Tooronga Family Dentistry in Glen Iris

What are braces?

Braces are the metal handles that we attach to the teeth and are connected by wires to control the movement of the teeth to a preferred position. In the past these brackets were connected to the teeth with metal bands. However, modern brackets are smaller and can be bonded to the teeth, preventing the need for the bands. There had been many improvements in the wires that connect the brackets together too. While in the past the wires were stiff and caused discomfort when first inserted, now new heat-activated archwires use your body heat to help teeth move more quickly and less painfully.

Dr Kaufman will be happy to explain which option is better for you, Braces or Clear Aligners.

Do teeth need a crown following a root canal treatment?

Teeth that require a root canal treatment are in a weakened state due to the destruction caused by decay or trauma. Following the completion of the root canal treatment it is important to seal the access to the canals and reinforce the tooth with a restoration. The common restoration previously used to seal the tooth and protect it was either a porcelain or a metal cap, known as a crown. If a larger portion of the tooth was missing an anchoring post had to be inserted into the root canal as well. But with the development of new composite materials in use at our practice, that are able to bond and reinforce the tooth, a crown may not be needed. These new composites which have fibre glass reinforcements  that support the tooth and allow me to reinforce the teeth. Before I use these materials I have to take into account 3 factors:

1. Is the tooth cracked? Unlike a broken bone, the fracture in a cracked tooth does not heal and can allow bacteria to re-invade the tooth. The crack can lead to a fracture that results in an extraction. So if a tooth is cracked, it is a serious condition and usually requires a crown.

2. Is there enough tooth to allow for a filling only? To place a filling there is a need for a good portion of the tooth to be available to bond to. If there is enough tooth remaining a filling is a good option . It does not prevent you from having a crown later on and it can prevent the loss of further tooth substance needed to be removed to make room for the crown.

3. What are the risks of waiting before a crown is made? If the tooth is intact a filling can be the final restoration and a crown if needed can be placed at a later stage. But if a large part is missing, there are a strong biting forces or there are multiple cracks then leaving the tooth without a crown is not such good idea.

In conclusion there is the option open for you when restoring a tooth following a root canal treatment to have a filling only. If you have been told that you need a crown, please come see us for a second opinion.

 

Best mouth guard for tooth clenching and grinding?

A night guard, also known as an occlusal splint, is an appliance that protects the teeth and other vital structures by offering a barrier between the upper and lower teeth. In a large review of the published literature it has been found that the occlusal splint is proven to prevent tooth loss.  There are  two important features of the splint, the material it is made of and it’s design, that impact its protective function.

Since one size does not fit all, the splints bought at the chemist have to be molded. That is the reason, they are made of a soft material. It has been claimed that a guard of a soft material, is better because it can cushion the impact on the teeth. But this concept has not been scientifically proven, Dr. Kaufman’s experience shows that a soft material caves in while a hard material dissipates the forces over a larger area, therefore reducing the impact of clenching and grinding forces to individual teeth. Leading to the conclusion that a hard occlusal splint would be better at tooth protection. The resilient mouth guards will allow for a perfect adaptation between the teeth and the splint, prevent pain from misfitting splints and avoid the loosing the splint easily.

Another property of the chemist splint  is that they are thick.  A recent study has shown that the soft mouth guard needs to be at least 4 mm thick for it to protect the teeth. This finding led the researchers to the conclusion that the thick mouth guards are uncomfortable to wear . While the hard acrylic splints Dr. Kaufman provided are thin to allow good protection without discomfort.

Since we have little control on clenching and grinding and it can arise from a variety reasons, we need to concentrate on protecting the teeth. A custom made splint of hard material is the ideal solution.

For an appointment to prescribe the right splint for you please contact us.

Tooth clenching, Tooth grinding or bruxism

Stress is an unfortunate part of our life, one of its manifestations is tooth clenching and grinding. Our mouth has evolved in such a way that it stays slightly ajar and the teeth don’t touch usually. This way the teeth can retain the strong enamel cap for longer and it is not worn down. The only time teeth are meant to come together is when chewing or swallowing. When we are stressed, among other things our main chewing muscles contract and the teeth  meet and press against each other, this is clenching. In some of us in addition to clenching other muscles start to pull the lower jaw forward and sideways leading to the grinding motion or bruxism. This process can be triggered by other lifestyle factors like  smoking, large caffeine intake and heavy alcohol consumption or by taking antidepressants.

