A patient comes into the office and says that he is having discomfort on one side. He has hasn't eaten on that side for months if not years. The culprit tooth has a small filling in it or no filling at all. In the x-ray the tooth looks perfectly normal.
I am most definetly starting to think CRACKED TOOTH!!
I place pressure on each cusp separately. On one of the cusps, as the patient opens from pressing, then the tooth starts to hurt. Yes it is a cracked tooth.
Can you see it on the x-ray? No you can't since the tooth is fractured and not broken. When it is fractured the two sides are close together and an X-ray will not pick up the fracture.
Why is it hurting if the sides are still together? This is because, as you bite down on the tooth, the sides of the tooth are flexing. At that point fluid moves in and out of the tooth causing pain.
So how do you fix it? This is the easy or hard part. It all depends where and how far down the root the tooth is fractured. To fix this problem you need a crown on the tooth. By shaving the tooth down and then covering it with a crown (or cap) all the forces of biting will be directed internally and the fractured parts will be held together thus stopping the pain. To test this, we place a temporary crown on the tooth first. If the symptoms disappear then we can go ahead with the permanent crown and have reasonable confidence in the outcome. If the fracture goes further down the root and beyond the crown then the symptoms may persist. We may need to do a root canal and the symptoms may then disappear. But overall the prognosis is now guarded. When the crown does not encompass the entire fracture the tooth may still be flexing and the long term prognosis is questionable.
Does this happen a lot? Actually it happens quite a bit, even teeth that have never had a filling in them get fractures. This is called wear and tear. If you never use your teeth this will never happen to you. Since most people use their teeth quite a bit and of course many of us also grind our teeth which makes this worse, quite a few of us will experience this throughout our lifetimes.
If you have any questions, you can always send me a note.
All the best
Dr. Ron Barzilay
Hamilton Ontario
Don't forget, you can become a follower of this blog!
Wednesday, March 28, 2012
Sunday, February 5, 2012
Is it time to have all my teeth out?
How many times has a patient come in and said, "Dr. I want all my teeth out!"
So many times I have said, YES you are right it is time to have them out and so many times I have said, NO it is not time.
How does a dentist decide whether this patient needs or should have all their teeth out?
There are a number of issues we must look at before arriving at the decision. Remember, once you take them out, you can't put them back. Afterwards the patient may have to deal with other issues such as retention of a denture, gaginess and general discomfort. And of course, even though a patient wants all his teeth out that doesn't mean that we have to do it.
The simpler cases are when the patients teeth are hopeless. When, the teeth are so rotten or the teeth are moving so much that there is really no choice but to extract all of the patients teeth and make them dentures. It starts to get complicated when those rotten teeth can be fixed and those receded gums can also be stabilized. Then what?
A partial denture is better than a full denture because it is more stable in the mouth since it can use solid teeth as aids for stabilization. Of course, no denture is the best, if we can just fix your teeth or create a fixed bridge. Nothing to take out and of course the feel is the most natural.
So here we move into the grey area. A patient comes into the practise and he has a fair number of teeth that are decayed and moving. He has not brushed his teeth in a number of years. When I ask him if we can fix his teeth will he start brushing them? He answers NO. Then the teeth are going to be lost no matter what and there is no point in wasting time trying to save these teeth because no matter what they will develop new problems again after we have done all the work to fix them.
A patient comes in with decay in his teeth, we fix all the teeth and then 6 months later the patient returns with large amounts of decay just as he had entered on the first day. He now tells us that he has 5-6 Tim Horton's triple triples every day. (That is triple sugar with the coffee) He says he refuses to stop this as it is his one vice. In this case we would also take the teeth out since the battle is lost before we even fired the first shot.
Sometimes a patient will come in who hasen't seen the dentist in 15 years, she may have 1-2 cavities and a lot of cleaning to do, but she is adamant that she needs all her teeth out. Well of course we won't take her teeth out because she doesn't need it. We will try to make the patient understand that their situation doesn't need such drastic measures and that they would be a lot happier with their own teeth.
All of these situations have happened to me and were dealt with as I have described. Every case is different and requires a different response. On the whole, keeping your teeth is better than extracting them, even keeping a few teeth is better than extracting them all but in some situations extracting all the teeth is the treatment of choice. The black and white cases are easy to decide. But through years of experience, through discussions with our patients of their needs and wants, we learn to make the proper and informed choices in the gray zone.
All the best
Don't forget to come visit us at www.rondentist.com
So many times I have said, YES you are right it is time to have them out and so many times I have said, NO it is not time.
How does a dentist decide whether this patient needs or should have all their teeth out?
