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Sore teeth after a Dental Cleaning?

Q: I wasn’t in any pain before my dental cleaning and now my teeth are sooo sensitive.

A: Lets review what happens with some dental cleanings.

04-04-2016 3-08-02 PMNo one likes surprises, especially in connection with something you were not expecting to be painful. Most everyone would also like to have a pain-free visit when they visit their healthcare providers, but this depends on the state of your health, the level of care required, your own pain tolerance and most importantly, expectations. Tips for a Pain-free Dental Cleaning visit can be found here.

This is why communication is a crucial aspect of the dental care experience. Building a trusting relationship relies on open, honest and effective communication. This requires the efforts of both parities.

If you were experiencing discomfort during your visit or required the intensity of cleaning that would leave you in pain afterwards, it sounds like there was something missing in the communication process between you and your provider.

Let’s take a look at how this could have been avoided…

Scheduling Your Appointment

Ideally, effective communication takes place before, during and after your cleaning. It begins with the first phone call to schedule your appointment when the administrative staff gathers as much information as possible to determine the type of appointment necessary and the appropriate time required. The questions they ask you will help them determine what information both you and the dentist should have so that everyone will be prepared for the visit.

 

Established Patients – If you are already a regular patient at a dental office, make it a habit to come in for your regular check-ups and cleaning and are not having any 04-04-2016 11-57-58 AMcurrent issues that you anticipate will have an impact on your appointment, then you can probably expect the kind of visit that you have become accustomed to at your dental office. If you have more tartar on your teeth than what is normally typical for you then your hygienist will let you know that your cleaning will probably be more involved than usual and suggest ways to help prevent future buildup.  Your cleaning appointment may be longer than anticipated or spaced out over two visits. Communication should be ongoing throughout the appointment as the hygienist gauges your comfort level.

 

New Patients – If you are a new patient to a dental practice then it is difficult to anticipate the level of tartar buildup and the condition of your teeth and gums. The administrative staff scheduling your appointment will let you know what to expect your first appointment. It is at this time that you may feel comfortable discussing any sensitivities, anxieties or dental problems you may have so that your dental provider will be aware beforehand and as many comfort aids as possible can be made available to you. A better idea of how much time and effort is needed for your cleaning will be determined during your first exam and you will be advised of what to expect at your next appointment. At Your Smile Dental Care, we try to get your cleaning started during your first new patient visit, if time permits. Again, during your actual cleaning procedure, your provider should let you know what is happening at all times and assessing your comfort level should be an on-going process throughout your visit.

Pre-Treatment

04-04-2016 11-09-47 AMIt is important to understand that there are different levels of cleaning depending on your dental health, the amount of tartar build-up in your mouth and when your last cleaning was. A proper assessment by one of the dental team members will determine how best to proceed with the safest, most comfortable and thorough cleaning they can provide. If you have a lot of tartar accumulation, then naturally your cleaning will probably be deeper and longer than a routine cleaning. You may even require several visits to complete your cleaning. All of this will affect your level of comfort, in addition to any dental sensitivities and anxieties you may already have.

There are times when a patient calls for a cleaning appointment and/or price, but has not had a dental visit in a very long time. This is where the communication begins. An experienced and thorough administration team will gather as much information as possible before discussing prices and scheduling the patient’s appointment. They will advise the patient that only a proper assessment by the dentist or hygienist can accurately determine the health of their mouth, the level of cleaning required and the associated price. Equipping the patient with this information beforehand will certainly avoid disappointment later.

The Stages of a Dental Cleaning Appointment

1. Pre Appointment – Before you even visit your dental office you should take note of anything that may directly impact your experience. Are you anxious? Do you have any sensitivities or sores in or about the mouth area such as cankers or cold sores? Are you in any pain or having a dental issue that could affect you during or after your cleaning? Letting your dental team member know these things beforehand will help them determine if they should modify or postpone your appointment.

