Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

What is preventative dentistry?

What is preventative dentistry?

 

The days of false teeth and dentures are in the past. It is now expected to retain all your natural teeth throughout your lifetime, and every measure is taken to prevent the loss/extraction of an adult tooth. The care and awareness of the mouth and teeth needs to start from birth. Children who have a healthy, cavity free primary dentition, usually have a strong, healthy adult dentition with fewer problems. One of the key elements in maintaining healthy teeth starts with good preventive strategies. It is important to find a dentist that practices preventative dentistry and focuses on the prevention of dental decay.

Does your dentist practice preventative dentistry measures?

Birth – 1 year of age

 

During the first year of your baby’s life is an exciting time of learning and experiencing the world. Your baby will encounter new sensory experiences every day. From birth you must clean your baby’s gums and sulci (the space where milk collects between the cheek and the gums) and the tongue. Using a soft piece of gauze in the mouth in conjunction with a xylotol based (fluoride free) age appropriate toothpaste to clean the mouth twice daily will reduce the risk of Candida infection (thrush) and will reduce the amount of bacteria living in the mouth. At 6 months of age (or when the first tooth appears) it is time to move onto a natural rubber finger brush. Massage your baby’s gums and brush their newly erupted teeth with Xylotol based toothpaste.

 

Why Xylotol?

 

Frequent eating of foods high in sugars and starches promotes tooth decay. Xylitol may reduce the risk of tooth decay if used whilst maintaining a low sugar diet. Many large-scale clinical studies have shown it to have long-lasting dental benefits. Over 25 years of clinical testing confirms that Xylitol is the best sweetener for teeth, which has led to official endorsements by dental associations in Finland, Norway, Sweden, England, Ireland, Estonia and the Netherlands of products containing high levels of this sweetener. A toothpaste containing Xylotol is one of the proven methods of reducing acidity in the mouth and reducing the incidence of dental decay.

 

What’s next?

 

Your child’s first visit to their dentist should coincide with their first birthday. Do not expect too much from your child at this stage, however it is an important time for your pediatric dentist to educate you about the dos and don’ts of taking care of your child’s teeth. Let your baby play in the dental chair, spend time getting to know their new dentist and become familiar with the dental setup at the practice. Every positive experience at the dental surgery will reinforce a good relationship with their dentist and build trust.

 

At one year of age it is time to bid farewell to your baby’s nighttime feeding habits. At this age, infants no longer require any milk for additional nutrition, as their nutritional needs should be met in full with solid meals during the day. Milk bottles after one year of age serve only as a pacifier and this habit is extremely difficult to break. Milk bottles/breast feeding before bed or during sleep time will wreak havoc on your child’s immature, newly erupted teeth. Nursing bottle caries occurs in infants who are left to suck on a milk bottle/breast fed throughout the night. Sugary drinks (fruit juice, honey sweetened tea) given in a bottle/sippy cup will also result in rampant decay of your infant’s teeth. Give only water at night. Never dip your baby’s pacifier in honey or any other sweetener.

 

2 -3 years old

 

By the time your child reaches 2 years of age, they should be familiar and completely comfortable with their dentist. They should feel happy to sit alone in the dental chair and experience having their teeth polished and inspected by their dentist. Children should visit their dentist every 5 months throughout their childhood. At approximately 2 ½ year of age, you should initiate a flossing routine. Flossing the teeth should be done every night after brushing. If practiced regularly, it will setup a lifelong habit of flossing for your child.

 

Fissure sealants

 

The fissures are the grooves present on the top surface of molar teeth. These run deep within the tooth’s structure and their full depth cannot be penetrated during brushing by toothbrush bristles. For this reason, your pediatric dentist will place sealants to close up these fissures. This prevents dental decay occurring in the fissures- one of the most common sites of dental decay in children’s teeth. Fissure sealants can be placed as early as 2 ½ years of age, if your child is compliant and relaxed in the dental chair.

 

Brushing

 

It is essential to brush your child’s teeth in the morning and at night. Regular removal of plaque from the teeth is the only way you will effectively prevent dental decay. If your child puts up a fight when it is time to brush teeth, nothing sends the message home faster than a dental check up, cleaning and a chat with the dentist. Your pediatric dentist has many tricks up their sleeves when trying to convince and teach children the importance of brushing. Once again, a good relationship between your child and their dentist will prove highly beneficial when trying to motivate and improvement in their brushing habits.

