It is not uncommon to have one or more teeth that are particularly sensitive to heat, cold, or pressure. If you have such a tooth, you probably want to know what caused it and what you can do about it. Here are some frequently asked questions, and their answers.

What causes teeth to become sensitive?
The most common cause of sensitivity is exposure of the tooth's dentin, a layer of the tooth's structure that is just below the outer protective layer (the enamel).

The dentin is sensitive but the enamel layer is not. Why?
The enamel is composed of minerals that are hard and protective. It is not living tissue and has no nerve supply. The dentin layer underneath is bone-like living tissue that does contain nerve fibers. It is protected by enamel above the gum line and by gum tissue in the area of the tooth's root, below the gum line. If the tooth's protective covering is reduced, the nerve fibers in that section of the dentin are exposed to changes in temperature and pressure, which they conduct to the inner pulp layer (nerve) of the tooth. The sensations that reach the tooth's interior pulp layer cause pain.

What causes exposure of the dentin layer in teeth?
Often the dentin is exposed by receding gums, causing areas of the tooth that are normally below the gum surface to be uncovered.

What makes gums recede?
One cause of receding gums is excessive, rough brushing techniques. This is particularly common in individuals who have a family history of thin gum tissues. Removing the film of bacteria called plaque requires only gentle action with a soft brush. This is one reason that we stress the value of learning proper and effective brushing techniques. Gum recession becomes worse after the uncovered dentin of the tooth's root is exposed to erosion from sweet and acidic foods and beverages, such as fruit juices.

Doesn't tooth sensitivity indicate decay?
Decay can also cause tooth sensitivity. As decay destroys a tooth's structure, it eventually invades the inner pulp of the tooth, causing greater and greater pain.

How can you prevent or reduce tooth sensitivity?
As we mentioned above, learn proper brushing techniques; we would be happy to demonstrate them. Use a toothpaste that contains fluoride, which increases the strength of the tooth's protective coating. In more serious cases, we can apply a fluoride varnish or a filling material as a barrier to cover sensitive areas. If you experience long-term tooth sensitivity, make an appointment for an assessment and diagnosis so that we can determine the cause and proper treatment.

Contact us today to schedule an appointment to discuss your questions about sensitive teeth. You can also read the Dear Doctor magazine article “Sensitive Teeth.”

When treating Temporomandibular (jaw joint) Disorder (formerly known as Temporomandibular Joint Disorder, TMJ), we feel we have two equally important challenges facing us. First, we must start your treatment by relieving the symptoms of pain and discomfort. We typically accomplish this with heat, mild pain medications, a diet of soft foods, and some simple jaw exercises. Once we have begun to relieve your pain, our second critical objective is to identify and remedy what is causing the pain. It could be the result of an injury or trauma to the jaws and/or teeth or it could be due to a bite issue or a filling or crown that is too high and thus causing a misaligned bite. There are many other reasons, so it is first necessary to obtain a thorough medical history and conduct a comprehensive evaluation so that we can properly diagnose and treat the TMD condition and what is causing it.

Next to stress resulting in clenching and grinding habits, the four most common causes leading to TMD include:

• Underlying dental conditions that are triggering muscle pain
• Internal joint derangement (displaced or improperly positioned jaw joint)
• Osteoarthritis (degenerative joint disease)
• Synovitis — the painful inflammation of a synovial joint-lining membrane that is characterized by swelling, due to effusion (fluid collection)

If you or another family member suffer from chronic jaw pain, please let us know so that we can properly address your concerns and conduct a thorough examination. Or if you are in constant or severe pain, contact us as soon as possible to schedule an appointment. You can learn more about the signs, symptoms, and treatment options for TMD by reading “TMD — Understanding The Great Imposter.”

Time to tune up the brightness on your teeth? Here are six modern methods of whitening and brightening your smile.

