Dental patients have amazing options for tooth replacement. Dental implants, for example, can replace the entire tooth, root and crown, giving patients a new tooth nearly as good as the old one.
Nearly—but not exact. Even implants can't match the full benefits of a natural tooth, including one in less than perfect shape. Our first goal as dentists, then, is to save a diseased tooth if at all practical before considering replacing it.
That often involves a root canal treatment to address decay threatening a tooth's interior. The procedure requires drilling into the tooth to access its innermost pulp, cleaning out the pulp and root canals, and then filling the empty spaces. Since all dentists are trained in basic root canal treatment, your general dentist may be able to perform it.
But some dental situations call for more advanced endodontics, the dental specialty for treating disease and other problems inside a tooth. So, in what situations would you see an endodontist?
When your dentist refers you. Your dentist wants you to receive the level of treatment necessary to save your tooth. After examination, they may determine your situation would be better served by the advanced training, equipment and techniques (including surgery) of an endodontist.
When your tooth has complications. Patients often need an endodontist when existing factors complicate treatment of advanced tooth decay. A patient may have dental pain that's difficult to pinpoint, requiring the diagnostic resources of an endodontist. It's also common for a tooth's root canal network to be highly intricate, and which respond better to treatment with specialized endodontic tools and techniques.
When root canal treatment fails. Most root canal treatments are successful in protecting the tooth from further infection. That said, it's still possible for a root-canaled tooth to become re-infected or develop more problems. Again, an endodontist and their “tool chest“ re-treating a root-canaled tooth may be the best option for saving it.
You also don't have to wait for a referral—you can see an endodontist if you believe they would be best to treat your decayed tooth. You can find one near you by visiting an online endodontist directory at www.aae.org/find. An endodontist may be the lifesaver your diseased tooth needs.
We all benefit from regular dental care, regardless of our state of oral health. But if you've experienced periodontal (gum) disease, those regular dental visits are even more important in making sure your healed gums stay that way.
Gum disease is a bacterial infection caused by dental plaque, a thin film of bacteria and food particles accumulating on tooth surfaces. The infection triggers inflammation in the gums that quickly becomes chronic. That's why people with gum disease have reddened and swollen gums that bleed easily.
The infection can aggressively spread deeper below the gum line, eventually affecting the bone. The combination of weakened gum detachment from the teeth and bone loss may ultimately cause tooth loss. But we can stop the infection by thoroughly removing all plaque and tartar (hardened plaque) from the teeth and gums. As the plaque is removed, the gums respond and begin to heal.
It's possible then even with advanced gum disease to restore health to your teeth and gums. But although the infection has been arrested, it can occur again. In fact, once you've had gum disease, your susceptibility for another infection is much greater. To stay on top of this, you may need to visit the dentist more frequently.
These upgraded visits known as periodontal maintenance (PM) are actually a continuation of your treatment. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for example, may need a visit every two to three months. Again, the state of your gum health will determine how often.
In addition to standard dental cleanings and checkups, PM visits will also include more thorough examination of the teeth and gums, particularly the health of the tooth roots. We'll also check how well you're doing with daily plaque removal and if there are any signs of gum infection. We may also prescribe medication, rinses or topical antibiotics to help control your mouth's levels of bacteria.
A patient's periodontal “maintenance schedule” will depend on their individual condition and needs. The key, though, is to closely monitor gum health for any indications that another infection has set in. By staying alert through dedicated PM, we can stop a new infection before it harms your dental health.
If you would like more information on 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 “Periodontal Cleanings.”
This year's Carol Burnett Award, presented at the Golden Globes, goes to Ellen DeGeneres for her “outstanding contributions to the television medium on or off the screen.” This is the latest in a long list of honors for the comedienne, talk show host and activist that includes Emmys, Grammys and Teen Choice Awards. And one not quite as well-known: a 2004 “Flossy” award.
DeGeneres received this honor from the National Flossing Council in recognition of her passionate promotion of oral hygiene, particularly flossing. She wrote about its virtues in her 2003 book, The Funny Thing Is…., saying, among other things, “Don't even think for a second that you can get away with not flossing.”
DeGeneres's motivational cheerleading for flossing is helpful and necessary because, well, many of us just don't like doing it. It requires more manual dexterity than its more popular sibling, brushing. And the tendency for the floss to gunk up with plaque residue for some is simply unpleasant.
Mainly, though, many folks think brushing is enough. Not so fast, according to dental professionals. While brushing removes disease-causing bacterial plaque from broad tooth surfaces, it can't effectively get into the spaces between teeth. It takes flossing to clear plaque from these more difficult areas.
But don't fret: There are ways to make flossing an easier—and more pleasant—task.
Ask us for help. As we said before, flossing does take some hand dexterity and coordination to perform. You may also wonder if you're doing it effectively. We can provide training and tips on how to be a more effective flosser at your next visit.