09-02-2015 8-14-23 PM2. Pre-Operative Assessment – Before the hygienist even begins cleaning your teeth, a medical and dental assessment is done. During the medical portion, you are asked a series of questions pertaining to your health. This is very important step since your current health and medications can have a direct impact on your dental health and level of sensitivity in your mouth. As the hygienist is evaluating your health, they are also determining how best to proceed with the safest, most comfortable and thorough cleaning they can provide. If it has been a number of years since your last cleaning and you have quite a lot of tartar build-up, a separate appointment may have to be scheduled to complete your cleaning. The hygienist will tell you what to expect at your cleaning appointment so that you will have no uncertainties.

3. Cleaning Stage – There are also different levels of cleaning depending on your dental health, the amount of tartar build-up in your mouth and when your last cleaning was. Sometimes your x-rays and the visual exam is all that is needed to determine the amount of build-up on your teeth. While other times, it’s not until the cleaning is underway that the amount of build-up is evident.

08-06-2015 9-24-20 AMThe hygienist will ask you to tell them if you experience any discomfort during the cleaning. They will also ask you periodically throughout the visit so that they can evaluate your level of comfort during your cleaning. Some people are sensitive to the water-spraying ultra-sonic cleaner, so the hygienist will switch to hand-scaling only. Others may not like the device that squirts air and water into their mouths. While still others are so sensitive or have so much cleaning to be done that they need a periodic break , laughing gas, pre-cleaning pain reliever or anesthetic.

A conversation about your concerns, fears or level of  anxiety should take place before the cleaning actually begins, so that you can both come up with a solutions for a more comfortable visit. As mentioned, some local aesthetic or conscious sedation (laughing gas) or a pre-cleaning pain reliever can be offered beforehand. If the patient has no prior history of discomfort during dental cleaning and begins to experience pain, then an entirely different conversation has to take place to determine the cause. Sometimes, it is the provider’s technique, an unexpected level of tartar build-up or another underlying health/medication issue in the mouth/body.

Provider Technique This is subjective issue and let’s be honest, most patients, who have had experience with dental cleanings have preferences that take shape over time and would like to have a choice when it comes to who will be providing their services. It’s important they be comfortable with the person who will be cleaning their teeth. When it comes to carrying out deep cleanings in a relatively gentle and thorough manner, some providers will do all they can to help accomplish this. Although the dental staff booking appointment will not make provider judgments to patients, it doesn’t hurt to let them know what your preferences, expectations and concerns are. In doing so, they may steer your appointment towards a provider that can best suits your needs. Unless a specific recommendation has been made by your family or friends to you, it is difficult to know what to expect at a new office. Being upfront is useful to the dental team and begins the open and honest communication relationship that helps make your healthcare experiences more predictable.

Toothpaste


4. Post Operative Assessment –
After your cleaning, the hygienist will tell you what you can expect in terms of post-cleaning discomfort, if any. Most people, who come in for regular cleanings, have no post-cleaning discomfort – in fact, their mouth feels clean and refreshed!  If there was a lot of accumulation on your teeth and the cleaning was more involved, then they will recommend the use of a pain reliever/anti-inflammatory, like ibuprophen, to get you through the day. There should be no surprises after your cleaning, if you are kept informed. If there was any uncertainties during the appointment, then your dental office will usually recommend that you call them if you have any questions over the next few days after treatemnt.

Home Care

10-03-2014 2-45-27 PM - CopyIt’s difficult to remove all of the plaque that builds up on your tooth surfaces even if you’re paying extra close attention. There is a small, free space between your teeth and your gums where you would insert your floss during home cleaning. You’ll notice, as you floss, that you are removing food and some soft, sticky plaque. The plaque that remains on your teeth in this space can become hard within a matter of days as your saliva begins to deposit minerals into it.

This hardened plaque is called calculus, commonly known as “tartar.” Calculus can only be removed by a professional dental cleaning using special scaling instruments. When a lot of tartar has built up on your tooth surfaces, especially below the gum line, it’s removal can sometimes lead to increased tooth sensitivity.

