Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

Types of treatment for a dental abscess

What is a tooth abscess? A dental abscess is a collection of pus that can form in the teeth or in the gums as a result of a bacterial infection. But what exactly is pus? If an infection forms in a part of your body, the battle between your immune system and the infection will create a collection of dead cells, which form pus. An abscess is your body’s natural way of keeping the pus in one place, therefore localizing the infection and stopping it from spreading to other areas of the body.

There are two different types of abscess which may occur in relation to the teeth, namely a periapical abscess and a periodontal abscess.

Periapical abscess: This can present as a very acute, intensely painful infection where the face swells and the patient is in agony and sometimes cannot even open the mouth. This is caused from a rapid influx of pus to the area accompanied with the swelling and inflammation of the surrounding tissues. The site of a periapical abscess is at the apex of a tooth root (this is where the nerve enters the tooth). The soft area at the centre of a tooth (the pulp chamber) is alive and filled with blood vessels and cells, so once infection reaches the tooth pulp it “goes rotten”and ultimately leads to abscess formation. Bacteria enters the pulp of the tooth through a communication between the mouth and the pulp chamber, namely a cavity. This allow bacteria to move into this sensitive area and populate it, leading to infection. A periapical abscess can also occur on a previously root treated tooth. Root canal treatment is unpredictable and a weak area of the tooth. Secondary infection after a root canal treatment is completed is quite common.

The treatment of a periapical abscess in a vital (alive) tooth is root canal therapy. During this procedure your dentist will clean out and remove all of the infected debris and fill it with an inert substance (gutta percha). The treatment of a periapical abscess in a root treated tooth is a little more extreme. Once an infection recurs, the options are increasingly limited. Re-root treatment of the tooth may be attempted (I would recommend only by an endodontist) however this is rarely successful long term. The second option (in some teeth) is a minor surgical procedure called an apicectomy, where the tips of the infected roots are removed and filled by a maxillo facial surgeon. This may prolong the lifespan of the tooth, but infection will likely set in again a few years down the line. My recommended treatment for a periapical abscess on a root treated tooth is extraction of the affected tooth, followed by implant placement.

Periodontal abscess: This is quite different from the previously mentioned periapical abscess. The source of this infection lies within the gingiva (gums). When oral hygiene is poor, a small space develops between the tooth and the gum. This is an ideal space for bacteria to breed and grow in. If oral hygiene is not improved this rapidly develops into a periodontal pocket. If bacteria in the pocket increases and debris and food becomes trapped in the pocket, an abscess will developed. Unfortunately a periodontal abscess is accompanied with underlying bone loss, so the damage becomes permanent. Treatment depends on the extent of the damage. If not too severe and if caught in the early stages, your dentist can debride and clean the area leading to healing. However in more complicated cases a periodontist may be needed to surgically debride and clean the infected area. All patients who have had periodontal problems should be placed on a long term maintenance program to prevent recurrence and maintain the health of their mouths.

Perio-endo lesions: This occurs when a periapical abscess and a periodontal abcess occur in conjunction. Sometimes it is difficult to definitively say which type of abcess occurred first. The treatment consists of root canal therapy combined with periodontal treatment at a periodontist, albeit the prognosis is generally poor and the tooth may not be salvageable.

The use of antibiotics in the treatment of an abscess is common practice. The reason for this is that the pus accumulation in the infected site makes the environment very acidic. The efficacy of the local anesthetics within this acidity is greatly reduced, therefore it is difficult for the dentist to make you numb. In these cases an antibiotic is prescribed first and then the root canal treatment/extraction can be completed far easier after a few days of taking the antibiotic.

A dental abscess is usually a dental emergency and requires immediate attention from a dentist. All the pain killers in the world cannot take away this type of pain. The best cure is prevention (apologies for the cliche!). My advice is regular, 6 monthly dental check ups to prevent these types of painful experiences.

4 Comments »

Case report

 

 

 

 

 

 

 

Before

 

 

 

This patient came in for treatment to restore the esthetic appeal of his smile. He felt his teeth were not visible enough and they had been neglected over the years. He wanted to be able to smile confidently again.

