Everything listed under: toothache

  • What can I eat following and extraction?

    Immediately following an extraction don't eat anything. If you are still numb you will only hurt yourself. If you insist on consuming some calories then stick with a liquid diet until the feeling returns. Once the feeling returns then you may cautiously eat a soft diet.

    A soft diet consists of any food you can mush or separate with your fingers. It also means nothing with seeds, nuts or any particle that will not easily dissolve or can be rinsed away. If you need to hold it with you hands to bite off a piece of food that's probably not a good idea. 

    You just had a tooth extracted and now you have a hole in your jaw. That hole needs to fill up with a blood clot and form a plug to allow healing. If the extraction involved an upper tooth it's unlikely to be a problem. Most humans eat sitting up or standing. Any food that enters the hole with likely fall out of the hole the same way due to simple gravity. Lower extractions are another story. The further back in your mouth the more likely pieces of food will collect and be deposited into the hole. Food in an extraction site is equivalent to having a splinter in your finger. If not removed it will likely get infected.

    So avoid popcorn, peanuts and seeds. Stick with high protein shakes, scrambled eggs, yogurt and similar soft foods.  If in doubt you can always call Dr. Gottlieb for some healthy suggestions.



  • Lingering Toothache

    Many of my patients will tell me that the worse pain they have ever felt is the pain of a dental toothache. For most patients a visit to the dentist usually leads to a clear-cut direction of care and a predictable resolution of pain. The solution may require a root canal or extraction. Depending on the location of the toothache, root canal therapy is 95% successful. The remaining 5% that remain symptomatic is the result of the irritated ligaments and bone that supports the tooth. Normal chewing will produce pain. The tooth may throb and wake you out of a sound sleep.  A number of conditions may still persist and the tooth pain now becomes chronic. If you experience tooth pain after a root canal, that lasts for more than two weeks, then the dentist needs to examine the tooth for an untreated canal, a tooth fracture, or possible neurological condition. 

    When a tooth fracture and untreated canal have both been ruled out medications are the first and most likely therapy to help restore the health of the ligaments and bone.  A dose of antibiotics may be administered to rule out an active dental infection. If the pain persists after dental treatment and antibiotics then the cause of the pain may be neurologic in origin and require a dentist that specializes in this type of pain management or a neurologist. The oral medications of choice are often not easily tolerated by patients and require some creativity in terms of dosage, time of administration, and the need for polypharmacy. Common choices include low-dose tricyclic antidepressants inclusive of amitriptyline, nortriptyline and sinequan. Additional medications such as benzodiazepines, lyrica, gabapentin, baclofen and trileptal are frequently used as well. The amount of medications will vary from case-to-case and may at times require the use of liquid suspensions instead of pills to achieve a balance between effectiveness and side effects. Topical medications used intra or extra orally may be beneficial as well. In situations where an autoimmune influence may be suspected medications called biologics (Enbrel, Humira) may be required. These medications should be prescribed by a rheumatologist whose skills are often essential as part of the pain care team. There are times, however, that response to these therapies is poor and pain continues. At some point in time if the pain just doesn't get any better you must consider extracting the tooth and hope this solves your problem.  

    For additional information or a second opinion call Dr. Gottlieb for a consolation without an obligation.

  • What to expect after a root canal.

    After the local anesthetic wears off it’s not unusual to have some soreness in and around the tooth that was treated. This soreness usually lasts about 3 days and gradually gets better. I’ve had patients that had discomfort for up to three weeks.

    Inflammation is the reason for the discomfort and is caused by your dental infection, the dental injection and the files used to open up the root canal system. I encourage patients, who can take ibuprofen, (Advil, Motrin) to take 800mg every 4-6 hours until comfortable. If the pain persists and you feel it is getting worse you should return to the office for an evaluation. All antibiotics have side effects so are no longer routinely given. If you experience swelling or escalating discomfort then antibiotics may be indicated.Obviously if you have an allergy to any prescribed medication don’t take it. If you develop allergic symptoms stop the medication and call the prescribing doctor.

    Avoid Chewing on the tooth until the final filling or crown is placed. Also eat soft foods to prevent a root fracture or aggravate the already sore tooth. Depending on the reason for the root canal a follow up appointment may be necessary.

    Your recovery and wellbeing is our number one concern. If you have any questions or concerns don’t hesitate to call the Levittown office (516) 796-6600

  • Cracked Tooth

    Everyone uses their teeth to chew food and sometimes other uses. Your teeth are not to be used as a tool. The tooth is made of enamel and a core material known as dentin. Enamel is as hard as glass and the dentin bone. If you chip the enamel many times it can be smoothed off or repaired with a composite bonding material. If the crack goes through the enamel and into the dentin then it can be a problem. Unlike bone, a tooth cannot repair itself so once a crack propagates into the dentin you may need a crown, root canal , or extraction.

