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DecidingtheFateofWisdomTeethMoreNuancedThaninthePast

If you're of a certain age, there's a good chance you've had your third molars—wisdom teeth—removed. At one time, extracting these particular teeth was a common practice, even if they hadn't shown any signs or symptoms of disease or dysfunction. But now, if you have a son or daughter coming of age, your dentist may recommend leaving theirs right where they are.

So, what's changed?

Wisdom teeth have longed been viewed as problematic. As the last of the permanent teeth, they often erupt on a jaw already crowded with other teeth. This can cause them to come in out of position—or not at all, remaining partially or totally submerged (impacted) beneath the gums.

Misaligned teeth are more difficult to keep clean of bacterial plaque, which in turn raises the risk of tooth decay or gum disease. Impacted teeth can put pressure on the roots of neighboring teeth, which further increases the risk for disease or bite problems.

To avoid these common problems associated with wisdom teeth, dentists often remove them as a preemptive measure. Given their size and possible root complexity, this is no small matter: Removing them usually requires oral surgery, making wisdom teeth extraction one of the top oral surgical procedures performed each year.

Today, however, many dentists are taking a more nuanced approach to wisdom teeth. While they still recommend removal for those displaying signs of disease or other problems, they may advise leaving them in place if the teeth are healthy, not interfering with their neighbors, and not affecting bite development.

That's not necessarily a final decision, especially with younger patients. The dentist will continue to monitor the wisdom teeth for any emerging disease or problems, and may put extraction back on the table if the situation merits it.

The key is to consider each patient and their dental needs regarding wisdom teeth on an individual basis. If warranted, removing the wisdom teeth may still be warranted if will help prevent disease, keep bite development on track and optimize oral health overall.

If you would like more information on wisdom 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 “Wisdom Teeth: Coming of Age May Come With a Dilemma.”

ARoutineDentalProcedureSavesThisMLBStandoutsBrokenTooth

During this year's baseball spring training, Minnesota Twins center fielder Byron Buxton got into a row with a steak dinner—and the beefsteak got the better of it. During his meal, the Gold Glove winner cracked a tooth.

Fortunately, he didn't lose it. Buxton's dentist rescued the tooth with a dental procedure that's been around for over a century—a root canal treatment. The dependable root canal is responsible for saving millions of teeth each year.

Dentists turn to root canal treatments for a number of reasons: a permanent tooth's roots are dissolving (a condition called resorption); chronic inflammation of the innermost tooth pulp due to repeated fillings; or a fractured or cracked tooth, like Buxton's, in which the pulp becomes exposed to bacteria.

One of the biggest reasons, though, is advanced tooth decay. Triggered by acid, a by-product of bacteria, a tooth's enamel softens and erodes, allowing decay into the underlying dentin. In its initial stages, we can often treat decay with a filling. But if the decay continues to advance, it can infect the pulp and root canals and eventually reach the bone.

Decay of this magnitude seriously jeopardizes a tooth's survival. But we can still stop it before that point with a root canal. The basic procedure is fairly straightforward. We begin first by drilling a small hole into the tooth to access the inner pulp and root canals. Using special instruments, we then remove all of the infected tissue within the tooth.

After disinfecting the now empty spaces and reshaping the root canals, we fill the tooth with a rubber-like substance called gutta percha. This, along with filling the access hole, seals the tooth's interior from future infection. In most cases, we'll return sometime later and bond a life-like crown to the tooth (as Buxton's dentist did for him) for added protection and support.

You would think such a procedure would get its own ticker tape parade. Unfortunately, there's a cultural apprehension that root canals are painful. But here's the truth—because your tooth and surrounding gums are numbed by local anesthesia, a root canal procedure doesn't hurt. Actually, if your tooth has been throbbing from tooth decay's attack on its nerves, a root canal treatment will alleviate that pain.

After some time on the disabled list, Buxton was back in the lineup in time to hit his longest homer to date at 456 feet on the Twins' Opening Day. You may not have that kind of moment after a root canal, but repairing a bothersome tooth with this important procedure will certainly get you back on your feet again.

If you would like more information about root canal therapy, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “A Step-By-Step Guide to Root Canal Treatment.”

By Tatiana Ostanina
December 31, 2021
Category: Oral Health
Tags: gum disease  
TroublingDataSaysSmokingMarijuanaCouldWorsenGumDisease

It seems with each new election cycle another U.S. state legalizes marijuana use. It remains a flashpoint issue that intersects politics, law and morality, but there's another aspect that should also be considered—the health ramifications of using marijuana.

From an oral health perspective, it doesn't look good. According to one study published in the Journal of Periodontology a few years ago, there may be a troubling connection between marijuana use and periodontal (gum) disease.

Gum disease is a common bacterial infection triggered by dental plaque, a thin biofilm on tooth surfaces. As the infection advances, the gum tissues become more inflamed and lose their attachment to teeth. This often results in widening gaps or "pockets" between the teeth and gums filled with infection. The deeper a periodontal pocket, the greater the concern for a tooth's health and survivability.