 

Diet

 

Many thousands of years ago, dental decay did not exist. The reason for this lies in the diet of prehistoric man. Early man had a diet high in raw fruits and vegetables and a relatively low protein content. Food was also very fibrous with zero refined carbohydrates and very low sugar content. They drank only water.

Minor dietary changes will make a great impact on the health of your child’s mouth. Fruit juice is extremely acidic and destructive. Children should drink only water. Limit the intake of refined carbohydrates like potato crisps, bread, muffins, cake, and cookies. Do not allow unhealthy between meal snacking. Give only sugar free between mean snacks. Steer clear of sticky sweets like fizzers, toffees and suckers.

 

Prevention is better than cure

 

Above all else, develop a trusting, positive relationship with your dentist. If you and your child trust your dentist and visit regularly, the road ahead will be a smooth, cavity-free journey.

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Diet and teeth.

How does diet affect your children’s teeth?

 

Diet is the key to a healthy, cavity free mouth. Many parents believe that choosing the best toothpaste will protect their young one’s mouths from holes and problems. This is unfortunately not the case. In order to fully understand the concept of diet affecting our teeth, you will need a short biology lesson.

 

Streptococci Mutans and Lactobacilli are the most common bacteria in the mouth responsible for tooth decay. When sugar is present in the mouth, these bacteria thrive off it, but unfortunately for us, through their own digestive process of these sugars, the waste products produced are acid. Specifically known as lactic acid, these by products leach out the calcium present in the teeth, thereby slowly weakening it. Over time, this demineralization (leaching out of calcium) of the tooth surface produces a hole. When sugars are present in high amounts, plaque forms. Plaque is the white/yellowish fur that we brush off our teeth every day. If plaque is left to ferment on the tooth surface, a cavity will result.

 

The goal in controlling plaque formation and cavities is to ultimately reduce the total intake of dietary sugar. It must be stressed however, sucrose (found in all sweets) is not the only sugar which damages teeth. Glucose (found in breads and rice), fructose (found in fruit), maltose (found in cereals and pastas) and lactose (found in milk) are all easily digested by mouth bacteria to form acid and destroy teeth. Dietary changes to alter the acidity of the mouth will directly reduce amount of plaque build up on the teeth, thereby reducing the chance of dental decay.

Our bodies do have a natural defense against acidity and this is saliva. Saliva acts as a natural cavity fighter. One of the key strategies in cavity reduction/elimination is to keep your mouth at a more alkaline pH (reduce bacterial acidity) throughout the day for longer periods. You do this by increasing saliva production and encouraging saliva production between meals.

This is how it works: When we eat a meal the pH of our mouths change in accordance to the type of food we have just eaten. Food containing higher amounts of carbohydrates and sugars will leave the mouth with an acidic pH, ranging from 1- 5. Increased saliva production will kick in and our saliva will buffer this acidity, slowly raising it back to the resting pH of approximately 7.5. If immediately after eating your main meal you have a sweet treat (piece of chocolate or a dessert), the acidity of your mouth does not change by much. Saliva is still produced and your mouth will quickly recover back to an alkaline pH, which does not allow sufficient time for bacterial colonization and acid production. The problem encountered, particularly with children, is sugary snacks given in between meals. Sugary snacks given an hour after a main meal will bring the pH of the mouth back down to an acidic level and bacteria will begin to thrive and produce more acid. It does not give the mouth time to recover from the acid overload and the mouth remains acidic for most of the day. This gives bacteria plenty of time to produce acidic waste and demineralize the teeth.

Give your children sugar free snacks between meals. Example: whole fruits and vegetables, nuts, sugar free (xylotol containing) chewing gum, cheese. Beware of dried fruit; this is very acidic and very high in sugar and not a good choice for in between meal snack.

Quick easy steps to making your child’s diet a tooth friendly diet

 

–     Allow sugar intake (sweets and treats) directly after main meals only. When sugar is given between meals as a snack, this leads to a high incidence of decay. The frequency of sugar intake has more impact than the amount of sugar intake. Between meal snacks should contain no sugar.

