Some people are very worried about radiation from x-ray machines. When they come for their appointment they wonder, do they really need this procedure or is it just something the doctor is using to pad his bill? This is a question that is sometimes hard for us to answer. The answer is kind of a ‘yes and no’. Because it’s a bit ambiguous, sometimes people will say no to the x-rays.
That’s OK. It really is. It saves us time and money not to have to do your x-rays, but it also means that if you have a silent problem, it will never get noticed until it’s too late. Typically, at our office we take an x-ray of any area of your mouth that you say is causing you pain. If you decline this x-ray, then the dentist will decline to do any dental work for you. Legally, we need x-rays of areas that we are going to be working on. These x-rays protect us from spurious lawsuits and protect you from having dental work done that you didn’t need. In both cases, the x-ray proves that you needed the dental work done.
If you are coming straight from another office and just had this x-ray taken there, then you can request a copy of that x-ray and bring it to us and eight times out of ten, we won’t need to take another x-ray. The other twenty percent of the time the x-ray the other office sent us wasn’t good enough for diagnosis. Since most offices now use digital x-rays, sometimes a printed x-ray just doesn’t show on paper what it would if it was in the x-ray program. Other times, the x-ray tech just didn’t do a good job taking an x-ray of that tooth.
We also take a few x-rays when you come for your cleaning appointment. These x-rays, called bitewings, show what is going on in the back of your mouth. Sometimes we take a couple of x-rays of the front teeth as well. The reason for these x-rays is that you might have a problem that you don’t know you have. We’re just checking things out to make sure that everything is okay in there. You can refuse these x-rays and we will still do your check up and cleaning. We just won’t be able to tell you if you need dental work done unless it is obvious on the outside of your tooth. If there’s a problem obvious on the outside of your tooth, the dentist will still require an x-ray before starting work on that tooth.
So the answer to the question “Do I really need this x-ray?” is no, if you’re not having pain then you technically don’t need an x-ray. And the answer to the question “Do I really need this x-ray?” is yes, we’re checking for problems that you are not aware of yet, or if you are having pain, we are ensuring that you really do need that tooth worked on.
Easter is another one of those fun holidays that revolves around eating and eating candy (who doesn’t get a bunch of candy for their kids on Easter?). Just like at Halloween it is very important to keep good dental hygiene when candy consumption is increased.
Three things to keep in mind are:
Don’t bite down on hard candies. Hard candies break teeth every single year. There is always at least one person that shows up the Monday after Easter at our office with a broken tooth. Don’t let that be you.
Jelly beans are yummy, but they also have the consistency of glue. Be very, very diligent about your brushing and flossing after eating gummy candies.
Brush your teeth about half an hour to an hour after eating candy. This will reduce the amount of sugar that rests on your teeth feeding harmful bacteria and creating cavities. If you brush your teeth right after eating, especially if you are eating something high in sugar or acid content (such as lemon, soda, tomato, salad dressing, etc.) you could be brushing away your enamel. So wait a little while to brush, but not too long.
Following these simple steps can help you maintain a healthy mouth through the holiday and throughout your life. Remember that a healthy mouth is a happy mouth. Happy Easter from all of us at Dr. Chae’s dental office!
In part three of this series, we are discussing the final step to take when you have a toothache. There are really only three options that you have once you have had your consultation. You can choose to do nothing, you can choose to get a second opinion, or you can choose to begin treatment either in full or in part. Sometimes due to fear of dental treatment or financial concerns people choose not to move ahead with the treatment that the dentist prescribes, but also do not get it done at another office.
Occasionally, when people come for their consultation, the dentist will prescribe a course of antibiotics to be completed before dental work is begun. When the antibiotic takes effect and the pain goes away, the patient assumes that the problem is taken care of and then they don’t come back to complete treatment. This is a mistake. Yes, dental work is uncomfortable and sometimes costly. No, you should not ignore your problem just because you have a co-pay or a fear.
We know. The antibiotic took care of any pain or swelling, BUT this is a temporary effect. If you need a tooth extracted/filling/root canal/crown the problem will not be solved by taking antibiotics it will only be delayed. These treatments are typically needed when a patient has decay.
