DR I M SALEJEE DAVENPORT DENTAL STUDIO Nutrition in Dentistry · Many toothaches and dental...

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DR I M SALEJEE DAVENPORT DENTAL STUDIO

OFFICE 66 DAVENPORT SQUARE GLENWOOD 4001 031-2028741

18Nutrition in Dentistry

Sugar is bad for your teeth. The issue really is thefrequency of eating sugar and the duration of its presence inyour mouth. It is probably better for your teeth if you ate alot of sugar over a relatively short period of time, and thencleaned your teeth, than if you just kept a few pieces ofsugar candy in your mouth all day long.It is not usual to see patients who have been relativelycavity free for many years suddenly present with newcavities. An increase in sugar intake is almost always thecause.Fruit and fruit juice contain citric acid which, given thename, is highly acidic. Fruit juice may also contain sugaradditives. Though fruit and fruit juice are excellentnutritionally they can also be a significant cause of cavities.

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Again, the issue is frequency of contact with the citric acidand the duration of its presence in your mouth.Drink all the juice and eat all the fruit you want but do so ina finite amount of time and then ideally, clean your teeth.Several glands in the mouth secrete saliva. They respond tomany stimuli including acidity and dryness. Saliva helps tocleanse teeth, begins digestion of food and acts as alubricant to the food we swallow.Drinking water is a convenient way to clean your teethwhen you don' t have access to a toothbrush, floss and/ormouthwash. It is also an extremely important part of dailynutrition. An average adult should drink about 50 ounces ofwater, or its equivalent, per day. You should drink evenmore water if you also consume significant amounts ofcaffeine or alcohol because these drinks cause dehydration.Water is the only liquid that should be kept bedside forthose who get thirsty at night.

19Halitosis -- known as bad breath to most -- isan embarrassing condition that can affect anyone atanytime, and is caused by several factors. The mostcommon causes of bad breath are preventable and easily

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treated, however certain medical conditions may also causebad breath. Chronic halitosis may indicate an underlyingmedical concern that should be addressed by your dentistor medical doctor.

Learn about the most common reasons why you mayexperience bad breath, and when you should see a dentist foryour halitosis.

Cause: The Food We Eat and DigestionThe food we eat can adversely affect our breath. Odors fromgarlic, onions, cabbage, and certain spices may result inhalitosis when the suspected food is absorbed into the bloodstream after digestion. When the blood has transferred to thelungs, the smell from the food is evident when you exhale.

With eating comes digestion, another cause of bad breath.Gasses produced during the digestive process may escapethrough your mouth, emanating the odor it produces.

Cause: Infrequent Brushing and Flossing

It may seem like an obvious factor, but when you examinehow limited and neglected brushing and flossing habitscontributes to bad breath, the cause hits you like a brick wall

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-- decaying food particles and bacteria trapped in yourmouth.

When the food we eat is left behind either because it istrapped in hard to reach places such as the wisdom teeth, thetiny hair-like follicles on the tongue, or simply becausebrushing and flossing is neglected, it begins to decay in yourmouth. The human mouth is 98.6 F, an ideal temperature forfood to begin to decompose. When you exhale, the odor fromthe decomposing food, bacteria, and plaque causes theoffensive odor.Cause: Oral Diseases and Infections

Periodontal disease is directly related to improper orneglected brushing and flossing. One major sign of thispotentially irreversible oral disease is halitosis. Theaccumulation of plaque, bacteria, and decomposing foodparticles contribute to bad breath as they destroy the delicatetissue that surrounds our teeth.

The same bacteria that cause gum disease, tooth decay, andabscessed teeth are also responsible for halitosis.

Cause: Dry MouthXerostomia is a condition that causes a decrease in theproduction of saliva, resulting in a dry mouth. Several factors

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cause xerostomia, some of which may need to be treated byyour doctor.

Saliva is necessary to provide lubrication the mouth to allowfor proper chewing and swallowing. Saliva naturally cleansesthe mouth and helps prevent cavities. If you are experiencingdry mouth, bad breath may occur because the food particlesremain trapped in the mouth to rot and cause the unpleasantsmell when you exhale.

Cause: Cigarette SmokingThe effects of smoking on our overall health and wellness arefrightening. Over 4,000 chemicals have been identified incigarettes, 200 of which are poisonous. Lung cancer andCOPD are obvious diseases that come to mind when youconsider the health risk associated with the habit. But did youknow smoking is also a major cause of periodontal disease?How does this relate to halitosis you ask? The smokeproduced from a cigarette is inhaled into the lungs, and thenexhaled through the nose and mouth. This causes animmediate effect on your breath because the chemicals andresidue from the smoke remain in your mouth and airways.Continued use of cigarettes contribute to gum disease, amajor cause of bad breath.

Cause: Medical Conditions

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Unexplained or chronic bad breath may be an indication of anunderlying medical condition or disease.

Ketoacidosis occurs in diabetics when there is insufficientglucose in the blood for the body to use as energy. Anobvious sign of this is a fruity-smelling odor in the breath.People with eating disorders may experience halitosis, as wellas frequent dieters. Breath that has a fishy smell or isreminiscent of urine or ammonia may be obvious in peoplewith chronic kidney failure. Sinusitis and lung infections alsocause bad breath. Children with a foreign body trapped intheir nose may experience halitosis. If suspected, see yourdoctor.

Treating and Preventing Bad BreathIn order to treat your bad breath, the root cause of halitosisneeds to be identified. Visit your dentist if you experiencechronic bad breath (in other words bad breath that nevergoes away).

Over-the-counter breath fresheners such as gum, mints,breath strips, breath sprays, and certain mouth rinses willonly provide a temporary relief from bad breath. Thesegeneral guidelines will assist you in managing, and hopefullyeliminating, your experience with bad breath.

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20DENTAL EMERGENCIES As we all know,

accidents can and do happen. If you or someone you knowhas a dental emergency, don’t panic. These tips will tell youwhat to do in case of a dental emergency.

1. ToothachesNever put any pain killers, including aspirin, on the gumbecause it can burn the gum tissue. Clean your mouth out byrinsing thoroughly with warm water. Gently floss around thetooth to remove any food particles that may be caught there.If your tooth continues to hurt, you should call your dentistas soon as possible. A toothache can result from severaldental problems. Regular dental check ups and dentalcleanings can help prevent toothaches.

