Sinus Infections vs. Tooth Pain

One aspect of my job that I enjoy greatly is the ability to help people who are in pain.  There are many causes of mouth pain, and although diagnosis is usually straightforward, sometimes it can be complicated.   In the majority of cases, patients present to our office with pain originating from the teeth or gums (e.g. cavities, damaged tooth nerves, gum disease, trauma to teeth, etc.) but not infrequently we see pain stemming from non-tooth sources as well.  It is the purpose of this brief post to outline and provide some information about one of the more frequently seen non-tooth sources of pain:  sinus infections (sinusitis). 

What are the Sinuses?

The bones of the face are not solid bones; they contain hollow spaces called sinuses which serve at least four purposes:  1)  They make the skull lighter and lessen strain on neck muscles, 2) They act as air-conditioners and humidifiers which filter the air we breathe, 3) they act as resonance chambers that aid in speech, and 4) they act as crumple zones (similar to how our cars are designed) that, in cases of trauma,  absorb energy which could otherwise cause brain damage.  These functions are great, but the real benefit of having sinuses is not so much in the spaces themselves, but in the special tissue which lines them on the inside:  a mucous membrane which is covered in tiny hair-like projections called cilia which protect us from dust, pollen, germs, and other foreign material in the air we breathe.  These cilia wave back and forth to trap and transport these unwanted things down our throats and into the stomach so that they cannot enter our bodies through breathing. 

Sinusitis: 

                Sinusitis is the inflammation of the sinuses, or more specifically of the mucous membrane lining the sinuses.  Due to the function and location of this special lining tissue (it is literally on the front lines of the immune system’s war with germs) it is susceptible to becoming infected or irritated.  Viruses and bacteria can cause sinusitis directly, and irritants such as allergens can irritate the membrane and cause the body to initiate an inflammatory response leading to sinusitis as well.  Although inflammation is a natural process of the immune system intended to fight germs, it is usually accompanied by discomfort and even pain.  Additionally, symptoms such as stuffiness, facial pressure, runny nose, loss of smell, headache, fever, bad breath, fatigue, and dental pain may be present.  Depending on what causes sinusitis, it can be classified as acute or chronic, and intensity can range from mild to severe. 

Dental Pain: 

Let’s look at that last symptom in a little more detail.  There are several sinuses in the bones of our skull, but one particular set of sinuses is located just above or to the side of the root tips of our upper molars/premolars.  Sometimes, these sinuses are so close to the teeth roots that only a paper-thin section of bone separates them.  Due to the proximity of these structures and the body’s inability to exactly pinpoint the location of pain, inflammation in the sinuses can be interpreted as tooth pain.  Often this pain manifests as a constant ache, pain upon biting or touching the teeth, or pain when lying down to sleep (due to the body’s position).  These symptoms all mimic the pain a patient feels when a root canal is needed.  In the case of an abscessed tooth needing a root canal, the source of the pain is within in the ligament which holds a tooth in its bony socket, but again, the tooth root can be so close to the sinus that it is hard to determine the exact source of the pain.  Anytime symptoms like this are felt on upper teeth, sinusitis always enters into a good dentist’s differential diagnosis as well as problems arising from the teeth themselves.  If a dentist were ignorant of sinusitis, many needless root canals would be performed and time and money would be wasted. 

Diagnosis and Treatment:

Luckily, there are several tests that dentists can perform to determine the source of a toothache, and dental x-rays can be taken to determine if a tooth has a cavity, abscess, etc.  In the case of tooth pain that persists for more than a couple of days it is always smart to schedule a quick dental visit to catch and fix a potential problem early.  If it is diagnosed that something is wrong with the tooth, appropriate dental treatment will be recommended.  If sinusitis is suspected, decongestants or antibiotics may be prescribed initially, followed by a period of healing and observation.  In serious cases referral to a medical doctor or an ear, nose, and throat specialist may be made. 

Nicolas K. Young, DMD

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BUILDING A GREAT SMILE

A good smile is a staple of creating great first impressions, excellent conversations, and lasting relationships.  A smile can help make you more memorable to others and, believe it or not, people will remember your name better if you are wearing a smile when you meet them.  Its power cannot be underestimated.

