Children have a lot of energy that's often channeled through physical activities and sports. Unfortunately, this also increases their risk of injuries, particularly to their teeth.

Injuries to the mouth can endanger permanent teeth's survival. For an older tooth, a root canal treatment might be in order. Not so, though, for a pre-adolescent tooth, even if it is permanent.

A young permanent tooth is still developing dentin, the large layer just below the enamel. This growth depends on the connective tissue, blood vessels and nerves within the pulp in the center of the tooth. Because a root canal treatment removes all of this tissue, it could stunt dentin and root growth and endanger the tooth's future.

Instead, we may need to treat it with one of a number of modified versions of a root canal, depending on what we find. If the tooth's pulp is unexposed, for example, we may need only to remove the damaged dentin, while still leaving a barrier of dentin to protect the pulp. We then apply an antibacterial agent to minimize infection and fill in the area where we've removed tooth structure.

If some of the pulp is exposed, we may perform a pulpotomy to remove just the affected pulp and any overgrown tissue. We then place a substance that encourages dentin growth and seal it in with a filling. If we go deeper toward the root end, we might also perform procedures that encourage the remaining pulp to form into a root end to stabilize the tooth.

If the entire pulp has been damaged beyond salvage, we may then turn to a procedure called an apexification. In this case we clean out the pulp chamber; at the root end we place mineral trioxide aggregate (MTA), a growth stimulator that encourages surrounding bone to heal and grow. We then fill in the root canals and chamber with a special filling called gutta percha to seal the tooth.

The deeper we must penetrate into the pulp, the higher the chances the young tooth's dentin and roots won't form properly, leading to later problems and possible loss. But by employing the appropriate one of these methods, we can minimize the risk and give your child's damaged tooth a fighting chance.

If you would like more information on children and dental injuries, 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 “Saving New Permanent Teeth after Injury.”

While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.

“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.

Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.

Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).

For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.

Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.

If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”

What’s the first thing that comes to mind when you think of the month of May? Balmy breezes? Sweet-smelling flowers? How about root canal treatment?

The last item might seem out of place…but for the last ten years, Root Canal Awareness week has been celebrated in May. So let’s take a closer look at this important—and often misunderstood—dental procedure.

What we commonly call a “root canal” is a special treatment that can save diseased teeth which might otherwise be lost. But the root canal itself is actually a set of hollow, branching passages deep inside the hard outer tissue of the tooth. The tiny “canals” contain the tooth’s soft pulp, including nerves, blood vessels and connective tissue. These tissues help teeth grow during childhood but aren’t necessary in healthy adult teeth—and, what’s worse, they can become infected via deep cavity or a crack in the tooth’s outer layers.

When bacteria infect the pulp tissue, the inflammation often causes intense discomfort. In time, the harmful microorganisms can also pass through the tooth’s root and into the tissue of the jaw, resulting in a painful abscess. Eventually, if it isn’t treated, the tooth will likely be lost.

Root canal treatment is designed to remove the infection, relieve the pain…and save the tooth. It is usually performed under anesthesia for your comfort. To begin the procedure, a small hole is made in the tooth’s enamel to give access to the pulp; then, tiny instruments are used to remove the diseased tissue and disinfect the tooth. Finally, it is sealed up against re-infection. Following treatment, a cap (or crown) is often needed to restore the tooth’s full function and appearance.

Despite some rumors you may have heard, root canal treatment is neither very painful nor likely to cause other health problems. So if you come across these discredited ideas, remember that dentists and dental specialists called endodontists perform some 25 million root canal procedures every year—and this treatment method  has been validated for decades.

Of course, like any medical procedure, root canal treatment is not 100% successful. While the procedure has a very high success rate, it’s possible that additional treatments will be needed in some cases. However, the alternative—extracting the tooth—has similar potential downsides; plus a replacement tooth will be needed to avoid the health and lifestyle troubles caused by missing teeth. But one thing is certain: Ignoring disease in the tooth’s soft tissues isn’t a good move, because the infection won’t go away on its own—and down the road it will only get worse.

