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   Simon W Rosenberg, DMD

Prosthodontics and Cosmetic Dentistry
The Center for High Tech Dentistry
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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 ally

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 tooth.

If you experience pain—

  • after you bite something
  • when the tooth is exposed to something very hot or cold
  • 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

ImageTooth 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 brilliance

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 tooth's pulp.

A chink in the armor is serious business Image

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 personalities

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 dilemma Image

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 box.


A Spoonful of Sugar Helps the Medicine Go Down

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 dentist.

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.

Lub-dub, lub-dub

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 own.

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 endocarditis?

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 truth Image

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. Image

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 this time!

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? Image

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 Image

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 Image

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 for exams).
• Go easy on caffeine and stimulants such as "energy drinks".
• 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 holidays.

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 of time.
• 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 hygienists

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 progress.

As always, be nice to your teeth so that they can be nice to you.

Orange - the Color of My World

Do you regularly brush and floss but your gums still bleed? Don't blame your toothbrush; your diet may be the culprit.

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 as:



Males (mg/day)

Females (mg/day)


0-6 mo




7-12 mo




1-3 yrs




4-8 yrs




9-13 yrs




14-18 yrs




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 amount—180 mg.

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 less.

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 includes:


Vitamin C (mg)

Orange juice


Grapefruit juice




Grapefruit Image




Tomato Image


Sweet red pepper


Broccoli Image




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 teeth.

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.

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