My Blog
By Barry Goodman, DDS
October 10, 2018
Category: Oral Health
Tags: root resorption  
GetanEarlyStartTreatingRootResorptionBeforeitsTooLate

Baby (primary) teeth look and function much like their permanent counterparts. Besides having a visible crown, they also have roots that maintain contact with the jawbone.

But there are some differences, the biggest one being the normal process whereby primary tooth roots dissolve or, in dental terms, resorb. Root resorption eventually leads to the tooth coming loose to make way for the permanent tooth.

Adult tooth roots can also resorb — but it's decidedly not normal. If adult root resorption isn't promptly treated, it could also lead to tooth loss — but there won't be an incoming tooth to take its place.

Although it can begin inside a tooth, adult root resorption usually begins on the outside. One type, external cervical resorption (ECR), begins around the neck-like area of the tooth not far below the gum line. Its initial signs are small pink spots where the tooth enamel has eroded; those pink cells within the space are doing the damage.

We don't fully understand the mechanism behind ECR, but there are some factors that often contribute. People with periodontal ligament damage or trauma, sometimes due to too much force applied during orthodontic treatment, have a high risk of ECR. Some bleaching techniques for staining inside a tooth may also be a factor.

The key to treating ECR is to detect it as early as possible before it does too much root damage. Regular checkups with x-rays play a pivotal role in early detection. Advanced stages of ECR might require more advanced diagnostics like a cone beam computed tomography (CBCT) scan to fully assess the damage.

If the lesion is small, we can surgically remove the cells causing the damage and fill the site with a tooth-colored filling. If ECR has spread toward the pulp, the tooth's inner nerve center, we may also need to perform a root canal treatment.

Either of these methods intends to save the tooth, but there is a point where the damage is too great and it's best to remove the tooth and replace it with a life-like dental implant or other restoration. That's why it requires vigilance through regular, semi-annual dental visits to detect the early signs of root resorption before it's too late.

If you would like more information on adult tooth root resorption, 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 Resorption.”

By Barry Goodman, DDS
September 30, 2018
Category: Oral Health
Tags: tooth pain  
FindandTreattheActualSourceofToothPaintoRelieveit

Determining which of your teeth is causing your toothache isn’t always easy — or even if it’s a tooth at all. The pain could be coming from a tooth, the gums, or both. Only a thorough dental examination can pinpoint the exact cause and best course of treatment.

If a decayed tooth is the problem, the pain may be coming from nerves and other tissue deep within the tooth’s pulp. The symptoms could be dull or sharp, constant or intermittent, specific to one area or spread out. It’s even possible for the pain to suddenly subside after a few days. This doesn’t mean the infection has subsided, but rather that the infected nerves have died and no longer transmit pain. Pain can also radiate from the actual source and be felt somewhere else — the pain in your sinuses, for example, could actually originate from an infected back tooth.

If the source is periodontal (gum) disease, the infection has begun in the gum tissues. As they become more inflamed they lose their connectivity with the teeth, bone loss occurs and the gums may “recess” or draw back. This exposes the tooth root, which without the protective cover of the gum tissues becomes highly sensitive to changes in temperature or pressure. As a result you may encounter sharp pain when you eat or drink something hot or cold, or bite down.

Treating these issues will depend on the actual infection source. An infected tooth often requires a root canal treatment to clean out the pulp and root canals of dead or infected tissue, fill them with a special filling, and seal and crown the tooth to prevent future infection. If the source is gum disease, we must manually remove the bacterial plaque causing the disease from all tooth and gum surfaces to stop the infection and allow the gums to heal. In advanced cases, surgical procedures may be necessary to repair damage and encourage new gum and bone growth.

Where dental disease has spread from tooth to gums or vice-versa, you may need treatments for both areas to address your overall condition. Whatever the treatment course, we can put an end to your tooth pain and restore health to your teeth and gums.

If you would like more information on the sources of mouth pain, please contact us today to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Confusing Tooth Pain.”

