“We all scream for ice cream,” the saying goes. But what if eating ice cream — or any very cold or hot food — literally makes you want to scream because your teeth hurt so much?

What causes sensitivity in teeth?

Understanding the anatomy of a tooth helps explain what happens when a tooth becomes sensitive to heat and cold. A tooth is composed of three types of tissue: a hard outer shell of enamel, the body of the tooth composed of the dentin, and an interior tissue of the pulp.

Enamel: The enamel forms the outside of the crown, the part of the tooth you normally see. Made of densely packed crystals of calcium, it is resistant to wear. It is not living tissue, and does not contain nerves, but it is capable of transmitting temperature like hot and cold.

Dentin: Inside the tooth's crown and root is a living tissue called dentin, which is a porous structure similar to bone. It is composed of microscopic tubules containing living cells, which are encased in a hard substance made of calcium crystals.

Pulp: The living dentin transmits sensation through to the pulp, which is in the center of the tooth and contains the tooth's blood vessels and nerves.

A tooth's enamel normally protects the dentin from exposure to extremes of temperature and pressure. If you wear away the enamel and expose the dentin, it will pass sensation through to the nerves in the pulp more directly. The result can range from a twinge to an excruciating pain.

Sensitivity can be caused by:

• Overzealous tooth brushing resulting in enamel wear and consequently dentin exposure and wear.
• Enamel and dentin erosion by acids in the foods and beverages you eat and drink.
• Tooth decay — the most common cause of sensitivity. Decay destroys enamel and dentin inflaming and infecting the living tissues of the pulp, which become increasingly painful.

What can you do to make your teeth less sensitive?

• Use a soft bristle tooth brush, and brush the affected teeth gently to remove all bacterial plaque. We can advise you on safe and effective brushing techniques.
• Use toothpaste that contains fluoride. Fluoride strengthens tooth surfaces and makes them more resistant to sensitivity and decay.
• Ask us about professionally applied fluoride varnishes or filling materials that can cover and replace sensitive or lost tooth structure.

Of course, if the problem is caused by tooth decay, make an appointment with us to remove the decay and place a filling in the sensitive teeth.

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.”

Let's say you happen to be sitting on a plane next to supermodel Bar Refaeli, who was recently voted #1 on Maxim magazine's Hot 100 list. You're a little nervous, but you want to make a good impression. What's the first thing she's going to look at? Your expensive suit? Your sculpted torso? How about — your smile!

“Teeth are the first thing I look at,” explained the glamorous cover girl in a Maxim interview. “A nice smile with beautiful teeth is the most attractive thing.”

We wholeheartedly agree. But, of course, not everyone is lucky enough to be born with a perfect set of teeth. What to do then?

“Let's just say that with today's orthodontists, I don't understand why people wouldn't fix them,” Refaeli stated. Need we say more?

The Israeli supermodel, who has appeared in several Sports Illustrated swimsuit issues, knows what she's talking about. Refaeli started modeling as a young child, but had to put her career on hold for a few years while she got braces. When they came off, at age 11, she began her steady climb to the top of the modeling business.

Plenty of aspiring actors and models — as well as regular folks — get braces as children. But if you're serious about improving your smile, it's never too late to have orthodontic treatment. For adults, there are many options available in addition to the standard metal appliances.

Colorless ceramic braces offer a less noticeable way to correct misaligned teeth. Made of high-tech materials that resist staining, their translucent appearance blends so well with the look of your natural teeth that it can be hard to tell you're wearing them.

Clear aligners are an alternative to braces that are worn 20-22 hours per day. They consist of a series of precision-made, transparent “trays” that gradually straighten your teeth over a period of time. Best of all, you can remove them for special occasions — like meeting a supermodel.

Which type of orthodontic treatment is best for you? Why not come in for a consultation and find out! Working together, we can evaluate your situation and develop an effective, individualized treatment plan that fits your lifestyle.

If you have questions about orthodontic treatment, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “Orthodontics For The Older Adult.”

It was one of those things that seemed like a good idea at the time. Maybe it was years ago, or maybe it was yesterday — at some point in your past life you had your tongue pierced and a metal bolt inserted. But now you are wondering whether you made a bad decision. If you have the bolt removed from your tongue, will your mouth go back to being the way it was before the piercing?

The answer is yes, your oral health will improve when you remove a tongue bolt. There are many reasons for this. Your tongue has a rich blood vessel supply to fuel its energy needs and heals quickly.