04-04-2016 5-11-26 PM modifiedIn order to understand why, you have to know that the hard tissue that covers the root is much less calcified than enamel is, making it more sensitive to irritants and temperature changes in the mouth. In order to protect the sensitivity anatomy of the root, your gums and underlying bone closely “hug” and insulate it from these sensations.

Much like your pant pockets that you may fill with stuff, the tartar accumulating under the gums is widening and deepening this free space between your gum and your root surface. It destroys the fibers that attach the gums to the tooth, and, if left long enough, will begin destroying supporting bone. Unfortunately, this destruction is usually a silent process that most people do not even realize is happening.

When your dental team member has removed this toxic tartar, you are now left with an enlarged pocketed area which is the space where the tartar use to be. This space is open to the mouth and the root surface is exposed to the hot and cold sensations, bacteria and other irritants it would otherwise have been covered with by tartar or protected from if the gum tissue was attached to it more snugly as it used to be.

Sometimes, there is so much tartar that has built up over time and is so far deep under your gums that it can not all be removed in one appointment Your hygienist will then ask that you make another appointment is a few weeks time. During this time your gums may be a little swollen from the scaling treatment, much like any wound would swell after being treated. The swelling will go down and shrink back to a level that will allow your hygienist to revisit the area in order to remove the remaining tartar safely and with less sensitivity.

Given time and proper home care, this pocketing of the gum can be reduced in size. However, destroyed gum tissue and attachment fibres are much more difficult to repair as they do not grow back once damaged.

We can not emphasize the importance of good oral hygiene at home. Your body has amazing
healing capabilities, but you must be patient and follow your dentist’s instructions.

 

Healing

20160425_132936_resizedMany people are quick to think that the dental team has done “something wrong” and this is why their teeth are now sensitive, yet were not before their appointment. It is important to remember that your teeth and gums are like any other part of your body. Damage can be occurring silently, without you ever having symptoms. When you visit us, we see the signs; we notice the damage that is already occurring.

We assume that you are here to see us for the care and attention that you deserve. Oftentimes, this requires more involved treatment that may leave you feeling some discomfort and tenderness afterwards. As one would expect after their family physician or surgeon has performed some invasive procedure, there will be a time of healing. Depending on the level of care needed, healing may be slower than you anticipated, but if you follow our instructions and the prognosis is good, we would expect your healing to be progressive.

Understand that disease and damage can occur in your mouth without you even realizing it. There are lots of people who lead very active and healthy lifestyles, who still have unhealthy conditions or diseases of the body. We have patients who are surprised to learn that, even with diligent home care, there is still room for improvement. Neglect is usually not intentional.

Lastly…

22-10-2015 10-15-17 AMWe often find ourselves back on the topic of communication. Open and frank conversations have to take place between you and your healthcare provider and you should expect nothing less. We assume that when you walk through our door you expect care and attention. It is with this in mind that we offer our patients advice or suggest improvements without the need for scolding or shame them. You should expect the type of partnership with your healthcare providers that is built on mutual respect and that allows you to speak freely and have these frank conversations.

Professional dental cleanings are important. The health of your teeth and gums depend on them. Neglect is not noticed so much when you are young, but as you age the warning signs and damage become increasingly more evident.

If you would like some tips on how to make your next cleaning more comfortable, see our blog: Tips for a Pain Free Dental Cleaning.

 

 

Yours in Better Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 


3 Comments

Frustrated about Chipped Teeth?

Why are my front teeth chipping?

A few years ago, I began noticing that my front teeth were starting to chip. First the chips were small and my dentist filed them down, but they keep chipping and I’m afraid that one day they might break right off. Help!

It’s not always a simple fix… 

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Of course, it is difficult to give an appropriate answer until a proper exam and bite analysis has been done, but you have a right to be concerned. Although enamel is the hardest substance in the body – twice the hardness of bone – teeth can fracture for any number of reasons. If there was no sudden trauma or injury that occurred causing them to break, then we have to look at other possible causes. 

The front teeth are slender, single rooted teeth. They are designed to bite into food not chew like the larger, multi-rooted molars. When atypical forces are applied to these teeth, they will eventually begin to break down as well as the surrounding jawbone that supports them. 