2. Broken Tooth

If your tooth breaks, the first thing you should do is contactyour dentist immediately. You should also clean your mouthout by rinsing thoroughly with warm water. Apply a coldcompress to the area to minimize any swelling.

3. Possible Broken Jaw

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If you think that your jaw might be broken, apply a coldcompress to the area to minimize any swelling. You will needto see your dentist immediately or go to the emergency roomof a nearby hospital.

4. Knocked Out Tooth

If your tooth has been knocked out, rinse the tooth off verygently to make sure it is clean. Do not scrub the tooth orremove any tissue that is attached to it. Be sure to place atowel or wash cloth in the sink so that it does not go downthe drain. If you can, gently place the tooth back into thesocket. If this is not possible, place the tooth in a smallcontainer or cup of milk. You will need to take the tooth withyou and get to your dentist immediately.

5. Bitten Tongue or Lip

If you have bitten your tongue or lip, gently wipe the areaclean with a cloth. Apply a cold compress to the area tominimize any swelling. If the bleeding will not stop, youshould go to the emergency room of a nearby hospital.

6. Something Caught Between Your Teeth

Gently insert a piece of dental floss or a dental flosser. Bevery careful not to cut the gum tissue. If you are unable toremove the object, contact your dentist. Never use a sharp

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object to try and remove something that is stuck in betweenyour teeth.

21Top 5 Reasons to Visit the Dentist

Visiting your dentist for regular check ups and cleanings canhelp prevent many dental problems as well as to help youmaintain optimal oral health. Don't wait until you have atoothache before you call your dentist.

1. To Prevent Gum DiseaseGum disease is one of the leading causes of adult tooth loss.If diagnosed in its early stages (gingivitis}, it can be treatedand reversed. If treatment is not received, a more seriousand advanced stage of gum disease called periodontitis mayfollow. Regular visits to the dentist for check ups and dentalcleanings, flossing daily and brushing twice a day are keyfactors in preventing gum disease.

2. To Prevent Oral Cancer

According to The Oral Cancer Foundation, someone dies fromoral cancer, every hour of every day in the United Statesalone. When you go for your regular dental check up and

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cleaning, your dentist and hygienist are also screening youfor oral cancer, which is highly curable if diagnosed early.

3. To Avoid Losing Your TeethSince gum disease is one of the leading causes of tooth lossin adults, visiting your dentist on a regular basis andmaintaining good oral hygiene is crucial for avoiding falseteeth and keeping your natural teeth.

4. To Prevent Dental EmergenciesMany toothaches and dental emergencies can be easilyavoided just by regular visits to the dentist. Your dentist candetect any early signs of problems with your teeth or gums.Early detection of cavities, broken fillings and gum diseaseare easily treatable. If these problems go untreated, rootcanals, gum surgery and removal of teeth could become theonly treatment options available.

5. To Help Maintain Good Overall HealthGum disease has been linked to heart disease, strokes,pancreatic cancer and more. Visiting your dentist for regularcheck ups can help you to avoid gum disease, thus promotingbetter overall health.

-22Bruxism is clenching or grinding your teeth. Most

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people are not even aware that they are doing this. In the UnitedStates, bruxism affects about 30 million to 40 million children andadults.

Some people grind their teeth only during sleep. This is called"nocturnal bruxism" or "sleep-related bruxism." Others grind orclench their teeth during the daytime as well. This is thought to berelated to stress or anxiety. Stress can occur for many reasons,including sad and painful events such as the death of a loved one orthe loss of a job. It can also occur from joyous events such as anew job or the birth of a baby.

Bruxism can have a variety of causes. Some experts view bruxismas nothing more than a habit. It also can be a result of the body'sreaction when the teeth do not line up or come together properly.Bruxism also can be a symptom of certain rare diseases of thenerves and muscles in the face. In rare cases, bruxism may be aside effect of some medicines that treat depression. These includeProzac (fluoxetine), Zoloft (sertraline) and Paxil (paroxetine).

People with severe bruxism can break dental fillings or damagetheir teeth. Rubbing the teeth together can cause the outer layers ofenamel to wear away, exposing dentin. This can result in toothsensitivity. Severe bruxism also has been blamed for:

Some cases of jaw dysfunction, also called

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temporomandibular disorders (TMD)

Headaches when you wake up in the morning

Unexplained facial painSymptomsYou may be a bruxer if you experience any of the following:

Rhythmic contractions of the jaw muscles

A grinding sound at night, which may disturb the sleep ofsomeone who shares a bedroom with you

A dull morning headache

Jaw muscles that are tight or painful – This can make ituncomfortable, even painful, to open your mouth wide,especially in the morning

Long-lasting pain in the face

Damaged teeth, broken dental fillings and injured gums

Painful jaw joint

Swelling (occasionally) on the side of your lower jaw caused byclenching. Chronic clenching exercises the jaw muscles. Likelifting weights, this makes the muscles grow larger. Once youstop clenching, the muscles will shrink and the swelling will goaway.

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DiagnosisIf you experience any of these signs and symptoms, see yourdentist. He or she can determine if you are a bruxer and how bestto treat it.

Your dentist will ask about your general dental health, whatsources of stress you have in your life, and what medicines youtake. If you share your bedroom, the dentist also may want to talkto that person. The dentist will ask about your sleep habits,especially about any unusual grinding sounds heard during thenight.

Your dentist will examine you, paying special attention to themuscles in and around your jaw. The dentist also will look at yourteeth for evidence of grinding. During this examination, yourdentist will check for tenderness in your jaw muscles and the jawjoint. He or she also will look for broken teeth, missing teeth andpoor tooth alignment.

A more detailed exam may follow if your dentist suspects that yourbruxism is related to dental problems. In addition to checking your"bite," (how your upper and lower teeth come together) the dentistwill examine your teeth and gums for damage caused by bruxism.Your dentist might also take X-rays of your teeth and jaws.

About 30% of children grind or clench their teeth. The rate is

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highest in children under age 5. If your child grinds or clenches hisor her teeth, discuss the problem with your family dentist. Mostchildren eventually outgrow bruxism and suffer no permanentdamage to their teeth.

