Dental Questions: Why do I need a root canal if my tooth doesn't hurt?

Has a dentist ever looked at an x-ray of your teeth and recommended a root canal? You probably know that root canals are performed to remove aggravated (and painful) tooth nerves. Why would a dentist want to do this procedure on a tooth that has never bothered you? The truth is that root canals are often used to protect teeth with "dead" nerves from future pain and infection. Take a look!

A root canal is a dental procedure where the nerve of the tooth is removed and the resulting empty nerve canal is filled with a sealing material. They are performed on teeth with some type of irreversible nerve damage. This typically stems from bacteria, trauma or deep/extensive dental work. Patients may complain of a painful tooth that throbs or has an exaggerated reaction to cold foods/drinks. These can be clues that the nerve has become so severely agitated that it will eventually wither out and die. Conversely, a patient can indicate that the gums around the tooth are swollen, the tooth is sensitive to biting or that there is a bump or pimple on the gums above a tooth. These types of findings suggest the nerve in the tooth has already died, and is now fueling a localized bacterial infection called an abscess. Either way, these types of teeth will eventually need root canals to solve their issues. 

Why might you need a root canal on a tooth that has never bothered you? A certain portion of the population will have the nerve in a tooth die in response to bacteria or trauma without pain or swelling. These teeth are usually discovered incidentally at a dental exam by visualizing an abscess on an x-ray. In most instances, this does not pose an emergency or cause for immediate concern. However, leaving the problem long term can lead to swelling, pain or the spread of infection.

Dental treatment recommendations can be difficult to understand, particularly when they involve root canals, crowns, implants or other complex procedures. At Thousand Oaks Family Dentistry, we are here to walk you through any difficult or confusing dental situations.  If you would like to know more about root canals, crowns or types of dental plain, please give our office a call!

Dental Questions: Why would a dentist place a temporary filling?

A filling is a filling, right? Then why would a dentist send you home with a "temporary" filling? What makes it any different from the permanent fillings you have on your other teeth? Do you need to worry about it falling out? Read on to see how and why dentists use temporary fillings to save and protect teeth!

A temporary or sedative filling is a type of dental procedure performed on a tooth with an uncertain prognosis or as an intermediate measure before further treatment. Imagine a patient who comes in for an emergency appointment with a large, painful cavity. While definitively saving the tooth may require a few different lengthy treatments, a dentist can remove decay and provide a temporary filling that same visit. This allows a tooth to be stabilized and desensitized so the patient can continue to function until a more definitive plan can be made. Many times, it is simply too early to determine the status of the tooth's nerves or gums and thus a temporary filling acts as a good interim measure. 

The most common material used in temporary fillings is a tooth colored compound called glass ionomer. This product bonds to tooth enamel, reacts well with moisture and has a natural calming effect on aggravated tooth nerves. Additionally, it enhances the effects of fluoride to provide extra defense against decay. The trade off is that glass ionomer is much weaker than permanent filling materials and does not stand up against tooth brushing, eating or chewing over time. Still, it's properties make it an ideal material to be used in temporary situations. 

How long will your temporary filling last? That question is impossible to answer without knowing the condition of the remaining tooth. In general, you should always end your temporary filling appointment with a plan for a permanent solution in the future. If you would like to know more about fillings, crowns, root canals or other dental procedures, please give our office a call!

Antibiotics in Dentistry

Antibiotic overuse is one of the most pressing issues in healthcare today. On top of the well-covered rise of MRSA infections, new strains of resistant bacteria are becoming more prevalent. With this in mind, clinicians around the world are working hard to cut back on antibiotic prescriptions and only use them when absolutely necessary. In the dental setting, many infections are not effected by antibiotics, and their use can potentially cause more harm than good. 

Most bacterial diseases of the mouth are addressed by either removing the bacteria or the "food source" for the infection. For example, a root canal works by disinfecting the inside of the tooth, removing the dead/dying tissue, and sealing the nerve canal with a rubber material. By cutting off the infection source, the immune system can naturally eliminate the bacteria from your body. Research has shown that adding antibiotics to this treatment does not improve healing or decrease chances of re-infection. Likewise, deep cleanings to treat periodontitis work by removing tartar/ infected tissue and giving the body a clean surface to reattach the gums and teeth. Again, the typical patient will not benefit from an antibiotic prescription (though antimicrobial rinses may be used to work locally in the mouth). 