By Barry Goodman, DDS
September 20, 2018
Category: Dental Procedures
WatchOutforRe-InfectionAfteraRootCanalTreatment

So, you've undergone a root canal treatment to save a decayed tooth. The tooth has a new lease on life — and the pain is gone too. But there's a reality you need to keep in mind — your tooth could become re-infected, putting you back in the same painful circumstance.

Root canal treatments are often necessary when decay works its way deep within a tooth, into the pulp. The excruciating pain a person feels is the infection attacking the bundle of nerves within the pulp tissue. If the infection isn't addressed promptly, it will continue to work its way to the root, eventually damaging the tooth beyond repair.

During a root canal treatment, we drill into the tooth to access the pulp chamber. After clearing it completely of its infected tissue, we then fill the chamber and root canals with a special filling and then seal off the access. A short time later we'll bond a crown over the tooth to protect it and to make it more attractive.

Most of the time, this preserves the tooth for many years. Occasionally, though, re-infection can occur. There are a number of reasons why: the first infection may have been more extensive than thought; the root canal network was more complex and some tinier canals weren't able to be identified; or the protective crown may once again get tooth decay contaminating the root canal.

If infection does reoccur it doesn't mean the tooth is lost. It's possible a second root canal treatment can successfully correct any problems, especially those that may not have been detected the first time. More complex cases might also require the services of an endodontist, a specialist in root canals. They're skilled in advanced techniques and have specialized equipment to handle even the most complicated root canal networks.

In the meantime, if you notice signs of re-infection like pain or swelling around a treated tooth, contact us promptly for an appointment. You should also contact us if the tooth is injured in an accident. The sooner we can treat your tooth, the more likely the second time will be more successful.

If you would like more information on preserving a tooth through root canal treatment, 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: How long will it Last?

DentalInjuryIsJustaTemporarySetbackforBasketballStarKevinLove

The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.

In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?

The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.

Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.

So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”

Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.

If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”

By Barry Goodman, DDS
August 31, 2018
Category: Dental Procedures
Tags: root canal  
DontFeartheRootCanal-itCouldSaveYourTooth

Many people consider a root canal treatment to be potentially an unpleasant experience. You might even feel a few butterflies fluttering in your stomach if we were to recommend one for you.

But there’s nothing actually to dread about this common and very effective treatment. The procedure doesn’t cause pain; in fact, it most likely relieves tooth pain. What’s more, it could save a tooth that would be otherwise lost.

The name comes from narrow passageways extending from the tip of the root to the innermost tooth pulp. The pulp contains nerves and other structures once vital to early tooth development. And although they’re not as important in a fully mature tooth, those nerves still function. In other words, they can still feel stimulation or pain.

That shouldn’t be a problem with a healthy tooth. But if tooth decay invades the inner pulp, those nerves now under attack will begin firing. You’ll know something’s wrong. As bad as it feels, though, the toothache isn’t your worst problem: if the decay isn’t stopped, it can spread through the root canals to the bone that could eventually lead to losing the tooth.

A root canal treatment removes the decayed pulp tissue and protects the tooth from re-infection. We first deaden the tooth and surrounding tissues with a local anesthesia and set up a rubber dam around the tooth to protect it from contamination from the surrounding environment. We then drill a small access hole through the enamel and dentin to reach the pulp chamber and root canals.

Using special instruments, we remove all the diseased tissue from the pulp and flush out the empty chamber and root canals with antibacterial solutions. After re-shaping the root canals, we fill them and the pulp chamber with gutta-percha, a rubber-like biocompatible material that conforms well to the root canal walls. We seal the gutta-percha with adhesive cement and then fill the access hole. Later, we’ll give the tooth further protection with a custom crown.

After the procedure, you may experience short-term minor discomfort usually manageable with over-the-counter pain relievers like ibuprofen. The good news, though, is that the excruciating nerve pain from within the tooth will be gone—and your tooth will have a new lease on life.

If you would like more information on saving a problem tooth with root canal treatment, 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: What You Need to Know.”





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