Posts for: December, 2013
Perhaps you or someone you know has been told they will need root canal treatment. Maybe you're experiencing some unexplained tooth pain, and you think you might need to have this procedure done. Nervous? You shouldn't be! A good understanding of this common and relatively pain-free dental treatment can go a long way toward relieving your anxiety.
What's a root canal? It's the small, branching hollow space or canal, deep within the root of the tooth. Like an iceberg in the ocean, a tooth shows only part of its structure above the gum line: That's the part you see when you smile. But about two-thirds of the tooth — the part called the root — lies below the gum. A healthy root canal is filled with living pulp tissue, which contains tiny blood vessels, nerves and more.
A “root canal” is also shorthand for the endodontic treatment that's called for when problems develop with this tissue. For a variety of reasons — deep tooth decay or impact trauma, for example — the pulp tissue may become inflamed or infected. When this happens, the best solution is to remove the dead and dying tissue, disinfect the canals, and seal them up to prevent future infection.
How is this done? The start of the procedure is not unlike getting a filling. A local anesthetic is administered to numb the tooth and the nearby area. Then, a small opening is made through the chewing surface of the tooth, giving access to the pulp. A set of tiny instruments is used to remove the diseased tissue, and to re-shape and clean out the canals. Finally, the cleared canals are filled with a biocompatible material and sealed with strong adhesive cement.
After root canal treatment, it's important to get a final restoration or crown on the tooth. This will bring your tooth back to its full function, and protect it from further injury such as fracture. A tooth that has had a root canal followed by a proper restoration can last just as long as any other natural tooth. And that's a long time.
If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”
Dental implants have come a long way since their introduction thirty years ago. Unlike their predecessors, today’s implants come in various shapes and sizes that can meet the precise needs of individual patients. Crown attachment has also developed some variety.
The actual implant is a titanium post surgically imbedded in the jawbone to replace the original tooth root. The restoration crown, the visible part of the implant system that resembles natural tooth, is affixed to the implant post. There are two basic methods to attach the crown: cement it to an abutment that has been installed in the implant; or screw it into the implant with a retaining screw from the underside of the crown. In the latter case, the abutment has been built into the crown.
While either method provides years of effective service, one method may work better than the other depending on the circumstance. Screw-retained crowns require no cement and are more easily removed than cemented crowns if it becomes necessary. On the other hand, the screw access hole can be visible, although the area can be filled with a tooth-colored filling; and although rare, chips near the access hole can occur. Occasionally the screw may become loose, but tightening or replacing the retaining screw is a simple matter because of the access hole.
A cemented crown looks more like a natural tooth and so is more useful in situations where cosmetics are a factor. The cement, however, can cause inflammation and contribute to bone loss in some patients when excess cement gets below the gums. Unlike a screw-retained crown, removal is more difficult and limited.
As a rule, screw-retained crowns are normally used in areas where the screw hole is not conspicuous, such as for posterior (back) teeth. They’re also more desirable than cemented when the implant is permanently crowned at the same time it’s surgically implanted, a process called “immediate loading.”
Which method of crown attachment is best for you? That depends on the implant location and other factors we would explore during a thorough pre-implant exam. Either way, the end result will be a life-like replica of your natural teeth, and a restored, vibrant smile.
If you would like more information on crown attachment to dental implants, 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 “How Crowns Attach to Implants.”
There’s more to tooth loss than you might think. Because teeth are part of a larger system that facilitates speaking, eating and digestion, a lost tooth could eventually affect your overall health.
Tooth loss is actually about bone loss. As living tissue, bone continually reforms in response to stimuli it receives from the body. The alveolar bone (which surrounds and supports the teeth) receives such stimuli as the teeth chew and bite, as well as when they contact each other. All these stresses — hundreds a day — transmit through the periodontal ligament to the bone, stimulating it to grow and remodel.
A lost tooth reduces this stimulation and causes the alveolar bone to resorb (dissolve) — as much as 25% of its width the first year alone. Unless the process is stopped, the underlying basal bone and the periodontal (gum) tissue will begin to resorb too. Without this structural support the facial height shrinks and the front teeth begin to push forward, making chewing and speaking more difficult. These teeth begin performing functions outside their normal range, leading to damage and possible loss.
The primary goal of oral hygiene and dental care is to prevent tooth loss. When tooth loss does occur, however, it’s then important to restore the lost tooth with an artificial replacement if at all possible — not only to regain form and function, but to also stop further bone loss.
While the fixed partial denture (FPD), also known as a fixed bridge, has been the restoration of choice for many decades, dental implants may be the better long-term option. Although more expensive initially, implants can achieve a life-like restoration without involving or altering adjacent teeth as with FPDs. Plaque retention and tartar accumulations are much less likely with an implant, and the bone-loving quality of titanium, the metal used for implants, actually encourages bone growth. As a result, implants have a much higher longevity rate than FPDs.
Taking care of your teeth through effective hygiene practices and regular checkups may help you avoid tooth loss altogether. But if it can’t be avoided, restoring lost teeth is the single most important thing you can do to prevent even greater problems down the road.
If you would like more information on dental implants, 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 “The Hidden Consequences of Losing Teeth.”
Without a doubt, an effective root canal treatment can extend the life of a tooth for many years. But sometimes even a well-maintained tooth can fall prey to disease months or even years after a root canal treatment. While there are a number of reasons to account for this failure, a common one is so tiny it could have easily been missed during the first treatment.
A root canal is an open space within the tooth that contains the pulp. The pulp is a connective tissue with a network of nerve fibers connected to the root that alert the brain to environmental changes involving the tooth. It is most important during the tooth’s early development, but becomes less important as we age. The pulp is susceptible to infection from tooth decay or periodontal (gum) disease, which if left untreated can threaten the tooth’s survival. During a root canal treatment, we enter these spaces, clear out the diseased pulp and fill the canal with a bio-compatible filling; we then seal it off to deter further decay.
The treatment could ultimately fail, though, because of accessory or lateral canals missed during the procedure. Like a tree with smaller branches growing out of its larger limbs, accessory canals are smaller access ways that branch off of the main root canals. These accessory canals, which can occur anywhere along a main canal, can be quite small and not easily detected during an initial root canal treatment. They are especially susceptible to infection due to gum disease if they open into the periodontal membrane, the main attachment point between teeth and bone.
If we suspect the presence of accessory canals (either initially or after ensuing problems following a root canal treatment), this could require the skills of an endodontist, a dentist who specializes in the treatment of a tooth’s interior. Accessory canals are treated in much the same way as larger canals, but may require an endodontist’s specialized microscopic equipment and filling techniques. Effective treatment of these smaller accessory canals will certainly improve the chances of a successful, long-term outcome for the tooth.
If you would like more information on root canal treatments, 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 “Accessory Canals.”