What Is A Dental Emergency?
Injuries to the mouth may include teeth that are knocked out (avulsed), forced out of position and loosened (extruded) or fractured. In addition, lips, gums or cheeks are often cut. Oral injuries are often painful and should be treated by Dr. Gianfortune as soon as possible.
How soon should I see a dentist?
Immediately. Getting to a dentist with 30 minutes can make the difference between saving or losing a tooth.
When a tooth is knocked out:
- Immediately call your dentist for an emergency appointment.
- Handle the tooth by the crown, not the root. Touching the root (the part of the tooth below the gum) can damage cells necessary for bone re-attachment.
- Gently rinse the tooth in water to remove dirt. Do not scrub.
- Place the clean tooth in your mouth between the cheek and gum to keep it moist. It is important not to let the tooth dry out.
- If it is not possible to store the tooth in the mouth of the injured person, wrap the tooth in a clean cloth or gauze and immerse in milk.
When a tooth is pushed out of position:
- Attempt to reposition the tooth to its normal alignment using very light finger pressure, but do not force the tooth.
- Bite down to keep the tooth from moving.
- Dr. Gianfortune may splint the tooth in place to the two healthy teeth next to the loose tooth.
What Is A Denture?
A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position. Complete dentures are either "conventional" or "immediate." A conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed. The drawback with an immediate denture is that it may require more adjustments after the healing has taken place.
Who needs a denture?
Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.
What happens when you get a denture?
Dr.Gianfortune can make a full conventional denture when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient's final denture is placed, following any minor adjustments.
New denture wearers need time to get accustomed to their new "teeth" because even the best fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients report discomfort with eating for several days to a few weeks. To get accustomed to chewing with a new denture, start with soft, easy-to-chew foods. In addition, denture wearers often notice a slight change in facial appearance, increased salivary flow, or minor speech difficulty.
How do you care for a denture?
A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpastes. Never use harsh, abrasive cleansers, including abrasives toothpastes, because they may scratch the surface of the denture. Don't sterilize your denture with boiling water because it will cause it to become warped. If you wear a partial denture be sure to remove it before brushing your natural teeth.
When not in use, soak it in a cleanser solution or in water. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.
Should a denture be worn at night?
While you may be advised to wear your denture almost constantly during the first two weeks- even while you sleep-under normal circumstances it is considered best to remove it at night. Research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. This promotes better long-term health of the gums.
Continue seeing Dr. Gianfortune regularly
It is important to continue having regular dental checkups so that Dr.Gianfortune can examine oral tissues for signs of disease. As of aging, your mouth will continue to change as the bone under your denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to reline (resurface the inside) your denture to insure a proper fit. Never attempt to adjust a denture yourself and do not use denture adhesives for a prolonged period because it can contribute to bone loss. When in doubt, consult Dr.Gianfortune.
Are there any alternatives to dentures?
Dentures are no longer the only way to restore a mouth that has few teeth. Strategically placed support, or implants, can now be used to support permanently cemented bridges, or anchors for a partial denture. The cost tends to be greater, but the implants and bridges more closely resemble the "feel" of real teeth. Dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants. Consult Dr. Gianfortune for advice.
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How Can I Take Care Of My Teeth?
Proper oral care can keep you smiling well into retirement. Brushing at least twice a day with a fluoride toothpaste and a soft-bristle brush are as important as ever. Flossing can help you save your teeth by removing plaque between teeth and below the gum line that your toothbrush cannot reach.
What are some problems I should watch for?
Gingivitis. Most people don't realize how important it is to take care of their gums. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and possible bleeding when you brush. If you have any of these symptoms, see Dr. Gianfortune at once. Gingivitis can lead to gum disease if problems persist. Three out of four adults over age 35 are affected by some sort of gum (periodontal) disease. In gum disease, the infection becomes severe. Your gums begin to recede, pulling back from the teeth. In the worst cases, bacteria form pockets between the teeth and gums, weakening the bone. All this can lead to tooth loss if untreated, especially in patients with osteoporosis. If regular oral care is too difficult, Dr.Gianfortune can provide alternatives to aid in flossing and prescribe medication to keep the infection from getting worse.
What if it's too difficult to brush?
If you have arthritis, you may find it difficult to brush and floss for good oral health care and prevention of disease. Ask Dr.Gianfortune for ways to overcome this problem. Certain dental products are designed to make dental care less painful for arthritis sufferers. You may want to try strapping the toothbrush to a larger object, such as a ball, to make the brush more comfortable to handle, or electric toothbrushes can help by doing some of the work for you.
Should I be concerned about dry mouth?
Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications or cancer treatment. This can make it hard to eat, swallow, taste and speak. In certain cases, such as radiation therapy, dry mouth can lead to severe complications, which is why it is important you see Dr. Gianfortune immediately before beginning any form of cancer treatment. Drinking lots of water and avoiding sweets, tobacco, alcohol and caffeine are some ways to fight dry mouth.
Periodontal Disease
Diagnosis
Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up.
A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.
Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:
Gingivitis
Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
Periodontitis
Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily.Slight to moderate bone loss may be present.
