Dental Questions: Can Any Tooth Be Replaced With An Implant?

Here, you can visualize how important bone space is in placing an implant. 

In theory, an implant could take the place of any tooth position in the mouth under ideal conditions. However, not every tooth will be a good candidate for replacement with an implant. The main limiting factors are space, bone size and bone health. For an implant to function properly, there needs to be enough distance between the adjacent teeth so that it can be placed without damaging the roots (which would necessitate both the implant and the tooth to be removed). Additionally, there needs to be ample bone height for the implant to sit in and integrate. This becomes a particular problem on the upper jaw, where the maxillary sinuses can encroach on potential bone space. Finally, the bone needs to be completely healthy. Patients with bone density disorders, recent infection or a history of taking certain medications may not be eligible for an implant. 

While we can accommodate a number of conditions with special implant shapes and grafting, there are some instances where placing an implant would be unpredictable or dangerous. In any case, a proper examination (with x-rays) is the only way to determine if you are eligible for a dental implant. If you would like to know more about implants, when we can place them and if you are eligible, please call our office!

Dental Questions: Can Sensodyne Pronamel Rebuild Enamel?

Unfortunately, there are no products that can “rebuild” dental enamel in the traditional sense. Our teeth do not have biological mechanisms that will allow them to create more enamel or to integrate new enamel. Any product that advertises otherwise will not be able to live up to its claims.

The enamel in our teeth is essentially a crystal made from calcium, phosphate and other minerals. When we consume acidic foods and drinks, the low pH causes the crystal to demineralize and become softer. This process can be further intensified by the cavity causing bacteria in our mouth. With time, this demineralization and constant acid exposure leads to permanent loss of enamel structure.

What Sensodyne Pronamel can do is remineralize the softened enamel. It contains a therapeutic dose of fluoride, which is extremely beneficial in restoring mineral content, slowing decay and protecting against future acid exposures. It is important to note that any mainstream toothpaste will have therapeutic levels of fluoride and will provide similar results. The most important factor is that you are using a fluoride toothpaste twice a day for two minutes, along with daily flossing.

Dental Questions: Can Bisphosphonates Affect Dental Care?

Some Common Brands of Bisphosphonates

If your physician has diagnosed you with osteoporosis, there is a good chance you have been (or will be) prescribed bisphosphonates such as Reclast or Fosamax. There is a possibility that long term use of these drugs can make it difficult for the jaw bone to heal when a tooth is removed.  If you are about to start using a bisphosphonate, it is recommended you have a dental evaluation to identify any teeth that might need to be removed now or in the future. This provides a better long term prognosis for your jaw's healing.  If you have been on a bisphosphonate for some time and need a tooth removed, then you will need to consult with both your medical doctor and dentist to discern the best way to proceed. The impact of Bisphosphonates on dental care highlights the importance of disclosing your complete medical history (including any changes) during a check up or examination. 

Dental Questions: Why Does Flossing Make My Gums Bleed?

A common complaint among patients is that “Flossing causes my gums to bleed, so I don’t floss.” In actuality, the reverse is true: not flossing on a regular, once-a-day basis will cause the gums to bleed when flossed occasionally. Plaque and tartar buildup beneath the gum surface leads to inflammation which in-turn causes bleeding. When you use a toothbrush, the bristles can effectively clean the tops and sides of the teeth. However, the interproximal space (space between two teeth) is impossible to reach with brushing alone.  Hence, we recommend using some sort of dental cleaning device between the teeth once a day. Floss, Butler Soft Picks, handle flossers and water picks can all be used to “brush” this space. There are a number of great options- even if you don't like traditional dental floss!

Dental Questions: Why are my Gums Bleeding?

Sometimes gums will bleed for obvious reasons, like cuts from flossing or abrasion from brushing. Other times, the root cause is less clear. The most common reason for gums to bleed randomly is due to calculus or tartar build up beneath the gum surface. Our office often sees patients that haven’t had their teeth professionally cleaned in a number of years. The number one complaint of these patients is that their gums bleed when brushing, when touched, or even while they are sleeping. A professional cleaning from a hygienist or dentist will remove the tartar, allow gums to heal and end the bleeding. 

Another common complaint is that gums bleed upon flossing. Interestingly, this is generally caused by not flossing enough. We recommend flossing or using some sort of hygiene instrument below the tooth contact once a day. This will help keep the gum tissue healthy and free of any plaque or tartar build up.

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. 

Dental Questions: Are sinus infections and pain on upper teeth related conditions?

In this X-Ray, the floor of the maxillary sinus (yellow line) and the roots of the molars (blue lines) are highlighted. Note how close they are in proximity to each other. 

            The roots of the upper molars are frequently embedded in the floor of the maxillary sinus. As such, the nerves supplying the upper teeth can "pick up" pain signals from an inflamed or infected sinus. Since the size of the maxillary sinus grows with age, this phenomenon can become more prominent in later years. However, it is still important to consult a dentist about severe tooth pain or changes in the size or shape of your teeth and gums. This can be a potential sign of an infection that needs to be treated immediately. 

Dental Questions: What Does It Mean If My Face Is Swollen?

Dental abscesses start small but can have very serious effects.

A swollen face in relation to tooth discomfort means that the tooth has an abscess that has not found a way to drain on it’s own.  An abscess forms when the body has detected a bacterial infection and “walled off” the affected area, but cannot naturally eliminate it. The associated swelling signifies a serious infection that has caused inflammation of the facial tissues. This is a health emergency and requires antibiotics and drainage of the abscess. 

Dental Questions: Can decay on an x-ray look smaller than it actually is in the mouth?

Dental x-rays are a case of "more than meets the eye."

Not only can the decay be bigger, it almost certainly will. Cavities on a tooth are always slightly larger in size than they would appear on an x-ray. For a standard dental radiograph, enamel has to loose about 40% of its mineral content before you can visualize the decay. In other words, the x-ray shows us a dark spot over the most demineralized areas, but the entire effected space will extend beyond this epicenter.  

Furthermore, it is important to remember that an x-ray is only a 2D image. When looking at a radiograph, we can only make accurate judgements in one axis (from the part of the tooth closest to the throat to the part closest to the front of the mouth). We can gather some information on the dimensions from the cheek side to the tongue side, but it is less reliable. Thus, it can become difficult to judge the extent of decay as an entire 3D "space."

Dental Questions: Can a dentist diagnose decay in the mouth that is not evident on an x-ray?

Yes, it is absolutely possible to diagnose decay in the mouth from a visual exam with a mirror and explorer.  Decay on the biting surfaces of the teeth can often be hiding in a pit, groove or fissure of the outer enamel layer. On a visual exam, the area can look like a dark spot in the white of the enamel or an explorer can get stuck in the cavitation. The x-ray won’t show the decay in this area if is still primarily in the enamel layer. However, once decay spreads past this first layer of defense and lands in the internal dentin layer of the tooth, it will definitely show up on an xray.

Take a look at the following pictures, taken from the same patient in the same appointment:

In reviewing the radiographs, there is no apparent decay in this patient’s molars. There aren’t any suspicious shadows or defects in the enamel and the teeth generally look healthy. 

However, a visual examination reveals the beginnings of a cavity forming in the two maxillary molars. The geography of the tooth allows the decay to be hidden as the three dimensional object is translated into a 2D X-ray. Conversely, not all pit and fissure stains are cavities. Dentists can recognise unique shapes, patterns and texture changes in teeth that differentiate staining from active decay. This further highlights the importance of the entire dental exam to make a proper diagnosis.