Ask Dr. Tinney
Here are the usual signs of infected teeth:
1) Pain to hot or cold
Does it hurt? As soon as you remove the hot or cold, how long does the pain linger on? Have you timed it on a “stopwatch” or by the second hand of a clock?
If significant pain lingers 60 seconds or beyond (without your tongue or anything else covering the tooth), chances are your tooth is infected.
Normally, you are able to pinpoint exactly which tooth is hurting, without any doubt.
If any of these symptoms are present, it’s time to call your dentist.
2) Unusual pain to tapping your tooth
Does it hurt? Tap other teeth in the area. Do they hurt as well, or is only one specific tooth painful to the tapping?
Frequently, its only one tooth that’s infected. However, others may also be involved. Sometimes pain from one infected tooth radiates out to other teeth which are not actually infected.
Significant pain from tapping your tooth is a common sign of tooth infection. It’s time to call your dentist if you are having any of these symptoms.
3) Swelling, redness or throbbing – call your dentist.
4) Pain or tenderness to pressure
Does it hurt when you grit or grind your teeth. Does it hurt when you chew? This might be an infection.
With your index finger, squeeze the gums on the facial side of your teeth, right at the level where you might imagine the roots are located.
Are you finding any areas of tenderness? Is it next to a specific tooth or is it more of an area of several teeth?
If your answers to any of these questions is “yes”, it’s time to call your dentist. You may have an infection.
5) Spontaneous pain (pain with no obvious cause)
Call your dentist. This may be a tooth abcess.
6) A soft “bump” or “blister” in the gum near a tooth
This may be a pus filled area called a fistula. Usually they’re soft, usually found on the facial gum area of a tooth.
These “bumps” can come and go. Sometimes they stay there all the time. Sometimes they open up and when you squeeze around them, pus comes out. When closed, nothing comes out.
This finding is normally not painful because infection is draining into your mouth, instead of swelling. Swelling can cause pain.
Even though this finding may not have pain, its not healthy. All mouth infections travel into your bloodstream increasing inflammation in other parts of your body.
Its time to call your dentist if you think you have any of these symptoms.
* Anytime you need to take pain pills for a “toothache”, it’s time to call your dentist.
** If you’re not sure your tooth is infected, its ok to call your dentist. That’s why you selected him/her to be your dentist.
***If your dentist does not follow-up with your calls or does not have another dentist to cover his emergencies, find another dentist or go to the nearest emergency room or 24/7 urgent-medical-care type facility.
How to tell if your gums are abcessed.
Gum infections usually have “deep”, “dull” aching pain.
Gums may have swelling and tenderness.
Many times swollen gum infections ooze pus out of the gum pockets that are infected.
A call to the dentist is advised if you notice these findings.
“My tooth hurts but only when I bite into something. It’s a “shooting” pain!”
Sudden, “shooting” pain to pressure or chewing, can be an infected tooth….or a cracked tooth (a tooth that’s actually splitting apart as pressure is applied)
Unlike an abcessed tooth, a cracked tooth is usually not painful to tapping, but it is painful to pressure.
Pressure applied to a cracked tooth is more like a “jolt” of pain. A sudden, deep, “stabbing” pain.
A cracked tooth may also have hypersensitivity to hot or cold. But this pain is momentary (not lingering like infected teeth)
* When you have the symptoms of “shooting” pain described above, you already have a deep, advanced crack. If the goal is to keep this tooth, to avoid loosing it, Immediate action is required in seeking a dentist!
* Early detection AND crown treatment of cracked teeth adds years of life to your teeth, especially if crowned before cracks become deep enough to cause pressure pain.
* Early tooth cracks are NOT usually painful. Usually they have no symptoms at all.
* Fillings placed inside cracked teeth exert splitting forces which drive the cracks deeper over time, destroying teeth much like an ax splits a log.
* Cracked teeth can only be saved by having your dentist place a crown on them.
* Crowns stabilize cracks by surrounding the tooth, preventing the tooth from flexing apart. It counteracts splitting forces increasing longevity of cracked teeth.
NOT all cracked teeth need crowns!
