Day: November 15, 2021 (page 1 of 1)

What fixes pulpitis?


While many of us have experienced tooth pain, it seldom becomes fatal. This was not the case in the past, and world history would probably be vastly different if we had 21st-century dental care readily accessible across the ages. Welcome back to Ask the Dentist podcast, where today we ask Dr. Burhenne “what fixes pulpitis”? Tune in to find out what pulpitis is, why the pulp of the tooth is so important, and how it can lead to serious health issues if left untreated. Find out the difference between reversible and irreversible pulpitis (and how a crown can help either situation), and how to manage acute pulpitis. From a basic anatomy lesson on what teeth are made of and how they are formed, to a simple explanation of why tooth pain is something you don’t want to leave unchecked, don’t miss out on this fascinating episode!

Key Points From This Episode:

An introduction to today’s question: what fixes pulpitis?Diving back into dental school, the textbooks Dr. B keptFind out about the anatomy of a tooth, from pulp to dentinWhat the pulp consists of: nerves, blood vessels, lymph nodes, and odontoblastsHow a tooth is formed (dentinogenesis)The role of the pulp in repairing certain types of tooth damageWhat happens to the pulp as you ageThe function of the pulp: sensation, nutrition, infection prevention, and possibly even balance!How pulpitis occurs; how it causes tooth pain and why it can result in tooth deathThe difference between reversible and irreversible pulpitisWhy you should never wait to get tooth pain treatedHow a crown can prevent reversible pulpitis from becoming irreversible pulpitisWhy a crown is worth having even if the issue is irreversible pulpitisHow to manage acute pulpitisDr. B’s idea for a book: how tooth pain has shaped world history

How to Submit Your Question:

Record your question for Dr. B at 

Links Mentioned in Today’s Episode:

Ask the Dentist

About Dr. Mark Burhenne

Follow Dr. B on Instagram @askthedentist

Follow Dr. B on Twitter @askthedentist

Ask Dr. B a Question

Functional Dentist Directory

The post What fixes pulpitis? appeared first on Ask the Dentist.

What’s The Future of Functional Dentistry?


As a functional dentist, Dr. B is used to being asked what functional dentistry is. However, this week, this question comes with a twist as fans ask Dr. B what he is most excited about in functional dentistry. Tune in to discover Dr. B’s journey to functional dentistry, from sleuthing as a child to setting up a directory globally for fellow functional dentists. Find out how functional dentistry ultimately saves lives and money, and why (despite this) the ADA doesn’t yet accept it as a specialization. We discuss diseases that functional dentistry can prevent, and Dr. B’s book recommendations that cover functional topics. From nasal breathing to flat dental plates, Alzheimer’s disease to sleep apnoea, Dr. B takes us through his tips and research into the pathologies that he has applied to functional dentistry, to benefit his patients and family members. Join us to hear all this and more about the future of functional dentistry.

Key Points From This Episode:

Dr. B’s weekend plans: why getting out from behind a screen post-vaccination is so importantWhy most people ask what functional dentistry isToday’s question: what Dr. B is most excited about in functional dentistryHow Dr. Mark Hyman is an inspiration for functional practitionersWhat motivated Dr. B to become a functional dentistWorking upstream: how functional dentistry ultimately saves lives and moneyHow the body compensating causes pathology and why it’s important to intercept these compensations early onRecognizing functional dentists: one patient and one practitioner at a timeTeaching functional dentistry: learning beyond your official educationThe systems that interact to affect your dental healthBecoming a practitioner of the oral-microbiomeDr. B’s “aha” moment about sleep apnea and prevention through dentistryThe oral-systemic connection: what happens in the mouth affects the bodyHow root cause thinking can save the entire healthcare system The importance of promoting nasal breathingUnderstanding the P. gingivalis bug and its link to Alzheimer’s diseaseWhy the future of dentistry is functionalFunctional dentistry throughout the world: From Brazil to Japan

How to Submit Your Question:

Record your question for Dr. B at

Links Mentioned in Today’s Episode:

Dr. Mark Hyman on LinkedIn

Breath: The New Science of a Lost Art

Ask the Dentist: 5 Sleep Apnoea Questions

Can gingivitis cause Alzheimer’s Disease? [A Scientific Review]

Ask the Dentist

About Dr. Mark Burhenne

Follow Dr. B on Instagram @askthedentist

Follow Dr. B on Twitter @askthedentist

Ask Dr. B a Question

Functional Dentist Directory

The post What’s The Future of Functional Dentistry? appeared first on Ask the Dentist.

