Michael A. Conrad

It is probably treatable. It all depends where you see stain on the tooth. If it is on the crown of the tooth, we might be able to polish it away. If it is on exposed root surfaces, it may be more problematic, since the root is quite porous and susceptible to deeper staining. If polishing doesn't remove stain, then tooth whitening or bleaching may be
indicated. It can eliminate most of the stains commonly found on the crown of a tooth, but can cause extreme sensitivity on the root surfaces with little result in lightening. If the teeth are bleached, any darkened fillings will have to be replaced to match the newly lightened teeth, since fillings will not lighten. In cases of extreme staining, sometimes it is necessary to cover the teeth with bonding, crowns or veneers to restore them to a lighter, more acceptable shade.

If bleaching is done, please be advised that the process leaves the enamel temporarily more porous and easier to stain. That means that you should avoid smoking and consuming dark beverages during the duration of the bleaching process (up to 10 days), otherwise the teeth may lighten with little polka dots of stain - not the look we are trying to achieve.

Also, please re-evaluate smoking in general. If you notice stain on your teeth, what is it doing to your lungs? When you consider all the possible cancer and heart risks, perhaps teeth staining is a serious warning sign. If you have only been smoking for a few years it is time to stop.

In my practice I see many patients, some of whom are smokers. Everyone is different. Some people smoke as many as 3 packs a day, and there is no tobacco smell on their breath or clothes and no stain on their teeth. Some smoke less than a pack a day and we can smell the evidence of their habit as soon as they arrive. They often have dark black or brown stain on their teeth. And we see patients in between those extremes. But the point is, everyone is different in their makeup and metabolism, so there is no one way that everyone responds physically to smoking, and that includes staining of the teeth and any other physiological effects that it may cause.

Please, it is time to stop.

Michael A. Conrad, DDS, PC

Yes, it is possible that an infection can develop from the extraction of wisdom teeth, but it is surprising how rarely that happens. When you consider that our mouths are filled with pools of bacteria, you would think that any wound in the mouth would easily get infected. But think how many times you may bite your lip or cheek or tongue - it may be sore for a few days, but then heals uneventfully.

Wisdom teeth are molars, and with any molar extractions, especially lowers, there is a chance of developing a postoperative infection. Sometimes, it happens because the patient does not correctly follow the post-op instructions. But sometimes it just happens. It can be called a "dry socket" and usually occurs when, for whatever reason, the blood clot is lost too soon, leaving a naked bony socket that is completely exposed to all the bacteria of the mouth. It often occurs around the second or third day after the surgery, after the patient was starting to
feel really good and recovered. The pain associated with a dry socket can be quite severe, more so than the initial extraction. It requires pain medicine, antibiotics, and a medicinal packing in the socket over a period of 3 to 5 days to resolve the problem.

Lower molar extractions have a higher chance of this happening because the blood supply of the lower jaw is not as robust as that of the upper jaw where there is a terrific blood supply. Consequently, clots on the lower jaw are simply lost easier, and the dry socket infection results. Dry socket infections can occur in the upper jaw, but are pretty rare.

On the whole, it probably doesn't really matter. Where it is sometimes important is in cases of extremely sensitive teeth. Some people need to use toothpastes that relieves sensitivity, and many find that, while effective initially, over time they seem to lose their effectiveness. Often switching to a different brand will restore effectiveness and
relieve sensitivity, but that will also diminish with time. Switching again to another different brand usually helps again, for a while. Eventually, the patient may end up getting good results from the original formulation once again.

Most of the times, it can be seen, but in the early stages of an abscess, it may not show up on any X-ray. Then, we have to make the diagnosis based on symptoms and testing of the tooth. The reason an abscess can be seen is because the infection has affected some of the bone around the root. It causes the bone to dissolve and be "eaten away", which results in a "hole" that shows up as a dark shadow. Sometimes it's very subtle, even for the dentist, and sometimes, it's very obvious.

We never know what one dentist will notice versus another dentist, but gum recession can be caused by many factors, one of which is over brushing. Using a hard toothbrush or scrubbing extra hard with any toothbrush can cause gum recession- of that there is no doubt. But some people have recession as an age-related problem, and others have it from a grinding and clenching problem. We can't do much about aging, but over brushing and clenching can be addressed.

As the gums recede, the root is exposed. There is no hard enamel on the root; in fact, it is much softer. Extra vigorous brushing over the root will actually wear away the exposed root and create a ditching effect, which itself can contribute to more recession. Yay.

So always use a soft toothbrush and start your brushing at the gum line and work away from it. Don't brush up and down or use the toothbrush like a scrubbing brush. More is not better- sometimes more is just more- and it will cause a problem.

If scrubbing and over brushing are not the problem, then investigate a clenching and grinding problem. Perhaps you might benefit from a night guard to prevent the problem when you are sleeping.

