Posts for: August, 2017
A traditional root canal procedure can be a “life-saver” for a decayed or injured tooth. But while it’s usually the best course for a damaged adult tooth, variations of the procedure are advisable for a new permanent tooth in a child or young adolescent.
This is because the inner pulp, the focus of the treatment, plays an important role in a young tooth’s development. When it first erupts a tooth’s dentin layer, the living tissue that makes up most of the body and roots of the tooth, hasn’t fully formed. The pulp increases the dentin layer over time in conjunction with jaw development.
Because a full root canal treatment removes all of the pulp tissue, it could interrupt any remaining dentin development in a young tooth. This could lead to poorly-formed roots and a less healthy tooth. For an immature permanent tooth, then, we would use variations of a root canal treatment depending on the nature and extent of the injury, the patient’s overall health and medications they may be taking.
Our main objective is to expose or remove as little of the pulp tissue as possible when treating the tooth. If the pulp hasn’t been exposed by the decay or injury, we may only need to remove the softened decayed or injured dentin while leaving harder dentin nearer the pulp intact. If, however, the pulp has become partially exposed by disease or injury, we would then perform a pulpotomy in which we remove only the exposed tissue and then place calcium hydroxide or mineral trioxide aggregate (MTA) to stimulate dentin growth that will eventually patch the exposure site.
In cases where decay or injury has rendered an immature tooth’s pulp tissue unsalvageable, we may use a procedure known as apexification that seals off the open, cylindrical root end of the tooth. This will allow bone-like tissue to grow around the root to serve as added support for the tooth. Although it can save a tooth in the short run, the tooth’s long-term survival chances may be lower.
By using these and other techniques we may be able to save your child’s immature tooth. At the very least, such a technique could postpone replacing the tooth until a more opportune time in adulthood.
If you would like more information on treating damaged teeth in children, 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.”
Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.
“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…
For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.
When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.
A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.
But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.
Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!
If you have questions about repairing chipped teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”
With college, a full-time job and an upcoming wedding to plan, Brooke Vitense had the hectic life of an average young woman in her twenties. But a chance discovery one morning would completely upend her normal life.
That morning Brook noticed white spots on the underside of her tongue while brushing her teeth. Not long after, she pointed out the spots to her dentist during her regular dental checkup. He recommended having the spots biopsied, just to be safe. She needed a wisdom tooth removed, so she scheduled the biopsy with her oral surgeon to coincide with the tooth extraction.
She soon forgot about the biopsy — until her dentist contacted her about the results. The lesions were pre-cancerous: he recommended she have them and a portion of her tongue removed surgically as soon as possible.
She underwent the procedure, but that wasn't the end of her ordeal. The follow-up pathology report indicated cancerous cells in the tissue excised during the procedure. To ensure elimination of any remaining cancerous cells they would need to remove more of her tongue as well as the lymph nodes from her neck.
Brooke survived her cancer experience and has since resumed her life. Her story, though, highlights some important facts about oral cancer.
Oral cancer is life-threatening. Although cases of oral cancer are rarer than other types of malignancies, the survival rate is low (50%). This is because lesions or other abnormalities are often dismissed as simple sores. Like any cancer, the earlier it's detected and treated, the better the chances for survival.
Anyone of any age can develop oral cancer. While most cases occur in older adults, young and otherwise healthy people like Brooke are not immune. It's important for everyone to make healthy lifestyle choices (good oral hygiene and nutrition, moderate alcohol use and avoidance of tobacco) and see a dentist whenever you see an abnormal sore or spot in your mouth.
Regular dental checkups are crucial for early detection. Had Brooke not seen her dentist soon after discovering the spots on her tongue, her survivability could have been drastically lower. Regular dental visits (and cancer screenings if you're at high risk) could mean all the difference in the world.
If you would like more information on the signs and treatment of oral cancer, please contact us or schedule an appointment for a consultation. You can watch Brooke's interview by visiting How a Routine Dental Visit Saved My Life