Hidden Dangers

Endodontic Abscess

An endodontic abscess forms at the root tip

An endodontic abscess is a pocket of pus that forms in the jawbone at the tip of a tooth root. An endodontic abscess is painful and can lead to much more serious conditions, but with prompt treatment, we can help you maintain a healthy mouth and body.

Symptoms of an endodontic abscess

You may realize that you have an endodontic abscess when:

• The tooth hurts when you tap or bite on it
• You have a bad taste in your mouth
• You experience pain and swelling

It is possible that you can have an endodontic abscess and experience no symptoms at all.

The causes of an endodontic abscess

An endodontic abscess is caused by an infection of the pulp layer of the tooth. It becomes infected when bacteria, which are always present in the mouth, invade the pulp through deep cavities, a fractured or broken tooth, or an injury to the tooth. In some cases, there is no apparent reason. The infection can then spread from the pulp chamber, down the root canals, through the tip of the root, and into the jawbone, where the pus builds up and creates a hole in the bone. This is the abscess. The abscess creates pressure inside the bone and on the ligaments surrounding the tooth, and this can cause excruciating pain. Sometimes, the abscess drains near the infected tooth, forming a gumboil.

Diagnosis and treatment

It is important to treat an endodontic abscess because, if left untreated, the abscess can damage the adjacent soft tissue, lead to bone loss, be a continuing source of infection that drags down your immune system, and even be life threatening. To find an endodontic abscess, we perform a thorough examination, including x-rays. On the x-ray above, you can see a dark area at the root tip, which indicates an endodontic abscess. We may also use an electric pulp tester to determine whether the pulp is inflamed or infected. An infected tooth will never heal on its own, so we remove the infection with root canal therapy, which allows the abscess to heal. Occasionally, however, the infection continues to grow after treatment. In that case, we may re-treat the tooth with root canal therapy or use a minor surgical procedure to stop the infection and restore the health of your tooth.

What If? Wednesday

Space Maintainers

If your child's bite becomes irregular from early tooth loss, an option is available to ensure proper tooth formation in the future. Space maintainers are a valuable investment in the success of your child's oral health for years to come.

Why are baby teeth important?

Normally, as a permanent tooth comes in under a baby tooth, the roots of the baby tooth dissolve away, and the permanent tooth replaces the baby tooth. In addition to being important for chewing, the baby tooth holds the adjacent teeth in place. When a baby tooth is lost early, due to decay or injury, the adjacent teeth may drift together, causing loss of space in the dental arch.

Placing a space maintainer

When a baby tooth is lost early, this shifting and loss of arch space can be prevented by placing a space maintainer. It generally takes two appointments to complete a space maintainer. During the first appointment, an orthodontic band is carefully placed and an impression is taken. A model of the child’s mouth is made from this impression so that the dental laboratory can form the space maintainer to the exact contours of the mouth. During the next appointment, the space maintainer is tried in, adjusted if necessary, and then cemented in place.

Caring for a space maintainer

Space maintainers are used until the permanent teeth begin to break through the gums. While wearing a space maintainer, it is important to avoid chewing gum, sticky candies, and hard foods like nuts or ice. Following up with periodic checks of the space maintainer here in our office will make sure it’s still functioning properly and keeping all the teeth in their proper position.

All About TMD

What is TMD?

Temporomandibular disorder, known as TMD, is a cycle of pain, muscle spasms, and joint imbalance where the jaw meets the skull. The lower jaw meets the skull at the temporomandibular join, known as the TMJ. This joint connects the temporal bone of the skull with the mandible bone of the jaw. Cushioning these two bones is a thin disc of cartilage. Five muscles support the joint.

Symptoms of TMD

When the balance of these bones, cartilage, and muscle is lost, it can cause:

• Headaches
• Earaches
• Difficulty opening and closing your mouth
• A clicking or popping in the joint
• A dull aching pain around the ear that spreads into the face
• Sore or painful jaw muscles

This cycle of pain, spasms, and joint imbalance can be started by clinching or grinding the teeth, a bad bite caused by missing teeth or poorly aligned teeth, a blow to the joint, arthritis or emotional stress.

Breaking the cycle

Clenching and grinding will often go away once a person’s stress is reduced. In the meantime, there are other ways to break this cycle. You can reduce muscle spasm and pain with:

• Moist heat
• Inflammation-reducing drugs and muscle relaxants
• Muscle massage
• A soft diet

To restore balance to the joint, we can crown teeth, fill spaces, adjust the bite using a procedure called equilibration, or even move teeth. A splint, which is a plastic mouthpiece, can reduce clenching and grinding, which will also help restore harmony to the joint. In extremely severe cases, surgery may be necessary to repair the damaged part of the joint.

Millions of people suffer from TMD. Treatment and lifestyle changes can break the TMD cycle and restore harmony to the joint.

FYI Fridays: Frenectomy

Frenectomy

What is the frenum?

