When I was asked to write a piece for Dr. Nelson’s blog about endodontics, I thought I might talk about the many recent changes that have taken place in my specialty over the last few years. I also thought about presenting some of the more interesting cases that we have seen in our office. However, it occurred to me that most people might not even know what an endodontist is. So I decided to start with the basics and answer the questions I hear every day from my patients. My hope is to not only educate, but also to ease some of the fears and apprehension that surround root canal therapy. For more information please visit our website at http://www.endoassoc.com/

Endodontic FAQ

1. What is a root canal?

   The actual procedure is called root canal therapy. All teeth have a canal system (the tooth is hollow) that contains blood vessels, nerves, and other tissues that were important when the tooth was developing. This collection of various tissues is called the dental pulp. In an adult, the dental pulp serves as a warning system when a cavity develops, sensitivity to sweets for example. The pulp is not necessary for the tooth to function. Root canal therapy is performed when the pulp is diseased or infected. During the procedure the canals are accessed, debrided, sterilized, and sealed with a root filling.

2. Why do I need a root canal?There are three main reasons why root canal therapy is performed:
   1. The “nerve” is dying: The dental pulp can experience a loss of blood supply, which leads to the death of the pulp. This occurs when a tooth has a large cavity for example and it can be extremely painful. Antibiotics and pain medications are generally not helpful in this circumstance. Only root canal therapy or extraction of the tooth will resolve the discomfort.
   2. Dental Abscess: If the pulp tissue dies and the root canal has not been performed, the tooth is prone to infection. Once infected, only root canal therapy or extraction will resolve the problem. Symptoms vary from patient to patient, ranging from no symptoms at all (your dentist tells you that infection was noted on a routine dental x-ray) to severe swelling and extreme pain requiring immediate treatment and possible surgical intervention.
   3. The tooth is badly broken down and the dentist needs to place a post inside the tooth to help retain a filling or crown.
3. Can I take an antibiotic to make the problem go away?Antibiotics will resolve the pain and swelling associated with an acute dental infection. The symptoms will return at some point because the source of the infection has not been treated. To do this, the antibiotic must be carried to the source (the infected root canal system) of the problem by blood circulation. Unfortunately, once a tooth is infected it has lost its blood supply and therefore antibiotics cannot get inside the tooth’s root canal system to eliminate the infection. The only means of doing so is through the cleaning and sterilizing process of root canal therapy or removal of the tooth.
4. What is an Endodontist?An endodontist is a dental specialist who performs procedures related to the root canals of teeth, from the routine to the very complex. In order to become an endodontist, a dentist must complete an additional 2-3 year residency program after dental school. Endodontists are thoroughly trained in dental anatomy, diagnosis of orofacial pain, and in the use of the surgical operating microscope (see photo). Microscopes are used almost exclusively by endodontists for visualization of intricate root canal anatomy at up to 21X. The additional training and instrumentation ensures that root canal related treatments are performed to the highest level of care.
5. Is the root canal procedure painful?Root canal therapy does not have to be unpleasant. The key to a painless procedure is ensuring the patient is adequately anesthetized (numb). Those patients who have had unpleasant experiences in the past, most likely, were just not numb enough. When a tooth is painful to begin with, it can make for a very uncomfortable procedure. Because endodontists deal with patients who come in with existing toothaches everyday, we are proficient at getting patients anesthetized. The vast majority of our patients find that the procedure is not painful. In fact, it is not uncommon to have patients fall asleep during treatment.
6. How long does a root canal take to perform?It depends on what tooth is being treated and if there are any complicating factors, but in general it takes a little more then an hour for a molar tooth once the patient is numb. Under some circumstances, it can take multiple appointments.
7. Will I be able to go to work after the procedure?Some soreness is expected for 2-3 days following root canal therapy, but this should not prevent a patient for going about their daily activities. Typically, over-the-counter anti-inflammatory medications such as ibuprofen and naproxen are very effective at managing post-operative discomfort. Please follow any post-operative instructions given to you by your treating dentist.
8. Will my tooth be different after a root canal?In order to perform root canal therapy a hole has to be drilled into the tooth. This results in a tooth that is more prone to fracture because of the loss of the additional tooth structure. That is why crowns are recommended on molar and premolar teeth after root canal therapy. The tooth will no longer feel hot or cold. The tooth maintains proprioception which is the ability to sense when something is between your teeth or when your teeth touch.
9. How long do root canals last?The long-term success of root canal therapy depends on different factors. The first is how well the root canal system was cleaned. The microscope and other specialized instruments play a major role in this, as does the clinician’s knowledge of dental anatomy (i.e. how many canals to expect to find inside a specific tooth). The second factor affecting the success rate is the timely restoration of the tooth following root canal therapy with a permanent filling and a crown. And lastly, the patient should maintain adequate oral hygiene to prevent future cavities that can lead to a recontamination of the root canal system. Today’s root canal treated tooth will last as long as any of the patient’s other teeth.
10. Do root canal treated teeth cause other diseases?Simply put, no literature exists that implicates root canal treated teeth as a cause of systemic disease. This idea comes from the 1920-30’s, when there was a prevalent theory that implicated not only root canal treated teeth but dentistry in general as the cause of many systemic diseases such as arthritis, intestinal disorders, and anemias. This led to a destructive form of dentistry in which extraction was considered the only treatment option in order to prevent or cure these systemic diseases. The theory was later disproved and rejected. Studies over the years have demonstrated that people with root canal treated teeth are no more likely to be ill then those without them. Unfortunately, some patients, physicians, and dentists still believe this theory is true. Recent attempts to reproduce the results of these early studies have failed to show a connection to systemic diseases. In re-evaluating the original studies, it is believed that the poor sanitary conditions and imprecise research methodology led to the flawed results. It is sad to think of the millions of unnecessary extractions that still occur because of this research.

