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Life of a tooth
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Different Signs
Dangerous things you may not know about

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How your mouth relates to the rest of your body
Our children's teeth
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Life of a Tooth
by Eric Cheung DDS, FAGD

The main purpose for this page is to motivate all of us to keep our teeth at picture #1 or healthy teeth surrounded by healthy gum.

Let's walk through the life of a tooth. Do all teeth have to go through this process? No, when archeologists find human skull and teeth, their teeth could still be intact. I bet human never have so much sugar, high fructose corn syrup, acidic food and beverages.

I have two questions for you.

Question #1. Which picture best describes your teeth and your gum?

Question #2. Which picture do you want your teeth and your gum to look like?

Need a little help? Let's talk about what each picture means.

In dentistry, we deal with two major diseases: cavity or tooth decay and gum disease.

Picture #1 Healthy Tooth

Note from Dr. Eric:
This is the artistic representation of a molar. I really love this series of pictures. Not perfect, but comfortable enough to look at. Feel free to share this link with your friends, family, co-workers and whoever would find useful. If it generates like a million hits, I will be happy to pay the artist loyalty.

The crown portion is exposed in the mouth. The root portion is anchored by the bone underneaths the gum.

A tooth has couple layers.

The outer layer is called enamel. Enamel is the toughest substance in our body. Usually white or somewhat transparent.

Dentin is the next layer. It is much softer. It is more yellowish.

The next layer is the pulp where the nerve and blood supply is. Bacteria loves these nutrients.

The nerve and blood supply connects to our whole body.

The gum (both the darker and ligher red) is hugging the tooth tightly. Normally, there is a space between 2-3mm. When we are checking your probing depth, your healthy gum will read 2's or 3's.

And the bone (yellow with dots) is at a good level.

Keep in mind, your Xray shows these layers in greyscale. If you want, ask us to show you the different layers. At the same time, allow us to ask you if we can post your Xray (no name or ID) here for educational purpose.

Question:
Do you think your teeth look like picture #1?
Do you want your teeth to look like picture #1?

Picture #2 Enamel Cavity

Small cavity that is still in the enamel.
Yellow/brown/black stain. Darker stain usually means deeper cavity.

Dr. Eric's note: In my early career, I thought bacteria is so smart. They manage to hide in some of the hardest to reach spot. Then I quickly realize bacteria and food are everywhere. You can brush them away. If you leave some bacteria behind for an extended period of time, cavity develops. Let Dr. Eric find out if you are missing any spot.

On the biting surface, pits and grooves or what dentists called fissures can hide bacteria. In general, as long as the surface is still strong and sound, your tooth does not need work done yet.

Food and bacteria can stay in between our teeth and around the gum line. Notice how thin the enamel around the gum line.

If I mentioned to watch some spots on your teeth, a smart person would spend more time brushing and flossing those spots to keep the cavity small. NOTE: I did not say brush harder. I said to brush longer (2 minutes) and make sure you reach the last teeth.

Some dietary adjustment will be beneficial too. If you can live with just water and cheese, good for you.

For everybody else, avoid sugar and acidic food or beverages including soda, anything carbonated, sticky candy and food such as raisins, even juice and citrus fruits are acidic and sports drink is both acidic and full of sugar.

Duration and frequency

For those of you who need these sugar food to survive, I highly recommend switching to water. Swallow any sugar and acid as soon as possible and drink some water to wash away the food.

Also, you can still eat the same amount, but cut down the number of trips you have snack. And get everything into your stomach.

Couple points:

1. Frequency. If you are going to eat candies, eat them all at one time is better than eat a little throughout the day.

2. Don't brush right after you have something acidic. Acid will weaken your teeth. Brushing right afterward will do more harm than good. So, please wait 30 minutes before brushing.

3. Sticky candies or candies that dissolves slowly supply sugar to bacteria to eat away your teeth.

4. Hard candies can break your teeth and your jaw.

5. Diet soda actually have more acid than regular soda.

6. Watch if you have a habit to put your food such as chewing gum somewhere in your mouth for an extended period of time.

7. A habit to hold the sugary acidic beverage in your mouth before swallowing

Question:
Do you think your teeth look like picture #2?
Do you want your teeth to look like picture #2?

Picture #3 Dentin Cavity

Now the bacteria works its way into the dentin. Since dentin is a lot softer, bacteria can spread very fast in all directions. Sensitivities to sweet and temperature may occur. Since cavity develops slowly, your body could adapt to the sensation and you may not feel anything.

Note: Advanced information. Feel free to skip this paragraph if too overwhelming.

