Dental X-rays

Reducing the exposure of people to radiation is a prime principle governing all medical professionals when we use X-rays for treament or diagnosis.  There is a risk and benefit to all treatments.  The amount of radiation from a standard set of dental X-rays is about equivalent with the exposure someone recieves in a plane trip from Brisbane to Sydney (or about 500 times less than in one mammogram).  We would recommend that general diagnostic dental X-rays for most people every 2 years will significantly reduce the risk of undetected decay causing irreparable damage (see photos).  We would consider the possibility of flying to Sydney every 2 years a low risk for harm from radiation.

 White areas are fillings

    Dark area is new decay bottom left Red line shows decay extent, Pink area is the tooth nerve outline

Why do we need X-rays in dentistry at all?   Decay usually occurs in areas hard to clean such as the flossing surfaces of the teeth.  The decay in the above photos occured in les than 18 months and could not be detected in the mouth due to its position under the gumline.  If the decay reached the nerve of the tooth there are two options for treatment.  One involves complicated and expensive root canal treatment (which needs several X-rays to complete) or removal of the tooth (which needs an X-ray to assess the risk of permanent nerve damage, breaking the root, damaging the sinuses etc).   If one took the approach of simply removing painful teeth and avoided any X-rays, then apart from the risk of permanent nerve damage or complications, the end result will be a poor ability to eat good healthy food.  The outcome of this is an increased risk of poor health and bowel cancer from poor nutrition.

This is why we try to balance the risks and benefits of treatment.  If you have 6 monthly dental checks, brush twice per day, floss every night, and eat a healthy diet with low processed carbohydrates, then dental X-rays can be taken less often.

Decay

 

 

 

 

 

 

It’s so sad to see unfortunate cases such as this.  Mostly because it is preventable, and secondly because it is a long hard road to any future recovery.  The causes of such extensive damage are many – fear of dentistry, poor diet, poor hygiene, lack of understanding the process of decay, medical issues such as reflux or bulemia, drug use, or a lack of access to a dentist.  Treatment will depend on what this person wants, can tolerate, and can afford.  I always quote my favourite three C’s – Comfort, Cosmetics, Cost

Comfort – the best option would be to save all the teeth possible, and replace the missing teeth with implants.  This would look and feel like a full set of natural beautiful looking teeth.  The problem is each tooth is so damaged it would probably need a root treatment and crown, and at roughly $5000 per implant tooth, this patient is unlikely to be able to afford such a complex treatment.  This is why I do my best to educate and help people understand the need to prevent this damage in the first place.

Cosmetics – the above result can look perfect, but so can a really well made denture.  I see very few people that can eat well with full dentures, although some tolerate a full upper denture reasonably well.  I emphasise tolerate – most people with dentures have forgotten how good it used to be to have teeth and just deal with it as best they can.  As they get older, the bone in their mouths becomes less able to support the denture, and I end up seeing many older people with intolerable dentures – usually blaming the fact that they can’t eat, have pain, and blame the fact on not being able to find a dentist that knows how to make a denture that fits.  These people really need an implant to help stablise the denture – back to cost.

Cost – it is all about balance at the end of the day.  If I was the above patient I would want to save whatever teeth I could – depending on my finances.  We could probably patch the decay and slow the breakdown process.  make some partial dentures to replace the spaces and build up the teeth which have worn down from the incredible workload.

The bottom line is – if you have teeth, prevention is better than cure (see my segment on general dentistry).  If you have damage to your teeth, the sooner you get them looked at the better.  If you have damage to your teeth, there are many options to get your mouth back on track.  You need to find a dentist who can discuss the options with you.  Finally – you have to be realistic – about your future level of care, or your budget, or what expectations you have.  You can’t get complex treatment, implants, and crowns for the price of a denture, and you can’t get a denture that feels like your on teeth.

White Fillings

Just a quick case that came in the other day.  There was decay in the pit on the side of the tooth which had penetrated all the way to the metal filling in the top of the tooth.  These old metal fillings also swell and corrode over time.  With chewing and cycling of hot and cold food/drinks, the teeth can crack.  (you know – that wonderful uh-oh moment while eating crackling at Christmas).  By the way – note the old white resin sealant on the tooth behind aimed at preventing getting the decay in the groove in the first place.

 

 

 

 

 

 

Tooth coloured resins are ideal in this situation.  They bond to the tooth – especially to enamel above the gum, and help restore the tooths former strength.  They may have to be replaced more often than the old metal fillings due to chipping or wear – but generally technology has advanced to the point where these are the first choice material for such cavities.

 

 

 

 

 

 

Apart from that they look great. 

 

 

General Dentistry

Prevention, prevention, prevention!

Bacteria grow on your teeth, eat sugar, and ferment it into acid – acid rots teeth.  More bacteria (i.e. high sugars and low brushing) = more decay

This is a young patient I saw recently after we used a dye to show the bacteria (plaque) growing on the teeth. 

As you can see, the bacteria are covering the teeth in a thick layer.  The following picture is a more common amount of plaque but still too much if you want to keep your teeth for life.