How Deep Is The Connection Between Gum Disease And COVID-19 Complications?

A new study published in the Journal of Clinical Periodontology came up with an interesting fact that there is a strong association between periodontitis and the complications of COVID-19. After examining more than 500 COVID-19 patients the researchers could deduce that those who had gum disease were at a greater risk of getting admitted into ICU, or put on a ventilator support and even more likely to die.

Why Did The Researchers Suspect A Connection Between Gum Disease And COVID-19?

Though Coronavirus SARS-CoV-2, the virus responsible for COVID-19, produces mild symptoms in most of the cases and has a fatality rate as low as 2%, it has been reported that 14% of the patients develop severe conditions that need immediate hospitalization and oxygen support. Acute respiratory distress syndrome (ARDS), sepsis, septic shock and multi-organ failure are a few serious complications of COVID-19 and these symptoms are characteristics of cytokine storm syndrome, an exacerbated immune response in which the proinflammatory cytokine levels spike up and there is a lot of tissue damage. Moreover, the severity of COVID-19 has shown to be more in elderly or obese patients and patients with comorbidities (like hypertension and diabetes).

Periodontitis is one of the most common gum diseases and around half the adult population worldwide is affected by mild to moderate form of periodontitis. In a person with severe periodontitis, the attachment between and the supporting tissues is destroyed. This can lead to tooth loss when left unattended. Cases with periodontitis are characterized by chronic inflammation that progresses to cause systemic inflammation. Like COVID-19, severe periodontitis has shown a marked increase in the levels of cytokines like TNF (Tumour Necrosis Factor)-alpha, CRP (C-reactive protein), ferritin and interleukins. Periodontitis has reported to have a strong association with conditions like diabetes, cardiovascular diseases and even premature death.

These similarities between  periodontitis and COVID-19 urged the researchers to conduct a case-control study and assess the extent to which the two are connected with each other.

This Is How They Conducted Their Study

 With the help of the national electronic health records of the State of Qatar dated between February 2020 to July 2020, a case-control study was conducted. Those patients who suffered from the complications of COVID-19 like death, ICU admission or assisted ventilation were identified as cases whereas patients who were discharged from the hospital and did not have any of the major complications were identified as controls.

Periodontal status, including interdental bone loss of both the groups were assessed with the help of dental radiographs uploaded in the electronic health records. Information on the possible risk factors like diabetes, smoking habit and body mass index was taken into consideration. Blood parameters relevant for the disease like concentration of D-dimer, C-Reactive protein, vitamin D and WBC levels were also extracted from the electronic health records for the purpose of assessment. The association between COVID-19 and periodontitis was analysed with the help of logistic regression.

Here Is What They Found In Their Study

A total of 568 patients were analysed out of which  528 patients were discharged without any complications (controls) whereas 40 patients had severe COVID-19 complications (cases). These are the most prominent findings of the study-

As expected, patients with severe complications were older and had more comorbidities than those who had minor COVID-19 symptoms.Around 80% of the patients suffering from COVID-19 complications had periodontitis.In the deceased patients, the concentration of CRP, D-dimer and WBC were phenomenally high whereas the lymphocytes were significantly lower than the surviving patients.The concentration of D-dimer, CRP and WBC was also found higher in those admitted to the ICU and those patients who needed assisted ventilation.Around half of the examined patients had periodontitis.Periodontitis showed an association with a greater risk of developing COVID-19 complications, death, ICU admission and assisted ventilation.HBA1c, CRP and WBC blood levels were phenomenally higher in COVID-19 patients who had periodontitis than those who did not have periodontitis.It was also seen that the successful treatment of periodontitis brought a marked improvement in the serum markers of systemic inflammation and enhanced overall metabolic control.

nd They Concluded…

On the basis of the above-mentioned findings, the researchers concluded that patients suffering from COVID-19 were 3 times more likely to be admitted to ICU, 4.5 times more likely to be in need for assisted ventilation and 9 times more susceptible to die if they had gum disease along with COVID-19.

