What is a dental emergency?
Well that could be different things for different people! When we watch glamerous TV emergency medicine shows we think of life threatening , every second is critical, heroic action. Nurses and physicians rush to gather data and make a diagnosis. Specialists are consulted. Bleeding is stopped. Hearts are restarted. Patients are stabilized.
“I have a cosmetic dentistry emergency!”
A broken tooth, right in the front, would constitute an emergency for most of us. A fractured veneer or porcelain crown would keep most of us from facing the public or going to work. Quick work with composite bonding usually provides, at least a temporary emergency fix. The tooth is etched with a mild acidic solution, a bonding agent is applied, and plastic resin can artfully be sculpted to replace the broken parts.
“I’ve been up all night with a toothache.”
Pain, unfortunately, is the motivator for many people to visit an emergency dentist. Now we are dealing with a medical problem as well as a dental one. As a matter of fact, many toothache problems are treated in the emergency room. Pain from an infected, abscessed tooth can land you in the hospital and can even be life threatening. Just as with any other medical problem a diagnosis must be made. Sometimes it’s simple. “This is the tooth, doc. It hurts when I bite on it and I’m swollen.” An x-ray often shows a dark area under the root where the infection has spread to the bone. Pain comes from a buildup of pressure. Treatment involves draining and treating the infection, then root canal treatment or extraction of the tooth to keep the infection from returning.
But not all toothaches are so straight forward. “It hurts on the left side, Doc. I can’t tell which one.” This can be a challenge to figure out. First of all the emergency dentist needs to put on his medical cap. Is the pain from a tooth are something completely different? Did you know that jaw pain can be the first sign of a heart attack? More commonly, sinus problems can mimic tooth pain. TMD (jaw Joint pain) can also cause jaw and facial pain. If it is from a tooth, which one and why? Sometimes the offending tooth can be identified by tapping (percussion) A tooth with an inflamed pulp will often be inflamed in the ligament surrounding the tooth. Tapping pressure pushes on the inflammation and causes pain. “That’s’ the one, Doc!” Now we have to have a diagnosis. Is the pain reversible with a sedative filling? Is the tooth cracked? Is it so deeply decayed that root canal treatment is necessary to relieve the pain?
“I bit on a pretzel and broke my tooth.”
Hard pretzels do bring be a lot of business! Often a cusp will break off on a tooth already weakened by a large filling. If the filling is old and leaky and bacteria has found a way to get underneath, the tooth structure becomes soft and it doesn’t take much to snap off a cusp. If the tooth isn’t cracked down the root or broken into the pulp the fix is usually straightforward; a temporary filling for now and a return trip for a porcelain crown to protect the tooth.
“My little girl fell off her bike and knocked out a tooth.”
This one requires quick action. If it’s a permanent tooth that came out (was avulsed) try to get to the dentist within thirty minutes to have it replaced. There is a good possibility the tooth will reattach.
Whether it’s a “cosmetic” emergency or a life threatening dental infection, your local emergency dentist is here to help!
Friday is my favorite day. Not that the other days of the week are bad. I really do still enjoy my family dental practice, but, for the last few years now, I’ve looked especially forward to Fridays. There is something neat about handing down almost three decades of experience as a dentist in Gettysburg, PA to a new generation of eager minds. For three years now I have forced myself, against my groggy will, to rise at the crack of dawn and suffer the unpredictable two hours of traffic to the University of Maryland Dental School in Downtown Baltimore.
The dental school is a huge, modern complex rising eight floors from its inner city block and standing proudly across from the medical school across the street. While I never went to the University of Maryland, (I’m a Georgetown graduate), I am proud to call this dental school my adopted alma mater.
