Mystery Solved: The Story on Canker Sores



Anyone who’s ever had mouth sores can attest to the fact that they are just as embarrassing as they are painful, but simply suffering through them does you no good. Get the facts on this common problem to take control of the situation before another outbreak. The Oral Surgery DC Team


Canker sores are quite literally a sensitive issue, but someone has to talk about it! What are canker sores (or “stomatitis”), why do they appear, and what can be done about them? Anyone who’s ever had mouth sores can attest to the fact that they are just as embarrassing as they are painful, but simply suffering through them does you no good. Get the facts on this common problem to take control of the situation before another outbreak.

How to Tell If It’s a Canker Sore

Because they are similar in name and can appear within fairly close proximity of each other, canker sores are often confused with cold sores. An easy way to tell the difference right off the bat is by checking to see if it’s on the inside or outside of your mouth. Cold sores, which are viral and highly contagious in nature, will appear outside of the mouth, on or close to the lip area. Canker sores, on the other hand, are not contagious and emerge along the insides of your cheeks, gums and the roof of your mouth. If you spot an inflammation with a white center and red border inside your mouth, and it causes sensitivity or soreness when talking or eating, it’s most likely a canker sore.

What Causes Canker Sores

Considering that stomatitis is often chronic, those who experience canker sores due to an injury, or eating something overly acidic, might actually consider themselves lucky. Otherwise, recurring flare-ups can be expected, especially if your case is connected to underlying conditions such as:

  • Stress
  • Menstruation
  • HIV & Other Blood Disorders
  • Food Allergies
  • Crohn’s Disease
  • Lupus
  • Genetics
  • Immune Disorders
  • Fatigue
  • Orthodontic Treatment
  • Vitamin Deficiencies
  • Chemotherapy

It is also worth noting that canker sores tend to be more common in teens, young adults and women.

Ways to Ease the Pain

On average, canker sores usually last between 7 and 10 days. While there is no way to rid yourself of a canker sore once it emerges, there are plenty of things you can do to alleviate the discomfort until it heals, such as:

  • Try an over-the-counter gel or painkiller for immediate relief
  • Steer clear of spicy, acidic and/or hot foods to avoid aggravating open sores
  • Rinse with water or mouthwash regularly to keep the sores free of food particles
  • Brush and floss with extra care to prevent unnecessary contact and/or added trauma

Understanding what caused the outbreak can also help you take preventative measures to minimize the chance of future flare-ups. If sores are food or allergy related, for example, simply steering clear of triggers can keep stomatitis at bay.

When Professional Care is Necessary

If painful sores persist past the ten-day period, are over a half-inch wide, and/or are accompanied by other symptoms such as diarrhea, joint pain, rashes or fever, see a dentist as soon as possible. Depending on the severity of your situation, he or she may prescribe medication, surgery, or recommend diagnostic tests. Even if your symptoms are mild, a dental exam can help rule out serious health concerns that could be causing the problem, and give you peace of mind.



How Safe Are Dental X-Rays?


By: 123Dentist


🙂As long as dental x-rays are used properly together with necessary safety precautions, its effect is extremely safe. Discuss the use of this device with your dentist so he can evaluate the factors if you need one. The Oral Surgery DC Team


Dental x-rays are a common diagnostic procedure that is considered extremely safe. Digital dental x-rays have very low doses of radiation, producing just a fraction of what you are exposed to in other imaging procedures. If you’re worried about whether you need dental x-rays, or wondering if you should forego this procedure due to other medical conditions, it’s helpful to dive a little deeper into what dental x-rays involve, why they’re performed, and how they’re best handled.

When these x-rays are performed properly with adequate safety precautions in place, there’s very little cause for concern. A routine examination with four bitewing x-rays exposes you to roughly the same amount of radiation you will experience during one to two hours on an airplane.

Who Needs Dental X-Rays

Dental x-rays are used diagnostically to help dentists see issues that are otherwise nearly invisible to the naked eye. Adults receive dental x-rays so dentists can better identify and treat various issues. Using these x-rays, your healthcare provider can see:

  • Areas of decay, including those in between teeth or under a filling
  • Bone loss associated with gum disease
  • Abscesses, which are infections at the root of the tooth or between the tooth and gum
  • Tumors
  • Changes in the root canal

Without an x-ray, many of these problems could go undiagnosed. With an x-ray as a reference, dentists are also better equipped to prepare tooth implants, dentures, braces, and other similar treatments.

Dental X-Rays and Children

Many parents are concerned about the impact of dental x-rays on children. Children are more sensitive to radiation. However, the amount of radiation in a dental x-ray is still considered safe for a child. As children’s jaws and teeth are continuously changing, it’s important to keep an eye on their development. These x-rays perform many important purposes for young patients. They help dentists to:

  • Make sure the mouth is large enough to accommodate incoming teeth
  • Monitor the development of wisdom teeth
  • Determine whether primary teeth are loosening properly to accommodate new permanent teeth
  • Identify decay and gum disease early

It’s important for children to visit the dentist regularly, and to get x-rays as recommended by the dentist. The exact schedule for these x-rays will vary depending on the child’s individual needs.

Dental X-Rays During Pregnancy

Pregnant women are generally advised to avoid dental x-rays. Though the radiation is minimal, it’s best to avoid all exposure when possible for the health of the developing fetus. For this reason, it’s important to tell your dentist if you are or may be pregnant.

However, there are some instances where pregnant women should still have dental x-rays performed. If you have a dental emergency or are in the middle of a dental treatment plan, you may still need x-rays during your pregnancy. Discuss the issue with your dentist to determine the best way to proceed. It’s crucial that you balance both your dental and prenatal health. Women with periodontal disease are at a higher risk of adverse pregnancy outcomes, so you shouldn’t neglect your teeth during pregnancy.

Your dentist can take greater precautions, such as using a leaded apron and thyroid collar, for all x-rays taken during your pregnancy if the procedure is deemed necessary. Keeping your dentist informed at all times is the best way to proceed.

Safety Precautions with Dental X-Rays

There are many things that your dentist can do to minimize the radiation from x-rays. Taking a single image rather than multiple images decreases exposure significantly. You can also speak to your dentist about using the lowest radiation setting possible, particularly for children. Leaded coverings can protect certain parts of your body from radiation.

Determining Whether X-Rays are Necessary

The best way to minimize radiation exposure from dental x-rays is to make sure these are only done when necessary. There is no set schedule for dental x-rays. Rather, it’s left to the healthcare provider to make an informed decision as to whether the patient needs x-rays with their examination. Factors that your dentist will consider include:

  • Age
  • Stage of dental development
  • History of oral health
  • Risk factors for various conditions
  • Presenting symptoms

One study revealed that performing a careful clinical evaluation of the patient can reduce the need for x-rays as much as 43 percent without any increase in the rate of undiagnosed diseases. So, if you’re concerned about exposure, ask your dentist to perform a visual examination before ordering x-rays. But keep in mind that there are several issues that there are many conditions that would likely only be diagnosed through x-rays.

To further minimize your need for x-rays, if you have x-rays from a previous dentist, make sure to transfer these to any new provider to eliminate the need for repeat procedures.

Dental x-rays are considered extremely safe. However, it’s important to understand the purpose of any procedure that will expose you to radiation. Don’t hesitate to discuss the need for dental x-rays with your dentist to better understand how he or she can help protect and improve your oral health.


