Dentist – San Francisco CA | Dr. Beverly Presley-Nelson

WHAT IS FLUORIDE AND WHY DO WE NEED IT?

By Dr. Wendy Fung

Fluoride is a naturally occurring compound derived from the element fluorine. Fluoride prevents and reverses early dental decay by making teeth stronger and more resistant to the bacterial acid that causes cavities. The mineral actually becomes a part of tooth structure, forming a different, “harder” compound. Fluoride can also help inhibit bacterial acid production, further reducing the rate of decay.

Fluoride can be obtained topically or systemically. Systemic fluoride is ingested through fluoridated water or other supplements. This helps teeth that are still forming and also makes fluoride available in saliva, which is beneficial since teeth are constantly bathed in saliva. Topical fluorides benefit teeth that are already in the mouth and include toothpastes and professionally applied therapies.

Fluoridation of community water is the adjustment of naturally occurring fluoride to the optimal level of 0.7 parts per million, as recommended by the U.S. Public Health Service. Fluoridating water is similar to fortifying milk with Vitamin D or table salt with iodine.
The Centers for Disease Control and Prevention has described water fluoridation as one of ten great public health achievements of the 20th century because it has reduced tooth decay by 20-40% in the last few decades, and studies done since water fluoridation began over 60 years ago have shown it to be safe.

Professionally applied fluoride therapies are the foams and rinses we recommend in our office. These fluorides are more concentrated than any over-the-counter product, so they are not needed as frequently. We do, however, recommend them at cleaning visits to give teeth a boost of cavity protection. We know the service is not always covered by insurance, nor is it the most pleasant taste…but isn’t your oral health worth it? Read more about fluoride, and its controversies, in our 2009 Newsletter posted on our website at www.healthytoothteam.com

Professionally-Applied

Professionally-applied fluorides are in the form of a gel, foam or rinse, and are applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are not needed as frequently. The ADA recommends that dental professionals use any of the professional strength, tray-applied gels or foam products carrying the ADA Seal of Acceptance.

Fluoride is a mineral that occurs naturally in all water sources, even the oceans. The fluoride ion comes from the element fluorine. Fluorine, the 17th most abundant element in the earth’s crust, is never encountered in its free state in nature. It exists only in combination with other elements as a fluoride compound
The Centers for Disease Control and Prevention has proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century.

Community water fluoridation is the single most effective public health measure to prevent tooth decay.
Fluoridation of community water supplies is simply the adjustment of the existing, naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the U.S. Public Health Service (0.7 – 1.2 parts per million) for the prevention of tooth decay. Water that has been fortified with fluoride is similar to fortifying milk with Vitamin D, table salt with iodine, and bread and cereals with folic acid.

Studies conducted throughout the past 65 years have consistently shown that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. Simply by drinking water, children and adults can benefit from fluoridation’s cavity protection whether they are at home, work or school.

Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste

Fluoride is effective in preventing and reversing the early signs of dental caries (tooth decay). Researchers have shown that there are several ways through which fluoride achieves its decay-preventive effects. It makes the tooth structure stronger, so teeth are more resistant to acid attacks. Acid is formed when the bacteria in plaque break down sugars and carbohydrates from the diet. Repeated acid attacks break down the tooth, which causes cavities. Fluoride also acts to repair, or remineralize, areas in which acid attacks have already begun. The remineralization effect of fluoride is important because it reverses the early decay process as well as creating a tooth surface that is more resistant to decay.

Fluoride is obtained in two forms: topical and systemic. Topical fluorides strengthen teeth already present in the mouth making them more decay-resistant. Topical fluorides include toothpastes, mouthrinses and professionally applied fluoride therapies.

Systemic fluorides are those that are ingested into the body and become incorporated into forming tooth structures. Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually bathes the teeth. Systemic fluorides include water fluoridation or dietary fluoride supplements in the form of tablets, drops or lozenges.