As I enter the third floor of the building my charges await me. The huge, ultramodern clinic floor is broken into sections by specialty: one area endodontics, or root canal treatment; one area periodontics; treatment of gum disease. One area is devoted to children’s dentistry. My section is for general dental practice; dental fillings, dental crowns, dental implants, cosmetic dentistry, etc.; the bread and butter of my Gettysburg dental practice. Six to eight third and fourth year dental students line up to present their cases. These are very bright, but totally inexperienced, dental students eager to sap my mind for the experience and dental wisdom they crave. For the tens of thousands of dental procedures I have performed and could now do in my sleep , they have done, at most, ten! For the thousands of patients, each with their own unique personalities, medical histories, and nerve anatomies, that I have come across in daily practice as a Gettysburg dentist, they have seen but a handful.
One by one the students present their cases. Medical histories can be involved and complicated. Is it safe for this patient to undergo routine dental treatment? Has a medical consult been ordered? Which local anesthetic is indicated and why? What do the x-rays tell us? What are the indications and contraindications for the proposed treatment plan? What are the choices of materials to be used?
Once the pre-op discussions are complete it's time to begin. Sometimes shaky, novice, student hands need my guidance and a little encouragement. How well I remember the first time I ever injected a patient with local anesthetic! Over the years I’ve learned how to give a virtually painless injection and I mentor the students in the technique. I teach them all I can about conservative, modern dental treatment. I stress the importance of treating the whole patient, not just the tooth.
Three hours later the morning clinic session is over. With prodding, encouragement, and often a little hands on help the procedures are completed and signed off. The appreciation of my students for my help more that makes up for the two hour city traffic retreat back to Gettysburg. I thoroughly enjoy my “day job” as a family and cosmetic dentist in Gettysburg, Pennsylvania, but I have to say teaching family dentistry one day a week refreshes the spirit and is good for the soul!
What is it like to be a dentist in Gettysburg? What is the typical day of a Gettysburg dentist? Well, here's what this family dentist did today.
The day began with Maia. Maia’s blue eyes welled with tears. The dental chair dwarfed her tiny, seven year old body. She clung to my assistant’s hand as she looked over all the strange “tooth ticklers” and squirmed nervously. “My big brother said it’s gonna hurt real bad, but my mommy said it wouldn’t be worse that a bee sting.”
“Oh my”, I thought. The family had already set the stage for a bad experience. This was going to take all my children’s dentist chairside skills! Well, we turned it all around and Maia had a great experience. Her first cavity was bonded with white, composite filling and she bragged to her mom that she never felt anything at all! We sealed the permanent molars and spent some time showing Maia how to brush and even floss so she will, hopefully, never have another cavity in her life.
Mrs. Wolfe was already in the next room. A new patient, she had called first thing this morning in pain, hoping we could work her in. Her jaw was swollen to the size of a golf ball on the lower right and she looked exhausted from lack of sleep. A quick, digital x-ray showed the culprit. An abscessed, lower right molar. I hate to blog gross, but a quick, small opening in the top of her dead tooth allowed a back pressure of pus to drain and almost instant pain relief followed. Mrs. Wolfe was a happy camper and so was I. The ability to immediately relieve pain is one of the most rewarding aspects of life as a Gettysburg dentist. Time for a course of antibiotics and a trip back in a week or so to go over some long term options.
Beep…beep..beep… the heart monitor called out its rhythm as our anesthesiologist provided his expertise in our dental sedation room. Sandra was meticulous about her health, but when it came to her teeth, her bad, childhood, dental experiences had left their mark. She hadn’t been to a dentist for 20 years before seeking us out for sedation dentistry. I remember when she first came in. A grown woman of 45, she had cried before we even examined her mouth. She tried to rationalize her fear, but she simply could not. Sandra lay quietly sedated in la la land as my team and I worked for three hours repairing years of dental neglect. She smiled at the end with pretty, new front teeth and whispered, “That felt like I was in the chair for five minutes!”