According to the study, researchers with Columbia University's College of Dental Medicine reviewed data collected from nearly 2,000 adults, a quarter of which used marijuana at least once a month. They found the marijuana users had about 30 individual pocket sites on average around their teeth with a depth of at least 4 millimeters. Non-users, by contrast, only averaged about 22 sites.

The users also had higher incidences of even deeper pockets in contrast to non-users. The former group averaged nearly 25 sites greater than 6 millimeters in depth; non-users, just over 19. Across the data, marijuana users appeared to fare worse with the effects of gum disease than those who didn't use.

As concerning as these findings appear, we can't say that marijuana use singlehandedly causes gum disease. The condition has several contributing risk factors: diet, genetics, and, most important of all, how well a person manages daily plaque removal, the main driver for gum disease, through brushing and flossing.

Still, the data so far seems to indicate using marijuana can make gum disease worse. Further studies will be needed to fully test this hypothesis. In the meantime, anyone using marijuana should consider the possible consequences to their oral health.

If you would like more information on marijuana and oral health, please contact us or schedule an appointment for a consultation.

By Tatiana Ostanina
December 21, 2021
Category: Dental Procedures
3WaystoCorrectaSmileWithMissingIncisors

In the classic holiday film, It's a Wonderful Life, George Bailey sees what life would be like if he'd never been born. In a variation on the theme, imagine your life if your teeth had never formed.

That's actually a reality for some—they're born without teeth, albeit usually only one or two. But even then, they're often more susceptible to problems with their bite, speech development and nutrition.

And if their missing teeth affects their appearance, their self-image could also take a hit. In particular, the maxillary lateral incisors on either side of the central incisors (those in the very front) can create an odd smile if missing.

Fortunately, we can correct the problem of missing lateral incisors with three possible solutions. The first is canine substitution, involving the pair of pointed teeth next in line to the missing incisors. In effect, we use orthodontic appliances like braces to move them toward the frontmost teeth and close the missing teeth gap.

It's a minimally invasive way to improve smile appearance. But because of their size and sharp edges, it's often necessary to alter the canines, perhaps even crown them. Some people may also need gum surgery to "blend" the gums with the repositioned teeth.

A second method is a fixed bridge, a series of fused crowns. Those in the middle replace the missing teeth, while those on the ends are bonded to the natural teeth on either side of the gap to support the bridge.

Bridges can function well for many years, but it does require permanently altering the supporting teeth for crowning. An alternative Maryland or bonded bridge doesn't require this alteration, but it's also less durable than a traditional bridge.

Finally, we could replace the missing teeth with dental implants, a titanium post imbedded into the jawbone with an attached life-like crown. An implant tooth can last for decades, and don't require alterations to other teeth. However, they're not suitable for younger patients who are still undergoing jaw development—a temporary restoration may thus be in order until the jaw matures.

Being born without certain teeth is something you can't do anything about. But you can change how it affects your appearance and life with one of these options for a new smile.

If you would like more information on correcting a smile with missing 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 “When Permanent Teeth Don't Grow.”

By Tatiana Ostanina
December 11, 2021
Category: Oral Health
Tags: tooth decay  
RecurringSinusInfectionsCouldBeaSignofToothDecay

It seems like every year you make at least one trip to the doctor for a sinus infection. You might blame it on allergies or a "bug" floating around, but it could be caused by something else: tooth decay.

We're referring to an advanced form of tooth decay, which has worked its way deep into the pulp and root canals of a tooth. And, it could have an impact on your sinuses if the tooth in question is a premolar or molar in the back of the upper jaw.

These particular teeth are located just under the maxillary sinus, a large, open space behind your cheek bones. In some people, these teeth's roots can extend quite close to the sinus floor, or may even extend through it.

It's thus possible for an infection in such a tooth to spread from the tip of the roots into the maxillary sinus. Unbeknownst to you, the infection could fester within the tooth for years, occasionally touching off a sinus infection.

Treating with antibiotics may relieve the sinus infection, but it won't reach the bacteria churning away inside the tooth, the ultimate cause for the infection. Until you address the decay within the tooth, you could keep getting the occasional sinus infection.

Fortunately, we can usually treat this interior tooth decay with a tried and true method called root canal therapy. Known simply as a "root canal," this procedure involves drilling a hole into the tooth to access the infected tissue in the pulp and root canals. After removing the diseased tissue and disinfecting the empty spaces, we fill the pulp and root canals and then seal and crown the tooth to prevent future infection.

Because sinus infections could be a sign of a decayed tooth, it's not a bad idea to see a dentist or endodontist (root canal specialist) if you're having them frequently. Treating it can restore the tooth to health—and maybe put a stop to those recurring sinus infections.

If you would like more information on the connection between tooth decay and sinus problems, 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 “Sinusitis and Tooth Infections.”





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