I want to have my wisdom tooth extracted

Today's post is about the problems ascossiated with the thrird molar a.k.a. wisdom tooth.
Lets begin with the backround story of the defendant.
Third molar a.k.a. wisdom tooth
                          
                               
 It erupts in the mouth between 17-21 years of age.It is the last tooth of the mouth and a residue of evolusion of the huan species.Meaning that because it used to be useful for our past human ancestors,it has outgrown its usefulness therefore future generations might not have third molars in the mouth. ,
It is positioned quite back in the jaw,so not only does it not contribute to the chewing of the food but it can very well cause problems ie caries due to the innability to properly clean the back teeth with the toothbrush.Also when it erupts, some people tend to believe that it causes their teeth to become crooked.This is partially true;when the third molar erupts it exercises pressure in the area.If there is a problem with the alignment of the teeth,then it becomes more evident.
 

     "So what do we do doctor?Do we extract the tooth,even though it is healthy?Isn't it wrong to do so?"

                          

 I stringly believe that when the wisdom tooth is healthy,we dont extract it.In the picture below (picture 1) you can see a panoramic x-ray of a mouth in which three out of fourr wisdom teeth have normally erupted in the mouth,without causing any problems,and the fourth is on his way out.The only discomfort that the patient might feel is pressure due to eruption and perhaps a little painful sensation.Occassionally some patients state that they have problems opening their mouth widely or are a bit feverish,but that is all.

                           
                                                        Picture 1
On the contrary in the xray below(picture 2) the wisdom teeth appear not to have the sapce required in the mouth;therefore a surgical extraction is needed because they will undoubtably cause problems when the start to erupt.


                        
                                                          Εικόνα 2

  Some doctors believe that if we extract a wisdom tooth then we must extract the opposing wisdom tooth,because it will cause a problem.It is my opinion that I don't extract healthy teeth.I notify the patient that there is a possibility that it will happen,but not now. If he wants to get it over with so as not to go through with this again,I extract both of his wisdom teeth.Or else we wait until the other wisdom teeth causes trouble,and then we procceed with the extraction.
 Another case scenario is what happens when the wisdom tooth has caries.If the caries can be dealt with by means of a dental filling,I do a dental filling In the picture below you can see a wisdom tooth where the dental caries has been removed and the cavity is shallow.I see no reason not to do a filling but rather to extract the tooth just because it is a wisdom tooth.

 

If the cavity is deep however,and we reach the dental pulp then we perform the extraction
.
 

A root canal treatment in wisdom teeth is not recomended because the inner morphology is atypical,and overall they are not worth fighting for.It is only recomended when the others molars have benn extracted and the wisdom tooth is the last tooth which can hold a fixed dental prosthesis(bridgework).

This is all I have to say about wisdom teeth.Don't forget;always brush! 


                                     

My two-year old fell and hurt his/her tooth;What now?

Today's post is about a real case scenario based on a true story

                                          

  Every child,from the moment he/she starts to walk, stands the chance and danger that he/she might fall and hurt somewhere.So a patient comes to the dental office and tells me that he and his daughter where in the amusement park,and his daughter bumped and hurt her tooth.Similar case scenario would include the house and an open door or a kitchen table or a sudden fall and a blow to the jaw.

When I examined the child I noticed that her tooth had become a little dark;not like the one shown in the next picture

                                         
but rather than the one seen in the picture below,with a grey hue although not all over the tooth.



It was more localized.Unfortunately I couldn't get a photo,because the child was petrified,so the pictures are from the web.
  I told the father, who had regretted his decision to go to the amusement park,that it was not something "to die for".Most likely the tooth,not his daughter, had suffered a concussion, and a small vain had bursted somewhere around or inside the tooth,causing this change in color.

His actions should be :

• To take a picture of the tooth,and to review it in a few months(2-3 months).There is a great propability that the color of the tooth will be less dark or near the natural tooth color.
• To be careful not to hurt the tooth again because repeated blows might cause more permanent and serious damage like necrosis of the pulp. Now the tooth is healing and is vulnerable.
• To check the gum surrounding the tooth,by lifting the lip,every week,in case there is a rash or a pimple-like buble.In the case that the lip was also hurt during the incident that action should be done when the healing of the lip nad gums is done.If the pimple-like buble appears,then things don't look good for the tooth and it might requier endodontic treatment or tooth extraction.And if the tooth belongs to the natal teeth,it might require the use of an orthodontic appliance,in order to keep the space for the permanent tooth. This is the dentist's decision,and it might not be necessary since the canine holds the position of the ather front teeth.
• Last but not least,he shouldn't worry about what other people will say about his daughter's black tooth. Children play,they fall and get hurt in the process.Everyone with a child or a nephew/niece knows that.