The clenching leads to the formation of minute cracks in the enamel which over time develop to larger visible cracks and extend to the dentine which is the inner layer of the tooth. The grinding or bruxing of the teeth leads to tooth chipping, wear and loss of tooth. Once the teeth have cracked or have been lost they will not heal back like broken skin or broken bone and they will continue to deteriorate. To prevent the destruction we need to separate the teeth when they are clenched and guide them in non-destructive paths when the muscles pull the jaw sideways. This is achieved with an occlusal splint or a night guard.

Why does my jaw click?

Jaw clicking is caused by the shift of a disk inside the jaw joint. It may be caused by different reasons. The clicking may sound very loud since the joint is just next to the ear and I have come across patients who refrain from eating out because of their joint sounds. But fear not since these sound are barely audible by other people. The dental name of the jaw joint is the temporomandibular joint or TMJ and the clicking is a part of a larger group of conditions called TMJ dysfunctions or TMD.
The TMJ is one of the most complicated joints in your body. It has several muscles and ligaments which allow different movements and when it is not functioning right you may feel:

  • pain around your jaw joint which can extend to your forehead, cheek, ear and neck.
  • restricted movement or locking of your jaw in an open position.
  • joint noise when you move your jaw.
  • difficulty chewing

These conditions may become worse when you’re chewing or if you’re feeling stressed.

Because the jaw joint is complicated and there are many possible causes of jaw problems, it can be difficult to find what is causing your symptoms. For this reason my routine exam includes an examination of your head, neck, face and jaw to see if there is any tenderness and to find out if the TMJ is painful or makes clicking noises when you move it.
Jaw joint dysfunction can often be treated successfully and doesn’t lead to other problems. Your treatment will depend on the type of jaw joint dysfunction you have.

For more information :

The Mayo clinic site

The National Institute of Dental and Craniofacial Research.

What benefits does fluoride provide for your teeth?

The discovery that, fluoride, when incorporated into the developing enamel, can lead to a more acid resistant crystal has revolutionized our treatment of decay. In the mid-1940s, communities in the United States started to put more fluoride in their water supplies to protect people against tooth decay. The fluoride from the water was beneficial for children with developing teeth. But research shows that not only children can benefit from the fluoride in the water, the addition of fluoride to water supply, tooth paste and mouth rinses has a preventive effect on adults as well as published recently in the Journal of Dental Research.

Fluoride helps because, when teeth are growing, it mixes with tooth enamel to form a more acid resistant fluorapatite crystal.  But fluoride can help even after your teeth are formed by attacking the bacteria that cause decay and by coating the enamel and dentine surfaces with a fresh layer of fluorapatite.

There are several ways to apply fluoride to the teeth with different concentrations of the active ingredients. Some can be bought and used  without dental supervision  like mouth rinses and tooth paste. But there are products which need to be prescribed or administered by Dr. Kaufman due to their higher concentration of the active ingredient and their special mode of application needed to achieve their action. These specialized products are recommended for patients with a high risk of decay that can arise from a dry mouth, high sugar intake, or a genetic predisposition for decay .

More reading about the beneficial aspects of fluoride can be found at the Australian Dental Association web site here.

 

What are the reasons for a dry mouth?

A dry mouth usually can point to  an underlying problem, rather than a disease in itself. There can be several reason for it which may include:

  1. Use of drugs or medication
  2. Dehydration or not drinking enough fluids throughout the day.
  3. Breathing through the mouth instead of through the nose.
  4. Diseased salivary glands like Sjogren’s syndrome or other auto immune disorders.
  5. An infection or obstruction in the salivary glands or ducts leading the saliva to the mouth.
  6. Nerve problems.
  7. As an outcome of cancer treatments.

