My Blog

Posts for: September, 2014

By John G. Fisher, DMD
September 29, 2014
Category: Oral Health
TaketheScreamOutofIceCream

“We all scream for ice cream,” the saying goes. But what if eating ice cream — or any very cold or hot food — literally makes you want to scream because your teeth hurt so much?

What causes sensitivity in teeth?

Understanding the anatomy of a tooth helps explain what happens when a tooth becomes sensitive to heat and cold. A tooth is composed of three types of tissue: a hard outer shell of enamel, the body of the tooth composed of the dentin, and an interior tissue of the pulp.

Enamel: The enamel forms the outside of the crown, the part of the tooth you normally see. Made of densely packed crystals of calcium, it is resistant to wear. It is not living tissue, and does not contain nerves, but it is capable of transmitting temperature like hot and cold.

Dentin: Inside the tooth's crown and root is a living tissue called dentin, which is a porous structure similar to bone. It is composed of microscopic tubules containing living cells, which are encased in a hard substance made of calcium crystals.

Pulp: The living dentin transmits sensation through to the pulp, which is in the center of the tooth and contains the tooth's blood vessels and nerves.

A tooth's enamel normally protects the dentin from exposure to extremes of temperature and pressure. If you wear away the enamel and expose the dentin, it will pass sensation through to the nerves in the pulp more directly. The result can range from a twinge to an excruciating pain.

Sensitivity can be caused by:

  • Overzealous tooth brushing resulting in enamel wear and consequently dentin exposure and wear.
  • Enamel and dentin erosion by acids in the foods and beverages you eat and drink.
  • Tooth decay — the most common cause of sensitivity. Decay destroys enamel and dentin inflaming and infecting the living tissues of the pulp, which become increasingly painful.

What can you do to make your teeth less sensitive?

  • Use a soft bristle tooth brush, and brush the affected teeth gently to remove all bacterial plaque. We can advise you on safe and effective brushing techniques.
  • Use toothpaste that contains fluoride. Fluoride strengthens tooth surfaces and makes them more resistant to sensitivity and decay.
  • Ask us about professionally applied fluoride varnishes or filling materials that can cover and replace sensitive or lost tooth structure.

Of course, if the problem is caused by tooth decay, make an appointment with us to remove the decay and place a filling in the sensitive teeth.

Contact us today to schedule an appointment to discuss your questions about sensitive teeth. You can also read the Dear Doctor magazine article “Sensitive Teeth.”


WhatDentalDeviceDoesTVHostVannaWhiteKeeponherNightstand

Here's an interesting tidbit of information on Wheel of Fortune host Vanna White: like many people, she grinds her teeth at night. In a detailed interview with Dear Doctor magazine, Vanna explained how she had to replace a filling in a back tooth several times because of her grinding habit. Eventually, she had her dentist make her a nightguard to protect her famous smile.

“I really try to sleep with it every night,” Vanna told the magazine. “I try to keep it on my nightstand so when I go to bed, I remember to put it in. Or I will put it by my toothbrush so I can put it in after brushing my teeth at night.”

The habit of teeth grinding or clenching is often associated with stress and/or sleep deprivation. It is referred to as “parafunctional” (“para” – outside, “function” – normal), meaning it can generate biting forces well outside the normal range — perhaps 10 times normal. This excessive force can affect many areas of the oral system. Teeth may become worn, chipped or loose; jaw joints or muscles can go into spasm; and some grinders (or “bruxers” as they are also called) may even experience discomfort of the head, ears, neck or back. Many times, a person with a grinding habit does not become aware of it until it is pointed out by a sleep partner or dental professional.

Like Vanna White's dentist, we often recommend a nightguard to those with nocturnal bruxing habits. It is made of a very thin, wear-resistant plastic that fits over the biting surfaces of the upper teeth only. The lower teeth are then free to glide or skate over the guard, which prevents them from biting into the upper teeth. Some people wear their guards during the day if they tend to clench their teeth when under stress.

If you are concerned about teeth grinding or interested in learning more about nightguards, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Vanna White, please see “Vanna White.” Dear Doctor also has more on “Stress & Tooth Habits.”


By John G. Fisher, DMD
September 18, 2014
Category: Oral Health
Tags: oral health  
ProteinInformationinSalivaCouldLeadtoBetterDiagnosticTests

You've probably never thought of the saliva swishing around in your mouth as amazing. The fact is, though, life would be a lot harder without it. Digestion would be quite unpleasant without its enzymes breaking down food during chewing; the soft tissues of our mouth would suffer more environmental abuse without its protective wash; and without its ability to neutralize acid, our tooth enamel would erode.

What's also amazing is what saliva can reveal about our health. As researchers discover more about this phenomenon, it's leading to better and less invasive ways to diagnose disease.

