前段时间作为美国AAID（American Academy of Implant Dentistry）种植协会种植医生资质认定的口试考官，我参加考核了很多位医生的种植知识和临床技能。

过程中有一个感触非常深：很多新手种植医生，其实并不是不会“种”，而是诊断不够完整，对于手术和修复过程中可能出现的问题预估不足，以及对种植后的长期维护重视不够。

而正巧最近诊所里也有咨询病人问我：

“种植牙是不是种一颗就一劳永逸？”

“是不是以后就永远不用管了？”

“是不是比天然牙还结实？”

今天就借这个机会聊聊：种植牙到底是什么？它的优势和局限是什么？种植牙真正长期成功，靠的又是什么？

一、种植牙并不是“装一个假牙”那么简单

很多病人理解的种植牙是：

“缺了一颗牙，塞进去一个假的。”

“假的就不会坏了。”

其实真正的种植牙，本质上是通过外科和修复技术，建立一个能够长期稳定承受咬合力的人造牙根系统。

它通常包括：

• 种植体（人工牙根）
• 基台（固定在种植体上并支撑牙冠的部分）
• 肉眼可见的牙冠部分

虽然牙冠很重要，但真正关键的，其实是下面植入骨头里的种植体，以及它周围骨组织和软组织的长期稳定。

只要这个部分健康，种植牙通常就是牢固稳定的。即使牙冠后期出现一些小问题，很多时候也都相对容易处理。

所以种植牙成功，并不只是“装上去”的那一刻。真正的成功，是几年、十几年以后，它依然还能稳定健康地存在。

二、种植牙最大的优势是什么？

种植牙之所以成为现代牙科的重要发展之一，是因为它确实解决了很多传统修复方式的局限。比如：它不需要磨小旁边健康牙齿来做牙桥。种植牙是自己支撑自己，没有固定桥“一损俱损”的连带性。

钛合金和骨头整合之后，可以给患者提供非常好的咀嚼功能。

同时，种植也有助于维持牙槽骨高度，减少长期缺牙后的骨萎缩。

而和活动假牙相比，种植牙在稳定性、舒适度和功能性上，通常更是完全不同的体验。

活动假牙常见的问题包括：

• 松动
• 压痛
• 咀嚼不稳
• 明显异物感

而稳定的种植修复，通常会自然和舒适很多。

三、但种植牙绝对不是“永久保险”

有些病人因为牙齿不好看，就想直接拔掉换种植。

如果天然牙还有保留价值，我一般都会非常明确地建议：不要为了单纯美容，把还能保留的天然牙轻易拔掉。

因为天然牙永远是最好的。

种植牙当然可以非常成功，但它并不是真正意义上的“一劳永逸”。

它虽然是没有生命的钛合金，但周围支持它的组织仍然是活体组织。它的长期健康，和骨头、牙龈、咬合系统、免疫系统都息息相关。

种植体周围同样有神经、有血管。

保养不当，一样会发炎。

而且一旦发炎，因为种植体周围血供条件和天然牙不同，很多时候反而比普通牙周炎更难控制。

四、种植牙最常见的问题：种植体周围炎

我一般会把它理解成：

“种植牙版本的牙周病”。

如果长期清洁不到位，菌斑和牙石不断堆积，就会慢慢造成：

• 牙龈发炎
• 出血
• 异味
• 骨吸收
• 深牙周袋形成

到了后期，就可能导致种植体松动甚至失败。

比较麻烦的是，很多种植体周围炎在早期并不疼。

所以很多病人会对此毫无察觉。

等真正出现明显症状时，往往已经发展了一段时间，骨头也已经开始吸收。

五、其次常见的问题：螺丝松动

这个问题通常和咬合有关。

因为种植体和骨头整合以后，中间是没有牙周韧带缓冲间隙的。

天然牙在受力时，会有牙周韧带提供一定缓冲保护；而种植牙没有这个“避震系统”。

所以如果存在：

• 咬合高点
• 夜磨牙
• 长期过大咬合力

就容易导致：

• 螺丝松动
• 瓷崩裂
• 骨吸收
• 极端情况下甚至种植体疲劳折断

很多时候，这其实是力学问题。

六、怎样最大程度优化种植，减少后续问题？

首先，全面正确的诊断非常重要。

前期多花时间，后期才更有可预知性。

诊断通常需要包括：

• CT影像骨量评估
• 咬合分析
• 牙周状况
• 全身健康情况
• 夜磨牙风险
• 是否吸烟
• 美学需求

手术过程中，则需要严格控制：

• 三维位置
• 种植体深度
• 角度
• 初期稳定性
• 骨量与骨密度判断
• 角化软组织处理

而修复也绝不仅仅是“装个牙冠”。

真正重要的是：怎样让种植体长期承受合理、稳定的力量。

包括：

• 咬合设计
• 力的方向
• 清洁通道设计
• 连接方式
• 螺丝固位还是粘接
• 夜磨牙保护

很多长期失败，其实都不是“没种好”，而是后期力学和维护问题。

七、哪些人更容易出现种植问题？

有的人种植以后很多年都很稳定；有的人明明已经很努力维护，问题却还是时有发生。

这里面确实存在个体风险差异。

临床上常见高风险因素包括：

1. 口腔卫生和牙周问题

尤其是原本就是因为牙周病导致缺牙，再做种植的患者。

这类患者口腔里的牙周致病菌群往往更复杂，因此每天有效清理和定期维护尤其重要。

2. 吸烟

吸烟会影响：

• 血供
• 愈合
• 骨稳定
• 免疫反应

种植体长期稳定性会明显受影响。

3. 全身疾病因素

比如：

• 糖尿病
• 骨质疏松
• 使用特定骨代谢药物
• 免疫缺损或免疫抑制状态

这些情况下，种植体健康监护通常需要更加密切。

4. 严重夜磨牙

长期过大咬合力，会明显增加机械并发症风险。

八、怎样让种植牙长期健康？

其实核心就几个字：

长期维护。

包括：

1. 认真清洁

刷牙、牙线、水牙线（冲牙器）以及种植专用清洁工具，都非常重要。

很多种植体周围炎，本质上仍然是菌斑控制问题。

控制住细菌，就控制住了疾病发展的源头。

2. 定期复查维护

包括：

• X光检查
• 牙周检查
• 咬合检查
• 专业清洁

不要拖延牙周病治疗，也要及时调整咬合高点。

很多问题如果早期发现，是完全可以控制的。

3. 控制夜磨牙

必要时佩戴夜磨牙垫。

4. 控制系统性疾病

包括：

• 戒烟
• 控制糖尿病
• 治疗骨代谢疾病

5. 出现炎症时尽早处理

一旦出现种植体周围炎，要尽早采取：

• 清洁
• 上药
• 必要时激光治疗等方式

避免炎症继续扩散，导致更多骨吸收。

九、最后一个很重要的观点

所以回到最开始那个问题：

种植牙是不是一劳永逸？

我的回答是：不是。

但这并不代表种植牙不好。恰恰相反，它是现代牙科非常重要、非常有效的治疗方式。

只是我们不能把它神化，不能把它理解成一个永远不会坏、永远不用管的新零件。

种植牙长期成功，前面靠医生的诊断、设计、手术和修复；后面靠病人自己的清洁、复查和维护。

医生需要尽力把风险降到最低，但医生不是上帝。

再好的种植系统，再好的医生，也无法替代病人后期自己的参与和维护。

真正长期成功的种植，不是医生一个人的工作，而是医生和病人长期共同维护的结果。

作者｜马国珺 Joyce Guojun Ma, DDS, PhD， MAGD

种植牙医｜DABOI/ID｜FAAID｜DICOI｜DABDSM 美东三州执业（NJ / NY / PA）

北京大学口腔医学院｜纽约大学牙学院｜

约翰霍普金斯大学神经科学博士

美国种植协会种植医师资格口试考官

专注：预防性牙科 · 咬合功能 · 全口重建 · 种植与植骨 ·牙周和种植激光治疗， 美容正畸 · 颞下颌关节病（TMD）· 睡眠呼吸障碍（OSA）

The post 种植牙是不是一劳永逸？关于种植牙的九点评述 first appeared on Prime Dental Care.

One thing that struck me deeply during the process was that many novice implant surgeons are not actually incapable of placing implants — rather, their diagnoses are incomplete, they underestimate the potential problems that may arise during surgery and restoration, and they do not pay enough attention to long-term maintenance after the implant is placed.

And coincidentally, a patient at the clinic recently asked me these questions:

“Is a dental implant a one-time, permanent solution?”

“Does that mean we’ll never have to worry about it again?”

“Is it even stronger than natural teeth?”

Today, let’s take this opportunity to talk about what dental implants actually are, what their advantages and limitations are, and what makes them truly successful in the long term.

