Dr. Park’s Dental Publications
Tooth Extraction | Prevention | Root Canal Treatment | Dental Crowns | Dental Implants
Dr. Park’s Own Published Articles.
Q. How often do you change your toothbrush?
A. I recommend my patient to change his/her toothbrush on the first day of each month.
1. Abscessed Tooth.
When you have tooth decay or gum disease, you can get an infection deep within the tooth or gum. This infection is an abscessed tooth and can be very painful. If it is not treated, the infection can spread and you can lose your tooth or have other health problems.
A tooth abscess is an infection at the root of a tooth or between the gum and a tooth. The most common cause is severe tooth decay. Other causes of tooth abscess are trauma to the tooth, such as when it is broken or chipped, and gum disease. These problems can cause openings in the tooth enamel, which then allows bacteria to infect the center of the tooth (the pulp). The infection may also spread from the root of the tooth to the bones supporting the tooth.
Toothaches that are severe and continuous and results in gnawing or throbbing pain or sharp or shooting pain are common symptoms of an abscessed tooth. Other symptoms may include: fever, pain when chewing, sensitivity of the teeth to hot or cold, bitter taste in the mouth, foul smell to the breath, swollen neck glands, general discomfort, uneasiness, or ill feeling, redness and swelling of the gums, swollen area in the upper or lower jaw, and an open, draining sore on the side of the gum. If the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn’t mean the infection has healed; the infection remains active and continues to spread and destroy tissue. Therefore, if you experience any of the above listed symptoms, it is important to see a dentist even if the pain subsides.
How is an abscessed tooth diagnosed? Well, your dentist will probe your teeth with a dental instrument. If you have an abscessed tooth, you will feel pain when the tooth is tapped by your dentist’s probe. Your dentist will also ask you if your pain increases when you bite down or when you close your mouth tightly. In addition, your dentist may suspect an abscessed tooth because your gums may be swollen and red. X-rays also might be taken for further diagnosis.
Strategies to eliminate the infection, preserve the tooth, and prevent complications are the goals of treatment. To eliminate infection, the abscess may need to be drained. Drainage may be done through the tooth by a procedure known as a root canal. The tooth may also be extracted, allowing drainage through the socket.
Finally, a third way to drain the abscess would be by incision into the swollen gum tissue. Antibiotics are prescribed to help fight the infection. To preserve the tooth, root canal surgery may be recommended to remove any diseased root tissue and a crown may be placed over the tooth. Sometimes, the affected tooth may need to be removed.
If your teeth experience trauma (for example, become loosened or chipped) seek prompt dental attention.
2. Gum Disease
Periodontal disease is an infection of the tissues and bone that support the teeth. Untreated gum disease can become very serious, causing teeth to become loose or fall out. Gum disease is usually caused by a buildup of plaque, an invisible sticky layer of germs that forms naturally on the teeth and gums. Plaque contains bacteria, which produce toxins that irritate and damage the gums.
Gum disease progresses in stages. Do your gums bleed when you floss or brush your teeth? Chances are you already have the mildest form of gum disease. Bleeding gums are usually a sign of gingivitis, the mildest form of gum disease. Other warning signs of gingivitis include gum tenderness, redness, or puffiness.
If plaque from teeth and gums isn’t removed by good daily dental care, over time it will harden into a crust called calculus or tartar. Once tartar forms, it starts to destroy gum tissue, causing gums to bleed and pull away from the teeth. This is known as periodontitis, a more advanced form of gum disease.
With periodontitis, gums become weakened and form pockets around the base of teeth. Bacteria pool in these pockets, causing further destruction of the gums. As periodontitis spreads, it damages deeper gum tissue and can eventually spread to areas of the jawbone that support the teeth. This can cause teeth to become loose and fall out. If it’s not treated, it can cause real trouble for your teeth.
Because this process is often painless, a person may be unaware a problem exists. Even if you don’t notice any symptoms, you may still have some degree of gum disease. Some people have gum disease only around certain teeth, such as those in the back of the mouth, which they cannot see. Only a dentist or a periodontist (which is a dentist who specializes in gum disease) can recognize and determine the progression of gum disease.
The body has a natural defense against periodontal gum disease- human saliva. The harmful bacteria in our mouths do not thrive in well-oxygenated environments. Human saliva, however, is rich in oxygen and that is why it helps keep the harmful bacteria populations under control. While a dry mouth and weakened immune system are contributing factors, the anaerobic bacteria are the true causes of gum disease and controlling their population through good oral hygiene and proper hydration are the best defenses against the condition and its potential for causing further medical problems.
