Tooth loss is often the unfortunate conclusion to a case of untreated periodontal (gum) disease—incentive enough to try either to prevent it or aggressively treat an infection should it occur. In either case, the objective is the same: to remove all plaque from dental surfaces.
Dental plaque (and its hardened form, tartar) is a thin buildup of bacteria and food particles on tooth surfaces. It's a ready food source for sustaining the bacteria that cause gum disease. Removing it can prevent an infection or “starve” one that has already begun.
Your first line of prevention is brushing and flossing your teeth daily to remove any accumulated plaque. Next in line are dental cleanings at least twice a year: This removes plaque and tartar that may have survived your daily hygiene.
Plaque removal is also necessary to stop an infection should it occur. Think of it as a more intense dental cleaning: We use many of the same tools and techniques, including scalers (or curettes) or ultrasonic devices to loosen plaque that is then flushed away. But we must often go deeper, to find and remove plaque deposits below the gums and around tooth roots.
This can be challenging, especially if the infection has already caused damage to these areas. For example, the junctures where tooth roots separate from the main body of the tooth, called furcations, are especially vulnerable to disease.
The results of infection around furcations (known as furcation involvements or furcation invasions) can weaken the tooth's stability. These involvements can begin as a slight groove and ultimately progress to an actual hole that passes from one end to the other (“through and through”).
To stop or attempt to reverse this damage, we must access the roots, sometimes surgically. Once we reach the area, we must remove any plaque deposits and try to stimulate regrowth of gum tissue and attachments around the tooth, as well as new bone to fill in the damage caused by the furcation involvement.
Extensive and aggressive treatment when a furcation involvement occurs—and the earlier, the better—can help save an affected tooth. But the best strategy is preventing gum disease altogether with dedicated oral hygiene and regular dental visits.
If you would like more information on preventing and treating 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 “What are Furcations?”
Today's dentures are more comfortable, more functional and more life-like than ever before—so much so that you might forget you have them in. Even so, dentures do have some downsides, and constant wear only amplifies those.
Our biggest concern is the effect dentures can have on bone health. Older bone is constantly replaced by newer bone, and the forces generated while chewing help stimulate this new growth. When a tooth is lost, however, this growth stimulus vanishes with it for that area of the bone. This may result in a slower growth rate, which can eventually lead to lost bone volume and density.
Dentures can't restore this lost stimulus, and may even make the situation worse. That's because traditional dentures rest on the bony ridges of the gums where the teeth once were. This can put pressure on the underlying bone, which can accelerate bone loss—and even more so when wearers leave their dentures in continuously.
Dentures can also contribute to disease if they're not regularly removed and cleaned. Besides oral yeast infections, bacteria-laden dentures can contribute to the production of a protein called interleukin-6 produced by the white blood cells. If a significant amount of this protein passes into the blood stream, it can increase body-wide inflammation and foster a systemic environment conducive to serious diseases like pneumonia.
If you wear dentures, then, it's good for your health (oral and otherwise) to incorporate two practices into your daily life. The first is to remove your dentures at night while you sleep. Not only will this help slow the progression of bone loss, it will also give your gums a chance to rest and recover from denture wear.
It's also important to regularly clean your dentures, either with an antibacterial soap or a special denture cleanser. During storage, keep your dentures in clean water or a peroxide-based solution designed for dentures. This will reduce the accumulation of bacteria on your dentures that can cause disease.
Dentures restore the dental function and smile appearance that a person loses with their teeth. Taking care of your dentures (and giving your mouth a daily rest from them) will help promote good oral and general health for you and a longer life for your dentures.
If you would like more information on denture care, 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 “Sleeping in Dentures.”
The NBA's reigning MVP Giannis Antetokounmpo may seem unstoppable, but he proved no match for a troubled tooth. Antetokounmpo, the self-proclaimed “Greek Freak,” missed one of the final three 2020 regular season games for a dental issue that resulted in last-minute oral surgery. According to a Milwaukee Bucks spokesperson, the star underwent “a root-canal like procedure.”
Root canal therapy, often simply called “a root canal,” may be needed when there is an infection inside the tooth. When dental pulp becomes inflamed or infected, excruciating pain can result. Pulp is the soft tissue that fills the inside of the tooth. It is made up of nerves, blood vessels and connective tissue. During root canal treatment, the pulp is removed, the space inside the tooth is disinfected, it is filled with a special material, and then the hole is sealed up.
A root canal is nothing to fear. It relieves pain by getting rid of infection and is so effective that over 15 million of them are performed in the U.S. each year. This routine procedure generally requires only local anesthetic, and your mouth should be back to normal within a day or two after treatment. Antetokounmpo can attest to that, as he returned to play the next day.
