If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.

In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.

Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.

When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.

The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.

At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.

Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

Periodontal (gum) disease can lead to serious infection and even loss of teeth; but it can easily be prevented. Here are seven things you can do to prevent gum disease — or stop it in its tracks if you already have it.

1. Understand the causes of gum disease. Diseases of periodontal (from the root words meaning “around” and “tooth”) or gum tissues start with bacteria collecting on your teeth, in the areas where the teeth and gums meet. The bacteria, called plaque or biofilm, irritate the surrounding tissues and cause them to become inflamed and swollen, and to bleed easily on contact. This condition is called gingivitis.
2. Brush correctly and effectively. Brushing twice a day is not just to polish your teeth to pearly whiteness. An important reason to brush is to remove the daily coating of plaque from your teeth. At your next dental appointment, ask me or our staff to show you the most effective way to brush.
3. Floss every day. Daily flossing removes the plaque that settles in between your teeth, in places where your brush can't reach.
4. Have regular professional cleanings. Our hygienist will remove plaque that you missed by brushing and flossing. This plaque hardens into a material called calculus or tartar. In a professional cleaning your hygienist uses special tools to scrape these materials away. The hygienist also measures the distances between your gums and teeth to make sure that inflamed gums have not separated from the teeth, forming pockets in which the bacteria continue to grow.
5. Recognize the signs of developing gum disease. These signs include any of the following: gums that bleed easily when you brush or floss; bad breath; red or swollen gums; and sensitive teeth.
6. Stop smoking. If you haven't stopped smoking for your heart or lungs, here is another reason to quit. Smokers are more likely to develop periodontal disease than nonsmokers. Smoking masks the effects of gum disease, so smokers are less likely to notice the symptoms, allowing the disease to progress to a greater degree before they seek help.
7. See our office right away if your teeth become loose or your gums become red and swollen. If inflamed gum tissues do not heal, the disease continues to progress. The tissues that attach your teeth to your bone, called ligaments, are lost as pockets deepen as the infection advances. Your gums may also become red, swollen, and painful. As the infection gets worse it eats away the bone around your teeth, causing the teeth to loosen and fall out.

So start with prevention and stop periodontal disease in its early stages.

Contact us today to schedule an appointment to discuss your questions about gum disease. You can also learn more by reading the Dear Doctor magazine article “Warning Signs of Periodontal (Gum) Disease.”

We tend to think of aspirin as a harmless medication. It is dispensed over the counter and is the most widely used OTC medication in the U.S. We take it without thinking we may be exposing ourselves to risks. But in certain situations aspirin can cause dangerous side effects.

What is aspirin, and how does it work?
The chemical name for aspirin is acetylsalicylic acid. It is used to reduce mild pain, inflammation and fever. When you take an aspirin, it blocks the formation of prostaglandins, substances your body creates that are associated with inflammation. Prostaglandins cause inflamed tissues to become red and swollen, but they also serve protective purposes, such as forming a barrier that protects the stomach from the acid it produces to digest your food. That's why long-term aspirin use can sometimes cause stomach bleeding and ulceration or other health problems.

Why do cardiac patients take aspirin?
Another effect of aspirin is to prevent blood platelets from clumping together. Blood platelets are structures in the blood, smaller than white or red blood cells, that aid clotting by sticking together at the site of an injury. This effect of aspirin can cause prolonged bleeding, but it may be beneficial to people who have cardiovascular (from cardio, meaning heart; and vascular, meaning vessel) disease with narrowed blood vessels.

Aspirin can keep blood flowing in the obstructed vessels and thus prevent heart attacks and strokes; but it can also increase the risk for strokes that are caused by bleeding in the brain. Most physicians attempt to lower such risks by asking their patients to keep their daily aspirin consumption to a low dose 81 mg “baby” aspirin.

How does aspirin affect your teeth and gums?
Be sure to let your medical and dental professionals know you are taking aspirin, and how much you take. Also tell us about other OTC medications you take, including herbal medications and supplements, because they may interact with aspirin to cause side effects.

