General Dentist or Dental Specialist?

A conundrum often faced by patients is- when should we visit a General Dentist and when should we approach a Dental Specialist?

A General Dentist can usually perform all basic procedures and specialist procedures to a certain degree. These procedures might include root canals, crowns, dentures and basic surgeries. They often self-determine which specialized treatments they want to perform themselves and when they would prefer referral to a specialist. 

A Dental Specialist spends a longer time in dental college to receive additional training in performing more specialized oral care in a particular field of study. Besides performing all basic procedures, they can perform highly specialized procedures in their field.

It is always best to first visit your family’s trusted General Dentist for your treatment. This will generally result in you receiving the care and treatment you need while being easier on your wallet. ;)  If a complicated procedure is needed, you will be referred to a specialist anyway.

From my Clinic Diaries:

A week back, a young patient came into my clinic with a fractured wisdom tooth and an associated lemon-sized swelling. Though she accepted that the best course was to eventually extract the tooth, she was terrified that she was due to visit a specialist for major surgery. She had heard that wisdom teeth had to be removed surgically and envisioned a dramatic and painful scene involving drills, hammers and rivers of blood.

She was misinformed in this case. A general dentist would commonly refer a patient to an oral surgeon for a wisdom tooth extraction when the tooth is impacted. An “impacted tooth” is a tooth that has not completely erupted, or a tooth that is positioned awkwardly in the jaw and not erupting in a normal manner. A surgeon would usually have to perform a minor surgery which would involve minimal drilling of bone, wedging out the tooth with simple leverage and suturing of the gum.

My patient had a completely erupted wisdom tooth and I proceeded with a simple, uneventful extraction of the tooth. And of course…I used local anesthesia too! ;)

What should you do if you swallow a dental bridge or a denture?

Most people who swallow a dental prosthesis, do so by accident. Often people do not even realize they have swallowed a bridge or a denture, its loss is discovered later. Sometimes it takes x-ray imaging to convince a person that a dental object has been swallowed- the truth can be a bit hard to swallow! ;)

When there are no symptoms; an x-ray or any other type of imaging, helps to check whether the position of the denture or bridge in the body is dangerous. In most cases, a physician’s initial suggestion will be to wait and watch.

Yes, a swallowed dental bridge usually obeys the old proverb, “This too shall pass”. You may be advised to keep close watch for 3-4 days and you may find the worry was just a “passing” thing ;) Do not attempt to vomit or take laxatives, it may do more harm than good. Unless a bridge is really very large, it is unlikely that you would have to take any further measures. You can wait and cross your bridges when you come to them. :)

Dental bridges are sometimes worth a small fortune. You can opt to have a retrieved bridge cleaned, sterilized and replaced in the mouth.

A swallowed denture with clasps can be a little tricky. Now this may be a bitter pill to swallow, but you may be advised to schedule a removal procedure. The hooks on a denture can lead to perforations so preventive steps are often necessary.

If you develop symptoms of painful swallowing, sore throat, choking sensation, fever, pain in the chest or abdomen, the dental object has to be removed using an interventional procedure. An inhaled dental prosthesis can cause a severe cough and difficulty in breathing. An immediate visit to the ER is the best bet.

Prevention: Your dentures and bridges need to have a good fit. Age-related bone changes can cause loosening of dentures. Never wear dentures at night. Prolonged denture use leads to decreased palate sensitivity. Along with chicken and fish bones, dentures can be swallowed by mistake. Always…always chew your food properly! This will make it less likely that you will swallow a dental prosthesis.

Chew on this: gum may be good for you!

The act of chewing gum increases flow of saliva in your mouth. If you chew sugar-free gum after a meal, the extra saliva flow will help neutralize acids and clear food from the mouth, basically washing your teeth for you. Saliva also contains calcium and phosphate which can strengthen tooth enamel. Clinical studies have shown that chewing sugarless gum for 20 minutes following meals can help prevent tooth decay. It may also prevent teeth staining, thus keeping your teeth whiter for longer.

Some people do not produce enough saliva. This may be due to illness or certain medications. Chewing sugar-free gum can help with dry mouth symptoms by stimulating saliva formation.

