Root Canal Therapy

The pulp of your tooth, which contains the nerve and tiny blood vessels, can become infected. The pulp has a limited ability to heal itself. This infection can be caused by a deep cavity that reaches the center of the tooth causing the pulp to die, a traumatic injury to the tooth, or an extensive preparation (drilling) of the tooth. The extensive preparation may have been done to prepare the tooth for a crown (cap) or other large preparation for a restoration. The pulp may or may not abscess immediately in these cases. It may take years for a problem to develop. The infected pulp tissue may or may not be painful. It may or may not be visible on a dental radiograph. A tooth with this type of an abscess is not usually extracted because the infection can be treated with endodontic therapy on the tooth. This routine procedure can save the tooth and enable you to avoid the harmful effects of tooth loss. It is successful in more than 90% of the teeth in which the treatment is completed.

Endodontic treatment can take from one to three appointments to complete. Teeth can have one to four canals that need to be treated.  An opening is created to access the nerve, and the abscessed nerve is removed from the root or roots. The canals where the nerves had been located are then cleaned and shaped and a medication may be placed in the canal to promote better healing.

When it has been determined that the canals are free of infection, they are filled with a special rubber-like material and sealed with a cementing medium. The abscessed area associated with the tooth will then begin to heal. It may take several months before healing is completed and for the tooth to become asymptomatic, that is, for any soreness in the area to disappear.

Once the endodontic therapy has been completed, the tooth is usually restored with a cast crown or onlay. This is done to protect the tooth and prevent it from fracturing. Failure to follow through with mandatory restorative procedures after endodontic therapy on a previously uncrowned tooth can result in a vertical fracture. If there is very little tooth structure remaining, we may also advise the use of a post and core to further help the tooth retain its final restoration. We will discuss restoration options specific to your needs.

Please note that this infection may cause discomfort between root canal appointments. This is normal and usually not a cause for any concern. Contact the office if there is pain and/or swelling. Remember to avoid biting down on the tooth until the root canal is completed and the final restoration has been placed. You may have had no discomfort from the tooth prior to the root canal treatment or have been unaware that you even had an abscess. However, you may experience pain or swelling after the root canal treatment has begun.

If we have prescribed antibiotics for the abscess, be sure to fill the prescription and take it until it is finished. It is important that you do this in order to quickly control the infection. If you do not take the prescribed medication, the resolution of the abscess may be delayed and problems with the postoperative pain are more likely.

If you have any questions about the root canal procedure or the final restoration of the tooth, please feel free to ask us at (512)250-5012. -Omni Dental Group

Osseous Surgery

Indications                                                           

When periodontal (gum) disease progresses to a more advanced stage, it is common for the underlying supporting bone to become involved. First, the soft, periodontal tissue becomes infected and inflamed. When the inflammation increases, the bone reacts to the infection. Bone is destroyed, and it does not return. You will generally not feel the gums becoming infected or the bone disappearing. Unfortunately, it is painless. Generally, by the time pain is involved, the condition is quite serious.

Since periodontal disease is site-specific, the bone loss will not be uniform. Some teeth will show slight bone loss, some teeth will show more serious loss, and some teeth will exhibit no bone loss at all. The bone loss around a specific tooth or teeth may be regular or irregular in form. The bone loss may be vertical, horizontal, or both. If irregular, surgery to correct the bone loss will be needed. It is not possible at this time to reliably regenerate all lost bone. Once it is gone, it is gone. Research involving the possibility of periodontal bone regeneration has been underway for some time. But at this time, there are few ways to regrow periodontal supporting bone after it has dissolved from periodontal disease.

Treatment

Until fairly recently, the only method of correcting the irregular bone was to smooth off the high spots. The new bone height between teeth would be even at the level of the most severe bone loss. Although the problem was now corrected, other teeth might lose healthy bone in the leveling process. This could and would make those teeth less stable, an unavoidable and undesirable consequence. In some cases, the nature of the bone defect still dictates that this procedure be done.

A better approach is to augment or build up the irregular bone in locations where it has been lost. This is accomplished with the placement of natural or synthetic bone in a procedure known as grafting. Natural bone has been used for over 3 decades and there have been no reported immune system problems. There are also autografts that use your own bone. Allografts are synthetic or freeze-dried natural bone.

