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.”
Proponents of legalized marijuana have won phenomenal gains over the last decade. Despite the federal government's continuing criminalization of the drug, several states including California, Colorado and Massachusetts, have voted to legalize its recreational use.
Most people are aware of the social and political controversies the marijuana legalization movement stirs. But there's another side to this roiling issue: the health effects of marijuana, particularly for your teeth and gums. What may be lost beneath the more exciting headlines about ballot initiatives is the growing evidence that habitual marijuana use may increase the risk and severity of periodontal (gum) disease.
Gum disease is a bacterial infection caused by dental plaque, a thin film of bacteria and food particles that accumulates on teeth. The spreading infection triggers inflammation, a normal bodily response to disease that's ordinarily beneficial. But if the inflammation becomes chronic it weakens the gums' attachment to the teeth. This can create voids or periodontal pockets of infection around the teeth. The disease can eventually damage the underlying bone, which could accelerate tooth loss.
Poor oral hygiene is the biggest factor for an increased risk of gum disease; thinner gum tissue (an inherited condition or related to poor tooth position) is another factor, as well as lifestyle habits like tobacco use or excessive alcohol consumption. Add marijuana to the list: there's now some evidence that its use increases the risk for more severe periodontal pockets if the disease occurs.
In a recent study, researchers with the Columbia University College of Dental Medicine reviewed statistics on the care for nearly 2,000 adult patients; a quarter of those in the study were frequent marijuana users. The marijuana users proportionately had deeper periodontal pocket occurrences than the rest of the patients in the study that didn't use the drug.
The study doesn't say that marijuana causes periodontal (gum) disease. But it does suggest that marijuana use might increase its severity. As with other substances and practices in our society, marijuana use comes with a caveat: it may be legal where you live, but it may not necessarily be good for your health.
If you would like more information on the effects of marijuana use on your oral health, 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 “As More States Legalize Marijuana, Link to Gum Disease is a Concern.”
If there's anything that makes Alfonso Ribeiro happier than his long-running gig as host of America's Funniest Home Videos, it's the time he gets to spend with his family: his wife Angela, their two young sons, and Alfonso's teenaged daughter. As the proud dad told Dear Doctor–Dentistry & Oral Health magazine, "The best part of being a father is the smiles and the warmth you get from your children."
Because Alfonso and Angela want to make sure those little smiles stay healthy, they are careful to keep on top of their kids' oral health at home—and with regular checkups at the dental office. If you, too, want to help your children get on the road to good oral health, here are five tips:
- Start off Right—Even before teeth emerge, gently wipe baby's gums with a clean, moist washcloth. When the first teeth appear, brush them with a tiny dab of fluoride on a soft-bristled toothbrush. Schedule an age-one dental visit for a complete evaluation, and to help your child get accustomed to the dental office.
- Teach Them Well—When they're first learning how to take care of their teeth, most kids need a lot of help. Be patient as you demonstrate the proper way to brush and floss…over and over again. When they're ready, let them try it themselves—but keep an eye on their progress, and offer help when it's needed.
- Watch What They Eat & Drink—Consuming foods high in sugar or starch may give kids momentary satisfaction…but these substances also feed the harmful bacteria that cause tooth decay. The same goes for sodas, juices and acidic drinks—the major sources of sugar in many children's diets. If you allow sugary snacks, limit them to around mealtimes—that gives the mouth a chance to recover its natural balance.
- Keep Up the Good Work—That means brushing twice a day and flossing at least once a day, every single day. If motivation is an issue, encourage your kids by letting them pick out a special brush, toothpaste or floss. You can also give stickers, or use a chart to show progress and provide a reward after a certain period of time. And don't forget to give them a good example to follow!
- Get Regular Dental Checkups—This applies to both kids and adults, but it's especially important during the years when they are rapidly growing! Timely treatment with sealants, topical fluoride applications or fillings can often help keep a small problem from turning into a major headache.
Bringing your kids to the dental office early—and regularly—is the best way to set them up for a lifetime of good checkups…even if they're a little nervous at first. Speaking of his youngest child, Alfonso Ribeiro said "I think the first time he was really frightened, but then the dentist made him feel better—and so since then, going back, it's actually a nice experience." Our goal is to provide this experience for every patient.
If you have questions about your child's dental hygiene routine, call the office or schedule a consultation. You can learn more in the Dear Doctor magazine article “How to Help Your Child Develop the Best Habits for Oral Health.”
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.”
Dental veneers, thin layers of porcelain bonded to chipped, stained or slightly crooked teeth, are an effective and affordable way to transform your smile. Their color, translucence and shape blend so well with the rest of your teeth that it's often difficult to tell them apart.
But traditional veneers have one drawback: although they're less than a millimeter in width, they can still appear bulky on unprepared teeth. To help them look more natural, we often have to remove some of the enamel layer from the tooth surface. Enamel doesn't grow back, so this alteration is permanent and the prepared teeth will require a restoration from then on.
But you may be able to avoid this—or at least keep the alteration to a minimum—with no-prep or minimal-prep veneers, two new exciting choices in cosmetic dentistry. About the width of a contact lens, we can bond these much thinner veneers to teeth with virtually no preparation at all or, in the case of a minimal-prep veneer, needing only an abrasive tool to reshape and remove only a tiny bit of the enamel.
These ultra thin veneers are best for teeth with healthy enamel, and can be placed in as few as two appointments. And besides being less invasive, the procedure is reversible—we can remove them and you can return to your original look without any follow-up restoration. One caveat, though: because of the strong bonding process used, it's not always easy to remove them.
Although their thinness makes it possible to avoid or minimize alterations, there are some dental situations like oversized teeth that may still require extensive tooth preparation. With some poor bites (malocclusions) orthodontic treatment to straighten the teeth may also be needed first.
All in all, though, no-prep or minimal-prep veneers could help you avoid the permanent tooth alteration that usually accompanies their thicker cousins. What's more, you'll have the beautiful, transformed smile that veneers can achieve.
If you would like more information on minimal or no-prep veneers, 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 “No-Prep Porcelain Veneers.”
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