Posts for: October, 2017
Mention “bacteria” and people begin looking for the germicide. The truth is, though, only a few strains cause disease — the rest are benign or even play a beneficial role.
This may shock you, but your body both inside and out is home to around 100 trillion single-celled organisms, exceeding the number of your native cells by 10 to 1. You won't notice them, though: bacteria are so small they only make up 1 to 3% of your total body mass. And each of us has a unique “microbiome” of micro-organisms: they influence a variety of processes like digestion and metabolism, and some even “teach” our immune systems to distinguish between helpful and harmful bacteria.
Of the 10,000 or more species of bacteria that inhabit the body, perhaps the most studied and understood are in the mouth. We even have a database that catalogs the gene sequences of oral bacteria. And what we've learned has enlarged our understanding of dental disease and how to prevent or treat it.
This new knowledge, for example, confirms that many of our modern lifestyle habits adversely affect oral health. For example, researchers have found higher concentrations of Streptococcus mutans, the bacteria most responsible for tooth decay, in current samples of biofilm than in those from preindustrial eras. The culprit seems to be the modern diet rich with carbohydrates like sugar that bacteria eat. Cigarette smoking can also make the mouth friendlier to disease-causing bacteria.
On the bright side, our growing knowledge of oral bacteria is helping us devise better prevention and treatment strategies. One example is the use of antibiotics to reduce the populations of disease-causing oral bacteria.
The broad, traditional approach kills not only malevolent bacteria, but beneficial strains as well. The approach may also be helping bad bacteria become resistant to common antibiotics. A newer approach targets specific bacteria with custom-designed antibiotics that won't kill other bacteria. There's also increased focus on ways to re-balance a person's normal microbiome if it's become skewed.
As we come to understand bacteria better — both good and bad species — these and other dental care efforts will benefit. With our increasing knowledge of these microorganisms that surround us the future looks bright for better oral health.
If you would like more information on the role of bacteria in oral health, 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 “New Research Shows Bacteria Essential to Health.”
You’ve recently learned one of your teeth needs a root canal treatment. It’s absolutely necessary: for example, if you have decay present, it will continue to go deeper within the tooth and it will spread to the roots and bone and could ultimately cause you to lose your tooth. Although you’re a little nervous, we can assure you that if we’ve recommended a root canal treatment, it’s the right step to take for your dental health.
There’s nothing mysterious — or ominous — about a root canal. To help ease any fears you may have, here’s a step-by-step description of the procedure.
Step 1: Preparing your mouth and tooth. We first take care of one of the biggest misconceptions about root canals: that they’re painful. We completely numb the tooth and surrounding tissues with local anesthesia to ensure you will be comfortable during the procedure. We isolate the affected tooth with a thin sheet of rubber or vinyl called a rubber dam to create a sterile environment while we work on the tooth. We then access the inside of the tooth — the pulp and root canals — by drilling a small hole through the biting surface if it’s a back tooth or through the rear surface if it’s in the front.
Step 2: Cleaning, shaping and filling the tooth. Once we’ve gained access we’ll clear out all of the dead or dying tissue from the pulp and root canals, and then cleanse the empty chamber and canals thoroughly with antiseptic and antibacterial solutions. Once we’ve cleaned everything out, we’ll shape the walls of the tiny root canals to better accommodate a filling material called gutta-percha, which we then use to fill the canals and pulp chamber.
Step 3: Sealing the tooth from re-infection. Once we complete the filling, we’ll seal the access hole and temporarily close the tooth with another filling. Later, we’ll install a permanent crown that will give the tooth extra protection against another infection, as well as restore the tooth’s appearance.
You may experience some mild discomfort for a few days after a root canal, which is usually manageable with aspirin or ibuprofen. In a week or so, you’ll hardly notice anything — and the tooth-threatening decay and any toothache it may have caused will be a distant memory.
If you would like more information on root canal treatments, 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 “A Step-by-Step Guide to Root Canal Treatment.”
A “gummy” smile, in which the upper gums are too prominent, is a common condition. There are several causes for gummy smiles — determining which one is the first step to having your appearance changed.
Although perceptions vary from person to person, most dentists agree a gummy smile shows 4 mm or more of gum tissue, and the amount is out of proportion with the length of the crown (the visible tooth). Teeth normally erupt through the gums during childhood and continue development until early adulthood, shrinking back from the tooth until stabilizing in place.
This typically produces a crown length of about 10 mm, with a “width to length” ratio of about 75-85%. But variations can produce differences in the relationship between teeth and gums and the width to length ratio of the teeth. The teeth may appear shorter and the gums more prominent. Worn teeth, caused by aging or grinding habits, may also appear shorter.
