My Blog
By Barry Goodman, DDS
July 17, 2019
Category: Oral Health
Tags: tooth pain  
Where-andHow-DoesitHurtGettingtotheSourceofToothPain

Although toothaches are common, not all tooth pain originates from the same source. But regardless of its cause, you need to take prompt action to find out and begin treatment.

Sensitive teeth, for example, usually cause a quick stab of pain when you eat or drink something hot or cold or when you bite down. If the pain lasts only a second or two, you may have a small area of decay in a tooth, a loose filling or an exposed root. The latter often occurs either because of over-aggressive brushing or periodontal (gum) disease. In both cases, the gums may have shrunk back or receded to expose the root surface.

A sharp pain when biting down may be a sign of decay or a loose filling; it could also mean you have a fractured or cracked tooth. For any of those causes, you'll need treatment to repair the problem and relieve the pain.

You may also experience a lingering tooth pain ranging from dull to sharp, or localized to one tooth or seeming to radiate from a general area, such as above the upper jaw. There are a number of possible causes, but two prominent ones are an abscess (a localized area of infection that's become inflamed) or deep decay within the pulp, the heart of a tooth.

This usually calls for a root canal treatment for the affected tooth. In this procedure we drill an access hole into the pulp and clear it of infected and dead tissue. We then fill the empty pulp chamber and root canals with a special filling and seal the access hole. Later, we bond a permanent artificial crown to the tooth to further protect it from re-infection.

Whether your pain is momentary or lingering, dull or sharp, you should see us as soon as possible to determine its cause. You should still see us even if sharp, lingering pain goes away — this could simply mean the infected nerves in the pulp have died but not the infection. The sooner you have the cause of your pain treated, the better your chances of a happy and less costly outcome.

If you would like more information on tooth pain and what to do about it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Pain? Don't Wait!

WhatHappensinaRootCanalTreatmentandHowitCanSaveYourTooth

Along with periodontal (gum) disease, tooth decay poses one of the two greatest threats to your teeth. Cavities are just the start: if decay invades the pulp, the tooth’s innermost layer, the infection created can continue to advance through the root canals to the supporting bone. This worst case scenario could cost you your tooth.

But we can stop this advanced decay in its tracks with a procedure called a root canal treatment. A root canal essentially removes all the infected tissue within the tooth and then seals it from further infection. And contrary to its undeserved reputation for being painful, a root canal can actually stop the severe tooth pain that decay can cause.

At the beginning of the procedure, we deaden the affected tooth and surrounding tissues with local anesthesia—you’ll be awake and alert, but without pain. We then isolate the tooth with a dental dam of thin rubber or vinyl to create a sterile environment around it to minimize contamination from bacteria found in saliva and the rest of the mouth.

We then drill a small hole through the enamel and dentin to access the interior of the tooth. With special instruments, we remove and clean out all the diseased or dead tissue in the pulp chamber and root canals. After disinfecting the empty spaces with an antibacterial solution, we’ll shape the root canals to make it easier to perform the next step of placing the filling.

To fill all the root canals and pulp chamber, we typically use a rubber-like material called gutta-percha. Because it’s thermoplastic (“thermo”—heat; “plastic”—to shape), we can compress it into and against the walls of the root canals in a heated state to fully seal them. This is crucial for preventing the empty tooth interior from becoming re-infected. Afterward, we’ll seal the access hole with its own filling; later, we’ll bond a permanent crown to the tooth for additional protection and cosmetic enhancement.

After the procedure you may have some temporary minor discomfort usually manageable with aspirin or ibuprofen, but your nagging toothache will be gone. More importantly, your tooth will have a second chance—and your dental health and smile will be the better for it.

If you would like more information on treating tooth decay, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Step-By-Step Guide to Root Canal Treatment.”

By Barry Goodman, DDS
June 27, 2019
Category: Oral Health
Tags: sensitive teeth  
3WaystoStoporReducePainfulToothSensitivity

Tooth sensitivity can be disheartening: you’re always on your guard with what you eat or drink, and perhaps you’ve even given up on favorite foods or beverages.