Hundreds of types of bacteria live in the mouth, so keeping plaque at bay is a constant battle. What should you do to avoid these problems? See your dentist if you notice any of these signs of gum disease. Do not hesitate to ask questions or feel embarrassed about the situation, it is better to treat it now until it leads to more serious problems.
Bad Breath
In most cases bad breath is caused by the presence of oral bacteria. There can be, however, other factors that influence the odor of one’s breath and, in fact, the quality of a person’s breath will ultimately depend on a number of different variables. Bad breath can directly relate to: Oral bacteria, conditions which promote the growth of oral bacteria, and not cleaning, or not being able to clean, those areas where oral bacteria reside. “Ninety percent of mouth odors come from mouth itself—either from the food you eat or bacteria that’s already there,” says Dr. Richard H. Price spokesman for American Dental Association.
Certain mouth conditions can exacerbate bacterial growth and odor, such as gum disease and dry mouth. Gum diseases are the result of bloody gums, creating more elements for bacteria to putrefy. Saliva helps flush out the mouth, keeping bacteria moving so they don’t settle down and multiply, while a dry mouth is a breeding ground for bacteria. Even if you don’t have much of a problem with bad breath you have probably noticed that your breath is least pleasant in the morning when you first wake up. This is because during the night a person’s mouth will become dry, due to the human body’s natural tendency to reduce salivary flow when a person sleeps. This same souring effect is sometimes noticed by teachers, lawyers, and anyone else whose mouth has become dry after having to speak for a prolonged period of time.
The presence of oral fluids encourages us to swallow and wash away bacteria, as well as the food and debris on which they feed. This same moisture also dilutes and washes away the waste products that oral bacteria produce. Additionally, saliva is the body’s natural mouth rinse. Beyond the washing and diluting effect that any oral moisture can provide, saliva has the added benefit that it contains compounds that kill oral bacteria and buffer their waste products. So, when our mouth becomes dry, all of the benefits that all types of oral moisture can produce are reduced. The net result is that the conditions for bacterial growth are enhanced while the neutralization of bacterial waste products is lessened. Ridding yourself of bad breath may be a several step process, but one way to start is by having good hygiene.
Practicing good oral hygiene is always important, so start here. There are three areas of concern in the mouth: the tongue, teeth, and gums. Brushing your teeth, flossing, and cleaning your gums, followed by rinsing thoroughly, will help minimize the problem by removing the buildup of bacteria.
The tongue may be loaded with decaying food particles and bacteria that cause bad breath. Brushing or scraping your tongue first thing in the morning and before bed will help eliminate the problem here. By removing the buildup of decayed material, a major breeding ground for bacteria, you will reduce your plaque as well. The plaque leads to periodontal disease, which, in turn, can lead to heart disease.
Secondly, eliminating certain types of foods, such as high-fat foods, meat, sugar, exotic spices, and dairy products is the next step in pinpointing the cause of bad breath. The types of food you eat may be one of the reasons for your bad breath. Acidic foods, for instance, create an environment for bacterial growth. High-fat and high-protein foods may not digest well and give off gas.
Eliminating periodontal disease and maintaining good oral health is essential to reducing bad breath. Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odors. Let your dentist know of any concerns.
3. Risks for Tooth Decay
Cavities are one of the most common worldwide health problems, and everyone who has teeth is at risk of getting them. But some factors increase the risk that you will get a cavity or develop tooth decay. If you do not clean your teeth after eating and drinking, plaque builds up, eroding your teeth. There are plenty of factors that play a role in decaying your teeth. An increasing number of older adults still have their natural teeth. However, over time, these teeth can wear down and become more vulnerable to tooth decay and cavities. Older adults also have more decay on root surfaces.
Tooth decay develops at varying rates. It may be found during a routine six-month dental checkup before the patient is even aware of a problem. In other cases, the patient may experience common early symptoms, such as sensitivity to hot and cold liquids or localized discomfort after eating very sweet foods. Some foods and drinks are more likely than others to cause decay. Fermentable carbohydrates are the biggest problem. These foods cling to your teeth for a long time.
