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By Dr. Marvin Ernst General and Cosmetic Dentistry
May 20, 2019
Category: Oral Health
Tags: oral health  
PreservingthePulpisPriorityOnewithaNewlyEruptedPermanentTooth

The change from primary teeth to permanent is an announcement to the world that a boy or girl is "growing up." "Growing up," though, is still not "grown"—the new teeth are still in a period of development that can affect how we treat them if they're injured or diseased.

While a new tooth erupts with all its anatomical layers, the middle dentin is somewhat thinner than it will be after it matures. The pulp, the tooth's innermost layer, produces new dentin and gradually increases the dentin layer during this early development period. While the pulp continues to produce dentin over a tooth's lifetime, most of it occurs in these early years.

To prevent or stop any infection, we would normally perform a root canal treatment in which we remove the pulp tissue and fill the empty pulp chamber and root canals. This poses no real issue in an older tooth with mature dentin. Removing the pulp from an immature tooth, though, could interrupt dentin development and interfere with the tooth's root growth. Besides a higher risk of discoloration, the tooth could become more brittle and prone to fracture.

That's why we place a high priority on preserving a younger tooth's pulp. Rather than a root canal treatment, we may treat it instead with one of a number of modified techniques that interact less with the pulp. Which of these we use will depend on the extent of the pulp's involvement with the injury or disease.

If it's unexposed, we may use a procedure called indirect pulp therapy, where we remove most of the tooth's damaged dentin but leave some of the harder portion intact next to the pulp to avoid exposure. If, though, some but not all of the pulp is damaged, we may perform a pulpotomy: here we remove the damaged pulp tissue while leaving the healthier portion intact. We may then apply a stimulant substance to encourage more dentin production to seal the exposure.

These and other techniques can help repair an injured young tooth while preserving most or all of its vital pulp. Although we can't always use them, when we can they could give the tooth its best chance for a full life.

If you would like more information on caring for your child's teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving New Permanent Teeth after Injury.”

By Dr. Marvin Ernst General and Cosmetic Dentistry
May 10, 2019
Category: Oral Health
SimpleStepstoFollowifYourChildhasaToothache

"Mom, my tooth hurts" isn't something you look forward to hearing your child say. But tooth pain is as common as other childhood ailments, so you may have to face it. Here are a few simple steps to make it easier.

First, ask your child where in the mouth it hurts and, if they can, tell you how long it's been hurting. Children's memories aren't always accurate, but you can still get a general idea that you can communicate with your dentist if you take them in.

Next, look in their mouth for anything out of the ordinary: gum swelling or bleeding, or dark spots on the teeth indicative of tooth decay. Look also for hard food particles like popcorn kernels caught between the teeth, which could be causing the pain. Gently floss between the teeth (even if you can't see anything) to remove any caught particles.

You'll also want to help ease their pain. You can apply an ice pack against the painful side of the jaw. Don't place ice directly on the skin, but use a container or cloth alternately against the jaw for a minute or so, and then away for a minute. You can also give them a dose of mild pain reliever like ibuprofen or acetaminophen appropriate for their age and weight—but never rub aspirin or other pain relievers on the gums, which tend to be acidic and can burn the skin.

Finally, you'll need to decide if you need to see a dentist and how soon. It might not be necessary with situations like the trapped food particles, but most of the time it's wise to have your dentist perform an examination for an accurate diagnosis and appropriate treatment. As to how soon, try to see the dentist immediately if the pain has continued from one day to the next or has kept your child up overnight. Otherwise, book an appointment for as soon as the dentist advises, even if the pain subsides.

A toothache at any age is never pleasant, but especially for children. Knowing these steps will help ease their discomfort and get them the relief and treatment they need.

If you would like more information on dental care for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child's Toothache: Have a Dental Exam to Figure out the Real Cause.”

By Dr. Marvin Ernst General and Cosmetic Dentistry
April 30, 2019
Category: Dental Procedures
NeilPatrickHarrisWhattheOscarsHostTreasuresMost

A few days before the Oscars, Vanity Fair magazine asked Academy Awards host Neil Patrick Harris to name his most treasured possession. Was it his Tony award statuette for best leading actor in a musical? His star on the Hollywood Walk of Fame? The stethoscope he wore while playing teenaged doctor Doogie Howser on TV? No, as it turns out, the 41-year-old actor’s most treasured possession is… his wisdom teeth. Yes, you read that correctly. “Oddly, I still have my four wisdom teeth,” Harris said. “I refuse to let them go or I’ll lose my wise parts.”

How odd is it for a 41-year-old to have wisdom teeth? Actually, not that odd at all. While it is true that wisdom teeth are often removed, there’s no one-size-fits-all approach to this. It all depends on whether they are causing problems now, or are likely to cause problems in the future.

The trouble wisdom teeth cause is related to the fact that they are the last molars to come in, and that molars are large in size. By the time wisdom teeth appear between the ages of 17 and 21, there often is not enough room for them in the jaw. Sometimes it’s because you may have inherited a jaw size that’s too small for your tooth size; and generally speaking, the size of the human jaw has evolved to become smaller over time.

