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Posts for category: Oral Health

By Paul David Epstein, D.M.D. & Associates, P.C.
April 07, 2021
Category: Oral Health
Tags: sensitive teeth  
TreatingToothSensitivityDependsonItsCause

A scoop of ice cream is one of life's little pleasures. But for one in three Americans, it could be something altogether different—an excruciating pain when cold ice cream meets teeth. This short but painful experience that can happen when dental nerves encounter hot or cold temperatures is called tooth sensitivity.

A look at tooth anatomy will help explain why. Teeth are mainly composed of outer enamel, a layer of nerves and blood vessels within the tooth called the pulp, and dentin, a porous layer in between. The pulp nerves pick up temperature and pressure sensations from outside the teeth through a network of tiny passageways (tubules) in the dentin. Enamel muffles these sensations before traveling the tubules, which prevents overstimulation of the nerves.

This careful balance can be disrupted, however, if the enamel becomes eroded by acid from foods or beverages, or as a byproduct of bacteria. This exposes the underlying dentin to the full brunt of outward sensations, which can then impact the nerves and cause them to overreact.

This hyper-sensitivity can also occur around the tooth roots, but for a different reason. Because the gums primarily protect this area rather than enamel, the roots can become hyper-sensitive if they lose gum coverage, a condition known as gum recession caused mainly by gum disease or over-aggressive hygiene.

Besides using dental products that block nerve sensation, reducing sensitivity largely depends on addressing the underlying cause. If gum disease, the focus is on removing plaque, a bacterial film on dental surfaces that causes and sustains the disease. Stopping an infection allows the gums to heal and hopefully regain their original teeth coverage. More advanced cases, though, may require grafting surgery to foster gum regeneration.

If the cause is enamel erosion or other results of decay or trauma, we can utilize a number of treatments depending on the extent of tooth damage including cavity filling, root canal therapy or crowning. As a last resort, we may need to remove a tooth that's beyond reasonable repair.

If you've begun to experience sensitive teeth, it's important that you see us as soon as possible. The earlier we can diagnose the cause, the less invasive we can be with treatments to ease or even stop this most unpleasant experience.

If you would like more information on tooth sensitivity, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treatment of Tooth Sensitivity.”

By Paul David Epstein, D.M.D. & Associates, P.C.
March 28, 2021
Category: Oral Health
Tags: toothache   oral health  
WhatToDoandNotDoforThese3CommonChildhoodDentalProblems

Knowing what to do—and what not to do—when your child is sick can greatly affect their health and well-being. That's especially true with dental problems.

Here then are some Dos and Don'ts for 3 common problems children experience with their teeth and gums.

Teething. An infant's first teeth breaking through the gums is a normal but often unpleasant experience. Fortunately, teething episodes only last a few days. And, there's usually no need to see the dentist unless they have a fever or diarrhea while teething. In the meantime:

  • Do: provide them chilled (not frozen) cloth or plastic items to bite and gnaw, and massage their gums to relieve painful pressure. You can also give them an age-appropriate dose of a mild pain reliever.
  • Don't: rub any medication on their gums, which can irritate them and other soft tissues. Never use alcohol or aspirin to alleviate teething discomfort. And avoid using anything with benzocaine, a numbing agent which can be hazardous to young children.

Toothache. Whether a momentary sensitivity to hot or cold or a sharp, throbbing pain, a child's toothache often signals tooth decay, a bacterial disease which could eventually lead to tooth loss.

  • Do: make a dental appointment at your child's first complaint of a toothache. Ease the pain with a warm-water rinse, a cold compress to the outside of the jaw, or a mild pain reliever.
  • Don't: rub medication on the teeth or gums (for similar reasons as with teething). Don't apply ice or heat directly to the affected tooth or gums, which can burn them.

Bleeding gums. Gum bleeding from normal brushing or flossing, along with red or swollen gums, may indicate periodontal (gum) disease. Although rare in children, it can still happen—and it can put an affected tooth in danger.

  • Do: see your dentist if bleeding continues for a few days. Continue to brush gently with a soft-bristled toothbrush around the gums to remove plaque, a thin-biofilm most responsible for gum infection.
  • Don't: brush aggressively or more than twice a day, which could unnecessarily irritate and damage the gums. And don't stop brushing—it's important to remove plaque buildup daily to lessen the gum infection.

If you would like more information on dental care for children, please contact us or schedule an appointment for a consultation.

By Paul David Epstein, D.M.D. & Associates, P.C.
March 08, 2021
Category: Oral Health
AsAntetokounmpoKnowsEvenanNBAStarCanBeSidelinedbyaToothache

The NBA's reigning MVP Giannis Antetokounmpo may seem unstoppable, but he proved no match for a troubled tooth. Antetokounmpo, the self-proclaimed “Greek Freak,” missed one of the final three 2020 regular season games for a dental issue that resulted in last-minute oral surgery. According to a Milwaukee Bucks spokesperson, the star underwent “a root-canal like procedure.”

Root canal therapy, often simply called “a root canal,” may be needed when there is an infection inside the tooth. When dental pulp becomes inflamed or infected, excruciating pain can result. Pulp is the soft tissue that fills the inside of the tooth. It is made up of nerves, blood vessels and connective tissue. During root canal treatment, the pulp is removed, the space inside the tooth is disinfected, it is filled with a special material, and then the hole is sealed up.

A root canal is nothing to fear. It relieves pain by getting rid of infection and is so effective that over 15 million of them are performed in the U.S. each year. This routine procedure generally requires only local anesthetic, and your mouth should be back to normal within a day or two after treatment. Antetokounmpo can attest to that, as he returned to play the next day.