One method of self-applied topical fluoride that is responsible for a significant drop in the level of cavities since 1960 is use of a fluoride-containing toothpaste. The American Dental Association recommends that children (over two years of age) and adults use a fluoride toothpaste displaying the ADA Seal of Acceptance or consult with a child’s dentist if considering the use of toothpaste before age 2. Other sources of self-applied fluoride are mouthrinses designed to be rinsed and spit out, either prescribed by your dentist or an over-the-counter variety. The ADA recommends the use of fluoride mouthrinses, but not for children under six years of age because they may swallow the rinse.

More than 65 years ago – on January 25,1945 – Grand Rapids, Michigan became the world’s first city to adjust the level of fluoride in its water supply. Since that time, fluoridation has dramatically improved the oral health of tens of millions of Americans. Community water fluoridation is the single most effective public health measure to prevent tooth decay. The Centers for Disease Control and Prevention has proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century. Approximately 72.4% of the U.S. population served by public water systems receive the benefit of optimally fluoridated water.

Fluoridation of community water supplies is simply the adjustment of the existing, naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the U.S. Public Health Service (0.7 – 1.2 parts per million) for the prevention of tooth decay. Water that has been fortified with fluoride is similar to fortifying milk with Vitamin D, table salt with iodine, and bread and cereals with folic acid.

Studies conducted throughout the past 65 years have consistently shown that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. Simply by drinking water, children and adults can benefit from fluoridation’s cavity protection whether they are at home, work or school.
Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.

Fluoridation is one public health program that actually saves money. An individual can have a lifetime of fluoridated water for less than the cost of one dental filling.
 
The American Dental Association continues to endorse fluoridation of community water supplies as safe and effective for preventing tooth decay. This support has been the Association’s position since policy was first adopted in 1950. The ADA’s policies regarding community water fluoridation are based on the overwhelming weight of peer-reviewed, credible scientific evidence. The ADA, along with state and local dental societies, continues to work with federal, state and local agencies to increase the number of communities benefiting from water fluoridation.

Cavities used to be a fact of life. But over the past few decades, tooth decay has been reduced dramatically. The key reason: fluoride. Research has shown that fluoride reduces cavities in both children and adults. It also helps repair the early stages of tooth decay even before the decay becomes visible. Unfortunately, many people continue to be misinformed about fluoride and fluoridation. Fluoride is like any other nutrient; it is safe and effective when used appropriately. This article will help you learn more about the important oral health benefits of fluoride.

• Fluoride: Nature’s Cavity Fighter
• Topical Fluorides
• Systemic Fluorides
• Conclusion
• Fluoride Supplement Dosage Schedule—2010

Fluoride: Nature’s Cavity Fighter

Fluoride is a mineral that occurs naturally in all water sources, even the oceans. The fluoride ion comes from the element fluorine. Fluorine, the 17th most abundant element in the earth’s crust, is never encountered in its free state in nature. It exists only in combination with other elements as a fluoride compound.
Fluoride is effective in preventing and reversing the early signs of dental caries (tooth decay). Researchers have shown that there are several ways through which fluoride achieves its decay-preventive effects. It makes the tooth structure stronger, so teeth are more resistant to acid attacks. Acid is formed when the bacteria in plaque break down sugars and carbohydrates from the diet. Repeated acid attacks break down the tooth, which causes cavities. Fluoride also acts to repair, or remineralize, areas in which acid attacks have already begun. The remineralization effect of fluoride is important because it reverses the early decay process as well as creating a tooth surface that is more resistant to decay.
Fluoride is obtained in two forms: topical and systemic. Topical fluorides strengthen teeth already present in the mouth making them more decay-resistant. Topical fluorides include toothpastes, mouthrinses and professionally applied fluoride therapies.

Systemic fluorides are those that are ingested into the body and become incorporated into forming tooth structures. Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually bathes the teeth. Systemic fluorides include water fluoridation or dietary fluoride supplements in the form of tablets, drops or lozenges.

Sources of Fluoride

Community water fluoridation
Community water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary to prevent tooth decay. Studies prove that water fluoridation continues to be effective in reducing tooth decay by 20 to 40 percent.