It should be noted that if the blow and the resulting trauma happens to a child older than six years,when the permanent teeth have erupted in the mouth,then things are more complexed and the possibility that an endodontic treatment will be required is greater,without being definite.

In any case a dentist's consultation is necessary everytime there is a trauma to the head that includes the mouth

Happy playing always with safety.Cheers


                        

Doctor why are my teeth black?

Today's post is about a frequent question from my patients

Why are my teeth black?Why are they not pearly white like the teeth of actors that I see on TV?

                                         

  Dental discoloration is a condition in which teeth are not so bright (color-wise,lol.)

NOTE : I am not talking about the unnatural brightness of some actors' teeth,when the color is described as bathroom-tile-like-white. This is atributed to other dental procedures.I am talking about the case in which the teeth,your teeth, don;t have a natural white color. The current color might be a wide range, from yellonwish to black.  

Tooth discoloration might be limited to a single tooth,or they might include several teeth. They might also be intrinsic( from the inside of the tooth) or extrinsic.
 
                                            

                Whoa doctor.Hold your horses.I am confused. Could you be more clear?

Ofcourse dear blog reader. Let me walk you through dental discoloration

First case scenario : Dental discoloration atributed to a single tooth 
 


1 There might have been an incident, such as an accident in which a tooth might be hurt. This is very common in children(which is going to be a topic in a future post),or bigger and older children(adults.).

                     
 
The management of sigle tooth discoloration in adults is different than in the case of children.Usually a root canal treatmant(RCT) must be carried.
There is also the case in which the tooth that has changed its' color is already treated with root canal. If this is the case,an internal bleaching must be performed.

2.Tooth change color in the presence of caries.Caries might also hide under a filling

                         
 (Amalgam filling with secondary caries(or caries ascossiated with the restoration).You can see the hallo of the amalgam being more black than usual.)

In this case the tooth will hurt during mastication or when we drink something cold.
How do we deal with that?We do a filling,or in the case of secondary caries we replace the filling with a new one.


3.A tooth might be black due to the black filling itself.This is a condition that is reffered as an amalgam tatto,due to the absorption of amalgam contents from the tooth.If that doesn't upset the patient,we leave it as it is. If it is upsetting the patient, for aesthetic reasons, then we can decide to replace it.

Fact: Amalgam tattoo might occur in the gums as well.But any discoloration of the gums must be checked by the dentist,to rule out malignancy(cancer)

                                          (Amalgam tattoo under fixed prosthesis,where there used to be a tooth ith an amalgam filling)


  The next case scenario is generalised discoloration of teeth. When this is the case,it means that something has happened that affected all of the teeth;so it is either genetic or it happened during pregnancy.

• It might be atributed to anaemia ie thalassemias.
• It might be atributed to prescribed drugs and antibiotics,that the mother used durnig pregnancy ie tetracyclins
• It might be due to fluorosis, which is the indigestion of fluoride more than it as needed,for a period of time.
• Iy might be due to dietery habits such as drinking  tea,coffee,red whine,cherries,berries soya sauce,vinegar etc.I am not saying to exclude these from your diet,but to eat them in normal quantity.
• Another factor might be age.Teeth become more dark while we age.
• ΓGenetics plays a huge role.The color of our teeth is controlled by genes.It's all about genes.
• Last but not least tooth discoloration might be linked to tobacco use,oral mouthwashes that contain chlorexidin,dietary supplements and some of the bacteria of dental plaque.

.                                                                                                                   

                          'Nough said doctor.Now what?

  
  First of all don't panic.For any tooth discoloration talk about it with your dentist.

If it is extrinsic,a good profecional cleaning of the teeth combined with a tooth bleaching procedure might give you the desired result. And if you are still not happy there are other options such as veneers or dental bonding procedures.

                Where the is will there is a way

                                           

How to take a dental impression

I am going to start today's post with an apology.I am sorry that my posts were not updated for a long time.I was a bit busy,and it is a bit difficult to run two professional blogs,the dentristry and to study for a post-graduate programme.
But I am back.

Today's post is about taking a dental impression,and making a good impression while doing it!

The process of taking a dental impression is a procedure,that many dentists believe it doesn;t need many explanations.Picture the following conversation

Dr. : "And then we are going to take a dental impression"
Patient : .....
Dr : "And afterards we are going to send it to the lab and .."

As you can understand the patient has no idea what the doctor is talking about. Tis is a common mistake made by dentists. It is not your fault that you don't know;it is the doctor's fault for not explaining.

Back to our post then.

