by Dr. Richard J. Walicki | Feb 16, 2013 | Cavities, Cavity, Dentistry, Tooth Decay, Toothache
Is it possible to have a cavity and not know it?
Consider this article a public service announcement. I really dislike it when patients lose their teeth unnecessarily. My practice philosophy is that if a person has a dental problem, the goal is to handle that difficulty first, but then empower the patient with the correct knowledge that will keep him out of trouble from there on out. Ideally, my hope is that most future visits to my office will only be for routine maintenance.
Unfortunately, and all too often, I encounter new patients with teeth that are so badly decayed there is little hope of salvage. Possibly just as frequently, I find these patients scheduling a checkup – usually after a long absence from dental care – who are surprised to learn that they have any cavities at all. Sometimes they will think they lost a filling when, in fact, a piece of their enamel has broken away.
Why are they surprised? The common denominator seems to be the idea that cavities are supposed to hurt.
Well, sometimes they do hurt. But most of the time – especially in the early stage – they don’t.
In fact, by the time a tooth does start to hurt you it’s usually pretty bad. More often than not, it is so bad that a dentist is evaluating whether it can be treated with endodontic (root canal) therapy or whether it needs to be extracted. A little understanding of basic dental anatomy is helpful here.
Take a look at the illustration below:
The outer layer of the tooth is comprised of enamel. This is the hardest substance in your body. It breaks up your food and is designed to last you a lifetime.
And now, here is the important part for you to understand: it doesn’t contain any nerves.
It is more than ninety-five percent mineral. Water and organic materials make up the balance. And because it doesn’t have nerves, it doesn’t have feeling. This is actually quite practical since it wouldn’t do to have pain every time you bit into something. On the other hand, it also means that it can be decayed without giving you a warning.
In fact, decay can also travel into the supporting layer – the dentin – and still not cause you pain. It usually has to travel pretty close to the inner layer that contains the blood vessels and nerves – the pulp – before you feel it. Of course, by then, the tooth has generally undergone considerable destruction.
Another factor that makes spotting decay difficult is the way it spreads. I have drawn two black triangles into the enamel above. Notice that the narrow point is on the outside of the enamel. The broader base faces the inside of the tooth. This is how decay usually travels. Sometimes, it will undermine the interior of the tooth while the outer, harder enamel still maintains its form . . . until it eventually crumbles because the underlying supporting dentin has been eaten away by decay.
Many cavities also form at the contact point between two teeth. These are areas that you simply cannot see. Even the dentist needs an x-ray to spot these cavities in most cases.
So what does all this really mean? Spotting decay is not always that easy. As dentists, we use visual examination, but we also rely on probes, x-rays, and even laser detection devices to locate cavities. Even then, it can be difficult to find cavities under existing fillings.
Don’t rely on pain to tell you if you have a cavity in your tooth. If you do, you can be assured that your treatment is likely to be more uncomfortable, expensive, and may even result in the loss of a tooth that could have been treated much more easily earlier in the game.
If you have a loved one, who still has their teeth and hasn’t seen a dentist in a while, have them read this article. You may be saving them from quite a bit of discomfort – not to mention time and money – if they catch potential problems before they are hopeless.
Some of you may be thinking, “No big deal. If it’s that bad, I’ll just pull it.” OK, sometimes that is necessary, but therein lies a lesson for another day.
by Dr. Richard J. Walicki | Jan 27, 2013 | Cavities, Cavity, Dentistry, Tooth Decay
Many of my patients have seen me use a dental instrument called a Diagnodent in the office. It is one of the latest diagnostic tools in dentistry.
No more poking and prodding. No additional radiation. No waiting until the film develops. A laser now detects cavities. And it may do it more accurately than conventional x-rays in many cases. How does it do it? It measures the amount of enamel and dentin lost and assigns a number using a special scale. The number helps the dentist decide if the tooth needs a filling or should just be checked again in several months. Small amounts of decay can disappear if the tooth hardens the softened enamel, a process called remineralization.
It gives you such accurate readings that if you decide to watch a tooth, six months down the road, you’ll rescan the tooth and check the reading. Sometimes we may find the numbers get smaller.
