One of the most widely used forms of dental imaging is the bitewing x-ray. So called because of the shape of the device that holds the exposable film a patient clenches between their back teeth, the bitewing x-ray is an effective means for detecting the earliest stages of tooth decay.
These early signs are small lesions on a tooth surface caused by mineral loss in the enamel. While we can identify them on front teeth through visual examination or bright lighting, they’re nearly impossible to see on the biting surfaces of back teeth. The bitewing x-ray solves this problem.
During the procedure, a narrow beam of x-rays is directed at the back teeth area. Since X-rays can transmit through solid matter, they pass through the teeth and gums to expose the film attached to the bitewing assembly.
X-rays pass through matter at different rates depending on the density of the tissue — a slower rate for harder tissues like teeth and bone and a faster rate for soft tissues like the gums. As a result, x-rays through teeth expose less of the film and appear as a lighter image than the gums. This difference is so precise even a tooth’s softer dentin appears slighter darker than its harder outer enamel.
This precision helps us identify decay lesions. Because the lesions on the enamel are less dense than the normal enamel, they’ll appear as dark spots. By detecting them at this stage we have a better chance for reversing the effects of decay or at least minimizing damage that’s already occurred.
Because x-rays emit radiation, there’s a natural concern about over-exposure and we go to great lengths to reduce it. Children may undergo a bitewing x-ray twice a year for developing teeth, while adults with healthy teeth are typically x-rayed just once a year. Advances in digital film and other technology have also helped lower the exposure rate.
Today’s standard 4-film bitewing x-ray produces about four days worth of what we receive on average from normal background radiation, so the health risk is quite negligible. The benefit, on the other hand, is much greater — the early detection of tooth decay could ultimately save a tooth.
You're not just a patient to your dentist—you're also a partner for achieving your best oral health possible. And it takes what both of you do to achieve it.
No doubt your dentist always strives to bring their "A Game" when providing you care. You should carry the same attitude into your personal oral hygiene—to truly master the skill of brushing.
Like its equally important counterpart flossing, brushing isn't mechanically complicated—you need only a minimum of dexterity to perform it. But there are nuances to brushing that could mean the difference between just adequate and super effective.
The goal of both brushing and flossing is to clean the teeth of dental plaque, a built-up film of bacteria and food particles most responsible for dental diseases like tooth decay and periodontal (gum) disease. Brushing removes plaque from the broad front and back surfaces of teeth, while flossing removes it from between teeth where a toothbrush can't reach.
While a lot of cleaning tasks require bearing down with a little "elbow grease," that's unnecessary with brushing—in fact, you may increase your risk of gum recession if you brush too vigorously or too often. All you need is to apply a gentle, circular motion along all tooth surfaces from the gum line to the top of the tooth—a thorough brushing usually takes about two minutes, once or twice a day.
Your equipment is also important. Be sure your toothbrush is soft-bristled, multi-tufted and with a head small enough to maneuver comfortably inside your mouth. Because the bristles wear and eventually lose their effectiveness, change your brush about every three months. And be sure your toothpaste contains fluoride to help strengthen your enamel.
One last tip: while it may sound counterintuitive, don't brush immediately after a meal. Eating increases the mouth's acidity, which can temporarily soften the minerals in tooth enamel. If you brush right away you might slough off tiny bits of softened enamel. Instead, wait an hour before brushing to give your saliva time to neutralize the acid and help re-mineralize your enamel.
Unlike your dentist partner, your role in caring for your teeth doesn't require years of training. But a little extra effort to improve your brushing proficiency could increase your chances for a healthy mouth.
If you would like more information on best practices for personal oral hygiene, 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 “10 Tips for Daily Oral Care at Home.”
When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.
“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”
The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”
A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.
It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.
So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
You may be among the one in three Americans who suffer from the pain of tooth sensitivity. Before attempting treatment, though, we must first identify the cause.
