Bad Breath (Halitosis)
Dr. Pichardo feels that while bad breath might be a symptom of some other disorder, it most likely stems from dental decay and periodontitis. Periodontitis is a disease affecting gums and bone that support the teeth, and it results from inadequate tooth brushing and flossing. In this disease, the irritated gums pull away from the teeth and form pockets between the teeth and the gums. These pockets fill with bacteria and pus which give off a foul odor. Patients with bad breath need a complete dental evaluation by Dr. Pichardo. If gum disease and/or dental decay is diagnosed, it can be treated readily. The patient will no longer have an infection in his or her mouth, and he or she will no longer have the embarrassment of bad breath.
Each year about 400,000 people (including many in the New York metro area) with cancer develop treatment-related complications in the mouth ranging from lesions to chronic dry mouth to bone disintegration. If serious, these complications can be life threatening. While many are unavoidable, some can be prevented or minimized. Dr. Pichardo recommends that whenever possible, a pre-therapy dental evaluation with a full set of mouth x-rays be performed. Any decay, gum disease and abscesses should be treated, if time permits, prior to chemotherapy and/or radiation therapy. Even patients who have no pain or dental disorders need a thorough cleaning. Our goal is to have the patient's mouth in optimal health prior to beginning anti-cancer therapy.
Children’s First Visit
The rule of thumb is "First visit by first birthday." An early examination with Dr. Pichardo and preventive care will protect your child's smile now and in the future.
For years dentists have been using silver-mercury amalgam fillings to restore decayed or broken teeth. The only other alternative was gold and that was too expensive for most folks. Now there is a new and economical way to restore teeth using tooth-colored resin fillings. The resin is made up of glass particles in a plastic matrix. We bond the putty-like material to the tooth with a high-intensity light. This hardens the material and allows it to be shaped and polished for immediate use. Once completed, the tooth has a natural appearance and is actually stronger than before due to the strength of the adhesive agent used to bond the resin to the tooth. Resin restorations not only look better, but they are stronger and last longer than the old silver-amalgam fillings.
There comes a point where the damage to the tooth has removed too much structure to hold a filling. The restoration must be done by a technique that will attach to the remaining tooth, stand up under heavier use and meet more elaborate cosmetic requirements. The crown is the dental restoration that can strengthen and restore the entire top of a tooth. The crown can also be part of the attachment of a fixed bridge for the replacement of teeth. The tooth is strengthened because it is covered from the outside with a casting of metal or ceramic that will wrap up and splint the tooth. The chewing of the tooth can be improved because it can be reshaped to match more efficiently with the opposing teeth. A crown can improve cosmetics by the use of modern ceramic processes that produce translucency and color that is more natural than has ever been possible.
The crown serves two important functions. First, it restores the appearance of your teeth and your face. If your tooth is severely decayed or cracked, the dentist will need to restore it prior to preparing a cap. Teeth also support the muscles in our faces, so anything less than a full tooth may affect the way you look. Second, a crown will be the same size and shape as the natural tooth. As a result, it will keep your jaw and bite aligned; it will also make sure that other teeth don't shift locations or take on a greater share of the work of biting and chewing.
Dental crowns are most often made of gold or porcelain. Crowns also can be made of stainless steel, but those crowns are often temporary and not designed for long-term wear. Porcelain crowns usually are built on a metal base, which fits snugly over the natural tooth. Porcelain crowns usually are so carefully matched in color, they cannot be distinguished from your natural teeth. Many people choose porcelain crowns for their cosmetic appearance and the confidence it gives them. New materials are now available that allow the use of "all-ceramic" crowns in some cases. They have a beautiful life-like appearance and short-term studies support their success, with long-term trials ongoing. Crowns also can be made of all gold. Some people prefer not to use gold because it stands out from the other teeth in appearance. At the same time, if the crown is on a back molar, some people feel the cosmetic issue is not a big one.
