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Tooth Pain that Shouldn’t Be Ignored – Newton, MA

By Christine Ambrose Many times a patient will come in for emergency dental treatment and have excruciating pain. They will say, “Well it only bothered me a little bit so I kept putting it off.” If several months have elapsed since the first symptoms, usually the damage is done and the prognosis for the tooth in question becomes less favorable. Here are some tips on dental pain you should not ignore, including one that may be a sign of a heart attack! Cracked Tooth Syndrome This is an incomplete fracture of a tooth. Nothing is visibly wrong with the tooth on the outside but internally there are cracks in the enamel and dentin. Symptoms are variable; some are pain on chewing, referred pain, and sensitivity to hot and cold foods or drinks. The most common symptom is sharp pain upon releasing chewing pressure. Most cracks rarely show up on an x-ray. Lower molars of older individuals are most frequently affected. Irreversible Pulpitis This symptom basically means that tooth has a painful response to hot or cold foods / drinks that lingers. It can also commonly present with spontaneous (unprovoked) pain. Dynamic changes can occur quickly, the tooth can go from being quiet to acute pain within hours. Sometimes pain can be relieved by applying heat or cold. It can be sharp or dull, localized or referred. Treatment to address pain entails initiating a root canal immediately. Abscess An abscess consists of a painful swelling with pus around the roots of the tooth. This indicates a very late stage where the tooth has already died and the infection has spread beyond the confines of the jaw bone. Symptoms are rapid onset of slight to severe swelling, moderate to severe pain, and tenderness. In severe cases, a fever maybe present as well. Jaw Pain Sometimes jaw pain that persists for more than a few days or becomes worse can indicate teeth grinding / clenching, or better known as bruxism. If symptoms do not improve with a nightguard, it may require further treatment by a TMJ specialist. Jaw pain can also be a symptom of a heart attack in women. Women are more likely than men to experience other symptoms than chest pain such as shortness of breath, nausea, and arm, back, jaw pain. For more information, contact Newton Wellesley Dental Partners. today.com  

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Should I Remove my Baby’s Tooth? – Newton, MA

Should I take out my child’s loose tooth? One of the most common concerns seen by Dr. Christine Ambrose, family dentist at Newton Wellesley Dental Partners,  is anxious parents will bring in their child and say “Help! He has two rows of teeth!” Project1 Usually what I will see is that the child will have a lower front tooth erupting up and behind their baby tooth. This condition does not always require treatment, in most cases the permanent tooth will come forward and push the baby tooth out. The tongue and jaw bone growth play an important role in influencing the permanent incisors into a more normal position with time. This condition can occur in children who will have crowded teeth and those who have adequate spacing. It does not mean your child will definitively need orthodontic treatment. Removal of other baby teeth in the area is not recommended because it could cause crowding issues later on.  In certain cases if the baby tooth is not loose by age 8, a dental X-ray should be evaluated and possible extraction needed. Some parents prefer to have the baby tooth out and the problem laid to rest. If you are considering this, here is a helpful video on removing your child’s tooth!  http://www.mouthhealthy.org/en/ask-an-ada-dentist/removing-loose-tooth?source=Morning_Huddle For additional blogs on other dental topics, click here. Contact Dr. Ambrose or Newton Wellesley Dental Partners. Source: mouthhealthy.org Photo from www.oralanswers.com

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Toothpaste Talk with Dr. Ambrose – Newton

