Instruments of a Dental Office

When you go to your dentist, do you ever wonder what those tools going into your mouth are used for? They can be pointy, sharp, loud and very scary looking! We are here to put your fears to rest! These tools are simple and were made to make your dental visit pain-free.

The prophy cup polishes teeth after cleaning 

 An explorer detects breaks in enamel

A perio probe measures sulcus depth

 The high speed handpiece prepares teeth for fillings, etc

The slow speed handpiece removes soft decay

The sonic scaler cleans teeth quickly and easily

The Micro Air-Abrasion handpiece prepares teeth for fillings

 The high velocity suction removes water quickly

 The slow speed suction keeps the mouth dry

 The curing light is used to harden white fillings

The air/water syringe squirts air and/or water

Takes diagnostic x-rays of your teeth 

Click here to HEAR what sound each instrument makes!

These tools help make modern dentistry possible! You can come for your dental appointment without worry of pain!

Here are some antique dental tools that, thankfully, no longer are used!

Douglas Lever: a combination of elevator and forceps

Clockwork Drill: the first drill that could rotate continuously to remove damage from a tooth

Civil War era set of dental forceps: the drill in the center telescoped to work on the root of the tooth being extracted. Can you believe that during this time, the dental anesthetic still had not been popularized?! Ouch!

If you have any questions about what instruments Omni Dental uses or how we use it, please feel free to check out our website or give us a call at 512-250-5012

Check out this article for a more in-depth look at antique dental tools: http://gajitz.com/the-whole-tooth-5-truly-terrifying-antique-dental-tools/

Sensitive Teeth

Teeth can become sensitive for many reasons. Sometimes, the sensitivity is an indication of a potentially serious problem. Other times, the dentally related problem may be small but the effects (the sensitivity) are extremely aggravating. 

What do we mean when we say "sensitive teeth?"
Twinges of pain or discomfort in our teeth in certain situations such as drinking or eating cold things, drinking or eating hot things, eating sweets, and touching the teeth with other teeth or the tongue. Your symptoms will involve reactions to temperature or pressure. Sensitivity to cold drinks or foods is the most common symptom. 

Two types of sensitivity:

1. Dentinal sensitivity
When the dentin (middle layer) of a tooth is exposed. Normally, dentin is covered by enamel. Dentin becomes exposed when the outer protective layers of enamel wear away. Dentin contains tiny openings called tubules. Inside each tubule lies a nerve branch that comes from the tooth's pulp (the nerve center of the tooth). When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches, causing sensitivity.

Causes:

• Inadvertent notching of the tooth surface and/or recession of the gum tissue (exposing the root surface of the tooth) caused by improper brushing: either brushing too hard, brushing with a toothbrush that is too hard, or using an improper brushing technique, which will wear away the enamel layer. This sensitivity can range from mild to extreme; the degree of sensitivity does not appear to be related to the size of the root exposure or notch.
• Poor oral hygiene, allowing tartar to build up at the gum line
• Untreated cavities
• An old filling with a crack or leak
• Receding gums that expose the tooth's roots, often caused by periodontal disease
• Gum surgery that exposes the tooth's roots
• Tooth whitening in people who have tooth roots that already are exposed
• Frequently eating acidic foods or drinking acidic liquids 
• Purposeful repositioning of the gum tissue during gum surgery can also lead to tooth sensitivity. While recession from brushing is slow, gum recession following gum repositioning occurs very quickly. The portion of the tooth once covered with gum and bone may now be exposed.  Root sensitivity in these instances can be quite severe and immediate. It can sometimes last four months or years if not treated.

2. Pulpal sensitivity
The reaction of the tooth's pulp. The pulp is a mass of blood vessels and nerves in the center of each tooth. Pulpal sensitivity affects only a single tooth.
Causes:

