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Posts for: August, 2014
When a permanent tooth has been injured, our first priority should be to save it. A root canal treatment (where the interior pulp of the tooth is removed and the pulp chamber and root canals are filled and sealed) is usually the best approach for tooth preservation.
An immature permanent tooth, however, presents a different challenge. While the pulp is less essential to a mature tooth’s vitality, it serves a critical purpose in the tooth’s early development before early adulthood. The pulp produces layers of dentin necessary for the tooth’s root system development. Completely removing the pulp at this stage may retard root development and cause the tooth to eventually weaken, and become brittle and darkened.
For younger teeth, we should therefore use alternative techniques that preserve as much healthy pulp as possible. One of these alternatives is Indirect Pulp Therapy, used when the pulp hasn’t been exposed by the trauma. With this technique we remove as much damaged dentin as possible while preserving the harder dentin closer to the pulp. After applying an antibacterial agent to protect against infection, and then filling and sealing the tooth, the pulp can continue to produce dentin in a normal way.
If pulp exposure has occurred, some form of pulpotomy — the partial removal of any damaged or infected pulp — would be in order. Our goal here is to leave as much of the pulp as possible, and then apply substances that stimulate the remaining pulp to create dentin. The most common type of growth substances are calcium hydroxide or mineral trioxide aggregate (MTA).
If the pulp isn’t at all salvageable, we may then turn to a procedure known as apexification. After removing the pulp we insert MTA at the root end of the tooth, then fill and seal the remaining interior as in a regular root canal treatment. The MTA will help the surrounding bone to heal and continue to grow around the root to further support the tooth.
Recent research into pulp stem cells promises further advances in this area. The regenerative qualities of stem cells could eventually help us “engineer” root development. Until then, there are still effective ways to give a young, damaged tooth a fighting chance to survive.
If you would like more information on preserving injured 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 “Saving New Permanent Teeth After Injury.”
What happens if you’re right in the middle of a song, in front of an arena full of fans… and you knock out a tooth with your microphone? If you’re Michael Buble, you don’t stop the show — you just keep right on singing.
The Canadian song stylist was recently performing at the Allphones Arena in Sydney, Australia, when an ill-timed encounter with the mike resulted in the loss of one of his teeth. But he didn’t let on to his dental dilemma, and finished the concert without a pause. The next day, Buble revealed the injury to his fans on his Instagram page, with a picture of himself in the dentist’s chair, and a note: “Don’t worry, I’m at the dentist getting fixed up for my final show tonight.”
Buble’s not the only singer who has had a close encounter with a mike: Country chanteuse Taylor Swift and pop star Demi Lovato, among others, have injured their teeth on stage. Fortunately, contemporary dentistry can take care of problems like this quickly and painlessly. So when you’ve got to get back before the public eye, what’s the best (and speediest) way to fix a chipped or broken tooth?
It depends on exactly what’s wrong. If it’s a small chip, cosmetic bonding might be the answer. Bonding uses special tooth-colored resins that mimic the natural shade and luster of your teeth. The whole procedure is done right here in the dental office, usually in just one visit. However, bonding isn’t as long-lasting as some other tooth-restoration methods, and it can’t fix large chips or breaks.
If a tooth’s roots are intact, a crown (or cap) can be used to replace the entire visible part. The damaged tooth is fitted for a custom-fabricated replacement, which is usually made in a dental laboratory and then attached at a subsequent visit (though it can sometimes be fabricated with high-tech machinery right in the office).
If the roots aren’t viable, you may have the option of a bridge or a dental implant. With a fixed bridge, the prosthetic tooth is supported by crowns that are placed on healthy teeth on either side of the gap. The bridge itself is a one-piece unit consisting of the replacement tooth plus the adjacent crowns.
In contrast, a high-tech dental implant is a replacement tooth that’s supported not by your other teeth, but by a screw-like post of titanium metal, which is inserted into the jaw in a minor surgical procedure. Dental implants have the highest success rate of any tooth-replacement method (over 95 percent); they help preserve the quality of bone on the jaw; and they don’t result in weakening the adjacent, healthy teeth — which makes implants the treatment of choice for many people.
So whether you’re crooning for ten thousand adoring fans or just singing in the shower, there's no reason to let a broken tooth stop the show: Talk to us about your tooth-restoration options! If you would like additional information, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Dental Implants vs. Bridgework.”
Periodontal (gum) disease is an infectious disease that progressively weakens the attachment of supporting tissues to the teeth, including gums, ligaments and bone. If not stopped, the loss of attachment will eventually lead to bone and tooth loss.
A thin layer of plaque that builds up on teeth (mainly due to poor oral hygiene habits) is the main breeding ground for the bacteria that cause gum disease. Our main treatment goal is to remove as much of this plaque as possible from tooth and gum surfaces. Much of the plaque can be removed using special hand or ultrasonic instruments that deep clean dental surfaces, including the roots. But while effective, these manual techniques may not address the full extent of infection, especially if the disease is well advanced.
If severe bone loss has already occurred, deep pockets of infection may have developed. As bone loss progresses, teeth with multiple roots may also develop an anatomical problem known as furcation invasions where the roots of the tooth branch off. If there continues to be signs of disease, like gum inflammation, bleeding or pus formation, it’s these hard to reach areas that may still be a problem even after extensive treatment. If so, we may need to take a different approach with antimicrobial or antibiotic products.
The most effective antimicrobial substance for reducing bacteria in biofilm is a chlorhexidine mouthrinse. The typical 0.12% solution is only available by prescription — if taken for a prolonged time it can result in tooth staining, affected taste or mouth irritation. To assure the solution reaches below the gum line, it will need to be applied by us in the office, followed up flushing irrigation of the affected area.
Another alternative is topically applied antibiotics that can stop or even reverse the progression of gum disease. There’s evidence that topical applications can penetrate into these deeper areas of infection. A common antibiotic used in this way is tetracycline, which has been shown to stop inflammation and infection.
These treatments don’t eliminate the need for mechanical cleaning, and the prolonged use of antibacterial products can have a detrimental effect on “good” bacteria (needed, for example, to complete the digestive process). It will depend on the extent of the gum disease to determine how successful conservative treatment may be. It’s also important that you contribute to your own dental health with a renewed daily oral hygiene habit.
If you would like more information on treatments for 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 “Treating Difficult Areas of Periodontal Disease.”