Tooth gem

Thinking about getting a tooth gem?

Tooth gems can be a fun non-permanent way to personalize your smile!

How do we place tooth gems?

We use the same bonding steps that a dentists uses when placing a white filling or braces. There is a weak acid that etches the tooth. Then a bonding agent helps connect the tooth to a resin that the gem sits in. Most gems have a backing that has lots of surface texture. This surface texture allows the resin to grab onto the gem. When you decide to remove the the tooth gem a dentist can pop it off for you and polish up your tooth. There is no cutting of your tooth and you do not need to get numb. You will not feel anything during this process. It is very similar to getting braces on but only for one tooth, instead of all of your teeth.

Who can place a tooth jewelry?

Anyone can place some tooth jewelry for you, including you! However, like most things in life, the people with the most experience will do a better job. No one has more experience bonding teeth than dentists but that does not mean only a dentist can do it. Putting people in order of least likely to most likely to do a good job it goes you if you try yourself, a tattoo artist, a general dentist, and then a cosmetic dentist. If someone is advertising that they do them they are likely pretty good at it, no matter what their profession is.

Who can get tooth jewelry?

Anyone can but most people are young adults from later teenagers to in their twenties. They are most common among young women. However, as you can see below men can get them too and we see football players and other athletes are the ones doing it.

What does a tooth gem cost?

That depends who is placing your tooth gem, how much the jewelry itself cost, and where you live. A dentist will be the most expensive and likely charge a couple hundred dollars, plus the costs of the gem itself. We currently only offer this service to existing patients.

Where do I buy tooth gems?

You can bond almost anything to your tooth. However, the jewelry made specifically for teeth will last longer on your tooth. We like the selection that Twinkles has and that is who we use.

 

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Black tongue

What are the causes for a black tongue?

A black tongue can result from a number of different causes. No matter the cause better hygiene can improve the condition, that means using a tongue scraper daily.

The main cause of a black tongue is a susceptible person who is not cleaning their tongue.

Susceptible individuals include those with dry mouth and smokers. If someone has a dry mouth and or smokes their tongue may turn black if they do not clean their tongue.

Another common cause can be a reaction with a medication.

There are many medications that can cause a black tongue. Many medications dry out the mouth and can cause it indirectly. Other medications are more direct; like Pepto Bismol, or any other substance containing bismuth subsalicylate. The bismuth reacts with sulfur, which is produced from bacteria, and makes the harmless black substance bismuth sulfide.

Iron supplements are another source of possible cause for a dark tongue.

You can see the black substance can be wiped off but not all of it.

Bacterial causes

Chromogenic bacteria cause black staining of teeth and tissue and can be to blame for a black tongue.

How do you eliminate the black color on your tongue?

You can get rid of the black tongue with just a little extra effort each day. If you know the cause you may be able to stop it by eliminating the cause. However, stopping smoking is about the only realistic thing that you can do and quitting is not easy. The other causes you likely just need to deal with the consequences.

So to eliminate the dark color of your tongue you need to clean the tongue twice daily. This is not difficult and should only take a few seconds each time. Get yourself a nice tongue scraper that you like and use that. If you want to do even more there are tongue brushes that you can add some sort of antimicrobial to. We recommend adding a little hydrogen peroxide to the tongue brush and using that on your tongue. It will quickly kill a lot of the bacteria on your tongue and will help eliminate your black tongue. Again only a few seconds is needed to clean your tongue.

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Mistakes wearing surgical masks

Top mistakes wearing surgical masks during a pandemic or flu season.

Mistakes wearing surgical masks are rampant and we see them everywhere. Let’s fix a few easy ones.

Is wearing a mask during a pandemic helpful?

The research is not great but seems to point to the answer being yes according to BMJ 2020 Greenhalgh. The biggest hurdle is that individuals are making mistakes when wearing surgical masks. These mistakes are making those individuals more prone to infection. Overall the recommendations are to wear masks in public but we can make that recommendation more definitive by decreasing the mistakes people are making.

We assume if someone is willing to wear a mask they will bother to do it correctly. Wearing it correctly and avoiding the simple mistakes are fairly easy if one is aware of the mistakes. We feel many of these mistakes come about because people feel the mask is a perfect permanent barrier and that is not true.

Mistake number 1 when wearing a surgical mask – Stop touching the front of the mask!