Expected DurationOf all children who brux between the ages of 3 and 10, more thanhalf will stop on their own by age 13.

In teenagers and adults, how long bruxism lasts depends on itscause. For example, bruxism can last for many years if it is relatedto stress that doesn't go away. However, if bruxism is being causedby a dental problem, it should stop when the teeth are repaired andrealigned. Often this occurs within a few dental visits.

PreventionIf your bruxism is related to stress, professional counseling mayhelp. You also can try strategies to help you relax. It may help tocut down on stimulants such as tobacco and caffeine.

In both children and adults, tooth damage related to bruxism can beprevented. The usual method is to wear a night bite plate or a bitesplint (a dental appliance worn at night to stop teeth grinding).Wearing a bite splint also can help relieve pressure on facialmuscles and the jaw joint. Hot compresses on facial muscles mayhelp relieve some of the muscle pain and tightness that bruxism can

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cause.

TreatmentThe treatment of bruxism varies depending on its cause:

Stress — If your bruxism is stress-related, your dentist orphysician may recommend professional counseling,psychotherapy, biofeedback exercises or other strategies tohelp you relax. Your dentist may prescribe a medicine such asdiazepam (Valium). This will be for short- term use, usuallyone week or so. It should be taken at night before you go tobed to help reduce grinding at night. You also may receive aprescription muscle relaxant to temporarily ease the spasm inyour jaw. You may also be fitted for a custom-made bite plate.If this does not help, your dentist may refer you to an oralsurgeon or to a dentist who has advanced training in head andneck pain.Dental problems — If your bruxism is related to toothproblems, your dentist probably will correct tooth alignment.In severe cases, your dentist may need to use onlays or crownsto entirely reshape the biting surfaces of your teeth. The dentistalso may make a mouth guard or bite splint that fits yourmouth and teeth. This will help prevent further damage to theteeth. In some cases, it may help your teeth and muscles torealign.

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Medicines — If you develop bruxism as a side effect ofantidepressant medicines, you have a couple of options. Yourdoctor may switch you to a different drug or give you anothermedicine to counteract your bruxism.

When To Call a ProfessionalCall your physician or dentist if you have symptoms of bruxism, orif you are told that you grind your teeth while you sleep.

SSee your dentist right away if you break a tooth, lose a filling, ornotice that your teeth are becoming loose.

PrognosisEven without special treatment, more than half of young childrenwith bruxism stop grinding their teeth by age 13. Meanwhile, yourdentist can fit your child with a night bite plate to preventexcessive tooth wear. This device is effective in almost all childrenwho use it as directed.

In teenagers and adults, the outlook is excellent if bruxism istreated properly and in a timely manner.

©2001-2012 Aetna All rights reserved

What is Bruxism?If you find yourself waking up with sore jaw muscles or a

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headache, you may be suffering from bruxism — the grinding andclenching of teeth. Bruxism can cause teeth to become painful orloose, and sometimes parts of the teeth are literally ground away.Eventually, bruxism can destroy the surrounding bone and gumtissue. It can also lead to problems involving the jaw joint, such astemporomandibular joint syndrome (TMJ).

How do I Know if I Have Bruxism?For many people, bruxism is an unconscious habit. They may noteven realize they're doing it until someone comments that theymake a horrible grinding sound while sleeping. For others, aroutine dental checkup is when they discover their teeth are wornor their tooth enamel is fractured.

Other potential signs of bruxism include aching in the face, headand neck. Your dentist can make an accurate diagnosis anddetermine if the source of facial pain is a result from bruxism.

How is Bruxism Treated?The appropriate treatment for you will depend on what is causingthe problem. By asking careful questions and thoroughlyexamining your teeth, your dentist can help you determine thepotential source of your bruxism. Based on the amount of toothdamage and its likely cause, your dentist may suggest:

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Wearing an appliance while sleeping — custom-made by yourdentist to fit your teeth, the appliance slips over the upperteeth and protects them from grinding against the lowerteeth. While an appliance is a good way to manage bruxism, itis not a cure.

Finding ways to relax — Because everyday stress seems to bea major cause of bruxism, anything that reduces stress canhelp-listening to music, reading a book, taking a walk or abath. It may help to seek counseling to learn effective ways forhandling stressful situations. Also, applying a warm, wetwashcloth to the side of your face can help relax muscles sorefrom clenching.

Reducing the "high spots" of one or more teeth to even yourbite — An abnormal bite, one in which teeth do not fit welltogether, may also be corrected with new fillings, crowns ororthodontics.

•

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An appliance wornwhile sleeping willprotect your teeth,but is not a cure.

23Baby Teeth - What Are Baby Teeth?Many people often wonder “Why fuss over the baby teethsince they are just going to fall out anyway?”

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The habits we learn at an early age are more likely to carryon into adulthood. That being said, when children areencourage to brush and floss daily, they will most likely carrythat habit on into adulthood.

The primary teeth are also important to provide:

Proper chewing and biting

Overall self-esteem

Speech development

Space for the larger adult teeth to erupt

Teeth that are decayed are not only unattractive, they arealso painful and require treatment from a dentist. Fears andphobias are learned early on. If a child has pleasantexperiences with healthy teeth and gums and can avoidpainful dental problems and procedures, as he matures intoan adult, his experiences at the dental office will be enjoyableand less fearful when facing dental procedures.

24Root Canal Therapy

Root canal therapy can be preformed in single or multiplevisits. Before the procedure, though, your dentist will adviseyou as to the number of appointments necessary to complete

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the canal. If you had an infection or abscess in the tooth, thedentist may choose to have you start antibiotics beforecompleting the root canal. Your dentist will begin theappointment by giving you local anesthetic to "numb" thetooth that is being worked on.

After your tooth is "numb", you may expect the followingprocedures:

A dental x-ray of the tooth, displaying the entire tooth inthe film (called a "periapical x-ray"), is taken for thedentist to refer to during the procedure.

The dentist will place a rubber dam over your mouth. Thisplastic shield, made from either latex or nonlatexmaterials, is used to keep the tooth isolated from yoursaliva and very dry before the final steps are taken tocomplete the procedure. The dentist will use differentchemical solutions to disinfect the inside of the tooth. Therubber dam is helpful in keeping these solutions fromentering your mouth.