1. Dental implants are not as simple as “getting a replacement tooth”

Many patients understand dental implants as:

“They replaced a missing tooth with a prosthetic one.”

“Artificial things don’t break down.”

In essence, a dental implant involves using surgical and restorative techniques to create an artificial tooth-root system that can stably withstand biting forces over a long period of time.

It typically includes:

• The implant (the artificial tooth root)
• The abutment (the part fixed to the implant that supports the crown)
• The visible crown

While the crown is important, what’s truly crucial is the implant itself — placed in the bone beneath — and the long-term stability of the surrounding bone and soft tissues.

As long as this part is healthy, dental implants are usually strong and stable. Even if some minor problems arise later on, they are often relatively easy to handle.

Therefore, the success of a dental implant is not just about the moment it is placed. True success lies in it remaining stable and healthy years — or even decades — later.

2. What is the biggest advantage of dental implants?

Dental implants have become a significant development in modern dentistry because they have indeed overcome many limitations of traditional restorative methods. For example, they do not require grinding down adjacent healthy teeth to create a bridge. Dental implants are self-supporting, unlike fixed bridges, where damage to one supporting tooth can compromise the whole bridge.

After the titanium implant integrates with the bone, it can provide very good chewing function.

At the same time, implants also help maintain alveolar bone height and reduce bone resorption that would otherwise follow long-term tooth loss.

Compared to removable dentures, dental implants typically offer a completely different experience in terms of stability, comfort, and function.

Common problems with removable dentures include:

• Looseness
• Tenderness
• Chewing instability
• A noticeable foreign-body sensation

A stable implant usually offers a much more natural and comfortable experience.

3. Dental implants are definitely not a “permanent guarantee”

Some patients want to have natural teeth extracted and replaced with implants because they don’t like the look of their teeth.

If a natural tooth still has value, I generally strongly advise against extracting it for cosmetic reasons — because natural teeth are always the best.

Dental implants can certainly be very successful, but they are not truly a “one-and-done” solution.

Although the implant itself is non-living titanium alloy, the tissues supporting it are still living tissues. Its long-term health is closely tied to the bone, gums, occlusal system, and immune system.

There are also nerves and blood vessels around the implant. Improper care can still lead to inflammation.

Moreover, once inflammation occurs, it is often more difficult to control than ordinary periodontitis, because the blood supply around an implant differs from that of a natural tooth.

4. The most common problem with dental implants: peri-implantitis

I usually describe it as:

“The dental implant version of periodontitis.”

If cleaning is not done properly over a long period, plaque and tartar accumulate and eventually cause:

• Gingivitis
• Bleeding
• Bad breath
• Bone resorption
• Deep periodontal pocket formation

In the later stages, this can lead to the implant becoming loose or even failing.

The tricky part is that many cases of peri-implantitis are not painful in the early stages, so many patients are completely unaware of it. By the time obvious symptoms appear, the disease has often progressed for some time and the bone has already begun to be resorbed.

5. Another common problem: loose screws

This problem is usually related to occlusion.

After an implant integrates with the bone, there is no periodontal ligament between them to provide a buffer. When natural teeth are subjected to force, the periodontal ligament provides some cushioning and protection; dental implants do not have this “shock-absorption system.”

Therefore, in the presence of:

• An occlusal high spot
• Nighttime teeth grinding
• Excessive bite force over a long period of time

…it can easily lead to:

• Loose screws
• Cracked porcelain
• Bone resorption
• In extreme cases, fatigue failure of the implant

Often, this is actually a mechanical problem.

6. How can we optimize implant placement and reduce later problems?

First and foremost, a comprehensive and accurate diagnosis is crucial. Spending more time in the early stages makes the later stages more predictable.

A diagnosis typically includes:

• CT imaging and bone-volume assessment
• Occlusal analysis
• Periodontal condition
• Overall health
• Risk of nighttime teeth grinding
• Smoking history
• Aesthetic needs

Strict control is required during surgery:

• Three-dimensional position
• Implant depth
• Angle
• Initial stability
• Bone volume and bone-mineral-density assessment
• Management of keratinized soft tissue

Restoration is far more than just “getting a crown.” What really matters is ensuring that the implant withstands reasonable and stable forces over the long term.

This includes:

• Occlusal design
• Direction of force
• Design for cleanability
• Connection method
• Screw-retained vs. cement-retained
• Nightguard protection

Many long-term failures are not actually due to “poor placement,” but to later problems with mechanics and maintenance.

7. Who is more likely to encounter implant problems?

Some people’s implants remain stable for many years after placement; others, despite their best efforts to maintain them, still experience recurring problems. There are indeed individual differences in risk.

Common high-risk factors in clinical practice include:

7.1 Oral hygiene and periodontal problems

This is especially true for patients who originally lost teeth due to periodontal disease and then underwent implant placement. These patients often have more complex periodontal pathogens in their mouths, so effective daily cleaning and regular maintenance are especially important.

7.2 Smoking

Smoking can impair:

• Blood supply
• Healing
• Bone stability
• Immune response

The long-term stability of the implant will be significantly affected.

7.3 Systemic disease factors

For example:

• Diabetes
• Osteoporosis
• Use of bone-metabolism medications (e.g., bisphosphonates)
• Immunodeficiency or immunosuppression

In these cases, implant health monitoring usually needs to be more frequent.

7.4 Severe bruxism (teeth grinding)

Excessive biting force over a long period of time can significantly increase the risk of mechanical complications.

8. How to ensure the long-term health of dental implants

In fact, the core can be summed up in just a few words: long-term maintenance.

This includes:

8.1 Clean thoroughly

Brushing, flossing, water flossers, and specialized cleaning tools for implants are all very important. Many cases of peri-implantitis are essentially plaque-control issues. Controlling the bacteria means controlling the source of the disease.

8.2 Regular check-ups and maintenance

This includes:

• X-ray examination
• Periodontal examination
• Occlusal examination
• Professional cleaning

Don’t delay periodontal treatment, and adjust occlusal high spots in a timely manner. Many problems can be completely controlled if they are detected early.

8.3 Control bruxism (teeth grinding)

Wear a nightguard when necessary.

8.4 Manage systemic risk factors

This includes:

• Quitting smoking
• Controlling diabetes
• Treating bone-metabolism diseases

8.5 Treat inflammation as soon as possible

If peri-implantitis occurs, treatment should be initiated as soon as possible, with options including:

• Cleaning
• Medication
• Laser therapy or other methods as needed

This helps prevent further spread of inflammation and additional bone loss.

9. One final important point

So let’s return to the original question:

Is a dental implant a permanent solution?

My answer is: no.

However, this does not mean that dental implants are bad. On the contrary, they are a very important and effective treatment in modern dentistry.

But we shouldn’t treat the implant as a miracle, nor view it as a new part that will never break and never need to be maintained.

The long-term success of dental implants depends on the doctor’s diagnosis, design, surgery, and restoration in the initial stages, and on the patient’s own cleaning, follow-up examinations, and maintenance in the later stages.

Doctors need to do their best to minimize the risks, but doctors are not gods. No matter how good the implant system or how skilled the doctor, it cannot replace the patient’s own participation and maintenance.

Truly long-term successful implant treatment is not the work of a doctor alone, but the result of long-term joint maintenance by doctor and patient.

The post Are dental implants a permanent solution? Nine important things to know about dental implants first appeared on Prime Dental Care.

检查后发现，她右上双尖牙已经发生纵向断裂，而且裂纹一直延伸到牙龈以下的根部。上下牙根本不敢碰，一碰就跳痛，还有明显的冷热敏感。她说感觉那颗牙像“长高了一块”，已经好几天没法正常吃东西，非常痛苦。很遗憾，这种情况牙齿已经保不住了，只能拔掉，再考虑种植修复。

她很郁闷地问我，说自己一直都认真刷牙，也按时洗牙，为什么还会变成这样。

我其实很理解她的困惑，也很赞同她这种想把事情弄明白的想法。很多牙齿问题，如果不去看原因，只是处理结果，很难真正预防下一次。

这里正好可以科普一下非龋坏性牙齿断裂的原因。从这颗牙的情况来看，我觉得主要有三个原因。第一，这颗牙以前做过大面积的银汞充填，本身结构已经变得比较薄弱。第二，她的牙齿排列有问题，缺少正常的尖牙保护。第三，是长期存在夜磨牙和牙关紧咬的习惯。

所以归根到底，这颗牙的断裂并不是细菌引起的，而是长期受力过大、慢慢累积造成的。也就是说，好好刷牙、定期洗牙当然很重要，但它主要预防的是蛀牙和牙周病，对这种“受力型”的问题，其实帮助有限。

