Teeth Abrasion and Erosion

Teeth Abrasion and Erosion

Abrasion and erosion are two types of damage that can wear away the tooth's outer covering, the enamel. Sometimes they also affect deeper parts of the tooth.

Tooth abrasion is caused by something rubbing or scraping against the teeth. Brushing too hard is a common cause of abrasion. Toothpicks can cause abrasion. So can partial dentures or retainers that you can remove.

Chemicals such as acids cause tooth erosion. Usually the acids are in citrus fruits and other foods. Stomach acids also can cause erosion if they come up into the throat and mouth. This problem is called acid reflux. People with the eating disorder bulimia can get tooth erosion because of repeated vomiting. Even the chlorine and other chemicals in a swimming pool can cause erosion over time.

Symptoms

Toothbrush abrasion causes V-shaped notches in the lower third of the teeth, near the gumline. Notches made by toothpicks may occur between the teeth. In contrast, tooth erosion leaves a smooth, scooped out area on the tooth surface.
Both abrasion and erosion can make teeth more sensitive to sweet, hot or cold food and drinks. The problem may be worse if the dentin under the enamel is exposed. Dentin protects the innermost part of the tooth, the pulp, which contains nerves and blood vessels.
Abrasion and erosion also can affect how your teeth look.

Diagnosis

Your dentist can examine your teeth to see if you have tooth abrasion or erosion. Sometimes they are diagnosed after the teeth become sensitive to temperature or sweet foods.

Treatment

Treatment for erosion and abrasion depends on how bad the damage is. If you have a large defect, you'll likely want to have the tooth fixed. If there is little damage, and your tooth is not sensitive, you may not need treatment.
For sensitive teeth, your dentist may recommend a fluoride gel or rinse to use at home. If you need your teeth fixed, your dentist will use a tooth-colored material to replace the area that has worn away. Two types of materials are used:

Composites (plastic fillings)
Glass ionomers
Your dentist or dental hygienist may also apply a fluoride varnish to the teeth.


Prognosis

The prognosis is excellent if the problem is caught early, and the cause is eliminated. If the process is allowed to continue, it can damage the center of the tooth, the pulp. The more damage is done, the more work will be needed to correct the problem.

Implants

What is a dental implant?
A dental implant is an artificial substitute/replacement for the root portion of your natural tooth and is anchored into a pre-drilled socket in your jaw-bone to support a crown, bridge or secure a denture firmly in place. Implants are made from titanium, a material that is well tolerated by bone and integrates easily with bone tissue. During the placement of a dental implant, the goal is to achieve a close contact between the outer surface of the implant and the surrounding bone tissue so they can “fuse” together (osseointegration), creating a stable support for the new teeth.










How is a dental implant placed?

Before any implants are placed, it is important for your dentist to assess the health of your teeth and gums. If there are any signs of gum disease or decay, these must first be treated. Thereafter, your treatment will be planned following several x-rays and, in some cases, a CT scan to assess that bone quality and check for nearby anatomical structures to avoid before any drilling. The procedure is usually carried out under local anaesthesia; IV sedation is sometimes used if it is a long procedure or the patient is very anxious.

The gum where the implant is to be placed is cut and lifted and a small hole is drilled in the jawbone at the precise location of the intended implant. The titanium implant is tightly fitted into this socket and the gum is stitched back over the implant. If there is insufficient bone material to accommodate the implant, a bone graft may be required, or the dentist may use smaller-sized mini implants if suitable.

Once the implant has been placed, it is left to heal and integrate with the jawbone for between six weeks to six months. The bone tissue will grow and anchor itself into the microscopic rough surface of the implant.

During this “healing period”, patients are given temporary teeth (bridges) or continue to wear dentures. It is important that temporary teeth do not exert any force on the healing implant. After the healing period, the gum is again lifted and a post is attached to the implant with a temporary crown. Four to six weeks later, when the surrounding gum tissue has matured, the final permanent restoration can be fitted to the implant.