Though more research is needed to establish the connection between COVID-19 complications and periodontitis, one thing has become clear that gum disease can aggravate systemic inflammation thereby, worsening the condition of the COVID-19 patients. Hence, this is the right time to give due importance to gum health and ensure that you take good care of them!

The post How Deep Is The Connection Between Gum Disease And COVID-19 Complications? appeared first on Ask the Dentist.

Did you miss our previous article…

Healing Craze Lines and Fractures with Hydroxyapatite

Cracked teeth are the third most common reason for tooth loss.1 But when it comes to your teeth, a crack is not just a crack. 

You may have what looks like cracked teeth, but it may just be a craze line or craze fracture. Cracked teeth may be an emergency, but a craze line is a cosmetic issue.

Dentists often find it challenging to define cracks in teeth. There are so many different degrees of cracked teeth, with each one requiring a unique solution. 

In this article, we will discuss what craze lines and craze fractures are. We will also look at symptoms, causes, and how to treat them, including whether you can use hydroxyapatite for treatment.

What are craze lines?

Craze lines are superficial lines with slight vertical splits in the outer layer of the teeth enamel. They are sometimes called hairline cracks or superficial cracks. 

While craze lines don’t affect your physical health, you may find that their visibility makes you unsatisfied with your smile.

In smokers or coffee drinkers, craze lines may appear as stain lines on your teeth. 

What causes craze lines?

Craze lines can occur due to the normal aging of the teeth—from wear and tear over time. 

Craze lines can also be caused by:

Grinding of teeth. Rapidly-formed craze lines could be the result of teeth grinding.Sleep bruxism. The hallmarks of sleep bruxism, a sleep-related movement disorder, are teeth grinding and clenching, which can lead to craze lines.2Bad habits. If you constantly bite your fingernails or chew gum, these bad habits can lead to craze lines. Orthodontics gone wrong. If your teeth are not positioned properly after an orthodontic procedure, it could lead to the formation of craze lines. 

Craze lines vs. craze fractures

Craze lines that go deeper are called craze fractures. Deep fractures are dangerous because they may be colonized by bacterial biofilms. Dentists often take out fillings to see how deep the lines have gone. 

When you bite on a fractured tooth, you may feel pain. Over time, the crack can propagate and affect the pulp, and you can end up with a dying tooth. 

In many cases, cracks that extend to the pulp can cause symptoms ranging from acute inflammation to total pulpal necrosis.3 You may need an intervention that prevents the crack from propagating further. 

Trauma can also cause your upper and lower jaw to hit together and cause a craze fracture in your tooth.

What are the symptoms of craze lines and craze fractures?

Patients experience different symptoms that may or may not indicate craze lines.

A crack that doesn’t show any signs or symptoms, such as hot or cold sensitivity, is probably a craze line. You shouldn’t worry about it but point it out to your dentist.

However, if you’re experiencing pain when you bite or chew, you may have a craze fracture. 

How can dentists help treat craze lines?

Regular visits to your dentist can help identify a craze line or deep fracture. 

When you go to your dentist, he or she may use dental imaging technology known as indocyanine-green-assisted near-infrared fluorescence (ICG-NIRF) to detect any cracks in your enamel. ICG-NIRF can also detect issues like dental caries and decays. 

During ICG-NIRF dental imaging, the enamel is illuminated with light at the excitation wavelength of about 750-800 nm, and then it is observed at longer wavelengths of over 800 nm.4 ICG is great because it is non-toxic and nonionizing. 

