You depend on your family dentist for most of your oral care. There are some situations, though, that are best handled by a specialist. If you or a family member has a deeply decayed tooth, for example, it might be in your long-term interest to see an endodontist.
From the Greek words, endo ("within") and odont ("tooth"), endodontics focuses on dental care involving a tooth's interior layers, including the pulp, root canals and roots. While general dentists can treat many endodontic problems, an endodontist has the advanced equipment and techniques to handle more complex cases.
The majority of an endodontist's work involves teeth inwardly affected by tooth decay. The infection has moved beyond the initial cavity created in the enamel and dentin layers and advanced into the pulp and root canals. The roots and underlying bone are in danger of infection, which can endanger the tooth's survival.
The most common treatment is root canal therapy, in which all of the infected tissue is removed from the pulp and root canals. Afterward, the empty spaces are filled and the tooth is sealed and crowned to prevent future infection. General dentists can perform this treatment, primarily with teeth having a single root and less intricate root canal networks. But teeth with multiple roots are a more challenging root canal procedure.
Teeth with multiple roots may have several root canals needing treatment, many of which can be quite small. An endodontist uses a surgical microscope and other specialized equipment, as well as advanced techniques, to ensure all of these inner passageways are disinfected and filled. Additionally, an endodontist is often preferred for previously root-canaled teeth that have been re-infected or conditions that can't be addressed by a traditional root canal procedure.
While your dentist may refer you to an endodontist for a problem tooth, you don't have to wait. You can make an appointment if you think your condition warrants it. Check out the American Association of Endodontists webpage www.aae.org/find for a list of endodontists in your area.
Advanced tooth decay can put your dental health at risk. But an endodontist might be the best choice to overcome that threat and save your tooth.
If you would like more information on endodontic dentistry, 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 “Why See an Endodontist?”
A disease happening in one part of your body doesn’t necessarily stay there. Even a localized infection could eventually affect your general health. Periodontal (gum) disease, a bacterial infection that damages gums, teeth and supporting bone, is a case in point.
There’s now growing evidence that gum disease shares links with some other serious systemic diseases. Here are 4 serious health conditions and how gum disease could affect them.
Diabetes. Gum disease could make managing diabetes more difficult—and vice-versa. Chronic inflammation occurs in both conditions, which can then aggravate the other. Diabetics must deal with higher than normal glucose levels, which can also feed oral bacteria and worsen existing gum disease. On the plus side, though, effectively managing both conditions can lessen each one’s health impact.
Heart disease. Gum disease can worsen an existing heart condition and increase the risk of stroke. Researchers have found evidence that chronic inflammation from gum disease could further damage already weakened blood vessels and increase blood clot risks. Treating gum disease aggressively, on the other hand, could lower blood pressure as much as 13 points.
Rheumatoid Arthritis. The increased inflammatory response that accompanies arthritis (and other diseases like lupus or inflammatory bowel disease) can contribute to a higher risk for gum disease. As with the other conditions previously mentioned, chronic inflammation from a gum infection can also aggravate arthritis symptoms. Treating any form of chronic inflammation can ease symptoms in both arthritis and gum disease.
Alzheimer’s disease. The links of Alzheimer’s disease to gum disease are in the numbers: a recent study found people over 70 who’ve had gum disease for ten or more years were 70% more likely to develop dementia than those with healthy gums. There is also evidence that individuals with both Alzheimer’s and gum disease tended to decline more rapidly than those without gum disease.
From the accumulating evidence, researchers now view gum disease as more than an oral problem—it could impact your total health. That’s why you should adopt a disease prevention strategy with daily brushing and flossing and regular dental visits (or whenever you notice puffy, reddened or bleeding gums). Stopping gum disease could provide you a health benefit well beyond preserving your teeth and gums.
Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.
Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.
TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.
There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.
Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.
For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.
One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.
The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.
If you would like more information on trigeminal neuralgia, 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 “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
One of the key elements in a child’s development is their first set of teeth. Although primary (“baby”) teeth last only a few years, they’re critically important for enabling a child to eat solid foods, speak and smile.
But they also provide one more important benefit—they hold the space in the jaw reserved for the permanent teeth developing just under the gums until they erupt. But if a child loses a primary tooth prematurely because of disease or injury, other teeth may drift into the vacant space and crowd it out for the intended permanent tooth. It may then come in misaligned or remain stuck within the gums (impaction).
To avoid this, we try to treat and preserve a diseased primary tooth if at all practical. For a primary molar, one of the large teeth in the back of the mouth, this might include capping it with a stainless steel crown.
Why a metal crown? Primary molars normally don’t fall out until around ages 10-12, so it may be years for a younger child before their permanent molars erupt. All during that time these particular teeth will encounter heavier biting forces than teeth in the front.
A steel crown is often the best solution for a molar given their longer lifespans and encountered biting forces. The crown’s metal construction can stand up to these forces while still protecting the tooth from re-infection from decay. And because molars are typically outside of the “smile zone” occupied by more visible front teeth, the crown’s metal appearance isn’t usually an aesthetic issue.
Crowning a molar usually takes one visit, a dentist typically performing the procedure with local anesthesia and possibly a mild sedative like nitrous oxide gas (“laughing gas”). After removing any decayed structure from the tooth, the dentist will then fit a pre-formed crown over the remaining structure, sized and shaped to match the original tooth as close as possible.
A stainless steel crown is a cost-effective way to added needed years to a primary molar that could otherwise be lost prematurely. Preserving it may help a child avoid bite problems and expensive future treatments.
If you would like more information on dental care for primary teeth, 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 “Stainless Steel Crowns for Kids: A Safe and Effective Way to Restore Primary Molars.”
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