PREMEDICATION BEFORE DENTAL TREATMENT

PREMEDICATION

Antibiotics Before Dental Treatment

Your physician or dentist may recommend that you follow special steps at home before your dental visit to safeguard your health. These steps may include taking antibiotics before your appointment. Administration of an antibiotic prophylaxis before dental procedures is commonly called premedication.

Here's why premedication is required for some patients. Any time there is bleeding in the mouth, oral bacteria can enter the bloodstream and travel to the heart.

What is infective endocarditis?

Infective endocarditis is an infection of the heart's inner lining (endocardium) or the heart valves. This can damage or even destroy your heart valves.

How does it occur?

Infective endocarditis occurs when bacteria in the bloodstream (bacteremia) lodge on abnormal heart valves or other damaged heart tissue. Certain bacteria normally live on parts of your body, such as the mouth and upper respiratory system, the intestinal and urinary tracts, and the skin. Some surgical and dental procedures cause a brief bacteremia. Bacteremia is common after many invasive procedures, but only certain bacteria commonly cause endocarditis.

Impacted Tooth

Impacted Tooth

What Is It?
An impacted tooth gets blocked on the way into your mouth. Wisdom teeth often are impacted.
Wisdom teeth usually begin to come in between the ages of 17 and 21. Dentists call these teeth third molars. They may become impacted because there's not enough room in your mouth for them. A wisdom tooth also might be trying to come in sideways. Or, it might be tilted in your jaw.
An impacted tooth can be painless. You may not even realize it's there. However, when an impacted wisdom tooth tries to come in, the flap of gum on top of it can swell. This can hurt. You might feel pain in nearby teeth, or in the ear on that side of your face. Plus, food particles can get stuck near the gum flap. This can lead to an infection called pericoronitis. If untreated, this infection can spread to the throat or into the neck.
Impacted teeth can get cavities. An impacted tooth can push on the neighboring molar. This can lead to tooth movement, decay or gum disease. It also can change the way your teeth come together. Rarely, impacted teeth can cause cysts or other growths in the jaw.

Symptoms

Symptoms include:
Swelling of the gum in the back of your mouth
Difficulty opening your jaw
Bad breath
A bad taste in the mouth
Pain when you open your mouth
Pain when chewing or biting
Pain can occur for several days and then disappear. It can come back weeks or months later.

Diagnosis
Your dentist will examine the area. If necessary, he or she will take X-rays. X-rays can show where your wisdom teeth are and if they are impacted.

Expected Duration
When the tooth is taken out, the symptoms will go away.

Prevention
There is no way to prevent an impacted tooth. You can prevent cavities by brushing and flossing.

Treatment
You can sometimes relieve minor irritation by rinsing with warm salt water (1/2 teaspoon of salt in 8 ounces of water). Over-the-counter pain relievers also may help.
If the tooth continues to cause pain, is infected or interferes with nearby teeth, the usual treatment is to take it out. Extracting one tooth can take 5 to 30 minutes, depending on where it is.
Patients are often referred to an oral and maxillofacial surgeon to have an impacted tooth removed. Before removing the tooth, your dentist or surgeon will discuss the procedure and the type of anesthesia and sedatives he or she will use. You will not be able to eat for six hours before surgery. If you take any medications, keep on schedule with them. Someone should drive you to the appointment and drive you home.
After the surgery you may have swelling of the cheeks and jaw. It may be hard to eat certain foods. Follow your dentist's or surgeon's instructions carefully for the best recovery. Complications of surgery are rare, but do occur.
An impacted tooth may not bother you or affect nearby teeth. In this case, you won't need immediate treatment. However, your dentist probably will recommend that the tooth be taken out to avoid future problems.
Many people have all four of their wisdom teeth taken out at once. Sometimes this surgery is done before the teeth have started coming in. This prevents future problems. This usually is done in an oral and maxillofacial surgeon's office with sedation and local anesthesia. Often, it is better to have your wisdom teeth taken out before you turn 21. The surgery usually is less complicated. The tissue and bone also heal better.