There are a number of issues we must look at before arriving at the decision. Remember, once you take them out, you can't put them back. Afterwards the patient may have to deal with other issues such as retention of a denture, gaginess and general discomfort. And of course, even though a patient wants all his teeth out that doesn't mean that we have to do it.
The simpler cases are when the patients teeth are hopeless. When, the teeth are so rotten or the teeth are moving so much that there is really no choice but to extract all of the patients teeth and make them dentures. It starts to get complicated when those rotten teeth can be fixed and those receded gums can also be stabilized. Then what?
A partial denture is better than a full denture because it is more stable in the mouth since it can use solid teeth as aids for stabilization. Of course, no denture is the best, if we can just fix your teeth or create a fixed bridge. Nothing to take out and of course the feel is the most natural.
So here we move into the grey area. A patient comes into the practise and he has a fair number of teeth that are decayed and moving. He has not brushed his teeth in a number of years. When I ask him if we can fix his teeth will he start brushing them? He answers NO. Then the teeth are going to be lost no matter what and there is no point in wasting time trying to save these teeth because no matter what they will develop new problems again after we have done all the work to fix them.
A patient comes in with decay in his teeth, we fix all the teeth and then 6 months later the patient returns with large amounts of decay just as he had entered on the first day. He now tells us that he has 5-6 Tim Horton's triple triples every day. (That is triple sugar with the coffee) He says he refuses to stop this as it is his one vice. In this case we would also take the teeth out since the battle is lost before we even fired the first shot.
Sometimes a patient will come in who hasen't seen the dentist in 15 years, she may have 1-2 cavities and a lot of cleaning to do, but she is adamant that she needs all her teeth out. Well of course we won't take her teeth out because she doesn't need it. We will try to make the patient understand that their situation doesn't need such drastic measures and that they would be a lot happier with their own teeth.
All of these situations have happened to me and were dealt with as I have described. Every case is different and requires a different response. On the whole, keeping your teeth is better than extracting them, even keeping a few teeth is better than extracting them all but in some situations extracting all the teeth is the treatment of choice. The black and white cases are easy to decide. But through years of experience, through discussions with our patients of their needs and wants, we learn to make the proper and informed choices in the gray zone.
All the best
Don't forget to come visit us at www.rondentist.com
Sunday, November 20, 2011
One of My Permanent Front Teeth is Dark
Many times a patient comes in with a front tooth that is dark in comparison to the tooth beside it. It may be grey or black or dark yellow. The patient has usually had this tooth discoloration for many years, some from childhood. They were used to it and it never bothered them until someone said something and now they are asking me.
Generally the discolorations that we are talking about are intrinsic. That means they come from inside the tooth.
A tooth that is yellower than the front tooth beside it is usually a result of a blow received to the tooth. The cells around the nerve of the tooth perceive some sort of challenge and reply by laying down new dentin. The dentin is the yellower inside of the tooth between the transparent enamel and the pulp of the tooth. Once you have a lot more of that yellow dentin there, we see the tooth as being yellower than the tooth beside it.
How do we treat this? We bleach just the one individual tooth and the results are quite good.
A tooth that is grey or black in color has usually had a root canal treatment done to the tooth. Sometimes some of the root canal filling materials are left in the top part of the tooth, the crown. It results in discoloration of the crown giving a grey or black color.
The treatment here is an internal bleach of the tooth. The root canal chamber is openned and any excess rootcanal material is removed. The tooth still has to be bleached as color has generally leached into the dentin. A bleach consisting of sodium perborate and hydrogen peroxide is placed in the tooth for a number of days and if the color is not quite right it is repeated. After the bleaching the tooth is closed with a new white filling.
In both situations these are both relatively simple solutions and work quite nicely, however not all situations are alike and depending on the situation other solutions, such as veneers or crowns, may be required.
I have touched on only two specific types of discoloration. There are many other reasons for discoloration and best that you consult with your dentist to see why your tooth has discolored and how it can be made to look more aesthetic.
If you have any question, just send me an e-mail and I will reply.
You can also follow my blog at your leisure.
All the best
Dr. Ron Barzilay
A denitist having fun doing dentistry in Hamilton Ontario.
http://www.rondentist.com/
Generally the discolorations that we are talking about are intrinsic. That means they come from inside the tooth.
A tooth that is yellower than the front tooth beside it is usually a result of a blow received to the tooth. The cells around the nerve of the tooth perceive some sort of challenge and reply by laying down new dentin. The dentin is the yellower inside of the tooth between the transparent enamel and the pulp of the tooth. Once you have a lot more of that yellow dentin there, we see the tooth as being yellower than the tooth beside it.
