My Blog

Posts for: April, 2020

By Aaron S. Berger, DMD
April 22, 2020
Category: Dental Procedures
Tags: teeth whitening  
StainsfromWithinaToothRequireProfessionalWhitening

Whether performed in a dental office or using a home kit, teeth whitening applications are quite effective for bleaching exterior (extrinsic) stains on enamel surfaces. But what if your discoloration comes from inside the tooth? In this case, extrinsic teeth whitening won’t work — you’ll need to undergo an “internal bleaching” method, which can only be performed in a dentist's office.

There are a number of causes for “intrinsic” staining, including too much fluoride exposure or tetracycline use during childhood. One of the more common causes, though, occurs from root canal treatments used to remove the remnants of the pulp tissue inside a tooth’s pulp chamber and root canals. Certain cements used during the procedure to help seal in the filling material and leftover blood pigments can cause the tooth to darken over time.

To alleviate this discoloration, we use a bleaching agent, usually sodium perborate mixed with a diluted solution of hydrogen peroxide to achieve a safe, accelerated color change. After determining that the root canal filling is still intact and the bone is healthy, we create a small cavity in the back of the tooth to access the pulp chamber. The chamber is cleaned of any debris or stained material and then thoroughly irrigated. The original root canal filling is then sealed off to prevent leakage from the bleaching agent.

We then place the bleaching agent in the cleaned-out space with a cotton pellet and seal it in with a temporary adhesive. This step is repeated for several days until we achieve the desired shade of white. Once that occurs we then seal the dentin with a more permanent filling and then restore the cavity we created with a composite resin bonded to the enamel and dentin.

If we’re successful in achieving the desired color, intrinsic whitening could help you avoid more costly options like veneers or crowns for an otherwise healthy and attractive tooth. The end result would be the same — a beautiful smile without those unsightly stains.

If you would like more information on treating internal tooth stains, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”


By Aaron S. Berger, DMD
April 12, 2020
Category: Oral Health
Tags: oral health   vaping  
ConcerningYourOralHealthVapingIsntaSafeAlternativetoSmoking

The first week of April is National Public Health Week, putting the spotlight on health issues that impact us all. The popular practice of vaping is one of those top issues this year due to its connection with recent lung illnesses and deaths. But this isn't a new problem—dentists have been critics of vaping for some time now over the growing evidence of its effect on oral health.

Vaping is the popular term for inhaling aerosol vapors through an e-cigarette (or e-cig for short). The electronic device contains a small reservoir filled with flavored liquids that contain nicotine and other chemicals. The device heats the liquid, turning it into a vapor that's inhaled or “vaped” into the lungs.

Vaping has been touted by proponents as a safer alternative to cigarette smoking. But there's growing evidence that vaping isn't a kinder and gentler way to “smoke.” A good portion of that evidence comes from dentists who routinely treat oral problems caused or worsened by vaping.

In reality, the adverse effects of vaping on oral health aren't much different from smoking. Like smoking, vaping ingredients can irritate the inside of the mouth and cause dryness, an ideal environment for dental disease. And nicotine, the main chemical in both vaping and smoking, constricts blood vessels that deliver nutrients and disease-fighting antigens to the gums and teeth.

If these hazards weren't bad enough, recent clinical findings seem to indicate they're only the tip of the iceberg. Researchers from New York University's (NYU) College of Dentistry have found evidence from a combined study of cigarette smokers, e-cig users and non-smokers that vaping may significantly alter the mouth's microbiome to the ultimate detriment of oral health.

A “microbiome” is a term describing the intricate relationship between the millions of microorganisms inhabiting the human body and the body itself. While a few are malicious, many, namely in the gut and mouth, help the body obtain nutrients from food and fight against disease. Disrupting that delicate balance opens the door to diminished health.

The NYU researchers found that both smokers and e-cig users had higher levels of pathogenic bacteria in their saliva than non-smokers, suggesting both habits disrupted the mouth's microbiome balance enough to allow less benevolent bacteria to flourish. They also found that both smokers and e-cig users had significantly higher incidences of gum disease (72.5% and 42.5%, respectively) than non-smokers (28.2%).

If you're a smoker, a cessation program to quit the habit—not switching to vaping—is the way to a healthier life. If you would like more information about the effects of vaping on your oral health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Vaping and Oral Health.”


By Aaron S. Berger, DMD
April 02, 2020
Category: Oral Health
Tags: nerve pain  
FacialNervePainCanbeControlled

Every year 150,000 people, mostly women over age 50, find out they have a painful condition called trigeminal neuralgia. For many it begins as an occasional twinge along the face that steadily worsens until the simple act of chewing or speaking, or even a light touch, sets off excruciating pain.

The source of the pain is the pair of trigeminal nerves that course along each side of the face. Each nerve has three separate branches that provide sensation to the upper, middle and lower areas of the face and jaw.

The problem arises when areas of the myelin sheath, a fatty, insulating covering on nerves, becomes damaged, often because of an artery or vein pressing against it. As a result, the nerve can become hypersensitive to stimuli and transmit pain at even the slightest trigger. It may also fail to stop transmitting even after the stimulation that caused it is over.

Although the condition may not always be curable, there are various ways to effectively manage it. The most conservative way is with medications that block the nerve from transmitting pain signals to the brain, coupled with drugs that help stabilize the nerve and decrease abnormal firing.

If medication isn't enough to relieve symptoms, there may be some benefit from more invasive treatments. One technique is to insert a thin needle into the nerve to selectively damage nerve fibers to prevent them from firing. Another microsurgical procedure attempts to relocate the nerve away from a blood vessel that may be compressing it.

The latter procedure has some higher risks such as facial numbness or decreased hearing, and is often better suited for younger patients. Older patients may benefit more from the needle insertion procedure previously mentioned or a directed beam of high-dose radiation to alter the nerve.

To learn the best options for you, you should first undergo a neurological exam to verify you have trigeminal neuralgia and to rule out other causes. From there, you and your doctor can decide the best course of treatment for your age and individual condition.

Trigeminal neuralgia can be an unpleasant experience. But there are tried and true ways to minimize its effect on your life.

If you would like more information on trigeminal neuralgia, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Trigeminal Neuralgia.”