How Stress Might Be Ruining Your Teeth


By: Kelsey Lindsey, Washingtonian


You may know that stress can cause upset stomachs and headaches, but did you know it can cause tooth decay? Here’s what to know and what you can do to protect your smile. The Oral Surgery DC Team

Backaches, sleepless nights, upset stomach. Just reading about the physical manifestations of stress can trigger a headache. Unchecked, stress can contribute to serious health conditions including high blood pressure, diabetes, and heart disease.

There’s another, less obvious part of our body both affected by stress and a sign of it: our pearly whites.

“Sometimes people end up with issues that they didn’t even know were dental, and they didn’t even know they were stressed,” says Danine Fresch Gray, a general dentist who owns Clarendon Dental Arts.

Clenching or grinding the teeth, a common dental problem that can be related to stress can cause headaches, chipped or flattened teeth, and tight jaw muscles. Improper bites and the breakdown of the temporomandibular joint connecting the skull to the jawbone may contribute to these dental woes, says Richard Rogers, a dentist in Frederick. Stress exacerbates grinding in those situations.

Rogers recently saw a college student home for a break who was experiencing jaw pain and clenching during his exams. “The analogy might be gas on the fire,” Rogers says. “There’s already a fire burning and they are doing some damage, but it’s not that dramatic. Then they go through a period of stress, and they start grinding harder and they wake up with a headache and say that it’s stress causing it.”

Certain drugs are taken for depression and anxiety, including Prozac and Zoloft, also may lead to jaw-clenching and teeth-grinding. “It’s just a side effect of the drug,” says Fresch Gray. “That’s a big one—lots of people don’t know that.”

Teeth-grinding and clenched jaws aren’t the only oral-health manifestations of stress. A 2007 review of scientific studies found that there’s a relationship between stress and periodontal disease, which includes gum and tissue infections such as gingivitis. Recent research from Canada also found that participants with more perceived stress reported poorer oral health and greater oral pain compared with participants who had less stress. Alex Vasiliou, the lead author of the study, explained in an e-mail that cortisol—a hormone involved in the body’s stress response—impairs the immune system, making a person more susceptible to gum disease.

Rogers says that someone stressed out or sick might be more apt to disregard proper oral hygiene, leading to inflamed gums or tooth decay: “They’ll just stop caring about things, and oral health falls into that.”

Fresch Gray has seen the number of patients with stress-related symptoms increase in the past year. Although it’s tempting to blame Twitter rants and turbulent politics, other factors no doubt contributed.

According to a recent “Stress in America” report from the American Psychological Association, Americans on average reported more physical symptoms of stress in 2017 compared with 2016, including anxiety, anger, and fatigue. The most common sources were the “future of our nation,” money, and work. It was the first significant increase in stress levels found by the APA since the inaugural survey in 2007.

While there are no Washington-specific numbers, a national survey in January 2017 found that 62 percent of urbanites were stressed by the election of Donald Trump, compared with 45 percent and 33 percent of people in suburban and rural areas, respectively.

Because of the connections between psychological stress and physical and oral health, a dentist must consider the whole person when a patient presents a stress-related dental issue. “One of the sayings is you never see a tooth walk through the door—it always has a human attached,” says Rogers. Teeth-grinding, for example, can be a sign of a sleep disorder. When someone has sleep apnea, the body’s effort to clear the airway may include grinding the teeth. “We monitor [patients’ sleep] and we say, ‘Here’s where you stopped breathing and gasped for air, and then you grind your teeth.’ ”

To treat a problem, Fresch Gray may look beyond dental fixes at such things as a patient’s diet and whether the person has diabetes, which can increase the risk of gum disease. “It’s not that you’re always stressed out,” she says. “It could be that you’re taking some drugs that you don’t know are making you clench, that you have diabetes or an autoimmune disease causing stress, or there are some extraneous external things like circadian rhythms and PTSD—all these things cause stress on your body that eventually show in your mouth.”

She recalls one patient who recently came into her office. A veteran who served in Afghanistan, the man was having trouble sleeping and was clenching his jaw. “I asked about PTSD, and he had it,” Fresch Gray says. “That stress is daily in his life, and we kind of got to the root of it, but I’m not necessarily the person to help with that.” She recommended he participate in a sleep study to diagnose any sleep disorders.

“I could have gotten him a mouth guard,” says Fresch Gray, “but that’s not going to solve the problem.”



More Preschoolers with Cavities Requiring Dental Surgery


By Melanie at


😞 The increasing number of preschool cavities is very alarming. As a parent, we need to ensure they practice good oral hygiene even before the eruption of his teeth. Learn the effective ways on how to keep your child cavity-free. The Oral Surgery DC Team


 What’s worse than going to the dentist? Taking your kids to the dentist—especially to find that they’ve got multiple cavities before they’re in kindergarten. The New York Times reports that a rise in the number of preschool cavities has led to a rise in the number of preschoolers requiring extensive dental work (often necessitating general anesthesia). Um, I guess not going to the dentist is actually worse than going.

Plus: The Link Between Sippy Cups & Cavities

As a mom of 2- and 4-year-old boys, I found myself squirming as I read the article, which led with a 2-year-old Seattle boy’s root canal, fillings and crowns, done to repair 11 cavities (kids that age have just 20 teeth in total). The Times reports that dentists nationwide are seeing more preschoolers from all socioeconomic backgrounds with 6 to 10 cavities or more, with a level of decay often necessitating general anesthesia because such young children have a hard time tolerating such extensive dental repairs while awake. (I’d have a hard time doing so too!)

While the number of preschool cavities is rising, dentists say that such tooth decay (and its painful treatment) is mostly preventable. Constant snacking, too much juice or other sugary beverages, drinking bottled water instead of fluoridated tap water and simply not knowing that kids so young should see a dentist are behind many of these cavities.

Plus: How to Keep Your Kids Cavity-Free

We checked in with Lawrence Limb, DMD, a pediatric dentist in New York City, to get his take on whether this is as serious and widespread a problem as it seemed after reading the Times’ report (hint: it is) and his suggestions for how parents can help prevent tooth decay in the littlest of kids.

In babies, Dr. Limb said that parents can usually get away with wiping the gums prior to the eruption of teeth to reduce the amount of bacteria on the gum pad. “As the teeth erupt (around six months), start introducing a toothbrush after each feeding,” he suggests. The American Academy of Pediatric Dentistry (AAPD) recommends using a “smear” of fluoridated toothpaste and a soft, age-appropriately sized toothbrush until age 2, and then a “pea-size” amount for kids ages 2 to 5. And while brushing after each feeding might be ideal for dental hygiene (albeit a lofty goal) while babies are at home, he acknowledges that for those in daycare or young children at school, brushing a minimum of twice a day should suffice.

Plus: Taking Care of Preemie Teeth

Of course, brushing a young child’s teeth isn’t as easy as brushing one’s own. But Dr. Limb points out that giving up on brushing or not doing a thorough job will lead to cavities and fillings down the line—which is vastly more painful than the temporary discomfort (or all-out tantrums) associated with brushing. If your child is particularly resistant to teeth brushing, Dr. Limb reassures that, “Kids do grow out of it as traumatic as it may seem. Treating the teeth [when there are cavities] is much more traumatic and difficult for the parent, patient, and dentist.”

Plus: How to Know If Your Child Is Getting Enough Fluoride

So, think you’ve got it covered because you brush your children’s teeth twice daily? How ‘bout flossing? “Flossing is as important as brushing,” says Dr. Limb. “It’s not easy to do as a parent, but it’s necessary,” especially between the back molars, which kids will need for chewing until 10 to 12 years of age, and which are at the highest risk of developing dental caries (cavities).

