My Blog

By Philip Girgis DDS
December 08, 2018
Category: Dental Procedures
Tags: dental implants  
IssuestoConsiderBeforeDentalImplants

With their durability, versatility and life-likeness, there’s no doubt dental implants have revolutionized teeth replacement. If you’re considering dental implants, however, there are some issues that could impact how and when you receive implants, or if you should consider another type of restoration.

Cost. Dental implants are initially more expensive than other tooth restorations, especially for multiple tooth replacement. However, be sure you consider the projected cost over the long-term, not just installation costs. Because of their durability, implants can last decades with little maintenance cost. In the long run, you may actually pay more for dental care with other types of restorations.

Bone health. Dental implants depend on a certain amount of bone to properly situate them for the best crown placement. If you’ve experienced extensive bone loss, however, there may not be enough to support the implant. This can often be overcome with grafting — immediately after extraction, at the time of implantation or a few months before implantation — to encourage bone growth. In some cases, though, bone loss may be so extensive you may need to consider an alternative restoration.

Gum Health. While implants themselves are impervious to infection, they’re supported by gum and bone tissues that can be affected. Infected tissues around an implant could eventually detach and lead to implant failure. If you have periodontal (gum) disease, we must first bring it under control and render your gums infection-free before installing implants. It’s also important to maintain effective oral hygiene and regular dental cleanings and checkups for optimum implant health.

Complications from osteoporosis. People with osteoporosis — in which the bones lose bone density and are more prone to fracture — are often treated with drugs known as bisphosphonates. In less than 1% of cases of long-term use, a patient may develop osteonecrosis in which the bone in the jaw may lose its vitality and die. As with bone loss, this condition could make implant placement difficult or impractical. Most dentists recommend stopping treatment of bisphosphonates for about three months before implant surgery.

If you have any of these issues or other complications with your oral health, be sure to discuss those with us before considering dental implants. With proper planning and care, most of these difficulties can be overcome for a successful outcome.

If you would like more information on pre-existing conditions that may affect implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Osteoporosis & Dental Implants” and “Infections around Implants.”

By Philip Girgis DDS
November 28, 2018
Category: Oral Health
Tags: cracked tooth  
FindingandTreatingaCrackedToothEarlyisKeytoitsSurvival

While most tooth loss stems from dental disease or injury, another major cause is a condition known as cracked tooth syndrome. What begins as a microscopic crack in an individual tooth’s enamel could ultimately grow to a fracture that endangers its survival.

Most often related to age-related brittleness, expansion and contraction of the enamel surface because of hot foods followed by cold foods and beverages, or grinding habits, cracked tooth syndrome usually occurs in three phases. The first phase is the emergence of miniscule cracks in the outer enamel known as craze lines. These can be very difficult to detect even with x-rays, and usually calls for specialized detection methods such as probing with a sharp instrument (an explorer) or fiber-optic lighting with dye staining to highlight enamel abnormalities. If you have pain symptoms, we may ask you to bite down on a bite stick or rubber pad to locate the area by replicating the sensation.

In the next phase, the craze line grows into a crack that penetrates below the enamel into the tooth’s dentin. Pain becomes more prominent and the risk of infection increases. Left untreated, the crack may enter the third phase, a full break (fracture) occurring deep within the inner layers of the tooth. The deeper the fracture occurs, the more serious the danger to the tooth, especially if the pulp is exposed.

The best treatment approach is to attempt to detect and treat a crack as early as possible. Craze lines and moderate cracks can usually be repaired with restorative materials like composite resins. A deeper crack extending into the pulp may require a root canal treatment and the tooth covered with a permanent, protective crown.

If, however, the fracture is too deep, the tooth may be beyond repair and will need to be extracted and replaced with a dental implant or permanent bridge. In any event, the sooner a cracked tooth is discovered and treated, the greater your chance of avoiding pain, discomfort, and, ultimately, tooth loss.

If you would like more information on cracked tooth syndrome, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Tooth Syndrome.”

By Philip Girgis DDS
November 18, 2018
Category: Oral Health
GameSetMatchMilosRaonicSaysAMouthguardHelpsHimWin

When you’re among the top players in your field, you need every advantage to help you stay competitive: Not just the best equipment, but anything else that relieves pain and stress, and allows you to play better. For top-seeded Canadian tennis player Milos Raonic, that extra help came in a somewhat unexpected form: a custom made mouthguard that he wears on the court and off. “[It helps] to not grind my teeth while I play,” said the 25-year-old up-and-coming ace. “It just causes stress and headaches sometimes.”

Mouthguards are often worn by athletes engaged in sports that carry the risk of dental injury — such as basketball, football, hockey, and some two dozen others; wearing one is a great way to keep your teeth from being seriously injured. But Raonic’s mouthguard isn’t primarily for safety; it’s actually designed to help him solve the problem of teeth grinding, or bruxism. This habitual behavior causes him to unconsciously tense up his jaw, potentially leading to problems with muscles and teeth.

Bruxism is a common issue that’s often caused or aggravated by stress. You don’t have to be a world-class athlete to suffer from this condition: Everyday anxieties can have the same effect. The behavior is often worsened when you consume stimulating substances, such as alcohol, tobacco, caffeine, and other drugs.

