I recently had a temporary crown
come loose and would like to know if there is any adhesive on the market that
I can apply myself to keep the crown in place for a few days until the permanent
crown is ready.
A
There are several propriety brands available fron chemists (drugstores). As
an emergency measure softened sugar free chewing gum may be useful
I have a question concerning dental
care while breastfeeding. I have a tooth that has a cracked filling which makes
it temperature sensitive and makes it difficult to chew on that side. Will it
harm the baby if I continue to breastfeed? Also, if I do get the filling fixed
will I need to discontinue breastfeeding for any length of time due to medications
that are used in numbing the area.
A
The answer to both questions is no - providing the treatment received complies
with current professional standards as dictated by the authoritites
I was wondering what the current
state-of-the-art knowledge is on:
(a) what causes Apthous Ulcers, and
(b) how to stop them, or at least minimize the time we have to suffer them.
A
Apthous ulcers are mouth ulcers without a specific cause.
The current explanation is that the cause is 'multifactorial' - ie they don't
know! Stress is often implicated. The only advice I give patients is to rinse
with warm salted water before mealtimes - it stings but calms the ulcers whilst
you eat [ususally the most painful time] Also this condition often resolves
itself so don't worry unduely.
I have a question concerning the
new "ionic" toothbrushes. In particular the hyg ionic toothbrush.
It claims to change the polarity of the teeth temporarily to remove plaque.
Do you think it works? Thanks in advance for your reply!
A
This is a new one on me!!
Who makes it? Sounds abit gimmicky since careful brushing removes plaque anyway!
First thoughts are no, it probably doesn't work any better than a normal [ and
no doubt cheaper! ] ordinary brush! Does anyone have any other thoughts?
Please email The Editor if you have any comments.
Please mark the subject "IONIC".
I am a 19 year old male and have
been advised by several dentists that I have a crossbite. My symptoms include
the popping and excessive moevment of my lower jaw as well as my top and bottom
incisors hitting each other. When I consulted an orthodontist 1 year ago to
seek treatment he advised me that I should wait 1 year, as my jaw was still
growing. My understanding is that the corrective procedure would involve 2 years
of braces and then surgery. Could you elaborate a bit more on the procedure?
Can the surgery be performed right away, without having to wear the braces?
Is it possible to get braces behind the teeth or clear braces with such a condition?
A
It is always difficult to respond to specific cases without actually examining
the patient but a few generalizations can be made. You mention that several
dentists have advised that you have a crossbite. There are several different
types of crossbites, each with different treatment protocols. If your orthodontist
has determined that orthognathic surgery is necessary for the correction of
your particular crossbite, then orthodontics is usually necessary before the
surgery. The reason for this is that the surgery is done to correct the relationship
of the maxilla (the upper jaw bone) and the mandible (the lower jaw). The individual
positions of the teeth themselves are generally not ideal within their respective
jaw bones. During the actual surgery, the fit of the upper teeth with the lower
teeth is used as a guide to set the respective jaws appropriately relative to
one another. Hence, if the positions of the individual teeth within their own
jaw are not as close to ideal as possible, the way they fit together in a biting
relationship cannot be used as a practical surgical guide. Usually, the pre-surgical
phase of orthodontics takes about two years and is generally followed by another
6 - 12 months of post-surgical orthodontics to finalize and fine-tune the occlusion.
You ask about "braces
behind the teeth" or "clear braces". Lingual braces are braces
that are placed on the lingual surfaces of the teeth ("behind the teeth").
These can be used in many cases but, generally, they are more difficult to use
and may require a prolonged treatment time. They are somewhat uncomfortable,
irritating the teeth and impeding the speech. Just how irritating or impeding
they are varies from patient to patient. Also, for technical reasons, they cannot
be used in all cases. It would be best to consult your orthodontist regarding
whether lingual braces would be advisable in your specific case.
Clear braces are applied to the teeth just like regular metallic braces and
are made of either ceramic materials or lexan polymer with a metal slot insert
to receive the treatment archwires. While there are some procedural differences
in how ceramic or polymer braces are used, they can generally be used in any
case that the metal brackets are used. Again, consult with your own orthodontist
for specific recommendations in your case.