Most cracks are within normal limits…they’re surface cracks, needing no treatment. Filling in these teeth are appropriate!
Microscopes are required to accurately detect deep early cracks that do require crowns.
I can’t say it too many times. Early cracks can be deep. The dentist cannot accurately detect them without a microscope.
Cracked teeth normally do NOT have symptoms until cracks are advanced. Early cracks grow, just like an automobile’s windshield cracks when a rock hits it.
If you ignore small cracks in your windshield, the cracks GROW until your windshield breaks and you have to get a new one.
You can see the cracks in your windshield? The cracks may concern you but might not bother you enough to get them fixed right away. Its easy to put it off.
Finally, when it starts to bother you,it may be too late for a simple repair. You have to replace the windshield when you’ve neglected fixing it for too long.
Cracked teeth get worse, just like windshields, only you don’t see them. Deep tooth cracks get deeper. Its not if, but when is your tooth going to break, and how badly will it break? We don’t know until it happens.
Microscopes are required to accurately detect deep early cracks that do require crowns.
* Severely cracked teeth may need to be extracted
“I’m having an emergency!”
What makes your tooth hurt? Do you have hot or cold pain that lingers after you remove the hot or cold? How long does it linger? Time it on a stopwatch or a clock. How many seconds does it linger after the hot or cold is removed? If its more than 60 seconds, its probably abcessed.
Next: Does it hurt to tapping? Can you tell exactly which tooth the pain is coming from? Is the gum around the tooth swollen? Is there any swelling in your face?
If the answers to any of these questions is yes, you need to call your dentist without delay.
If you are not able to speak with your dentist, go to the nearest urgent care medical facility or the nearest emergency room, as soon as possible.
Self medicating, other home remedies or ignoring the problem, can lead to permanent, irreversible damage, more extensive, costly and more invasive treatments.
In rare cases, ignoring these symptoms of infection and failing to see a professional health care provider, may result in serious even life threatening complications.
BROKEN OR CHIPPED TEETH:
Find and save broken tooth fragments. Rinse them in warm water. Call your dentist.
Teeth which have been knocked out:
Try not to touch the tooth root. Rinse the tooth in warm water if it’s dirty.
Do not scrub the tooth root. Do not try to remove any soft tissue fragments which may be attached to the root.
Try to put the root back into the tooth “socket”, where it came from. And immediately go to your dentist.
If you can’t put the tooth back into its original spot, submerge the tooth in milk (if you have it) or a full cup of water with a pinch of salt in it, or use “Save-a-Tooth” solution (best- you can buy it online and have it ready in advance especially if your youngster is involved in contact sports).
Do everything you can to have your dentist replace the tooth back into its socket within one hour!
The tooth has not come out of it’s socket, but its longer than the teeth “next door” It’s loose. Take over-the-counter pain medications as needed. Apply cold compresses. Call your dentist. Your dentist needs to see this, especially if it’s a permanent tooth.
You can find over-the-counter dental cement. Place this inside the tooth where the filling was lost. This is a temporary measure. It’s usually ok to do this, temporarily
If you’ve lost an inlay, onlay, crown (permanent restorations), call your dentist.
If you’ve lost a temporary restorations that were recently made after dental impressions for new dental work, call your dentist.
Bleeding from the mouth:
Where is the blood coming from? Did dirt get into the wound?
1) Rinse your mouth with room temperature water containing one pinch of salt per cup.
2) Apply pressure to the bleeding site using moist gauzes or wet tea bags. Bleeding should deminish within 20 minutes with constant pressure.
3) To help control swelling, apply cold compresses (ice bags) over the facial areas involved for 10 minutes and repeat.
4) If dirt was in the wound you may need a tetanus vaccination.
5) Over-the-counter pain medication is ok. Follow all instructions on the labels. Tylenol is better than aspirin in cases of bleeding.
6) Do not allow bleeding to continue.
If bleeding persists, you must see your dentist or
an emergency room professional immediately
How to tell if you have cavities
Tooth decay can look like dark spots or brown stains on teeth or around fillings and cracks in teeth.
Sometimes eating sweets will indicate that you may have a cavity.
Most cavities have no pain or other symptoms until they become very large.They’re invisible, until they get larger.
