How can I have a cavity if my tooth does not hurt?

June 22, 2011 alexnguyen

Your tooth will only hurt if the cavity penetrates the chamber which houses the nerve inside your tooth. A cavity begins from the outside surface of your tooth and usually balloons inwards until it penetrates the nerve. Bacteria from the cavity and temperature exposure will cause the nerve to become inflamed and eventually ... die. That's when it really hurts.

The best way to diagnose the extent of a cavity is to use proper radiographs. Regular check-ups allow your dentist to catch cavities in their early stages of development. A small cavity is much easier and inexpensive to fill, than to wait until that cavity dictates the need for root canal, build-up, and crown treatments.

The Xray below shows 3 cavities on a patient who has not been to the dentist in a number of years. This patient has no pain in her dentition, yet it is a matter of time before these cavities become big problems for her dental health.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Allergies and Toothache

April 12, 2011 alexnguyen

The arrival of Spring induces allergy symptoms such as itchy/watery eyes, excess nasal irritation and drainage, dry cough, skin rash, etc. However, there is a unique symptom which occurs sometime in conjunction with excess drainage in the sinus: Toothache on the upper molars or bicuspids. The upper bicuspid and molar roots are embedded in the sinus cavity. When the sinus cavity is filled with excess drainage from allergies, pressure from the sinus on the roots can cause a discomfort which mimics a toothache. An improper diagnosis may result in unnecessary root canal treatments to alleviate the associated pain. Careful examination and tests should be done to rule out toothache associated with sinus drainage or infection.

In this case, a regiment of antibiotics and antihistamines may very well alleviate the toothache-like problem. Yes, sometimes you can blame pollen for your toothache !

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Problems with Root Canal Teeth and the Importance of Proper Advanced Planning for Dental Implants

November 14, 2010 alexnguyen

Root Canals will alleviate pain from the affected teeth. However, when root canals are not done properly problems may not be evident until much later. This patient described the symptom as "some discomfort around my old crown".

Thorough clinical exam and xray revealed a fractured root where a large post was placed in the canal. The root canal and crown were done many years ago. Root canal treated teeth have a higher chance of root fracture. Although the patient had no pain after the treatment, the failed root canal and post placement sustained a low grade infection around the root area. Where there are infections, bacteria slowly cause the jaw bone to break down.

In areas where the bone is extremely dense, the patient may not have any symptom until too much bone have been lost. In the xray below we can see the outline of the extent of the bone loss. What you cannot see when looking at the area inside the mouth is an entire wall of bone that has been destroyed. That wall of bone used to exist between the root and the gum tissue on the out side.

So why is this discussion important in treating these kinds of problems?

If we simply extract this tooth, the bone loss area will collapse. After the area has healed, any subsequent grafting procedures and treatment planning for dental implant in the area may become extremely difficult to carry out.

If your treatment preference is to replace this tooth with a dental implant, it is crucial that you consult with the right clinician to properly treatment plan the situation. Carrying out the treatment with proper advanced planning will minimize further complications to the area.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

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Another Case of Sensitivity after Resin Filling

April 22, 2009 alexnguyen

Here is another case where voids in resin fillings will cause the tooth to be sensitive. This patient's complaint was "I had some fillings done on my upper left quadrant, and the teeth on that side have been sensitive since." The black arrow points to a distinct void underneath the white filling. To correct the problem, we will need to redo this filling for the patient.

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Sensitivity Problems with tooth colored fillings?

September 26, 2008 alexnguyen

Do you have sensitivity problems after you had a tooth colored filling placed? Tooth colored fillings are also known as resin fillings or composite fillings. When done correctly, this material can be made to look like your tooth was never touched. We can make a filling blend in well with a tooth. It can look very beautiful. However, when resin fillings are mishandled, the tooth may feel more sensitive to temperature than before the filling was placed.

Here are some possible causes of your sensitivity after a resin filling was placed:

Improper removal of decay
Improper bonding technique
Improper placement technique
Improper adjustment of the fillings after it was placed

Yesterday a patient came in to see me because she had sensitivity to cold and sweet on her upper left quadrant. This xray revealed a resin filling was placed with folds within it, and there was a gap between the filling itself and the tooth structure. In addition, there was decay underneath the filling when I removed it.

In this scenario, the cause of the sensitivity with this filling was due to 3 of the above 4 reasons. The remedy was for me to remove the entire filling and all decay underneath. Then a new perfect filling was placed, and the sensitivity went away!

In the xray below, note the arrows pointing toward the improper contact between the filling and the tooth.

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