The device (the Diagnodent) is painless, and very safe. It does not necessarily find more decay. It helps us decide if it’s true decay. If small cavities are detected, patients can take steps that will help to remineralize the tooth and may avoid a filling entirely.
This new laser cavity detection system does not replace all x-ray technology. But it is one more tool we have to help keep your cavities small and your dental bill smaller.
by Dr. Richard J. Walicki | Mar 9, 2012 | Cavities, Cavity, Periodontal Disease, Tooth Decay, Toothache
In an ideal world we wouldn’t get cavities, have gum problems, or ever lose a tooth. Perhaps, the world might not be ideal, even then, but at least we wouldn’t have those problems.
Unfortunately, it is a fact of life that many people do lose their teeth – either to tooth decay or periodontal disease – and then require tooth replacements. Despite the growing popularity and acceptance of dental implants as prosthetic tooth substitutes, removable dentures still constitute the most common solution to missing teeth.
If a person still has some natural teeth, they may get what we term a “removable partial denture.” If they have lost all of their teeth, typically they will get a full denture. A commonly observed problem, however, is that once the dentures are made, patients tend to wear them far beyond the point where the denture continues to function well. A little background regarding the problem with dentures may help clarify why this is so:
Some people think that if they get rid of all of their teeth and get dentures they will finally see an end to their dental problems. This is far from reality. Actually, what happens is that patients simply trade one set of dental problems for another. While many patients will tell you that they eat just fine with their dentures, it has probably been so long since they had their real teeth, they have forgotten what it is like to eat normally.
What are some of the disadvantages of wearing dentures?
- You lose up to 50% of your biting force.
- A full upper denture covers your palate and interferes with your ability to taste your food.
- Dentures can move when you eat, speak, cough, or sneeze.
- Food accumulates around your dentures after a meal.
- Sore spots can develop when the hard denture rubs against your gums.
- Patients with an active gag reflex may not be able to even wear a denture without feeling as though they will gag.
- Multiple relines of the denture may be required as the shape of your mouth changes. This can happen as a result of gaining or losing weight, or as a result of bone shrinkage and aging.
- Atrophy of the upper or lower jaws can make it impossible to develop suction with the denture.
How long do they last?
This is an interesting question, because it is not unusual to encounter patients who tell you their denture was made twenty or even thirty years ago. Believe me, at that point, they are seldom good-looking dentures! But it underscores something about denture wear that is not well understood.
Once a denture is made and, assuming it fits well at the time of delivery, most patients expect – and can experience – good retention and stability.
But the key point is – once made – the dentures don’t change. Yet your mouth can – and often does. New medications can also cause your mouth to become dry, leading to irritation and sore spots. Osteoporosis could lead to shrinkage of the jaw. Despite these changes, many patients attempt to make up for new problems with denture adhesives. Unfortunately, this can open the door to even more irritation, and denture creams containing zinc have even been linked to other health problems such as numbness, tingling and muscle weakness.
While relines can assist with these changes and correct the fit of your denture to improve retention, many patients would do well to consider re-making their dentures after about five years to seven years. In my experience, waiting too long beyond that time period can make the transition to a new denture more difficult.
200 Year-Old Denture
When the change is minimal, such as one might expect after about five years, the transition is generally quite easy. It also helps to have a spare denture for those “oops!” moments. Over the years, I have experienced patients dropping dentures into the sink while cleaning them, accidentally dropping them into garbage disposals, having dogs and cats chew them, and more. Patients will bite into hard objects and break a tooth, they take them out at night and sometimes sit on them, they get stepped on – and one, believe it or not, was even stolen! That was simply too strange a story to recount here.
If your denture is over five years old, talk to your dentist about whether it is time to reline or remake your denture. You will be glad you did.
by Dr. Richard J. Walicki | Dec 28, 2011 | Cavities, Cavity, Dentistry, Tooth Decay
In a previous article, Foods That Are Bad For Your Teeth, I reviewed three broad categories of foods that can be detrimental to your dental health. These were sugars and sweeteners, low fat foods, and foods that contain white, especially bleached, flour.
