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 | Feb 10, 2013 | Uncategorized
Should you or shouldn’t you?
Not long ago, I heard something from a patient that really surprised me. Now, that in itself is significant, because after practicing dentistry in Philadelphia for over 20 years, I thought I had just about heard it all. This patient, who up until recently had a great record of regular follow-up visits for cleanings and check-ups had been missing in action for about a year and a half. After we caught up with her and found out what was behind her unusual lapse in dental care, I learned that, among other things, she had been listening to a friend who had asked her: “Why do you want to go to the dentist? He’ll just find things that are wrong with you. And it’s so expensive.”
Wow!
Quite apart from the fact that this patient usually left her checkup without a need for any additional treatment, I thought to myself “With friends like that, who needs enemies?”
Well, here’s one to chew on: Let your oral health go and sure it may be expensive. That is, if you choose to get back into shape. Maybe even really expensive.
But, take care of yourself and – unless you have a serious accident – it’s very unlikely.
Statistically, I have found that patients who keep up with their bi-annual visits, have far less treatment that needs to be done. At times, an old filling or two may require replacement, but usually not a lot beyond that. That’s just normal wear and tear.
People who grind or clench their teeth often experience a higher need for dental work due to added stresses on their teeth, but we have solutions for this too.
All-in-all, having regular check-ups keeps the bulk of your hard-earned money in your pocket and not mine. Think about it. It’s just common sense.
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 | 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 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?
