Do I Need a Root Canal?

People often have the misconception that root canal therapy is a painful experience and mistakenly believe that having an infected tooth removed is a preferable choice. Also known as endodontic (“endo” – inside; “dont” – tooth) treatment, a root canal will relieve the severe pain that is caused when the tooth nerve has become inflamed. Unfortunately, extracting an infected tooth can introduce many additional problems that could be avoided with a root canal.

A root canal may be necessary if a deep cavity or trauma to the tooth has occurred, causing the inside pulp to become infected or inflamed. Often, pressure develops inside the core of the tooth which is the source of sharp, lingering pain when biting down or when exposed to temperature changes, particularly from hot foods and liquids. Sometimes, a dull ache may be present and the gum may be sensitive to pressure. Left untreated, an abscess may develop and infection can spread from the tooth to the surrounding bone, and even into the bloodstream.

Immediate dental treatment for a suspected endodontic infection is always the best course of action, and the treatment is relatively pain free and is performed under a local anesthetic administered by the dentist. First, the dentist will have to x-ray the suspicious tooth to diagnose the problem and will sometimes test the tooth to determine whether the nerve is in the process of dying. Once it has been determined that an infected tooth requires a root canal, and the tooth and surrounding area are numb, a small opening is made into the tooth, just as if one were having a filling placed. The infected, dying nerve and blood vessels are removed and the root canals are smoothed, cleaned, disinfected and filled with a rubber material. Some patients feel slight tenderness around the tooth for a day or two, but generally aspirin or ibuprofen will provide sufficient relief. After the nerve has been removed a tooth is no longer living, and the lack of blood supply causes it to become brittle over time. Your dentist will almost always advise you to have a crown placed on an endodontically treated tooth to protect it.

Most of the time a root canal can be performed in a single appointment and the crown will require two more visits to complete. The end result is that you will have kept your natural tooth and restored it to full function. Because bone loss and shifting of the remaining teeth often result when a tooth is extracted, the root canal avoids these complications as well.If you are confronted with the recommendation to have root canal treatment, or if you are experiencing unexplained pain when chewing or to temperature, don’t hesitate to inquire about your options or ask for further information about endodontic treatment to restore your smile and comfort. Have you had a positive experience with root canal therapy? We would like to hear your comments… and they may even help alleviate the concerns of others.

Diabetes and Periodontal Disease

Diabetes and periodontal disease are two common chronic diseases that are reaching epidemic proportions in America; and in fact current research indicates that the two diseases actually directly influence each other. Periodontal disease effects more than half of all adults; and according to recent statistics released by the American Diabetes Association, 25.8 million children and adults in the United States are diabetic. Another 79 million people are pre-diabetic, meaning that they are at risk for developing this serious disease which can affect many major organs including the heart, blood vessels, nerves, eyes and kidneys. Scientists understand a great deal about both diseases and they are learning more all the time… considering the number of people at risk and the potentially life threatening consequences of developing either of these conditions, isn’t it a good idea to know your risks and to understand how the two diseases are linked?

What is Diabetes?

Diabetes is a complicated disease which involves the inability of the body to make the hormone insulin (Type I) or to use the insulin that it makes (Type II). Insulin is necessary to move glucose, also known as “blood sugar” from the blood stream into the cells, to be used for energy that sustains life. When cells do not receive adequate glucose, the body stops functioning…and if too much glucose accumulates in the blood, a variety of severe health complications can occur. Furthermore, people with diabetes are at higher risk for infections and they tend not to heal as well as people without the disease because their immune systems don’t function as effectively.

Type one diabetics are born with the disease, and are treated with replacement insulin. However, type II diabetes generally develops slowly over time as insulin receptors are damaged or destroyed, thought to result from chronic inflammation. Periodontal disease is jointly caused by the by-products of oral bacteria and the body’s inflammatory response to those bacteria. The common thread appears to be inflammation, but how does the diabetes-periodontal disease relationship work? Researchers have determined that there are several reasons for the association.

• Chronic inflammation occurs in the body for a variety of reasons including untreated periodontal infections and even excessive body fat, and the long standing inflammation causes tissue damage. This process is how the gums and bone surrounding the teeth are destroyed in periodontitis. Similarly, inflammation damages the part of the cell that allows insulin to work (the insulin receptor) making cells “insulin resistant”. As the body’s cells become increasingly resistant to insulin, type II diabetes develops. Untreated, the process continues: damaged tissue itself causes more inflammation, so one disease provokes the other.

• High blood sugar inhibits and slows circulation. The body heals itself of infections by using specialized cells and substances transported in the blood to the site of an infection. Sluggish circulation impairs this natural healing ability, which makes the gum tissues more susceptible to infections and much more difficult to treat.
• High glucose levels in saliva promote growth of bacteria that cause periodontal disease.
• Untreated periodontal disease can actually increase blood sugar and make it more difficult to control; and a study in the Journal of Periodontology found that if Type II diabetes is poorly controlled, patients are more likely to develop periodontal disease.

