Inside your tooth, beneath the white enamel and a hard layer called dentin, is a soft tissue called pulp. This tissue contains blood vessels, nerves and connective tissue, which help grow the root of your tooth during its development. A fully developed tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.

A modern root canal treatment is nothing like those old sayings! It’s very similar to a routine filling and can usually be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. Getting a root canal is relatively painless and extremely effective. You’ll be back to smiling, biting and chewing with ease in no time.

Saving the natural tooth with root canal treatment has many advantages:

• Efficient chewing
• Normal biting force and sensation
• Natural appearance
• Protects other teeth from excessive wear or strain

All About Root Canals

A root canal (also known as an endodontic treatment) is a serious procedure, but one that general dentists and specialists handle every day. Before engaging in any type of dental work, it’s important to know the facts about root canals.

Does a root canal hurt?

Since patients are given anesthesia, a root canal isn’t more painful than a regular dental procedure, such as a filling or getting a wisdom tooth removed. However, a root canal is generally a bit sore or numb after the procedure, and can even cause mild discomfort for a few days.

How do you know if you need a root canal?

Root canals are needed for a cracked tooth from injury or genetics, a deep cavity, or issues from a previous filling. Patients generally need a root canal when they notice their teeth are sensitive, particularly to hot and cold sensations.

• There are a few symptoms that mean you might need a root canal—
• Severe pain while chewing or biting
• Pimples on the gums
• A chipped or cracked tooth
• Lingering sensitivity to hot or cold, even after the sensation has been removed
• Swollen or tender gums
• Deep decay or darkening of the gums

Can I go to school or work after getting a root canal?

Although you will most likely be numb for 2-4 hours following the procedure, most patients are able to return to school or work directly following a root canal. However, it is advised against eating until the numbness is completely gone.

How much does a root canal cost?

The cost varies depending on how complex the problem is and which tooth is affected. Molars are more difficult to treat; the fee is usually more. Most dental insurance policies provide some coverage for endodontic treatment.
Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with an implant or bridge to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration.

Dental radiographs can alert your dentist to changes in your hard and soft tissues. In children, radiographs allow the dentist to see how their teeth and jawbones are developing. Like medical radiographs, dental radiographs allow your dentist to evaluate any injuries to your face and mouth.

Dental radiographs can help your dentist identify diseases and developmental problems before they become serious health issues. Early detection of an infection or injury also can limit or prevent further damage to other areas of the mouth.

SAFETY OF DENTAL RADIOGRAPHS

Some people wonder if dental radiographs are safe because they expose the patient to radiation. Several factors and practices work together to make dental radiography safe. The amount of radiation used to obtain dental radiographs is very small. For example, bitewing radiographs—two to four images of the back teeth—expose a patient to about 0.005 millisieverts (mSv) of radiation (a millisievert is a unit of measure).1 By comparison, because radiation is part of our environment, people in the United States are exposed, on average, to 3.2 mSv every year from background sources of radiation.1 Basically, you get more radiation being outside or watching tv than you do from a single x-ray

Dentists follow the ALARA principle, which stands for “As Low As Reasonably Achievable,” when obtaining radiographs. This radiation safety principle limits your exposure by incorporating the following techniques:

• use of the fastest image receptor (that is, the fastest film speed or digital speed);
• reduction in the size of the x-ray beam to the size of the image receptor whenever possible;
• use of proper exposure and processing techniques;

A lead apron will be used when someone is pregnant, had head/throat/neck radiation therapy, or when a patient requests the use of one. Because of the low amount of radiation, Washington State has made this determination.

Because of the low radiation dose associated with dental radiographs, people who have received radiation treatment for head and neck cancer can undergo dental radiography safely. In fact, head and neck radiation treatment can increase the risk of developing tooth decay, making the radiographs all the more important for these patients.

If you are pregnant, tell your dentist. During your pregnancy, you may need to have radiographs taken as part of your treatment plan for a dental disease that requires immediate attention. Use of the leaded apron and collar will protect you and your fetus from radiation exposure. To learn more about the benefits and safety of dental radiographs, talk with your dentist.

