Common Symptoms / Questions

Tooth Sensitivity

Sensitivity can occur when enamel is worn away and the underlying layer, called dentin, is exposed, or if you recently had a deep filling placed. Dentin has tubules which act like pores that communicate to the nerves and blood vessels inside the tooth. The sensitivity you feel may be caused by the movement of fluids in and out of these pores, or changes in temperature. Sometimes your tooth can heal. The blood vessels inside the tooth can deposit dentin and block the tubules themselves. Desensitizing agents can sometimes be applied to exposed dentin closing these pores from the outside as well. Fluoride treatments can also help to add mineral and strengthen the dentin, which can help with the sensitivity caused by bleaching. Sensitivity can be more complex. A large deep filling may cause sensitivity, which may either heal on its own, or progress into an irreversible situation. In any instant, your sensitivity should be systematically tested by us to be sure. There are more severe types of sensitivity that can cause permanent injury to the nerves and blood vessels inside the tooth. If the nerve does not heal on its own, it can eventually die and become inflamed or infected, needing a root canal. This type of condition is usually consistent with a larger injury or cavity extending deep into the dentin.

Tooth Pain

A tooth may experience pain based on the degree and nature of the injury to the tooth. A chip in the enamel, a small cavity, an old filling, or a large cavity that extends into the nerve of the tooth may cause pain in many different forms. Often the offending tooth may refer pain to other areas, or to make matters worse, the pain can go away, just in time for your visit to us. For you, it may not always be easy to tell which tooth is causing the problem. A thorough exam, an x-ray, and a detailed system of tests will help us localize the offending tooth. The best possible treatment for that tooth is based on what we know about you, your overall health, and the objective data that we gather. In our view, if a minimally-invasive treatment can resolve your pain and work for the long term, it will be used first. If natural tooth structure can be preserved, it will be. It can be as simple as shaving down a tooth that is biting too high, applying a desensitizing agent, or placing a filling. There are times however, such as in cases of severe decay, injury, or loss of surrounding bone, that the tooth will need a larger filling, a crown, root canal or an extraction. In these cases, we insist on providing you with a comfortable and pain-free experience, and we will work until you are happy with the result. It is our view that the reason for any treatment decision should be apparent to you, and that you always have choices.

Sensitive/Bleeding Gums

If you are experiencing bleeding gums when brushing or eating, you may have an infection. Left untreated, this infection can cause destruction to the surrounding bone and soft tissues; it may progress into periodontal disease. Untreated periodontal disease means that there is a constant source of bacteria and inflammation in the mouth, which can affect the entire body. Recent evidence has linked periodontal disease and its accompanying inflammatory process with coronary artery disease, stroke, complications with diabetes, and low birth weight. In diagnosing the pain in your gums, we feel it is important to gather very specific information about you, your overall health, your diet and your hygiene routine. The treatment that is right for you is very specific. It may involve adjustments in your medications or diet, or coaching you on how to maintain specific sites in your gums. When you become an active participant in your dental health, this helps to make your treatment as minimally invasive as possible. Surgical treatment of periodontal disease is an option that may need consideration, but only after the best efforts are made at a comprehensive, medical approach. Good tissue health can often be achieved without surgery. Your soft tissue is very much a part of your smile. Having healthy gums and a good soft tissue profile will also help achieve the best possible results for any crowns, bridges, or reconstructive work.

Musculofacial/TMJ

Many patients complain of pain in the jaw, pain on opening or closing, or pain when waking up in the morning. Like tooth pain, jaw pain can be unpredictable and have a number of different possible causes. It can be based upon an underlying medical or neurological condition, or a habit like clenching or grinding the teeth. Patients having excessively worn teeth or no teeth may experience jaw pain due to a collapsed bite, because the jaw routinely closes beyond its normal intended range. These patients may benefit from restorations or prostheses that open the bite to its original level. Jaw pain can even be referred pain from a decayed or impacted tooth. Treatments for jaw pain vary greatly, and the complexity of your treatment will depend on the severity of the underlying cause. It is our aim to gather all possible evidence and to isolate the underlying cause. If you have a decayed tooth, or a clenching or grinding habit, then treating the offending tooth, or providing you with a bite splint can often work. Jaw pain is complex. Before surgical options are considered, a comprehensive management approach is the first line of defense.

