the tooth can become irritated by the bacterial toxins and, reactive to hot, cold, sour or sweet, thus causing toothaches. Unchecked, the pulpal injury may result in the death of the pulp tissue, creating a dental abscess or tooth infection. a small swelling or gum blister may be present near the affected tooth. Tooth abscesses are a very serious dental emergency and must be treated immediately. Erupting wisdom teeth and periodontal (gum) disease can also cause significant pain and discomfort and should be evaluated promptly.

To maximize the possibility of successfully reinserting a tooth which has been knocked out, the following steps must be followed:

• Retrieve the tooth, handling it carefully on the crown (white) part of the tooth, being very careful not to touch or damage the roots. The tooth may be cleaned gently in water, taking care not to scrub, as that may cause further damage. (Be sure that the sink is closed!)
• Carefully attempt to reposition the tooth in the original socket and then slowly and gently bite down to hold it in place.
• Alternatively, place the tooth in a small container filled with milk.
• Call our office during our regular office hours. If the office is closed, immediately call/attend at any Calgary Emergency Dental Clinic. Quick dental attention will greatly increase the tooth’s survival.

Lacerations, puncture wounds, tears in the lips, cheek mouth and tongue should be assessed immediately, either at the dental office or the Emergency room.

• Clean the injury with warm water. If the tongue or lip is bleeding, gently apply pressure with gauze.
• Cold compresses may reduce swelling.
• A cut in the mouth may appear to be bleeding more heavily due to the presence of saliva.
• Pain should never be treated with aspirin or ibuprofen as they are anticoagulants and will inhibit the clotting, thereby increasing bleeding. It is permissible to take acetaminophen or Tylenol, as directed.

A fractured or cracked tooth usually requires immediate dental attention, as damage may have occurred to the internal tooth structure as well as the outside of the tooth. Pain may or may not be present. The extent of the damage will then be assessed and a diagnosis as to whether or not the tooth can be saved.

• After arranging a dental appointment, carefully rinse your mouth with warm water.
• A cold compress may be applied if the tooth fracture was the result of a trauma.
• Acetaminophen (never Aspirin/Advil) may be taken as directed to reduce pain.
• Do not apply painkiller to the site, even a product like Orajel, as they can burn the gum tissue around the tooth.

Once you arrive at our office we will take an x-ray to determine the state of the tooth. If it appears that the pulp (the soft tissue inside the tooth) has been damaged, endodontic treatment may be recommended. If the pulp is healthy, a crown may be recommended. A simple resin restoration may suffice, if the fractured tooth has sufficient structure.

Should a temporary restoration become loose, or fall off, try to put it back in place with Vaseline, Chapstick, toothpaste or denture adhesive. This should keep it in place until you return to our office.

A lost or broken filling, may be uncomfortable, but is not an emergency, unless pain or discomfort occurs with it. A small piece of sugarless gum may be placed on the site, until you are able to arrange a dental appointment.

Oral hygiene, both home and the care you receive at the dental office is extremely important to both your dental health as well as your overall well being. The condition of your teeth and gums can have a direct influence on your overall health. Current research demonstrates the mouth-body connection, with heart disease, diabetes, stroke, COPD and many inflammatory response diseases being linked to oral health. This makes promoting and maintaining a high level of oral hygiene critical to avoiding health complications resulting from periodontal or gum disease.

Typically, you should have your teeth checked and cleaned at least twice a year. This time interval is generally sufficient to catch dental problems before they become too serious. Patients who have periodontal disease, are at high risk for cavities or with health complications may be scheduled for more frequent visits. Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.

While an insurance plan often limits the number of examinations a patient may have in a coverage year, they understand the role of preventative visits and allocate a set number of scaling or cleaning time units per coverage year. Typically this coverage is sufficient for a patient to have the required number of cleaning and examination appointments.

It is useful to be familiar with the terms of any dental insurance coverage you may have. Depending on your plan, you will be covered for a certain number of specific dental treatments per year. For more information, consult your insurance provider or contact our office, where our insurance experts can help you to understand your coverage and get the most out of your dental benefits.

