Tooth Trauma

Just another routine day in the dental office.  I thought I would quickly post these photos which show a young fellow who fell over a concrete ledge.  The teeth may or may not end up with major consequences - fortunately mum saw the cracks and brought him straight in for an X-ray and check.  See how the enamel is like shattered glass.  The inside of the tooth is flexible and has stopped the cracks running right through.  I have a small chip on one of my teeth which hasn’t changed for 15 years but another patient of mine ended up with the tooth dying and needing root canal treatment.  This was from a small simple fall so it just reinforces why it is so important to wear a custom fitting mouthguard during sports.

Pregnancy and Dentistry - Mythbusters

A patient rang our practice recently querying some problems about their wisdom teeth but having heard that you shouldn’t see a dentist while you are pregnant.  This is a common story for us so it’s time to bust the myth.

• When you are pregnant you shouldn’t see a dentist - wrong - overall health during pregnancy is essential - healthy mother healthy body.  Your mouth is the first line of defense to infection in the body and the immune system hypes up during pregnancy.  If your hygiene drops (not uncommon when you have a lot of issues going on while you are pregnant) your gums may become more red or bleed.  Your dentist can continue regular cleans and hygiene and give advice on keeping things comfortable.
• My mother lost all her teeth because the baby took all her calcium.  wrong - your body gets calcium from your diet and failing that from your bones.  Your bones can be formed and reformed but your teeth grow once and then they are as hard as they will get.  Usually what has happened is the person already had decay or problems not picked up before they found out they were pregnant.  They then didn’t have dental care for the period of pregnancy and early childhood due to the business of motherhood.  By the time they go to the dentist they are in pain, have multiple large cavities and may opt to extract some teeth.

So why should we go to a dentist if we don’t feel any problems?

The problem of dentistry and pregancy is related to risk assesment.  Ideally, we would rather do nothing other than a check and clean during pregnancy and avoid X-rays (unfortunately X-rays may be the only way to detect some problems but usually we can leave for a few months).  If a patient has some small cavities and we know about it we can try simple preventive measures to see that the teeth will last until the baby is born then fix them.

If decay is deep there is a chance of an abcess (an infected tooth).  If you leave a tooth until it is abcessed then we have several concerns.  Leaving the abcess means the mother carrying an infection and this can be a threat to the mother and child.  Abscesses are treated by removing the tooth (an X-ray may be needed) or root canal treatment (many Xrays are needed) or antibiotics (what about the safety of the child?).  By finding deep decay early we can dress the tooth and reduce the risk.

Basically waiting until you have problems puts you and your child at risk.  If we know about the problems early we have less risk and more options.  But that goes for everyone whether pregnant or not.  I have one filling - but I go for a check and clean every 6 months, brush twice a day, floss every night. 

Remember - there are no wrong choices in life - only consequences

Your child’s teeth

You know, 90% of dentistry is preventable and the basics of good diet, regular effective cleaning, and fluoridated water saves many people from ever needing a filling.  But what other factors can parents do to maximise there childs potential for a healthy mouth.  A huge part that is overlooked is the psychological.

Compare these 3 cases, that I see on a regular basis.

• 1  Parent has never brought child to a dentist, who now has a toothache or has fallen and broken a tooth.  Mum and dad are both frightened of dentist and tell the child in a nervous voice to ‘be brave’ and ‘it won’t hurt‘.  I once saw a father bring a 5 yr old in who had never seen a dentist, had an abscess, and the father said ‘Come on mate, time to get the needle’.  Some parents even think it’s fun to tease the child - forgetting that a child’s sense of understanding is vastly different, and the joke goes bad when the child freaks out and needs to see a specialist under a general anaesthetic.

• 2  Parent is aware of all the right language, child’s teeth are fine and well cleaned, but the child is clingy.  Parent doesn’t let the child speak and tries to be there 100% - unfortunately that means not letting the child climb into the chair but the parent putting the child in the chair or even sitting with them.  Sometimes both parents come in and hover over the child within a 2 foot radius and become so close and desperate that the child is ok that the dentist has no room to even look at the child or try to start conversation.