The cavity and fillings are classified based on the number of surfaces. If you hold a fist up. There are five surfaces facing different directions: buccal (facial), lingual, mesial, distal, occlusal (incisal). The sixth surface is the forearm or the root. The short forms are: B (F), L, M, D, O (I). Dr. Eric may say something like “MOD on tooth #3.” The cavity is involved with three surfaces. Most general dentists in the US use the numbering system from 1 to 32 for permanent teeth and A to T for twenty baby teeth. The number starts from the top right side, the upper right wisdom tooth is #1, second molar is #2... the top left wisdom tooth is #16, the lower left wisdom tooth is #17... the lower right wisdom tooth is #32. The alphabet starts from the upper right second baby molar #A to lower right second baby molar #T.

END OF ADVANCED INFORMATION

In general, the more surfaces, the bigger the cavity, the longer to restore and the higher the cost too.

During the dental exam, your tooth will feel soft and sticky. In this case, we need to remove the cavity and do a filling. Not enough tooth structure will need a buildup and a crown.

During the treatment appointment, if the cavity is too close to the pulp, where the nerve is, Dr. Eric will recommend to place a liner or pulp cap to lessen the chance to have sensitivities afterward. We will explain in picture #4 if cavity reaches the pulp.

Question:
Do you think your teeth look like picture #3?
Do you want your teeth to look like picture #3?

Picture #4 Cavity to pulp

When the cavity go into the pulp, you will not be reading this and you will be calling all dentists to get treatment. Just in case, my office number is (209) 358-0800.

The confusing thing is this pain could disappear for awhile and then come back. Let's solve this mystery.

When bacteria first reaches the pulp, your nerve will signal pain. Our body will try to fight it. However, the end of the root is restricted and limits immune cells to do their job. To make matter worse, all the nutrients will speed up bacterial growth. More bacteria and more pain up to a point until the nerve is dead. The nerve or part of the nerve can no longer feel, so the pain goes away. Unfortunately, bacteria will stay and advance towards the end of the root.

Once the bacteria works its way down to the end of the root, bacteria will cause an infection. Smelly puss could start coming out. The cheek or other area in the head and neck area could swell up. And the pain will not go away unless the tooth receives treatment.

Question:
Do you think your teeth look like picture #4?
Do you want your teeth to look like picture #4?

Picture #5 is blank
There is no tooth

Here are some reasons:

• Cavity too big
• Not enough tooth to hold anything
• Fracture/crack tooth
• Problematic wisdom teeth
• Extra teeth
• Trauma
• Whole body health such as osteoporosis, diabetes and cancer
• Braces related
• No bone to support your tooth and the tooth just comes off

Question:
Do you think your teeth look like picture #5?
Do you want your teeth to look like picture #5?

The good news is that Atwater Family Dental can help to identify signs early and teach you how to prevent tooth loss. Contact our office at (209) 358-0800 for your next dental exam.

Now, let's talk about gum disease.

Gum disease or periodontal disease deals with the gum and the underlying bone.

Here are some statistics.

According to the Centers for Disease Control and Prevention (CDC), half of Americans aged 30 or older have the more advanced form of gum disease.

Gum disease affects approximately 64.7 million Americans.

Over 70% of Americans aged 65 or older have gum disease.

More common in men than women

People living below the federal poverty level, less than a high school education, and smokers are at higher risk.

Reference: CDC website regarding periodontal disease

 

Dr. Eric always use a tree on the ground as an analogy.

The root of the tree is holding onto the dirt.What if someone is shovering the dirt away? The tree will be loose and unstable. The tree will eventually fall down.

Similarly, a different set of bacteria causes the gum recession and bone loss and eventually the tooth doesn't have any support and fall off.

Gum disease takes many years to develop, but once there, the disease does not go away.

If it doesn't hurt, how to tell if someone has gum disease?

Warning signs:

• bad breath or bad taste that won't go away
• red or swollen gums
• tender or bleeding gums
• painful chewing
• loose teeth
• sensitive teeth
• gums that have pulled away from your teeth
• any change in the way your teeth fit together when you bite
• any change in the fit of partial dentures

Risk factors:

• Smoking
• Diabetes
• Poor oral hygiene
• stress
• heredity
• crooked teeth
• underlying immuno-deficiencies such as AIDS
• fillings that have become defective
• taking medications that cause dry mouth
• bridges that no longer fit properly
• female hormonal changes such as with pregnancy or the use of oral contraceptives

Reference: CDC website regarding periodontal disease

 

Ready for some pictures?

Picture #1 Healthy Tooth

Healthy tooth and health gum does not have much food and bacteria buildup. Healthy gum does not bleed. Good bone support.