A mask is not a 100% full proof barrier to all infective agents. Some can and do get through. The older and the more damp your mask gets, from your breath or air humidity, the worse the mask is. If you touch your mask, you put whatever is on your hands on the mask. That’s the air you are breathing!

Your hands go everywhere! Consider your hands to have active infection on them at all times and wearing gloves just means that your gloves have infection on them. So do not touch the front of your mask with anything! To remove your mask do so by the ear strap. Try not to adjust your mask. If you find you need to constantly adjust your mask then you need a different mask. Constant adjustments of the mask can increase your risk to infection vs no mask at all.

Mistake number 2 – Masks do not last forever.

Many people have 1 or 2 masks they wear all day for days or weeks at a time. You are almost certainly doing more harm than good with that strategy. You either need to disinfect your mask, letting it sit in a paper bag for 4 days is enough to kill many viruses, or wash your mask if it is cloth. Do not wear your mask in situations you do not need to. In general, the longer you wear it the less effective it will become. For instance, take it off in your car.

Not covering your nose and mouth, makes wearing a mask useless.

This should go without saying but you’ll commonly see this mistake. The mask needs to cover your breathing holes, it the nose and the mouth. Having it off the nose means yhou get the risk of cross contamination of wearing the mask but none of the benefits.

Other common mistakes wearing surgical masks.

Other mistakes are fairly minor. Having a poor fit by not adjusting the metal strip over your nose, decreases the usefulness of a mask. Some spray the mask with disinfectant, thinking that will help. Wet masks do not work as well.

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Pediatric dental medication

What is the correct pediatric dental medication for the child?

Pediatric dental medication will depend on the weight of the child. That and any allergies are the two most important pieces of information you will need to write a pediatric RX. Personally I have found the easiest method to write a script for a child is to use an app. Dental Drugs and DentalMeds are my favorite but Pedi QuikCalc is good too.

Antibiotics for children with dental infection.

The most common is Amoxicillin 125mg/5ml or 250mg/5ml depending on their weight. Remember most infections we can and should eliminate surgically and reduce our overuse of antibiotics.

Amoxicillin 125mg/5ml

Disp: 150 ml

Sig: 1 tsp q8h for 7 days

Penicillin VK is written the same way. Clindamycin is for those with allergies to amoxicillin or similar.

Clindamycin 75mg/5ml

Disp: 150ml

Sig: 1 tsp 8h for 7 days

Prescription pain medication for children

Alternating Tylenol and Advil is very effective and really all many need. However, when that is not enough codeine is the next level. Again child weight is critical and you should check for the proper dose for the child’s weight.

Acetaminophen w/ Codeine (125mg/12mg codeine)/5ml

Disp: 150 ml

Sig: 1 tsp q8h prn pain

Fluoride for children

We have an entire post on fluoride for children.

Prescription pediatric dental medications and proper dosages

Patients should always follow their pediatric dentist’s recommendations in terms of dosing. Dentist’s should rely on apps, charts, or drug reference guides that utilize the child’s weight to avoid any errors.

 

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Black stain on children’s teeth?

Is chromogenic bacteria the cause for black stain on children’s teeth?

Chromogenic bacteria is the primary cause for black stain on children’s teeth. We see it almost exclusively on children and it is fairly common.

What is chromogenic bacteria?

There are several species of bacteria that we all carry in the upper respiratory tract. They are anaerobic gram negative rod bacteria that form black colonies, which appears to us as black staining. It is unclear what role they play exactly in the forming of the stain. The lit review by Żyła 2015 in Biomed Res Int. finds Actinomyces spp play a role as well

Is chromogenic bacteria the cause for your child’s black stain on their teeth?

Most likely this is the cause but your dentist can say for sure. The appearance is pretty easy to diagnosis but some decay may look similar, so you should let a dentist diagnosis any black stain.

How do we remove the black stain from children’s teeth?

Your dentist can remove the stain with our cleaning instruments. This is not something that home products will be able to remove.

How do we prevent the black stain on children’s teeth from returning?

Without knowing the cause, prevention is difficult. If you find the cause then you may be able to eliminate the black stain. Some staining is from iron supplements which may be more beneficial than the staining is harmful. Iron fortified rice is another example of something that may cause the black satin on children’s teeth.

