We’ve all come to expect bumps, bruises and cuts when we’re out and about, especially when kids are part of the deal. Consequently, many people tote along bandages, ice packs and antiseptics. Some even carry bee sting kits and accidental poisoning remedies. But what happens if your crown or filling falls out? Or if your child knocks out a permanent tooth or breaks her braces? And what would you do if you got a toothache out in the middle of nowhere?

Dr. Richard Price, spokesman for the American Dental Association, recommends packing along a small dental first-aid kit, which should include: clove oil, a natural pain reliever tweezers a dental mirror (ask your dentist where to pick one up) small cotton pellets kept in a zipper-style bag (again, ask your dentist where to get these) petroleum jelly dental floss soft dental wax, carried by drugstores or available from your orthodontist your dentist’s phone number your insurance information instructions (below) for temporary dental first aid If you lose a filling Pain is the issue here. If you aren’t in any pain, simply keep the area clean and see your dentist as soon as you can. If it hurts, take clean tweezers and grab one of the cotton pellets. Dip it in a little bit of clove oil and place it in the tooth. Don’t just dab it; put the whole cotton pellet in the tooth and leave it there. This should minimize the pain until you can get to a dentist. Caution: NEVER put an aspirin on your tooth or gum.

Aspirin is an acid and can burn the tissue. If a cap or a crown falls off Coat the inside of the cap or crown with petroleum jelly and gently place it back on the tooth. See your dentist as soon as you can. If wires on braces break There are a few things you can do to minimize the discomfort of orthodontic wire protruding from your teeth. Ideally, cover the sharp end with a small piece of dental wax; orthodontists will provide this material for you. If you don’t have any wax, you can use a little chunk of pre-chewed sugarless gum. It’s not pretty, but it does the job. If you knock out a tooth If it’s a baby tooth, don’t worry about it. However, if it’s a permanent tooth, you should keep the tooth in the mouth, between the cheek and gum, to keep it moist. But if that’s not possible, submerge the tooth in a glass of milk. And no matter where you hold the tooth, get to a dentist as quickly as possible. It’s likely the tooth can be saved IF you get to the dentist within 30 minutes of losing the tooth. If a tooth becomes dislodged or loose Get to a dentist immediately. Many dentists will make room in their schedule to tend to dental emergencies.

Laser bleaching can whiten your teeth in one hour. However, Laser whitening cannot make your teeth pearly white. Home bleaching can whiten your teeth pearly white, but this approach takes too much time. You need to wear a bleaching tray all-night for about 10-14 days for this effect. The best way to get your teeth pearly white in a short time is the combination of these two bleaching modalities.

Laser Whitening + Take home bleaching = Power whitening

Called power whitening, it’s often used with take-home whitening procedures. For a power-whitening treatment, your dentist first protects your gums, and then carefully applies a concentrated whitening agent.  The laser light will heat up the medication for about one hour. This will “jump-start” the whitening. Then, at the end of the laser treatment, you will be given a whitening agent and a customized tray with detailed instruction to continue the whitening at home. You need to wear the tray for 1-2 hour at home for about 5 days.

After five days, our dentists will see you in the office to carefully examine the progress. In most of the cases, the treatment is successful, even when dealing with the toughest stain. Occasionally, in rare instances, our dentist may have to generously give you more bleaching agent and ask you to wear the tray for additional 3-5 days.

Proper tooth brushing involves four things:

• a soft toothbrush
• toothpaste with fluoride
• the correct brushing angle
• brushing in a pattern

It’s important to brush at least twice a day using a soft toothbrush. The flexible bristles of a soft toothbrush are gentler on the gums and make it much easier to remove the plaque below the gum line, where periodontal disease starts.

Use a toothpaste that contains fluoride. Fluoride hardens the outer enamel layer of the teeth. It might stop a cavity in its tracks and give you more resistance to future cavities.

