Chipped, Broken and Bruised Teeth

I hear stories all of the time about people who have accidentally chipped or broken teeth while playing sports, horsing around with friends, or even from being bumped while drinking from a bottle. Others tell stories about chewing ice cubes and feeling a sharp pain on a back tooth.

If a tooth gets chipped or damaged – you want to see your dentist as soon as possible. Your dentist will examine the tooth to tell whether the nerve has been injured. If this is the case, you may need a root canal. Early detection may put off or even avoid the root canal for years.

When a tooth chips or cracks:

1. If you can find the chip of tooth, take it with you to the dentist. It may be possible to bond large chips back onto the tooth which keeps your same familiar smile. If the chip can’t be used, the dentist has lots of tooth-colored filling materials to make your tooth look as natural as possible.

2. If you need to drink something or rinse your mouth, try something lukewarm rather than cold or hot. This not only keeps you from screaming, but it may help protect the nerve.

3. If there is bleeding, hold a clean cloth on the area until the bleeding stops --- about 10 minutes.

4. Take an over-the-counter pain reliever and call your dentist.

Sometimes a tooth may be bruised from a traumatic blow. Watch it. You will need to see your dentist if the tooth gets sensitive to temperature or if it hurts as you eat. This pain is a sign that the nerve or ligament of the tooth may be injured.

In the example of the ice chewer, there may have been a weak spot on a molar and biting on the ice created a hairline fracture. (Physics note: the back of the jaw is a lever, like a nutcracker; it generates a lot of mechanical pressure that could create a fracture in a weak area of the tooth.) Afterwards, each time this person bit down on something with the injured molar, the crack in the tooth expanded, putting pressure on the nerve, and causing pain. Once the pressure was released, the crack closed and the tooth felt just fine.

Cracked teeth can be bonded or crowned to try to stop the pain. However, if you are still feeling pain when chewing, a root canal will be the next step. Unfortunately, some cracked teeth are not repairable; they end up being extracted and replaced with a bridge or an implant.

Injuries to Permanent Teeth

Last week, a friend’s child had a bike accident and a permanent front tooth was knocked out. Times like this call for cool and calm thinking. If the tooth is re-inserted in less than an hour, with the nerves and the blood vessels intact, there is a good chance that it will be successful. Here’s what you should do.

1. Stay Calm. Your child is probably scared and in pain. It is important for you to stay calm and reassuring. And, call your dentist.

2. Don’t clean the tooth – You don’t want to disturb the nerves and blood vessels on the tooth. Pick the tooth up by the crown.

3. An adult can try putting the tooth into his/her mouth. Be careful not to swallow the tooth, but an adult outside working or playing may not have anything to keep the tooth moist, so your mouth may work great in the short term.

4 If you are at home, put the tooth in a cup with milk or clean water.

5. Get to your dentist. Try to get the child and the tooth to the dentist within an hour. Call ahead to be sure that someone will be there to help you. You may be directed to another dentist or even to a hospital emergency room.

At the Dentist’s Office. The dentist will carefully clean the tooth put it back into the socket and may use a splint to hold the tooth in place. The tooth may require a root canal in the future.

If the tooth cannot be saved, all is not lost. Removable and permanent replacements can be made and an implant may be the ultimate solution.

Injuries to teeth, both baby teeth and permanent ones are very common. A broken tooth needs to be restored and a discolored tooth needs to be watched for swelling or pain.

Regardless of the type of injury, call your dentist who can give you advice specific to your situation.

And remember to wear a mouth guard when playing sports, biking or other times when injuries may occur.

Stay Cool and Hydrated

School is out! The hot weather has arrived and with it, the risk of heat-related dehydration. In the heat, our bodies tend to lose more water than usual, and that makes us more susceptible to dehydration. Watch for:

o Dizziness
o Headache
o Dry mouth or nose
o Nausea
o Vomiting
o Muscle Weakness

Dehydration can be dangerous. So if it is hot and you’re feeling any of these symptoms, get out of the sun and start drinking water. As a dentist, I recommend fluoridated water. Fill a water bottle with tap water and keep it with you when active and outside. Drinking fluoridated water not only helps you stay hydrated, it also helps your teeth. Check here to see if your public water system is fluoridated: http://apps.nccd.cdc.gov/MWF/Index.asp

Fluoride, a natural substance added to water, plays an important role in healthy tooth development and cavity prevention. Fluoride works by stopping or even reversing the tooth decay process, keeping tooth enamel strong and solid.

The United States Centers for Disease Control (CDC) considers community water fluoridation one of the 10 greatest public health achievements of the 20th century. They say water fluoridation may reduce tooth decay by 20-40%.

