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Normal tooth wear

September 5th, 2017

How long should teeth last before they become worn down?  Well I have seen patients in their 90's having worn only about 1 mm (a very small amount) of the edges of their teeth away.  I have also seen patients in their 30's who have worn 4-5 mm (about half of the exposed tooth) away.   In the both cases they often feel the amount of wear is normal.  When a 30 year has lost half of the tooth due to wear they will often not make it much past 50 before the teeth are so worn down that there is little chance of saving them.

Below are three pictures showing different amounts of tooth wear and patients in their 40's.  We should expect to see a similar amount of tooth wear for each of them.

(First Picture)

This is what would be normal to see for someone in the 40's. The teeth are in line which means function well together as well as look nice. By distributing the force of chewing across the mouth the teeth protect each instead of damaging each other during chewing.

(Second Picture)

In this mouth the teeth are crowded and because of the crowding the teeth function in a way that wears the teeth unevenly.  Many patients with teeth worn like this assume it is because of grinding.  Grinding may contribute to the wear however the majority of the wear in cases like this are because the teeth do not work together.

When this person chews she the crooked teeth fit into the worn and chipped patterns in her mouth.  Some areas have worn completely through the enamel and other areas have no wear at all.  If the teeth wear in the correct position the wear would be more even and with this balance there would be less wear overall.

(Third Picture)

Now this is not uncommon to see.  Most of the time a patient with this much tooth wear is in their 50's or 60's but I have seen cases were they are in their 30's or 40's.   Their are 3 things that contributed to this.  First the position of the teeth was such that they were biting on just the edges, second an acidic mouth leading to softer enamel and third teeth grinding.

It is common for people to think that if they brush, floss and avoid candy all will go well.  While that definitely helps poor tooth position, tooth grinding and having an acidic mouth will still result in damage leading to early tooth loss.  Tooth position is mostly genetic.  People who grind their teeth rubbing their teeth together for hours instead of minuets each day.  An acidic mouth can be due to diet, medications or other medical conditions such as acid reflux.  In all of these situations  excessive tooth wear can be prevented or corrected.

Do you have a question about the wear on your teeth?  Please let us know in the comments.

Subtle and Obvious

August 1st, 2017

I recently had a patient come in and while I was talking with her she told me she "wanted to do as little as possible"  I told her "Great! so do I, and in order to be able to do that we may need to do some things sooner rather than latter."

After the exam in which I found a cavity on one tooth and a crack on another.  A cavity left alone will only get bigger until it goes from an infection on part of the tooth to a much larger and painful infection at which point it will need an extraction or root canal both much more invasive and expensive than a filling or even a crown.  A crack will continue to extend and usually does so downward in a way that we can not monitor until it goes into the nerve or under the bone booth of which would involve an extraction or a root canal.

When I told her of the findings and the eventual results she again replied "I want to do as little as possible, so I don't plan on doing anything."  Unfortunately what she didn't realize she was saying was "I want to wait and hope that the inevitable will not happen or at least wait until my problems are to obvious to ignore."

More unfortunate than that is the fact that this is what the majority of patients naturally want to do.   Nationally only 50% of people see the dentist regularly and only 30% of the recommended treatment is ever completed.  The result is often tooth loss (which costs just as much as a filling) or more extensive and expensive treatment to handle a larger more obvious problem.

Subtle problems of  top teeth
Subtle problems with bottom teeth

Most people would look at the pictures of the subtle problems and think there is actually no problems at all.  There is some early decay on some of his silver fillings.  His back teeth (molars) also have some dark spots in the center of the teeth which are small cavities.  His middle teeth (premolars) have grooves at the gum line and his front teeth have worn down due to the way his teeth function together.

These problems may not be very apparent now but if left untreated eventually they will progress to something for difficult to address.  How long will it take?  That answer is different for everyone.  The one answer that is the same is that it will need less treatment now than it will later.

More apparent problems top teeth
More apparent problems bottom teeth

We can't be sure how long it will take for problems to develop into greater problems but it's safe to say that 5-10 more years it is very likely the early but not very apparent problems of the first photos can easily become the serious problems in the second set of photos.  Some of the small fillings with decay will eventually crack commonly resulting in loss of the tooth,  Early decay will progress into large decay which can mean tooth loss, or extensive treatment to save. Wear on the front teeth can result in significant loss of tooth structure or tooth loss.