Angle the bristles of the brush along the gum line at a 45-degree angle. Apply firm but gentle pressure so the bristles slide under the gum line.

Move the brush over the entire surface of two or three teeth at a time in small, circular motions. Allow some overlap as you move to the next teeth. Tilt the brush and use the tip to brush the backs of the front teeth.

It’s fine to brush in any regular pattern you choose, but since the insides of the teeth tend to get less attention, you might start with the insides of the upper teeth, then go to the insides of the lower teeth. Switch to the outsides of the upper teeth, and then the outsides of the lower teeth. Brush the chewing surfaces of the upper teeth, then the lower teeth. End by gently brushing your tongue and the roof of your mouth. This removes germs to help keep your breath fresh.

 
In one person’s mouth, the number of bacteria can easily exceed the number of people who live on Earth. This is according to Sigmund Socransky, a dental researcher at the Forsyth Dental center in Boston, who also asserts that in a plaque-free mouth, 1,000 to 100,000 bacteria live on each tooth surface, but when plaque is present, as many as 100 million to one billion bacteria may be growing on each tooth. It staggers the mind. But what does it do to the body?

Although many of these bacteria are beneficial, some can be quite harmful. In particular, the bacteria that flourish in your mouth when you have periodontal (gum) disease can permanently damage your gums, as well as the bone and connective tissue that support your teeth; this can result in tooth loss. But these bacteria impact more than just your mouth. Researchers are finding that that they can worsen—or even cause—problems elsewhere in the body. Strokes, cardiac conditions, diabetes, stomach ulcers and pneumonia have all been shown to be more prevalent or to worsen in those suffering from gum disease.
Heart attacks

University of Buffalo researcher Dr. Robert J. Genco found that, over a ten-year period, those with gum disease were three times more likely to suffer a heart attack. The precise reason for this causal relationship is still a mystery, but Genco suggests that the disease-causing bacteria may enter the bloodstream through tiny tears in the gums, then infect the liver and cause it to produce proteins that clog the arteries. Another possibility, Genco said, is that the bacteria may infect the arteries of the heart directly, producing blockages. He bases these theories on the fact that the oral bacteria porphyromonas gingivalis have been found in the arteries of those suffering from blockages and subsequent heart failure.

Infective endocarditis
Oral bacteria can also be life-threatening to those with a heart valve ailment. Because of this, those with afflictions such as mitral valve prolapse, rheumatic heart disease, a congenital heart defect, or a heart murmur may need to take antibiotics prior to receiving any dental treatment that might dislodge harmful bacteria into the bloodstream. The antibiotics are a precautionary measure to protect against infective endocarditis, a rare and sometimes fatal disease that can damage the valves and tissues of your heart. The bacteria from plaque—S. sanguis—is one of the most frequent causes of endocarditis, according to studies at the University of Minnesota in Minneapolis.

Strokes
University of Buffalo researchers studied the health histories of nearly ten thousand people between the ages of 25 and 75 and found that the 35 percent who had severe gum disease were also twice as likely to have suffered a severe stroke. Why? Dr. John Marler of the National Institute of Neurological Disorders and Stroke said that oral bacteria can cause fatty deposits in the carotid arteries in your neck. If these deposits break loose and travel through your bloodstream into your brain, they can lodge there, blocking blood flow to the brain and causing a stroke.

Diabetes
Periodontal disease probably doesn’t directly cause diabetes, said Dr. Perry R. Klokkevold of the UCLA School of Dentistry, but it can make managing the disease much more difficult. The bacterial infection caused by periodontal disease diminishes the body’s ability to manage its insulin levels, greatly upsetting a diabetic’s blood sugar levels. This can result in complications such as blindness, heart problems, and kidney disease.

“We know that having gum disease will worsen diabetes,” said Dr. Christopher Saudek, a diabetes specialist at Johns Hopkins University in Baltimore. “People with diabetes should be careful to keep their gums healthy.”

