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By Edward C. Smith, DMD, MPH, LLC
November 20, 2018
Category: Oral Health
Tags: dental injuries  
BaseballFanCatchesHerOwnKnocked-OutTooth

When your favorite baseball team wins, it's hard not to get excited — especially if you're right there in the stadium. It's even better when a player tosses the ball to fans. But sometimes, in the heat of the moment, things can go awry.

That's what happened during a recent game at New York's Yankee Stadium. After catching the ball that ended the game in an 8-2 Dodgers win, Los Angeles outfielder Yasiel Puig tossed it into a cheering crowd of supporters. “I saw it coming at me and I remember thinking, 'I don't have a glove to catch this ball,'” Dodgers fan Alyssa Gerharter told the New York Daily News. “I felt it hit me and I could feel immediately with my tongue there's a hole. And I looked down at my hand and saw there's a tooth in my hand.”

Ouch. Just like that, one fan's dream became… a not-so-good dream. But fortunately for the 25-year-old software engineer, things went uphill from there. Ushers quickly escorted her into a first-aid room at the stadium. She was then rushed to a nearby hospital, where the upper front tooth was re-inserted into her jaw. After a follow-up appointment at her dentist's office the next day, Gerharter said she remains hopeful the re-inserted tooth will fuse with the bone, and won't require replacement.

We hope so too. And in fact, she has as good a chance of a successful outcome as anyone, because she did everything right. If you're not sure what to do about a knocked-out tooth, here are the basics:

  • locate the tooth, handle it carefully (don't touch the root surface), and if possible gently clean it with water
  • try to open the person's mouth and find the place where the tooth came from
  • carefully re-insert the tooth in its socket if possible, making sure it is facing the right way
  • hold the tooth in place with a soft cloth as you rush to the dental office or the nearest urgent care facility
  • if it can't be replaced in its socket, place the tooth in a special preservative solution or milk, or have the person hold it between the cheek and gum (making sure they won't swallow it) — and then seek immediate care at the dental office
  • follow up at the dental office as recommended

In general, the quicker you perform these steps, the more likely it is that the tooth can be preserved. How quick is quick? The best outcomes are expected when re-implantation occurs in no more than five minutes. So if you're in this situation, don't wait: get (or give) appropriate first aid right away — it just might save a tooth!

If you would like more information about what to do in a dental emergency, contact us or schedule an appointment for a consultation. You can learn more the Dear Doctor articles “Knocked Out Tooth,” and “The Field-Side Guide to Dental Injuries.”

By Edward C. Smith, DMD, MPH, LLC
November 10, 2018
Category: Oral Health
Tags: celebrity smiles   retainer  
MargotRobbieKnowsAGreatSmileIsWorthProtecting

On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.

“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”

Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.

Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.

A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.

Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.

So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.

If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”

By Edward C. Smith, DMD, MPH, LLC
October 31, 2018
Category: Oral Health
CleaningYourOralApplianceExtendsitsLifeandEnsuresGoodHealth

Oral appliances run the gamut from night guards and retainers to full or partial dentures. Millions of people depend on them for restoring or maintaining dental health.

Today's user-friendly appliances reflect the latest advances in technology. But that doesn't mean you can simply "place them and forget them." Their longevity depends on taking care of them.

The most important aspect of appliance care is keeping them clean. Although bacteria have no effect on an appliance's materials, they can accumulate on its surfaces and raise the risk your natural teeth and gums will be infected. To reduce that risk you should clean your appliance every day.

The best way is with a countertop ultrasonic cleaner. These units emit high frequency sound vibrations that loosen plaque (a thin film of bacteria and food particles) from even the appliance's tiniest crevices. Most units cost between $40 and $60, and pose less of a scratching risk to the appliance's surfaces than manual cleaning.

If you'd prefer to use a brush, there are some dos and don'ts to follow. You can use a cleaner especially designed for your appliance, but less expensive mild dish detergent or hand soap (with an antibacterial agent) will work too. Don't use toothpaste — most contain an abrasive ingredient for removing plaque from enamel that could leave microscopic scratches on your appliance. Use a soft-bristle toothbrush (but not the one you use for your natural teeth) or one designed for your appliance.

While boiling kills bacteria, the high heat can soften and warp the plastic material in an appliance. This could alter how the appliance fits in your mouth, making them loose and uncomfortable to wear. You should also avoid bleach: it can whiten acrylic or nylon designed to mimic the red color of real gum tissue.