Lunch, for me, is more of a power nap time that an eat time. A time to recharge. I looked over the afternoon’s schedule. At two I would make a porcelain cap for Carmen’s upper lateral incisor. Carmen was 62. She’d broken her tooth in a bicycle accident when she was 11 and it had been down hill since. After years of patching it had finally given up the ghost and broken off at the gum-line. Luckily, dental technology had improved since Carmen’s accident. We had replaced her tooth with a titanium dental implant anchored in the jaw several months ago and today we would make the final, beautiful, all porcelain crown that goes on top. From three feet away, no one would be able to tell it wasn’t her real tooth.
Three o’clock , a Cerec , in office, computer cad cam created porcelain crown and bonded, composite fillings. Four o’clock, two orthodontic patient checks. One had Fast Braces on, and it was always fun to see how much her teeth had moved since the last visit. The other, preferring no visible wires, was wearling Invisalign aligners.
There is more. In between procedures I’ll be checking the progress of our periodontal therapy patients as they work with the hygiene department. Periodontal disease is one of the most widespread infectious diseases and the most common reason for tooth loss. It has been implicated in heart disease, diabetes, and even dementia. Treating and controlling gum disease is one of the most important jobs of the modern, family dentist and it is important healthcare.
The day in the life of a Gettysburg dentist is sometimes hectic, sometimes stressful, often rewarding, but never boring! I honestly look forward to tomorrow.
RP-VITA Remote Presence Robot receives FDA Clearance
The future is here as the FDA has approved a new, patient friendly robot that wonders into patient hospital rooms and helps to remotely diagnosis problems with the help of a physician specialist who may be thousands of miles away! The joint venture between iRobot, the inventor of the home robot vacuum cleaner called Roombas, and InTouch Health, this five foot tall avatar may well be the one to greet you as you awaken after your next surgical procedure. While, perhaps, not as warm and fuzzy as Dr. Kildare, these medical robots may well improve patient outcomes and reduce health care costs in line with the aims of the Affordable Care Act.
So why is your local, Gettysburg Dentist talking about medical robots?
Because the same medical technology revolution is occurring in the modern dental practice! One of the most common dental procedures is the placement of a porcelain crown. Most of us who grew up in the 60s or 70s have a mouthful of amalgam (silver-mercury) fillings. Over the years these metal fillings expand and contract, develop microscopic openings at the margins, and cause teeth to crack and break. Generally, a tooth that is more filling than tooth needs a crown or onlay to hold it together, to restore natural function and, hopefully, preserve it for a lifetime of chewing and smiling. Traditionally, the dentist uses local, dental anesthesia to numb the tooth, remove the decay, build the tooth back together and then prepare it for the crown covering. A very accurate mold is made of the prepared tooth and this mold, or impression, is sent to a laboratory. Once at the lab, a team involving a dental lab technician and a porcelain artist take over to custom fabricate the dental crown by hand. The final result must be precision crafted to fit perfectly with no gaps and to blend in perfectly with the natural teeth. The patient leaves the dental office with a temporary, dental cap and returns in about three weeks to have the cap removed and the new porcelain crown bonded to the tooth. There are lots of steps where errors can occur, especially if the dentist is unable, or unwilling to us a high quality dental lab, Unfortunately, more and more dentists are having dental work made in China and other cheap, poorly regulated, off shore factories. But that is for another story!
OK. Back to the Dental Robot Story.
Imagine this. The dentist prepares your tooth as before. Instead of the patient having to leave the office with a temporary dental cap, a robot technician is wheeled into the room! Called a Cerec machine this hi tech, dental office technology uses a special infrared wand to digitize the tooth. The Cerec trained dentist then designs the dental crown on a computer screen and wirelessly emails the design to a cad-cam, dental robot located in another room. In about 15 minutes of fascinating buzzing and whirring a perfectly shaped and colored dental crown or onlay is almost magically produced and can be bonded to the tooth in one visit.
Robotic type Cerec dentistry can be ideal for use in sedation or sleep dentistry. Fearful dental patients don’t have to come back for multiple visits. The teeth can often be prepared for Cerec type crowns and finished in one visit while the patient is sedated by the dentist anesthesiologist. No dreading the second visit to put the crowns on!
