McAdams Dental and Scottsdale Prosthodontists: Family, Cosmetic and Emergency Dental
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Scottdale, AZ 85254
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My Tooth Hurts!

3/16/2013

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My Tooth Hurts!

We saw a lot of emergency toothaches this week and Dr. McAdams thought it would be a good time to shed a little light on the testing we do to determine why your tooth hurts.  You may remember the "cold test" where something cold is applied to your tooth to see how it responds:

Well, this is a very important test that tells us a lot about the health of your tooth.  Dr. McAdams considers the following possibilities when looking at a toothache to determine how to proceed:

FIRST WE RULE OUT THE OBVIOUS SOLUTIONS:

1.  Have you had a cold or allergies recently?  Many tooth aches are caused by sinus pressure because the roots of your top back teeth are very close to your sinuses.  If all else is normal, this type of toothache can be treated with over the counter sinus medication.

2.  Do you have something stuck in your gums?  It can be very difficult to tell if your tooth pain is coming from your tooth or your gums, but we often find things wedged in the gums and removal of it can relieve your toothache.  We find all kinds of things from broken toothpicks to popcorn husks in there.

3.  Do you have gum recession?  Many times an overzealous brusher will cause themselves gum recession and this can cause minor sensitivity to temperature changes.  In this case, the patient can relieve the issue by using a sensitive formula toothpaste to desensitize the exposed root surfaces.  (It might take a couple weeks to kick in).

4.  Is the tooth cracked or decayed?  At times a piece of the tooth can be missing, and it might expose the sensitive inside layer of the tooth.  This can require a simple filling to solve the problem, but the fix may warrant extraction depending on how close to the gums the crack gets.  If this is the case, get it fixed quick!
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ALL ELSE EQUAL, WE USE THE COLD TEST:


The cold test tells us the overall health of the tooth, and how to treat the problem.  Generally a toothache proceeds like so:

1.  A healthy tooth with no cavities, cracks or issues has what we call a "vital pulp."  Cold stimulus on a vital tooth will cause an immediate reaction that will immediately dissipate when the cold is removed.  The reaction shouldn't be terribly painful, but you should know your tooth touched something cold.

2.  Minor pain will develop in response to damage.  In this case the toothache is causing nerve irritation.  If the tooth is highly sensitive but the pain does not linger for a while after it starts this is called "reversible pulpitis" and the tooth can be fixed at this point with a minor procedure.  Think of this as a red flag, its time to see a dentist.

3.  Major pain will then develop if the problem goes untreated and the tooth starts to respond to cold in a very painful way.  At this point, the pain will linger after the cold is gone and this tells us that the nerve in the tooth is damaged beyond the point that it will heal.  This is caused "irreversible pulpits."  Unfortunately, at this point a root canal is needed if the tooth is to be saved.  

4.  Suddenly the toothache goes away.  Now the tooth can't feel cold at all and the test gives us no response.  At this point most people think they dodged the bullet and that they will no longer need dental treatment.  What they don't know is that the nerve has now died and the diagnosis now is "necrotic pulp."  At this point, bacteria have killed the tooth and are now using the nerve of the tooth as a food source brew a large infection.  After a few months of unchecked infection, the symptoms will return because the infection slowly deteriorates the bone around the tip of the tooth until the pain returns along with swelling, draining infection, and a terrible odor/taste in some cases.  Depending on how long the infection goes untreated, patients may find themselves hospitalized by an infection that migrates to the heart, or worse, the brain.  At this point, an antibiotic can relieve symptoms temporarily but treatment is absolutely necessary.

For more information, read about root canals on the ADA website:

https://www.mouthhealthy.org/all-topics-a-z/root-canals.aspx/​

Dr. McAdams recommends seeking treatment for a toothache as soon as you can.  Because the symptoms are difficult to identify on your own, he suggests you find a dentist you can trust and sort out the cause of the pain as a team.  If you are looking for a Phoenix based dentist consider visiting our office.  We would love to meet you!
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Will My Veneers Last Forever?

3/8/2013

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Will My Veneers Last Forever?

You may be surprised to learn that a porcelain veneer is not a permanent solution to improving your smile.  In fact, it is common for a set of veneers to need replacement at some point between 5-10 years after bonding them to your teeth due to normal wear and tear.  

Here is a perfect example of what to watch for:  At McAdams Dental, we recently encountered a situation where a set of porcelain veneers had outlived their useful life.  The patient enjoyed 13 years of showing off her beautiful porcelain smile, but you might notice that over time a few problems have developed.  Notice the spacing between the front teeth, fading color, dark stained pitting, and yellowing/darkening along the gums at the edges of the veneers shown in the photo below:
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Our patient was ready for an update to her smile and as a birthday gift to herself, we worked together to provide her a set of veneers that she was happy to show off, in fact….she couldn't stop smiling!  After carefully assessing the patients concerns, we were careful to place the edges of the veneers in a more healthy and beautiful location, all spaces between the teeth were closed, and a more natural transition of color from a translucent tip to the natural shade near the gums was used to improve upon her flat, all white smile.  

In the end, we achieved successful improvement by placing 8 porcelain veneers on her upper front teeth, compare before and after in the photo below:

BEFORE AND AFTER PHOTO:  SMILE UPDATING WITH VENEER REPLACEMENT

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The patient was quite happy with her more natural looking smile, and the improved health of her gums, Dr. McAdams felt that a more natural shade than flat white would complement the patients skin tone and facial features.  See for yourself in the smile photos below.

AFTER PHOTOS:  LEFT AND RIGHT SIDE SMILE PHOTOS

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11111 N. Scottsdale Road #220
Scottsdale, AZ 85254
Call Dr. McAdams:  480-991-4727
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Email us:  smile@mcadamsdental.com