So can you replace your tooth-bush and floss with bubble-gum? Sorry to burst the bubble, but chewing gum is NOT a substitute for brushing and flossing! Brushing teeth with a soft brush and fluoridated tooth paste is still the gold standard in oral hygiene.

Now you may find this difficult to digest…but chewing sugar-free gum can also help with your digestion! If you chew gum after meals, excess saliva is produced. This forces you to swallow more. Increased swallowing keeps your stomach busy forming digestive acids. Your meal will digest faster!

Are you trying to lose weight? There are claims that chewing gum reduces hunger. The chewing action and flavor of gum supposedly reduces craving for other snacks too. Of course if you expect only chewing gum to shave off those inches, it is only your patience that will wear thin! ;) Gum should only be an accompaniment to diet and exercise.

Recent preliminary research shows that gum may increase focus, concentration and alertness. It possibly also eases stress and tension.

Just remember, don’t bite off more than you can chew! Swallowing gum is not very healthy and constant chewing between meals may lead to excess production of stomach acids. Gum with sugar leads to tooth decay, so chew only sugar-free gum sweetened with xylitol.

How clean is your toothbrush?

Your toothbrush helps keeps your teeth and gums healthy and clean. For that, it needs to be clean itself!

Where do you keep your toothbrush?

Most people have small bathrooms. Perhaps you keep it on the flush tank or near the sink 2-3 feet from the toilet. Every time a toilet it flushed, numerous air-borne bacteria are sprayed into the air. Many may find their way to a nearby toothbrush and lodge themselves there comfortably. This would make your toothbrush a breeding ground for bacteria which would find their way into your mouth eventually.

Store your toothbrush away from your toilet. If your bathroom is small, a bathroom cabinet would be a good idea. You can store it in your room too.

Moist brushes are a hot-bed of germs

How do you store your toothbrush?

Perhaps you keep your toothbrush horizontally, lying on a shelf. You may be very conscientious and keep the toothbrush head in a little plastic case, hoping that it stays clean. Unfortunately, a moist toothbrush head in a closed plastic case is a safe haven for bacteria. They flock there, breed actively and wait for an opportunity to get into your mouth.

Do not enclose the moist brush head in a plastic case or let it lie on its side in a puddle of water. It would be best to store your toothbrush in an upright position. Let the water drain away and allow it to dry before enclosing it.

Keep in mind…

- DO wash your hands with soap and water thoroughly before brushing.

- DO rinse your brush thoroughly before and after use, preferably in warm water.

- DO change your brush every three months. Even the brush head on an electric tooth-brush needs to be changed as often. Change it sooner if the bristles are obviously frayed or if you have a weak immune system. Change your brush if you have been ill.

- DO NOT share your tooth-brush with anyone. It may be romantic to share a brush, but it is not as romantic to exchange germs.

- DO NOT store several brushes in close contact. Separate them out in individual holders.

 Ultra-violet light sanitization, heating brushes in microwaves  or spraying brushes with sanitizing sprays have not been shown to have any positive or negative health benefit.

Remember, there is no reason to panic! Our mouth harbors several types of bacteria and our bodies can take care of a few more bacteria from a tooth brush without succumbing to infection. That said, a healthy balance of bacteria in the mouth should be maintained, prevention being better than cure. :)

Teeth can be sensitive too!

Tooth sensitivity is the discomfort or tingling felt on having cold or hot drinks, sweets, ice-creams. This pain may be felt when cold air hits the teeth or while brushing and flossing too.

Sensitivity in a single tooth usually suggests that the tooth has developed a cavity or is cracked and needs urgent attention. A tooth filling can also cause sensitivity.

Global tooth sensitivity or sensitivity across many teeth has several causes.

Why does global teeth sensitivity occur?

