Posts for: January, 2019
There’s one sure thing about tooth decay: you can’t ignore it. In fact, the best outcomes result from finding it early and treating it before it enters the pulp in the center of the tooth, often a filling or similar treatment.
If it does advance to the pulp, you may need a root canal treatment to save the tooth. This is a moderately invasive procedure where we access the pulp and root canals, tiny passageways leading to the root and supporting bone. We then remove all the diseased tissue and fill the empty pulp chamber and root canals with a special filling. Later we’ll crown the tooth for added protection against future infection or fracture of the tooth.
But there’s also another less-invasive method than a root canal called pulp capping. It’s only appropriate to use, however, if the pulp has become exposed or almost exposed by decay, but hasn’t yet shown signs of disease.
Pulp capping can be either direct or indirect. We use direct pulp capping if the healthy pulp has been exposed by the disease process. We first isolate the tooth from the rest of the mouth to prevent contamination and then proceed to remove all of the tooth’s decayed dentin structure. We then apply a biocompatible material directly over the pulp to protect it from further decay and to facilitate healing. We then restore the tooth, usually with a filling, to its proper function and life-like appearance.
When the pulp is threatened by decay but not yet exposed, we may then use the indirect method. In this approach we first remove most of the decayed dentin, but leave a small amount next to the pulp to keep it covered. We then treat this remaining dentin with a material to help it heal and re-mineralize, followed by a temporary filling of the tooth. A few months later we’ll remove this filling and inspect the treated dentin. If it has regenerated sufficiently, we remove any remaining decay and permanently restore the tooth.
As we said, pulp capping is only used with patients with deep decay whose pulp tissue is healthy. But when we can use it we can avoid some of the permanent alterations that often come with a root canal treatment and still save the tooth.
If you would like more information on treatments for tooth decay, 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 “Pulp Capping: A Procedure that May Save a Decayed Tooth.”
It’s likely you depend on your regular dentist for the lion’s share of your dental care. But in cases of advanced disease or trauma, you may need the services of a dental specialist.
This could be the case with periodontal (gum) disease, a bacterial infection triggered by a thin biofilm on tooth surfaces called dental plaque that isn’t adequately removed through daily oral hygiene practices. While your regular dentist can effectively treat many forms of gum disease, there are times when you should see a periodontist who specializes in the gum, supporting bone and connective tissues.
So, when should you see a periodontist for gum disease treatment? Here are 3 situations that may call for this important dental specialist.
If your dentist refers you. Your dentist may be quite proficient in treating gum disease, mainly by removing the dental plaque and tartar sustaining the infection. But if the infection has advanced deep within the gum tissues especially around the roots and bone, you may need more advanced measures, including surgery, performed by a periodontist.
If you’d like a second opinion. Of course, you don’t need a referral to see a periodontist. You can make an appointment with one for another opinion about your diagnosis and recommended treatment plan. If you choose to see a periodontist, make sure they have access to all your dental and medical records, as well as your past health history.
If you have other health issues. Gum disease often doesn’t occur in a vacuum – it may exist and even influence (or be influenced by) other inflammatory medical conditions. If you have such a condition like diabetes or cardiovascular disease, you may opt to see a periodontist first for a more comprehensive evaluation.
In the meantime, keep an eye out for the first signs of disease including red, swollen or bleeding gums (if you smoke, be aware smoking hides these signs of disease). And practice daily brushing and flossing as well as obtaining regular dental cleanings to keep plaque accumulation to minimum. Preventing gum disease and getting treatment as early as possible may help you avoid more invasive treatments later.
If you would like more information on treating gum disease, 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 “When to See a Periodontist.”
We've known for decades that fluoride strengthens tooth enamel and lowers the risk for decay. And while adding it to toothpaste and drinking water are the more common ways for getting it into the body, an increasingly popular way—especially for children—is to apply fluoride directly to the teeth.
But is topical fluoride really worth the effort and expense? And, are there any side effects to treating teeth this way?
As to the first question, researchers have performed numerous studies measuring fluoride's effectiveness for preventing tooth decay. The Cochrane Oral Health Research Group recently reviewed studies on topical fluoride applications involving nearly 10,000 children and adolescents between the ages of 2 and 15. The combined average for all the studies showed a 28% reduction in decayed teeth for patients who received topical fluoride compared to those who didn't.
This was especially true for children at high risk for decay: directly applying fluoride gels, foams or varnishes to teeth reduces that risk substantially. But there are also side effects to this application. Fluoride in general has only one known safety concern, a condition known as fluorosis. Too much fluoride over time can cause heavy discoloration of the teeth. This does not affect the health of the teeth, but it can look unattractive and require cosmetic treatment to reduce its effect.
There's little to no risk for fluorosis with the controlled treatments offered by dentists; the fluoride solution remains on the teeth no more than a few minutes. But there is a possible side effect during treatment due to the relatively high dose of fluoride used. If the patient accidentally swallows some of the solution, the concentration of fluoride can cause stomach upset, vomiting or headaches.
Dentists minimize the chances for this by usually using the more difficult to swallow varnish form of topical fluoride on younger patients, and using trays or other barrier devices to isolate the fluoride solution from the rest of the mouth. Under professional supervision, it's rare for an accidental ingestion to occur.
The risks for these side effects are quite low, and the benefits of topical fluoride for reducing the chances for decay can more than outweigh them. Fluoride applications are one of many ways we can protect your child's current and future dental health.
If you would like more information on decay prevention techniques like topical fluoride, 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 “Fluoride Gels Reduce Decay.”