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Posts for: May, 2019

By Bruce P. Mercado, DDS, PC
May 27, 2019
Category: Dental Procedures
Tags: teeth whitening  
StainingWithinaToothRequiresaClinicalWhiteningApproach

Home whitening kits are a popular way to turn a dull smile into a dazzling one. But these self-applied products only work for teeth with outer enamel stains — if the discoloration originates inside a tooth, you’ll need professional treatment.

Known as “intrinsic staining,” this type of discoloration most often occurs within a tooth’s pulp or dentin layers. There are a number of causes like tooth trauma or tetracycline use at an early age. A root canal treatment used to remove infection from deep within a tooth can also cause discoloration: sometimes blood pigments left after tissue removal or the filling materials themselves can stain a tooth’s interior.

Intrinsic staining can often be treated by placing a bleaching agent, usually sodium perborate, into the tooth’s pulp chamber. But before undertaking this procedure on a tooth that’s undergone a root canal treatment, we want to first ensure the filling is intact and still adequately sealing the tooth from infection. We also want to make sure the supporting bone is also healthy.

If all’s well, we access the pulp in the same way as the root canal treatment, and preferably through the same access hole. We then clean out the pulp chamber of any stained matter and then ensure the root canals remain filled and sealed off from the pulp chamber.

We can then place the bleaching agent into the pulp, a process that will need to be repeated every three or four days to achieve the desired level of brightness. After each session we place a cotton pellet over the opening and held in place with a temporary adhesive; we can easily remove and re-apply this covering during subsequent sessions. Once we’ve achieved the desired color change, we seal the tooth with a permanent filling and restore the access cavity with a tooth-colored composite resin material bonded to the enamel and dentin.

There are other options for an intrinsically stained tooth like veneers or crowns that outwardly cover the discoloration. Internal bleaching, however, is a more conservative approach that causes less alteration of the tooth. If successful, it can restore a stained tooth to a brighter, more attractive shade.

If you would like more information on internal bleaching, 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 “Whitening Traumatized Teeth.”


By Bruce P. Mercado, DDS, PC
May 17, 2019
Category: Oral Health
Tags: oral health  
WhatYouShoulddoAboutThisBizarreDrugSideEffect

Drugs play an indispensable role in treating disease. For example, life without antibiotics would be much more precarious—common infections we think nothing of now would suddenly become life-threatening.

But even the most beneficial drug can have disruptive side effects. Antibiotics in particular can cause a rare but still disturbing one: a growth on the tongue that at first glance looks like dark hair. In fact, it's often called "black hairy tongue."

It isn't hair—it's an overgrowth of naturally occurring structures on the tongue called filiform papillae. These tiny bumps on the tongue's upper surface help grip food while you're chewing. They're normally about a millimeter in length and tend to be scraped down in the normal course of eating. As they're constantly growing, they replenish quickly.

We're not sure how it occurs, but it seems with a small portion of the population the normal growth patterns of the papillae become unbalanced after taking antibiotics, particularly those in the tetracycline family. Smoking and poor oral hygiene also seem to contribute to this growth imbalance. As a result, the papillae can grow as long as 18 millimeters with thin shafts resembling hair. It's also common for food debris and bacteria to adhere to this mass and discolor it in shades of yellow, green, brown or black.

While it's appearance can be bizarre or even frightening, it's not health-threatening. It's mostly remedied by removing the original cause, such as changing to a different antibiotic or quitting smoking, and gently cleaning the tongue everyday by brushing it or using a tongue scraper you can obtain from a pharmacy.

One word of caution: don't stop any medication you suspect of a side effect without first discussing it with your prescribing doctor. While effects like black hairy tongue are unpleasant, they're not harmful—and you don't want to interfere with treatments for problems that truly are.

If you would like more information on reactions to medication that might affect your oral health, please contact us or schedule an appointment for a consultation.


By Bruce P. Mercado, DDS, PC
May 07, 2019
Category: Oral Health
Tags: fluroide  
KeepanEyeonYourFamilysFluorideIntake

Fluoride is a critical weapon in the war against tooth decay. But this natural chemical proven to strengthen tooth enamel has also aroused suspicion over the years that it might cause health problems.

These suspicions have led to rigorous testing of fluoride's safety. And the verdict from decades of research? We've found only one verifiable side effect, a condition called enamel fluorosis. Caused by too much fluoride present in the body, enamel fluorosis produces white streaks and patches on teeth, and can develop into darker staining and pitting in extreme cases. But other than having an unattractive appearance, the teeth remain sound and healthy.

Fortunately, you can reduce the risk of fluorosis by limiting fluoride exposure to within recommended limits. Fluoride can show up in processed foods and other substances, but the two sources you should focus on most are oral hygiene products and fluoridated drinking water.

Dentists highly recommend using toothpaste with fluoride to fight tooth decay. But be careful how much your family uses, especially younger members. An infant only needs a slight smear of toothpaste on their brush for effective hygiene. At around age 2, you can increase the amount to about the size of a vegetable pea.

As to drinking water, most utilities add fluoride to their supply. If yours does, you can find out how much they add by calling them or visiting cdc.gov ("My Water's Fluoride"), where you can also learn more about recommended levels of fluoridation. If you think it's excessive, you can switch to water labeled "de-ionized," "purified," "demineralized," or "distilled," which contain little to no added fluoride.

Even if your fluoridated water is within recommended levels, you may wish to take extra precautions for infants nursing with formula. If possible, use "ready-to-feed" formula, which usually contains very low amounts of fluoride if any. If you're using the powdered form, use only water with the aforementioned labeling for mixing.

Before making any drastic changes that might affect your family's fluoride intake, consult with your dentist first. And be sure you're keeping up regular dental visits—your dentist may be able to detect any early signs of fluorosis before it becomes a bigger problem.

If you would like more information on maintaining the proper fluoride balance with your family, 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 “Tooth Development and Infant Formula.”