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Wednesday, April 26, 2017

Tooth Sensitivity and Solutions

Everyone has tooth pain when they bite into something hot or cold, right? 

No! Hypersensitivity is actually your first indication that something is wrong. Tooth sensitivity affects about 1 in 2 adults. There are many causes tooth sensitivity and it is an easily treatable condition.

Causes of tooth sensitivity

  • How you brush your teeth. Brushing with too much force or using the incorrect toothbrush are the most common reason for tooth sensitivity. Over time, your enamel may get worn down and the dentin tubules (cover your tooth surface and are like pores that lead to the nerve) are exposed which causes pain especially when you eat acidic, sticky or hot or cold beverages. Over-zealous brushing can also cause gum recession, which exposes the tooth root and the delicate nerve endings which causes sensitivity. Solution: brush gently with the proper toothbrush.
  • You may clench or grind your teeth (bruxism). You may do it while awake, especially under stress but you not even know you are doing while you sleep. If you wake with sore jaw muscles, suffer from headaches, notice teeth are chipped, cracked or worn this could be the cause. Solution: Dr. Bertolini can do a comprehensive exam to evaluate your specific treatment plan. This plan will most likely include wearing an occlusal splint or night guard while you sleep to prevent further damage and relieve some of the pressure of your bruxing. These are custom made by Dr. Bertolini or his lab to ensure it treats your unique situation.
  • You whiten your teeth. For some people, tooth whitening can cause tooth sensitivity. This is temporary and treatable. Solution: Dr. Bertolini recommends wearing our whitening trays for two-30 minute periods every other day instead of overnight to reduce this pain. Following up with a desensitizing toothpaste 30 minutes after whitening. He also recommends beginning whitening treatment with a low-concentration product and increase if you do not have symptoms.
  • You may have a cavity. When decay occurs, the tooth structure becomes softer and more porous and the enamel is not able to protect the tooth properly, which may be causing the sensitivity. Solution: Have the decay removed and restoring the tooth with a crown, onlay or bonding.
  • You may have gum disease. When you have gum disease, your gums may begin to recede and expose your tooth root and the delicate nerve ending which can cause sensitivity. Solution: Having regular check-ups are your best defense to detect and treat gum disease at its earliest stage. Desensitizing toothpaste, Dr. Bertolini recommends one containing potassium nitrate which works by shielding the exposed nerve endings which reduces the sensitivity.

Managing tooth sensitivity

Depending on the cause of your sensitivity, using a desensitizing toothpaste, containing potassium nitrate might be all you need. Unfortunately, these do not work for everyone. Another option is a fluoride varnish Dr. Bertolini would apply to the sensitive areas to strengthen the tooth enamel and reduce the pain. A third option is a bonding resin he can apply to protect the sensitive root surfaces. If your pain is caused by excessive loss of gum tissue, a surgical gum graft may be your best solution. An office visit is the only way to determine the cause of your sensitivity and the best solution for your unique situation

Wednesday, April 12, 2017

Some Wisdom On Extracting Wisdom Teeth

In our previous blog post, Some Wisdom On Wisdom Teeth, we discussed what wisdom teeth are and why you may need to have them removed. Today we are covering what will happen if they do need removed and post-op instruction to achieve proper, timely healing.
If your wisdom teeth are extracted by our dental office, Dr. Bertolini will give you a local anesthetic to numb the area of removal. If your teeth are severely impacted, Dr. Bertolini will refer you to an oral surgeon for the extraction and they would use a general anesthetic which would cause you to be asleep for the procedure. In either scenario, after the extraction you may need stitches to promote healing of the tissue. Some stitches will resorb or dissolve over time and others will need to be removed by the doctor. Dr. Bertolini will tell you whether yours need to be removed.

The recovery period after an extraction should only last for a few days and you can avoid complications if you follow these instructions:

Right after surgery

  • Keep gentle pressure on the extraction site by biting on gauze. 
  • Use 2 pieces of gauze folded in half and in half again. 
  • Check every 10-15 minutes, changing gauze as needed. Call our office or the oral surgeon if bleeding persists after 24 hours.