• Decay or infection. When a tooth is decayed, temperature changes and sweets will make it sensitive. The solution can be as simple as removing the decay and placing an appropriate restoration.
• A recent filling. A tooth may be sensitive to cold for several weeks after you get a filling. The metals in amalgam (silver) conduct the cold very well, transmitting it to the pulp. Bonded (tooth-colored) fillings require etching the tooth with acid before the filling is placed. In some cases, this etching removes enough enamel to make the tooth sensitive. If a filling is defective or failing, leakage around the filling may cause the tooth to become sensitive. The solution can be as simple as removing the defective filling and placing an appropriate restoration.
• Excessive pressure from clenching or grinding
• A cracked or broken tooth. If the tooth is fractured, you may be sensitive to temperature changes or when chewing food. This fracture condition may be hard to diagnose. If you think you might have this type of sensitivity, read our blog post on "cracked tooth syndrome."
• A tooth can become sensitive after it has been prepared (drilled) for a restoration (filling). You may have been anesthetized during the procedure, so you did not feel any discomfort when the nerve in the tooth reacted to the heat generated by the drill. The closer the drill comes to the nerve, the more likely it is to cause a sensitivity problem. The high-speed rotation of the bur in the drill generates heat, and the response of the nerve to heat is inflammation. This inflammation is felt by you as a "sensitivity."  If the decay, fracture, or drilling was not too deep, this sensitivity will decrease over time. A week to a month or two is not an unusual length of time for the sensitivity to disappear. A good sign is the continued decrease of sensitivity.  However, if the occlusion (bite) is off after the restoration has been placed, the tooth may either become sensitive or may stay sensitive. Once the bite is adjusted, though, the sensitivity should disappear.
• A dying nerve. This can be the result of a deep cavity. Commonly, the sensitive tooth holds an old large filling. The nerve may be damaged during drilling and the nerve has been dying gradually ever since. If this is the problem, the tooth will need endodontic treatment (root canal treatment).

See this post about the 10 biggest causes of tooth sensitivity.

How will the doctor diagnose sensitivity?
Your dentist will look at your dental history and will examine your mouth. You also will need x-rays to show if there is decay or a problem with the nerve. The dentist will ask about your oral habits. Grinding or clenching your teeth can contribute to sensitivity. Your dentist also will look for decay, deep fillings, and exposed root surfaces. During the consultation, your dentist uses an instrument called a spray gun to dispense air across every area of each tooth in order to locate the sensitivity. He or she may use an explorer - a metal instrument with a sharp point - to test teeth for sensitivity.
 
How will it be treated?

• Your dentist or dental hygienist will clean your teeth. If your teeth are too sensitive to be cleaned, your dentist may use a local anesthetic or nitrous oxide before the cleaning. 
• If there is a notch in the tooth or the shape of the defect is appropriate, the defect is restored (filled in) with a bonded material. This can give immediate relief -- sometimes partially, sometimes fully. 
• When there is no defect to be restored, the exposed and sensitive root surfaces are covered with a dentin-bonding or other material. This material is invisible and has very little thickness, so you do not notice any change in the appearance of the tooth; but it works. It may have to be reapplied after several months because the bonding material has worn away by tooth-brushing.
• If you have pulpal sensitivity and the tooth's nerve is damaged or dying, you will need a root canal. Your dentist will remove the nerve and place a non-reactive substance in the space where the nerve was. The tooth will no longer have a continuous barrier of enamel to protect it. Therefore, it will be restored with either a composite filling or a crown.
• Your dentist may apply a fluoride varnish to protect your teeth. This temporarily reduces sensitivity and strengthens your teeth.
• Using fluoride toothpastes and fluoride mouth rinses are home will help to reduce sensitivity. You can also buy toothpastes just for sensitive teeth. You should choose a fluoride mouth rinse that uses neutral sodium fluoride.

How can I prevent it?

• Brush twice a day and floss daily
•  Use a soft or ultrasoft toothbrush 
• Brush gently up and down, rather than side to side 
• Use a fluoride toothpaste and mouth rinse 
• Use a toothpaste that protects against sensitivity 
• Get treatment for grinding or clenching your teeth (bruxism), like a mouthguard

If you have any questions about tooth sensitivity, please feel free to call our office for a consultation at (512) 250 - 5012.

Dental Injection

The amount of discomfort caused by any one dental injection can vary significantly. And even though so many patients are focused on the fact that a needle is involved, most of the pain from a dental injection is not related to the needle itself. Instead, it has to do with the location and type of tissue in which the shot is given.

Why is it not the needle's fault?
The needle initially does prick as it first enters the skin, but this only lasts for a split second. Once the needle is in position, the dentist does not move it around, so what would cause a further pricking sensation?

What is causing the pain?
The bulk of the discomfort that a patient experiences during an injection has to do with the act of placing a quantity of liquid (the anesthetic) into soft tissues. Shots in different locations have varying potential to hurt. It is the act of dispensing the anesthetic liquid into tissue that is painful.



Shots that are less likely to hurt:
Loose tissue: In some locations, the tissue receiving the injection is comparatively "loose," thus making it easy for the injected anesthetic solution to find a space to occupy.

• In locations where the tissue is relatively loose and flabby, the anesthetic solution will flow into the tissue easily and you probably will not feel the injection process much at all. Shots given on the cheek side of a person's upper molars, and probably even this bicuspids, involve this type of tissue and are often remarkably painless.

