Category Archives: Dentistry

Root Canal Retreatment

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A root canal is not something that we normal humans would look forward to. How about the poor people who have to have a root canal retreated? It’s a common perception that once a root canal has been done, there will never have to be anything else to do for that tooth. While that is true with most root canals, there is an occasional one that is not successful.

Root Canal Tooth Needing Retreatment

The most common reason is not being able to get a good seal on the root. Any leakage around the root canal filling material can allow bacteria to filter in. Since there are no blood vessels in the area (those were removed by the root canal process), there will be no way to get antibodies and white blood cells to the area. This way, the bacteria can proliferate causing an infection. The only way to correct this problem is to retreat the root canal. That is done by opening up the tooth, then softening and removing the gutta percha filling material. After that is done, it’s a good time to search for extra canals or unusual root anatomy. All of the canals are cleaned thoroughly and irrigated with sodium hypochlorite. At this point, a decision is made on whether to place medication in the tooth and allow it to heal for a week or two or to go ahead and fill it that day. Retreatments do not enjoy the same success rate as original root canals, but they work often enough that they are sure worth giving a try.

Parulis

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A parulis is commonly called a “gum boil”. It is caused by an infection around a tooth root that has expanded to the point that it has burrowed through the outer layer of the bone and has begun to seep into the mouth. This tooth infection can be started by a deep cavity, or fracture of the tooth, or by a severe gum pocket that has caught some food in it. With infections, the body tries to ward off the onslaught of bacteria by sending an army full of white blood cells to the area. As these white blood cells and bacterial sludge collect, they will put pressure on the surrounding tissues, in this case bone. Since bone is very sturdy, initially, the infection will put pressure on nerve endings causing much pain. As the pressure builds, the bone will begin to erode. At this point, the bone has been weakened and begins to expand. The resulting pus will find the weakest point and break through the bone. At this point, there is usually major relief of pain since the pressure has been relieved inside the bone. Just because the pressure has been relieved doesn’t mean that the saga is over. The source of the problem must be addressed, that means either doing root canal treatment, gum treatment, or extraction.

Abfraction

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No – abfraction has nothing to do with those pesky arithmetic problems that we solved in school. It is a phenomenon that happens along the cervical area of a tooth. The cervical area is along the gum line. An abfraction lesion is a “V” shaped notch in the tooth that forms along the gum line. It was previously thought that these cavitations were caused by overly aggressive tooth brushing or by leeching out through chemical erosion, it is now postulated that forces of the bite will cause the tooth to flex causing tiny cracks to form over the years eventually forming the classic “V” furrow. There are no studies at this time which prove beyond a shadow of a doubt that these wedge formations were caused by biting forces, however, it comes the closest to explaining a phenomenon that can’t be caused by tooth brushing alone. These cavitations can be observed for a while, but they should be restored before they get too deep. By rounding out the “V” shaped notch during the cavity preparation, biting forces will be more evenly distributed, helping to slow the process. Due to tooth flexion during chewing, fillings placed in these areas tend to need to be replaced more often.

How Does a Porcelain Laminate Stay in Place?

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Porcelain laminate veneers are a wonderful way to conservatively change the shape and color of teeth with a durable long-lasting restoration. The laminates are extremely thin (thinner than finger nails) veneers of porcelain. They are held in place by a bonding resin cement. The word “bonding” is somewhat of a misnomer as there is very little true adhesion involved. The enamel surfaces of the teeth and the inside surface of the porcelain are etched with an acid solution. This creates microscopic crevasses in those surfaces. A liquid plastic is flowed over these areas and filters down into the tiny crevasses. The plastic is then hardened with the rest of the cement with an intense light source. A silanating agent that has double bonds for porcelain and the resin cement will provide some mild adhesion for that interface and the new generation dentin bonding agents will also help adhere to areas where the dentin , the inner layer of the tooth, shows through. The resin cement can also help with the color of the tooth. The cement is naturally translucent, however, different agents can be added that can change the color and the opacity of the laminate, thus masking any problems with the underlying teeth.

Sleep Apnea

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Sleep apnea can be a potentially life threatening condition. Unlike simple snoring, a sufferer of sleep apnea will stop breathing for as much as a minute to a minute and a half. This can happen many times during the night. As a result, the person will awaken in order to restart the breathing process. This causes sleep deprivation leading to lack of alertness and drowsiness during the day. It is important that cases of sleep apnea be diagnosed by a physician. If there is airway obstruction, many times, surgical procedures can be performed to alleviate the problem.

C-PAP Nose piece

A C-PAP (continuous positive airway pressure) machine may be prescribed. A specially fitted nosepiece is worn at night during sleep. It helps to keep the airway open, prevent snoring, and stops interruptions in breathing. There are some sufferers who can be helped with oral appliances that bring the mandible (lower jaw) forward, helping to open the airway. It can be helpful for those who have difficulty wearing a C-PAP machine at night. A physician should make the decision as to whether to try the oral appliance or not. If so, our office can construct an appliance to see if it alleviates the problem.

