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Posts for tag: tooth decay

By Dr. Mark Shulman
September 14, 2018
Category: Oral Health
Tags: tooth decay  
NewAdvancesCouldRevolutionizeDecayTreatment

The basics for treating tooth decay have changed little since the father of modern dentistry Dr. G.V. Black developed them in the early 20th Century. Even though technical advances have streamlined treatment, our objectives are the same: remove any decayed material, prepare the cavity and then fill it.

This approach has endured because it works—dentists practicing it have preserved billions of teeth. But it has had one principle drawback: we often lose healthy tooth structure while removing decay. Although we preserve the tooth, its overall structure may be weaker.

But thanks to recent diagnostic and treatment advances we’re now preserving more of the tooth structure during treatment than ever before. On the diagnostic front enhanced x-ray technology and new magnification techniques are helping us find decay earlier when there’s less damaged material to remove and less risk to healthy structure.

Treating cavities has likewise improved with the increased use of air abrasion, an alternative to drilling. Emitting a concentrated stream of fine abrasive particles, air abrasion is mostly limited to treating small cavities. Even so, dentists using it say they’re removing less healthy tooth structure than with drilling.

While these current advances have already had a noticeable impact on decay treatment, there’s more to come. One in particular could dwarf every other advance with its impact: a tooth repairing itself through dentin regeneration.

This futuristic idea stems from a discovery by researchers at King’s College, London experimenting with Tideglusib, a medication for treating Alzheimer’s disease. The researchers placed tiny sponges soaked with the drug into holes drilled into mouse teeth. After a few weeks the holes had filled with dentin, produced by the teeth themselves.

Dentin regeneration isn’t new, but methods to date haven’t been able to produce enough dentin to repair a typical cavity. Tideglusib has proven more promising, and it’s already being used in clinical trials. If its development continues to progress, patients’ teeth may one day repair their own cavities without a filling.

Dr. Black’s enduring concepts continue to define tooth decay treatment. But developments now and on the horizon are transforming how we treat this disease in ways the father of modern dentistry couldn’t imagine.

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

DontLettheAcidinSportsandEnergyDrinksRuinYourToothEnamel

Sports and energy drinks — two different types of popular beverages. But though different they have one thing in common: they can both wreak havoc on your tooth enamel.

That's because each contains high concentrations of acid. And acid is tooth enamel's mortal enemy — prolonged exposure with it causes the minerals in enamel to soften and erode, a process called de-mineralization.

Demineralization becomes even more pronounced when the mouth's pH levels fall below 4.0 into the acidic range. A sampling of various brands of sports and energy drinks reveal mean pH levels below even that threshold. Energy drinks are especially harmful to enamel because the type of acid they contain is more concentrated.

So, what can you do to minimize this threat to your dental health? The optimal thing to do is avoid such beverages altogether, especially energy drinks. If you currently re-hydrate after hard work or exercise with sports drinks, consider switching to water, nature's hydrator.

If you do, however, continue to drink these beverages, then follow a few precautions to lessen the acidic levels in your mouth:

Wait until mealtimes. Saliva is your body's way of neutralizing acid in your mouth, but it takes about 30 to 60 minutes for it to fully buffer acid. If you're sipping between meals on acidic beverages, saliva can't keep up. So, wait until you eat or limit your sipping time on a drink.

Rinse with water. Since water's pH is neutral, swishing some in your mouth right after drinking a sports or energy drink will help reduce acidity.

Wait an hour to brush. Your enamel will begin demineralizing as soon as it encounters acid. If you brush right away you could be sloughing off miniscule amounts of softened minerals. By waiting an hour you give your saliva time to buffer and help re-mineralize the enamel.

Although popular, especially among teenagers and young adults, overindulgence in sports and energy drinks could damage your teeth and increase your risk for tooth decay. With a little moderation and common sense, you can keep your enamel strong and healthy.

If you would like more information on the effects of sports and energy drinks on dental 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 “Think Before you Drink.”

TreatingaBabyToothwithInnerDecaycanbeComplicated-butStillNecessary

Even though a child’s primary (“baby”) teeth eventually give way, it’s still important to treat them if they become decayed. Primary teeth serve as guides for the emerging permanent teeth — if they’re lost prematurely, the permanent tooth may come in misaligned.

If the decay, however, affects the tooth’s inner pulp, it poses complications. A similarly decayed adult tooth would be treated with a root canal in which all the pulp tissue, including nerve fibers and blood vessels, are removed before filling and sealing. Primary teeth, however, are more dependent on these nerves and blood vessels, and conventional filling materials can impede the tooth’s natural loss process. It’s better to use more conservative treatments with primary teeth depending on the degree of decay and how much of the pulp may be affected.

If the decay is near or just at the pulp, it’s possible to use an indirect pulp treatment to remove as much of the softer decay as possible while leaving harder remnants in place: this will help keep the pulp from exposure. This is then followed with an antibacterial agent and a filling to seal the tooth.