While bruxism affects thousands of people, some don’t even suspect they have it. That’s because it may occur at any time — even while you’re asleep! The powerful jaw muscles that clench and grind teeth together can wear down tooth enamel, and damage both natural teeth and dental work. They can even cause loose teeth! What’s more, a clenching and grinding habit can result in pain, headaches and muscle soreness… which can really put you off your game.

There are several ways to relieve the problem of bruxism. Stress reduction is one approach that works in some cases. When it’s not enough, a custom made occlusal guard (also called a night guard or mouthguard) provided by our office can make a big difference. “When I don’t sleep with it for a night,” Raonic said “I can feel my jaw muscles just tense up the next day. I don’t sense myself grinding but I can sort of feel that difference the next day.”

 An occlusal guard is made from an exact model of your own mouth. It helps to keep your teeth in better alignment and prevent them from coming into contact, so they can’t damage each other. It also protects your jaw joints from being stressed by excessive force. Plus, it’s secure and comfortable to wear. “I wear it all the time other than when I’m eating, so I got used to it pretty quickly,” said Raonic.

Teeth grinding can be a big problem — whether you put on your game face on the court… or at home. If you would like more information about bruxism, contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Stress & Tooth Habits” and “When Children Grind Their Teeth.”

By Philip Girgis DDS
November 08, 2018
Category: Oral Health
Tags: smoking  
QuittingSmokingcanImprovetheHealthofYourTeethandGums

While cigarette smoking has been linked with lung cancer and heart disease, it, can also contribute to dental disease. You can reduce these risks by doing one thing — quitting smoking.

But that’s easier said than done: forty-six percent of smokers try to quit every year, but only one in ten are successful long term. The difficulty is tied to tobacco’s active ingredient, nicotine, an addictive substance that triggers chemical and behavioral dependence. Nicotine “re-wires” the brain to feel pleasure when it encounters the chemical, and to feel bad when it’s deprived. Social, occupational or recreational activities can further reinforce the habit.

Many smokers try to quit through sheer willpower or “cold turkey.” Because of nicotine’s addictive properties, this rarely works — instead, you need a comprehensive strategy tailored to you.

You should begin first with trying to understand your individual smoking patterns: when do you smoke, how frequently, or during what activities? To help with this you can use a “wrap sheet”, a piece of paper you keep wrapped around your cigarette pack. Each time you take out a cigarette, you would record how you feel on the sheet. This also slows down the action of taking out a cigarette and lighting it, which can help you become less mechanical and more mindful of your habit.

You can also break your dependence by gradually introducing restrictions to your smoking: smoke only in certain locations or at certain times; substitute other stress-relieving activities like a walk or other physical exercise; or gradually reduce the number of cigarettes you smoke. You can do the latter by setting a goal, say to smoke 20% fewer cigarettes each successive week; this will force you to increasingly make choices about when you smoke.

Finally, don’t try to go it alone. You can benefit greatly from professionals, including your dentist, to help you kick the habit through Nicotine Replacement Therapy (NTR) with prescription medication, counseling or smoking cessation support groups.

Quitting smoking isn’t so much stopping a behavior as it is “unlearning” one and establishing new, healthier ones. The first step, though, is accepting you need a change, one that will benefit your whole life.

If you would like more information on quitting smoking, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Strategies to Stop Smoking.”

By Philip Girgis DDS
October 29, 2018
Category: Oral Health
Tags: oral health  
HaveTeethorJawProblemsCheckedBeforeYourNextFlightorDive

Among the “to-do” items on your pre-dive checklist like “Pack wetsuit” or “Fill scuba tanks,” be sure to add one other: “Check my dental health status.”

While that may seem like an odd concern, the changes in atmospheric pressure you encounter while diving (or flying, for that matter) could amplify oral sensitivity and intensify pain if you have pre-existing teeth or jaw problems.

The reason for this is the effect of basic physics on the body. All anatomical structures, including organs, bones and muscles, equalize external pressures the body encounters. We don’t notice this at normal atmospheric pressure, but when we encounter an extreme — either lower pressure during air flight or higher pressure during a scuba dive — we may feel the effects of the pressure on any structure with a rigid-walled surface filled with either air or fluid. These structures can’t equalize the pressure as fast as other areas, resulting in pain or discomfort. This is known medically as “barotrauma,” or more commonly as a “squeeze.”

One structure in particular could have an effect on your upper teeth and jaws: the sinus cavities of the skull, particularly the maxillary sinuses just below the eyes. Their lower walls are right next to the back teeth of the upper jaw and, more importantly, share the same nerve pathways. It’s quite possible, then, for pain from one area to be felt in the other, commonly known as “referred pain.” A toothache could then be felt in the sinus region, and vice-versa.

During a squeeze, then, pain levels from existing problems in the teeth and jaws that were previously tolerable (or even unnoticed) may well become amplified as the pressure from the sinus cavity impinges upon the jaw. That dull toothache you’ve been having may suddenly become excruciating at 30,000 feet — or 30 meters under the surface.

That’s why it’s important to see us if you’ve experienced any signs of tooth decay, gum disease or TMD, including pain, before your next dive or air flight. And, if you encounter any significant pain while flying or diving, be sure you consult with us as soon as possible when you return. Taking action now could help you avoid a miserable, and potentially dangerous, flying or diving experience in the future.

If you would like more information on pressure changes and dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Pressure Changes can Cause Tooth and Sinus Pain.”





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