R. G. Keim, BS, DDS
Associate Professor
Department of Orthodontics, University of Tennessee
What is the safest, nondestructive
way to whiten teeth. I smoke and drink a lot of iced-tea?
A
Firstly you should visit the hygienist and/or your dentist and have them professionally
cleaned. If the colour of your natural teeth is dark you may be able to have
them whitened using a peroxide gel dispensed by the dentist.On a day to day
basis avoid 'smokers' toothpastes, which are too abrasive. Certain specialist
toothpastes, such as 'Rembrant' may be useful.
Please explain the cause of infection
and extreme pain after a root canal on an non-abscessed tooth. Also, on average
how long after a root canal is numbness to be expected?
A
The infection was probably already in the tooth - hence the need for the root
treatment. It is possible that some of the infection from the tooth escaped
throught the end of the root into the bone below. After the treatment this remaining
infection can flare up causing much pain. Usually a course of antibiotics will
releave the symptoms.
Root filled teeth often feel 'dead' because there is no live nerve left in the
tooth.
Please describe the root canal procedure
and when is it necessary.
A
Firstly a small hole is drilled into the biting surface , in far enough to reach
the nerve chamber inside (the nerve will have been damaged or will have died
to necessitate the treatment is the first place)
An instrument is passed inside and an x-ray taken. This is to measure the length
of the root. Electrical measuring probes are also sometimes used.
The canal is filed with small files (either by hand or attatched to a drill)
and at the same time cleaned with fluid.
It is then dried and the rounded canal sealed with (usually) a rubber material
called gutta percha and a paste.A final x-ray is taken.There can be a couple
of additional stages and the treatment usually takes several visits. It is a
fairly common proceedure.
About three years ago I had my wisdom
teeth sealed with ionomer sealant. How long does this last for and can I get
it re-done if necessary?
A
The longevity will depend on a number of factors; the exact type of material
used, your diet (do you eat alot of abrasive foods etc) the way your teeth bite
together etc. 5 years would normally be the minimum life-span. This procedure
is quite straight forward to repeat so don't worry.
My dentist wants to replace an old
filling that has developed a crack with a "space-age tooth colored restoration
that is manufactured in the laboratory". The material is called Concept.
The restoration will cost about $500. A regular silver filling will cost about
$100. What are the pros and cons of this new material ? Have any long term studies
been performed with it ?
A
The new materials look better and are laminated into the tooth - hence the end
result is very strong. Also they do not contain mercury like the silver ones.
They are much more difficult to do - hence the cost. However the silver ones
have been used for many years and are tried and tested. It really comes down
to personal choice these days. I think I should add that I avoid using 'mercury
fillings' on my children.
I just had my front incisor broken
about 1/8 inch above the gum line, and have been wondering about the advantages
of dental implants over a conventional bridge. Is implant technology mature?
Is there maintainance involved? Is it cost effective in the long run? If I need
a replacement in 15 years, will there be implants that fit my "socket"?
Do they look better than bridges? Does it mess up the gum line?
A
Implants avoid drilling your remaining teeth to fit a conventional bridge =
less destruction. They are, however, expensive by comparison
The technology can now be considered to be mature.
Maintenance usually involves removing the superstrucure each year, cleaning
and replacing - plus an x-ray. Home maintenance [ flossing etc ] is very important.
In real terms maintenance shouldn't be a problem.
There shouldn't be a problem if you need a replacement in 15 years. The aesthetics
of bridges are usually better, although these days there is little to choose
between them.
In short if I had a gap an implant would be my first choice!
I recently broke my jaw, and am sitting
at home (surfing, of course) drinking through a straw with my jaws wired shut
for three weeks.I am particularly concerned about the long term affects that
the wires and hardware will have on my teeth and gums. Can you give me some
idea on what I can expect as far as long term effects, and what preventative
measures I can take?
A
As long as you avoid excessive sugar in your diet, and clean the teeth as best
as possible (I know that won't be easy) there should be no long term effects
of the 'hardware'.
Drink water as opposed to juices etc., and consider using a mouthwash containing
fluoride. If you have to have liquid food try to get the low sugar ones (diabetic
ones should be ok).