    The symptoms of a cracked tooth varies from a simple rough edge to throbbing toothache. If you can chew on a soft object without pain then the fracture is likely limited to the enamel. If upon chewing something soft like a rubber band and you experience shooting pain then the crack likely continues on into the dentin and possibly down into the bone. 

    If you can't chew on your tooth call for an immediate appointment. Don't wait until it hurts. 

  • Rampant tooth decay from raisins.

    Once or twice a year one of my regular patients with perfect teeth will call me with a toothache. Andy had a toothache. When I reviewed his chart all 28 teeth were intact. The X-rays taken 6-8 months ago looked great. Our new X-Ray now revealed rampant tooth decay causing the toothache. 

    My first question was did you start any new medications? When he denied taking any new medications I then asked are you eating raisins?  His wife decided to start giving the entire family healthy snacks. Raisins are nature's natural gummy bears. They are very high in sugar and stick to every tooth surface. Many patients feel if it's natural or organic it can't do any harm. Natural foods or supplements can be very high is sugar or interact with your regular medications. 

    As a rule if it contains sugar (natural or not) and sticks to your teeth it will cause decay and not a good idea. Sugar free products that stick to your teeth can also cause decay so be careful when choosing your snacks. If you think you have a cavity call the Levittown office (516) 796-6600 for a quick exam. It's a lot easier, cheaper and faster to fix a small cavity than wait until it hurts.

  • Your bleeding gums are a problem.

    Contrary to what you may have been told bleeding gums is not normal. You wouldn’t ignore blood in your urine or blood leaking out of any other body part so why do many patients ignore their bleeding gums.

    Bleeding gums is usually caused by a bacterial infection and could be the first sign you have early gum disease or a more advanced case. Smoking reduces the amount of bleeding but doesn’t mean you don’t have a problem. If you wake up in the morning with blood on you pillow you should be examined to determine the cause. If your gums bleed while brushing or flossing you should also come in for a check up.

    Don’t wait until it hurts. Most problems can be easily treated and stabilized before it becomes a major issue. Call the Levittown office at (516) 796-6600 to set up an appointment for a regular cleaning and exam.

  • Popcorn in my gum.

    I see dental emergencies every day but the number of emergencies always increases after the New Year. One of the main reasons for this is; everyone starts their New Years resolution to loose weight and consumes mass quantities of popcorn, and various seeds.

    Popcorn and sunflower seeds may be considered a diet food but the shell of both often gets stuck behind the third molars or underneath the gum leading to a gum abscess. When treated early the infection will quickly go away and no real harm is done. If left untreated it can lead to severe pain and irreversible bone loss. If you suspect something is caught in or around your tooth call the Levittown office and we will see you quickly and treat the problem before it becomes a major emergency.

  • When should I use Orajel or Anbesol?

    NEVER! Did I make my opinion clear? Many patients will apply Orajel or Anbesol to a tooth or their gums when they have a toothache. A toothache is a dental infection caused by bacteria entering the tooth or even deeper into the bone. You need to treat the cause of the problem and placing a numbing gel on it doesn't make it go away. Antibiotics and pain medications, like Advil, should be taken initially along with a call to the dentist.

    The active ingredients are: allantoin, benzocaine, camphor and white petrolatum. The two main products, camphor and benzocaine are numbing and anesthetic agents. Orajel - Anbesol contains 20% benzocaine and if used improperly has many dangerous side effects. The FDA recommends against its use as an oral medication yet it is still sold over the counter and often abused. Often times these products will cause a chemical burn making it more difficult for the dentist to find your problem.

    Since cold sores are caused by a virus and generally brought on by stress or exposure to the sun: rest and time may be the best remedy. If you have sores inside your mouth the dentist may be able to treat the sore with a laser or topical medication to reduce your pain and speed up the healing process.

    If the pain is so bad that you are thinking of applying any of these products to your tooth or the surrounding gum area call the dentist. You can always call the Levittown office and we will make sure to see you as soon as possible to make you comfortable.

  • Dental X-rays and the link to benign meningiomas.

    Earlier this Spring an article published in Cancer found that patients with benign brain tumors (meningiomas) had certain types of dental X-rays during their lifetimes. I was surprised that this type of sensationalist journalism was actually published. As a trained evidence based dentist I quickly reviewed the study and found the conclusions to be radiobiologically impossible.