 

–      The best type of sweet for a child is chocolate. Sticky sweets like toffees/fizzers/jelly sweets/suckers stick in between and around the teeth and result in destruction of the teeth for a much longer duration as the sugar lies in and around each tooth. It is difficult to clean this sugar off the teeth and they are extremely acid producing.

–      Beware of dried fruit; this is not a good snack. It has a very high sugar content and high acidity. It not only causes dental decay but acid erosion of the teeth.

–      End each meal with a small piece of cheese/some milk/xylotol chewing gum. This neutralizes the mouth and stimulates saliva production.

–      Limit fruit juice intake to ½ a cup per day (if needed). I always advise parents to try to eliminate all juice and sodas from the diet. They do not give hydration. Children should only drink water. If your child does drink a soda/fruit juice, ensure they drink it through a straw, so it bypasses the mouth and the teeth and is swallowed immediately.

–      All babies must be weaned off their nighttime milk bottle/breast feed by the age of 1. At 1 year old they no longer require the nutrition of the milk during the night, as their diet is predominantly solid food. If your child still enjoys the bottle as a pacifier at night, put only water in this bottle. Rampant dental decay results if children are kept on a bottle/breast past one year of age.

–      Never add sugar/honey to rooibos tea. This sugar will rapidly decay teeth, especially if given through a bottle/sippy cup.

Dental decay is a preventable disease. Diet is at the centre of this preventative concept. Without a lower sugar intake, you cannot expect a cavity free mouth. The acidity produced by sugar does not only affect the mouth. This type of acidic environment in the body allows viruses/bacteria/infections to thrive and leaves the body more susceptible to disease. Reducing/eliminating sugar from your child’s diet will have positive effects in all the bodily systems. Change their eating habits today.

 

 

 

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Teething

Teething

There are many myths associated with teething which date back to the dark ages. Babies are protected by their own natural immunity that was transferred to them through their mother’s placenta and this immunity lasts until approximately 6 months of age. A large majority of babies are also breast fed up until 6 months of age and gain immunity through the breast milk. So at 6 months there is a sudden drop in these forms of natural immunity and protective antibodies, which increases risk for infection. Coincidentally it is at around 6 months of age that the first teeth usually appear. For this reason it is doubtful that teething causes symptoms (like fussiness, diarrhea, runny nose and fever) but in actual fact these common symptoms are not related to teething at all and just coincidentally appear at the same time as emerging teeth. In addition the increased stress associated with teething could make your child more vulnerable to infection right before a new tooth appears.

I advise parents to keep a watch for vomiting and listless behavioral patterns, as these are almost always a sign that the problem is not teething. Keep a close eye on the behavior of your baby.  If your baby starts vomiting and has a fever for an extended period of time, exceeding 38 degrees Celsius you must contact your doctor. Teething should not require emergency care. If there is any concern that something other than teething may be causing symptoms, contact your health-care provider. The only signs that should be associated with teething are restlessness, increased salivation and fist/hand chewing.

baby_teething

Teething remedies

I am a firm believer in Baltic Amber bead teething necklaces. Amber beads release Succinic acid, which is then absorbed into the body when kept in constant close contact with the skin. The long-term exposure to Succinic acid reduces inflammation that in turn eases the pain and discomfort stemming from the chronic oral inflammation of the mouth during teething and boosts immunity and the body’s ability to fight infection during this susceptible period. It works with the body to support the immune system, restore health, and reduce infection as well as pain. I recommend that this necklace be worn from 2 months of age, every day. At night, secure the necklace around the ankle of your baby with their sock so it does not present as a choking hazard.

I also recommend a visit to your homeopath. A homeopathic teething remedy and immune supporting remedy (like Oscillococcinum) taken from early on, in combination with teething beads has shown very effective results in alleviating teething pain and other illness accompanying the teething period.

Give your baby something fibrous to chew on like a cold carrot stick/apple slice. Natural rubber teething rings chilled in the fridge are also effective. Their gums are itchy so help them out by massaging the gums with a natural rubber finger brush combined with a Xylotol based toothpaste.

Do not give your child teething biscuits/rusks as these are high in sugar and promote plaque accumulation. Do not give your child any sugary drinks (fruit juice, sweetened tea etc) in their bottle. This may pacify your child short term, but the long-term damage and addiction to sugar is irreversible.