Sealants

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Sealants are coatings that are placed on the chewing surfaces of teeth. Their placement can save literally thousands of dollars over the course of a lifetime. To place a sealant, the dentist or assistant will clean all of the plaque off the tooth. This can be done with a traditional prophy cup, just like one used when getting ones teeth cleaned, or by air abrasion, kind of like a mini-sandblaster. Then, an acid solution is placed in the chewing surface. This will etch the enamel surface of the tooth. The enamel has a frosty appearance but microscopically, there are huge crevasses created when the acid dissolves away some of the mineral content of the tooth surface. It is this microscopic layer that is responsible for the retention of sealants. At this point, the acid is thoroughly rinsed off and a liquid plastic is flowed over the surface. An extremely intense light beam is placed over the area which hardens the plastic. The liquid has flowed into the microscopic crevasses and is not hardened in such a way that the sealant “adheres” to the tooth. Sealants are used only on the chewing surfaces to seal the tiny pits and fissures that are very susceptible to cavities. It will not seal in between the teeth or at the gum line. By placing sealants at an early age when the teeth are most susceptible to decay, it can help prevent cavities. Once a cavity is in place, it will have to be maintained over a person’s lifetime, necessitating multiple re-fills and many dollars spent. That is why it is best to place the sealants on children.

Snoring

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Snoring can be a very irritating problem that can put a strain on relationships. However, snoring can be a sign of the much more serious malady called sleep apnea. Not all snorers have sleep apnea, therefore, it is important to have the condition checked by a physician to be certain that it is not a serious problem. Even if sleep apnea is not present, snoring can be very annoying, even going so far as causing marital problems. Sufferers have even woken themselves up during a deep sleep due to their snoring. There are some solutions available that can be done without the need of a professional: lose weight, change to a different sleep position, and avoid things like alcohol, sedatives, or caffeine before bedtime. There are some surgical solutions that can help. Radio frequency waves can be used to shrink the tissue of the soft palate or a laser-assisted uvuloplasty can be done to remove the uvula. It has been found that holding the mandible (lower jaw) forward during sleep can help some people to stop snoring.

Appliance to Hold Mandible (lower jaw) Forward

In our office, we can construct an anti-snoring appliance, but only after a patient has been checked by a physician to rule out sleep apnea.

Toothbrush Abrasion

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As a dentist it is my moral and ethical obligation to tell my patients to brush their teeth. It is always a pleasure to see patients who take good care of their teeth. It is especially gratifying when we see a patient whose home care was far from sterling, but has gotten on the wagon and started brushing regularly. The problem is that some people get too much of a good thing. By being over-zealous with the toothbrush, one can damage their teeth and gums. We used to be taught to brush as hard as we could. That is reminiscent of the good old days when the bristles were made of natural materials. Once these bristles came in contact with saliva, they would soften, thus, more force could be applied without causing damage. Now the bristles are made of nylon which doesn’t soften when moistened.Toothbrush Abrasion Effects Therefore, vigorous scrubbing with a toothbrush can wear away gums and tooth. The gums will first recede due to the abrasion which can cause tooth sensitivity at the exposed root. Next, since the dentin (inner layer of the tooth) is much softer than enamel and it is now exposed to the brush because of the receded gums, it will wear away in a saucer like fashion at the gum line. This will require a filling to correct the damage. The better thing is prevention. Don’t overdo it on the force placed on a toothbrush. Plaque is not that difficult to remove with gentle brushing.

Repairing Chipped Teeth

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Bonding To Repair a Broken Tooth

Before

A chipped front tooth can be a very unsettling thing for a person of any age.  Before the bonding era, the tooth would have to be whittled and a crown (cap) placed.  Now, front teeth can be restored to the point where the repair is virtually imperceptible.  The tooth is first cleaned up and any rough edges are smoothed.  A long bevel is prepared on the enamel surface to increase the amount of enamel that is available for bonding.  Then, an acid solution is applied to the surfaces.  After rinsing, thousands of microscopic crevasses are present.  Although they are very tiny, these areas allow for a liquid plastic to be flowed into these crevasses then hardened with an intense light source.  This alone is adequate to retain the repair in place for a number of years.

Bonding To Repair a Broken Tooth After

Dr. Gangwisch Repaired This Tooth With Bonding

 A composite (tooth-colored filling material) is then color matched with the remaining tooth.  It is built up in multi-colored increments in order to mimic nature.  Each layer is light hardened, then it’s time to contour and polish the restoration.  The resulting filling looks great when it is finished.  With proper care, this repair can last five to ten-plus years.  Since it is not as durable as porcelain, one must be careful not to bite on hard things with it.  The tooth may eventually require a crown, but repairing a chipped front tooth with a bonded filling can be a conservative, less-expensive alternative.

Restoring Root Canal Teeth

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Once a root canal has been completed, it is extremely important that the tooth be properly restored. If not, then there would be a good chance that the tooth could be lost permanently. The reason for this is the dental pulp which houses a collection of nerves and blood vessels in the center of the tooth will bathe the inner tooth layer (the dentin) with fluid, allowing the tooth to flex under load. Once the source of the moisture is gone, the tooth becomes very brittle. I always recommend that all chewing teeth have a crown placed soon after a root canal has been completed. I have even had the unfortunate experience of needing to extract a tooth only weeks after root canal treatment due to the tooth fracturing through to the root because it had not been properly restored yet. Some front teeth, if they have adequate remaining tooth structure, can be restored with just a filling.

Crown Over Root Canal Tooth

To place a crown on a back tooth, usually a crown buildup needs to be done. A crown buildup is a core of filling material that is used to replace the tooth structure that was lost in the root canal process and due to decay. This core may need to be retained with pins or a large post that is placed in one of the canals. With a quality, well-timed final restoration covering and protecting a root canal tooth, that tooth should give decades of future service.