那这种情况能不能提前避免？其实大多数时候是可以的，并不是完全随机发生的。治疗关键是发现风险，控制风险，治疗和减少咬合创伤。

先说银汞充填的问题。银汞不像树脂那样可以和牙齿粘在一起，它更像是靠机械方式卡在牙齿里。如果范围比较小，牙齿本身还有足够的结构来承受。但一旦面积变大，牙齿剩下的部分就会越来越薄，长期受力就容易在内部产生隐裂。

就像一块已经有细小裂纹的玻璃，看着还在，但其实已经很脆了。平时不一定有感觉，但哪一天咬到一点硬东西，就可能一下子裂开。

所以有时候医生会建议把大的银汞换掉，或者在关键地方有隐裂的情况下直接做牙冠保护。但很多病人在没有疼的时候会犹豫，甚至会问，这颗牙还能撑多久。这个问题其实很难回答，因为这是一个慢慢积累的过程，什么时候“临界点”到了，没有人能准确预测。一旦真的裂开，就要看裂到哪里，如果只是表面或者牙神经，还可能通过根管治疗和牙冠保住；一旦裂到牙根下面，就基本没办法挽救了。

第二个方面-咬合问题。正常情况下，我们的尖牙在侧方运动时是有保护作用的，它的位置，形态还有粗壮长根都决定了它可以承担比较大的侧向力量。这样后牙就不会承受太多不该承受的力。

但这位患者的尖牙位置不对，也就是我们常说的“虎牙外突”，导致她在咬东西或者磨牙的时候，尖牙基本不起作用。那原本应该由尖牙承担的力量，就转移到了双尖牙上。

如果这颗双尖牙本身是健康的，可能还能撑一段时间。但偏偏它又有大面积银汞充填，本来就比较脆，再加上长期受力，就更容易出问题。

第三个不容忽视很重要的因素是夜磨牙和牙关紧咬。很多人会说，那我平时注意一点，不用那边吃不就好了。但问题是，白天可以控制，晚上是控制不了的。很多人睡着以后磨牙或者咬牙，力量往往比白天还大，而且是持续的。

长期下来，对牙齿的损伤其实是很明显的。

那怎么预防呢？主要有两个方向。

一个是从根本上调整咬合，比如通过正畸把牙齿排齐，让尖牙回到应该发挥作用的位置。这样整个受力会更合理，对长期保护牙齿是很有帮助的。这也是治病治因最理想的治疗！

另一个是比较直接的办法，就是戴夜间牙套。它可以让牙齿在夜里不直接接触，把磨损和压力转移到牙套上。对于不打算或者不适合做矫正的人来说，这是一个很重要的保护手段。只是尖牙保护的缺失并没有得到改善。不戴牙套行使咬合功能时后牙受力还是过大。

所以总结一下，有些牙齿断裂并不是因为蛀牙，而是因为长期受力不均造成的。青少年时期把牙齿排整齐，对以后咬合健康是很重要的。成人做矫正，也不仅仅是为了好看，更多是为了功能上的改善。如果不愿意矫正，至少可以考虑夜间牙套或者修复磨损尖牙来保护牙齿。

另外，定期检查时，如果医生提示某颗牙风险比较高，比如有隐裂或者充填过大，还是建议认真考虑下一步的保护措施。很多时候，问题在早期是有机会控制的，一旦发展到断裂，就会变成我们不愿意看到的结果。

很多牙齿问题，并不是突然发生的，而是长期积累的结果。

对患者来说，最难的往往不是治疗，而是在没有明显症状的时候，是否愿意去处理那些“看起来还可以用”的高风险牙齿。

从医生角度，我们更希望看到的是——

在牙齿还没有断裂、还没有疼痛的时候，就已经完成风险控制。

如果你有以下情况，其实可以稍微多留意一下：

• 某颗牙做过比较大的充填

• 咬东西时偶尔有一点不舒服，但说不清具体位置

• 有夜磨牙或白天紧咬牙的习惯

• 医生曾经建议过牙冠或保护性修复，但你还在观望

这些都不一定马上出问题，但往往提示这颗牙已经进入“高风险阶段”。

牙齿的很多结局，其实不是在疼的时候决定的，而是在还不疼的时候就已经埋下了伏笔。

如果能在早期多做一步，有时候真的可以避免走到拔牙这一步。

作者｜马国珺 Joyce Guojun Ma, DDS, PhD

全科牙医｜MAGD｜DABOI/ID｜DICOI｜DABDSM

美东三州执业（NJ / NY / PA）

北京大学口腔医学院｜纽约大学牙学院｜

约翰霍普金斯大学神经科学博士

专注：预防性牙科 · 咬合功能 · 全口重建 · 牙周激光治疗 · 种植与植骨 · 美容正畸 · 颞下颌关节病（TMD）· 睡眠呼吸障碍（OSA）

The post 不是蛀牙，却拔了牙：很多人忽略的牙齿断裂真相 first appeared on Prime Dental Care.

The examination revealed that her upper right premolar had fractured longitudinally, with the crack extending to the root below the gum line. She was extremely sensitive to touch, experiencing sharp pain at the slightest touch and significant sensitivity to hot and cold. She said the tooth felt like it had “grown a piece out of its original size,” and she hadn’t been able to eat normally for several days. Unfortunately, the tooth could not be saved and had to be extracted, with implant restoration to be considered later.

She asked me, quite upset: even though she had always brushed her teeth diligently and had them professionally cleaned regularly, why had things turned out this way?

I understand her confusion and agree with her desire to understand things clearly. Many dental problems, if only the symptoms are treated without addressing the underlying cause, are difficult to prevent from recurring.

This is a good opportunity to explain the causes of non-caries tooth fractures. Based on this tooth’s condition, I think there are three main reasons. First, this tooth had a large amalgam filling previously, which weakened its structure. Second, her teeth were misaligned, lacking proper canine protection. Third, she had a long-standing habit of bruxism (teeth grinding) and jaw clenching.

So ultimately, the tooth fracture wasn’t caused by bacteria, but rather by long-term excessive force that accumulated gradually. In other words, while brushing your teeth properly and getting regular cleanings are important, they primarily prevent cavities and periodontal disease, and offer limited help for problems related to physical force.

Can this situation be avoided in advance? Actually, most of the time it can; it doesn’t happen completely randomly. The key to treatment is identifying the risk, controlling the risk, and treating and reducing occlusal trauma.

Let’s first discuss the issue of amalgam fillings. Unlike resin, amalgam doesn’t adhere to the tooth; it’s more like it’s mechanically secured within the tooth. If the area is small, the tooth itself has sufficient structure to withstand the force. However, as the area increases, the remaining portion of the tooth becomes thinner, making it prone to developing internal cracks under long-term stress.

It’s like a piece of glass with tiny cracks; it looks fine, but it’s actually quite brittle. You might not feel it normally, but one day you might bite into something hard and it could suddenly shatter.

As such, dentists sometimes recommend replacing large amalgam crowns or, in cases of microcracks in critical areas, directly placing a crown for protection. However, many patients hesitate because they are not currently experiencing pain, and may even ask, “How much longer can this tooth hold up?” This question is actually difficult to answer because it is a gradual, cumulative process, and no one can accurately predict when the “critical point” will be reached. Once a crack does appear, it depends on where it has spread. If it’s only on the surface or near the dental nerve, it might be possible to save the tooth through root canal treatment and a crown; but if the crack extends below the root, it is beyond saving.

The second aspect is occlusion. Normally, our canines provide protection during lateral movements; their position, shape, and robust roots allow them to withstand relatively large lateral forces. This prevents the posterior teeth from bearing excessive stress.

However, this patient’s canines were mispositioned, what we commonly call “protruding canines,” which meant that her canines were essentially ineffective when she bit or ground her teeth. The force that should have been borne by the canines was then transferred to her premolars.

If the premolar itself were healthy, it might have held up for a while. But it has a large area of ​​amalgam filling, which makes it more brittle to begin with, and with long-term stress, it’s more likely to develop problems.

The third crucial factor that cannot be ignored is nighttime teeth grinding and jaw clenching. Many people might say, “I’ll just be careful during the day and avoid chewing on that side.” But the problem is, while you can control it during the day, you can’t control it at night. Many people grind or clench their teeth while asleep, often with more force than during the day, and this is continuous.

Over the long term, the damage to teeth is actually quite obvious.

So how do we prevent it? There are two main approaches.

One approach is to fundamentally adjust the bite, such as through orthodontics to align the teeth and return the canines to their proper positions. This results in more balanced force distribution, which is very helpful for long-term dental protection. This is the ideal treatment that addresses the root cause of the problem!

