Visit Dr. Tara Moshiri's Expert Page on Find-a-top-doc for more recent Q&A's to all current dental topics!
What is tooth decay and how can it be prevented?
Plaque is an insidious substance-a colorless, sticky film that blankets your teeth and creating an environment in which bacteria erode tooth enamel, cause gum irritation, infection in inner structures such as pulp and the roots, and in extreme cases, tooth loss. Some of the biggest culprits causing plaque are foods rich in sugar and carbohydrates, including soda beverages, some juices, candy and many kinds of pasta, breads and cereals. Plaque also can attack fillings and other restorations in your mouth, which can lead to more costly treatment down the road. Plaque is one of the biggest causes for tooth decay. It also causes your gums to become irritated, inflamed, and in some cases, bleed. Over time, the decay process may cause your gums to pull away from your teeth, a condition called receding gums. In addition, the long-term decay process can lead to infections in your gums and can eat away at the bone structures under the teeth. Inside your teeth, decay can gradually destroy the inner layer, or dentin, the pulp, which contains blood vessels, nerves and other tissues, and the root.
Sealants are liquid coatings that harden on to the chewing surfaces of teeth and are showing a great deal of effectiveness in preventing cavities-even on teeth where decay has begun. The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses these intricate structures on the chewing surfaces of your teeth. Sealants are applied to the chewing surfaces and are designed to prevent the intrusion of bacteria and other debris into the deep crevices on the tops of teeth. Sealants actually were developed about 50 years ago, but didn't become commonly used until the 1970s. Today, sealants are becoming widely popular and effective; young children are great candidates for preventative measures like sealants (especially on molars) because in many cases, decay has not set in. Even on teeth where decay is present, sealants have been shown to fight additional damage.
Sealants are applied by first cleaning the tooth surface. The procedure is followed by "etching" the tooth with a chemical substance, which allows the sealant to better adhere. After the sealant is applied, a warm light source is directed to the site to promote faster drying. Sealants usually need re-application every five to 10 years.
What is an abscessed tooth & how can it be treated?
An abscessed tooth is a pocket of pus, usually caused by some kind of infection and the spread of bacteria from the root of the tooth to the tissue just below or near the tooth. In general, a tooth that has become abscessed is one whose underlying pulp (the tooths soft core) has become infected or swollen. The pulp contains nerves, blood vessels and connective tissue, and lies within the tooth. It extends from the crown of the tooth, to the tip of the root, in the bone of the jaws. An abscessed tooth can be an extremely painful condition. In some cases, antibiotics are administered in an attempt to kill an infection. If antibiotics are ineffective and an abscess is shown to be damaging the pulp or lower bony structures, a root canal procedure may be needed to remove the dead pulp and restore the tooth to a healthy state.
What is Xerostomia & how can it be treated?
Xerostomia or dry mouth happens when your mouth produces little to no saliva. What little saliva you have might be thick and stringy. But dry mouth is more than just feeling thirsty. Saliva helps you taste what you eat and drink, and it helps you digest your food. It flushes food particles away from your teeth and neutralizes acids to help prevent tooth decay. Lack of saliva causes the skin in and around the mouth to become dry and tight. Your lips may become cracked, and sores might form at the corners of your mouth. Your tongue can feel rough and dry as well. And you might have trouble swallowing or difficulty speaking without the lubrication that saliva provides.
What is halitosis & how can it be treated?
An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have "chronic halitosis," which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin. Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.
What causes bad breath?
Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth - on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting. Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease. Gum disease is caused by plaque - the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.
Here are characteristic bad breath odors associated with some of these illnesses:
- Diabetes acetone, fruity
- Liver failure - sweetish, musty
- Acute rheumatic fever - acid, sweet
- Lung abscess - foul, putrefactive
- Blood dyscrasias - resembling decomposed blood
- Liver cirrhosis - resembling decayed blood
- Uremia - ammonia or urine
- Hand-Schuller-Christian disease - fetid breath and unpleasant taste
- Scurvy - foul breath from stomach inflammation
- Wegner`s granulomatosis - Necrotic, putrefactive
- Kidney failure - ammonia or urine
- Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor
- Syphilis - fetid
Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.
Caring for bad breath
Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.
Eliminating periodontal disease and maintaining good oral health helps to reduce bad breath. If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.
Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.
If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.
Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including "Zytex," which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.
How safe are dental X-rays & how often should dental X-rays be taken?
Dental radiographs (x-rays) are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam. Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan. Without x-rays, problem areas may go undetected.
Dental x-rays may reveal:
- Abscesses or cysts.
- Bone loss.
- Cancerous and non-cancerous tumors.
- Decay between the teeth.
- Developmental abnormalities.
- Poor tooth and root positions.
- Problems inside a tooth or below the gum line.
Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!
We are all exposed to natural radiation in our environment. The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources. Dental x-rays produce a low level of radiation and are considered safe. Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental x-rays. These precautions include using lead apron shields to protect the body and using modern, fast film that cuts down the exposure time of each x-ray.
The need for dental x-rays depends on each patient’s individual dental health needs. Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease. A full mouth series of dental x-rays is recommended for new patients. A full series is usually good for three to five years. Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.
