HowaRootCanalCouldSaveYourDiseasedTooth

Just a century ago a heavily decayed tooth was most likely a goner, but that all changed in the early 1900s when various treatments finally coalesced into what we now call root canal therapy. The odds have now flip-flopped—you're more likely to preserve a decayed tooth than to lose it.

By decay, we're not referring only to cavities in a tooth's enamel or outer dentin. That's just the start—decay can quickly spread deeper into the dentin close to the pulp, the central portion of a tooth containing bundles of nerves and blood vessels. It can then move into the tooth's pulp chamber, causing the pulp to die and producing infection that will eventually infect the surrounding supporting bone.

Root canal treatments are often a lifeline to a tooth in this perilous condition. After numbing the tooth and surrounding tissues with local anesthesia, we start the procedure by drilling a tiny hole to access the central pulp and root canals. We then use specialized tools to remove all of the infected tissue within these interior spaces.

After thoroughly disinfecting the tooth of any decay, we shape up the root canals for filling. We then inject a rubbery substance known as gutta percha and completely fill the tooth's resulting empty spaces. This filling helps to prevent a recurrence of infection within the tooth.

Once we've filled the tooth, we seal off the access hole to complete the procedure. You may experience a few days of mild discomfort, but it's usually manageable with over-the-counter pain relievers. Later, we'll cement a crown over the tooth: This provides additional protection against infection, as well as adds support to the tooth structure.

One more thing! You may have encountered the notion that undergoing a root canal is painful. We're here to dispel that once and for all—dentists take great care to ensure the tooth and the area around it are completely dead to pain. In fact, if you were experiencing a toothache beforehand, a root canal will alleviate the pain.

To get the best treatment outcome for tooth decay, it's important to uncover it as soon as possible. The earlier we begin treatment, the more likely we can bring your tooth back to good health.

If you would like more information on 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 “A Step-By-Step Guide to Root Canal Treatment.”

YouMightAvoidPermanentToothAlterationWithTheseNo-PrepVeneers

If you know anyone with dental veneers, you've likely heard how much they love them. These thin shells of dental porcelain bonded to the front of teeth can hide a multitude of defects—from chips to mild gaps between teeth.

But your friend may also have told you their teeth required some preparation before the dentist bonded the custom veneers. That's because traditional veneers, although relatively thin, can still appear too bulky if applied straight to the teeth.

To help them look more natural, dentists often remove a tiny amount of surface enamel. Even though doing this won't harm your teeth, having less enamel (which doesn't grow back) could leave your teeth vulnerable to disease and sensitivity. Teeth prepped in this manner will require a veneer or some other form of restoration from that point on.

Up until recently, few people could avoid having their teeth permanently altered prior to receiving veneers. Now, though, you may have an alternative: a new, ultra-thin veneer that requires little to no tooth preparation beforehand. These new options are known as no-prep or minimal-prep veneers.

These new veneers are as thin as contact lenses, and have such a low profile that they don't have to fit under the gum line (often the case with traditional veneers and one of the reasons for tooth alteration). The dentist may still need to reshape the enamel using an abrasive tool, but it's much less of an alteration than what may be required of traditional veneers.

And unlike traditional veneers, it's unlikely you'll need local anesthesia during their application, a common practice with tooth prep before veneers. You may also be able to have these veneers removed later without the need for another restoration to cover the teeth.

No-prep/minimal-prep veneers are well-suited for people with small (or those that appear so), worn or slightly misshaped teeth. On the other hand, those with oversized teeth or teeth that jut forward may still need some prep work even with these ultra-thin veneers.

To find out if these new veneers are right for you, you'll need to undergo a comprehensive dental exam. If they are, your teeth may be able to avoid permanent alteration—and still look amazing with your new veneers.

If you would like more information on porcelain dental 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.”

TheDisappearingToothGap-MichaelStrahanPullsanEpicAprilFoolsPrank

If you're a fan of former NFL player and current host of Good Morning America Michael Strahan, then you're well aware of his unique smile feature—a noticeable gap between his front teeth. So far, Strahan has nixed any dental work to correct the gap, often saying it was part of "who I am."

But if you follow him on Twitter, you may have been shocked by a video he posted on March 30th of him sitting in a dentist's chair. Calling it a "moment fifty years in the making," Strahan said, "Let's do it." After some brief video shots of a dental procedure, Strahan revealed a new gapless smile.

But some of his Twitter fans weren't buying it—given the timing, they sniffed an elaborate April Fool's Day ruse. It turns out their spider senses were on target: Strahan appeared once again after the video with his signature gap still intact, grinning over the reaction to his successful prank.

The uproar from his practical joke is all the more hilarious because Strahan has let it be known he's truly comfortable with his smile "imperfection." But it also took him awhile to reach that point of acceptance, a well-known struggle for many people. On the one hand, they want to fix their dental flaws and improve their smile. But then again, they're hesitant to part with the little "imperfections" that make them unique.

If that's you, here are some tips to help you better navigate what best to do about improving your smile.