Another, more direct method is to wear a night guard. This prevents the teeth from directly contacting each other at night, transferring wear and pressure to the night guard. This is a crucial protective measure for those who don’t plan to or are unsuitable for orthodontic treatment. However, the lack of canine protection is not addressed: the back teeth still experience excessive force when performing biting function.

In summary, some tooth fractures are not caused by cavities, but by uneven stress over a long period. Straightening teeth during adolescence is crucial for future bite health. Adults undergo orthodontic treatment not only for aesthetics but also for functional improvements. If orthodontic treatment is not desired, at least consider getting a night guard or repairing worn canines to protect the teeth.

Additionally, during regular checkups, if your dentist indicates that a particular tooth is at high risk, such as having a hidden crack or an overly large filling, it’s advisable to carefully consider the next protective measures. Often, problems can be controlled in their early stages; once they progress to fracture, it becomes an outcome we don’t want to see.

Many dental problems do not occur suddenly, but are the result of long-term accumulation.

For patients, the most difficult part is often not treatment, but whether they are willing to deal with those high-risk teeth that “seem usable” when there are no obvious symptoms.

From a doctor’s perspective, we want to promote better risk control before the tooth breaks or causes pain.

If you have any of the following conditions, you might want to pay a little more attention:

• A tooth had a relatively large filling

• Occasionally feeling a slight discomfort when biting, but not being able to pinpoint the exact location

• A habit of grinding teeth at night or clenching teeth during the day

• Your dentist has recommended crowns or protective restorations, but you are hesitating because you aren’t experiencing any immediate problems

These may not necessarily cause immediate problems, but they often indicate that the tooth has entered a “high-risk stage”.

The fates of teeth are not determined once they are in pain; the seeds of their eventual demise are almost always sown before the pain begins.

If you can take extra precautions early on, you avoid having to get a tooth extracted.

Author: Joyce Guojun Ma (马国珺), DDS, PhD

Translated by Eddy Tian

About the Author

Author｜Joyce Guojun Ma, DDS, PhD

General Dentist | MAGD | DABOI/ID | DICOI | DABDSM

Practicing medicine in the three eastern states (NJ / NY / PA)

Peking University School of Stomatology | New York University School of Dentistry |

Johns Hopkins University Neuroscience PhD

Specializing in: Preventive dentistry, Occlusal function, Full mouth reconstruction, Periodontal laser treatment, Implants and bone grafts, Cosmetic orthodontics, Temporomandibular joint disorder (TMD), and Sleep-disordered breathing (OSA).

Part 2:

https://eddytian.substack.com/p/is-periodontal-disease-destiny-dental

Part 1:

https://eddytian.substack.com/p/the-dangers-of-ignoring-a-toothache

The post Tooth Fractures Unrelated to Cavities: Dental Health Misconceptions and Cautionary Tales (Part 3) first appeared on Prime Dental Care.

都说牙周病是个慢性病，可以存在很久不痛不痒。谁能想到，我大年夜看的第二个病人，居然是一位牙周病末期、整个半边脸都肿起来的50多岁软件工程师。

他的诉求是牙痛。半边脸明显肿胀，头也胀得厉害。他说行业被 AI 影响严重，刚刚被裁员，保险也马上要没了。以前工作繁忙，也没大理会过牙。有时候刷牙偶尔出血，他就少刷那一边。口气不太清新，他觉得这是遗传——他父亲也是这样。平时就用点漱口水，嚼嚼口香糖。年纪大了，牙口也不太好，硬的东西有时咬不动。

这次这么严重是第一次。半年前也疼过一次，正赶上年中考核，他就自己吃了点以前剩的抗生素，后来就“好了”。

我拍了 X 光，一看左下两个磨牙，都是传说中的 “Floating tooth”。也就是说，整个牙齿几乎被炎症包围，牙根周围的骨头已经被侵蚀殆尽。左下区域大面积肿胀。他说感觉牙齿好像比以前“长出来”了一点，不敢合嘴，一碰就疼，不碰也疼，想死的心都有。但还不能死，还得给上大学的孩子赚学费，还要努力找工作。一周以后还有个面试，请我一定今天帮他“治好”。

我看着这两颗几乎游动在炎症脓液里的牙，问他：你说的“治好”是指什么？他说：给他补一下，或者来点强力的药，把它治好。

我真是哭笑不得。医生不是上帝啊。就是上帝，也没能让您的牙挺到天荒地老，更何况是医生。这两颗牙，肯定是保不住的。巧妇难为无米之炊，你想让空中楼阁给你提供咀嚼功能，那是绝不能够的。

更可惜的是，这两颗牙并没有什么明显龋齿，问题在于大面积牙石附着。虽然这次是局部急性发作，但看其他牙的情况，也大差不差，是一个重度牙周病的整体状态。

我问他上次看牙是什么情况。他说以前在印度看牙，都说他牙很好。来美国后一直打拼，牙也没出过什么大问题。五年前看过一次牙，那个牙医看了他两分钟就走了，然后让他做很贵的深洁牙治疗。他当时没什么症状，觉得自己并不需要。更“可恶”的是，他们不给他做普通、便宜的洗牙。他只做了检查，就再也没回去。

听完这一席话，我真的觉得牙科科普是任重而道远。太多思想误区和错误认知，即使受过高等教育，读了硕士、博士，隔行如隔山，Dental IQ 还是这样低。现实情况，可能比我们以为“大家都该知道的”要差很多。

所以今天我们就来讲讲牙周病吧。

它是不是宿命？

它是不是永远治不好的无底洞？

为什么会得牙周病？

普通人到底该怎么办？

怎么才能避免在大年夜，给医生下达一个根本不可能完成的任务？

牙周病的真正属性是：慢性炎症性疾病，它以口腔厌氧细菌为核心驱动。牙周病的治疗，不是像补牙一样一次就能完成。它和高血压、糖尿病在本质上是一样的——不是靠“神医”，也不是靠“猛药”，而是靠长期、正确、持续的管理。

所以它不是无底洞，而是一个需要你参与行动的保卫战工程。

有人说：“我也刷牙啊，我也不怎么吃甜的，还没蛀牙，怎么就得牙周病了？”

真正的原因有三步：

第一，牙菌斑长期没有被清理干净，刷牙不到位，不用牙线或冲牙器，牙龈边缘线这个主战场长期失守；

第二，牙石一旦形成，牙周病就进入“加速模式”，它是细菌的永久据点，也是炎症的慢燃引线，一旦形成，刷牙已经刷不掉了；

第三，牙周病真正的“杀伤力”，来自时间。日积月累的厌氧细菌侵蚀造成骨头缺损，牙周袋越来越深，又无法自我清理。

如果专业洗牙没有针对牙周病做深层洁治，只洗了牙龈以上，就像隔靴搔痒，牙龈以下的细菌大本营根本不会伤筋动骨，它们继续作威作福，牙周病自然越来越严重。

很多病人会问：不就是洗牙吗？为什么还要分普通洗牙和深层洁牙刮治？

这里面其实差别非常大。

我们平时说的“普通洗牙”，医学上叫洁治，主要清理的是牙龈以上能看到、能摸到的牙石和菌斑。它的目的，是预防，是给健康或接近健康的牙周环境做日常维护。对没有明显牙周袋、骨吸收不明显的人来说，普通洗牙是足够的，也是应该定期做的。

但一旦发展到牙周病，问题的主战场就已经下移到了牙龈下面。细菌躲在牙周袋里，附着在牙根表面，普通洗牙根本够不到，也清理不到。这个时候，如果还只是反复做牙龈以上的洗牙，就像只擦桌面、不管桌子底下的垃圾，看起来干净了，问题其实还在。

深层洁牙刮治，针对的正是这些牙龈以下的感染源。它的目的不是“洗得更白”，而是把牙根表面的牙石、菌斑和炎症组织清理干净，让牙龈有机会重新贴附，控制炎症继续向下发展。这是一个治疗性操作，而不是单纯的保养。

很多病人会觉得：“我又不疼，为什么不能先做普通洗牙？” 但对已经形成牙周袋、出现骨吸收的人来说，不做深层洁治，牙周病是不会因为普通洗牙而好转的。表面看着干净，下面的细菌大本营却依然存在，炎症还在继续。

这也是为什么有些病人觉得：“我明明也一直洗牙，牙周病怎么还在进展？” 问题不在于你有没有洗牙，而在于洗的是不是该洗的地方。

当然，深层洁牙刮治也不是“一劳永逸”。它的效果，取决于后续的口腔卫生维护和定期复查。如果治疗后不配合清洁、不维护，炎症还是可能复发。牙周病的管理，从来不是一次性的。