Advanced Periodontitis
The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.
Treatment
Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.
Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!
If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.
If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planning (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planning). This procedure helps gum tissue to heal and pockets to shrink. Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.
If the pockets do not heal after scaling and root planning, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).
Maintaining your overall health
Studies have shown that maintaining a healthy mouth may keep your body healthier and help you avoid diabetes, heart disease and stroke. The best way to achieve good oral health is to visit Dr. Gianfortune for a cleaning at least twice a year.
Why Are My Teeth Sensitive?
Tooth sensitivity is caused by the stimulation of cells within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp). When the hard enamel is worn down or gums have receded-causing the tiny tube surfaces to be exposed-pain can be caused by eating or drinking food and beverages that are hot or cold; touching your teeth; or exposing them to cold air. Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth.
Is tooth sensitivity a common condition?
Sensitive teeth is one of the most common complaints among dental patients. At least 45 million adults in the United States and 5 million Canadians, suffer at some time from sensitive teeth.
What can I do about sensitive teeth?
Tooth sensitivity can be reduced by using a desensitizing toothpaste, applying sealants and other desensitizing ionization and filling materials including fluoride by your dentist, and decreasing the intake of acid-containing foods. Tartar control toothpastes will sometimes cause teeth to be sensitive as well as drinking diet soft drinks throughout the day.
Avoid using hard bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth's root surface and expose sensitive spots. The way to find out if you're brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you're brushing too hard.
What can the dentist do for my sensitive teeth?
Dentists have a variety of regimens to manage tooth hypersensitivity, including both in-office treatments and patient-applied products for home use. If you are diagnosed with dentin hypersensitivity, your dentist may apply a desensitizing agent or a protective coating. You may be prescribed a stannous fluoride gel or an over-the-counter desensitizing toothpaste containing fluoride and either potassium nitrate or strontium chloride. These ingredients help block transmission of sensation from the tooth to the nerve. It also might help to massage the special paste onto your gums with your finger after brushing.
Why Do I Need X-rays?
Radiographic or X-ray examinations provide Dr.Gianfortune with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help Dr. Gianfortune determine the presence or degree of periodontal disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.
Do all patients have X-rays taken every six months?
No. Your radiographic schedule is based on Dr.Gianfortune's assessment of your individual needs, including whether you're a new patient or a follow-up patient, adult or child. In some cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.
Should I be concerned about exposure to radiation?
All health care providers are sensitive to patients' concerns about exposure to radiation. Dr.Gianfortune has been trained to prescribe radiographs when they are appropriate and to tailor radiographic schedules to each patient's individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, Dr. Gianfortune knows which techniques, procedures and X-ray films can minimize your exposure to radiation What is orofacial pain?
Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles or temporomandibular joint. Problems can include temporomandibular joint discomfort; muscle spasms in the head, neck and jaw; migraines, cluster or frequent headaches; pain with the teeth, face or jaw; or anxiety or depression
You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. Pain also can be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics.
Some may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while others experience clicking when moving the jaw or even locking if the jaw is opened or closed.
Temporomandibular disorders (TMD)
The National Institutes of Health estimates that more than 10 million Americans have TMD, or problems affecting the jaw joint and/or muscles. Your temporomandibular joints are located where the skull connects to your lower jaw. To feel these joints, place your fingers in front of both ears and open your mouth. The muscles on the sides of your head and face control the joints' movements. Researchers believe women between 20 and 40 are most likely to suffer from TMD because of the added estrogen in their bodies.
Headaches
One in eight Americans suffers from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which may be related to the bite. Headaches also can be caused by clenching jaw muscles for long periods of time. Signs that may indicate a headache from a dental origin include:
- Pain behind the eyes
- Sore jaw muscles or "tired" muscles upon awaking
- Teeth grinding
- Clicking or popping jaw joints
- Head and/or scalp is painful to the touch
- Earaches or ringing
- Neck, shoulder or back pain
- Dizziness
- Sleep disorders
If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing disorder, such as snoring or sleep apnea. Bruxism is the technical term for grinding and clenching. Snoring that goes undiagnosed may lead to an increased tendency for the airway to collapse, leading to sleep apnea. Sleep apnea is a condition when the tissues and muscles in the back of the throat collapse the airway. This can cause a person to wake up multiple times in the middle of the night, sometimes without knowing it.
Are there any treatments available?
Dr. Gianfortune has a variety of treatments that will help alleviate your orofacial symptoms. One device is called an orthotic, or splint, that is worn over the teeth until the bite can be stabilized. Permanent correction may require reshaping teeth, building crowns, orthodontics, or a permanent appliance for the mouth.
Other ways to alleviate the pain include:
- Place an ice pack on the painful area for 10 minutes, three or four times per day.
- Eat softer foods and avoid chewing gum or ice.
- Cut food into smaller pieces.
- Keep upper and lower teeth slightly apart except when chewing or swallowing. Keeping your tongue between your teeth may help with this.
- Sleep on your back.
- Don't rest your hand on your chin. When talking on the phone don't rest the receiver on your shoulder.
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