This patient is a 47 year old man who used to drink a lot of Coke and eat lots of M&M’s. He had extensive decay along the gum line and extending under his gums on all his back teeth. These photos are of his upper right and left quadrant teeth before and immediately after. I was able to restore all these teeth without gum surgery or root canals. And his smile looks so much better now.
This patient is a 26 year old woman who uses an Advair asthma inhaler. The inhaler causes dry mouth which allowed these cavities to form. If you use an inhaler always rinse out with water after and brush your teeth as soon as you can following inhaler use. Make sure to see your dentist regularly to check for tooth decay. The cavity in the last molar was to the nerve. I was able to avoid a root canal by placing a vitrebond pulp cap over the exposed nerve and a ceramic composite restoration to restore the tooth. Looks great!!!
This patient had deep decay on her teeth. I extracted her back molars and was able to save this premolar tooth with a pulp cap and a bonded ceramic restoration.
by Philip A. Gentry, DDS, FAGD
Fellow, Academy of General Dentistry
Dean’s Faculty, Clinical Asst. Professor, Department of General Dentistry, Advanced Education in General Dentistry,
University of Maryland School of Dentistry
The next patient broke her upper first molar biting on a hard piece of food.
This patient cracked his molar biting a chicken bone. I was able to save the tooth, and without a root canal, but it did require a crown lengthening periodontal surgery and a crown.
This next patient bit down on a mint candy and fractured her molar down the root. The tooth could not be restored and was extracted and we will place a dental implant.
It is true that sugar does cause cavities, but it’s not the sugar directly. The naturally occurring streptococcus bacteria that live in our mouths consume the sugar, ferment it, and produce acid such as lactic acid. It is these acids that cause teeth demineralization and the formation of cavities. So it is actually the acid from the bacteria in plaque in our mouth that eats the holes in our teeth causing cavities.
Here’s the interesting part, it’s not the total amount of sugar we eat, but the total amount of time the sugar is in contact with our teeth. It is preferable to have a piece of pumpkin pie with a scoop of ice cream for Thanksgiving dessert, than sip on a soda all afternoon. It is better to have a few sugar cookies, or slice of Christmas apple pie, than to repeatedly sip coffee with sugar all morning long. One Altoids mint or cough drop per hour throughout the day is ten times more cavity producing than 1 big piece of cake for dessert, even though the cake has much more sugar and calories.
The repeated cycles of eating sugar and acid formation is what is the key. It is the frequency, or the amount of time the sugar is in the mouth, not the total amount of sugar. So do enjoy a few scrumptious (and quick) holiday desserts, just please make sure to brush and floss after every meal and visit your dentist regularly. Happy Holidays!!!
Philip A. Gentry, DDS, FAGD
To understand root canal treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it
A root canal is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, or a crack or chip in the tooth. In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gum tissues. Sometimes, however, there are no symptoms.
The dentist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the root canal, then fills and seals the space. Afterwards, a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.
Many root canal procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment is completed.
Root canal treatment can often be performed in one or two visits and involves the following steps:
1. The dentist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, a small protective sheet called a “dental dam” is placed over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. An opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.
3. After the space is cleaned and shaped, the dentist fills the root canals with a biocompatible material, usually a rubber-like material called gutta-percha. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed usually 1 week later.
Most teeth can be saved. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored.
When deep decay that is close to the tooth pulp is present in a tooth, many times it requires a root canal. In this 35 year old patient, Dr. Gentry restores her upper bicuspid tooth without a root canal or crown. Gentry cleans out the decay, places a Vitrabond glass ionomer pulp cap, and places a Herculite composite restoration, using the Garrison Matrix System.
Cavities are permanently damaged areas in the hard surface of your teeth that develop into tiny openings or holes. Cavities, also called tooth decay or caries, are caused by a combination of factors, including bacteria in your mouth, frequent snacking, sipping sugary drinks, and not cleaning your teeth well. Cavities and tooth decay are among the world’s most common health problems.
If cavities aren’t treated, they get larger and affect deeper layers of your teeth. They can lead to severe toothache, infection and tooth loss. Regular dental visits and good brushing and flossing habits are your best protection against cavities and tooth decay.
Some examples of Dr. Gentry fixing patient’s dental cavities:
