While patients are usually grateful that local anesthesia blocks the pain that they might otherwise feel  as a result of removing tooth decay with a dental drill, many dislike the discomfort associated with lingering numbness after they leave the office. Fortunately, there is something that can be done about this inconvenience. OraVerse^®  is an injectable drug (phentolamine mesylate) that reverses the effects of local anesthetic and allows patients to experience normal sensation in their lips and tongues about twice as fast as they normally would. As a result, patients can smile, speak, and drink sooner. OraVerse^®  is not recommended for use in children under 6 years of age or weighing less than 33 lbs.

P.S. The administration of OraVerse^®  does not hurt since it is injected into a part of the mouth that is already numb from anesthetic.

The more we learn about the connection between oral health and general overall health, the more we understand how healthy gums and teeth help keep serious chronic conditions at bay. The underlying factor seems to be inflammation-causing bacteria that can travel from diseased gums to other parts of the body through the blood stream. Thus, it makes sense that keeping our teeth clean and our gums healthy may help reduce the risk of heart disease. In fact, recent research has found that people who have their teeth professionally scraped and cleaned  had a 24% lower risk of heart attack and a 13% lower risk of stroke compared to those who had never had a dental cleaning. That’s quite a benefit!

P.S. Gum disease is much more prevalent among diabetics. In fact, periodontal disease is often considered the sixth complication of diabetes.

When children lose permanent teeth due to accidents or sports-related injury, the teeth can sometimes be re-implanted if the knocked-out tooth is handled properly and reinserted quickly. Otherwise, children and parents must work with the dentist to come up with an appropriate tooth-replacement solution. While dental implants are normally the treatment of choice, their use in children with underdeveloped jaws may impede jaw growth and prevent other teeth from growing into their natural positions. With this in mind, girls must wait until they are at least 14-15 years old to get dental implants, and boys should be at least 17 years old. Until then, the dentist can fill the gap caused by a missing tooth with a denture.    

P.S. If a permanent tooth is knocked out and can be recovered, it is important to hold it by the crown (top portion), rinse it (not scrub) very carefully in saline solution or tap water, gently put it back in its socket, and immediately get to the dentist’s office.

When a tooth becomes badly infected, it can only be saved by a root canal procedure that involves removal of the nerve and pulp inside the tooth. This “endodontic treatment” is preceded by injections of local anesthetic, after which an opening is created in the tooth’s crown and into the pulp chamber. After the pulp is removed, the chamber is cleansed and enlarged. Then, a temporary filling is set into the tooth’s crown. On the next visit, the temporary filling is removed and the root canals are filled with special rubber-like material and permanently sealed. Again, a temporary filling is set in place, which is subsequently removed when a crown is placed on the restored tooth.

P.S. Because a tooth’s nerve serves no other purpose than to provide the sensation of hot or cold after the tooth has emerged through the gums, its removal with root canal treatment alters neither the tooth’s health nor its function.

It is estimated that about 46 percent of Americans over the age of 65 are missing six or more teeth. This is a problem because, aside from leaving unsightly gaps, missing teeth compromise chewing ability. Equally important, missing teeth tend to throw the bite off balance, which leads to malocclusion (“bad bite”) and increased likelihood of damage occurring to the remaining teeth. Malocclusion also increases the prospect of gum disease and may be a contributing factor to temporomandibular joint (TMJ) syndrome. Beyond these effects, there is the serious potential for misalignments of remaining teeth due to lack of support and restraint from missing teeth. These are all good reasons to see the dentist immediately after losing a tooth.

P.S. Twenty percent of Americans over age  65 have lost all their teeth.

For patients with tooth imperfections, resin bonding provides an effective and affordable means of remedying tooth discolorations, gaps, and chips. However, porcelain veneers are superior in terms of strength, durability, and aesthetics. These factors may make porcelain veneers preferable to bonding for correcting tooth defects, particularly in the most visible teeth. In addition, porcelain veneers may be used to lengthen a tooth and to give the illusion that malpositioned teeth are straighter. The veneers are rigid shells that are firmly attached to outer tooth surfaces once the surfaces have been prepared to accept them. This preparation consists of removing a thin layer of enamel and etching the surface. Usually three office visits are required for the entire process.

P.S. Because porcelain veneers are individually sculpted, they are difficult to differentiate from natural teeth.

Do you wonder how cavities actually form? Tooth decay begins with harmful bacteria in the mouth that feed on sugars and carbohydrates. If poor oral hygiene allows these bacteria to continue to grow without interference, the acid they produce (as a by-product of metabolizing sugar) can demineralize (dissolve) tooth enamel. Ordinarily, this process happens slowly, giving the body time to replenish (remineralize) the enamel. However, when populations of bacteria outpace the body’s ability to rebuild enamel, the first stage of tooth decay (dental caries) results, appearing as a spot discernable only to the dentist or on an x-ray. The dentist may stop this decay process by applying fluoride, but  once the decay has penetrated the tooth enamel, a cavity forms.

P.S. Fluoride and minerals in saliva help increase remineralization of teeth.

            Back in the early 1800s, a theory called “focal sepsis” maintained that infections in the mouth led to disease in the rest of the body. Today, scientific evidence backs up this theory, providing more reason than ever for people to brush and floss their teeth. According to a study of nearly 12,000 adults, those with poor oral hygiene had a 70 percent greater risk of heart disease than those who brushed twice a day and were less likely to have unhealthy gums. Healthy gums are important because gum disease increases the risk of heart disease and diabetes since the inflammation associated with gum disease plays a role in the buildup of clogged arteries. Good oral health promotes overall health.

P.S. Research shows that people with poor oral hygiene test positive for two factors called C-reactive protein and fibrinogen, both of which signal inflammation in the body.

            When the portion of the tooth covered by enamel becomes so damaged from decay or trauma that it must be replaced, the dentist prepares a restoration known as a “crown.” The first step involves tapering the outside edges of the damaged tooth into the form of a peg (or post, if root-canal treatment is necessary) that will later accept the overlying “cap.” Then, impressions of the tooth and the teeth immediately adjacent to it are prepared, from which the lab will construct the replacement crown. The crown may be fabricated of gold alloy, metal covered with porcelain veneer, or resin. During the second visit to the dentist, the temporary crown is removed and the permanent crown is cemented into place. 

P.S. Even though a tooth is crowned, it still must be flossed and brushed along with the rest of the natural teeth.

            There is another option for patients who find shots of anesthetic and the whir of a dental drill discomforting. Over a number of years, the Erbium:YAG laser has proven to be effective in removing tooth decay. Decay removal and tooth preparation with a laser doesn’t require the use of anesthesia, and it works with better precision to spare more of the healthy tooth. Patients report feeling no more than a slight tingling sensation as the Erbium:YAG laser removes tooth decay. The laser also creates a better bonding surface so that tooth-colored fillings can be expected to last longer. While a traditional drill works faster, with an Erbium:YAG laser, there is no need to wait for the anesthetic to kick in.

P.S. Because an Erbium:YAG laser is not designed for removing old amalgam fillings and preparing teeth for crowns or bridges, a traditional drill must be used to do this work.