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Should You Have Your Wisdom Teeth Removed?

Jennifer Flach was a college junior when her wisdom teeth started making themselves known.

“My other teeth started moving around,” she remembers. “The wisdom teeth were pushing out and undoing some of the orthodontic work I had done in high school.”

At the same time, her brother — who’s two years younger and was also in college — had no symptoms. But the family dentist suggested his wisdom teeth should come out too.

Jen and her brother had back-to-back wisdom tooth extractions and recovered together at home during spring break. “It was quite a week at my parents’ house,” she says.

Patrick Grother was 26 when his dentist mentioned that his wisdom teeth might need to be removed. His bottom left wisdom tooth had partially erupted into his mouth and a flap of gum still covered it. “The dentist said food would get trapped there and it could get infected,” he says. Patrick then visited a periodontist, who said that the gum flap could be cut away but it would grow back.

“I put it off for awhile,” Patrick said, but he eventually had the wisdom teeth on the left side of his mouth extracted.

A few people are born without wisdom teeth or have room in their mouths for them, but like Jen and her brother, many of us get our wisdom teeth taken out during our college years. And like Patrick, many of us are first alerted to the problem when our wisdom teeth don’t emerge (erupt) into the mouth properly because there is not enough toom for them to fit.

“A part of the tooth may remain covered by a flap of gum, where food particles and bacteria can get trapped, causing a mild irritation, a low-grade infection called pericoronitis and swelling,” says Dr. Donald Sadowsky, professor emeritus of clinical dentistry College of Dental Medicine and the Mailman School of Public Health. This usually happens with the lower wisdom teeth. Pericoronitis and the pain it causes is the most common reason people need their wisdom teeth taken out.

Pericoronitis is just one of the reasons that you may need to have a wisdom tooth or more than one removed.

In many people, the wisdom teeth never even partially enter the mouth. Often the teeth are tilted under the gum and blocked from coming in by bone or other teeth. Dentists call these impacted teeth; they may cause pain, but you may feel nothing at all for years. You may not even be aware that you have wisdom teeth until your dentist sees them on an X-ray.

Regular dental visits are important during your teens and early twenties because this is the time when teeth are most likely to decay. Regular visits allow your dentist to follow the progress of your wisdom teeth with X-rays.

Even if your wisdom teeth aren’t causing any pain or other problems, they may cause problems at some point. The most common problems are decay, infection, and crowding or damage to other teeth. But more serious complications can occur, including the development of a cyst that can cause permanent damage to bone, teeth and nerves.

However, not all wisdom teeth need to be removed.

If removing wisdom teeth is necessary, it’s easier in younger people because the tooth roots are not fully developed and the bone in which the teeth sit is less dense. Extracting your wisdom teeth before any complications develop also allows for shorter recovery time and less discomfort after the surgery.

Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Plaque — What It Is And How To Get Rid Of It

People used to think that as you got older you naturally lost your teeth. We now know that’s not true. By following easy steps for keeping your teeth and gums healthy – plus seeing your dentist regularly — you can have your teeth for a lifetime!

Plaque: What is it?

Plaque is made up of invisible masses of harmful germs that live in the mouth and stick to the teeth.

  • Some types of plaque cause tooth decay
  • Other types of plaque cause gum disease

Red, puffy or bleeding gums can be the first signs of gum disease. If gum disease is not treated, the tissues holding the teeth in place are destroyed and the teeth are eventually lost.

Dental plaque is difficult to see unless it’s stained. You can stain plaque by chewing red “disclosing tablets,” found at grocery stores and drug stores, or by using a cotton swab to smear green food coloring on your teeth. The red or green color left on the teeth will show you where there is still plaque—and where you have to brush again to remove it. Stain and examine your teeth regularly to make sure you are removing all plaque.

Ask your dentist or dental hygienist if your plaque removal techniques are okay.

Step One: Floss

Use floss to remove germs and food particles between teeth. Rinse.

Holding floss. Using floss between upper teeth. Using floss between lower teeth.

NOTE! Ease the floss into place gently. Do not snap it into place — this could harm your gums.

Step Two: Brush Teeth

Use any tooth brushing method that is comfortable, but do not scrub hard back and forth. Small circular motions and short back and forth motions work well. Rinse.

To prevent decay, it’s what’s on the toothbrush that counts. Use fluoride toothpaste. Fluoride is what protects teeth from decay.