You may not be able to tell if you have cavities. A dentist has to do that for you.
Many times cavities are invisible even to X-rays’ because X-rays fail to detect 76% of early stage cavities.
Once 50% of the calcium in teeth is destroyed, X-rays do reveal cavities which are still invisible to the human eye.
In my office several technologies are used to detect dental decay, tooth cracks and fractures, invisible to all other technologies:
1) Standard X-rays are taken because they do reveal decay that’s invisible to the human eye. However, X-rays can not be trusted completely.
2) Magnification and fiberoptic lights add greater depths of detection:
Binocular microscopy (16-18X + magnification)
Intra oral microscopes with fiberoptic lights detect cavities which x-rays miss. Photos of everything I see on microscopes are also displayed on monitors for patients to see (up to 40X)
Microscopic loupes with fiberoptics mounted on my safety glasses are used during every procedure (3X)
Fiberoptic Transillumination detects decay missed by X-rays, by making teeth transparent and seeing through them. Cavities become visible.
Diagnodent Laser detects early stage tooth decay, missed by X-Rays.
Tooth decay dyes before and after removing decay is the only way to be 100% sure all decay has been found and removed.
DIRECT RESIN RESTORATIONS:
Tooth colored resins are bonded to teeth to repair damage from cavities, tooth chips and rough edges, to cover sensitive roots, close spaces or to improve the shapes and miner cosmetics of teeth.
Tooth colored resin fillings are good replacements for silver fillings.
Direct resin restorations are done at the dental chair. They require only one office visit. They’re best suited for small cavities and small problems.
Because direct resin restorations are not as strong as other materials, longevity is shorter, they may stain, chip or break periodically, requiring repairs or replacement.
Indirect restorations: Inlays, onlays, crowns, veneers
(These restorations require laboratory procedures and at least 2 office visits)
Inlays take two office visits. They are custom made restorations crafted from gold or tooth colored porcelain. These restorations are stronger than direct resins and last much longer. Porcelain inlays are very cosmetic.
Onlays are restorations made from gold or tooth colored porcelain. Two office visits are necessary. These restorations are recommended for cavities that are too large for inlays but not large enough for crowns. Longevity is good. Strength is good. Cosmetics are good.
When cavities are too large for onlays and the tooth has substantial damage, crowns are needed. Crowns cover the entire tooth. They’re fabricated from gold or tooth colored porcelains. Longevity is excellent. Strength is excellent. Crowns can be placed on implants. Cosmetics are excellent. Two office visits are necessary.
Tooth colored, porcelain veneers are the most beautiful and least invasive of all dental restorations.
Veneers are designed to correct crooked teeth, chipped teeth, to close spaces, increase tooth length, whiten teeth beyond what’s possible from bleaching.
Veneers are the premier cosmetic restoration. Sometimes more than two office visits are necessary. The number of office visits depends upon the challenges of each case.
1) Your bite, your chewing functions, your tooth wear and wear patterns, your oral hygiene and gum health must be acceptable. Failure to control every one of these areas, will comropmise your veneers and your risk of premature failure is high (fractures, breaking, debonding, color contamination).
2) Bite problems are the number one reason for veneer failures. Many times a “diagnostic mounting” is absolutely mandatory. Without proper control of “Bite Disease” veneers are guaranteed to fail prematurely.
The “diagnostic mounting” tells the dentist if you are a good candidate for veneers, or not.
Veneers done correctly, are very strong once they’re bonded to place. They have good longevity with efficient daily flossing and brushing (10+years)
It’s to your advantage NOT to proceed with veneers if “Bite Disease” is not properly considered, treated and controlled in advance.
3) If your gums are not in “tip top” health, bleeding may occur at your delivery apointment and blood will “sheet” between your veneers and the resin that bonds them to your teeth.
When this happens the color of your veneers can be permanently destroyed and the bond strength is compromised (affected veneers may fall off).
4) Porcelain veneers can be done as zero prep veneers (no drilling of teeth) or minimal prep venners (very little tooth structure removed). Minimal prep veneers are normally done without dental injections because preparations are ultra conservative. Temporary veneers are not needed as well.