Decay means that your tooth is compromised and additional treatment is needed to fix the problem. Antibiotics take care of infection only and if you put off treatment because you are feeling better, you could cause yourself serious harm. Teeth and bone do not regenerate. Cavities don’t spontaneously heal. Broken teeth won’t recover no matter how long you wait. You must go to the dentist and have him fix the tooth if you want to keep the problem from getting worse. There is no way around this.
The consequences of not acting on the dentists recommendations is that you could lose your teeth. When you leave an infection or decay alone and take no steps to fix the situation you open the door for further damage to your teeth and health. Maybe you think that this is just dental office rhetoric and you won’t have the problems that I’m describing. You would be wrong. I’m not overstating the problem. If anything, I’m understating it since decay and infection have a tendency to spread.
I can’t tell you how many times a patient has come in and the dentist says that they need a cavity filled. The patient never comes for their filling appointment and then a year later when they are having pain again, they come in and need a root canal and crown on the tooth that originally needed a filling and fillings, root canals and/or crowns on the teeth surrounding the originally compromised tooth.
Fillings run between $150 and $250. Root canals run around $800 and crowns run around $1200. The patient could have saved themselves pain and 10-20 times the money by getting the filling done. If you need a payment plan, ask for it. If you need a Valium to calm your fears, ask for it. Do what it takes to get your teeth taken care of while the problem is small because the problem will only get larger the longer you wait.
If you are not sure that you trust your dentist’s diagnosis, then for heaven’s sake, go get a second opinion. Or even a third opinion. Every dentist has a different degree of talent. Some do very well at one thing and suck at another. If you have ever been to more than one dentist then you know what I’m talking about. The point is that you take care of the problem and that you are comfortable that your treatment plan is the best fit for your health and your wallet.
If you find that you are getting the same treatment plan from your regular dentist and a new dentist, but the cost is less at the new dentist, you can ask your original dentist if he will be willing to price match. As long as you bring in a written copy of the treatment cost estimate by the second dentist and it is for the exact same treatment, often we are willing to meet or beat their pricing.
We want to preserve our good relationship with you. Like any other customer service based organization, the patient may not always be right, but you are always important. What you think of us matters. Because you matter we will sometimes take a hit to our bottom line if it means that you are satisfied with our service. Without you, we would not be here. We know it and plan accordingly.
Personally, I hate to go to the doctor. I do not like to pay for healthcare. It’s not really fear of what the treatment will be or even the cost to my budget, although there is a small element of that. It’s more that I’m certain that I should just be healthy and not have to put up with sickness and I don’t have time to be sick anyway.
I think this attitude goes back to my childhood. Mom was always angry with any of us who got sick. She took any failure to remain healthy personally. One time, my brother waited 2 weeks to tell her that he had broken his ankle because he didn’t want to upset Mom. The crazy part is that he walked to school each day. He’d rather endure the pain than the lecture. Mom’s lectures were both infamous and endless.
Because of this I tend to wait until there is absolutely no other choice than to go to the doctor. The benefit to this is that emergency room personnel see you immediately. No hours-long waiting for me! The down side is that I’m usually in a lot, a lot, of pain by the time I get there.
The thought of going to the dentist only to be told that there is nothing wrong with you is so very frustrating. To make sure this doesn’t happen, you can ask yourself the questions that the dentist will ask before you come.
This does two things. First, it causes you to think about whether you need to go to the dentist or not. Second, it gives you a good idea of what you actually need and enables you to clearly communicate it to the dentist. If your pain is quick to come and go, then you might just have sensitive teeth. If you have pain that lasts longer than five minutes, then you might need to see your dentist.
Does the pain come with hot, cold, sour or sweet foods? This could be sensitivity, which you can resolve by using Sensodyne toothpaste. It could also be an indication that you need a cavity filled or a root canal. Your dentist will know which treatment is best for you.
Which tooth is the origin of the pain? Since the nerves in your jaw are connected to the nerves in your teeth, this question can sometimes be hard to answer correctly. You should think carefully and try to discern which tooth is the one that is hurting because if you come in and have a tooth x-rayed that is not the one that is painful, then of course the x-ray isn’t going to show what is wrong. Did your recently break or fracture your tooth? Is there an abscess? The location of a broken, fractured or an abscessed tooth is a good indication of where your pain is coming from.