If the pulp is partially exposed but doesn’t appear infected, a technique called direct pulp capping could be used to cover or “cap” the exposed pulp with filling material, which creates a protective barrier against decay. If decay in a portion of the pulp is present, a pulpotomy can be performed to remove the infected pulp portion. It’s important with a pulpotomy to minimize the spread of further infection by appropriately dressing the wound and sealing the tooth during and after the procedure.

A pulpectomy to completely remove pulp tissue may be necessary if in the worst case scenario the pulp is completely infected. While this closely resembles a traditional root canal treatment, we must use sealant material that can be absorbed by the body. Using other sealants could inhibit the natural process when the primary tooth’s roots begin to dissolve (resorb) to allow it to eventually give way.

These all may seem like extraordinary efforts to save a tooth with such a short lifespan. But by giving primary teeth a second chance, their permanent successors will have a better chance of future good health.

If you would like more information on treating decay in primary teeth, 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 “Root Canal Treatment for Children’s Teeth.”

By Dr. Mark Shulman
October 31, 2014
Category: Oral Health
Tags: tooth decay   toothache  
WhatToDoAboutAChildsToothache

It's 3:00 PM, your child has just come back from the school playground — and she's complaining of a toothache that's making her miserable. She can't seem to say if there was a particular injury or a blow, but the more she talks about it, the worse it gets. You're the parent... what are you going to do now?

If you've ever been through this type of situation, you know that a calm demeanor and a little TLC can go a long way. But how do you know whether you're facing a dental emergency, or a routine booboo? Here are a few general rules that may help.

First, relax: Without a fever and facial swelling, a child's toothache isn't usually an emergency. But any tooth pain that keeps a child up at night or lasts into the next day should be evaluated by a dentist. Even if it's nothing but a small cavity (the most common cause of toothache) you don't want to let it go untreated. That could allow it to turn from a small discomfort into a major problem — like a painful abscess.

There are some things you can do at home to try and get a handle on what's causing the pain. Encourage the child to show you exactly where the pain is located, and to tell you when and how it started. Then, examine the area closely. Look for obvious brown spots, or even tiny cavities (holes) on biting surfaces or between teeth, which might indicate decay. Also check the gums surrounding the tooth, to see if there are sores or swelling.

You may find evidence of a traumatic injury, like a cut or bruise — or, if only swelling is apparent, it may mean an abscess has formed. If nothing looks amiss, try gently flossing on either side of the hurting tooth. This may dislodge a particle of food that's causing pain and pressure.

If the pain persists, you can try giving an appropriate dose of ibuprofen or acetaminophen, or applying an ice pack on the outside of the jaw — one minute on and one minute off. But even if you can make the immediate pain go away, don't neglect the situation that caused it. Unless you're absolutely sure you know why the toothache occurred, you should bring the child in for an examination. It will put your mind at rest — and maybe prevent a bigger problem down the road.

If you have questions about toothaches in children, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “A Child's Toothache.”

By Dr. Mark Shulman
October 07, 2014
Category: Oral Health
Tags: tooth decay  
LimitingRefinedSugarinYourDietcanReduceRiskofToothDecay

“Cut down on sweets, especially between meals” is perhaps one of the least popular words of advice we dentists regularly give. We’re not trying to be killjoys, but the facts are undeniable: both the amount and frequency of sugar consumption contributes to tooth decay. Our concern isn’t the naturally occurring sugars in fruits, vegetables, grains or dairy products, but rather refined or “free” sugars added to foods to sweeten them.

The World Health Organization and the U.S. Food and Drug Administration both advise consuming no more than 50 grams (about ten teaspoons) of sugar a day. Unfortunately, our nation’s average per person is much higher: we annually consume around 140 pounds per capita of refined sugars like table sugar or high fructose corn syrup, more than three times the recommended amount. Soft drinks are the single largest source of these in our diets — Americans drink an average of 52 gallons every year.

The connection between sugar and tooth decay begins with bacteria that ferments sugar present in the mouth after eating. This creates high levels of acid, which causes the mineral content of tooth enamel to soften and erode (a process called demineralization) and makes the teeth more susceptible to decay. Saliva naturally neutralizes acid, but it takes about thirty minutes to bring the mouth’s pH to a normal level. Saliva can’t keep up if sugars are continually present from constant snacking or sipping on soft drinks for long periods.

You can reduce the sugar-decay connection with a few dietary changes: limit your intake of sugar-added foods and beverages to no more than recommended levels; consume sweets and soft drinks only at meal times; replace sugar-added foods with fresh fruits and vegetables and foods that inhibit the fermentation process (like cheese or black and green teas); and consider using mint or chewing gum products sweetened with xylitol, a natural alcohol-based sugar that inhibits bacterial growth.

Last but not least, practice good oral hygiene with daily brushing and flossing, along with regular office cleanings and checkups. These practices, along with limits on refined sugar in your diet, will go a long way toward keeping your teeth and mouth healthy and cavity-free.

If you would like more information on the relationship of sugar and dental disease, 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 “Nutrition & Oral Health.”



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