Next, the dentist will begin the procedure by drilling asmall hole through the tooth in to the area known as thepulp chamber -- this is where the nerve of the tooth islocated.

Your dentist will begin using tiny files, which are designedto remove the nerve from the tooth and any infectedtissue. Certain files can be used by hand; others areconnected to a slower moving dental hand piece, called a

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"rotary instrument." The dentist may require another x-rayat this point to determine the length of the root. It iscritical that the entire nerve is removed to preventtoothaches after the procedure and re-infection of thetooth, which would result in the need for retreatment orextraction of the tooth. In order to prevent this, thedentist needs to get as close to the tip, or apex of thetooth, to remove all of the nerve. This is usually thelongest part of the procedure.

Once the dentist is confident that the entire tooth hasbeen cleaned out, the tooth is dried with tiny absorbentpaper points. When completely dry, the dentist will place amaterial (called "gutta percha") in to the tooth. Guttapercha is a rubber material designed to seal the inside ofthe tooth. Your dentist will remove any remaining decayfrom the tooth and will decide to either put a temporaryfilling on to close the tooth or proceed with placing apermanent filling. If your root canal is performed by anendodontist; a dentist that specializes in root canals, hewill place a temporary restoration and send you back toyour general dentist for the restoration. Chances are, yourdentist will recommend having a crown put on to thetooth. Since the nerve and blood supply to the tooth hasbeen taken away, the tooth may become brittle over time,resulting in a cracked tooth. A crown is designed toprevent this from happening.

Root Canal Treatment -Start to Finish

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1. A Deep Infection

Root canal treatment is needed when an injury or a large cavitydamages the tooth's root. The root becomes infected or inflamed.

2. A Route to the RootThe dentist numbs the tooth. An opening is made through the

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crown of the tooth to the pulp chamber.

3. Removing the Infected/Inflamed Tissue

Special files are used to clean the infection and unhealthy pulp outof the canals. Then they shape the canals for the filling material.Irrigation is used to help clean the canals and remove debris.

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4. Filling the Canals

The canals are filled with a permanent material. Typically this isdone with a material known as gutta-percha. This helps to keep thecanals free of infection or contamination.

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5. Rebuilding the Tooth

A temporary filling material is placed on top of the gutta-percha toseal the opening. The filling remains until the tooth receives apermanent filling or a crown. A crown, sometimes called a cap,looks like a natural tooth. It is placed over the top of the tooth.

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6. Extra Support

In some cases, a post is placed into the root next to thegutta-percha. This gives the crown more support.

7. The Crowning Touch

The crown is cemented into place.

25how wisdom teeth are removed:

1. After the elected method of sedation has taken effect,the oral surgeon or dentist starts the procedure bynumbing the tooth and tissues in the area of the mouthwhere the wisdom teeth are located, with a local

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anesthetic. You've probably already had an x-ray, knownas a panorex, taken of the wisdom teeth, but sometimesthe dentist requires additional x-rays the day of theprocedure. Any additional x-rays will be taken at thispoint in the procedure.

2. Once the patient is completely numb from the localanesthetic and the required x-rays have been taken, thedentist begins the surgical part of the procedure byremoving the gum tissue that is covering the area wherethe wisdom tooth is located. If the wisdom tooth isimpacted, an incision is made in the gum tissue, in orderto access the tooth. The gum tissue is then pushed outof the way with a surgical instrument until the tooth isvisible. There is a good chance that an impacted wisdomtooth could be fully or partially covered in bone. If thereis bone covering the wisdom teeth, a high-speed handpiece is used to drill through, and remove the bonecovering the tooth. If the wisdom tooth has alreadyerupted into your mouth, the dentist will loosen theconnective tissue from around the wisdom tooth.

3. Once the impacted wisdom teeth are visible to thedentist, various surgical instruments are used to gentlyloosen the wisdom tooth from any connective tissue inthe tooth's socket. The use of the high-speed hand piecemay be used on and off throughout the extraction. Thesame procedure applies for a wisdom tooth that wasalready erupted. It may be necessary for the dentist to

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cut the tooth into sections before it is removed. This isdone because the tooth is at risk for breaking while it isbeing removed from the socket.

4. Once the wisdom tooth is loose, or it had beencompletely sectioned, it is ready to be removed. Thedentist will remove the wisdom tooth with a selection ofsurgical instruments that are designed to remove thetooth from the tooth's socket.

5. Now that the wisdom teeth are gone, it may benecessary for the dentist to use stitches to close thearea where the teeth were. This is done for surgicallyremoved impacted wisdom teeth and in cases where thedentist feels the patient will heal better with stitches inplace.

6. The dentist will give you some post-operativeinstructions to follow, along with a small amount ofgauze for you to bite down on.

Wisdom tooth removal, albeit a nerve-racking thought, is avery common dental procedure. Wisdom teeth may beremoved in your dental office or in a surgical office.

26Xerostomia is the clinical term for having a drymouth.

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Why is a dry mouth considered to be a diagnosable dentalcondition? A decrease in saliva is known to cause somevery uncomfortable symptoms. Along with theuncomfortable symptoms of xerostomia, a dry mouth isalso known to cause many other serious dental problems,such as bad breath and tooth decay.

It is advisable for you to see your dentist or physician ifyou suspect that you may have xerostomia. In order todetermine the cause of your xerostomia, your dentist orphysician will need to evaluate your oral and overallhealth. Once a potential cause has been determined,learning about the common treatments and remediesused to treat xerostomia will help you regain a sense ofzen in your mouth.

27 Tooth SensitivityTooth sensitivity is due to the exposure of dentin, the part of thetooth which covers the nerve, either through loss of the enamellayer or recession of the gums. Temperature changes and certain

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foods (acidic or sweet) can cause the tooth or teeth to be painful.The pain usually subsides after a short period of time.

The dentin contains a large numbers of pores or tubes that run fromthe outside of the tooth to the nerve in the center. When the dentinis exposed, these tubes can be stimulated by changes intemperature or certain foods. Here is an image of what the dentintubes look like under the microscope:

The dentin contains a large numbers of pores or tubes that run fromthe outside of the tooth to the nerve in the center. When the dentinis exposed, these tubes can be stimulated by changes intemperature or certain foods. Here is an image of what the dentintubes look like under the microscope:

The best way to find out why a tooth is sensitive is to have dentalprofessional examine you. They can look for the signs of dentinexposure, and run tests to determine what the true cause of the

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sensitivity is. Sometimes, the sensitivity is due to a cavity or gumdisease – these can be treated to address the sensitivity. Othertimes, the cause of the sensitivity is because the enamel has beenlost through abrasion or erosion, or the gums have receded, causingthe roots to be exposed.