Your lips, cheeks and tongue are connected to your jawbone with a fold of tissue called the frenum. If the frenum is too long or too short, it can cause problems and should be removed. This procedure is called a frenectomy.

The frenum at all stages of life

The frenum can be fixed in all stages of life. If an infant’s frenum is too long, it can make it difficult for the baby to breast feed. Toddlers just learning to speak may get “tongue tied” because the frenum is close to the tip of the tongue. Even teens and adults have this problem, and a frenectomy can help them, too. An abnormally attached frenum can prevent baby teeth from properly erupting. As a child ages, a frenum that is attached too closely to the teeth can cause a gap to form between the teeth. The gap cannot be closed unless the abnormal frenum attachment is surgically removed. A short or tight frenum will constantly constantly tug on the gum tissue and can cause the tissue to pull away from the tooth, leading to serious gum recession, tooth decay, and periodontal disease. For adults who wear a denture, the frenum can pull the denture and loosen it, which makes wearing the denture extremely uncomfortable.

The procedure

A fenectomy is performed in the dental office usually with just a local anesthetic, and takes only about 10 or 15 minutes. The frenum can be removed with a scalpel or a laser. If a laser is used, it is very important that you remain completely still, so you may be offered sedation if you think it might help you relax. If your dentist must suture the area, healing may take a few weeks.

Pericoronitis

A painful problem

Pericoronitis is an inflammation of the gum tissues that cover the chewing surface of molars that have not fully erupted through the gum tissue. It most often occurs with the wisdom teeth, also called third molars. Pericoronitis is painful and can lead to more serious problems. It is important to treat it as soon as possible to restore the health of your mouth.

Symptoms of pericoronitis

You may realize you have pericoronitis when:

• Your back gums are swollen, red, and painful
• You have a bad taste, pus or odor in your mouth
• You have difficulty opening your mouth wide

The causes of pericoronitis
The most common cause of pericoronitis is food, bacteria, or plaque trapped beneath a flap of gum tissue. The flap is formed when a molar begins moving toward the surface of the gum tissue. Before the tooth erupts through the gum, gum tissue covers the area completely, but as the molar emerges, only part of the tooth remains covered by gum tissue. This creates a flap where food and bacteria can become easily trapped but that is difficult to clean. Inflammation and infection can very quickly develop. In addition, if the upper molar comes through fully before the lower one, the upper tooth may bite down on the lower gum flap, worsening the condition.

Diagnosis and treatment

It is important to treat pericoronitis because, if it is left untreated, a much more serious infection can spread to the neck and cheeks. To determine whether you have pericoronitis, we perform a thorough examination. The exam may include probing the gum around the affected tooth and taking x-rays. To treat pericoronitis, we remove plaque and bacteria from the affected tooth and rinse around and under the gum flap. To prevent pericoronitis from recurring, we may, depending on the circumstances, surgically remove or reshape the gum around tooth, or extract the tooth. Homecare may include rinsing your mouth with warm salt water or an antimicrobial mouthwash. We may suggest that you use an oral irrigator to help keep the area bacteria-free.

FYI Fridays

Cold Sores

Cold sores, also called fever blisters or oral herpes, are small sores that form most commonly on or near the lips. Cold sores usually follow a predictable pattern of four stages that lasts about 10 to 14 days. The first symptom is a painful, itchy tingling. A day or so later, small red blisters appear. Then, in a few days, the blisters form into oozing sores with yellowish crusts. Finally, in a week to 10 days, the sores scab over and heal. Outbreaks can be accompanied by low fever, headaches, body aches, and fatigue. Cold sores are painful and annoying, but be patient. They do go away on their own, and you will soon be pain-free again.

The cause of cold sores

Cold sores are caused by the herpes simplex virus. Symptoms appear from 1 to 3 weeks after initial exposure. Once you are infected with the virus, it lives in your nervous system forever. Certain triggers seem to set off outbreaks. Some of these triggers include exposure to ultraviolet light, physical and emotional stress, fatigue, hormone fluctuations, the menstrual cycle, and illnesses like fever, cold, or flu.

Diagnosis and treatment

There is no cure for cold sores, but you can ease the pain by applying over-the-counter remedies that contain numbing agents, like benzocaine or phenol, washing the infected area gently with water and an antiseptic soap, applying either a warm compress or ice, and avoiding spicy or acidic foods during an outbreak. If this is the first time you have a cold sore, or if fever, swollen glands, or bleeding gums accompany your cold sore, let us know right away, so we can determine the correct diagnosis. In some cases, we may prescribe an anti-viral medication.

Preventing the spread of cold sores

The cold sore virus is extremely contagious. It spreads by direct contact with an infected person or through contact with personal items such as infected towels, toothbrushes, or razors. You can help to prevent cold sores from spreading by:

• Not touching the area
• Washing thoroughly with water and an antiseptic soap if you have touched the sore
• Not touching anyone if you have just touched the sore
• Not kissing anyone while symptoms persist
• Being extremely careful to prevent the spread of the infection to the eye, as blindness can result