Brush the tongue for a fresh feeling! Rinse again.
Remember: food residues, especially sweets, provide nutrients for the germs that cause tooth decay, as well as those that cause gum disease. That’s why it is important to remove all food residues, as well as plaque, from teeth. Remove plaque at least once a day — twice a day is better. If you brush and floss once daily, do it before going to bed.

Another way of removing plaque between teeth is to use a dental pick — a thin plastic or wooden stick. These sticks can be purchased at drug stores and grocery stores.
Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.
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Pericoronitis

Wisdom teeth do not always emerge (erupt) into the mouth properly because there may not be enough room in the mouth for them to fit. Sometimes, a part of the tooth may remain covered by a flap of gum. Food particles and bacteria can get trapped under this flap and cause a mild irritation, a low-grade infection called pericoronitis and swelling. This usually happens with the lower wisdom teeth.

What You Can Do

You cannot treat pericoronitis at home. Do not use warm compresses on your face. If you recognize the symptoms, get treatment right away. The symptoms may include:

  • A bad taste in the mouth — This often happens when there’s an infection.
  • Bad breath (halitosis)
  • Pain in the area around your back teeth — Pericoronitis usually occurs around the wisdom teeth.
  • Swelling behind the very back teeth — If you have pericoronitis, you’ll notice that the gum tissue in the back of your mouth is swollen. This swelling may not allow you to bite comfortably without pinching the swollen tissues between your teeth.
  • Not being able to open your mouth fully

What Your Dentist Will Do

Pericoronitis can be tricky to treat because the overlying flap in the tissue won’t go away until the wisdom tooth fully emerges naturally — which is unlikely to happen — or is removed by an oral surgeon.

Your dentist, however, may try to treat the problem without extensive procedures. He or she will clean the area thoroughly to remove damaged tissue or pus. If the area is infected, you’ll be given oral antibiotics as well.

Your dentist will tell you how to keep the area clean, which is the best way to prevent the problem from coming back. You will have to brush and floss every day and also rinse your mouth with water several times a day. This will help to prevent food particles from building up in the area.

If the condition returns, your dentist probably will send you to an oral surgeon, who will remove the tooth. Once the tooth is out, you should not have the problem again. If the problem is caused by an upper wisdom tooth biting the gum covering a lower wisdom tooth, the upper one may be removed first.

Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Mouth-Healthy Eating

If you want to prevent cavities, how often you eat can be just as important as what you eat. That’s because food affects your teeth and mouth long after you swallow. Eating cookies with dinner will do less harm to your teeth than eating them in the middle of the afternoon as a separate snack. Of course, overall poor nutrition can contribute to periodontal (gum) disease and can have other long-term effects on your mouth. Learning how food affects your oral health — long-term and short-term — is the first step toward mouth-healthy eating.

Immediate Effects of Food

Changes begin in your mouth the minute you start to eat certain foods. Bacteria in your mouth make dental plaque become more acidic, and the acid starts the process that can lead to cavities.

How does this happen?

All carbohydrate foods eventually break down into simple sugars: glucose, fructose, maltose and lactose. Some foods, called fermentable carbohydrates, break down in the mouth, whereas others don’t break down until they move further down the digestive tract.

It’s the fermentable carbohydrates that work with bacteria to begin the decay process and eventually destroy teeth. They include the obvious sugary foods, such as cookies, cakes, soft drinks and candy, but they also include less obvious food, such as bread, crackers, bananas and breakfast cereals.

Certain bacteria on your teeth use the sugars from these foods and produce acids. These acids dissolve minerals inside the tooth enamel in a process called demineralization. Teeth also regain minerals in a natural process called remineralization. Saliva helps this process, as does fluoride and some foods.

Dental decay begins inside the tooth enamel when minerals are being lost faster than they are being regained.

The longer food stays near the bacteria on the tooth, the more acids will be produced. So sticky carbohydrates, such as raisins, can do more acid damage. But other foods that pack into crevices can also cause decay. Potato chips are a terrific example. Eat a handful of chips and see how long you have to work to get all the stuck bits out from between your teeth. Teeth with a lot of nooks and crannies, such as molars, are more likely to trap food and are more susceptible to decay.

To make matters worse, tooth-unhealthy foods don’t create acids on your teeth only while they are being eaten. The acids stick around for the next half-hour.

People who sip soft drinks or sweetened coffee throughout the day or who eat many small sweet or carbohydrate snacks provide a sugar source for the bacteria to produce acid almost constantly. And because acid damage is cumulative, decay is more likely. Studies have shown that those who eat sweets as snacks between meals have higher incidences of decay than those who eat the same amount of sweets with their meals.