I am a male, 48 years old and I do
not have a tooth that does not have a filling. My teeth are brittle and my fillings
are constantly falling out. I also have four or five crowns, one of which has
come off. I am tired of spending so much time and expense repainring teeth that
seem to be old, brittle and not worth saving. I have been considering getting
a complete set of dentures or trying implants. Even when I ask a dentist why
I should not go ahead and do this, I get the reply, "Wouldn't you really
rather have your own teeth?" Never do I get a good medical reason. My mother
has had dentures for over forty years and does not have problems and can eat
anything she wants do. I realize implants are expensive, but so is repairing
the sorry teeth that I have.
A
Although your mother manages well with her dentures I can assure you this is
rare. If given the choice it is always better to work on the natural teeth than
extract any replace with dentures and/or implants.
Obviously if they are beyond repair then they should be removed. This is impossible
to be diffinitive about without examining you. If in doubt - keep them - they
will be gone a long time!!
My daughter is diagnosed with TMJ.
The disk is out of place, in front of the joint, such that it interferes with
opening the mouth. The oral surgeon is suggesting a splint for two weeks. Is
this reasonable? If this does not work, he recommends laser surgery. What is
the treatment of choice?
A
A splint is the treatment of choice because of the none-invasive nature. Often
the result is good.
For more difficult cases various forms of surgery are possible. The type suggested
will vary from patient to patient. The symptoms should reflect the need for
such extensive treatment i.e. surgery should be regarded as a last resort.
I have a friend who has had lifelong
TMJ problems and reports that sometimes the joint just "pops out."
I have begun to have TMJ pain but no clicking or locking. What makes the joint
"pop out?" Could it happen to me? How would I keep it from happening?
A
Your friend has a lax temporo-mandibular joint (TMJ) that allows excessive movement
of the lower jaw-bone so that the joint subluxes (pops out).
Apart from surgery that is quite invloved there is little constructive treatment
available. Having said that it is not usually too much of a problem - more of
an inconvenience. It does not follow that your joint will behave the same in
future.
It sounds like you have a more classical TMJ dysfunction syndrome - rather than
a hyper-extensible joint like your friend. The simplest treatment for you (which
has a good success rate) is a 'bite guard' that you wear at night - please ask
your dentist for his/her thoughts.
Lichen planus: Could you
tell me what this is? Where it comes from? How to treat it?
Will it go away? What aggravates it?
A
It is a degenerative change in the skin of the mouth (and sometimes other areas
of the body )
Its cause is unknown (possibly hormonal influence - more often seem in middle
aged ladies)
Treatment in severe cases by steriod therapy
Spicey foods aggrevates it. Sometimes it disappears of its own accord
Q
I am having two wisdom teeth removed next week. The fact that you can get HIV
from dental equipment worries me. I would like to know what the sterilisation
guidelines are and what is the likelihood of a dentist not adhering to these
guidelines. Thank you.
A
Patients only risk infection from dental equipement that is nor sterilised between
patients. Your best reassureance would be to ask the dentist outright about
his 'cross-infection ' control proceedures and tell him/her of your concerns.
These days we use as many disposable items as possible- other pieces of equipement
should be scrubbed, rinsed and put through an autoclave cycle between patients
Recently, I have been experiencing
several infections in my mouth which last for several days, then die away, only
to re-occur at a later date. I was wondering if there is any evidence of viruses
lying dormant in dental nerves, which are activated by a specific stimuli, as
seen in the Herpes simplex virus which causes Cold Sores and lies dormant in
nerves to the lips. The infections seem to occur only under specific teeth.
A
If the infections come up in 'heads' which discharge pus then it sounds like
we are dealing with abcesses arising in the associated teeth. If the infections
are small painful ulcers that arrive in crops, last about 5-7 days then heal,
only to reappear somewhere else in a week or so then it is probably Recurrent
Minor Oral Apthous Ulcerations - cause unknown (possible stress link) and not
serious. No effective cure.
On the other hand cold sores ARE dormant herpes viruses in nerve trunks - but
I am pretty certain they do not manifest inside the mouth - only around it and
the face. I think it would be useful to have a word with your general Dental
Practitioner.