Toothpaste Talk Dr. Christine Ambrose, family practitioner at Newton Wellesley Dental Partners, asks, “How do you choose your toothpaste?" With all the selection available in the dental aisles at stores, settling on one tube can be a bit overwhelming. Most manufacturers make toothpastes that target top concerns for oral health. Project1Toothpaste generally serves two functions:  removing plaque, the bacterial film that forms on teeth and gums daily, and preventing decay by strengthening tooth enamel with fluoride. For most patients, I recommend simple advice. Choose a toothpaste that has fluoride, controls tartar, and is ADA approved. Everything else comes down to personal preference like how the toothpaste makes your mouth feel after brushing. Fluoride can help restore weakened enamel to prevent decay. However once there is decay, the toothpaste cannot reverse that process. Tartar control helps slow the rate at which bacteria adhere to the gums and teeth. The ADA seal means that the product has met criteria for safety and efficacy. The FDA does not test toothpaste to verify compliance.  To find an ADA seal product: http://www.ada.org/en/science-research/ada-seal-of-acceptance/ada-seal-products Do whitening toothpastes work? Whitening toothpastes do work in the short term, however to see significant changes in tooth shade, these pastes don’t do much because there isn’t enough whitening ingredients in them. For whiter teeth, consider in-office teeth whitening procedures. Do anti-sensitivity toothpastes work? Yes, these toothpastes have proven to work very well. Most contain potassium nitrate, which helps close up areas of exposed dentin. If OTC sensitive toothpastes do not seem to help, you can switch to a prescription-strength toothpaste. How much toothpaste should I use? The amount varies based on age.  For most adults, a pea-sized dollop is adequate. For children between 6 months to 2 years I recommend training toothpaste (no fluoride)  until the child is able to rinse and spit. Once your child can spit, use a fluoride toothpaste the size of a grain of rice and gradually increase the amount to the size of a pea by 6 years. For more information on Dr. Ambrose, click here To contact the office or check out patient reviews, click here http://www.mouthhealthy.org/en/babies-and-kids/healthy-habits http://www.ada.org/en/science-research/ada-seal-of-acceptance/product-category-information/toothpaste Artwork: www.everdayhealth.com

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Oral Diseases Associated with Women – Newton, MA

Dr. Christine Ambrose, family practitioner at Newton Wellesley Dental Partners, often sees many of her female patients  who demonstrate some type of tongue abnormalities.  She asks, “do you know what Sjogren’s Syndrome, systemic lupus erythematosus (SLE), and burning mouth syndrome (BMS) all have in common? They are all oral diseases that are much more prevalent among women causing dry mouth, unpleasant taste, and pain in the tongue”. Sjogren’s Syndrome Sjogren’s syndrome is an autoimmune condition where the immune system begins to attach the body’s own tissues affecting the salivary and lacrimal glands. Chronic inflammation closes down the salivary duct system. Women comprise 80% of cases with a 9:1 female to male ration. The average at diagnosis is 35-50 years. The most common symptom is dry mouth, xerostomia.  This causes the papillae on the tongue to shrink and results in tongue pain or glossodynia. Project1Patients complain of burning and altered taste, and need liquid to swallow food. Fungal infections can arise because of the lack of saliva. There is no cure, nonsteroidal anti-inflammatory drugs are used for mild cases, corticosteroids and immunosuppressive drugs can be used for more involved cases. There are prescription medications to stimulate salivary flow, and artificial salivary substitutes. Dental treatment should include a prescription fluoride gel. The lack of saliva leaves patients with Sjogren’s at higher risk for tooth decay. Systemic Lupus Erythematosus SLE is also an autoimmune disease where lymphocytes attack connective tissues. There are periods of “flares” and remissions. It is 8-10 times more prevalent in women than men. The average age at diagnosis is 31 years. African American and Hispanic women are affected three times more than Caucasians. Project285% of patients have experienced rash and skin lesions and 95% have oral lesions. These oral lesions can look like white lines or striae along the inside of the cheeks to red centers (apthous ulcers) along the palate, lips, and gingiva. The five year survival rate is 90%, and the 10 year is 80%. Systemic steroids, antimalarial and immunosuppressive drugs are used to treat severe symptoms. Burning Mouth Syndrome BMS is a rare condition with chronic burning in the anterior or posterior mouth without obvious cause or clinical signs. It is more common in women than men 7:1 and 90% of affected women are postmenopausal. Symptoms include burning sensation in the tongue, gingiva and anterior palate or entire mouth. There is dry mouth with increased thirst, metallic taste, and altered or loss of taste. BMS can have an underlying medical etiology usually GERD, inflammatory bowel disease, hypertension treated with ACE inhibitors, type 2 diabetes, hypothyroidism, and nutritional deficiencies or iron, zinc, folate, thiamin, riboflavin, pyridoxine, or cobalamin. BMS maybe the first symptom of vitamin B12 deficiency.  Many patients also have depression, stress, anxiety, mood changes, and personality disorders. Treatment may include anti-anxiety drugs and antidepressants. It is also recommended to drink fluids, avoid carbonated beverages, coffee, alcohol and tobacco. A humidifier at night may help. Being familiar with these symptoms and preventative care strategies will help management by the patient’s physician and dentist. For more blogs on other dental topics, click here. To contact the office or Dr. Ambrose, click here. Sources: Dentaltown February 2016 CE Oral Diseases Associated with Women by Deborah Levin Goldstein http://www.tannlegetidende.no/i/2015/2/d2e704