为啥自身免疫力不能自救呢？其实牙周病的发病机理，本身就有自身免疫力参与的重大原因。

打个比方，身体的抗炎反应在牙周组织里，更像是一场势均力敌的战争。身体的白细胞、巨噬细胞、各种炎症因子和抗体，都在努力想把炎症包裹起来、消灭掉。这个战场，就发生在骨头和细菌接触的边缘。

但问题在于，身体的这些举措往往是伤敌一千，自损八百。牙石本质上是钙化的细菌军团，身体免疫力达不到对这些细菌的全面包围。整个战场反复征战，民不聊生。结果是，在吞噬表面细菌的同时，也间接造成了感染区域骨壁细胞的破坏。骨头的支撑越来越差，细菌反而越钻越深。这个发病机理过程叫做Host-mediated tissue destruction（宿主介导的组织破坏）。

那为什么牙周病能“拖这么久都没事”呢？

答案是：牙槽骨里感知疼痛的神经末梢本来就很少，所以牙周病在早期、中期，甚至不少晚期阶段，都不太疼。

最初给你的信号，可能只是刷牙出血、口气不好，接着出现牙龈有点红肿，牙缝慢慢变大，甚至牙齿逐年移位。这其实和身体很多慢性问题很像。高血脂、高血压，也可以在身体里存在很久，如果不定期体检，根本发现不了。可要是等到出现血管堵塞、心绞痛的症状，再治疗，是不是就太晚了一点？

内科医生看了血检报告，就可以诊断高血脂并开始治疗；同理，牙医通过牙科 X 光结合口内检查，也可以诊断牙周病，并建议进行深层洁牙、刮治，必要时配合激光等治疗。

如果在发病早期就开始治疗，牙槽骨还在相对不错的位置，牙齿还没有明显松动，炎症在患者积极配合下，是可以得到很好控制的。通过深层清洁和定期维护，就不会积重难返、愈演愈烈。

但现实中，如果牙医没有和病人讲清楚牙周病的重要性，只是花两分钟检查，没有足够的口腔卫生宣教，病人往往难以理解。就像这位患者经历的一样，牙医看了片子，一眼知道是牙周病，就下达了治疗计划。可病人因为不理解、不信任，没有真正听进去，接受治疗。

一个人的认知，往往决定了这个人的命运。如果没有认识到治疗的必要性和重要性，患者在做决定时，很容易掺杂大量其它因素，比如说工作繁忙和价钱因素。再加上美国的牙科保险系统对牙科并不友好，更加剧了这种情况。

如果像医疗保险那样，大家只付少量固定挂号费，其它由保险承担，医生和病患之间的关系也许会好很多，整体的牙科预防和治疗情况也会好很多。但现实是，牙科保险更像是预付金额存储，一年只付到一定额度，其它都需要自费。这大大影响了病人接受治疗的速度和效率。

于是，很多人在“既有要补的牙，又有要治的牙周病”之间，往往会先选择补牙，而无限期延迟、甚至拒绝医生建议的深层洁牙。很可惜，牙医也只能治疗愿意接受治疗的人。

当骨吸收超过根长一半，冠根比例大于 1 时，牙齿的支撑明显受损，就会出现明显松动、反复红肿，甚至像这位患者一样，发展成严重的根尖脓肿，严重影响生活质量。这时候，往往已经没有太多选择，只能拔牙、植骨、换成种植，及时止损，防止炎症继续扩散。

从医生的角度来说，病情越严重，患者反而越容易接受治疗。因为事实胜于雄辩，患者自己已经意识到“这病非治不可”。而在早期阶段，医生的建议却常常因为各种原因被忽视、被拒绝。

严格来说，牙周病本身不是遗传病， 不是宿命。真正“遗传”的，是每个人对炎症的反应方式，是免疫系统的敏感度、牙周组织的易感性，而不是牙周病这个结果本身。家族的生存环境也和细菌菌群种类有关。

同样的口腔细菌，有些人反应轻，有些人反应重；有些人牙石多、炎症发展快，有些人相对慢一点。这和基因有关。但如果没有牙菌斑、牙石这些外因，单靠遗传，并不会凭空长出牙周病。不同细菌种类致病力也不同，有些细菌在同样微环境里造成的破坏更大。

换句话说，遗传决定的是“容易不容易”，不是“会不会”。生活环境、习惯、口腔清洁、是否定期检查和及时治疗，才是真正决定牙周病走向的关键因素。

有遗传倾向的人，更不能像这位患者一样，因为父亲这样、自己这样，就觉得是正常的，而是应该比别人更加努力地和牙周病作斗争。

我愿意花时间和病人讲这些发病机理，也是希望大家能够防微杜渐，多做预防，治疗小病，别舍不得花小钱，等到以后却不得不花大钱。身体健康，本来就应该排在第一位。

很多人心里都有一个下意识的偏见：牙科是可有可无的，是美容，“牙是牙，身体是身体”。可问题是——牙龈下面不是空气，是血管。牙周病，本质上是一个长期存在的、开放性的细菌炎症源。

每天刷牙、咀嚼，甚至睡觉时，细菌和炎症介质都有可能进入血液循环。这不是耸人听闻，而是医学共识。研究表明，牙周病和系统疾病关联密切。慢性牙周炎患者，冠心病、动脉粥样硬化、中风的风险都会显著升高。这不是因为牙“影响心”，而是长期炎症状态会加速血管损伤。你口腔里的炎症，身体并不会假装没看见。

牙周病和糖尿病还是一个双向关联。糖尿病患者更容易患牙周病；。反过来，牙周病这个长期炎症源的存在，也会让血糖更加难以控制。研究显示，控制牙周炎，本身就有助于改善血糖水平。很多人拼命控糖、吃药、打针，却放任口腔里一个持续释放炎症因子的“火源”，得不偿失啊！

除此之外，牙周炎还和女性早产、妊娠并发症相关；在老年人中，牙周致病菌可以被吸入肺部，加重慢性呼吸系统疾病。慢性牙周炎作为一种全身低度慢性炎症状态，也和神经退行性疾病风险有关。

牙周炎不像心梗那样突然，不像中风那样吓人，也不像肿瘤那样被反复宣传。它更像一个一直没关的阀门，一点点消耗你。你以为牙龈只是个小问题，扛一下就过去了，其实你扛的是长期炎症，是免疫系统的持续负担，是身体修复能力的慢慢透支。

牙周病也许不会让你“马上出事”，但它和全身其他系统的关联，会让你在别的地方更容易出事。

牙周病不是宿命，但它是一种需要你认真对待的慢性病。早点管理，你保住的不只是牙，还有你整体的健康状态。

The post 牙周病是不是宿命？从一个“Floating Tooth”的病例说起 first appeared on Prime Dental Care.

About the Author

Dr. Joyce Guojun Ma earned her undergraduate degree from Peking University School of Stomatology and her DDS from New York University College of Dentistry. She has practiced as a general dentist in the United States for 15 years, holds the Master of the Academy of General Dentistry (MAGD) designation, and is licensed to practice dentistry in New Jersey, New York, and Pennsylvania. She also holds a PhD in Neuroscience from Johns Hopkins University and has completed seven years of intensive neuroscience research training during her doctoral and postdoctoral studies.

Read Part 1 here: https://eddytian.substack.com/p/the-dangers-of-ignoring-a-toothache

A Case That Began with a “Floating Tooth”

Periodontal disease is a chronic condition, capable of existing quietly for years without causing any pain or obvious symptoms. However, if you wait until symptoms to treat it, the disease will have already inflicted irreversible damage on your oral health. The second patient I saw on New Year’s Eve was a man in his 50s with end-stage periodontal disease, which caused severe swelling of the entire left side of his face.

He came in because of throbbing tooth pain.

He told me his industry had been hit hard by AI; he had just been laid off, and his insurance was about to expire. He had been busy with work for years and hadn’t paid much attention to his teeth. Occasionally his gums bled when brushing, so he brushed less in those areas. His breath wasn’t fresh, but he assumed it was genetic, as his father had the same issue; he used mouthwash, chewed gum, and managed as best he could to mitigate the symptoms. As he got older, his bite felt weaker; hard foods were difficult to chew.

This was the first time things had become this severe. Six months earlier, he had experienced pain once before, but it coincided with a mid-year performance review, so instead of seeing a dentist, he took some leftover antibiotics on his own, alleviating the pain.

I took X-rays.

The lower left two molars were what we call “floating teeth”. In other words, the teeth were almost entirely surrounded by inflammatory tissue, and the bone around the roots had been nearly completely destroyed. The entire left mandibular region was severely swollen.

He said his teeth felt like they had “grown longer”, and couldn’t close his mouth due to the pain. He said he felt like dying, but couldn’t because he had a child in college to support. He had a job interview in a week and begged me to “cure it today.”

Looking at those two teeth, essentially floating in inflammatory pus, I asked him what he meant by “cure.”

