dr. jaouni

Microsurgery: Better than Ever Before

Over the last 10-15 years, the field of endodontics has changed dramatically with considerable improvements in particular in the area of endodontic surgery! In fact, studies have shown that the traditional method of apicoectomy was fifty percent less successful than the current microsurgical success rate.

Microsurgery-Better-than-Ever

Why? The most important reason for the increased success rate has to do with the microsurgical materials and instruments themselves.

Here we offer a run-down of benefits of modern microsurgery over traditional apicoectomy methods:

  • Visual Enhancements – The microscope offers a more accurate visualization (both magnification and illumination) of infected canals and irregular anatomies, which leads to better identification and treatment.
  • Smaller Osteotomy – Better visualization and smaller instruments allows us to work within smaller osteotomies. This reduces the amount of bone that needs removing and therefore offers a quicker healing time and reduces the risk of tooth loss down the road.
  • Better Access to Difficult Areas: With microsurgery, we have enhanced access to narrow spaces and other difficult anatomical sites for irrigation.
  • Less Damage: Enhanced visualization allows us to avoid damaging nerves and the maxillary sinus.
  • Better Cleaning of the Apical Canal Space: Traditionally it has been very difficult to fully sterilize the apical canal space because it is very complex in its anatomy.
  • Enhanced Root-End Fillings: Ultrasonic tips are now specially designed to allow for preparation without reducing visibility – this results in a better seal of the filling.

All of these advancements help us save more teeth than we ever could before!

It’s Alive! Your Tooth, that is!

People often wonder, “How does a tooth get to the point of infection?”

It's Alive

It’s a common misconception that teeth are not alive. That belief leads to confusion about how teeth become infected. Because you can’t “feel” the part that you can see (the crown), many people think that their teeth are not alive. Yet, the opposite is true. Most of the material that makes up your teeth is, in fact, made of living cells. Since the material is alive, it makes a great hosting site for bacterial infections!

Similar to hair and fingernails, there is a part of your teeth that is not alive – it is the outermost part, called “enamel”. This is the hard, white part that you can see. It is made of calcium phosphate, a very hard mineral that is perfect for breaking down food when you eat. Underneath that enamel, however, is where all of the live action happens!

Starting on the outside and working our way in, we find dentin (alive), and then the pulp cavity and root canal, through which nerves and blood vessels flow.

Generally speaking, if the enamel is intact, bacteria cannot get through to the pulp to cause problems. However, if there is a crack in the outer part of the tooth due to injury or decay, this creates a pathway for bacteria to enter into the innermost part of the tooth (the pulp cavity and canal) causing infection of the living tissue.

That is when endodontic treatment becomes essential! The only way to remove the infected material is manually, by accessing the canal itself, irrigating and then filling, or closing off access, to the inside of the tooth again.

Endodontic Retreatment: When Root Canals Fail

As with any dental or medical procedure, occasionally, endodontic treatment does not live up to its expected results and the root has to undergo retreatment. You may have noticed pain in the tooth or you may have no pain at all. Either way, with detailed imaging, we can see when root canal therapy has failed and when it is time for retreatment.

Endodontic Retreatment

 

 

 

 

 

 

 

Why does it happen? Some of the most common reasons for a root canal to fail include:

  • Narrow canals: If your canals are too narrow or curved, this may have made it difficult for the original procedure to be performed thoroughly.
  • Inadequate Seal: After cleaning a root canal, we fill it with a restorative material. If that material doesn’t make a complete seal, reinfection is possible.
  • Complicated Anatomy: If your canals are shaped abnormally, the original treatment may have missed areas that needed cleaning.
  • Delayed Restoration: If there was a delay between the initial treatment and the placing of the crown or other restoration, reinfection may have occurred.
  • New Decay, Cracks or Fractures can introduce new infections into the root area.

Surgical vs. Non-Surgical Retreatment

Our first choice is always to save your natural tooth using the least invasive means possible. Natural teeth are far superior to their artificial counterparts when it comes to nutrition, lifestyle, aesthetics and the long-term health of your jaw.

During endodontic retreatment, we will need to essentially “reopen” your tooth to access the root area, removing the original restoration in the process. If your canals are too narrow or obstructed, we may need to perform an apicoectomy (surgical treatment) instead of a traditional, non-surgical root canal.

And, lastly, if neither of these methods presents a viable option to save your tooth, really our only other course of action is to remove the tooth. Since the removal of a tooth causes additional restoration work down the road, which can be more expensive, we always try to save the tooth first!

If you are experiencing pain in a tooth that previously underwent root canal therapy, give us a call! We can help you decide if retreatment is right for you!

The Many Faces of Tooth Pain

Many people think that a painful tooth means they need a root canal treatment. While that is sometimes true, it’s not always the case. In fact, there are many other reasons that teeth can hurt!

The Many Faces of Tooth Pain

Here, we offer a guide to some common types of tooth pain and what that pain may be trying to tell you:

Sensitivity to hot and cold foods:

If the pain is short-lived, you probably do not have a serious problem, but more likely a loose filling or a small amount of gum recession that has resulted in root surface exposure. Use sensitive teeth toothpaste and a soft brush with an up and down motion. If this doesn’t help after a week or so, give us a call.

Heat sensitivity after an appointment:

Some types of dental work can inflame the pulp inside your teeth, causing sensitivity for several weeks. If it lasts longer than that, let us know.

