Sensitive teeth is sometimes caused by erosion--the dissolving of the enamel or dentin by a chemical process. A recent multicenter study found dental erosion is on the rise, with a surprising 30% prevalence among 10 to 14 year olds.

Erosion is often caused by the acids found in soft drinks, some fruit juices, sports drinks, and some herbal teas. When consumed in excess these beverages can easily strip the enamel from teeth leaving them brittle and sensitive to pain. Other sources of erosion can be medicines and some underlying medical conditions such as acid reflux disease and disorders associated with chronic vomiting, including bulimia, that bring stomach acids into the mouth.

If erosion is determined to be the cause of the sensitivity, the first step is to determine and control the source to prevent continued destruction. The eroded surfaces then may be replaced with appropriate materials to stop the sensitivity. Without first managing the cause, the reparative dentistry may also be destroyed.

An accurate diagnosis of why teeth are sensitive is the key. Hypersensitive teeth caused by erosion is just one of the possible causes. More serious conditions could be decayed or cracked teeth which also require preventative and restorative dental procedures.

Do you avoid ice in your drinks? Are you fearful of having a certain area cleaned by the hygienist? Teeth that are sensitive to temperature, touch, or even air are one of the most common complaints dentists hear.

There are many reasons for sensitive teeth, including cavities and cracked teeth. Fortunately, most sensitivities are a result of a less serious cause.

Underneath the strong outer layer of a tooth is the dentin layer, which is less dense. Dentin has microscopic canals leading to the pulp of the tooth. When these miniature tubes lose their protective layer, they allow temperatures, sweets, touch, or drying to transmit a stimulus to the nerve fibers located in the pulp. These nerve fibers signal the pain of a hypersensitive tooth. Fortunately, the painful stimulus does not cause permanent damage to the nerve of the tooth, but it can be extremely unpleasant. Most sensitivities occur near the gumline as a result of toothbrush abrasion, acidic erosions, or compressing and flexing forces of clenching. There are over-the-counter desensitizing toothpastes available that help block the canals from transmitting sensations to the nerves. These toothpastes are often the first step to managing the problem; but if they do not provide adequate relief, let your dentist know. There are several other professional approaches available.

As with most things in dentistry, accurate diagnosis is the key to relieving sensitive teeth; or more importantly, to separate hypersensitive teeth from more serious conditions such as decayed or cracked teeth that get worse with delay.

Next to “getting a shot” do you hate leaving the dental office with numbness, wondering if you are drooling on yourself or afraid you will bite your tongue when you eat? Help is on the way.

Novalar Phamaceuticles of San Diego has just won approval for OraVerse from the FDA. In clinical trials OraVerse cut the time it took for full sensation to return to the numbed area by more than half. The basis for the drug is a decades old anti-hypertensive drug. After a dentist finishes a procedure where anesthesia is used, the dentist would inject OraVerse into the same site. It doesn’t literally “reverse” the anesthetic, but utilizes an indirect approach. Here's how it works: When a dentist administer local anesthetics it is usually combined with another drug called epinephrine that acts to constrict the blood vessels. This keeps the blood from carrying away the anesthetic too quickly. OraVerse does the opposite, dilating blood vessels so the anesthetic can be carried away faster.

Some procedures, such as extractions, where longer anesthesia will keep the patient more comfortable would likely not be advisable for OraVerse use. Since an additional dental procedure will come with some cost to the patient, OraVerse may may be too costly for routine use. However, for patients concerned about being able to eat or speak without numbness after a dental procedure, the availability of this new dental procedure, may be worth the additional incremental cost.

The primary bacteria responsible for tooth decay, Strep. mutans, has the specialized ability to survive in acid. Unfortunately, the breakdown of carbohydrates creates an acid environment that reduces other less harmful bacteria while the Strep. mutans can thrive and cause tooth decay. One of the reasons is the ability of Strep. mutans to make the fatty acid enzyme called FabM, which protects it from acid attack. When researchers shut down the production of FabM the Strep. mutans became almost 10,000 times more vulnerable to acid damage. Further research has shown FabM or close relatives may be responsible for all Strep. and Staph. bacteria’s resistance to the body’s defenses. These families of bacteria are responsible for meningitis, pneumonia, “flesh eating infections”, as well as infections around heart valves and stents.

