Signs Wisdom Teeth Need Extraction

Impacted Wisdom Tooth

WISDOM TEETH

"Wisdom teeth" can be an anomaly in its own right.  Some people have them and those teeth are just fine.  Others have to put up with the occasional discomfort.  And still others have to deal with persistent throbbing pain.  So how does one know if wisdom teeth need to be extracted?

WHERE ARE MY WISDOM TEETH?

Wisdom teeth are typically the very last molars in the mouth.  Also called third molars, they are usually the most posterior teeth in each quadrant (upper right, lower right, upper left, lower left).  Most adults have four wisdom teeth, one in each quadrant.  In very rare cases, some adults have develop a "fourth molar" which is usually nonfunctional, atypical in shape, and may be located deep beneath the jaw bone.

WHEN DOES MY WISDOM TEETH NEED TO BE REMOVED?

Some common signs and symptoms that wisdom teeth need an extraction include:

• Persistent throbbing and aching pressure adjacent to the wisdom teeth that is not going away.  This may be due to insufficient space for the wisdom tooth to fully erupt.  May be also known as hard tissue impaction, and feel like a toothache, and as such may require emergency dentistry.
• Swollen and bleeding gums directly on top of the wisdom tooth.  This is also known as soft tissue impaction and pericorinitis.
• Wisdom tooth causing tooth decay and cavity to the tooth next to the wisdom teeth.  In some cases the wisdom tooth is erupting at an angle (mesial impaction) causing decay and/or external resorption of the adjacent tooth.  After the wisdom tooth is extracted, the affected tooth may need a filling or root canal and porcelain crown, or even an extraction, depending on the size of the cavity.
• When the wisdom tooth is so far back in the jaw it is hard to keep the area clean, and the tooth has a large cavity that is difficult to restore.
• If the wisdom tooth is difficult to keep clean, there is bone loss that causes the tooth to have periodontal involvement.

WHAT IS THE FUNCTION OF THE WISDOM TOOTH?

Research suggests that humans in the past had larger jaws to accommodate wisdom teeth, and it is thought that the wisdom teeth were used to help with chewing of foliage and plants due to a predominantly plant based diet.  As humans evolved and diets changed that included meat, the jaw decreased in size and wisdom teeth no longer serve its once thought to be designed function for foliage chewing.  The result is wisdom may become impacted, overgrown, and thus need to be either restored or surgically extracted.

If you have any questions on wisdom teeth extractions, be sure to consult your family dentist or oral surgeon.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Teeth Whitening At the Dentist

Teeth Whitening

Teeth whitening has become a popular part of cosmetic dentistry, and is easy to do!  Thinking about getting your teeth whitened?  What is it like getting your tooth bleached?  Ever wonder what exactly it is?  How and why does it work? 

A tooth has essentially three layers: enamel, dentin, and pulp.  Enamel is the hard outer layer, dentin is the softer inner layer of the tooth, and the pulp is where the nerve and live tissues are.  Children's teeth (baby teeth) are naturally white when they first erupt.  Over time, as people age and permanent teeth erupt, teeth become less porous and the teeth appear darker and stained.

FOODS THAT CAUSE DARK AND GREY STAINS

Foods and drinks such as tea, wine, soy sauce, coffee, blueberries, and betel nuts can cause dark and yellow stains within the enamel of the teeth.  Over time, the stains can penetrate the enamel layer and the dentinal tubules, causing teeth to appear grey, dark, and yellow.  Other products than can also cause teeth staining include coke, certain antibiotics like tetracycline, and excessive fluoride.

HOW TEETH WHITENING WORKS

Bleaching products use hydrogen peroxide that interacts with water to form carbamide peroxide.  The peroxide travels within the enamel tubules to the dentin, breaking down the stains in the enamel and dentin.  Teeth thus appear to be whiter and brighter as the stains are dissolved and the enamel and dentin are more porous in the process.

TEETH WHITENING WITH STORE PRODUCTS

In the store, one can purchase whitening toothpastes, paint-on gels, and whitening mouthwashes.  These products may contain a mild abrasive that remove very mild extrinsic surface stains.  Some companies such as Crest sell whitening strips, which can help remove mild to moderate dark stains.  Most of these products contain very little hydrogen peroxide and have not been tested, so such whitening effects may not be as effective.