• A complete medical and dental history will be taken. Medications and medical conditions may have a significant impact on your dental health (dental health may also affect other health conditions).
• Any insurance coverage will be entered into the computer. At the end of your visit we will electronically submit to your insurance company. Typically the insurance company pay us and we collect any difference from you.
• Digital x-rays will be taken, these have significantly less radiation than conventional x-rays. The x-rays are essential for the diagnosis of dental caries (decay), tumors, cysts, the position of roots and teeth as well as for periodontal considerations such as bone loss.
• One of the Registered Dental Hygienists will perform a thorough examination of your gums and teeth, including mobility and bone levels. They will assess the health of your gums the presence of any gum disease.
• The dental cleaning involves removing calculus (the hardened plaque), which has become firmly attached to the surface of the tooth. Calculus forms above and below the gum line, and can not be removed by brushing.
• Plaque is also removed. Plaque is a sticky, nearly invisible film which forms on the teeth. It is a living colony of bacteria, food debris and saliva. Toxins are produced by the bacteria which inflame the gums and thus start the process of periodontal disease.
• Polishing of the teeth removes stain as well as any remaining plaque.
• Instruction on flossing and brushing techniques will also be given.
• Great care will be given to ensure that there is no or little discomfort during the cleaning. If sensitivity is a concern, options for the cleaning will be discussed with you. The hygienists pride themselves on their compassionate, non judgmental manner and inform without lecturing.
• Dr. Jennifer Silver completes a thorough dental examination which involves reviewing of the xrays, the hygienist’s findings and a complete physical examination, including an oral cancer screening.
• Findings are discussed with you and if any treatment is required, options are explained.
  Treatment costs are provided and Insurance company pre-estimates for future treatment can be arranged, if necessary.

Dental X-rays are necessary to aide your dentist in evaluating your oral health. They provide valuable information on abnormalities like tooth decay, infections, and gum disease that might be lying beneath your teeth and gums. The frequency or amount of X-rays you need to have taken depends on the present state of your oral health, age, risk for disease, and signs and symptoms of oral disease that you may be experiencing.

Compared to the daily levels of radiation we are commonly exposed to in North America, the amount of radiation we receive when dental X-rays are taken is quite small. Estimated exposure to radiation is measured in millisieverts (mSv) or millirems (mrem), and allows for comparison of other sources of radiation to that experienced when we have very localized exposure that occurs with dental X-rays. Depending on the type, dental X-rays typically produce around 0.02 mSv, or 2 mrem. *

Some comparisons of radiation from different sources and estimated exposure:

• Bitewing radiographs: 0.038 mSv*
• Full-mouth series: 0.150 mSv*
• Lower gastrointestinal (GI) tract radiography: 4.060 mSv*
• Upper gastrointestinal (GI) tract radiography: 2.440 mSv*
• Chest radiograph: 0.080 msV*
• Living in a brick house: 0.10 mSv per year*
• One cross-country flight: 0.05mSv*
• Cosmic (Outer Space) radiation: 0.510 mSv per year*
• Earth and atmospheric radiation: 3.000 mSv per year*

Research published in 2004 has determined that every year 89.2% of Canadians have medical diagnostic X-rays taken, with an attributable risk of developing cancer from this radiation of 1.1% for both men and women.* When compared with other types of medical X-rays, dental radiographs usually expose patients both to lower doses of radiation as well as radiation that is not directed at areas of the body that have the highest rates of cancer, such as breast and prostate cancer.

The safety of dental X-rays has greatly increased in recent years due to advances in technology, and our office has modern machines that take and store X-rays digitally. Digital xrays reduce the already low level of radiation found in conventional dental xrays by nearly 90%/ We look forward to discussing any questions or concerns you may have regarding your safety or that of your children.

A number of medications have oral side effects that impact your health and comfort. These include dry mouth (xerostomia), inflammation of tissues in the mouth (stomatitis), and enlargement of the gums (gingival hyperplasia). It is important for your dentist to be aware of what medications you have been prescribed in order to watch for these common side effects and to be able to treat them accordingly. As well, dentists often prescribe antibiotics and other medications that may have negative interactions with those you are currently taking. When dental surgery is performed, it is necessary to know if patients are taking medications that will modify their bleeding characteristics in order to ensure the correct actions are taken to minimize patient risks.

Even though these are not prescribed medications, vitamins, supplements, and herbal remedies can have very real effects on your health.