If your community’s water is not fluoridated, fluoridated bottled water is available.

Have fun throughout the summer. Remember to wear sunscreen. Sip water throughout the day. And choose fluoridated water to keep your body hydrated and your smile bright!

Mouth piercings: Let a healthy smile make the fashion statement

Tongue piercings, lip piercings, cheek piercings – they all seem to be a part of an innocent teenage fad of fashion and self expression. But, often overlooked are the heath risks associated with oral piercings, and there are numerous:

o Infection – The wound created by an oral piercing, the vast amount of bacteria in the mouth, and the introduction of additional bacteria from handling the jewelry creates a breeding ground for infection.

o Uncontrollable Bleeding or Nerve Damage – Numbness or loss of sensation at the site of the piercing can occur if nerves have been damaged. If blood vessels are punctured, prolonged bleeding can occur.

o Increased Saliva – Mouth jewelry often increases salivary flow which could result in temporary or permanent drooling. It can also result in difficulty chewing and swallowing food, and speaking clearly.

o Pain and Swelling – Oral piercings, specifically tongue piercings, often lead to pain and swelling which can be severe enough to block the airway and make breathing difficult.

o Blood Poisoning or Endocarditis – Due to the wound created by the piercing, it is possible for bacteria to enter the bloodstream and lead to the development or blood poisoning or endocarditis – an inflammation of the heart or its valves.

o Injuries to the Gum Tissue – People with oral piercings have a greater risk of gum disease than those without oral piercings. Mouth jewelry can come into contact with gum tissue resulting in injury as well as a recession of the gum tissue which can lead to loose teeth and tooth loss.

o Damage to Teeth – Teeth that come into contact with mouth jewelry can chip or crack.

o Choking – Mouth jewelry that becomes loose in the mouth can become a choking hazard. If swallowed, studs, barbells, or hoops can result in injury to the digestive tract or lungs.

So, before you consider an oral piercing, think about its affect on your oral health and overall health and talk to your dentist.

Skip the mouth jewelry fad and let a healthy smile make a fashion statement.

Men’s Health and Wellness: Oral Health

Good oral hygiene and regular dentist visits are important for everyone, but studies and surveys show that men are less likely than women to seek preventative dental care and often neglect oral health for years. In fact, one of the most common factors associated with infrequent dental checkups is just being male.

The average male is less likely to brush his teeth after every meal (20.5% compared with 28.7% of women). He is also less likely to brush his teeth twice a day (49% compared with 56.8% of women), and more likely to develop periodontal (gum) disease.

Periodontal disease is a result of plaque that hardens into a rough, porous substance called tartar. The acids produced and released by bacteria in tartar irritate the gums and create periodontal pockets that fill with even more bacteria which often leads to bleeding, red, swollen or tender gums, persistent bad breath, and loose or separating teeth. Researchers have also found a connection between gum disease and cardiovascular disease, which can place people at risk for heart attacks and strokes.

Things to keep in mind:

Do you take medications?

• Because men are more likely to suffer from heart attacks, they are also more likely to be on medications that cause dry mouth. Heart or blood pressure medications and antidepressants often inhibit salivary flow which increases the risk for cavities as saliva helps to reduce the cavity-causing bacteria found in your mouth.

Do you smoke or use tobacco?

• Statistics show that the average man will lose 5.4 teeth by the age of 72. If he is a smoker however, he can plan on losing 12 teeth by the age of 72.
• If you smoke or chew, you also have a greater risk for periodontal disease and oral cancer. Men are affected twice as often as women.
• The most frequent oral cancer sites are the tongue, the floor of the mouth, and soft palate tissues in the back of the tongue, lips and gums. If it goes undetected and is not treated in its early stages, oral cancer can spread and lead to chronic pain, loss of function, irreparable facial and oral disfigurement, and even death. More than 8,000 people die each year from oral and pharyngeal diseases. If you use tobacco, it is important to regularly see your dentist for cleanings and to ensure that your mouth remains healthy and cancer free.

Do you play sports?

• For those of you who participate in sports, you have a greater potential for trauma to your mouth and teeth. If you play contact sports, like football, soccer, and basketball, it is extremely important that you use a mouth guard to protect your teeth.

Despite your gender, it is extremely important that we all take care of our oral health. The following tips will help to improve your oral health and therefore your overall health:

• Use a soft-bristled toothbrush to reach every surface of the tooth. If the bristles on your brush are frayed, buy a new one.
• Replace your toothbrush every 3 months or after you have been sick.
• Brush your teeth with fluoride toothpaste twice a day for at least 3 minutes. This can reduce tooth decay by as much as 40%.
• Floss daily.
• Visit your dentist at lease twice a year for cleanings.

