My Blog
By Tiffany C. Leung, DDS
December 02, 2021
Category: Dental Procedures
Tags: root canal  
GotQuestionsAboutRootCanalsWeHaveAnswers

You might have a few questions should you find out you need a root canal for a tooth infected with advanced decay. Most will be about what you should expect before, during and after a procedure.

But first, let's deal with a couple of your obvious concerns right upfront:

  1. No, contrary to your Uncle Bill, it won't be painful (if the infected tooth is throbbing, though, the procedure will relieve your pain);
  2. Yes, based on outcomes for millions of treated teeth over several decades, the odds are high the procedure will save your tooth.

As to other questions you might have, here's a basic 411 concerning your upcoming root canal procedure.

The "Why." Many consider tooth decay to be mainly a cavity forming in the outer enamel and dentin layers of a tooth. But tooth decay can destroy tooth structure as it advances through to the pulp, the heart of a tooth. The resulting infection will also spread into the root canals to eventually infect the roots and supporting bone. A root canal treatment removes the decay and stops the advancing infection in its tracks.

The "How." There are a number of variations on the procedure, but they all follow this basic process: After thoroughly numbing the tooth and surrounding tissues, we drill a hole into the tooth to access the pulp chamber and the root canals. We then remove all infected tissue through this access and disinfect the tooth's interior spaces. We then fill these spaces with a rubber-like filling to prevent future infection.

The "After." Once we've completed filling, we seal the access hole. Sometime later, we'll crown the tooth to provide further protection against infection and add support to the tooth. In the meantime, you may have a few days of discomfort, which is usually manageable with mild pain-killers like ibuprofen or acetaminophen.

A lot of root canals can be performed by a general dentist, but more complicated cases may require an endodontist. In either scenario, a root canal could give your infected tooth another chance at life that it wouldn't otherwise have.

If you would like more information on root canal therapy, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment.”

HeadOffaCrossbiteatthePassWithThisOrthodonticAppliance

At what age should you begin treating a poor bite? Many might say with braces around late childhood or early adolescence. But some bite problems could be addressed earlier—with the possibility of avoiding future orthodontic treatment.

A crossbite is a good example. In a normal bite, all of the upper teeth slightly cover the lower when the jaws are shut. But a crossbite occurs when some of the lower teeth, particularly in back, overlap the upper teeth. This situation often happens when the upper jaw develops too narrowly.

But one feature of a child's mouth structure provides an opportunity to intervene and alter jaw development. During a child's early years, the palate (roof of the mouth) consists of two bones next to each other with an open seam running between them. This seam, which runs through the center of the mouth from front to back, will fuse during puberty to form one continuous palatal bone.

An orthodontist can take advantage of this separation if the jaw isn't growing wide enough with a unique device called a palatal expander. This particular oral appliance consists of four, thin metal legs connected to a central mechanism. The orthodontist places the expander against the palate and then uses the mechanism to extend the legs firmly against the back of the teeth on both sides of the jaw.

The outward pressure exerted by the legs also widens the seam between the two palatal bones. The body will respond to this by adding new bone to the existing palatal bones to fill in the widened gap. At regular intervals, the patient or a caregiver will operate the mechanism with a key that will continue to widen the gap between the bones, causing more expansion of the palatal bones until the jaw has grown to a normal width.

The palatal expander is most effective when it's applied early enough to develop more bone before the seam closes. That's why it's important for children to undergo bite evaluation with an orthodontist around age 6. If it appears a bite problem is developing, early interventions like a palatal expander could slow or stop it before it gets worse.

If you would like more information on interceptive orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Palatal Expanders.”

By Tiffany C. Leung, DDS
November 12, 2021
Category: Oral Health
Tags: tmj disorders   jaw pain  
PersistencePaysOffinFindingReliefFromChronicJawJointPain

Tenderness; headaches; difficulty chewing; excruciating pain. These are a few of the symptoms you could endure with a jaw joint or temporomandibular disorder (TMD or TMJ). This group of disorders disrupts the daily lives of millions of people around the world.

This month is TMJ Awareness Month, to shed light on these debilitating conditions and how best to manage them. Although controlling TMD isn't always easy, it can be done with the right blend of treatments.

The temporomandibular joint—actually a pair of joints connecting the lower jaw to the skull on either side of the face—is "ground zero" for TMD. These are ball-and-socket joints similar to the hip or shoulder, but with a unique addition—a cushioning disk that lies between the adjoining points of the two bones that temper the forces generated when you eat, speak or bite down.

Researchers believe TMD can arise from a variety of sources, including traumatic injury, psychological stress or mechanical dysfunction within the joint and cushioning disk. These problems can create blood flow constriction, which in turn causes the accumulation of chemical waste byproducts in the jaw muscles. This in turn and cause the muscles to spasm and become inflamed and sore.

Treatments are also as numerous as the possible causes of TMD. But for the most part, they range along a continuum of conservative to aggressive approaches.

