Dental Questions: Why do I need a root canal if my tooth doesn't hurt?

Has a dentist ever looked at an x-ray of your teeth and recommended a root canal? You probably know that root canals are performed to remove aggravated (and painful) tooth nerves. Why would a dentist want to do this procedure on a tooth that has never bothered you? The truth is that root canals are often used to protect teeth with "dead" nerves from future pain and infection. Take a look!

A root canal is a dental procedure where the nerve of the tooth is removed and the resulting empty nerve canal is filled with a sealing material. They are performed on teeth with some type of irreversible nerve damage. This typically stems from bacteria, trauma or deep/extensive dental work. Patients may complain of a painful tooth that throbs or has an exaggerated reaction to cold foods/drinks. These can be clues that the nerve has become so severely agitated that it will eventually wither out and die. Conversely, a patient can indicate that the gums around the tooth are swollen, the tooth is sensitive to biting or that there is a bump or pimple on the gums above a tooth. These types of findings suggest the nerve in the tooth has already died, and is now fueling a localized bacterial infection called an abscess. Either way, these types of teeth will eventually need root canals to solve their issues. 

Why might you need a root canal on a tooth that has never bothered you? A certain portion of the population will have the nerve in a tooth die in response to bacteria or trauma without pain or swelling. These teeth are usually discovered incidentally at a dental exam by visualizing an abscess on an x-ray. In most instances, this does not pose an emergency or cause for immediate concern. However, leaving the problem long term can lead to swelling, pain or the spread of infection.

Dental treatment recommendations can be difficult to understand, particularly when they involve root canals, crowns, implants or other complex procedures. At Thousand Oaks Family Dentistry, we are here to walk you through any difficult or confusing dental situations.  If you would like to know more about root canals, crowns or types of dental plain, please give our office a call!

Dental Questions: Why would a dentist place a temporary filling?

A filling is a filling, right? Then why would a dentist send you home with a "temporary" filling? What makes it any different from the permanent fillings you have on your other teeth? Do you need to worry about it falling out? Read on to see how and why dentists use temporary fillings to save and protect teeth!

A temporary or sedative filling is a type of dental procedure performed on a tooth with an uncertain prognosis or as an intermediate measure before further treatment. Imagine a patient who comes in for an emergency appointment with a large, painful cavity. While definitively saving the tooth may require a few different lengthy treatments, a dentist can remove decay and provide a temporary filling that same visit. This allows a tooth to be stabilized and desensitized so the patient can continue to function until a more definitive plan can be made. Many times, it is simply too early to determine the status of the tooth's nerves or gums and thus a temporary filling acts as a good interim measure. 

The most common material used in temporary fillings is a tooth colored compound called glass ionomer. This product bonds to tooth enamel, reacts well with moisture and has a natural calming effect on aggravated tooth nerves. Additionally, it enhances the effects of fluoride to provide extra defense against decay. The trade off is that glass ionomer is much weaker than permanent filling materials and does not stand up against tooth brushing, eating or chewing over time. Still, it's properties make it an ideal material to be used in temporary situations. 

How long will your temporary filling last? That question is impossible to answer without knowing the condition of the remaining tooth. In general, you should always end your temporary filling appointment with a plan for a permanent solution in the future. If you would like to know more about fillings, crowns, root canals or other dental procedures, please give our office a call!

Dental Questions: Does every tooth need a crown after a root canal?

As a rule of thumb, if you have a root canal performed on a tooth, you should expect to have a crown placed afterwards. Crowns help restore the structure and rigidity to a tooth after it has been "hollowed out" by the root canal process. In a few instances, a dentist may not recommend placing a crown on a tooth as part of definitive treatment. However, these cases are certainly the exception, and not the rule. 

To perform a root canal, an opening has to be created to access the nerve space within the tooth. This involves removing important structural components of the dental enamel, and thus rendering the tooth much more likely to fracture. A crown remedies this problem by creating a solid cap around the tooth that braces it against biting and chewing forces. Root canal treated teeth also frequently require buildups to replace lost tooth structure and posts to resist against lateral and shearing forces. The cost and time investment of these treatments need to be considered when you choose to have a root canal performed. Without them, the tooth has an much higher chance of breaking during normal use. 

In some cases, a dentist will not recommend placing a crown on a root canal treated tooth. Depending on how the patient bites and how much natural tooth structure remains, anterior (front) teeth do not always need crowns. Because they are not primary chewing teeth, the front teeth tend to deal with much less force than the canines, premolars or molars. Additionally, teeth opposing (biting into) dentures or teeth that have nothing to chew against may not need crowns after root canal treatment. In these instances, there is not enough force generated to put the weakened tooth at risk. 

