July 1 2007 Newsletter
Life is a Crackup -- Stress
can crack your teeth
Funny how life deals us all kinds of challenges. Sometimes,
we learn to go with the flow and adapt where necessary.
Sometimes, we find a way to detour around a challenge. But in
the long run, that persistent challenge finds us again and
makes us deal with it.
Your teeth can be one of those challenges. Wouldn't it be
nice if you were born with perfect teeth? You wouldn't have to
brush or floss. You wouldn't need fillings or dentures. But
when you get a toothache, reality sets in and you have to make
a decision. Do you wait, hoping that the toothache to go away
on its own, or do you immediately call the dentist? Hopefully,
you chose the latter.
The dentist -- your friend and
Today, we know so much more about your teeth and the
importance of good oral health care. For instance, we know that
periodontal disease has been connected to heart problems,
pancreatic cancer and diabetes. We know that the health of your
mouth is directly related to your overall health.
The dental care professional is on the front line of the
battlefield whenever you experience any "abnormal" event
relating to your mouth, its tissues and the teeth. The dentist
has big ammunition to save you and protect you from your many
dental enemies. One of those enemies is a cracked tooth.
Teeth take a beating
Your teeth are nothing short of miraculous. They chew ice
and popcorn kernels. They open soda pop cans, pull staples out
of paper, cut your fingernails, take small lids off of
containers, and try to withstand all manner of abuse. You know
you shouldn't use your teeth for those tasks, but ... well. For
being naughty to your teeth, they sometimes crack to show you
the erring of your ways.
A warning toothache
A toothache is an early warning sign that something is not
right with a tooth. It could be caused by a cavity or a trauma,
but there are other related symptoms that point to a cracked
If you experience pain—
- after you bite something
- when the tooth is exposed to something very hot or
- that comes and goes throughout the day
you likely have a cracked tooth.
Sometimes, it is not easy for the dentist to diagnose the
condition. A tooth fracture doesn't show up on an x-ray. But,
odds are not in your favor. It might seem strange to have pain
after biting, but here's what happens. Biting down on a cracked
tooth causes the two pieces to shift out of position. When you
stop biting, the pieces snap back into place, giving you quite
a zing. That movement also irritates the tooth's pulp. The pulp
contains tissue, nerves and blood vessels that can be easily
inflamed. Oftentimes a weakened tooth will crack near a large
filling, or a cusp will break. A cusp is the rounded "point" on
each corner of a molar.
Crazy for you
Tooth cracks come in different shapes and
sizes. Sometimes a crack is really a craze. A craze is not
a passing fad. Just like a dinner plate that has tiny
zigzag lines in the glaze, a tooth can have a network of
itsy-bitsy cracks that do not go completely through the
enamel layer. This is called a crazed tooth, which usually
does not need dental attention.
On the cusp of
Unlike your intellectual pursuits, a fractured cusp is not
to be taken lightly. A cusp can fracture and break off from the
tooth. Luckily, a broken cusp usually does not affect the
A chink in the armor is serious business
When a crack moves down the tooth and reaches the pulp
chamber, the tooth's alarm system goes into high gear.
Sometimes a crown can save the tooth. If not, and the pulp is
damaged, the tooth may need a root canal. If the crack extends
below the gum line, the tooth might have to be extracted.
The yin and yang of split
On the other hand, your tooth could look like a baseball bat
that shatters when it makes contact with a 98-mph fastball. The
tooth splits into two pieces. Shouldn't have chewed that ice
cube, eh? If you are extraordinarily lucky, both halves can be
saved. More likely than not, only one half of the tooth can be
saved, which means you will need a major restoration.
Getting to the bottom of this
Perhaps the worst case scenario is a tooth that cracks from
the root upward. Virtually undetectable, the crack inches along
until the bone and gum are infected.
Unfortunately, teeth do not heal like a broken arm bone,
which is just one more good reason to work closely with us. The
earlier that dental problems are identified, the better for
your teeth and your overall health.