Dentures are removable prosthetic devices designed to replace missing teeth. Partial dentures are dentures that replace only a few missing teeth. Complete dentures are dentures that replace a complete set of missing teeth. Conventional dentures are dentures that are made and placed after the remaining teeth are removed and the tissues have healed. Immediate dentures are dentures that are placed immediately after the removal of the remaining teeth. An over-denture is a denture that fits over a small number of remaining natural teeth or implants.
Partial dentures are dentures that replace only a few missing teeth. Removable partial dentures are attached to your natural teeth with metal clasps or devices called precision attachments. Your partial denture may feel awkward or bulky for the first few weeks, but your mouth will eventually get used to it. Initially, you may want to wear your partial denture all the time. Your dentist will give you specific instructions on how long it should be worn and when it should be removed. Generally, your mouth tissues need to rest so it is advisable that you take out your partial denture at least 15 minutes per day. Your partial denture may help your speech. It can be difficult to speak clearly when you are missing teeth. However, it also will take time to get used to it.
For a few weeks, new dentures will feel awkward until you become accustomed to them. They might feel loose until the cheek and tongue muscles learn to hold them in position. It is not unusual to feel minor irritation or soreness. The patient needs to see his or her dentist for regular fit adjustments to relieve any sore areas. We find that dentures will need to be relined, remade, or rebased due to normal wear over a period of time and normal shrinkage of your gums and bones. Eating with dentures will take a little practice. You should start with soft foods that are cut into small pieces. As you become used to chewing, you can return to your normal diet. There are only a few eating restrictions for denture wearers. Avoid biting down directly on crunchy or hard foods, like whole apples, hard pretzels, crusty bread, or large sandwiches. They can break because of the angle where the denture comes into contact with the hard surface.
Biting is limited only by the stability of the dentures themselves. Insufficient bone structure (shrunken bone ridges covered by gum tissue), old or worn dentures, and a dry mouth decrease stability. Today's dentures have been significantly improved through advances in both dental and materials technologies. As a result, dentures that fit properly usually do not require adhesives to secure the dentures. When you are just getting used to dentures, adhesives may be advised, but otherwise should not be necessary.
We feel a loose denture is a sign that it doesn't fit your mouth correctly. When first getting used to dentures, you may notice them slipping when you laugh, smile, or cough, which is caused by air getting under the base and moving it. The more you wear dentures, the better you will be able to control their movements in these situations. If your mouth has insufficient bone structure, dentures will be more difficult to retain. Dental implants may be advisable. These are placed in the bone and retain the denture with small, precision attachments.
When cleaning your dentures, you should first rinse away loose food particles thoroughly. Then moisten your toothbrush and apply denture cleanser. Brush every surface, scrubbing gently to avoid damage. The denture needs to be cleaned two to three times daily. In addition to taking care of your dentures, taking care of your mouth also is vital if you wear full dentures. This includes brushing your gums, tongue, and palate every morning with a soft-bristled brush before inserting your dentures. This stimulates your tissues and helps remove plaque.
If your dentures crack or break, call your dentist immediately. Normally, dentures can be repaired quickly, often on the same day. Damaged dentures can cause additional oral health problems, so see your dentist right away. Never attempt to repair dentures yourself. They require professional repair and adjustment. Glues often contain harmful chemicals and are not effective in the proper repair of dentures.
Diet and Dental Health
Diets low in certain nutrients reduce resistance to oral and dental infections, that is, periodontal disease (gum disease) and decay. Dr. Pichardo feels a healthy immune system is essential to controlling periodontal disease. Counseling in the Four Basic Food groups will improve dental health and general health. The consumption of sugar, especially in sticky forms or in a baby bottle while sleeping, contributes to the rapid development of dental decay. The trace nutrient fluoride may not be adequately supplied by bottle or municipal water supplies throughout the Westchester area. Supplementation with oral tablets and topical application will reduce the incidence of dental decay by more than 60%. Together, a balanced diet, daily use of fluoride, effective brushing, and sensible eating habits can reduce the risk of, or even prevent, infectious dental disease. Please don't hesitate to call Dr. Pichardo at 914-235-7453 if you need more information on diet or fluoride supplementation and its relationship to dental health.