And no need to wait until all of your child’s teeth are in to make the first visit to a dentist. The AAPD recommends seeing a pediatric dentist once the first tooth emerges, or no later than the child’s first birthday. Surprised? I was too—especially since my kids’ pediatrician hadn’t recommended making that first trip until age 2 (which in all honesty seemed really early to me even then). But, Dr. Limb explains that that first trip is important in terms of helping to establish not just proper oral hygiene but also getting parents to be more mindful of their children’s diet and nutrition and their impact on dental health. Following that first visit, Dr. Limb and the AAPD recommend check-ups every six months.

Not concerned about potential cavities because your child’s teeth look fine and he seems happy? Dr. Limb explains that cavities are often found in the back teeth (which are tough for parents to see well) and adds that many kids never experience any kind of oral pain unless there is a significant amount of decay—so don’t assume that your kid’s teeth are healthy just because he hasn’t complained to say anything is hurting. Additionally, dentists can find and treat cavities at a very early stage, using local anesthesia and a DVD for distraction, instead of the heavier duty sedation required for long, multiple procedures.

Adds Dr. Limb, “There are risks with general anesthesia or any kind of sedation with a child. Any conscientious doctor will always be concerned. In my office, we try to treat children while awake. [These procedures] also place a great amount of financial liability on the parent—but can be easily avoided. As dentists, we really try to drive home the fact that these things can be avoided—[cavities] are treatable, but prevention is the best treatment overall.”

Dr. Joel Berg, director of the Center for Pediatric Dentistry at the University of Washington and Seattle Children’s Hospital, explained to why treating cavities in baby teeth is so important, especially when those teeth will fall out anyway: “’We have to fix cavities to treat the overall health of the child. We see kids coming into emergency rooms with swollen faces from untreated cavities. Kids are not good at reporting tooth problems and this can lead to other orthodontia problems later and even trouble to pay attention at school.’”

To help prevent cavities in the first place, Dr. Limb and other dentists recommend:

  • seeing a dentist regularly
  • drinking fluoridated water (bottled water generally has little to no fluoride)
  • eating a balanced diet
  • reducing the frequency of snacking
  • paying attention to proper oral hygiene (including regular brushing and flossing)
  • avoiding sharing utensils or putting your child’s pacifier in your mouth, as tooth decay can be contagious


Has your child had any cavities yet?



Advances in Dental Care: What’s New at the Dentist


By: WebMD


😃 With technological advancement, tooth restoration was made easy. Thanks to these modern tools used in dental practices today, there are a lot of good options to keep our teeth beautiful. Check them out! The Oral Surgery DC Team


Are you behind on your dental visits, and now you’re being driven in by a toothache, other dental problems, or guilt?

If so, be prepared — not for a lecture from your dentist — but for discovering that there is a host of new options to keep teeth healthy and beautiful.

Here are some of the newer dental care procedures and techniques that leading dentists are bringing into their practices.

Improving Dental Health: How High-Tech X-Rays Can Help

In some dental offices, digitized X-rays (think digital camera) are replacing traditional radiographs. Although digital X-rays have been on the market for several years, they have recently become more popular with dentists.

Digital X-rays are faster and more efficient than traditional radiographs. First, an electronic sensor or phosphor plate (instead of film) is placed in the patient’s mouth to capture the image. The digital image is then relayed or scanned to a computer, where it is available for viewing. The procedure is much faster than processing conventional film.

Your dentist can also store digital images on the computer and compare them with previous or future images to see how your dental health is being maintained.

And because the sensor and phosphor plates are more sensitive to X-rays than film is, the radiation dose is significantly reduced.

Digital X-rays have many uses besides finding cavities. They also help look at the bone below the teeth to determine if the bone level of support is good. Dentists can use the X-rays to check the placement of an implant — a titanium screw-like device that is inserted into the jawbone so that an artificial tooth can be attached.

Digital X-rays also help endodontists — dentists who specialize in root canals— to see if they have performed the procedure properly.

Lasers for Tooth Cavity Detection

Traditionally, dentists use an instrument they call the “explorer” to find cavities. That’s the instrument they poke around with in your mouthduring a checkup. When it “sticks” in a tooth, they look closer to see if they find decay.

Many dentists are now switching to the diode laser, a higher-tech option for detecting and removing cavities. The laser can be used to determine if there is decay in the tooth. The dentist can then choose to watch the tooth, comparing the levels at the next visit, or advise that the cavity be removed and the tooth filled.

When healthy teeth are exposed to the wavelength of the diode laser, they don’t glow or fluoresce, so the reading on the digital display is low. But decayed teeth glow in proportion to the amount of decay, resulting in higher readings on the display.

The diode laser doesn’t always work with teeth that already have fillings, but for other teeth, it could mean earlier detection of cavities. Note also that the diode laser does not replace X-rays; it detects decay in grooves on the chewing surface, while bitewing X-rays can find decay between and inside teeth.

Faster Dental Care: CAD/CAM Technology

The CAD in this technology stands for “computer-assisted design,” and the CAM for “computer-assisted manufacture.” Together, they translate into fewer dental visits to complete procedures such as crowns and bridges.

Traditionally when a patient needs a crown, a dentist must make a moldof the tooth and fashion a temporary crown, then wait for the dental laboratory to make a permanent one. With CAD/CAM technology, the tooth is drilled to prepare it for the crown and a picture is taken with a computer. This image is then relayed to a machine that makes the crown right in the office.

Thinner Veneers Preserve More Tooth

Veneers are the thin, custom-made shells or moldings that are used to cover the front of crooked or otherwise unattractive teeth. New materials now make it possible to create even thinner veneers that are just as strong.

What’s the advantage for you? Preparing a tooth for a veneer – which involves reshaping the tooth to allow for the added thickness of the veneer — can be minimal with the thinner veneers. Less of the tooth surface must be reduced and more of the natural tooth is kept intact.

Better Bonding and Filling Materials

If you’ve chipped a tooth, you can have it fixed to look more natural than it would have in the past, thanks to improvements in bonding material and bonding techniques.

Today’s bonding material is a resin (plastic), which is shinier and longer lasting than the substance used in the past. Often, dentists will put layers of resin on a tooth to bond and repair it. Because of the wider range of shades available, they can better blend the bonding material to the tooth’s natural color.

In restorations, when a cavity needs to be filled, many dentists have also abandoned amalgams for “tooth-colored” composite or porcelain fillings, which look more natural.

Better Dental Implants

Implants to replace lost teeth are now more common than in years past. First, a titanium implant or screw-like device is inserted to serve as a replacement root, fusing with the jawbone and protruding above the gum line. An abutment covers the protruding part and a crown is placed over that.

In the past, implants often failed. Now, the typical life of an implant is about 15 years or longer. About 95% of implants today are successful, according to the American Academy of Oral and Maxillofacial Surgeons.

New Gum Disease Treatments for Better Dental Health

When the supporting tissue and bone around your teeth doesn’t fit snugly, “pockets” form in the gums. Bacteria then invade these pockets, increasing bone destruction and tooth loss.

A variety of treatments can help reverse the damage. They range from cleaning the root surfaces to remove plaque and tartar to more extreme measures such as gum surgery to reduce the pockets.

