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PreservingthePulpisPriorityOnewithaNewlyEruptedPermanentTooth

The change from primary teeth to permanent is an announcement to the world that a boy or girl is "growing up." "Growing up," though, is still not "grown"—the new teeth are still in a period of development that can affect how we treat them if they're injured or diseased.

While a new tooth erupts with all its anatomical layers, the middle dentin is somewhat thinner than it will be after it matures. The pulp, the tooth's innermost layer, produces new dentin and gradually increases the dentin layer during this early development period. While the pulp continues to produce dentin over a tooth's lifetime, most of it occurs in these early years.

To prevent or stop any infection, we would normally perform a root canal treatment in which we remove the pulp tissue and fill the empty pulp chamber and root canals. This poses no real issue in an older tooth with mature dentin. Removing the pulp from an immature tooth, though, could interrupt dentin development and interfere with the tooth's root growth. Besides a higher risk of discoloration, the tooth could become more brittle and prone to fracture.

That's why we place a high priority on preserving a younger tooth's pulp. Rather than a root canal treatment, we may treat it instead with one of a number of modified techniques that interact less with the pulp. Which of these we use will depend on the extent of the pulp's involvement with the injury or disease.

If it's unexposed, we may use a procedure called indirect pulp therapy, where we remove most of the tooth's damaged dentin but leave some of the harder portion intact next to the pulp to avoid exposure. If, though, some but not all of the pulp is damaged, we may perform a pulpotomy: here we remove the damaged pulp tissue while leaving the healthier portion intact. We may then apply a stimulant substance to encourage more dentin production to seal the exposure.

These and other techniques can help repair an injured young tooth while preserving most or all of its vital pulp. Although we can't always use them, when we can they could give the tooth its best chance for a full life.

If you would like more information on caring for your child's teeth, 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.”

YouMightAvoidaRootCanalwithThisTooth-SavingProcedure

The sooner you get treated for tooth decay, the less likely you'll lose your tooth. That could mean a simple filling—or you might need a root canal treatment if decay has reached the inner pulp.

There's also another procedure for advanced decay called pulp capping. It's a bit more involved than filling a cavity but less so than a root canal. We can use it if decay has exposed or nearly exposed the pulp, but not yet infected it—otherwise, you may still need a root canal treatment to remove the diseased pulp tissue.

There are two types of pulp capping methods, direct and indirect. We use direct pulp capping if the pulp has been exposed by decay. After isolating the tooth to protect other teeth from contamination, we remove all of the decayed dentin up to the pulp. This may cause some bleeding, which we'll stop, and then clean and dry the tooth area.

We'll then apply a protective biocompatible material directly over the pulp to promote healing and protect it from further infection. We then restore the tooth's appearance and function with a life-like filling.

We use the indirect method, a two-part process separated by six to eight months, when the pulp tissue is close to the surface but not yet exposed. We initially remove the majority of decayed tooth structure, but leave some of it in place next to the pulp chamber. Although this remaining dentin is softened and decayed, we'll treat it with antibacterial chemicals, then cover it with a biocompatible material and a temporary filling.

Over the next several months the treated structure has a chance to re-mineralize as it heals. We then remove the temporary filling and assess the level of healing progress. If the regenerated dentin appears healthy, we can then remove any remaining decay and restore the teeth as we would after a direct pulp capping.

At the very least, pulp capping could buy your affected tooth time before a root canal will finally be needed. Under the right circumstances, it's an effective way to save an otherwise lost tooth.

If you would like more information on tooth decay treatments, 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 “Pulp Capping: A Procedure that may Save a Decayed Tooth.”

YourTeenagernotReadyforanImplantHeresWhatWeCanDoInstead

Losing a tooth can be traumatic, but a dental implant can dramatically turn that experience around. Providing functionality, life-like appearance and durability, implants stand out as the premier restoration for lost teeth.

For adults, that is. An older child or teenager with a missing tooth may need to wait a few more years for an implant. The reason: jaw development. A person's jaws, particular the upper jaw, continue to grow with most growth completed by early adulthood. Natural teeth with their periodontal attachments develop right alongside the jaw.

But because an implant attaches directly to the jawbone, its position is fixed: it won't change as the jaw grows and may gradually appear to sink below the gum line. That's why we wait to place an implant until most of jaw maturity has occurred after full jaw maturity. For females, we try to wait until 20 years of age and for males, usually 21 years of age. These are guidelines as some people mature faster and some slower, so a discussion with your dentist or surgeon is necessary to make an educated decision.

While we wait, we can install a temporary replacement for a child's or teenager's lost tooth, usually a partial denture or fixed modified ("Maryland") bridge. The latter affixes a prosthetic (false) tooth in the missing tooth space by attaching it to the back of natural teeth on either side with bonded dental material. It differs from a traditional bridge in that these supporting teeth aren't permanently altered and crowned to support the bridge.