Also be aware that sometimes you may have had recession for a long time but it is stable. Perhaps the previous dentist noticed that and did not record any changes, so there may not have been a good reason to address it with you. A new dentist, not knowing your history, may be going only.

It all depends on how large the filling is and how you may or may not want to change your lifestyle habits. If the filling is very large, a veneer or a crown my be necessary to cover the area with a stronger restoration that will not stain. But if the filling is smaller, those other options would be too invasive. Then another filling is necessary. Please know that tooth-colored fillings are all a form of plastic, and that material is actually porous, and will eventually soak up stain from drinking or eating dark things like colas, root beer, red wine, tomato sauce, blueberries and dark chocolate. Also, smoking contributes greatly to the staining. If you do a lot of those things, expect your fillings to stain over time. Some patients only get 3 to 5 years of of life with that type of filling. But new materials are being developed everyday, and there may be a new product that would last longer. I just saw a promising one this week and will be ordering some for use in situations involving constant staining.

Many times an abscess can be sen on an x-ray- but not always.  An
abscess is visible usually in later stages of the condition when
infection has affected and dissolved some of the bone surrounding the
root, leaving a dark area or shadow in that area.  Usually, when
visible, the condition has been growing for 6 to 9 months. But
sometimes, in the early stages of an abscess, when the infection hasn't
yet caused too much visible damage, we have to rely on symptoms for the
diagnosis of abscess.  Some of those symptoms are: pain to biting,
spontaneous pain (toothache), pain to hot or cold that lingers beyond a
few seconds, or a draining "blister" alongside the tooth.  We can even
test  the tooth with a mild electric current to see if the nerve
reacts.  If it doesn't, it means that the pulp of the tooth has mostly
or totally died and an abscess is forming.

Waterpiks can be effective in cleaning between teeth, but usually they are an addition to flossing and brushing.  In the case of a full mouth of braces, where regular brushing and flossing is extremely difficult, the Waterpik is a wonderful aid.  However, in patients with beginning gum problems involving deeper pocketing around the teeth, proper flossing is most essential, as is regular care at the dental office. Everyone would like a quick fix in life, but sometimes "shortcuts" do not take care of the entire issue.  Certainly if the patient has a problem with using hands to floss or there is some other mechanical issue with flossing, then the Waterpik is the best choice, and certainly better than not cleaning at all.  If you can floss, that's the best thing.  Then, also using the Waterpik can only help keep you healthier!

It depends on a few things.  Some general dentists don't have extensive experience in removing impacted wisdom teeth, and thus are not comfortable with the procedure.  Then there are those with good experience that encounter a particularly difficult case that would be better handled by an oral surgeon.  But the usual reason is that the patient needs or wants to be sedated, and many general dental practices are not equipped or trained to provide general anesthesia, while surgical offices are fully equipped and trained for that.

Michael A. Conrad, DDS

This can be a very serious problem.  It is never a good sign that a tooth is loose.  That condition can come from three possibilities. First, there may be a problem with the attachment in the bone, and that could be related to the injury or may have begun before that.  That would be a periodontal problem.  Second, there could be an abscess, or a buildup of infection from the severe blow to the tooth.  That infection can loosen a tooth in certain circumstances, and results from the blood supply to the tooth being damaged and the pulp of the tooth dying.  Third, there could be a fracture somewhere in the root causing the looseness.  Of all three possibilities, the second is the best, and is the one with the greatest chance of long-term treatment success.  The other two possibilities are more serious, and ultimately, they have a grim future.  Examination and x-rays by a dentist are vitally important if you are to have any chance to keep that tooth.

Michael A. Conrad, DDS, PC

Sensitivity can come from so many factors that it is hard to tell you exactly what to do. Have you had recent x-rays to make sure there are no cavities or deteriorating fillings or other restorations? If nothing shows on x-rays, there is another device called the CariVu that can sometimes reveal problems in teeth that x-rays simply can't see- such as cracks or hidden decay. You may also have areas of receded gums with portions of the roots exposed. If so, those areas may be treated with a bonding agent to seal off the exposed root and decrease sensitivity. If that's the case, the treatment may be relatively quick and easy, but often needs to be repeated. You may also be a tooth clencher and grinder, putting a lot of mechanical stress on your teeth. Something like that might be helped with some sort of bite guard.

So, as you can see, there are many possible reasons for your sensitivity, and you would need some professional consultation and diagnosis to pinpoint the cause. We usually start with sensitive toothpaste, since that takes care of the problem in the majority of the cases. But, it's nice to be special and get more involved care. Good luck with the problem and I hope that it can be cleared up soon. If you can't enjoy ice cream or coffee, life just isn't as fun...

Michael A. Conrad, DDS, PC