Preoperative radiographs, clinical examinations, and periodontal charting will give us an understanding of the type of osseous surgery that is necessary. However, the full extent of the problem may not be fully discovered until the area is exposed during surgery. Radiographs are a two-dimensional, black-and-white representation of a three-dimensional, full-color area. For this reason, treatment goals will remain the same, but the surgery method may be modified. Prognosis of the teeth needing surgery, options, and a best guess for treatment progress will be discussed prior to treatment.

To perform periodontal osseous surgery, a flap must be raised.  A local anesthetic is used and postoperative discomfort is handled with medication.  After this surgical procedure, sutures and a periodontal dressing are placed.

Osseous surgery may be the only treatment that will successfully help to retain your teeth after severe periodontal disease has been present for some time. Keeping your own natural teeth is generally better than having dentures.

If you have any questions about periodontal osseous surgery, please feel free to ask us at (512)250-5012.

-          Omni Dental Group.

Flap Procedures

Periodontal flap procedures may be the most universal and commonly used of all periodontal surgical techniques. A flap is a section of gum tissue that has been freed from its underlying attachment in order to gain direct vision and access to the periodontal structures that are underneath. These periodontal structures are not normally accessible to the patient or dentist. The length and shape of the flap relate to the particular region of the surgery and the nature of the required treatment. An excellent analogy is that the procedure is like lifting the flap of an envelope to look at the contents, then closing the flap when done.

It is important to have healthy gums.  If you think a flap procedure might be for you, contact us soon.

Indications

Flap procedures are indicated in cases of periodontal disease with active or nonresponsive pockets that are too deep to be treated successfully with scaling, root planing, or curettage. The flap may be raised to treat one tooth, a sextant (six teeth), or a quadrant (eight teeth). The advantage of the flap procedure is the shorter treatment time needed due to the improved access to the affected area. The root surfaces can be seen directly for better and more accurate cleaning. Pockets can be selectively reduced, or regeneration of lost tissues can be attempted. Many times the flap procedure is used strictly for correcting soft tissue defects. At other times, when the damage is more severe, the flap is used to gain access to the hard periodontal supporting structures for osseous (bone) surgery. 

Procedures

Preoperative radiographs, clinical observation, and periodontal charting assist in planning which procedures are required during the flap procedure. However, none of these procedures give a direct view of the treatment site. Flap procedures are most often done by a periodontal specialist (a periodontist).  While the periodontist may have a specific treatment plan for treating the diseased areas, when the flap is raised, the method for treating your particular problem may be modified. It may involve regenerative procedures. Bone grafting with natural or synthetic bone may be done. Guided tissue regeneration (GTR) may be attempted. These procedures may be done separately or in conjunction with one another. Other options include direct scaling and root planing of calculus (tartar) that might exist and the reshaping of a bone in a particularly difficult area.

The procedure involves the use of a local anesthetic so there is no pain during treatment. After the procedure is done, there is normally little postoperative discomfort. Prescription medication may be provided to deal with this.  It is uncommon for surgical problems to arise after the flap is closed. Sutures will be used and a periodontal dressing (pack) may be placed for one week. After that time, the pack may be left off or reapplied, depending on your individual healing progress. Flaps normally heal quickly and well. Four to eight weeks after the procedure, the tissue appears normal. If indicated, further dentistry (fillings, crowns, etc.), can then be completed.

If you have any questions about periodontal flap procedures, please feel free to ask us at (512)250-5012.

-          Omni Dental Group  

Metal Sensitivity

It has become clear that many people can develop sensitivity to some of the metals commonly used in dental restorations.  This may or may not have been the case in past years.  Perhaps patients were not as sensitive to metals then, or may be the sensitivity was not recognized and diagnosed properly.  There are many different kinds of metals used in dentistry.  We in this office have, for years, limited your exposure to possible problems by using either materials that have fewer combinations of metals or metals that have a very low potential for sensitivity reactions.