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Sports and Dental Injuries – Newton, MA

According to Dr. Christine Ambrose, family dentist at Newton Wellesley Dental Partners, “Many tooth related injuries I have seen in practice are often related to trauma from sports. It is estimated in the U.S. that between 13-39% of all dental injuries are sports related with males being injured twice as often as females. Children are most susceptible to sports related oral injury between the ages of 7 and 11 years. With the warmer months up ahead and increased sports activities, please keep safety a priority! Project1 The consensus among experts is to wear a mouth guard for any contact sport! The National Federation of State High School Associations requires mouth guards for football, hockey, lacrosse, and field hockey. It has been demonstrated that since the introduction of mouth guards facial injuries were reduced significantly. Some sports are still lagging in in injury protection. Recent studies show basketball has the highest injury rate with male and female students.  I have seen multiple tooth related injuries in connection with basketball. Patients usually will say they got an elbow or fell. The American Academy of Pediatric Dentistry recommends a mouth guard for all children and youth participating in the following sports: acrobatics    handball    sky diving basketball    ice hockey soccer           bicycling inline skating    softball boxing        lacrosse squash        equestrian events martial arts    surfing extreme sports    racquetball volleyball    field events rugby        water polo field hockey    shot putting weight lifting    football skate boarding    wrestling gymnastics    skiing Youths participating in leisure activities should also be cautious of dental related injuries. For example, I have also seen a few cases that were caused by trampoline jumping. The American Academy of Pediatrics reports that a significant number of head and neck injuries occur, with head injuries as the most common as a result of falls. The AAP also recommends against recreational trampoline use because current safety measures have not decreased injury rates with a mouth guard. Although some sports related traumatic injuries are unavoidable, most can be prevented. Helmets, masks, and mouth guards have been shown to reduce the frequency and severity of dental and orofacial trauma. Mouth guard types: Type I – Custom fabricated. The benefit is superior retention, protection and comfort. They are the most costly option. They offer the most comfort because dentists can take into account how the upper and lower teeth fit together and access breathing comfort. Type II- Boil and bite. Most commonly used but vary greatly in protection retention, comfort and cost. Type III- Stock mouth guards / OTC. These must be held in place by clenching.  They offer the least  protection but maybe the only option if patient is undergoing orthodontic treatment with brackets. The American Association of Orthodontists reported that 67% of parents stated their children do not wear a mouth guard in organized sports. Talk to your dentist about which mouth guard is the right option for you or your children. All athletes constitute a population that is susceptible to dental trauma. Please keep your families safe during recreational sports! For addition information, click here. To contact the office to arrange a consultation, click here. http://www.aapd.org/media/policies_guidelines/p_sports.pdf http://www.dentalcare.com/en-US/dental-education/continuing-education/ce127/ce127.aspx?ModuleName=coursecontent&PartID=1&SectionID=-1 image: chigagokidds.com

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