However, delaying root canal treatment when you need it can have serious consequences. If left untreated, an infection inside the tooth continues to spread, and it may move into the gums and jaw and cause other problems in the body. So, how do you know if you may need a root canal? Here are some signs:

Lingering sensitivity to hot or cold temperatures. One sign of nerve damage inside your tooth is pain that is still there 30 seconds after eating or drinking something hot or cold.

Intense pain when biting down. You may feel pain deep within your tooth, or in your jaw, face or other teeth. The pain may be hard to pinpoint—and even if it improves at times, it usually comes back.

A chipped, cracked or discolored tooth. A chip or crack can allow bacteria to enter the tooth, and the tooth may darken if the tissue inside is damaged.

A pimple on the gum. A bump or pimple on the gum that doesn't go away or keeps coming back may signify that a nearby tooth is infected.

Tender, swollen gums. Swollen gums may indicate an infection inside the tooth or the need for periodontal treatment.

And sometimes there is no pain, but an infection may be discovered during a dental exam.

Tooth pain should never be ignored, so don't put off a dental visit when you have a toothache. In fact, if a bad toothache goes away, it could mean that the nerves inside the tooth have died, but the infection may still be raging. Also, be sure to keep up with your regular dental checkups. We may spot a small problem that can be addressed before it becomes a bigger problem that would require more extensive treatment.

Remember, for dental issues both large and small, we're on your team! If you would like more information about tooth pain, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Tooth Pain? Don't Wait!” and “Root Canal Treatment: What You Need to Know.”

By Paul David Epstein, D.M.D. & Associates, P.C.
November 08, 2020
Category: Oral Health
TheHowieMandelEffectAvoidDentalDiseaseThroughDailyBrushingandFlossing

Howie Mandel, one of America’s premier television personalities, rarely takes it easy. Whether performing a standup comedy gig or shooting episodes of America’s Got Talent or Deal or No Deal, Mandel gives it all he’s got. And that intense drive isn’t reserved only for his career pursuits–he also brings his A-game to boosting his dental health.

Mandel is up front about his various dental issues, including multiple root canal treatments and the crowns on his two damaged front teeth. But he’s most jazzed about keeping his teeth clean (yep, he brushes and flosses daily) and visiting his dentist regularly for cleanings and checkups.

To say Howie Mandel is keen on taking care of his teeth and gums is an understatement. And you can be, too: Just five minutes a day could keep your smile healthy and attractive for a lifetime.

You’ll be using that time—less than one percent of your 1,440 daily minutes—brushing and flossing to remove dental plaque buildup. This sticky, bacterial film is the main cause of tooth decay and gum disease. Daily hygiene drastically reduces your risk for these tooth-damaging diseases.

But just because these tasks don’t take long, that’s not saying it’s a quick once-over for your teeth: You want to be as thorough as possible. Any leftover plaque can interact with saliva and become a calcified form known as calculus (tartar). Calculus triggers infection just as much as softer plaque—and you can’t dislodge it with brushing and flossing.

When you brush, then, be sure to go over all tooth areas, including biting surfaces and the gum line. A thorough brushing should take about two minutes. And don’t forget to floss! Your toothbrush can’t adequately reach areas between teeth, but flossing can. If you find regular flossing too difficult, try using a floss threader. If that is still problematic, an oral irrigator is a device that loosens and flushes away plaque with a pressurized water stream.

To fully close the gate against plaque, see us at least every six months. Even with the most diligent efforts, you might still miss some plaque and calculus. We can remove those lingering deposits, as well as let you know how well you’re succeeding with your daily hygiene habit.

Few people could keep up with Howie Mandel and his whirlwind career schedule, but you can certainly emulate his commitment to everyday dental care—and your teeth and gums will be the healthier for it.

If you would like more information about daily dental care, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Daily Oral Hygiene: Easy Habits for Maintaining Oral Health” and “10 Tips for Daily Oral Care at Home.”

By Paul David Epstein, D.M.D. & Associates, P.C.
October 09, 2020
Category: Oral Health
TreatingaChildsToothInjuryMayRequireSpecialConsideration

Often as children grow older, their participation in sports or similar activities increases. While generally encouraged, this greater activity does increase injury risk, especially to the mouth.

In fact, the late childhood to early adulthood demographic is the most prone portion of the population to incur dental injuries. To complicate matters, their dental development is often incomplete, posing a number of treatment obstacles for an injured tooth.

For example, the primary means for preserving an injured adult tooth is a root canal treatment: damaged or diseased tissue within the pulp, the tooth’s innermost layer, is removed and the empty chamber and root canals filled and sealed to prevent infection. But while a fully matured tooth can function without the nerves and blood vessels of the pulp, a developing tooth needs these tissues for continued tooth formation. Otherwise, tooth development can stall and cause problems later on.

The most common solution for younger teeth is to remove any damaged tooth structure without disturbing the pulp if at all possible followed by a filling. That’s contingent, though, on whether we find the pulp unexposed or undamaged—if it is, we’ll try to remove only damaged or diseased pulp tissue and leave as much healthy tissue intact as possible. To aid with healing and tissue re-growth, we may also place medicinal stimulators between the pulp and the filling.

Jaw development may also pose a challenge if the injured tooth is too far gone and must be removed. Our best choice is to replace it with a dental implant; but if we install the implant while the jaw is still growing, it may eventually appear out of place with the rest of the teeth. It’s best to postpone an implant until full jaw maturity in early adulthood.

In the meantime we could provide a temporary solution like a removable partial denture or a modified bonded bridge that won’t permanently alter nearby teeth. These methods can adequately restore the function and appearance of missing teeth until the jaw is mature enough for an implant.

While injuries with young permanent teeth do pose extra challenges, we have effective ways to address them. With the right approach, the outcome can be just as successful as with a mature tooth.

If you would like more information on dental care in the formative years, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving New Permanent Teeth after Injury.”