Stained/Discolored Teeth

Today, many patients are interested in whitening their teeth. Whitening may be an option, but the underlying cause of the staining must be determined first. Many patients are surprised to learn just how much of an impact they can have on their teeth with simple modifications in their diet and hygiene routines. If you are a patient who smokes, drinks coffee, red wine, or soda, bleaching can do serious harm to your teeth, and its results will be short-lived. The first step is to establish a good home-care regimen with you. Once you understand the biology of your mouth, and how to promote a continuous neutral pH in your mouth, your teeth may get lighter before we even begin whitening. The key is in knowing this simple fact: Every time you take a sip of a sugary or acidic drink, your mouth becomes an acidic environment, which takes an hour to return to neutral pH on its own. If you limit the amount of offending foods/drinks between meals, and restrict them to mealtime, you’re promoting a better oral environment. Drinking tap water also helps. A gentle brushing after lunch; rinsing with water after drinking coffee or red wine… these small things can make a huge difference. Whitening then, will be more effective for you in the long term. For some people, whitening simply will not work. Intrinsic Staining refers to stains that may have been incorporated into your teeth during development. During childhood, excessive fluoride intake, tetracycline, and high fever can cause color changes in developing teeth that will be unaffected by bleaching. The stains are called intrinsic because they are part of the makeup of the teeth. Whitening will not work on teeth stained by metal fillings either. In these cases, bonding, porcelain veneers, or crowns may be necessary.

Misaligned Teeth
Many patients are now aware of Invisalign, a series of clear trays worn by patients to straighten crooked teeth. Invisalign can dramatically improve your smile. This seems fairly well-known. However, many people are unaware of the health and hygiene benefits of invisalign when compared to conventional orthodontics, or non-treatment. Recent studies show that crowded or malpositioned teeth can be harder to keep clean and vulnerable to cavities or periodontal problems. While good home care and routine checkups remain imperative, moving the teeth into a smooth arc has been shown to help resolve these issues. The ideal arc form has contacting teeth in a smooth u-shape. The gums have a regular scalloped pattern. This is not only a great smile, but a more hygienic, cleansable form with improved bone architecture. Invisalign is based on principles of orthodontic tooth movement. Continuous light pressure on a tooth will cause it to move through the bone and deposit new bone behind it. This is a non-surgical and less invasive treatment option for correcting a periodontal problem, and a great adjunct to your home care and regular checkups.
Invisalign vs. Braces
Adult patients tend to be more compliant with the regimen of wearing invisalign trays than younger patients. Conventional braces, which are fixed to the teeth are better for younger patients for this reason. Also, for more complex cases, such as with a severe overbite or underbite, you may need conventional braces to get the best outcome. Whether you use invisalign or braces, excellent home care and hygiene are a must. With braces however, hygiene can be more difficult. Not only can plaque accumulate around the brackets and wires, but flossing takes much longer and is often ignored. Invisalign’s removable aligners are less expensive than conventional braces, and they allow patients to more thoroughly clean and floss their own teeth. Whether your case is being handled by us or by an orthodontist, routine checkups and prevention of cavities and gum disease are a must.
Invisalign and Malocclusion
When a tooth is out of position, it may bite hard or irregularly when compared to the other teeth. Invisalign can also help to correct this problem. Part of having a smooth arc form is having the teeth bite and distribute forces evenly around the entire arch. Some cases may be too complex for Invisalign. It works ideally with cases of mild crowding or spacing and localized malocclusion issues. In cases of severe crowding, overbite or underbite, conventional orthodontics may be necessary.
Anxiety, Dental Phobia
We acknowledge that many people are apprehensive about coming to the dentist. Often, an acute dental problem or accompanying pain can make it worse. Our approach is aimed at understanding and listening to you. When dealing with anxiety, it is important that we first acknowledge your concerns. Assuming we have a diagnosis and you choose a particular treatment option, we begin by using small steps aimed at relieving your pain and building your trust. A prescription medication may be needed a few days prior to treatment to minimize associated infection and inflammation. On the day of treatment, we try to make our office feel familiar to you, to revisit any questions or concerns you may have, and to put you in a comfortable place with your favorite music.
Nitrous Oxide
Assuming your medical history allows it, we can offer nitrous oxide to you with most dental treatment you receive with us. Nitrous oxide is a mild inhalational anesthetic that can be just enough to help relieve your anxiety and pain while you remain conscious. Nitrous oxide is useful to dentistry because it is appropriate for the minimally invasive nature of most dental procedures. For most of dentistry, there simply is no need to assume the risks or complications involved with sedation or general anesthesia. Nitrous oxide is safe. It can be adjusted and quickly reversed. After 5 minutes of breathing 100% oxygen, the effects of nitrous oxide are almost completely gone. Many people associate dental anxiety only with the injection, so nitrous oxide can be used briefly and then reversed immediately after the injection is given. The goal is to make you feel safe, comfortable, and in control.
Local Anesthesia
The paradox of dentistry is that local anesthetics make most dental procedures virtually painless, yet the injection itself is something that all patients would rather avoid. This is why we take so many measures to establish your comfort before we even get to this point. Once you are in the chair and we need to get an area numb, we use the most gentle and pain-free techniques possible. Our goal for you not to feel anything. Not even the slightest pinch. A relaxing environment, a gentle technique, coupled with the use of varying anesthetics makes this possible. Once you’ve had the injection, it may take time to establish good anesthesia, so you may have to sit back and listen to your favorite music while you wait for it to take effect.