Dentalnews (en)

Toothache 3/5

Maybe you don’t have a toothache, but your face kind of hurts, or is this a case of trigeminal neuralgia?!
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The colleague comes to the rescue
The dentist has no idea what to do, most of the teeth have been removed, only some are left, but the pain is still there. The ear, nose and throat specialist was not informed about these goings-on, but is faced with an anxious patient who has lost their faith in the system, and not being able to find a specific cause, takes a crack at a diagnosis – a trigeminal neuralgia.
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A neurologist of course rejects this, and surmises a case of atypical facial pain. And so the patient starts „doctor-hopping“, a plethora of diagnoses, but no end to the pain. Everything is falling apart, you’re turning into a nervous wreck, and maybe even getting depressed?

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You’re willing to try just about anything, even homeopathic treatment and other types of “alternative” medicine – with no guarantee of success!

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You can no longer tell where exactly the pain is coming from, maybe there are still a few teeth left, maybe your mother and grandmother also had problems with their teeth, so what’s to stop that from happening to you?!

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Stay tuned for: Once upon a time there was the tooth IV

Toothache 1/5

This week we would like to show you how it all began, just like one of those cartoon documentaries on evolution – except that we’re doing the evolution of the tooth!

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You know how some stories are long and need to be told in parts. Well, this is going to be a five-part series, which we personally think is long enough!
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Here is a short preview of all of this week’s episodes

1. Getting my fillings replaced was a good idea, so why do I still have a toothache!
2. One root canal after the other, but the toothache won’t go away?!
3. Maybe you don’t have a toothache, but your face kind of hurts, is this a case of trigeminal neuralgia?!
4. Teeth gone, toothache and desperation still around!
5. The journey’s over, now you’ve made it to this article!

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Getting my fillings replaced was a good idea, so why do I still have a toothache!
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The sun is shining.
You’re finally making money on your own, you have long since left your parents’ house, and you may even have a family of your own. You have everything anybody could ever want – there’s a nice car in the driveway in front of your house, your four children are happily playing in the garden. You and your partner have achieved all your goals, you got your college degree, and then embarked on a great career – you’ve spent 15 years abroad and speak 4 languages.
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We are parents, lovers, adventures and friends in one, the only thing we always forget about is our teeth, until one fine day we decide to replace our old amalgamate fillings by something newer, whiter and more natural, composite fillings (white fillings). For a small sum, say 50-150€ we get our spanking new white fillings.
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Clouds on the horizon
You’re already on your way home when you start feeling pain after getting your fillings – one or more of your teeth start to ache! And when you bite down on something you get some kind of unpleasant „feeling“. Some of us are lucky, and it takes days, weeks, months, or even years until you start having problems with your teeth. Many of us only have problems for a short while but years later they come back in full force, and you have a bumpy ride ahead.
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Toothache – what now – what happened?
Plastics fillings consist of little building blocks, called monomers – kind of like legos. Once the dentist points the strange lamp at the fillings, these  monomers turn to polymers. The light puts the legos together – and the plastic hardens, a process called polymerisation.
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But the plastic can only harden thoroughly if moisture is kept away from the tooth, and this can only be done using a cofferdam. Moreover, the plastic should be applied in thin layers and allowed to harden immediately, otherwise the bottom layers will stay soft. Done properly, this may take up to an hour!
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These fillings should not be used on chewing surfaces either, as the polymers are unstable and monomers can start breaking out of the structure.
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Depending on how the procedure was performed (moist, without layering, deep fillings) loose monomers may be present from the very beginning, and start to break away eventually. These monomers are also “poison” to the dental nerve, which gets damaged and gives you a toothache. This may happen right away, or it might take days, weeks, or months, depending on the depth of the filling, how well the filling was made and the quality of the materials used. Your judgement may also be influenced by your sensitivity to pain.

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Stay tuned for: Once upon a time there was the tooth II

Our appearance is influenced by many different factors, one of the biggest being our teeth!

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Health, beauty and feeling good are becoming ever more important in the industrialized countries. One interesting aspect is that ideals diverge in the northern and southern countries of Europe, in the South (for example Spain, Italy, Greece, etc.) having gaps in your teeth is very common if you live in the countryside.
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A mouth full of healthy teeth tends to be the exception rather than the rule, it is more common to be gap-toothed. And although city-dwellers tend to have less gaps, they do not pay much attention to the appearance of the teeth they do have.
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Gold teeth, bad crowns, ugly amalgamate fillings and/or and or badly made plastic fillings are the norm!