In general, expect to need a crown placed as part of completing your root canal treatment. At Thousand Oaks Family Dentistry, we do our best to inform patients of their complete treatment needs- from start to finish. If you would like to learn more about root canals, crowns, fillings or cavities, please give our office a call!

Antibiotics in Dentistry

Antibiotic overuse is one of the most pressing issues in healthcare today. On top of the well-covered rise of MRSA infections, new strains of resistant bacteria are becoming more prevalent. With this in mind, clinicians around the world are working hard to cut back on antibiotic prescriptions and only use them when absolutely necessary. In the dental setting, many infections are not effected by antibiotics, and their use can potentially cause more harm than good. 

Most bacterial diseases of the mouth are addressed by either removing the bacteria or the "food source" for the infection. For example, a root canal works by disinfecting the inside of the tooth, removing the dead/dying tissue, and sealing the nerve canal with a rubber material. By cutting off the infection source, the immune system can naturally eliminate the bacteria from your body. Research has shown that adding antibiotics to this treatment does not improve healing or decrease chances of re-infection. Likewise, deep cleanings to treat periodontitis work by removing tartar/ infected tissue and giving the body a clean surface to reattach the gums and teeth. Again, the typical patient will not benefit from an antibiotic prescription (though antimicrobial rinses may be used to work locally in the mouth). 

Antibiotics are used in dentistry for instances of severe infection, pain and swelling that spreads away from the tooth. In these cases, the immune system may be "losing" its fight against the bacteria, and can benefit from some outside help. If you are prescribed antibiotics, take the entire bottle as directed, even if you start to feel better earlier. Finishing only part of a regimen puts you at risk for developing a new, stronger infection. For more information on dental infections, antibiotics and tooth pain, please give our office a call. 

Dental Questions: Are root canals painful?

If there was a ever a classic trope of bad dental experiences, it would certainly be the root canal. From cartoons to movies to TV shows, we are taught from a young age that root canals are the most painful of all dental procedures. Fortunately, this bad press is entirely undeserved. Root canal treatment offers relief from excruciating pain and a near instant improvement of symptomatic teeth!

For starters, a "root canal" is a dental procedure where the nerve inside the tooth is removed and replaced with sealing material. It is usually performed on a tooth with an infection (where the now-dead tissue is feeding bacteria) or with an inflamed nerve. In either circumstance, removing the internal nerve pulp and cleaning the inside of the tooth relieves symptoms of extreme pain and pressure. After performing a root canal, the tooth will most likely need a crown and/or post placement to add strength back to its structure. 

A root canal procedure will not be more painful than any other dental treatment. Endodontists (root canal specialists) require that the patient is completely numb so that there are no undue delays or interruptions to the root canal process. The most common complaint after receiving this therapy is a sore jaw from staying open for the duration of the procedure. In cases of extreme infection, some teeth may be difficult or impossible to fully anesthetize. In these cases, the endodontist may elect to use antibiotics or mild sedation to maximize the numbing effect. Either way, you will be completely comfortable for the entire appointment. 

If you have dental pain and think you might need a root canal, don't panic! Tooth pain comes from a number of different causes and requires a complete dental exam to diagnose. If you would like to schedule an appointment today, please give our office a call!

Dental Questions: What can a dentist do for tooth pain

At some time in their lives, everyone has experienced unexpected dental pain. It probably didn't show up at a convenient time (it never does) and you were probably willing to do anything to stop the pain. Fortunately, dentists are highly skilled in diagnosing and treating tooth pain. Read on to learn what we can do for patients in distress. 

As a disclaimer, this article will focus mainly on pain originating from the tooth nerve. An entire spectrum of problems can present as tooth pain (sinus infections, muscle spasms, gum disease, etc.), and a thorough exam with x-rays is the only way to confirm the source of your discomfort. 

The nerve in your tooth may become irritated for a number of reasons, ranging from exposure to extreme temperatures to decay and even fractures. Usually, this irritation is reversible meaning the nerve will calm down on its own. However, in certain cases the tooth can cross a threshold and become irreversibly inflamed, meaning the pain will persist until the tooth nerve dies. At this point, the nerve has to be taken out of the mouth- either via root canal or by extracting the tooth. 