During the time before implants we should understand that the area where the implant will be placed will undergo some bone deterioration, a common consequence of missing teeth. Forces generated as we chew travel through the teeth to stimulate renewing bone growth all along the jawbone. But with a lost tooth the chewing stimulation ceases at that part of the bone, slowing the growth rate and leading to gradual bone loss.

Fortunately, the titanium posts of dental implants stimulate bone growth as bone cells naturally grow and adhere to their surfaces. Before then, though, if the bone volume is diminished, we may need to graft bone material to stimulate bone growth that will enlarge the jaw bone enough for an implant to be placed.

It usually isn't a question of "if" but "when" we can provide your child with an implant for their missing tooth. In the meantime, we can prepare for that day with a temporary restoration.

If you would like more information on dental restorations for teenagers, 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 “Dental Implants for Teenagers.”

By Pender Dental Care
April 26, 2019
Category: Dental Procedures
J-LosUnluckyBreakChippingaToothonStage

Whether she’s singing, dancing or acting, Jennifer Lopez is a performer who is known for giving it all she’s got. But during one show, Lopez recently admitted, she gave a bit more then she had planned.

“I chipped my tooth on stage,” she told interviewers from Entertainment Tonight, “and had to finish the show….I went back thinking ‘Can I finish the show like this?’”

With that unlucky break, J-Lo joins a growing list of superstar singers—including Taylor Swift and Michael Buble—who have something in common: All have chipped their teeth on microphones while giving a performance.

But it’s not just celebs who have accidental dental trouble. Chips are among the most common dental injuries—and the front teeth, due to their position, are particularly susceptible. Unfortunately, they are also the most visible. But there are also a number of good ways to repair chipped, cracked or broken teeth short of replacing them.

For minor to moderate chips, cosmetic bonding might be recommended. In this method, special high-tech resins, in shades that match your natural teeth, are applied to the tooth’s surface. Layers of resin, cured with a special light, will often restore the tooth to good appearance. Best of all, the whole process can often be done in just one visit to the dental office, and the results can last for several years.

For a more permanent repair—or if the damage is more extensive—dental veneers may be another option. Veneers are wafer-thin shells that cover the entire front surface of one or more teeth. Strong, durable and natural-looking, they can be used to repair moderate chips, cracks or irregularities. They can also help you get a “red-carpet” smile: brilliant white teeth with perfectly even spacing. That’s why veneers are so popular among Hollywood celebs—even those who haven’t chipped their teeth!

Fortunately, even if the tooth is extensively damaged, it’s usually possible to restore it with a crown (cap), a bridge—or a dental implant, today’s gold standard for whole-tooth replacement. But in many cases, a less complex type of restoration will do the trick.

Which tooth restoration method did J-Lo choose? She didn’t say—but luckily for her adoring fans, after the microphone mishap she went right back up on stage and finished the show.

If you have a chipped tooth but you need to make the show go on, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Artistic Repair of Chipped Teeth With Composite Resin” and “Porcelain Veneers.”

WhyYouShouldFlossAroundtheImplantsSupportingYourBridge

We've been using bridges to replace missing teeth for decades. Now, recently-developed implant-supported bridges are even more dependable, promising greater durability and less interference with remaining natural teeth.

But just like other restorations, you'll need to keep implant bridges clean to ensure their longevity. Although both the bridge and implants are impervious to disease, the supporting gums and bone aren't. If they become infected, they can break down and your restoration will fail.

Cleaning an implant-supported bridge includes flossing around each of the implants to remove dental plaque, a thin film of food particles and bacteria most responsible for dental disease. To perform this task, you'll have to pass the floss between the bridge and gums to access the sides of each implant.

To help make it easier, you can use a tool like a floss threader, a thin, shaft-like device with a loop on one end and a needle-like point on the other. You'll first thread about 18" of floss through the end and then pass the threader between the bridge and gums with the sharp end toward the tongue.

With the threader completely through, you'll then wrap the floss around your fingers as with regular flossing and move the floss up and down each side of the implants you can access. You'll then pull the floss out, reload the threader and move to the next section, repeating this process until you've flossed each side of each implant.

You can also use pre-cut floss with a stiffened end to thread between the bridge and gums or an interproximal brush with a thin bristled head that can reach underneath the bridge. And you might consider using an oral irrigator, a pump device that sprays a stream of pressurized water to remove and flush away plaque around implants.

To round out your hygiene efforts, be sure you visit your dentist at least twice a year for dental cleanings. Your dentist can also advise you and give you training on keeping your implants clear of disease-causing plaque. Cleaning around your implants will help ensure your restoration will last.

If you would like more information on caring for your dental restoration, 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 “Oral Hygiene for Fixed Bridgework.”





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