With this article I would like to spend some time talking about an area that I feel receives entirely too little attention – whether by patients, or dentists, for that matter. Possibly, this comes about for the simple reason that by the time many patients arrive at the dentist they are looking for resolution of a specific problem. In this sense, the market has conditioned both patients and doctors into focusing upon the end-game.
This has its place and fills a need. Patients who are in pain do not generally want to hear about what they should be eating – they want to handle their pain. Yet, knowing what foods can repair teeth may be a key element in establishing their future long-term dental stability.
In today’s economic climate, health care has undergone many challenges and the consumer has been faced with high medical and dental costs. Consequently, health care is not infrequently reserved for the handling of emergencies. This is actually counter-productive, as emergency dental care is also expensive. Couple this with efforts by the patient to reduce costs, and the “treatment” may be a decision to remove the offending tooth. Later, when the patient starts to regret his choice and seeks tooth replacements, he may find that replacement costs are many times more than had they handled the problem once discovered.
Economics can also influence the quality of the food we consume. In an effort to save money many consumers will also select lowest cost items. These are typically quite profitable for the producer but are usually highly processed and very unprofitable for your health.
So what do you need to know?
Let’s start with this simple concept: If what you eat comes out of a box, a jar, a can, or a plastic wrapper, it has been processed.
Your diet is the single most important thing that you can control to create or maintain a healthy mouth. When you eat too many processed foods – especially those that contain sugars and bleached flour – you create effects that may not be immediately noticed by you. For example, the level of blood sugar can become elevated and with it a person can experience elevated cortisol. Cortisol is a hormone produced by your adrenal gland and is responsible for raising blood sugar. It also affects the flow of parotin (a salivary gland hormone) and, in so doing, can lead to cavities. Cortisol also counteracts insulin which regulates carbohydrate and fat metabolism in the body, and it slows down bone formation.
The inability to metabolize fats, in turn, can keep you from benefiting from the healthy foods that can help you to repair your teeth.
So, you see, it is a little like the children’s song “The foot bone’s connected to the ankle bone. And the ankle bone’s connected the leg bone.” The bottom line: what we do – or don’t do – can have unseen and unwanted effects when it comes to our diet and teeth.
Maintaining healthy hormones is very important to your dental health as well as to your general health. The relationship between demineralization and remineralization is balanced when hormones are healthy. When unbalanced, calcium and phosphorus can be pulled out of the blood and create deficiencies in our bones as well as the teeth. It can also create a condition wherein your body becomes excessively acidic. An acid environment is more receptive to the growth of bacteria and fungi. If there is one take-home message that you take out of this article it should be that real food – namely unprocessed food, as nature intended that it be consumed – will not only support your general health, but will also support your teeth.
What foods, then, are good for your teeth?
- Proteins: Eat proteins in order to regulate blood sugar. As mentioned above, blood sugar fluctuations are one of the key reasons that we lose minerals. High quality proteins such as grass fed, or wild game are best. While I realize that this may pose a problem for vegetarians, it doesn’t alter the fact that the most productive stores of minerals, protein, and fats are derived from meats. Vegetarians must rely on eggs and cheese for their protein.
- Foods with phosphorus: Possibly more important than calcium for your teeth, phosphorus can be obtained from milk and cheese. Raw, unpasteurized milk is best. Unless, strictly vegan, vegetarians should have no trouble getting their phosphorus from these sources. Other good sources of phosphorus include organ meats of both land animals and those from the sea. Muscle meats (most common meats consumed, i.e., not from organs such as liver or kidney, for example) are also a good source, as are beans and nuts. Organ meats have more phosphorus than muscle meats. Although present in some grains, the quantities can be insufficient or difficult to absorb, and this may not be the best choice for your teeth.
- Trace minerals are important: In addition to phosphorus, the following deficiencies can also lead to problems with tooth decay – iron, copper, magnesium and manganese. Foods with iron include shellfish and organ meats. Copper is found in liver and mollusks. Smaller amounts exist in mushrooms. Magnesium can be found in fish, nuts, and spinach. Manganese, also important in the regulation of blood sugar, occurs in liver, kidneys (organ meats), mussels, nuts, and pineapple, to name a few sources. Other trace minerals may also play a role, but are too numerous to mention here.