After having three or four shots
of Lydacaine, my dentist still could not get my tooth numb enough to drill.
I was having a root canal done on the second tooth from the back, bottom row.
He gave me a shot which I believe he called the PDL, it was a very painful shot
and made a buzz sound while applying it. I admit it worked great, but I had
a weird reaction, my heart beat very fast and I shook all over, while this was
going on, my dentist told me it was adrenaline and a normal reaction. It wore
off after about five minutes and the root canal was done, with no pain and no
problems. My question is this:
What kind of shot was it, how far did that needle drill into what part of myjaw(was
it the bone)? It hurt like hell...what kind of medicine was in the needle that
I would have that kind of reaction, was this a normal occurrence..? I've had
it happen twice, with a different dentist, but always a root canal on very bottom
back tooth. I'm just curious to know, and also would like to know of other options
if any. Please dont say brush more !
A
I think you are describing an injection down the side of the tooth, into the
periodontal ligament itself. This ligament encases the root and therefore is
in close association with the nerve entering the apex of the root.
The pain is caused because the area of injection is sandwiched between the outer
surface of the root and the boney socket the root is lying in. Hence it is a
fairly rigid arrangement - the anaesthetics solution being forced into the region
causes a localised pressure build up that is transmitted along the pain fibres.
Also because it is a highly vascular area the adrenaline in the anaesthetic
mixture may enter the ciculatory system and directly affect the heart. It's
not serious but a little disconcerting!
Nerve block injections are the alternative - but the perio injection was given
when the other failed to work.
Where could I get an article or research
supporting the connection between dry mouth (due to medications) and rapid tooth
decay?
A
I suggest you do a literature search in the library of your local University
( the librarians should be able to help ). I have seen articles in the past
in the British Dental journal and I am sure there will be references in the
American Dental Journal etc as well. Your nearest teaching Dental Hospital should
also have some information for you.
1 week ago I went to the dentist
for a toothache. It was diagnosed as an old filling and was marginal whether
a root canal was needed. To my relief, the dentist decided
not to go with the root canal. Since then, the ache did not go away immediately,
but instead slowly improved; and as of now I still have a ache but better than
before. Yesterday I felt comfortable chewing normally but was foolish enough
to test the tooth with some piping hot noodles. That area started to throb but
an Advil took the pain away quickly.
Question is if it is normal for an ache to take so long to go away? Or does
it imply that a root canal is imminent? Or if I am on the mends, is there some
thing I can do to help me heal (herbs, over-counter medication, eating guidelines...)?
A
It sounds as if the tooth is damaged and extremes of temperature are causing
it to flare up. I would normally go ahead with a root filling for the patient
as this should give a permanent result.
My teeth are becoming very sensitive
to temperature changes. As I walk outside in the cold, there is a period of
time where they hurt and as they acclimate, begin to feel normal.
I am fairly young, but do have all my permanent teeth, but thought this might
be an indication that my teeth were shifting or something equally serious? My
dentist has remarked that I begin using a "sensitive" orientated toothpaste.
What are your thoughts on this?
A
There are several possible causes for the sensitivity - apart from holes from
either decay or missing filling / leaking fillings or crowns the most common
cause is exposed root surface. This can be the result of gum disease or fierce
toothbrushing- the net result is the same. Covering agents, such as Sensodyne,
work very well in most instances. In more severe cases your dentist will apply
specialist agents, place covering fillings or possibly use a 'soft' laser -
take his/her advice.
Do you recommend a particular toothpaste?
A
For most patients the important thing is that it contains fluoride to ensure
optimum protection of the dental enamel. Also, very abrasive formulas should
be avoided as these can cause damage.
What do you mean by abrasive formulas?
A
Some smoker's dental powders are very gritty and apart from removing stains
remove tooth substance as well!
What do I do if I have severe toothache
and I can't contact my dentist?
A
Unfortunately very few pain killers are effective for dental pain. However,
ibuprofen may be of some help. If you have pain from an obvious hole in your
tooth, you could try some oil of cloves on a small piece of cotton wool. We
recommend patients are seen regularly by their dentist to monitor any developing
problems befor they become emergencies.