If tooth to gum proportionality is normal, then the cause may be upper lip movement. When we smile, muscles cause our lips to retract 6-8 mm from the lip’s resting position. If the amount of movement is greater (meaning the lip is hypermobile), it may show too much of the gums. The upper jaw can also extend too far forward and cause the gums to appear too prominent.
There are a number of ways to improve gummy smiles, depending on the cause. Periodontal plastic surgery known as crown lengthening removes and reshapes excess gum tissue to reveal more of the tooth. Lip hypermobility can be reduced with Botox injections (to paralyze the muscles) or in some cases with surgery to reposition the muscle attachments. Orthognathic surgery can be used to surgically reposition an overextended upper jaw. Other cosmetic enhancements such as orthodontics, bonding or porcelain restorations can also prove effective.
The first step is to obtain an accurate diagnosis for your gummy smile. From there, we can devise the best treatment approach to bring your smile back into a more attractive proportion.
If you would like more information on minimizing a gummy smile, 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 “Gummy Smiles.”
Your temporomandibular joints (TMJ), located where your lower jaw meets the skull, play an essential role in nearly every mouth function. It’s nearly impossible to eat or speak without them.
Likewise, jaw joint disorders (temporomandibular joint disorders or TMD) can make your life miserable. Not only can you experience extreme discomfort or pain, your ability to eat certain foods or speak clearly could be impaired.
But don’t assume you have TMD if you have these and other symptoms — there are other conditions with similar symptoms. You’ll need a definitive diagnosis of TMD from a qualified physician or dentist, particularly one who’s completed post-graduate programs in Oral Medicine or Orofacial Pain, before considering treatment.
If you are diagnosed with TMD, you may then face treatment choices that emanate from one of two models: one is an older dental model based on theories that the joint and muscle dysfunction is mainly caused by poor bites or other dental problems. This model encourages treatments like orthodontically moving teeth, crowning problem teeth or adjusting bites by grinding down tooth surfaces.
A newer treatment model, though, has supplanted this older one and is now practiced by the majority of dentists. This is a medical model that views TMJs like any other joint in the body, and thus subject to the same sort of orthopedic problems found elsewhere: sore muscles, inflamed joints, strained tendons and ligaments, and disk problems. Treatments tend to be less invasive or irreversible than those from the dental model.
The newer model encourages treatments like physical therapy, medication, occlusive guards or stress management. The American Association of Dental Research (AADR) in fact recommends that TMD patients begin their treatment from the medical model rather than the dental one, unless there are indications to the contrary. Many studies have concluded that a majority of patients gain significant relief with these types of therapies.
If a physician or dentist recommends more invasive treatment, particularly surgery, consider seeking a second opinion. Unlike the therapies mentioned above, surgical treatments have a spotty record when it comes to effectiveness — some patients even report their conditions worsening afterward. Try the less-invasive approach first — you may find improvement in your symptoms and quality of life.
If you would like more information on treating TMD, 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 “Seeking Relief from TMD.”
Fatigue, irritability and family complaints about snoring — all tell-tale signs you may have sleep apnea. There’s more to this condition than being grouchy the next day — the long-term effect could increase your risks for life-threatening diseases.
But how do you know if you actually have sleep apnea? And if you do, what can you do about it?
Undergo an exam by a physician trained in “sleep medicine.” Sleep apnea occurs when the airway becomes blocked while you sleep, dropping the body’s oxygen levels; your body awakens to re-open the airway. The event may only last a few seconds, but it can occur several times a night. Even so, sleep apnea is one potential cause among others for snoring or fatigue. To know for sure if you have sleep apnea you’ll need to undergo an examination by a physician trained to diagnose this condition. He or she may then refer you to a dentist to make a sleep appliance if you have mild to moderate apnea.
Determine the level of your apnea’s intensity. Not all cases of sleep apnea are equal — they can range in cause and intensity from mild to advanced, the latter a reason for concern and focused intervention. Your physician may use different methods for determining the intensity of your case: review of your medical history, examining the structures within your mouth or having your sleep observed directly at a sleep lab. Getting the full picture about your sleep apnea will make it easier to develop a treatment plan.
Match the appropriate treatment to your level of sleep apnea. If you have moderate to advanced apnea, you may benefit from continuous positive airway pressure (CPAP) therapy, an electrical pump that delivers pressurized air through a mask worn while you sleep that gently forces the airway open. It’s quite effective, but uncomfortable to wear for some people. Advanced cases may also require surgery to alter or remove soft tissue obstructions. If, you have mild to slightly moderate apnea, though, your dentist may have the solution: a custom-fitted mouth guard that moves the tongue, the most common airway obstruction, down and away from the back of the throat.
If you suspect you may have sleep apnea, see a trained physician for an examination. It’s your first step to a good night’s sleep and better overall health.
If you would like more information on sleep apnea treatments, 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 “If You Snore, You Must Read More!”