Dentist talk: The staining and severe wear you are seeing on this dentition is not caused from dental decay. The severe tooth wear is caused by attrition, abrasion and erosion. Abrasion is the loss of tooth structure by mechanical forces from a foreign element, namely a toothbrush. When your toothbrush is too hard and you use it too aggressively, it leads to gingival (gum) recession. Gingival recession exposes the root surface of the tooth, which is a lot softer than the tooth crown because it does not have a hard enamel covering. As you continue to brush in an abrasive manner, tooth structure is destroyed at the gumline. Attrition is the loss of tooth structure by mechanical forces from opposing teeth. Tooth grinding is directly related to stress levels. With the ever increasing stresses of daily life, jaw clenching and tooth grinding have become a common problem. The immediate problem is the vertical loss of tooth height as grinding continues. The flat occlusal plane (biting surface) seen in the above pictures is an excellent example of the results of years of tooth grinding when it goes untreated. Erosion is caused by excessive consumption of acidic foods and drinks ‘dissolving’ away the surface of the tooth, like fruit juice, coca cola and dried fruit. This is more commonly seen on the palatal surface of the teeth, however this patients’ diet did consist of a lot of acidic foods and it did contribute to the overall tooth wear.

Besides the obvious esthetic problem, the bigger dental issue is the loss of vertical tooth height. Due to the excessive grinding habit, the teeth are much shorter than they were originally. This leads to the bite becoming “closed”. As the vertical height gets shorter, the face will begin to collapse which ages the patient tremendously and adversely affects chewing functions and parafunction. In order to treat the problem, the vertical height needs to be restored to its original height. Therefore the “bite needs to be opened”. Opening the bite requires increasing the height of every tooth in the mouth with full crown coverage of the entire dentition. Because the patient is a chronic bruxer (grinder), porcelain fused to metal crowns are used as these are stronger. Dental implants will be placed into the areas where there are missing molar teeth.

After

 

 

 

 

 

 

 

 

 

 

 

 

 

There is one more lower mandibular tooth that requires a crown. This will be completed once the implants have been placed and all the molar teeth will be restored at one time. You will notice that this patient only has teeth up to his premolar teeth. This is in fact adequate for chewing and gives sufficient chewing surfaces for normal function. The molar teeth implants will complete the dentition for the perfect result. A bite plate was also made for the patient to wear at night to prevent porcelain fracture and ease the grinding habit. After opening the bite 3mm, the patient was extremely happy with the increased length of teeth that are now far more visible during speech, smiling and function. I was also very pleased with the good result.

With attention to fine detail and careful planning this type of case is very exciting to treat and so rewarding when patients’ lives are changed by their new smiles (:

3 Comments »

And dont forget to floss…..

Have a great weekend ! (:

2 Comments »

Tooth Sensitivity…..

Tooth Sensitivity is a common problem I am faced with on a daily basis. Patients come in and complain of varying degrees of sensitivity and seek help and solutions. The treatment of tooth sensitivity is a tricky one. The most common cause of tooth sensitivity is gingival recesion resulting from aggressive brushing techniques. The susceptibility of the gums to recession increases with age. As the gum recedes upwards, the root surface of the tooth becomes exposed. The crown of the tooth is covered by a protective layer of enamel. The root however does not have this enamel covering and is thus far more sensitive (particularly to changes in temperature).

All the television adverts for sensitive toothpastes claim to cure patients instantly and miraculously of their painful sensitive teeth. It would truly be a miracle if these toothpastes worked so well! However the fact is, they dont. The other ugly truth is that once the gum has receded it will never move back down into its original position- the damage is therefore permanent.This means its time to trade in your frayed and aged brush, for a soft gentle brush which will not cause further damage to your gums. If you are battling to find a really soft toothbrush, just buy something from the kiddies range!

There is only one product (which is not available from retail stores but only through dentists) that I feel truly treats and improves tooth sensitivity. It is not the purpose of this blog to market any specific products, so I will not mention the name, however if you email me I will gladly provide you with the name of the product.