On the brighter side, some foods actually help to protect teeth from decay because they increase saliva flow and neutralize the acids produced by bacteria, making the enamel less likely to be demineralized. For example, aged cheese eaten immediately after other food helps buffer the acid. That’s another reason why eating sweets between meals causes more cavities. Between-meal snackers not only have an overall longer period when their teeth are exposed to acid, they don’t eat other foods with the snack to moderate the effects of the sugar.

Chewing sugarless gums also can help protect your teeth against cavities. Xylitol, an ingredient in some sugarless gums, has been shown to reduce the amount of bacteria in the mouth and help buffer the teeth against the effect of acid. Most sugarless gums and sugarless candies increase the flow of saliva, which has natural antibacterial properties.

Long-Term Effects

Like the rest of your body, your mouth depends on overall good nutrition to stay healthy. In fact, your mouth is highly sensitive to poor nutrition, which can lead to premature tooth loss, serious periodontal (gum) disease and bad breath. Many nutritional problems will affect the mouth before the rest of the body. This is because the cells in the lining of the mouth — called the oral mucosa — are constantly being created and destroyed. In some areas of the mouth, cells completely turn over, with a whole new group of cells taking the place of old cells, in three to seven days.

What To Eat

The current and best recommendation for overall good nutrition is to follow the Dietary Guidelines for Americans, developed by the U.S. Department of Agriculture and the Department of Health and Human Services. The guidelines are simple in concept:

  • Eat whole grains daily, such as brown rice, oatmeal and whole wheat bread instead of refined grains, such as white bread and white rice.
  • Eat healthier vegetables, including dark green and orange vegetables.
  • Eat a variety of fruits.
  • Choose a diet with plenty of grain products, fruits and vegetables.
  • Choose fish, beans, nuts and seeds for some of your protein needs.
  • Choose beverages and foods to moderate your intake of sugars.
  • Choose and prepare foods with less salt.
  • If you drink alcoholic beverages, do so in moderation.
  • Aim for a healthy weight and be physically active each day.

To help people understand these guidelines, the USDA has replaced the old Food Guide Pyramid with a new, interactive tool called MyPyramid. The new tool is actually many different pyramids customized for a person depending on age, gender and physical activity.

Your diet, like the pyramid, should have a strong base of grains; at least 2½ cups of vegetables a day; at least 2 cups of fruits a day; at least 3 cups of calcium-containing milk, yogurt and cheese; and proteins such as meats, beans, eggs and nuts. Eat fats and sweets sparingly.

To prevent tooth decay, you should follow a few additional guidelines to keep the amount of acid created by the bacteria on your teeth to a minimum. Here are some tips:

  1. Limit between-meal snacking to reduce the amount of time your teeth are exposed to acid. If you snack, choose foods that are not fermentable carbohydrates.
    • Best choices — Cheese, chicken or other meats, nuts or milk. These foods may actually help protect tooth enamel by counteracting acidity or by providing the calcium and phosphorus needed to remineralize teeth.
    • Moderate choices — Firm fruits like apples and pears and vegetables. Although firm fruits contain natural sugars, they have a high water content that dilutes the effects of the sugars and they stimulate the flow of saliva, which has antibacterial factors and helps protect against decay. Vegetables do not contain enough carbohydrates to be dangerous.
    • Worst choices — Candy, cookies, cakes, crackers, breads, muffins, potato chips, french fries, pretzels, bananas, raisins and other dried fruits. These foods provide a source of sugar for certain bacteria on the teeth to produce acid. The problem can be worse if the foods stick to or get caught between teeth.
  2. Limit the amount of soft drinks or any other sugar-containing drinks, including coffee or tea with added sugar, cocoa and lemonade. Fruit juices contain natural sugars that can also cause decay. Limit the amount of time you take to drink any of these drinks and avoid sipping them throughout the day. A can of soda finished with a meal is better than a can of soda finished over two hours because your teeth are exposed to high acid levels for a shorter amount of time.
    • Better choices — Unsweetened tea, milk and water, especially fluoridated water. Tea also has fluoride, which can strengthen tooth enamel and milk can also help deter decay. Water helps flush away food debris and can dilute the sugar acids.
  3. Avoid sucking on hard candies or mints, even the tiny ones. They have enough sugar to increase the acid produced by bacteria to decay levels. If you need a mint, use the sugarless varieties.
  4. Very acidic foods (such as citrus fruits) can make the mouth more acidic and may contribute to tooth demineralization and erosion. The effects of acid exposure are cumulative, so every little bit counts.
  5. Brush your teeth after eating to remove the plaque bacteria that create the destructive acids. If you cannot brush after every meal, brush at least twice a day to thoroughly remove all plaque bacteria.
  6. Chewing sugarless gum that contains xylitol can help reduce the risk of cavities. It not only helps dislodge some of the food stuck to your teeth, it also increases saliva flow to help buffer the acids.

Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Illustrations: How A Tooth Decays

Illustrations: How A Tooth Decays

Healthy Tooth
Healthy Tooth
Enamel is the hard outer crystal-like layer. Dentin is the softer layer beneath the enamel. The pulp chamber contains nerves and blood vessels and is considered the living part of the tooth.

White Spots
White Spots
Bacteria that are exposed to sugars or carbohydrates can make acid, which attacks the crystal-like substance in the tooth’s outer surface. This process is known as demineralization. The first sign of this is a chalky white spot. At this stage, the decay process can be reversed. Using fluorides at home and in the dental office can help the tooth repair itself.

Enamel Decay
Enamel Decay
Demineralization continues. Enamel starts to break down. Once the enamel surface is broken, the tooth can no longer repair itself. The cavity has to be cleaned and restored by a dentist.

Dentin Decay
Dentin Decay
The decay reaches into the dentin where it can spread and undermine the enamel.

Pulp Involvement
Pulp Involvement
If decay is left untreated, it will reach the tooth’s pulp, which contains nerves and blood vessels. The pulp becomes infected. An abscess (swelling) or a fistula (opening to the surface of the gum) can form in the soft tissues.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Apicoectomy

What Is It?

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth).

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

What It’s Used For

If a root canal becomes infected again after a root canal has been done, it’s often because of a problem near the apex of the root. Your dentist can do an apicoectomy to fix the problem so the tooth doesn’t need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.

In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Preparation

Before the procedure, you will have a consultation with your dentist. Your general dentist can do the apicoectomy, but, with the advances in endodontic microsurgery, it is best to be referred to an endodontist.

Your dentist may take X-raysand you may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.

If you have high blood pressure or know that you have problems with the epinephrine in local anesthetics, let your dentist know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site so the endodontist can see the root. You may feel your heart rate speed up after you receive the local anesthetic, but this will subside after a few minutes.

How It’s Done

The endodontist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed along with the last few millimeters of the root tip. He or she will use a dye that highlights cracks and fractures in the tooth. If the tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.

To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the endodontist to see the area better. Your endodontist then will take an X-ray of the area before suturing the tissue back in place.

Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Follow-Up

You will receive instructions from your endodontist about which medications to take and what you can eat or drink. You should ice the area for 10 to 12 hours after the surgery, and rest during that time.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.

You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.

Your stitches will be removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

Risks

The endodontist will review the risks of the procedure at the consultation appointment. The main risk is that the surgery may not work and the tooth may need to be extracted.

Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.

An apicoectomy is usually a permanent solution, and should last for the life of the tooth.

When To Call a Professional

If you’re having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist, who will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.

Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Cracked Tooth Syndrome

What Is It?

Unlike teeth with obvious fractures, teeth with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome more often occurs in molars, usually lower molars, which absorb most of the forces of chewing.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth. Sometimes a person’s normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

Teeth with large fillings or teeth that have undergone root canal treatment are weaker than other teeth and may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.

Symptoms

You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess, but the tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may become loose.

Many people with cracked tooth syndrome have symptoms for months, but it’s often difficult to diagnose because the symptoms are not consistent.

Diagnosis

Diagnosis of cracked tooth syndrome is often difficult. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Your dentist also may take X-rays, although X-rays often do not show the crack.

Your dentist may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it.

Your dentist may shine a fiber-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Expected Duration

How long symptoms last depends somewhat on how quickly a cracked tooth can be diagnosed. Even then, treatment may not always completely relieve the symptoms.

Prevention

If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of cracked tooth syndrome.

Treatment

Treatments for cracked tooth syndrome do not always completely relieve the symptoms.

Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the center of the tooth, which contains the tooth’s nerves).

If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. If a crack affects the pulp, you probably will need root canal treatment. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time.

In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or a bridge.

When To Call a Professional

If you experience pain upon biting or chewing, contact your dental office.

Prognosis

Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Cheilosis/Cheilitis

What Is It?