So this May, while you’re taking time to smell the flowers, spare a thought for the often-misunderstood root canal. If you’d like more information on root canal treatment, please contact us or schedule a consultation. You can also learn more by reading the Dear Doctor magazine articles “A Step-By-Step Guide to Root Canal Treatment” and “Root Canal Treatment: What You Need to Know.”

You brush and floss every day to rid your teeth and gums of disease-causing plaque. But while “showing up” is most of the battle, the effectiveness of your technique will win the war.

So, how good are you at removing plaque? One quick way to find out is the “tongue test”—simply rub your tongue along your teeth: they should feel smooth and “squeaky” clean. Surfaces that feel rough and gritty probably still contain plaque.

For a more thorough evaluation, your dental hygienist may use a product during your regular dental visit called a plaque disclosing agent. It’s a solution applied to your teeth that dyes any bacterial plaque present on tooth surfaces a certain color while leaving clean surfaces un-dyed. The disclosing agent shows you where you’re effectively removing plaque and where you’re not.

These products aren’t exclusive to the dental office—you can use something similar at home if you’d like to know how well you’re doing with your hygiene before your next visit. You can find them over-the-counter as tablets, swabs or solutions. You may even find some that have two dye colors, one that reveals older plaque deposits and the other newer plaque.

You simply follow the product’s directions by first brushing and flossing as usual, then chewing the tablet, daubing the swab on all tooth and gum surfaces, or swishing the solution in your mouth like mouthwash for about 30 seconds before spitting it out. You can then use a mirror to observe any dye staining. Pay attention to patterns: for example, dyed plaque scalloping along the gum line means you’ll need to work your brush a little more in those areas.

The dye could color your gums, lips and tongue as well as your teeth, but it only lasts a few hours. And while plaque disclosing agents are FDA-approved for oral use, you should still check the ingredients for any to which you may be allergic.

All in all, a plaque disclosing agent is a good way to occasionally check the effectiveness of your plaque removal efforts. By improving your technique you may further lower your risk of dental disease.

If you would like more information on learning how effective your oral hygiene really is, 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 “Plaque Disclosing Agents.”

Your child’s dental care wouldn’t be the same without x-ray imaging. It’s one of our best tools for finding and treating tooth decay.

But since x-rays emit radiation, is your child in any danger when they’re exposed?

X-rays, an invisible form of electromagnetic energy, will form images on exposed film after passing through the body. Because it takes longer for x-rays to pass through dense tissue like teeth and bones, the corresponding areas appear lighter on the film than less dense tissue like the gums. We can detect decay because the diseased tooth structure is less dense and thus appears darker against healthier tooth structure.

The downside of x-rays, though, is the radiation they emit could potentially alter cell structure and increase the risk of future cancer, especially with children. That’s why we follow a principle known as ALARA when using x-ray imaging. ALARA is an acronym for “as low as reasonably achievable,” meaning the doses for an x-ray session will be as low as possible while still gaining the most benefit.

Advances in technology, particularly the development of digital processing, has helped reduce the amount of radiation exposure. We’re also careful with what types of x-rays we use. The most common type is the bitewing, a device with the film attached to a long piece of plastic that the child holds in their mouth while biting down.

Depending on the number of our patient’s teeth, we can usually get a comprehensive view with two to four bitewings.  A typical bitewing session exposes them to less radiation than what they’re receiving from natural environmental background sources each day.

Keeping the exposure as low and as less frequent as possible greatly reduces health risks while still getting the full benefit of early decay detection. Still, if you have concerns about your child’s x-ray exposure, we’ll be happy to discuss our approach and all the precautions we take using x-ray imaging.

If you would like more information on x-ray diagnostics and your child, 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 “X-Ray Safety for Children.”