Similar to blood, saliva is composed of proteins containing RNA and DNA molecules which together hold the genetic instructions the human body needs to reproduce cells. We can therefore test saliva for health conditions as we do with blood, but with less invasive collection techniques and far less hazard to healthcare workers from blood-borne diseases. For example, doctors now have a saliva test that can detect the presence of HIV viruses that cause Acquired Immune Deficiency Syndrome (AIDS). Another saliva test will soon be available that can test for hepatitis.

Unfortunately, only a few such tests now exist. Researchers must first identify and then catalog saliva's biomarkers, protein molecules that correspond to specific health conditions — a daunting task since most are marked not by one but hundreds of proteins. Then it's a matter of developing diagnostic devices that can detect these biomarkers.

Although that too is a huge task, existing technology like mass spectrometry (already used to help detect early stages of oral cancer) could be a promising starting point. This process measures the portion of the light spectrum emitted by a molecule, a feature that could help identify a saliva protein by its emitted light signature.

Thanks to the work of these researchers, many of them in the dental profession, information about our bodies contained in saliva may soon be accessible. That accessibility may lead to earlier diagnoses and more successful treatment outcomes.

If you would like more information on saliva and your oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Secrets of Saliva.”


By John G. Fisher, DMD
September 10, 2014
Category: Oral Health
Tags: dental anxiety  
EncounteringPositiveExperiencestheKeytoOvercomingDentalAnxiety

If you’re apprehensive about visiting the dentist, you’re not alone. Studies show a majority of us — as high as 75% — have experienced some form of anxiety about dental treatment. Between 10% and 15% of those have a high degree of anxiety that may cause them to avoid visiting the dentist altogether.

If you’ve experienced this level of anxiety, you weren’t born with it. Such fears develop from early experiences with dentistry, or from stories or attitudes relayed to us by others. While this undue emotional stress could adversely affect your general health, the greater threat is to your oral health, if it causes you to avoid dental care altogether.

Fortunately, anxiety from the thought of dentistry can be overcome. The best approach is relatively simple — counteract the bad experiences of the past with new, more positive experiences. Moderate dentistry should be able to completely eliminate any discomfort during treatment. And with each new good experience, your feelings and attitudes will gradually change over time for the better.

The first step is to discuss your anxiety about dental care with us. It’s important to establish trust with your care provider from the outset if you want to successfully overcome your anxiety. We will listen and not discount or diminish the reality of your fears and their emotional and physical effect; instead, we will work with you to include overcoming anxiety as a part of your treatment plan.

The next step is to proceed with treatments and procedures you feel you can easily undergo, so that at the end of each visit you’ll have a more positive view of that particular treatment (and that you could undergo it again). We won’t rush to complete treatments until you’re ready for them. Although this may extend the duration needed to complete a procedure, it’s important for us to proceed at a pace more conducive to creating and reinforcing new positive feelings and attitudes about dental visits.

In the end, we want to do more than treat an immediate or emergency-related dental condition. We want to help you overcome the anxiety that has kept you from seeking long-term dental care — and thus better dental health — a part of your life.

If you would like more information on overcoming dental treatment anxiety, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Overcoming Dental Fear & Anxiety.”


AcuteToothPainmaybeSignalingYourNeedforRootCanalTreatment

We now have amazing therapies to replace lost teeth with life-like replicas that look and perform like real teeth. But for oral health in general it’s still better to save a natural tooth if we can.

That’s the main purpose of a root canal treatment — to rescue a tooth whose pulp (an area of tissue and nerve bundles inside the tooth) has died from trauma or ravaged by a bacterial infection that continues to progress up into the bone via the root canals. By accessing the pulp through a small opening in the top of the tooth we remove the dead and infected pulp tissue, thoroughly disinfect the empty pulp chamber and root canals, and then fill them with a special filling. We then seal the opening (and later install a permanent crown) to prevent future fracture of the tooth and re-infection.

So, how can you know your tooth is in danger? Your first indication may be an intense tooth pain that comes on quickly. This pain is emanating from the nerves in the pulp as the tissue begins to die. Once the nerves have died, they will no longer transmit pain signals: hence the pain will subside rather quickly in about two or three days.

So it is important to understand that the absence of pain doesn’t mean the infection has subsided — quite the contrary, it’s still present and active, making its way along the root canals of the tooth. At this point you may begin to notice a secondary pain when you bite down on the tooth. This is originating from other nerves located around the periodontal ligament (the main tissue that helps hold teeth in place with the bone) as the tissues become inflamed from the infection. You may also develop an abscess, an area in the gum tissue where infectious pus may collect. Depending on its location, the abscess can be acutely painful or “silent,” meaning you may not feel any pain at all. The infection is still there, though, and the tooth is still in danger.

If you encounter any of the pain symptoms just described, you should visit us for an examination as soon as possible. If the cause indicates the need for a root canal treatment time is of the essence — the longer we delay, the greater the risk of ultimate tooth loss.

If you would like more information on root canal treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Signs and Symptoms of a Future Root Canal.”