If you think you have a craze line, the first thing you should do is schedule an appointment with your dentist. You don’t want that craze line to deepen and become a craze fracture. 

Unfortunately, if the fracture goes below the gum line or to an area that we cannot reach, like a restoration with a crown and filling, it will leak bacteria, affect the pulp, and result in bone loss. So don’t let that fracture propagate below the gum line, or we will not be able to extract it.  

Craze lines are harmless, but if you insist on treatment, your dentist may offer the following cosmetic procedures:

Teeth whitening. This works best if your craze lines are stained. Smokers and coffee drinkers may benefit from teeth whitening. Teeth whitening will not remove craze lines but will improve their appearance.Porcelain veneers. Dental porcelain veneers are made up of thin shells that can bond directly to your teeth. They can mask stains just like teeth whitening but are more durable. Porcelain veneers also need to be custom-made for each tooth. Cosmetic bonding. Dentists can use something called composite resin to mask the appearance of craze lines. Cosmetic bonding is more affordable than porcelain veneers. 

Can you use hydroxyapatite toothpaste to heal craze lines and fractures?

The short answer is, “no.” Fluoridated or hydroxyapatite toothpaste cannot seal craze lines. Hydroxyapatite toothpaste is beneficial for remineralizing damaged teeth. However, remineralization cannot occur in craze lines or fractures because they are constantly moving. 

However, as a functional dentist, I recommend regular use of hydroxyapatite toothpaste and not fluoridated toothpaste. Although more people are becoming aware of the ingredients they cook with, they do not check for the ingredients in their toothpaste brand. 

Unfortunately, adults and children are constantly exposed to toxic ingredients in their homes or places they visit frequently. Some examples of harmful metals and chemicals are lead, mercury, arsenic, glyphosate, and chemicals found in air pollution.

It’s nearly impossible to control the level of exposure to all of these toxic ingredients. But when it comes to fluoride, it’s a no-brainer: you can replace fluoride in toothpaste with hydroxyapatite.

What exactly is hydroxyapatite?

You may be wondering what hydroxyapatite is and why it’s in toothpaste.

Hydroxyapatite, in its natural form, is a form of calcium that makes up 97% of your tooth enamel and 70% of the dentin of your teeth. The rest of your enamel is actually composed of water, collagen, and other proteins.

The beauty of hydroxyapatite is that we don’t have to take away something that prevents decay—we have a replacement that isn’t toxic, is biomimetic, and has proven to be safe.

You can heal cavities and prevent new ones from forming by remineralizing your teeth. Hydroxyapatite is one very effective way to do that.

Hydroxyapatite performs just as well as fluoride, in some cases better, with none of the toxicity concerns. 


Craze lines and fractures are difficult to diagnose, but through careful examination, your dentist can determine what you’re dealing with.

If you think you are experiencing pain because of a craze line or fracture, tell your dentist.

Hydroxyapatite or fluoride will not heal your craze lines or craze fractures. However, consider using hydroxyapatite toothpaste for other advantageous properties.

Regular visits with your dentist will be beneficial in case you need an intervention for your craze lines or fractures. 


1. Li Z, Holamoge YV, Li Z, et al. Detection and analysis of enamel cracks by ICG-NIR fluorescence dental imaging. Ann N Y Acad Sci. 2020;1475(1):52-63. doi:10.1111/nyas.14374

2. Bruxism (teeth grinding) – Symptoms and causes. Mayo Clinic. Accessed April 2, 2021.

3. Ricucci D, Siqueira JF, Loghin S, Berman LH. The cracked tooth: histopathologic and histobacteriologic aspects. J Endod. 2015;41(3):343-352. doi:10.1016/j.joen.2014.09.021

4. Alander JT, Kaartinen I, Laakso A, et al. A Review of Indocyanine Green Fluorescent Imaging in Surgery. Wei G, ed. International Journal of Biomedical Imaging. 2012;2012:940585. doi:10.1155/2012/940585

The post Healing Craze Lines and Fractures with Hydroxyapatite appeared first on Ask the Dentist.

Did you miss our previous article…