And finally is not helpful to apply commercial teething gels as these topical preparations have little to no effect- the child swallows most of the gel and continuous application is impractical and may lead to sensitivity to benzocaine.

 

Teething is a time when your child needs above all else, love and support.

 

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Do I need to floss my child’s teeth?

Flossing one’s teeth is probably one of the most tricky skills to master in this lifetime and that is why most people do not do it. However consider this analogy: after a day of gardening and digging in the dirt with your hands, they are covered in mud and sand. You go to the basin and wash your hands vigorously with your most potent hand soap. You rinse the soapy water off only to reveal your finger nails filled with dirt underneath. Only when you take a nail brush a scrub under your nails is all the dirt removed. Imagine if you just left all that dirt and bacteria to live and remain under your nails indefinitely…

The same applies to your mouth and especially your child’s mouth. We eat and drink all day long, bathing our teeth in sugars and carbohydrates which allows bacteria to thrive and easily attach to all the surfaces of the teeth. After a rigorous scrubbing with the toothbrush, you are only removing the plaque/food/debris from the outer surface of your teeth; you are only cleaning 60% of your tooth surfaces. This leave 40% of tooth surfaces uncleaned, covered in plaque and susceptible to breakdown by bacteria. Flossing removes the bacteria below the gums. Decay occurring between the teeth is the second most common site of tooth decay in children. Decay between the teeth of children is very difficult to detect and even more difficult to treat.

The types of cavities that develop as a result of not flossing are in my opinion “silent killers”. The hole starts directly in between two teeth and slowly burrows into the center of the tooth. You are usually completely unaware that this hole exists because you cannot feel it with your tongue and the pain is not felt because the open tooth structure is shrouded between the adjacent teeth or compacted with food (nummy!). Only once the hole has increased in size enough, does the unsupported covering of enamel fracture/cave in. This is when people decide to visit me; once it is too late and the tooth generally requires a root treatment/extraction/pulpotomy(in primary teeth).

Silent destruction that ultimately leads to abscess development

The other important reason for flossing is to prevent gum disease from occurring in the gum areas between the teeth. Brushing alone is not adequate to keep the mouth healthy and free of disease. Bad breath is often caused by masses of bacteria/plaque breeding and thriving in the areas between the teeth. Plaque matures every 24 hours, so it is imperative to break this cycle and floss every day. Bleeding gums when you floss is a sign that you need to floss more!

Example of how to floss around the gum line

To prevent these disaster cavities from developing and to prevent gum disease you need to clean away the plaque/bacteria/food that accumulates under and around the gumline in between the teeth. You do this with dental floss, every night, last thing before bedtime. Flossing must be initiated in children from the age of 2 years. Even if their molar teeth have not grown out yet, start to floss around the mouth each night and entrench this habit into their daily routine. This will set them up for a lifetime of good oral health.

You only need to floss the teeth you want to keep…

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Baby teeth eruption patterns

Many parents ask me when will their little one will start to lose their baby teeth. A large number of parents I see are under the misconception that the primary dentition (baby teeth) are not important because “they will fall out anyway”. This attitude must be adjusted. The primary teeth are vital for the child’s oral health and normal oral development for a number of reasons.

Firstly the primary teeth are used to chew and eat with. Children only lose the front 8 incisor teeth at the age of 6 years. These are then replaced by the adult upper and lower incisor teeth (front teeth). The back teeth (primary molar teeth) remain in the mouth till the age of 10 – 11 years. So if these teeth decay at an early age and it does pose a problem from a functional perspective.

Secondly the primary teeth act as space maintainers that “guide”the adult teeth into their correct positions. If a primary molar (specifically the second upper/lower primary molar) is lost prematurely, an orthodontic space maintainer is required to keep the open space in tact and prevent the permanent molar tooth from drifting forward into the space. If a space maintainer is not placed timeously, this could create an orthodontic problem later on in the child’s life. If a child loses a baby tooth early as a result of tooth decay or an accident, a permanent tooth may erupt early and potentially come in crooked due to limited space.