On the other hand, either the lack of a smile or tooth-related distractions within the smile often can give the wrong first impression about who you really are and can create obstructions to the development of many good, healthy relationships.

Modern dentistry has the power to help make many positive changes to your smile.  Sometimes those changes involve things as simple as minor shape changes to the enamel of your front teeth.  Other times those changes may involve treatment as complex as braces followed up by either crowns or veneers.

Below you will find before and after photos of people we have worked with over the years to improve their smiles.   We are dedicated to achieving an ideal esthetic result that blends the skills we have developed over the years with your esthetic end-goal and budget.



BEFORE                                  AFTER

Making changes to your smile can be a scary proposition.  However, when changes are made with skill, patience, and an eye firmly planted on the final goal, the results can be life changing.  Esthetic dentistry, including crowns and veneers, are one of the most satisfying services we provide for our patients.

If you have ever considered having crowns or veneers, or making any other changes to the looks of your front teeth please give us a call.  We would be happy to have a free Esthetic Smile Consultation to consider what we could do to help you achieve your ideal smile.

Happy Smiling!

Dr. David Barry, DMD

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Temporomandibular Disorder and Occlusal Splints

             Temporomandibular Disorder or TMD is characterized by having pain either in the temporomandibular joint (TMJ) or in the muscles of the face.  There are other symptoms that can be associated with this pain including popping and clicking noises or not being able to open or close the mouth all the way.  This pain might be very acute or of a more chronic nature.  Diagnosis and treatment of TMD is very possible but can take some time with various approaches. 

            There are many different reasons that someone might have pain in the area of the TMJ.  The most important thing that needs to happen is getting the right diagnosis of the pain.  In some cases there is an underlying systemic disease.  Once that right diagnosis is found the treatment can then begin.  The most common causes for the pain are: stress, grinding your teeth, arthritis, abnormal use of muscles when not eating, etc. 

            In treating TMD, there is not fail safe treatment that guarantees the removal of pain, but various things are employed that can provide the relief.  The first step is teaching what causes the pain and eliminating some of the habits that cause and aggravate the muscles and joint.  These might include clenching or grinding and stress management.  Next, a combination of medications, including NSAID’s, like ibuprofen and opiates, to reduce the inflammation and pain, and physical therapy, to allow the muscles of the face to return to their proper uses.  In some cases an appliance that can be worn at night will be prescribed.  This is what we call an occlusal splint or a night guard.  It is a type or retainer that is worn at night to reduce the wear on the teeth if there is grinding occurring.  It also helps to reduce the pain by realigning the TMJ and can provide some relief.  In some cases changing the shape and realigning them to come together in a different way will help, but this treatment is not as recognized and usually is done as a last resort.  The final option in treating TMD is having surgery.  This is a last resort if nothing else is working and there is still intense pain. 

            In conclusion, the first step in helping to eliminate this pain is seeing your dentist or other specialist.  In reading this article it might be the start of your journey.  Make an appointment and we can help to get you out of pain and back to eating and functioning.

Dr. Mark Barry, DDS

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How to Make Your Cleaning Visit as Comfortable as Possible

I know for many of you there is a certain amount of dread when you receive the card reminding you that it is time again to have your teeth cleaned and checked.  Most often that dread is because of the possible upcoming discomfort.  Sometimes it is because of previous dental visits that did not go well.  There are many things we can do to make your visit more comfortable, don't try and be brave and "tough it out!"  Please let us know when you feel discomfort.  Some of the options we can offer are:

• Desensitizing polish paste can be applied at the beginning of your cleaning.  This helps many people that are sensitive when the ultrasonic scaler (this is noisy and sprays water) is used.
• Warming the water.
• Applying topical anesthetic if your gums are extra sensitive.
• Nitrous Oxide, Laughing gas is very effective for many people in reducing both anxiety and discomfort.
• Blankets are available if you feel cold.
• iPods are available and loaded with a wide variety of music for you to listen to.

These are some of the things we can do to help make your visit more comfortable.  Regular cleaning appointments are also important to make your visits more comfortable.  Smooth teeth free of rough calcium deposits are much easier for you to remove bacterial film or plaque from.  It is the plaque that causes the gums to bleed and cavities to form.

