Even though a child’s primary (“baby”) teeth eventually give way, it’s still important to treat them if they become decayed. Primary teeth serve as guides for the emerging permanent teeth — if they’re lost prematurely, the permanent tooth may come in misaligned.
If the decay, however, affects the tooth’s inner pulp, it poses complications. A similarly decayed adult tooth would be treated with a root canal in which all the pulp tissue, including nerve fibers and blood vessels, are removed before filling and sealing. Primary teeth, however, are more dependent on these nerves and blood vessels, and conventional filling materials can impede the tooth’s natural loss process. It’s better to use more conservative treatments with primary teeth depending on the degree of decay and how much of the pulp may be affected.
If the decay is near or just at the pulp, it’s possible to use an indirect pulp treatment to remove as much of the softer decay as possible while leaving harder remnants in place: this will help keep the pulp from exposure. This is then followed with an antibacterial agent and a filling to seal the tooth.
If the pulp is partially exposed but doesn’t appear infected, a technique called direct pulp capping could be used to cover or “cap” the exposed pulp with filling material, which creates a protective barrier against decay. If decay in a portion of the pulp is present, a pulpotomy can be performed to remove the infected pulp portion. It’s important with a pulpotomy to minimize the spread of further infection by appropriately dressing the wound and sealing the tooth during and after the procedure.
A pulpectomy to completely remove pulp tissue may be necessary if in the worst case scenario the pulp is completely infected. While this closely resembles a traditional root canal treatment, we must use sealant material that can be absorbed by the body. Using other sealants could inhibit the natural process when the primary tooth’s roots begin to dissolve (resorb) to allow it to eventually give way.
These all may seem like extraordinary efforts to save a tooth with such a short lifespan. But by giving primary teeth a second chance, their permanent successors will have a better chance of future good health.
If you would like more information on treating decay in primary teeth, 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 “Root Canal Treatment for Children’s Teeth.”
You have a great smile: beautiful white teeth all perfectly aligned. But unbeknownst to you, periodontal (gum) disease might even now be damaging your gum tissues, setting the stage for future tooth and bone loss — and a ruined smile.
While it’s easy to miss the early stage of this disease caused by bacterial plaque on tooth surfaces, there are a few signs if you pay close attention. Bleeding gums after moderate brushing or flossing could indicate normally resilient gum tissues have begun to weaken. You may also notice a slight redness and swelling around the margins of the gums and a bad taste or breath. As it progresses, you may experience painful abscesses (infected pockets that develop between the gums and tooth) and loose teeth, a late sign of tissue detachment and bone loss. If you are a smoker, nicotine reduces swelling and bleeding of the gums, removing signs you have a disease. If you smoke, you need to see your dentist regularly.
While renewed daily oral hygiene is important for stopping gum disease, you may also need professional care to bring it under control. The main treatment calls for the manual removal of plaque and calculus (hardened deposits of plaque) that are sustaining the infection. Dentists and hygienists both can perform scaling, which removes plaque and calculus at or just below the gum line, and root planing to clean accessible root surfaces.
In more advanced cases, though, you may need the services of a periodontist, a specialist in treating diseased or injured gums, bone and other connective tissues that support the teeth. They’re also skilled in more advanced treatments like gum flap surgery that more fully exposes a tooth’s root area for plaque and calculus (or tartar) removal, or tissue grafting procedures that improve the health and appearance of damaged gums.
If you suspect you have gum disease, the place to start is with your family dentist. They can determine if your case will respond to basic scaling, root planing or antibiotic treatment. If the disease appears more advanced or with complications, they will most likely refer you to a periodontist for treatment.
If you’ve already seen bleeding, swelling or redness, see your dentist as soon as possible. The sooner you begin treatment for any case of gum disease, the less likely it will lead to the loss not only of your teeth but your beautiful smile.
If you would like more information on the treatment of periodontal (gum) disease, 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 “When to See a Periodontist.”
Cavities can happen even before a baby has his first piece of candy. This was the difficult lesson actor David Ramsey of the TV shows Arrow and Dexter learned when his son DJ’s teeth were first emerging.
“His first teeth came in weak,” Ramsey recalled in a recent interview. “They had brown spots on them and they were brittle.” Those brown spots, he said, quickly turned into cavities. How did this happen?
Ramsey said DJ’s dentist suspected it had to do with the child’s feedings — not what he was being fed but how. DJ was often nursed to sleep, “so there were pools of breast milk that he could go to sleep with in his mouth,” Ramsey explained.
While breastfeeding offers an infant many health benefits, problems can occur when the natural sugars in breast milk are left in contact with teeth for long periods. Sugar feeds decay-causing oral bacteria, and these bacteria in turn release tooth-eroding acids. The softer teeth of a young child are particularly vulnerable to these acids; the end result can be tooth decay.
This condition, technically known as “early child caries,” is referred to in laymen’s terms as “baby bottle tooth decay.” However, it can result from nighttime feedings by bottle or breast. The best way to prevent this problem is to avoid nursing babies to sleep at night once they reach the teething stage; a bottle-fed baby should not be allowed to fall asleep with anything but water in their bottle or “sippy cup.”