Invisalign orthodontics is yet another example of robotic type, dental treatment available from your hi tech Gettysburg Invisalign dentist. Your crooked teeth are digitally recreated and then digitally straightened, allowing a series of tooth straightening dental aligners to be robotically fabricated. Incredible technology!
While the robot dentist is not yet ready to roll into the room ask you to open wide, your hi technology Gettysburg dental office is already here and the future is coming fast!
Tooth-related habits can be conscious (brushing and flossing) or unconscious—chewing on pencils, for example. Dental habits become bad when teeth are expected to do things they are not cut out for—opening bottles, chewing off the little plastic tags on new clothing, trimming nails, and so on. And bad dental habits can be downright dangerous. To name a few:
Swiss Army Mouth
Mistaking your teeth for a sort of all-purpose bottle-cap-removal-unit-plus-toolbox is a great way of developing unnecessary chips, fractures, and dislocations.
If this is you, resist the urge (and reward yourself with a Swiss Army knife—far less expensive than reconstructing a tooth).
The Ice Crusher
Human teeth and the HMS Titanic have at least one thing in common: neither was designed for impacting large quantities of ice. Besides potentially fracturing tooth enamel, chewing ice can irritate the pulp chamber where the nerve is and reduce the tooth’s resistance to stress. Leave your ice in the drink where it belongs. Or treat yourself to a Snow-Cone.
The Midnight Grinder
Professionally, we call it bruxism—tooth grinding that often goes on while a person sleeps. It is a common habit and one that is hard to control if it happens while asleep.
A dental exam can tell us if you’re a bruxer. Grinders have found relief in comfortable, custom-fitted nightguards.
But just as important is learning to control the emotional stress—actual or created—that may be bringing it on. Advice for bruxers--try rest, exercise, meditation or whatever else might help you learn how to better handle the daytime tensions that express themselves in nighttime grinding.
Teeth were no more meant to trim fingernails than they were to open bottles. This is an especially important habit to avoid if you have fragile, reconstructed, or cosmetically enhanced teeth. Carry a nail file—or sugarless gum, if the habit originates from stress or anxiety.
Thumbsucking is the most common habit of infancy. Early on, it’s harmless. But after a while, it can pose dental problems. The compulsive 5- and 6-year-old thumbsucker can change the shape of the roof of the mouth, causing upper teeth to protrude and lower teeth to jut in.
Sometimes a reward for not sucking helps. Or try taking a photograph of your child sucking his thumb. Often—when he sees himself—he wants to quit on his own. The real key here is to help your child stop rather than make him stop.
No matter how you take your tobacco (easily, the world’s least beneficial plant), it’s not good for your mouth or teeth. Cigarette, cigar, and pipe smoking increase your risk of gum and oral cancers. You knew that. But even smokeless tobacco (snuff and chewing tobacco) does damage.
For one thing, tobacco juice generates a white pre-cancerous growth, leukoplakia, which progresses to oral cancer in more than 5 percent of diagnosed cases. Nicotine also reduces blood flow to gums—diminishing natural resistance to infection while encouraging detachment of gum tissue from the tooth itself.
Sports team dentists advise athletes (and their impressionable young fans) to nix the nicotine habit and instead, take up sugarless gum.
Some habits are good, some bad, some simply harmless. Everybody has them. Little people often get theirs by imitating big people. Many big people acquired theirs when they were little people. If you have bad habits try to find good ones to reward yourself for breaking the bad.
Try to deny it, but everyone in the household knows if you snore or even, maybe, have sleep apnea. Just ask. Gentle snoring is irritating enough, but some snorers boom so loudly, the spouse retreats to another room for shut-eye. A trained sleep dentist or sleep apnea dentist may be the person to call!
About 40% of adults, mostly men snore. During sleep, throat muscles relax and narrow the airway, especially if the snorer carries a bit of extra weight. Excess tissue vibrates with every breath, and anyone within earshot awakens.
