My Blog

Posts for: June, 2020

By George H Johnson, Jr., DDS, FAGD
June 29, 2020
Category: Oral Health
Tags: tooth decay  
PreventionandEarlyDetectionofRootCavitiesCouldSaveaTooth

Tooth decay is one of two dental diseases most responsible for tooth loss (gum disease being the other). In the absence of treatment, what starts as a hole or cavity in a tooth's outer layers can steadily advance toward its interior.

Most people associate cavities with the crown, the part of a tooth you can see. But cavities can also occur in a tooth's roots, especially with older adults. Root cavities pose two distinct difficulties: They can lead to more rapid decay spread than crown cavities within a tooth; and they're harder to detect.

Tooth roots are ordinarily covered by the gums, which protects them from bacterial plaque, the main cause for decay. But roots can become exposed due to receding gums, a common problem with seniors who are more susceptible to gum disease.

Unlike the enamel-covered crowns, tooth roots depend on gum coverage for protection against bacteria and the acid they produce. Without this coverage, the only thing standing between tooth decay and the roots is a thin material called cementum.

If decay does enter a tooth's interior, saving it often requires a root canal treatment to remove decayed tissue in the inner pulp and root canals, and then replacing it with a filling. But if we're able to discover a root cavity in its early stages, we may be able to fill it like a crown cavity.

The best strategy, though, is to prevent root cavities from forming. This starts with a dedicated daily regimen of brushing and flossing to remove dental plaque. If you're at high risk for root cavities, we may also recommend antibacterial mouthrinses and other aids.

Regular dental visits are also a must: a minimum of twice-a-year dental cleanings to remove stubborn plaque and calculus (hardened plaque) deposits. For added protection against root cavities, we can also apply fluoride varnish to strengthen teeth. And regular visits are the best way to detect any cavity in its early stages when treatment is less invasive.

A heightened risk of dental problems like root cavities are a part of the aging process. But partnering together, we can lower that risk and increase the longevity of your teeth.

If you would like more information on root cavities, 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 Cavities.”


By George H Johnson, Jr., DDS, FAGD
June 19, 2020
Category: Dental Procedures
3ReasonsaRootCanalTreatmentMightFailandWhatYouCanDoAboutIt

It's not an exaggeration to say the modern root canal treatment has saved millions of teeth over the last century. Without this procedure, there's not a lot we can do to stop advanced tooth decay from infecting and destroying a tooth.

What's more, a root canal treatment could extend the life of a tooth for decades. Notice we said could—although most root canals do have satisfactory outcomes, there's still a chance a tooth may become re-infected. Here are 3 possible causes for an unsuccessful root canal treatment, and what you can do to lessen their impact.

The severity of the infection. Tooth decay usually begins at the enamel layer, softened by the acid produced by bacteria. Untreated, the infection can then spread through the next tooth layer of dentin until finally infecting the innermost pulp. From there the infection can move through the root canals to the bone, dramatically increasing the danger to the tooth. Root canal treatments have a higher chance of success the earlier they're performed in the disease progression, so see your dentist at the first sign of pain or other tooth abnormality.

The root canal network. An effective root canal procedure eliminates all dead or diseased tissue in both the pulp chamber and the root canals (these are then filled to prevent future infection). But this may prove difficult with teeth that have intricate root canal networks because of a higher risk of overlooking some of the canals. It may be best in such cases for an endodontist, a specialist in treating interior tooth issues, to perform the procedure using their advanced techniques and microscopic equipment.

The age of the tooth. Root canal treatment can weaken a tooth's structural integrity, especially with older teeth. This can make them more susceptible to fracture and a higher chance of infection. We can avoid this outcome by placing crowns on root-canaled teeth: The crown provides structural strength to the tooth and can add further protection against infection. Older teeth may also benefit from the placement of a small support post within it to further add stability before applying the crown.

If you would like more information on root canal treatment, 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: How Long Will It last?


By George H Johnson, Jr., DDS, FAGD
June 09, 2020
Category: Dental Procedures
Tags: dental implant  
YourGumsandBoneNeedtoBeHealthyBeforeGettingImplants

If you've been dealing with a tooth that needs to be removed—or it's already missing—you may be looking to replace it with a dental implant. And it's a great choice: No other restoration can provide the appearance and function of a real tooth like an implant.

You and your smile are ready for it. The question is, though, are your gums and underlying bone ready? These dental structures play a critical role in an implant's stability and eventual appearance. A problem with them may make placing an implant difficult if not impossible.

An implant requires around 2.0 millimeters of bone thickness surrounding the implant surface for adequate support and to minimize the chances of gum recession. But tooth loss often leads to bone loss that can drop its thickness below this threshold. This can make placing an implant problematic.

Fortunately, though, we may be able to address the lack of sufficient bone through bone grafting. By placing grafting material within the empty socket, we create a scaffold for new bone cells to grow upon. Over time this subsequent growth may be enough to maintain an adequate thickness of bone for an implant to be placed.

The gums may also pose a problem if they've shrunk back or receded from their normal positions, as often happens because of gum disease (which may also have precipitated the tooth loss). Again, grafting procedures can help ensure there's adequate gum coverage for the implant. And healthier gums may also help protect the underlying bone from loss.

There are several techniques for placing gum tissue grafts, depending on how much recession has taken place. One procedure in particular is often used in conjunction with implant placement. A small layer of synthetic collagen material or gum tissue referred to as pa dermal apron is included with the implant when its placed. Settling into the bone socket, this apron helps thicken the gum tissues, as well as preserve the underlying bone.

During your preliminary exams, we'll assess your bone and gum health to determine if we should take any steps like these to improve them. It may add some time to the implant process, but the end result will be well worth it.

If you would like more information on dental implants, 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 “Immediate Dental Implants.”