- Healthy fats: These are a great source of energy, but are also important to help maintain hormonal function and balance. Among the healthy fats are olive oil, butter, beef, chicken, pork and duck fat. Avocado and coconut oil are also healthy fats, especially if from organic sources. Vegetable fats do not generally contain the vitamins that help to re-build our teeth.
- Fat soluble vitamins D and A: Simply put, without adequate stores of these two vitamins, we can’t get the calcium and phosphorus into our bones or teeth. People with tooth decay are typically lacking these two vitamins. Seafood is an excellent source of Vitamin D. If you don’t have easy access to seafood, or if you don’t like it, lard, or pork fat, will help. Suet, or beef fat appears to be more effective, however. Another excellent (and relatively simple) way to get Vitamin D is with daily exposure to sunlight. Consuming fermented cod liver oil is still another easy way to get Vitamin D into your diet.
Eating healthy is the single-most effective action you can take to protect your teeth – and your overall health. It is also one thing that you can control. Take the time to learn which foods can provide you with proteins, phosphorus, healthy fats, vitamins D and A, as well as trace minerals, and you will be well on your way to healthier teeth and gums!
by Dr. Richard J. Walicki | Dec 19, 2011 | Cavities, Cavity, Dentistry, Tooth Decay
This is the first of a two-part series that discusses the effect of foods on our teeth. Part One will review those foods considered harmful to the teeth, and Part Two will discuss foods that can actually help to rebuild them.
Generally, more attention is given to the former than the latter. From a viewpoint of prevention, this has its value. Nevertheless, a good understanding of which foods are beneficial to dental health is, in my opinion, of no lesser importance. In actual fact, this understanding may hold the key to not only improving an individual’s dental health, but very possibly their general health as well.
While there are usually several components to any program that leads to improved dental health, of these, it is my opinion that diet is paramount.
Dentists generally spend the bulk of their time discussing the importance of hygiene. I, too, have addressed this topic in several articles. Nevertheless, over time, I have come to see the value of spending a great deal more time with patients reviewing and modifying their diets. Truthfully, this is more challenging – and meets with greater resistance. But it is vitally important.
I don’t think it is important to the exclusion of hygiene, however. Yet, I have come across some opinions that promote diet only. So let’s take another look at this area more broadly, just to put it into perspective.
Hygiene involves care of the entire body. Naturally, that includes the mouth. While good personal hygiene is generally something one should practice for themselves – it is also important to insist others maintain it as well. Consider the following example:
Let’s say you have adopted a diet of fresh organic food and you are now on your way to your local butcher to purchase some fresh meat. You arrive and are greeted by someone who smells as though he hasn’t bathed in a week. His hair is greasy. His hands are dirty and after he unceremoniously coughs into them, he wipes one hand on a dirty shirt. Then he reaches over for your fresh cut of meat and holds it up for inspection.
You would have a right to refuse it. Not because there is anything wrong with grass-fed, hormone free meat. Rather, it would be because the person clearly practices poor hygiene and may infect you – and whoever else they come into contact with. You wouldn’t be wrong to say something about it.
Similarly, good oral hygiene is simply a reflection of the total care of one’s body. This also means getting sufficient rest and exercising regularly.
That having been said, let’s take a quick look at what types of food cause people dental problems.
These can be simplified into three broad categories. As you will see, however, they comprise a very wide array of commonly consumed foods.
- Sugar and Sweeteners. The first category I will mention is the one nearly everyone focuses upon and possibly falls into the category of “common knowledge.” Despite this fact, you might be surprised by the quantities of sugars and sweeteners that are regularly consumed in a typical diet. When the quantity of sugar in the blood rises it upsets the balance of calcium to phosphorus in the blood as well. This has the effect of pulling calcium out of our teeth and bones. Low phosphorus levels likewise affect the mineral content of dentin, which is the layer of tooth structure supporting tooth enamel.