If room is lacking, the adjacent molar (that came in earlier) can interfere with the path of eruption — causing the wisdom tooth to come in at an odd angle. The wisdom tooth can hit up against that other tooth, possibly causing pain or damaging the adjacent tooth. This is known as “impaction.” Sometimes the wisdom tooth breaks only partway through the gum tissue, leaving a space beneath the gum line that’s almost impossible to clean, causing infection. A serious oral infection can jeopardize the survival of teeth, and even spread to other parts of the body.

If a wisdom tooth is impacted, will you know it? Not necessarily. A tooth can be impacted without causing pain. But we can see the position of your wisdom teeth on a dental x-ray and help you make an informed decision as to whether they should stay or go. If removal is the best course of action, rest assured that this procedure is completely routine and that your comfort and safety is our highest priority. If there is no great risk to keeping them, as Neil Patrick Harris has done, we can simply continue to monitor their condition at your regular dental checkups. It will be particularly important to make sure you are reaching those teeth with your brush and floss, and that you keep to your schedule of regular professional cleanings at the dental office. All healthy teeth are indeed worth treasuring.

If you would like more information about wisdom teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”

By Dr. Marvin Ernst General and Cosmetic Dentistry
April 20, 2019
Category: Oral Health
Tags: toothache  
YourToothacheMightnotbeCausedbyaTooth

A toothache means a tooth has a problem, right? Most of the time, yes: the pain comes from a decayed or fractured tooth, or possibly a gum infection causing tooth sensitivity.

Sometimes, though, the pain doesn't originate with your teeth and gums. They're fine and healthy—it's something outside of your tooth causing the pain. We call this referred pain—one part of your body is sending or referring pain to another part, in this instance around your mouth.

There are various conditions that can create referred pain in the mouth, and various ways to treat them. That's why you should first find out the cause, which will indicate what treatment course to take.

Here are a few common non-dental causes for tooth pain.

Trigeminal Neuralgia. The trigeminal nerves situated on either side of the face have three large branches that extend throughout the face; the branch to the jaw allows you to feel sensation as you chew. When one of the nerve branches becomes inflamed, usually from a blood vessel or muscle spasm pressing on it, it can refer the pain to the jaw and seem like a toothache.

Temporomandibular Joint Disorder (TMD). These two joints that connect the lower jaw to the skull can sometimes become dysfunctional for a variety of reasons. This can set up a cycle of spasms and pain that can radiate throughout the jaw and its associated muscles. The pain can mimic a toothache, when it actually originates in the jaw joints.

Teeth Grinding. This is an unconscious habit, often occurring at night, in which people clench or grind their teeth together. Although quite common in children who tend to grow out of it, teeth grinding can continue into adulthood. The abnormally high biting forces from this habit can cause chipped, broken or loosened teeth. But it can also cause jaw pain, headaches and tenderness in the mouth that might feel like a toothache.

These and other conditions unrelated to dental disease can seem like a tooth problem, when they're actually something else. By understanding exactly why you're feeling pain, we can then focus on the true problem to bring relief to your life.

If you would like more information on oral pain issues, please contact us or schedule an appointment for a consultation.

By Dr. Marvin Ernst General and Cosmetic Dentistry
April 10, 2019
Category: Dental Procedures
Tags: porcelain veneers  
YourTeenagersTeethMayNotBeMatureEnoughforVeneers

Teenagers and adults alike can improve their smile appearance with dental solutions like teeth whitening or orthodontics. But there are a few cosmetic solutions like porcelain veneers that are better suited for more mature teeth.

Veneers are composed of thin layers of dental porcelain that are bonded to the outside of teeth. They're kind of a tooth "mask" that hides blemishes like chips, discoloration or mild bite problems. They're often less involved and expensive than other types of dental restoration.

Even so, we usually need to remove some of the natural tooth's enamel before applying them. Veneers placed directly on unprepared teeth can appear bulky, so we remove some of the enamel to create a more natural look. And although usually only a slight amount, the alteration is permanent and will require the tooth to have some form of restoration from then on.

This usually doesn't pose a major issue for adults, but it could for a teenager's younger teeth. The nerve-filled dentin in a teenager's still developing tooth is thinner and closer to the pulp (nerve tissue) than in more mature teeth.

There's at least one situation, though, where veneers might be applied safely to a teenager's teeth without this concern. If the teen has abnormally small teeth and are receiving veneers to improve their appearance, they might not need alteration. Because the teeth are already thinner than normal, the "no-prep" veneers may not look bulky when directly bonded to them without preparation.

With most cases, though, it might be best to pursue other options that at the very least can make a cosmetic difference until their teeth are mature enough for veneers. For example, we might be able to repair chipped areas with composite resin material that we form and bond to the tooth to achieve a life-like appearance.

We can discuss these and other options for safely improving your teenager's smile. The important thing is to achieve a more confident appearance without endangering their future health.

If you would like more information on cosmetic treatments for teenagers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Veneers for Teenagers.”





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