Self-Applied

One method of self-applied topical fluoride that is responsible for a significant drop in the level of cavities since 1960 is use of a fluoride-containing toothpaste. The American Dental Association recommends that children (over two years of age) and adults use a fluoride toothpaste displaying the ADA Seal of Acceptance or consult with a child’s dentist if considering the use of toothpaste before age 2. Other sources of self-applied fluoride are mouthrinses designed to be rinsed and spit out, either prescribed by your dentist or an over-the-counter variety. The ADA recommends the use of fluoride mouth rinses, but not for children under six years of age because they may swallow the rinse.

Professionally-Applied

Professionally-applied fluorides are in the form of a gel, foam or rinse, and are applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are not needed as frequently. The ADA recommends that dental professionals use any of the professional strength, tray-applied gels or foam products carrying the ADA Seal of Acceptance.

Systemic Fluorides

Systemic fluorides such as community water fluoridation and dietary fluoride supplements are effective in reducing tooth decay. These fluorides provide topical supplements are effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.

Community Water Fluoridation

Fluoride is present naturally in all water sources. Community water fluoridation, which has been around for over 50 years, is simply the process of adjusting the fluoride content of fluoride-deficient water to the recommended level for optimal dental health. That recommended level is 0.7 parts fluoride per million parts water. Water fluoridation has been proven to reduce decay in both children and adults. While water fluoridation is an extremely effective and inexpensive means of obtaining the fluoride necessary for optimal tooth decay prevention, not everyone lives in a community with a centralized, public or private water source that can be fluoridated. For those individuals, fluoride is available in other forms.

WE PRACTICE PREVENTIVE DENTISTRY
Kathleen O’Connor Hanley R.D.H.

As you know, we work hard to educate our patients on how to take care of their teeth and keep them healthy for life. That education always begins with what we call our “plaque control” class. This is the class we give every patient at their first cleaning appointment. At this appointment, we explain what plaque is, what it does and instruct patients on how to get plaque free every 24 hours. This is the most important service that we provide for our patients. So many people brush and floss but aren’t really sure why. They often think that brushing and flossing is important for food removal but the true goal is to disorganize colonies of bacteria that produce acid (for more detailed info see Newsletter 2009 “Getting Plaque Free” on our website www.healthytoothteam.com).

We still really like the Rotadent automatic toothbrush as a tool to help get plaque free. There are many power brushes on the market but the small head size, soft bristles and pointed brush design make this our favorite. If I haven’t shown it to you already, ask me at your next cleaning.

Fluoride is another important part of our preventive plan. Fluoride can benefit teeth two ways. One way is ingesting fluoride; this is really only beneficial when the permanent teeth are forming. Once the teeth are formed, only topical fluoride is really beneficial. Topical application of fluoride on clean teeth can actually change the chemical make up of enamel and help make teeth more resistant to decay. It can also help with sensitivity due to recession, erosion or abfraction. We recommend our patients rinse with a prescription strength fluoride rinse when they have their teeth cleaned because it is absorbed best by clean teeth. We often recommend ACT home fluoride rinse for home use or a prescription strength gel for those with high caries rate, sensitivity and/or recession. When used properly, it is an extremely effective part of dental disease prevention but it is not without its controversies, which you can read more about in another article I wrote (2009 Newsletter, “Fluoride Supplements” posted on our website www.healthytoothteam.com).

Proper diet choices play a big part in dental health as well. We educate our patients to know that disrupting colonies of plaque is the most important thing but avoiding excessive sugar and dietary acid exposure is important as well. A more in depth discussion of dietary issues can be found in “Juice Beware” in the 2008 Newsletter, on our website www.healthytoothteam.com.

Once we have achieved tooth and gum health with our patients, maintenance becomes the emphasis. Each patient is assessed and a maintenance schedule is suggested based on individual results. Some patients are prescribed the standard 6 month schedule, but we have many patients that come every 3-4 months due to their dental condition. Keeping your appointments at the recommended intervals is a vital part of the preventive plan.

WHAT IS AN ABSCESS?

By Dr. Presley-Nelson

The word abscess conjures up the mental picture of a fluid or pus filled area of infection in our minds, such as an abscess on an injured leg that needs to be cleaned out and medicated. This mental picture serves well to describe intra-oral abscesses. There are 2 kinds of dental abscess to address.