IN-OFFCE TEETH BLEACHING

• The dentist can fabricate custom whitening trays for one to do tooth whitening at home.  Once molds of teeth are taken and trays are made, one places a hydrogen peroxide gel within the custom trays.  The trays are worn over a period of two to three weeks.
• Some dentists also offer same day bleaching.  A high concentration of carbamide peroxide gel up to 40% is placed on the teeth for a duration of 25-30 minutes and repeated two to three times.  This method is effective against moderate to heavily stained teeth due to the gel concentration, and usually takes a single 90 minute session.

TEETH WHITENING SIDE EFFECTS

Dental bleaching is relatively safe but as with any dental procedure there are side effects.  Tooth whitening side effects include minor cold/hot tooth sensitivity, gums irritation from the hydrogen peroxide gel, and lingering tooth sensitivity to cold.

Interested in teeth whitening?  Be sure to consult with your family dentist.  Tooth bleaching can be a regular part of your regular dental care; you and your dentist can discuss which whitening method may be appropriate.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants Single Tooth

Dentistry today is vastly different due to increases in oral health research and technology, and dental implants is one of the leading services dentists are able to provide today for their patients.  Implants are many times a viable option as to afford a long term replacement and viable solution to missing teeth.

Today, let's go over the single tooth dental implant, which is also known as an endosseous implant or dental fixture.

WHAT IS A DENTAL IMPLANT?

A dental implant is a component that is surgically placed within the jaw bone, which in turn supports a prosthesis (ie. dental porcelain crown, bridge, or denture).  Via a biological process called ooseointegration, the implant fixture (typically made from titanium), forms an intimate bond to the bone.  At this point the dental surgeon would also determine if a bone graft is required.  If there is insufficient bone structure to hold the implant firmly in place, additional bone may need to be be added to the implant site via a bone graft.  If the implant area is in an area of esthetic importance (ie. front tooth with an exposed smile line) the dentist may elected to add additional gingival tissue to improve the appearance of the implant fixture via a soft tissue graft.

After the implant is placed, the implant fixture is given time to heal and integrate with the bone, usually for 3-6 months.  Once the implant osseointegrates with the bone, an abutment is attached to the implant which contains and hold the dental prosthetic (ie. crown, bridge, or denture).  The dental prosthetic may then be attached to the abutment and implant via cement or screw..

WHEN IS A SINGLE TOOTH IMPLANT INDICATED?

There are situations when a single implant may be desirable:

1. Accidental trauma to a single tooth, while the teeth adjacent to the affected area are normal and healthy.  An example would the loss of a front tooth due to an accident.
2. A tooth has cracked from heavy occlusal trauma (bruxism and nighttime grinding) and is not saveable with a root canal and/or dental crown.
3. A tooth that has such severe decay it is no longer restorable with a root canal and crown.
4. A tooth with an existing filling or crown that has such deep and severe decay it is not longer saveable with a new restoration.
5. A tooth that has luxated (tooth fell out of its socket) from a sports or playground accident, or physical altercation. 
6. A tooth has cracked and sustained a fracture after a root canal from normal chewing, and the tooth is no longer saveable and requires tooth extraction.
7. A tooth that has severe localized periodontal disease with aggressive bone loss.  With such periodontal involvement and bone loss, the tooth may be mobile and have poor bone support and susceptible to infection.
8. One particular area of the jaw has an inherent missing tooth.  For example, some people are genetically born with a single missing adult tooth, and this may cause difficulty chewing, self awareness in their smile, or food-induced gum trauma and irritation.

AM I CANDIDATE FOR A SINGLE TOOTH IMPLANT? 

The dentist and surgeon would determine if you are a viable candidate for a single tooth dental implant.  A successful implant would require healthy jaw bone and gingiva.  Oral hygiene, diabetes, smoking, a compromised immune system, and heavy uncontrolled bruxism/grinding are important factors to take into consideration of the implant's success.  Age may be a factor; one may want to wait until the age of 20 as that is when the jaw bone has completed its full maturation growth cycle. 