What causes sensitive teeth?
If you wince with pain after sipping a hot cup of coffee or chewing a piece of ice, chances are that you suffer from "dentin hypersensitivity", or more commonly, sensitive teeth.
Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits.
At least 45 million adults in the United States suffer at some time from sensitive teeth.
Sensitive teeth result when the underlying layer of your teeth (the dentin) becomes exposed. This can happen on the chewing surface of the tooth as well as at the gum line. In some cases, sensitive teeth are the result of gum disease, years of unconsciously clenching or grinding your teeth, or improper or too vigorous brushing (if the bristles of your toothbrush are pointing in multiple directions, you're brushing too hard). Abrasive toothpastes are sometimes the culprit of sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes, may increase tooth sensitivity. In some cases, desensitizing toothpaste, sealants, desensitizing ionization and filling materials including fluoride, and decreasing the intake of acid-containing foods can alleviate some of the pain associated with sensitive teeth.
Sometimes, a sensitive tooth may be confused by a patient for a cavity or abscess that is not yet visible. In any case, contact your dentist if you notice any change in your teeth's sensitivity to temperature.
What is a Canker/Cold Sore & how can it be treated?
People sometimes confuse canker sores and cold sores, but they are completely unrelated. Both can be painful, but knowing the differences can help you keep them in check. A canker sore is typically one that occurs on the delicate tissues inside your mouth. It is usually light-colored at its base and can have a red exterior border. A cold sore or fever blister, on the other hand, usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid. In most cases, patience is the best medicine for treating canker sores. A healthy diet and good oral hygiene are usually the best remedy, but some special rinses and anesthetics can help. Cold sores can be treated effectively with some over-the-counter topical creams; sometimes, an antiviral medication will be prescribed by your doctor.
What are symptoms of Impacted/Wisdom Teeth?
Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems. If wisdom teeth are causing a problem and are not pulled, they can sometimes become impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: pain, inflammation, and some kinds of infections. Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one's ability to properly bite down, speak or eat.
What is Teeth Grinding/Bruxism & how can it be treated?
Teeth grinding, also called bruxism, is often viewed as a harmless, though annoying, habit. Some people develop bruxism from an inability to deal with stress or anxiety.
However, teeth grinding can literally transform your bite relationship and worse, severely damage your teeth and jaws over long periods of time. Teeth grinding can cause abrasion to the chewing surfaces of your teeth. This abnormal wear and tear will prematurely age and loosen your teeth, and open them to problems such as hypersensitivity (from the small cracks that form, exposing your dentin.) Bruxism can also lead to chronic jaw and facial pain, as well as headaches.
If no one has told you that you grind your teeth, here are a few clues that you may suffer from bruxism:
- Your jaw is often sore, or you hear popping sounds when you open and close your mouth.
- Your teeth look abnormally short or worn down.
- You notice small dents in your tongue.
Bruxism is somewhat treatable. A common therapy involves use of a special appliance worn while sleeping. Less intrusive, though just as effective methods could involve biofeedback, and behavior modification, such as tongue exercises and learning how to properly align your tongue, teeth and lips.
People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth. One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.
People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.
Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep. Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint. Traumatic injuries also can cause jaw dislocation. In these cases, jaw surgery, may be required to correct the condition. Some jaw surgery can be performed arthroscopically.
Anyone who participates in a sport that carries a significant risk of injury should wear a mouth protector. Sports like basketball, baseball, gymnastics, and volleyball all pose risks to your gum tissues, as well as your teeth. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.
A mouth guard can prevent serious injuries such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures and neck injuries by helping to avoid situations where the lower jaw gets jammed into the upper jaw. Mouth guards are effective in moving soft issue in the oral cavity away from the teeth, preventing laceration and bruising of the lips and cheeks, especially for those who wear orthodontic appliances. Mouth protectors, which typically cover the upper teeth, can cushion a blow to the face, minimizing the risk of broken teeth and injuries to the soft tissues of the mouth. If you wear braces or another fixed dental appliance on your lower jaw, a mouth protector is available for these teeth as well. A properly fitted mouth protector may be especially important for people who wear braces or have fixed bridge work. A blow to the face could damage the brackets or other fixed orthodontic appliances. A mouth protector also provides a barrier between the braces and your cheek or lips, limiting the risk of soft tissue injuries. Although mouth protectors typically only cover the upper teeth, your dentist or orthodontist may suggest that you use a mouth protector on the lower teeth if you have braces on these teeth too. If you have a retainer or other removable appliance, do not wear it during any contact sports.
Types of mouth guards
There are three types of mouth protectors:
- Stock - Inexpensive and come pre-formed, ready to wear. Unfortunately, they often don't fit very well. They can be bulky and can make breathing and talking difficult.
- Boil and bite - Can be bought at many sporting goods stores and may offer a better fit than stock mouth protectors. They should be softened in water, then inserted and allowed to adapt to the shape of your mouth. If you don't follow the directions carefully you can wind up with a poor-fitting mouth protector.
- Custom-fitted - Made by your dentist for you personally. They are more expensive than the other versions, but because they are customized, they can offer a better fit than anything you can buy off the shelf.