Before You do the Root Canal...

Here’s the scenario:

You’re in the dentist’s office. You have a cavity. You’re numb. The dentist starts the procedure drilling away the decay. He or she finds the decay hits the nerve. The next statement might be, “I’m sorry, but the decay has gone too deep. You need a root canal.”

Here’s another scenario:

Your dentist takes an x-ray. It might be a routine check, or you may have a toothache. He/She finds an abscess or a trapped infection that is located in the bone. It’s plainly visible on the x-ray. He/She says, “You need a root canal.”

On the inside of every tooth root, there is a hollow tube or canal. Inside that tube are small blood vessels that nourish the tooth and nerves that allow us to feel cold sensation. The blood vessels and nerves are sensitive to bacteria, so if a bacteria-filled cavity comes close to the nerve, you may feel some pain. That bacteria may also infect the blood vessels and nerves, causing them to die. That’s where the term, “dead tooth,” comes from. The bacteria doesn’t just stay in the tooth. It can travel up though the canal and infect the bone that surrounds the tooth. A root canal procedure removes the nerve from the tooth, and cleans out the infection from within the tooth. It is very successful at controlling such infections.

So it would seem logical that if there is an infection in the tooth, or if decay has reached the nerve, that a root canal should be done. But hold on. Not so fast.

Root canal procedures are very successful, but the long-term success of the entire tooth has very much to do with the strength of the remaining tooth structure. In other words, if you have a tooth that has been badly broken down by decay or has substantial filling material in it, then that tooth is a weakened tooth. The more tooth structure that has been lost, the more decay that is in the tooth, the more filling material that is in the tooth, the weaker the tooth is. And the weaker the tooth is, the more it’s prone to fracture.

There is one other factor involved. The blood vessels in the canal provide moisture to the tooth root. A tooth without those blood vessels becomes brittle. . What happens when you lose moisture in your skin? That’s right. It cracks. And a root canal treated tooth is exactly the same. While it does save the tooth, the tooth is more likely to crack.

Therefore, the question that you as an informed consumer should ask is, “How restorable is the tooth?” Is there sound, healthy tooth structure above the gum line? What are the chances that if I save the tooth with a root canal, that the tooth will remain sound?

If the tooth is not easily restorable, a dental implant is often the most reliable alternative.

Dr. Lee Sheldon

It’s not the Denture

It happened in our office again just last week. And seemingly, it happens almost every week. Here’s the line—“I’ve just had a denture made, and it doesn’t fit right.” I check it, and it fits as well as it’s going to fit. What’s the problem? Often, it’s not the denture. It’s you.

Now this is not an excuse for a denture that doesn’t fit right. That sometimes happens too, and with minor corrections, that can be remedied. This is for the person who says, I’ve never had a denture fit as well as the first one.

Now why would that be? Denture materials, if anything, have improved over the years. The impression materials that we use likewise have improved. The denture impression procedure is critical, and this is a skill that most dentists master in dental school. It’s one of the fundamental procedures that we learn before we ever get into practice. So if it’s not the materials, and it’s not the dentist, what could be the problem?

The minute the teeth come out, the bone that held the teeth shrinks away. For some, it’s a gradual shrinkage. For some, it’s more dramatic. For almost all, the shrinkage continues over time, simply due to the pressure of the denture on the ridge. Every time you bite down, every time you clench your teeth, you are placing pressure on the ridge. And that pressure results in shrinkage of that ridge. We call it “ridge resorption.” Did your dentist tell you to take your dentures out at night? It was to help prevent shrinkage of the ridge, because we often clench our teeth at night.

The ridge shrinks, and of course the denture doesn’t. So what else happens over time? Do you notice that the lower third of your face is shorter? That your chin is closer to your nose? That’s because of ridge resorption. Do you notice that your lower jaw juts out when it didn’t before? Same thing—ridge resorption. How about your nose sticking out farther than it used to because your upper lip puckers in? Ridge resorption again.

Here are some methods that help limit ridge resorption.
1. Save your natural teeth, if you can predictably.
2. If you wear dentures, take them out as much as possible and certainly at night. 3. Get dental implants, preferably as closely as possible after you lose your teeth.

Resorption starts on the first day that you lose your teeth. Denture wearers are often the people least likely to see the dentist on a regular basis. But the need for dental care never stops. Your dentist can check for resorption, reline or remake your dentures, and adjust your bite to minimize the damage that may otherwise occur. Don’t let the loss of your teeth stop your dental visits. Just as you need your physician to monitor your health, you need your dentist to monitor your oral health.