Your tooth is in peril if its innermost layer, the pulp, becomes infected and inflamed. Deep tooth decay, repeated dental procedures or fractures can all expose the pulp and ultimately the roots to infection and lead to tooth loss.
But that scenario isn't inevitable — we can often save the tooth with a root canal treatment. By accessing the tooth's interior through a prepared hole, we're able to clean out the infected tissue in the pulp chamber and root canals, and fill the empty space with a special filling. We then cap the tooth with a custom crown to protect it from a re-infection.
Root canal treatments have a very high success rate — chances are good your tooth will survive for many years afterward. But there's a slight chance the tooth may become re-infected; in that case, a second root canal treatment may be in order.
In a few cases, though, a second root canal may not be advisable, and could even accelerate damage to the tooth. For example, if past dental work resulted in an extensive crown restoration, accessing the root canals the conventional way will require disassembling that restoration. This could weaken the tooth significantly.
We can approach the problem from a different route: instead of accessing the tooth's interior through the crown (the visible part of the tooth), we instead perform a surgical procedure called an apicoectomy, which accesses the tooth at the root end through the gums.
In this procedure we numb the area with local anesthesia and then make a small incision through the gums at the level of the affected root. After access, we remove any diseased tissue around the root and a few millimeters of the root tip itself. We then insert a small filling in its place to seal the canal and prevent further infection. In some cases we may also insert a graft to encourage bone growth and aid in healing.
Over time, the affected area will heal and return to normal function. Even if a traditional root canal treatment can't be used, an apicoectomy could be another option for saving your tooth.
If you would like more information on your options for preserving a problem tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Apicoectomy.”
Are bleeding gums something you should be concerned about? Dear Doctor magazine recently posed that question to Dr. Travis Stork, an emergency room physician and host of the syndicated TV show The Doctors. He answered with two questions of his own: “If you started bleeding from your eyeball, would you seek medical attention?” Needless to say, most everyone would. “So,” he asked, “why is it that when we bleed all the time when we floss that we think it’s no big deal?” As it turns out, that’s an excellent question — and one that’s often misunderstood.
First of all, let’s clarify what we mean by “bleeding all the time.” As many as 90 percent of people occasionally experience bleeding gums when they clean their teeth — particularly if they don’t do it often, or are just starting a flossing routine. But if your gums bleed regularly when you brush or floss, it almost certainly means there’s a problem. Many think bleeding gums is a sign they are brushing too hard; this is possible, but unlikely. It’s much more probable that irritated and bleeding gums are a sign of periodontal (gum) disease.
How common is this malady? According to the U.S. Centers for Disease Control, nearly half of allÂ Americans over age 30 have mild, moderate or severe gum disease — and that number increases to 70.1 percent for those over 65! Periodontal disease can occur when a bacteria-rich biofilm in the mouth (also called plaque) is allowed to build up on tooth and gum surfaces. Plaque causes the gums to become inflamed, as the immune system responds to the bacteria. Eventually, this can cause gum tissue to pull away from the teeth, forming bacteria-filled “pockets” under the gum surface. If left untreated, it can lead to more serious infection, and even tooth loss.
What should you do if your gums bleed regularly when brushing or flossing? The first step is to come in for a thorough examination. In combination with a regular oral exam (and possibly x-rays or other diagnostic tests), a simple (and painless) instrument called a periodontal probe can be used to determine how far any periodontal disease may have progressed. Armed with this information, we can determine the most effective way to fight the battle against gum disease.
Above all, don’t wait too long to come in for an exam! As Dr. Stork notes, bleeding gums are “a sign that things aren’t quite right.” Â If you would like more information about bleeding gums, please contact us or schedule an appointment. You can read more in the Dear Doctor magazine article “Bleeding Gums.” You can read the entire interview with Dr. Travis Stork in Dear Doctor magazine.
It’s something you think about often—especially when you look in a mirror or at a photo of yourself. You wish something could have been done about it a long time ago. But now you think you’re too old to correct your misaligned teeth—your “crooked” smile.
Actually, you can transform your smile through orthodontics, whatever your age. Millions of your peers have done just that—currently, an estimated one in five orthodontic patients is an adult.
If orthodontics isn’t right for you it won’t be because of age, but most likely the condition of your gums and underlying bone or your overall health. That first factor is extremely important: if you’ve lost a significant amount of bone due to periodontal (gum) disease, there may not be enough to support the force of moving the teeth during orthodontics.
