By Vincent J Castellano DMD
November 27, 2021
Category: Dental Procedures
Tags: root canal  
YourDecayedToothMightNeedaDifferentKindofRootCanalTreatment

Advanced decay doesn't necessarily mean it's curtains for an infected tooth. Millions of teeth in that condition have been saved by a tried and true procedure called root canal therapy.

Although they may vary according to the complexity of a case, all root canal procedures share some similarities. After numbing the tooth and gum areas with local anesthesia, the procedure begins with a small hole drilled into the tooth to access the infected pulp and root canals, tiny passageways inside the root.

The dentist then uses special instruments to clear out infected tissue from the pulp and canals, followed by thoroughly sanitizing the resulting empty spaces. This is followed with filling the pulp chamber and root canals with a rubber-like substance (gutta percha) to seal the interior of the tooth from further infection. Later, the dentist typically crowns the tooth for further protection and support.

Root canals have become the standard treatment for teeth with advanced decay. There are, however, some circumstances where performing a root canal isn't a good idea. For example, a previously root-canaled tooth with a crown and supporting post. A dentist would need to fully disassemble the restoration to gain access into the tooth, which could significantly weaken it.

But there may be another option if a standard root canal is out of the picture: a surgical procedure performed by an endodontist (a specialist in interior tooth treatment) called an apicoectomy. Instead of drilling through the tooth crown, the endodontist accesses the tooth root through the adjacent gum tissue.

Like a traditional root canal, the procedure begins by anesthetizing the tooth and surrounding gums. The endodontist then makes a small incision through the gums to expose the diseased tissues at the tooth's root. After removing the infected tissue and a few millimeters of the root tip, they place a small filling to seal the end of the root canal against infection and suture the gum incision.

This is a specialized procedure that requires the state-of-the-art equipment and advanced techniques of an endodontist. But it does provide another possible option for saving a diseased tooth that might otherwise be lost.

If you would like more information on treatments for tooth decay, 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 “Apicoectomy: A surgical Option When Root Canal Treatment Fails.”

By Vincent J Castellano DMD
November 17, 2021
Category: Oral Health
Tags: gum recession   gum disease  
GumRecessionCouldHaveLong-RangeConsequencesForYourDentalHealth

We're all familiar with optical illusions, which our brain visually perceives in a way different from the actual reality. A kind of optical illusion may also happen in your mouth: Your teeth appear to have gotten "longer." They haven't actually grown—instead, the gums have shrunk back (or receded) to reveal more of the tooth.

Unfortunately, this isn't an amusing visual trick! Gum recession isn't healthy, and it could endanger your teeth.

Receding gums occur for a variety of reasons. Some people are simply more genetically disposed to recession because they've inherited thinner gum tissues from their parents. You can also damage your gums through over-aggressive brushing.

But the most common cause for gum recession is periodontal (gum) disease, caused by bacteria inhabiting a thin biofilm on tooth surfaces called dental plaque. The more plaque present on your teeth, the more plentiful the bacteria, which can sharply increase your risk of infection. Unless treated, gum disease can eventually weaken the gums' attachment to teeth that can then cause the gums to recede.

Normally, the gums cover and protect the tooth roots from bacteria and other hazards, similar to the way enamel protects the tooth's visible crown. But teeth lose this protection when the gums recede, exposing them to disease-causing bacteria and other oral hazards.

Fortunately, there is hope for receded gums. The primary way is to first treat the gum disease that caused it: If the recession has been mild, this may help the tissues regain their former coverage. More severe recession, however, may require highly technical grafting surgery with donor tissue to promote new tissue growth at the site.

But the best approach is to avoid recession in the first place by preventing gum disease. This requires removing bacterial plaque daily through brushing and flossing, as well as regular dental visits for more thorough cleanings. Dental visits are also important if you have a higher risk profile for gum recession like thinner gum tissues.

Gum recession isn't just an inconvenience. It can put your oral health at long-term risk. But you may be able to avoid its occurrence by practicing daily oral hygiene and seeing your dentist regularly.

If you would like more information on gum recession, 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 “Gum Recession.”

By Vincent J Castellano DMD
November 07, 2021
Category: Oral Health
Tags: gum disease   nutrition  
CurbYourCarbConsumptiontoBoostYourDefensesAgainstGumDisease

You're doing the right things to avoid the return of gum disease: brushing and flossing every day, dental visits on a regular basis and watching for symptoms of another infection. But while you're at it, don't forget this other important part of gum disease prevention—your diet.

In relation to oral health, not all foods are alike. Some can increase inflammation, a major factor with gum disease; others strengthen teeth and gums. Carbohydrates in particular are a key part of this dynamic.

The body transforms these biomolecules of carbon, hydrogen and oxygen into the sugar glucose as a ready source of energy. But glucose levels in the bloodstream must be strictly controlled to avoid a harmful imbalance.

When elevated the body injects the hormone insulin into the bloodstream to bring glucose levels into normal range. Eventually, though, regular injections of insulin in high amounts in response to eating carbs—known as "spikes"—can increase inflammation. And, inflammation in turn increases the risk and severity of gum infections.