Here are some other basics of infant dental care that every parent should know:
- Wipe your baby’s newly emerging teeth with a clean, moist washcloth after feedings.
- Brush teeth that have completely grown in with a soft-bristled, child-size toothbrush and a smear of fluoride toothpaste no bigger than a grain of rice.
- Start regular dental checkups by the first birthday.
Fortunately, Ramsey reports that his son is doing very well after an extended period of professional dental treatments and parental vigilance.
“It took a number of months, but his teeth are much, much better,” he said. “Right now we’re still helping him and we’re still really on top of the teeth situation.”
If you would like more information on dental care for babies and toddlers, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “The Age One Dental Visit” and “Dentistry & Oral Health for Children.”
When you visit us for your regular checkup we're examining more than your teeth and gums. We're also checking to see if you're having problems with soft tissues in and around your mouth.
Besides canker sores, rashes or other types of abnormalities, our exam may uncover strange looking lesions known as lichen planus on the inside of the mouth. These purple-tinted bumps or rash-like discolorations are named for their similarity in appearance to lichen fungi found on trees or rocks. Although these mouth sores may look odd, they're fairly rare and usually do not cause concern.
Most people don't even know they have lichen planus until it's discovered during a dental exam. If there are any symptoms, it's usually a feeling of roughness, tenderness or itching. They may increase your sensitivity to spicy or acidic foods, but rarely cause extreme pain. If they're located around the gums, you may also notice a little soreness after brushing or eating.
To confirm it is lichen planus, we need to perform a biopsy. During this procedure, we remove a tiny amount of the affected tissue and have it examined microscopically. We do this not only to determine the correct diagnosis, but also to rule out more serious problems like pre-cancerous lesions or oral cancer.
Thankfully, though, this worst case scenario is quite rare, and although the condition can't be cured, there are some things you can do to keep any discomfort to a minimum. If the lesions are irritating, we recommend using a soft toothbrush with gentle brushing action. You may also want to limit or avoid spicy or acidic foods like citrus, tomatoes, hot peppers and caffeinated drinks. Managing stress can also help. For some extreme conditions, we can prescribe a topical steroid to help relieve discomfort.
If you notice any of the above symptoms, be sure to contact us or point it out at your next appointment. Once we know what we're dealing with, we can take steps to treat you.
If you would like more information on different types of mouth sores, 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 “Lichen Planus.”
Want to know the exact wrong way to pry open a stubborn lid? Just ask Jimmy Fallon, host of NBC-TV’s popular “Tonight Show.” When the 40-year-old funnyman had trouble opening a tube of scar tissue repair gel with his hands, he decided to try using his teeth.
What happened next wasn’t funny: Attempting to remove the cap, Fallon chipped his front tooth, adding another medical problem to the serious finger injury he suffered a few weeks before (the same wound he was trying to take care of with the gel). If there’s a moral to this story, it might be this: Use the right tool for the job… and that tool isn’t your teeth!
Yet Fallon is hardly alone in his dilemma. According to the American Association of Endodontists, chipped teeth account for the majority of dental injuries. Fortunately, modern dentistry offers a number of great ways to restore damaged teeth.
If the chip is relatively small, it’s often possible to fix it with cosmetic bonding. In this procedure, tough, natural-looking resin is used to fill in the part of the tooth that has been lost. Built up layer by layer, the composite resin is cured with a special light until it’s hard, shiny… and difficult to tell from your natural teeth. Best of all, cosmetic bonding can often be done in one office visit, with little or no discomfort. It can last for up to ten years, so it’s great for kids who may be getting more permanent repairs later.
For larger chips or cracks, veneers or crowns may be suggested. Veneers are wafer-thin porcelain coverings that go over the entire front surface of one or more teeth. They can be used to repair minor to moderate defects, such as chips, discolorations, or spacing irregularities. They can also give you the “Hollywood white” smile you’ve seen on many celebrities.
Veneers are generally custom-made in a lab, and require more than one office visit. Because a small amount of tooth structure must be removed in order to put them in place, veneers are considered an irreversible treatment. But durable and long-lasting veneers are the restorations of choice for many people.
Crowns (also called caps) are used when even more of the tooth structure is missing. They can replace the entire visible part of the tooth, as long as the tooth’s roots remain viable. Crowns, like veneers, are custom-fabricated to match your teeth in size, shape and color; they are generally made in a dental lab and require more than one office visit. However, teeth restored with crowns function well, look natural, and can last for many years.
So what happened to Jimmy Fallon? We aren’t sure which restoration he received… but we do know that he was back on TV the same night, flashing a big smile.
If you would like more information about tooth restorations, please contact us or schedule a consultation. You can learn more in the Dear Doctor magazine articles “Porcelain Crowns & Veneers” and “Artistic Repair Of Front Teeth With Composite Resin.”
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