During your cleaning we will remove hard calculus deposits and polish your teeth to smooth surfaces and remove the plaque.  It is also our goal to observe any areas you are having difficulty cleaning and teach you how to more effectively clean them.  So, when you receive that reminder card or call, come on in.  Working together we will/can come up with a plan to lessen your dread and you can look forward to a beautiful healthy smile for a lifetime.

Rosalie--Hygienist

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Implants vs. Endodontics

Should I Save This Tooth or Replace It With An Implant?

One of the most common questions we find our patients face in regards to saving or losing single teeth is whether or not they should spend their hard earned money (and their time) on doing (or re-doing) a root canal in order to save the tooth or if they should just remove the tooth and replace it with an implant.  If you are, or if you have faced this decision you likely know exactly what I am talking about.

There are several factors involved in making this kind of decision.  On this post I will attempt to address some of them in simple terms.

Longevity

“Which one will last longer . . . a root canal and a crown or removing the tooth and replacing it with an implant?”

If a root canal has never been done on this tooth before and a root canal is now needed research has shown that either doing a root canal and placing a crown on it or removing the tooth and placing an implant can both last a long, long time.  However, if a root canal has been done previously and needs to be done again it will likely not last as long as an implant would.

One important factor with longevity is whether or not a crown is placed on your tooth after the root canal is done.  Research shows that if a root canal is done on a back tooth and a crown is not placed on the tooth you are six times more likely to have the tooth break.   If this happens you may not have a choice but to remove the tooth and place an implant.  Bottom Line: If you choose to do a root canal on a back tooth in order to save the tooth, put a crown on the tooth within one month of having the root canal done.

Cost

Neither doing a root canal and a crown nor removing a tooth and placing an implant are inexpensive.  On average, if you are going to do a root canal and a crown you will spend between $1500 and $2200.  To remove the tooth and replace it with an implant you will spend somewhere between $3000 and $3500.

Health of the Tooth

In our experience this has been one of the most important factors in determining how successful a root canal and a crown will be.  If a lot of the tooth has broken or if there is a large cavity in the tooth there will not be very much of the tooth left for the crown to hold on to.  And if there is minimal healthy tooth structure left the crown will likely break off of the tooth after the root canal has been done.  When this happens usually the only option you have left is to remove the tooth and replace it with an implant.

Overall Physical Health

In some cases your health may determine which treatment to pursue.  There are certain physical conditions that make it ill-advised to remove any teeth and place implants.  In these cases you may have no choice but to try to save the tooth by doing a root canal and a crown.

These physical health conditions are best evaluated by your dentist at the Barry Family Dental Group.  Before considering removing any tooth or any other surgical procedure we will conduct a thorough questioning of your physical health to determine whether you are healthy enough for the procedures required for dental implants.

Personal Preference

How attached, emotionally, are you to this tooth?  Are you the kind of person who wants to keep every single tooth for as long as possible no matter what the cost or the hassle you must go through?  Or, are you the kind of person who simply wants the least expensive treatment possible with the best result possible?  Does the thought of a root canal bother you?  What about oral surgery?

In making this decision this is likely the single most influential driving factor in making this decision.  How attached are you to your teeth?

Conclusion

There are many things to consider in deciding whether a tooth should be removed or saved.  If you or a loved one are currently facing this decision please call us and set up a consultation appointment with one of our Dentists.  We would be happy to provide you with information and recommendations to help you with this important decision.

Dr. David Barry, DMD

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Anxiety

I love being a dentist.  I love the opportunities my profession provides me to help people look better, be healthier, and get out of pain.  I get to work with good people.  I rarely have to sit at a desk in front of a computer.   I get to work with my hands in field that incorporates art, science, business, interpersonal relationships, and a variety of other studies.  No two days are alike and I never feel bored.  The hours are good and I feel well compensated for all of the time, effort, schooling, and debt I’ve put into being a dentist.  There’s just one problem:  people are scared to death of me and avoid me like they avoid public speaking or the bird flu. 

                In the tradition of my favorite late night talk show host, I’d like to present  . . .