Women appear to have more reactions to metals than men.  Studies indicate that at least one woman in seven has an adverse reaction to metals.  It may be related to the jewelry that women wear, especially earrings for pierced ears. The posts can be made of stainless steel that contains nickel.  You might notice, after some time wearing the jewelry, that your earlobes get red, dried out, or itchy.  It can also be seen any place that jewelry comes into contact with your skin -- wrist, neck, fingers, etc.  If this is your case, you are having a metal sensitivity reaction.  If you have any of these problems, it is probably advisable that you limit contact with the problem-causing metals.  This can include metals used in restoring your teeth.

At times, you could even notice a metallic taste in your mouth.  This can come from silver amalgam fillings that are commonly used.  Some studies show leakage of metal through the tooth into the tooth supporting structures (periodontal ligament) from the posts bonded into the tooth after the root canal treatment.  These posts are entirely surrounded by tooth or restorations and are not at all in contact with the oral environment.  Other oral signs of metal sensitivity include gum tissue that remains chronically red and swollen or bleeds easily where it comes into contact with the metal crown or filling.

Which metals are used in dentistry?  Silver fillings (available since approximately 1816) can contain copper, silver, zinc, mercury, and other metals.  At this time, we know that several countries have mandated reduced use of silver fillings because of health concerns.  Crowns are composed of gold, silver, platinum palladium, and others.  A post used to strengthen a tooth after a root canal is either stainless steel or titanium.  Sensitivity to each of these metals has been exhibited -- some more than others.  Gold and titanium rank low.  Titanium has been used for years for joint replacements.  Pure gold is too soft to be used in dental restorations and titanium is too brittle.  If you have a metal sensitivity and need a crown, it may be better to use a metal that is only gold and platinum -- or perhaps a bonded ceramic material.  While these options may prove to be more expensive than others, metal sensitivity should be avoided.

Nonmetal Options
Options to metal restorations include bonded resins, ceramics, and porcelain.  While it is possible that you could have sensitivity to some of the bonding materials, these types of sensitivities are not all common.  The advantages of silver fillings are that they are quick to place and comparatively inexpensive.  Advantages of cast metal used under porcelain crowns is similar; the metal/porcelain crowns are less expensive to make and easier to place than full ceramic varieties.

We would prefer not to use silver/mercury fillings, especially for children and women planning to have children.  Bonded tooth-colored resins significantly reduce the need for drilling a tooth. They look better and help keep the tooth stronger than silver fillings.  If you have a proven metal sensitivity, we will automatically choose materials with less potential for causing you problems

If you have questions about sensitivity to metal, please feel free to ask us at (512)250-5012 or drop by one of our Austin locations.  -Omni Dental Group.



 

White Teeth! Part 2: Two Available Techniques

Two Available Techniques
There are two types of whitening available.  One is done by the patient at home, and the other is done by us during an office visit.  They can be done separately or in conjunction with each other.  The at-home technique involves using a soft, thin, comfortable mouthguard-like tray.  An impression is made of your teeth, and custom whitening trays are fabricated.  Then at hom, you place the whitening solution in the trays and wear them for an hour or two each day or sleep with them in place all night.  With in-office whitening, you come to the office for 1 or 2 hours, and a stronger whitening solution is applied by us and activated for that time.  Usually only one visit is required.

The color change should last for 3 to 7 years in most people.  The color change you see immediately after whitening is completed will regress one shade over the course of 1 to 3 months, with most of the change taking place in the first week.  If you drink a lot of coffee, tea, cola beverages, red wine, or if you smoke, the teeth may begin to turn darker again.  When this happens, the whitening process can be repeated.

The possible side effects include temporary white discoloration of the gum tissue if the office whitening solution comes into contact with the gum.  This goes away quickly.  The teeth may become slightly sensitive to temperature changes for a short time.  This also goes away quickly.  There is no damage to the tooth enamel, dentin, or pulp from the whitening process.  Fillings and crowns do not whiten.  When your teeth change to a lighter color, you may need to have those fillings and/or crowns redone.  We will let you know whether this is a possibility before we whiten your teeth.  There are no other adverse effects known.

The teeth that show when you talk, smile, or eat are the teeth that would benefit your appearance most if whitened.  Usually the top teeth are whitened because they are much more visible than the bottom teeth, but both arches can be successfully whitened.  The lower teeth take about three times as long to reach the color change of the top teeth.

If you have any questions about whiter teeth, please feel free to ask us at (512)250-5012.
-Omni Dental Group

Whiter Teeth! Part 1: Why are They Yellow?