One type is called “endodontic” abscess because of the latin root word “endo” meaning “within” or “inside“. “Dont” is Latin for tooth. This abscess is from the death and infection of the dental nerve or “pulp” that is INSIDE the tooth. This is treated by cleaning out the dead and infected pulp, and filling the area with clean sterile material, along with the possible administering of an antibiotic. We call that “root canal therapy” or “root canal treatment“. Some symptoms of endodontic abscess are pain upon biting or pressure, and sometimes a deep ache or throb. The pain comes from the accumulation of pus and infection in the tissues surrounding the tip of the root.

Another kind of abscess is called “periodontic abscess” because of the latin root word “perio” which means “around” and again, “dont” meaning tooth. This abscess has nothing to do with the nerve inside the tooth. Instead it is an accumulation of pus and infection along the side of the tooth, in the periodontal ligament that lines the socket. This comes from gum infection, surrounding the tooth, and is usually started by deep gum pockets that fester. It is treated by cleaning out the gum pocket and possibly by the use of antibiotics or antimicrobials.

Read more about endodontic abscess in the article “Reversible and Irreversible Pulpitis“. Read about preventing gum disease and periodontal abscess in articles about plaque control under Patient Education.

TEMPORO-MANDIBULAR JOINT DISORDER

By Dr. Presley-Nelson

Sometimes referred to as TMJ or TMD, this is a common malady in today’s high stress world. If you have tenderness in the joint area in front of your ears, pain or headache in the temple region, or tired aching jaws in the morning, you may have TMD.

This joint, which is the “hinge” between your lower jaw and your skull, can be the most over worked joint in your body. It is used for chewing, speaking, facial expression, and swallowing. Some people even work this joint unnecessarily by chewing gum or clenching and grinding due to stress. And, if your bite is not perfect it is thought that you may even stress your joint just trying to get all your teeth together at once. Some doctors relate grinding to sleep apnea, others to stress and still others to neurological tics. Whatever the cause, the joint is likely to be over-worked. One interesting way that the temporomandibular joint can be over stressed occurs when folks think that their teeth should touch when resting, but a normal jaw rest position is with the teeth 2 to 5 mm apart (called freeway space). Not allowing freeway space at rest can irritate the joint. Also, habits, like popping your joint on purpose or posturing with your jaw jutted forward or sleeping with your jaw jammed sideways can cause trouble.

Signs and symptoms of trouble include popping or clicking upon opening, locking open, or difficulty opening, and, of course . . . pain. If you think you have TMD tell your dentist.

What Can Be Done?

Well the first line of defense when the situation is acute are a group of palliative measures:

• Soft foods
• Small bites
• Warm compress
• Stop gum chewing . . . or other bad habits (see above)
• Be aware of clenching or grinding and . . . take steps to reduce it.

The use of non-steroidal, anti-inflammatory agents like Nuprin, Advil, or Alleve; perscription anti-inflammatory agents are also good.

The next step (after a good exam), might be to have a night-guard (TMJ Splint) made to hold your jaw slightly apart in a restful position, (freeway space). This is a small appliance similar to a retainer, usually worn at night and easily tolerated. It can ease the stress of clenching or grinding habits (bruxism). While worn, it evens out a bad bite. This plus attempts to control stress may be all that is necessary. In most cases, a night-guard and the above palliative measures bring symptoms under control.

Occasionally TMD may become more complicated. Teeth that hit “high” or first may need to be altered to reduce bite discrepancies. In some more extreme cases help from a TMD Clinic at a Dental School or a consult with a Specialist may be necessary. Special joint X-rays or MRIs may be needed. Arthritis should be ruled out. Biofeedback, sleep studies and/or counseling may accompany night-guard or other appliance therapy and in some cases surgery to the joint may be an option. Seek treatment early to avoid permanent joint damage. Remember, you are not alone if you are suffering with TMD and help is for the asking.

Besides damaging the joint, chronic clenching and grinding habits can damage teeth, and their support mechanisms. Cracked tooth syndrome can be the result. Ruminating tooth sensitivities that come and go may be a clue that you have a clenching or grinding habit.