In recent years, the focus of gum disease treatment has expanded beyond reducing the pockets and removing the bacteria to include regenerative procedures. For instance, lasers, membranes, bone grafts, or proteins that stimulate tissue growth can be used to help regenerate bone and tissue to combat the gum disease.




8 Natural Ways to Freshen Your Breath


By: Zoe Blarowski, Care2 Healthy Living


Say ahhh! It’s National Fresh Breath Day! Check out 8 natural ways to freshen your breath. 😁 The Oral Surgery DC Team


Bad breath happens to nearly all of us at some time. It’s embarrassing and can impact your work, social and intimate life. Luckily, bad breath can often be prevented or stopped with some basic, natural care and treatments.

A variety of issues can cause bad breath, which is medically known as halitosis. Poor dental hygiene can promote odor-causing bacteria to build up in your mouth. Certain foods and lifestyle habits, such as smoking, can also impact your breath.

Bad breath may be a sign of other health conditions as well, like tonsillitis or gingivitis. If you have persistent bad breath, always check with your dentist or doctor to rule out anything more serious.

Even if you’ve dealt with the underlying causes, there may still be days when your breath is just off. Or you simply want to freshen up your morning breath. Either way, read on to find out some natural ways to combat bad breath.


You’ve heard it before, but it’s important to brush your teeth twice a day in order to fight bacteria and plaque. Also, floss once a day to remove food debris from in between your teeth. If you don’t like commercial toothpastes, there are many excellent natural toothpaste options. Care2 has a recipe for homemade toothpaste. Consider adding activated charcoal to your brushing routine as well.

Oil pulling has also been shown to improve oral health and reduce smelly bacteria, as well as scraping your tongue each morning. And if you have a mouth guard or dentures, make sure you regularly disinfect them.


Bad breath can be a sign of poor digestion, so what’s good for your gut is good for your breath. Eating foods that are rich in probiotics is an excellent way to boost your beneficial bacteria, which will out-compete any unwanted bacteria. You can also check out these other suggestions on how to supercharge your digestion.


Rinsing with a baking soda solution is shown to effectively kill mouth bacteria. Mix one teaspoon of baking soda in a cup of water and swish some in your mouth for at least 30 seconds. You can also add a couple drops of essential oil to the mix for extra anti-bacterial action, such as peppermint, tea tree or clove oil.


Chewing on fresh herbs will give you a quick breath pick-me-up. Mint, thyme, basil, oregano, parsley and cilantro are all well-known bacteria fighters that will also leave a delicious aftertaste behind. Brewing them into a tea is another good option.


Aromatic spices like fennel, cloves, cardamom, cinnamon, ginger or anise provide a tasty way to counteract any unpleasant smell on your breath. You can chew on whole seeds when possible or steep some spices to make a tea. Enjoy the tea as a hot drink or use it cooled as a mouthwash.


Bad breath can be an unfortunate side-effect of low-carb diets. When your body breaks down fats instead of carbohydrates for energy, it creates foul-smelling ketones. Production of ketones is the body’s reaction to starvation. And that’s one reason why they smell bad, because it’s a sign something is wrong.

It’s always recommended to avoid refined carbohydrates, like white bread and potato chips. But make sure you eat enough healthy carbohydrates to properly fuel your body, including fruits, vegetables, whole grains and legumes.


You naturally produce about 1 liter of saliva every day. Saliva contains enzymes that break down any lingering food particles in your mouth, keeping bacteria at bay. Low saliva production can lead to nasty breath as the bacteria counts in your mouth rise. If your mouth feels dry, reach for some water. Also give your mouth a quick swish for extra cleaning action.

Other effective breath-freshening drinks are cow’s milk and green tea. The fat in milk is able to neutralize odor-causing compounds from certain foods, such as the sulphur in garlic. And a 2011 study showed that green tea can reduce mouth bacteria and prevent bad breath and plaque build-up.

But, not all drinks are created equal. Coffee and alcohol should be avoided as they both dry out your mouth and promote bad breath.


A diet rich in vitamins and minerals helps your overall health, including your digestive health. And when your body is in good health, you’re far less likely to develop bad breath. Fruits and vegetables are the best natural source of vitamins and minerals, so make sure you get your recommended 5 to 9 servings per day.

Vitamin C is particularly effective at curbing bad breath because it’s known to prevent gingivitis and gum disease, which can be major causes of halitosis. Reach for peppers, kale, broccoli, strawberries, cauliflower, pineapple, kiwi and citrus fruits as these are all especially high in vitamin CApples and lettuce have also been shown to be effective at stopping garlic breath.

If you want to prevent bad breath in the first place, avoid foods known to foul your breath, such as onions, garlic, meats, cheese and sugary foods.



New intraoral scanner challenges the dental market in 2017 – Heron™ IOS


By: Dental Products Report


🙂 Good news for everyone! 3DISC has announced a new 3D scanner designed for dentists to make digital impressions. This is another product created to improve the modern dental practice and provide an efficient service to dental patients. The Oral Surgery DC Team


3DISC has announced a new 3D scanner designed for dentists to make digital impressions.

3DISC, a provider of digital X-ray and 3D imaging technology for dental clinics, has announced the upcoming launch of Heron™ IOS, a new intraoral 3D scanner designed for dentists to make digital impressions. The hand-held scanner is challenging the market with its simplicity and ease of use. Comprising a small, lightweight hand and mouthpiece, it is not only a leader in ergonomics but also challenges existing market prices by offering highly competitive pricing without compromising its high quality.

“In the development of Heron™ IOS – our focus has been to bring a scanner to market that easily fits into the modern dental practice and workflows. Sleek and small, lightweight, ergonomic design in a solution that delivers great depth perception, color recognition, and speed. We understand that, first and foremost, the unit had to be precise in order to create digital impressions that the dentist can rely on,” says 3DISC CEO Sigrid Smitt Goldman.

Additionally, the scanner development and design are based on four important cornerstones:

  • Open architecture – With output format STL and PLY. Compatible with most dental CAD systems, ensuring maximum flexibility for lab integration.

  • Price – The exact price is not yet available, but the scanner will be at the low end of the price scale – reasonable and affordable.

  • Ease of use – With the help of live video feed and guidance tools, the user is guided to perform a scan of the full dental arch in a workflow. The scanner itself is intuitive and extremely easy to use with its light and small design, and a rotating tip that provides the best angle for scanning.

  • Productivity – With precision, ease of use and openness comes productivity. It facilitates automation in the dentist’s workflow, as well as great communication options both between the dentist and the lab and between the dentist and patient. A perfect impression makes a perfect fit.

“There is a high-end segment in the industry for fully featured, advanced products and technology, where you naturally pay for innovation, as well as for the premium brands – the Ferraris of intraoral scanners. However, we recognize that dentists and clinics that primarily perform the most common restorations and a limited amount of impressions per year have different needs. With them in mind, we have created a scanner that covers all common features and restorations. Heron™IOS takes its own spot in the middle segment of the market – the “Volkswagen” of scanners – as the sensible and smart choice,” says Thomas Weldingh, executive VP of sales and marketing.

The solution – Heron™ IOS is a digital impression taking the smart and cost-efficient way.

The scanner is an optical impression system that creates digital 3D models for dental restorations. It records the tooth morphology, analog impressions or gypsum models for use in CAD/CAM for dental restorative prosthetic devices. A ‘cradle’ holds the scanner when not in use, and each unit comes with order management software for PCs, as well as lab integration with Exocad DentalCAD. The scanner software is set up to aid in the creation of restorations such as Crowns, Bridges, Inlays, Onlays, and Veneers. It also offers premium features such as color capture, shade-matching and a built-in heater to prevent fogging.