On the conservative end, doctors treat TMD as a joint problem and borrow heavily from orthopedics. These types of treatments include the use of anti-inflammatory and muscle relaxing medications, icing or heating, stretching exercises, physical therapy and massage. Dentists may also provide mouth guard appliances for patients with clenching or tooth grinding habits to decrease biting forces.

On the more aggressive end are interventions like orthodontics or dental work. But, while these were common recommendations 20-30 years ago, it's no longer thought to be necessary for treating most TMD disorders and should not be recommended as a cure or solution for TMD.  At the furthest extreme is actual jaw surgery to relieve symptoms or repair damage within the joints. The latter, however, has not yet amassed a solid track record, and should be considered as a last resort.

Finding the right combination of therapies to give consistent relief sometimes requires a bit of trial and error. Most doctors recommend starting first with the most conservative methods before considering more aggressive measures. You should also undergo a complete dental exam to see if teeth or gum problems are contributing to your symptoms.

TMD can make your life miserable. But with some persistence and patience, you can find what works for a life without pain and dysfunction.

If you would like more information about managing TMD, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Seeking Relief From TMD.”

UnlikeBradPittYouDidntMeanToChipYourToothWeCanStillFixIt

It's not unusual for serious actors to go above and beyond for their roles. They gain weight (or lose it, like Matthew McConaughey for True Detective). They grow hair—or they shave it off. But perhaps nothing tops what Brad Pitt did to assume the character of Tyler Durden in the movie Fight Club—he had his dentist chip his teeth.

While a testament to his dedication to the acting craft, Pitt's move definitely falls into the category of "Kids, don't do this at home." Fortunately, people deliberately chipping their teeth isn't a big problem. On the other hand, accidentally chipping a tooth is.

Chipping a tooth can happen in various ways, like a hard blow to the jaw or biting down on something too hard. Chipping won't necessarily endanger a tooth, but the missing dental structure can put a damper on your smile.

But here's the good news: you don't have to live with a chipped tooth. We have ways to cosmetically repair the damage and upgrade your smile.

One way is to fit a chipped or otherwise flawed tooth with a dental veneer, a thin wafer of dental porcelain bonded to the front of a tooth to mask chips, discolorations, gaps or other defects. They're custom-made by a dental lab to closely match an individual tooth's shape and color.

Gaining a new smile via dental veneers can take a few weeks, as well as two or more dental visits. But if you only have slight to moderate chipping, there's another way that might only take one session in the dentist's chair. Known as composite bonding, it utilizes plastic-based materials known as composite resins that are intermixed with a form of glass.

The initial mixture, color-matched for your tooth, has a putty-like consistency that can be easily applied to the tooth surface. We apply the composite resin to the tooth layer by layer, allowing a bonding agent in the mixture to cure each layer before beginning the next one. After sculpting the composite layers into a life-like appearance, the end result is a "perfect" tooth without visible flaws.

Unlike Brad Pitt, it's pretty unlikely you'll ever find yourself in a situation requiring you to purposely damage your teeth. But chips do happen—and if it happens to you, we have more than one way to make your teeth as good as new.

If you would like more information about repairing dental flaws with veneers or composite bonding, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Artistic Repair of Front Teeth With Composite Resin.”

By Tiffany C. Leung, DDS
October 23, 2021
Category: Dental Procedures
5SignsYourChildMayBeDevelopingaPoorBite

A Malocclusion—better known as a poor bite—can have far-ranging consequences that could follow a child into adulthood. Bite abnormalities make it more difficult to chew and digest food. And, misaligned teeth are also harder to keep clean, increasing the risk of dental disease.

But the good news is that we can often curb these long-term effects by discovering and treating a malocclusion early. A poor bite generally develops slowly with signs emerging as early as age 6. If you can pick up on such a sign, interventional treatment might even prevent a malocclusion altogether.

Here are 5 possible signs that might indicate your child is developing a poor bite.

Excessive spacing or crowding. A poor bite may be developing if the gaps between teeth seem unusually wide or, at the opposite spectrum, the teeth appear crooked or "bunched up" from crowding.

Underbite. In a normal bite the teeth on the upper jaw arch slightly cover the lower. If the opposite is true—the lower teeth are in front of the upper—then an underbite could be forming.

Open bite. Normally, when the jaws are shut, there is no open space between them. But if you notice a space still present between the upper and lower teeth when the jaws are shut, it may indicate an open bite.

Crossbite. This abnormal bite occurs when some of the lower teeth bite in front of the upper, while the remaining lower teeth are properly aligned behind the upper. Crossbites can occur with either the front or the back teeth.

Front teeth abnormalities. Front teeth especially can indicate a number of problems. In a deep bite, the upper front teeth extend too far over the lower teeth. Protrusion occurs when the upper teeth jut too far forward; in retrusion, the lower teeth seem to be farther back than normal.

See your dentist if you notice these signs or anything else unusual with your child's bite. Better yet, schedule a bite evaluation with an orthodontist when your child reaches age 6. Getting a head start on treating an emerging malocclusion can save them bigger problems down the road.

If you would like more information on malocclusions and their impact on your child's oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Problems to Watch For in Children Ages 6 to 8.”





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