A dental impression is the procedure in which a negative copy of your mouth is made(it is like a copy but imagine looking at it from a mirror) like the one shown in the picture below.

             

This impresion is going to be used to cast an exact copy of your mouth so as to use it for diagnosing and planning your treatment.

The impression depicted above,was used as a final dental impression for a fixed dental prosthesis,that is why it has two materials of different color.It was taken with a silicone-based material for extra detailed depiction of the teeth.
 In case we only want a study model we use a cheaper material such as alginate.

                                        

What is the process like ?

We put the material in a dental tray




                         


                         



 We put the dental tray inside the patient's mouth and wait for the material to set.


                         


When the material sets it is roughly like so

                   

It may have abother color;that depends on the material's brand

With this impression we cast the patient's teeth using dental die stone (aka gypsum)
Thus we have the following image


                    

which is an exact duplicate of the patients' mouth for us to study.

Thank you for reading.And dont forget to smile!





                            

Clenching or grinding of teeth .Am I a bruxist?

   The theme of today's post is the habit that some people have and that is to clench or/and grind their teeth. And the proper medical terminology is "Bruxism"





                                             

  When we talk about bruxists,there are several categories.Some people only grind their teeth, others just clench them, and others clench and grind together. Bruxism is a para-functional habit.A para-functional habit is one  means that that we do and don't feel that we do it (unconsciously), which doesn't serve a particular cause.For instance when we bite and eat our food,it is a functional habit.Otan we bite our nails it is a para-functional or nonfunctional habit. Other parafunctional habits range from bitting the internal part of our cheeks, biting pen or pencil chewing ice (which we will deal in a separate post ) and of course clenching or gnashing of teeth.
  Especially as for the clenching or grinding of our teeth, it usually occurs during the night when we can't control it.It is possible to do it during the day (day clenchers), so it is easier to treat, since we realize that we are doing it. It is certainly a result of stress and becomes worse (more intense) in times of stress; a noise like a rubbing stone on another is heard, so our roommate / friend / parent / our brother tells us that he hears something like that during the night,coming from us so we then seek treatment for our condition. This sound can only be heard if you grind or clench and grind your teeth,because if you only clench your teeth there won't be a sound         

               "But how do para-functional habits cause problems in the mouth?"

                                                 

   Para-functional habits cause muscle and joint function when it is not necessary.


                                        

  So the muscles and the joints(TMJ TemporoMandibular Joints)are constant motion and contraction.That means that they get more burden when they don't have to,and less relaxation.Then fatigue kicks in.
Continuous muscle contraction can lead to headaches and migraines as well as problems in the joint (temporomandibular joint disorders or TMD) resulting in a clicking sound every time we open or close our mouth.Pain might co-exist when we open or close our mouth.Also as a result of the strain and the fatigue our jaws might feel a bit stiff when we wake up in the morning.     
                     
                       " But what happens to the teeth and what can we do? "

                                          
The prolonged clenching or teeth grinding teeth causes damages.Let us see examples of patients suffering from bruxism.
The first patient in the early stages of bruxism

                                                     



   


                                          



                                    
                              

 

The only thing is that we can notice are some cracks in the teeth and slight wear on the incisal edges of the teeth.
   If  treatment is not sought the problem will escalate and visible damage to the teeth will start to show.
 The teeth,due to the clenching and grinding begin to decline in height and appear slightly smaller,with a further wear of their incisal edges.

                         
If even the treatment is not sought,and we leave the condition untreated for a long period of time, then the teeth end up like this

 
See how worn and damaged the teeth are.And for a better understanding of the last picture let us process it a bit.

  Notice how much dental structure(tooth) has been lost length-wise. The patient has a fixed bridge in the upper teeth and this worsens the problem, because prosthetic restorations (crowns / bridges) are stronger than natural teeth, so the grinding and / or clenching of teeth cause damages to the natural teeth that oppose them.You can see the major aesthetic and functional problem createdfor this patient. And rehabilitation is much more difficult and much more invasive and more expensive of course for the patient.
  Besides the problems with the length of the teeth, clenching / grinding teeth creates non-carious lesions.

 

These are called "abfractions",and they are loss of tooth in the area over the gum line,that weaken the tooth even more.  Naturally,if left untreated ,problems only grow.
  
"What can I do now Doctor? I am more stressed than before"

 


  The treatment for bruxism is a splint or mouthguard which the patient during sleep.

