The words “root canal” can strike fear into the hearts of mortal men. With modern techniques, most root canals can be performed with little or no pain. The first concern is proper diagnosis. No one wants to undergo root canal treatment – painless or not – only to find out that it was unnecessary. Some types of tooth pain can be reversible without resorting to a root canal. Removing decay and placing a sedative filling will sometimes do the trick. If there is pain along the “gum line”, the dentist can apply a desensitizer to the root to see if the condition improves.
When one goes to the dentist with a toothache, it is not unusual for the culprit to be another tooth. This is called referred pain and it’s very important that the dentist performs a number of tests to determine the exact source. It is extremely important that the patient doesn’t take any kind of analgesic, such as ibuprofen or Tylenol, before an appointment. This can mask the symptoms and skew the diagnostic tests that the dentist performs. Another possibility is that the pain could be coming from something other than a tooth. 
During spring and fall, it is very common here in Atlanta for patients to appear in my office with “toothaches” only to find out that it was sinusitis. Taking adequate time during the diagnostic phase can save much time, money, and discomfort by getting it right the first time.
Category Archives: Dentistry
Lasers in Dentistry
There are two classes of lasers used in dentistry today – ones that cut soft tissue and ones that cut hard tissue. The lasers use a single color (wavelength) of intense light to heat the target. This beam can be focused to an extremely tiny area thus allowing pinpoint accuracy. As it cuts, it will coagulate blood vessels to minimize bleeding and will sterilize the cut surface. The soft tissue laser can be used to reshape gums for a better cosmetic contour and can be used to remove growths in the mouth. Lower intensity lasers can be used to detect cavities in their earliest stages before they can be detected on x-rays or visually. Hard tissue lasers will actually cut tooth structure. If the cavity is not too deep, it may be possible to prepare the cavity and remove the decay without the use of local anesthetic, a big plus for all of the needle-phobics. The heat of the laser can also seal the freshly cut dentinal tubules, the tiny, microscopic pores in the inner layer of a tooth. This can help reduce post-operative sensitivity. For many people, just the thought of not having a drill and scalpel is a great way to ease the tension and anxiety surrounding dental treatment.
Complications From Tooth Extractions – Dry Socket
Most tooth extractions heal uneventfully, however, recovery can be greatly complicated by the dreaded dry socket. A dry socket occurs when the blood clot that fills the socket becomes dislodged or never fully forms in the first place. It is important after a tooth extraction to leave the surgical site undisturbed so that the blood clot has a chance to mature. If one vigorously rinses their mouth out or puts negative pressure in their mouth by doing things like sucking through a straw or drawing in cigarette smoke, the blood clot can easily come out. The result is a hole in the gums – hence the term “dry socket”. Another big factor is smoking. The nicotine will constrict blood vessels making it difficult for a proper blood clot to form, Making one more susceptible to a dry socket.
When a dry socket does occur, you will know it. After three to four days following the extraction, an intense pain will occur. There will be no redness or swelling, like with an infection. You can try to control the pain with an anti-inflammatory, such as ibuprofen, but it is best to call your dentist. Although a dry socket is not life threatening, it still is extremely painful and your dentist can help relieve the pain. Plus, it would be good that the dentist can rule out more serious problems. If it is a dry socket, then the dentist will flush out the debris from the socket, then place a medicated packing in the area for one week to ten days. The dry socket should be healed by that time and the packing can be removed.
Tooth Knocked Out On The Soccer Field
In my dental career, I have had the opportunity to help two individuals who knocked their teeth out during sporting events. The first one was during a soccer match. I was watching a buddy of mine play in an adult soccer league when all of a sudden with a couple of minutes left in the game, a fight broke out near the far sideline. Once that was broken up, they completed the game. Afterwards, I noticed that all of the players from both teams were over by that sideline looking on the ground. I thought that someone had lost a contact lens. At that time, my friend, knowing that I am a dentist, came over and told me that a player had had a tooth knocked out during the fight and was wondering if I could help. As I walked across the field, the player came over holding his tooth in his hand. Since we were standing in the middle of the field with no water available (the field was only serviced by Port-A-Potties), I had him roll the tooth around in his mouth to clean the dirt off of it. Then, crunch time came. I took the tooth and firmly inserted it back into the socket. I could tell that it smarted quite a bit but I don’t normally carry a syringe full of Novocaine with me. There certainly weren’t any tears. There was no way that he was going to let his teammates think he wasn’t tough. I instructed him to see his dentist the next day. When I checked with him later in the week, he was doing just fine. His dentist did a root canal for the tooth. A year later, I asked my buddy how his teammate was doing and he said that his tooth was doing just fine. Happy endings are always nice.
Extracting Teeth
Removing a tooth is not the brute force that is the common perception. Extracting teeth actually requires a lot of finesse. There is a small space between the tooth and the bone. This is where the periodontal ligament resides. This ligament is what holds teeth in. Teeth are not set rigidly in concrete. If you’ve ever looked in the mirror and tried to wiggle your teeth with your fingernails, then you’ve probably noticed that the tooth will move slightly. This allows the force of the bite to be buffered before it gets transmitted to the bone. The trick to extracting a tooth is to break the periodontal ligament. Pressure is applied slowly until the microscopic fibrils of the ligament begin to snap. If the pressure is applied too fast, then the tooth will usually break apart in a very inopportune place.