He said:

“Can you just fill them? Or give me some really strong medication and make it better?”

I was honestly speechless.

Doctors are not gods. Not everything can be easily cured in a single visit, or even at all. These teeth were beyond saving, like castles on sand without any foundation to make them last.

What made it even more pitiful was that these teeth had no significant decay; the two teeth were completely intact. The problem was massive calculus accumulation. The pain and swelling was an acute local flare-up of the two teeth, but the condition of the other teeth showed the same characteristic pattern: the symptoms of generalized severe periodontal disease.

I asked about his last dental visit.

He said that he immigrated here from India. He used to have good teeth back in India. After coming to the U.S., he focused mainly on building his career, neglecting his health needs due to lack of time. He only saw a dentist once five years ago. That dentist looked at him for two minutes and recommended an expensive deep cleaning procedure, which he did not understand why and felt completely overkill. Since he had no symptoms, he felt it was unnecessary. What upset him even more was that they wouldn’t offer a “regular, cheaper cleaning.” He only had the exam, and never went back.

Hearing this, I felt it is truly imperative to provide dental education to the general population. We have done far from enough!

There are so many misconceptions. Even people with advanced degrees—master’s, PhDs—can have an extremely low Dental IQ. In reality, the general level of understanding may be far worse than we assume.

So today, let’s talk about periodontal disease: Is it fate? Is it an endless, incurable money pit? Why does it happen? What should ordinary people actually do? How can we avoid letting the disease progress to the point of irreversible damage and losing teeth?

Is Periodontal Disease Fate?

No.

But it is a chronic disease.

Periodontal disease is fundamentally a chronic inflammatory condition, driven primarily by anaerobic oral bacteria. Its treatment is not like filling a cavity—something that can be done once and completed. You can’t quickly cure periodontal disease any more than something like hypertension or diabetes. It is not curable by miracle doctors or powerful drugs, but by careful long-term management of dental health.

It is not a bottomless pit, but rather a defending war that requires the patient’s participation.

How Does Periodontal Disease Develop?

Many patients ask:

“I brush my teeth. I don’t eat much sugar. I don’t even have cavities. Why do I still get periodontal disease?”

The answer usually unfolds in three steps:

1. Dental plaque is not adequately removed over time.

Brushing is incomplete, floss, waterfloss or interdental cleaning is not used, and the gumline remains chronically neglected, allowing bacteria to accumulate.

2. Once plaque mineralizes into calculus, the disease accelerates.

Calculus is a permanent stronghold for bacteria and a slow-burn fuse for inflammation. Once it forms, brushing alone cannot remove it.

3. The real damage comes from time.

Over years, anaerobic bacteria cause progressive bone loss. Periodontal pockets deepen, making self-cleaning impossible and allowing the disease to get worse and worse.

A “regular” cleaning that addresses only what is above the gumline would be akin to cutting weeds off at ground level instead of pulling them up by the roots: though it might look clean visually, the source of the problem is still there, and the disease will keep progressing.

What is the Difference Between “Regular Cleaning” and “Deep Cleaning”?

The difference is substantial.

Routine cleaning (prophylaxis) removes plaque and calculus above the gumline. Its purpose is prevention: the maintenance of healthy gums. For patients without significant pocketing or bone loss, this is appropriate and should be done regularly.

Once periodontal disease develops, however, the battlefield moves below the gums. Bacteria adhere to root surfaces inside periodontal pockets, areas that routine cleaning simply cannot reach. At this stage, superficial, routine cleaning will not be effective.

Scaling and root planing (deep cleaning) targets these subgingival (beneath the gums) infection sources. Deep cleaning removes bacterial deposits and inflamed tissue so the gums can reattach and inflammation can be controlled. This is no longer maintenance; it is fundamental first line treatment for a budding chronic disease.

Patients often ask:

“I’m not in pain; why can’t I just do a regular cleaning instead?”

For patients with periodontal pockets and bone loss, regular cleaning alone will not stop disease progression. The surface may look clean, but the bacterial core persists. This is where some patients feel confused:

“I get my teeth cleaned regularly, so why is my periodontal disease getting worse?”

The issue is that no amount of routine cleaning will remove bacteria and infection beneath the gums. Furthermore, even deep cleaning is not a one-time cure: its success depends on home care and regular follow-ups to prevent bacteria from recolonizing the cleaned areas. Periodontal disease management is never a once-and-done event.

Why Can’t the Immune System Take Care of It?

For periodontal disease, the immune system is part of the problem.

When the immune system detects pathogens within the body, it attempts to destroy the pathogens by sending phagocytotic cells (which engulf and destroy other cells) and pro-inflammatory signals (which cause inflammation) to the site of infection.

However, the immune response causes a lot of collateral damage; the majority of common disease symptoms (like fevers and coughing) are caused by the immune system fighting back against pathogens. If the infection is very resilient, this becomes a serious problem as the immune system will end up destroying the healthy tissues around the infection as it attempts to combat it.

Calculus is essentially a calcified bacterial army that is too resilient for the immune system to fully eliminate. Repeated battles destroy not only bacterial residues, but also surrounding bone cells. As bone support weakens, bacteria penetrate deeper. This process is known as host-mediated tissue destruction.

Why Can Periodontal Disease Exist for So Long Without Pain?

Because the alveolar bone contains very few pain receptors.

Early, middle, and even many late stages of periodontal disease are not painful. Early warning signs may include gum bleeding, bad breath, mild redness, widening spaces between teeth, or gradual tooth migration.

This mirrors many chronic systemic conditions. High blood pressure and high cholesterol can exist silently for years. But if you wait until the characteristic chest pain or stroke symptoms appear, it would be far too late.

Physicians diagnose hyperlipidemia through blood tests. Once abnormality is found, proper treatment will be recommended before symptoms occur. Likewise, dentists diagnose periodontal disease through X-rays and clinical exams. Treatment plan of deep cleaning, if necessary with additional laser assisted treatment may be recommended. Early diagnosis allows for effective intervention before irreversible damage such as tooth mobility occurs. Do not be tempted to skimp on regular dental checkups because your teeth have always been fine in the past; it is because of those regular checkups that any issues could be detected and treated early.

Is Periodontal Disease Genetic?

Strictly speaking, periodontal disease itself is not genetic.

What is inherited is how an individual’s immune system responds to inflammation: immune sensitivity and tissue susceptibility. Family environments and shared bacterial profiles also play a role. In other words: genetics determine how easily disease develops, not whether it must develop, similarly to many other chronic conditions.

Without plaque and calculus, genetics alone do not create periodontal disease. People with genetic susceptibility should be more proactive, not more resigned.

Periodontal Disease Is Not Just a Dental Problem

Below the gums are not air spaces; there are blood vessels.

Periodontal disease is a chronic open inflammatory source. During brushing, chewing, and even sleep, bacteria and inflammatory mediators can enter the bloodstream.

Research shows strong associations between periodontal disease and coronary artery disease, atherosclerosis, and stroke, due to chronic systemic inflammation.

Periodontal disease also has a bidirectional relationship with diabetes. Diabetic patients are more prone to get periodontal disease, and uncontrolled periodontal inflammation worsens glycemic control. Treating periodontal disease can improve blood sugar regulation.

Additionally, periodontal disease is linked to preterm birth, pregnancy complications, worsening of chronic respiratory disease in older adults, and increased risk of neurodegenerative conditions through sustained low-grade inflammation.

Periodontal disease may not cause immediate crises like heart attacks or cancer, but it slowly drains your body’s resilience, making you more susceptible to other infections.

It may not make you collapse today, but greatly increases the likelihood that something else will fail tomorrow.

Final Thoughts

Periodontal disease is not fate.

But it is a chronic condition that deserves serious attention and diligent maintenance.

Manage it early, and you preserve not only your teeth, but your overall health.

The post Is Periodontal Disease Destiny? Dental Health Misconceptions and Cautionary Tales (Part 2) first appeared on Prime Dental Care.