Shots that are more likely to hurt:
Dense tissue: In other areas, the construction of the tissue will be dense and tight. The anesthetic solution is injected, and it must forcibly make its own space - this is what pinches so much.

• In situations where the soft tissue receiving the injection is relatively tight and dense, the anesthetic liquid must force its way in. This type of instance is where you are likely to feel discomfort. As an example, injections given directly into the type of tight gum tissue that surrounds a person's teeth and covers over their palate are likely to pinch.

Will my shots hurt?
Ask your dentists what to expect with any specific injection. You may be pleasantly surprised to learn what they have to say.

What can I do to ease the pain?
Give your dentist some cooperation with the injection process. The more you cooperate with your dentist, the more pleasant the experience will be.

• The more you rush your dentist, the more likely it is to hurt: One factor associated with ease with which the anesthetic solution can enter into soft tissue has to do with the rate at which it is injected. The slower the rate, the less potential there is for discomfort.
• Be a cooperative patient: If you are an uncooperative patient, your dentist's natural instinct will be to speed up the injection process so it is finished more quickly. That is the exact opposite of what you want.
• Help your dentist be on-target, the first time: When a dentist performs a dental injection, they must place the anesthetic in the proper location. This takes a little concentration. If the dentist is focused on your behavior, as opposed to just performing the injection, it will increase the likelihood that the injection will be off-target and additional shots will be required. 
• If you want it to hurt, it will: Some people place themselves in a position of creating a self-fulfilling prophecy. They expect the injection to hurt and therefore do not give the process a chance, thus making a guaranteed unpleasant experience. 

If you have apprehensions about injections, let your dentist know in advance. They can address your concerns and take steps to make the process as pleasant for you as possible.

Extractions

Reasons for Recommending Tooth Extraction
Teeth may need to be extracted for several reasons, including but not limited to:

• severe periodontal disease
• irreversible damage to the nerve tissue inside the tooth (and the patient decides against saving the tooth)
• failed endodontic therapy
• extreme fracture or decay of the tooth structure
• improper positioning of the tooth or for orthodontic purposes

To a great extent, the reason for the extraction will influence the amount of discomfort you might experience subsequent to the procedure. When the tooth is to be extracted for periodontal reasons, there will be reduced bone support for the tooth and the tooth might be removed more easily than if there were full bone support. In this case, there might be lessened discomfort following the extraction.

The Procedure
1. Numb the tooth: Your dentist will need to anesthetize (numb up) both your tooth and the bone and gum tissue that surround it. This is done as an injection.

2. Extraction: The root portion of a tooth is firmly encased in bone (its socket), and tightly held in place by a ligament. During the extraction process, the dentist needs to both "expand the socket" (widen and enlarge it) and separate the tooth from its ligament, to the point where the tooth is loose and free to come out.

• What does it mean to "expand" a tooth's socket? If you have ever tried to remove a tent stake that has been driven deeply into the ground, you know that you can't just pull the stake straight up. Instead, you first have to rock the stake back and forth, widening the hole in which it is lodged. Once the hole has been enlarged enough, the stake will come out easily.
• How does the dentist expand the jaw bone? The bone inside the jaw is spongy. When a dentist applies firm pressure to a tooth (forcing it against the side of its socket), the bone will compress. After repeated application of pressure, from many different angles, the entire socket gradually becomes expanded. At some point, enough space will have been created (and the ligament separated from the tooth enough) that the tooth will come out.

3. Closing the extraction site: Once your tooth has been removed, your dentist will begin the process of closing your extraction site. This may include:

• Removing infected or pathologic tissue by curetting (scraping) the walls of the tooth socket
• Using finger pressure to re-compress the "expanded" socket
• Rounding off sharp bone edges
• Evaluating the tooth socket for sinus complications (upper back teeth)
• Washing out ("irrigating") the socket, so to remove any loose bone or tooth fragments that remain
• Placing stitches (usually only after surgical extractions).
• Placing folded gauze over your extraction site and then having you bite down on it so to create firm pressure

The Tools

1. Dental Elevators: During the extraction process, a dentist will usually use an elevator first. These instruments are designed to be wedged in the ligament space between the tooth and its surrounding bone. As the elevator is forced and twisted, the tooth is pressed and rocked against the bone. This helps to expand the socket. It also helps to separate the tooth from its ligament. As this work is continued, the tooth will become more and more mobile. In some cases, the elevator may be able to shove the tooth on out. If not, the dentist will switch to the use of extraction forceps and remove the tooth with them.

