Whoops! Denture Blunder!

The Bite Runner

The bite or what dentists call “occlusion” refers to the way your teeth come together when you close your jaw. Ideally we want the bite to be balanced, meaning that all the back teeth touch at the same time when biting and swallowing. When touching the biting edges of your top and bottom teeth together, the back teeth should separate. When the teeth do not meet in this manner and interferences with jaw movement result, dental problems like clenching and grinding, excessive tooth wear, and temporomandibular joint (TMJ) issues can arise.

A bad bite can contribute to clenching (usually during the day, holding upper and lower teeth together forcefully) and grinding (usually while sleeping, sliding clenched teeth side to side). Most people who exhibit this behavior are completely unaware that they are doing it and if they are aware, often do not realize that this is abnormal. The daily “clenchers” with bad bites also tend to grind their teeth at night, blissfully unaware that they are causing compounding the damage to their teeth, gums, and TMJ.


The teeth of those people with bad bites tend to demonstrate some common characteristics. Typical problems visible are heavy wear facets where the teeth contact improperly, cracked or fractured teeth, cracked or fractured restorations, notching of the root surfaces (abfractions), and worn down teeth. Teeth naturally wear down with age and use, but with excessive stress teeth wear at an exaggerated rate. The teeth will exhibit “wear beyond their years.”

Gum (periodontal) problems are also exacerbated by a bad bite. Unusual forces or stresses can strain the socket like bone surrounding the teeth. With constant stress the bone breaks down and is lost. When the bone goes, the gums go with it. Over a period of time there is nothing left to support the teeth and they become loose and painful.


Bite problems can cause many TMJ issues. The main symptoms are clicking, locking open or closed, pain in the TMJ and muscles surrounding, muscle tension, and migraine or tension headaches. All these problems occur when the joint is excessively stressed which makes the muscles work harder. The muscles spasm and constrict nerves and blood supply to the sides of the head resulting in headaches.

So how do we fix a bad bite? The solution is determined by the cause of the bite problem. If the bad bite is a result of improper tooth position, braces can be an effective treatment. If the bad bite is a consequence of missing teeth, bridges, partials, dentures, and implants can be used to restore the bite. If the bite problem causes clenching and/or grinding, a bite guard would be an effective treatment to reduce damage to the teeth and TMJ.

LORD OF THE FLOSS

Flossing is an annoying little habit that is so easy to do but so hard to do regularly. Most people would not think of going without brushing twice daily but those same people typically do not floss at all. Ever. Your mother was right. You should floss your teeth every day! Picture this - if you think about the shape of a tooth as a box – you can see that brushing only touches three sides of the box, the top and two of the sides. Flossing is the only way to clean the sides of the box that touch other boxes. Flossing is the only way to clean in between your teeth. Period. You can brush perfectly and use mouthwash and special toothpaste, it doesn’t matter. You will still have plaque and bacteria between your teeth. And between the teeth is where all the problems begin.


Without flossing the gums get red and inflamed, the condition dental personnel call gingivitis. This low grade inflammation causes levels of CRP (C-reactive protein) to increase in the bloodstream. CRP is a marker for inflammation in the body. High levels of this protein are associated with increased risks of premature birth, heart disease, strokes, and most recently, Alzheimer’s disease. The higher the CRP levels, the higher the risk. Of course, gingivitis isn’t the only cause of increased CRP levels. Smoking, high blood pressure, diabetes, and infections all contribute to raising CRP levels. Flossing is just one easy way for anyone to decrease the level of inflammation in the body.

Although the above is scary, most children and teens aren’t concerned with their CRP levels. But this does not mean that flossing isn’t important for them. The bacteria between the teeth can also cause cavities. Although decay is found most commonly on the pits and fissures on the biting surfaces of the back teeth, the second most common place for decay is in between the teeth, where the teeth contact each other. This decay doesn’t hurt and isn’t visible to the eye in the initial stages. It can only be seen on xrays. Without flossing, the contact points between the teeth are never cleaned. Add a little sugar to that bacteria sitting in the tooth and you have the recipe for decay.

When flossing, the floss shouldn’t “snap” between the teeth. Most people just snap the floss between and think the job is done. There is a little more to flossing properly. Wrap floss around your fingers and while moving the floss up, down, back, and forth wipe the side of each tooth in the contact. Angle the floss so it wraps around the tooth in a “C” shape and go below the gumline. Don’t forget to wrap the “C” around the other tooth too to make sure you floss both teeth that are touching. If you have the floss positioned properly, this will not hurt. Wind the floss so a fresh piece of floss can be used for each contact. Floss behind the last tooth too, this is an area that is difficult to reach with brushing. Once you get the hang of it, flossing is easy to do, even without looking in a mirror. Flossing should be a part of your regular hygiene, just like brushing.

The Needle and the Damage Done...

For many people, the fear of receiving a dental injection is enough to keep them away from seeing a dentist, even when they are fully aware that it is a necessity for good health. If you are one of those patients, know that you are not alone. It is estimated that at least 10% of adults have this fear, called Trypanophobia or commonly, needle phobia. Some phobics are afraid of dental injections in particular and some are afraid of all “shots”, avoiding any dental or medical care that involves injections and/or needles, like vaccinations, blood tests, etc. But do note that there are options for needle phobic people to get the health care they need.