At an emergency visit, a dentist will evaluate what is causing the pain, the health of the tooth nerve and if the tooth is overall "fixable." If the pain is coming from a tooth with a cavity or fracture that extends down the root and beneath the gums, it may be best to extract it and consider replacement options in the future. However, if the offending problem is well isolated and treatable, you will probably want to opt for a root canal. At most emergency appointments, a dentist will not complete a full root canal. Rather, they perform a procedure called a pulpectomy, where the nerve is removed and the roots are sterilized and filled with a temporary material. This procedure ends the pain and provides short term protection against bacterial invasion of the tooth. A full root canal will be required to reliably seal the nerve space and minimize risk of re-infection. 

If you can't get to a dental office right away and need relief from pain, over the counter NSAID medications like ibuprofen are excellent at treating dental discomfort. You may be tempted to request a prescription pain reliever, but these will not treat the inflammatory component of your pain like an NSAID. Before taking any medication for the first time, please consult with your dentist. If you have further questions on tooth pain, gum pain or emergency appointments, please give our office a call!

Specialist Spotlight: Dr. Lee of Thousand Oaks Endodontics

At Thousand Oaks Family Dentistry, we are proud of the network of skilled dental specialists we have created. Whether you are in our office or one of our associates’ offices, know that you will be treated with respect, kindness and experience. Today, we would like to highlight Dr. Jonathan Lee at Thousand Oaks Endodontics.

Endodontics is the subspecialty of dentistry focused on treating infections and injuries to the nerve of the tooth by performing root canals. here, the tooth nerve is removed and replaced with a resilient filling material called gutta percha. Endodontist may also perform surgical procedures to patch tooth roots or splint teeth after an injury. In his state of the art office, Dr. Lee performs all these procedures (and more!) with compassion and the highest levels of expertise. 

A Conejo Valley native, Dr. Lee completed dental school at USC and his residency at Temple University in Pittsburgh. If you would like to know more about Dr. Lee's office, root canals or why you are being referred to see a specialist, please give our office a call!

Website: http://www.thousandoaksendodontics.com/

Phone number: 805 370 0110

 

Recent changes to our Root Canal Policies

Our office recently changed our protocols on finishing root canal procedures done by endodontic specialists. These changes reflect the safest and most effective dental practices known today. As with all procedures carried out at Thousand Oaks Family Dentistry, we put your treatment, comfort and convenience first!

When a root canal is finished, you are essentially left with a tooth sans nerve tissue and a small opening at the top. This opening is a necessary part of the root canal procedure that allows the endodontist to reach the nerve tissue and roots. Unfortunately, it is also a major deterrent to the long term structural integrity of the tooth. In order to restore strength to the tooth, the opening needs to be sealed with a special filling material called a core and finished off with a dental crown. This core material chemically bonds to the enamel and protects against fractures and cracks. Many times, a device called a post will be added to the core to provide more rigidity when necessary. Posts extend partially down one root and create an additional structural anchor for the core to adhere to. 

Historically, the endodontists we work with would complete the root canal procedure and place a temporary filling into the opening (a "temporary core). This material does not actually bond to dental enamel and only serves to keep bacteria and food out of the inner tooth. It is very easy to remove, allowing for the quick re-access of a tooth if the first root canal was unsuccessful. Patients then had to return to our office, have the temporary filling removed and have a permanent restoration placed. Not only did this create a new opportunity for bacteria to invade the tooth, it caused our patients to spend days to weeks functioning with a severely weakened tooth. 

Currently, our endodontic specialists are placing permanent posts and cores at the time of root canal completion. This ensures the tooth is continuously sealed and structurally reinforced prior to crown placement. While immediately placing a permanent core can make re-accessing the tooth more difficult, the positives largely outweigh any negatives. Very few teeth end up needing immediate re-access, and the continued structural support of the tooth is a far more important factor in long term root canal success. 

If you would like to know more about root canals, posts, cores or any other dental procedures, please call our office. We are always happy and excited to walk you through any part of your dental treatment!

Root Canal Rumors

    If you search the web for “root canals” right now, chances are you will get two kinds of results: advertisements for local endodontists (root canal specialists) and articles on the dangers root canal treatment. Multiple pages will come up claiming endodontics are everything from toxic to cancer causing and even DNA altering. Is there any merit to these arguments? In this article, we hope to show you the truth behind root canals- a safe and remarkable treatment that has saved millions of teeth from extraction!

    Before we explain the controversy behind endodontics, we need to clarify how the procedure works in general. When a tooth becomes traumatized -be it from decay, physical force or extreme temperatures- the nerve tissue inside can become irritated and dies. This leaves behind a perfect space for bacteria to colonize and form an abscess. The abscess is a collection of bacteria that your immune system has contained and walled off, but cannot eliminate.