How do we treat this? We bleach just the one individual tooth and the results are quite good.
A tooth that is grey or black in color has usually had a root canal treatment done to the tooth. Sometimes some of the root canal filling materials are left in the top part of the tooth, the crown. It results in discoloration of the crown giving a grey or black color.
The treatment here is an internal bleach of the tooth. The root canal chamber is openned and any excess rootcanal material is removed. The tooth still has to be bleached as color has generally leached into the dentin. A bleach consisting of sodium perborate and hydrogen peroxide is placed in the tooth for a number of days and if the color is not quite right it is repeated. After the bleaching the tooth is closed with a new white filling.
In both situations these are both relatively simple solutions and work quite nicely, however not all situations are alike and depending on the situation other solutions, such as veneers or crowns, may be required.
I have touched on only two specific types of discoloration. There are many other reasons for discoloration and best that you consult with your dentist to see why your tooth has discolored and how it can be made to look more aesthetic.
If you have any question, just send me an e-mail and I will reply.
You can also follow my blog at your leisure.
All the best
Dr. Ron Barzilay
A denitist having fun doing dentistry in Hamilton Ontario.
http://www.rondentist.com/
Thursday, September 29, 2011
Front baby tooth is now black!
The parents call up and say "my child's front tooth is black. What should I do?"
Well the first thing we tell them is they should come in so we can have a look.
The history of this situation is that the child had received a blow to this front tooth at some point in time and now the tooth had turned dark. This tooth is no longer vital (alive). The nerve inside the tooth has died. The tooth darkens.
If there is no sign of infection, no swelling of the gum, no pain, we leave this tooth alone. It will most likely fall out by itself when the permanent tooth comes in. The permanent tooth will come in without any problems. If there are signs of infection we will extract this tooth so that the infection will not affect the developing permanent tooth.
This is what happenned to my daughter when she was about 3. She fell, hit her front tooth and it turned dark. The gums were fine, no sign of infection so we just left it alone and today she has a beautiful smile. (14 years later)
Just another day for a Hamilton Dentist!
www.rondentist.com
If this was helpful to you join the followers of this blog.
All the best
Dr. Ron
Well the first thing we tell them is they should come in so we can have a look.
The history of this situation is that the child had received a blow to this front tooth at some point in time and now the tooth had turned dark. This tooth is no longer vital (alive). The nerve inside the tooth has died. The tooth darkens.
If there is no sign of infection, no swelling of the gum, no pain, we leave this tooth alone. It will most likely fall out by itself when the permanent tooth comes in. The permanent tooth will come in without any problems. If there are signs of infection we will extract this tooth so that the infection will not affect the developing permanent tooth.
This is what happenned to my daughter when she was about 3. She fell, hit her front tooth and it turned dark. The gums were fine, no sign of infection so we just left it alone and today she has a beautiful smile. (14 years later)
Just another day for a Hamilton Dentist!
www.rondentist.com
If this was helpful to you join the followers of this blog.
All the best
Dr. Ron
Friday, September 16, 2011
Composite or Amalgam, White Fillings or Silver Fillings
I am still getting those questions regarding fillings.
Which is better, white or silver? Are silver fillings safe? Should I remove all my silver fillings and replace them with white?
First let me say that in my office we do 99% of our fillngs in white. I believe that most dental offices today do most of their fillings in white. What has driven this change is the aesthetics of these fillings. Who would not rather have white fillings in their mouth versus the dark fillings that may become visible as we smile or talk.
Having said that, when I graduated dental school, white fillings in the back teeth were available but they weren't that good. They leaked alot around their edges which resulted in alot of sensitivity after the filling and alot of recurrent decay. Due to these facts, many dentists were reluctant to place them but with the years and the advancement in materials and techniques these problems have been resolved. Today most dentists are very comfortable placing them.
So what about silver fillings? Are they bad fillings? Are they dangerous to your health? Should they be replaced? Are dentists still placing them?
Silver fillings are good fillings that have been around for over 100 years. Their safety has been proven over the years with numerous studies. I have many of these in my mouth and if I thought there was a problem with them, I would be the first to change them.
Many patients do ask me if they should replace the old ones or if they can replace them with the white ones? I tell my patients that just because the filling is old does not mean it has to be replaced. If there is no breakage of the filling or decay underneath it then there is no reason to replace it. If it is not broken don't fix it. If the darkness of the filling bothers the patient from an aesthetic perspective then yes we can go ahead and replace them. I do warn my patients who want them replaced that they should know that when a filling is replaced we usually must make the hole the filling was in slightly deeper in order to get the old filling out. In the really deep fillings where the filling is close to the nerve this may necessitate root canal treatment if there is pain after the filling.