The “sensitive brand’ toothpastes on the market do, in theory provide some relief, but it is minimal in my experience. Most of the time, patients just learn to live with the fact that they have sensitive teeth. They steer clear of ice cold drinks or ice creams and just take a lot more care in choosing the colder foods. Some people are so sensitive (like myself) that they cannot even bite into a piece of fruit that has been inside the fridge.

The most important thing is to not let the gum recession get any worse. Your dentist will provide you with specific oral hygiene instructions to ensure this. The good news is, with time, the longer the root is exposed to the oral environment the less sensitive it becomes. As you get older the sensitivity will ultimately decrease, however this may take years.

In closing, brush gently to prevent tooth sensitivity. Prevention is better than cure- especially when there isnt one!

Leave a comment »

HealOzone Revealed! Say goodbye to cavities and goodbye to painful dental visits

HealOzone is the best news for any patient who does not like visiting the dentist. Oxygen kills the decay causing bacteria that cause dental caries. These bacteria (known as anaerobic bacteria) thrive in an environment where there is little or no oxygen. Cavities develop as the environment below the surface of the tooth becomes acidic. Ozone not only kills the acid-making bacteria, it also neutralizes their acidic waste. Many municipal drinking water systems kill bacteria in the water using ozone. Also ozone is at least ten times stronger than chlorine as a disinfectant. The medical community — especially in Europe — have been using ozone for decades to speed up wound-healing and to treat a variety of diseases.

The new environment that occurs following the bio-chemical change (from acidic to alkaline) in the lesion allows minerals to flow back into the tooth, hardening and reversing the effects of decay. Early cavities can heal. The minerals to assist this repair can come slowly from the saliva or much quicker from mineral-rich solutions soaked into the teeth following the ozone treatment. Research seems to indicate that once a tooth is remineralized, it is very unlikely the decay will come back. Multiple ozone treatments over a period of months can improve chances even better.

Ozone is used to treat early tooth decay before it turns into a big hole. Once the affected tooth surface has been treated with the ozone, a composite filling can be placed straight away, directly onto the treated tooth surface. NO injections. No drilling. NO PAIN.

Ozone therapy is an amazing tool for treating small areas of decay, however when cavities have become much larger, ozone treatment alone will not suffice as the only treatment. However, after the decay on these larger cavities has been removed, ozone may be used to sterilize the tooth surface. This will allow for remineralization of the tooth surface beneath the restoration and will reduce the occurrence of secondary decay beneath restorations.

Ozone may also be used to treat oral ulcers, cold sores and gum disease. When applied to the affected tissues, after just one treatment symptoms will reduce significantly and healing will progress at a much faster rate. After a second and third ozone treatment, healing will often be complete.

Dental ozone is right here, right now, and poised to make us look at traditional dentistry with a new set of eyes!

More info : http://www.quintpub.com/display_detail.php3?psku=B8830

7 Comments »

Tooth decay and your diet

This post looks at how to reduce tooth decay through your diet.Teeth are constantly changing. The tooth consists of different layers. The innermost core of the tooth (called the dental pulp) contains a mass of nerves and cells. These cells have a regenerative function. So teeth are able to heal themselves. This is why some cultures like the African Wakamba tribe can file their front teeth into sharp points without causing damage. The process of regeneration is slow (like the process of tooth decay). Fortunately, a decaying or broken tooth has the ability to heal itself. Pulp contains cells called odontoblasts, which form new dentin if the diet is good. Below is a copy of what Dr. Edward Mellanby commented about his wife’s research on the subject. This is taken from Nutrition and Disease:

Since the days of John Hunter it has been known that when the enamel and dentine are injured by attrition or caries, teeth do not remain passive but respond to the injury by producing a reaction of the odontoblasts in the dental pulp in an area generally corresponding to the damaged tissue and resulting in a laying down of what is known as secondary dentine. In 1922 M. Mellanby proceeded to investigate this phenomenon under varying nutritional conditions and found that she could control the secondary dentine laid down in the teeth of animals as a reaction to attrition both in quality and quantity, independently of the original structure of the tooth. Thus, when a diet of high calci­fying qualities, ie., one rich in vitamin D, calcium and phosphorus was given to the dogs during the period of attrition, the new secondary dentine laid down was abundant and well formed whether the original structure of the teeth was good or bad. On the other hand, a diet rich in cereals and poor in vitamin D resulted in the production of secondary dentine either small in amount or poorly calcified, and this happened even if the primary dentine was well formed.