• The “4 G’s” (Ginger, Garlic, Gingko, and Ginseng) have the potential to increase bleeding by decreasing platelet aggregation in the blood when taken with the medication Coumadin (warfarin).hyscience.com
• Feverfew, glucosamine, and green tea have been known to cause similar effects as well, in addition to a number of other commonly-used herbs and supplements.*
• Ginseng is particularly important for your dental care provider to be aware of, for the potentially dangerous effects it may create when combined with regular use of aspirin and Non-Steroidal Anti Inflammatory drugs. *
• Medications called biphosphonates (often prescribed for breast and prostate cancer, myleloma, and osteoporosis) have been linked to osteonecrosis of the jaw, which may arise and be worsened by insufficient vitamin D.
• Inadequate vitamin D intake has been associated with poor periodontal (gum) health. Osteoporosis Canada has recently developed guidelines that recommend daily vitamin D supplements of 400 IU to 1,000 IU for adults under age 50. Having an adequate intake of vitamin D has also been linked to decreasing gum bleeding upon probing. In healthy patients over 50 years of age, one study determined that those who received 500mg of calcium as well as 700 IU of vitamin D per day showed a lower risk of tooth loss. A separate study found that patients who took the same amount of calcium but more than 400 IU of vitamin D per day had better oral health, including shallower probing depths, fewer bleeding sites, lower gingival index values and less attachment loss.
• While many sources point toward the usefulness of vitamin therapy in increasing oral health, potential toxicity has been noted for certain vitamin uses. Using vitamin supplements to prevent deficiencies can often be overdone or based on inadequate scientific evidence of the long-term side effects of effectiveness of such treatment. For example, vitamin C has been promoted as a preventative and cure for periodontal disease without adequate scientific evidence to support this. * In fact, adverse secondary effects of certain vitamin utilization are well documented, and people should consult their physician or dentist when considering vitamin therapy to treat either a local or systemic health issue.
• Some foods can have positive effects on oral health. For example, fatty fish and nuts can help protect people from gum disease. These are high in polyunsaturated fatty acids, which can make consumers 30% less likely to develop gingivitis and 20% less likely to develop periodontitis. Small and easy changes in your diet in this way may drastically improve the condition of your gums and teeth, improving overall well being as a result.

Yes! Maintaining a healthy lifestyle has more to maintaining healthy gums and teeth than many people are aware of. Finding and maintaining a healthy weight, alongside having high levels of physical fitness, are associated with a lower incidence of severe periodontitis (gum disease). Because gum disease is associated with other diseases, like heart disease, diabetes, and rheumatoid arthritis, there is an added incentive to pursue an active lifestyle and a healthy diet.

Certain classes or types of drugs are particularly important to be aware of for their ability to negatively influence your oral health.

• Non-Steroidal Anti-Inflamatories: Commonly referred to as NSAIDs, these drugs are designed to reduce fever and inflammation when taken orally. Ibuprophen, with brand names such as Advil and Motrin, is a widely-taken over-the-counter medication that has the potential to increase bleeding upon invasive dental surgery as well as to cause dry mouth (xerostomia).1
• Antidepressants: Both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants can cause a wide range of oral side effects, including swelling of the salivary (partoid) glands, dry mouth (xerostomia), and tongue discolouration. The SSRI Paxil is particularly troublesome for its high incidence (up to 36% prevalence) of xerostomia as well as grinding of the teeth (bruxism).1
• Vasodilators and Vasoconstrictors: Vasodilators such as nitroglycerin may cause dry mouth and tooth disorders, 1
• Beta Blockers: These are medications commonly prescribed to treat conditions such as hypertension, angina, and edema. The most prevalent oral side effects of these are gingival enlargement (up to 20% for drugs such as Procardia and Dilacor) and xerostomia. 1
• Anticonvulsants: Prescribed for the treatment of seizures, anticonvulsants such as Dilantin (phenoytoin), Donnatal (phenobarbitone) and Epilim (sodium valproate) have been noted to cause gingival enlargement. This side effect is most prominent with Dilantin, where prevalence of gingival enlargement may be as high as 50%.
• Immunosuppressants: Neoral and Sandimmure (cyclosporin) may cause gingival enlargement at a prevalence of 25-30% in adults and up to 70% in children. Deltasone (prednisone) is another immunosuppressant that may cause xerostomia in 1-10% of users.

Estrogen oral contraceptives can have negative effects on periodontal health. While pills with a high estrogen content have been traditionally associated with these negative impacts, there have been recent studies linking modern low-estrogen pills to periodontal disease. Increasing attachment loss, as reduction of the connective tissue surrounding the tooth, has been noted, with a study published in 2007 finding that twice as many patients with aggressive periodontal disease were pill users.* These women tended to have higher levels of plaque, gingivitis and bleeding upon probing, although differences here were not statistically significant.

Because of these potential side effects, it is important to inform your dentist of all the medications you are currently taking, making sure to mention changes in your overall or dental health from the time of your last visit.

Due to the ways in which gum disease affects your entire body, there are multiple issues to take into consideration when looking at oral hygiene throughout pregnancy.

• Gingivitis caused by pregnancy affects approximately 50% of women. Many women experience discomfort from sore or bleeding gums from gingival inflammation.1
• During pregnancy, this gingivitis may worsen, making women increasingly at-risk for developing periodontal disease during this time.1
• There is a strong association between the presence of periodontal disease and the risk of preterm birth. Women who become pregnant must be especially careful about practicing proper hygiene techniques at home, as periodontal disease can increase this risk by up to seven times.1
• Undergoing treatment to manage your periodontal disease throughout pregnancy may not reduce the risk of preterm delivery.

The current lack of mechanisms to specifically address these risks makes prevention of gum disease through proper oral hygiene especially important in contributing to your health and the health of your baby.