What Can Be Done?If the sensitivity is due to a cavity, a restoration can be placed. Ifgum disease is the cause, the dental professional can perform athorough cleaning of the area.

However, if the cause is from dentin being exposed, then there area number of professional and at home treatments that can be usedto reduce the sensitivity.

In Office Procedures:

Fluoride varnish can be applied to exposed areas,strengthening the enamel and dentin

Fluoride foam or gel can be placed into a mouth tray; youthen sit with this in your mouth for 3-5 minutes, providingthe teeth with a high concentration of fluoride tostrengthen the areas

Bonding agent, the material used to stick tooth coloredrestorations to teeth, can be used to seal the dentin

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surface and provide a barrier to the stimuli that causesensitivity

At Home:

Use a very soft bristle tooth brush, with low abrasivetooth paste

Brush correctly and do not over brush

Use a tooth paste specially formulated to soothe thenerve endings in the tooth

Use a high concentration fluoride toothpaste (given to youby the dental professional) to strengthen the toothsurface

There are a number of treatments available, and your dentalprofessional can help you find those that will work best, dependingon your situation. Always seek a dental professional's help – do nottry to diagnose this problem yourself. It may be the sign ofsomething more serious, and only a dental professional can tell youwhat it really is.

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28 Dental plaque risk and cancerIf you have persistent dental plaque, it may be associated with anincreased risk of dying early from cancer.

That’s according to an observational study published June 11 in theonline journal, BMJ Open. It doesn’t necessarily mean that dentalplaque causes cancer, say the authors, but controlling bacteria inthe oral cavity may boost one’s health by reducing a source ofinflammation.

Dental plaque is made up of a film of bacteria that covers thesurfaces of the teeth, including the gaps between the teeth andgums. It leads to tooth decay and gum inflammation, with thepotential for tooth loss, and has been implicated in systemic healthproblems.

For the study, researchers wanted to find out if plaque might be arisk factor for early death from cancer due to infection andinflammation, both of which are thought to have a role in up to onein five cancers. To accomplish this, they tracked the health ofalmost 1,400 randomly selected Swedish adults from Stockholmfor 24 years (1985-2009). Participants were in their 30s and 40s atthe start of the monitoring period, and were all quizzed about

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factors likely to increase their cancer risk, such as smoking andlevels of affluence.

Participants’ mouth hygiene was also assessed to investigate theirlevels of dental plaque, tartar, gum disease and tooth loss. Whilethey had no overt gum disease, participants did have substantiallevels of plaque on the tooth surface.

By 2009, 58 people had died of cancer—around a third of whomwere women (35.6 percent). The average age of death was 61 forthe women and 60 for the men. The women would have beenexpected to live around 13 years longer, and the men an additional8.5 years, so their deaths could be considered premature, say theauthors of the study, “The Association of Dental Plaque WithCancer Mortality in Sweden: A Longitudinal Study.”

Deaths among the women were predominantly caused by breastcancer while those among the men were attributed to a range ofdifferent cancers. The dental plaque index in those who died washigher than those who had survived, with values of 0.84 to0.91—indicating that the gum area of the teeth had been coveredwith plaque. The values among the survivors were consistentlylower (0.66 to 0.67)—indicating that the gum area was onlypartially covered with plaque.

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When all the risk factors were considered, age almost doubled therisk of a cancer death. Male gender increased the odds by 90percent.

After the other potential risk factors known to be associated withpremature death—such as lower educational attainment, smoking,frequency of dental visits, and lower income—were accounted for,the associations observed between age, male gender, amount ofdental plaque and premature death remained strong.

Dental plaque was associated with a significantly (79 percent)increased risk of premature death, although the absolute risk ofpremature death was low, with only 58 out of 1,390 participantsdying after 24 years.

However, the authors caution that their findings do not prove thatdental plaque causes or definitely contributes to cancer.

29Healing after Extractions and Oral

Surgery

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After one or more teeth have been removed, you will want todo all the right things for the area to heal quickly andsmoothly. This requires that a blood clot is formed. Theblood clot covers the extraction site and allows the area toheal. A lot of the tips below help the blood clot to formproperly and not become dislodged.

Do’s:

It is normal for the area to be tender for the first few days,and in most cases simple over-the-counter pain relief isenough to ease any discomfort. Start taking painkillersimmediately afterwards – don’t wait until pain sets in!It’s far easier to prevent pain than to make it go away.The usual painkillers of choice are ibuprofen orketoprofen (some products have codeine added for extrapain relief). Check with your dentist or another healthcare provider that you can take these (for example,asthma sufferers shouldn’t). If you can’t, your dentist willbe able to recommend an alternative. Avoid disprin(aspirin) as this thins the blood and can make your mouthbleed. Check with your dentist or pharmacist if you feelyou need something stronger.Go home, take it easy for the rest of the day, and don’texercise for at least 12 to 24 hours. If you want to liedown, and for the first night following surgery, keep your

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head up with pillows if possible. Do not bend over or doheavy lifting for 2-3 days.If you still feel numb 6 hours later, call your dentist or oralsurgeon! If you get back in within 24 hours, your oralsurgeon can inject some steroids into the nerve area,which can help reduce swelling and may help speedrecovery. Prolongued numbness can also be due to alonger-lasting local anaesthetic (marcaine) – in this case,the effect is intentional, but your oral surgeon shouldhave specifically told you that they’ve used this.Your dentist should let you know how to control anybleeding. Usually, a gauze pad will be placed on thearea, and you should try and keep firm pressure on it.You should change this dressing about every 30 to 45minutes, depending on the amount of bleeding.WARNING: Some people are freaked out by the amountof blood. Relax – a small amount of blood is mixed with alarger amount of saliva (or “spit” in dentist speak), whichcan make it look a lot more dramatic than it is! Manydentists will give you a package of gauze to take homewith you, but you may want to buy some gauzebeforehand. If you need to use it, fold the clean gauzeinto a pad, thick enough to bite on, then moisten it andplace it directly on the extraction site. Hold the gauzefirmly in place, by biting down on the pad or using finger

