When a tooth is removed, there’s not really one specific place it goes.  Some methods of disposal cost the dentist money, others result in a small profit for the dentist, and others are just a little weird.

Read on to find out what happens to extracted teeth.

Eight Journeys Your Extracted Tooth May Take

After a tooth is extracted, the dentist will usually place it on the tray next to the dental chair.  While a lot of people may think that an extracted tooth has hit the end of the road; its journey has just begun.

Here’s eight different journeys that your tooth may take after it leaves your mouth.

1 – Incinerated with Biomedical Waste

According to the OSHA Bloodborne Pathogen Standard, extracted teeth should be placed in a hazardous waste container.  After that, the teeth are normally picked up by a medical waste management company that takes them and then incinerates them with other biomedical waste.

Normally, teeth that do not have any metal from prior dental work go to an oven to be incinerated.  If the tooth has metal, it will likely follow one of the next two routes of disposal.

2 – Go to a Metal Recycling Center

If the extracted tooth has amalgam filling material in it, then incineration causes mercury to be released into the atmosphere.  Because of this, regulations normally do not permit the incineration of extracted teeth containing amalgam, and they must be sent to a specialized recycling center that can remove the amalgam before disposing of the teeth.

Find out what’s in an amalgam filling.

3 – Go to a Dental Scrap Metal Dealer

The dental scrap metal industry is not well-known.  If your tooth had a lab-made restoration on it, your dentist may very well save it and ship it off to a scrap metal dealer who will melt down the metal, assay it, and cut your dentist a check.

A simple Google search for “dental scrap metal refiner” or a quick browse through professional dental journals will reveal many advertisements for companies that make their money from buying metal that used to be in someone’s mouth.

This Sun-Sentinel article tells the story of Michael Kutschmende, a man with cerebral palsy who had four gold teeth extracted at the dental office.  His dentist refused to give them back.  This article exposes the world of dental scrap metal recycling and how dentists can profit from extracted teeth.

Below is an interesting video from the company Crown Men that details the process of getting valuable metal from restorations on extracted teeth.  If you head over to their website, you can read testimonials from dentists who have received a free iPod Touch along with a check after their first time using the service.

 4 – Kept by the Patient

Although some dentists believe otherwise, there are no regulations prohibiting a dentist from giving patients back their teeth following extractions.  The American Dental Association, the Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health Administration (OSHA) all give this practice a green light.  However, many dentists do not return extracted teeth to patients and it remains a controversial subject.

To learn more about this controversy and to find out what some patients do with their extracted teeth, read the post Can You Keep Your Extracted Teeth?

5 – Used for Educational Purposes

Some teeth end up being donated to universities. Many dentists save extracted teeth so that they can be donated to a university and used by dental students for their learning.

In the summer between earning my business degree and going to dental school, I dropped off several empty jars at local oral surgeons’ offices.  They kindly filled them with extracted teeth that I used in learning how to work on human teeth.

While in dental school I wrote a post about how a chipped tooth can be fixed with a filling. I used an extracted tooth for that project!

Extracted teeth aren’t just used by dental students to further their learning. Dentists use them as well for continuing education; some continuing education courses require that a dentist bring extracted teeth to the course so they can practice on them. I went to a thrilling course on how to do better root canals and took a few extracted teeth in order to practice the new techniques that were taught.

6 – Used for Research Purposes

Dental companies are always performing research to determine the best way to bond fillings and crowns to teeth, how to make teeth more resistant to cavities, how teeth react to different forces, and many other things.  When figuring out how to improve their tooth-related product, real teeth work best.

7 – Get Sold to the Highest Bidder

This is probably the least likely path that an extracted tooth takes.  It requires that the patient be famous.

Dr. Bill Dorfman, the dentist that was on the TV show Extreme Makeover, has bragged to TMZ that he saves his famous patients’ teeth when he pulls them.

He states, “There have been a few really famous people and I thought one day maybe I could sell this on eBay.”  In a later interview with TMZ, Dr. Dorfman backtracked this claim…

He may be able to get a pretty good price on eBay for a celebrity’s tooth, but it seems likely a lawsuit would follow in order to determine who is rightfully entitled to the cash.

Back in 2011, an interesting piece of Beatles memorabilia went on the auction block.  John Lennon’s tooth was acquired by Canadian dentist Dr. Michael Zuk, who said he was obsessed with it.  He ended up paying over $30,000 for it; a sum that makes the tooth fairy want to bury her head in shame.

In one article, Dr. Michael Zuk said that he plans on taking the tooth on tour, to be shown off at dental schools worldwide.  He also alluded to the fact that we may be able to someday clone John Lennon, since the nerve on the inside of the tooth contains John Lennon’s DNA.

Who knows, maybe Taylor Swift’s wisdom teeth are hidden away in somebody’s attic awaiting the auction house at some future date!

8 – Become Trophies for the Dentist

Painless Parker was a dentist who practiced around 100 years ago.  He once pulled 357 teeth in one day and then had them strung as a necklace that he wore around his neck.  He also had a bucket of teeth he’d extracted that he brought with him when he lectured on dental hygiene.  That bucket of teeth can be seen today at Temple University’s dental history museum.

Although this likely wouldn’t happen today in the United States, there are dentists in other countries who still show off the teeth that they have removed.  Below is a street dentist in Morocco, showing off the teeth he’s pulled, and the dentures that he’s ready to put in his next patient’s mouth.