DO YOU NEED A ROOT CANAL OR NOT?

By Dr. Presley-Nelson

 

To understand how we determine when root canal treatment is necessary, you need to understand the nature of pulpitis.

WHAT IS PULPITIS?

It is inflammation of the dental pulp. The pulp is the nerve and blood supply that are inside a tooth. When the pulp is inflamed a tooth may become sensitive.

The cause of pulpitis is mainly insults to the pulp. The first cavity (at age 7 possibly) insults the nerve with bacteria. The filling to correct it may insult the nerve mechanically. In later years, the second cavity and the second repair job may add to the insult. A blow to the tooth or undue forces may cause cracks, and therefore insults. Any broken cusp or a crack that can’t even be detected may further insult the pulp and the crown procedure that follows may add insult as well.

In many cases, such as those described above, the dental pulp may become, and stay inflamed and sensitive, but still have a chance to heal and recover. We call this reversible pulpitis, the symptoms of which are as follows: sensitivity that slowly gets better, or sensitivity only when something occurs to cause it, like drinking cold water.

Irreversible pulpitis is when a nerve has been insulted beyond recovery. Tissues in the pulp die and abscess will occur sooner or later. Often the tooth will abscess soon, but it can take months or years to occur.

Irreversible pulpitis means that Root Canal Therapy is necessary if the tooth is to be saved. Symptoms are ever worsening sensitivity, prolonged sensitivity, and pain that lingers awhile after the stimulus is removed. Also, spontaneous pain, not caused by any stimulus is a sign, as well as night awakening pain.

To Summarize:   Reversible Pulpitis Discomfort caused by cold or other stimuli Discomfort relieved when stimulus is removed Symptoms getting slowly better Discomfort easily controlled by over the counter analgesics Irreversible Pulpitis Spontaneous pain, NOT caused by stimuli Lingering pain, even after stimulus removed Getting worse or lasting too long Discomfort does not respond well to analgesics Night awakening Root canal necessary

DENTAL IMPLANTS: WHAT TO CONSIDER?

By: Dr. Presley-Nelson

Many patients, today, are confronted with the choice of implants in their dental treatment plans. Perhaps they have had a recent extraction. Or maybe they have had some missing teeth for some time, and want to restore their dentition. Perhaps they have struggles with removable dentures or partial dentures and wish to have more solid functioning. For many reasons, the public needs to be informed about what implants are and how implants can help them. San Francisco periodontist and implantologist, Dr. Paul Speert, reports that “Dental implants are now the treatment of choice in most instances for the replacement of missing teeth, and is one of the most predictable treatments we have in dentistry. They can be done for single tooth as well as multiple tooth replacements. There are very few contraindications.”

Dental implants are artificial substitutes for natural tooth roots. These implants are like a metal screw or rod and are inserted into the jawbone by a periodontist or oral surgeon. Then a prosthesis is built over it by a general dentist, such as Dr. Presley-Nelson or Dr. Fung. That prosthesis may be a crown or a bridge or some sort of removable partial denture or full denture. Occasionally a second specialist, a prosthodontist, may be needed if the case is particularly difficult.

In Dentistry Today Magazine, October, 2007 ,in an article entitled “Implantology”, Dr. Americo Frenando, ’84 graduate of the University of Manitoba, states: “Knowing what is known today about implant dentistry, it is surprising to me that dental schools are still teaching dentists to cut down healthy teeth to replace missing teeth with bridges. A mountain of evidence unequivocally supports that replacement of teeth with implants is the new standard of care.” Here Dr. Fernando seemingly makes the case for implants even stronger.

The procedure to receive implants is performed comfortably, by the periodontist or oral surgeon, with local anesthesia and often IV medication, within their offices, and takes only an hour or two. Then the work is closed up and let heal for some months. Upon healing, an abutment or small metal piece is installed, which protrudes out of the gum and allows the crown or other prosthesis to be made upon it. Several months and usually 2 dental offices are involved.

The dis-advantages are more time and monetary investment. The advantages are a more life-like restoration that does not harm or rely upon neighboring teeth, and that offers very solid and long lasting support.

