Does chewing ice harm my teeth?

Q:

I have a habit of chewing ice, it feels good and relaxes me after a long day. Will this have any long term impact on my teeth? via email Saturday August 21, 2010

A:

Thanks for the question! Chewing ice can be detrimental to your teeth as it is a repetitive force that is applied to your teeth. Ice a hard substance which when chewed between teeth over time can have the potential to cause small fractures on the tooth surface. These small fractures on the surface of the tooth can over time become larger until a piece of tooth actually fractures off.

As well, ice is cold thus the temperature change in the mouth may cause existing fillings in the teeth such as composite (white) or amalgam (silver) fillings to contract and when the ice is taken away to once again expand. When this happens repeatedly, the area between the filling and the tooth can become weaker and allow leakage between the tooth which has the potential to irritate the pulp and nerve of the tooth.

I would recommend trying to stop this as it can be harmful to the dentition. As well, I would suggest you seen your physician as repetitive ice chewing can be related to anemia (low iron levels), this is called Pica.

Have a great day!

Dr.tushar

Braces for teeth that are crooked

Q:For as long as I can remember my teeth have been crooked and over the years they have seemed to become even worse. I am very unhappy with the look of my smile and thinking about straightening them. I want to do the best thing possible, what do you suggest for crooked teeth? Via email Thurs. August 10, 2010

A:It is hard to answer your question on a whole since I have not examined your teeth in person, but I will provide some answers below which you may explore to see what is the best option for you.The first choice is orthodontics (braces) as these will address the alignment of both your teeth and jaw, thus providing a more harmonious bite and long term aesthetics. Orthodontics are optimally done by an orthodontist who has many years of expertise/training with straightening teeth and ensuring it is done properly. The time span for orthodontics can vary from a short period of time (sometimes less than a year) to multiple years depending on the situation that presents upon examination and x-rays.Another choice is veneers. Veneers are thin tooth coloured shells that are cemented onto the teeth. When teeth are out of alignment, crooked or have small spaces between them, custom made veneers may be permanently adhered to individual or groups of teeth to give the appearance of straight, evenly spaced teeth and smile. Veneers are not an option for everyone and prior to going with this choice the dentist should fully examine and assess whether veneers are a good long term option for your teeth, smile and aesthetics. Veneers do not last forever, the lifespan can be anywhere from 5-10 years and then they will need to be changed to new ones.Regardless of which route you take to straighten your teeth, please see a qualified dentist to assess the right route to go.

Great question!

Dr.Tushar Kherde

Sore on lip that is not healing

Q:

I have had a sore on my bottom lip for two months, the size stays about the same but over the last two months it has formed a scab a few times and then fallen off. When the scab falls off it seems to heal for a few days then it comes back again. I am concerned only because it never seems to heal and go away completely. I am 45 years old, a previous 1 pack a day smoker up until 4 years ago. Should I go see my dentist?
Via email

A:

Hello , sorry to hear about the sore on your lip. I urge you to see your dentist or physician as soon as possible to assess the lesion as any lesion within the oral cavity or the surrounding structures should heal and go away within two weeks maximum. The fact that you have been a smoker in the past puts you at higher risk for possible changes in your oral tissue due to the exposure to harmful chemicals within cigarettes.

Your dentist and physician should be made aware this has been occurring for two months and it has not went away, this will help them diagnose the lesion better. As well, they may also perform a biopsy to test the tissue to see what it is.

Good luck and if I can be of any assistance please do not hestitate to ask.

Regards,

Dr.Tushar

Dry mouth due to medication's side effects

Q:
I have been on Celexa for over a year. About one month after I started this medication my mouth became very dry, upon reading the side effects for this medication it said that one of the possible side effects was dry mouth. I have found it has become worse during the year, so much at times that my tongue can stick to the top of my mouth and when I wake up in the morning my mouth is like a desert. If I continue on this medication long term, can my body become used to it and will my mouth become less dry? I am unhappy with the side effect (this seems to be the only one so far) but it has helped tremendously in other aspects so I want to continue. (via email)

A:
Thank you for your question . The medication you are on is a SSRI(selective serotonin reuptake inhibitor), which is commonly used for people who have depression and anxiety. I am glad to hear it is helping you! A common side effect of SSRI's is decreased salivary flow/dry mouth. I cannot tell you if this side effect will go away or not, as everyone's body responds differently to medication and I am not in a position as a dentist to answer that question.