Ulcers
Some stomach ulcers are believed to be caused by a bacterium called helicobacter pylori. Dr. Sherie Dowsett of the Indiana University School of Dentistry said that this bacteria is often found in dental plaque. From the teeth, the bacteria can migrate to the stomach, where they eat small holes in the stomach’s lining, producing painful ulcers.

Pneumonia
Bacteria that reside in plaque are inhaled into your lungs each time you draw a breath. Among these are chlamydia pneumoniae and pseudomonas aeruginosa, two strains of bacteria notorious for causing respiratory disease. Normally, the body’s immune system fights off these harmful invaders. But sometimes, such as after surgery or during an illness, the immune system’s resistance to infection is low. It’s then that these opportunistic bacteria attack the lungs and cause bacterial pneumonia, an infection that kills about 83,000 people each year.

The solution? Destroy their habitat 
Daily brushing and flossing removes much of the plaque—the destructive bacteria’s cozy habitat within your mouth. Gently brushing your tongue and the roof of your mouth removes even more. These simple acts of oral hygiene keep the bacteria count down to a more manageable level and minimize the chance that they’ll move on to wreak havoc elsewhere in your body. And of course, there’s the huge added benefit of cleaner, healthier teeth, fresher breath, and gums free from periodontal disease. You’ve got everything to gain, and nothing to lose, by simply devoting about ten minutes a day to ridding your mouth of plaque.

Crowns, veneers, bonding, orthodontic work: these may be significant investments to restore the health of your teeth or enhance the attractiveness of your smile. If you have had any of these procedures, you should be aware that one of the simplest methods to safeguard your investment is to stop biting your nails.

Isn’t it a harmless habit?

Your fingernails are an important part of your hands, as they provide support for the surrounding tissues and help you to pick up and move things. Created from a type of protein (keratin) that is produced and renewed constantly by living skin cells, fingernails also can reflect the state of your health.

If you bite your nails, the appearance of your hands may suffer, especially when your nails are splintered or chipped, your cuticles are bleeding or torn, and the skin around your nails looks chewed. But beyond the unattractiveness of broken nails, several oral health-related problems can arise. These include:

• Damaging crowns, veneers, and bonded teeth
• Creating small fractures in your incisors or the enamel of your front teeth
• Causing problems with orthodontic treatment
• Increasing the potential for gingivitis and ulceration of your gums
• Passing infections between your fingers and mouth
• Spreading oral diseases, such as herpes

Doesn’t everyone do it?

Some people bite their nails when they are stressed, worried, or bored, while others simply nibble their nails unconsciously. According to a study published in Psychological Reports, nail biters encompass all ages:

• 28 to 33 percent of children who are 7-10 years old
• 44 percent of adolescents
• 19 to 29 percent of young adults
• 5 percent of older adults

Males are more likely than females to bite their nails (10 percent fewer girls than boys). Also, people with higher levels of intelligence are more likely to bite their nails; this may be because higher levels of responsibility and stress lead to increased tendencies for nail biting.

Breaking the habit: easier said than done?

Nail biting is a fairly common habit, but it may take a conscious effort to break. Keep in mind, it’s better to break an unhealthy habit than to break or chip your beautiful teeth and nails!

Replacing an old habit with a new one takes time, patience, and conscious effort. Here are some suggestions to help you be successful:

• Carry an emery board or nail clippers with you.
• Have professional manicures to smooth and improve the look of your nails.
• Use bitter-tasting commercial products on fingernails.
• Wear gloves or bandages.
• Snap a rubber band against your wrist as a reminder to stop nail biting.
• Hold a small stone or play with a small toy, such as a squishy ball.
• Relax more and take regular, deep breaths.
• Do yoga to focus on calming techniques, or do other exercises that require you to use your hands.
• Examine potential reasons for stress or worry, and make changes in your life as needed.
• Ask a family member or friend to remind you if you are biting your nails. Then do something else together!