Do you have a sinus infection or cough? Sometimes these conditions aggravate the nerves in your teeth, without actually causing an infection or damage to your teeth. If you have a sinus infection or a cough that is affecting your teeth, then you should see your medical doctor to take care of the symptoms before rushing to the dentist. The dentist cannot prescribe you an anti-biotic for any reason other than tooth infections. Only your medical doctor can correctly diagnose and treat a sinus infection or cough.
By clarifying what exactly is the problem in your mouth you will know whether you need to see a dentist or not. You will also know what you need to talk to him about. It’s better to go into the office with a clear idea of what is going on.
On a final note, if you have severe swelling, pain or both then you should go to your dental office immediately as these are signs of a serious and life threatening infection.
Recently we had a patient come in for some fillings only a couple of months after his cleaning only to find that he needed another cleaning. In just two months he had such a large build up of plaque that Dr. Chae didn’t believe him about brushing. I know that from my own experience, sometimes I just have extra plaque notwithstanding my diligent brushing and flossing. For myself I bought a dental pick and use it about once a month to get my trouble spot (that’s not doctor approved, by the way, it just makes me feel better about my mouth).
I’d like to pass on some of the little tricks that I’ve learned to reduce the amount of build-up, when you have a naturally high amount of plaque.
It’s not the amount of toothpaste that determines how clean your teeth get. It’s not whether you use an electric toothbrush or just a hand toothbrush. Brushing each tooth front and back is what determines how much plaque you are going to show the dentist when you come for your appointment. Sonicare toothbrushes are awesome and they work really great, but having one isn’t strictly necessary. If you pay attention to each tooth when you are brushing this will remove most of the plaque.
Don’t forget the gumline
Go all the way to the gumline when you are brushing. Brushing only the middle or top of your teeth isn’t going to get all of the build-up. You should go all the way to the gumline on the front and the back of your teeth. Gently massage your teeth and gums with your toothbrush. You don’t want to brush too hard as this can wear away your gums, but you definitely want to get all the gunk off.
Use floss diligently
In our office we sometimes laugh about the flossing timeline. It goes like this: Week of dental appointment, you’re doing vigorous flossing. Two weeks after dental appointment, you floss if you remember to. One month after dental appointment, you’re back to ignoring the floss. I seriously think that this is how it goes with most patients. However, this is not the most effective way to good oral hygiene. Flossing daily will let you keep your teeth into your old age. I have a friend who’s 68yrs old. She’s been flossing every day for forty years and has all of her own teeth except for one. She regularly has people ask her where she got her dentures, because her teeth look so nice. She always thinks it’s funny that she has to disappoint them by telling them that these are her natural teeth. That’s how important flossing is. It’s the only way to keep your teeth.
Keep note of your trouble areas
I have a spot on my lower front teeth on the back side that collects plaque no matter how diligent I am at flossing and brushing. I have to take extra care with this spot or it will get gross really fast. Another trouble area that a lot of people have is the back teeth. Your molars have a wide flat chewing surface and food typically gets caught in it. It’s also harder to reach with your toothbrush and floss. All of that adds up to cavities if you aren’t making sure that it gets enough attention. There is a good reason that most people have fillings in their back teeth. You are also statistically more likely to have root canals, crowns, bridges, implants and dentures for the back teeth than you are for the front teeth. So pay attention to those areas that are hard to reach and make sure that they are getting thoroughly clean.
A waterpik is not a necessity, but like an electric toothbrush, it sure can be nice. A waterpik is basically a water jet that is meant to clean your teeth. You use it after brushing to rinse away any lingering plaque. This is especially helpful if you have a little perio problem. The waterpik can help you get to those pockets between your teeth and your gumline. Ask your dentist if this product is right for you.
You really don’t want dentures. I know that some people think that they do, but trust me on this. Denture patients are typically unsatisfied, especially right after they get dentures for the first time. It affects your ability to speak and to enjoy food. There is usually some really painful and expensive dental work that has to be done before receiving dentures too. It is much better for your health and happiness if you take care of your own teeth. It’s not difficult. It does take a little time in the evening and the morning, but it is not a big sacrifice.
With the New Year everyone is trying to lose weight and eat healthy. This is a really good goal to have at any time of the year, but there are some foods that are healthy for your body that will mess up your teeth.