If left alone anther 5-10 year and the problems progress even more the patient in the second photos may very well be in dentures. Treatment when things are obvious results in being more time consuming, costly and having less favorable results than if treatment was completed when problems were early and less involved

13 things that can go wrong in your mouth besides cavities

July 11th, 2017

Most people would say they go to see the Dentist to get checked for cavities.  Many people are only concerned during their exams if they have cavities or not.  I also hear the jokes about being out of a job if they find a cure for getting cavities.

Cavities, or caries as the dentist calls them, are a major part of what I treat as a Dentist.  Still there are plenty of other problems that Dentist's can detect, help prevent and or treat. In fact some of them are just as common if not more common than cavities.  Here is a list of 13 things that we look for other than cavities.

13- Sleep apnea: 1 in 5 Adults have sleep apnea and 1 in 15 have a severe problem. This leads can lead to many medical problems and an increase risk of car accidents.  A Dentist can both screen for and help treat Sleep apnea.

12- Oral cancer: Multiple cancers first show they have metastasized by showing up in the mouth. They can also originate from the mouth.  The gums don't aren't as thick as the skin and so cancers sign can appear earlier in the mouth.

11- Tissue trauma: Patients can be chewing on their checks and be unaware of this, also I have seen chemical burns from hydrogen peroxide and other chemicals.

10- Auto immune diseases:  Sometimes the bodies immune system with start to attack itself and signs of this can appear in the mouth.  Some examples include, Sjogren's syndrome, pemphigoid, pemphigus and lichen planus.

9- Tooth resorption: Then tooth can just start to deteriorate from in the inside-out or the outside-in.  The cause of tooth resorption is still unknown.  Even though it's rare it will often randomly happen to someone who has otherwise taken great care of their teeth.

8- Decalcified teeth: Acid exposure can cause teeth to become decalcified,  When this happens the teeth will develop a chalky white appearance and will have a higher risk for cavities. We often see this after braces come off, there can be a ring of decalicified tooth where the brackets ended.  There are several treatment options available for decalcified teeth.

7-Genetic tooth conditions:  There are some people out there that unfortunately never develop enamel on their teeth, or develop defective enamel. Also people can genetically just not develop some teeth.

6- Cracked teeth: Teeth usually start to crack or break due to large fillings.  There are plenty of times were tooth with no prior work will just crack.  This can be due to external trauma, I've seen many teeth break from baseballs, or trauma from someone having a heavy bite.

5-Temporal mandibular joint dysfunction: TMJ is what people often call this but TMJ only stands for temporal mandibular joint and we all have a TMJ, in fact we have 2.  The TMJ is the most complicated joint in the body, it hinges, it slides and it rotates, most other joints just hinge or slide. Ligaments, discs, bone can all lead to functional problems in the joint.

4- Muscle pain: Also referred to as TMJ because the way the discomfort is felt is closely the same.  However, muscle pain is a different problem with different solutions.  Bite problems and over use of the muscles commonly lead to pain, sometimes this even feels like it's a tooth problem because of referred pain.

3- Tooth wear: Often considered to be normal excessive tooth wear can lead to major problems.  I have patients who are in their 90's that have worn through about 1 mm at most of their teeth.  I also have patient who are in their 30's who have worn through 4+mm or over 1/3 of the exposed tooth.  The former is normal, the later is problematic and becomes more complicated and expensive to treat over time.

2- Chewing malfunction: Having straight teeth is more than aesthetic, it is also for optimal functional. Improper tooth position is often the root (pun intended) of tooth wear as well as joint and muscle pain.  Braces can make so many things better even if you didn't have them when you were younger.

1- Periodontal disease (gum disease): Essentially this in inevitable given enough time and can commonly result in irreversible bone loss after as little as a couple of years of not seeing the Dental Hygienist.  No matter how well you clean, bacteria on your teeth will develop into a hard tartar called calculus that will infect your gums.  This results in bacteria leaking into your blood via the gums that your bodies defenses can not adequately reach.  So it continuously will leak bacteria into your blood stream unless removed during a dental hygiene appointment.

Why does my tooth hurt?

June 6th, 2017

There can be many reasons a tooth can hurt and sometimes there is actually nothing wrong with the actual tooth.  People often wonder why a tooth hurts when it has had a root canal, or why it only hurts to with pressure but not colds or the other way around.  Others come in confused  by symptoms that are inconsistent.  There are plenty of patients I see that fell a tooth ache but are not sure which tooth or even if it is a top of bottom tooth or even multiple teeth.  There are many thing that can cause a tooth to hurt and only a few sources of tooth pain.