*If you have additional unanswered questions, call the office to schedule an examination and consultation.
**We also offer Free Cosmetic Evaluations where full examinations are NOT performed, but basic overviews are provided and your questions are addressed.
Some cavities are so deep that the nerve becomes infected. Whenever enough solid tooth structure remains after all decay is removed, root canal therapy is feasible.
Root canals have a bad reputation for being very painful.
Severely infected teeth are difficult to numb. When infection is controlled prior to root canal therapy, the risk of pain is actually very rare.
Root canal therapy removes infection and seals the roots. Following root canal therapy, your tooth should be restored with an appropriate restoration as soon as possible.
Typically these teeth are covered by crowns or onlays within 30 days of root canal completion. This strengthens the underlying tooth which has been weakened by decay.
Failure to restore teeth properly (as recommened) following root canal therapy, frequently leads to tooth fractures and extractions.
“Ok STOP! I hate the dentist!”
“I can’t even deal with the thought of what YOU do!”
“Hold on, take it easy”
“Here’s how we’re able to help that”
•Little blue pills are crushed and sprinkled under your tongue.
•They keep you in a twilight, dream-like, relaxed state.
•You’re able to answer questions and respond to our instructions.
•You have no awareness and no cares about us or what we do
•You’ll have no idea of what time it is, even if you’ve been in the chair for hours!
•You won’t remember anything about what we did.
*Click of this link for more details, “Sedation Dentistry“
“Call my office. Schedule an interview”
Ask for a Sedation consult, its FREE
(no dental instruments, no dental exam or procedure, just talking & meeting us)
(no needles, no numbness, no drills, no pain, no smell, no noise, no vibrations)
Rarely do any of my patients need dental injections to get numb for these fillings.
Air Abrasion fillings use no drills because early stage cavities can be air-brushed away.
Its a fine,“gritty” partical-beam with a “swishing” sound.
My instrument is powered by helium gas, so the partical beam brushes out decay gently, at very low pressures, (as low as 20 PSI) well below the pain threshold of most patients.
*This is early stage detection of decay AND non-invasive, pain-free restorations that look natural. Why watch cavities grow until they have to be drilled out by traditional methods?
**Drills make large holes, remove good tooth structure along with decay, and vibrate, leaving micro stress cracks in teeth.
Air Abrasion only removes soft decay, leaving healthy tooth structure alone. Click on this link for more details, “More about Air Abrasion”
Implants are tooth replacements which have roots just like natural teeth. They look and function just like natural teeth.
Implants are now considered to be the standard of care, (when placement is possible).
Implants outlast all other methods of tooth replacement.
Severe impact injuries (like automobile accidents) and gum disease are the main threats to loss of implants.
These restorations never decay. They outlast all other restorative options. But gum disease can destroy the bone that holds them in place.
About 80% of adult Americans have gum disease. 35% of them also have a genetic disorder which makes these individuals significantly more susceptible to gum disease.
Failure to identify these individuals in advance, and failure to commit to vigilant gum care for a lifetime could result in premature loss of implants.
We use genetic medicine to screen implant patients before they undergo implant treatment. It’s called a PST test.
Are you one of the 35% who could lose your implants prematurely to gum disease?
If we both know your genetic status in advance, and we both know what you’re ready, willing and able to do about maintaining good gum health, then and only then do we know if implants are appropriate for you.
Again, your gums must remain healthy in order to achieve expected longevity for implants. If you are PST positive, implants are still possible however vigilant, ongoing gum care for life is necessary.
If you’d like more details about implants click this link, “MORE ABOUT IMPLANTS”
Bridges are the next best option for tooth replacement, whenever possible.
Where natural teeth are missing, teeth on both sides of the space are used as “anchors”. Crowns are placed on these teeth and replacement teeth are attached to both crowns.
It’s a single, “all-in-one” restoration which is permanently cemented over both anchor teeth. Bridgework is very common.
Removable partial dentures:
Sometimes when you’ve lost a number of natural teeth, implants or fixed bridgework may not be possible. In this case, removable partial dentures may be the best option.