Let’s look at some of the possible causes for chipped front teeth: 

25-04-2016 10-42-28 AM1. Injury/Trauma – When a front tooth has received a “hit”, parts of the tooth can break. If just the crown portion *fractures, then the extent of repair depends on how severe the break was. A small, simple break can be fixed with matching tooth coloured filling material with or without pins for reinforcement. If the break is more complicated and the nerve centre of the tooth has been damaged, then a root canal will be performed before the broken tooth is repaired. The extent of the trauma will often determine the likelihood of future maintenance for the tooth. Even a filling that is placed on a small, fracture can fall out repeatedly simply because the chemical bond between the tooth and the filling material is weaker than the bonds of natural enamel. Longer term solutions like veneers or full coverage crown may be recommended.

*Fractured root – Because there are many degrees of cracked or chipped teeth, it is important that you see your dentist for a proper clinical and radiographic examination. The treatment and outcome will depend on the type, location and extent of the break. Early intervention is very critical as delaying treatment can result in the loss of your tooth. 

2. Grinding/Clenching – This can be a very destructive force upon teeth causing them to fracture and become loose. Because it is usually a unconscious habit, it is difficult to control without the aid of an bruxism appliance. Nowadays, your dentist may also recommend the use of Botox to relax the facial and jaw muscles involved in the dynamics of bruxism. Until this habit is under control, teeth and their supporting structures will continue to wear and breakdown. 

25-04-2016 10-56-25 AM3. Missing teeth – Losing teeth, either due to trauma or disease, and not replacing them with a suitable, long-term solution causes fewer teeth to do the work of many. The forces in the mouth during chewing and clenching can reach a staggering 150 lbs/square inch. These forces are naturally designed to be distributed throughout the dental arches and the work shared by 28 to 32 teeth. It is when fewer teeth are expected to withstand this tremendous load that we begin to see destruction to the jaws, muscles, teeth, and gums. Ideally, a dentist will perform a comprehensive evaluation of the dental collapse that is occurring in a patient’s mouth. Only then can a proper recommendation be made. 

25-04-2016 11-19-29 AM4. Bite – Sometimes, after orthodontic treatment, tooth repair, tooth loss or injury, a person’s bite can become off-kilter. If your upper and lower teeth are not meeting properly, or teeth have shifted from their original positions, the aforementioned forces can be brought to bear on a few teeth before the rest of the dentition realigns itself in the chewing process. This constant high biting, unequal distribution of forces and readjusting of the jaws can cause havoc to the teeth and muscles. A bite analysis is performed, high bite areas are identified and then readjustments can be made so that the entire bite is equalized. Sometimes, the collapse of the dental arches and teeth over the years requires more comprehensive intervention with a treatment plan that involves a considerable amount of readjusting and opening of the bite.

Ortho 15. Post Ortho – Sometimes. after completing orthodontic treatment to correct crooked or misaligned teeth, other bite issues arise. It is important that you stay in touch with your orthodontist so that they can re-evaluate your bite periodically. Orthodontics is a complex dental specialty and treatment outcomes may vary from person to person. If you have developed TMJ, grinding, or other problems after your braces have been removed, further treatment considerations and adjustments may have to be made. 

Expectations vs Reality

There’s an old Neil Young lyric that comes to mind when we talk about expectations, They give you this, but you pay for that.”

Nobody wants to be sold a false set of goods or have unexpected treatment outcomes, but sometimes, what seems like a simple fix can actually be a problem that is not easily resolved the first appointment.  Your dentist may have initially concluded that filing down your teeth will fix your bite, but continuing to do so will just cause another set of issues without determining what the real source of the problem is.

When the uncertainties of a dental issue are fully explained beforehand and something has to be repaired again or requires additional maintenance and readjusting, then it’s no surprise to the patient nor the dentist. If you are returning time and time again for the same issue then a decision has to be made. Has your dentist recommended a long term solution but you are not ready to commit financially? Are you expecting a quick fix or patchwork dentistry? Perhaps, the dentist cannot determine the source of your problem and needs to refer you to another dentist for further evaluation.

