My Blog

By John P. Ducar, DDS, Inc
March 12, 2019
Category: Dental Procedures
Tags: apicoectomy  
IfaRootCanalCantbeDonethisProcedureMightSaveYourTooth

Untreated tooth decay can destroy your teeth; prompt action as soon as its diagnosed will help prevent that undesirable outcome. And even if decay has advanced into the tooth's pulp and root canals, there's still a good chance we can stop it with a root canal treatment. Using this procedure, we can clean out the infection and refill the tooth's interior space with a special filling to protect it from further infection.

Although root canal treatments have gained an unwarranted reputation for pain, they rarely cause even the mildest discomfort. More importantly, they work, which is why they're the go-to treatment dentists use for advanced decay.

But sometimes a unique dental situation might make performing a root canal extremely difficult—possibly even doing more harm than good. For example, trying to access the interior of a tooth with a crown restoration might require removing the crown, which could further weaken or damage the tooth. In other cases, the root canals might have become calcified due to trauma or aging and become too narrow to access.

Even so, we may still be able to save a tooth through a minor surgical procedure called an apicoectomy. Rather than access the diseased area through the tooth crown as with a root canal treatment, an apicoectomy makes access to the infected tissue at the root end.

An apicoectomy also differs from a root canal treatment in that we'll need to surgically go through the gum tissue. After numbing the area with a local anesthetic, we'll make a small incision through the gums at the level of the infection. After removing any infected tissue, we would then fill the space with a small filling to prevent re-infection. We then close the incised gum tissues with sutures and allow them to heal.

With the help of fiber optic lighting and surgical microscopes, endodontists (specialists in interior tooth problems) can perform an apicoectomy quickly and with very little trauma at the surgical sight. If you undergo an apicoectomy, you should be back to normal activity in a day or two at the most. And like its sister procedure the root canal, an apicoectomy could help preserve your teeth for many years to come.

If you would like more information on this and other 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 John P. Ducar, DDS, Inc
March 02, 2019
Category: Oral Health
LifeIsSometimesaGrindforBrookeShields

Ever since childhood, when her career as a model and actress took off, Brooke Shields has enjoyed worldwide recognition — through advertisements for designer jeans, appearances on The Muppet Show, and starring roles in big-screen films. But not long ago, that familiar face was spotted in an unusual place: wearing a nasal anesthesia mask at the dentist's office. In fact, Shields posted the photo to her own Instagram account, with the caption “More dental surgery! I grind my teeth!” And judging by the number of comments the post received, she's far from alone.

In fact, researchers estimate that around one in ten adults have dental issues that stem from teeth grinding, which is also called bruxism. (Many children also grind their teeth, but it rarely causes serious problems, and is often outgrown.) About half of the people who are teeth grinders report problems like persistent headaches, jaw tenderness and sore teeth. Bruxism may also result in excessive tooth wear, and may damage dental work like crowns and bridges; in severe cases, loosened or fractured teeth have been reported.

Researchers have been studying teeth grinding for many years; their findings seem to indicate that it has no single cause. However, there are a number of factors that play a significant role in this condition. One is the anatomy of the jaw itself, and the effect of worn or misaligned teeth on the bite. Another factor relates to changes in brain activity that occur during the sleep cycle. In fact, nocturnal (nighttime) bruxism is now classified as a sleep-related movement disorder. Still other factors, such as the use of tobacco, alcohol and drugs, and a high level of stress or anxiety, can make an individual more likely to experience bruxism.

What can be done for people whose teeth grinding is causing problems? Since this condition may have many causes, a number of different treatments are available. Successful management of bruxism often begins by striving to eliminate the factors that may cause problems — for example, making lifestyle changes to improve your health, creating a soothing nighttime environment, and trying stress-reduction techniques; these may include anything from warm baths and soft music at bedtime, to meditation and mindfulness exercises.

Several dental treatments are also available, including a custom-made occlusal guard (night guard) that can keep your teeth from being damaged by grinding. In some cases, a bite adjustment may also be recommended: In this procedure, a small amount of enamel is removed from a tooth to change the way it contacts the opposite tooth, thereby lessening the biting force on it. More invasive techniques (such as surgery) are rarely needed.

A little tooth grinding once in a while can be a normal response to stress; in fact, becoming aware of the condition is often the first step to controlling it. But if you begin to notice issues that could stem from bruxism — or if the loud grinding sounds cause problems for your sleeping partner — it may be time to contact us or schedule an appointment. You can read more about bruxism in the Dear Doctor magazine article “Stress and Tooth Habits.”