Question:
Do you think your gum look like Picture #1?
Do you want your gum to look like Picture #1?

Picture #A Gingivitis

The brown thing around the tooth is food, bacteria, plaque, tartar and anything else that sticks to it. At this stage, the gum is red and sometimes bleeds when brushing and flossing.

The good news is gingivitis is still reversible. Don't let it develops into more advanced disease: periodontistis.

Notice not much buildup around the upper half of the crown. With some decent brushing, the plaque will not stay on most part of the crown. Plus saliva and tongue can move most food away. The trouble spots are always the cheek and tongue side near the gum line and also area in between teeth. That's why we teach to brush around the gum line at a 45 degree angle. Once again, not brushing harder, but brushing longer time-wise and reaching all the way to the last teeth. Don't forget flossing.

Question:
Do you think your gum look like picture #A?
Do you want your gum to look like picture #A?

Picture #B Mild to moderate gum disease

The gum is definitely more red and swollen. The bacteria, food and plaque become calcified to become tartar. And the gum is peeling away, so more bacteria, food, plaque and tartar go deeper into the root.

This is the stage to have gum recession too. With all these dirty things, the gum does not want to come close and run away. The trouble is without the gum, the root surface is exposed. Root surface is like dentin, or much softer. The tooth gets cavity easier and bacteria grows faster too.

Brushing too hard, grinding and clenching, acid erosion, biting fingernail, pencil or other things could also damage the gum to expose the root.

At this stage, treatment involves scaling and root planing or deep cleaning to remove those tartar to give the gum a chance to heal. At the same time, good home care is very important.

Question:
Do you think your gum look like picture #B?
Do you want your gum to look like picture #B?

Picture #C After deep cleaning

After deep cleaning, the gum is healing. But probably just a little too late, do you notice the bone loss? The level of the bone is not as high as before. Do you see the exposed root surface (cementum)? The gum is definitely further away from the tooth.

Bone regeneration is not as predictable. The specialist usually have to put some bone and gum tissue back. The specialist charges even more.

Along with good home care, this tooth could still last for awhile.

Question:
Do you think your gum look like picture #C?
Do you want your gum to look like picture #C?

Picture #D Advanced stage of gum disease

This is the advanced stage of gum disease. The gum is far away from the tooth. The brown line shows where the bacteria is. Keep in mind, food, plaque and tartar is present along that brown line. Even more bone loss (not shown as much in the picture).

When we probe, you will hear numbers beyond 6. Usually the length of the root is between 10-15mm. When a person has 9 mm pocket and 3 mm gum recession, there is only 3mm of gum or bone to hold onto the tooth. No wonder that tooth will move and fall off.

Treatment involves the care of the specialist. And sometimes unfortunately, the teeth are hopeless and best with extraction and possibly an implant, bridge, or partial or denture to replace that missing tooth/teeth.

Question:
Do you think your gum look like picture #D?
Do you want your gum to look like picture #D?

So, the choice is your.

Question #1. Which picture best describes your teeth and your gum?

Question #2. Which picture do you want your teeth and your gum to look like?

 

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Oral Hygiene

Oral hygiene is very important. We want to continue to smile, chew, and talk without any discomfort. Brush twice a day for two minutes, floss every day, and visit your dentist every 6 months will bring great benefit to your health. Here are some flyers. Feel free to click on the pdf files to read them all.

FS_BrushingBasics.pdf
Brushing your teeth two times a day is an important part of your daily oral hygiene routine. Check out the flyer

FS_FamilyOralHealth.pdf
Children learn by example. Lead your kids and family to good oral health. Check out the flyer.

FS_Flossing.pdf
Here is your how, when and why guide to flossing your gums to a state of health. Check out the flyer.

FS_Mouthwash.pdf
Mouthwashes are not a necessity to a healthy mouth, but there are several out there that can help you prevent cavities and reduce sensitivity. It is definitely an addition, not a substitution to brushing and flossing. Check out the flyer.

FS_OralHygiene.pdf
Floss First, Brush Second! Keep you healthy. Check out the flyer.

FS_Plaque.pdf
Plaque is a live bacteria that lives in your mouth. Learn how to control the acid byproduct bacteria leaves in your mouth. Check out the flyer.

FS_Toothbrushes2.pdf
Size and shape does matter! Choose the brush that fits your needs. Check out the flyer.

FS_ToothpasteAbrasivity.pdf
So many toothpaste choices. Educate yourself on what is available for you. Check out the flyer.

FS_Xylitol.pdf
Xylitol is one of the best kept secrets. Read on to find what you can do to reduce cavities. Check out the flyer.

