Posts for: December, 2018
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”
More than likely your great-grandparents, grandparents and even your parents had a common dental experience: when one of their teeth developed a cavity, their dentist removed the decayed portion (and maybe a little more) through drilling and then filled the cavity. In other words, treatment was mainly reactive—fix the problem when it occurred, then fix it again if it reoccurred.
You may have had similar experiences—but the chances are good your dentist’s approach is now quite different. Today’s tooth decay treatment is much more proactive: address first the issues that cause tooth decay, and if it does occur treat it with an eye on preventing it in the future.
This approach depends on maintaining equilibrium between two sets of competing factors that influence how your teeth may encounter tooth decay. This is known as the caries balance (caries being another name for tooth decay). On one side are factors that increase the risk of decay, known by the acronym BAD: Bad Bacteria that produce acid that dissolves the minerals in tooth enamel; Absence of Saliva, the body’s natural acid neutralizer; and Dietary Habits, especially foods with added sugars that feed bacteria, and acid that further weakens enamel.
There are also factors that decrease the risk of tooth decay, known by the acronym SAFE: Saliva and Sealants, which focuses on methods to boost low salivary flow and cover chewing surfaces prone to decay with sealant materials; Antimicrobials, rinses or other substances that reduce bad bacteria populations and encourage the growth of beneficial strains; Fluoride, increased intake or topical applications of this known enamel-strengthening chemical; and Effective Diet, reducing the amount and frequency of sugary or acidic foods and replacing them with more dental-friendly choices.
In effect, we employ a variety of techniques and materials that inhibit BAD factors and support SAFE ones. The foundation for prevention, though, remains the same as it was for past family generations—practice effective oral hygiene by brushing and flossing daily and regular dental cleanings and checkups to keep bacterial plaque from accumulating and growing. Your own diligent daily care rounds out this more effective way that could change your family history of tooth decay for you and future generations.
Home whitening kits are a popular way to turn a dull smile into a dazzling one. But these self-applied products only work for teeth with outer enamel stains — if the discoloration originates inside a tooth, you’ll need professional treatment.
Known as “intrinsic staining,” this type of discoloration most often occurs within a tooth’s pulp or dentin layers. There are a number of causes like tooth trauma or tetracycline use at an early age. A root canal treatment used to remove infection from deep within a tooth can also cause discoloration: sometimes blood pigments left after tissue removal or the filling materials themselves can stain a tooth’s interior.
Intrinsic staining can often be treated by placing a bleaching agent, usually sodium perborate, into the tooth’s pulp chamber. But before undertaking this procedure on a tooth that’s undergone a root canal treatment,Â we want to first ensure the filling is intact and still adequately sealing the tooth from infection. We also want to make sure the supporting bone is also healthy.
If all’s well, we access the pulp in the same way as the root canal treatment, and preferably through the same access hole. We then clean out the pulp chamber of any stained matter and then ensure the root canals remain filled and sealed off from the pulp chamber.
We can then place the bleaching agent into the pulp, a process that will need to be repeated every three or four days to achieve the desired level of brightness. After each session we place a cotton pellet over the opening and held in place with a temporary adhesive; we can easily remove and re-apply this covering during subsequent sessions. Once we’ve achieved the desired color change, we seal the tooth with a permanent filling and restore the access cavity with a tooth-colored composite resin material bonded to the enamel and dentin.
There are other options for an intrinsically stained tooth like veneers or crowns that outwardly cover the discoloration. Internal bleaching, however, is a more conservative approach that causes less alteration of the tooth. If successful, it can restore a stained tooth to a brighter, more attractive shade.
If you would like more information on internal bleaching, 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 “Whitening Traumatized Teeth.”