Conclusion

As you can see, there most assuredly is life after death for your pearly whites.  There are many paths a tooth can take out of the dental office.

Do you have any questions or comments regarding the wild world of extracted teeth?  Did I miss anything? I’d love to hear what you have to say in the comments section below. Thanks for reading!

I remember a female oral surgeon let me bend the rules once with a teenager who begged for his extracted teeth, but she told me to keep it on the down-low.

So that’s what I learned in dental school and thought was gospel: Patients are not allowed to get their extracted teeth back.

There are many dentists that refuse to give patients their teeth after removal. I know of one that even gives kids a “Tooth Fairy I.O.U.” coupon in lieu of their extracted tooth and tells them to simply put that under their pillow and that the Tooth Fairy will understand.

But is it really necessary to go that far and be a Tooth Fairy Scrooge when it comes to giving patients their extracted teeth?

Let’s find out.

Can You Keep Your Extracted Teeth?

Yes, you can keep your extracted tooth. There are no federal laws or regulations that prohibit, let alone discourage, dentists from giving patients their extracted teeth.

Let’s take a look at some of the excuses dentists use to justify keeping extracted teeth that a patient requests to keep:

• “It’s infectious waste and could infect other people if I let you take it.  I can’t be held liable for that.”
• “OSHA prohibits me from giving you back your extracted tooth.”
• “It’s against the CDC regulations for me to give it back.”

Below, I’ll discuss what the Occupational Safety and Health Administration (OSHA), and the Centers for Disease Control and Prevention (CDC) say about giving extracted teeth to patients.

What the Experts Say About Giving Extracted Teeth to Patients

According to OSHA’s Bloodborne Pathogen Standard, extracted teeth are considered potentially infectious materials and must be handled accordingly.  When a dental office disposes of extracted teeth, they must be placed in medical waste containers.  However, since OSHA only regulates employee interactions, not patient interactions, OSHA has no say in whether a patient can keep their extracted tooth as stated by the textbook, Cottone’s Practical Infection Control in Dentistry:

Extracted teeth can be returned to patients on request, at which time provisions of the federal OSHA standard no longer apply.  Again, some state and local regulations may be more stringent, so it is best to be knowledgeable about applicable regulations in your local area.

In her book, Recommended Infection-Control Practices for Dentistry, (yep – it’s one of those books that you just can’t put down!) Barbara Gooch states the following:

The handling of extracted teeth used in dental educational settings differs from giving patients their own extracted teeth.  Several states allow patients to keep such teeth, because these teeth are not considered to be regulated (pathologic waste) or because the removed body part (tooth) becomes the property of the patient and does not enter the waste system.

The CDC has stated that “Extracted teeth may be returned to the patients upon request and are not subject to the provisions of the OSHA Bloodborne Pathogens Standard.”

So now that we’ve addressed what the CDC and OSHA have to say about extracted teeth, let’s address the other excuse that dentists sometimes use: that the tooth is infectious waste and could pose an infection risk if they carry it out of the office.

Now obviously a tooth that has just been extracted does have some blood and saliva on it.  However, it doesn’t require much time to quickly disinfect a tooth and rinse it off.  Dentists already have protocols in place for disinfecting extracted teeth that need to be sent to dental labs. The CDC, when discussing sending extracted teeth to dental labs, states that:

[Extracted teeth] should be thoroughly cleaned (i.e., blood and bioburden removed), disinfected with an EPA-registered hospital disinfectant with a tuberculocidal claim, and thoroughly rinsed before being handled in the in-office laboratory or sent to an off-site laboratory.

Clearly this is a different scenario since we are talking about teeth being sent home with patients rather than being sent to dental labs.  But I believe that if an office is disinfecting teeth before giving them back to patients, then it is highly unlikely that the teeth pose a greater infection risk than the person that the tooth came from, should they have a disease.

Now that we’ve established that there are no nationwide bans on dentists giving patients their extracted teeth, and that disinfected teeth are highly unlikely to cause infection, let’s explore state regulations.

Do State Dental Boards Allow Dentists to Give Patients Their Extracted Teeth?

I called the dental boards of the four most populous states in the United States as well as the dental board of Virginia, since that’s where I practice.  These five states comprise over 35% of the population of the United States so it’s somewhat representative.

Here’s what the state dental boards had to say:

California

Unfortunately, California did not return my phone call. I left them a voicemail asking if they had any state regulations that would prevent a dentist from giving their patient a recently-extracted tooth.

Fortunately, I was able to spend some time digging through the laws, rules, and regulations governing the practice of dentistry in California and I am confident that they do not have any laws that would forbid a patient from taking their extracted tooth home.

Texas

The dental board in Texas had to research my question and then get back to me.  When they did, they told me that as long as the tooth was sterile, it could be given back to the patient.  I then clarified whether the tooth had to be sterile or just cleaned off, since sterilization would be time-consuming. They then told me that as long as I cleaned it off well, it would be fine to give it back to the patient.

New York

When I called the state dental board of New York, the man I spoke with told me that I could only give baby teeth back to patients but that it’s not allowed to give adult teeth back to patients.  I then threw him a curveball and asked about an adult tooth that had a gold crown on it that the patient really wanted back.  He relented and said it would be fine as long as it was clean.  When I asked him if New York had any written rules regarding this sort of situation, he said there were none.