Cheilosis (also called cheilitis) is a painful inflammation and cracking of the corners of the mouth. It sometimes occurs on only one side of the mouth, but usually involves both sides. This disorder occurs most frequently in people with ill-fitting dentures that fail to adequately separate the upper and lower jaws. People with habits that irritate the corners of the mouth, like licking or rubbing those areas, also are more likely to develop cheilosis. Moisture gathers in skin folds at the corner of the mouth and provides a fertile environment for the formation of yeast (Candida) infections.

People with health disorders such as anemia, diabetes and immune deficiencies are particularly vulnerable.

Symptoms

Cracking, painful inflammation and sometimes weeping at the corners of the mouth.

Diagnosis

Your dentist or physician first will look to see if your dentures are fitting properly. He or she also will ask about your oral habits, such as licking the corners of your mouth. Blood tests may be done to test for anemias or immune deficiencies, and a smear or culture from the area may be tested to detect bacterial or yeast infections.

Expected Duration

Once the underlying cause is corrected, healing usually is quick.

Prevention

If you wear dentures, visit your dentist to be sure they fit properly and adequately support the face. Avoid licking or rubbing the corners of your mouth.

Treatment

Treatment focuses on eliminating causes such as oral habits or poorly fitting dentures. Infections may be treated with steroids or antifungal or antibacterial medications applied directly to the affected area. Severe infections, particularly in people with underlying medical problems, may require antifungal drugs that are taken orally.

When To Call A Professional

If you experience constant or repeat inflammation in the corners of your mouth, you should contact your dentist or doctor.

Prognosis

Good, once the cause has been eliminated.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Canker Sores

What Is It?

This disease causes painful, round ulcers to develop on the linings of the cheeks and lips, the tongue or the base of the gums. The tendency to develop these ulcers is inherited. Ulcers also can be associated with other diseases, particularly connective tissue diseases such as lupus or Behçet’s syndrome, which cause symptoms on the eyes and genitals as well as the mouth. There can be one or many ulcers at the same time, and they are recurrent, which means they keep returning. Multiple ulcers are scattered across the lining of the mouth, not clustered. Most people get one to three of these lesions at each episode, but a small number of people get more than a dozen ulcers at a time.

The cause of canker sores is not known, but most theories involve an immune abnormality. Certain blood diseases, vitamin and mineral deficiencies, allergies, trauma and Crohn’s disease cause similar ulcers. Canker sores are often confused with cold sores, which are caused by a herpes virus.

Approximately 17% of the population has recurrent aphthous stomatitis, which is classified into three categories:

  • Minor ulcers are less than 1 centimeter (slightly less then ½inch) in diameter and do not leave scars. The sores usually heal within two weeks.
  • Major ulcers (also called Sutton’s disease) are almost ½ inch or more in diameter, take longer than minor ulcers to heal and may leave scars.
  • Herpetiform ulcers are clusters of dozens of smaller ulcers. This form is rare.

People tend to have two to six ulcers per episode and have several episodes each year. For most people, canker sores are merely an annoyance, but some people experience large, painful, frequent sores that can reach 2 to 4 centimeters in diameter. The ulcers can interfere with speech and eating and can last for weeks to months, causing significant pain and disability. When they do heal, they may leave scars that can make it more difficult to move the tongue and can destroy oral tissue.

Symptoms

You may feel a burning or tingling sensation in an area of inflammation before an ulcer appears. An ulcer takes two to three days to form completely. The sores are round, shallow and symmetric, which means they are the same on all sides. The are painful. They usually are found on the inner part of the lips and cheeks and the tongue.

Diagnosis

Canker sores are the most common recurring oral ulcers and are diagnosed mostly by process of elimination. If the ulcers become more frequent or severe, are accompanied by other symptoms (such as rashes, joint pain, fevers or diarrhea) or are larger than about ½inch in diameter, you should visit your dentist or physician. He or she will try to rule out blood diseases, connective tissue diseases, drug reactions and skin disorders. A biopsy and blood tests may be required to rule out other conditions or diseases.

Expected Duration

The painful stage lasts 3 to 10 days, and most canker sores disappear within 2 weeks.

Prevention

There is no way to prevent canker sores.

Treatment

Treatment focuses on relieving symptoms. Rinsing with a warm-water solution and eating bland foods can minimize discomfort. Anesthetic medications or over-the-counter agents that are placed directly on the sores to coat them also may help.

People with more severe disease may need steroid medications placed on the lesions. These medications significantly shorten the healing time of the ulcers and prevent them from becoming larger. Other possible treatments include placing a medication called chlortetracycline (Aureomycin) on the sores or injecting steroids into the sores. In very severe, disabling cases, your dentist may prescribe oral medication.