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pressure, for about half an hour to an hour. If this doesn’tstop the bleeding, moisten a tea bag with water and foldit in half and bite down on it for 30 minutes (the tannicacid in black tea helps stop bleeding). Some slightbleeding for the first day or so is normal. But if you stillbleed more heavily after an hour or two, contact yourdentist.While you shouldn’t rinse for the first 24 hours, after thisinitial period you should gently rinse 4 times a day usingwarm salt water (1 teaspoon of salt in a glass of warmwater). Do not spit out forcefully! Rinse after every mealand snack, making sure that the water removes any bitsof food around the area where the tooth is missing.Your dentist may also advise you to use chlorhexidinemouth rinse (Corsodyl in the UK, available inpharmacies, Peridex in the US, prescription-only) for 10days or so following surgery. This kills bacteria.Be careful not to dislodge the blood clot when brushingnear the extraction site for 3-4 days. You can carefullywipe the area with a clean, wet gauze pad. If you can’tget a toothbrush into your mouth due to swelling ordiscomfort (after wisdom tooth removal), chlorhexidinemouthwash (see above) is a handy adjunct.

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Stick to a liquid or soft food diet for the first day or two.Examples include soups, yoghurts, fruit milkshakes,smoothies, mashed potatoes, etc. A Vitamin Csupplement may also be helpful. Avoid spicy foods, hotdrinks and sodas for 3-4 days, to prevent irritation andburns. Tips for soft foods can be found here: Soft FoodSuggestionsIf you’ve been prescribed antibiotics, follow theinstructions and make sure you finish the course.Swelling and sometimes bruising can occur after surgery,esp. with so-called “wisdom teeth” (short for wizzies).The worst swelling, pain and jaw stiffness normallyoccurs 2 or 3 days after surgery. On the day of thesurgery, apply ice packs for 15 minutes on then 15minutes off until bedtime. This will keep swelling to aminimum. Also keep your head elevated until bedtime.Moist heat after 36 hours may help jaw soreness. Arnica(a homeopathic treatment available from pharmacies andhealth stores) can be taken orally and/or as a cream tohelp with the swelling.After wizzie removal, try to gently keep stretching yourmouth open to get it moving again. It can be tempting justto not open it wide at all, but that can lead to permanentlimitated opening (“trismus”). Don’t overdo it, though!

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If you can get hold of it in time, chlorine dioxide gel isgreat for post-op healing after extractions and anythingwhich might leave your gums a bit sore. It’s also great fororal ulcers and burns. Unfortunately, it’s not sold inshops, so unless your dentist sells it, Oxyfresh DentalGel is only available by mail order.

Don’ts:

Don’t be tempted to rinse the area for 24 hours aftertooth removal.Avoid hot food or drinks until the numbing wears off. Youcannot feel pain while you’re numb and may burn yourmouth. Also take care not to accidentally chew yourcheek!Don’t poke at the extraction site! – keep your fingers andtongue away from this area.Avoid sucking (ahem… through straws and stuff),spitting, and blowing your nose (unless you have to).This is because positive or negative pressure coulddislodge the blood clot. If you have a cold or allergies oranything that will want you blow your nose or sneeze,take appropriate medications to treat these.Try not to smoke for as long as possible afterwards, butat the very least for the rest of the day. Smoking can

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interfere with the healing process, and also the suckingmotion could dislodge the blood clot.Avoid alcohol for 24 hours, as it could delay the healingprocess.

The Healing Process:It usually takes gum tissue about 3-4 weeks to heal. Thebone can take up to 6 months to heal completely. However,pain should be lessening by the second day. But it variesfrom person to person, and also depends on how easy ordifficult the tooth removal was.

“There’s a piece of bone coming out where the tooth has beenpulled!”You may feel the sharp edge of the socket with your tongueand sometimes, little bits of bone may make their way to thesurface and work their way out. This is perfectly normal andharmless. If a small bit of bone is annoying you and youdon’t want to wait until it comes out by itself, you can askyour dentist to remove it for you.

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“I’m still in pain. What should I do?”Pain that lasts for up to a week or so but is gradually gettingbetter is normal. You could ask your dentist or pharmacist forstronger painkillers.

Pain that starts to get worse after two days is consideredabnormal and you may want to see your dentist. This couldbe a sign of “dry socket”.

Dry SocketA dry socket occurs when the blood clot for healing becomesdislodged or doesn’t form. In that case, the bone and finenerve endings are not protected and exposed to air, food,and liquids. Dry socket delays the healing process and canbe very painful.

If you suspect dry socket, see your dentist. S/he will place amedicated dressing in the socket which will almost instantlyrelieve pain. If the area is infected, your dentist may alsoprescribe a course of antibiotics. The medicated dressingshould be changed every day or two at the start, and then atlonger intervals. Though some dressings are designed tostay in and dissolve by themselves.

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If you follow the “do’s” and “don’ts” above, you’ll minimizeyour chances of getting dry socket.

“My dissolvable stitches aren’t dissolving!”This is a common problem with dissolving stitches. You canget your dentist to remove them if they don’t come out bythemselves. Many people are worried about the removal ofthe stitches (whether dissolvable or not) but it is an entirelypainless process and you don’t need any numbing for it:

“I had them removed after 10 days so needed to cut them totake them out – cut is the wrong word it was more of a ‘snip’,I had about 6 to 8 ‘snips’ altogether for 13 extraction sites –then gently using a pair of tiny tweezers pulled them out withbarely any feeling at all, kind of a little tug – please notethere was NO PAIN what so ever and it took seconds.”

“just a small pinch and that was it”

“everyone was right, it wasn’t painful, just felt like a tug”

“I just felt a tiny bit of tugging”

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30 Whitening - What Causes toothDiscoloration?While people have different colors of skin and hair, they alsohave genetic differences in tooth color. Some teeth are moreyellow, while others yellow with aging. Natural tooth color canbe discolored by a number of causes. The surface of the teethcan be stained by tobacco, coffee, tea, berries and other foodsas well as by deposits of calculus (which is better known astartar).