In this edition of the Perfect Smile podcast, Dr. Nelson answers the question — are sealants just for kids?  As well as advice on using flouride, floss, and how often to change your toothbrush.

[audio:http://www.portlandmainedentist.com/podcasts/perfect-smile-02.mp3]

Perfect Smile Podcast, Episode 2 – Are Sealants Just For Kids?

Let us know what you think at http://twitpic.com/2a2ne

In our last issue of Share a Smile (you can find the link on our homepage) we shared with you the new found link between drinking coffee  and oral cancer prevention. Coffee has many other health benefits like reducing your risk of type 2 diabetes, Alzheimer’s disease, and more. Coffee is rich with antioxidants – in fact, Americans get more antioxidants from coffee than from any other food or beverage. Try this Three- Bean Coffee Chili recipe to help boost your health during the final stretch of winter.

Makes 8 entree sized servings

1/4 cup olive oil

3 lg onions chopped

6 large garlic cloves

1/4 cup chili powder

1/4 cup ground cumin

2 tbsp dried oregano leaves

2 28-oz cans crushed tomatoes

2 tbs honey

1 cup strong coffee

2 15 oz cans black beans, rinsed and drained

2 15 oz cans kidney beans, rinsed and drained

1 1 oz garbanzo beans, rinsed, and drained

1 roasted red pepper, seeded and chopped

1 cup chicken stock (can substitute tomato juice)

1 tsp. each: salt, cayenne pepper, ground cinnamon

1. Heat oil in large pot over medium-high heat. Add onions and cook until tender (about 8 mins) Add garlic and cook for another minute.

2. Mix chili powder, cumin, and oregano. Cook 1 minute.

3. Mix in tomatoes, honey, and coffee. Add drained beans, red pepper, chicken stock, and remaining spices. Bring to simmer. Reduce heat to medium – low and simmer 60 minutes uncovered or until mixture thickens.

4. In mixture consistency is too thin, use a potato masher or immersion blender to smash a portion of beans to theicken the chili.

5. Optional: Top with nonfat sour cream, chopped avocado, grated low fat cheddar cheese, chopped green onions, or jalepeno peppers.

The babies are coming! A Perfect Smile celebrated our 3 expectant mommies at a surprise baby shower last Thursday at Eggspectations.  We are all looking forward to welcoming Kathy, Michelle, and Rebekah’s new babies – coming this spring!  Stay tuned…

This is our first entry of A Perfect Smile ’s podcast series. In this episode Dr. Nelson answers basic nutritional questions for healthy teeth and gums.  Learn how to eat better — your teeth will thank you!