Antibiotics are used in dentistry for instances of severe infection, pain and swelling that spreads away from the tooth. In these cases, the immune system may be "losing" its fight against the bacteria, and can benefit from some outside help. If you are prescribed antibiotics, take the entire bottle as directed, even if you start to feel better earlier. Finishing only part of a regimen puts you at risk for developing a new, stronger infection. For more information on dental infections, antibiotics and tooth pain, please give our office a call. 

Dental Questions: What can a dentist do for tooth pain

At some time in their lives, everyone has experienced unexpected dental pain. It probably didn't show up at a convenient time (it never does) and you were probably willing to do anything to stop the pain. Fortunately, dentists are highly skilled in diagnosing and treating tooth pain. Read on to learn what we can do for patients in distress. 

As a disclaimer, this article will focus mainly on pain originating from the tooth nerve. An entire spectrum of problems can present as tooth pain (sinus infections, muscle spasms, gum disease, etc.), and a thorough exam with x-rays is the only way to confirm the source of your discomfort. 

The nerve in your tooth may become irritated for a number of reasons, ranging from exposure to extreme temperatures to decay and even fractures. Usually, this irritation is reversible meaning the nerve will calm down on its own. However, in certain cases the tooth can cross a threshold and become irreversibly inflamed, meaning the pain will persist until the tooth nerve dies. At this point, the nerve has to be taken out of the mouth- either via root canal or by extracting the tooth. 

At an emergency visit, a dentist will evaluate what is causing the pain, the health of the tooth nerve and if the tooth is overall "fixable." If the pain is coming from a tooth with a cavity or fracture that extends down the root and beneath the gums, it may be best to extract it and consider replacement options in the future. However, if the offending problem is well isolated and treatable, you will probably want to opt for a root canal. At most emergency appointments, a dentist will not complete a full root canal. Rather, they perform a procedure called a pulpectomy, where the nerve is removed and the roots are sterilized and filled with a temporary material. This procedure ends the pain and provides short term protection against bacterial invasion of the tooth. A full root canal will be required to reliably seal the nerve space and minimize risk of re-infection. 

If you can't get to a dental office right away and need relief from pain, over the counter NSAID medications like ibuprofen are excellent at treating dental discomfort. You may be tempted to request a prescription pain reliever, but these will not treat the inflammatory component of your pain like an NSAID. Before taking any medication for the first time, please consult with your dentist. If you have further questions on tooth pain, gum pain or emergency appointments, please give our office a call!

How Can I Soothe a Toothache?

Note: Never start taking any medication for the first time (even OTC products) without consulting a medical or dental professional first. Never exceed the prescribed dosing for a medication or use it in a method for which it was not designed. 

Toothaches always seem to spring up at the least convenient times. Often enough, they show up 6pm on a Friday before a long weekend. When you can't get to a dentist right away, what should you do about your pain? In this article, we hope to give you some direction (and comfort) in helping your dental woes.

The first thing to do with any type of dental pain is give your general dentist a call. Even after hours, every office should have a means of getting into contact with either your own dentist or one of their associates. An exception to this would be excruciating pain, possibly combined with swelling, fever and warmth around a tooth. In these instances, your first choice should be to head to an emergency room, as this can be the sign of a serious infection. 

Beyond getting into contact with a dental professional, there are a few steps you can take to reduce your symptoms. If the pain feels like it is coming from a tooth directly, we suggest taking an NSAID medication like ibuprofen (Advil). Most dental pain comes from pressure inside the tooth or bones, and is best treated by drugs (such as ibuprofen) with anti-inflammatory properties. We do not suggest taking any left over narcotics you may have on hand, as they are potentially harmful and will not stop the pain as effectively as an NSAID. 

If your pain feels like it is coming from your gums, try flossing gently to see if you can dislodge any stuck food (popcorn kernels are the worst offenders). Beyond this, we recommend rinsing with warm salt water to soothe inflamed tissue. Never try to apply Asprin, Advil or other medications directly to the gums. This will only irritate the tissue and create more pain. We also suggest staying away from topical toothache creams/gels, due to their lack of effectiveness and potentially dangerous side effects.

If your pain has a specific trigger, make note of it and try to avoid using your teeth in that manner. Knowing what causes the tooth to flare up can be an important factor in diagnosing the exact problem. If you would like to know more about toothaches, dental pain or gum pain, please give our office a call! 

Dental Questions: Why does my tooth hurt after a filling/crown?