If the stain is from chromogenic bacteria, which is highly probable if it is not decay, then we do have ways to eliminate it. Some children have had luck using CloSys mouth rinse, as it targets sulfur producing bacteria. If the stain is from chromogenic bacteria, then oxygenating mouthwashes will get rid of it. Amosan or just hydrogen peroxide in the brown bottle will work.

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Impression issues

PVS dental impression problems

Dental impression problems will arise no matter how experienced you are or what material you use. However, with experience and knowledge the number of issues decreases significantly.

Dental impression problems that have to do with materials

These can be unavoidable. Perhaps the material was in an area of the office that is very cold and the time to set was off. Maybe there was some minor manufacturing issue. Perhaps you the dentist are trying a new material or left some bonding agent on the tooth that the impression material interacts poorly with. Some materials set at different times and mixing and matching different companies may mess with proper setting.

Failure to set properly will likely either be a material issue or timing.

A failure of a dental impression material to set has many possible causes. Material that is bad or has expired can cause issues. Temperature plays a role as does not enough time. There are also many products that can interfere with the setting of the material, most common is bonding agent. This often occurs when dentists are experimenting with Immediate Dentinal Sealing for the first time.

Below is an example of impression material failing to set. Possible causes are too short of time, expired or poor material, cold material, impression setting inhibited by some unknown product.

To see the high resolution image click here.

Dental impression problems that have to do with technique or patient management

Some of these are dentist’s issues, which is a nice way of saying mistakes. Some are patient management issues that with time the dentist will learn to avoid. Timing is likely the main issue with inexperienced doctors or assistants. Every brand has a set time in which you must have the material in place or the impression will not turn out properly. Missing margins and other poor impressions will often be a combination of difficult situation and lack of experience. Poor positioning is a dentist error that will decrease with experience.

Biting on the dental impression tray

Biting on the impression tray will cause an issue and certainly will interfere with the labs ability to set the bite correctly. This is most often seen when a patient has a third molar in occlusion and they do not have much room for the tray to fit.

The images below show an impression where the patient bit on the metal tray and was not able to close all the way. The two images on the right show how you check to verify this did not occur. When you hold the impression up the light you should be able to see through it. That proves their teeth were touching. If you can not see through the impression material then you need to investigate the cause.

Tips to avoid and detect dental impression problems

• Follow the instructions of your manufacturer. Don’t mix and match materials and set times. Don’t use expired materials.
• Using higher magnification is always helpful for everything. You will be capable of seeing issues with margins with higher magnification much easier.
• Don’t use cold material or know that if it is cold you need to let it set longer.
• Try in your impression tray beforehand so you know it fits properly. Also have them bite together so you can see how their teeth fit.
• If doing IDS or any bonding procedure be sure to rinse all the excess away with alcohol and rinse that with water.
• Check the margins of the impression. Next check the other teeth near by for voids. Then check the opposing for voids and pulls.
• Finally, hold the impression up to the light to ensure you have the patient biting.

For more information on dental impressions click the link.

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dental stitch fell out

Dental stitch fell out, now what?

Dental stitch fell out and you don’t know what to do? Well you will need to contact your dentist to know for sure if that is OK or not. However, we can tell you in general what you need to do and if it is OK.

Are you sure it’s a dental stitch?

It probably is if you think it is. However, maybe it is something else. Also there are some stitches we place that dissolve and will come out and some that we want to stay in.

A PTFE dental stitch that fell out. This one is easier because the knot is still there. Most will not still have the knot.

Is it OK that the dental stitch fell out?

That really depends on what you had done and how long ago it was.

How long ago was your surgery?

No matter what was done the more healing that has occurred the less likely it is that losing a stitch will matter. In other words, the later the better.

What kind of dental surgery did you have?

For a dental implant the stitch coming out a little early is probably fine. However, if there was bone grafting done at the time of the dental implant then that may be a problem. If the stitch fell out after an extraction, then as long as 2 or 3 days have past, it’s almost certainly fine. If you had major bone grafting by itself or some sort of soft tissue grafting, then a stitch coming out can be a big problem. No matter what it is likely best to call your dental office and let them know.

What do dental stitches look like?

There are far too many kinds of stitches in use in dentistry to even give you an answer on this one. However, the most common will be either black, white, purple, and flesh colored. PTFE is one of the most common and it is always white. Silk is another common suture and is black. There are several purple sutures. Gut sutures are flesh colored.

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