2. Advantages of a CBCT Scan over conventional x-rays: A conventional x-ray of your mouth limits your dentist to a two-dimensional or 2D visualization. Diagnosis and treatment planning can require a more complete understanding of complex three-dimensional or 3D anatomy. CBCT examinations provide a wealth of 3D information which may be used when planning for dental implants, surgical extractions, maxillofacial surgery, and advanced dental restorative procedures. Benefits of CBCT scans include:

• Higher accuracy when planning implant placement surgery;
• Greater chance for diagnosing conditions such as vertical root fractures that can be missed on conventional x-ray films;
• Greater chance of providing images and information which may result in the patient avoiding unnecessary dental treatment;
• Better diagnosis of third molar (wisdom teeth) positioning in proximity to vital structures such as nerves and blood vessels prior to removal;
• The CBCT scan enhances your dentist’s ability to see what needs to be done before treatment is started.

3. Radiation: CBCT scans, like conventional x-rays, expose you to radiation. The dose of radiation used for CBCT examinations is carefully controlled to ensure the smallest possible amount is used that will still give a useful result. The dosage per scan is equivalent to 2 regular dental x-rays. However, all radiation exposure is linked with a slightly higher risk of developing cancer. But the advantages of the CBCT scan outweigh this disadvantage.

4. Pregnancy: Women who are pregnant should not undergo a CBCT scan during the second trimester due to the potential danger to the fetus. Please tell the dentist if you are pregnant or planning to become pregnant.

5. Diagnosis of non-dental conditions: While parts of your anatomy beyond your mouth and jaw may be evident from the scan, your dentist may not be qualified to diagnose conditions that may be present in those areas. If any abnormalities, asymmetries, or common pathologic conditions are noted upon the CBCT scan, it may become necessary to send the scan to an Oral and Maxillofacial Radiologist for further diagnosis.

What Is Periodontal Disease?

Periodontal disease mainly starts with the formation of plaque around the teeth. Plaque is the yellow film on your teeth caused by food and bacteria in your mouth. When plaque build-up mixes with the saliva, it hardens over time and turns into tarter. Tarter containing bacteria will irritate the gums around the teeth by attaching to the outer surface of the teeth and roots and releases poisonous toxins. These toxins cause an infection and an inflammation of the gums. Worse, if left untreated they can ultimately cause bone loss and eventually tooth loss. Keep in mind the lost bone will never grow back.

Fortunately, scaling and root planing can help. Scaling and root planing is a procedure that treats the infected area by meticulously cleaning the tarter and bacteria from the teeth and their roots.

Detecting Periodontal Disease

One way to diagnose periodontal disease is by taking dental x-rays. X-ray images assist in making the tarter build up under the gums more visible. X-rays also show the current condition of the bone.
The second method of diagnosis is a clinical examination in which your dentist can visually check the amount of plaque and tarter build up as well as the color and shape of the gums as indicators for gum disease.
The third and last method of diagnosis is by measuring the pockets that form between the gums and teeth. Destructive bacteria contained in plaque and tarter cause the formation of these pockets. Any pocket that measures greater than 3mm is probably an indication of periodontal disease.

Scaling And Root Planing Treatment

Deep cleaning, or scaling and root planing is normally performed by your dentist or dental hygienist in a couple of visits. The exact number of visits however depends on your dentist and the amount of tarter build up. Often your dentist will choose to administer local anesthetic to make the procedure virtually painless. The goal of the procedure is to eliminate the infection by removing the bacteria containing plaque and tarter that has attached to your teeth and their roots under the gum.
The deep cleaning is either done manually or with an ultra-sonic instrument called a cavitron, or sometimes a combination of the two. Both techniques loosen and remove plaque and tarter build up.
In addition, antibacterial irrigants or local antibiotics such as Arestin may be used in conjunction with the cleaning procedure to further reduce the number of bacteria around the gums.

What is the basic difference between a general cleaning and deep cleaning and can I choose the type of cleaning I get?