                                              


It looks like a bleaching tray,for home bleaching of the teeth,but more tough. So when the patient grinds or clenches his teeth, he grnds the mouthguard leaving the teeth intact.Also the mouthguard relaxes the muscles, because they are not in continuous strain.And with the mouthguard out body(and mind) gradually learns not to clench or grind the teeth.Naturally the mouthguard need adjusting, especially in the early visits, in order to distibute the stresses evenly on all the teeth.Te adjustment is done by the dentist.
Let us see photos with the mouthguard worn

                                                       

  The red and black dots are from the articulation paper used to check for even stress distribution on all the teeth. The mouthguard is not forever; it may need redoing, if damaged by the bruxist patient.
  It might seem a little strange at first to wear it during the night and sleep with it but this feeling is the beginning of the treatment.It will seem inconvenient at first and during the first few days you may not be able to fall asleep easily, because there is a  feeling of a full mouth or because of  the increased saliva secretion, but you will get used to it.If you can accept your problem and understand that this is the only treatent, then you will show discipline
   Exercises of the jaw,can also be started as treatment for bruxism , but it is dangerous t blog about them.N ot because I'm afraid to share my knowledge, but due to the fact that if the wrong exercises to address the problem are implemented , the problem may get worse..Also some cases can be treated with anti-stress medication.
Hope I've you informed even more.

Sleep tight!



                                               

Root Canal Treatment(RCT)

Today's post will be about  the endodontic or root canal treatment . 

 To be honest ,I can not really be sure what someone thinks when he hears the term root canal treatment. 

They might think something like that 

 

  or something or like that

  Certainly in both cases they are wrong!

 The endodontic or root canal treatment is the process in which the pulp of the tooth (or the nerve of the tooth), due to the fact that it has been contaminated by bacteria(microbes), is removed and replaced by a biocompatible material, so that the tooth can remain functional inside the mouth. 

  In the the past, and I mean up until 30 years ago,it wasn't a biologically accepted treatment option, but the dentist simply put a necrotic agent of the pulp (nerve), usually arsenic, and the tooth stopped hurting due to pupl necrosis.Naturally such teeth were doomed to be extracted, but we're talking about an era where knowledge of dentistry and dental education were very low.

Let us see the stages of root canal treatment together. 

We said that the nerve of the tooth (the pulp), has been exposed to bacteria(microbs).This can be happen due to damage of the tooth, ie from caries.Another possibility is a fracture of the tooth.

                                            

.As we see in the image below the decay has reached the nerve ( pulp) of the tooth.In this case we do the following:   

                           

 

• Perform local anesthesia and then excavate the tooth,to remove dental caries and gain access to the root canals (canals where the nerve of the tooth is located). The whole procedure is done by isolating 

either with cotton swabs

   

 

 

or with a rubber dam

 

  

 

as the seen in the pictures.
Of course Greeks patients are not very familiar or happy with the use of the rubber dam, because they feel that it chokes them.

•   We remove the nerve using endodontic files and at the same time we prepare the walls of the tooth to place the biocompatible nerve substitute.These endodontic files (some patinets refer to them as"hooks") are those depicted in the picture below.  

 

• Between the different sizes of endodontic files we irrigate the inside of the tooth with an antimicrobial agent, which may be either sodium hypochlorite (or chlorine) or chlorhexidine or a combination of both under suction.This irrigation is done with a syringe and directly into the root canals,were the tooth nerve used to be.
•  We then proceed in sealing the tooth with a biocompatible material.Usually guttapercha is used  in the form of cones. Guttapercha cones are these ones  

 

• Finally, we restore the tooth.This depends on how much tooth structure is remaining.We can seal it with a filing or a crown. All these are described in the video below.

                                     

  Apart from the use of manual instruments,which I've shown above, now rotary instruments are used in the procedure of  root canal tretment therapy, doing the same job with the manual, faster.
  How many appointments does it take for the root canal treatment? Depending on the tooth and the philosophy of the dentist,it takes one up to four appointments, if ​​each stage is done separately. If the tooth is accompanied by a swelling,and during the tretment it there is a continuous flow of pus or a tooth abscess, appointments may increase. Between visits the tooth is covered with a temporary filling material,and if pus is present,we place a medicine (usually calcium hydroxide), to absorb the pus. You may be given antibiotics if the swelling is big.
  Who does the root canal treatment procedure? Both the general dentist and the specialist endodontist. There are some general dentists who do not perform root canal treatments, and there are some endodontists who believe that they and they alone can perform root canal treatment therapies.These two are the extremists of the dental profession.
  What is life expectancy of a root canal treatment? In this question I can not answer with precise.A root canal treatmant is a dental treatment. It can be for a long period of time,some times for a lifetime,but problems can also delelop.For this reason when recalling the patients for preventive treatment therapy an x-ray (radiographic) examination should be done.
 

      I hope I've helped a bit.Don't forget to smile!