Health conditions like severe heart-valve disease, uncontrolled diabetes or drugs to treat arthritis or osteoporosis can also make tooth movement difficult. And, if you have restricted saliva flow (dry mouth), wearing orthodontic devices could be uncomfortable and increase your risk of tooth decay.
If, however, your mouth and body are reasonably healthy (and you don’t have a difficult bite problem to correct), there’s no reason why you can’t undergo orthodontic treatment. The only other thing that might hold you back is concern over your appearance during treatment. Many adults balk at the possible embarrassment of wearing metal braces “at their age.”
If this is a concern, you may have an alternative: clear aligners. These are a series of computer-generated clear plastic trays that conform to the individual contours of your teeth. Each tray is slightly different—you wear one for a short period of time (usually two weeks) before moving on to the next tray to successively and gradually move your teeth. They’re nearly invisible to others and, unlike fixed metal braces, you can take them out for a rare special occasion.
The only way you’ll know whether correcting your misaligned teeth is a viable option is to undergo a full orthodontic evaluation. From there we can help you decide if and how you want to gain a straighter, more attractive smile.
If you would like more information on adult orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Orthodontics for the Older Adult.”
While it may not be one of your favorite features in the dental office, the dental drill is nevertheless necessary for treating problem teeth. It’s used primarily for removing decayed or damaged structure and preparing a tooth for fillings or other restorations.
Dental drills have been used for decades and are quite effective — but they have their drawbacks. Their rotating burrs often remove portions of healthy tooth structure along with decayed material. Friction from the drill action can cause discomfort, so local anesthesia is usually needed. Drills can also emit a high-pitched machine noise that’s unsettling to many patients.
There’s a growing alternative to the drill, known as air abrasion. Although the technology has been around since the 1950s, the development of new suction pumps that capture the resulting dust from its use has made it more palatable as an option to the traditional drill.
Also known as particle abrasion, the technique uses a pressurized stream of fine particles (usually aluminum oxide, an abrasive powder) directed at teeth to wear away (abrade) the tooth’s structural surface. We can be quite precise in the amount of surface material removed, so it’s useful for diminishing stains or roughing the surface for bonding materials like composite resin. We’re also able to remove decayed material with very little impact on surrounding healthy structure, and you may not need anesthesia during the procedure.
While this quiet alternative to the noisier drill is quite versatile, it does have its limitations. It’s not that efficient for preparing larger cavities for restoration or for removing older amalgam fillings. The teeth to be treated must be carefully isolated to prevent the fine particle dust produced from being swallowed by the patient or spread into the air. High-volume suction equipment is a must or the procedure will create a “sandstorm” of particles in the room.
Still, for situations suited to it and with proper isolation measures, air abrasion can be effective and comfortable. If the technology continues to improve, the dental drill may soon become a relic of the past.
If you would like more information on procedures using air abrasion, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Air Abrasion Technology.”
People with diabetes have special concerns when it comes to dental care. In fact, 1 in every 5 cases of total tooth loss is linked to this widespread health condition. November is National Diabetes month, so it’s a good opportunity for us to answer some frequently asked questions about oral health and diabetes.
Q. Can I get a dental implant to replace a missing tooth even if I have diabetes?
A number of studies have shown that people with diabetes can be good candidates for dental implants, but there are some concerns regarding dental implant treatment, which involves minor surgery. Wounds tend to heal more slowly in people with diabetes, who are also more infection-prone than those without diabetes. In diabetic individuals with poor glucose control, research has also shown that it takes longer for the bone to heal after implant placement. We will take these (and other) factors into account when planning your implant treatment. However, in many situations even poorly controlled diabetes does not necessarily preclude dental implant treatment.
Q. I’ve heard people with diabetes have a higher risk for gum disease. Is that true?
Yes. Research shows that people with diabetes are more susceptible to periodontal (gum) disease, especially when their diabetes is poorly controlled. The reverse is also true: untreated periodontal disease can worsen blood sugar levels. So it’s important to manage both of these inflammatory conditions. If you notice the early signs of gum disease, such as inflamed or bleeding gums, please bring this to our attention. Early gum disease (gingivitis) is much easier to treat than more advanced forms—which can eventually lead to tooth loss.
Q. If I have diabetes, how can I protect my oral health?
Keep doing your best to control your blood sugar levels with exercise and a healthy diet—and stick to an effective daily oral hygiene routine, which includes both brushing and flossing and coming in for regular dental checkups and cleanings. Make sure to let us know what medications you are taking and update us on any changes. If you notice any mouth sores, swelling or inflammation, bring this to our attention as soon as possible.
This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.