My Blog

By Bruce E. Hanley DDS
April 16, 2019
Category: Oral Health
Tags: toothache  
4ThingsyouShoulddoifYourChildComplainsofaToothache

If your child has a toothache, there’s good news — and not so good news. The good news is the pain rarely indicates an emergency. On the downside, though, it may definitely be something that needs our attention.

Here, then, are 4 things you should do as a parent when your child tells you their tooth hurts.

Try to find out exactly where the pain is and how long it has hurt. Ask your child which tooth or part of the mouth hurts. You should also find out, as best you can, when the pain started and if it’s constant or intermittent. Anything you learn will be useful information if you bring them to the office for an examination. And, any tooth pain that keeps your child up at night or lasts more than a day should be examined.

Look for signs of recent injury. Your child may have suffered a blow to the mouth that has damaged the teeth and gums. Besides asking if they remember getting hurt in the mouth, be sure to look for chipped teeth, cracks or other signs of trauma. Even if there aren’t any outward signs of injury, the tooth’s interior pulp may have been damaged and should be checked out.

Look for signs of dental disease. Take a close look at the tooth your child’s complaining about: do you see brown spots or obvious cavities? You should also look for swollen gums or sores on the inside of the mouth. If there’s been no apparent injury, these could be signs of infection related to tooth decay.

Try to relieve pain symptoms. If you don’t see anything unusual, there may be a piece of candy or other hard food debris between the teeth causing the pain — gently floss around the tooth to dislodge it. If the pain persists give appropriate doses of ibuprofen or acetaminophen (not aspirin). If there’s swelling, you can also apply an icepack on the outside of the jaw. In any case, you should definitely schedule a visit with us for an examination.

If you would like more information on dental care for your child, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child’s Toothache.”

By Bruce E. Hanley DDS
April 06, 2019
Category: Oral Health
KeepanEyeontheJawBoneAfteraTeenagersToothLoss

Accidents happen, especially to teenagers involved with sports or similar activities. In an instant they can lose one or more teeth and permanently alter their smile.

Fortunately we can restore a teenager’s lost teeth, but often not immediately as a permanent restoration with a dental implant requires maturity of their jaw structure. Our focus then turns to the age of the patient and the condition of the underlying bone. A future dental implant, your best choice for tooth replacement, depends on bone for support, but also the age of the patient as it relates to jaw development.

There are a couple of ways an accidental tooth loss can harm supporting bone: first and foremost, the impact of the accident itself can damage the bony socket. To find out for sure we may need to perform a cone beam scan, a type of x-ray that allows us to view the area three-dimensionally. If we do find damage, we can attempt to repair the socket through bone grafting.

Bone can also suffer from the long-term absence of a tooth. Bone has a growth cycle in which older cells dissolve and new ones form to take their place. The force generated by teeth when we eat or chew helps stimulate this growth. Without stimulation, as with a missing tooth, the bone may not grow at a healthy rate. In time, it could lose some of its volume and density and not be able to support an implant.

Installing an implant right after tooth loss could help avoid this situation. Bone has a natural affinity with the titanium post imbedded in the jaw and will naturally grow and adhere to it. But we can’t place an implant with a teenager. This is because the jaw is still developing so an implant would gradually become misaligned as the jaw grows. It’s best to install an implant later after full jaw development in early adulthood.

Today, we can place a bone graft in the empty socket right after tooth loss. The graft serves as a scaffold for bone cells to grow on and will help keep the bone volume at a healthy level until we can install an implant.

Timing is everything in restoring a teenager’s accidental tooth loss. But with coordination and care for the supporting bone, a teenager can eventually enter their adult years with their smile intact.

If you would like more information on restoring your teenager’s smile after tooth loss, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants for Teenagers.”

YouShouldBrushandFlossAroundYourImplanttoEnsureitsLongevity

With a 95%-plus success rate, dental implants are an effective and durable replacement for lost teeth. But we can't place them and forget them: if you don't clean and maintain them they could fail as a result of disease.

The inorganic materials that make up the implant aren't in danger of infection. But the living gums and bone that surround and support the implant are at risk. In fact, there's a particular periodontal (gum) disease involving implants called peri-implantitis (“peri” – around; implant “itis” – inflammation).

Peri-implantitis begins when the gum tissues around the implant become infected and inflamed. This happens most commonly because plaque, a thin film of bacteria and food particles, builds up on implant surfaces. Another less frequent cause is a buildup of excess cement used to bond the crown to the implant. We need to remove the built-up plaque or the excess cement during your dental visit.

If the infection isn't treated or you don't keep up effective, daily hygiene practices, the infection can grow and extend deeper into the tissues and finally the bone. This can destroy the all-important integration of bone and metal titanium post that has created the implant's strong hold. When that support becomes compromised the implant can lose its attachment and, if untreated, eventually fail.

It's important to keep an eye out for any indications you may have a gum infection around an implant. Look for redness, swelling, bleeding or pus formation. If the implant feels loose, this may mean that extensive bone loss has already occurred. If you encounter any of these signs, see us immediately for an examination.

The best approach, though, is to prevent peri-implantitis in the first place. So, brush and floss daily around your implant as you do your natural teeth. And be sure you keep up regular dental cleanings and checkups.

With proper care and maintenance you can avoid problems with disease that could affect your implant. Healthy gums and bone will ensure your implant will last for many decades to come.

If you would like more information on preventing disease involving your dental implants, please contact us or schedule an appointment for a consultation.

ADifferentKindofChipShotforProGolferDanielleKang

While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.

“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.

Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.

Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).

For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.

Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.

If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”

AddressYourTeethGrindingHabitEarlytoAvoidPotentialToothLoss

Teeth grinding and other biting habits are more than a nuisance — they can generate twenty to thirty times the forces of normal biting. Over the long term, this can cause significant damage to teeth and supporting gums and bone.

This particular kind of damage is known as occlusal trauma (meaning injury from the bite). In its primary form, the habit itself over time can injure and inflame the jaw joints leading to soreness, swelling and dysfunction. The teeth themselves can wear down at a much faster rate than what normally occurs with aging. And although less common but even more serious, the periodontal ligaments holding teeth in place to the bone can stretch and weaken, causing the teeth to become loose and increasing the potential for tooth loss.

There are a number of techniques and approaches for treating excessive biting habits, but they all have a common aim — to reduce the amount of force generated by the habit and the associated problems that result. A custom occlusal guard, often worn while sleeping, helps lessen the force by keeping the teeth from making solid contact with each other. Tissue soreness and swelling can be relieved with anti-inflammatory drugs like aspirin or ibuprofen, muscle relaxants or physical therapy. In cases where stress is a main driver, behavioral therapy and counseling may also be helpful.

Biting forces are also an issue for patients with periodontal (gum) disease. In this case even biting forces within normal ranges can cause damage because the diseased gums and bone have already been weakened. If gum disease is a factor, the first priority is to treat the disease by removing built up plaque. Plaque is the thin film of bacteria and food remnant that’s both the cause and continuing growth of the infection, as well as tartar (calculus) from all tooth and gum surfaces.

A thorough dental exam will reveal whether a tooth grinding habit is playing a role in your teeth and gum problems or if it’s magnifying the damage of gum disease. In either case, there are appropriate steps to stop the damage before it leads to tooth loss.

If you would like more information on teeth grinding or other biting habits, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Loose Teeth.”





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