What is the difference between veneers
and bonding?
A
Bonding usually means attaching tooth coloured filling material to the natural
tooth substance to effect a repair or cover what's underneath eg stained or
damaged enamel. The material is microscopic quartz silicate particles within
a plastic polymer matrix.
Veneers are facings made of porcelain or heat strengthened plastic, which are
bonded onto the teeth. It is usually possible to get a better final appearance
than just be using the bonding material mentioned above, although each case
has to be assessed individually by your own dental surgeon.
My dentist has advised palate expansion
and lateral arch development. Do I need these? What is a palate expansion? And
what is lateral arch development
A
David Bowdon, Consultant Orthodontist at Chester Royal Infirmary, UK writes:
Palate expansion is indicated to eliminate a displacement of the lower jaw caused
by premature contacts of opposing teeth and which result in a unilateral crossbite
of the opposing upper and lower posterior teeth. The need to correct a bilateral
crossbite is more controversial; it may be left untreated or treated in conjunction
with the other needs of the malocclusion. The decision will be influenced by
the initial inclination of the teeth and width of the underlying upper jaw bone.
Lateral arch development is suggested when arches may be correctly related laterally,
to move teeth on to a larger arc of a circle and thus relieve mild crowding.
Developmental lateral expansion within the limits of expected arch width growth
or where posterior teeth are tilted lingually, may be expected to be stable.
However, the long term stability of previously well related arches treated by
developmental expansion awaits evaluation as do more extravagant claims regarding
an improvement in nasal airway, hearing and chronic respiratory infection.
Without examination it is, of course, not possible to comment upon the need
for treatment or the methods of expansion which might be applied in an individual
case.
What can I do about my halitosis?
I suck mints and clean my teeth often...?
A
The first thing is to stop using mints unless they are sugar free (and the sugar
free ones often have a laxative effect in large doses). I would recommend that
you have your teeth professionally cleaned by a dental hygienist and thereafter
ensure that you brush your teeth twice a day and floss them every day as well.
I know that this is a bit of a bind, but it is the most effective way of guarding
against halitosis. Make sure you check with your doctor that there is no underlying
medical cause, such as quinsy or a gastric problem.
I am a 28 yr. old female who just
got braces yesterday. My othodontist used clear brackets, w/clear bands and
a small (.14) wire which I must wear on my upper teeth for 9 months to cure
a gap between my front teeth caused by pyarreah (sp?)
My questions is, when I get the braces off in 269 days, how do I know this won't
just happen again? I get 3 month cleanings by my peridontist but as the gap
happen so quickly this time (went from perfectly straight teeth to a 1/4"
gap in 1 year!) I don't want to go through this again (and $4000).
A
Once your teeth have been straightened you will probably have a 'retainer' fitted.
This may be a small metal bar fixed behind the teeth so it is not visible and
so it will keep the teeth in their correct position. It may be advantageous
to leave this on long-term.
What is VERY important is the origional cause (the gum disease) is treated and
monitored carefully. Good home care is important.
What is the difference between plaque
and tartar? Also, when I see an oral hygenist, what are they scraping off my
teeth? I brush, floss, and use a water pick daily, so I shouldn't have anything
to scrape off my teeth.
A
Plaque is a soft deposit of bacteria etc that grows on the teeth. This can be
removed easily by brushing, it reforms within hours. Tartar is plaque that has
calcified (hardened). It occurs within days in plaque that is undisturbed by
brushing (usually in the hard to reach areas of the mouth) - this has to be
scrapped off by a professional eg hygienist. Ask your hygienist to show you
how to effectively clean the areas where tartar is forming.
I have been advised by my peridontist
that I need to have gum grafting done on my lower gums. He explained the procedure
to me. As I understood it, they take tissue from your palate and glue it on
to your gums.
My question is how much discomfort can I expect and how long does the recurperation
period last?
A
The grafting you refer to is normally uncomfortable for about 10-14 days, although
often the sympotoms are quite mild. A dressing is applied to the surgery site,
and this contains sedative agents that promote healing and reduce the discomfort.
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