Devices invented to stop snoring:
A masks that strap directly over the mouth to muffle snores; snoreballs, a
tennis ball sewn into the pocket of a T-shirt worn backwards (to turn the snorer over); snore alarms; respirators or CPAP machines; and, finally, a snore guard or snore appliance or dental sleep apnea appliance. This kind of dental appliance, something like an athletic mouthguard, keeps air passages open during sleep. It’s simple and it works. Find snore guards or dental sleep apnea appliances at a trained, sleep apnea dentist.
Getting a better night’s sleep
Meanwhile, snoring and sleep apnea research goes on. Studies at the University of Pennsylvania focus on English bulldogs, whose facial structure makes them prone to snoring. Some medications may be helpful. You could sleep in the garage. You’re getting sleepy...
One of the most elusive comforts of life is a simple good night’s sleep. Especially as we get a little older and our sleep requirements change, a night of tossing and turning or frequent awakening can change how you greet the next morning. Sometimes the damage goes beyond grumpiness to distraction, lapse of memory, or even physical lethargy.
The American Medical Association maps a common sense plan for fine-tuning your personal biological clock when getting to sleep becomes a chore. The goal: sleep deep when you do, and awake clear-eyed and alert.
And sweet dreams
• Figure how much sleep you need by following a set schedule for about a month. Add or subtract 30 minutes, and assess how you feel.
• Stick to your new schedule, even on weekends. If you nap, do so at the same time every day. If you go to sleep late, get up at your regular time anyway.
• Exercise in the afternoon, if you can, rather than in the morning.
• No coffee, tea or cola late in the afternoon and beyond. Get enough sodium. Don’t go to sleep too hungry or too full.
• The bedroom is for sleeping and such, not for TV. A dark, quiet, secure place is best—just cool enough.
• Set the alcohol and sleeping pills aside.
• Don’t worry. Keep a notepad on the night table and write down what’s bothering you before you settle in.
There’s snoring and then there’s snoring
A simple yes to any of these symptoms could indicate you’re on your way to the dark side of snoring: sleep apnea, or obstruction of the airways during sleep. Lack of air isn’t something you should—or can—live with. Ask us to have a look, and we’ll discuss the extent of your symptoms.
What's your snoring or sleep apnea score?
■ Does your snoring bother your partner, wake you during the night, or send the dog howling?
■ Do you walk around in a stupor when morning comes?
■ Daytime, are you on the verge of falling asleep, or cranky and unable to concentrate?
■ Are you substantially overweight?
■ Do you awake and gasp for breath? No? Ask your partner.
If you or someone you know snores or may have sleep apnea I encourage you to contact us for help. Dr. Samuels is is a Gettysburg dentist trained in the fitting of snore appliances and can work with your physician, if necessary to help treat sleep apnea. Often this treatment is covered by medical insurance. Many people have difficulty tolerating CPAP machines and do much better with a dental sleep appliance.
Start with a snore guard dental appliance. Your family could likely use the zzzzzzs.
Scientists and physicians are beginning to change their minds about what’s most likely to put patients at high risk of cardiovascular disease. For some time now, the key factors were believed to be things like heredity, high cholesterol, a sedentary lifestyle, age and obesity. But now a new component is beginning to emerge as possibly the most critical of them all: inflammation.
Inflammation can be the result of an infected wound. But a more common—and more persistent form—originates not on the skin but inside the mouth. Dentists call this periodontitis, perio, or simply, gum disease.
While periodontitis may result in tooth loss—which is bad enough—we’re discovering apparent links between perio and problems in other parts of the body including diabetes, heart disease, and complications of pregnancy like low-birth weight babies.
Although the jury is still out and the relationships are complex, the essence of the problem is this: periodontitis is an infection that can be picked up by the blood in the gums (and there’s plenty there) and spread where it can do additional dirty work. That’s why stopping the spread of perio—or better, preventing it in the first place—is important for reasons that go way beyond saving teeth.