Dry Mouth (Xerostomia)
More seniors today in the New Rochelle area have retained their own teeth, avoiding the trauma of removable dentures. Many are on medications creating dryness of the mouth as a side effect. Without the natural benefit of saliva to decrease bacterial action, Dr. Pichardo is seeing an increase of cavities on the root surfaces of these patients. Anyone on a medication causing a dry mouth effect should be encouraged to visit Dr. Pichardo for regular dental cleanings and topical fluoride rinses.
Early Childhood Caries (ECC)
Signs and appearance of baby teeth displaying bottle caries include brown baby teeth with fragmented edges and upper front baby teeth that break easily. Children who have erupted teeth or are past the age to be weaned are highly susceptible to rotted front teeth when being put to bed with a bottle containing milk, juice or other sugar-containing liquids. There is decreased salivary flow during sleep and clearance of the liquid from the teeth is slowed. The liquid pools around the upper front baby teeth and creates an excellent environment to promote the growth of decay-causing bacteria. Removing the bottle before the first tooth appears and wiping the child's gums and teeth with a soft cloth before being put to bed can help prevent decay.
Emergency Dental Treatment
Many people don't see a dentist on a regular basis. They go only when they feel they have a problem. We call this "crisis treatment" as opposed to "preventive treatment". While these patients may feel they are saving money, it usually ends up costing much more in both dollars and time. The reason for this is that most dental problems don't have any symptoms until they reach the advanced stages. An example is tooth decay. We hear all the time, "Nothing hurts... I don't have any problems". But tooth decay doesn't hurt! Until, that is, it gets close to the nerve of the tooth. Then a root canal and crown are usually necessary, instead of a small filling, which could have been placed several years ago when the cavity was small. Dr. Pichardo can usually detect a cavity 3-4 years before it may develop any symptoms. It is not uncommon to see a patient with a tremendous cavity despite the patient never having felt a thing!
Gum Disease (Periodontal Disease)
The American Dental Association says that 75-80% of all adults have or will have some form of gum disease. Gum disease, or more correctly called "periodontal disease", is a bacterial infection in the gums and supporting structures of the teeth. It can be divided into several categories. The first stage is called "gingivitis" and is characterized by gum tissue that is red, puffy, and bleeds easily when touched with a toothbrush, floss or dental instrument. The second, third, and fourth stages are initial, moderate, and advanced "periodontal disease", respectively. These stages are different from gingivitis because the infection has destroyed the bone supporting the teeth, causing eventual tooth loss.
Periodontal disease can go on for years without pain and without detection unless specific examination procedures are performed. Visual oral examination by itself (even by a dentist) will not reliably detect periodontal disease until it has reached an advanced stage. Early detection and adequate diagnosis require measurement of pockets (the crevice between the tooth and gum) with a periodontal probe.
Losing a tooth by accident or by extraction is not the end of the matter. When a tooth is missing, the resulting gap will allow nearby teeth to tilt or drift from their normal position, and the teeth above the gap will move downward. Aside from the obvious cosmetic problem, the changed positions of these teeth can lead to severe bite problems causing jaw pain and headaches. Missing teeth should be replaced to keep other teeth in their normal position. This can be done with a fixed bridge or a dental implant. Both of these treatments offer a good functional and cosmetic result.
A dental implant is a titanium metal replacement for a root of a tooth that is surgically implanted in the jawbone. As the body heals for approximately two to six months after the surgery, the bone around the implant fuses to the implant through a process called Osseo integration. After the healing phase is complete, the implants are used to anchor crowns, bridges, or dentures.