[audio:http://www.portlandmainedentist.com/podcasts/perfect-smile-01.mp3]

Perfect Smile Podcast, Episode 1 – Nutritional Advice for Healthy Teeth

Another wonderful “mini-revolution” in orthodontics is the self-ligating bracket (brace).  These are braces placed traditionally, on the front side of teeth however they are much smaller, more comfortable and aesthetic than braces of the past.  A brace basically acts as a handle on the tooth which is used to move it.  The wire that goes into the brace is what does the moving.  Traditionally what has connected the two is a metal or elastic ligature while self-ligating braces use a slide mechanism to hold the wire into the brace. This decreases friction in the system allowing the teeth to move more freely, quickly and comfortably. These braces are also easier to keep clean.  Without the elastic ties which attract and collect plaque,  self-ligating braces make dental hygiene during treatment much easier.  We have been using this type of brace in our practice for approximately three years and have seen a great improvement in treatment efficiency with a decrease in treatment time and number of office visits required to complete active treatment.  In addition, because we’re moving teeth with less friction, we are able to use lighter forces and achieve changes in the jaws that previously would have required palate expanders or jaw surgery.

Something that has not changed recently in orthodontics is the recommended age that a child should first be seen by an orthodontist.  The American Association of Orthodontists recommends that this be at age 7.  Though only some of the permanent teeth are erupted at this age, subtle problems with jaw growth and erupting teeth can be detected.  There is a strong chance that a patient of this age will be placed on “observation recall” to initiate treatment when more permanent teeth come in, however, some problems are easier to correct if found and addressed early. Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated. For each patient who needs treatment there is an ideal time for it to begin in order to achieve the best results. Early intervention gives the orthodontist the chance to:

-          Guide jaw growth

-          Lower the risk of trauma to protruded front teeth

-          Improve appearance and self-esteem if a child is being teased

-          Guide permanent teeth into a more favorable position

-          Improve the way lips meet

It’s not always easy for parents to tell if their child has an orthodontic problem.  Here are some signs or habits that may indicate the need for an orthodontic examination:

-          Early or late loss of baby teeth

-          Difficulty in chewing or biting

-          Mouth breathing

-          Thumb sucking

-          Finger sucking

-          Crowding, misplaced or blocked out teeth

-          Jaws that shift or make sounds

-          Biting the cheek or roof of the

-          Jaws and teeth that are out of proportion to the rest of the face

-          Teeth that meet abnormally or not at all

If any of these problems are noted by parents, regardless of age, it is advisable to consult an orthodontist.  It is not necessary to wait until age 7.

For more information on Dr. Podhouser or Orthodontic Associates visit www.bracesofmaine.com

Good news! We have teamed up with some area professionals to bring you the latest and greatest information through our Guest Blog Series. Our first entry is from our very good friend, Dr. Bruce Podhouser of Orthodontic Associates. Orthodontic technology changes fast, so we are so lucky to have him help keep us up to speed!

What’s New in Orthodontics 

As with many aspects of daily life, computers have led to some exciting changes in orthodontic treatment. These changes enable treatment to be more comfortable, efficient, aesthetic and generally easier on the patient. For instance, braces and orthodontic wires can now be custom made to each patient on CAD computer software. We have recently incorporated the iBraces Lingual Appliance system into our practice. These are braces that attach behind the teeth and are virtually invisible. This is a great option for teenagers and adults seeking an alternative to standard braces. These lingual braces are ideal for patients who require orthodontic treatment for significant bite and cosmetic issues, but have aesthetic or comfort concerns due to activities such as playing musical instruments, sports, modeling or public speaking. Though lingual braces have been in use for several years, their use has been limited due to bulkiness of the brace leading to discomfort, difficulty with speech, and a challenge for the orthodontist to bend wires properly.

The newer CAD fabricated lingual iBraces feature:

-100% customized low-profile brackets adapted to the patient’s tooth anatomy for superior bracket placement and patient comfort

-Minimal speech interference

-Minimal tongue irritation

-Made from gold alloy with no nickel content

-A sequence of precisely formed archwires designed by computer and bent using state-of-the-art fabrication technologies

-Require fewer adjustments so there is less patient discomfort

-Utilize shape memory wires that are quite biologically friendly

-Deliver efficient,effective tooth movement

Check out more from Orthodontic Associates at bracesofmaine.com

Stay tuned for more guest bloggers coming soon!