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Dr. Thomas

Archives for September 2021

Are cavities or teeth grinding causing tooth pain?

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Man holding the side of his face perhaps from teeth grinding related to sleep apneaCould grinding my teeth and night cause lower back teeth pain. My dentist says that I need to wear an appliance at night, but my teeth look fine. I already have a CPAP machine for sleep apnea. I am concerned that my dentist might find cavities at my next exam. Could something other than teeth grinding cause the pain? – Thank you, Luke

Luke,

Dr. Thomas would need to examine your teeth and jaw moment and review your x-rays for an accurate diagnosis. If you grind your teeth at night, there are likely signs of wear on them, and they do not look fine.

How Does Teeth Grinding Affect Your Oral Health?

When you grind your teeth, it weakens them and can lead to several issues, including:

  • Wear on teeth
  • Bulges or notches near the gumline
  • Tooth sensitivity
  • Jaw or neck pain

During an exam, your dentist should check for signs and symptoms of stress on your teeth.

The pain you describe does not sound like tooth decay is the cause. Possible causes of tooth pain include gum disease or trauma from grinding. Although you already wear a CPAP for sleep apnea, you can benefit from wearing a nighttime mouthguard. The nightguard will serve as a cushion between your teeth to prevent damage while you grind your teeth.

Appliances for Teeth Grinding and Sleep Apnea

Many patients wear a CPAP machine for sleep apnea and a night guard for clenching or grinding. Each appliance has its purpose and will contribute to your oral and overall health. And scientific evidence shows that teeth grinding may be related to sleep apnea. Many oral sleep apnea appliances also resolve teeth grinding by moving your jaw forward to open your airway and alleviate grinding.

If you are hesitant about your dentist’s diagnosis, consider getting a second opinion.

 

Dr. Siny Thomas, a Sugar Land, Texas dentist, sponsors this post.

Will an onlay work for a cracked second molar?

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I had an old filling in a lower left second molar. The filling cracked 2 or 3 months ago, and the tooth broke in mid-September. My dentist tried to repair the crack, but I still cannot put pressure on the outside of the tooth without feeling intense pain. Now my dentist wants to try an onlay. I prefer not to go through trial and error with the tooth. Will an onlay work, or will I need a crown? I am thinking about calling another dentist for an emergency appointment just to see what they recommend. Thanks for your input. Alok from Seattle

Alok,

Thank you for your question.

Dr. Thomas would need to examine your tooth and x-rays to determine the type and extent of the tooth crack. The location of the tooth crack can also affect the treatment options. But your question is about onlays, so without suggesting a diagnosis or explaining treatment options, we will discuss onlays.

Dental Onlays

A dental onlay is a ceramic restoration covering one or more cusps or peaks of a tooth. Some onlays work well for tooth cracks, but others have restrictions. A dentist’s goal is to stabilize and repair a crack to prevent a tooth from fracturing.

Onlay advantages

A dental onlay has several advantages over a dental crown.

Preserves more tooth structure – A dental crown requires shaving down your tooth on every side. But an onlay removes only the damaged portion of a tooth.

  • Promotes gum health – An only does not extend below the gumline and is healthier for gum tissue than a crown.
  • Versatile materials – A dentist or lab can make onlays of gold, ceramic, or hardened composite. The options for materials are adaptable depending on your needs.
  • Gold is durable – A gold restoration is more durable than ceramic and would protect virtually any cracked tooth.
  • Ceramic or porcelain has limitations – Although they make beautiful onlays, ceramic or porcelain may not be strong enough to hold a severe vertical crack. The ceramic and tooth are at risk of cracking.
  • Hardened composite has limited longevity – Composite may work for a basic onlay but is not strong enough for a cracked tooth.

Repairing a Cracked Second Molar

Diagram of an onlay above a molar tooth - for dental emergency info from Sugar Land, TX dentist Dr. Siny Thomas

An onlay covers the broken portion of a tooth

Most dentists would repair a cracked tooth with a ceramic or gold crown. But others skilled in ceramics and onlays understand the techniques required to preserve your tooth with an onlay. We recommended asking your dentist how many cases like yours they have resolved with an onlay. Ask to see before-and-after photos, and ask about the current status of the patients’ onlay.

If you are unsure of your dentist’s recommendation, we recommend getting a second opinion from an advanced cosmetic dentist. Although you can make an emergency appointment with another dentist, the second opinion may not be worthwhile unless they have advanced cosmetic dentistry training. Even so, the dentist would need to examine your x-rays—or take new ones—for an accurate diagnosis.

Best wishes for a healthy resolution.

Dr. Siny Thomas of Sugarland, Texas, sponsors this post. He is a graduate of the Kois Center for cosmetic and restorative dentistry.

 

Will Dental Crowns Help Tetracycline Stains?