In the past, the loss of teeth (edentulism) was dismissed as a natural part of the aging process, and dentures were considered a normal sign of old age. While such ignorance is rapidly becoming a thing of the past, there is still not a general awareness of the seriousness of edentulism. Multiple tooth loss is most commonly caused by periodontal disease, i.e. gum and bone disease. We know that periodontal disease has a high statistical correlation with chronic debilitating disease, such as diabetes, cardiovascular disease and arthritis. So it is not very surprising that studies now show a shortened life expectancy by as much as 10 years for persons who have lost their natural teeth, when compared to those who have kept their teeth. In addition to longevity, quality-of-life differences are just as significant. The functional efficiency of dentures has been measured to be only 20% of that of natural teeth. Dr. Pichardo Has no doubt nutritional deficiencies will be much more prevalent in those without their natural teeth. Loss of teeth often causes a feeling of loss of wholeness and a sense of deterioration and aging. Given these factors, we feel that preservation of the natural teeth is integral to whole-person wellness.
While mouth guards are not mandatory equipment in all sports, their worth is indisputable. Mouthguards cushion blows to the face and neck. A mouthguard should be part of every athlete's gear, no matter the sport. Even adults or weekend athletes need to protect their smile and preserve their health. Dr. Pichardo feels that you should wear a mouthguard at all times when playing sports. Wear a mouthguard custom-fitted by a dentist, especially if you wear bridges or braces. There are two types of mouthguards:
custom-made and ready-made. Custom-made mouthguards are designed by a dentist and made on a cast of your teeth. These cause very little interference with speaking or breathing. They provide the best protection and fit over braces and fixed bridges. They also cost a bit more. Ready-made: are purchased at most sporting goods stores. They are the less expensive, but less effective and less comfortable. Please call our office at 914-235-7453 if you would like to "play it safe!" and wear a comfortable mouthguard and protect your teeth.
One of the easiest problems to spot is a build-up of plaque. Plaque is a soft, sticky layer of bacteria which is constantly forming on the teeth. Usually it is invisible to the naked eye, but when a person is not brushing adequately, it can build up to where it appears to be a thick whitish coating on the teeth at the gum line. If not removed, it can lead to gum disease. Another potential problem, which is easy to spot, is missing teeth. Many patients Dr. Pichardo sees assume that if they are still able to eat, they are all right. However, very often losing just one tooth can lead to a loss of support, and teeth begin to drift into the empty space, causing a change in the bite. It also forces the remaining teeth to carry an additional load, sometimes past their ability to adapt. In most cases, when even one tooth is lost, the remaining teeth suffer and are more likely to be lost as well. Dr. Pichardo’s focus is in the treatment of problems such as these.
Many mothers have experienced gum disease, dental pain and/or tooth extraction during or shortly after their pregnancy. This is often seen as being a "normal" side effect of being pregnant. However, we feel that dental disease, which is an infection of the teeth and/or gums, is not "normal" for any patient. There are three basic events that happen during pregnancy which make the patient more susceptible to dental disease. First, hormonal changes may make the gums more susceptible to gum disease. Second, pregnant women tend to eat smaller, more frequent meals, exposing their teeth and gums to sugars and acids more often. Third, cravings for "junk foods" and inadequate oral hygiene pose an increased threat to the teeth and gums. Pregnant women are advised to schedule a dental evaluation and receive preventive dental care. Personalized oral hygiene instruction by Dr. Pichardo will be given to fight disease and promote overall good health for the mother and her baby.