However, delaying root canal treatment when you need it can have serious consequences. If left untreated, an infection inside the tooth continues to spread, and it may move into the gums and jaw and cause other problems in the body. So, how do you know if you may need a root canal? Here are some signs:
Lingering sensitivity to hot or cold temperatures. One sign of nerve damage inside your tooth is pain that is still there 30 seconds after eating or drinking something hot or cold.
Intense pain when biting down. You may feel pain deep within your tooth, or in your jaw, face or other teeth. The pain may be hard to pinpoint—and even if it improves at times, it usually comes back.
A chipped, cracked or discolored tooth. A chip or crack can allow bacteria to enter the tooth, and the tooth may darken if the tissue inside is damaged.
A pimple on the gum. A bump or pimple on the gum that doesn't go away or keeps coming back may signify that a nearby tooth is infected.
Tender, swollen gums. Swollen gums may indicate an infection inside the tooth or the need for periodontal treatment.
And sometimes there is no pain, but an infection may be discovered during a dental exam.
Tooth pain should never be ignored, so don't put off a dental visit when you have a toothache. In fact, if a bad toothache goes away, it could mean that the nerves inside the tooth have died, but the infection may still be raging. Also, be sure to keep up with your regular dental checkups. We may spot a small problem that can be addressed before it becomes a bigger problem that would require more extensive treatment.
Remember, for dental issues both large and small, we're on your team! If you would like more information about tooth pain, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Tooth Pain? Don't Wait!” and “Root Canal Treatment: What You Need to Know.”
While mouth pain can certainly get your attention, what exactly hurts may be difficult to identify. It might seem to emanate from a single tooth, or a group of teeth. Then again, it might not be clear whether it's coming from teeth or from the gums.
Still, it's important to pinpoint the cause as much as possible to treat it correctly. One of the main questions we often want to answer is whether the cause originates from within a tooth or without.
In the first case, tooth decay may have entered the pulp at the center of the tooth. The pulp contains nerve bundles that can come under attack from decay and transmit pain signals. Incidentally, if the pain suddenly goes away, it may simply mean the nerves have died and not the infection.
The decay can also spread into the root canals leading to the root and supporting bone, and then make the jump into the gum tissues. One possible sign of this is the one mentioned earlier—you can't quite tell if the pain is from the tooth or the surrounding gums.
The root canals could also serve as a transportation medium for infection in the other direction. In that case, gum disease has advanced into the bone tissues around a tooth near its roots. The infection can then cross into the tooth. Again, both a tooth and the gum tissue around it can become diseased.
We have effective treatments for individual occurrences of interior tooth decay or gum disease: The former usually requires a root canal treatment to remove infected tissue and fill and seal the tooth from future infection; we alleviate gum disease by removing the dental plaque causing it and helping the gum tissues to heal. But combined tooth and gum infection scenarios are more difficult to treat, have a poorer prognosis and may require specialists.
To reduce the risk of either tooth decay or gum disease developing into this greater problem, it's best to take action at the first sign of trouble. So, see your dentist as soon as possible when you encounter oral pain or if you notice swollen or bleeding gums. The earlier we treat the initial outbreak of disease, be it tooth decay or gum disease, the better your chances of a successful and happy outcome.
If you would like more information on tooth pain, 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 “Confusing Tooth Pain.”
Some things in life are almost guaranteed to make you go, "Uh, oh"—your car won't start, your a/c goes out, or, worse yet, you get an unexpected letter from the IRS.
Here's another: One of your teeth is loose. And, if you don't act quickly, that loose tooth may soon become a lost tooth.
But first, we need to find out why it's loose. It's usually due to one of two types of injury related to your bite. One type is called primary occlusal trauma. This results from your teeth encountering higher than normal biting forces. This often happens if you habitually gnash or grind your teeth together outside of normal functions like eating or speaking.
The other type is secondary occlusal trauma. In this case, the supporting gum tissues and bone have been weakened or lost by disease, with the gum tissues possibly becoming detached. Without this support, even normal biting forces could loosen a tooth.
Our treatment approach for a loose tooth may differ depending on which of these is the cause. For primary occlusal trauma, we want to reduce the biting forces that have contributed to loosening the tooth. One way to do this is to create a mouthguard that when worn prevents teeth from making solid contact during grinding episodes.
For secondary trauma, we want to first focus on treating any gum disease responsible for weakening the gum tissues. Once we have it under control, the gums and bone tissues can heal and possibly regain and strengthen their attachment with the tooth.
At the same time, we may also need to stabilize a loose tooth to prevent its loss. This usually involves splinting, whereby we use neighboring healthy teeth to support the loose tooth. One way to do this is to attach a metal strip across the backs of the loose tooth and its more stable neighbors, or by way of a channel cut through the top biting surfaces of the teeth.
If a loose tooth regains its attachment with the gums and bone, it may stabilize and any splinting can be removed. If not, splinting may become a permanent solution. Either way, prompt treatment can help us save your loose tooth.
If you would like more information on treating loose 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 “Loose Teeth: Biting Forces Can Loosen Teeth.”
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