Florida

Florida wins the gold medal for clarity, as they were the only state that actually covers this scenario in their state’s rules and regulations.  The following is from their regulations, 64B5-25.007 Disposition of Biohazardous Waste.

(2) Extracted teeth may be rendered non-biohazardous by disinfection so that they may be returned to the patient or the patient’s legal guardian.

Virginia

The kind lady that answered the phone at the Virginia Dental Board told me that my home state of Virginia does not have any rule or regulation that would keep a dentist from giving their patient an extracted tooth.

There Likely Are No Laws Preventing Patients from Keeping Their Extracted Teeth

It would be nearly impossible for me to search out every state and local regulation regarding extracted teeth, but I find it highly unlikely that a state or municipality would actually have a rule preventing dentists from giving people their extracted teeth.

I’ve pulled out lots of wiggly teeth for kids at no charge and I can’t imagine telling them that if I pull it out, their tooth is infectious waste, but if they pull it out at home, they can put it under their pillow.

Next let’s take a look at what on earth would compel someone to keep their extracted tooth…this is where things get interesting!

Why Would Someone Want to Keep Their Extracted Tooth?

I’ve extracted hundreds of teeth, but here’s one that stands out:  We had just finished taking out a woman’s remaining teeth; about a dozen or so.  She glared with hateful eyes at the dental tray and growled, “Where’s that brown one?!  I’m taking that little $#@%&! with me.  It’s given me a lot of trouble in my life.”

I smiled underneath my mask and told her she could have it.  I pictured her taking the tooth to her backyard, hanging it from a tree and firing a round at it, blowing it to pieces.

Throughout my dental career, I’ve also heard several other reasons from people who want to keep their teeth:

• One patient was making a necklace of all her extracted teeth.
• An elderly lady wanted to show her grandchildren her tooth so that they wouldn’t repeat her oral hygiene mistakes.  I admire her motivation, but hate to imagine the horrific look on that little grandchild’s face when he sees Granny’s rotten tooth!
• There are quite a few 20-something guys that simply want to show their teeth off to their friends.
• A gentleman from a foreign country wanted to take his tooth back to his native land and have it buried there.
• Many people believe that all parts of their body should be buried for religious purposes.  There is quite a debate on Mi Yodela, a question and answer site about Judaism regarding the burial of body parts before and after death.  I also came across a site on Islam burial practices which recommends that “teeth cut off or extracted during lifetime are also buried.”  As I’m not a member of either of those faiths, I cannot vouch for these sites, but it does add an interesting dynamic to this debate.
• Many people keep a collection of their teeth. While this may be cute for baby teeth (I think my mom still has a 35mm film canister of my baby teeth somewhere), it’s not so cute for ugly, decayed adult teeth that needed to be pulled!

For whatever reason, many people hang on to their extracted teeth.  According to users on this Ask forum, some people have kept their extracted teeth until they die, when the teeth have been sold at estate sales.  One woman recounted the story of her dad keeping his extracted molars: “My dad has all of his extracted molars in with the tooth washers in his nuts and bolts organizer.”

What to Do When Your Dentist Won’t Give You Your Extracted Tooth

Some dentists may know that they are permitted to give patients their extracted tooth but still have the attitude of, “If you really wanted to keep this tooth, you should’ve taken better care of it, then you could’ve kept it — in your mouth.”

There are many cases reported by the media where patients have been upset that their dentist wouldn’t give them back their teeth.  Here are a couple of those cases for your reading pleasure.

My favorite story has to be of a man who was so upset that his dentist wouldn’t give him back his extracted tooth, that he wrote to his elected representative, North Dakota Senator Kent Conrad.  Senator Conrad wrote to OSHA on behalf of his constituent and OSHA replied that there is nothing in the bloodborne pathogen standard that would prevent a dentist from giving a patient back their teeth.

An Arizona woman, Becky Coty, had a tooth extracted with a gold crown and the dentist would not return it to her.  After she contacted the local news channel, which published her story, the dentist reached out and compensated her for the tooth.

Unfortunately, there’s probably not much you can do (aside from trying to get some publicity) if your dentist doesn’t want to give you back your extracted tooth after it’s been taken out.

How to Keep Your Extracted Teeth

If you know that you want to keep your extracted teeth, it’s best to discuss this with your dentist in advance.  Although there aren’t any laws prohibiting dentists from giving back teeth, I’m not aware of any laws that require dentists to give patients their extracted teeth upon request.  It’s more of a gray area.

I recommend letting your dentist know ahead of time that you want to keep your tooth.  That way the issue can be resolved beforehand.  If your dentist resists the idea, you can always check around and you’ll likely be able find a dentist who will let you keep your extracted tooth.

My guess is that most dentists simply default to what they learned in dental school, which seems to vary.  Unlike my school, New York’s Stony Brook School of Dental Medicine states in their Policies & Procedures Manual, “Return of extracted teeth to the patient is allowed, if the patient requests.”

Do you have any questions about extracted teeth and who they belong to?  Any crazy stories about what people have done with their extracted teeth? I’d love to hear about them in the comments section below.  Thanks for reading!

Upon looking at his cell phone, the son says, “Wait guys, we’ve gotta stay away from 32 Elm Street. he’s a dentist… He’s givin’ out floss!”

The dad responds with one word that sums up this crazy behavior: “Weirdo!”