Unless we've advised you otherwise, don't wear the appliance around the clock, a practice that raises the chances of bacterial accumulation. And be sure you also brush and floss your natural teeth every day.

Keeping both your mouth and your appliance clean helps ensure the best oral health possible — and that your appliance will last longer.

If you would like more information on caring for oral appliances, please contact us or schedule an appointment for a consultation.

By Edward C. Smith, DMD, MPH, LLC
October 21, 2018
Category: Oral Health
Tags: local anesthesia  
GettheRealFactsAboutLocalAnesthesia

A lot of people don’t like dental work because they believe it will be painful or uncomfortable. There’s an anatomical reason to back up that concern — the mouth with its dense network of nerves in the teeth and gums is one of the most sensitive parts of the human body.

But modern dentistry has helped solve much of the problem of pain with advances in local anesthesia. Using substances that temporarily block electrical impulses within the nerves of a selected area of oral tissues, there’s a good chance you’ll feel little to no discomfort even during moderately invasive procedures.

Unfortunately, you might have heard some complaints from others about local anesthesia that might make you wary of it. Many of these complaints, however, aren’t fully based on all the facts. So, let’s set the record straight about local anesthesia and what you can expect.

No need to be afraid of needles. Nobody enjoys the painful prick from an injection needle, and some people are highly fearful of them. But although it’s necessary to use a needle to deliver anesthesia to deeper levels of tissue, it’s possible you won’t feel it. That’s because we’ll typically apply a topical numbing agent to the skin surface that deadens the top layers where we insert the needle.

That numb feeling afterward won’t last long. One of the chief complaints in the past about local anesthesia was the irritating numbness that could long linger after a procedure. Today, however, with more advanced anesthetics and formulae, we’re better able to gauge the duration of the medication’s effect.  This has greatly reduced the length of time afterward your mouth might have that awkward numbing sensation.

Anesthesia isn’t necessary for every procedure. Unless you have hypersensitive teeth, a lot of dental procedures don’t require anesthesia. Your enamel, for example, has no nerves and actually serves as a kind of “muffler” for sensations to lessen their effect. Cleaning your teeth or removing portions of the enamel can normally be performed without the need for numbing medication.

For procedures, though, where pain could be a factor, local anesthesia can make all the difference in the world. In these cases, anesthesia is your friend — it can help you receive the dental care you need without the discomfort.

If you would like more information on pain-free dentistry, 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 “Local Anesthesia for Pain-Free Dentistry.”

By Edward C. Smith, DMD, MPH, LLC
October 11, 2018
Category: Oral Health
Tags: tmj disorders  
TryConservativeMeasurestoTreatingTMDBeforeMoreAggressiveOptions

After ruling out other possibilities for your constant jaw joint pain, your doctor has diagnosed you with a temporomandibular disorder (TMD). Now that you know what you have, what can you do about it?

Unfortunately, it's not always an easy answer. Ideas about treatment are almost as numerous as theories on the causes of TMD. By and large, though, we can classify treatment into two broad categories: conservative and aggressive.

The conservative approach is the result of many years of experimentation and application; it's also much less invasive than aggressive treatments. For most patients, though, these treatments can offer significant relief from pain and dysfunction.

Conservative treatments are based primarily on the philosophy that the temporomandibular joint is like any other joint, and should be treated that way. Treatments include thermal therapies like ice or heat packs applied to the jaw, physical therapy (gentle stretching, jaw exercise, and massage) and pain and muscle relaxant medication. In cases where teeth grinding may be a contributing factor, we might recommend a bite guard worn in the mouth to reduce biting pressure.

On the other end of the spectrum are treatments like altering the bite or the position of the jaw. The purpose of bite alteration is to change the dynamic when the jaws are in contact during chewing or clenching, and reduce pressure on the joints. This is often done by reshaping the teeth's biting surfaces, moving the teeth with orthodontics or performing crown and bridgework. Another possibility, actually modifying the lower jaw location, requires surgery. All of these aggressive treatments are done in order of less to more invasiveness.

These more aggressive treatments, especially jaw surgery, are irreversible. Furthermore, studies on results have not been encouraging — there's no guarantee you'll receive relief from your symptoms. You should consider the aggressive approach only as a last resort, after you've tried more conservative measures. Even then, you should get a second opinion before undergoing more invasive procedures.

Hopefully, you'll see relief from therapies that have made a significant difference for most TMD sufferers. And that's our goal: to reduce your pain and dysfunction and help you regain your quality of life.

If you would like more information on TMD causes and 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 “Seeking Relief from TMD.”





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