Root Canal Therapy – Friend or Foe?

Root Canal Therapy – Friend or Foe?

So you have been to your dentist and been told that your tooth needs root canal therapy. Most people have the instant reaction of fear. They hear that root canal treatment is torturous, doesn’t really work and is the stuff of horror movies. All of this is not true but I’ll come back to that.

First, lets discuss why root canal therapy is needed. Inside each tooth lives a little nerve chamber, called the “pulp”. This contains all the nerves and blood vessels that keep your tooth alive. If this becomes irritated because it has a large filling sitting very close to it, a big decayed cavity near it or if its been exposed by a fracture or break then you experience pain. This pain usually is pretty severe and throbbing in nature. It is often made much worse by temperature changes of hot and cold food and drink and this pain can linger for some time.

What may happen next is that the pain may disappear like a miracle! Unfortunately this is not good news. This probably means that the pulp has given up and died. The nerve chamber then gets over run by bacteria and becomes slowly infected. This causes the areas around the roots of the tooth to become inflamed. This can develop further into a dental abscess causing extreme pain and swelling with you often not even able to touch the tooth without severe pain.

This is all pretty grim reading, but there is a way to help. This is where root canal therapy comes in. An x-ray is taken of the tooth before treatment, the tooth is anesthetized so that no pain or discomfort is felt during treatment and a rubber sheet, known as a dental dam, is placed over the tooth to isolate and protect the tooth and the rest of your mouth during treatment. Next, a small access cavity is made into the tooth so that the dead or dying nerve can be accessed. Now remember, this wont be felt because you have had sufficient anesthesia. The dentist will then remove the nerve tissue from inside the tooth and from inside the roots so that no further pain is felt. A further series of X-rays may be taken to help the dentist determine all the nerve has been cleaned out. A therapeutic dressing/ointment is placed into the tooth and a temporary filling is then placed into the access cavity to protect the inside of the tooth. This is left in place giving ample time for the tooth to settle down and for the dressing to work.

You should leave that appointment realising that is was not bad at all. In fact, I have had a great number of people fall asleep in the chair whilst having this procedure. You will then return next week for more of the same but this time the root canals and pulp chamber fully cleaned, disinfection and will be sealed and filled up to prevent any reinfection of the tooth.

You may have a mild discomfort following root canal treatment but this is normally completely managed with over the counter pain killers. Overall, this treatment has a very high success rate as long as all the correct steps and precautions are taken by your dentist. Long term it will most probably be recommended that your tooth will require a crown to restore it. This is something I will cover in a future blog.

David Hurst BDS (Lon)

Sugar, acid and tooth decay

Sugar, acid and tooth decay

So what are the facts about how sugar and acid damage teeth?

Teeth are covered by layer of enamel. This is an extremely hard material and is able to withstand a great deal of force. But start throwing acid at it and it will slowly fall apart. The modern diet is dangerously high in sugar and acid. Every time we introduce carbohydrate into our mouths, the bacteria that inevitably will be in our mouths will feed on this sugar and produce a waste product in the form of lactic acid. This acid is extremely dangerous and will erode and decay the enamel in our teeth.

Luckily the saliva in our mouths acts as a buffer. This saliva will help to wash away the acid and also neutralize the acid stopping its harmful affects on our teeth. The question then is why do we still get decay then if we have this saliva fighting for us to get rid of the acid? The problem we have is that the saliva we produce is just not enough to control a repeated sugar and acid attack on our teeth. Saliva can control a short attack of sugar but if you snack repeatedly throughout the day on sugary food and drinks then the mouth cannot keep up, the sugar overtakes, the acid levels spike in the mouth and the erosive decay process on our teeth occurs.

So from a diet point of view we need to dramatically reduce our sugar intake and if we must feel the urge then have it at mealtimes only (ideally once a day) and not in between. The mouth will be able to cope with this. You must of course brush at least twice a daily after meals and floss so you can physically remove/reduce the harmful bacteria on our teeth and in our mouths.

Other ways we introduce dangerous acids to our teeth is by the consumption of acidic drinks. We are all aware of the damaging effects of carbonated drinks such as coke and lemonade but some may not be aware of the damaging effects of fruit juices. Not only are these packed with sugar but also are very acidic. If these are a common part of your diet then you really need to consider cutting them back as they will only cause damage. Also important is to not brush your teeth directly after consuming acidic fruits as this will only rub the acid further into your teeth, let your mouth naturally cleanse itself for 30 minutes before brushing.