- Low Fat Foods. This includes such items as skimmed or low-fat milk, which many individuals assume helps their teeth if they consume it in sufficient quantities. Unfortunately, this is a fallacy that gets many people in trouble. Milk that is homogenized and pasteurized has been stripped of its nutritive value. Pasteurization kills off the probiotic (good bacteria) quality of raw natural milk. Paradoxically, this can allow pathogenic (bad) bacteria to grow more easily in pasteurized milk. Also, the absence of healthy fat can affect hormonal function which, in turn, may affect mineral levels adversely.
- Bleached (White) Flour. Products that contain white flour can also be damaging to teeth – especially when combined with sugars and in the absence of healthy animal fats. If one stops to consider how many foods are made with white flour, this can create quite a dietary challenge. Furthermore, if not removed after meals, these foods will create a thin sticky layer of what is basically a form of sugar. Because this, in turn, can stick to the teeth for hours – and becomes acidic – it can accelerate that demineralization process that breaks down the outer layer of your teeth, resulting in tooth decay. Also, the bleaching process typically adds chlorine dioxide or benzoyl peroxide to make the flour appear bright white. You don’t need these in your diet.
In the next article, we will cover what foods are good for your teeth. The positive side to this story is that there is good news and you can do something to remineralize or rebuild your teeth; however, knowing how foods come into the picture and which ones are detrimental to your teeth and gums is a critical element for taking control of your dental health.
by Dr. Richard J. Walicki | Dec 5, 2011 | Cavities, Cavity, Cosmetic Dentistry, Dentistry, Periodontal Disease, Tooth Decay, Toothache
Let’s face it: seeing a doctor – any sort of doctor – can be expensive. And dentists are no exception. But if a person’s diet and home care have been lacking, the cost of dental treatment can quickly sky-rocket. One of the problems with dental care has to do with the fact that many patients still suffer from the idea that if they don’t feel anything wrong with their teeth, then all is well.
Unfortunately, when it comes to teeth, most people miss the boat entirely with this concept. The reason is simple: the outer part of the tooth – the enamel – is mostly mineral and has no nerves. That means you can have a cavity and not know it. Several, actually. Most dentists will attest to the fact that many patients are shocked to learn they have any cavities at all.
The trouble is that by the time a cavity actually gets big enough to pose a problem, it’s a PROBLEM. For most people that trouble is spelled P-A-I-N.
It’s really no small wonder that so many individuals associate going to the dentist with toothaches. For those patients, it is the only time they will actually make an appointment. They go because they now know they have a cavity. Pain is a huge motivator. . . .
By the time a tooth hurts, though, the cavity is usually pretty close to the nerve. This means that if there is still enough tooth structure left to work with, the dentist may consider a root canal to remove the source of the pain – in other words – the nerve. Usually, this is not cheap. A root canal on a molar can cost over a thousand dollars when performed by a specialist. Then the patient has to go back to the dentist to have the tooth built up again (because so much tooth structure was lost to decay) and finally, the tooth may even need a crown. Lacking a blood supply and nerve thanks to the root canal, the tooth is now brittle and can break. Since your back teeth get a lot of pressure when you chew, failing to crown it may result in the tooth cracking and all that money you spent on the root canal goes out the window.
In a number of cases, because many people simply fear getting a root canal (not because they actually had one, but because they heard that a friend of a friend had a bad experience, and they never want to go through THAT), they opt to remove the tooth instead.
But now they have to replace the missing tooth or else their teeth will shift around and their bite goes awry. And fixing that new problem typically costs even more!
It can be frustrating.
Many people figure no one will see a missing back tooth, so why not pull it, since that is cheaper? At least they think so – until they notice their front teeth starting to form gaps, and find that food gets stuck all over the place whenever they eat. But then again, what if it’s a front tooth that needs to go?
You possibly think: “Wow, this is a problem, but I still really need to find something cheap.” OK, then. If you live in Philadelphia, you may Google “affordable Philadelphia dentist” or “cheap dentist.” A number of listings for dental implants appear, maybe some for “affordable cosmetic dentistry.” Wow, this isn’t sounding at all affordable!!! Wait! A couple of dental schools come up too. “Hmmm. Do I really want someone in their first year of dental clinic restoring my front tooth? It will be less expensive. But, then again . . . .”