When To Call a Professional
Call your dentist if you experience pain in your back teeth. If you visit your dentist regularly, he or she will keep track of your wisdom teeth and let you know if you need to have them taken out. Your dentist may take extra X-rays to check your wisdom teeth. Routine X-rays often don't show these teeth.

Prognosis
The outlook after surgery is excellent.

Gum Disease (Periodontal Disease)

Gum Disease (Periodontal Disease)

Gum disease – also known as periodontal disease and periodontitis – is an inflammatory condition affecting the tissues surrounding a tooth, and is the leading cause of tooth loss. Gingivitis is a bacterial infection of the tissues in the mouth and potential precursor of gum disease.
Once gum disease sets in, the toxins produced by the bacteria damage the teeth's connective tissue and bone, effectively destroying them and fostering tooth loss.

The Signs of Gum Disease
As a gum infection progresses, the bone tends to recede; the gums may or may not recede. In some cases, the root of the tooth becomes exposed, occasionally causing tooth sensitivity. Furthermore, pus may be produced, and pockets may form between the gum and tooth.
Since bone recession is not visible to the naked eye, and if left undetected, may contribute to tooth loss, it is important to visit your dentist for professional examinations and dental cleanings to identify gum disease.
Here are some common signs of gum disease you and your dentist can look for:
Bleeding gums during tooth brushing or otherwise.
Sensitive, red or swollen gums.
Bad breath.
teeth that are loose or appear to have shifted.

Causes of Gum Disease
There are a number of causes of gum disease, each of which can be corrected and controlled. The causes of gum disease include:
1. Improper Dental Hygiene: If plaque is not removed through daily dental hygiene practices and regular professional dental cleanings, bacteria may set in and cause gingivitis, which may eventually result in gum disease.
2. Organic Changes in the Mouth: Changes that occur in metabolism and hormone levels during pregnancy, puberty and menopause may affect the organic balance in the mouth, and make teeth more susceptible to gum disease.
3. Medical Conditions: Serious conditions that affect the body's ability to produce sugar (such as diabetes or kidney disease) may contribute to periodontal disease. Furthermore, the Center for Disease Control has found an association between certain illnesses (including diabetes, stroke and heart attack) and gum disease. Finally, medications used to treat medical conditions may produce the overgrowth of gums. Overgrown gums are more susceptible to bacteria, and therefore gum disease.
4. Saliva Flow Inhibitors: Certain medications that produce oral side effects or dry mouth syndrome (xerostomia) may contribute to a reduction of protective saliva flow, and potentially to gum disease. Seniors may be more susceptible to dry mouth syndrome because of the natural reduction of salivary flow associated with age.
5. Poor Functional Habits: Teeth grinding or clenching may impair the surrounding tissue and is a possible contributor to gum disease.