Call and make an appointment if you are experiencing any
problem with your teeth. No matter how minor the problem may
seem, it could be hiding a serious condition that needs
immediate treatment. Helping you maintain good dental health is
why we are here.
Spoonful of Sugar
"Why is it I get gloomy when I have my teeth cleaned?"
you might wonder. Then you realize it is because you always
had to take medicine before a cleaning or before any dental
work could be done. The medicine seemed like a nuisance,
but your dentist assured you it was necessary.
As a young child you had been diagnosed with a heart
murmur, which you hadn't given any thought to except when
you went to your new dentist for the initial visit. On the
medical history form, you checked off illnesses and
conditions you had over the years. One of the selections
was "heart murmur." Vaguely remembering the incident that
prompted your diagnosis, you placed a check mark in the
A Spoonful of Sugar Helps the Medicine Go
When the hygienist reviewed the form, she inquired about
your heart murmur. The hygienist explained that there is a
connection between teeth and the heart and told you that
you might need to have antibiotic therapy before they could
clean your teeth. Then a light bulb went on. You realized
why you had to take medicine as a child before you went to
The heart is related to my teeth?
It may sound unusual, but yes, it is. Any dental
procedure that causes the gums to bleed opens a porthole
for bacteria that naturally live in your mouth to enter the
bloodstream. Even a simple teeth cleaning will result in
minor gum bleeding when the hygienist uses a probe to
examine the health of the soft tissue surrounding a tooth.
Bacteria and the heart are not bosom buddies.
But first, let us explore your heart murmur to better
understand the broader picture before we launch into the
dental aspect. Surprisingly, over half of all children are
diagnosed with a heart murmur according to the KidsHealth
Web site. Typically, the condition disappears on its
When the heart beats, it makes a lub-dub sound. "Lub" is
when the heart valves close and squeeze blood from the
upper chambers of the heart to the lower chambers. "Dub" is
when the valves close as the heart pushes the blood out
into the arteries traveling away from the heart to the rest
of the body.
The murmur can be a result of many factors, one of which
is a valve that doesn't entirely close. A murmur refers to
a whishing sound as the blood seeps through the constricted
valve opening, much like letting air escape out the neck of
a balloon. Generally, a heart murmur is innocent, but
sometimes it indicates a more serious problem. For example,
the heart could have a hole in it.
Sometimes we determine that a patient with a heart
murmur should take antibiotics before having a dental
procedure performed, just to be on the safe side.
The heart under attack
When a dental procedure causes bleeding and bacteria
enter the bloodstream, the heart is a vulnerable target
sitting at the center of a bullseye. When bacteria attack
the heart, they set up a permanent campsite on a heart's
whishing valve where they grow into a thriving colony.
Bacterial colonies on heart valves result in a condition
called "infective endocarditis," or infection
(infective), inside (endo-), the heart
(card-), causing an inflammation (-itis).
One common bacterium that lives inside everyone's mouth is
Streptococcus viridans. It is a relatively harmless
bacterium until it enters the bloodstream. It is the
foremost culprit that causes infective endocarditis.
How do you know if you have infective
A few of the symptoms include an ongoing fever, fatigue,
headaches and profuse sweating. When the disease
progresses, tiny dark lines will appear under the
fingernails. A person who might be at risk for infective
endocarditis is someone who has a congenital heart problem
or a valve abnormality.
Tell the truth, the whole truth and nothing but the
Because there is a direct link from many procedures that
are done to your teeth to other areas of your body, it is
critical to be truthful when completing medical forms or
answering our questions. Your good health depends on you.
Whenever you have a change in your health, it is wise to
contact us and provide the new information so that it can
be added to your dental history.
Every cloud comes with a silver lining
For anyone who has been diagnosed with a heart murmur,
we have good news. In May 2007, the American Dental
Association and the American Heart Association published
new guidelines for infective endocarditis. Many people who
once had to routinely take medications before they had a
dental procedure, no longer need to take precautionary
antibiotics. The study concluded that only a small number
of cases of infective endocarditis would likely develop if
antibiotics were not taken beforehand. The AHA recommends
that only people who have conditions that have the highest
risk of developing infective endocarditis take antibiotics.