Some people suffer from chronic pain as long as the bolt is in place. In addition to pain, tongue piercing is associated with other risks. The bolt can chip your teeth or cause tooth sensitivity. It can also cause your gums to recede from your teeth. You may also suffer from inflammation and infection in your gums. This can lead to bone loss and ultimately to loss of teeth.

A piercing and tongue bolt can also cause damage to the nerves in your tongue. This causes pain for some people until the bolt is removed. Your tongue is well supplied with nerves as well as blood vessels. That is why biting your tongue hurts and bleeds a lot, another good reason for not having a piercing.

So what happens if you have the bolt removed? In most cases conditions in your mouth will return to normal. We will want to monitor your condition after removing the bolt to make sure it has not caused collateral damage to your gums and teeth and other oral structures.

Removing the bolt will leave your tongue with a hole that is likely to close spontaneously. If it does not close, a small surgical procedure can remove the skin that lines the holes, which are then stitched closed. This procedure is done with local anesthesia so you don't feel anything, and healing is usually quick and without complications.

If you are having second thoughts about a tongue piercing, it's time to make an appointment for a consultation with us. You can also view the Dear Doctor magazine article “Oral Piercing.”

Though it's been a while since Olivia Newton-John sang her way into our hearts in the movie Grease, her smile is as radiant as ever. Today, Olivia is still singing, acting and busy with new ventures such as authoring a cookbook and raising money for the cancer center that bears her name in Melbourne, Australia. Whichever part of the world Olivia finds herself in, she protects that beautiful smile with an oral appliance that many find beneficial.

“I wear a nightguard to prevent wear on my teeth, custom-made by my dentist,” Olivia recently told Dear Doctor magazine. “I love it!”

Olivia's device, also referred to as a bite (occlusal) guard, is designed for people who clench or grind their teeth at night, or during stressful periods. Made of thin, wear-resistant plastic, it is custom-made to fit exactly over your top teeth. This allows the bottom teeth to slide gently across the top teeth without biting into them. Not only does this prevent excessive tooth wear, it also helps relax the muscles of the jaw.

Grinding or “bruxing,” as it's also called, can affect virtually any part of the oral system: the jaw joints or muscles, resulting in spasm and pain; the teeth themselves, resulting in wear, fractures or looseness; it can even cause an aching in the ears, head, neck or back.

If you are a teeth-grinder, you might not even know it unless a sleeping partner hears it or your dentist notices signs of wear. These habits are called “parafunctional” (para – outside, function – normal), meaning the biting forces it generates are well outside the normal range — sometimes as much as 10 times normal. So it's no wonder that damage to teeth can occur if they are not protected.

If you have any questions about grinding habits or nightguards, please contact us or schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Olivia Newton-John, please see “Olivia Newton-John.” Dear Doctor also has more on “Stress & Tooth Habits.”

We have noticed that there are two types of patients when it comes to enhancing a person's smile. One type, which we'll call the “Perfect Minded” patient, expects teeth that are completely regular in their arrangement and of maximum whiteness and brightness, often beyond the range of traditional guides for tooth color. They are looking for a perfect “Hollywood” smile. The other, the “Natural Minded” patient, is looking for a more natural look. This person expects a general sense of regularity and alignment of teeth with definite brightness, but not so much that the teeth are noticeable before and above other facial features. Which type are you?

The “Perfect Minded” Patient
While you expect maximum regularity and alignment of teeth along with maximum whiteness and brightness, the “perfect minded” patient requires a smile completely symmetrical (balanced from one side to the other). If we drew a vertical line down the center of your face (midline), it would fall directly between your front teeth and your smile would look just the same on each side of the line. You also expect your smile to be horizontally symmetric, so that it matches the curvature of your lower lip and the gum lines match from side to side.

The “Natural Minded” Patient
You are looking for a more subtle, natural look produced by including some minor irregularities in your look. Like the “Perfect Minded” individual, you still expect your teeth to be generally regular and well aligned but you also want to have some minor asymmetries (not matching) as you move farther back along your jaw to make your teeth look real. Your preference in tooth color is not a super shade of white, but for a tooth color that looks very natural for your facial skin and hair color.

There is no right or wrong here. What is important is to be sure to communicate your expectations to us before embarking on a program of smile redesign.

Contact us today to schedule an appointment to discuss your questions about Smile Design. You can also learn more by reading the Dear Doctor magazine article “Great Expectations — Perceptions in Smile Design.”