2. Extraction Forceps: A dentist will usually keep a number of different extraction forceps on hand. Each one will have a design that's been specially made to grasp a certain type of tooth. When they're used, the dentist will grasp the tooth with the forceps and them firmly and deliberately rock it back and forth as much as it will. Because the bone that surrounds the tooth is compressible, the socket will expand. In addition to a rocking motion, a dentist will also rotate the tooth back and forth. This twisting action helps to rip and tear the tooth from the ligament that binds it in place. At some point, the socket will be enlarged enough, and the ligament torn enough, that the tooth can be easily removed.

What will I feel?
1. Pressure
2. You should not feel any pain 
3. Expect to hear startling extraction noises: These are often just routine

Following the Extraction
We will tell you the reason for the extraction and let you know what to expect following the procedure. Please follow the instructions given to you. If antibiotics are prescribed, take them until the prescription is completely finished. If pain medication is prescribed, take it only if necessary. If the medication prescribed contains a narcotic component, such as codeine, do not drive a motor vehicle or operate machinery that could prove dangerous to yourself or others. Expect some bleeding to occur from the extraction site for the first 24 hours. Remember, there is now a hole in your jaw from which the tooth has been removed, and the hole can be quite large. Some bleeding is to be expected.

• Do not spit, rinse, or smoke for 24 hours
• Do not drink through a straw for 24 hours
• It would be a good idea not to brush near the extraction site for a day or two
• When you brush and floss the area, be gentle!
• For 24 hours after the extraction, try to chew food away from the extraction site
• Some slight swelling in the area is to be expected, especially if the extraction was difficult
• If sutures are placed, return to have them removed
• If medication has been prescribed for possible post extraction discomfort, take it as directed
• If prescription medication has NOT been given, you may take your usual over-the-counter pain reliever, as directed

 Please notify us if:

• There is extended bleeding from the extraction site. Slight bleeding for several hours is normal.
• Anything other than slight swelling occurs.
• Discomfort continues for more than 24 hours, especially if it is not relieved by over-the-counter pain relievers.

Some infrequent complications of routine oral surgical procedures include (but are not limited to):

• fracture of adjacent teeth or restorations (which of course would mean that these affected areas must be restored to normal function after the healing of the extraction site)
• separated root tips or root fragments
• temporary or permanent nerve damage to the area, resulting in anesthesia or paresthesia (numbness)
• incomplete healing, resulting in severe pain - a "dry socket"
• fracture of the surrounding bone

If you have any questions about reasons for dental extraction, please feel free to ask us.

Cracked Tooth Syndrome (CTS)

What is CTS?
Minuscule cracks can form on your teeth, threatening your dental health. Why? 

• Age plays a factor - as we get older, our teeth tend to weaken, making them susceptible to tiny hairline fractures that are not visible to the naked eye. 
• We increase our chances of developing cracked teeth by exposing them to trauma, such as bruxism and chewing on hard objects.
• When teeth have been heavily filled, it is not unusual that they develop cracked (or split) tooth syndrome (CTS). 

Symptoms include a sharp pain when you bite down into something hard. When you open your mouth and the teeth are no longer touching, the pain goes away. The pain does not usually linger after the biting action is finished. The fact that you feel pain when pressure is applied to the tooth means that the nerve is being affected. If the problem is not solved quickly, the nerve may die and the tooth will then require endodontic treatment (root canal).

Why does it hurt when I eat?
Pressing an object against the tooth opens the crack, causing the underlying dentin to move and irritating the pulp chamber (which contains the tooth's nerves). When the pressure is released, the crack immediately closes, causing a sharp pain. If left untreated, the pulp will eventually become damaged, and you will start to feel sensitivity to hot and cold or prolonged pain.

Common sites of cracked teeth

• Premolars and molars, the back teeth that grind and crush food 
• A tooth that has recently been drilled and a great amount of tooth structure has been lost
• A tooth that has an extensive filling (usually silver amalgam) that has been in place for a long time 
• Or a tooth that only has a small silver filling  
• The filling has weakened the tooth just enough so that when you chew or bite, the tooth and filling separate slightly (flex), causing immediate and sometimes severe pain.

Types of cracked teeth:

• Fractured Cusp: When the cusp (the raised section of the biting surface of your tooth) becomes fractured. If a fractured cusp does not break off on its own, it will need to be removed by a dentist and replaced by a dental crown.
• Cracked Tooth: Run vertically, originating from the top part of the crown and working their way down. Treatment typically entails a root canal followed by a dental crown. If the crack has extended below the gum line, the tooth may require a tooth extraction. 
• Split Tooth: When a cracked tooth is not treated, the crack can extend beyond the root, causing the tooth to split. Although these teeth are difficult to save, they can sometimes be treated with a root canal. 
• Vertical Root Fracture: Sometimes the crack starts at the bottom of the root and works its way up. If caught early, endodontic dental surgery may correct the situation. 