The new AHA guidelines might apply to you. At your next
dental appointment, be sure and ask us about your
situation. Perhaps you won't need that spoonful of sugar
Immediately contact us if you notice any unusual
symptoms after having a dental procedure. We are on the
front line of your healthcare and want to head off any
health issue that might occur.
In a Clench
Did Rip Van Winkle Wear a Nightguard?
How well did you sleep last night? Before you settle
down for "a long winter’s nap" to have that "midsummer’s
night dream," you might want to see if these questions
apply to you:
• Do you wake up with an earache or headache?
• Do your jaw muscles feel sore or tight?
• Do your teeth or gums feel sensitive or tender?
• Do your teeth appear worn down or chipped?
• Do you frequently have unexplained facial pain?
• Does the inside of your cheek feel chewed up?
• Does anyone in your household (or college dorm room)
complain that your teeth grinding wakes them up?
• Do you wake up tired?
Getting a good night's sleep
These are symptoms of bruxism. "Bruxism" means to grind,
gnash, or clench the teeth. This condition can affect all
ages. In fact, 50 to 96 percent of adults and 15 percent of
children may show signs of bruxism. The sleeper might have
25 bruxism episodes each night.
An episode typically lasts four- to-five seconds, but
those few seconds add up to severe dental damage to the
teeth or jaw joint. There are several theories about the
causes of bruxism, but stress is often a contributing
factor. If bruxism is not treated, your teeth, fillings, or
crowns may become worn down. Eventually you might grind
away your tooth enamel and loosen the teeth themselves.
Those loose teeth can then shift in the jawbone. You could
also crack a tooth or a filling because of the heavy biting
pressure during a bruxism episode. So, what can you do to
alleviate stress that may be affecting your bruxism?
Tips for children
Even if children still have their baby teeth, they may
display signs of bruxism. Some tooth grinding is normal in
children, and they usually outgrow it. Children often
clench or grind their teeth because a cold, earache or
allergy makes them uncomfortable. They may also grind their
teeth when they are losing their baby teeth and getting
their permanent teeth.
If bruxism is causing your child discomfort, you might
want to create a comfortable routine before bedtime. Try a
warm bath or shower, soft music, a soothing story, or a
cuddly stuffed animal to help the child relax.
Self-care tips for students
In middle-aged and older children, school exams may
create extra stress, which may cause bruxism to escalate.
In addition to the tips for children, here are some tips
especially for students:
• Avoid "all nighters" (staying up all night to study
• Go easy on caffeine and stimulants such as "energy
• Do not use tobacco, alcohol, or drugs.
• Give your teeth some extra attention with brushing and
flossing when exams are over.
• Schedule a dental checkup while you are home for the
Self-care tips for adults
Many adults do not know they have bruxism, or they do
not believe they have it simply because they are unaware of
it. Some people believe that their teeth must touch at all
times; they unintentionally create bruxism over time.
Unfortunately, bruxism episodes can go on for several years
before the person realizes their teeth are ground down.
In addition to the tips for children and students, here
are some tips especially for adults:
• Pay attention to your body. If you are feeling tense,
angry, frustrated, aggressive, or overworked, notice where
that feeling manifests itself and relax!
• Exercise every day and add a little more time to your
exercise routine on those more stressful days.
• Avoid caffeine after mid-afternoon, and be careful not to
consume too much caffeinated beverages in a one-day period
• Gently press a warm, wet washcloth to the side of your
face to help relax the muscles.
• Practice resting your tongue upward. Keep your teeth
apart and lips together.
Additional care from dentists and
Another option is to prescribe a nightguard, which looks
like a plastic retainer. We make an impression of your
teeth so that the nightguard precisely fits your bite.