Fermentable carbohydrates include all sugars and most cooked starches. Examples include milk, honey, table sugar, soda, raisins, cake, hard candy, breath mints, dried fruit, cookies, dry cereal, bread and potato chips. Some food that may seem like obvious culprits may not be after all. For instance, although candy bars, jelly beans and caramels are sticky and sugary, they’re easily washed away by saliva, making them less of a threat than are potato chips, which stubbornly stick to your teeth. When it comes to your teeth, the amount of sugary snacks you eat is less important than when you eat them. If you frequently snack or sip sodas, acid has more time to attack your teeth and wear them down.
This is also why parents are encouraged not to give babies bottles filled with milk, formula, juice or other sugar-containing liquids at bedtime. The beverage will remain on their teeth for hours and cause erosion — often called baby bottle tooth decay. If you’re nursing or feeding an infant formula, talk to your health care providers about how to prevent early tooth decay. Parents can easily prevent baby bottle tooth decay by not allowing a child to fall asleep with a bottle containing sweetened liquids. Bottles should be filled only with plain, unsweetened water.
The child should be introduced to drinking from a cup around six months of age and weaned from bottles by twelve months. If an infant seems to need oral comfort between feedings, a pacifier specially designed for the mouth may be used. Pacifiers, however, should never be dipped in honey, corn syrup, or other sweet liquids. After the eruption of the first tooth, parents should begin routinely wiping the infant’s teeth and gums with a moist piece of gauze or a soft cloth, especially right before bedtime.
Parents may begin brushing a child’s teeth with a small, soft toothbrush at about two years of age, when most of the primary teeth have come in. They should apply only a very small amount (the size of a pea) of toothpaste containing fluoride. Too much fluoride may cause spotting (fluorosis) of the tooth enamel. As the child grows, he or she will learn to handle the toothbrush, but parents should control the application of toothpaste and do the follow-up brushing until the child is about seven years old.
Tooth Extraction
A tooth extraction might be indicated if repairing a damaged tooth is not practical. Broken, cracked, or extensively decayed teeth can be extraction candidates. Some teeth will have extensive decay (dental caries) in such an extreme manner that an extraction might be considered the best, or at least a reasonable, solution. Of course there will be a number of factors that will come into play with any specific situation.
In some cases the obstacles that present themselves might be so formidable that a repair for the tooth is simply not possible. In other cases the cost of needed dental treatment or else a questionable long-term outlook for the success of the treatment may be the reason an extraction is chosen. Some teeth are extracted because they are mal-positioned. As an example, sometimes when wisdom teeth come in they lie in a position that proves to be a constant source of irritation to the person’s cheek (by either rubbing against the cheek or causing the person to bite it). As a solution, it may be suggested that the offending wisdom teeth should be extracted.
Also, teeth might be extracted because they provide very little service to the dental patient but do offer risk for becoming problematic. A common example is a wisdom tooth that has come in but has no matching tooth to bite against. Wisdom teeth are typically in a region of the mouth that is hard to clean, thus placing them and their neighboring tooth at greater risk for decay and periodontal disease. Depending on the precise circumstances that they find, your dentist may advise their patient that removing a nonfunctional tooth might be in that patient’s best long-term interest in regards to maintaining good oral health.
Impacted teeth are often extracted. Impacted teeth are teeth whose positioning in the jaw bone is such that they cannot erupt into normal alignment. So by definition, impacted teeth are mal-positioned and because they are mal-positioned they are often nonfunctional. This combination of factors makes impacted teeth common candidates for extraction as well.
An important aspect of aftercare is encouraging a clot to form at the extraction site. The patient should put pressure on the area by biting gently on a roll or wad of gauze for several hours after surgery. Once the clot is formed, it should not be disturbed. The patient should not rinse, spit, drink with a straw, or smoke for at least 24 hours after the extraction and preferably longer. He or she should also avoid vigorous exercise for the first three to five days after the extraction.
For the first two days after the procedure, the patient should drink liquids without using a straw and eat soft foods. Any chewing must be done on the side away from the extraction site. Hard or sticky foods should be avoided. The mouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed. Wrapped ice packs can be applied to reduce facial swelling. Swelling is a normal part of the healing process; it is most noticeable in the first 48–72 hours after surgery. As the swelling subsides, the patient’s jaw muscles may feel stiff. Moist heat and gentle exercise will restore normal jaw movement. The dentist or oral surgeon may prescribe medications to relieve postoperative pain.
Tooth extractions are necessary when decay or an abscessed tooth is so severe that no other treatment will cure the infection and should be done as soon as possible to avoid the spread of infection and more serious problems. Always ask your dentist for any questions that you may have. It is always in your advantage to fix the problem as early as possible.