Treatment

Vertical Fracture

• Treatment will involve at least one x-ray to assist in the diagnosis and to rule out other causes. We will try to find the section of the tooth that is causing the problem by pushing on the various sections of the tooth or having you bite on a hard object.  
• When the section of the tooth that is cracked is found, it makes treatment easier. First, the tooth is anesthetized and the old filling is removed. 
• Then we carefully inspect the area to determine whether the cracked section can be seen. Very often it is visible at this point. 
• The next step is to see whether the split area can be fixed with a direct filling (bonded). This is the ideal situation if the crack is small.  If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings and bonded amalgam filling will hold the tooth together making it less likely to crack



Crown

• Your dentist may first place an orthodontic band around the tooth to keep it together. If the pain settles, the band is replaced with a filling that covers the fractured portion of tooth (or the whole biting surface).
• Unfortunately, this rarely occurs. If the crack goes too far vertically, there is a possibility the tooth may need to be removed and replaced with an artificial one (bridge, denture, or implant). More often (over 95% of the time), the biting surfaces of the tooth must be entirely covered and protected first with a provisional (temporary) onlay or crown. 
• If this is successful in eliminating the pain (we usually wait for a few weeks to be sure the problem is resolved), an impression for a laboratory-fabricated casting - either a porcelain or resin onlay or a crown - is made. If adequate tooth structure remains, a partial coverage restoration - an onlay - is preferred. If the tooth has been badly cracked or if not much tooth remains, then a crown will be necessary. The purpose of either type of cast restoration is to unite all sections of the tooth so it cannot move or separate under normal biting forces. If the provisional restoration is successful in eliminating the pain, we expect that the final cast crown or onlay will correct the problem. 
• The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved.

The earlier a split tooth is diagnosed and treated, the better success there is in treating it. If the split is severe, a root canal may be necessary to save the tooth. Depending on the symptoms you describe, we may choose to treat it as a bite adjustment, small filling, or larger preparation for an onlay or  crown. If these do not work, the treatment plan will be modified. If left untreated, the tooth may eventually be lost. It is also possible that the initial split of the tooth may be such that it cannot be saved, despite our best efforts.

Delaying Treatment
What happens if CTS is not treated quickly? The best you can hope for is that the tooth continues to hurt only when you chew or bite. This does not often happen. Usually, the broken section of tooth gets weaker and weaker until it fractures off. Additionally, if the crack gets deeper into the tooth, the nerve will die and the tooth will need endodontic treatment before the crown or onlay is placed. Sometimes the nerve is immediately affected by the initial split and dies. This may occur quickly or may take years before it is evident. Every case of CTS is unique. If it is any consolation, the cracked tooth is not your fault. It is a result of your teeth being drilled and filled with big silver fillings when you were younger. We see this particular dental problem mostly in patients who are between 25 and 45 years old.

Unfortunately, cracked teeth do not go away. Many times, they only hurt when you bite on them from one particular angle. If the fractured segment is not stressed, the tooth feels normal. You might also be able to "train" yourself to chew on different teeth and avoid the cracked tooth. At best, you only postpone necessary treatment while the nerve may be slowly dying.

After Treatment
If treated by adjusting your occlusion (bite) on the tooth
This will lessen the symptoms. If the discomfort you feel when you bite is not eliminated within one week of treatment, please call our office and let us know. If the split is still present, a different approach will have to be tried. Give the tooth a few days to "calm down" before you try to bite down on hard foods.

If treated by removing the old restoration and placing a bonded filling in its place 
If the split is small, this may eliminate the problem. Do not bite down hard on the tooth for a few days, then gradually place more pressure on the tooth. Call our office in one week and let us know how it feels. If the split is still causing a problem, a different approach must be tried. If left untreated, the tooth may split further and you may need endodontic treatment and a crown. If the tooth splits severely, it may have to be extracted.

If treated by cementing a temporary crown onto the cracked tooth with temporary cement 
Because the crack was so severe, this procedure was used to determine whether or not the tooth can be treated without performing a root canal. Please give the tooth several days of rest before you try biting down on hard foods. Expect the tooth to be sensitive for a few days after the temporary is placed. This is normal. Gradually apply more force when you bite into foods, and gradually try to eat harder foods. Expect the temporary crown to remain in place for several weeks, until it can be determined whether or not the problem is solved.

If you have any questions about cracked tooth syndrome, please feel free to ask us.