Periodontal disease can have an effect on one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is on most occasions little or no discomfort. Inadequate oral hygiene often causes gingivitis. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque severely irritate the gums. The toxins stimulate the body to switch on a chronic inflammatory response.  This inflammation destroys the tissues and bone that support the teeth. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be extracted.

Types of Periodontal Disease

There are many forms of periodontal disease. The most common ones include the following.

Gingivitis
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good at home oral care.

Aggressive Periodontitis
A form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Chronic Periodontitis
A form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva. It is recognized as the most frequently occurring form of periodontitis. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a Manifestation of Systemic Diseases
Periodontititis, often with onset at a young age, associated with one of several systemic diseases, such as diabetes.

Necrotizing Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.

Source: American Academy of Periodontology

Randy Huffines, D.D.S., director of the department of dental geriatrics at the Veteran’sAdministrationMedicalCenterinMountain Home,Tennessee, said there are a number of reasons for the high incidence of cavities in seniors.

• More seniors are keeping some or all of their natural teeth for a lifetime. Over 95 percent of seniors have gums that have receded, or grown away, from the teeth.
• This exposes tooth roots, so they are susceptible to acid attacks from food, resulting in root decay.
• Seniors drink less tap water, often opting for bottled or purified water instead, so they don’t get the protective benefits of fluoridated water.
• Homecare is more difficult for older adults, due to manual dexterity problems related to arthritis or physical disabilities.
• Seniors are often taking medications that reduce saliva flow; saliva is the body’s natural defense against tooth decay.
• Transportation problems keep many seniors from seeing a dentist regularly for exams and cleanings.

If you’re an older adult, you can minimize decay and control destructive gum disease by seeing your Gilbert dentist on a regular basis. She and her hygienist can work with you to devise an oral self-care program that enhances your dental health, and consequently, your overall health! You’ll feel better, you’ll taste your food more fully and therefore eat better, and you’ll be more likely to retain your natural teeth for a lifetime!

Treatment options
In the last 10 years there have been dozens of new types of whitening procedures that can eliminate the stain in teeth.  Your Gilbert dentist has multiple options that can work for you, including in office whitening and take home products.  Most whitening products will whiten teeth and leave you with a bright beautiful smile.  Results do vary based on the anatomy of a persons tooth and types of stains. 

Back teeth
A number of factors can contribute to tooth discoloration in back teeth, including genetics, drugs taken during tooth formation, infected teeth, root canal treatment, smoking and consumption of certain foods. However, silver amalgam fillings are the primary cause. Silver fillings contain copper, mercury, tin, and silver that can, over time, blacken the teeth and the gums.

Treatment
Dentists have several white filling materials they can use to replace dark silver fillings.

1. Direct resins: These can be placed directly on the tooth in a single appointment. The correct shade of resin is selected, pressed into place, sculpted, hardened with a special light, and finally adjusted and polished. Direct resins are economical, strong, and adequate restorations but are generally less durable than the other white fillings in this category

2. Indirect resins: The term “indirect” means that the restoration is constructed on a model in a lab rather than directly in a patient’s mouth. Involving a lab makes this a two-appointment procedure. A dental lab uses additional techniques to harden these restorations and make them significantly more durable.

But what happens if your crown or filling falls out? Or if your child knocks out a permanent tooth or breaks her braces? And what would you do if you got a toothache out in the middle of nowhere?

Dr. Boyse and Dr. Snell recommend packing along a small dental first-aid kit, which should include:

• clove oil, a natural pain reliever
• tweezers
• a dental mirror (ask your dentist where to pick one up)
• small cotton pellets kept in a zipper-style bag (again, ask your dentist where to get these)
• petroleum jelly
• dental floss
• soft dental wax, carried by drugstores or available from your orthodontist
• your dentist’s phone number
• your insurance information
• instructions (below) for temporary dental first aid

If you lose a filling
Pain is the issue here. If you aren’t in any pain, simply keep the area clean and see your dentist as soon as you can. If it hurts, take clean tweezers and grab one of the cotton pellets. Dip it in a little bit of clove oil and place it in the tooth. Don’t just dab it; put the whole cotton pellet in the tooth and leave it there. This should minimize the pain until you can get to a dentist. Caution: NEVER put an aspirin on your tooth or gum. Aspirin is an acid and can burn the tissue.

