Friday, February 21, 2014

Sensitive Teeth

Is the taste of ice cream or a sip of hot coffee sometimes a painful experience for you? Does brushing or flossing make you wince occasionally? If so, you may have sensitive teeth.
Possible causes include:
  • Tooth decay (cavities)
  • Fractured teeth
  • Worn fillings
  • Gum disease
  • Worn tooth enamel
  • Exposed tooth root
In healthy teeth, a layer of enamel protects the crowns of your teeth—the part above the gum line. Under the gum line a layer called cementum protects the tooth root. Underneath both the enamel and the cementum is dentin.
Dentin is less dense than enamel and cementum and contains microscopic tubules (small hollow tubes or canals). When dentin loses its protective covering of enamel or cementum these tubules allow heat and cold or acidic or sticky foods to reach the nerves and cells inside the tooth. Dentin may also be exposed when gums recede. The result can be hypersensitivity.
Sensitive teeth can be treated. The type of treatment will depend on what is causing the sensitivity. Your dentist may suggest one of a variety of treatments:
  • Desensitizing toothpaste. This contains compounds that help block transmission of sensation from the tooth surface to the nerve, and usually requires several applications before the sensitivity is reduced.
  • Fluoride gel. An in-office technique which strengthens tooth enamel and reduces the transmission of sensations.
  • A crown, inlay or bonding. These may be used to correct a flaw or decay that results in sensitivity.
  • Surgical gum graft. If gum tissue has been lost from the root, this will protect the root and reduce sensitivity.
  • Root canal. If sensitivity is severe and persistent and cannot be treated by other means, your dentist may recommend this treatment to eliminate the problem.
  • Occlusal adjustment: improper bite or bite prematurities from night grinding need to be corrected.
Proper oral hygiene is the key to preventing sensitive-tooth pain.  Selection of an appropriate tooth brush and toothpaste  reduce the abrasion (wear) which in turn reduces senstitivity.

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Friday, February 14, 2014

Oncology Pocket Guide to Oral Health- Part 2


The oral complications of chemotherapy depend on the drugs selected, dosages, the degree of dental disease, and use of radiation. Chemoradiation therapy carries a significant risk for mucositis.
Before Chemotherapy

  • Refer patients to a dentist for a pretreatment oral health examination, 1 month, if possible, before cancer treatment begins.
  • Tell the dentist the treatment plan and timetable.
  • Advise the dentist if radiation therapy is also planned.
  • Allow at least 7 to 10 days of healing from oral surgical procedures before the patient begins myelosuppressive therapy.
  • Check for immunosuppression or thrombocytopenia before any oral procedures in patients with hematologic cancers.
During Chemotherapy

  • Consult with the oral health team to schedule dental treatment.
  • Conduct blood work 24 hours before any dental procedure. Postpone if
    • platelet count is less than 75,000/mm3, or abnormal clotting factors are present.
    • neutrophil count is less than 1,000/mm3.
  • Determine if there is a need for antibiotic prophylaxis before any dental procedures in patients with central venous catheters.
  • Consult the dentist to explore a possible oral source of infection when fever is of unknown origin.
  • Ask patients frequently about their oral health.
After Chemotherapy

  • Resume a regular dental recall schedule when chemotherapy is completed and all side effects, including immunosuppression, have resolved. 
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