The important thing is to remember to brush the gumline, and floss to clean the bits left in between the teeth.  Dental disease is one of the most preventable diseases on the planet yet affects the greatest population.  Brush with a soft brush effectively twice a day, floss each night, eat healthily, avoid soft drinks, and visit a dentist six monthly for a check and clean.

I’d much rather clean teeth every 6 months than do fillings, root treatments, crowns and extractions.  Hope to see you soon!

More tooth coloured fillings

Just haven’t had the time to write lately.  Here is a nice set of filling replacements I did this week.  The old amalgam fillings have cracked and leaked.  You can see the decay on the right side of the top filling, the crack in the middle filling, and the downside of large metal fillings is the cracked off cusp in the molar on the bottom. 

The molar needs to be crowned to keep the tooth for any length of time.  If it isn’t crowned the large tooth coloured filling may crack or leak and end up leaving the tooth in an unsavable state.  At this stage it has bought the patient some time to organise for a crown, and allowed me to see what damage lay beneath that old amagam and check that the nerve in the tooth will be ok.  The top 2 fillings went very well and should be there for many years if kept clean.

Happy Christmas all.

What’s a root canal?

Root canal treatment – it’s no big drama or mystery and gets very bad press.  Basically the centre of your tooth is hollow and filled with blood vessels and nerves just like the rest of your body.  If bacteria get in here you get swelling like any other cut or infection, except the swelling strangles the blood supply leaving an infected chamber in the tooth.  Without a blood supply, your body can’t heal this area, and the toxins spread out from the root into the surrounding bone eventually causing swelling, pain or damage to the root.

Root canal treatment involves cleaning away the bacteria and toxins – imagine flushing out termites from an ‘infected’ tree.  Then a filling material is placed into the hollow root chamber to prevent further bacteria getting back in.  Just as a dead tree doesn’t fall out of the ground, a ‘dead tooth’ doesn’t fall out either.

Here is a picture of an infected front tooth – the dark area around the root is the extent of the infection.  The white areas are all filling – basically this tooth has been filled to death from larger and larger fillings.

The next 2 pictures show the root treatment the day it was completed and then 12 months later when the bone has healed.

Most teeth need a crown to protect the seal and rebuild the tooth due to the damage from the original decay, large filling, or trauma.

Myth: pain – more people fall asleep during root treatment for me than any other procedure.  If the tooth is properly numb then it is a time consuming but uneventful procedure.  Some people may feel pain if the tooth is acutely inflammed and infected – and this may mean a temporary sedative dressing for a few weeks and treating when the infection has settled.  With patience and a gentle technique it is not a difficult procedure.

Myth – I had root treatment and the tooth was pulled out anyway. – some treatments do fail.  A large number fail from not sealing over with a crown – the filling compromise leaked or cracked.  Some teeth should be done by a specialist – an endodontist, if the roots appear really twisted or hard to clean thoroughly.

The most important thing to know is that root treatments become the only option a dentist has to save your tooth if you wait until you are getting pain before you come to the dentist.  Your choices in dentistry are:

1 - small cavity found during check-up means a small filling needed

2- leave the hole a while a large filling and risks that the tooth will need a crown or root canal treatment 5 or 10 years down the track

3- leave the hole till it starts getting sensitive means a large filling that may or may not work and probable root treatment between 1 week and a few years in the future

4 -leave until a throbbing toothache means root treatment now to save the tooth, and it may not go numb and could hurt more and need a dressing

5 – leave till the tooth rots further and pain goes – only alternative is extraction and risks of serious infection.  Although rare people still do get hospitalised and even die from dental infection.

It is an old but true saying – “A stich in time saves nine”

Tongue and Lip Piercings

Well it’s been quite a while since I have written – apolgies for being too busy on the coal face.  Just thought I would show a couple of pictures of damage occuring from oral piercing.  I have no judgment either way on whether it is attractive or sexy.  Here are some basic facts that people with piercings should be aware of before proceeding.

Any piercing has a risk of infection – the tongue is one of the most blood filled muscles of the body and and infection in the tongue can be life threatening – in fact a death has happened before.  This risk is not great, but as a dentist I am always very cautious about any damage to the tongue – so it intrigues me to see people without medical training skewering such a delicate area.

Make sure the final tongue piercing bar is not too long - you are likely to crack cusps of your back molars by mistake, or even split and lose a tooth (see my post on cracked teeth for a photo).  People also play with piercings and habitually put them between their teeth.  Your teeth versus metal piercings is not a fair match – see the neat wear and grooves on these next 2 patients – both of them can close their teeth completely around the piercing.

 

Finally – teeth are prone to calculus (hard scale) building up on the teeth.  This causes the gums to receed and teeth to fall out in old age.  The calculus also builds up on the piercing eventually causing a large hole and the piercing falls out – the hole doesn’t heal.  The lip piercing also strips away the gum and bone attachment to the bottom front teeth making them likely to fall out early.

I have seen piercings last without problems, and they are a matter of taste – but be aware of the risks.  It does make me smile that my most nervous patients that are frightened of needles are the most likely to come back with a tongue piercing – such is life

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