3DISC will debut this new scanner at the International Dental Show (IDS) 2017. With this world premiere, 3DISC takes an important step toward further solidifying their position in the dental industry by using its expertise of imaging technologies and creating new products that address the needs of the dental market. The new scanner from 3DISC will be available this year, with shipments expected to begin in Q4.


Gray and Black Market Dental Products: Are You at Risk?


By: Consumer Guide to Dentistry


💉 Have you heard about the gray and black market before? To avoid the risks and harmful effects of using these products, let us be aware of how they are made and labeled before they are sold. The Oral Surgery DC Team


Imagine you’re in the market for a new camera, but you’re not interested in paying top dollar. In an effort to save money, you decide to browse through one of countless stores offering “deep discount” pricing on name brand, top-of-the-line cameras. Chances are, those cameras made their way to the retailers via the “Gray Market” or, worse yet, are counterfeit or even “Black Market” products. In other words, they might not be the real deal, the warranties — if any — are questionable, and as a buyer, you’d better beware.

Unfortunately, Gray and Black Market products aren’t limited to high-priced consumer electronics. Dental materials — everything from the composites used to create minimally invasive composite bonding veneers, to the impression materials used to create moulds of your teeth for precision crowns and porcelain veneers — also are being sold in unauthorized ways to unsuspecting dentists.

What are Gray Market and Black Market Dental Products?

Gray Market dental products are those sold legitimately by a manufacturer intended for export or sale elsewhere, or those that are counterfeit to look like the real deal, which make their way back to the United States and are ultimately sold to dentists through unauthorized channels.

Black Market dental products are either stolen or otherwise transported and distributed in ways that avoid regular taxes and fees, making their way to the end user through risky and unknown supply chains.

More often than not, both types of products are outdated and expired, repackaged and relabeled. Usually the cost for these dental products and materials is significantly less than manufacturers originally intended. However, the ultimate cost in terms of treatment longevity and patient safety could be high, according to dental material science experts.

Poor Product, Material and Treatment Performance

When Gray Market, Black Market or counterfeit dental materials are used, dentists cannot be sure how those materials will perform, or how long the restorations they’re placing will last. That’s because most Gray and Black Market products travel back and forth between multiple countries via long shipping and handling processes that subject them to harsh stress and strain that negatively impact their effectiveness.

This is particularly true for the adhesives used to secure dental restorations in place, and for the impression materials used to create molds of your teeth. Inaccurate and faulty impressions ultimately result in improper and poorly fitting restorations that could chip, fracture or result in tooth decay. However, other dental materials — such as sealants, ceramics and composites — and products sold on the Gray or Black Market also could perform poorly or below acceptable standards.

Legitimate products that are sold to dentists through the proper channels are manufactured nearby to control the materials, prevent expiration and prevent exposure to extreme temperatures that could negatively affect performance when used in dental treatments.

How Gray and Black Dental Markets Happen

Many businesses these days are trying to compete in the “global marketplace.” Unfortunately, not all countries can afford to pay the same prices for products that we pay here in the United States. As a result, many companies have different prices for their products throughout the world, and sometimes there’s quite a big difference between what consumers in one country pay for a product and what that product is sold for in another country. It’s no different with dental products and materials.

Because dental product pricing fluctuates between countries, it becomes more profitable for distribution chains to find unauthorized ways to sell the products back in the United States. The price will be lower than what U.S. dentists usually pay, but more than what overseas dentists are paying, so those unauthorized sellers make a bigger profit.

The Law Isn’t Black and White

The dental products, equipment and materials sold and used in the United States are regulated by the Food and Drug Administration (FDA) to ensure they meet appropriate standards, as well as confirm their safety and efficacy. For this reason the FDA inspects dental manufacturing facilities to ensure compliance with federal guidelines. The FDA also must approve products, materials and equipment before they are marketed and sold in the United States. Those approved by the FDA carry specific serial numbers on their packaging.

Gray and Black Market products making their way back into the United States typically were intended for sale in other countries and may not be approved by the FDA for use. As such, their packaging is usually altered or changed to appear consistent with other “for sale in the U.S.” products. Therefore, there’s no way to guarantee that Gray or Black Market products meet FDA standards or are FDA approved.

Experts have pointed out that while Black Market products are illegal according to the laws of most countries, the sale and purchase of products on the Gray Market approved by the FDA typically are not illegal. Again, however, because these products usually have been tampered with, it’s hard to determine if they’re the real thing.

What Can You Do?

Sometime in 2011, the FDA is expected to announce stronger rules for material and product labeling that will affect anything considered a medical device, including dental products, materials and equipment. Such packaging will enable manufacturers and their authorized dealers to better track and identify discrepancies in the distribution chain.

Additionally, dental product manufacturers are working harder to label and package products intended for foreign countries as a completely different product or material brand. This will make it harder for unauthorized channels to reintroduce the product into the United States on the Gray Market.

That’s comforting to know. It’s also good to know that dentists are concerned with the oral health of their patients and strive to deliver the best possible care using scientifically proven materials. Reputable dentists purchase legitimate and tested products from well-known and respected manufacturers and product dealers and likely will be willing to answer your questions about the materials they use and the manufacturers from whom they’ve purchased them.

Therefore, do not be afraid to ask about the type and brand of dental products your dentist will be using for your treatment. Understanding what’s involved with your treatment will enable you to have confidence in your dentist and participate actively in the process.


A Guide to Common Dental Problems

Woman running water and holding a toothbrush
By: Sally Solo, Real Simple
😄 Keep this guide to common dental problems handy so you’ll achieve the perfect smile everybody would want to see! The Oral Surgery DC Team

Problem: Tooth Decay

Also known as dental caries or cavities, tooth decay occurs when plaque, a sticky film of bacteria that forms when you eat sugars or starches, is allowed to linger on teeth for too long.

Who’s at risk: Anyone can get a cavity, but children and older people are the most prone. The incidence among children has been declining, thanks to community water fluoridation and the increased use of fluoride toothpaste, but “more than half of all children have cavities by the second grade,” according to the U.S. Department of Health and Human Services report Healthy People 2010. Older adults are prone to cavities at the root because protective gum tissue often pulls away.

What to do: Don’t give plaque a chance: Brush with a fluoride toothpaste and floss every day. Children can also benefit from sealants (plastic coatings applied to the chewing surfaces of their back teeth) as soon as their adult molars come in. Older people should be particularly vigilant: “Those who have a tendency toward dry mouth should receive regular fluoride treatments from a dentist and use a fluoride-containing mouth rinse,” says Bruce Pihlstrom, D.D.S., acting director of the Center for Clinical Research at the National Institute of Dental and Craniofacial Research (NIDCR).

Problem: Gum Disease

A bacterial infection caused by plaque that attacks the gums, bone, and ligaments that keep your teeth in place. The early stage is known as gingivitis, the advanced stage as periodontitis.

Who’s at risk: Everyone. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that half of all adults have some signs of gingivitis. Most at risk are people with poor oral hygiene; those with a systemic disease, such as diabetes, that lowers resistance to infection; and smokers. Women also have a tendency to develop gingivitis during pregnancy. Other risk factors are stress, which weakens the immune system, and genes. “Some people can have gingivitis all their lives and never progress to periodontitis,” says Bruce Pihlstrom, D.D.S., acting director of the Center for Clinical Research at the NIDCR. “It depends on a person’s susceptibility to the disease.”