To be eligible for an implant, a visit to the periodontist or oral surgeon is necessary to see if you are able to receive one. Quoting periodontist Dr. Paul Speert again, here he relates what he looks for in an implant candidate:

“There are very few contraindications for having a dental implant. One must be in reasonably good health. Diabetics can have implants, but it is important for the diabetes to be controlled. Smoking is not a contraindication although there is a slightly decreased success rate compared to nonsmokers. The main requirement for dental implants is having enough bone. If a tooth is to be removed and an implant is to follow, we will do a procedure to preserve the bone, called socket grafting, and whenever possible, we place the implant at the time of extraction. We call this immediate placement. If the tooth is already missing, and there is a question about whether there is enough bone, we can do a special x-ray called a tomogram (like a cat scan). This gives us a picture of the bone in cross section; from this we can see bone volume, bone density, and locate vital structures that we want to avoid. If the bone is adequate, the placement of a dental implant is a fairly simple procedure with very little postoperative discomfort. In situations where there is an insufficient amount of bone, we have bone graft procedures to create more bone. If we don’t need a lot of grafting, in many cases the grafting can be done at the time of implant placement, resulting in reduced treatment time and expense All in all, we work to make implants a successful choice for you.”

Further reading material is available in the office upon asking. An article comparing the cost, insurance coverage, and viability of a fixed bridge versus an implant appeared in this Newsletter 2 years ago. It can be obtained in the office.

Dr. Speert maintains that “dental implants are the biggest change to come along in my 36 years of practice. I have been placing dental implants since 1989. There have been many improvements in dental implants, especially modification of the surface that which has shortened the treatment time due to more rapid integration into the bone (called osseointegration). Dental implants are costly, but their long term predictability and desirable results compared to more conventional treatments makes them well worth it. Patients are extremely satisfied with this treatment.” Dental implants are here to stay, and here to serve your dental needs reliably and well.

CRACKED TOOTH SYNDROME

by Beverly Presley-Nelson, D.D.S.

Cracked tooth syndrome is a group of symptoms and occurrences that can be an annoying problem for a patient and a diagnostic challenge for a dentist. At one time this syndrome was called, “Green Stick Fracture” in some dental circles. Imagine trying to break a tree branch that is still somewhat “green” or fresh and will not break all the way through. Teeth can behave this way. A single fracture or several microfractures may occur that cannot be detected by dental x-rays or readily seen with the human eye. They exist, but like the green branch, they are not broken all the way through. A tooth may appear to be intact but may have one or more of these fractures. This is not the same as the tiny “craze” lines that may be observed on the surface of some front teeth. “Craze lines” are shallow and of no consequence. “Green stick” fractures are deeper into the tooth and usually not easily seen.

The first sign of cracked tooth syndrome may be when a part of a tooth actually falls away such as with a broken cusp. This may be a precursor to, or a hint of other unseen fractures within the tooth.

On the other hand, a tooth with a “green stick” fracture may never break apart. Instead they may have symptoms of pain upon biting. This often is a sharp, quick pain that is not easy to reproduce at will. It
may be felt only occasionally when the patient chews just a certain way. Or a cracked tooth may be tender to all pressure or even sensitive to other stimuli, such as cold air. Sometimes it is hard for the patient and the dentist to be sure which tooth is affected.

Sometimes a routine dental procedure will “bring to light” or exacerbate an existing “cracked tooth syndrome”.

A bonded resin restoration often solves cracked tooth syndrome. A crown (cap) usually solves it. Sometimes a crown does not solve it because the dental pulp is irreversibly inflamed and root canal therapy will be necessary. This can be done after a crown is placed by drilling through it. A patient may opt to have root canal therapy before trying a crown to avoid disturbing the crown, “just in case”.

Once in awhile, this syndrome results in recurring problems at the neck of the tooth or in the root of the tooth even after a crown has been placed or root canal therapy performed. These problems include breakage, leakage, or other failures. There can even be a vertical root fracture that eventually necessitates removal of the tooth itself.

It is heartening, however, to know that most teeth with cracked tooth syndrome can be managed with just a bonded restoration or, more likely, a crown.