The University of Rochester Medical Center has received a grant from the National Institute for Dental and Craniofacial Research to investigate FabM and other bacterial proteins. These studies could lead to our ability to develop a multi-prong attack on bacteria instead of the current single-prong antibiotic therapies. “Our goal is to force the major bacterium behind tooth decay to destroy itself with its own acid as soon as it eats sugar,” said principal investigator Robert G. Quivey, PhD. In addition to helping prevent cavities, it may also lead to new antibacterial combination therapies for other types of infections that have become resistant to currently available treatment.

If you have been told you do not have enough bone for tooth implants or you chose not to do implants for financial considerations, mini implants may be exactly what you need.
The bone underlying a denture deteriorates because there are no longer teeth present. This results in dentures slipping and wobbling which lets food underneath the base and can create sore areas especially a with lower denture. The lips have to work harder to keep the denture in place, and this makes a natural expression difficult and can even affect speech. The loss of jawbone results in an aged facial shape. These problems rob many denture wearers of their confidence in social situations.
Conventional implants have been used to provide stable denture anchorage and maintain remaining jawbone. However, they require sufficient bone volume in order to be placed, and it will take three to six months for bone to grow around the fixture before the denture can be anchored to the implants. These restrictions used to mean that not everyone was a suitable candidate for implants.
A mini implant is only 1.8 millimeters in diameter (about the size of a toothpick) which means that there is always enough bone in the front of the jaw to place them and much less surgery needed to accomplish the placement. In addition they have been designed so they can be secured to the lower denture during the same office visit. Mini implants are placed in the morning, the denture immediately attached, and the patient will be comfortably eating lunch that same day. As an added bonus, the simplicity of attachment components and reduced surgery means lower costs compared to the conventional implant process.
Mini implant technology means everyone can have a well fitting, comfortable lower denture. Contact our office for a consultation.

Healthy Oral Hygiene Can Mean Substantial Medical Cost Savings

With mounting evidence linking poor oral hygiene to a range of medical problems, health plans are starting to cover more dental services. Insurers are finding that paying for certain dental services now, such as additional cleanings, gum treatment, prescription mouth washes, periodontal maintenance, and sealants and fluoride varnishes, can reduce the incidence of more serious (and costly) health problems later on. Studies have found that early detection and treatment of gum disease may result in significantly improved outcomes for serious health problems such as heart disease and diabetes and healthier pregnancies.

Insurance companies, including Cigna and Aetna, allow enhanced benefits to groups they feel have greater risks. These new benefits include an additional (third) cleaning a year, antimicrobial mouth rinses, or scaling and root planing. “We can save medical costs by getting people to have dental care at the right times in there lives,” says Glenn Melenyk, a dental consultant with Blue Cross Blue Shield of Michigan. Guardian Life and MetLife are making available implants and fluoride varnish for children and adults (if employers elect to add them to their company’s plans). Since these enhanced benefits come at a time when many employer-provided benefit packages are under pressure to cut medical costs, it shows a strong belief in the value of early detection and increased preventive dental care. We should all heed this advice.

Advances in modern dentistry have the potential of significantly improving our health and fitness and ultimately our quality of life. One of the best decisions we can make is to decide to be well informed about our options for dental treatment, whether or not they are covered by our insurance.

Because there are many causes and side effects of dry mouth, there are many ways to manage it. If your physician can determine the cause of the dry mouth, it may be possible to provide a specific cure. If the dryness is due to medication, your doctor may be able to reduce the dosage or change to a less drying medication. Unfortunately, the nature of many diseases means that the continuation of the medication takes precedence over the problems related to the dry mouth.

There are things that can be done to stimulate more saliva. One simple solution could be mechanical stimulants such as foods that require a lot of chewing like apples, carrots, or celery. Sipping water or other sugar free liquids frequently while eating and throughout the day can often help. A humidifier will reduce drying with breathing. Chewing gums without sugars such as Biotene, Eclipse, Orbit, and Trident are helpful without increasing potential for decay. Over the counter saliva substitutes like Salivart, Xerolube, or Oral Balance Moisturizing Gel help moisten and lubricate the mouth when there is inadequate saliva. There are other products such as Mouth-Kote or Optimoist and the Salitron System manufactured by Bisonics, which is an electric reflex salivary stimulation system. There are prescription medications that increase the flow of saliva but they have side effects.

From a dental point of view the reduction of saliva can cause a dramatic increase in active decay. It is usually associated with increased build-up of plaque around the gumline of teeth with recurrent decay around existing fillings and crowns or on the roots. Increased use of fluorides (similar management to children) will reduce this problem. This can take the form of mouth rinse with fluoride, prescription strength fluorides, or even custom dental trays to hold the fluoride around the teeth longer if the problem is severe.