The most common cause of global tooth sensitivity is brushing with a hard brush or using an abrasive tooth-paste. Enamel, the thick outer covering of the tooth, gets damaged and is removed over time, exposing the softer yellow dentine. Dentine contains fluid-filled tubes which lead to the nerves at the core of the tooth. Without enamel to protect them, these nerves are easily stimulated by fluid movement in the dentinal tubules and make teeth sensitive. So if you don’t want your teeth to be sensitive, they need to have a thick skin! :)

Acid erosion of teeth causes sensitivity. Regular consumption of carbonated drinks like colas and fruit juices or gastro-esophageal reflux disease (GERD), more commonly known as “heartburn”, leads to tooth erosion and thus, sensitivity.

Gum disease leads to gum recession, which means that gums pull away from the teeth or become loose. The tooth root can get exposed. Tooth roots are covered with cementum, not enamel. Cementum is very soft, more susceptible to decay and if brushed hard, wears off even faster to expose dentine.

Bruxism or teeth grinding is a habit that may be caused or worsened by stress. It is often done subconsciously. Bruxism may cause gum recession and decay which leads to sensitivity as described above. It may wear off the enamel from the tops of teeth, cause cracks and tooth fractures and thus expose the dentine.

Teeth whitening may cause sensitivity if teeth are already compromised in one of the above ways. This is because the whitening agent has to undergo a chemical reaction with enamel. A chemical reaction with thin enamel or dentine can cause sensitivity. Products of inferior quality, such as over-the-counter strips or gels bought online or at a chemist may contain highly acidic unstable bleaches. A dental consultation and examination is very important before whitening.

Treatment

Tooth sensitivity can be prevented by using a soft bristled tooth brush and brushing gently. Toothpastes should not be too abrasive and acidic foods should be avoided.

Non-alcoholic mouthwashes with fluoride content may help re-mineralize teeth. Often an underlying condition needs to be treated. A mouthguard for bruxism, antacids for gastric reflux would reduce sensitivity. Desensitizing toothpastes help decrease symptoms.

Dentists can recommend special gels to decrease sensitivity. Special varnishes can be painted onto the teeth or bonding may be applied over exposed dentine.

Summer Tips For Teeth Care

Summer Tips For Teeth Care has been featured in the Femina issue dated 30 May, 2012!

See a snapshot of the article below this month's blog update

Bat for your teeth this summer

Summer sports and outdoor games may lead to broken teeth. A forceful blow can even cause a tooth to pop out of its socket!

Play safe: wear a mouth-guard

Your dentist can give you a protective mouth-guard. This will protect your teeth. If you break a tooth, rinse to clean the area, place a cold compress and call your dentist. If your tooth falls out, do not clean it. Immediately place it in milk or hold it under your tongue. Rush to your dentist! You may be able to have the tooth replaced in its socket.

Don’t drown your teeth

Swimming pool water is rich in chemicals used for disinfection. This can be very damaging to your teeth. Prolonged exposure to  pool water can even lead to hard brown deposits on teeth. This is known as “swimmer’s calculus”.

Let your teeth breathe

After swimming, rinse your mouth with mouthwash or atleast clean drinking water. 

Soft drinks are hard on teeth

Summer heralds the onslaught of tooth stripping colas. Sports drinks and energy drinks too have a high concentration of acids and cause dental damage. Excessive citrus content is acidic and will wear down tooth enamel. 

Protect your teeth
Have fizzy drinks with meals as saliva production increases and neutralizes acids.  Do not swish acidic beverages in your mouth. Sip with a straw to minimize enamel loss. Rinse your mouth after having sugary drinks. Hydration is important so consume lots of water, especially after meals.

Floss after candy-floss

Sugary snacks like ice-cream and candy-floss stick to teeth and lead to tooth decay.

Fiber is like detergent
Eat plenty of fresh fruits and vegetables. Pears, lettuce and carrots are detergent foods and clean away sticky food particles. Avoid snacking between meals, but if you do, chew sugarless gum. It will help clear some of the debris stuck in your teeth. Brush twice a day with a soft brush and fluoridated toothpaste. Floss daily too!


In Femina issue, 30 May 2012:

Pregnancy and Oral Care

Expecting a baby? Here's what to expect from a mother's teeth and gums.
Research shows that bacteria from a mother’s mouth can be transmitted through amniotic fluid to her unborn child. Dental health of a pregnant woman, which is practically ignored, is a risk factor for poor birth outcomes (premature delivery, a low birth-weight baby or fetus infection). 