The Top 10 Reasons People are Scared of Coming to the Dentist:

10. Pop Culture.  Television and movies have not been kind to dentists.  If you are familiar with this, this, or this, I bet these scenes cross your mind every time you cross the threshold of a dental office.  Pop culture hates me and is out to make me look like a barbarian.

9.   Past Memories.  Kids today don’t know how easy they have it.  Ask any Baby Boomer about their childhood dental office and they’ll tell you horror stories of ungloved hands, gigantic drills, stern and uncaring personalities, scary hospital environments, and abundant tears.  Even though today’s dental scene is significantly more kind and inviting, old memories, especially bad ones, die hard. 

8.  Smells and Sounds.  My wife remarks nearly every day when I come home to hug her “go change, you smell like a dental office.”  Although I’ve grown almost completely desensitized to that antiseptic/fluoride/dead tooth smell, I definitely remember it distinctly from the days when I came to the office solely as a patient.  Additionally, who can hear the high pitched whine of a dental handpiece and feel completely at ease (besides dentists, of course)?  It’s been determined through several studies that sounds and smells, trigger memories better than other senses, so if any of those memories are unpleasant, they can be a real deterrent to visiting the dentist. 

7.  The Flossing Lecture.  Dental visits can be stressful and embarrassing enough without hygienists and dentists piling on with their lectures on hygiene.  When I was in high school, I left a Provo dentist for this very reason.  I still have bad memories of his doom and gloom outlook toward my teeth (which were always pretty good, by the way) and his apparent desire to appear smart in front of me.  The traditional authority model of “I’m the doctor and you’re just a patient; do what I say” is not pleasant to endure.

6.  The Time Requirement.  Almost everyone will agree that regular checkups and visits for treatment are important, but why must it be so inconvenient to schedule?  Most dental offices are only open during normal business hours—basically when you are at work or school.  Vacation time is sometimes hard to take for fun things, let alone for something you really don’t enjoy doing.  Then there’s the issue of waiting; how frustrating is it when you call hoping for an appointment next week and all that’s available is a slot two months away? 

5.  The Cost of Dental Care.  Spending time on something you’d rather not do is one thing, but even more frustrating to some is spending money on an unpleasant experience.  Dentistry, like any type of health care, is not cheap.

4.   The Value of Dental Care.  Cost and value are different concepts.  Yes dental treatment can be expensive, but to anyone who values good health, aesthetics, and the ability to eat a steak, it is a great value.  Many do not place such a premium on dental care, or simply do not value it at all.   I learned this lesson early while in dental school in Louisville, Kentucky when patients in their 20’s asked me to pull all their teeth because “my dad had dentures, my grandpa had dentures, and I just want to get rid of these teeth so I can get my dentures”.  Unfortunately, some patients only come around when they are in severe pain; one by one, teeth are pulled and dentures are the ultimate result.  In most of these cases, valuation of dental health is the issue. 

3.  The Uphill Battle.  “Another cavity!  I just had three at my last checkup six months ago.  I promise I’ve been brushing and flossing.”  Unfortunately some individuals seem to be very susceptible to dental decay in spite of modest preventive efforts.  Most of these individuals need almost perfect hygiene and diet modification to stay cavity-free but, unfortunately, many are not willing to put forth that kind of effort (or don’t understand what is needed).  Hygiene habits are hard to break and the result can seem like an unwinnable fight. 

2.  Pain.  If you’ve ever had a painful emergency situation, you’re well aware that a dentist can be your best friend, but for anyone else, going to the dentist = pain.  In spite of using very effective anesthetics, some teeth can be “hot” (resistant to numbing medicine) and what is enough anesthetic to tranquilize one individual might be the equivalent of a throat lozenge for another.  Even though we strive to avoid it, there is sometimes pain involved in dental care.  And to be perfectly honest, it’s probably not even the pain that’s the worst part, it’s the anticipation of pain. 

1.  The Needle.  By far the scariest instrument in a dentist’s arsenal (yes, even more than “the iron hook”) is the dental syringe.  The needle has probably warded off more dental treatment than all the above items combined.  And what do dentists call it?  “Just a little pinch.”  What follows the needle is probably even better.  Who doesn’t love that nice numb feeling that persists hours after treatment is complete? 