关于作者:

马国珺医生是北大牙学院本科，纽约大学牙学院博士毕业，在美行医十五年的一名全科牙医，拥有美国全科牙医协会专家头衔（Master of Academy of General Dentistry MAGD），以及新泽西、纽约和宾州的牙科行医执照。同时她也是约翰霍普金斯大学毕业的神经科学博士，有博士和博士后七年的神经科学深入学习和科研经历。

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最近有感动想写一些牙科科普文。这个念头来源于最近看到的很好的医疗科普文和我在大年夜的一些经历。12月31号，大部分医生都在休假，而我却因为诊所的急诊预约来加班。

大家知道 IQ 和 EQ，智商和情商。在牙科界我们也有个词叫 Dental IQ，指的是牙科常识的水平。Dental IQ 高，预防意识强；对各种常见牙科病症的自我筛查能力更强；也更知道在发生各种牙科状况时应该采取什么样的自我保护和初步措施。更重要的是对自己将来的治疗有足够的预期，并能在第一时间制定迅捷有效的行动方向。这系列科普文主要是想帮助非专业人士提高 Dental IQ。

元旦前一天我不得不加班时，看了三位牙痛的病人。有俗语说“牙疼不是病，疼起来真要命”。这句话半真半假：“疼起来真要命”是真，“牙疼不是病”是假。

那天看的几位病人还挺有代表性，就和大家分享一下他们的故事吧。

第一位是个对看牙有恐惧的资深女医生。她说她能不看牙医就不看，因为每次看完都会很不舒服。上次看牙也是因为牙疼，大概两年多前。这次又疼了，没办法，不能吃东西了，不得不来。

我检查了一下：一个超大的牙洞，已经腐坏到神经了。得，这是牙髓炎，牙齿里的神经发炎了。又是大的治疗！要杀神经做根管治疗，还要装牙冠。这种治疗后总也是要一点时间恢复的。我赶紧抓紧时间和她讲：“每次看完牙不舒服，是不是每次做的都是比较大的治疗？上次洗牙是什么时间？”她回答说：”啊呀，是的，牙特别不好！工作忙，牙都治不完，也没得时间洗牙。” 我不禁感慨，怎样才能帮助她从这种牙病魔咒里走出来？怎样才能让更多的人认识到，牙病拖成这样子很惋惜，咋就不能多爱自己一点，早些来呢？

我想用浅显一点的语言讲一下牙髓炎的发病过程，帮助大家理解发病机理，了解早期症状，继而防微杜渐。牙髓炎是细菌感染性疾病，是从牙齿表面小龋坏开始的。细菌先要附着在牙齿表面一段时间形成不易清除的菌斑和牙石，就好比它建了一个游离于身体免疫机能之外的可以自我保护的城堡。细菌代谢我们吃的东西之后会产酸，然后酸开始腐蚀牙齿表面的牙釉质。这一步发展比较缓慢，因为牙釉质矿物含量很高，比较坚硬。这时往往是无症状期，一般只有照 X 光才能看到龋坏的影子。

细菌繁殖成指数增长模式，一变二，二变四……滚雪球一样越滚越大。当龋坏到达牙本质（牙的内层结构）时，因为牙小管提供了更适合细菌生长和扩散的物理空间，龋坏发展速度会急速加快。这个时期，根据个人疼痛阈值、敏感程度，就有可能出现症状：比如吃冷饮、喝热茶会敏感。但是不吃这些，症状就没那么明显。有些人会想：那我不吃过冷过热的不就好了？问题在于：这个阶段神经感知到牙齿结构变化，给出的是个“红色警报”，它自己还没有真正发炎。它的警示也只在吃冷、热或者甜食时出现，其他的不在它小宇宙范畴之内。这个时期，常规牙科检查和 X 光其实很容易确诊，治疗也相对容易。

但如果这个时期病人因为各种原因忽略了这些微小警报，或者本身不是敏感体质，比较大条、能扛，龋坏继续发展一段时期后，症状可能又会进入“时有时无”的间歇期。疼痛感知靠的是神经信号传导。大脑接到信号后会整合信息给出指令：行动派可能立刻安排看牙，但如果当时它不是你最重要的事，你可能会选择忽视它。这个信号被抑制多了，大脑甚至可能逐渐学会“忽视”，这就是 desensitization（脱敏/习惯化）。直到更强烈的信号出现，才会出现下一波症状。

有些人选择吃点止痛药，挺一挺。也有人说“牙疼就是上火了”，消消炎就好了；甚至还有人自己乱用抗生素。很抱歉，这个阶段“消炎”往往不解决根本问题。一个核心原因是：牙本质本身几乎没有血供，它主要靠牙髓腔的神经血管系统提供非常有限的组织间隙液体（可以粗略理解为“虹吸式供应”）。所以很多时候，靠血液循环带过去的药物，并不能有效到达细菌真正藏身和扩散的位置。

如果这一时期没有治疗，细菌最终会抵达牙髓腔。症状可能变成：什么也不做的时候就自发痛；吃一口凉的疼几个小时；夜里疼醒；咬东西疼……生活会被它严重影响。有人会问：我自己吃点药不行吗？找医生开点止疼片和抗生素是不是就可以了？答案是否定的。为啥喉咙发炎吃抗生素就能好，牙神经发炎就不行呢？这还得回归到血供。喉咙血供丰富，抗生素能通过血液到达“战场”，细菌无处可逃，用够剂量和时间长度就可能结束战斗。而牙齿要通过根尖唯一的神经血管束进入牙髓腔。在这个通路还“通畅”的时候，抗生素有时确实可能让症状短暂减轻——但大家别忘了细菌是怎么来的：它起始位置在牙齿表面，行进途中有太多缺乏血供的地方可以“藏匿”。这也是为什么牙髓炎吃抗生素往往只能缓解、很难根治：细菌大军储备太雄厚，“躲避空间”太强悍，很多并不在抗生素的有效射程之内。

人也不可能长期吃抗生素。一旦停药，细菌又会卷土重来。每一次反复，都会造成神经血管束进一步损伤。直到神经血管束“崩塌”，炎症会通过牙根通道进入根尖和骨头内，造成根尖炎。这是比牙髓炎更严重的疾病发展阶段。这一阶段主要症状往往是咬合痛，疼痛强度会很高，有时会出现跳痛。因为牙齿是致密结构，里面的炎症渗出、脓液和压力积存，排不出去就会向根尖游走，通过根尖孔到达根尖牙槽骨，开始侵蚀骨头。这时 X 光会看到根尖区域的改变：骨密度降低，炎症区显示阴影。到了这一步，如果还只想吃药解决，效果往往更有限，因为药物更难进入牙齿内部。真正的治疗方向只有一个：从源头把腐质去掉，把细菌清干净。根管治疗充填后放一个坚固的牙冠。

所以说牙疼这件事，很多时候并不是突然发生的“灾难”，而是身体用一次次更响的方式提醒你：它早就开始了，只是你一直在硬扛、在拖、在等它自己好。可牙齿的很多问题，真正“最容易、最省钱、最保牙”的窗口，往往就在最早那一点点敏感、最早那一丝不舒服的时候。

更好的理念其实也不复杂：把“等疼了再治”，换成“定期检查、提前预防”。定期看牙医，让专业人员帮你系统看护口腔健康；该拍片就拍片、该洁牙就洁牙、该补的小洞趁早补。用预防做最好的治疗，很多时候不仅省钱，更省心，也是在保护未来的自己!

The post 大年夜还在加班看急诊：牙疼这件事，真的别拖着扛着（一） first appeared on Prime Dental Care.

The day before New Year’s, I saw three patients who came in with tooth pain. There’s a saying: “A toothache isn’t a disease—but when it hurts, it can be agonizing and unbearable torment.” That line is half true and half false: “When it hurts, it can be agonizing and unbearable torment” is true; “a toothache isn’t a disease” is false.

The patients I saw that day were quite representative of common dental emergencies that can be easily prevented or handled well with a bit higher dental IQ, so I want to share their stories to help more people in need.

Patient #1: A Senior Female Physician Who Is Deeply Afraid of the Dentist

The first patient was an experienced female physician who was deeply fearful of dental visits despite being a health professional herself. She told me she would avoid dentists whenever possible because she felt miserable after every dental appointment. The last time she came was also because of pain… more than two years ago. When the pain became so bad she couldn’t eat, so she had no choice but to come in.

I examined her painful tooth: there was a huge cavity, already decayed all the way to the nerve. That was classic pulpitis, or infection of the dental nerve. That meant major treatment was necessary: removing the nerve, root canal therapy (therapy of cleaning and sealing the nerve chamber), and then a crown or a cap. Recovery would also take time. I took the opportunity to ask her:

“When you said you always feel awful after dental visits, was it because each time you needed rather big procedures? When was your last dental cleaning?”

She replied, “Yes. My teeth have always been terrible. I’m so busy at work, I can’t even finish all the recommended treatments, and I don’t have time for cleanings.”

I couldn’t help thinking: How can we help her break out of this cycle? How can we help more people understand that it’s such a pity to let dental disease progress this far; why not love yourself a bit more and come in earlier?

A common reason why some patients neglect their dental health is because they don’t understand the consequences of forgoing routine dental care. Many people believe dental disease is something that suddenly occurs, like the flu, and might treat it similarly, by just taking some over-the-counter medicines, but these are dangerous misconceptions. Dental disease is something that develops over time, and medication generally isn’t effective for curing dental disease. As such, I want to explain dental nerve infection in simpler language: how it develops, what early symptoms look like, and how to prevent it.