The first thing that I do when I’m trying to lose weight is substitute something with low calories for my usual snacks. Popcorn is a great substitute for chips and other salty snacks, but a stray kernel (and there is always a stray kernel, isn’t there?) that hits your teeth right can fracture or break your teeth. Another thing to be on the lookout for with popcorn is the stray kernel shard. Sometimes those little pieces can get right under your gums against your tooth and be nearly impossible to get out since it suctioned to the tooth.
Almonds are delicious and very healthy for you. Whole almonds are also about the relative hardness of granite. If you are chewing whole almonds to get your protein fix then you are likely to break and fracture your teeth all over the place. Let me tell you a story about a girl who used to love to eat almonds for her mid-afternoon pick-me-up. I had a lot of dental work the next year. If you really can’t give up your almonds then buy the sliced ones to snack on. They are more expensive, but the difference is that you don’t end up with thousands of dollars of dental work.
Chewing on ice creates the same problems that chewing on almonds does. Ice is harder than your teeth. I have a family member who loves to chew ice. He hates drinking water. He has had a lot of dental work as a result. You might as well be chewing on rocks if you are chewing on ice. It has the same effect on your teeth
There are some other foods that aren’t healthy for you that people tend to break their teeth on. I know that I’ve mentioned these before, but I wanted to reiterate how important this is.
Hard candy/cough drops
Please don’t chew these. If you really need cough drops because you’re sick, remember that they will help your throat the most if you suck on them. When you chew on hard candies or cough drops then you can easily fracture your teeth.
Carmel, laffy taffy, starburst, etc
Chewy, sticky candies that create suction against your teeth will pull out expensive dental work like it’s their job. It’s better to avoid eating this altogether. If you have teeth that are prone to dental problems then you should avoid these foods like they might give you the plague. Trust me the amount of money and pain that this will save you will be well worth the change in habits.
When you have pain and go to the dentist you expect that he will be able to do something for you. It’s so frustrating when your teeth hurt and the dentist can’t find anything wrong in the x-rays! But what can you do? You can’t make the dentist work on your teeth if he doesn’t see anything wrong!
There are some things that you can do to make sure that doesn’t happen. The first thing is to think carefully about where the pain is. Sometimes you feel pain in a generalized area and mistake which tooth is actually hurting. The nerves of your teeth are connected in your jawbone and when one becomes inflamed, it can cause the other nerves to give you pain signals as well. If you have the dental assistant x-ray the wrong tooth, then of course, it’s not going to show a problem. Or even worse, maybe it does show a problem, but since it’s the wrong tooth you still have pain! You got the work done and no relief.
The second thing that might be causing you trouble is your sinuses. If you are prone to sinus problems, when they start to act up you could have pain in your upper teeth. It can be particularly bad pain when your tooth is embedded in the sinuses. An x-ray will show if any of your teeth are overlapping your sinuses, but usually, there is nothing wrong with the teeth themselves. The way to resolve this sort of toothache is to take sinus medication (This happens to me all of the time. I speak from experience.).
If you have a bad cough, this could also cause you tooth pain in your lower teeth. The reason for this is that there is a nerve at the base of your throat which connects to your lower teeth. When you cough hard and repeatedly this nerve sends a pain signal all along its connections. There is likely nothing wrong with your teeth in this situation. As with the sinus problems, taking care of your cough will stop the tooth pain.
Sensitivity to hot, cold, sweet or sour foods could also cause you teeth pain. If you have sensitive teeth, we recommend that you use Sensodyne toothpaste and avoid foods that might trigger pain. Sensodyne’s Pronamel toothpaste remineralizes your teeth which is how it reduces your sensitivity. As your dentin is built up, your nerves are less exposed to temperature and sweet or sour foods. Over time you should be able to add these things back into your diet.
Sometimes if you have a filling or crown that has fractured but didn’t break, you could have pain. This might or might not show up on an x-ray. If it doesn’t show up on an x-ray, sometimes it will show up visually but often times you only have your pain to go by. Talk to your dentist about whether or not it could be a fractured filling or crown.