 

• 3  Parent lets child have some space, sits in the room to give the child reassurance, and then starts reading a magazine and appears uninterested and unconcerned.  The child focuses attention on what the dentist is saying, and sees that if mum or dad isn’t concerned, then there is probably not much to worry about.  Parent brings child every 6 months and child develops relationship with the dentist.

The first scenario children I see usually need to go to a specilaist and be treated with sedation.  They remain fearful of dentists for life, meaning irregular visits and eventually loss of their teeth.

The second scenario often mature and develop confidence, but if they ever have an accident or develop a hole in a tooth it is hit and miss how they respond.  Sometimes they get to age 20 without ever needing a filling, and then become freaked out if they ever need the slightest bit of work done.  Fear of the unknown makes then then avoid coming in for the recommended treatment.

The third group are comfortable with the dentist and I can give even the very young a needle or filling with no tears, no fuss, mum or dad in the room, and smiles when they leave.

All kids have inate personalities, and these are somewhat modified by their experiences over life.  Yes parenting is hard and there are no easy answers, but my advice for what it is worth is this: be a role model to your kids as they will look to you always, look after your teeth and develop in them the same preventive behaviours, take them to the dentist regularly (time goes FAST! ), be available but give them room to explore. 

And always (not dental related) - seek to be like your children and not to make your children like you - they have their own path to find.  Happy parenting 

Marc

Tooth coloured fillings

Just a bit of basic dentistry for today.  Two teeth with old failing fillings - although you can see the dark shadow next to one of the fillings, the decay is already very deep here.  These teeth were causing no pain and people often wait until it is too late.

Decay should be picked up as soon as possible - an X-ray usually shows this much sooner.  These teeth have already decayed close to the nerve and under the gum.  When these fillings fail (as everything does eventually) then the teeth will need root treatments and crowns or removal.  If you get your fillings checked regularly, and any fillings are replaced while they are small, that means you could replace the fillings every 10 years and still not damage the nerve over a lifetime - if you wait till you have pain or deep decay - you may get one more filling and then it is going to be complex work or lose the tooth.  Prevention is always better than cure.

But I think these went pretty well 

Orthodontics?

I saw this girl recently and we have been waiting for her eye tooth (canine) to pop through.  In the meantime the front teeth have been worn down slightly.  It shows how important the eye tooth can be in supporting the overall bite.  many people think orthodontics is just for cosmetics - I want straight teeth etc.  but your teeth are designed to function for chewing.  Note how the eye tooth is a big long butress tooth designed to keep the lower jaw from grinding and damaging the other teeth.  Without it you can see the wear and chipping in the photos from grinding of the teeth during sleep (bruxism).

This is the same reason I try to convince older adults not to lose the eye tooth if possible because the remaining teeth start to break down.  This high stress area often leads to repeated fracture or failure of any replacement tooth such as a bridge or denture.

Crowns and Cracked Teeth

On rare occasions even unfilled natural teeth break due to the force of chewing, but the larger your fillings get and the more tooth that is drilled away, the more likely that your tooth can break.  Dentists often notice small cracks in filled teeth and say,”gee you better watch that tooth because one day it may need a crown”.  It is important not to crown a tooth without considering that it is going to cut away even more tooth, but if the tooth is already showing stress, a crown is like a helmet over the tooth and will protect it.

The following tooth presented to me with no pain and the patient hoped it could be just repaired until I showed him the X-ray.  Remember no pain doesn’t mean no problems - 30 stories down when falling off a 60 story building causes no pain but you are in deep trouble.

It is quite rare to break a tooth with such a small filling, but if there are obvious cracks in a tooth and you want to reduce the load try replacing the metal filling with a bonded tooth coloured filling, or a full cover crown.  My advice always is that a gold onlay or crown is the best alternative because it strengthens the tooth without needing to drill as much as a traditional crown, and gives great protection.  The following is a failed tooth with a large tooth coloured filling that I saw in a teenager today - the tooth was unsavable.  Also pictured is a gold onlay that has been present over 40years.