Existing natural teeth act as anchors for a customized metal substructure. Part of the appliance also has clasps built into the metal substructure. These clasps “hook” to the natural teeth, keeping everything secure and tight.
Replacement teeth are embedded into a resin base that looks like natural gums. Everything is firmly attached to the metal substructure.
Removable partial dentures are lower in cost than other methods of tooth replacement and have good longevity.
When you’ve lost all of your teeth (or about to lose them) full dentures may be the only option (assuming no implants).
There are 2 types of full dentures. “Your first set” and “your next sets”.
1) “Your first denture”
Your first set of dentures are what I call Transitional Dentures. I call them transitionals because, for many, it’s one of the most difficult, frustrating, embarrassing and uncomfortable experiences imaginable. Not for everyone, but it is for many. It is a major transition.
Your first dentures have to be made before your teeth are removed. That’s so you’ll have teeth on the very day they’re removed.Let’s say your jaw and teeth (before surgery) are a size nine. Just like a pair of shoes, only it’s your first denture.
On the day of your surgery, teeth, bone and some soft tissue are removed. As soon as that happens, your actual jaw size is now an 8. So your size 9 denture is placed over a size 8 jaw.
“It’s going to be loose! It’s going to look bulky!”
That’s not all. Jawbone is stable when it’s stimulated by teeth. As soon as teeth are removed, your jawbone knows it and immediately goes into “shock”.
The jaws begin to melt down, going to other parts of your body where it’s needed.
As a result, your new jawbone (the denture bed) shrinks and reshapes itself rapidly in the first 30 days. This continues for 6 months on average.
The shrinking is uneven. Your dentures continually get looser and looser. One side settles in making “pressure sores” until that area melts down. Then another spot settles in, causing new “pressure sores” until that area melts down…. and the cycle repeats, over and over, for 6 months.
You may need many adjustments weekly, during month one. Transitional Dentures can become so loose that adhesives may not work. At that stage, many patients use denture “pads” to fill up the space. But the gums are still tender from the surgery. You have new sore sore spots daily. You have to take transitional dentures out often for relief.
Shrinking continues in months 2-6 at a slower rate each month. By month 6 your size 9 denture is laying down on a size 6 or 7 denture bed.
The jawbone has finally stabilized. Too much denture bed has been lost to reline the denture. Your Transitional Denture needs to be thrown away. That’s why we make this denture as inexpensive as possible.
A new denture can be made at this time without any of the problems associated with “your first denture”
2) “Your next sets”
I make conventional dentures in several steps after jaws are fully healed and stabilized
1st appointment: impressions for custom molds
2nd appointment (one week later): final impressions
3rd appointment (one week later): bite design
4th appointment (one week later): wax try in with teeth
5th appointment (one week later): final delivery
How to know if you have Gum Disease
1) Do your gums bleed or hurt when you brush your teeth?
2) Are your gums ever sore, puffy or swollen, tender?
3) Has anyone said, “You’ve got bad breath!”
4) Are you starting to see spaces between your teeth?
5) Do your teeth look longer than they used to?
6) If you squeeze your finger against your gums (near the teeth), do you see any yellowish substance oozing out?
7) Are you a diabetic, taking insulin?
8) Are diabetic but not required to take insulin?
9) Have you had gum disease before?
10) Does your spouse or significant other have gum disease? It’s contagious, mouth-to-mouth.
11) Have you lost any teeth because of gum disease?
12) Are you a smoker?
13) Are you over 50 years old?
Are you answering yes to even a few of these questions? If so, you need to schedule an examination with your dentist.
Here’s how we detect and treat gum disease
1) Initial evaluation:
Electronic instrumentation is used to assess and measure your gum health
Advanced Salivary Diagnostics (genetic medicine)
Stage one: A pre-screening test of your mouth for pathogens (disease causing bacteria)
X-rays and visual examination
2) If there are positive signs of gum infection:
We test your saliva.
Stage two: You swish a sterile saline solution around in your mouth for 30 seconds and spit it into a special tube. Your tube is sent to the DNA lab for analysis. We receive a bacterial genetic profile of your pathogens (the mix of all bacteria causing your gum disease, at this time).