                From my perspective as a dental patient I can identify and agree with most of the items on this list.  I fully understand that coming to see a dentist isn’t your favorite thing in the world.  There is some fear and anxiety involved.  Fortunately, most people are able to deal with the small or moderate amount of anxiety that comes with the experience, but for those with a true dental phobia or strong aversion to one or more items on my list, the experience can be truly horrifying.  At Barry Family Dental, we strive to make each patient comfortable and minimize the discomfort and anxiety you may feel.  In spite of how dentistry was in the past or how it is viewed in cinema and television, an experience at our office is much more comfortable than you may think it would be.  Compassion, understanding, and kindness are ideals that we strive to live each day, with each patient that comes through our door.  With iPods and headphones, free nitrous oxide (laughing gas to help patients relax), and use of the latest dental technologies and techniques, we attempt to minimize the sounds, smells, and discomfort of dental treatment and make your visit as quick and relaxing as possible.  We are providers with most dental insurances and offer various payment options to help our patients obtain treatment.  Although we are busy, we have extended business hours (open until 6:00 on some days and open almost every Saturday) to help accommodate your schedule and will always make time if you are need urgent care.  We hope you value dental treatment and will do our best to answer questions and provide education in a non-condescending manner where it is needed.  If you or someone you know is apprehensive about dental treatment, we’d love to help.  Dentists really aren’t as bad as you think we are.

Nicolas K. Young, DMD

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Dry Mouth

Saliva is your friend  

That slimy wet watery substance found in your mouth is actually one of your best friends.  Saliva is very important for many different reasons.  It plays a necessary and vital role when eating and chewing.  We don’t recognize how important it is until you lose part of it and find your tongue sticking to the top of your mouth.  Think back on those times when you have a really intense situation or your adrenaline kicks in and you can’t pull your tongue off the roof of your mouth.  It can be really annoying and hard to talk or eat anything. 

Saliva also helps in keeping the teeth healthy and strong.  It washes away food and debris from the teeth and gums.  Some of the minerals found in your saliva can actually help fight cavities by replacing those that are lost when a cavity first develops.  Some people have a condition where they are always like this.  It is called xerostomia, or dry mouth.  This condition is not a disease but a symptom caused by a myriad of different reasons.

What causes dry mouth?

            In the majority of cases xerostomia, dry mouth, is a side effect of using some types of medications.  These medications include antihistamines, diuretics, blood pressure meds, muscle relaxants and painkillers just to name a few.  Up to 400 different medications have this side effect.  When taking a new medication it is important to look at the list of side effects to see if this condition is listed. 

            Other causes of xerostomia are head and neck cancer, head and neck radiation therapy, stress, Sjodgren Syndrome, endocrine disorders, Parkinson’s disease, diabetes, stroke and AIDS.  Dry mouth can also be the cause of some hormonal changes during pregnancy and   menopause. 

What are the symptoms?

            Here is a list of some of the symptoms of xerostomia.  Read down this list and see if you have one or more of these:

-          a sticky, dry feeling in the mouth or throat

-          limited saliva that seems thick or stringy

-          a burning sensation in the mouth

-          trouble in chewing, swallowing, or speaking

-          an altered sense of taste

-          a rough dry tongue

-          cracked lips, sores or split skin at the corners of the mouth

-          an infection in the mouth

-          increased plaque (a thin film of bacteria), tooth decay and gum disease

-          bad breath

Dealing with dry mouth, JADA, Vol. 136, May 2005, pg 703

Treatment for Xerostomia.

            There are some things that you can do if you are experiences a dry mouth.  In some cases if it is a side effect of medication you can ask you doctor if there is another type of medication that you can take that doesn’t cause dry mouth.  In most cases the medications are too important to switch or stop.  In that case there are some saliva replacement options available.  Alcohol free mouth rinses, such as Biotene, are available over the counter and some by prescription.  Taking frequent sips of water or using sugar free candy or gum can increase the secretion of saliva.  Most important is the need of proper oral hygiene.  Tooth decay can run rampant in a mouth that is dry.  Brushing and flossing after every meal and more frequent dental cleanings can help to keep your teeth cavity free. 

            If you are experiencing any of these conditions please make an appointment and let us help.  We want your mouth and teeth to be healthy and cavity free.

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