COST OF DENTAL IMPLANTS

What does a dental implant cost?  The costs of the implant from start to finish will vary widely and dependent on many factors. These factors include: type of material used, state where the service is performed, the type of insurance coverage, if a bone graft is required, the type of abutment used, and the type of crown that is placed.  The dentist's front office would be able to give you an estimate of the costs associated with the dental implant. 

If you have any questions or concerns regarding dental implants, the steps involved, and the costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Painful Canker Sores in the Mouth

Canker Sore

What are Canker Sores?

Ouch!  Ever get that annoying and painful sensation inside your mouth?  Often times it can suddenly occur without warning, and it can be very painful to touch, making it difficult to eat.

Also known as aphthous ulcers, or aphthous stomatitis, these are benign and non-contagious lesions that form anywhere inside the mouth.  It can occur on the tongue, inside the cheek, on the gums, the roof of the mouth, on the floor of the mouth, or inside the lips.  Some people may notice a discoloration or an unusual feeling prior to its onset.  When the canker sores are fully formed, it is usually a small white circular lesion in the middle, while the outside border is bright red.  In severe cases the interior of the lesion may even bleed, while also causing a slight fever.  Such cases would suggest the body is fighting an infection.

However, be careful if one notices sores on the outside of the lips.  These are not canker sores, but rather herpetic lesions that are very contagious.  Such lesions should be treated accordingly by your dentist and physician.

What causes Aphthous Ulcers?

Unfortunately we don't really know what causes aphthous ulcers (canker sores).  Some studies suggest it may be due to environmental factors like stress, physical trauma and injury to the affected area, or even smoking.  Highly acidic foods may also play a role (ie. lemon, lime, figs, and tomatoes).

A Journal of American Board of Family Medicine  suggests that low levels of Vitamin B12 may also be a possible cause of canker sores.  Other studies also suggests that folic acid and iron may play a similar role, but its unclear if such supplements may improve healing or reduce occurrence.

Despite common misconceptions, there is no established association between canker sores and autoimmune diseases.  Recent studies show that such occurrences have no common antibodies, and are believed to be independent of each other.

How to treat and manage Canker Sores?

Treatment for aphthous ulcers is palliative at best (ie. controlling and managing pain and its symptoms).  Prevention is difficult because the exact cause is not clearly demonstrated and not understood.

• Most sores (minor aphthous ulcers) will heal on its own within 7-10 days.  Over the counter ointments such as Zilactin-B may help with pain relief).
• For sores that are larger in size and severity (termed major aphthous ulcers) medications such as a corticosteroid rinse may help (ie. hydrocortisone sodium succinate aka Solu Cortef and beclomethasone dipropionate aerosol).

Other methods that may decrease the occurrence of canker sores include:

• Wearing a sportsguard to prevent injury to the gums and gingiva during athletic events
• A diet high in Vitamin B12, folic acid, and iron (ie. dark and leafy green vegetables like spinach and kale, red meats like beef, and fortified dairy products like milk and yogurt)
• Good oral hygiene  and regular dental cleanings and checkup
• Avoiding foods that may irritate the gums and mucosal lining (ie. spicy foods, acidic vegetables and fruits like lemon, lime, escarol, pimento, tomatoes, and any vegetables processed with vinegar, such as canned artichokes, pickles, sauerkraut). 

If you have any questions or concerns regarding canker sores, or if you notice your sore has not healed within 14 days, please consult your doctor or dentist.

Warm Regards from your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Mouthguard and Sports in Dentistry

MOUTHGUARD

With the start of the new year in 2014 and Superbowl XLVIII coming up in February 2, 2014 I thought it would be a good idea to talk about the relationship between dentistry and sports.

Contact sports like football, basketball, soccer, rugby, boxing, lacrosse, and hockey often subject the human body to physical trauma, and one area is the teeth and gums.  To help prevent and reduce injury to said teeth, lips, and gums, a sports mouthguard is recommended.  Incidentally a mouthguard may also be used as adjunctive treatment for bruxism and tooth bleaching.