Discoloration of the tooth internally can also result from aging,injuries, excessive fluoride, certain illnesses and takingantibiotic tetracycline during early childhood. Althoughbleaching successfully lightens most discolorations, certaintypes (like those caused by tetracycline) are more difficult toremove.

Chairside Bleaching

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There are two types of bleaching procedures.Bleaching may be done completely in the dentaloffice (known as “chairside bleaching”) or a system

may be dispensed by the dentist to use at home (called“in-home bleaching”).

Chairside bleaching takes from 30 minutes to onehour per visit. It is not uncommon for the teeth tobecome slightly sensitive following bleachingtreatments. To protect the mouth, a gel-likesubstance is applied to the gums and a rubber“shield” is placed around the necks of the teeth. Achemical solution, the oxidizing agent, is paintedonto the teeth. A special light may be used toactivate the agent.

Before After

To achieve the best results, teeth may be bleacheda shade lighter than the desired since they willtend to darken slightly with time. Generally two toten visits may be necessary to complete the

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process of chairside bleaching.

In-home BleachingWith in-home bleaching, the dentist makes an impression for amodel of the teeth, fabricates a custom-fitted tray and prescribes ableaching agent that comes in the form of a bleaching gel. Thegel is placed in the custom-fitted tray and worn up to two hoursdaily or at night for about two weeks. The amount of time thecustom-fitted tray is worn and the duration may vary according toa person’s individual need and the recommendations of thedentist. The dentist will monitor the entire process of in-homebleaching to assure its effectiveness and safety.

Over the counter products that are self-administered are notrecommended, although they may appear to cost less. Bleachingtreatment should be done under the supervision of a dentistfollowing a proper exam and diagnosis. Whiteners with the ADASeal of Acceptance have proven to be safe and effective.

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Teeth whitening has become so popular that it seems likeeveryone is doing it. If you want to obtain a bright and whitesmile, teeth whitening may be just what you are looking for.Not only is teeth whitening effective, it can also drasticallychange your smile and improve your self-esteem at the sametime.

The peroxide ingredient in most teeth whitening products iswhat actually bleaches the enamel and makes your teethwhiter. The strength of the whitening treatment typicallydepends on the strength of the peroxide contained in thewhitening product. The current percentages of peroxide inteeth whitening products are 10%, 16% and 22%.

If you are considering teeth whitening, be sure to review thefacts about teeth whitening with your dentist first. Only yourdentist can tell you if your teeth and gums are healthyenough to go through a whitening process.

If your dentist has determined that you are a candidate tohave your teeth whitened, you will need to decide which teethwhitening method to choose from.

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Teeth Whitening Options

In-Office Bleaching -- In-office teeth whitening offersexcellent results. This procedure is performed in the dentaloffice and can be done quickly, usually in a little over anhour. In-office bleaching is expensive, but the time thatyou save by having immediate results can make thisoption appealing.

Teeth Whitening Trays and Gels -- Teeth whiteningtrays and gels are effective, but the desired results takelonger to achieve than with in-office bleaching. Dependingon the strength of peroxide in the gel, these clear traysare usually worn a couple of hours a day or overnight andcould take anywhere from 3 days to a couple of weeksbefore any results are noticed. There are basically twotypes of teeth whitening trays and gels: Those purchasedfrom your dentist and those purchased over the counter.While they will both whiten your teeth, the two have noteddifferences.

Teeth whitening kits from the dentist produce faster andmore effective results because they contain a strongerperoxide-bleaching agent than whitening kits purchasedover the counter. Another benefit of trays and gels fromthe dentist is that the trays are custom made and fit yourteeth exactly. Over-the-counter trays are generic sized

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and could allow the bleaching agent to come into contactwith your gums, causing irritation.

Teeth Whitening Strips -- Teeth whitening strips arepopping up in every drug store across the nation. Thesewhitening strips sold over the counter are fairlyinexpensive, easy to use and most of them really work.Teeth whitening strips may take take longer to producethe desired results depending on the strength of peroxidethat they contain. Good Housekeeping did an interestingstudy about which whitening strips work the best.

Teeth Whitening Toothpastes -- Teeth whiteningtoothpastes contain mild abrasives to remove surfacestains. Some whitening toothpastes may have additionalpolishing agents and special chemicals that are moreeffective against stains than regular toothpastes, but teethwhitening toothpastes are not designed to actually"bleach" your teeth.

Other Teeth Whitening Products -- New teethwhitening products are always popping up includingwhitening chewing gum, dental floss and mouthwashes.While these products are relatively new, not muchresearch has been done to prove or disprove theeffectiveness of these whitening products. I have actuallytried all three and I am sad to say that while they tastedgood or worked well, I didn’t see any whitening results.

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If you are still unsure, ask your dentist to recommend a teethwhitening treatment for you. If you live in the United States,be sure to look for the American Dental Association (ADA)seal of acceptance on over-the-counter teeth whiteningproducts.

How is Professional In-Office TeethWhitening Done?Professional teeth whitening delivers optimum whiteningresults in a short amount of time. Available under thesupervision of a dentist, this method of tooth whitening isgaining popularity, despite the fact that it is considered themost expensive method of chemically whitening your teeth.

Answer:

You may expect the following during your professionalin-office teeth whitening appointment, but not limited to:

Teeth are polished with pumice, a grainy material used toremove any plaque on the surface of the tooth.

Your mouth will be isolated with gauze to keep your teethdry during the procedure. Retractors may also be used to

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keep your cheeks, lips and tongue away from thewhitening solution.

A barrier is placed along your gumline to protect it fromthe whitening solution.

The teeth are then coated with the whitening solution onthe front surface of the tooth. Your office may choose touse either hydrogen peroxide or carbamide peroxide as thebleaching agent. Many whitening products require a curinglight or laser to be used to add heat to the solution toactivate the peroxide. It will then be left on the teeth for30 to 60 minutes, or reapplied in specific increments oftime for up to one hour, depending on the brand.

Once the optimum shade has been reached, or themaximum application time has passed, the teeth arerinsed with water and a fluoride application may be usedto help ease the sensitivity some people experience withtooth whitening.

You will be instructed to avoid foods and beverages thathave a high level of pigment, such as coffee, tomato sauceor juice, yellow mustard, or red wine, and tobacco use for24 hours after the procedure to allow the enamel pores toclose to prevent re-staining.