 

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Different Signs

Our body gives us signs to warn us. Your mouth shows signs too. Let us explore what some of those signs mean. Catch them early, so we can prevent future problems.

BruxismFS.pdf
Teeth occasionally sore or sensitive to cold? Headaches? Cracks in teeth? You may be clenching or grinding your teeth. Check out the flyer.

FS_Allergies_and_Dentistry.pdf
Some allergic reactions are mild, while others can be severe and life-threatening. Please inform our dental staff of any allergy you have. Check out the flyer.

FS_CancerCare.pdf
Cancer treatments affect your oral health. Consult your dental office for advice prior to your treatment. Check out the flyer.

FS_DentinHypersensitivity.pdf
Do you avoid cold drinks or food? Don't let acid erode away your teeth. Check out the flyer.

FS_DryMouthX.pdf
Do you always feel your mouth dry? Saliva is a very important buffer. Many medications reduces salivary flow and cause cavities. Check out the flyer.

FS_EatingDisorders.pdf
Eating disorders are real, complex, and often devastating conditions that can have serious consequences on your overall health and oral health. Check out the flyer.

FS_Halitosis.pdf
Bacterial waste is the #1 cause of bad breath: Flossing & Brushing (your tongue too) to reduce bacteria and please do not let cavities grow. Check out the flyer.

FS_MouthSores.pdf
Mouth sores are swollen spots or sores in your mouth, on your lips, on your tongue, or on the skin surrounding your mouth. Check out the flyer.

FS_OralCancer.pdf
Reduce your risks of oral cancer. Quit smoking and drinking. HPV in men and women are causing oral cancer! Check out the flyer.

FS_SleepApnea.pdf
Are you gasping for air in your sleep? Ask your physician to do a sleep study. Talk to me if you know you need a CPAP, but refuses to use one even if you know the consequences. Check out the flyer.

FS_ToothErosion.pdf
Tooth wear can happen from diet, acid reflux, grinding/clenching or brushing too hard. Acidic food and drinks can cause tooth erosion and tooth sensitivity. Check out the flyer.

FS_WisdomTeeth.pdf
Wisdom teeth are usually removed done to decay, infection, or impaction. One of the worst thing is to wait too long and the wisdom tooth erupts sideway and damage the second molar. Now both teeth need to be removed. Check out the flyer.

 

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Dangerous things you may not know about

FS_DentalEmergencies_2.pdf
Learn what to do before you encounter an emergency. And if dental emergency ever occurs during off hours, call 911, text my office and facebook message my office. Check out the flyer.

FS_DentalEmergencies.pdf
Dental emergency is so important and let's review again. Check out the flyer.

FS_E-Cigarettes.pdf
E-cigarettes are not an alternative. Read about ways to quit smoking. Check out the flyer.

FS_EffectsofSmoking08.pdf
Using tobacco can harm your mouth, including your teeth and gums, in a number of ways. How does yellow and brown teeth, gum disease, cancer make you attractive? Check out the flyer.

FS_OralPiercing_Dec13.pdf
Oral piercing cause damage to your teeth as well as your soft tissues in your mouth. Check out the flyer.

FS_OralWarningSigns.pdf
Your mouth is the opening to your entire body. How does diabetes, eating disorders, alcohol use disorders, and cancer affect the mouth? Check out the flyer.

 

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Do you fit the following description?

FS_DentalAnxiety.pdf
Going to the dentist can cause anxiety, and that’s a normal reaction. Tell your dental team of your anxiety they will help make a plan to ease your stress. Check out the flyer.

FS_Geriatric_Dental_Care.pdf
Aging doesn't mean losing your teeth. Like everyone else we just have to learn how to keep your mouth healthy as we age. Check out the flyer.

FS_MensOralHealth.pdf
Men are less likely than women to take care of their physical health and, according to research, their oral health is equally ignored. Don't let the tiny bacteria beat you up. Check out the flyer.

FS_Pregnancy.pdf
Thinking about getting pregnant. Take care of your teeth first. Dental work during pregnant is doable, but why put the baby in any avoidable risk. At the same time, being pregnant doesn't mean no dental appointment and no dental work ever. Please inform us if you are pregnant or possibly pregnant. Check out the flyer.

FS_WomensOralHealth.pdf
Learn how to adjust your oral health depending the stage of life you are in. Check out the flyer.

 

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How your mouth relates to the rest of your body

FS_Endocarditis.pdf
Understanding endocarditis and when antibiotics are taken prior to dental procedures. Check out the flyer.