The pressure to extract a tooth can be applied by a variety of instruments; the most common being the forceps. Forceps look like common household pliers only with very specialized beaks. Other instruments called elevators are commonly used. Elevators resemble a screwdriver, except that is is curved to match the contours of a tooth. An elevator is placed between the teeth and gently rotated until the tooth raises from it’s socket. This way, teeth can be removed in a very comfortable manner.
Tooth Extractions
A goal of every dentist is to save teeth, however, there are times that the best thing for a tooth is to remove it. If there is not enough room for wisdom teeth – out they come. If the teeth are too crowded, then the orthodontist may recommend extracting some strategic teeth to make room. We can rebuild teeth that are broken down by decay or fracture from the “ground up” but if the damage slips too far below the gums or bone, then the best alternative may be extraction. Fractured teeth many times can be saved by placing a crown or cap over them, however, if the fracture goes too deep into the root, then the only solution is removal. Teeth that have had root canal treatment tend to be very brittle since there is no nerve inside to bathe the tooth with fluid. If these teeth are not restored with a crown, then there is a high likelihood that the tooth will split and need to be taken out. The most common reason for the need for tooth extraction is gum disease. Severe periodontitis (gum disease) can affect many or all teeth in the mouth causing the teeth to loosen and thus will need to eventually be removed.
Bitewing X-rays
Bitewing x-rays are the routine x-rays that the dentist takes to check for cavities in between the teeth. These x-rays are important because tiny cavities can be spotted when they first start forming. Catching cavities at that stage is extremely helpful in catching decay while it is small and easily treated with just a filling. If a cavity gets large enough that it can be seen with the naked eye then there is a great possibility that the decay could already be in the nerve. If that is the case, then what could have been a few hundred dollars worth of dentistry to fix could suddenly cost thousands of dollars to repair. Bitewing x-rays are also very helpful in seeing bone damage due to periodontal (gum) disease. As the disease progresses, it causes the bone that holds the teeth in to erode away. If left unchecked, the damage to the bone could be so severe that teeth could be lost. Seeing this damage in it’s early stages can alert the dentist that there is a problem brewing. Since once bone is lost, the damage is irreversible, so catching bone loss before before it happens is very important.
Temporary Replacement of Missing Front Teeth
Whenever a tooth is lost, there is a mandatory healing period. Most people don’t want to walk around snaggle-toothed until a month or two has passed. There are some temporary measures that can be done in the interim to avoid the embarrassment of going without a front tooth.
Temporary Bridge After Implant Placement
If a bridge is planned, then the teeth on either side of the extraction site can be prepared (removing the enamel) and a plastic temporary can be constructed. This way, the patient can leave the office with their smile intact. One to two months waiting time is necessary before taking final impressions because the gums will recede during that time. If the permanent bridge is started too early, then there will be a hole between the artificial tooth and the gum will appear.
Temporary Denture to Replace a Missing Tooth
Another option is a temporary partial denture called a flipper. This nickname is very descriptive because the denture tends to flip around in the mouth during function. It has a plastic plate that covers the roof of the mouth, so it will affect taste and speech. But at least one can leave the office with teeth to smile with.
Cleaning Dental Implants
Single tooth implants can be brushed and flossed just like normal teeth. When two or more implants are tied together, special implements will be needed for daily cleaning. Bridge threaders are plastic needles that floss is threaded through the eye of the needle. The threader is passed under the bridgework, then the floss can be manipulated normally after that. 
Tiny brushes that look like baby bottle brushes are attached to handles and are a great way to get between teeth in areas that are accessible. A water pik can be used to clean food particles out from underneath a denture or bridge. It is important to use it on a low setting in order not to cause any damage to the gums that surround the implants. A water pik is not strong enough to clean plaque so a brush and floss is still mandatory. When a professional cleaning is done, it is important to let the dental hygienist know that you have dental implants. Special titanium cleaning instruments are necessary. Use of dissimilar metals can cause corrosion of the titanium implant surface. With proper home care, implants can last for many years.
Dental Implant Restoration
Once an implant has had time to heal and an abutment (the metal post that protrudes through the gums) has been placed, it is now time to make the implant look and function like a tooth. Depending on how many teeth need to be replaced and how many implants are present will determine how the area will be restored. For a single tooth, it’s just a matter of constructing a conventional crown (cap). For a section of missing teeth, a row of teeth can be made and screwed into the abutments. For patients who are needing all of their teeth in a particular arch (upper or lower) replaced, there are a number of options available. If two implants are placed, then the abutments can be placed that have little balls that look like trailer hitches. Then “O” rings are placed inside the denture to allow it to snap onto the implant abutments. Although this setup doesn’t hold the denture in rigidly, it does keep it from shifting laterally, greatly improving function. If four or more abutments are present, then special clips can be placed in the denture that can hold the denture in fairly firmly. The denture can then be unclipped to allow for easy cleaning underneath. The other alternative is to screw the denture directly to the abutments. This way, the denture is rigidly held in place and is as close to having one’s natural teeth.