by Dr. Richard J. Walicki | Oct 18, 2011 | Uncategorized
Recently, I saw four new patients in my dental office during a given week. All four of those patients scheduled their visits because they perceived pieces of their tooth chipping away. In three out of four of those cases, the offending tooth was so badly decayed that the tooth couldn’t be saved. Yet only one of those patients came in with any discomfort.
The common thread in each of these cases is that the patient waited until the tooth was actually breaking apart to seek dental care. All too often, the trigger that brings people to the dentist is pain. Yet here, we had at least three cases where pain was not a factor and yet the tooth was decaying.
How is this possible?
A little understanding of dental anatomy helps here. The outer layer of teeth, the enamel, is the hardest substance in your body. Because its composition is predominantly mineral, it is possible to have decay throughout that layer without experiencing any sensation. In fact, it is even possible for your dentist to drill that part of the tooth (in most cases) without pain. The next layer under your enamel is called dentin. Decay can travel into the dentin – where it usually spreads more quickly, because it is not as hard – and a person still may not experience pain.
By the time a tooth that is decayed hurts, the decay has generally travelled so far that it nears the innermost layer – the pulp. The pulp contains nerves and blood vessels – so, naturally, pain becomes a factor. If a patient is lucky enough to have enough tooth structure remaining, chances are that the tooth will need a root canal if it is to be saved. Otherwise, extraction is the usual alternative.
One lost tooth can lead, in turn, to still other dental problems. Most notably these include shifting teeth, TMJ problems, periodontal problems, cosmetic difficulties or simply difficulty chewing. It may even lead to the loss of more teeth – not to mention the fact that tooth replacement options can become rather expensive.
Hopefully, just understanding that a lack of pain does not equate to a lack of problems will prompt some readers that haven’t seen a dentist in a long time to do so. Sometimes people fear learning that they have cavities that need to be treated, and so they put off the examination. Consider, however, that it is better to learn you have five teeth that need fillings, than to learn you have several that have to be extracted.
by Dr. Richard J. Walicki | Oct 17, 2011 | Uncategorized
As a dentist, it’s not unusual to find me browsing the dental aisle from time to time. I like to see what’s new. What I find particularly interesting, though, is watching people as they make their product choices.
My impression is that one area which seems to attract the most indecision relates to the subject of which toothbrush to buy. With manual toothbrushes people ponder over whether to get a soft bristle, a medium hardness, or an outright hard bristle. Then, the question becomes should it be angled or straight?
In my office, people also frequently ask: “How often should I replace my toothbrush?” (As often as once every other month. Don’t let it go beyond three months on average, however. Also, replace your brushes after being sick. The bristles retain germs.)
Then there is the question: is an electric toothbrush really better than a manual? If so, what kind of electric brush? Sonic, rotary, or oscillating?
It can get pretty confusing. So let me sum it up for you.
While I’m not sure every dentist will agree with me (only “three out of four” of us agree on anything anyway) 🙂 here is my opinion:
If you’re buying a manual brush, get a soft bristle. If you are deciding between a manual and electric – go for the electric. In my experience battery-powered brushes are fine, but rechargeable brushes are more convenient and eliminate the cost of frequent battery changes. Rotation-oscillation is usually preferred, but I have seen excellent results with the sonics as well.
Soft bristles are kinder to the gums, and since you should be paying attention to your gum-line when you brush, this is important. When I was in dental school I recall a lecture explaining that soft bristles were also “end-rounded,” which means that if you looked at the tips of the bristles under magnification, their ends are, well, rounded. This is in contrast to bristles that are cut off at sharp angles on the harder brushes. I guess the manufacturers figure if you’re going to buy the harder bristle, “What the heck. There is no point to rounding off these babies, let’s keep ’em really rough.” The trouble is this can be abrasive to your gums.
As for the electric brush, I think a consensus exists that — per time spent brushing — more plaque is removed. So this is worth the extra investment. If finances are tight, I believe that you still can achieve excellent results with a manual brush – if you use it correctly. This means brushing in the correct directions, with the right motions and with the appropriate amount of force. Have your dentist or hygienist demonstrate the recommended technique to you. Also, if you have all of your teeth, you should spend at least two minutes brushing them. In my observation, the trouble is that most people simply don’t brush long enough. So time your brushing. One study showed most people think they are brushing much longer than they actually are. Since human nature seems to be inclined to “rush the brush,” this is where electric brushes have an advantage over the manual variety. Many of the electrics have built-in timers. You can still cheat, but at least you will know you are doing it.
by Dr. Richard J. Walicki | Oct 13, 2011 | Uncategorized
Here is an interesting exchange I had with a patient not too long ago. I’m getting ready to start a cleaning after completing my examination. His gums are red (he has gingivitis), there is plaque visible, and I just know those gums will bleed when I start to clean them. I’d like to help him get this under control, but I suspect he doesn’t floss, so I ask “Do you floss?”
His answer: “Whenever I need to.”
I’m thinking: “That would be, like, EVERY DAY.” But instead I ask: “How often is that?”