Your teeth are made of layers of different organic tissue. The pulp at the center of the tooth contains nerves that transmit pain or pressure sensation to the brain. The pulp is encased by dentin, a layer of tissue composed of tiny tubules that conduct temperature and pressure changes from outside the tooth to the pulp nerves. The hard outer enamel shell shields the dentin from over-stimulation from these sensations.
There are, however, some instances where the dentin may become exposed and cause sensitivity in the tooth. This can occur when the gum tissue recedes and the root of the tooth is exposed to the oral environment. If the root loses its surface coating (referred to as cementum, a cement-like outer layer around the root surfaces) because of over-aggressive brushing (too hard for too long) or advanced periodontal (gum) disease, sensitivity is often the result.
Another instance is enamel erosion. Although made of the hardest substance in the human body, enamel has one major enemy — acid. A high oral acid level brought on by over-consuming acidic foods and beverages or as a symptom of gastric reflux disease dissolves (de-mineralizes) the enamel’s mineral content. Brushing just after eating actually contributes to de-mineralization because the enamel is in a softer state. It requires forty-five minutes to an hour for your saliva to neutralize acid and restore minerals to the enamel — you may actually be brushing away enamel with this practice.
Once we know the underlying cause, we can use an appropriate method to reduce sensitivity. One way is to reduce nerve sensitivity in the dentin’s tubules or block them altogether. There are several chemical products for both home and dental office application that can reduce sensitivity and encourage enamel re-mineralization (as can the fluoride added to toothpaste). We can also strengthen enamel and provide a mechanical barrier to acid through concentrated fluoride in a varnish applied to tooth and root surfaces. And, life-like restorations like crowns or veneers not only improve the appearance of your teeth, they can also provide coverage for exposed dentin.
If you are experiencing painful sensitivity, make an appointment to visit us. Once we know the source, we can treat the problem and reduce your discomfort.
If you would like more information on tooth sensitivity and how to treat it, 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 “Treatment of Tooth Sensitivity.”
Even though a child’s primary (“baby”) teeth eventually give way, it’s still important to treat them if they become decayed. Primary teeth serve as guides for the emerging permanent teeth — if they’re lost prematurely, the permanent tooth may come in misaligned.
If the decay, however, affects the tooth’s inner pulp, it poses complications. A similarly decayed adult tooth would be treated with a root canal in which all the pulp tissue, including nerve fibers and blood vessels, are removed before filling and sealing. Primary teeth, however, are more dependent on these nerves and blood vessels, and conventional filling materials can impede the tooth’s natural loss process. It’s better to use more conservative treatments with primary teeth depending on the degree of decay and how much of the pulp may be affected.
If the decay is near or just at the pulp, it’s possible to use an indirect pulp treatment to remove as much of the softer decay as possible while leaving harder remnants in place: this will help keep the pulp from exposure. This is then followed with an antibacterial agent and a filling to seal the tooth.
If the pulp is partially exposed but doesn’t appear infected, a technique called direct pulp capping could be used to cover or “cap” the exposed pulp with filling material, which creates a protective barrier against decay. If decay in a portion of the pulp is present, a pulpotomy can be performed to remove the infected pulp portion. It’s important with a pulpotomy to minimize the spread of further infection by appropriately dressing the wound and sealing the tooth during and after the procedure.
A pulpectomy to completely remove pulp tissue may be necessary if in the worst case scenario the pulp is completely infected. While this closely resembles a traditional root canal treatment, we must use sealant material that can be absorbed by the body. Using other sealants could inhibit the natural process when the primary tooth’s roots begin to dissolve (resorb) to allow it to eventually give way.
These all may seem like extraordinary efforts to save a tooth with such a short lifespan. But by giving primary teeth a second chance, their permanent successors will have a better chance of future good health.
If you would like more information on treating decay in primary teeth, 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 “Root Canal Treatment for Children’s Teeth.”
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