29-12-2014 6-30-52 PMThere are risks and benefits involved with treatments in all healthcare professions. This is why communication is so very important. Disappointment, misunderstanding and frustration can be avoided when a dentist helps a patient understand and manage a situation that may be more complicated or chronic in nature.

When a patient is offered solutions, but for whatever reason, decides not to comply with treatment recommendations, then they need to understand the possible future implications of their decision. However, if a particular problem persists after repeated dental visits and following all of your dentist’s advice, then it is reasonably acceptable to ask your dentist to refer you to a dentist more specialized in your particular dental issue.

There is nothing quite as long lasting and as strong as your natural teeth. Preventing dental disease, breakdown and injury in the first place is your best bet for avoiding the uncertainties of some treatments that may require on-going monitoring, modification or even re-treatment. 

If you are new to the area or just searching for a dental family to call your own, Dr. Sam Axelrod and his team of caring professionals are always here to help. We’re just a phone call away to answer any questions or concerns you may have.

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Your in Better Dental Health,

The Your Smile Dental Care Team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 

 

 


2 Comments

Tips for a less Painful Dental Cleaning

Not everyone SMILES when having their teeth cleaned!

04-04-2016 3-25-58 PMNothing costs more in the long run like neglect.  This is why we promote regular dental re-care visits and cleanings so passionately. But for some people, cleanings are not exactly routine – they are painful!

A visit to the hygienist can be a real deal breaker when it comes to professional dental visits with some people avoiding cleanings at all costs. Technique is a learned skill. For some, it comes naturally, while for others it takes time to really hone their craft.

A good hygienist will be both thorough in their technique and gentle, but understand that dental scaling is often a tedious and time consuming process. The more build-up you have, the longer and more involved the procedure.

You can help predict your next cleaning experience by following some, if not all, of the following advice.

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1. The more frequent you have your teeth cleaned professionally, the less buildup there will be and the less tender and sensitive your gums will be.

2. Good home oral hygiene (especially flossing) helps to reduce the tartar accumulation. Oftentimes, using an electric toothbrush will do a more thorough job.

3. Take an anti-inflammatory before and after your appointment to reduce any discomfort during and after the cleaning.

4. Ask if you can have topical numbing spray/gel or have your teeth frozen (anesthetic) during the cleaning.

5. If your teeth are sensitive or you have gum recession, try switching to a toothpaste for sensitive teeth to build up some resistance in the sensitive areas.

6. You can reduce the chance of sensitive gum recession by not wearing them away with harsh toothbrushes, toothpastes or scrubbing action.

7. If you can identify exactly what exactly causes you discomfort during the cleaning (water-sprayer, ultrasonic cleaner etc…), perhaps your hygienist can offer an alternative cleaning method.

8. If you have a lot of tartar buildup, break up the cleaning over 2 or more appointments

9. Sometimes, an earlier appointment in the day will help if you find yourself more fatigued as the day wears on. Worth a try!

10. Ask around. Like any professional skill, it takes time to hone your craft, so to speak. If you feel that you need to switch hygienists, perhaps the office employs more than one or ask your family and friends for a good recommendation.

11. A scolding, judgmental hygienist can also be a painful experience. Advice can be given in a compassionate tone without reducing it to a lecture. Never be intimidated to the point where you let this type of conduct go unanswered. Let the hygienist AND the dentist know how you feel.

12. Do not judge the quality of dental treatment based on the absence of pain afterwards. If it has been a long while since you’ve had your teeth cleaned last, a good, thorough cleaning can leave gums swollen and sore. Your hygienist will tell you what to expect after your cleaning and what you can do to relieve post-cleaning discomfort.

 

There’s a saying – “A toothbrush can’t remove 6 months worth of tartar 30 minutes before your dental appointment.” Our goal is to help you have the best patient experience possible. Being an engaged advocate for yourself and taking responsibility for a healthier you by using the techniques described above will go a long way in improving your future dental cleanings.

Yours in Better Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com