FS_GERD.pdf
Heartburn, or acid indigestion, is a common symptom of chronic acid reflux, also known as gastroesopheageal reflux disease (GERD). Acid reflux can cause enamel errosion leading to sensitivity. Check out the flyer.

FS_Nutrition.pdf
What you put in your mouth directly affects your whole body. Check out the flyer.

FS_Perio_and_diabetes.pdf
Periodontal Disease and Diabetes
Diabetic develops infections faster and heals slower than people without diabetes. Check out the flyer.

FS_PeriodontalCardiovascular.pdf
Periodontal Disease and Cardiovascular Disease
Control your periodontal disease and reduce the risk of cardiovascular disease. Check out the flyer.

FS_PeriodontalDisease.pdf
Periodontal Disease ?Minimize your chances of periodontal disease by seeing your hygienist; flossing and brushing regularly. Check out the flyer.

 

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Our children's teeth

From infants to young adults, how can you help them to stay healthy.

FS_BabysOralHealth.pdf
It's never too early to start taking care of your little one's teeth. If you love your kids, don't kiss on their lip. You will give bacteria to them. Check out the flyer.

FS_ChildrenandToothDecay.pdf
Tooth decay is the most common chronic disease among children. Learn about prevention. Check out the flyer.

FS_ChildrensOralHealth.pdf
Set the stage for your children's lifelong oral health. Lead by example too. Check out the flyer.

FS_ChildsFirstDentalVisit.pdf
Come early, bring kids with you to your visit so they know what to expect. Check out the flyer.

FS_DentalSealants.pdf
When the teeth are still forming, teeth have grooves and depression. Seal those grooves and depressions to prevent cavities. No anesthetics needed. Check out the flyer.

FS_FASD.pdf
Drinking alcohol while pregnant may cause life long birth defect. Just don't do it! Check out the flyer.

FS_Nutrition_Children.pdf
Teach your children to make healthy food decisions. Check out the flyer.

FS_Pacifiers.pdf
Pacifier is controversial in dentistry. I have heard of wean children off as early as six months to six years old. Without pacifier, they might suck on their finger instead. Try to figure out if the baby is having stress and smooth more. Check out the flyer.

FS_SportsDentistry.pdf
A custom guard can prevent many injuries to teeth, neck and jaw. Check out the flyer.

Orthodontics_FS.pdf
Want to learn more about braces? Check out the flyer.

TeensFS.pdf
Teen's Oral Health
Teens should be sure to see their dentist at least twice a year. Check out the flyer.

 

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Procedures

FS_Bridges.pdf
A fixed bridge is a dental appliance that replaces one or more missing teeth—thus “bridging” the space between the two adjacent natural teeth or implants. Check out the flyer.

FS_CosmeticDentistry.pdf
Different ways to improve your smile and confidence. Check out the flyer.

FS_Crowns.pdf
Crowns or caps can be the lasting restoration your mouth needs. Check out the flyer.

FS_Dental-Implants.pdf
Dental implant is the closest thing to the missing tooth. No wonder it is the best option. Check out the flyer.

FS_Dentures.pdf
Learn what to expect prior to getting dentures. Need care & occasional checkups. Check out the flyer.

FS_Mouthguards.pdf
One elbow to the mouth will drive home. Custom-fabricated mouthguards are essential for preventing athletic oral/facial injuries, such as broken teeth, jaw fractures, cerebral hemorrhages, and neck injuries. Check out the flyer.

FS_RootCanalTherapy.pdf
Want to learn more about root canal treatment? Check out the flyer.

FS_Sedation.pdf
Help us Help you! If you riddled with anxiety, let's find a good solution prior to your visit. Check out the flyer.

FS_TMD.pdf
Temporomandibular Disorder
(TMD) occurs when the temporomandibular joint (TMJ) is damaged or deteriorated, or when the muscles surrounding the joint malfunction, causing imbalanced jaw movement. Jaw joint pain is terrible! Learn about TMD and what you can do to help with the pain. Check out the flyer.

FS_ToothExtraction.pdf
Teeth are usually extracted because decay and damage has left the tooth unable to be repaired through other methods. Learn what to expect if you need an extraction. Check out the flyer.

 

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Call Atwater Family Dental today and schedule your next dental appointment so we can keep it at picture #1.
Healthy teeth surrounded by healthy gum..

Give us a call today, you deserve it, 209.358.0800.
(Best time to reach us: 9am to 1pm, 2pm-4:30pm Monday to Thursday)

Or click the
TEXT HERE link to send us a text.

Or
fill in your information and we will call you to schedule your next appointment.

Dr. Eric K. Cheung D.D.S.

596 Bellevue Rd.
Atwater, CA 95301

209.358.0800

 
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