(Over-the-counter nightguards don't fit as well, and they
may become dislodged in your mouth while you sleep.) The
nightguard takes the force of your biting and grinding to
prevent further damage to your teeth and to keep them from
shifting. By keeping your teeth apart, a nightguard
relieves pressure off the jaw joint.
We may also recommend onlays or crowns to replace the
worn parts of your teeth. Or we may recommend other
techniques to help prevent your jaw from moving out of
alignment and to relieve the pressures of bruxism.
If you've experienced any of the symptoms of bruxism, be
sure to let us know. During your next checkup, we can look
for signs of bruxism, such as worn-down teeth, broken
restorations (such as fillings and crowns), or unusual
sensitivity. We may examine your teeth, your jawbone
structure, and the inside of your checks for damage, and we
may want to take x-rays or plan treatments to follow your
As always, be nice to your teeth so that they can be
nice to you.
Orange - the Color of My
Do you regularly brush and floss but your gums still
bleed? Don't blame your toothbrush; your diet may be the
A study reported in the Journal of Periodontology showed
that people who ingested less then 60 milligrams (mg) of
vitamin C each day have a higher rate of periodontal
disease than people who get more than that amount.
The United States Department of Agriculture (USDA)
recommends the minimum daily requirement for vitamin C
19 yrs and older
19 yrs and older
Vitamin C—your gums' friend
You are likely familiar with the story about the British
sailors who, in the 1700s, developed scurvy because no one
knew vitamin C was important to maintain good health. Now
we know that vitamin C helps to heal wounds and maintain
healthy cartilage, blood vessels, bones and teeth.
If you don't have enough vitamin C, you could experience
gingivitis (inflammation of the gums) and bleeding gums, as
well as weakened tooth enamel.
Your body cannot manufacture vitamin C; it has to be
obtained through diet. And because it is water-soluble, it
needs to be replaced every day.
Another outcome of the study mentioned earlier, showed
that when it comes to vitamin C and healthy gums, more is
better. A person who consumed less than 60 mg of vitamin C
each day had a 150 percent greater chance of developing gum
disease that someone who consumed three times that
In another study that measured the effects of vitamin C
deficiency on gum health, researchers at the University of
California San Francisco School of Dentistry did a dietary
test on several men. The diet excluded all fruits and
vegetables, which are typically high in vitamin C. During
the test, some men received a vitamin C supplement.
At the end of the study, researchers found that the
men's gums bled more during the weeks that they received no
vitamin C. When they received vitamin C, their gums bled
Helping gums stay healthy
When you brush and floss and your gums bleed, are
irritated, tender, swollen or red, you have early gum
disease (gingivitis). This is caused by food particles and
bacteria on your teeth. The residue from the bacteria forms
plaque. When the plaque hardens on your teeth, it becomes
tartar (also called calculus). Your gums become infected
and pull away from your teeth. This forms pockets where
even more bacteria can hide and reproduce.
If untreated, the infection attacks the roots of your
teeth and the jawbone, which can lead to bone loss. At this
stage gingivitis has progressed to the more serious problem
of periodontal disease. Periodontal disease is the leading
cause of adult tooth loss in the U.S.
Getting vitamin C in your diet
Many fruits and vegetables are good sources of vitamin
C. You might cut open a cantaloupe, eat part of it and
store the rest in the refrigerator. Alarmingly, that stored
section of melon will lose 35 percent of its vitamin C in
less than 24 hours. Oxygen, the element we need to help
stay alive, destroys vitamin C in foods.
The USDA publishes a list of foods high in vitamin C; it
Vitamin C (mg)
Sweet red pepper
You could also increase the amount of vitamin C in your
body by taking supplements, but caution is needed. You
should read labels carefully. Chewable vitamin C often is
sweetened with sugar, which can erode the enamel on your
Call our office, or email us at info@DrSimonRosenberg.com, or
ask us during your dental appointment if you are
considering a vitamin C supplement. We can recommend a
source for you that will be healthy for your teeth and
gums. Working together, we can develop a plan to keep your
teeth and your gums healthy and happy.