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WhyandHowtoSaveaDiseasedTooth

Let's say you have a diseased tooth you think might be on its last leg. It might be possible to save it, perhaps with a significant investment of time and money. On the other hand, you could have it replaced with a life-like dental implant.

That seems like a no-brainer, especially since implants are as close as we have to natural teeth. But you might want to take a second look at salvaging your tooth—as wonderful as implants are, they can't beat the real thing.

Our teeth, gums and jaws form an intricate oral system: Each part supports the others for optimum function and health. Rescuing a troubled tooth could be the best way to preserve that function, and replacing it, even with a dental implant, a less satisfying option.

How we save it will depend on what's threatening it, like advanced tooth decay. Caused by bacterial acid that creates a cavity in enamel and underlying dentin, decay can quickly spread into the tooth's pulp and root canals, and eventually threaten the supporting bone.

We may be able to stop decay and save the tooth with a root canal treatment. During this procedure, we remove diseased tissue from the pulp and root canals through a drilled access hole, and then fill the empty spaces. We then seal the access and later crown the tooth to protect it against future infection.

A second common threat is periodontal (gum) disease. Bacteria in dental plaque infect the outer gums and, like tooth decay, the infection quickly spreads deeper into the root and bone. The disease weakens gum attachments to affected teeth, hastening their demise.

To treat gum disease, we manually remove built-up plaque and tartar (hardened plaque). This deprives the infecting bacteria of their primary food source and “starves” the infection. Depending on the disease's advancement, this might take several cleaning sessions and possible gum surgery to access deep pockets of infection around the root.

Because both of these treatment modalities can be quite in-depth, we'll need to assess the survivability of the tooth. The tooth could be too far gone and not worth the effort and expense to save it. If there is a reasonable chance, though, a rescue attempt for your troubled tooth might be the right option.

If you would like more information on whether to save or replace a tooth, 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 “Save a Tooth or Get an Implant?

TakePositiveActionwithYourChildsThumb-SuckingHabit

As a parent you’re concerned with a number of issues involving your child’s health, not the least of which involves their teeth. One of the most common is thumb-sucking.

While later thumb-sucking is a cause for concern, it’s quite normal and not viewed as harmful in infant’s and very young children. This universal habit is rooted in an infant swallowing pattern: all babies tend to push the tongue forward against the back of the teeth when they swallow, which allows them to form a seal while breast or bottle feeding. Infants and young children take comfort or experience a sense of security from sucking their thumb, which simulates infant feeding.

Soon after their primary teeth begin to erupt, the swallowing pattern changes and they begin to rest the tongue on the roof of the mouth just behind the front teeth when swallowing. For most children thumb sucking begins to fade as their swallowing pattern changes.

Some children, though, continue the habit longer even as their permanent teeth are beginning to come in. As they suck their thumb the tongue constantly rests between the front teeth, which over time may interfere with how they develop. This can cause an “open bite” in which the upper and lower teeth don’t meet properly, a problem that usually requires orthodontic treatment to correct it.

For this reason, dentists typically recommend encouraging children to stop thumb-sucking by age 3 (18-24 months to stop using a pacifier). The best approach is positive reinforcement — giving appropriate rewards over time for appropriate behavior: for example, praising them as a “big” boy or girl when they have gone a certain length of time without sucking their thumb or a pacifier. You should also use training or “Sippy” cups to help them transition from a bottle to a regular cup, which will further diminish the infant swallowing pattern and need for thumb-sucking.

Habits like thumb-sucking in young children should be kept in perspective: the habit really isn’t a problem unless it goes on too long. Gentle persuasion, along with other techniques we can help you with, is the best way to help your child eventually stop.

If you would like more information on thumb sucking, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Thumb Sucking in Children” and “How Thumb Sucking Affects the Bite.”

AMinorProcedureCouldMakeBreastfeedingEasierforYouandYourBaby

The American Academy of Pediatrics and other healthcare organizations recommend breastfeeding as the best means for infant feeding. While bottle feeding can supply the nutrition necessary for a baby's healthy development, breastfeeding also provides emotional benefits for both baby and mother.

But there might be an obstacle in a baby's mouth that prevents them from getting a good seal on the mother's breast nipple—a small band of tissue called a frenum. This term describes any tissue that connects a soft part of the mouth like the upper lip or tongue to a more rigid structure like the gums or the floor of the mouth, respectively.

Although a normal part of anatomy, frenums that are too short, thick or inelastic can restrict a baby's lip or tongue movement and prevent an adequate seal while nursing. The baby may adjust by chewing rather than sucking on the nipple. Besides a painful experience for the mother, the baby may still not receive an adequate flow of breast milk.