Do we still use silver fillings? Yes we do. The white fillings are more technique sensitive fillings. (that is also why they are a little more expensive than silver fillings) When we place the white filling, the area must be perfectly dry. If it is not dry then we may get leakage of the filling and subsequent sensitivity and recurrent decay. As you know the mouth is a wet place and for some people in certain areas of the mouth it is almost impossible to keep the area dry. For these people we still use silver fillings as it is not so technique sensitive and it can successfully be place in areas that still have some wetness.
We still use silver fillings in children as these fillings can be placed faster than white fillings and in a child whose attention span is limited and where you need to get the job done quickly, silver fillings are a valuable tool.
Some insurance providers only pay the cost of silver fillings in the posterior teeth and then it is up to the patient wether they would like silver fillings or pay the difference for white fillings.
White fillings and silver fillings, both are good. White is more aesthetic but don't rush out to have the silver replaced unless it bothers you aesthetically.
All the best from this dentist in Hamilton Ontario on this beautiful summer day. (yes it is still summer but not for much longer)
http://www.rondentist.com/
PS. If you like the info on this blog, join this site as a follower.
Which is better, white or silver? Are silver fillings safe? Should I remove all my silver fillings and replace them with white?
First let me say that in my office we do 99% of our fillngs in white. I believe that most dental offices today do most of their fillings in white. What has driven this change is the aesthetics of these fillings. Who would not rather have white fillings in their mouth versus the dark fillings that may become visible as we smile or talk.
Having said that, when I graduated dental school, white fillings in the back teeth were available but they weren't that good. They leaked alot around their edges which resulted in alot of sensitivity after the filling and alot of recurrent decay. Due to these facts, many dentists were reluctant to place them but with the years and the advancement in materials and techniques these problems have been resolved. Today most dentists are very comfortable placing them.
So what about silver fillings? Are they bad fillings? Are they dangerous to your health? Should they be replaced? Are dentists still placing them?
Silver fillings are good fillings that have been around for over 100 years. Their safety has been proven over the years with numerous studies. I have many of these in my mouth and if I thought there was a problem with them, I would be the first to change them.
Many patients do ask me if they should replace the old ones or if they can replace them with the white ones? I tell my patients that just because the filling is old does not mean it has to be replaced. If there is no breakage of the filling or decay underneath it then there is no reason to replace it. If it is not broken don't fix it. If the darkness of the filling bothers the patient from an aesthetic perspective then yes we can go ahead and replace them. I do warn my patients who want them replaced that they should know that when a filling is replaced we usually must make the hole the filling was in slightly deeper in order to get the old filling out. In the really deep fillings where the filling is close to the nerve this may necessitate root canal treatment if there is pain after the filling.
Do we still use silver fillings? Yes we do. The white fillings are more technique sensitive fillings. (that is also why they are a little more expensive than silver fillings) When we place the white filling, the area must be perfectly dry. If it is not dry then we may get leakage of the filling and subsequent sensitivity and recurrent decay. As you know the mouth is a wet place and for some people in certain areas of the mouth it is almost impossible to keep the area dry. For these people we still use silver fillings as it is not so technique sensitive and it can successfully be place in areas that still have some wetness.
We still use silver fillings in children as these fillings can be placed faster than white fillings and in a child whose attention span is limited and where you need to get the job done quickly, silver fillings are a valuable tool.
Some insurance providers only pay the cost of silver fillings in the posterior teeth and then it is up to the patient wether they would like silver fillings or pay the difference for white fillings.
White fillings and silver fillings, both are good. White is more aesthetic but don't rush out to have the silver replaced unless it bothers you aesthetically.
All the best from this dentist in Hamilton Ontario on this beautiful summer day. (yes it is still summer but not for much longer)
http://www.rondentist.com/
PS. If you like the info on this blog, join this site as a follower.
Monday, July 18, 2011
Alpha Omega Sailing Day
I went sailing last week with Alpha Omega Dental Fraternity. They hold this event every summer and I have gone for the last number of years and every year I enjoy the day. The event is held at the Toronto Island Yacht Club.
This year I brought my daughter with me. She just finished first year at York University in sciences and is working this summer on a concurrent Bachelor of Education. We played tennis in the morning then went swimming before lunch. After lunch we spent 4 and a half hours on Lake Ontario on just a glorious sailing day. The sun was shining, but it was cool out on the lake and it was just a beautiful relaxing day.