What to do: See a dentist regularly, and tell her if your gums feel tender or bleed. Gingivitis can be reversed with regular brushing and flossing. To combat periodontitis, a dentist or periodontist may perform a deep cleaning around the teeth and below the gum lines and prescribe medication to combat the infection. If the disease has progressed to affect your gums and bone, your dentist might suggest surgery, such as a gum graft.

Problem: Tooth Infection

The pulp inside the tooth (which contains nerves) is damaged or becomes infected because of decay or injury. The root canal, which connects the top pulp chamber to the tip of the root, may become infected, too.

Who’s at risk: Anyone with a deep cavity or a cracked tooth, which can let in bacteria. An injured tooth can have a problem even if it’s not visibly cracked or chipped.

What to do: If you feel pain in or around a tooth, see your dentist. He may refer you to an endodontist, who specializes in root-canal procedures. In one to three visits, the dentist will perform the notorious root canal (which is much less painful than it used to be). He will remove the pulp, clean the pulp chamber and root canal, then fill the tooth. Finally, he may seal the tooth with a porcelain or gold crown.

Problem: Gum Disease

A bacterial infection caused by plaque that attacks the gums, bone, and ligaments that keep your teeth in place. The early stage is known as gingivitis, the advanced stage as periodontitis.

Who’s at risk: Everyone. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that half of all adults have some signs of gingivitis. Most at risk are people with poor oral hygiene; those with a systemic disease, such as diabetes, that lowers resistance to infection; and smokers. Women also have a tendency to develop gingivitis during pregnancy. Other risk factors are stress, which weakens the immune system, and genes. “Some people can have gingivitis all their lives and never progress to periodontitis,” says Bruce Pihlstrom, D.D.S., acting director of the Center for Clinical Research at the NIDCR. “It depends on a person’s susceptibility to the disease.”

What to do: See a dentist regularly, and tell her if your gums feel tender or bleed. Gingivitis can be reversed with regular brushing and flossing. To combat periodontitis, a dentist or periodontist may perform a deep cleaning around the teeth and below the gum lines and prescribe medication to combat the infection. If the disease has progressed to affect your gums and bone, your dentist might suggest surgery, such as a gum graft.

Problem: Tooth Infection

The pulp inside the tooth (which contains nerves) is damaged or becomes infected because of decay or injury. The root canal, which connects the top pulp chamber to the tip of the root, may become infected, too.

Who’s at risk: Anyone with a deep cavity or a cracked tooth, which can let in bacteria. An injured tooth can have a problem even if it’s not visibly cracked or chipped.

What to do: If you feel pain in or around a tooth, see your dentist. He may refer you to an endodontist, who specializes in root-canal procedures. In one to three visits, the dentist will perform the notorious root canal (which is much less painful than it used to be). He will remove the pulp, clean the pulp chamber and root canal, then fill the tooth. Finally, he may seal the tooth with a porcelain or gold crown.



Paresthesia (nerve damage) after wisdom tooth removal or injection. Causes | Duration | Treatment



😱 Have you heard about Dental Paresthesia? Discover its signs, symptoms, causes, and treatment before you’re at risk! The Oral Surgery DC Team


What is paresthesia?

Dental paresthesia is a possible postoperative complication associated with the removal of teeth (most frequently lower wisdom teeth), or in some cases receiving a dental injection.

(This condition can also be a post-op complication of root canal treatment or dental implant placement but that is not the focus of our coverage here.)

Causes – The onset of paresthesia is a result of nerve trauma. It involves the situation where during the patient’s procedure a nerve lying in the immediate area has received some type of insult. In most cases, the event involved has crushed, bruised, stretched or otherwise irritated the nerve. Less likely, it may have actually been nicked or severed.

Signs and Symptoms – As a result of the traumatic event, the person experiences a change in, or loss of, sensation in the tissues and structures that are serviced by the nerve. The lip, facial skin, tongue and lining of the mouth are all commonly affected areas.

Outcomes – The altered state typically persists for an extended period (days, weeks, months), ultimately resolving on its own without specific treatment. In some cases, the change in sensation that’s noticed may be permanent, or only partially resolves.


As mentioned above, dental paresthesia may be a complication associated with tooth extraction or receiving a dental injection. We discuss each situation separately:

a) Paresthesia as a complication of tooth removal.

Most cases of paresthesia following an extraction occur in conjunction with the removal of lower 3rd molars (wisdom teeth) and to a lesser extent lower 2nd molars (the next tooth forward).

Tooth roots lying in close proximity to the Inferior Alevolar nerve.

A person’s risk generally correlates with the positioning of their tooth.

A) The tooth’s roots may lie in close proximity to the primary nerve running through the jawbone (see illustration).

B) Or the position of the tooth may be such that surrounding soft tissues must be incised and reflected back so adequate access can be gained. If so, the prominent nerve running through these tissues may be traumatized or even severed.

Which nerves are usually affected?

The major nerves that lie in close proximity to 2nd and 3rd molars (wisdom teeth), and thus are at risk for receiving trauma or damage during the extraction process, are:

  • The Inferior Alveolar nerve. – This nerve runs the length of the lower jawbone in its Mandibular canal (a tunnel-like structure through which the nerve and associated blood vessels run).

    The canal lies more or less in the center of the jawbone, at a level lying just below the roots of the teeth it holds (when they are fully erupted, thus explaining why the roots of impacted teeth tend to lie close to this nerve, see illustration above).

    At a point near its end, the Inferior Alveolar nerve gives rise to a branch called the Mental nerve. It exits the jawbone and runs to and services the tissues of the lower lip and chin region. (If the Inferior Alveolar nerve displays symptoms of paresthesia, this branch will too.)

  • The lingual nerve. – This nerve runs through the soft tissues that cover over the inside surface of the lower jaw. It provides services for these tissues, and also branches off to and provides sensory perception for the tongue.

What can cause nerve trauma that leads to paresthesia?

Nerve bruising or stretching can result in significant levels of nerve irritation. Compressive forces may physically crush the nerve. Less likely, the nerve may have been partially or even completely severed.

  • Compressive forces might be generated by the movement of the tooth as it’s loosened up or removed, or by the extraction instruments being used. (An explanation of how teeth are removed.)
  • The dental drill or hand instruments used to remove bone tissue or section the tooth during the extraction process may nick or sever the nerve.
  • To gain access to the tooth, a gum tissue flap may need to be created. During events associated with incising and/or retracting this tissue, the nerve that lies within it may be traumatized or even severed.

b) Paresthesia associated with dental injections.

Other than surgical procedures, some cases of paresthesia are caused by routine dental injections.

Which nerves are most often affected?

The greatest risk of paresthesia lies with injections given to numb up lower back teeth. This is termed an inferior alveolar nerve block injection.

  • The lingual nerve. – This is the same nerve mentioned above that runs through the soft tissues that cover the inside surface of the lower jawbone. 70% of cases involve the Lingual nerve.
  • The Inferior Alveolar nerve. – This is the nerve mentioned above that runs through the jawbone’s Mandibular canal. However, as related to injection paresthesia, the location at which the nerve is traumatized is prior to its entry into the bone (at a point during which it courses across the inside surface of the posterior jawbone).
  • The Maxillary nerve. – While rare, this nerve that services aspects of the upper jaw may be affected.