You can view the commercial below, then scroll down to find out why I will continue to give out Halloween candy to trick-or-treaters who knock on my door.

Three Reasons Why Dentists Shouldn’t Give Out Floss for Halloween

Here’s three reasons why dentists shouldn’t be giving out toothbrushes, floss, and other oral hygiene paraphernalia to unsuspecting trick-or-treaters on Halloween.

1 – An Occasional Treat Is Good

Halloween is just once per year.  It’s not like kids are out collecting mass quantities of candy every day!  While it’s true that regularly eating candy and other sugary foods will take its toll on your teeth, the occasional splurge won’t ruin your teeth.  If you are a parent, just remind your kids to brush, floss, and rinse when they are done enjoying their loot.

One of the four things cavities need to grow is time.  If you only occasionally splurge on candy, your chances of getting a cavity from consuming it are slim.

2 – Teeth Are for Chewing

You have teeth to enjoy them.  Having teeth and not enjoying the occasional treat is like having a nice car that never leaves the garage.

Hopefully you are making a consistent effort to take care of your teeth so that they can last you for years to come — so reward yourself now and then!

Read Can Kids Eat Halloween Candy and Have Healthy Teeth? to learn how to have healthy teeth while enjoying Halloween treats.

3 – The Purpose of Halloween Isn’t to Change Behavior

There’s a time and place for everything. Is a child really going to start flossing after they receive floss in their bag of Halloween candy?  They probably won’t change their habits overnight from that simple gesture.  Finding floss among their treats might even lessen their enjoyment of the rest of their candy because it will make them feel guilty for eating so much sugar.

People have their reasons for doing what they do, and there are more appropriate ways — and times — to teach people the importance of oral hygiene.

Enjoy Your Halloween Candy

I’m sure there are plenty of dentists that will be busy handing out floss this Halloween.   Maybe they have noble intentions, but unless they’re careful they could be labeled Halloween’s version of Scrooge.

Me?  I’ll be busy giving out miles of Fruit by the Foot.

As you take a look at the pictures below, you may notice that some people look confident with braces, and some people don’t.  If you try to smile and look proud of your braces, people will see you as more confident, and you’ll likely enjoy having braces more.  It all comes down to attitude.

Hopefully there’s someone here that looks similar to you!

60 Photos of Teenagers with Braces

#1

This blond young woman appears confident as she smiles, showing off a pink powerchain on her upper braces.

#2

This young man appears confident even though he wears glasses and his braces pop right out at you.  Even with the braces and glasses, he proudly shows off blue and orange colored bands around his braces.

#3

This blond-haired, blue-eyed young woman smiles, showing off gray and green colored bands around her braces.

#4

This blond-haired, blue-eyed young woman sports silver-colored elastic bands around her braces.

#5

This brown-haired, blue-eyed young man is sporting blue and green colored elastics on his braces.

#6

This young woman is proudly smiling, showing her blue elastics on her upper braces.

 #7

This young woman is rocking a few different shades of blue elastics on her braces: light green, teal, and blue.

 #8

This blond-haired, blue-eyed young woman is smiling, displaying her upper and lower braces with black and pink-colored elastics.

#9

This young man is smiling enough that we can see his red elastic bands on his upper braces.

#10

This young woman is smiling big enough to show off her upper and lower braces with pink elastics.

#11

This young woman probably needs to work on her smiling skills!  She’s displaying pink and green colored elastics alternating on the top teeth with green bands on the lower four front teeth with pink bands next to them.

#12

This young man smiles, showing off blue-colored elastic bands on his braces.

#13

This young woman looks pretty happy with the world, showing off pink and green colored elastics.

#14

This young woman smiles revealing a silver powerchain that links the braces on her upper teeth.

#15

This young man isn’t afraid to prove to the world that pink isn’t just for girls.

#16

This young woman is seen sporting a popular choice for braces colors: pink and green.

#17

This young woman also thinks highly of the colors green and pink.

#18

This young man has chosen blue and green for his elastics.

#19

This young lady has chosen silver elastic bands that match the silver color of her braces.

#20

This young man displays a blue powerchain on his braces.  He can’t contain his large smile as he listens to an audio version of OralAnswers.com.

#21

This blond lifeguard rocks a pink powerchain.

#22

This young woman chose white elastics to help hide the silver color of her braces.  Although white bands can be a good choice for some, many teenagers with braces find that they make their teeth look more yellow.

#23

This young man  confidently smiles, unafraid to show the world that he has braces.

#24

This young woman has ceramic brackets, which don’t stand out quite as much as the silver brackets.

#25

This young man isn’t trying to hide the fact that he wears braces.  His strategy seems to have garnered the interest of at least one woman.

#26

This fashionable young woman probably enjoys the bling her braces add to her outfits…and it looks like she can’t stop looking at the attractive fellow in photo #25!

#27

This young woman confidently displays her braces for the world to see.

#28

This young man’s confidence goes a long way at convincing the viewer that he is comfortable with his braces.

#29

This young lady’s mouth just needs some Christmas lights to be all ready for the holidays.

#30

This young brunette displays her top-notch oral hygiene skills by using an interdental cleaner to help keep her pearly whites healthy.

#31

This young man is having a fabulous hair day as he shows off his ceramic braces which are designed to hide the fact that the person has braces.

#32

This confident young woman shows off her braces.

#33

This young woman probably wouldn’t be smiling so big if she knew she lost her braces wire.