Even if the there are multiple reasons for the dryness in the mouth the outcomes of lack of saliva are the same:

  1. A rough, dry tongue that tends to stick to the roof of the mouth or cheeks.
  2. A burning sensation in the mouth or on the tongue.
  3. Loss of food taste as a result from the loss of papillae on the tongue.
  4. Problems with speaking, chewing or swallowing especially dry food like biscuits.
  5. Saliva that feels thick or stringy and loss of the moisture in the mouth.
  6. Dry and cracked lips.
  7. Bad breath .
  8. Increased  risk for tooth decay
  9.  Susceptibility to oral thrush infections
  10. If you have dentures they become loose.

To help with a dry mouth there are several solutions that depend on the source of dryness. As part of my assessment I check for the signs of mouth dryness and provide the right solutions. Please don’t hesitate to contact us to make an appointment so I can provide you with the advice appropriate to you.

Tooth sensitivity

Tooth sensitivity starts when  the softer part of your tooth that lies under the tooth enamel, called “dentine”, becomes exposed. The dentine has tiny tubes that are filled with fluid, any changes in the flow of the fluid are felt as pain. Eating or drinking foods and drinks that are hot, cold or sweet can cause this fluid to move. The exposure of the dentin to the oral environment can happen when a cavity is formed in the tooth or when the thin layer of mineral called “cementum” covering the dentine is worn down.

The cementum covers the root portion of the teeth, if the gums recede the cementum is exposed and can wear away either by acids from out diet or from vigorous brushing. The saliva can recover the damages caused by the acids or the brushing if it is plentiful in calcium and phosphate. Tooth mousse is a product that can provide the protection to the dentin by depositing minerals it contains on the tooth surface, when the saliva fails to do so.

Desensitizing tooth pastes act in a different way, by acting on the nerve in the tooth. In order to achieve a long lasting relief from the sensitivity, brushing twice daily with the desensitizing tooth paste is needed.

If sensitivity persists it is important to come and see us since it may indicate that there is a cavity in the tooth.

 

What sugar does to your teeth.

The World health organization described dental diseases as the most prevalent globally. More than 90% of Australian adults have experienced tooth decay and close to  60% of 14-year-olds have decay in their permanent teeth. The World health organization has embarked on a process to establish the recommendations of sugar intake for adults and children .

Many people don’t realise that the adverse impact of sugar intake is just as bad for teeth as it is for the increased risk of obesity, type 2 diabetes and heart disease. Toothy decay results from the acid produced when sugar and oral bacteria combine. The acid produced melts the tooth and creates cavities that provide a protected environment for the next generation of bacteria that continue to expand the cavity. To reduce the risk of decay fluoride has been introduced in the water, tooth paste and many other products. But even though fluoride is readily available, tooth decay is a major health concern. Left untreated the cavities allow the bacteria access to the tooth pulp and the bone.

The risk of tooth decay is reduced when the level of sugar intake is less then 10 percent of the caloric intake.

Your teeth can cause you sinusitis.

s2The upper back teeth are in close proximity to the group of air chambers(sinuses) in our skull as can be seen in the cross section on the right. This close relationship is important.

If a tooth cavity is not treated the bacteria spread to the pulp chamber and from there invade the surrounding bone. This is commonly known as a dental abscess and can be treated with a root canal treatment. But if the tooth is not treated the bacteria can continue and spread to adjacent structures the sinus, the orbit and they can even reach the brain causing an infection there.

The first stage of bacterial spreading is many times a chronic or acute sinusitis. The signs of it are headache or facial pain or pressure of a dull, constant, or aching sort over the affected sinuses in both acute and chronic stages of sinusitis. This pain is localized to the involved sinus and may worsen when the affected person bends over or when lying down. Infection of the eye socket can follow, which may result in the loss of sight and is accompanied by fever and severe illness. Another possible complication is the infection of the bones (osteomyelitis) of the forehead and other facial bones or the body may drain the infecition to the surrounding tissues causing a large swelling in the face. Halitosis (bad breath) can be felt some times as the bacterial products manifest themselves.

The treatment involves draining the bacteria and removing or treating the tooth which is the source of the infection .If you suffer from these symptoms it would be advisable to visit us .