Sensitive Teeth — A Sensitive Issue

Is enjoying ice cream or sipping hot coffee sometimes painful to you? What about brushing or flossing your teeth?  If so, you may have sensitive teeth.

 

Possible causes of sensitive teeth

  • Tooth decay (cavities)
  • Fractured teeth
  • Worn fillings
  • Gum disease
  • Worn tooth enamel
  • Recession
  • Exposed tooth roots

 

A tooth is made of layers; at the centre are nerves and blood vessels.  These are protected by an outer layer of strong enamel in the crown (above the gums).  The root is protected by the gums and a tooth layer called cementum.  The bulk of a tooth is the middle layer called dentin.  Dentin is less dense than enamel and cementum, and contains microscopic tubules (small hollow canals). When the protective covering of enamel or cementum or gums are lost, the dentin tubules are exposed and can transmit heat, cold, acid and sugar to the nerves and cells on the inside.  Dentin can be exposed when gums recede or enamel is worn or fractured off.

 

Sensitive teeth can be treated.  The type of treatment depends on the cause of the sensitivity.  Your dentist may suggest one of a variety of treatments:

  • Desensitizing toothpaste: Some toothpastes are designed to decrease sensitivity and contain compounds that help block transmission of sensations through dentin tubules.  These usually require several applications before relief is experienced.  Different toothpastes have different compounds, so one may work better for you than other.
  • Fluoride gel: Topical application of fluoride strengthens tooth enamel and reduced transmission of sensations. This can be done in-office or with special take-home treatments.
  • Crown, Inlay, bonding: These techniques can be used by your dentists to restore tooth structure lost from decay, wear or chipping.
  • Surgical gum graft: If recession has occurred, and gum tissue has been lost, surgery can be done to recover this soft tissue protection of the root, and reduce sensitivity.
  • Root canal: Severe and persistent sensitivity often cannot be treated by other means; your dentist may recommend treating the tooth with a root canal to eliminate the problem.

 

Proper oral hygiene is the key to preventing sensitive-tooth pain.  Ask your Dentist or Periodontist if you have any questions about your daily oral hygiene routine or concerns about tooth sensitivity.


Peri-Implantitis — Risk Factors, Diagnosis and Treatment

Peri-implantitis is an inflammatory process that involves progressive bone loss and suppuration affecting the soft tissue and bone surrounding an implant. It is associated with a bacterial infection that, unless treated, leads to the eventual loss of the implant.

 

What Causes Peri-implantitis?

Peri-implantitis is a result of a variety of patient and treatment conditions that collectively lead to bacterial colonization. These include those associated with the patient’s presenting medical condition, the implant itself, the restoration and the maintenance of good oral health.

 

How is Peri-implantitis Diagnosed?

Patient Symptoms may include pain, mobility of the implant and a bad taste. It is important to note that in most cases there may be no symptoms noticed by the patient.

Signs observed by the dentist or hygienist include suppuration and profuse bleeding around the implant, progressive bone loss and increasing probing depths (see images A & B).

 

How is Peri-implantitis Treated?

Non-surgical therapy is not supported by the literature.

Surgical treatment:

- Open flap debridement to gain access, disinfect, and re-prepare the exposed surface of the implant.

- Open flap debridement and disinfection with bone regeneration (see images C, D & E).

NB: Laser therapy has been proposed for both surgical and non-surgical therapies, however, there is no scientific evidence for its efficacy above traditional treatment

 

Major Risk Factors of Peri-implantitis

 

Patient Factors:

- Poorly controlled diabetes

- Smoking

- Untreated Periodontics

- Poor oral hygiene, and non-compliance with a maintenance program

 

Implant/Prosthesis Factors:

- Uncleansable prosthesis

- Excess cement

- Loose/ill-fitting or broken components


Herbal Medications

Herbal medications are very popular. According to North American surveys 30-40% of the population report using herbal medications or similar alternative treatments.

 

Why does my dentist care about herbal medications?

Herbal medications can put you at risk because they interact with important medications we use in dentistry.

 

  • Acacia – can decrease the absorption of Amoxicillin, and therefore alter the effectiveness of this antibiotic
  • John’s Wort & Valerian – can increase the effects medications such as Codeine, benzodiazepines (Lorazepam), or sedative agents used in our office during sleep dentistry.

 

Other medications alter normal functions in your body:

  • Ginkgo, ginseng, green tea, garlic (starting with the letter ‘G’) – these all affect your body’s ability to stop bleeding. This is very important in surgery and relevant to your body’s ability to heal.

 

For these reason we may recommend you stop taking some of your herbal medications prior to treatment to prevent possible complications.

 

“Drug interactions with herbal medications can put you at risk”

 “Report any medications, including herbal medications, to your dentist.”


Legalization of Marijuana — What Dental Patients Need To Know

The Cannabis Act will likely become law in 2018. This means that in addition the existing program for medical marijuana, the recreational use of marijuana will be legal for adults 18 years and older. What does this mean for your oral health?

 

 

Oral adverse effects of Marijuana

Studies have shown that using cannabis can have a number of adverse effects on your oral health.

  • Xerostomia (dry mouth)
  • Dental caries (cavities/tooth decay)
  • Periodontal disease
  • Soft tissue problems (stomatitis, leukoedema, and leukoplakia)
  • Oral cancer
  • Infections
  • Drug interactions:
    • Increased drowsiness if combined with drugs such as codeine and antidepressants (increased drowsiness)
    • Increased bleeding with aspirin, NSAIDs, blood thinners, antiplatelet drugs
    • May influence sugar levels, so caution is advised in patients taking diabetes medications
    • Other possible interactions with: sedatives, CNS depressants, pain relievers, analgesics, corticosteroids.

Little is known of the potential risks of treating patients who use cannabis, including patients who have active cannabis in their body at the time of treatment. Some possible issues include increased heart rate and changes in blood pressure. Cannabis may also lead to fainting spells. For these reasons caution is advised in using cannabis to manage stress or anxiety associated with your dental appointment.

 

Approved Medial uses

Currently there are two synthetic cannabinoid-based medications available in Canada: 1) Nabilone, an antiemetic used to treat nausea and vomiting associated with chemotherapy. 2) Nabiximols used to relieve pain. Physicians may authorize the use of cannabis oils and marijuana for patients with specific medical conditions, such as cancer, HIV/AIDS, MS, or other chronic diseases, when conventional medical treatments are unsuccessful.

 

Why don’t we know more?

There is limited research on the therapeutic effects of cannabis because it is considered as Schedule II drug under the Canadian Controlled Drugs and Substances Act. This is why many physicians and researchers advocate for a change in the schedule.

 

Your advocate in the future

With these impending legal changes, what we know about the potential medical applications and consequences of using cannabis will increase dramatically. Deciphering this information is not always easy. Dr. Caudry is here for you. With her experience and background in scientific research, Dr. Caudry can help advise you on the latest information as it becomes available to ensure you understand any health and dental risks.