The affordable dentist is someone who will understand your situation and can help you to find a workable solution for your circumstances. Many offices offer low-cost or interest-free programs that help you get the work you need today and then spread payments out over time. In some cases, it may be helpful to set up a lay-away program, especially if you have specific needs for which you have been given an estimate of treatment costs. In this manner you won’t end up spending your money on other less-essential items. Many offices will assess a minor fee to manage this plan, but it is usually quite small.
In the meantime, it is essential to keep yourself out of trouble with good preventive dental practices. Learn what diet has to do with your teeth and which home care habits are best. Remember, when it comes to teeth and gums, “no pain” most definitely does not always mean “no problems”.
by Dr. Richard J. Walicki | Dec 2, 2011 | Cavities, Cavity, Dentistry, Periodontal Disease, Tooth Decay, Toothache
“If it ain’t broke, don’t fix it.” Isn’t that how the saying goes?
Well, when it comes to teeth, most people really can’t tell if it’s broken.
Consider these interesting dental tidbits:
- Periodontal (gum) disease is the number one cause of tooth loss world-wide. That’s basically a condition in which you lose the bone that surrounds your teeth, so that even healthy teeth may fall out.
- Most people who get cavities diagnosed by their dentist didn’t have any idea that they even had a cavity.
- A substantial number of patients who clench or grind their teeth — resulting in worn-out, chipped, and cracked teeth — swear that they don’t.
- Some patients who come into a dental office convinced that they have a cavity because of pain, actually don’t have a cavity at all.
What the heck?! Yeah, it can get a little confusing, and that’s probably why at one point or another many people find themselves confronting a dental emergency. Some emergencies are simply the result of accidents. After nearly twenty years of practice, I have seen quite a lot of these too. But in reality, the vast majority of dental emergencies are simply caused by neglect. So here are a few tips on how to stay out of trouble:
1. Never open anything with your teeth. Just don’t do it. I have restored countless teeth after people tried to open or hold objects with their teeth. It’s not worth it. Grab a scissor, pliers, bottle-opener or whatever you need to do the job. Your teeth were made to chew your food.
2. Use an athletic mouth guard if you play sports. Sports are fun and can be great exercise. They can also cause teeth to get punched out, kicked out or knocked out. Use a professionally made mouth guard if you play sports.
3. See your dentist regularly. Some things can even be tough for your dentist to detect. Unless you have x-ray vision and can see inside your own head, you will never know if you have decay between your teeth until it is so large that it starts to look ugly or pieces of the tooth actually fall apart. Also, you don’t want your first realization that you have periodontal disease to come from noticing that your teeth are loose. Your dentist should also be checking for oral cancer at your examination visits. If you have it, early diagnosis can be a matter of life or death.
4. Brush and floss your teeth daily. There is simply no substitute for prevention. Brushing your teeth after every meal and flossing at least once a day goes a long way in protecting you from oral diseases — not to mention bad breath.
5. Wear a custom night guard if you grind or clench your teeth. Bruxism — the term used for the grinding or clenching of teeth, has been observed by dentists to be increasing in frequency among their patient populations. No doubt, stress has a great deal to do with this, but if you have been diagnosed with bruxism don’t take it lightly — because your teeth won’t either. I have also noticed a significant rise in bruxism over the last 10 or so years and its effects can be devastating.
Oh, and that emergency dentist you were thinking of using. You know, you saw the billboard on the way to work. He’s the one that is willing to see you 24/7. So, in the worst case scenario, you will have someone to go to, right?
I wonder how many people he has actually treated at 3:00 AM? If it happens at all, I’m certain it doesn’t happen often. Sure, you can CALL him 24/7, but you’ll be seen at the first opportunity. And if he does agree to see you after hours or on a weekend, it will likely cost you a few extra hundred in addition to the cost of your treatment. By the way, be prepared to bring cash, because he may not accept checks or a credit card from a brand-new emergency patient.
The moral of the story is simple. Use common sense and just don’t let things get that far along. If it has been more than six months since you have seen your dentist (unless you have full dentures) you are over-due. Even patients with dentures should see their dentist at least once a year to check the fit of their dentures, be evaluated for adjustments or relines, to have the dentures cleaned, and to check for oral cancer.
How long has it been since your last dental visit?