Lastly, the health of the primary dentition is a very good indicator for future oral health. If a child’s teeth are taken care of from an early age and they are educated about the importance of keeping their mouths clean and visiting their dentist regularly, they tend to have far fewer dental problems later in life. Children who suffer with many dental cavities from an early age, require extensive dental treatment and this general leaves them loathing the dentist. It is up to the parents to enforce good oral hygiene habits at home and bring them to visit the dentist every 6  months.

What can you expect from your child’s teeth?

By the age of 3 years, your child should have all their primary teeth (20 in total).

Between the ages of 5 – 7 years the upper and lower anterior incisor teeth will fall out and the permanent incisor teeth will grow out.

At approximately 6 years of age, the first permanent molar teeth will grow into the mouth. No teeth will fall out to accommodate the growth of these teeth. This is a good time to visit the dentist and have fissure sealants placed on the molar teeth.

Between the ages of 9 and 11 years, your child will lose their primary molar teeth and these will be replaced by the permanent premolar teeth.

The second permanent molar teeth will grow through the gums at approximately 8 – 9 years old. These should also have a fissure sealant placed on them to prevent dental decay.

By the age of 12- 13 years, all the permanent teeth should have erupted into the mouth and the primary teeth all fallen out.

 

 

The ages I have mentioned above are only averages. Timing can vary, though, and girls generally lose baby teeth earlier than do boys. The last baby teeth typically fall out by age 12 or 13. There can be a deviation of up to 2 years when it comes to tooth eruption times. If your child is “late” with their eruption pattern, please do not worry at all. If you are genuinely concerned about a tooth not wanting to grow out, you can see your dentist for a panoramic xray which will show exactly where the teeth are sitting and if they might be missing.

The picture below is a representation of a child skeleton of approximately 5 years old. You will notice the primary teeth present in the mouth. All the adult are present in the maxilla and mandible (jaw bones) of the child, ready and waiting to grow into the mouth.

The formative years are a wonderous time and so much is going on in a small child’s body. It is up to you as the parent, to respect these small miracles and help your child look after their teeth. With proper care, you can help your child’s permanent teeth last a lifetime. There are no second chances after the permanent teeth erupt! (:

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What is a dental microscope ?

The use of a dental microscope in routine dental treatment has truly revolutionized the way dentist operate and the level of care that is provided. With a dental microscope, procedures can be carried out more accurately and more reliably using up to 24 X magnification of the teeth and surrounding structures. The dental microscope is the single most significant acquisition to enhance an operator’s clinical skill set. All dentists can do better work with the operating microscope. Margins that might inadvertently be left open can be closed. Cracks can be more accurately diagnosed, and treated. Caries that, in the past, needed to progress until seen with the naked eye can be treated earlier. Most dental needs can be treated more conservatively, with less loss of healthy tissue.

Never before has the dentist been so well equipped. A dentist using a microscope is better able to diagnose pathologies. The dual advantages of increased illumination and magnification provided by the surgical microscope make the delivery
of dental care easier. The initial rewards of vision enhancement are improved visualization, greater accuracy in eye-hand movements, and improved ergonomics.

Improved lighting, coupled with magnification, provide a clear distinction between surfaces that may look similar in color or texture under traditional working conditions, but look very different under the microscope. Decay, dentin, enamel, composite and porcelain are easily distinguishable from one another and can be viewed with unprecedented detail under the scrutiny of a microscope.

Dental microscopes can play a fundamental role in the daily comings and goings of an experienced dental practitioner. It is now widely regarded as one of the most important pieces of equipment in a dentist’s room. Dental microscopes are also beneficial for patients, as the microscope enables the patient to see inside their mouth, giving them a better understanding of what is going on and enabling them to participate in the treatment process. The microscope may be particularly beneficial for patients who are a little anxious about having treatment, as the dentist can explain what is going to happen more clearly.

Through the use of dental microscopes general dentistry has been allowed to advance and modernize, giving both dentists and patients a level of care and treatment that is second to none.

I am extremely proud and excited to be introducing the Seiler Evolution XR6 dental microscope to my practice. This is a huge step and will elevate the level of care I give my patients to even greater excellence. Read more on the Seiler website…

 

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What is a Periodontist ?

Many patients come for a routine dental visit and are then referred off to see a “periodontist“. Here I will answer what a periodontist does and you can then decide if you need one.