See a cosmetic dentist. A cosmetic dentist is singularly focused on smile enhancement, and particularly in helping patients decide what changes they want or need. If you're looking for such a dentist, seek recommendations from friends and family who've changed their smiles in ways you find appealing.

Get a "smile analysis." Before considering specific cosmetic measures, it's best to first get the bigger picture through an examination called a "smile analysis." Besides identifying the defects in your smile, a cosmetic dentist will use the analysis to gauge the effect any proposed improvements may have on your overall facial appearance.

Embrace reality. A skilled cosmetic dentist will also evaluate your overall oral health and assess how any cosmetic procedures might impact it. This might change your expectations if it whittles down the list of enhancement possibilities, but it may help determine what you can do to get the best improved smile possible.

A great cosmetic dentist will work diligently with you to achieve a new smile that's uniquely you. Even if, like Michael Strahan, you decide to keep a trademark "imperfection," there may still be room for other enhancements that will change your appearance for the better.

If you would like more information about a "smile makeover," please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Cosmetic Dentistry.”

TakeStepsWhileWearingBracestoDeterWhiteSpotFormationonYourTeeth

Correcting a poor bite not only creates a more attractive smile, but ultimately a healthier one too. But braces, a common way to correct bites, could put your teeth and gums at higher risk for disease while wearing them.

That's because the brackets and wires that make up braces can get in the way of cleaning your teeth of dental plaque, a thin bacterial film that causes disease. Plaque can accumulate in these obstructed dental areas, and could lead, in one possible scenario, to a problem you may not even notice until after the braces come off—white spots on the teeth, or white spot lesions (WSLs).

WSLs occur because of "demineralization," a process caused by acid from bacteria stripping the enamel in these spots of underlying minerals like calcium. As a result, the spots look chalky and opaque in contrast to the rest of the enamel's normal translucence.

Even though more difficult with braces, daily oral hygiene remains the best defense against WSL formation. Fortunately, these difficulties can be overcome with the help of specialized tools like an interproximal toothbrush, which can get under and around braces better than a regular brush. A water flosser device, which clears away between-teeth plaque with pulsating water, can be just as effective as dental floss and easier for orthodontic patients to use.

Orthodontic patients can also make their mouths "less friendly" to harmful bacteria by cutting back on sugary snacks or acidic beverages like sodas, energy or sports drinks. It's also a good idea to avoid alcohol, tobacco or caffeine, all of which can diminish saliva flow needed to keep the mouth healthy.

If WSLs do occur, it's possible that they may eventually remineralize on their own after the braces come off. We can also foster remineralization with over-the-counter or prescription-grade fluoride pastes or gels, or apply fluoride directly to the affected teeth. In advanced cases, we can often inject a tooth-colored resin beneath the white spot to stabilize it and make it appear less opaque.

In any event, it's always a good idea to keep a close watch on your teeth during orthodontic treatment. Staying vigilant and proactive will help you avoid disease while wearing braces.

If you would like more information on dental care while undergoing orthodontic 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 “White Spots on Teeth During Orthodontic Treatment.”

SedationCanAlleviateAnxietyandOpentheWayforNeededDentalCare

Discovering how pain and anxiety complicated disease care, many ancient civilizations turned to natural substances like root herbs or alcohol to ease their effect. Today, we've developed more effective agents, which enable patients to undergo many treatments they would otherwise be unable to endure.

There's been immense progress in particular in methods for reducing patient anxiety during dental treatment. In contrast to physical pain, anxiety is more aptly defined as mental discomfort. Dental anxiety, the apprehension a person feels at the prospect of dental care, can be serious enough that a person avoids dental care altogether, even with serious teeth or gum issues.

Adages like "Just suck it up and get through it" can be hollow words to someone with serious dental anxiety. Today's dentist understands that anxiety is very real and a serious impediment to care. Fortunately, modern dentistry has effective measures to alleviate it.

This commonly involves an approach with two phases. In the first, the patient takes an oral sedative an hour or so before the appointment to produce an initial calming effect. In the second phase at the appointment, the dentist initiates intravenous or IV sedation, a deeper application that continues throughout the treatment session.

With IV sedation, we deliver the sedative medication through a small needle inserted into a patient's vein, placing the patient in a highly relaxed state. Unlike general anesthesia, which renders a patient unconscious, sedated individuals remain somewhat awake, often able to respond to verbal commands or physical stimuli.

In further contrast to general anesthesia, IV sedation doesn't require assisting patients with breathing or circulation. Even so, one of the treatment staff will continue to monitor vital signs while the patient is sedated.

Since the introduction of Pentothal in the 1930s, the first sedative used for medical and dental procedures, we've developed other safe and effective sedatives that flush from the body quickly and have few after-effects. Many have an amnesiac effect, so that the patient remembers little or nothing at all about the procedure.

Sedation therapy can accomplish two things. First, an anxious patient can have a more positive experience during dental treatment. And, as these positive experiences accumulate, a patient prone to anxiety may develop a readiness to receive treatment before a problem goes too far.

If you would like more information on dental sedation techniques, 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 “IV Sedation in Dentistry.”





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