#34

This young man confidently smiles, letting the world know that he’s proud of his braces.

#34

This red-haired, blue-eyed young woman sports her Damon braces with confidence.

#35

This brown-haired young woman shows off her braces with purple-colored elastics.

#36

This young man proudly sports some light-green colored bands and a thin mustache.

#37

This dark-brown-haired young woman proudly shows off her braces.

#38

This young woman shows us through her big smile that it is possible to maintain beautiful teeth even while wearing braces.

#39

This young woman is trying to make her teeth appear whiter by going with an off-white elastic band.

#40

This teenage young lady shows that you can still look good during the initial phase of braces while your teeth are still crooked.

#41

This young lady shows off a sweet, innocent smile with her braces.

#42

This young woman shows off her Damon braces with a confident smile.

#43

This teenage girl recently had her braces put on.  If we give her a few months, she’ll soon move from a half-smile to a full, confident smile.

#44

This young man is trying to distract from his braces with some facial hair.

#45

This young woman cleverly distracts the viewer from her braces to her eyes.  One way to take the emphasis off of your braces is to guide the attention away from your mouth to other features.  She does this with her eye shadow and her large earrings.

#46

This young woman’s braces are barely noticeable.  You can ask your orthodontist about more aesthetic options such as ceramic braces and lighter-colored wires.

#47

This teenage girl just got her braces, and is still getting used to smiling with them.

#48

This young man proudly shows off his gray and green colored elastic bands for his braces.

#49

This young woman displays a confident smile with her braces.

#50

These teenage girls are having fun swimming.  It’s important to remember that braces don’t define who you are,!l Life continues to go on and you can participate in the same activities you did before you had braces.

#51 and #52

You can see the same teenager in the above and below photos.  Notice how the different smile totally changes the appearance of her whole face.  After you get braces, practice smiling and speaking in front of a mirror, as the braces will make your mouth feel different.

#53

This young man can confidently laugh at a joke.  Don’t be afraid to let people know you have braces, because they will probably notice even if you try to hide it.

#54

This young woman has consulted with her orthodontist about aesthetic optiosn to help disguise braces.

#55

This teenage girl has taken some of the focus off of her braces by wearing glasses that stand out with purple frames.

#56

This young lady is still working on getting her smile right with braces, as she’s scrunching up her nose a little bit, causing more of her upper gums to show.

#57

This teenage boy proudly waves, desperate to show off his braces to anyone who will look.

#58

This teenage girl takes some of the focus off of her braces with some green eye shadow.

#59

This young blond-haired teenager proudly displays her braces with confidence.

 #60

This young woman disguises her braces with a white powerchain.

Be Confident

Hopefully this sampling of photos of teenagers with braces has helped you see how you might look with braces.

One of the most important takeaways is to simply be confident with braces.  They are temporary – they won’t define who you are. You might as well be confident while you have them.

If you have any questions about braces, feel free to leave them in the comments section below.  Thanks for reading!

In the same decade that water fluoridation commenced, people in non-fluoridated areas wondered how their children could reap the the benefits of fluoride if their water supply was not yet fluoridated.

Trials were performed in which dietary fluoride supplements were administered to children in order to determine if they could receive fluoride’s anti-cavity effects in pill form.

After this trial period, the American Dental Association (ADA) came up with the very first fluoride dosage schedule in 1958.  In the years that followed, the American Academy of Pediatrics as well as the ADA had two separate fluoride dosage schedules.  Unfortunately, many children started getting dental fluorosis, and as a result, the amount of recommended fluoride was gradually reduced.  Finally, in 1994 the ADA and AAP finally agreed on the following schedule, which was reaffirmed in 2010.

Fluoride Supplement Dosage Schedule 

Do All Children Need Fluoride Supplements?

Even if your water does not contain fluoride, your child may not need fluoride supplements.  The American Dental Association states that fluoride supplements are intended for use by children “living in non-fluoridated areas and at high risk of developing tooth decay.”

Your child’s dentist can help you determine how at-risk your child is for developing tooth decay.  If your child is at low risk of developing cavities, then fluoride supplements are inappropriate whether or not your family’s drinking water is fluoridated.

While fluoride can help prevent cavities in high-risk children, it’s important to remember that cavities aren’t caused by a deficiency in fluoride.

Learn about what really causes cavities here.

Do you have any questions about fluoride supplements?  Feel free to leave your questions and comments in the section below.  Thanks for reading!

Sinuses are simply chambers in your head that allow air to circulate to get warm and moist before it travels down to  your lungs.  Normally, the body is able to keep the sinuses clean and healthy, despite the dark, moist environment that bacteria love.

However, when conditions are right, bacteria can grow out of control in the sinuses, causing a sinus infection.  One cause of sinus infections is the common cold.  Interestingly enough, teeth can also cause sinus infections.

Before we get into a discussion on how teeth can cause sinus infections, we’ll talk about where the sinuses are located.

Where Are Sinuses Located?

There are a few different sinuses located in the facial area — around the cheeks, nose, and above the eyes.   The diagram below gives you a little better idea of where the sinuses are, and how they look when they are healthy, versus how they look when they are infected.

If you look at the diagram above and imagine a row of upper teeth, you can see how the roots of the upper teeth come into close contact with those sinuses on each side of the nose.   These sinuses are known as the maxillary sinuses.  While there are several sets of sinuses, the maxillary sinuses are the only sinuses that can also be infected by a tooth-related problem.

