Archive for the ‘Root Canal Therapy’ Category
Root Canal Alternatives
Wednesday, November 11th, 2009
Last week we talked about root canals, but what are your options if that’s not possible or desirable? Actually, the only alternative if the nerve has died or become infected, would be to remove the tooth. So the real choice is what to do with the space once the tooth is gone.
This is probably one of the most difficult dental choices people face. It’s difficult to lose the tooth in the first place, but then what do you do? There is the Zen choice of course, called the no choice. You wake up five years later and that space is still there.
Unfortunately, it is usually not that simple. The other teeth gradually collapse into that space from the sides and from the opposite arch, causing an increase in the tendency for decay and gum disease because of their unnatural relationships. There is a loss of function and comfort in the affected area, and a general malocclusion from the change in the way the teeth bite together. This in turn increases the muscular tension around the temporomandibular joints, causing premature arthritis, headaches, and cervical spine misalignment. It’s a cascading effect that seems very far reaching and maybe a little far fetched.
But these are very real consequences. The sneaky part is that it happens so gradually, like the old boiling frog adage. It’s like after three or four years you wonder why you hear a crunching noise when you open your jaw, or why you get those tension headaches.
There are some priorities, however, when considering whether to replace a tooth. A wisdom tooth of course is virtually disposable, and although it’s recommendable to replace any lost second molars, I must admit the loss in function and the shifting in the other teeth is minimal. But the first molars bear more stress than any other tooth, so replacing those or anything forward is an absolute must. And there is also the obvious cosmetic concern if the space is visible.
You usually have three basic ways to replace a missing tooth. The first is a removable partial denture. Although it’s the least expensive and it will maintain the correct relationship between the teeth, it’s not very functional or comfortable, or natural looking. It’s also a little overkill for one or two missing teeth, and is more useful when there are more spaces than teeth.
The second choice is a fixed bridge. This typically consists of two crowns that have the replacement tooth fused between them. The one piece ceramic construction can be computer generated for unparalleled accuracy. It is permanently cemented in place for a completely natural appearance and function.
The third choice is a dental implant. It is a titanium post coated with calcium that is very biocompatible. It functions like a root, and then a crown is attached at its surface. It is as close as you can come to a natural tooth.
The cost and appearance are similar for the bridge or the implant, but there are other pros and cons that may influence your choice. Although the success rate is better for the implant, it can take up to eight months after the extraction to finish, whereas the fixed bridge can be done much sooner. Whatever the choice though, it is much better for you in the long run to replace a missing tooth.
Dr. Moulton’s article was published in the Desert Valley Times on November 10th, 2009
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More Than Everything You Wanted to Know About Root Canals
Wednesday, October 28th, 2009
Oh that term, Root Canal. It elicits a response somewhere in the neighborhood of colonoscopy. It’s wrapped in a shroud of forboding. It’s the standard against which all forms of discomfiture are measured. “I’d rather have a baby than a root canal.” “Well, that went over like a root canal.” “A root canal is like waterboarding.” No, I actually liked waterboarding. My brothers used to do that to me when I was a kid.
But you get the picture. In actuality, root canal therapy is usually no different than a filling (not that that’s a big thrill). In most cases, the nerve is so dead, it has no feeling left in it. The pain and sensitivity to touch is the pressure in the bone at the tip of the root where the infection is building. That’s very easy to get numb. So the apprehension surrounding root canals is exaggerated. Probably associated with the pain the person is already suffering when they come in to the office, or a throwback to the cowboy days when the barber used to give you a pint of whiskey and dust off the pliers they just used to shoe the horse.
It doesn’t just stop there, however. There are options to consider before you do the root canal and even after it’s done. The first thing you need to decide is if you even want the root canal therapy. Research has shown that no matter how well a root canal is done, bacteria continues to grow within the tooth. Whether that’s a health hazard or not depends on who you are talking to. An endodontist would just say, nonsense, but a homeopathic physician would have a fit.
There are other considerations, such as how much decay or gum disease is present, cracks in the root, and medical complications.
Then there is the decision about what to do with the tooth after the root canal is done. The standard recommendation is to put a crown or cap on the tooth. This idea is engendered by the fact that 83% of root canal failures come from teeth that haven’t been capped afterward, but that statistic is skewed. It’s also true that 83% of teeth that receive root canals are not followed up with a cap, so in actuality, doing a crown afterward has no bearing on the success of the endodontic therapy.
It can have a bearing on the success of the tooth, however. Endodontically treated teeth become more brittle than vital teeth. Also, according to a study by Dr. Jay H. Levy, nonvital teeth are less sensitive to pressure, so you may inadvertently chew harder on them than you would a normal tooth.
On the other hand, I put a lot of value on the health of the gums, and no crown margin can come near to the periodontal health that the natural tooth gives you. With that in mind, I like to compromise on the necessity of a crown when possible. If no more than 40% of the tooth is lost to decay, there are no cracks or mercury amalgam fillings in the tooth (they expand and are what causes the cracks), and if asthetics is not a concern, then I like to go with a bonded composite filling instead of a crown. It’s often a cleaner choice in my estimation, not to mention less expensive.
Next week, what are your options if you and or your dentist decide against a root canal.
Dr. Moulton’s article was published in the Desert Valley Times, October 27, 2009
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