My Blog

Posts for: November, 2019

ToExtractornotExtractTheBigDecisionAboutYourChildsWisdomTeeth

Your child's permanent teeth come in gradually, starting just as they begin losing their primary ("baby") teeth and not ending until late adolescence or early adulthood. That's when the third molars or "wisdom teeth" close out the process.

Because of their late arrival, wisdom teeth have a high potential for dental problems. With a greater chance of crowding or obstruction by other teeth, wisdom teeth often get stuck fully or partially below the gums and bone (impaction) or erupt out of position. In one study, 7 in 10 people between the ages of 20 and 30 will have at least one impacted wisdom tooth at some time in their lives.

It's not surprising then that wisdom teeth are among the most extracted teeth, to the tune of about 10 million per year. Besides those already diseased or causing bite problems, many are removed preemptively in an attempt to avoid future problems.

But wisdom teeth usually require surgical extraction by an oral surgeon, which is much more involved than a simple extraction by a general dentist. Given the potential consequences of surgical extraction, is it really necessary to remove a wisdom tooth not creating immediate problems?

That's not an easy question to answer because it's often difficult to predict a wisdom tooth's developmental track. Early on it can be disease-free and not causing any problems to other teeth. But as some researchers have found, one in three wisdom teeth at this stage will later develop disease or create other issues.

For many dentists, the best approach is to consider extraction on a case by case basis. Those displaying definite signs of problems are prime for removal. But where there are no signs of disease or other issues, the more prudent action may be to keep a watchful eye on their development and decide on extraction at some later date.

More than likely, your dentist will continue to have an ongoing discussion with you about the state of your child's wisdom teeth. While extraction is always an option, wisdom teeth that aren't yet a problem to dental health may be best left alone.

If you would like more information on treating wisdom teeth issues, please contact us or schedule an appointment for a consultation.


By David E. James, DDS
November 14, 2019
Category: Oral Health
Tags: fluoride  
FluoridatedDrinkingWaterHelpsCurbToothDecaySafely

The U.S. Centers for Disease Control and Prevention calls it “one of the ten most important public health measures of the 20th Century.” A new vaccine? A cure for a major disease? No—the CDC is referring to the addition of fluoride to drinking water to prevent tooth decay.

Fluoride is a chemical compound found in foods, soil and water. Its presence in the latter, in fact, was key to the discovery of its dental benefits in the early 20th Century. A dentist in Colorado Springs, Colorado, whose natural water sources were abundant with fluoride, noticed his patients' teeth had unusual staining but no tooth decay. Curious, he did some detective work and found fluoride in drinking water to be the common denominator.

By mid-century, fluoride was generally recognized as a cavity fighter. But it also had its critics (still lively today) that believed it might also cause serious health problems. Ongoing studies, however, found that fluoride in tiny amounts—as small as a grain of sand in a gallon of water—had an immense effect strengthening enamel with scant risk to health.

The only condition found caused by excess fluoride is a form of tooth staining called fluorosis (like those in Colorado Springs). Fluorosis doesn't harm the teeth and is at worst a cosmetic problem. And it can be avoided by regulating the amount of ingested fluoride to just enough for effectively preventing tooth decay.

As researchers have continued to learn more about fluoride, we've fine-tuned what that amount should be. The U.S. Public Health Service (PHS), which sets standards for fluoride in drinking water, now recommends to utilities that fluoridate water to do so at a ratio of 0.7 mg of fluoride to 1 liter of water. This miniscule amount is even lower than previous recommendations.

The bottom line: Fluoride can have an immense impact on your family's dental health—and it doesn't take much. Excessive amounts, though, can lead to dental staining, so it's prudent to monitor your intake. That means speaking with your dentist about the prevalence of fluoride in your area (including your drinking water) and whether you need to take measures to reduce (or expand) your use of it.

If you would like more information on how best fluoride benefits your family's dental health, 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 “Fluoride & Fluoridation in Dentistry.”


By David E. James, DDS
November 04, 2019
Category: Oral Health
Tags: facial pain  
YoucanGetRelieffromFacialPain

Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.

Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.

TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.

There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.

Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.

For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.

One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.

The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.

If you would like more information on trigeminal neuralgia, 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 “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”