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.
by Dr. Richard J. Walicki | Jul 14, 2011 | Cavities, Cavity, Tooth Decay, Toothache
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 at the bottom of this post.
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 | Jul 11, 2011 | Cavities, Cavity, Dentistry, Tooth Decay, Uncategorized
Sounds like a pretty basic question for a dentist, doesn’t it? In fact, I’m not really asked that question often because “everybody knows” you should brush your teeth twice a day. But should you really?
After all, you can pick up almost any tube of toothpaste and it says right there” brush twice daily, or as directed by your dentist”.
Some time ago, I started asking patients how often they brushed their teeth when they came in for their periodic cleanings. The most common answer – by far – is “twice a day.” My next question is usually, “Yes, but when during the day do you brush?” As you read this, many of you who do brush twice daily are thinking “when I get up and again before I go to bed.”
If you have experienced dental cavities, that could be part of the problem.
When I mention this to patients I usually get this sort of silent stare. It’s kind of a cross between, “well that makes no sense at all” or, “then I might as well just give up.”
Let me explain. 
It starts with an understanding of what causes dental cavities. There are a few basic elements. The most obvious is that you need to have a tooth. Additionally, you need cavity-causing bacteria. Then you also need a fermentable carbohydrate. This is an important point. Carbohydrates include sugars and starches, but the process of fermentation creates acids. Once the acids form, there is another element that comes into play: time.
If we break these factors down further, it is useful to look at what we can control in the cavity-causing process. For the sake of argument, let’s assume we are starting out with a full set of teeth, so that’s not entirely in our control. Next, there is the factor of cavity-causing bacteria. We all have both good and bad bacteria in our mouths. While I could get into a discussion of promoting the good and suppressing the bad, this is also not always easily controlled.
The next two factors, however, we have a great deal of control over.
We can control what we eat. Recognition of which foods are acid forming is also useful. But I’m a realist and understand that sometimes we are just going to eat (or drink) those things anyway.
And this is where the time factor comes in.
A little analogy may be helpful here. What would you do if you spilled a strong acid on your bare skin? Chances are you would run right over to the nearest sink and try to wash it off. But what if you had a leather jacket on and didn’t notice right away? First of all, you would end up with a hole in your jacket, but eventually – with time – it would reach your skin and start to hurt.
It’s much the same with teeth. Your enamel is a protective layer that doesn’t have any feeling because it is mostly mineral and doesn’t contain any nerves. But given enough time, the acid – even a weak one – breaks through and gets to the underlying softer and more sensitive areas.
So, don’t give it time.
Change your brushing habits and do so after every meal. About a half hour after eating is ideal. If you absolutely can’t brush on occasion, chewing a sugarless gum (preferably containing xylitol) can help.
What most people do, though, is wake up and brush. Then they have breakfast and don’t brush. The acids that are formed following the meal slowly dissolve our tooth enamel. Roughly when the acids wear off, they have another meal or a snack and freshen up the acid. Few people brush after lunch, so it’s a few more hours of wearing the enamel away. Just when that acid wears off people freshen it up again with dinner. They don’t always brush after dinner either, so the acid now has even more time to work. Finally, they brush before going to bed. This cycle can, and typically does, go on for days, weeks, months and years. Given enough time, the cavity becomes large enough to require a filling.
So, if you only eat two meals a day, brushing twice a day is probably fine. But if you eat three times a day, how often should you brush? You get the idea.
The really odd thing is that I can go over this with someone thinking they get it. A couple of years later, I’ll ask: “How often do you brush your teeth?” Believe it or not, the answer is often the same as when I asked the first time. Hopefully, however, you will get it. Remember also that you can’t ignore flossing and expect to escape cavities, even if you do brush after every meal. The area between your teeth can’t be reached by the toothbrush bristles. About a third of all cavities filled by dentists occur in this location.
Nevertheless, if you follow the advice above I think you will find yourself encountering far less tooth decay over the years. Hoping it works for you as well as it has for me.
by Dr. Richard J. Walicki | Jun 26, 2011 | Cavities, Cavity, Dentistry, Tooth Decay, Toothache
I have been practicing dentistry for just over twenty years. In that time, I have had strangers, friends and family ask me questions about their dental problems. Maybe this question is one that has come up for you too. One of the more frequent queries I run across goes something like this:
“I recently went to the dentist and I was told I needed to have a filling done. It didn’t bother me before, but it does now – and what’s more, I’m being told I’ll probably need a root canal! Did I mention the tooth wasn’t bothering me? But now I’m looking at over $2,000 in dental bills, because once I’m done with the root canal I’ll have to put a crown on the tooth!”
Are you thinking, hmmm, that darned dentist probably should have just left the tooth alone?
Yeah, that’s usually what they are thinking too.
One of the first questions I then ask is: “Was there already a large filling on the tooth?” Invariably, the answer has been “yes.” In which case, my response is usually “Well, then, it’s really not that unusual.”
The first thing to understand is that the tooth was already treated before. The fact that it already has a large filling, suggests that either the original decay was extensive or it had to be replaced several times. Depending upon the location in the mouth, and severity of pressure placed upon the teeth, fillings do require replacement. Teeth are also not immune to new decay and larger fillings do not typically last as long as smaller ones.
So, picture a filling that originally came close to the nerve. Now, there is either new decay between the old filling and the remaining tooth structure – putting it even closer to the nerve – or there may be a fracture occurring between the tooth and filling because there is not enough enamel left to support the filling. Either way, the nerve is under assault.
The next comment is usually “Well, since it wasn’t bothering me, shouldn’t he have just left it alone?” Trust me, this is not a favorite situation for your dentist either. If he leaves it alone, the likelihood of it turning into a root canal is higher. Then the question becomes “why didn’t he tell me about it sooner?” And if it doesn’t turn into a root canal the patient risks losing the tooth if it fractures. So, really, the tooth’s chances of remaining calm are better if it is treated sooner.
Probably the biggest problem here is the omitted communication. Most of the time, the patient simply wasn’t told there would be a risk of post-operative sensitivity. While the dentist can’t entirely control whether the tooth will recover from a deep cavity or not, it helps when the patient knows there is a chance of later discomfort. The moral of the story: don’t put off your dental treatment. Small cavities conserve more tooth structure and seldom bother you afterwards. Large or deep feelings always put the tooth at risk of more treatment or greater discomfort.
by Dr. Richard J. Walicki | Jun 5, 2011 | Cavities, Cavity, Dentistry, Tooth Decay
Probably one of the most common dental misconceptions revolves around the idea that in order for a tooth to have a problem it has to hurt. Certainly, if a tooth is aching, we can agree that there is most definitely something wrong. But can a tooth have a cavity and not hurt you? If so, should this still be a cause for concern?
Watch this short video to learn how this situation may have something to do with you. CAVITIES 101