Prevention
As always, good oral and dental hygiene can help prevent cavities and tooth decay. Brush after eating or drinking is one way to start. Brush your teeth at least twice a day and ideally after every meal, using fluoride-containing toothpaste. To clean between your teeth, floss or use an inter-dental cleaner. If you can’t brush after eating, at least try to rinse your mouth with water or chew gum.
In fact, researchers are developing new means to prevent tooth decay. One study found that chewing gum that contains the sweetener xylitol temporarily retarded the growth of bacteria that causes tooth decay. In addition, several materials that slowly release fluoride over time, which will help prevent further decay, are being explored. If your dentist feels you are at higher risk of developing a cavity, using a fluoridated mouth rinse can help reduce your risk as well.
Considering dental sealants, especially for children are a good idea. A sealant is a protective plastic coating that is applied to the chewing surface of back teeth — sealing the grooves in the teeth most likely to get cavities. The sealant protects tooth enamel from plaque and acid. Sealants can help both children and adults. All school-age children are recommended to get sealants. Sealants last for several years before they need to be replaced.
Try to avoid frequent snacking and sipping. Whenever you eat or drink something, you help your mouth create acids that destroy your tooth enamel. Your teeth are under constant attack every time you eat or drink fluids. Considering healthier types of food are to your advantage. Some foods and beverages are better for your teeth than others. Avoid foods that get stuck in grooves and pits of your teeth for long periods, such as chips, candy or cookies. Instead, eat food that protects your teeth, such as cheese, which some research shows may help prevent cavities, as well as fresh fruits and vegetables, which increase saliva flow, and unsweetened coffee, teas and sugar-free gum, which wash away food particles.
Consider fluoride treatments. Your dentist may recommend a fluoride treatment, especially if you aren’t getting enough fluoride naturally; such as through fluoridated drinking water. Drinking tap water with added fluoride has helped decrease tooth decay significantly. But today, many people drink bottled water that doesn’t contain fluoride. In a fluoride treatment, your dentist applies concentrated fluoride to your teeth for several minutes.
You can also use fluoridated toothpaste or mouthwash. You can also ask your dentist about antibacterial treatments. Some people are especially vulnerable to tooth decay, perhaps because of medical conditions, for instance. In these cases, your dentist may recommend special mouth rinses or other antibacterial treatments to cut down on harmful bacteria in your mouth. Always remember to visit your dentist regularly. Get professional tooth cleanings and regular oral exams, which can help prevent problems or spot them early. Your dentist can recommend a schedule for your situation.
Root Canal Treatment
“Root canal” is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth’s nerve lies within the root canal. A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.
When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause: Swelling that may spread to other areas of the face, neck, or head, bone loss around the tip of the root, drainage problems extending outward from the root and a hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.
A tooth’s nerve is not vitally important to a tooth’s health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth. Since some of the reasons why the nerve of a tooth and its pulp become inflamed and infected are due to deep decay, repeated dental procedures on a tooth and/or large fillings, following good oral hygiene practices (brushing twice a day, flossing at least once a day, and scheduling regular dental visits) may reduce the need for a root canal procedure. Trauma resulting from a sports-related injury can be reduced by wearing a mouth guard.
A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist’s comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.
Saving your natural teeth is the very best option, if possible. Your natural teeth allow you to eat a wide variety of foods necessary to maintain proper nutrition. The root canal procedure is the treatment of choice. The only alternative to a root canal procedure is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting. These alternatives not only are more expensive than a root canal procedure but require more treatment time and additional procedures to adjacent teeth and supporting tissues.
Dental Crowns
For teeth that are badly damaged, dental crowns can be an effective treatment option. The dental crown procedure utilizes tooth-shaped coverings made of metal, ceramic, or porcelain to restore strength and eliminate discomfort. In addition, dental crowns may be used to anchor a dental bridge or to cap a dental implant post.
Dental crowns are made of metal, ceramic, or porcelain fused to metal. The type of crown utilized during your dental crown procedure will depend on your unique needs and goals, as well as the recommendation of your dentist.
Although their metallic color makes them a poor choice for highly visible teeth, dental crowns made of metal can be an ideal option for repairing decayed or damaged back teeth. They are extremely durable and can be applied with less removal of the natural tooth than all porcelain or ceramic crowns. Metal crowns may consist of various materials, including gold alloy, palladium, nickel alloy, or chromium alloy.