Drs. Mellanby set out to see if they could use their dietary principles to cure tooth decay that was already established in humans. They divided 62 children with cavities into three different diet groups for 6 months. Group 1 ate their normal diet plus oatmeal (rich in phytic acid). Group 2 ate their normal diet plus vitamin D. Group 3 ate a grain-free diet and took vitamin D.

In group 1, oatmeal prevented healing and encouraged new cavities, presumably due to its ability to prevent mineral absorption. In group 2, simply adding vitamin D to the diet caused most cavities to heal and fewer to form. The most striking effect was in group 3, the group eating a grain-free diet plus vitamin D, in which nearly all cavities healed and very few new cavities developed. Grains are the main source of phytic acid in the modern diet, although we can’t rule out the possibility that grains were promoting tooth decay through another mechanism as well.

Dr. Mellanby was quick to point out that diet 3 contained some carbohydrate (~45% reduction) and was not low in sugar: “Although [diet 3] contained no bread, porridge or other cereals, it included a moderate amount of carbohydrates, for plenty of milk, jam, sugar, potatoes and vegetables were eaten by this group of children.” This study was published in the British Medical Journal (1) and the British Dental journal. Here’s Dr. Edward Mellanby again:

The hardening of carious areas that takes place in the teeth of children fed on diets of high calcifying value indicates the arrest of the active process and may result in “healing” of the infected area. As might be surmised, this phenomenon is accompanied by a laying down of a thick barrier of well-formed secondary denture… Summing up these results it will be clear that the clinical deductions made on the basis of the animal experiments have been justified, and that it is now known how to diminish the spread of caries and even to stop the active carious process in many affected teeth.

Dr. Weston Price also had success curing tooth decay using a similar diet. He fed underprivileged children one very nutritious meal a day and monitored their dental health. From Nutrition and Physical Degeneration (p. 290):

About four ounces of tomato juice or orange juice and a teaspoonful of a mixture of equal parts of a very high vitamin natural cod liver oil and an especially high vitamin butter was given at the beginning of the meal. They then received a bowl containing approximately a pint of a very rich vegetable and meat stew, made largely from bone marrow and fine cuts of tender meat: the meat was usually broiled separately to retain its juice and then chopped very fine and added to the bone marrow meat soup which always contained finely chopped vegetables and plenty of very yellow carrots; for the next course they had cooked fruit, with very little sweetening, and rolls made from freshly ground whole wheat, which were spread with the high-vitamin butter. The wheat for the rolls was ground fresh every day in a motor driven coffee mill. Each child was also given two glasses of fresh whole milk. The menu was varied from day to day by substituting for the meat stew, fish chowder or organs of animals.

Dr. Price provides before and after X-rays showing re-calcification of cavity-ridden teeth on this program. His intervention was not exactly the same as Drs. Mellanby, but it was similar in many ways. Both diets were high in minerals, rich in fat-soluble vitamins (including D), and low in phytic acid.

Price’s diet was not grain-free, but used rolls made from freshly ground whole wheat. Freshly ground whole wheat has a high phytase (the enzyme that degrades phytic acid) activity, thus in conjunction with the long yeast rises common in Price’s time, it would have broken down nearly all of its own phytic acid. This would have made it a source of minerals rather than a sink for them. He also used high-vitamin pastured butter in conjunction with cod liver oil. We now know that the vitamin K2 in pastured butter is important for bone and tooth development and maintenance. This was something that Dr. Mellanby did not understand at the time, but modern science has corroborated Price’s finding that K2 is synergistic with vitamin D in promoting skeletal and dental health.