What I can help you address is the dry mouth. Dry mouth and decreased salivary flow can put you at higher risk for developing dental cavities and possibly gingivitis/periodontitis. Salivary is important for it's ability to 'wash' the teeth. The liquid component of the saliva helps to rinse/wash the teeth of debris (food and bacteria) so they can be swallowed and not stuck on or in between the teeth. When food becomes stuck and it is not washed away then the potential for cavities to form is much higher. Saliva also has what is called amylase which is an enzyme which begins the process of digestion, specifically starches in the mouth. As well, saliva has the ability to buffer the oral cavity (decreasing the acidity level) to lower the risk of cavity formation.

Tips to help with dry mouth both to help your mouth feel better and prevent cavities

1. Drink water during the day (preferably water with fluoride in it as this will help keep the teeth strong).

2. Chew sugar-free gum after meals if you are not able to brush/floss, this will help mechanically remove food from the teeth and may increase salivary flow to help buffer the mouth).

3. Brush a minimum 3x day for 2 minutes with a fluoridated toothpaste to remove plaque from the teeth

4. Floss a minimum of 1x day to remove plaque from between the teeth

5. Use a fluoride mouthwash 1x day to help remineralize the teeth to prevent decay.

6. You can use a product called Biotene which are dental products specifically designed for those who have dry mouth, it can help stimulate saliva flow.

7. Use a humidifier at night to put moisture into the air that can be transferred to the oral cavity.

8. Use Sorbees sugar-free hard candies during the day to stimulate saliva flow. These candies were created for diabetics but they are also great for people who have dry mouth as they are sugar-free.

9. See your dentist and dental hygienist regularly for cleanings and check-ups to help prevent problems before they begin.

I hope this has been of some assistance to you.

Regards,

Dr.Tushar

Root Canal Treatment

What is non-surgical endodontic treatment?
This is a method of treating the inside of the tooth, also known as a root canal treatment. It is one of the most common dental procedures that can be performed to prevent tooth loss.
To help you understand endodontic treatment, we would like to familiarize you with the anatomy of your tooth. Inside your tooth, under the white tooth enamel and the hard layer of tooth, called dentin, is a soft tissue known as the pulp. The pulp consists of blood vessels, nerves and connective tissue which help to create the surrounding hard tissues of the tooth during development.
The pulp can be found in the center of the tooth and can extend all the way to the tip of the roots where it connects to the tissues surrounding the root. The pulp has a very important role during a tooth’s development. However, a tooth that has reached full maturity can survive without the pulp, because it continues to receive nourishment by the surrounding tissues.

Why do I need endodontic treatment?
If the soft tissue inside the root canal of a tooth becomes inflamed or infected, then a root canal treatment is necessary. There can be a variety of factors that cause the inflammation or infection such as: repeated dental procedures on the tooth, deep decay, crack s or chips in tooth.

What are the signs of needing endodontic treatment?
Indication signs to look for include pain, tenderness to touch and chewing, prolonged sensitivity to hot or cold, discoloration of the tooth, swelling of the surrounding tissue, and drainage. Symptoms may not always be present.

How does endodontic treatment save the tooth?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the canal, a channel inside the root, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full functions. After restoration, the tooth continues to function like any other tooth.

Will I feel pain during or after the procedure?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure. For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontic's instructions carefully. Your tooth may continue to feel slightly different from your teeth for some

time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist.