When To Call a Professional

Canker sores usually are painful but are not a significant risk to your health. However, if you have severe, recurring canker sores, or if they are becoming worse, consult your dentist or physician. He or she may do tests to look for blood problems such as anemias or deficiencies of iron, folate or vitamin B12. Some research has shown that canker sores improve when these deficiencies are treated. Persistent or large ulcers can also occur as a part of other, more significant, disorders, including inflammatory bowel disease, connective tissue diseases, drug allergies, arthritic disorders, inflammatory skin disorders and cancer.

Prognosis

Most canker sores clear up without treatment and do not leave scars, although they usually return.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Bringing Teeth into Alignment with Orthodontic Treatment

crooked teethThe American Association of Orthodontists reports that in the United States 4.5 million people are wearing braces or other dental appliances to straighten teeth and provide a healthy, beautiful smile (1). As many of us know, an orthodontist is a dentist with additional clinical training to treat malocclusions (improper bites), which may result from tooth irregularity and jaw issues.

Why Do Teeth Become Crooked?

Terry Pracht, DDS, past president of the American Association of Orthodontics says that both heredity and environmental factors can create crooked teeth and bite problems. Dr. Pracht mentions that hereditary factors include crowded teeth, teeth where there is too much space and malocclusions. He also mentions that crooked teeth can be caused by thumb sucking and tongue thrusting as well as accidents occurring to the jaw (1).

What are Treatment Options to Straighten Teeth or Malocclusions?

There are three stages of orthodontic treatment. The first is when appliances are used to gain space in the mouth. For example, palatal expanders are used to expand the width of the palate and lingual bars are used to expand the lower jaw. The active corrective stage is next when the braces are placed on the teeth. The teeth are then adjusted and then straightened and malocclusions are corrected over a period of time based upon the severity of the irregularity of the teeth and jaw issues. The third stage is the retention stage after braces are removed and when the teeth are monitored through the use of a retainer (removable or fixed) and semi-annual orthodontic visits are conducted to maintain the straightened smile.

Types of Braces

Braces from over 30 or so years ago included large metal bands that were enclosed and cemented around each tooth. Braces can be attached to the cheek side of the teeth as well as the tongue side of the teeth depending on what your orthodontist recommends to you for treatment. Braces, arch wires and bands can be colorful and a lot of fun for children, adolescents and teenagers to choose from.

Today, tiny brackets are placed onto the front surface of the tooth and are made of metal or ceramic. The brackets are bonded to the front tooth surface with a glue-like material and metal bands can be used on the back teeth. Arch wires are placed inside the brackets and are made of a heat-activated nickel-titanium source that can become warm due to the temperature in the mouth, which will allow it to apply constant pressure on the teeth as well as when the arch wires are adjusted at the orthodontist’s office.

Another newer alternative to braces is the Invisalign system which uses a series of clear removable aligners that are worn during the day and night to help in moving teeth into the correct alignment. When eating or brushing and flossing, the aligners may be removed.

Caring for Braces

Your orthodontist, dentist or dental hygienist will provide you with thorough instruction of how to properly clean your braces. There are many toothbrushes you can use both manual (specifically designed for orthodontic patients), power, electric or sonic. Ask your dental professional which is be best for you. Brushing should be conducted at least 2-3 times per day at a 45 degree angle in a back and forth motion. Be sure to remove plaque at the gum line to prevent gingivitis (inflammation of the gum tissue). Be sure to angle the toothbrush at the gum line and then gently brush around the brackets to remove plaque and food debris.

It is very important to clean in between your teeth with a floss threader and floss, a stimudent (tooth pick cleaner) or a proxabrush (interproximal cleaning brush) may be used if there is space between the teeth. Oral irrigators may be recommended to remove food debris and irrigate the gum tissue to remove disease and odor-causing bacteria that may be there if you have gingivitis. An antibacterial toothpaste and over-the-counter antimicrobial mouth rinses could also be used with the oral irrigator or alone.

How to Maintain a Smile After the Braces are Off

After your orthodontist has determined that your braces can be removed, it is very important that a retainer (a plastic appliance) be worn during the day or night as recommended by them. The retainer can be cleaned with warm water or toothpaste and a toothbrush after you wear it and placed in a plastic container when not in use.

See your dental professional for a twice a year professional cleaning and the orthodontist for regular maintenance appointments.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.