Is Halloween bad for teeth?

Seeing as tonight is Halloween, this is a topical question. No Halloween is not bad for teeth but gorging with candy is! Holidays in general are a time for enjoying sweets, but Halloween is certainly the candy manufacturers favorite holiday.

Now don't get me wrong, I enjoy candy now and then, but eating too much is bad for teeth. Every time candy is eaten it lingers in the mouth for twenty minutes or so. Sugar is a preferred diet for the bacteria in our teeth's plaque and feeding them sugar throughout the day is a bad idea!

Probably the best strategy to follow around Halloween is to not allow your kids to keep their bags of candy nor keep candy left out around the kitchen, but instead parents should keep it in their possession and dole it out a little at a time. The basic idea is to not let your kids snack all day long on their candy for weeks after Halloween since that could definitely lead to cavities.

Can a Cavity Fix itself?

No it can't, but some carious lessions do seem to peter out and arrest. The problem is that it is difficult for a dentist to be sure about whether this has happened without cleaning out the lesion.

Sometimes a long standing lesion has layers of blackened and dryed out decayed matter, but at the deapest part of the lesion there still seems to be some activity. This part of the lesion is wetter and a lighter chocolate color, that often seems to be associated with "active decay". Only by cleaning out the entire lesion and treating it can a dentist be sure that the lesion if arrested.

Can extensive dental treatment put a patient at risk for developing other health problems?

It is not unusual for patients undergoing long dental appointments to comment that they feel slightly under the weather afterwards and sometimes the next day as well. This feeling of malaise passes after 48 hours,but doesn't seem to have lasting effects.

A new study,published in Annals of Internal Medicine(October 19, 2010 vol. 153 no. 8 499-506)may suggest otherwise. It suggests that extensive dental treatment may place some patients at a slightly greater risk for vascular events. The study found that "The rate of vascular events significantly increased in the first 4 weeks after invasive dental treatment (incidence ratio, 1.50 [95% CI, 1.09 to 2.06]) and gradually returned to the baseline rate within 6 months".

Although this finding is alarming, it clearly doesn't mean that patients should avoid dental treatment. The studies authors conclude that "the absolute risks are minimal, and the long-term benefits on vascular health will probably outweigh the short-lived adverse effects."

Clearly this finding needs to be further studied to help minimize any potential risks to patients undergoing extensive dental treatments.

Should a dentist offer medical advice?

Although a dentist is licensed primarily to treat diseases and disorders of the oral cavity, He or she is in position to observe his patients in other aspects as well. Dentists are not licensed to treat medical conditions unrelated to the mouth but they do have a responsibility to observe their patients holistically. A dentist routinely sees his patients every year, and consequently spends a good deal of time with them.

In the course of these visits the dentist will invariably have conversations with patients and often medical problems unrelated to dentistry are brought up. Although dentists are not necessarily well versed in every phase of medicine, as concerned health care providers they can encourage patients to seek appropriate medical treatment for a condition.

This is especially true when treating the elderly, since they often have an increased need for dental treatments and often have a long standing relationship with their dentist. Often a dentist can play a role by encouraging them to seek appropriate treatment for medical problems that they are experiencing.

How do you do an indirect pulp cap?

I have been performing my version of an indirect pulp cap for over twenty years. I have had good results and most of the time they work(probably better than 85%). Indirect pulp caps involve leaving some affected dentin over the pulp and medicating it with something that may inactivate any residual bacteria remaining in the layer of 'affected dentin' without killing the pulp. I usually use Dycal as my initial layer over this affected dentin and then place another less water soluble material over it such as Vitrabond, IRM or Miracle Mix. All of these second layers also seem to inhibit decay and the growth of caries forming bacteria. The dycal seems to dessicate the small amount of decay(or affected dentin) remaining, and may then allow secondary dentin to slowly form.

I do remove 95% of the decayed matter in the tooth and will remove very soft dentin material if it is in 'bulk'. I Use very small spoon excavators with tublicid red and very gentle hand pressure to remove the softened dentin near the pulp. I utilize a strong light to illuminate the tooth. so that I can avoid accidentally exposing the pulp. Often when well illuminated the dentin near the pulp is partially translucent and the pink from the pulp can be visible prior to removing the thin layer of dentin covering it.

I consider an indirect pulp cap a success if the tooth remains asymptomatic over time, but do periodically check periapical radiographs for signs that the tooth has become non vital such as a periapical radioluscency.

Why do you take an X-ray after filling a tooth?

I do commonly take one bitewing xray after filling a tooth in which the proximal(side next to the adjacent tooth) surface is restored. This will show me some relevant information. It helps me visualize the proximity of the filling to the pulp and to see if the tooth is filled without any voids,gaps or overhangs. It also allows me to check the proximal contour(How the filling contacts the adjacent tooth).

Sometimes teeth that are filled are in need of a crown and the X-ray is used to send the insurance company, since it shows how much filling is in the tooth. Often that is one of the criteria an insurance company uses when deciding to allow or disallow a treatment plan for a crown.

Many dentists do not take this sort of check film,but choose to wait until the patient has his or her next check up films taken. This is certainly OK, but I usually choose to check at the visit I place a filling if I am placing a filling.

What does a dentist do with crowns or bridges that he removes from a mouth?

When a crown or a bridge is removed, many patients ask if it has any value? I guess they are hopeful that they can apply some of the value to the new restoration that will be needed.

The answer is not much. Most crowns that I remove I place in the trash. There is a market for scrap metal, but the value of a scrap crown is usually not high. I haven't checked recently(the price of gold is sky high!), but the dental scrap dealers generally don't reimburse us much for old crowns.

Scrap gold is worth more than semi-precious or non precious metal scrap. The last time I sold my scrap gold t, I had collected a batch for over five years and I received less than three hundred dollars.

Unfortunately, unless a dentist has a large amount of gold, dental scrap dealers tend to make low offers for it(they like to make a profit on their purchases). When scrap is present in large quantities it can be sent to a refiner and it can be worth more, but the refiner is paid a fee for his work.