Cold Sores and Fever Blisters

Cold Sores and Fever Blisters

Cold sores and fever blisters are caused by herpes simplex virus type 1 (HSV-1). This virus is passed from person to person by saliva, or by skin contact. Cold sores usually appear as clusters of tiny blisters on the lip. Most people are first infected with HSV-1 before they are 10 years old.
After this first infection, the virus remains in the nerves of the face. In some people, the virus becomes active again from time to time. When this happens, cold sores appear. HSV-1 can get active again because of a cold or fever.
Stress also can lead to a cold sore outbreak. This includes mental and emotional stress, as well as dental treatment, illness, trauma to the lips or sun exposure. HSV-1 also can infect the eyes, the skin of the fingers and the genitals. Most genital herpes infections are caused by herpes simplex type 2 (HSV-2), however.
HSV-1 can cause serious illness in people who have other health problems. The virus also can cause serious illness in people whose immune systems are weakened by either illness or medications they are taking.
Symptoms
People infected with HSV-1 for the first time may have fever, headache, nausea and vomiting. They may have painful swelling and open sores in the mouth. Some people have a sore throat. These symptoms usually begin about a week after someone is exposed to HSV-1.
Cold sores appear when HSV-1 is reactivated later in life. They may occur after a period of illness or stress, poor nutrition or sunlight exposure, or for no known reason. Dental procedures that stretch the lip may occasionally trigger the virus.
The border of the lip is the most common place that these sores appear. They may occasionally occur inside the mouth, too. This is more likely in people who have weakened immune systems or other medical problems.
The first sign of a cold sore is a tingling, burning or itching. This is followed by swelling and redness. Within 24 to 48 hours, one or more tiny blisters ("fever blisters") appear. These blisters pop and form painful sores ("cold sores"). The sores eventually are covered by crusts. The crusts are shed and form again while the sore heals.
Diagnosis
Your dentist or physician usually can diagnose cold sores by asking you about your medical history and examining you. If you have other medical conditions, your physician can do other tests to diagnose cold sores. These tests are usually not necessary in healthy people.
Expected Duration
When you are first infected with HSV-1, symptoms can last for 7 to 14 days. Cold sores usually crust within 4 days and heal completely within 8 to 10 days.
Prevention
To help to prevent a first herpes infection in children do not let them be kissed by anyone who has cold sores, fever blisters or signs of a first herpes infection. However, HSV-1 is very common. Most children will be infected by the time they reach adulthood. Several different vaccines are being developed against HSV (types 1 and 2), but these appear to protect only people who have never been infected.
There is evidence that using sunscreen on your lips will prevent cold sores caused by sun exposure. Antiviral medicines may prevent cold sores from forming. In certain situations, your dentist or physician may prescribe these medicines. If you are going to encounter a known trigger, a medicine taken in advance can decrease the chance of a cold sore.
Treatment
Some medicines can help cold sores heal faster. They also relieve pain and discomfort. The medicines are acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). These drugs cannot get rid of the virus. You need to take them each time you can feel a cold sore coming on. Once you have blisters on your lip, the medicines will not help much.
These drugs also can stop cold sores from popping up in the first place. Some people take them when they know they will be under stress.
Keep the area clean and apply lip balm. Try not to touch the area. Avoid kissing anyone while you have blisters and sores.
When To Call a Professional
Cold sores are common. They usually are not dangerous. If you have a weakened immune system (because of a disease, or because of medicines you are taking), HSV-1 can cause a serious illness. Call your dentist or physician immediately if:
Lip or mouth sores persist longer than one week
The sores make it hard for you to talk or swallow
You develop a fever
A second outbreak of blisters occurs