In these early studies, it is clearly evident that diet is a huge contributing factor to tooth decay. This fact seems to have fallen to the back of most dentists’ minds and their patients. It is important to remember that tooth decay needs a substrate of carbohydrate to occur. Without this, the decay process cannot take place. It is almost impossible to eliminate this carbohydrate substrate from our diet entirely and from our mouths, however when it is reduced, the impact is exponential and the decay process is halted in its tracks.

More emphasis needs to be placed on diet. A combination of a caries-preventing diet and good oral hygiene practices will inevitably result in a reduction and elimination of decay.

Some elements to bring into your new and improved “decay reducing” diet I have recommended below:

  • Bread and refined grain products (like cereals) should be limited/avoided.
  • Limited nuts; beans in moderation, only if they’re soaked overnight or longer in warm water (due to the phytic acid).
  • Increase your intakes of GREEN, leafy vegetables
  • A limited quantity of fruit and especially fruit juice
  • At least two portions of cooked/raw vegetables daily
  • Vitamin D3 supplements (this also boosts the immune function)
  • Eliminate all processed and “fast” foods from the diet.
  • Constant sipping of water throughout the day.
  • Eliminate all fizzy cool drinks and “sticky sweets” (like toffees and fizzers)
Leave a comment »

Leave a comment »

Dental Forensics

I’m always amazed to hear of air crash victims so badly mutilated that they have to be identified by their dental records. What I can’t understand is, if they don’t know who you are, how do they know who your dentist is? “Paul Merton”

Unidentified bodies come to light frequently, having drowned, burned, been murdered, having committed suicide or died from natural causes. Usually sufficient evidence is apparent to be able to positively identify the body, but from time to time, this identification will rely on dental evidence. All mouths are different and the trained eye of the forensic odontologist will be able to offer a considerable amount of useful information. Most obvious will be to provide an accurate charting of the teeth and fillings present to compare with dental records of missing persons. This often leads to a positive identification.

Despite recent advances in DNA technology, dental identification still offers a rapid and cost effective approach.

Even if only a few teeth are available, an opinion can still be offered on age, habits, oral hygiene, and individual features which may match with ante-mortem records.

Where the subject has no teeth, useful information can still be gleaned from the study of any dentures and by X-raying the jaws and skull.

It is important that the services of a forensic odontologist be sought early in these cases, as much time consuming police work can be avoided given a dental report early in the investigation.

Bite Marks:

Marks are frequently seen on the victims of assault including child abuse but not recognised as bites. This vital evidence often goes unrecognised by the untrained person. Any curved bruise should be treated as suspicious and the sevices of a forensic odontologist sought early in the investigation. Not only will an opinion be given but the odontologist will be able to work with the photographer to demonstrate the bite to advantage using different light sources.

It will also be the function of the forensic odontologist to take dental impressions of any suspects, be prepared to make a comparison and, if necessary, to present the evidence in court as an expert witness.

The forensic odontologist will also be able to recognise and record bite marks in other substances such as foodstuffs (apples, cheese, chocolate), leather (key rings and belts) and wood (pencils).

The shape of the bitemark can give useful clues about the person who caused it and may lead to the implication or exclusion of an individual under investigation.

Example:

An assailant punched his victim and then threatened to kill her. In the struggle he bit her on the breast. A forensic odontologist directed the photography of the bite mark, took impressions of the suspect’s teeth and prepared transparent overlays to make a comparison. This evidence convinced an Old Bailey jury that the accused was, indeed, the attacker. He was convicted and sentenced accordingly.

 

Resource: “British Association for Forensic Odontology – BAFO”

 

Leave a comment »

How do you know if you have bad breath?

One of the most difficult things to tell is if your own breath really smells. Our own nose becomes desensitized to the odour of our own breath because the human brain does not register any sensations that are sensed for long periods of time: this includes the smell of your own breath. Halitosis (bad breath) is a common problem my patients complain about and they find it very embarrassing. Some bad breath symptoms are sour taste in the mouth, metallic taste, post nasal drainage, halitosis, film on tongue, tongue film, dry mouth, yellow film. Usually there is a simple solution, but this depends on the cause. Some dental causes of bad breath are extensive dental decay, gum disease, dental abcess, oral cancer, xerostomia (dry mouth). Medical conditions may also lead to bad breath: post nasal drip, tonsillar infections, lung diseases, liver diseases and diabetes.