It has been postulated that cracked tooth syndrome is more common in recent years due to an increase in clenching and grinding, resulting from modern day stress. Dentists can fabricate night guards to help protect teeth from such a habit.

By: Dr. Presley-Nelson

DO YOU CLENCH AND GRIND YOUR TEETH?

Many patients can answer that question with a resounding “Yes!” Others are unsure but suspect that they may do so unconsciously and/or in their sleep.

SO WHAT?  SO WHAT IF GRINDING AND CLENCHING OF THE TEETH OCCUR?

The answer to that question is Bruxism can damage the teeth, the supporting structure of the teeth (the periodontium) and the Temporo-Mandibular-Joint (TMJ), which is the “hinge” between your upper and lower jaw.

HOW CAN YOU TELL IF THEY ARE BRUXING?

If you clench or grind while sleeping, someone may report hearing or seeing you do it. If not, signs that you are bruxing in your sleep are tired jaw muscles upon waking, TMJ pain or very sensitive teeth. Sometimes headache in the temporal area may be a clue. “Catching yourself” clenching or grinding during waking hours is possible once you know that it is a harmful habit. Teeth were only meant to touch during chewing. The rest of the time, the jaws should be at restwith the teeth slightly apart (2-4 mm). This is called “Freeway Space” and is what our anatomy was designed for.Our teeth are encased in bony crypts or sockets that are lined with many tiny suspension cords (like rubber bands). This system is called a periodontal ligament (PDL). The PDL allows movement and provides cushioning for the teeth. If you keep clenched together, the teeth are always jammed down hard into their sockets and damage can occur. Let those teeth rest and float on their suspension systems except for when chewing food. Amazingly, that adds up to only about 10-15 minutes of socket compression a day. If that’s all the system was built to bear, imagine the destruction that can come from the overload of constant tooth contact. Not only can the PDL, gum tissue, and bone support be broken down, but the teeth themselves can wear down. Flattened and worn areas occur on teeth as well as chipping and thinning, or even cracking. Enamel rods can be “plucked” out of cuspal areas, leaving holes. Enamel rods may “ping” away at the neck of the teeth, leaving those deep “cuts” in the dentin near the gum line that dentists call abfractions. Imagine also, the effect on a joint that doesn’t have rest and healing time. Therefore the TMJ can also suffer also.

People respond differently to bruxism and the forces applied vary. Some patients will suffer with joint problems, others will instead have tooth or periodontal damage. Long term, untreated bruxism can result in a combination of problems in the three areas.

WHAT CAN BE DONE ABOUT IT?

If you clench or grind consciously, make efforts to stop. If you brux at night, get a night guard and wear it as soon as you can. It is a retainer-like device that is easily tolerated and protects your teeth from wear. It keeps the jaws apart a few millimeters so you can’t compress your jaw joint completely. It helps to even out a bad bite. In some cases, it can help interrupt the habit. Other people may just grind against the guard, at least sparing the teeth and keeping the joint uncompressed. Relief from many symptoms can be had from a properly made night guard that is custom fitted to even out bite problems and ramp forces along stronger teeth. Some people wear a “night” guard while on the computer or commuting to work. A softer homemade sports guard may help short term in an emergency, but is not as therapeutic as a well-made professional one.

WHAT CAUSES CLINCHING AND GRINDING?

The cause of bruxism is explained in theories only, due to the difficulty of controlling the variables for formal study. Stress may be a factor. A kind of neurological “tic” may be suspected. Unconscious attempts to even out a bad bite may be a culprit. The irritating sensation of sinus pressure (especially in children whose sinuses are convoluted and poorly drained) has been suspected. Even skeletal misalignment and psychological issues from abuse have been proffered as a cause, as well as sleep apnea. If a simple night guard does not abate the problems, referral to a specialist or a “bruxism” clinic at the dental school may be necessary. There, an MRI or special x-rays may offer valuable joint information. Biofeedback, counseling, sleep studies, and/or an orthotic device to reposition the jaw may be needed.Bruxism is a serious dental and head and neck problem and should not be ignored. Please tell us if you may be clenching or grinding.