Have you ever been frustrated with trying to figure out why your tooth is hurting?  I will explain the different neural sources of tooth pain and the causes that lead those sources to hurt.

First a very brief anatomy lesson

The tooth has a hard enamel shell on the top part the sticks out of the gums.  The part of the tooth in the bone, the root of the tooth, is made up of a less hard material called cementum.  Going from the outside in just past the enamel is dentin.  The dentin is softer like the cementum and is more porous. In the center of the tooth is the pulp which consists of the blood vessels and nerve.

Supporting the tooth on the outside is the gingiva or gums.  Inside the gums is the bone and between the bone on the tooth is a ligament.  Tiny nerves inter and exit the tooth from all around the root, but the main nerve exits out of the tip of the root.  This nerve then connects to larger and larger branches of the nerve that are connecting with other teeth and even other parts of the mouth.  Eventually the nerves travel all the way back to the brain.

Sources of tooth pain

A tooth will hurt if the nerve is aggravated.  This can happen in many ways but I will narrow it down to four categories:

  1. The nerve inside of the tooth is aggravated
  2. The nerves in the ligaments and bone surrounding the tooth are aggravated
  3. The nerves in the gingiva or gums are aggravated.
  4. The nerves are aggravated at a different spots heading back to the brain and they are referring back to the tooth.

Causes of pain: A long list that is a brief view of possible problems.

There are a signs and symptoms that help me as a Dentist to find out what might be causing one of the sources of pain hurt. It is very helpful to know how the tooth is hurting, what causes it to hurt and even when it hurts.  There are also things I can look for and test for that help to find the cause of the pain.  Using both your description of the pain and what we find on x-ray, photos and tests we are able to find the cause of the pain.

What can cause these different sources of pain to actually hurt?  Well the list is long but I will do my best to list some of main causes per category

1.  The nerves inside of teeth can hurt because of:

  • A cavity reaching the never,
  • a crack reaching the nerve,
  • the dentin being exposed from worn enamel, the dentin pores the communicate cold and hot more with the nerve,
  • a cavity extending into the dentin causing dentin pore communication of cold, hot and sweets
  • swelling in the tooth putting pressure on the nerve from physical trauma
  • swelling in the tooth from dental work, Yes we need to do this in order to correct worse current or future problems with tooth, the soon a problem is addressed the lower the chances are
  • a broken tooth exposing the pulp/nerve of the tooth
  • chemical exposure opening pores in the tooth that communicate with the nerve (this is usually from tooth bleaching)

2. The nerves for the ligaments and bone surrounding a tooth can hurt because of:

  • an infection from the inside of the inside of the tooth coming outside in the ligament space
  • a crack extending down the root of the tooth that is under bone, this can irritate the ligament and the bone
  • swelling of the ligament from physical trauma
  • swelling of the ligament from a traumatic chewing habits
  • swelling of the ligament from an unstable bite when chewing
  • loss of bone support cause the tooth to become loose and irritate the remaining bone
  • physical trauma that breaks the bone an not the tooth
  • abnormal growth in the bone affecting the nerve

3. The nerves in the ginigva (gums) are aggravated:

  • Physical trauma to the gums (from multiple sources)
  • Chemical trauma to the gums (from multiple sources)
  • Burns on the gums
  • plaque leading to bacteria infecting the gums
  • Tartar (hard plaque) leading to bacteria infecting the gums but also placing physical presser on the gums
  • viral infections, such as cold sores
  • fungal infections
  • abnormal growth in the gums affecting the nerve

4. The nerves can be aggravated in a different location referring pain to the teeth because:

  • Swollen salivary ducts from an infection
  • Swollen salivary ducts that are just clogged (for lack of a better laymen term)
  • Swollen clenching muscles that refer pain back to the tooth
  • Swollen jaw balancing muscles that refer pain back to the tooth
  • Tense muscles that refer pain back to the tooth
  • Sinus troubles that refer pain back to the tooth
  • Any of the first three sources problems getting mixed up in the nerve highway back to the brain that refers pain to another tooth instead of the actual problem tooth

With the many possibilities of tooth pain it's a good thing we take time with our patients so we can get a clear picture of what is going on and why.

I would love to hear your comments on any confusing dental problems you may have had as well as what happened to help correct it.  If you have a tooth that's bothering you please call us at 520.745.9723 or send us a appointment request at