Month: June 2018

Many people consider a root canal treatment to be potentially an unpleasant experience. You might even feel a few butterflies fluttering in your stomach if we were to recommend one for you.

But there’s nothing actually to dread about this common and very effective treatment. The procedure doesn’t cause pain; in fact, it most likely relieves tooth pain. What’s more, it could save a tooth that would be otherwise lost.

The name comes from narrow passageways extending from the tip of the root to the innermost tooth pulp. The pulp contains nerves and other structures once vital to early tooth development. And although they’re not as important in a fully mature tooth, those nerves still function. In other words, they can still feel stimulation or pain.

That shouldn’t be a problem with a healthy tooth. But if tooth decay invades the inner pulp, those nerves now under attack will begin firing. You’ll know something’s wrong. As bad as it feels, though, the toothache isn’t your worst problem: if the decay isn’t stopped, it can spread through the root canals to the bone that could eventually lead to losing the tooth.

A root canal treatment removes the decayed pulp tissue and protects the tooth from re-infection. We first deaden the tooth and surrounding tissues with a local anesthesia and set up a rubber dam around the tooth to protect it from contamination from the surrounding environment. We then drill a small access hole through the enamel and dentin to reach the pulp chamber and root canals.

Using special instruments, we remove all the diseased tissue from the pulp and flush out the empty chamber and root canals with antibacterial solutions. After re-shaping the root canals, we fill them and the pulp chamber with gutta-percha, a rubber-like biocompatible material that conforms well to the root canal walls. We seal the gutta-percha with adhesive cement and then fill the access hole. Later, we’ll give the tooth further protection with a custom crown.

After the procedure, you may experience short-term minor discomfort usually manageable with over-the-counter pain relievers like ibuprofen. The good news, though, is that the excruciating nerve pain from within the tooth will be gone—and your tooth will have a new lease on life.

If you would like more information on saving a problem tooth with root canal treatment, 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 “Root Canal Treatment: What You Need to Know.”

It’s often best health-wise to preserve even the most troubled tooth—including a child’s primary (“baby”) tooth. If that sounds like too much effort for a tooth that lasts only a few years, there’s a big reason why—if it’s lost prematurely, the incoming permanent tooth above it could erupt out of position.

Preserving a decayed primary tooth could include procedures similar to a root canal treatment, commonly used in adult permanent teeth with inner decay. However, we may need to modify this approach to protect the primary tooth’s pulp. This innermost layer plays a critical role in early dental development.

Because an adult tooth has reached maturity, removing diseased pulp tissue has little effect on its permanent health. But the pulp contributes to dentin growth (the layer between it and the outer enamel) in primary and young permanent teeth, so removing it could ultimately compromise the tooth’s long-term health.

Our goal then with a child’s tooth is to remove as much diseased tissue as possible while involving the pulp as little as possible. What techniques we use will depend on how much of the pulp has become infected.

For example, if decay has advanced to but hasn’t yet penetrated the pulp, we may remove all but a small amount of the decayed structure just next to the pulp to avoid its exposure. We may then apply an antibacterial agent to this remaining portion and seal the tooth to curb further infection.

If on the other hand the pulp has become infected, we may try to remove only the infected portion and leave the remaining pulp intact. We’ll only be able to do this, however, if we deem the remaining pulp healthy enough to remain infection-free after the procedure. If not, we may need to remove the entire pulp as with a traditional root canal. This option, though, is a last resort due to the possible effect on dentin growth and the tooth’s long-term health.

As you can see attempts to preserve a primary tooth can be quite involved. But if we can help it reach its full life span, it could mean better dental health for a lifetime.

If you would like more information on caring 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 “Root Canal Treatment for Children’s Teeth.”

Even with picture perfect teeth, you may still be unhappy with your appearance. The problem: too much of your upper gums show when you smile.

There’s no precise standard for a “gummy smile”—it’s often a matter of perception. As a rule of thumb, though, we consider a smile “gummy” if four or more millimeters of upper gum tissue show while smiling. In any event if you perceive you have a gummy smile, it can greatly affect your self-confidence and overall well-being.

The good news is we can often correct or at least minimize a gummy smile. The first step, though, is to find out why the gums are so prominent.

There are a few possible causes: the most obvious, of course, is that there’s more than normal gum tissue present. But the cause could be the front teeth didn’t fully erupt in childhood and so the gums appear more prominent. Other causes include the upper lip moving too far upward when smiling (hypermobile) or an elongated upper jaw that’s out of proportion with the face.

Finding the exact cause or combination of causes will determine what approach we take to minimize your gummy smile. If too much gum tissue or not enough of  the teeth show, we can use a surgical procedure called crown lengthening to expose more of the crown (the visible part of a tooth), as well as remove excess gum tissues and reshape them and the underlying bone for a more proportional appearance.

A hypermobile upper lip can be treated with Botox, a cosmetic injection that temporarily paralyzes the lip muscles and restricts their movement. But for a permanent solution, we could consider a surgical procedure to limit upper lip movement.

Surgery may also be necessary for an abnormal jaw structure to reposition it in relation to the skull. If, on the other hand it’s the teeth’s position and not the jaw causing gum prominence, we may be able to correct it with orthodontics.

As you can see, there are several ways varying in complexity to correct a gummy smile. To know what will work best for you, you’ll need to undergo an orofacial examination to determine the underlying cause. It’s quite possible there’s a way to improve your smile and regain your self-confidence.

If you would like more information on improving a gummy smile, 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 “Gummy Smiles.”