Preventing Tooth Decay
Fluoride, in proper dosage, has been shown to significantly reduce dental decay. When fluoridated water has less than the ideal amount or is not available, fluoride supplements are recommended. (A call to your local water district is all that is necessary to determine whether your water has fluoride or not). When supplements are needed, the administration of fluoride supplements should begin shortly after birth and continue through the time of eruption of the second permanent molars (approximately 12 years of age). Regular dental check-ups should begin no later than 18 months of age. Regular brushing and flossing lowers the chance of developing cavities. We know that the most decay-prone areas of teeth are the grooves and depressions on the chewing surfaces of the back teeth, which require further preventive care. To prevent decay, a plastic-like coating called a sealant should be painted on the chewing surfaces of all the back teeth. Nationwide studies have shown that sealants can reduce tooth decay by as much as 90%. The American Dental Association recommends, and Dr. Pichardo agrees, that sealants be placed as soon as the first adult back teeth come in at age 6 or 7. Sealants should continue to be used as each adult back tooth comes into the mouth. All back teeth that need to be sealed are present by age 13. Sealant application is simple, fast, and painless.
A root canal procedure limits the infection and keeps it from destroying the tooth. During the root canal treatment procedure, the dentist removes the inflamed or infected tissue, carefully cleans, disinfects, and shapes the root canal space inside the tooth, and then fills and seals this space. It may take one or more appointments to complete the procedure. A protective restoration should be placed after root canal treatment has been completed in order to restore the tooth to function and help prevent tooth fracture. We think of a root canal as washing the invasive bacteria out of the root, filling it with a biocompatible material that soothes the area, then sealing it back up again. Top it off with a solid filling or a crown, and you're as good as new. That means you get to keep your tooth. And that's a good thing.
Root canal therapy has three purposes:
- Stop the toothache
- Prevent bacteria and pain from spreading into the jaw
- Maintain the original tooth instead of replacing it with a denture or bridge
The root canal is actually a channel that runs from the root of the tooth, which connects to the bone, up to the top surface of the tooth. The canal contains blood vessels, nerves, and the complex cells that make up the living tissue inside the tooth. This lifeline inside the tooth is called the pulp. When a tooth is decayed or cracked, bacteria can get to the pulp. The acid from the bacteria irritates the pulp and it becomes inflamed; it's the same process you watch when other parts of your body become infected. When the pulp tissue becomes inflamed, it's harder for blood to flow to the tissue, and the resulting pressure creates pain inside your tooth. Endodontic disease can manifest itself with a wide variety and combination of symptoms. Common symptoms of endodontic disease include:
- Lingering sensitivity to cold liquids
- Lingering sensitivity to hot liquids
- Sensitivity to sweets
- Pain to biting pressure
- Pain that is referred from a tooth to another area, such as the neck, temple, or the ear
- Spontaneous toothache, such as that experienced while reading a magazine, watching television, etc.
- Constant or intermittent pain
- Severe pain
- Throbbing pain
- Pain that may occur in response to atmospheric pressure changes, such as when flying or scuba diving
- Pain that may occur in response to postural changes, such as when going from a standing to a reclining position
If you have any of these symptoms, it would be wise to visit us because you might have root canal disease or another dental problem. Some of these symptoms may also be attributable to decay, defective fillings, periodontal diseases, cracked teeth, or other tooth or bite-related problems. On other occasions, the symptoms may even be caused by disorders that are not related to the teeth.
Dr. Pichardo feels that good habits of effective daily brushing, diet, and use of fluoride will help the aging person adapt to changing conditions. Reduced salivary flow and addition of medications will affect oral health dramatically. Teeth will darken because of long-term exposure to plaque and changes in the dentin within the tooth. The gums may recede and uncover the roots. Exposed roots will be darker than the enamel part of the tooth and are prone to decay. Fillings can decay and darken, too, as they weaken over time. Dry mouth may develop. Saliva is useful to lubricate, wash away plaque, and neutralize the acid produced by plaque. Flow of saliva can be reduced by a medical disorder or be a side effect of antihistamine, decongestants, pain killers or diuretics. The build-up of plaque will accelerate tooth decay. There will also be more gum infection which will cause a loss of bone support for the teeth. Poorly-fitting or poorly-cleaned dentures, illness, and some medications increase the severity of the problem.