Teeth Sensitivity

TEETH SENSITIVITY

Many of us say we have "sensitive teeth." We usually mean that we feel twinges of pain or discomfort in our teeth in certain situations, including:
Drinking or eating cold things
Drinking or eating hot things
Eating sweets
Touching the teeth with other teeth or the tongue
There are two types of tooth sensitivity:
Dentinal sensitivity occurs when the dentin (middle layer) of a tooth is exposed. Normally, the dentin is covered by enamel above the gumline and by cementum below the gumline. Dentin is made up of tiny openings called tubules. Inside each tubule lies a nerve branch that comes from the tooth's pulp (the center of the tooth). When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches. This causes sensitivity.
Dentinal sensitivity can affect one or more teeth. Dentinal sensitivity occurs when the outer protective layers of enamel or cementum are removed, exposing the dentin. Some causes of dentin exposure include:
Brushing your teeth too hard. This wears away the enamel layer.
Poor oral hygiene. This may allow tartar to build up at the gum line, leaching minerals from the tooth.
Long-term tooth wear
Untreated cavities
An old filling with a crack or leak
Receding gums that expose the tooth's roots. Receding gums often are caused by periodontal diseases or by brushing too hard.
Gum surgery that exposes a tooth's roots
Excessive tooth whitening in people who have tooth roots that already are exposed
Frequently eating acidic foods or drinking acidic beverages
Pulpal sensitivity is a reaction of the tooth's pulp. The pulp is a mass of blood vessels and nerves in the center of each tooth. Pulpal sensitivity tends to affect only a single tooth. Causes include:
Decay or infection
A recent filling
Excessive pressure from clenching or grinding
A cracked or broken tooth
If you experience a sharp pain upon biting, you may have a cracked tooth or a broken or cracked filling.
Symptoms
Both dentinal and pulpal sensitivity usually involve reactions to temperature or pressure. Sensitivity to cold drinks or foods is the most common symptom. Less often, the teeth are sensitive to hot temperatures. If a single tooth changes from cold sensitivity to hot sensitivity, the tooth's nerve may be dying. In this case, root canal treatment is necessary.
Diagnosis
Your dentist will look at your dental history and will examine your mouth. He or she will ask about your oral habits. Grinding or clenching your teeth can contribute to sensitivity. Your dentist also will look for decay, deep metal fillings and exposed root surfaces. He or she may use an explorer—a metal instrument with a sharp point—to test teeth for sensitivity.
A tooth may be sensitive to cold for several weeks after a filling is placed. The metals in amalgam (silver) conduct the cold very well, transmitting it to the pulp. Bonded (tooth-colored) fillings require etching the tooth with acid before the filling is placed. In some cases, this etching removes enough enamel to make the tooth sensitive. However, advances in bonding now make it less likely to cause tooth sensitivity.
Your dentist or endodontist can conduct tests to see if you need root canal treatment.
Expected Duration
If your tooth becomes sensitive after a silver filling is placed, the sensitivity should go away in several weeks. Some sensitivity may not go away over time. This means the tooth probably needs a root canal.
Sensitivity in more than one tooth may disappear in a short time or it may continue. It depends on the cause of sensitivity. Every case is different. Some people have sensitive teeth for only a month or two. Others have the condition for much of their lives.
Prevention
Dentinal sensitivity — You might be able to reduce your chances of dentinal sensitivity by:
Brushing twice a day and flossing daily
Using a soft or ultrasoft toothbrush and brushing gently up and down, rather than side to side
Using a fluoride toothpaste and mouth rinse
Using a toothpaste that has the American Dental Association (ADA) Seal of Approval and provides protection against sensitivity
Getting treatment for grinding or clenching your teeth (bruxism)
Pulpal sensitivity — If a tooth needs root canal treatment, there is no good way to prevent pulpal sensitivity other than to get the needed treatment. Delaying root canal treatment may result in further problems and is not recommended.
Treatment
Dentinal sensitivity is quite treatable, whatever the cause.
Your dentist or dental hygienist will clean your teeth. If your teeth are too sensitive to be cleaned, your dentist may use a local anesthetic or nitrous oxide before the cleaning.
After a cleaning, your dentist may apply a fluoride varnish to protect your teeth. This temporarily reduces sensitivity. It also strengthens your teeth. Your dentist also may apply an in-office treatment for sensitivity. These products block the openings (tubules) in your teeth and reduce sensitivity.
Using fluoride toothpastes and fluoride mouth rinses at home also will help to reduce sensitivity. Toothpastes are available just for sensitive teeth.
Talk to your dentist about which fluoride rinses you should use. Some over-the-counter rinses are acidic. Others are not. You should choose a fluoride mouth rinse that uses neutral sodium fluoride.
Pulpal sensitivity can be treated with a root canal if the tooth's nerve is damaged or dying. If the sensitivity is from a new amalgam (silver) filling, it should go away on its own in several weeks. In some cases, a new filling may be too "high" and may be causing sensitivity. Your dentist can polish the filling in this case. Sensitivity caused by grinding or clenching should diminish as the condition is treated.