How Often Do Teeth Cause Sinus Infections?

Hupp’s Contemporary Oral and Maxillofacial Surgery textbook states, “Periapical or periodontal infections of maxillary posterior teeth may erode superiorly through the floor of the maxillary sinus.  Approximately 20% of cases of maxillary sinusitis are odontogenic.”

Basically, that’s a fancy way of saying that tooth and gum abscesses of the upper back teeth can eat through the bone and invade the maxillary sinus.  It further says that about 20% of all maxillary sinus infections are caused by tooth infections, rather than another cause.

Below, you’ll find a couple of examples of how tooth infections or abscesses can cause sinus infections.

A Case of an Abscess Close to the Sinuses

Here is an x-ray of a tooth that had a root canal and crown done previously, but the infection at the roots had never quite healed.  I have outlined some of the important structures below for those of you who are not accustomed to reading x-rays.

I colored the sinus blue and the tooth infection red in the x-ray below:

As you can imagine, the infection and the sinuses do overlap, as you can see in the x-ray below.

Although it looks like the sinus and the infection are overlapped on the x-ray, it doesn’t necessarily mean that the infection has broken into the sinus and causing a sinus infection.  It could be that the abscess is either in front of or behind the sinus in this x-ray, because the x-ray is simply a snapshot of the whole area and doesn’t tell us if things are closer to the front or the back.

If you take a look at the x-ray above, you can see how close the maxillary sinus is to the upper teeth.  Sometimes there is only a thin membrane separating the roots of the upper teeth and the sinus, making it very easy for an infection to travel into the sinuses.

Although this person wasn’t exhibiting any symptoms of a sinus infection, but the x-rays do a good job of showing just how close the abscess is to the sinus.

A Case of Sinusitis Caused by a Tooth

This person had chronic sinusitis for the last few years, that started shortly after she had a metal post put into one of her upper back teeth.  Upon looking at her x-rays I noticed that the metal post that was put in one of her upper teeth looked like it had pierced through edge of the tooth and gone slightly into the bone.  This caused an abscess that was leaking into her sinus.

Here’s the x-ray of her upper right teeth:

To make the x-ray below easier to see, the tooth is green, the infection is red, and the sinuses are blue:

Sadly, due to the fracture in the tooth caused by the large metal post, the tooth had to be extracted.

The oral surgeon who extracted the tooth told me that the tip of the tooth broke off just above the metal post, causing the root fragment to get pushed into the sinuses during extraction.  He had to open up the sinus to retrieve the root and he was able to suction out a lot of the infection — he said it was a pretty bad infection.

Teeth Can Cause Sinus Infections

While sinus infections can cause teeth to to hurt, hopefully this post has helped you see that infections from the upper back teeth can easily make their way into the sinuses and cause sinus infections.

It is important to remember that unhealthy teeth are just one cause of sinus infections, and that there are several other causes.  If you suspect your sinus infection is caused by a tooth, you should see your dentist to confirm this.

Do you have any questions, concerns, or comments?   Feel free to leave a comment in the comments section below.  Thanks for reading!

This was a big problem with anesthetics back over 100 years ago.  Then, something exciting (to dentists anyway) happened!  A guy named Abel discovered adrenalin (a more common name for epinephrine) in 1897.   In 1903 Braun suggested using adrenalin as a “chemical tourniquet” to make anesthetics last for a longer period of time.

This Braun fellow recommended using epinephrine at the very small concentration of 1 part to 10,000.  That may seem weak, but we’ve found that even diluting it to 1 part to 200,000 still retains the beneficial effects of epinephrine while minimizing the side effects.

Epinephrine is what is known as a vasoconstrictor, which is just a fancy word for something that causes your blood vessels to constrict, or get smaller.

Why Dental Anesthetic Has Epinephrine

It is this vasoconstrictor effect of epinephrine that makes it so useful in dental anesthetic.  By constricting your blood vessels, it benefits you and your dentist in the following three ways.

1 – The anesthetic gets absorbed more slowly into your body because blood flow to the injection site is decreased.  Since blood levels of the local anesthetic are decreased, the risk of having an “overdose” of the dental anesthetic is minimized.

2 – Since there is less blood flow, the dental anesthetic stays put right around the nerve for a much longer time, allowing it to work for a longer period of time than it would without epinephrine.  This means that you stay comfortable throughout the entire procedure.  It also means that you might be numb for a few hours after leaving the dentist – a sometimes unwanted and embarrassing side effect!

3 – Minimizes bleeding where the anesthetic was administered.  This is great if the dentist is performing a more involved surgical procedure involving the gum tissue since it makes it much easier to see what we’re doing if there’s hardly any bleeding.

Epinephrine is the most common vasoconstrictor used in dental anesthetic in the United States.  In Europe, a vasoconstrictor called levonordefrine is commonly used.

If you prefer to not have these beneficial effects of epinephrine or if you have had heart problems, your dentist may elect to use a dental anesthetic without epinephrine. If that’s your preference and you want to seem like you know what you’re talking about, just ask your dentist for Carbocaine without epinephrine. That’s the most common brand name of dental anesthetic without any epinephrine.

If you have any questions about dental anesthetic and epinephrine, feel free to leave a comment below.  Thanks for reading!

