Inadequate Dental Exam
Results in Continued Pain

Dr. Al Danenberg Nutritional Periodontist
June 25, 2018




Inadequate Dental Exam


Last week a friend of mine, whom I will call Craig, called me. He lives about 300 miles away from where I live. He told me about his dental problem. His story is a recurring concern I have about some dentists performing an inadequate dental exam. A lack of an in-depth exam can result in continued pain for the patient as well as expensive, unnecessary, and possibly harmful treatment.



Craig’s Problem

Craig told me that several weeks ago he had pain in his upper left molar area. He had so much pain that he could not sleep. Ibuprofen was not taking care of his pain. So, he went to his dentist, who took an x-ray.


Craig is a healthcare professional, but not a dentist. So, Craig understands medical terminology and the process of correctly diagnosing a problem.


His dentist explained that he saw an old filling in the last molar that could be causing the problem. The doctor recommended to remove the old filling and replace it with a new one. Craig accepted the dentist’s conclusion, and the dentist proceeded to remove the filling and place a new one at that appointment.


My friend believed that the dentist knew what he was talking about and left the office after the procedure. Craig thought his problem was solved. However, the pain was not gone. It just got worse.


He returned to his dentist the following week and explained the problem was getting worse. The dentist then suggested that the tooth probably had a crack and would require a root canal and crown to save the tooth. At that point, Craig was concerned about his dentist’s diagnosis. So, he called me for my opinion.



My Opinion

Craig emailed the digital x-ray to me, so I could explain what I saw. It was a standard, two-dimensional dental x-ray. When I looked at the x-ray, I noticed changes in the bone density around the roots of his molar teeth. These changes suggested the teeth were in trauma. The trauma was typical of a clenching or grinding habit. Tooth trauma like this could wiggle the teeth and damage the jawbone. This could cause pain in the tooth area, pain in the muscles of the jaw, and pain in the jaw joint.


After I explained to Craig what I saw in his x-ray, he told me that he clenches his teeth most of the time. My next question to my friend was, “Did your dentist ask if you were aware of clenching or grinding your teeth?” Craig told me his dentist never discussed it nor questioned him about it. He also said the dentist never explained what he saw in the x-ray other than the old filling.


I told Craig a 3D x-ray of the area might help identify if there was a cracked root or other damage around the tooth that could not be seen from a standard dental x-ray. I also suggested that he purchase a soft bite guard from the drug store to cushion his bite while he slept. If the pain was only from clenching or grinding, then the soft bite guard might be able to lessen the severe pressure and possibly relieve the pain.


Craig immediately went to his drugstore and purchased a soft bite guard for about $20. He called me the next day excited, “Last night was the first night in several weeks that I had no pain and could sleep all night long.”



Closing Thoughts

I know that diagnosing problems in dentistry can be difficult. But, a well-trained dentist should be able to look at an x-ray and see what I saw.


When there are obvious changes in the bone suggesting tooth trauma, then one of the first questions the dentist needs to ask the patient is, “Are you aware of any habits of clenching or grinding your teeth?”


Certainly, the first thing a dentist should not do is replace an old filling before a thorough evaluation is done. An inadequate dental exam often results in a misdiagnosis and continued pain as was the case for my friend Craig.


To completely correct Craig’s problem, he may need to have various chewing surfaces of his teeth smoothed and polished to “even out” his bite pressures. Also, Craig may need a customized bite guard.



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What Did You Say I Have?

        Alvin H. Danenberg, DDS       November 8, 2015


evolution r“What did you say I have? I brush my teeth everyday and floss when I can. Now you say I have gum disease that is eating away at my jawbone! How did this happen to me?”


You are not alone!


A study published in 2010 demonstrated that 93.9% of adults in the United States had some form of gingivitis, which is inflammation of the gum tissues surrounding the teeth.


Another study published in 2012 by The Centers for Disease Control and Prevention stated that 47% of the US adult population has periodontitis (the advanced stage of gum disease that eats away at the jawbone). If you were over 65 years old, the prevalence of this advanced infection jumped to 70%. Wow!


Advanced gum disease typically does not hurt. The earlier stage of this disease, which is gingivitis, usually produces bleeding gums. But, if gingivitis progresses to the more advanced stage of periodontitis, the bleeding generally stops as the infection moves deeper under the gums to begin destroying the jawbone.


If left untreated, periodontitis will cause teeth to get loose. Teeth will become sore and painful to the touch. Chewing will become uncomfortable. Infection that is around the tooth root could be pushed into the blood system, affecting other areas of the body. These gum infections could also become severe in the mouth resulting in much swelling, bleeding, and odor. Once the structure of the jawbone is significantly destroyed, the only option would be to extract the teeth involved. In addition to mouth problems, gum disease has been associated with many other bodily conditions such as diabetes, pre-term and low-weight babies, heart disease, and many more.


There are many causes. The most common is bacteria that get under the gums around the teeth that thrive off of the sugars and refined carbohydrates we eat abundantly everyday. Another cause is the lack of efficient oral hygiene, which includes effective tooth and gum cleaning habits. Additional causes are the health of our digestive system, the nutrients that are in our foods, our stress level, and our genetic predisposition. Frequently, habits like gritting or grinding your teeth, even if you are not aware of this habit, could weaken the jawbone and result in further destruction.


You cannot change your genetics, but you can change the quality of foods you eat and your lifestyle, and you can learn to properly clean around your teeth and gums.


Those who read my blogs may know that I am a periodontist (gum specialist) with 41 years experience in treating patients with advanced gum disease. I also am licensed in the laser gum treatment called LANAP® (Laser Assisted New Attachment Procedure), which is patient-friendly and involves no cutting with scalpels and no stitches. I have found this to be the best way to treat advanced gum disease. In addition, I am a Certified Functional Medicine Practitioner using this background to guide patients to a healthier diet and lifestyle. Some of my patients decide to complete a 3-Day Food Journal, which allows me to evaluate their eating and lifestyle habits and then to recommend healthier food and lifestyle choices.


I offer my patients a Lifestyle Repair Plan, in which I recommend an anti-inflammatory diet, selecting from a host of nutrient-dense foods. These are the foods that have a great deal of nutrients packed into each calorie. My Plan also incorporates changes in lifestyle that are critical for overall health. Included are concepts of health maintenance like Oral Care, Restorative Sleep, Efficient Exercise, and Stress Reduction – concepts that I have summarized into simple and doable steps.


My goal for my patients is to treat their active gum infections, teach them methods to maintain a healthy mouth, and assist them with eating and lifestyle changes that could lead not only to a healthier mouth for the rest of their lives but also to a healthier body.