Of course if the tooth has so much filling that a crown isn’t going to cause much further tooth loss then tooth coloured porcelain crowns look better like the one I did here -

Team Building

I love the team I work with.  A good group of people can make your day special no matter where you work.  A beautiful thing happened today when some of our staff were across the road for lunch.  A phone call came to the surgery and a woman had seen these happy fun loving people and the uniform name.  She had no idea where we were but wanted to come to our dental practice.  These staff are so great to work with and it is a huge compliment to them, and a learning excercise for anyone in business, about the response from patients when they see you passionate about a great team, fun work environment, and getting the best out of life.

Thanks guys!

Health funds and dentistry

Over the years things have got more complicated.  Remember when there was one phone company, and everyone new what the special low rate times were to call?  Dentists used to have a health fund guide as to what patients could get back for any treatment but now different patients get different amounts back for the same treatments even when in the same fund.  There is now a push for dentists to affiliate with particular funds and be called ‘preferred providers’ - that means patients have less gap to pay or even no gap for treatment after their health fund rebate if they go to these practicioners.  My concern is this:

Health funds are a business and even non-for-profit ones need to maximise their pool of funds to pay out for large unexpected claims.  Dentists accept these preferred agreements so they can attract more patients, but they treat these patients at a lower fee.  For the dentist to make the same income, they must see more patients.  History has shown that the fees paid by funds increase by a minimum over the years because the fund needs to maximise its profit, so as costs increase from updated materials, new modern equipment, and inflation the dentist must see more and more patients and work faster.

Does a tired fast working dentist sound like the best way to have your mouth treated.  Ok, I can do a filling faster - but you should ask - how long will it last?  is this quality? - and the cost of poor quality dentistry in the long term is far greater.  I would rather just try to do my absolute best, in an appropriate time, for an appropriate fee.  I hope my patients realise that my goal is to keep their mouths as healthy as can be for life. 

Happy easter

Hope everybody had a safe and happy Easter.  You know, chocolate is not bad for teeth.  Sugar can’t harm teeth, but it is fermented into acid by bacteria in your mouth, and the acid eats your tooth away.  If you clean all the bacteria from your mouth by good brushing, nightly flossing, and regular dental check-ups with prophylaxis cleaning, then eating chocolate won’t harm your teeth.  Just eat a bit, not grazing on it all day - that speeds up the grow of bacteria.

Happy eating, and Happy Easter!

Mouthguards

A custom fitting mouthguard is one of the wisest decisions you can make for yourself or your children if playing sport.  You have one chance with your adult teeth and trauma can lead to endless expense, pain and heartache.  The minimim damage you may sustain to your teeth would be one tooth getting chipped - and to fix it is the same cost as a custom fitting mouthguard.  Parents say to me that a mouthguard is expensive and they only get one season before kids grow out of it.  It costs less than most sports shoes - and kids grow out of these too!

The second worst scenario is a tooth dying and needing root canal treatment - 3 times cost of a mouthguard

The third is snapped off - root treatment and crown - 11 times cost of a mouthguard - and eventual loss of tooth

The fourth knocked out - root treatment/crown and future implants - 45 times cost of mouthguard

Remember - that is if it is just ONE tooth!   And no replacement will ever look or function as good as the real thing - would you rather a real eye, or a false eye?  We can make pretty good false eye’s - but I wouldn’t want one.  A custom guard fits acurately over the gums and bone around the teeth to distribute any force evenly onto the jaws.  A boil and bite mouthguard transmits force through the guard and onto the teeth leading to a high risk of tooth fracture and limited protection.  Finally a custom guard is laminated and thin meaning comfort and better breathing - many kids lose teeth playing sport because they didn’t wear the guard, stating it was not comfortable.  I try to make the best fitting guard with careful attention to how far it extends into the mouth and under the lips.

And don’t forget they come in some kewl colours