They called this the epinephrine reaction, and I blindly believed it. I even wrote a post about why dental anesthetic makes your heart beat faster. Until one day, this belief was questioned by a comment on that article (which actually caused Gavin to post a rather entertaining comment).  I realized that I’d blindly believed what I’d been taught without doing any research of my own.

In this follow-up article, I’ll answer the question: Can dental anesthetic really make your heart beat faster?

People Report That Dental Anesthetic Makes Your Heart Beat Faster

A few weeks ago, a woman told me that she hates getting injections because it makes her heart beat really fast.  I asked her if a dentist had ever offered her the anesthetic brand Carbocaine (a type of dental anesthetic without any added epinephrine).  She told me that she’d never heard of it.  I tried it on her and she told me that it was the first injection she could remember where she didn’t feel like her heart was beating out of her chest.

Naturally, this (along with other similar experiences) made me a believer that regular dental anesthetic with epinephrine can indeed make your heart beat faster.  As a dentist I realize that stories, while fun and exciting, may not be a very good source of evidence, so I decided to do some more in-depth research.

Can Dental Anesthetic Really Make Your Heart Beat Faster?

The main question here is whether or not the small amount of epinephrine inside the dental anesthetic makes your heart beat faster or if it’s simply caused by the epinephrine your body releases in response to being afraid of the crazy dentist that’s about to poke you.

Many years ago, it was thought that the tiny amount of epinephrine in the dental anesthetic made no difference in your heart rate, and any change in your heart rate was simply caused by the “fight or flight” response.

Many studies have since confirmed that the epinephrine in dental anesthetic can cause an increase in your heart rate.

One study states that “intravenous administration of 0.015 mg of epinephrine with lidocaine results in increase in the heart rate ranging from 25 to 70 beats per minute, with elevations in the systolic blood from 20 to 70 mm Hg.”  For your information, one cartridge of dental anesthetic contains 0.018 mg of epinephrine — that’s even more than the amount pharmacy-no-rx.net that has been shown to increase the heart rate by 25 to 70 beats per minute.  Here’s a link to one of those studies that discusses this.

Malamed’s dental textbook on anesthetic even confirms what I’d discovered.  It says, “Contrary to a previously held position that the intraoral administration of “usual” volumes of epinephrine produced no cardiovascular response and that patients were more at risk from endogenously released epinephrine than they were from exogenously administered epinephrine, recent evidence demonstrates that epinephrine plasma levels equivalent to those achieved during moderate to heavy exercise may occur after intraoral injection.”

That simply says that the epinephrine in dental anesthetic can make your heart beat very fast, even tricking it into beating as fast as it would if you were exercising.

The author goes on to state that even if your dentist does inject slowly and “pull back” to ensure that they don’t inject into a blood vessel, your heart can still beat faster: “However, even following usual precautions (e.g. aspiration, slow injection), sufficient epinephrine can be absorbed to cause sympathomimetic reactions such as aprehension, tachycardia, sweating, and pounding in the chest (palpitation): the so-called “epinephrine reaction.”

More Evidence That Dental Anesthetic Can Make Your Heart Beat Faster

Even more evidence that dental anesthetic can make your heart beat faster comes from the American Heart Association.  They recommend that any patients with heart disease receive a maximum of 0.04 mg of epinephrine from dental anesthetic.  That’s usually the equivalent of just two cartridges of dental anesthetic.  For comparison’s sake, a normal person without heart disease can receive up to eleven cartridges of anesthetic.

This shows that the AHA believes that the epinephrine in dental anesthetic can have an effect on the heart, and that’s why they recommend limiting it so strictly.

The textbook Dental Management of the Medically Compromised Patient confirms this by stating “If [a vasoconstrictor] is considered essential, use cautiously (maximum 0.036 mg epinephrine or 0.20 mg levonordefrin).”  Levonordefrin is similar to epinephrine, but it is mostly used in European countries, not in the U.S.

Lastly, the American Acamedy of Pediatric Dentists even has guidelines for dentists telling us what to do when a patient has a reaction to the epinephrine in dental anesthetic.  They say to reassure the patient, ensure they’re breathing well, and to check their vital signs if necessary.

Dental Anesthetic Can Make Your Heart Beat Faster

In summary, the most recent studies and evidence all point to the fact that the epinephrine (or levonordefrin for my European friends) can definitely make your heart feel like its beating out of your chest!

Do you have any questions about dental anesthetic and how it affects your heart?  Feel free to leave them in the comments section below.  Thanks for reading!

Not many parents want to hear those words, especially if their child has dental anxiety.

Last summer, I saw a three year old child who needed to have a filling on one of his upper molars.

The only reason he sat still in the chair long enough for us to remove the decay and get a filling put in was because we told him we were going to give him a yellow colored filling.

He loved tractors, and wanted it to be yellow like his toy tractor. When he was all done, we took a picture of it and gave it to him so he could show his friends and family.

I’ve found that giving children a colored filling (along with some other things we do to make the comfortable), helps them to sit in the dental chair and get their mentalhealthupdate.com needed dental work completed.

Find out why baby teeth need to have fillings if they just fall out.

Colored Fillings

Colored fillings are made of the same composite materials as tooth-colored fillings, they simply have more exciting coloring added to them.

At our office, we have five colors to choose from: blue, green, yellow, orange, and pink.

To the right, you can see how the pink filling looks on a tooth – it’s what most of the girls end up choosing.  That filling, as well as the green one above, was placed to fill in a cavity that formed between the teeth, which is one of the more common places you can get a cavity.