     The use of a topical anesthetic prior to injection is very helpful. This numbs the surface of the skin so that the penetration of the needle is not felt. It needs to be on the surface of the tissue for at least a minute or two to have the full effect. For extremely phobic people, there is available a strong topical anesthetic that penetrates deeper into tissue. This type of topical anesthetic, called EMLA, can be used in extremely sensitive areas or on extremely sensitive people. It is not always used in dentistry because it tastes bad, compared to the flavored topical agents that work fine for most people.


Using nitrous oxide (commonly called laughing gas) for relaxation helps many phobics get beyond their fear. This is safe for all ages; the only major contraindication to receiving nitrous oxide is for pregnant women. It induces a calming, relaxing effect that allows the patient to remain fully awake, but with a great reduction in anxiety. Patients who use nitrous oxide report feeling warm and tingly and a general sense of euphoria. They are fully aware of what’s going on around them and are able to get treatment without their fear standing in the way.

Some people find it easier to receive an injection if they keep their eyes closed. Dentists will often talk while giving an injection to keep the patient’s mind distracted. Injections given too fast tend to be more painful, so the slower the injection, the less it will be felt. This runs counter intuitive to most phobic’s fears, because they want it done as quickly as possible. So if you find yourself wondering why it takes so long to give an injection, be aware that it is for increased comfort. Some patients find that wearing head phones with music or an audiobook playing helps keep them distracted. Dentists can usually work around whatever it takes to relax the patient and allow them to receive treatment. The main goal is for the patient to receive the health care they need with a minimal amount of stress and discomfort.

Tooth Decay - 10 Things I Hate About You

Tooth decay affects almost everyone. If you are one of the lucky ones unaffected by decay, consider yourself blessed. Almost everyone has had decay at one time in their lives.

Here are a few things I hate about tooth decay.

- Tooth decay is stinky. The openings into the tooth trap more bacteria and food debris which can cause bad breath and a foul taste.- Tooth decay is sneaky. You might not be aware that decay exists because there often is no pain or sensitivity. But like cancer, just because you don't feel it doesn't mean it's not there.
- Tooth decay hurts kids. Pain from tooth decay is one of the leading reasons that children miss school. In the last decade children experiencing decay has risen 28%. Tooth decay is the most common chronic disease in children - five times more common than asthma.
- Tooth decay is expensive. Treating decay with fillings is costly but if not treated early on, more expensive procedures like root canals and crowns may be needed to restore the teeth.
- Tooth decay hurts adults. Many people who never had decay as children can get root decay as adults. This is due to a natural decrease in salivary function and increased use of medications which tend to dry out the mouth.
- Tooth decay is ugly. Who wants brown, gray or orange spots on their teeth?
- Tooth decay is on the rise. Soda is a leading culprit because of the acids it contains. The acid dissolves the enamel and then the sugar attacks the weakened enamel.
- Tooth decay is mean. It can affect one's ability to taste, chew, swallow, speak and even smile.
- Tooth decay spreads. One tooth with decay can pollute other teeth. People with active decay have high numbers of the decay causing bacteria which can in turn affect all their teeth.
- Tooth decay grows. A cavity that has penetrated the enamel layer of the tooth will continue to grow steadily and deeper into the tooth. The rate of growth depends on the individual and diet.



     Many physically and mentally disabled people live in residential centers, cared for on a daily basis by people other than family. Even when residential staff is caring and compassionate, often training is not in place for daily dental care of patients.
     High levels of oral disease are present in these disabled populations due to lack of care. Many residents at these institutions cannot maintain any level of oral hygiene due to physical inability or mental incapacity. Having poor dental health can impact eating ability, diet, weight, speech, appearance and social interactions. Those living in residential care centers are completely reliant on their care givers to provide regular dental hygiene. It becomes necessary for family members to educate and discuss expectations with caregivers so that the disabled person's needs are met.
     For dependent and cognitively impaired adults, the provision of necessary daily hygiene can be challenging and daunting for care givers. It gets further complicated when patients have reduced dexterity, impaired sensory functions, cognitive problems and behavioral issues.

      Medications that are commonly used in these populations, like anti-depressants, blood pressure medications, diabetes medications and anti-psychotics often cause decreased salivary flow which in turn creates more dental problems. When salivary flow decreases, the amount of decay increases dramatically. Lowered salivary flow also creates an oral environment where dentures and partials can become uncomfortable, causing sores to develop.
     People with diabetes have a greater incidence of gum disease, which can in turn be associated with a greater risk of heart disease. In order to successfully manage overall health care in this population, attention to dental care becomes imperative. The following recommendations can be addressed by family members and caregivers.
- Assistance in daily oral hygiene, meaning daily plaque removal via brushing and denture cleaning. Ideally, brushing should be done twice daily. Dentures should be removed while sleeping. Flossing or use of floss aids can be implemented when physical skill allows.
- Regular dental examinations whether at the facility or at an outside dentist.
- Use of antimicrobial mouth rinses/sprays to decrease food debris, plaque and bacteria.
- Reducing intake of sugary foods.
     Poor oral health and dental pain can impact the disabled person's general well-being and quality of life. Regular oral health practices fall upon caregivers when disabled people cannot take care of themselves.
Family members can ask care givers what dental services are provided for residents and what kind of training they have had to provide those services. A consultation with a dentist can provide family members with the tools they need to make recommendations for their loved one's care.