As mentioned, numerous factors may contribute to halitosis. The first I would like to write about (and one I see daily) is gingivitis and periodontal disease (gum disease). When bacteria becomes trapped in the small pockets and spaces between the gum and the tooth, they make a home for themselves in the warm, dark, wet oral environment. As the amount of bacteria increases, they produce byproducts which contain a foul odor. It is this bacteria that causes the distinct fetid smell from gum disease patients. Regular scale and polish treatments at the dentist combined with daily oral hygiene home practice will eradicate and prevent this.

Dry mouth is a common symptom with people suffering from halitosis, and it is also one of the causes of halitosis. Dry mouth  (also known as xerostomia) causes a number of changes to occur in the mouth. First of all the bacteria become more concentrated in the saliva, and they tend to evaporate more readily into the air. When this occurs, bad breath will be stronger and more noticeable at greater distances. Additionally, the pH or acid/base balance of the mouth becomes altered, and this provides an environment that is more conducive to the growth of anaerobic bacteria (bacteria that grow without the presence of oxygen). Because there is less saliva the flushing or cleansing effect of saliva is reduced. If you find yourself suffering with dry mouth, try chewing sugar free (or xylitol based) chewing gum. This will increase the amount of saliva you produce and will flush out the excess bacteria.

Smokers not only have the stench of cigarette smoke emanating from their mouths, but the breath is heavy and thick. The obvious cure would be to stop smoking, however if you are not ready to go down this path, brushing your teeth three times a day (with a soft toothbrush), flossing every evening, chewing a xylitol chewing gum and using an alcohol-free mouth rinse will reduce the bad breath symptoms.

If you’re not sure whether or not you have bad breath, and you have nobody to ask try these at home:

1. The Cotton Test: Wipe the top surface of your tongue with a piece of cotton gauze and smell it. This is probably the most honest way. Also, if you notice a yellowish stain on the cotton, it’s likely that you have an elevated sulfide production level. Sulfides are one of the byproducts produced by the offending bacteria that lead to halitosis.

2. The Lick Test: Lick the back of your hand. Let that dry for about 10 seconds and then smell. If you notice an odor, you may have a breath disorder because the sulfur salts from your tongue have been transferred to your hand.

3. The Dental Floss Test: Run a piece of dental floss between your back teeth (this is the mostly likely place where you may get food caught) and then smell the floss. This may be an indication of the level of odors others detect.

If you don’t have the constitution to perform any of these home tests then visit your dentist!

3 Comments »

7 more reasons kissing is healthy for you…

Kissing feels great but there are other reasons that this habit can benefit your health. Its not only fun – its good for you! Researchers have revealed several reasons why kissing can improve your health:

Image

1.Those who kiss their partner goodbye each morning live five years longer than those who don’t.

2.Kissing strengthens your immune system: because you are exposed to the germs of your partner in small doses, your body activates its immune system and builds up immunity against this bacteria it is exposed to.

3.Relieves allergies: The results of a Japanese study found that half an hour of kissing can slow down histamine production and provide relief from sneezing and a runny nose.

4.Kissing uses 30 facial muscles and it helps keep the facial muscles tight, preventing baggy cheeks! The tension in the muscles caused by a passionate kiss helps smooth the skin and increases the circulation.

5. When you kiss, you produce extra saliva and this saliva neutralizes the acids that cause tooth decay. It may also help to wash away food particles and plaque. Also, saliva contains mineral salts that can strengthen your teeth.

6.Stress relief: Kissing reduces anxiety and stops the ‘noise’ in your mind. It increases the levels of oxytocin, an extremely calming hormone that makes you feel good and feel connected with the other person.

7. It boosts self-esteem: There is nothing better than a passionate kiss for a major dose of the feel good factor. “In theory, when you’re kissing, you’re happy. And when you’re happy, you feel good about yourself.” says psychotherapist Paul Zeal.

Leave a comment »