Congressman Elijah Cummings (MD) Salutes Maryland’s Oral Health Heroes

In 2007, when a 12-year old Maryland boy died from an untreated oral infection, collective outrage throughout the state started a revolution to fix oral health in Maryland. Today, Maryland is a national leader in effective and innovative programming that has improved access to care, particularly for those who are uninsured or underinsured.

To celebrate just how far Maryland has come, on June 4, Maryland honored six community leaders for their work in igniting change. Awards were presented to:

• Secretary John Colmers, Department of Health and Mental Hygiene who provided the high level leadership for change in Maryland,
• Dr. Harry Goodman, director of the Office of Oral Health at the DHMH who developed innovative programs that have enabled thousands of children to get basic oral health screenings, fluoride varnish and referrals to dentists through pediatricians,
• State Senator Thomas McClain Middleton and State Delegate Peter Hammen, each of whom supported significant and needed policy, funding, and legislative and political efforts to support proposed changes,
• Dr. Scott Wolpin, dental director of Choptank Community Health Systems who has developed an excellent model for a comprehensive community approach to oral health,
• Dr. Winifred Booker, a leader in Maryland dentistry and practicing pediatric dentist.

Each played a key role in helping communities across Maryland better address the need for regular access to quality oral health care.

Speaking at this celebration, Congressman Elijah Cummings recalled the memory of Deamonte Driver, saying the untimely death of the 12 year old boy from untreated dental disease, is real and raw to him. He could have been Deamonte Driver, growing up thinking it was normal to have dental pain and decay. In congratulating the 2010 Heroes, Cummings observed that each Hero brought “skill to the table and compassion to the task.” He thanked them for "bringing life to life" and reminded the audience that work has to continue so this kind of tragedies doesn’t happen again. It is important to get this message out to public that the time to get dental care is not only when a child is in pain is critical.

This 1st Oral Health Heroes Celebration was hosted by the Maryland Dental Action Coalition (MDAC) with support from the DentaQuest Foundation. The work doesn’t end here; as someone in the audience said, “MDAC needs to act like the “Terrapin” who sticks its neck out and never moves backward.”

I have no doubt that it will.

Guest Post by Ralph Fuccillo, President of the DentaQuest Foundation

Maryland Hosts First Oral Health Heroes Celebration

On June 4, the Maryland Dental Action Coalition (MDAC) will host Maryland’s first annual Oral Health Heroes celebration at the National Museum of Dentistry in Baltimore beginning at 9am. The agenda includes a panel discussion, “Closing the Gap: Making Oral Health Accessible, Affordable, and Achievable,” followed by the presentation of awards. I appreciate the opportunity extended to me by the MDAC to moderate the panel.

The Maryland Dental Action Coalition* is an interesting story about how a community came together in response to tragedy. The group was first established as the Dental Action Committee in 2007 by Maryland’s Secretary of Health and Mental Hygiene John M. Colmers in response to the tragic death of 12-year old Deamonte Driver from an untreated dental infection. The first goal of the Dental Action Committee-- a remarkable team of legislators, policy makers, health administrators, and local dental practitioners from across Maryland-- was to establish policies, practices and public education initiatives aimed at preventing such a tragedy from happening again. In the span of a few years, Maryland has become a national model for constructive change. I can only image how difficult it must be to select just a few of the remarkable individuals working on behalf of better access to prevention and oral health care throughout Maryland for recognition this Friday.

I am looking forward to hearing the insights of the well-informed and energetic panel that the MDAC has assembled:

• Catherine Dunham of the Children’s Dental Health Project
• Dr. Leslie Grant, Past President of the National Dental Association and Chair of the Legislative Committee
• Dr. Norman Tinanoff, of the Department of Health Promotion and Policy of the University of Maryland (and a member of the DentaQuest Foundation’s Board of Directors)
• Laurie Norris, Campaign Manager for the Pew Charitable Trust’s Children’s Dental Campaign
• Barbara Klein, Associate Vice President, Government and Community Affairs for the University of Maryland.
  

I anticipate a lively discussion on the state of oral health in Maryland, what is on the horizon to continue the progress Maryland has made, and how oral health access and oral disease disparities will be addressed in national heath reform. If you are near the National Museum of Dentistry on Friday morning (June 4), join us for this unique celebration of oral health in Maryland.

And check back next week for news from the event.

*The Maryland Dental Action Coalition has a 2009 grant from the DentaQuest Foundation to support its transition to a sustainable statewide oral health coalition.

Guest Post by Ralph Fuccillo, President, DentaQuest Foundation