Frequent dental check-ups

If possible, a visit to the dentist should be planned before pregnancy for a check-up and to complete all required treatment. If this is not possible, dental treatment can still be safely planned for the second trimester before the final stretch, pun intended! ;) Overdosing on painkillers to avoid treatment can be harmful to the mother and baby. No point in gritting teeth (no pun intended!) and bearing pain either.

Pregnancy has an effect on gums

High hormonal levels in a mother's system often causes an exaggerated response to dental plaque. This results in pregnancy gingivitis -puffy red gums which may be tender and bleed on brushing. Occasionally pregnancy tumors may appear. These gum over-growths have a red, mulberry-like surface. They have to be surgically removed after delivery. Frequent dental cleaning at appropriate times during pregnancy removes plaque. Brushing and flossing well always helps!

Dealing with Morning Sickness and Food Cravings

In case of frequent vomiting, the stomach's acidic contents demineralize tooth enamel. Rinsing the mouth out with a neutralizing mouthwash helps.

Craving for sugary snacks is common but this causes tooth decay. A balanced diet with wholesome foods such as dairy products, fresh fruits and vegetables is a good source of essential minerals.

Pregnancy Myths

- Teeth will be lost during pregnancy

Your teeth are in your hands, not literally ofcourse! ;) Good oral hygiene and early visits to the dentist will prevent any problem. 

- Dental radiographs (x-rays) are forbidden in pregnancy

Excessive radiation can be harmful, but radiation from dental x-rays is very low. A mother’s untreated dental infections can pose a bigger risk to a baby’s health than dental x-rays. Sometimes radiographs are absolutely necessary in dental emergencies and dentists use leaded aprons to minimize radiation exposure. X-ray technology is much safer today. 

- Calcium from teeth is lost during pregnancy

An unborn child gets calcium from a mother’s diet, not teeth! If a mother does not ingest sufficient calcium, her body will provide the baby with calcium from her bones. It is best to consume dairy products or take supplements recommended by an obstetrician.

- Pregnant women are not allowed local anesthetic injections

Local anesthesia is allowed at certain times during a pregnancy. Necessary dental treatment can be scheduled in the second trimester.

The daily grind: is stress setting your teeth on edge?

 Is stress or depression wearing you down? It may be wearing down your teeth too! Emerging research indicates that stress not only invites hypertension, diabetes, heart attacks, stomach problems and migraines, but also damages your teeth.

Stress is related to:

Bruxism

Grinding of the teeth or clenching of the jaw is a habit that may be caused or worsened by stress. It is often done subconsciously and leads to wearing and fracturing of teeth. Pain develops in the face and ear as the jaw joint gets damaged.

Tender gums, bleeding or swollen gums, loose teeth and bad breath

Research shows that the immune system has a more difficult time fighting off infection in the presence of stress. Cortisol, a hormone produced in excess by stress, can lead to increased destruction of gums and jaw bone, as well as to a suppressed immune system that allows the bacteria to flourish.

Mouth sores

Non-contagious canker sores are small grey-white ulcers with red borders. These can be painful and are known to occur at the time of emotional upsets. Cold sores or “fever blisters” are contagious fluid filled blisters that can be triggered by stress or lack of sleep.

Poor oral hygiene from unhealthy eating routines

It gets hard to take care of everyday things when you are stressed, sad or depressed. You may smoke or eat unhealthy food. You may ignore your oral hygiene and not schedule regular dental check-ups. Unhealthy eating routines can cause acid reflux which may erode your teeth making them susceptible to decay.

Even drugs used for treatment of stress or depression may cause dry mouth. Decreased saliva causes tooth decay.

Regular exercise, plenty of sleep and a balanced diet can reduce stress. A positive mental attitude is beneficial too!  Meditation and yoga are also helpful. This will help you live better and longer with a healthy smile. You can make your body happy and healthy by keeping your natural teeth! :)

Tooth & Jaw Pain: Is your heart crying out for help?