How Pulpitis Develops (in simple language)

Pulpitis is a bacterial infectious disease. It often starts as a small cavity on the tooth surface. Bacteria first attach to the tooth and, over time, form dental plaque and calculus: calcified “ bacteria city” on the teeth, akin to a fortress that sits outside your immune system’s direct reach and protects itself.

Bacteria in the mouth “feeds” on food you take in the mouth, and produces acid as a waste product, which in turn erodes the enamel (see reference image) on the tooth surface. The mouth eventually produces saliva to counteract the acid, but acid erosion can overrun the body self defense system and build up over time. Furthermore, drinking acidic drinks like sugary sodas will expedite this process, which is why dentists caution against them. Enamel erosion via acid progresses slowly because enamel contains a lot of minerals and is very hard; it is often asymptomatic (no symptoms), and many cavities at this stage are only noticed on a dental X-ray.

Bacteria multiply exponentially: one becomes two, two becomes four, snowballing rapidly. Once decay reaches dentin (see reference image), the process can accelerate dramatically because dentinal tubules (microscopic tube-like structures that run from the dentin to the pulp (see reference image), the innermost part of the tooth) provide physical pathways that make bacterial spread easier.

At this stage, depending on your pain threshold and sensitivity, you may start to notice symptoms such as sensitivity to cold and hot. But without trigger, the discomfort may seem minor. Some people think, “Fine, I just won’t eat or drink very hot or cold things.” The problem is: at this point, the nerve is sending an early red alert: it isn’t fully inflamed yet, but it’s warning you. Because the warning only shows up with certain stimuli (cold, heat, sweet foods), many people ignore it. Nonetheless, routine dental exams and X-rays can usually diagnose this stage easily, and treatment is relatively straightforward.

If you come in for regular cleanings every six months, cavities can be identified and treated at this stage without problems.But if you ignore these small alarms, whether due to busy life style, fear, or because you’re simply not very sensitive, the decay continues. Symptoms may then enter an intermittent phase: sometimes present, sometimes not.

Pain perception depends on nerve signals. When the brain receives pain signals, it integrates them and tell other parts of the body what to do. People with strong action force may schedule a dental visit right away upon receiving the first signal. But if it’s not their top priority at the time, it might get suppressed. If that signal suppression happens repeatedly, the brain can gradually “learn” to ignore it. This is called desensitization or habituation: getting used to the pain, ignoring it until a stronger pain signal forces you to pay attention.

Some people take painkillers and pray to hope it is taken care of. Others say, “It’s just life stress,” and try self healing remedies, aka: rest, wait and see; some even misuse antibiotics. Unfortunately, at this stage, none of these fix the root problem.

A key reason is the blood supply. Dentin has almost no blood supply. It relies mainly on the nerve-and-blood-vessel system inside the pulp chamber, and even that support is limited to a weak “siphon-like” supply. As a result, medications carried through the bloodstream often cannot effectively reach the places where bacteria are hiding and spreading within tooth structure.With the same reason, body self defense system like white blood cells, macrophages and antibodies cannot reach far enough to destroy the bacteria city inside of the dentin.

If no proper treatment is done, bacteria eventually travel down and reach the pulp chamber. Symptoms may escalate into spontaneous pain even when doing nothing, pain that lasts for hours after a sip of cold water, waking up at night with throbbing pain, and even chewing pain that seriously affect daily life.

People may ask: “Why can a throat infection most of the time resolve with antibiotics, but pulpitis usually can’t?” It comes back to blood supply. The throat has rich circulation; antibiotics can reach its “battlefield” easily, leaving bacteria with nowhere to hide. With adequate dose and duration, bacteria can be extinguished and the disease is cured. A tooth, however, has a much narrower route: the pulp is accessed mainly through the single neurovascular bundle entering at the root tip (essentially, there’s just one small connection). When that pathway is still relatively “open,” antibiotics may sometimes reduce symptoms temporarily, but remember where the bacteria came from: they started on the tooth surface and traveled inward through many areas with poor blood supply where they can “hide”. This is why antibiotics can relieve pulpitis but rarely eradicates it. And no one can take antibiotics long-term without causing additional more serious problems. Once you stop, bacteria will rebound. Each recurrence further damages the neurovascular bundle. Eventually, when that bundle “collapses,” infection can travel through the root canal to the root tip and into the surrounding bone, causing apical periodontitis: infection of the bone- a more advanced stage of the disease.

At this stage, the main symptom is often severe spontaneous pain and biting pain, sometimes with a throbbing pulsating sensation. It may make a person feel miserable because the top and bottom teeth can barely touch otherwise excruciating pain occurs. Because teeth are dense structures, inflammatory fluid, pus, and pressure build up inside and cannot expand or drain easily. The pressure then pushes infection toward the root tip, exits through the apical foramen, reaches the surrounding alveolar bone, and begins to erode it. On X-ray, the bone density around the root tip decreases and appears as a dark area, indicating bone “eaten away” by bacteria.

By this point, if you still hope to solve it with medication alone, the effect is usually even more limited because it’s even harder for drugs to get to the inside of the tooth with the neuro vascular bundle being collapsed. The only way to treat this is to remove the decayed tissue at the source and clean out the bacteria. That means root canal treatment, filling/sealing the canals, and then placing a strong protective crown.

The Point: Tooth Pain Usually Isn’t a Sudden “Disaster”

Most toothaches aren’t sudden catastrophes. They are your body trying, again and again, louder each time, to tell you that something’s wrong. This started long ago. You’ve just been toughing it out, delaying, hoping it will go away on its own.

But for many dental problems, the most “easy, affordable, tooth-saving” window is often at the very beginning, when there’s only a slight sensitivity, the faintest discomfort.

The better approach is not complicated: replace “wait until it hurts” with regular checkups and prevention. See a dentist routinely so a dental professional can monitor your oral health systematically. Take X-rays when needed, get cleanings when needed, and fill small cavities early. Using prevention as the best treatment often saves not only money, but also stress, and it protects your future self.

Author｜Joyce Guojun Ma, DDS, PhD

General Dentist | MAGD | DABOI/ID | DICOI | DABDSM

Practicing medicine in the three eastern states (NJ / NY / PA)

Peking University School of Stomatology | New York University School of Dentistry |

Johns Hopkins University Neuroscience PhD

Specializing in: Preventive dentistry, Occlusal function, Full mouth reconstruction, Periodontal laser treatment, Implants and bone grafts, Cosmetic orthodontics, Temporomandibular joint disorder (TMD), and Sleep-disordered breathing (OSA).

The post The Dangers of Ignoring a Toothache: Misconceptions and Cautionary Tales (part 1) first appeared on Prime Dental Care.

1. Brush and floss daily.
2. Use fluoride products for added protection.
3. Stay consistent with your dental checkups.

Don’t let your dental hygiene slip! Book your appointment today and take the first step toward a healthier smile.
 

 

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Understanding Teeth Shifting and the Importance of Monitoring Dental Health

Maintaining a balanced bite and healthy gums is crucial for overall dental stability. However, some individuals may notice that their teeth are shifting over time. This can be a concerning development, but understanding the possible reasons behind it can help you take the necessary steps to address the issue.

Teeth shifting usually occurs due to excessive force, compromised support or a combination of both. Excessive force can stem from behaviors like heavy clenching, grinding, biting too hard or even trauma. On the other hand, compromised support might result from missing teeth, periodontal disease, bone loss or crowded teeth. Depending on the underlying cause of teeth shifting, different treatments may be recommended. If the issue is due to excessive force, options such as bite adjustments, night guards or orthodontic treatments like Invisalign® clear aligners may be effective. For compromised support, solutions might include replacing missing teeth with dental implants, straightening teeth with Invisalign, treating periodontal disease or undergoing bone regeneration therapy with laser treatments.

At Prime Dental Care, we utilize state-of-the-art digital scanners to document teeth positions, which is a valuable tool for monitoring your dental health. If you are experiencing teeth shifting, we encourage you to visit our beautiful Montgomery office. Mention this blog to receive a complimentary smile and teeth position evaluation with our advanced digital scanner.

Our skilled team, led by Dr. Joyce Ma, is trained to provide comprehensive care for all the dental issues mentioned above. We will conduct a thorough evaluation and offer the best recommendations tailored to your specific needs, with no strings attached!

At Prime Dental Care, we are committed to helping you achieve a healthy, beautiful smile. Dr. Joyce Ma and our dedicated dental team will work with you to evaluate your teeth and create a personalized treatment plan that meets your unique needs. Don’t hesitate to take the first step towards better dental health. Call us today at 908-450-7788 to schedule your consultation and learn more about restorative dentistry in Montgomery, New Jersey!

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