For the first 24 hours 

  • Eat soft foods today and chew more toward the front of your mouth.
  • Be careful not to bite the inside of your cheeks, lips or tongue while you are still numb. 
  • Do not eat or drink things that are very hot (temperature hot or spicy hot) or things that are very cold. You don’t want to shock the extraction sites. 
  • Do not smoke and do not drink through a straw - both can dislodge the blood clot in the extraction site, causing a dry socket (which can be very painful.)
  • Do not drink alcohol or carbonated beverages. 
  • If needed, for discomfort, take what you would normally take for muscle aches or if Dr. Bertolini prescribed something for pain, take as directed.
  • Do not lie flat, elevate your head and chest with pillows.
  • Use ice packs on the outside of your cheeks, do this for about 20 minutes at a time.
  • No strenuous activity, it may cause an increase in bleeding.
  • Continue your regular oral hygiene, carefully near the extraction site.

24 hours after extraction

Extraction Upper Extractions Sites

  • Starting 24 hrs after surgery, rinse the area with a mixture of sea salt or non iodized salt in warm water (1/4 tsp. salt in 8 oz. warm water). 
  • Do this after each meal to keep the sites clean. 
  • Do this rinse at least 7-10 days after the surgery. 
  • Use moist heat for discomfort after the first 24 hours. This could be a wash cloth or hot water bottle (just not too hot).

Lower Extraction Sites

  • Starting 24 hrs after surgery, fill the plastic syringe you were given by our office with a mixture of sea salt or non iodized salt in warm water (1/4 tsp. salt in 8 oz. warm water). 
  • Looking into the mirror over the bathroom sink, aim the tip of the syringe at one of the sites, gently press on the plunger of the syringe to push water into the site and remove any food debris. 
  • Continue with the other side. 
  • Do this after each meal to keep the sites clean. 
  • Do this rinse for at least 7-10 days after the surgery. 
  • Use moist heat for discomfort after the first 24 hours. This could be a wash cloth or hot water bottle (just not too hot).
Please contact Dr. Bertolini if anything unusual occurs: bleeding will not stop, pain lasting beyond 72 hours that the pain reliever will not relieve, fever greater than 101.
Complete healing of gums may take three to four weeks. For the first day or two, eating soft foods and avoid things that could get stuck in the extraction site is best. As the sites begin to heal, regular foods that require chewing can be added back into your diet.
If you do need your wisdom teeth removed, it's best to have the procedure done promptly because the more time that passes increases risks of complication and longer healing time.

Wednesday, April 5, 2017

Some Wisdom On Wisdom Teeth

What are wisdom teeth?

Wisdom teeth is another name for the last teeth in your permanent dentition, also known as third molars, usually arriving between the ages of 17-25 years. While most people have wisdom teeth, it is common to have a varying number of them, usually between one and four but occasionally more. Most wisdom teeth are impacted, which means you would not be able to see them when you look in your mouth because they have not erupted through your gingival tissue (your gums and supporting tissue).
If they are not visually present, Dr. Bertolini will confirm their presence with a panoramic x-ray and give you a diagnosis. If they do not need to be extracted because they have room to erupt through the tissue and won't cause problems for the surrounding molars, it is very important that they be examined regularly at your hygiene appointments. The location of wisdom teeth in your mouth can make it extremely difficult to clean and floss around effectively.

Why remove wisdom teeth?

Wisdom teeth are the last to develop and despite your best efforts they, more often than not, cause problems because of a lack of space in your jaw. This lack of space causes:

  • Wisdom teeth that do erupt can cause crowding or damage to other molars, because of lack of space.
  • Wisdom teeth can erupt partially and create a place for food and bacteria to get trapped, which then leads to cavities or infection.
  • If wisdom teeth do not erupt in proper position, it is extremely difficult to brush, floss and clean between adjacent teeth.
  • If wisdom teeth are impacted, they will probably never erupt and can cause a cyst to form in the area which can cause damage to surrounding bone and teeth.
Besides disturbing the position of your other molars and difficulty cleaning, wisdom teeth may need to be extracted because the area can become infected. If this should occur, Dr. Bertolini would schedule an emergency extraction.

What are signs of infection?

  • Swollen gum tissue behind the last molar.
  • A bad taste or smell in your mouth.
  • Intense pain in the back of your mouth when biting down.
  • Swelling in the general area of the wisdom teeth; could be teeth, jaw or cheek.
  • Difficulty swallowing, breathing or fever.
If not removed promptly, the infection can damage your other teeth and the bone around the infection site or become cystic. Warm salt water rinses or antibacterial mouth rinse and OTC painkillers can be used as short-term remedies, until your extraction appointment. Prolonged use of painkillers can actually worsen the condition because, while your pain is masked, the infection will worsen without removing its source. 
If you have any of the above symptoms of infection, being seen by Dr. Bertolini at the first sign will help minimize any complications.