With a variety of tooth whitening methods available,whitening your teeth has never been more accessible. Areyou dreaming of a white smile? Before considering whitening

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your teeth, book an appointment for a check-up and cleaningwith your dentist. Surface stains will need to be removedbefore whitening to achieve optimum results. Your dentist willthen determine if you are a candidate for tooth whitening.

Are You a Candidate for Tooth Whitening?

Not everyone can use tooth whitening solution.Circumstances that may prevent the use of tooth whiteningproduct are:

Teeth that have restorations , such as veneers or havingbeen bonded with white fillings, cannot be whitened withhydrogen or carbamide peroxide. These materials do notwhiten past the color they were originally made. The colorof these types of restorations were determined by thesurrounding teeth. If the surrounding teeth are whitened,the restorations will stand out and look artificial. Replacingold or discolored restorations will allow you to change theirappearance.

Teeth that have internal staining, discoloration fromdevelopmental conditions or have been root canalled maynot be affected by the typical whitening process. Internaltooth whitening or permanent restorations may be anoption to consider.

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Natural tooth colors that are brown or gray in hue may notproduce desired results. Typically, teeth with a yellow huewill produce the best results.

Pregnant or nursing mothers should avoid whitening theirteeth as there is not enough research to determine thesafety of tooth whitening products during pregnancy orlactation.

People with hypersensitive teeth should avoid toothwhitening, because this process may enhance the level ofsensitivity they experience.

How Are Teeth Whitened?

Enamel, the first layer of tooth surface, is actuallysemi-translucent, or clear. The layer underneath the enamel,known as dentin, is typically yellow, but may be gray, brownor black. This hue is what is seen penetrating through theenamel. In order to whiten the dentin, a peroxide solution isplaced on the enamel. This process opens the pores of theenamel, allowing the solution to reach the layer of dentin.The solution will then begin to lighten the dentin, resulting inthe appearance of whiter teeth.

Several brands of tooth-whitening products are on the marketthat all promise one thing -- noticeable results. Professionalin-office whitening, professional take-home whitening and

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over-the-counter whitening products remain the mostcommon ways to whiten your teeth.

It is important to have realistic expectations when evaluatingyour final results; it may take several treatments to achieve awhiter smile. Whitening results may not be permanent, asyour teeth will naturally pick up stain from foods orbeverages or from tobacco use. Remember to brush and flossdaily, and visit your dentist for regular cleanings andexaminations. Tooth whitening results will vary from personto person, so chose an option that will suit your specific needand budget.

31Different Types of Cosmetic Dental

Procedures

There is no doubt that cosmetic dentistry is on the rise. Evena few reality shows have given us an inside view of how adentist can transform almost anyone’s smile into the beautifulbright smile that most of us have always dreamed about.

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There are several choices available for cosmetic dental workand your dentist will be able to help you determine which onewill work the best in transforming your smile.

Teeth Whitening - Also called “teeth bleaching” canbrighten and whiten your teeth from discoloration and / orstaining. This procedure can be done in the dental office or athome. Not everyone’s teeth can be bleached, so it is veryimportant to check with your dentist first.

Veneers - Veneers are a thin shell made out of porcelain orcomposite material. They are custom made and cemented tothe front side of the tooth. A veneer can be used to treatdental conditions such as a slightly crooked tooth, discoloredteeth, chipped teeth or even to cover spaces in between theteeth.

Implants - A dental implant is a metal device designed toreplace missing teeth. The device is usually made out oftitanium and is surgically placed into the jawbone where thetooth is missing. Unlike a dental bridge, an implant ispermanent. A dental implant is designed to act as the tooth

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root and can anchor an artificial tooth or teeth such as acrown, bridge or denture.

Crowns - Crowns, also referred to as caps, are custom madeto fit over your whole tooth after the dentist has prepared it.They are usually made out of acrylic or porcelain that hasbeen fused to metal, to withstand biting pressure. Crowns canbe used in cosmetic dentistry to treat teeth that are poorlyshaped, badly decayed, broken or chipped, have had largefillings and to cover spaces in between teeth.

Shaping - Also referred to as “enamel shaping” is theprocess in which the dentist can reshape the tooth by filing orremoving some of the enamel. This process is usually notpainful and can produce immediate effects.

Bonding - bonding is the process in which tooth coloredmaterials are adhered (bonded) to the tooth. This is aprocedure that can be used to repair or improve theappearance of a tooth that has been badly stained, broken orchipped.

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Orthodontic Treatment - Orthodontics are not just for kids.More and more adults are seeking treatment fromorthodontists for cosmetic purposes. If you have buck teethor crooked teeth, ask your dentist if an orthodontist can helpyou.

32 What is Emdogain?

Emdogain is an enamel matrix complex of native proteinsthat play a key role in the development of tooth supportingtissues Emdogain mediates the formation of cementum onthe root of a developing tooth providing a foundation fornecessary tissues by mimicking the biological processes ofnatural tooth development. Basically, it's a growth factorthat can help your natural regenerative processes inrepairing tooth structure, bone and tissue where it hasbeen used.

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33 What is bone grafting & GBR?

Bone grafting is a surgical procedure that replaces missingbone with a material called a bone graft[bio oss]. This materialnot only replaces missing bone, but also helps your bodyregrow lost bone. This new bone growth strengthens thegrafted area by forming a bridge between your existing boneand the graft. Over time the newly formed bone with replacemuch of the grafted material. GBR is a procedure in which amembrane is placed over the bone graft site. This membranefurther encourages new bone to grow and also prevents thegrowth of scar tissue into the grafted site.

Bio-Oss is completely safe. Since it is highly purified bone, noallergic reactions or infections have been observed following itsuse. Every batch of Bio-Oss goes through highly controlledprocessing and sterilization procedures which remove all

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impurities. At the end of these procedures, every batch ofBio-Oss must pass rigorous tests for purity and sterility, assuringthe total safety of materials © Osteohealth Co

DR I M SALEJEE DAVENPORT DENTAL STUDIO Nutrition in Dentistry · Many toothaches and dental...

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Transcript of DR I M SALEJEE DAVENPORT DENTAL STUDIO Nutrition in Dentistry · Many toothaches and dental...