Practice, practice, practice. You probably think nothing of riding a bicycle, and yet it probably took you weeks or months as a kid to become proficient. Similarly, your first attempts at flossing might feel awkward, but you'll improve with practice, so don't give up.
Brush before you floss. Most people floss before brushing, but if you tend to encounter a lot of soft plaque debris that makes flossing “icky” for you, then try brushing first to clear a good portion of it out of the way before you floss. Just be aware, most professionals believe that flossing first is better because it loosens up debris between teeth so the bubbles from the toothpaste can carry it away. But any flossing is better than no flossing!
Try flossing tools. For some people, floss picks, small pre-threaded tools you can use with one hand, seem easier to maneuver than regular floss thread. If you have issues with manual dexterity, an oral irrigator can make the task easier: This handheld device uses a stream of pressurized water to loosen and flush away plaque between teeth.
So, follow Ellen DeGeneres's advice she gave Tulane University graduates during a commencement speech: “Remember to exfoliate, moisturize, exercise…and floss.” The latter, along with brushing, will certainly help keep your teeth and gums healthy.
Most of us have no clue how the ancient holiday tradition of kissing under the mistletoe originated—but it sure doesn't stop us from keeping the tradition alive! Yet although eager to join a certain someone under the hanging twig, you still might hesitate to apply the old smackeroo out of fear your breath isn't as fresh as it should be.
Bad breath has tormented us humans long before we started osculating (kissing) under trimmings of viscum album (the scientific name for mistletoe). Our resulting discomfort has inspired a myriad of remedies, from ancient Egyptian toothpastes containing natron (also used in embalming mummies) to 19th Century American breath mints made of ingredients like cardamom, essence of rose and licorice root.
Today, we're much better at relieving common bad breath because we've uncovered its primary source: bits of food and mucus accompanied by oral bacteria on undisturbed areas the mouth, particularly the tongue. As the debris interacts with the bacteria, it releases chemical compounds called VSCs (volatile sulfur compounds) that emit a classic rotten egg smell.
The key then is to remove the source of these VSCs. You might think that means doing a better job of brushing and flossing, and you're right. But it can involve more.
Keeping your tongue clean. Since the tongue is a prime collecting point for debris and bacteria, it makes sense to keep it clean. That might simply mean brushing its surface when you brush your teeth. You might, however, benefit from using a tongue scraper if you have more stubborn accumulations.
Maintaining your dentures. These and other dental appliances can accumulate food debris that if not removed can cause a “stink.” You should clean dentures daily using a denture cleaner or mild antibacterial soap and then rinse them off thoroughly. It also helps to take them out at bedtime.
Seeking dental care. Another source of bad breath could be tooth decay or gum disease, or even older dental work in need of repair. Treating these and other conditions (like an oral yeast infection) not only improves your dental health, it could do wonders for your breath.
There are also other sources of foul breath unrelated to the mouth—and some can be serious diseases like diabetes, cancer or lung infections. If your chronic bad breath doesn't respond to your hygiene efforts, it's a good idea to get checked medically.
Now as to holiday traditions, we can't help you maneuver your prospective sweetheart under the mistletoe with you—you're on your own, pal (or gal). But by following these tips for sound oral care, we're sure you'll have the “fresh breath” confidence to follow through from there.
What a difference forty years can make: Dental bridges once occupied the top spot for choices to replace missing teeth until the arrival of dental implants in the 1980s. Today, dental implants are the gold standard for dental restoration.
But although bridgework may have lost “first chair” in the orchestra of restorations, it's still a viable option. In fact, it can be the best option in certain situations.
Bridges consist of a series of porcelain crowns fused together like fence pickets. The center crowns, known as the pontics, “bridge” the gap left by a missing tooth or teeth. The crowns on each end, the abutment teeth, crown the natural teeth on either side of the gap to support the bridge.
Bridges are effective and durable, but with a major downside: To accommodate the abutment crowns, we must reduce the size of the natural teeth to which they'll be attached. This alteration can weaken those teeth's structure and require them from then on to have some form of restoration. They're also at higher risk for tooth decay.
Implants, on the other hand, don't require this alteration, and may also be more durable than bridges. Why then consider a bridge?
Price can be a factor: Implants may be more expensive, especially involving multiple teeth. Keep in mind, though, that this only compares the initial cost: Because implants have a 95% or more ten-year success rate, with further evidence they could potentially last for decades, they may actually cost less in the long-run than bridge restorations that have a higher chance of being replaced sooner.
But the prime reason is that some dental situations aren't suitable for dental implants. For instance, implants require a certain amount of bone for proper placement, so people with extensive bone loss may not be able to acquire them. Health conditions like uncontrolled diabetes or a compromised immune system can also complicate implant installation. A bridge in these cases may represent a better alternative.
With the help of your dentist, you'll need to consider your individual situation, dental and financial, in deciding between an implant or a bridge. And, if a dental bridge is your best option, it will be a solid choice for restoring your missing teeth and your smile.
If you would like more information on various dental restoration methods, 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 “Crowns & Bridgework.”
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