 Sharp pain when biting:

Sometimes sharp pain can be caused by a loose filling, other times it may signal that there is a crack in your tooth. Either of these scenarios requires evaluation by a professional, so please give us a call.

Pain/Sensitivity lasting longer than 30 seconds:

Often this means that the pulp (innermost part of your tooth) has been damaged. Without intervention, you may lose this tooth so it is important to call us to find out if you may need root canal treatment.

Frequent, dull aching in the jaw.

This can happen when excessive grinding of the teeth happens (bruxism), or it could even be a sign of a sinus headache or infection. Please call us for more information.

Severe pain, pressure or swelling of the gums:

This may mean that you have an abscessed, infected tooth that may have spread to other tissues in the mouth. This is a serious situation that requires an immediate call to our office for instructions.

The Science Behind Oral Cancer

Can drinking coffee really help prevent oral cancer? What about different types of foods? Numerous studies have been published that claim certain foods and drinks can prevent oral cancer but when it comes to a disease that will affect 43,250 people this year, it’s important to get the facts.

The Science-Behind-Oral-Cancer

Oral cancer, also referred to as mouth or head and neck cancer, occurs when there is a problem with the lifecycle of a normal, healthy cell. Cells are supposed to grow and divide into new cells as your body needs them but when this process goes wrong, your body over produces cells. These extra cells can cause a tumor to form. Depending on the type of cells in the tumor, it could be cancerous or benign.

Some studies may say they have proof that a specific food or drink helps to prevent mouth cancer but in reality the best way to prevent the disease is to avoid certain risk factors like smoking and drinking. Drinking in excess accompanied by smoking makes you highly susceptible to the disease and should be avoided.

Most oral cancers start in the tongue in what are called the flat cells and they can spread to other parts of the body if they aren’t caught early (in doctor lingo, cancer of these flat cells is called squamous cell carcinoma). Interestingly, when these oral cancer cells spread to other parts of the body such as the lungs, they are still considered oral cancer cells rather than lung cancer cells. Where these abnormal cancer cells begin is what they will always be referred to as, regardless of where they spread.

Doctors still don’t know why one person gets oral cancer while another person does not, but it is important to note that oral cancer is NOT contagious. Avoiding risk factors and eating healthy is key to preventing oral cancer. Make sure to visit us regularly so we can check for signs of oral cancer!

Facial Injuries – What Do I Do?

It’s important to know what to do when you or someone close to you has been injured, especially when it comes to facial injuries. The inside of your mouth is made up of delicate soft tissues that when cut can become infected and easily damaged if the wound isn’t taken care of quickly. Anyone who has had a facial laceration knows that there is a high degree of emotional and physical pain involved when it comes to a facial laceration. So what should you do?

Facial-Injuries

A laceration is a tear or jagged wound and is usually caused by blunt trauma. If you’ve been in an accident and there is any kind of trauma to your face, it is important to seek emergency assistance right away. Lip lacerations are one of the most common types of facial injuries and require careful repair. Lacerations are closed using silk or gut sutures and are done carefully in order to prevent any cosmetic damage. If a tooth is knocked out you should place it in salt water or milk as soon as possible. The sooner the tooth is placed back into the dental socket, the better chance it has of surviving. Do not clean or wipe off the tooth since there are crucial parts of the tooth that could become damaged.

Replanting teeth and treating tooth fractures can be handled by an oral surgeon along with facial trauma but if you have been involved in a serious accident you should go to the closest hospital emergency room as soon as possible. Facial bone fractures cannot be treated with a cast like other parts of the body. The surgical placement of plates around the affected area is a recent development in medicine that allows for a faster recovery time and involves the fewest incisions necessary.

Any kind of traumatic injury to your face is serious and should be addressed immediately to prevent further damage and scaring. If you’ve had a recent injury and think you may have a facial bone fracture, call us immediately to schedule a consultation.

What is an Apicoectomy?

“What is an Apicoectomy? Is it surgery? Is it painful? And why do I have to have one?” In our practice, we hear these question almost every day, so we thought we’d take a moment here to clarify what an apicoectomy actually is.

What is an Apicoectomy

Word Origin:

To better explain what an apicoectomy is, let’s look first at the origin of the word.   As is true with most medical terminology, the key to understanding this procedure lies within the origins of the word itself.

Your teeth are comprised of many parts, the main three being the crown (the part that you can see), the root canals (the long skinny parts that extend from the crown into the jaw) and the root tip, also called the “apex”, which comes from the Latin word meaning “tip” or “point”.

When a patient complains of infection or pain in a tooth that previously had root canal treatment, often it is because there is a problem in the apex area. So, during an “apicoectomy”, we remove (“ectomy”, from the Latin word excise) the apex (“apico”) along with any additional infected tissue that we find.

The Procedure:

Usually, local anesthesia is all we need to make you comfortable during the procedure, which takes about 30-90 minutes to complete. In fact, many patients have reported that the apicoectomy was even less painful than the original root canal treatment!

Recovery:

You may be sore or numb for a few days after the procedure, but usually over-the-counter anti-inflammatory drugs (NSAIDs) such as ibuprofen are all that is needed to control the pain. We will remove the stitches 2-7 days after the procedure, and most soreness and swelling will be gone by 14 days.

If you have any questions about apicoectomies or other procedures, please don’t hesitate to contact our office for more information!

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