(Smith 2005) [reference sources]

What creates injection nerve trauma?

The irritation or damage caused may be due to:

  • Direct trauma caused by the needle itself.

    The largest gauge needle used in dentistry has a diameter of .45mm. In comparison, the size of the nerves that lie at risk are on the order of 4 to 7 times larger (on the order of the size of a spaghetti noodle).

    For this reason, a nerve receiving a nick is the most likely event, as opposed to being severed completely.

  • Hematoma formation.

    The movement of a needle through soft tissues may rupture blood vessels, thus causing the release of blood. Constriction of the hematoma (swelling of clotted blood) that then forms may place pressure on nerve fibers that pass through it.

  • Neurotoxicity of the anesthetic. – The anesthetic that’s been injected may cause localized chemical damage to the nerve.

Signs and symptoms of paresthesia.

Paresthesia is a sensory-only phenomenon (meaning symptoms involving muscles, like paralysis or spasm, are not involved).

In most cases, the nerve damage is not identified during the dental procedure itself but instead first noticed as a postoperative complication during the hours following.

Paresthesia – Signs and symptoms.

  • The person experiences an altered, diminished, or even total loss of sensation.

    (A diminished sense of feeling is termed “hypoesthesia.” The total loss of sensation is referred to as “anesthesia.”)

  • The extent of the affected area reveals the region serviced by the damaged nerve(s), and hence which are involved. Inferior Alveolar nerve = lip, chin. Lingual nerve = tissue lining on inside of jaw, tongue.
  • One or more sensations may have been affected: touch, pain, proprioception, temperature or taste.
  • The effects may affect a person’s speech, chewing function or cause drooling. They may interfere with activities such as playing a musical instrument.

Even when the effects experienced are just minor, they can be difficult for a person to cope with. Their quality of life may be significantly affected. Social interactions may be inhibited.

Other characteristics.

  • For some people, the sensation they experience may be a persistent tingling, numbness or “pins and needles” effect (similar to the feeling they experience when having a tooth anesthetized for a dental procedure).
  • Some people may experience “dysesthesia” (the feeling of painful or unpleasant sensations).

Characteristics unique to dental injection paresthesia.

On occasion, while receiving a dental injection a person may experience an “electrical shock” sensation as the needle makes physical contact with their nerve. (This would be most common with inferior alveolar nerve block injections, the type of “shot” used to numb up lower back teeth.)

Having experienced a shock is not necessarily an indication that paresthesia will occur but there is a relationship.

  • As many as 15% of people who experience this sensation go on to experience some degree of paresthesia.
  • 57% of people who ultimately do experience paresthesia did experience the shock effect.

(Smith 2005)

How long does the numbness/sensory loss of paresthesia last?

For those patients who are affected, one of 3 scenarios will play out.

  • In most cases, the paresthesia is transient, resolving on its own after a short period, usually measured in one or two to several weeks.
  • With cases lasting longer than 6 months, the condition is classified as being persistent.
  • For a small number of cases, the loss (complete, partial or partially resolved) is permanent.

We discuss statistics and events associated with case progress and outcomes in greater detail below.

Evaluating a patient’s risk for paresthesia.

A) Location, location, location.

As discussed above, one primary risk factor for paresthesia is simply the proximity of the tooth being extracted to nearby nerves (and therefore increased likelihood that they’ll be traumatized during the extraction process).

Identifying risk using x-rays.

In the case of the mandibular nerve, the dentist’s pretreatment x-ray evaluation of the tooth can give a hint as to what configuration exists.

The outline of the canal inside the jawbone that houses the mandibular nerve can usually be seen on x-rays. And its apparent closeness to the roots of the tooth planned for extraction can be evaluated.

2-D vs. 3-D imaging

One difficulty associated with using x-rays to make this determination is that common dental radiographs are just a 2-dimensional representation (a flat picture) of a 3-dimensional configuration. And for this reason, only an educated guess can be made about the precise relationship that exists.

A more definitive determination can be made using 3-D imaging, such as a Cone Beam CT scan. This technology is becoming more and more commonplace in the offices of oral surgeons, and even some general practitioners.

It does however come at a greater expense, both in financial terms and in the level of radiation the patient is exposed to.

Is 3-D x-ray imaging really necessary?

Only the dentist performing the patient’s work can determine if this level of evaluation is indicated. But we can report that studies (Deshpande 2013, Kositbowornchai 2010) have shown that traditional 2-D imaging can reliably provide a practitioner with a high level of information regarding the configuration that exists, especially when a multi-x-ray technique is used.

But similar in how a dentist’s clinical skills are an important factor in reducing their patient’s risk for paresthesia (discussed next), a dentist’s experience in interpreting the telltale signs to be discovered on 2-D radiographs would be expected to be an important factor too.

Risk and impaction type.

A tooth’s precise orientation in the jawbone plays a role in paresthesia risk in two ways: 1) Tooth-nerve proximity. 2) It can greatly affect the surgical difficulty (and thus level of trauma) associated with removing the tooth.

As general rules:

  • Any lower wisdom tooth that’s angled or positioned toward the tongue-side of the jawbone places the lingual nerve at greater risk.
  • Lower full-bony impactions, especially horizontal and mesio-angular ones (pictures), are the type of extraction most likely to result in trauma to the mandibular nerve.

B) Surgical factors / Clinician skill.

Research has demonstrated that: 1) The dentist’s level of experience, 2) The surgical technique they use, and 3) The amount of time they require to complete the extraction process – will each play a role in the patient’s risk for experiencing paresthesia.

A research paper by Jerjes (2010) bluntly states that one of the main risks for developing permanent sensory loss as a complication of nerve damage experienced during tooth extraction was the surgical skills/experience of the operator.

Clearly, this is a primary reason why a general dentist will refer wisdom tooth extractions they anticipate will be challenging and thus lie beyond their skill level to an oral surgeon.

C) Age as a risk factor.

After the age of 25, a person’s risk for experiencing paresthesia is generally considered to increase.

Relatively “older” patients (those over the age of 25, and especially over the age of 35 years) usually have wisdom teeth that have more fully formed roots and denser surrounding bone. Both of these factors tend to increase the difficulty of performing the tooth’s extraction, and thus raise the level of trauma involved.

This is one reason why asymptomatic full-bony impacted wisdom teeth that show no sign of associated pathology are often left alone in people over the age of 35.

C) Dental injections.

The vast majority of cases of paresthesia resulting from dental “shots” involve those used to numb up lower back teeth (specifically inferior alveolar nerve blocks).

But as opposed to oral surgery where the patient’s risk can be evaluated during their procedure’s planing stage, there’s no way for a dentist to anticipate beforehand which dental injections might result in this complication.

Paresthesia occurrence – Statistics.

a) As related to wisdom tooth extraction.

In a review of research studies evaluating paresthesia after wisdom tooth extraction, Blondeau (2007) found incident rates ranging from 0.4% and 8.4%.

One large study (Haug 2005) evaluated the outcome of over 8,000 third molar extractions. It found an incidence rate of less than 2% for subjects age 25 years and older (as mentioned above, an age group that’s relatively at-risk for this complication).

b) As related to dental injections.

It’s been estimated that roughly 1 out of 27,000 Inferior Alveolar Mandibular blocks (the type of dental injection used to numb up lower back teeth, and the one most associated with this complication) will result in paresthesia.

