Is there any way to avoid a root canal when cleaning out a deep cavity?

When treating a patient with a deep cavity I have a particular way of cleaning out the decay in order to minimize the likelihood of exposing the nerve. I carefully and gently remove the decay from the sides walls of the cavity preparation and when my access is completed and the walls are clean, I finish cleaning the part of the tooth closest to the pulp.

Sometimes I am able to avoid root canal treatments by placing medicament's over affected dentin before placing the final restoration. "Affected Dentin" is another word for softened dentin, that has been affected by the bacteria in the decay, but can be retained if treated with dycal and vitrabond or dycal and IRM. Most dentists remove this tooth material instead of preserving it. When removing it , they can expose the pulp and the patient then needs a root canal.

I do not advocate performing direct pulp caps, but instead make use of this "indirect pulp cap procedure". In my experience this procedure has a high success rate. Direct pulp caps involve placing material directly over small pulp exposure. Although I have done these on occasion, they are not as predictable.

Is there any reason not to remove a tooth that your dentist has recommended extracting?

Although there I times when an extraction is needed immediately due to infection, often times the extraction of hopeless teeth can be planned to coincide with the placement of bone grafting or an implant.

Currently, implant restorations are usually recommended for single tooth replacements when conditions allow. Implants and their restorations can be a highly reliable and predictable way to replace a missing tooth.

One important caveat is that implants require adequate bone present to be successful. Unfortunately, many patients have a tooth removed and wait years to inquire about an implant and often they do not have sufficient bone to easily place an implant. Implants can be expensive and many patients do not have the financial where with all to immediately replace a tooth with an implant. For this reason, I sometimes delay removal of a root until a patients finance allow for its implant replacement. The retained root can often function as a place holder for the implant, retaining the surrounding bone until the patient is ready for an implant replacement.

Of course there are many cases where this strategy will not work. This is especially true when there is an infection around a hopeless tooth. This can cause the surrounding bone to be compromised and it is usulally better for a patient to have the tooth removed in order to prevent the spread of the infection(the further destruction of the surrounding bone).

When do you recommend that your patients seek a second opinion?

When I examine a patient, I encourage them to seek a second opinion if they seem uncertain about what I am proposing as a possible treatment. I am always more comfortable moving forward with a procedure if the patient and I are on the same page. If they are uncertain then possibly it is best for them to seek a second opinion especially if no emergency treatment is immediately neccesary.

Another reason for suggesting a second opinion is if I feel a tooth has a guarded or questionable prognosis even after I might perform treatments. In that event, I might suggest a visit to an appropriate specialist for a second opinion, prior to commencing any treatment.

Often it is good for me and the patient to hear a second opinion concerning a tooth or teeth that may or may not respond favorable to a given treatment. Dentists have choices to make about treatments.. Often decisions can be best determined after a consult with the appropriate specialist. The adage ‘Two heads are better than one” definitely can apply.

What kind of night guards do you recommend?

I usually recommend a full maxillary night guard made from hard acrylic. It is has a 'flat plane' design with no 'tissue contact'. I often add two ball clasps that fit between the maxillary first molar and the second premolar. Ball clasps are wires that can enhance the retention of night guards. Hard acrylic night guards tend to be more durable and better tolerated than the soft vinyl variety.

When inserting night guards, I take care to adjust their occlusion so that bruxing is discouraged and a patient goes into anterior guidance when making side to side movements with their jaw. I try to remove posterior contacts during excursions since their getting rid of these tends to eliminate my patients ability to brux when wearing the night guard.

When worn, night guards designed in this manner , tend to allow patients to rest their jaws during the night and can help to alleviate some of their TMD symptoms.

What are the Top Blogs about Dental and Oral Health?

A new post on www.mastersinpublic health attempts to answer this question. Finding good sources of dental information can be a challenge. This post may make the chore less difficult. It lists what it considers the top dental blogs and has it organized by relevant categories. I am please to report that Ask Dr Spindel made it onto this list in the Dentist Blogs category in the number 4 spot. Although I write this dental blog as a public service, recognition is always appreciated. Thanks for the acknowledgement.

How long do porcelain veneers last?

In my experience, if they are bonded correctly and have the bite adjusted properly, they can last 10 to 15 years. The problem is that when they are done for people in their twenties, they may need to be replaced 5 times or more during a lifetime.

Partly for this reason, I have been advocating straightening the teeth with Invisalign clear braces and offering minor bonding procedures for altering the teeth slightly. This seems less invasive then preparing teeth for 10 porcelain veneers. Also bonding can be repaired more easily and affordably.

I still offer porcelain laminates but I choose my cases carefully. Not everyone requires porcelain veneers to improve their smile. If simple bleaching combined with Invisalign will produce a good looking and natural looking smile,then often that is the option I recommend.

What information does a dental X-ray provide that would help my dentist determine if I need a root canal?

If a patient has a symptomatic tooth, radiographs can be very helpful to a dentist in making his diagnosis. A well taken X-ray will show whether the periodontal ligament is intact at the apex. Often teeth that are non vital and have become contaminated with bacteria either display a radioluscency "attached" to the apex. This can be evidence of an infection that has traveled to the bone at the end of the tooth. Sometimes the apex doesn't display a full fledged radioluscency, but instead displays a widened periodontal ligament(PDL).

Other information that can be obtained from radiographs are the proximity of any filling to the pulp, the presence or absence of decay or infraboney periodontal defects. Radiographs also can be helpful in diagnosing some types of tooth fractures as well.

Bite wing radiographs although not good for spotting infections, are extremely helpful to determine the presence of intraproximal decay and can be a great help in evaluating the margins of dental restorations.

Periapical X-rays( that show the entire tooth) are better for picking up tooth related infections.

Panorex radiographs show all the entire mouth and jaws in one film and are good for oral surgeons or implant surgeons to complete their diagnosis and treatment plans. Most Panorex radiographs do not show individual tooth in as fine detail as an individual periapical X-rays and I do not find them as useful for routine dental examinations.

What does it mean if I have itchy gums?

This is question that patients sometimes ask during their 'allergy season'. When I examine there gums they usually look slightly redder than usual. This is thought to be due to an increase in the amount of eosinophils present in their gums (due to their allergic state). It has been said that the increased proportion of the eosonophils in the gums may be related to perceived itchiness. Also when patients are suffering with an allergy they have an increase in the amount of histamines released in tissues that cause itchiness.

Some medicines can cause itchiness and if the onset of this reaction coincides with a new medication a patient should consult their physician.