I am going to being with a few definitions to get us on the same page:

PERIODONTIUM: This refers to all the supporting structures that surround the teeth. The specific tissues that make up the periodontium are the alveolar bone, periodontal ligament, cementum and the gingiva (or gums).

PERIODONTICS: This is the study of the periodontium and the branch of dental specialty that treats diseases of the periodontium.

Therefore, a periodontist is a specialist dental practitioner who treats and manages diseases and conditions of the periodontium. Most often a patient requires the expertise of a periodontist when they suffer from periodontal disease. Anyone can develop periodontal disease. It is usually a slow process (but sometimes can be very acute & develop rapidly) of destruction that develops over time when the oral hygiene of the mouth is poor. Initially patients suffer with bleeding gums. People assume that this is normal and do not seek treatment. Bleeding gums then become a part of their daily life. The bleeding is caused from a chronic inflammation of the gums due to the presence of bacteria in dental plaque. This is known as gingivitis. The dental plaque present on the tooth surfaces will turn to calculus, a hard accretion that cannot be removed with a toothbrush. The gingivitis, if untreated, will turn into periodontal disease which causes the destruction of the alveolar bone that houses teeth. The result is loosening of the teeth and if untreated, eventual loss of the teeth. The primary role of a periodontist is to treat periodontal disease, by removing the calculus that has accumulated and reverse the chronic inflammatory process. The objective is to halt the destructive process of bone loss through a number of minor surgical and non surgical procedures.

In addition the treating periodontal disease, a periodontist may place dental implants, surgically extract problem teeth, place bone grafts and place gingival grafts.

In general, it is advisable to see your dentist for an assessment first before booking directly with a periodontist. An astute dentist will be able to assess the severity of any possible gum problems and refer you to a suitable periodontist if you need one.

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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.

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Gum Recession

Question:

What causes gum recession and can it be prevented?

Answer:

Gum recession occurs gradually, over months or years and gets worse with age. The gumline rises with time which results in the root surface of the tooth being exposed to the oral environment.The tooth crown is covered by a hard layer of enamel which protects it against decay and toothbrush wear. The tooth root does not have this protective enamel covering and is a lot more vulnerable. One of the most common signs of gum recession is teeth that are highly sensitive to cold and touch at the gumline. Gum recession is a common problem I see in my practice, and if left untreated over time it can leave teeth more susceptible to cavities and continued discomfort and sensitivity.

When gum recession occurs on the front teeth it is quickly noticed by patients because it is esthetically displeasing. However it is less commonly diagnosed early on the back teeth.

Some factors that contribute to increase gum recession are poor oral hygiene, tobacco use, and a genetic predisposition to thin bones and gums. Sometimes when teeth have been moved outwards during orthodontic treatment (braces) recession can be seen later in life as the gums are thinner in these areas. Clenching and grinding the teeth at night can exacerbate the problem, and wearing a bite plate at night may help. Gum recession resulting from a bacterial infection is also coupled with bone loss around the teeth. This is severe and leads to loosening and eventually loss of the teeth. Newer research is pointing towards “abfractions” as the cause of gingival recession. These are “wear” points at the neck of the tooth , where the enamel has disappeared and dentin is exposed.

The most common cause of the gum recession is aggressive brushing techniques with a toothbrush that is too hard. Incorrect brushing causes daily insult to the thin gum tissue around the tooth neck and in response to this the gum recedes. The best way to prevent gum recession is regular visits to the oral hygienist and dentist. Early treatment is the best way to avoid tooth decay, tooth loss, and infection.

Dental Erosion is the acidic dissolution of the teeth-starting with the softening (demineralization) of the enamel and underlying dentin and subsequent structural tooth loss. It’s caused by acids in food and beverages as well as by regurgitated stomach acid resulting from reflux disease (in contrast, cavities are caused by acid-producing bacteria on the teeth, which feed on sugars). Overbrushing, abrasive toothpaste, tooth grinding, and other excessive mechanical wear and tear can dramatically worsen the damage caused by dental erosion.

Gum grafting surgery is a treatment option for gum recession and often involves taking tissue from the roof of the mouth and attaching it to remaining gum tissue. However the success rate is low.

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