Everyone knows that pain in the left arm and shoulder may indicate a heart attack. Rather, it is hoped that everyone knows that. 
But did you know that pain in the teeth and jaw can also be an indicator of a heart attack?

There are many reported cases of people having heart attacks without experiencing tell-tale signs like left arm and shoulder pain. Even shortness of breath or cold sweats may not always occur.

Most heart attacks begin with subtle symptoms - with only discomfort that often is not described as pain.

Did you know these symptoms may also herald a heart attack?

Pain: in the jaw, gums and teeth, face, neck, upper abdomen or legs! This is usually a pressure pain or a burning pain.

Invisible Symptoms: Visual or sleep disturbances, stress, unusual fatigue, anxiety, nausea and vomiting, flushing, dizziness, panic attacks or a feeling of impending doom.

Heart attacks may be prevented if your doctor is aware of your symptoms in time.

A study shows that the most severe symptoms in the 90 days before an attack included pain and anxiety/fatigue. Majority of women who have suffered heart attacks did not have chest pain or upper left arm or shoulder pain preceding it. Research also shows that women may experience symptoms which lead to a heart attack almost 4-6 months before the attack!  

WAIT !

This does not mean that every time you have tooth or jaw pain, you should visit a cardiologist! More often than not, the cause is dental. A visit to the dentist is recommended to help zero in on the cause. A follow-up visit with your family doctor may be advised, if required. It is important to remember that pain is the body’s way of warning us of disease. Please do not ignore warning signs and symptoms.

For those with an academic interest...

Read about a very unusual case reported by Dr. Hatim Attar and me.

Dental Pathology Overlapping With Cardiac Origin Of Jaw Pain Leading To Myocardial Infarction: A Case Report

32 Reasons for a Professional Shine...

...every tooth being a reason to smile!

Unfortunately, teeth are not always perfectly shaped and not everyone has a smile with their teeth forming a perfect curve. Even if you brush and floss with a great deal of effort; there may be that one little nook or cranny that gets missed out. It may happen where one tooth overlaps another, or perhaps it may happen right at the back, maybe around your wisdom teeth. Often gaps between teeth are overlooked too.

Sadly, it is these hard-to-reach spaces that cause problems. These un-cleaned areas will harbor bacteria that are itching to wage war on your teeth.

During the day, a soft sticky film called plaque forms on the teeth. Plaque contains bacteria which form acids and weaken your teeth. Weakened teeth begin to decay.

Normally, a good brushing with a brush and fluoridated toothpaste can sweep away most of the plaque. However, plaque re-forms every few hours. Also sometimes plaque gets left behind in the hard-to-reach spaces. In a short while, plaque hardens into calculus or tartar which brushing cannot remove. If this gritty tartar is allowed to remain on your teeth, it helps bacteria thrive right next to your gums. This may then cause infection and bleeding. It is almost impossible to brush away tartar.

Dental scaling or dental cleaning is done to remove this tartar and leave your teeth clean and smooth so you can continue to clean them easily at home. A dentist can also remove stains (such as tea, coffee and tobacco) making it harder for the bacteria to get a foothold on your teeth. Polishing is then done using rotating brushes and paste. This makes your teeth look and feel cleaner. Scaling and polishing can be finished in a very short time if you care for your teeth regularly at home and brush well.

From my Clinic Diaries:

You can have too much of a good thing.

One of my patients recently visited the clinic for dental scaling and polishing. After a complete cleaning and polishing with flavored paste, she confessed that she usually schedules her appointment prior to a date. She inquired whether it was possible to come in for a quick polishing once a week before going on a date and admitted that it boosted her kissing skills.

I had to regretfully decline. The dental paste I use for polishing does have visibly sparkling effects and a refreshing flavor, but it is certainly more abrasive than daily use toothpaste. Regular use of professional polishing paste may cause wearing of tooth enamel. Professional cleaning is usually necessary once in six months or when recommended by a dentist.




If you would like more detail, this YouTube video describes the formation of plaque, its effects and the process of dental scaling.