The average healthy adult produces about 3 pints of saliva a day. It is something that most of us don’t think about unless we don’t produce enough. That’s because saliva makes it easier for us to talk, helps prevent tooth decay by washing food and plaque away from our teeth, limits bacterial growth that can dissolve tooth enamel or lead to mouth infections, enhances our ability to taste our food, and makes it easier to swallow. Minerals found in saliva help repair early tooth decay and neutralizes damaging acids in our mouth; and enzymes in saliva aid in digestion.

Reduced saliva causes increased tooth decay, plaque, and gum disease. Bad breath, burning or tingling sensation of the tongue, split skin or sores at the corners of the mouth can also be a result of dry mouth.

While there are many causes of dry mouth, medications are frequently the culprit. Several hundred medications, including over-the-counter drugs, can cause dry mouth. Many medications used to treat depression and anxiety, high blood pressure, urinary incontinence, and Parkinson’s, as well as anti-diarrheals, muscle relaxants, and antihistamines often cause dry mouth.

Talk with your dentist or physician if you find eating dry foods uncomfortable or notice oral changes that may be related to dry mouth. There are treatments that help, and lack of saliva is too important to ignore.

Sudden, sharp, brief pain in teeth in response to a stimulus is termed hypersensitivity. Hypersensitivity has been reported in as much as half of the population in some studies. The stimulus can be due to touch (toothbrush, floss, or tooth cleaning), changes in temperature, sweets, or biting forces. What is the cause and how can it be stopped?

There are many different causes of sensitivity: recession of the gums exposing root surfaces; abrasion of enamel due to use of a stiff tooth brush or using dental instruments at home; erosion of enamel caused by acidic food or drinks, bulimia, or gastrointestinal reflux; clenching or grinding the teeth; cracked teeth or fillings; or even plain old decay.

The first step is to determine the cause so the appropriate treatment can be matched to the cause of the discomfort. Acidic erosion, for example, can be approached by controlling the causative factors--diet or reflux--to stop the acid attack. Then your dentist may further seal the exposed area or replace lost enamel with filling materials to protect the pulp. In some cases a simple over the counter toothpaste for sensitive teeth may be effective. However, this would not help at all with a cracked tooth where delay in seeking treatment may result in the need for a root canal or even the loss of the tooth if it splits. A full coverage crown would be needed to prevent propagation of the crack in this case.

A visit to the dentist to sort out the possible cause is the best way to get to the bottom of the problem. You can help your dentist determine the correct cause by paying attention to what causes the pain, how long it lasts, and how it may have changed over time. The more accurately you can describe symptoms to your dentist the better your dentist will be able to determine the proper action to help relieve your discomfort.

With the advent of extreme makeovers on so-called “Reality TV” there is a misconception that all smiles can be fixed with a dozen DaVinci veneers. The way veneers are routinely the solution on television one would think all unaesthetic smiles are due to an insufficiency of porcelain in the mouth. The truth is that there are other methods of correcting the look of the front teeth that might be more appropriate and significantly less expensive.

While a television show creates more drama when the smile is corrected instantly, more times than not the altering of the appearance of healthy teeth by putting a drill to them isn’t the best solution. Tooth movement (orthodontics) does not fit within the time frame of a half-hour television show so television makeovers inadvertently misinform the public about all their dental options including the latest technology for adult orthodontics.

Porcelain veneers are well suited to widening teeth to eliminate gaps, lengthening teeth that are too short, and cosmetically covering teeth that are badly chipped or excessively worn from tooth grinding.

Orthodontics (braces), however, is a far better solution for teeth that are crowded or rotated or when there are uneven tooth levels. Trying to make teeth look regular and even by filling in deficient areas with porcelain or cutting back prominent areas will too often provide a less than satisfactory result. Correctly positioned teeth through orthodontics will yield a more natural result. Properly aligned teeth not only need less maintenance, they will function better (like well fitting gears) and be more comfortable.

Minor tooth movement reduces the amount of correcting porcelain required and the number of teeth that may need to be veneered. The result is a more comfortable and natural smile. Consult your dentist or orthodontist to determine what all your options are. You might be pleasantly surprised to learn that adult orthodontics often takes less time than you might think, it can sometimes be done right in your dentist’s office, and clear braces are virtually undetectable. You will get a more comfortable, natural result and save money by not veneering all your front teeth. You can’t beat that combination.


In my experience adult patients are extremely pleased with clear braces (both the process and results), and often they comment that they wish they had considered doing it sooner.