So, why not cut out carbohydrates altogether? That might be akin to throwing out the proverbial baby with the bath water. A wide range of carbohydrates, particularly fruits and vegetables, are a rich source of health-enhancing nutrients.

It's better to manage your carbohydrate consumption by taking advantage of one particular characteristic: Not all carbohydrates affect the body in the same way. Some cause a higher insulin response than others according to a scale known as the glycemic index. It's better, then, to eat more of the lower glycemic carbohydrates than those at the higher end.

One of the latter you'll definitely want to restrict is refined sugar—which also happens to be a primary food source for bacteria. You'll also want to cut back on any refined or processed foods like chips, refined grains or pastries.

Conversely, you can eat more of a number of low glycemic foods, most characterized as "whole", or unprocessed, like fresh fruits and vegetables, or whole grains like oatmeal. You should still, however, eat these in moderation.

Better control over your carbohydrate consumption is good for your health overall. But it's especially helpful to your efforts to keep gum disease at bay.

If you would like more information on nutrition and your 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 “Carbohydrates Linked to Gum Disease.”

RussellWilsonsFunnyVideoAsideRemovingWisdomTeethisNoLaughingMatter

There are plenty of hilarious videos of groggy patients coming out of wisdom teeth surgery to keep you occupied for hours. While many of these have turned everyday people into viral video stars, every now and then it really is someone famous. Recently, that someone was Seattle Seahawks quarterback Russell Wilson.

The NFL star underwent oral surgery to remove all four of his third molars (aka wisdom teeth). His wife, performer and supermodel, Ciara, caught him on video as he was wheeled to recovery and later uploaded the clip to Instagram. As post-wisdom teeth videos go, Wilson didn't say anything too embarrassing other than, "My lips hurt."

Funny videos aside, though, removing wisdom teeth is a serious matter. Typically, the third molars are the last permanent teeth to erupt, and commonly arrive late onto a jaw already crowded with other teeth. This increases their chances of erupting out of alignment or not erupting at all, remaining completely or partially submerged within the gums.

This latter condition, impaction, can put pressure on the roots of adjacent teeth, can cause abnormal tooth movement resulting in a poor bite, or can increase the risk of dental disease. For that reason, it has been a common practice to remove wisdom teeth preemptively, even if they aren't showing any obvious signs of disease.

In recent years, though, dentists have become increasingly nuanced in making that decision. Many will now leave wisdom teeth be if they have erupted fully and are in proper alignment, and they don't appear to be diseased or causing problems for other teeth.

The best way to make the right decision is to closely monitor the development of wisdom teeth throughout childhood and adolescence. If signs of any problems begin to emerge, it may become prudent to remove them, usually between the ages of 16 and 25. Because of their location and root system, wisdom teeth are usually removed by an oral surgeon through one of the most common surgeries performed each year.

This underscores the need for children to see a dentist regularly, beginning no later than their first birthday. It's also a good idea for a child to undergo an orthodontic evaluation around age 6. Both of these types of exams can prove helpful in deciding on what to do about the wisdom teeth, depending on the individual case.

After careful monitoring throughout childhood and adolescence, the best decision might be to remove them.  If so, take it from Russell Wilson: It's worth becoming the star of a funny video to protect both current and future dental health.

If you would like more information about wisdom teeth removal, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Wisdom Teeth.”

By Vincent J Castellano DMD
October 18, 2021
Category: Oral Health
Tags: facial pain  
ThereMayBeaSolutionToYourFacialPain

Physical pain is unpleasant—but not knowing why you're hurting makes it worse. Thousands of people encounter such as experience when parts of their face suddenly and mysteriously erupt in pain.

Often, though, the mystery can be quickly solved—more than likely, it's a nerve disorder known as trigeminal neuralgia (TN). Typically seen in people over 50 (and in more women than men), TN is a chronic condition that produces brief episodes of acute, spasmodic pain.

The source of this pain is the trigeminal nerve, which courses down each side of the face. Each nerve consists of three distinct branches that serve the upper, middle and lower areas of the face and jaw.

Physicians usually find that a blood vessel has come in contact with the nerve at some point, and the resulting pressure has damaged the nerve's outer insulative layer (myelin sheath). This causes the nerve to become hypersensitive at the point of contact, overreacting in a sense to the slightest touch (even a wisp of wind) on the face and jaw.

TN isn't the only source of facial pain. It can also accompany other conditions like TMD, which is why it's important to undergo a diagnostic examination. If you are diagnosed with TN, there are a number of ways to manage it. The most conservative approach (and the one usually tried first) is the use of medications to block pain signals from the nerve to the brain or to lessen abnormal nerve firing.

If medication proves ineffective or there are other factors related to age and health, you may be a candidate for a surgical solution. In one such procedure, a surgeon inserts a thin needle into the affected nerve and selectively damages some of its fibers to prevent the transmission of pain signals. Another procedure relocates the impinging blood vessel, which then allows the nerve to heal.

These surgical methods are effective but they can cause side-effects in rare cases like numbness or hearing impairment. It's best then to discuss with your doctor which approach would be best for you and your life situation. Ultimately, though, there are ways to relieve you of this painful condition.

If you would like more information on treating facial pain, 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 “Trigeminal Neuralgia.”





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