Dentist - Towson
8600 LaSalle Rd. Suite 406 Severn Bldg.
Towson, MD 21286
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Posts for: December, 2015

TreatingaBabyToothwithInnerDecaycanbeComplicated-butStillNecessary

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.”


By Dr. Mark Shulman
December 15, 2015
Category: Dental Procedures
Tags: root canal  
ASecondRootCanalTreatmentMayHelpSaveanEndangeredTooth

When decay spreads to the tooth’s inner pulp, a root canal treatment may be necessary to save it. It’s a common procedure: after removing all tissue from the pulp, the pulp chamber and root canals are filled with a special filling. The tooth is then sealed and a crown installed to protect the tooth from re-infection and/or fracture, possibly extending the tooth’s life for many years.

Sometimes, however, the tooth doesn’t respond and heal as expected: the number, size and shape of the patient’s root canals may have complicated the procedure; there may have been a delay before installing the final crown or restoration or the restoration didn’t seal the tooth as it should have, both occurrences giving rise to re-infection. It’s also possible for a second, separate occurrence of decay or injury to the tooth or crown to undo the effects of successful treatment.

It may be necessary in these cases to conduct a second root canal treatment, one that may be more complicated or challenging than the first one. For one thing, if the tooth has been covered by a crown or other restorative materials, these will most likely need to be removed beforehand. In cases where the root canal network and anatomy are challenging, it may require the expertise of an endodontist, a dental specialist in root canal treatments. Using advanced techniques with microscopic equipment, an endodontist can locate and fill unusually narrow or blocked root canals.

Because of these and other possible complications, a root canal retreatment may be more costly than a first-time procedure. Additionally, if you have dental insurance, your particular benefit package may or may not cover the full cost or impose limitations on repeated procedures within a certain length of time. The alternative to retreatment, though, is the removal of the tooth and replacement with a dental implant, bridge or partial denture with their own set of costs and considerations.

The complications and costs of a repeated procedure, though, may be well worth it, if it results in a longer life for the tooth. Preserving your natural tooth is in most cases the most desired outcome for maintaining a healthy mouth.

If you would like more information on root canal treatments, 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.”


By Dr. Mark Shulman
December 07, 2015
Category: Dental Procedures
Tags: fillings  
DentalAmalgamContinuestobeaDurableandSafeToothFilling

Recently, a number of new filling materials that mimic tooth color have come into popular use and, so far, have proven more durable than past versions. Even so, the traditional metal-based dental amalgam remains a viable choice, especially for less visible back teeth and their higher biting forces.

Used for more than a century, dental amalgam is a metal alloy composed of silver, mercury, tin and copper. The mixture is carefully proportioned so that potentially hazardous mercury is kept to a minimum and bonded with the other metals. Amalgam in its initial form is quite pliable so that it can be molded into the tooth structure under repair. Afterward it sets hard to form a durable filling that can withstand the daily force generated when we bite and chew food.

Besides durability, dental amalgam rarely causes an allergic reaction in a patient, and it’s easy for trained dentists to apply. On the downside, however, it can cause temporary temperature sensitivity in the tooth just after filling, and the tooth itself may require some removal of healthy structure to help keep the filling in place. And from an aesthetic point of view, its metallic appearance is considered unattractive especially for front teeth.

The presence of mercury in amalgam has also raised concerns over the years. “Free” mercury — atoms that escape through vapor emitted by the metal — can enter the bloodstream and potentially harm the nervous system. But after extensive study and research, U.S. and international health bodies including the American Dental Association have concluded any free mercury released during chewing is extremely low and well below any harmful levels. These studies have also found no ill effects in either children or adults with dental amalgam fillings.

Deciding on the type of filling material to use — dental amalgam or a newer composite resin, resin ionomer or glass ionomer — depends on a number of factors including the location of the teeth to be filled, the extent of decay and your personal preferences. Taking these into account, we’ll be happy to discuss which type of filling will suit you best for repairing decayed teeth.

If you would like more information on filling material options including dental amalgam, 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 “Silver Fillings — Safe or Unsafe?


By Dr. Mark Shulman
December 06, 2015
Category: Oral Health
Tags: oral health   pregnancy  
IsDentalTreatmentSafeDuringPregnancy

If you’re pregnant, you may find yourself pondering decisions you didn’t have to think about before. Should you have that glass of wine… or skip it, because of the alcohol; go for the sushi… or avoid uncooked foods; take the pain reliever… or live with the headache. And if you have a toothache — or even if you’re overdue for a checkup and a cleaning — you may also be wondering whether having dental treatment (especially treatment that might involve local anesthetics) is safe for you and your developing baby.

Fortunately, a study that recently appeared in the Journal of the American Dental Association (JADA) should let expectant moms breathe a little easier. The research concludes that it’s safe for pregnant women to undergo dental treatment, including procedures that use local anesthetics.

And that’s good news indeed, because while maintaining good oral health during pregnancy is critical for the developing baby, many expectant moms experience problems during this period.  Some common issues include a higher risk of tooth decay due to increased carbohydrate consumption, and sore or bleeding gums from a condition called pregnancy gingivitis.

According to the study’s lead author, Aharon Hagai, D.M.D., "[Pregnancy] is a crucial period of time in a woman’s life, and maintaining oral health is directly related to good overall health." Yet, as Dr. Hagai notes, pregnant women sometimes avoid the dentist even if they have a problem. So his team set out to determine whether having dental treatment with anesthesia affected the outcome of pregnancies. They compared a total of 1,004 women, some of whom had dental treatment with local anesthesia, and some who did not.

The research showed there was no significant difference between the two groups. This applied in terms of both major medical problems (such as cleft palate, heart defects or cerebral palsy) and other issues, including low birth weight and preterm delivery. Dr. Hagai summed it up this way: "We aimed to determine if there was a significant risk associated with dental treatment with anesthesia and pregnancy outcomes. We did not find any."

So if you’re pregnant, there’s one less thing to worry about. Go ahead and schedule your routine dental check up — and remember that it is particularly important to have cleanings during pregnancy.  If you experience changes in your oral health, don’t hesitate to come in for an office visit and cleaning; that way, you can make sure your hormonal changes are not playing havoc with your gums. There is an old saying in some cultures that for every child a woman has, she loses a tooth. Don’t let that happen to you.

If you have questions about oral health and pregnancy, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine article “Expectant Mothers: Dental facts you need to know” and “Pregnancy and Oral Health.”




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