Another thing that could cause your teeth to hurt is grinding and clenching your teeth in your sleep. Eventually, this will cause you to have teeth problems due to breakage. It might not show up right away, but this will eventually put enough stress on your teeth to cause fractures, grinding down of the chewing surface and cavities. If this is the cause of your dental pain, then you can have your dentist make a mouth guard for you. You wear it while you are sleeping and unable to stop yourself from grinding your teeth. It protects your teeth and keeps them from breaking.
Sensitivity can also be caused by using a whitening treatment. Even if you didn’t have sensitive teeth before whitening your teeth, you could have sensitivity afterward. Typically, this sensitivity will only last a few days, but it can linger depending on the depth of your treatment. Those who already have sensitive teeth should avoid whitening their teeth as they will have pain afterward.
Finally, you should trust your body. If none of the scenarios I’ve mentioned fits the description of your pain, don’t give up. If your dentist can’t figure out what is wrong, get a second opinion. Dentistry is an art as much as a science and it involves a lot of trust on your part. You shouldn’t feel that you have to just live with pain. Sometimes if your doctor just can’t see what’s wrong, someone else can. It all depends on what sort of dentistry the doctor was trained in and what he usually sees in his office appointments. One dentist might be perfect for fillings, but terrible at extractions. And vice versa. Just like there are varying degrees of ability for singing, there are varying degrees of ability for dentistry. As a final thought, some things are negotiable and some things aren’t. If your dentist uses words like ‘must’, ‘have to’, and ‘unavoidable’ then you are likely to get an estimate that is similar, if not exactly the same, from another dentist.
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Wisdom Teeth, sometimes called 3rd molars, are the last set of teeth to grow in. They typically start coming up in your teenage years. Some people are missing wisdom teeth and never have any grow in. Other people, like one unfortunate relative, have extra wisdom teeth. Most of us just have one in each quadrant for a total of four.
Your dentist will almost always recommend that you get your wisdom teeth pulled before you are off of your parents insurance as a teenager. While there are some exceptions to this rule, for the most part your dentist wants to get the wisdom teeth out before they start to cause you problems.
You’re probably thinking, “But they don’t hurt! Why should I go through the pain of having perfectly good teeth removed?” This is valid question. As dental professionals, we get used to being right. Normally, people just do what we tell them to do. Sometimes we get impatient with questions because of this, but your question is not actually unreasonable.
So to answer to the best of my ability: You might or might not really need to get your wisdom teeth out. BUT-So very many people actually run into problems with these teeth later that statistically you will need them out within the next decade. I know that when you’re sixteen you think that a decade is a really long time, but sixteen plus ten is twenty-six, the age that most people are kicked off of their parents insurance.
The other reason that your dentist will recommend getting the wisdom teeth out is that many times your wisdom teeth are in there wonky. By wonky I mean like sideways, pointing in the wrong direction such as backwards, towards your jaw or laying on its side and etc. So, while it’s trying to grow it will grow in the wrong direction causing you pain and messing with your other teeth. If you have teeth like this your dentist would have used words like impacted to describe what was going on in your mouth.
A completely bony impaction is what I was just describing to you, the sideways tooth. It will usually be all the way under your jaw bone. Now, when you are a little younger, like 13, 14, or fifteen your wisdom teeth might not have roots and so they would still be completely bony impacted. However, without a compelling reason, your dentist will usually let those babies grow some roots before tackling your wisdom teeth extractions. The reason is that without any root to stabilize the tooth, it’ll spin in the socket while he’s trying to extract. Imagine trying to pull out a ball-bearing with WD-40 all over it with a pair of needle nose pliers and you have an idea of what it’s like for your dentist to try to pull an immature wisdom tooth. Very traumatic for you and very frustrating for him! No bueno!
Another phrase your dentist might use to describe your wisdom teeth is partially bony impacted. This tooth is probably not lying on its side, but it’s not straight up and down either. A partially bony is likely either leaning into your second molar or there’s not enough room in your mouth for it to come up all of the way or both. This will also eventually cause you pain and it could also cause cavities to form on the second molar. Food gets trapped behind your second molar on top of your wisdom teeth and causes both the second molar and the wisdom tooth to decay.
Even if your wisdom teeth are coming in straight up and down, if you have teeth crowding your dentist might still recommend that they come out. This would be to alleviate current crowding and prevent further crowding. This helps you not have to have braces if you didn’t already need them. If your wisdom teeth are coming in straight up and down with no leaning into the teeth next to them and no crowding, then congratulations! You are a statistical minority and probably don’t need your wisdom teeth out.