If you've ever had dental pain after a filling or crown, you know how frustrating this situation can be. Did something go wrong? Is it normal? Rest assured, "post operative sensitivity" is one of the most common complaints after dental work. Depending on the type, timing and severity of pain, it can indicate a few potential problems. Read on to catch a glimpse into how we interpret and treat patients with after-treatment pain!

Any time a dentist uses an instrument to modify the structure of a tooth, there is a chance that this procedure will irritate the dental nerve. Typically, this pain is reversible and is a response of the tooth cells being transiently injured during treatment. It is usually described as weak or dull and resolves on it's own in about two weeks. If we are working near the pulp of the tooth (such as with deep cavities and certain fractures) there is a higher likelihood of causing irreversible irritation of the dental nerve. In this scenario, the tooth becomes hyper-sensitive as the inner tissue becomes necrotic. Patients usually describe this pain as a sharp, prolonged sensitivity to hot/cold foods. Over time, it transitions to a spontaneous pain and sensitivity to taping and chewing. In these instances, the best solution is to perform a root canal to clean out the dead tissue and relieve any infection that may be present. 

Beyond these types of nerve irritation, some fillings become sensitive due to the nature of the materials we use in dentistry. Many types of fillings and crown cements are physically bonded to the tooth. This process involves painting on a resin "glue" and using a light to cure it to the tooth. The chemical change causes a small amount of shrinkage that can put pressure on the microscopic tubes in the tooth's dentin layer. Patients usually feel this pain as sharp and sensitive to biting and chewing. To solve this, we may change the material used to fill your tooth or remove the old filling and place a temporary "sedative" filling and see if the nerve calms down. Interestingly, we usually see this type of pain on smaller fillings, as they tend to have more walls made of natural teeth, and thus more surface area to place tension on. 

A final (and probably most common) source of post-operative pain is the filling/crown simply being too high. We check every single restoration we place with marking paper to make sure it doesn't change the way your teeth together. However, the ligaments in your teeth can feel changes on a microscopic level and can be difficult to account for. This problem is easily detected and fixed- we simply need to remove the area of the filling/crown that is interfering with your opposing teeth. 

Any patient complaint of pain after a procedure is taken very seriously and typically handled the same way. We will have you come in for an emergency appointment where we will take an X-ray (to see where the nerve is) and check the bite (to rule out a "high" restoration). We use this information to perform other tests to narrow down the possibilities to a correct diagnosis. Our ultimate goal at this visit is to get you out of pain and make a plan to protect the tooth long-term. If you would like to know more about the fillings we place and the risks/benefits of these procedures, please give our office a call. 

Dental Questions: What can I do to make a toothache feel better?

Generally, toothaches are caused by inflammation of the nerve inside the tooth. The best way to temporarily relieve the pain is by taking a nonsteroidal anti-inflammatory over-the-counter medication such as naproxen sodium (Aleve) or ibuprofen (Motrin).  If the tooth is sensitive to temperature and biting pressure, then it likely needs a root canal to completely resolve the pain.  If there is swelling around the tooth or in the face, then the nerve inflammation has progressed to an infection and antibiotics and a root canal are required to fix the situation. 

You may be tempted to use over-the-counter toothache remedies such as topical anesthetic (Orajel). However, these medications are best used to treat sore gum tissue caused by ulcers or canker sores and will do little to remedy actual tooth pain. Remember, a toothache is caused by an inflammatory process that is occurring within the tooth (and not in the surrounding gums). Additionally, do not try crushing aspirin or other medications and placing them against the tooth area. These medications are only meant to be taken orally, and can cause serious chemical burns on the gum tissue and mucosa. 

Video Blog on TMJ Pain and Night Guards

Greetings, my name is Dr. Kari Ann Hong and I have a family dentistry practice where I see patients from all age groups. In my practice, I see a number of patients that clench or grind their teeth at night.  This extra function at night can cause headaches, morning muscle pain when chewing, temporomandibular joint (TMJ) pain, tooth pain, and breakage of teeth.  The number one way to protect the teeth and muscle groups from the clenching and grinding is to wear a custom fitted night guard.

The first step in making a night guard is to take impressions of your teeth and to take an impression of how your teeth come together when your jaw is slightly open.  From the impressions, we make stone models that are used to fabricate a custom fitted acrylic night guard.  Usually we make the appliance for the lower arch.  During the one hour fitting appointment, we adjust the surface of the acrylic so that when the upper teeth touch the appliance, they all hit evenly.  Also, when you grind side to side or forward, the appliance is adjusted so that the majority of the force happens on the front off the appliance. This helps protect the facial muscle groups and the TMJ.