If a cap or a crown falls off
Coat the inside of the cap or crown with petroleum jelly and gently place it back on the tooth. See your dentist as soon as you can.

If wires on braces break
There are a few things you can do to minimize the discomfort of orthodontic wire protruding from your teeth. Ideally, cover the sharp end with a small piece of dental wax; orthodontists will provide this material for you. If you don’t have any wax, you can use a little chunk of pre-chewed sugarless gum. It’s not pretty, but it does the job.

If you knock out a tooth
If it’s a baby tooth, don’t worry about it. However, if it’s a permanent tooth, you should keep the tooth in the mouth, between the cheek and gum, to keep it moist. But if that’s not possible, submerge the tooth in a glass of milk.

And no matter where you hold the tooth, get to a Gilbert dentist as quickly as possible. It’s likely the tooth can be saved IF you get to the dentist within 30 minutes of losing the tooth.

If a tooth becomes dislodged or loose
Get to a dentist immediately. Your Gilbert dentists will make room in our schedule to tend to dental emergencies.

Gums infected with periodontal disease are toxic reservoirs of disease-causing bacteria. The bacteria hide in pockets next to the teeth, where the gums have pulled away from the tooth surface. When gums are this infected, they frequently bleed.

Researchers at theUniversityofMinnesotainMinneapolisrecently discovered that bleeding gums common in severe gum disease provide an open doorway for plaque bacteria to enter the bloodstream. This bacteria, Streptococcus sanguis, can cause blood clots that block arteries and trigger heart attacks.

“Severe periodontitis is the equivalent of about nine square inches of chronic wound around the teeth,” said Dr. Mark Herzberg, director of the study. “It offers considerable opportunity over time for these bacteria to enter the blood.”

In the study, researchers injected the plaque bacteria into rabbits’ veins and then monitored their hearts. Clots formed immediately, and within 30 minutes, the blood flow to the rabbits’ hearts was reduced, reported Herzberg.

Researchers caution that they don’t know whether these results can be reproduced in humans. Nevertheless, this emerging research strengthens the strong link between poor dental health and heart disease.

More heartache from gum disease

Other studies have shown that plaque bacteria entering the bloodstream through infected gums might also cause a potentially fatal heart disease called infective endocarditis. This is a bacterial infection that causes the sac around the heart to become inflamed. Herzberg has shown that the S. sanguis plaque bacteria is one of the most frequent causes of endocarditis.

More than just speculation

In a study of 400 older men, researchers inMichiganfound that those with severe gum disease were four and one-half times more likely to have coronary heart disease than those without gum disease.

TheUniversityofMichiganstudy, conducted by Dr. Walter Loesche, analyzed a sample of 400 men in long-term care at the Ann Arbor VA Medical Center. All men were over 60 years of age, and those whose gum disease correlated with heart disease had bleeding from nearly every tooth and had 14 or fewer teeth remaining.

Findings from the same study also revealed a possible relationship between regular dental exams and a reduced risk of stroke. “Patients who saw a dentist at least once a year were four times less likely to have a history of (stroke),” Loesche said.

The lesson to be learned? Brush, floss, and see your dentist regularly. Because we now know that good oral health can prevent more than just gum disease.

Sources: Dr. Walter Loesche, “The Link Between Systemic Conditions and Diseases and Oral Health,” University of Michigan.
Dr. Eugene J. Whitaker, Temple University School of Dentistry.
The Academy of General Dentistry
The American Academy of Periodontology
The American Dental Association
American Academy of Neurology – 51st Annual Meeting in Toronto, Canada, April, 1999.