He replies: “Whenever food becomes noticeably stuck between my teeth.”
I’m actually detecting just a little annoyance now, and then he says: “Yeah, every dentist I have ever been to mentions the flossing thing.”
Well, I suppose I could talk about his favorite color, or maybe something equally inane, like the weather — but somehow the ‘flossing thing’ seemed appropriate. And then it occurred to me, maybe that IS “flossing” for this guy. And how many others, I wondered?
Therefore, in my quest to help rid the world of gingivitis and periodontal disease, (which just may be the shared goal of “every other dentist” who has recommended flossing) I’d like to clarify a few points about what it is and what it isn’t. While floss is unquestionably effective at removing food particles from between your teeth, just picking out the occasional chunk of steak from between your teeth doesn’t classify as “flossing.”
Flossing involves taking a piece of floss – say, about eighteen inches or so – grasping it between your thumb and index finger (just a few inches apart), then holding it in a “C” shape against the side of your tooth. Pre-threaded flossers are just fine in my opinion. Use whatever you are most comfortable with and whatever will get you to floss regularly. Rub the floss up and down the sides of every tooth. You actually want to slide the floss under the gum line. This cleans out areas your toothbrush cannot effectively reach.
Imagine not cleaning some parts of your teeth – ever. Or maybe, you just clean some teeth and not others. Do you think the unclean teeth might become more subject to tooth decay? If you answered “Yes!” then you would be right. This is exactly what occurs when you don’t floss. The parts of the teeth that are in contact with each other never get brushed. It’s not physically possible. So, a sizeable portion of all the fillings I end up having to place for patients are between the teeth. This is so easily helped . . . floss!
If you are just beginning to floss, you can expect your gums to bleed. Don’t let this ‘freak you out.’ A number of patients have said to me over the years “I tried flossing but it made my gums bleed, so I quit.” No. Bacteria, gingivitis, and nutritional deficiencies made your gums bleed. Flossing will help. You just need to stick with it until you notice less and less bleeding.
It is important to have your teeth and gums examined regularly. While gingivitis and periodontal disease are bad enough, there are a few even more serious conditions that could contribute to bleeding gums.
I actually could go on for quite a while about the many benefits to your overall health that flossing brings, but I’ll spare you for now. Or shall we just talk about the weather?
by Dr. Richard J. Walicki | Sep 19, 2011 | Cavities, Cavity, Dentistry, Tooth Decay
ScienceDaily (2011-08-23) — Researchers in the UK have discovered a pain-free way of tackling dental decay that reverses the damage of acid attack and rebuilds teeth as new. The pioneering treatment promises to transform the approach to filling teeth forever. Â
Click on this link to read the full article.
by Dr. Richard J. Walicki | Sep 9, 2011 | Cavities, Cavity, Dentistry, Tooth Decay
Following is a reprinted article that outlines a real, but ultimately preventable, tragedy. As you will see from the attached video, some people scarcely believe that a tooth infection can produce such severe consequences.
From Medscape Medical News
by Laird Harrison, Freelance Writer for Medscape
September 9, 2011 — An unemployed man died last week because he couldn’t afford treatment for his infected third molar, according to news reports.
Citing physicians and family remembers, Cincinnati’s WLWT television station said the infection killed 24-year-old Kyle Willis when it spread from his tooth to his brain.
Dentists advised Willis, the nephew of funk bass player Bootsy Collins, to have the tooth extracted 2 weeks earlier, but Willis had no insurance and decided to wait, according to the report.
“He should have gone to the dentist to take care of the toothache, and it wouldn’t have escalated to this. It’s a lesson learned by all,” said Willis’ aunt, Patti Collins.
Suffering from headaches and swelling, Willis later visited an emergency department, where he got prescriptions for antibiotics and analgesics.
He could only afford 1 of the prescriptions and chose the pain medicine. Willis felt better, but swelling in his brain killed him.
Willis’ fate recalls the widely publicized 2007 death of 12-year-old Maryland boy Deamonte Driver, whose tooth infection also spread to his brain. Driver’s mother had trouble finding a dentist who would treat him for what she could pay. Physicians estimated that they had spent $250,000 trying to save him from an infection that could have been prevented by a simple extraction.
The Patient Protection and Affordable Care Act of 2010 expanded dental care subsidies for children of indigent families but has no provisions to pay for adult dental care. Many states have never offered adult dental benefits for Medicaid patients, and others have eliminated these benefits in recent years as revenues have shrunk in the recession.
Although Ohio does offer such benefits, Willis’ family had recently lost its benefits, according to ABC News.
In April, the Kaiser Family Foundation reported that 33% of people surveyed skipped dental care or dental checkups because they could not afford them.
Dentists who operate free clinics for the underserved say they are often overwhelmed by the demand.
Willis leaves behind a 6-year-old daughter. Family members are organizing funds for Willis’ funeral expenses and for his daughter’s college education. Donations may be made to: Kyle Willis Memorial Fund, 604 Ohio Pike, Cincinnati, Ohio 45245-2141.