There are 13 pathogens known to cause gum disease. Your test tells us which bacteria are causing your infection, how many microbes are present, is your own body able to kill them or do you need antibiotics.
Which antibiotics or combination of antibiotics are necessary, in what dose and quantity, how long you’ll need antibiotics and when to retest to make sure your pathogens are gone or already repopulating.
Gum infection can return. It may have different, more invasive pathogens. Genetic testing tells us how and when to modify your treatment. It enables us to monitor your gum conditions and treat appropriately and scientifically.
If your gum disease persists or if different pathogens are showing up in your tests…We’ll need to examine and test your spouse or significant other because:
Gum Disease is contagious, mouth-to-mouth.
(You may be getting their pathogens)
We use several other genetic tests as needed
3) Plaque index therapy: to control the underlying cause of gum disease. This is done before, during and after treatment to prevent bacterial re-population
4) Laser assisted gum therapy
5) Assess systemic affects from gum disease upon your body: systemic inflammation, risks of diabetes and cardiovascular disease.
*To learn more about the diagnosis and treatment of gum disease, click on this link “Gum Disease”
**Failure to control gum disease using these conservative treatment modalities may lead to premature loss of teeth or surgery to save teeth.
***Bacteria from gum disease have been found in heart valves, heart arteries, peripheral arteries, lungs and recently, a stillborn baby was delivered. Cause of death was infection from mother’s gum disease. Check out the details by clicking on this link,
“STILLBORN BIRTH FROM GUM DISEASE”
Causes of a dry mouth
Some prescription medications cause dry mouth as a side effect. Your primary medical provider may be able to prescribe alternative medications or adjust your dose. A medcal consultation would be necessary for that.
There are medical conditions and syndromes, which cause dry mouth. Ask your primary medical provider about your concerns at your next physical.
Dentistry has no cure for dry mouth. Dry mouth will increase tooth decay and gum disease.
Drink water and sip it throughout the day. Keep water at your bedside at night. Stay hydrated.
Sugar-free hard candies and sugar-free gum may stimulate production of saliva
Do not use mouthwash containing alcohol. Alcohol dries out oral mucosa
Avoid drinks containing alcohol or caffeine. Both alcohol and caffeine dry out the oral mucosa. They also increase urination which dehydrates the mouth.
How to get whiter teeth
Teeth whitening can increase tooth hyper-sensitivity, especially if if your teeth are already sensitive.
There are ways to counteract hypersensitive teeth. We use “MI” paste. A white paste in a tube that you squeeze out into bleaching trays. “MI” paste remineralizes and desensitizes teeth. It also kills bacteria .
Its better to treat tooth hyper-sensitivity prior to whitening.
Hyper-sensitivity is also cause by clenching and grinding teeth. Splints are the best way to deal with that.
Don’t be in a hurry to whiten if your teeth are already sensitive.
You should also have healthy gums prior to whitening. You should NOT have crowns, veneers, fillings or any other restorations visible in your smile zone. Restorations do not whiten.
If you do have restorations that display in your smile zone, its ok to whiten teeth as long as your’re prepared to have existing restorations remade to match up with your new, whitened, natural teeth. Or accept the look of darker restorations next to your whiter natural teeth.
Whitening works very well for “yellow” teeth. Darker, “brown” or “gray” tones are difficult to bleach.
Tetracycline discoloration, for example, is difficult. Veneers or crowns may be the best options for whitening in these cases.
We offer in office whitening, take home whitening and both. We prefer chemical whitening only.
Depending on who’s research you read and believe, bleaching with lasers or Zoom systems vs pure chemical bleaching have been shown in case studies to achieve virtually the same results.
I’ve used both laser whitening and chemical only. Myself, my staff, and patients I’ve tested, cannot tell the difference.
In office whitening costs more because we have to dedicate the treatment room for about one hour.
Laser whitening has the same treatment room cost plus, costs for the laser technology.
I’ve stopped using lasers to whiten teeth because we get great results at far less cost for our patients, without it.
The information on this website is posted for educational purposes only. It is not a substitute for professional care. Any and all diagnosis and treatment recommendations can only be provided after examination by a licensed Dentist.