Perio and the Heart
Studies in Finland noted that heart attack patients tended to have more severe oral infections like tooth decay and gum disease. Another study, following healthy patients over an 18-year period, suggested gum disease sufferers were twice as likely to die of a heart attack and nearly three times as likely to die of stroke. Other studies suggest that periodontitis is associated not only with heart attack and stroke, but is linked to a thickening of the artery wall, which typically hastens heart attack.
Protect Your Gums
Recently, oral biologists at the University of Buffalo have shown that levels of two inflammatory proteins known to raise the risk of heart disease can be reduced substantially by regularly treating inflamed gums. Blood samples drawn from patients with high levels of C-reactive protein (a known heart disease risk) and fibrinogen (which can promote blood clotting) were observed and reduced over 12 months simply through aggressive treatment of gum disease. This is exciting news!
We’re learning more about the relationship between inflammation, sore gums, teeth, heart disease, and other ailments every single day. We’re also learning what an additionally harmful effect tobacco use has on these relationships.
Gum Disease plus Smoking
Within the past few years, the U.S. Surgeon General, Vice Admiral Richard Carmona, M.D., issued a report which, in part, concluded “evidence is sufficient to infer a causal relationship between smoking and periodontitis”—not to mention cancer of the oral cavity.
Do you smoke? Do you have sore, inflamed gums? Are you worried about your heart’s health, and how much time may still be available to enjoy your life and family?
What to Do
Fighting periodontal disease through outstanding daily hygiene and regular dental appointments is a three-for-the-price-of-one proposition: protect your gums, protect your teeth, and protect your health in general. If it’s been a while since your last dental examination, let the dentists and hygienists at Samuels Dental Arts P.C. help you! Give one of our friendly ladies a call at 717-778-4268.
Are you looking for a straighter smile without the hassle and discomfort of traditional braces? Look no further than Fastbraces®!
Fastbraces® used advanced technology to move the tooth crown and the root of the tooth at the same time, yielding a much quicker treatment time than is possible with traditional braces. Now, patients who require braces can get amazing results often with far less sensitivity, generally in about a year, and in some cases, even just a few months.
Learn more about Fastbraces in Gettysburg, PA.
Recent studies have shown that a great many Americans are ignoring a simple activity that will keep their smiles looking gorgeous, help prevent cavities, reduce tooth loss, and – as many dentists and physicians believe – significantly reduce the chances of heart disease and strokes.
Though a large majority of patients swear they do this simple activity, according to the American Dental Association, more than 90% of Americans don’t! What is that simple activity? That’s easy – it’s flossing your teeth! And just remember, a quick and strenuous attempt to floss right before your visit to our office doesn’t fool us! Please continue reading – it can change your life!
Flossing is the absolute best method of cleaning bacteria and debris from the spaces in between your teeth and underneath your gums. Left alone, that harmful film can cause cavities and gum disease, as it eats away at the bone that actually holds your teeth in place and causes your teeth to loosen and, sooner or later, be lost. What’s worse, recent research has linked gum disease to heart disease and strokes. But there’s hope for everyone!
Most activities require practice and patience. You couldn’t play a musical instrument without practice and, more often than not, academic or professional tutelage. You probably never solved a complex puzzle the very first time you sat down to try it. And though flossing is certainly much easier than either of the aforementioned activities, far too many people try it just a few times and then give up in frustration believing that they can’t, and never will, do it correctly. But with a little patience and practice you definitely can! And some of the better flosses in stores today make it so much easier than it has ever been in the past.
We at Samuels Dental Arts want you to keep your beautiful teeth for the rest of your life and maintain the best overall good health possible. Doing so involves flossing – remember, that simple activity – every day. We’re here to help you! Feel free to call us at (717) 778-4268 and we will arrange for one of our friendly, professional dental team members to give you a personal lesson. Or simply ask during one of your regular appointments. We know that flossing correctly takes practice. But with the proper technique and commitment you’ll be a pro – and maintaining your beautiful smile and overall good health. Don’t wait another day! Call us today for more information. Your life and your smile are worth it!