There are a lot of foods that people love to eat on holidays. Unfortunately for us, on Halloween not very many of them are healthy. In fact, most of them are unhealthy. If you are very health conscious and don’t want to promote unhealthy habits in your children, you can set a good example for them by giving treats that are healthier than M&M’s without coming across like the wicked witch in Snow White (“Don’t you want this lovely apple, dear?”).
As an employee at a dental office I find that a lot of people have a hard time finding healthy alternatives to candy on Halloween. We find that candy, baked goods, and soda are the number one foods that cause people to get cavities. These items are very hard to clean off your teeth even if you are a diligent brusher and flosser. Personally, since Halloween comes just once per year, I feel that a little indulgence is ok. But the suitcase full of loot? Yeah, probably not.
When I was a little girl, my Mom’s strategy was to tell us every day for the week leading up to Halloween that sometimes bad people put razor blades or poison in Halloween candy so she will have to check our candy before letting us eat it because she didn’t want us to be hurt. I was eight years old before I realized that the candy that she said was “poisoned” was actually always her favorite kind. I was a lot older than that before I realized that in our neighborhood where we knew every single person (and played with their kids regularly), that the likelihood of anyone poisoning anything was vanishingly small (Yea, small town America!). I still laugh about it. Even though this was an effective strategy to keep us from eating too much candy, I’m not suggesting that you lie to your children (remember we’re trying to be good examples). I just thought that I’d share her clever solution to keeping the five of us from too much of a sugar high.
Some strategies that I endorse are: when you are throwing a Halloween party you can easily switch out some of the worst offenders for healthier alternatives. However, when you go out Trick-or-Treating you cannot control what other people give your kids. The best you can do, is try to come up with other things for your kids to eat instead. One of my favorite websites is www.Snackgirl.com. She usually has really good alternatives to the regular junk food. This year she posted a great article about Halloween treats that I wanted to pass on to as many people as possible. The link to the Snack Girl’s Halloween articles is http://www.snack-girl.com/snack/top-ten-healthy-halloween-tips-2011/. She had some good suggestions for changing things up.
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Halloween is coming up and begins the season of candy. (How’s that for holiday spirit?) Regardless of your stand on Halloween (some object, don’t ask me why!), over the next three months there is going to be a lot of holiday eating going on. In my family, the turning of the fall leaves also signals the beginning of birthday season, so you can see why it’s on my mind! With the ready availability of seasonal goodies it’s really important that you don’t let your dental care go by the wayside even though it’s not nearly as fun as partying.
It only takes a few minutes to make sure that you are safe from cavities, this year. While every dental office is different in what they give to patients after their cleanings are complete, many will give patients a small hygiene kit. In this kit, which varies by the office, (I can only guarantee what my office puts in it.), is usually a toothbrush, a toothpaste sample and a couple of the Y-shaped flossing things (how do you like my technical language?). It’s convenient and discreet to carry with you in your purse or your car. All you have to do is remember to use it.
From my experience, the holidays leave a dental office either completely empty or full to bursting. The reason for this is that nobody wants to interrupt their busy social schedule to come to the dentist… until they broke a tooth on a piece of hard candy, nut or other food. Then they need it fixed, fixed, fixed! However, if you keep up your dental hygiene and continue to come to your regular appointments, you’ll be much less likely to be sitting in my office on November first.
Ahh, the day after Halloween. The true witching-hour for a dental office. When the costumes come off and the candy has begun to be consumed. So, here’s the deal. Hard candy should not be bitten. While it makes a lovely crunch, it can also make an uncomfortable crunch in your teeth. If you have a hairline fracture, a cavity, a weak spot or whatever in your teeth, chewing hard candy will cause your teeth to break. Milk Duds and Laffy Taffy might taste good, but we call them filling- and crown-removers. They couldn’t work any better to remove your expensive dental work, than if they were designed to do so. There has been many a November first when someone came in to tell me that they were ‘just eating a piece of candy…’ You get the idea. So be careful Trick-or-Treating and be careful when you’re eating your loot and most of all, remember to brush your teeth at least twice per day.
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