Why Do Teeth Get Yellow?
The intrinsic (normal) color of your teeth is related to the color and thickness of the enamel and dentin, as well as the types of foods and liquids you ingest.  The thinner the enamel, the darker the underlying dentin; the more coffee, tea, cola beverages, and red wine you drink, the darker your teeth will be.  Cracks that are commonly found in the enamel of your teeth may provide a pathway for discoloring fluids to reach the underlying dentin.



If you have a yellow, brown, or orange shade to your teeth, in most cases it can be made lighter by the whitening procedure.  Whitening works very well in removing age-related darkening of your teeth.  This age-related darkening is most likely due to years of drinking the beverages discussed above, or other environmental factors, rather than genetics.  No drilling or anesthesia is required for whitening.  Your teeth will not become weaker.  Because the mineralization of teeth varies so much from person to person, there is no way to determine how many office visits it will take to effect the color change change or how white the teeth will get.  The darker your teeth are, the more time required for the change and the more distinctive the color change will be.

The whitening procedure will also work to a lesser degree on teeth with tetracycline discoloration.  We have seen several fair to good results from both in-office and at-home whitening.  It does take more time to achieve good results on this type of stain, and unfortunately, sometimes the change is minor.

If you have any questions about stained teeth or whitening procedures, please don't hesitate to ask us at (512)250-5012. -Omni Dental Group

Are You Wise to the Ways of Wisdom Teeth?

Human beings have more teeth than they actually need: four more, to be exact.  The third molars (wisdom teeth) are the last teeth on each side and in each arch of the mouth.  If we don't need them, why do we have them?  Hundreds of thousands of years ago, our ancestors didn't look a great deal like we do today.  They had smaller bodies but larger and more powerful jaws.  Their diet dictated this jaw structure and number of teeth.  Our ancestors ate a tougher and more abrasive type of food.  It wasn't cooked well, and it wasn't ground up well.  There are a lot of hard grains and foods that required lots of chewing.  Big jaws were capable of holding more teeth for this chewing.

Today, we don't need the heavy grinding capacity that early humans had.  Food is easier to eat, less abrasive, and much softer.  Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles.  The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total).  Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing.  The wisdom teeth often do not have enough room to grow properly.  Eventually, thousands of years from now, humans will not have wisdom teeth.  They have lost their function and are gradually disappearing, just like the appendix.

Since the jaw is too small (for most people) to accommodate the third molars, they come into the mouth partially, poorly positioned, or not at all.  They can be fully erupted, partially erupted, a soft tissue impaction, partial bony impaction, or full bony impaction.  If teeth come in well and you are able to keep them clean, we leave them alone.  If they are crowded or poorly positioned and cannot be kept clean, they are like an accident waiting to happen.  Decay and gum infection are likely to result.  These teeth are usually removed -- ideally before they begin to cause big problems with the second molars that are directly ahead of them.  Teeth that are partially erupted should always be removed: there is too much opportunity for gum infection to begin.  If the teeth cannot be cleaned, chronic painful inflammation may occur (pericoronitis).  The earlier they are removed, the better your healing will be.

Less complex extractions (fully erupted teeth or partial soft tissue impactions) can be done by a general dentist.  We will refer difficult extractions to an oral surgeon for treatment.  Depending on the type of extraction and the medical history of the patient, the extractions may be done in an office or in the hospital.  This will be determined after viewing radiographs of the teeth.  Having all four wisdom teeth out at the same time is a common practice.  Postoperative discomfort can be minimal to extreme -- in the case of difficult full bony impactions.  Antiinflammatory and pain relief medications are prescribed appropriately.

We do not need wisdom teeth to eat well.  If they need to come out, it is better they come out (1) before they cause problems with the adjacent teeth that you really need and (2) when you are younger and heal well.  If you need to have one wisdom tooth taken out , also have the opposing wisdom tooth removed.  When a tooth does not meet an opposing tooth, it "super erupts" or continues to grown out of the normal position.  When left for some time, the remaining tooth can develop decay and gum disease and cause the same thing to happen to the tooth in front of it.

If you have questions about wisdom teeth, please feel free to ask us at (512)250-5012.  
-Omni Dental Group