Root Canal treatment Procedure 1. A Deep Infection Root canal treatment is needed when an injury or a large cavity hurt the tooth's root.The root becomes infected or inflamed. 2. A Route to the Root The dentist numbs the tooth. An opening is made through the crown of the tooth to the pulp chamber. 3. Removing the Infected/Inflamed Tissue Special files are used to clean the infection and unhealthy pulp out of the canals. Then they shape the canals for the filling material. Irrigation is used to help clean the canals and remove debris. 4. Filling the Canals The canals are filled with a permanent material. Typically this is done with a material known as gutta-percha. This helps to keep the canals free of infection or contamination. 5. Rebuilding the Tooth A temporary filling material is placed on top of the gutta-percha to seal the opening. The filling remains until the tooth receives a permanent filling or a crown. A crown, sometimes called a cap, looks like a natural tooth. It is placed over the top of the tooth. 6. Extra Support In some cases, a post is placed into the root next to the gutta-percha. This gives the crown more support. 7. The Crowning Touch The crown is cemented into place. How much will the procedure cost? The cost varies depending on how complex the problem is and which tooth is affected. Molars are more difficult to treat, the fee is usually more. Most dental insurance policies provide some coverage for endodontic treatment. Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with a bridge or implant to restore chewing function and prevent adjacent teeth from shifting.These procedures tend to cost more than endodontic treatment and appropriate restoration. With root canal treatment you save your natural teeth and money. Will the tooth need any special care or additional treatment after endodontic treatment? You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings. Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing theendodontic procedure can save the tooth. What causes an endodontically treated tooth to need additional treatment? New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure. Can all teeth be treated endodontically? Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost.When endodontic treatment is not effective, endodontic surgery may be able to save the tooth.

Why is my front bottom tooth dark?

Q:
Via email from Amit

I have noticed over the past two years my lower front tooth has become darker than the teeth beside it. The tooth almost looks grey. When I was 17 (I am now 26) I fell on my face off a skateboard. At that time I cut up my lips a lot and banged my bottom teeth, but nothing happened at the time and I haven't thought of it since until I noticed my tooth was going grey. I don't have any pain, but I do not like how it looks at all.and wondering what to do.

A:

I cannot comment specifically on your tooth as I haven't examined it, but I can give you some broad answers that may help guide you in what to do next.

First, a tooth that darkens overall and has a greyish appearance typically is one in that the nerve and pulp is dying or dead. A healthy tooth has a rich vascular network within the pulp which nourishes the tooth, when trauma occurs that blood supply overtime can coagulate like a bruise and the nerve of the tooth ceases having sensation. This is when the grey colour appears and unfortunately stays.

The solutions to this may vary, in most cases a root canal can be performed which takes the dead nerve and pulp out of the tooth and replaced with an inert material which fills the space. After the root canal is performed a dental crown or cap may be recommended to protect the remaining tooth structure and prevent fracture. This new dental crown can be matched to your existing adjacent teeth to look as natural as possible.

In select cases where a dental crown or cap is not the choice, dental bleaching may be done on the inside of the tooth to remove the staining on the inside of the tooth. After this bleaching is completed a permanent filling would be put on the tooth to cover the hole where access was made to perform a root canal.

I hope this has helped. Your next step is to visit a Dentist to assess your particular dental situation.

Thanks for the great question!

Should I avoid dentistry while I am pregnant?

Q:
via email April 9, 2010 from Yasmin J

I am 8 weeks pregnant and I am wondering when I can get my teeth cleaned as I have noticed that my gums are bleeding and sore. My last dental cleaning was over 1 year ago so I am definitely due.

A:

Thank you for your question Yasmin and congratulations on your pregnancy! Dental care during your pregnancy is very important both for yourself and for your baby. Typically my personal recommendation is as minimal dental treatment possible within the first trimester when the fetal organ's are developing. While dental treatment may not harm this development, it is best to limit potential risk. I recommend dental treatment be done in the second trimester and third if need be (after fetal development is complete). Dental treatment in these latter trimesters should allow for flexibility of movement for the mother as laying on the back for an extended period of time can place pressue on the interior vena cava, so movement during the appointment is necessary.

A dental cleaning in the second trimester and a subsequent one prior to the birth of the baby is important to remove bacterial plaque and tartar to help prevent pregnancy gingivitis-pregnancy hormones and increased blood flow cause the gums to become increasingly sensitive to bacterial plaque, thus inflammation of the gums occurs. Brushing and flossing at home to remove the bacterial plaque is vital to maintaining a healthy mouth during pregnancy, while visiting the dentist assists in removal of both bacterial plaque and tartar both above and below to prevent gingivitis and allowing it to heal.

Pregnancy and your teeth

X-rays are normally not taken during a check-up at your dentist while pregnant so being aware of any warning signs of dental problems is very important, for example a new area of sensitivity, ache/pressure or bad taste/pus should be thoroughly checked to ensure no dental issues are occurring.

Great question, thank you!