The most common cause for this painful sensitivity is dentin exposure caused by receding gums. Dentin contains tiny open structures called tubules that transmit changes in temperature or pressure to the nerves in the pulp, which in turn signal pain to the brain. The enamel that covers the dentin, along with the gum tissues, creates a barrier between the environment and dentin to prevent it from becoming over-stimulated.

Due to such causes as aggressive over-brushing or periodontal (gum) disease, the gum tissues can recede from the teeth. This exposes portions of the dentin not covered by enamel to the effects of hot or cold. The result is an over-stimulation of the dentin when encountering normal environmental conditions.

So, what can be done to relieve painful tooth sensitivity? Here are 3 ways to stop or minimize the symptoms.

Change your brushing habits. As mentioned, brushing too hard and/or too often can contribute to gum recession. The whole purpose of brushing (and flossing) is to remove bacterial plaque that’s built up on tooth surfaces; a gentle action with a soft brush is sufficient. Anything more than two brushings a day is usually too much — you should also avoid brushing just after consuming acidic foods or liquids to give saliva time to neutralize acid and restore minerals to the enamel.

Include fluoride in your dental care. Fluoride has been proven to strengthen enamel. Be sure, then, to use toothpastes and other hygiene products that contain fluoride. With severe sensitivity you may also benefit from a fluoride varnish applied by a dentist to your teeth that not only strengthens enamel but also provides a barrier to exposed dentin.

Seek treatment for dental disease. Tooth sensitivity is often linked to tooth decay or periodontal (gum) disease. Treating dental disease may include plaque removal, gum surgery to restore receded gums, a filling to remove decay or root canal therapy when the decay gets to the tooth pulp. These treatments could all have an effect on reducing or ending your tooth sensitivity.

If you would like more information on the causes and treatments for sensitive teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Sensitivity.”

By Barry Goodman, DDS
June 17, 2019
Category: Oral Health
Tags: celebrity smiles   retainer  
MargotRobbieKnowsAGreatSmileIsWorthProtecting

On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.

“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”

Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.

Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.

A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.

Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.

So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.

If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”

ReplacingaToothorSavingit-WhichShouldyoudo

Over a lifetime, teeth can endure temperatures ranging from freezing to near boiling, biting forces of as much as 150 pounds per square inch and a hostile environment teeming with bacteria. Yet they can still remain healthy for decades.

But while they’re rugged, they’re not indestructible — they can incur serious damage from tooth decay or periodontal (gum) disease, two of the most prevalent oral infections. If that happens, you could be faced with the choice of removing the tooth or trying to save it.

Because today’s restorations like dental implants are quite durable and amazingly life-like, it might seem the decision is a no-brainer — just rid your mouth of the troubled tooth and replace it. But from a long-term health perspective, it’s usually better for your gums, other teeth and mouth structures to try to save it.

How we do that depends on the disease and degree of damage. Tooth decay, for example, starts when high levels of acid soften the minerals in the outer enamel. This creates a hole, or cavity, that we typically treat first by filling with metal amalgam or, increasingly, composite resins color-matched to the tooth.

If decay has invaded the pulp (the innermost layer of the tooth), you’ll need a root canal treatment. This procedure removes infected material from the pulp and replaces the empty chamber and the root canals with a special filling to guard against another infection. We then cap the tooth with a life-like crown for added protection.

Gum disease, on the other hand, is caused by dental plaque (a thin film of bacteria and food particles on tooth surfaces), and requires a different approach. Here, the strategy is to remove all of the plaque and calculus (hardened plaque deposits) we can find with special hand instruments or ultrasonic equipment, and often over several sessions. If the infection extends deeper or has created deep pockets of disease between the teeth and gums, surgery or more advanced techniques may be necessary.

Though effective, some of these treatments can be costly and time-consuming; the tooth itself may be beyond repair. Your best move is to first undergo a complete dental examination. From there, we can give you your best options for dealing with a problem tooth.

If you would like more information on the best treatment approach for your teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Save a Tooth or Get an Implant?





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