• In-office “power” bleaching under the supervision of my staff and me is recommended if your teeth are badly stained, or if you are about to have veneers or crowns made. It's quick, safe, and effective. Gels containing high concentrations of bleach are applied to your teeth in our office, often with the enhancement by heat and light to make them act faster. Results show teeth becoming up to ten shades lighter in about an hour.
• “Take home” whitening solutions and trays are designed to fit your mouth and can also be provided by my office. The technique is easy to perform and is less expensive than in-office power whitening system, although it takes longer to see the same results. General recommendations are for 30 minute applications twice a day. You can usually see a change after two to four sessions. This requires patience, because it is important not to exceed recommended exposure in order to avoid damage to your teeth, gums, and the inside skin of your mouth. After two weeks of use, teeth can be expected to be about eight shades lighter.
• Whitening strips look like clear Band-Aids that are applied to the tooth surfaces. They should be worn twice a day for 30 minutes each time, for seven days. On average, they claim to lighten teeth more than three shades. They take about two weeks to work at 30 minutes per day.
• “Paint on” or “Brush on” whitening formulas are also available. These are gels that are painted onto the teeth every night at bedtime, for two weeks. Some claim that this line of home whitening can whiten teeth two to five shades. These gels may make your mouth feel goopy, but they are relatively inexpensive. Some gels come with a small brush to scrub them onto the teeth.
• Over-the-counter “mouth-tray” whiteners use mouth trays that are not designed for your particular mouth, so they may not fit well and may be messy or uncomfortable. They are filled with gel and worn 45 minutes a day for one week. On average, teeth become two shades whiter.
• Whitening gum is a relatively new product. It requires chewing two pieces for at least 20 minutes, four times a day, to see an effect.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

As the youngest person ever to host Entertainment Tonight, Maria Menounos, an independent filmmaker, actress, and co-host of daily entertainment news program Extra, has made a huge splash in the world of entertainment journalism. However, she is also an avid ambassador for the American Diabetes Association, a cause that is very dear to her heart because her father is a diabetic.

Her father's illness taught Menounos and her family about the importance of maintaining good general and dental health. This included a diet packed with fruits and vegetables, many of which they raised themselves. According to Menounos, they also ate little-to-no junk food. These habits still help keep the busy celebrity journalist fit and smiling with beautiful, healthy teeth.

Speaking of her smile, Menounos openly discusses her oral health in her interview with Dear Doctor magazine. She has had no major dental enhancements — not even braces — but does occasionally brighten her smile with tooth whitening. She also feels that her teeth are healthy due to the sealants she had as a child.

We could not agree more with Maria! Sealants for the tiny grooves in teeth known as “pits and fissures” are something that every parent or caregiver should consider for their children. The enamel of newly erupted teeth is more permeable, meaning that the acids produced by bacteria in the mouth can damage these teeth more easily, making them more susceptible and less resistant to decay. The good news is that dental sealants help protect teeth until the enamel has matured. Because of sealants — along with fluoride, good hygiene, and better nutrition (including less sugar consumption), tooth decay has been dramatically reduced.

If you are interested in learning more about dental sealants, contact us today to schedule an appointment so that we can conduct a thorough examination. During this private consultation, we will also discuss any questions you have as well as what treatment options will be best for you or your children. However, to learn more about dental sealants now, you can continue reading the Dear Doctor magazine article “Sealants for Children.” And to read the entire interview with Maria Menounos, please see the Dear Doctor magazine article “Maria Menounos.”

Nate Berkus, author, interior designer and host of his own television program, The Nate Berkus Show, is a consummate professional who has always focused on “helping others love the way they live,” as he puts it. Berkus is known as one of America's most beloved go-to-guys for inspiration on the latest design trends. And then there is his captivating smile.

In an exclusive interview with Dear Doctor magazine, Berkus discusses his trademark smile. Unlike most people in Hollywood, his smile is totally natural — he never wore braces or had any cosmetic work. However, Berkus does give credit to his childhood dentist for the preventative healthcare he received as a young boy. Berkus states, “I'm grateful for having been given fluoride treatments and sealants as a child. Healthy habits should start at a young age.”

As for his oral hygiene routine today, Berkus says he brushes his teeth at least two times a day, and sometimes three times a day. Berkus is also an avid “flosser” and follows the important flossing advice he learned from his dentist: “Floss the ones you want to keep.”

In addition to his design expertise, Berkus is right on the mark with his opinions on oral hygiene. In fact, he inspired our office to put together the following list of facts and oral health tips:

• The first step in improving your oral health is to learn good oral hygiene behavior. Simply put, to maintain optimal oral health, you must brush and floss properly so that you thoroughly remove the dental plaque.
• The second step is a thorough evaluation system. We are a key part of this step. During your next office visit, we can conduct a thorough examination, review your brushing and flossing techniques, examine the health of your tongue and discuss any questions you have. We can also clean your teeth and ensure that you leave our offices confident with your new oral hygiene routine. And if you don't have an appointment, contact us today to schedule one.

To learn more about improving your oral hygiene, you can continue reading the Dear Doctor magazine article “Oral Hygiene Behavior - Dental Health For Life.” And to read the entire interview with Nate Berkus, please see the article “Nate Berkus.”