David Hurst BDS (Lon)

The Importance of Flossing

The Importance of Flossing

The one thing people can’t be bothered to do or never get round to. Cleaning in between their teeth. Happily you will brush your teeth but often ignore flossing, still thinking your teeth and mouth are clean.

Trust me, a toothbrush, regardless how top of the range, will not clean in between your teeth. In fact by not flossing you have only cleaned 2/3rds of your teeth surfaces. In between the teeth resides bacteria and food particles. If left this will lead to bacteria attacking the teeth and cavities. The number of cavities I see in otherwise clean mouths is phenomenal and this could have been easily prevented by spending 1-2 minutes once a day flossing.

The bacteria left behind will also lead to odours and bad breath. Next time you floss, smell it afterwards. You will understand what I mean.

I look in a lot of mouths everyday and its instantly clear if a patient flosses or not. The gums are healthy and pale pink, don’t bleed and there is no halitosis. Surely we all want our mouths like this? Also, these mouths are nearly always without decay and the patients probably have never lost a tooth. Sound good? Then floss!

David Hurst BDS (Lon)

Some questions answered about the odd things in a dental surgery:

Some questions answered about the odd things in a dental surgery:

What is that blue light that shines in my mouth?

This is a curing light that sets a filling’s state from a moldable “plastic’ state into a hardened state. This makes the filling immediately set and useable. This only applies to white composite fillings. Amalgam silver fillings will set by themselves, usually by 24 hours.

What are the funny magnifying glasses my dentist wears?

These would be dental loupes. These magnify everything within a certain field of view. This is usually around x2-3 magnification.

What is the putty material used to take a mould of my teeth?

This will either be a material called alginate or a silicone putty material. Both are used to capture all the details of your teeth and surrounding gums and soft tissues. They are used for different situations which I wont go into in this article.

What is the instrument used to clean my teeth?

This would be an ultrasonic scaler. This vibrates at a very high, sonic, frequency and efficiently but gently removes the tartar and stains from your teeth. They will then use an abrasive paste to polish the surface of the teeth making feel very smooth.

When I had root canal treatment they was a machine used that kept bleeping?

That would have been an apex locator. This machine will tell your dentist where the very tip of your root is. This allows them to clean all the way down the root and not beyond. This avoids leaving behind any harmful, infected tissues and also prevents traumatizing the tissues beyond the tip of the root.

What are the strange numbers and words used when my dentist is looking at my teeth?

These are the numbers we give to teeth so internationally all teeth are numbered in the same way to avoid confusion amongst the profession. The words will be identifying any fillings or oddities in teeth and the surfaces of teeth they are affecting.

If you can think of any other questions you would like to ask please reply to this post.

David Hurst BDS (Lon)

Do Whitening Toothpastes Work

Do Whitening Toothpastes Work

Nearly everyone wants whiter teeth for as little money and effort as possible. It is the natural human mantra of the path of least resistance. So when it comes to have a bright brilliant smile whitening toothpastes seem to be the way forward.

A common question is “Do whitening toothpastes actually work?” The answer is unfortunately not really. If you have some light general staining on your teeth then whitening toothpastes may go some way to remove these. The fact is whitening toothpastes are just more abrasive than normal toothpastes. This makes it more likely to remove staining and brighten teeth up but only slightly. In reality the way you will truly remove all stains from teeth is by visiting your dentist or hygienist.

To whiten your teeth you will need to visit your dentist to have some whitening trays made for your teeth and to have prescribed some whitening gels. These gels will contain a certain percentage of a peroxide compound. Its this compound that will whiten your teeth. The peroxide will be able to whiten the internal and external structure of your teeth. Whitening toothpastes will only attempt to scratch off the stains on the outside surface of teeth. In fact, if you suffer with sensitive teeth you may wish to steer clear of these more abrasive toothpastes as it may make your teeth more sensitive.

All toothpastes have a degree of sensitivity so most will claim to have some degree of whitening potential but only on a very small scale. So in summary do whitening toothpastes work? Not how you would want them to.

David Hurst BDS (Lon)