Thursday, October 9, 2014

Furcation Involvement

What is the furca?
The roots of the teeth are covered and surrounded by bone and gum tissues when they are in their normal state and have been disease-free. Only the crown portion is visible. Some teeth toward the back portion of your mouth have two or three roots extending into the jaw bone from the crowns of the tooth. This "V-shaped" area where the tooth branches or forks into two or three roots is called the furcation or furca. The furca is also covered with bone and is attached to the tooth by periodontal ligament fibers.

Normal amount of bone and gum vs. loss of bone
As long as a furcation of a multirooted tooth is covered with the normal amount of bone and gum, everything is fine and the furca holds no exceptional interest for the dentist or dental hygienist. When there is an alteration in the density of the furca bone, or it actually starts to resorb (disappear due to some type of dental pathology), the furca area becomes important and interesting. Continued loss of bone would lead to loss of the tooth.

The loss of the bone in the furca area could be related to periodontal disease (gum disease). The periodontal pathology in the furca could be part of a localized problem - only present at that one site - or a sign that there is a more widespread problem that needs attention. The breakdown of bone in the furcation could also indicate that the nerve inside the tooth is dying, and the tooth will need a root canal (endodontic treatment). 



Treatment
If the breakdown is specific to the site on that one tooth, treatment would be localized. The type of therapy recommended would depend on the severity of the breakdown. Minimal disease might be treated by a dental prophylaxis (cleaning) and reinforcement of personal oral self-care. Treatment of a more extensive breakdown could involve aggressive periodontal procedures including but not limited to periodontal surgery and bone augmentation. You may be referred to a periodontist for these procedures.

If the furca breakdown is a sign of more widespread periodontal disease, the whole mouth will be evaluated and specific treatment recommendations will be made.

There are many very small nerves that exit through various portions of the tooth, and a localized furcation problem could indicate that the nerve in a tooth is dead or dying and the tooth may require a root canal.

Cleaning
You may think that teeth are difficult to floss and brush when tooth alignment and gum position are ideal. When there is bone loss in a furca, daily oral self-care becomes more complicated. A furca is a difficult area to clean - the more bone loss, the more difficult. In extreme cases, there is no bone or gum left in the furca, and a patient could actually place an interdental cleaning aid completely between the roots of a two-rooted tooth. For a three-rooted tooth with a furcation involvement, the cleaning process is even more of a problem.

You have been diagnosed with a furcation involvement problem. After careful examination, a treatment recommendation will be made. Our recommendation will be based on not only treating your furcation problem but also preventing further exposure of the furcation area.

If you have any questions about a furcation involvement, please feel free to ask us.  

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