Due to concerns about the cost of a custom fitted night guard, sometimes patients will buy over the counter boil and bite type appliances.  The disadvantage of these boil and bite appliances, is that the opposing teeth don’t have freedom of movement, thereby potentially causing additional interferences for the TMJ and increased firing of the muscle groups that help our jaw open and close.  Depending on your medical and/or dental insurance plan, there usually is some coverage for a custom fitted night guard to treat TMJ pain.  If you would like to find out if a custom fitted night guard is right for you, and what your cost would be, please fill out the contact us page.

CAMBRA and Preventative Dentistry

    At Thousand Oaks Family Dentistry, we tend to ask a lot of questions. Some of them are are expected (“Do you floss regularly?”), while others (“What type of water do you drink?/Do you chew gum?”) might raise some confusion. While our investigations might seem slightly tedious, they are critical to our practice philosophy and how we treat our patients. These questions are part of a revolutionary preventative dentistry strategy known as CAMBRA.

    CAMBRA, or Caries (cavity) Management By Risk Assessment is a series of weighted factors and criteria that allow dentists to quickly and effectively determine tooth decay risk. By going over your dietary habits, home care techniques and medical history, we can obtain an accurate picture of how your tooth decay will progress (or continue to stay static) in the coming years. While this isn’t a “crystal ball” looking into your smile’s future, it is the best marker we have at determining your unique oral health situation.

    This screening technique relies on a simple thought process: if your habits and lifestyle lend themselves to an acidic, dry or bacteria prone mouth environment, then you will be at a greater risk for tooth decay. While this may seem obvious, what CAMBRA does is determine which factors are the most destructive, which ones can be “treated” and which ones are based on habits or lifestyle. Using this information, we can help our patients better manage their tooth decay, ultimately resulting in fewer office visits, fillings and incidences of dental discomfort.

Once we have determined your risk for tooth decay, we can make recommend products that can help you better manage your unique risks. One of these great products is Carifree Ctx3. This mouthwash-like rinse combines pH neutralization (to minimize mouth acidity), fluoride (to rebuild enamel) and xylitol (to naturally inhibit acid-producing bacteria). We love this rinse because it targets three of the decay cornerstones outlined in CAMBRA in an easy and convenient delivery method.

    Here is an example of how CAMBRA works: A 24 year old male comes in with and is diagnosed with a cavity on one of his molars. We go over his medical history and see he is taking medications that cause dry mouth. When discussing his eating habits, we find that he is a frequent snacker and enjoys sticky, processed foods. Finally, we note that he almost exclusively drinks bottled water and sports drinks. Using CAMBRA, we can determine that his tooth decay risk is likely caused by his medication and eating/drinking habits. We then recommend that he considers cutting back on snacking and sticking to 3 meals a day, stops drinking sports drinks (when not necessary) and starts drinking more filtered water, to both counteract the dryness caused by his medication and add fluoride exposure. While we will still need to treat his current tooth decay, we have now given him the knowledge and tools to better manage his oral care in the future.

    At our office, we treat every patient as a unique individual with unique needs. This is why CAMBRA fits so well with how we perform dentistry. It is not a one-size-fits-all approach, but rather a dynamic diagnosing tool that flexes with you. We are proud to operate our office on the CAMBRA model, and are incredibly satisfied with the results our patients have seen!

New Technology- The Wand

For many patients, the dreaded “ Novacaine* shot” is a source of anxiety, fear and apprehension. The process almost seems backwards; you have to sit through a painful injection just so you can avoid being in pain later. However, this does not have to be the case.

At Thousand Oaks Family Dentistry, all of our operatories are equipped with a device called The Wand. This device uses modern technology to provide pain-minimized and often undetectable dental anesthetic delivery.

While this system still utilizes a needle, this is the end of its similarities with traditional syringes. It uses air power and electric servos to target the primary source of anesthetic discomfort: delivery speed. In almost all dental shots, pain isn’t sourced from the actual needle, but rather from the medicine entering the tissue. The Wand counteracts this by giving the dentist complete control over speed of delivery.

By adding the anesthetic at a slower and more consistent speed, the tissue has time to numb at an appropriate pace to delivery. This minimizes pain and gives the doctor absolute control over location and amount of medicine delivered. Many of our patients are unaware that they have even received a shot by the time we are done!

*Note: Novacaine is no longer a commonly used anesthetic in dental offices. Our office uses a variety of optimized Novacaine variants for different applications and conditions.