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15 years ago, my dentist used dental bonding to hide tetracycline stains. He did an excellent job, and I had no issues with his work. But over the years, the bonding started to wear and look yellow. I’ve relocated since then and have a new dentist that my family and coworkers recommended. I asked for porcelain veneers instead of bonding because I know it lasts longer than bonding. My dentist recommended six crowns instead of veneers because he said he could hide the stain better with crowns and improve my gummy smile. Regrettably, I listened.

The tetracycline stains show through my crowns. My dentist says the lab will redo the faulty crowns, but he thinks other crowns look okay. I wish I had insisted on veneers, and now I am concerned that I am on a course of repeat dental work and will not be able to break the cycle. How should I proceed? Thank you. Hae-Won

 

Hae-Won,

We are sorry to hear about your experience. Many dentists who are uncomfortable using porcelain veneers recommend dental crowns instead. Concealing tetracycline stains is a challenging procedure for most dentists.

Do Dental Crowns Work for Tetracycline Stains?

Unfortunately, now that your dentist has prepared your teeth for crowns, the only way to correct the issue is with more crowns. You do not have enough tooth structure remaining for veneers. But this time, you can take control of the situation by looking for an advanced cosmetic dentist to complete the work. And there are factors to insist on this time.

Correction for eight teeth—not six

One porcelain veneer - available from Sugar Land cosmetic dentist Dr. Siny Thomas

If you cannot get porcelain veneers, a skilled cosmetic dentist will still achieve beautiful results

When you smile, at least eight teeth show. Some people with broader smiles show more than eight teeth. So, six crowns are not enough to hide all the teeth affected by tetracycline stains when you smile. But a cosmetic dentist will analyze your smile and determine the extent of stains on your remaining front teeth and whether crowns are the best option.

Find a dentist with advanced, post-graduate cosmetic dentistry training

Without advanced cosmetic dentistry training, a dentist will not understand the color issues involved in the stains and how to manipulate porcelain to conceal them. Look for an artistic cosmetic dentist who will achieve natural-looking results. Please don’t return to your dentist to resolve the issue.

Schedule consultations with at least two cosmetic dentists to discuss your options.

 

Dr. Siny Thomas of Sugar Land, Texas, sponsors this post. He is a graduate of the Kois Center for cosmetic and restorative dentistry.

Is Sleep Apnea Causing My Morning Headaches?

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Young woman waking up with a morning headache - for sleep apnea info from Sugarland, TX dentist Siny Thomas, DMDIf you wake up most mornings with a headache, sleep apnea might be the cause. The American Migraine Foundation confirms that snoring increases the risk of chronic headaches and that sleep apnea patients often awaken with a headache. But how do you know if sleep apnea is causing your morning headaches?

Is Sleep Apnea Causing Your Morning Headaches?

One reliable way to determine if sleep apnea is causing your morning headaches is to determine if you have sleep apnea. Ultimately, you will need an exam and sleep study to determine if you have the condition, but you may recognize that sleep apnea might be causing some of your signs and symptoms.

Sleep apnea signs and symptoms

Obstructive sleep apnea results from a blocked airway while you are asleep. Signs and symptoms include:

  • Loud snoring
  • Daytime sleepiness
  • Difficulty concentrating
  • Morning headaches
  • Morning dry mouth
  • Morning sore throat
  • Choking or gasping for breath

According to the National Sleep Foundation, sleep apnea can increase the risk of other medical conditions, including:

  • Heart attack
  • Heart disease
  • High blood pressure
  • Stroke

What Causes Sleep Apnea Morning Headaches?

People with obstructive sleep apnea stop breathing for brief periods while asleep. Breathless moments reduce the oxygen level in your bloodstream. The oxygen-deprived blood affects all your organs, including your brain.

This sequence precedes your headache:

  • Oxygen in your blood decreases
  • Carbon dioxide increases
  • Blood vessels in your brain dilate

And you can awaken with a morning headache.

How Does a Sleep Apnea Morning Headache Feel?

Dull pain usually characterizes a sleep apnea morning headache. Other headache symptoms include:

  • Location: Above the eyebrows but can spread throughout your head
  • Frequency: Daily
  • Length: An hour or two

Do You Think Sleep Apnea Is Causing Your Morning Headaches?

If you think sleep apnea is causing your morning headaches, schedule an appointment with your medical doctor. Your doctor will refer you to a specialist for an overnight sleep study to monitor your sleep and breathing and determine if sleep apnea is causing your symptoms.

Sleep Apnea and Morning Headache Treatment

Often, treatment options for sleep apnea and morning headaches include wearing an oral appliance while you sleep. The custom-made appliance will move your lower jaw forward to keep your airway open and ensure your blood oxygen levels are steady throughout the night. You will rest better. And it might be the answer to prevent you from waking up with a morning headache.

 

Dr. Siny Thomas, a Sugar Land, TX, dentist, sponsors this post.