As the name deep cleaning implies, the main difference is that scaling and root planning goes below the gum to remove plaque or tarter build up from the tooth’s root where the bone is affected by the infection, whereas, regular cleaning only removes the plaque or tarter above the gum.

Ultimately, you have the right and are responsible for making your own decisions on your care but the dental team does have the right to refuse to only do a general cleaning if they feel a deep cleaning is your best option for your health.

Periodontal Follow-up Care

Periodontal disease cannot currently be cured; it can only be controlled, so it is important to follow your dentist’s recommendations for follow-up maintenance cleanings (usually every 3-4months). In addition to routine checkups, performing proper dental hygiene at home is of course also important to help prevent the reoccurrence of this destructive disease.

Side Effects

Only a minority of patients experience any negative side effects. They can occur if the nitrous level is too high or if the amount being inhaled quickly changes. Potential side effects are as follows:

• Headaches
• Shivering
• Excessive sweating
• Nausea and/or vomiting
• Fatigue

Once the nitrous oxide has been turned off, a patient needs to receive oxygen for at least five minutes to avoid a headache. The oxygen purges any remaining gas from the lungs while aiding the patient in becoming alert and awake.

Meals are another focus point when receiving nitrous oxide. It's a good idea to eat lightly prior to your procedure and avoid a big meal for three hours afterward.

Nitrous Oxide for Children

Not only is it safe for children, but laughing gas is a preferred sedation method for children who are nervous or anxious about a pending procedure. Discuss with your child's dentist ahead of time to determine the appropriate sedation method. Some children may suffer from nausea or have difficulty wearing the mask needed to breathe it in.

Contraindications for Nitrous Oxide

While it's an effective sedative that's easy to administer, nitrous oxide might not be the right choice for you. Tell your dentist if you have any of the following conditions: first trimester of pregnancy, COPD (chronic obstructive pulmonary disease), a methylenetetrahydrofolate reductase deficiency, or a cobalamin deficiency. Additionally, if you are receiving treatment using bleomycin sulfate or have a history of emotional issues or drug addiction, laughing gas may not be recommended.

Prosthodontics
Prosthodontics includes a range of aesthetic procedures, including the reshaping of individual teeth to accept crowns, veneers or bridges, and surgical insertion of dental implants for mounting artificial teeth or dentures.

Preparing for Surgery
If you're facing any form of oral surgery, there are several measures you can take to ensure you're ready when the time comes. Your dentist or other staff will review your medical history, and it's important to mention all medications you take including over-the-counter products, vitamins and supplements. Depending on the procedure planned and your medical history, your oral health professional may administer antibiotic prophylaxis. The American Dental Association explains that those who have prosthetic joints, have certain heart conditions or have a compromised immune system may benefit from premedication.

On Surgery Day
On the day of surgery, if you are to have IV anesthesia, you should avoid food and drink for eight hours before the procedure. Patients with chronic conditions, such as diabetes and hypertension, will be monitored during the procedure for any complications relating to the anesthetic. If you are not having iv anesthesia, please eat about 1-2 hours before your appointment. Avoid greasy or highly caffeinated items.

Recovering from the Procedure
Any form of oral surgery requires a recovery period, during which you may be limited to certain types or consistencies of food or methods of taking in nutrition. A surgical extraction will likely only require some over-the-counter pain medication. During the recovery period, it's important to follow the instructions of your oral surgeon or dentist, and to contact your dentist if you have any questions or concerns. Don't wait until an oral infection develops or complications occur. Call your dentist as soon as you notice anything out of the ordinary.
Remember that your entire medical and dental team will be behind you every step of the way, from preparing for to recovering from your oral surgery. With their help, you'll return to feeling your best in no time.

There are many types of mouthguards. Some are pre-formed, while others are customized to fit your teeth and jaw. Most mouthguards are used only on your top teeth, though some people need to have mouthguards on both their top and bottom teeth.

After a thorough examination, we would be happy to discuss your options so you can protect your teeth from grinding during the night and damage during your favorite sports activities.

To learn more about mouthguards and how we can care for your teeth, please contact us today at (360) 365-5165.