HISTORY

In the mid 1940s Dr. Rodney Lilyquist, a dentist in Los Angeles, is credited with the introduction of the modern mouthguard for athletes.  A UCLA basketball player and a San Francisco 49er quarterback were among the first athletes to utilize the mouthguard.  1940s/1950s studies show that dental injuries accounted for as much as 50% of all injuries in football in the US.  By 1960, the American Dental Association (ADA) began recommending the use of mouthguards in contact sports.  In 1962, all US high school football players were required to wear mouthguards.  In 1973 the NCAA required mouthguards for all college football players.  The result has been a reduction in dental trauma, injuries, and contact related dental emergencies.

MOUTHGUARD AND DENTAL TRAUMA

The role of mouthguards is prominent where accidental or incidental impacts to the face, mouth, and oral cavity can cause physical harm and oral and maxillofacial trauma.  Schools and various sports associations have begun mandating mouthguard use.  Unfortunately some studies have shown such individuals in high contact sports have low compliance of regular mouthguard usage.  However, studies have also shown that even with regular usage, complete effectiveness against dental trauma is not always achieved due to poor fit and size.

SOME TYPES OF MOUTHGUARDS

There are a few types of mouthguards available today:

• READY MADE: These mouthguards are already premade.  The only adjustment possible is via a scissor or trimming knife to approximate shape.  Protection and fit is considered poor.
• MOUTH ADAPTED/STORE BOUGHT:  These are readily available in many over the counter pharmacies and sports stores.  They come in a prefabricated thermoplastic material that one takes home and boil to allow the material to adapt to the teeth.  Protection and fit are considered average and better than the "ready mades" but overall protection is compromised due to the soft vinyl material.
• CUSTOM MADE: Your dentist takes a custom mode of your teeth via an impression material, usually via a hyrdo-colloid alginate or vinyl-polysiloxane material.  The mouthguard is hence made from the impression taken.  Protection and fit is considered more optimal with this type due to the indirect custom impression, and the material is a hard, rigid, durable, and protective.

If you have any questions regarding sports and mouthguards be sure to consult your family dentist to discuss which mouthguard is right for you.

Warm Regards from your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Toothbrushes, which one should I use?

With so many toothbrushes out there to choose, how do I select a proper toothbrush?  All toothbrushes are the same, right?

While any toothbrush combined with a fluoridated toothpaste will be effective in helping one achieve optimal oral health and dental hygiene, there are a few factors and variables in a toothbrush one should be aware of:

• Manual toothbrush - This is your traditional toothbrush as shown in the photo above.  Through trial and error, the fundamental design of the manual toothbrush is a thin handle along with a head containing bristles.  Often times a thinner head can help reach and clean difficult areas of the mouth.
• Electric toothbrushes - Essentially a handle with a motorized head that either vibrates or rotates the bristles of the toothbrush, it actually vibrates the bristles faster than one can achieve by hand.  Studies have shown that while it can be more effective in removing plaque surrounding the teeth's enamel and around the gingiva, if one has optimal brushing habits via a manual brush, there is no need to switch.  The bristles on electric toothbrushes are typically replaceable.
• Soft bristle head - Your dentist or dental hygienist usually recommends a soft bristle head as hard bristles can actually damage the tooth's enamel and dentinal layer. Harder bristle tooth brushes eliminates plaque more efficiently but can cause more physical stressful to the teeth and gum.  Studies have shown that using a soft to medium tooth brush achieves the best compromise between cleaning effectiveness, tooth wear, and gingival health.
• Bristle lifespan - One should be aware the condition of the bristle.  If one notices the bristles to be flared and worn out, the toothbrush head needs to be replaced to allow for optimal cleaning effectiveness.  The typical lifespan of a toothbrush should be approximately 2-3 months.  Excessive wear of the bristles may suggest over aggressive brushing with possible re-evaluation of brushing techniques.

If you have any questions on how to select a toothbrush, be sure to ask your family dentist or dental hygienist at your next dental cleaning and oral checkup appointment.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com