    I've been practicing in Levittown for over 30 years and have treated over 8,000 patients and can't recall a single patient with a meningioma. The actual study questioned 1,433 patients with the tumor to a control group of 1,350. The tumor group participants ranged in age from 20-79 and had to recall the time in their life when the X-rays were taken and how many. 

    Sometimes conclusions in life are very obvious. If you jump out of an airplane with a parachute you live and without one you don't. This study concluded that patients who had 2 or 4 bitewing X-rays had a 50 to 100 percent higher risk of developing a meningioma compared to patients who received a full mouth series of X-Rays or a Panorex film. The problem is that a full mouth series of X-rays contains 2-4 bite wings and then 16 additional X-rays as well. A Panorex film exposes the entire mouth. The conclusion defies all logic and science. The energy from a dental X-ray travels in a straight line and most of it is absorbed by the lead backing on the film. Little if any energy ever reaches the brain.

    Today dental care and dental X-rays are much safer. The amount of electronic radiation is limited and confined to the small area examined. The American Dental Association (ADA) has established guidelines to follow for radiation safety and many times the X-ray is limited to your toothache or specific problem. If you have any concerns about dental X-rays play it safe and ask the dentist. You can always call the Levittown dental office at 516-796-6600 to discuss you concerns.

  • How do I know if I have Gum Disease

    It can be hard to know and you can have gum or periodontal disease without pain or symptoms. If you haven't been to a dentist in a while and rarely floss your teeth there is a good chance you have one of the stages of gum disease. 

    You may notice your gums are bleeding, red in color or have some tenderness. Bad breath is another sign of periodontal disease. If you notice pus between your teeth and gums you have a problem and should be evaluated by the dentist.

    Smoking can mask many of the signs and symptoms of periodontal disease until it's too late. I would encourage all patients to come in for a brief examination for any dental problem. Your dental problems are a lot easier to treat early when it starts than to wait until it's too late. The mouth is a window into the health of your body so make a New Years resolution to call the Levittown Dental Office and take care of your teeth and gums.

  • Do not stop your Plavix, Aspirin or Coumadin

    dental treatment before PlavixPlavix, aspirin, Coumadin or any other blood thinners are prescribed for patients to treat or prevent very serious medical conditions. Your medical problems are more important that a toothache. In my 29 years of practice I have never stopped, decreased or changed the medications a patient was taking prior to treatment. 

    Depending on the dental treatment required you may have more bleeding and bruising afterwards. For simple fillings expect some minor swelling at the injection site. If you are having your teeth cleaned the gums will bleed a little more but is very manageable with direct pressure. Just because you are on a blood thinner that does not mean you can't have your teeth cleaned. You must take care of your gums otherwise the dental patient after plavixheavy buildup of plaque and calculus will result in more bleeding and bone loss around the teeth. Many patients over the course of their lifetime will require a root canal therapy.  Root Canal therapy is a very controlled procedure and I have performed many in one or multiple visits without any complications. I always tell the patient to expect a little more soreness - bruising in the area of the injection site. When I'm extracting one or more teeth on a patient taking blood thinners I expect a little more bleeding and they look black and blue in the area of the injections and on the outside of their face around the area of surgery.

     All of these medications have therapeutic levels and I always call the patients physician to confirm their blood levels are in the therapeutic range prior to treatment. My advice is to continue taking your medication and always advise your dentist prior to treatment.

    If you would like additional information simply contact me using the contact form or call the office in Levittown. The phone number is 516-796-6600.

  • My root canal tooth hurts.

    Picture of a root canal toothRoot Canals are very predictable and can be done painlessly. According to the American Dental Association ( ADA ) root canals are 90% successful. Nine out of ten teeth that undergo a root canal will last a lifetime. One in Ten will fail and remain painful and require the root canal to be done over, possible surgery to remove the end of the root or extracted.

    It’s very normal for a tooth that just had root canal to be tender or uncomfortable. This usually lasts about 3 days and occurs when chewing on it. I have seen patients that have had pain for up to two weeks.

    Make sure the tooth is not touching (high) when you close your teeth together and take advil or other medications as prescribed. If you are still concerned call us at the Levittown office. The phone number is (516)-796-6660.

    If you would like additional information simply contact me using the contact form. 

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Dr. Marc Gottlieb is one of Long Island's leading dental practicioners, specializing in helping those who feel anxiety or apprehension when visiting the dentist. He can be reached at marc@anxietyfreedental.com