If you have been told to take aspirin because of a cardiac condition or procedure, be sure to follow your recommended treatment. Do not suddenly discontinue aspirin therapy; doing so can increase your risk for heart attack and stroke. Ask us if you should stop taking aspirin before a major dental or oral surgery, but do not stop taking it on your own. We will consult with your physician about your medical condition and let you know our recommendation. In most cases you can continue your aspirin therapy without causing excessive bleeding during the dental procedure.

Contact us today to schedule an appointment. You can also learn more by reading the Dear Doctor magazine article “Aspirin: Friend or Foe?”

In modern society, a bright, white smile conveys optimal health, youth and sound teeth. However, various influences including age, wear, diet, and lifestyle may prevent you from having and maintaining the glistening smile you long to share with the world. Luckily, there are many safe, inexpensive, and successful treatment options for discolored or stained teeth.

We can perform a “power bleaching” in our office to whiten teeth that are severely stained or discolored. This procedure whitens the external surfaces of the teeth by using a high concentration (35-45%) hydrogen peroxide solution, which is sometimes activated by a specialized light. To prevent irritation of the mouth's soft tissue lining during this procedure, we will isolate your gums and membranes with a rubber dam, a silicone or other effective barrier. Professionally applied in-office power bleaching provides control, speed, and predictability capable of lightening teeth up to ten shades in an hour. Don't try this at home! Our staff will take precautions in the office to avoid side effects and possible tooth sensitivity.

We can also provide you with custom-made, vacuum-formed, plastic bleaching trays for use with a take-home whitening application. In this instance, a gel made from carbamide peroxide (4-7% hydrogen peroxide, safe for home use) is delivered to the tooth surfaces in the bleaching trays. You will need to wear the tray for 30 minutes twice a day, which is a longer process than in-office bleaching. The first subjective signs of whitening will occur after three or four sessions, allowing whitening of up to eight shade units.

Another home-based option, whitening strips, essentially look like band-aids for the teeth. They are capable of lightening teeth by about three shades after being worn directly on the surface of the teeth for 30 minutes twice a day for one week.

If you have always wanted whiter teeth, schedule an appointment so we can determine which of these treatment options would work best for you. For more information on the fundamentals of teeth whitening, read the informative Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter...”

When it comes to tooth pain, it is important to identify two things: what is causing your pain and what can be done about it. In some instances you can handle it yourself at home; however, for others, you should contact us so that we can diagnose and treat the problem. See how much you really know about tooth pain by taking our true/false test.

1. It is perfectly normal to experience tooth sensitivity to hot and cold foods for a few days after dental treatment.
   True or False
2. If you experience sharp pain when biting down on foods, you should hold off on contacting us to see if the pain gets better on it own.
   True or False
3. Tooth pain is caused by a reaction of nerves inside the tooth's enamel with the severity of the pain dependant upon the type and degree of the stimulus.
   True or False
4. Generally speaking, pain is a protective response that ranges from minor to severe as a way of informing the body that something is wrong.
   True or False
5. If a tooth's root surface is sensitive, you should use a firm toothbrush to ensure that you are keeping the area clean by thoroughly removing dental bacterial plaque.
   True or False
6. Lingering pain after eating hot or cold foods and liquids probably means that the pulp within your tooth is probably damaged or inflamed as a result of deep tooth decay or injury from a physical trauma.
   True or False
7. Regarding tooth sensitivity, you should only contact us if the pain persists for several months because this is not likely to be anything serious.
   True or False
8. If a tooth's pulp becomes damaged or dies, you will need a root canal.
   True or False
9. With tooth pain, knowing how long to wait before you contact us can save physical, financial and emotional stress.
   True or False
10. People often confuse tooth and sinus pain because they both can feel the same — a dull ache with pressure in the upper teeth and sinus area on one or both sides of the face.
    True or False

Answers: 1) True. 2) False. You should contact us asap for an examination before the pain worsens. 3) False. The nerves are located in the tooth's pulp chamber. 4) True. 5) False. Use a soft bristled toothbrush not a firm one. 6) True. 7) False. While tooth sensitivity generally does not signal a serious issue, if it persist for days or worsens, contact us. 8) True. 9) False. Early interception is best. 10) True.

To learn more, continue reading the Dear Doctor magazine article “Tooth Pain? Don't Wait!” Or contact us today to schedule an appointment to discuss your questions.