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In the more northern countries of Europe (Austria, Switzerland, the Netherlands, Germany, …) you will rarely find such poor work. If you do, then the person probably could not afford better work. There is a definite trend towards „White“.

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The concept of „aesthetic dentistry“ came to us from the USA. White is not enough – everything has to look natural and teeth are not totally white!

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Ironically, Galip Gürel – a Turk – is the chairperson of the Association for “Aesthetic Dentistry”. There is a trend towards teeth that look more natural. Teeth like those of the former Austrian Chancellor Dr. Klima are a sign that incompetent dentists and dental technicians were at work.

A crown need not be visible, much less a plastic filling in the front (picture above)! These are works of art, which not all dental technicians can master, and crowns such as this can cost €1500-2000.

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A €500 crown stays visible, but should not cause any inflammation and/or recession of the gums – a groove cut and threads should be the standard nowadays, no matter the look!

Composite (Plastic) fillings – are they worth the cost?

White fillings are in ever greater demand – but they are not always a good idea!

People are sick of silvery amalgamate, people want to look good, and this includes having a perfect set of teeth. Many people are now getting their amalgamate fillings replaced by white fillings. In the picture you see diffrent white Fillings: Composite (1); Glasionomercement = GIZ (2); Ceramicinlays (3); Goldceramicinlays (4).

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Be aware: Composite fillings do not work that well in side teeth, a fact which many people do not know!

–Even manufacturers warn that these fillings should only be used to correct surface defects, since teeth do not react well to them. The tooth nerve often dies when this type of filling is used, leading to a root canal.

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Patients who get their amalgamate fillings replaced by plastic are in for a bumpy ride. The fillings consist of tiny building blocks called monomers. As soon as a dentist shines a lamp on the filling, these little monomers start to connect – like Lego blocks, a process called polymerisation, which results in polymers – larger building blocks.

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But these plastic structures are not stable enough to hold up under chewing, so little „Lego blocks“ – monomers – start to separate (green area means Composite Fillings are ok, red area means Composite Fillings are not ok). These free-floating monomers are very toxic, they invade the tooth nerve, and the nerve dies.You do not feel the pain right away, it may take years for the   „dead“ tooth to start making trouble, so patients do not always attribute this problem to the plastic filling. Some patients experience problems immediately after the plastic is inserted, such as problems when chewing, pressure, excessive sensitivity to heat or cold.

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While some dentists specialize in this type of filling and use a coffer dam, special covers and layering methods to prevent complications, but plastic fillings still end up costing about as much as a ceramic inlay. But ceramic inlays are much better for your teeth than composite fillings – assuming the inlay is inserted correctly.

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White teeth may be more trouble than they are worth! Think about what you’re doing. If you invest in your teeth, then be sure to use goods materials – gold, titanium or ceramics!

And/or develop a better brushing technique, because if you have poor brushing habits then you will need fillings someday.

Toothache 2/5

One root canal after the other, but the toothache won’t go away?!
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Going to a dentist helps – doesn’t it?
„You have a bad tooth“ whatever that means – it’s something patients hear all the time.
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A tooth can’t help being “bad”, after getting „poisoned“ by the monomers injected into it. Good root treatment is performed using a coffer dam, a magnifier and a lot of patience – here you can see how it’s done.
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Sometimes things don’t run that smoothly, sometimes the root canal is not thoroughly cleaned to the tip, sometimes the instruments are not well-sterilized, and sometimes the tooth is not filled up.
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Pain after root treatment?!

Badly performed root treatment means that problems persist, and this is where it gets complicated, because it’s hard to tell whether the pain is the result of a badly performed operation on a specific tooth, or whether it’s coming from the tooth right next to it, which also got some plastic filling. Are you allergic to this type of filling?
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This is not an allergy!
An allergic reaction requires the presence of immune cells and therefore blood. But the tooth is a mineral, and although monomers can seep through it and damage the nerve, the dentine does not contain any blood. At most, you may have a contact allergy, which will make itself felt in the membrane, but this is a different kettle of fish.
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One root canal after the other!
Because dentists don’t know what to do in cases like these, they just keep performing root canal treatment. But the toothaches continue, so they go on to perform root tip resections. Normally the ordeal should be over, but then even more problems may appear:
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If the resection was not properly performed, and the canal not cleaned, either from above (orthograde) or from below (retrograde)!

• Are there still any teeth left which have plastic fillings?
• Has the inflammation/ have the monomers spread even further?
• Was faulty root treatment performed at some point, and is only now starting to cause problems?
• Was root tip resection performed correctly  – using sterile instruments in a sterile environment?

Stay tuned for: Once upon a time there was the tooth III