Notice the dark halo around the tooth root (where the arrow is pointing)? That is an abscess that will need to be treated with a root canal. 

A root canal tries to interrupt this process before the abscess leads to a dangerous systemic infection or damages the tooth beyond repair. Essentially, the inner tooth structure is cleaned, shaped and sterilized using very specific techniques. After the tooth is completely prepared, the roots are filled with a material called Gutta Percha. Gutta Percha is a natural rubber derived from tree sap that both seals the tooth and resists breakdown. After the endodontic treatment is completed, a crown is placed for increased rigidity and longevity.

A visual guide on how root canals are performed

    Many articles that criticize endodontic treatment quote studies that were performed by Dr. Weston Price in the 1920’s. His research indicated that bacteria from incompletely sealed root canals could spread out to the rest of the body and cause systemic problems like arthritis and cancer. These conclusions were quickly disproved, as his data was obtained using outdated and inaccurate scientific methods. Current research shows no correlation between root canal treatment and increased risk for any disease. It is important to remember that the end goal of endodontics is to lower the bacterial load from infection, so that your immune system can naturally eliminate any residual microorganisms. In this sense, endodontics seek to work with your body, not against it!

    Still, many internet blogs insist that root canals can cause cancer. A commonly quoted statistic is that 97% of terminal cancer patients have at least one root canaled tooth. First, it is unclear what scientific study this number actually originated from. Secondly, even if there is a correlation, there is no causation between root canals and cancer. It would be equally (in)valid to say that cancer causes root canals- a truly absurd notion. Finally, this statistic is almost certainly false. A 2013 study by the Journal of the American Medical Association found that patients with root canals actually had a 45% lower cancer risk (again, this describes correlation and not necessarily causation).

    Overall, we can see that the majority of the anti-root canal argument relies on 90 year old disproven research, conjecture and anecdotal evidence. In contrast, peer-reviewed scientific research on endodontic treatment has continuously demonstrated that root canal therapy is safe, effective and highly successful. If you have further questions on root canals and why they are great treatment options, please give our office a call. We are always excited to keep our patients informed and knowledgeable on the best practices in dentistry!

Specialist Spotlight- Conejo-Simi Endodontics

Dr. Stoops

Dr. Bollinger

Dr. Cobin

At Thousand Oaks Family Dentistry, we are proud of the network of skilled dental specialists we have created. Whether you are in our office or one of our associates’ offices, know that you will be treated with respect, kindness and experience. Today, we would like to highlight the services offered at Conejo-Simi Endodontics, the office of Doctors Cobin, Bollinger and Stoops.

At Conejo Simi Endodontics, an array of services are provided towards preserving infected or chronically inflamed teeth. Beyond root canals, their office can diagnose internal fractures in tooth roots, retreat failing root canals and more. The end result is relief from pain, removal of infection and a longer lifespan for a tooth that would otherwise need to be extracted.  

In diagnosing and providing endodontic treatments, Doctors Cobin, Bollinger and Stoops bring together years of experience with state of the art technology. Their office is highly corroborative, and utilizes the doctors’ multiple perspectives and techniques in treating your case. Cone Beam CT scans are used to visualize your tooth in three dimensions while precise microscopes expose nearly every facet of the tooth structure. This technology and clinical skill distills to a better understanding of what exactly is happening in your mouth. Their office can then better work within many different constraints- whether personal needs, medical conditions or timing issues.

Beyond their technology and technical abilities, Conejo Simi Endodontics prides themselves in being an extremely communicative and open environment. They take time to listen to patient needs and respond appropriately. If you are apprehensive, they can help relax you with music, movie glasses or even blankets in addition to conscious or IV sedation. If you need further instructions or referrals, they are happy to walk you through why endodontic treatment isn’t appropriate at this time. Simply put, they want you to feel informed, listened to and supported. On top of patient communication, their staff does an excellent job of corresponding with our office, providing us with clear and informative report of your procedure. This translates to quick and continuous treatment of your dental needs.

In total, we are proud to refer to Conejo Simi Endo because of their compassion, communication and expertise. If you would like to know more about Doctors Cobin, Bollinger and Stoops or any other of our fantastic specialists, please give us a call.  We want our patients to know they are in good hands, whether with us or one of our specialists.

For more information on Conejo Simi Endodntics, please visit their website at: www.conejosimiendo.com