Bottle-feeding is an option since it may be easier for a baby with abnormal frenums to negotiate during nursing. But the problem might also be alleviated with a minor surgical procedure to snip the frenum tissue and allow more freedom of movement.

Often performed in the office, we would first numb the frenum and surrounding area with a topical anesthetic, sometimes accompanied by injection into the frenum if it's abnormally thick. After the numbing takes effect, we gently expose the tissue and cut it with either surgical scissors or a laser, the latter of which may involve less bleeding and discomfort. The baby should be able to nurse right away.

If you wait later to undergo the procedure, the baby may already have developed compensation habits while nursing. It may then be necessary for a lactation consultant to help you and your baby "re-learn" normal nursing behavior. It's much easier, therefore, to attempt this procedure earlier rather than later to avoid extensive re-training.

While there's little risk, frenum procedures are still minor surgery. You should, therefore, discuss your options completely with your dental provider. Treating an abnormal frenum, though, could be the best way to realize the full benefits of breastfeeding.

If you would like more information on treating tongue or lip ties, please contact us or schedule an appointment for a consultation.

MileyCyrussLittleSecretStraighteningHerSmileWithLingualBraces

Miley Cyrus's rise to fame began when she was cast in the Disney series Hannah Montana. She played the title character, Hannah Montana, a famous singing star hiding her true identity, ordinary girl, Miley Stewart. In her real life at the time, Miley Cyrus had her own little secret—she was undergoing orthodontic treatment to straighten her smile.

Like many teenagers (as well as many adults), Cyrus's dental bite wasn't in proper alignment. She could have gone the traditional way by straightening her smile with braces fixed to the front of her teeth. It's an effective treatment, but the metallic hardware can overwhelm a person's appearance.

With her various roles in the public spotlight, Cyrus and her family wanted an effective but out-of-sight method for moving her teeth. They chose a relatively new one called lingual braces. Unlike traditional braces, the hardware for lingual braces is fixed on the back of the teeth (or the tongue side, hence the term “lingual”).

Lingual braces can correct any bite problem labial (“lip”) braces can, just through different mechanics of movement. Its main appeal is that the hardware is hidden behind the teeth, so only you and your orthodontist need know you're wearing braces.

There is also less risk of damage to the mouth or the braces themselves if you're in a sport or profession where you're at high risk for facial blows. And unlike patients with traditional braces, you'll have an unobstructed view of your progress over the course of treatment.

Lingual braces do tend to cost more than traditional braces. Some patients also have difficulty at first with speaking and tongue comfort, though most grow accustomed to the braces within a couple of weeks. Because lingual braces are relatively new, there's been a limited number of orthodontists offering it.

But lingual braces are just one of the ways to straighten teeth. Modern dentistry offers several ways to give you your dream smile. If you have dental problems or would like to improve the look of your smile, please contact us or schedule a consultation, and we can discuss your options. To learn more, read the Dear Doctor magazine articles “Lingual Braces” and “The Magic of Orthodontics.”

WeCanRidYouofThatIrritatingLumpinYourMouthYouKeepBiting

You might not be aware how much force your jaws generate while you eat or chew. But you can become aware in a hurry when part of your inside cheek or lip gets in the way.

What may be even worse than the initial painful bite are the high odds you’ll bite the same spot again—and again. That’s because of a feature in the skin’s healing process.

As a surface wound heals, it often forms a cover of fibrous tissue consisting of the protein collagen. This traumatic fibroma, as it’s called, is similar to a protective callous that develops on other areas of damaged skin. In the process, though, it can become “taller” than the surrounding skin surface, which increases the chances of another bite.

This second bite often results in more fibrous tissue formation that rises even higher from the skin surface, which then becomes more likely to be bit again. After repeated cycles, the initial wound can become a noticeable, protruding lump.

These kinds of sores are typically not cancerous, especially if they’ve appeared to form slowly over time. But they can be a nuisance and the occasion of sharp pain with every subsequent bite. There is, though, an effective way to deal with it—simply have it removed.

While it involves a surgical procedure—an oral surgeon, periodontist or dentist with surgical training usually performs it—it’s fairly minor. After numbing the area with a local anesthetic, the dentist will then completely excise the lesion and close the resulting gap in the skin with two or three small sutures (it could also be removed with a laser). The wound should heal within a few days leaving you with a flat, flush skin surface.

The tissue removed is usually then biopsied. Although it’s highly unlikely it was more than an annoying sore, it’s still common procedure to examine excised tissues for cancer cells. If there appears to be an abnormality, your dentist will then see you to take the next step in your treatment.

More than likely, though, what you experienced was a fibroma. And with it now a thing of the past, you can chew with confidence knowing it won’t be there to get in the way.

If you would like more information on dealing with common mouth sores, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Common Lumps and Bumps in the Mouth.”





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