At this rate, it’s been estimated that during the course of their career a dentist will have 1 to 2 patients develop this complication. (Smith 2005)

How long does paresthesia last?

In most cases, a patient’s paresthesia will resolve on it’s own over time, with the amount of time ranging from just a few days, to several months, to over a year. In some cases a person’s sensory loss, complete or partial, is permanent.

Generalities about recovery.

A person’s level of sensory loss, their potential for recovery (full or partial), and the timeline associated with it will all correlate with the type (nerve irritation, crushing, nicking or severing) and extent of the original injury. Unfortunately, these are factors that are usually unknown.

Experiencing altered or diminished sensation implies that the nerve is still at least partially intact, a situation that favors recovery. But the complete loss of sensation doesn’t necessarily mean that the nerve has been completely severed. A nerve that’s been crushed can display this same symptom.

a) As related to wisdom tooth extraction.

Spontaneous recovery.

In cases associated with wisdom teeth, Queral-Godoy (2005) found that most recoveries took place within the first 3 months. At 6 months, one-half of all of those affected experienced full recovery.

Persistent paresthesia.

(This classification refers to cases where the patient’s condition lasts longer than 6 months.)

Pogrel (2007) reviewed studies that had evaluated complications associated with wisdom tooth removal and found reported incidence rates of persistent paresthesia ranging between 0% and 0.9% for the Inferior Alveolar nerve, and 0% and 0.5% for the Lingual nerve.

Paresthesia recovery – General rules of thumb.
  • If a patient’s condition has not completely resolved within a two month time frame, the probability of their having some degree of permanent sensory deficit increases (although full resolution may still occur).
  • If some level of deficit still remains after nine months, it’s unlikely that complete resolution will occur.

(Bhat 2012)

b) As related to dental injections.

Spontaneous recovery.

In 85 to 94% of cases, spontaneous complete recovery typically occurs within 8 weeks.

Persistent paresthesia.

Symptoms lasting more than 8 weeks are less likely to fully resolve.

(Smith 2005)

What can be expected during recovery?

Signs of paresthesia resolution.

Recovery from paresthesia, just like with any type of healing, is a process. And for that reason, any progress toward returning to normal can be expected to be a gradual transformation over a period of time. However, as the statistics above indicate, the time frame involved can be quite variable, ranging from just days to many months, to over a year.

  • As sensation in the area starts to reappear, the degree of detail it provides should sharpen over time, hopefully returning all of the way back to normal parameters.
  • Since the nerve fibers that transmit different types of sensations have different structural characteristics, one type of sensation may make a quicker recovery than others.
  • As you might expect, the sooner the first signs of renewed sensation appear, the more favorable the chances are for complete recovery (see statistics above).
  • It may be that no progress is experienced for a period of time (weeks, months), and then signs start to appear.
Why paresthesia recovery rates vary.

The most important determining factor in a person’s rate of recovery (and also how complete their recovery will be) is the nature and extent of the insult/damage that the nerve has received. As simple examples:

  • A nerve that is still structurally intact (like those that have been bruised, stretched or compressed) can be expected to make a quicker, fuller recovery than one that has been severed.
  • Nerves that have been nicked, as opposed to completely severed, have the quicker, more-favorable prognosis.

Of course, in most cases the nature and extend of what’s occurred isn’t known. And as such, developing any specific rules about patient recovery rates are simply impossible to make.

Treating permanent paresthesia.

Establishing a baseline for comparison.

Testing / mapping the affected areas.

As a way of documenting the extent of a patient’s condition, both initially and as recovery occurs, the affected area should be mapped.

To do so, different types of sensory tests are performed, and those regions (lip, facial skin, tongue, etc…) that respond with no or altered sensation are recorded.

The mapping may include:

  • Light Touch – A small cotton ball is brushed against the skin to see if it can be felt, and if the patient can discern the direction of the ball’s movement. Moist tissues (like the lining of the mouth) can be difficult to evaluate with this test.
  • Sharp vs. dull discrimination – Areas are prodded with a pin or other sharp-pointed tool. The patient is asked if they can feel a sensation, and if so whether it feels sharp or dull. A comparison to the same location on the patient’s unaffected side is made also.
  • Two-point Discrimination – A pair of calipers having a pair of sharp points is systematically touched to the affected area, using various distance settings. The patient is asked if they are able to feel this contact as one or two individual points.
  • Taste stimulation – Cotton balls soaked in saline (salt), sugar (sweet), vinegar (sour) or quinine (bitter) solution are drawn across the side of the tongue to see if a taste response is triggered.
Testing frequency.

After the results of a person’s initial testing has been documented, comparisons can then be made periodically to evaluate the patient’s progress towards returning to normal.

Some sources suggest that evaluations should be conducted every 2 weeks for 2 months. Then every 6 weeks for the following 6 months. After that, every 6 months for 2 years, followed by yearly evaluation as long as full recovery has not occurred. (Smith 2005)

Surgical repair. / Microsurgery.

In cases of persistent or permanent paresthesia, surgical repair may be possible.


It’s difficult to know what to report in terms of what’s considered the best timing for the nerve’s attempted repair. It’s best said the a decision to attempt a repair, and subsequently the timing for it, depends on the nature of the sensory loss experienced (full, partial, recovering, etc…) and therefore best evaluated by the doctor (oral-maxillofacial surgeon, neurosurgeon or micro-neurosurgeon) who will provide the treatment.

  • Surgery is frequently delayed until a point 6 to 12 months after the original injury, so to allow time for a repair to occur on its own if it will.

    Some studies however (see below) seem to report that prompt repair increases the chances of case success.

  • It may be that in situations where it is positively known (visualized) that the nerve has been cut that proceeding promptly with a repair attempt makes the best plan.
  • Surgery may be attempted even much later on. The studies we cite below report surgeries having been performed multiple years following the patient’s original injury, although we don’t know the outcome of these cases.
Microsurgery success rates.

A paper by Pogrel (2007) reports that results for surgical intervention vary widely. Success rates appear to range between 50 and 92%, however some reported successes only involve partial recovery. Even if just partial recovery was achieved, many patients still considered the attempt worthwhile.

A sampling of findings reported by research studies:

  • Strauss (2006) evaluated the outcomes of Inferior Alveolar nerve repair experienced by 28 patients treated by one surgeon.

    50% reported significant improvement in their condition, 43% slight improvement and 7% gained no benefit. The average wait period before surgical repair was attempted was 6.6 months following the patient’s initial injury.

  • Bagheri (2012) evaluated the outcome of 186 Inferior Alveolar nerve repair surgeries performed by multiple surgeons. On average the surgeries were performed 10.7 months following the patient’s initial injury, with the range being 0 to 72 months).

    It was determined that 81% of cases resolved favorably, resulting in either a functionally useful (partial) or complete recovery. The study noted a drop in case success for surgeries performed at a point 12 months and beyond the patient’s initial injury.

  • In an evaluation of 222 Lingual nerve microsurgeries performed by multiple surgeons, Bagheri (2010) reported 66% of cases experienced complete recovery, 25% functionally useful recovery and the remainder no or inadequate improvement.

    On average, the surgeries were performed 8.5 months after the patient’s initial injury (range 1.5 to 96 months). The study noted that shorter intervals tended to improve case outcomes. It also found a significant drop in case success for surgeries performed at a point 9 months and beyond the patient’s initial injury.

Much less information exists about the surgical repair of paresthesia resulting from dental injection. In some cases, long-term drug therapy is used to help these patients manage their condition.