While we can do a colored filling to repair most cavities in baby teeth, nobody has had us do one on a front tooth yet!

What about the other half?

My guess is that they’re the ones who floss twice a year — right before their dental checkups.  They think they can pull a fast one on us, but here’s a little secret: dentists can tell when you’ve been  flossing and when you haven’t.

How Dentists Can Tell When You’re Not Flossing

The way we can tell if you’re not flossing is if your gums are bleeding.  Although there are other, less common conditions that can make your gums bleed, gingivitis is the main cause.  Gingivitis is when the gums are inflamed due to all of the bacteria in your mouth collecting right between the gums and the teeth.

The problem is that it takes about a week of daily flossing for gingivitis to go away and make it so your gums don’t bleed when they are cleaned.

The most authoritative book on the gums — that’s 1,328 pages dedicated to your gums! — states the following:

The presence of plaque for only 2 days can initiate gingival bleeding on probing, whereas once established, it may take 7 days or more after continued plaque control and treatment to eliminate gingival bleeding.

So, if you end up brushing and flossing really well right before your dental cleaning and exam, your teeth will be clean, but your gums will still show the main sign of inflammation: bleeding.

If you really want to trick your dentist into thinking you’re brushing and flossing regularly, you’ll have to do it for at least seven days before your visit. And if you’re gonna do that, why not simply brush and floss every day?

Upon first glance, many parents are understandably concerned that their child has a serious problem in their mouth.  The photo I used in the original article isn’t very clear, and I thought it would be good to post a couple more photos that were recently shared with me.

Photos of Eruption Cysts

The photo below shows two eruption cysts over the permanent upper front teeth.  The teeth are still white, the purple color is due to bruising that has occurred between the gums and the permanent tooth.  Usually, no treatment is necessary and the teeth will come through within a couple of weeks.

The next photo shows an eruption cyst where the upper left six-year molar is preparing to come into the mouth.  Many parents may not even notice eruption cysts when they occur this far back in the mouth.

Fact: Since many eruption cysts occur on the back teeth and only last a few weeks, they often go undetected.  Because of this, nobody really knows how common eruption cysts really are.  Most estimates say that they occur in under 1% of all children.

To Treat or Not to Treat

Normally, eruption cysts don’t need any treatment.  The tooth will usually poke through the eruption cyst and come into the mouth on its own within a couple of weeks.  If the eruption cyst is causing lots of pain, or if it is causing concerns due to its appearance (as in the first photo), it can be cut open to expose the tooth.

You can click the following link to check out a picture of a tooth after its eruption cyst has been opened.

More Pictures of Eruption Cysts

You can find more photos of eruption cysts in this article that appeared in the Indian Journal of Dental Research.

If you have any questions or concerns on eruption cysts, feel free to leave a comment in the comments section below.  Thanks for reading!

Here are five good reasons why you should.

Five Reasons to Go to the Dentist

1 – Catch Problems While They’re Small

If you regularly visit the dentist, your dentist will be able to tell you about smaller problems that you can easily and inexpensively get fixed.  The quicker you get a cavity filled, for example, the longer the filling will last.  If you put off getting a cavity filled while it’s small, it could cost significantly more to get it fixed when it needs a root canal and crown a few years down the road.

You won’t feel any symptoms with most dental problems until they are advanced.  If you have gum disease, it’s important that you get it treated.  However, unless you develop a gum abscess or have gum disease that is at a very advanced stage, you likely won’t experience any pain.

2 – Dental Care Is Better Than It Was In the Past

If you had a bad experience in the past, let me assure you that dentistry has come a long way.  There have been many recent advancements in the kinds of materials that we can use to fix your teeth.  Many modern restorations such as crowns and veneers look completely natural and can give you the kind of smile you’ve always wanted.

3 – There Are Ways to Alleviate Dental Fear

There are many drugs that you can take before you go to the dentist to make you drowsy so that you will be less anxious during your procedure.

Also, if needles frighten you, many dentists can fill small cavities using a laser without any anesthetic.  If you do require an anesthetic, there are very strong topical gels that can be placed on your gums before the injection to make the injection nearly painless.

We’ve come a long way since the dark ages when dentists were a little crazy — check out these pictures of old school dentistry if you don’t believe me.

4 – There Are Better Deals Due to the Economy

Many dentists are running new patient specials due to the fragile state of the economy.  They figure it’s better to get a new patient in even if they charge a really low price than to have empty slots.

If you perform an internet search with the terms “dentist the name of your city“, you will likely find some good deals that will allow you to have a free or low-cost exam and x-rays to get an overall idea of your general dental health.

5 – There are Financing Options Available

Also due to the economy, some dental offices are willing to accept payments for dental work performed rather than requiring the full amount at the time of service.

Another excellent option that we offer at my practice is called Care Credit.  This allows patients to have the dental work performed and then make 12 equal, monthly payments over the course of the year without paying any interest.  If you do go this route, just make sure that you make all of your payments on time.  If you don’t pay on time, then they will charge interest, which is how they make a lot of their money.

There’s No Time Like The Present

If you’ve made it this far, go ahead and make that appointment!  If you’re hesitant to make a dental appointment, feel free to leave a comment below and let me know why.  I’ll try to get back to you and resolve any concerns you might have.

Have a great year!