Posts for: November, 2014
Contrary to what you might think, a knocked out tooth doesn’t inevitably mean tooth loss. Time is of the essence — the shorter the interval between injury and replanting the tooth, the better the tooth’s long-term survival. The longer the interval, on the other hand, the less likely the tooth can survive beyond a few years. That phenomenon is due to the mouth’s natural mechanism for holding teeth in place.
The tooth root maintains its attachment with the jaw bone through an intermediary tissue known as the periodontal ligament. Tiny fibers from one side of the ligament securely attach to the tooth root, while similar fibers attach to the bone on the opposite side of the ligament. This maintains stability between the teeth and bone while still allowing incremental tooth movement in response to mouth changes like tooth wear.
While the ligament fibers will attempt to reattach to a replanted tooth’s root, the longer the tooth is out of the socket the less likely the fibers will fully reattach. An “ankylosis” may instead form, in which the root attaches directly to the jaw bone without the periodontal ligament. In this situation the body no longer “recognizes” the tooth and begins to treat it like a foreign substance. In all but the rarest cases, the tooth root will begin to resorb (dissolve); at some point (which varies from patient to patient) the attachment becomes too weak for the tooth to remain in place and is lost.
Ideally, a knocked out tooth should be replanted within 5 minutes of the injury (for step-by-step instructions, refer to The Field-Side Guide to Dental Injuries available on-line at www.deardoctor.com/dental-injuries). Even if you pass the 5-minute window, however, it’s still advisable to attempt replanting. With a subsequent root canal treatment (to remove dead tissue from the inner tooth pulp and seal it from infection), it’s possible the tooth can survive for at least a few years, plenty of time to plan for a dental implant or similar tooth replacement.
If you would like more information on treatment for a knocked out tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Knocked Out Tooth.”
Considering all the intensive conditioning, practice and training they do, most people would expect elite athletes to be… well… healthy. And that’s generally true — except when it comes to their oral health. A major study of Olympic contenders in the 2012 London games showed that the oral health of athletes is far worse than that of the general population.
Or to put it more succinctly: “They have bodies of Adonis and a garbage mouth.”
That comment, from Dr. Paul Piccininni, a practicing dentist and member of the International Olympic Committee’s medical commission, sums up the study’s findings. In terms of the numbers, the report estimates that about one in five athletes fared worse in competition because of poor oral health, and almost half had not seen a dentist in the past year. It also found that 55 percent had cavities, 45 percent suffered from dental erosion (excessive tooth wear), and about 15 percent had moderate to severe periodontal (gum) disease.
Yet, according to Professor Ian Needleman of University College, London, lead author of the study, “Oral health could be an easy win for athletes, as the oral conditions that can affect performance are all easily preventable.”
Many of the factors that had a negative impact on the athletes are the same ones that can degrade your own oral health. A follow-up paper recently published in the British Journal of Sports Medicine identified several of these issues. One is a poor diet: The consumption of excessive carbohydrates and acidic foods and beverages (including sports drinks) can cause tooth decay and erosion of the protective enamel. Another is dehydration: Not drinking enough water can reduce the flow of healthy saliva, which can add to the damage caused by carbohydrates and acids. The effects of eating disorders (which are more commonly seen in certain sports, such as gymnastics) can also dramatically worsen an individual’s oral health.
Sound familiar? Maybe it’s because this brings up some issues that dentists have been talking about all along. While we don’t mean to nag, this study does point out that even world-class competitors have room for improvement with their oral hygiene. How about you? Whether you’re a triathlete in training, a weekend warrior or an armchair aficionado, good oral health can have a major effect on your well-being.
If you have additional questions about oral health, please contact us or schedule an appointment for a consultation. For more information, see the Dear Doctor magazine article “Good Oral Health Leads to Better Health Overall.”
Fluoride has been proven to strengthen tooth enamel against decay. That’s why it’s not only added to toothpaste and other dental products, but also to drinking water — in nearly three-quarters of U.S. water systems.
While research has eased most serious health questions about fluoride, there remains one moderate concern. Too much fluoride over time, especially in infants and young children, could lead to “enamel fluorosis,” an excess of fluoride in the tooth structure that can cause spotting or streaking in the enamel. While often barely noticeable, some cases of fluorosis can produce dark staining and a pitted appearance. Although not a symptom of disease, fluorosis can create a long-term cosmetic concern for the person.
To minimize its occurrence, children under the age of 9 shouldn’t regularly ingest fluoride above of the recommended level of 0.70 ppm (parts per million). In practical terms, you as a parent should monitor two primary sources of fluoride intake: toothpaste and drinking water.
Young children tend to swallow toothpaste rather than spit it out after brushing, which could result in too much fluoride ingestion if the amount is too great. The American Academy of Pediatric Dentistry therefore recommends a small “smear” of toothpaste for children under two, and a pea-sized amount for children up to age six. Brushing should also be limited to no more than two times a day.
Your child or infant could also take in too much fluoride through fluoridated drinking water, especially if you’re using it to mix infant formula. You should first find out the fluoride levels in your local water system by contacting the utility or the health department. If your system is part of the U.S. Centers for Disease Control and Prevention’s (CDC) “My Water’s Fluoride” program, you may be able to access that information on line at http://apps.nccd.cdc.gov/MWF/Index.asp.
If the risk for developing fluorosis in your area is high, you can minimize your infant’s intake with a few recommendations: breastfeed rather than use formula; use “ready-to-feed” formula that doesn’t need mixing and contains lower fluoride levels; and use bottled water specifically labeled “de-ionized,” “purified,” “de-mineralized,” or “distilled.”
Fluoride can be a wonderful adjunct to dental care in reducing risk for tooth decay. Keeping an eye on how much fluoride your child takes in can also minimize the chance of future appearance problems.
If you would like more information on the possible effects of fluoride on young children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”