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.
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.
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.
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”.
“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?
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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