All ceramic crowns may be made of porcelain, resins, or dental ceramic materials. They create an extremely natural-looking appearance and are typically used on front teeth. The tooth-colored ceramic material is translucent, like the enamel of your natural teeth, and size and shade can be carefully matched to complement the rest of your smile. However, ceramic dental crowns are not as resilient as metal crowns and do not function as well on back teeth, which sustain a lot of pressure from biting and chewing.
Dental crowns made of porcelain fused to metal are stronger than all-ceramic versions and more aesthetically pleasing than those made of metal. However, their metal shell gives porcelain fused to metal crowns an opaque appearance. Because they lack the reflective quality of natural teeth, porcelain fused to metal crowns are not as discreet as all ceramic crowns. Additionally, over time, a thin metal band may be visible along the gum line with this type of crown.
Typically, the dental crown procedure is completed in two stages. During the first stage, the dentist removes portions of your natural tooth’s structure to accommodate the dental crown. Surrounding teeth may also be prepared in this way. An impression is made and sent to the lab, where your dental crown is created in about two weeks. A temporary crown will be in place between visits to ensure the most natural look and feel. When you return to the dentist’s office, the temporary crown is removed and your new, custom dental crown is securely bonded in place. For some patients, the dental crown procedure is altered to meet specific goals.
For example, if crowns are being utilized to anchor a dental bridge or as a dental implant restoration, the steps in the dental crown procedure will be slightly different. Also, teeth with extensive damage may require that a root canal be performed prior to placing the crown. Additionally, new technology has made it possible to complete some dental crown procedures in a single office visit. A consultation with your dentist can help you better understand the unique steps in your dental crown procedure. While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown is to practice good oral hygiene.
A crown can lose its support if the teeth or bone holding it in place are damaged by dental disease. While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the underlying tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day and flossing once a day-especially around the crown area where the gum meets the tooth. See your dentist and hygienist regularly for checkups and professional cleanings.
Dental Implants
A dental implant is an artificial tooth that replaces a tooth that has been taken out. Implants are natural looking, can provide support for dentures, and do not affect the teeth bordering them. They are as stable as your real teeth and protect you from the loss of jawbone, which occurs when you lose teeth. It is important to consider treatment.
When you lose your teeth, you gradually lose the bone that supported them. As this bone disappears, problems with other teeth nearby and a lack of support for dentures, partials and bridges increase. These could include pain, mobility, lack of retention for prosthetics, sharp, painful ridges, mobile gum tissue and sore spots.
The tongue enlarges to accommodate spaces of missing teeth. With tooth loss, a five-fold decrease in function occurs and the diet shifts to softer foods. Also, when bone is lost, numbness to the lower lip or even the possibility of fracture of the jaw rises. Since the bone is deteriorating, it will spread and deteriorate around healthy teeth and ultimately cause the loss of those teeth. Here’s a very easy way to explain what happens.
Picture a brick wall; take a brick right out of the middle of the wall. What happens? Eventually, the brick above starts to fall in from lack of support, the bricks to the side start shifting toward each other and those eventually fall out; then the process starts all over for those bricks nearest them. It’s a similar process in the mouth. In addition, this progression will affect the ability to provide the same treatment in the later stages of bone loss than if treatment had been started earlier in the process. It’s much better to replace a tooth before all of the side effects kick in. By waiting, you risk the possibility of not being able to provide the same, simple type of treatment that would have been possible earlier.
Anyone is a candidate for implants. In fact, anyone who is missing one or more (even all) of their teeth may be a candidate for implants. If one or a few of the teeth are missing, implants in conjunction with a crown or bridge can replace those teeth and function as normal teeth without losing more bone and being subject to decay. If all or most of your teeth are missing, then implants may be placed to anchor a loose denture. Sometimes, if there is already some bone loss, bone can be added and regenerated or a technique called bone expansion can be used to create a more ideal site for the implant(s).
Ultimately, a consultation with a dentist who is knowledgeable on these procedures can help determine your individual needs. Although, If you are a smoker who is considering a dental implant, your dentist will likely advise you to give up smoking before undergoing the process because smokers face a higher risk of implant failure.
Since the procedure can be extremely expensive, you risk wasting your money on dental implants if you do not give up the habit. On the plus side, dental implants are not susceptible to the formation of cavities; still, poor oral hygiene can lead to the development of peri-implantitis around dental implants. This disease is tantamount to the development of periodontitis (severe gum disease) around a natural tooth.
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