Many of the risk factors that are associated with Type II diabetes can be minimized through healthy lifestyle changes; and fortunately the same is true of periodontal disease. Good home care practices and regular dental checkups are the keys to good oral health, especially for people diagnosed with or at risk for diabetes. Eliminate tobacco use as well… research has shown that diabetic smokers may be 20 times more likely than diabetic non-smokers to develop periodontal disease! The major risk factors for developing Type II Diabetes include:

• High blood pressure
• High blood triglyceride (fat) levels
• High-fat diet
• High alcohol intake
• Sedentary lifestyle
• Obesity or being overweight

Many people feel overwhelmed by everything they need to learn when they are first diagnosed with diabetes, but they quickly realize that they must take steps to manage their condition every day. Excellent oral care is an essential step in that process, and the good news is that your dental team understands its important role.

Research at Columbia University has demonstrated that dentists can often identify patients with undiagnosed diabetes based on what they observe about the conditions in the mouth during a checkup. So, if you are at risk or suspect you might have the symptoms of either diabetes or periodontal disease, please take the risk seriously and speak to both your dentist and physician … it could save your life. If you have already been diagnosed with either condition then you should know that your dentist is committed to working with you and the rest of your medical team to maintain optimal health and quality of life.

Oral Piercing: The Price of Beauty

Body piercing is a popular form of self-expression these days, but it isn’t as safe as you may have been told. The American Dental Association opposes the practice of piercing the tissues in and around the mouth and you may want to research and think about some of the consequences that the local piercer may not know about…

Even if the piercing salon is reputable and the equipment is sterile, the human mouth is a warm, moist environment with a rich blood supply and home to literally millions of bacteria. A piercing site is an open wound, and the perfect place for bacteria to enter the blood stream and cause serious or life threatening infections such as septicemia. When these bacteria multiply in the blood stream and colonize in distant parts of the body such as the heart, they can cause endocarditis, a serious (and sometimes fatal) inflammation of the heart valves and tissues.

Common problems following piercing in and around the mouth include scar tissue, excessive drooling and speech problems. Oral jewelry may interfere with chewing or swallowing, and excessive sensitivity to metals such as eating utensils – and even your own fillings- is not uncommon. Jewelry that is accidentally bitten will likely fracture or chip tooth enamel or fillings, damage which is not just cosmetic- it can necessitate a root canal and crown or even an extraction. When jewelry consistently rubs against gum tissue, recession that exposes the roots and sometimes the bone can occur. Unfortunately, these effects are often permanent and require surgery to correct. In practical terms, some other undesirable effects of an oral piercing include

Complications of tongue piercing are very possible: Damage to the blood vessels in the tongue can cause serious blood loss; and the nerve can be easily punctured causing numbness, loss of taste or movement – damage that is sometimes temporary, but can also be permanent. After a piercing the tongue will swell, as you might expect- but occasionally the swelling is serious enough to block the airway.
If your mind is made up, and you are still sure that you want an oral piercing, there are some precautions that can make your choice safer:
• Plan ahead: Speak to your dentist (the expert in oral anatomy) for advice about the location you have chosen.
• Be sure your piercer has good references and is professional and competent. Sterile equipment and a clean environment are essential.
• Get instructions for aftercare, and follow them. Kissing, alcohol, or touching the site with unwashed hands are out of the question until it has healed, and good oral hygiene is imperative to minimize the risk of infection. There are several good over the counter, alcohol free mouth rinses that are effective at reducing bacteria. If it becomes necessary, the dentist can prescribe an effective antiseptic rinse.
• The piercing procedure and your oral jewelry should use surgical grade stainless steel, which is hypoallergenic. However, watch for inflammation (redness, swelling and pain) that doesn’t go away- this could be an indication that you are allergic to the metal in your jewelry, and you will need to remove it.
• When the tongue has been pierced, a short length of barbell is best, because it moves less and is less tempting to play with. Even tapping of jewelry against your tooth enamel can create tiny fractures

• Plastic jewelry is always preferable to metal because it is gentler and kinder to the enamel.

• As with anything else in the mouth, oral jewelry collects plaque and food particles. Remove and clean it regularly, and replace it if it becomes damaged.

• Don’t wear oral jewelry during a dental visit because it can interfere with x-rays, but do be sure to tell the dentist or hygienist about your piercing so that they can examine the site and look for possible problems.

• Most importantly, if your piercing causes any sensitivity or discomfort don`t hesitate to remove it.
• See your dentist or doctor right away if you experience symptoms of illness!

Fashion trends come and go and although most are harmless and fun, the price of being trendy may be higher than you expected. The potential cost of an oral piercing can be anything from minor cosmetic issues and sensitivity to thousands of dollars worth of repairs to the teeth, or permanent damage to the nerves and skin in the mouth. Ask yourself if the fashion statement is worth the potential long term cost. Have you experienced any negative effects as a result of oral (lip, tongue, cheek, etc.) piercings?