Throughout the day many discussions ensued regarding all kinds of topics, of course mainly dental, but as my daughter and I sat with 3 sailors(dentists), UofT class of 52, 56 and 62. An interesting discussion took place. One of the gentleman (our skipper later that day) at his 55th class reunion was asked to speak on the major changes that have occurred in the 55 years since they graduated. He asked the other two what they thought was the single greatest change or innovation they had experienced in dentistry since they had graduated. They both replied "the air rotor." To those non dental people, the air rotor is the high speed drill that we use to drill teeth. When these gentleman graduated, they were trained on the low speed drill , the same drill that had been powered by a footpedal for so many years. (theirs had been electric but still very slow.)
He asked me what was the greatest change that I had seen since I had graduated (class of 86). I said that it was the advent of the dental implant to general practise. The implant has changed so much in terms of the way we do dentistry and the solutions that we can now give our patients.
Well as I sat there with my daughter, I reflected on the passage of time and the work and contribution to the profession of so many who have come before us. I remembered that when I attended my first Ontario Dental Association meeting as a student in 1982, I had met a retired dentist who liked to still attend the meetings. He had graduated in 1923 and he spoke to me about what he had seen in his lifetime as a dentist. Unfortunately, I don't remember his name but I do remember this meeting with him. So as I sat there with my daughter, who is considering going to dental school, I reflected on this gathering of generations and the passing of collective wisdom and knowledge from one generation to another in our profession. I think my daughter also felt that there was something special in this moment. I wondered wether in 20 or 40 or 60 years from now my daugher will be sitting on a sailboat telling some young dentist or dental student of all the glorious changes she had seen in her life as a dentist.
I wonder?
http://www.rondentist.com/
This year I brought my daughter with me. She just finished first year at York University in sciences and is working this summer on a concurrent Bachelor of Education. We played tennis in the morning then went swimming before lunch. After lunch we spent 4 and a half hours on Lake Ontario on just a glorious sailing day. The sun was shining, but it was cool out on the lake and it was just a beautiful relaxing day.
Throughout the day many discussions ensued regarding all kinds of topics, of course mainly dental, but as my daughter and I sat with 3 sailors(dentists), UofT class of 52, 56 and 62. An interesting discussion took place. One of the gentleman (our skipper later that day) at his 55th class reunion was asked to speak on the major changes that have occurred in the 55 years since they graduated. He asked the other two what they thought was the single greatest change or innovation they had experienced in dentistry since they had graduated. They both replied "the air rotor." To those non dental people, the air rotor is the high speed drill that we use to drill teeth. When these gentleman graduated, they were trained on the low speed drill , the same drill that had been powered by a footpedal for so many years. (theirs had been electric but still very slow.)
He asked me what was the greatest change that I had seen since I had graduated (class of 86). I said that it was the advent of the dental implant to general practise. The implant has changed so much in terms of the way we do dentistry and the solutions that we can now give our patients.
Well as I sat there with my daughter, I reflected on the passage of time and the work and contribution to the profession of so many who have come before us. I remembered that when I attended my first Ontario Dental Association meeting as a student in 1982, I had met a retired dentist who liked to still attend the meetings. He had graduated in 1923 and he spoke to me about what he had seen in his lifetime as a dentist. Unfortunately, I don't remember his name but I do remember this meeting with him. So as I sat there with my daughter, who is considering going to dental school, I reflected on this gathering of generations and the passing of collective wisdom and knowledge from one generation to another in our profession. I think my daughter also felt that there was something special in this moment. I wondered wether in 20 or 40 or 60 years from now my daugher will be sitting on a sailboat telling some young dentist or dental student of all the glorious changes she had seen in her life as a dentist.
I wonder?
http://www.rondentist.com/
Monday, July 4, 2011
What a great country we live in! Happy Canada Day!
I spent Canada Day at Sibald Point Provincial Park with my family. It was a glorious day! The sun shone all day and it was just one of those beautiful summer days. I have been to Sibald Point many times but I don't think that I had ever seen it quite so full. Everyone had something on a barbecue somewhere. This is Canada, people from all over the world, working hard , trying to make a better life for themselves and their children. Here we all were just having a great time together. The really interesting thing was that you could walk down the beach or through the grass and you heard just about every language on Earth being spoken but when you went close to the water and watched all the little kids playing with each other, they were just speaking English. I said to myself, here is the future of this country and it looks pretty promising. I enjoyed a great Canada Day with my family and am very proud to be living in this great country of ours!
www.rondentist.com
www.rondentist.com
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