By John P. Ducar, DDS, Inc
February 19, 2019
Category: Oral Health
Tags: oral hygiene  
TestYoureBrushingandFlossingSuccesswithaPlaqueDisclosingAgent

Brushing and flossing your teeth provides a lot of benefits, including a brighter smile and fresher breath. But the primary benefit—and ultimate goal—is removing dental plaque. This biofilm of bacteria and food remnants on tooth and gum surfaces is the number one cause for dental disease.

Brushing and flossing can effectively keep plaque under control. Unfortunately, plaque can be a stubborn foe, hiding in areas easily missed if you're not thorough enough.

So how do you know you're doing a good job brushing and flossing? One quick way is to use your tongue or dental floss to feel for any grittiness, a possible sign of remaining plaque. Ultimately, your dentist or hygienist can give you the best evaluation of your hygiene efforts during your three or six-month checkup.

But there's another way to find out more definitively how well you're removing plaque in between dental visits: a plaque disclosing agent. These over-the-counter products contain a dye solution that stains plaque so it stands out from clean tooth surfaces.

A disclosing agent, which can come in the form of tablets, swabs or a liquid, is easy to use. After brushing and flossing, you apply the agent according to the product's directions. The dye reacts with plaque to stain it a distinct color. You may also find products with two-tone dyes that stain older and newer plaque different colors to better gauge your overall effectiveness.

You then examine your teeth in the bathroom mirror, looking especially for patterns of missed plaque. For example, if you see dyed plaque running along the gum line, you'll know you need to concentrate your hygiene there.

After observing what you can do to improve your future efforts, you can then brush and floss your teeth to remove as much of the dyed plaque as you can. The staining from the dye is temporary and any remaining will fade over a few hours.

Using a disclosing agent regularly could help you improve your overall hygiene technique and reduce your risk of disease. Ask your dentist for recommendations on products.

If you would like more information on improving your oral hygiene, 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 “Plaque Disclosing Agents.”

By John P. Ducar, DDS, Inc
February 09, 2019
Category: Oral Health
Tags: gum recession  
4ThingsthatcanCauseGumRecessionandWhattodoAboutThem

Besides attractively showcasing your teeth, your gums protect your teeth and underlying bone from bacteria and abrasive food particles. Sometimes, though, the gums can pull back or recede from the teeth, leaving them exposed and vulnerable to damage and disease.

Here are 4 things that could contribute to gum recession—and what you can do about them.

Periodontal (gum) disease. This family of aggressive gum infections is by far the most common cause for recession. Triggered mainly by bacterial plaque, gum disease can cause the gums to detach and then recede from the teeth. To prevent gum disease, you should practice daily brushing and flossing and see your dentist at least twice a year to thoroughly remove plaque. And see your dentist as soon as possible for diagnosis and treatment at the first sign of red, swollen or bleeding gums.

Tooth position. While a tooth normally erupts surrounded by bone, sometimes it erupts out of correct alignment and is therefore outside the bony housing and protective gum tissue. Orthodontic treatment to move teeth to better positions can correct this problem, as well as stimulate the gum tissues around the involved teeth to thicken and become more resistant to recession.

Thin gum tissues. Thin gum tissues, a quality you inherit from your parents, are more susceptible to wear and tear and so more likely to recede. If you have thin gum tissues you'll need to stay on high alert for any signs of disease or problems. And you should also be mindful of our next common cause, which is….

Overaggressive hygiene. While it seems counterintuitive, brushing doesn't require a lot of "elbow grease" to remove plaque. A gentle scrubbing motion over all your tooth surfaces is usually sufficient. On the other hand, applying too much force (or brushing too often) can damage your gums over time and cause them to recede. And as we alluded to before, this is especially problematic for people with thinner gum tissues. So brush gently but thoroughly to protect your gums.

If you would like more information on treating 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 John P. Ducar, DDS, Inc
January 30, 2019
Category: Dental Procedures
RootCanalTreatmentAlleviatesPainandSavesYourTooth

If you’re undergoing your first root canal treatment, it’s understandable if you’re apprehensive. So, let’s cut to the chase about your biggest fear: a root canal treatment doesn’t cause pain, it relieves it — and saves your tooth too.

You need this procedure because decay has spread deep into your tooth’s inner pulp. The infection has already attacked the nerves bundled within the pulp chamber, the source of the pain that led you to us in the first place.

The real concern, though, is the infection continuing to travel through the canals of the tooth root. If that happens, you’re in danger of not only losing the tooth, but also losing surrounding bone, adjacent teeth or damaging other important structures close by. Our goal is simple: remove the infected pulp tissue and seal the empty chamber and root canals from further infection with a special filling.

We begin by numbing the tooth with local anesthesia — you won’t feel anything but slight pressure as we work. After placing a dental dam — a thin sheet of rubber or vinyl — around the affected tooth to maintain a clean work area, we drill a small hole through the biting surface of a back tooth or in the rear surface of a front tooth. We’ll use this hole to access the pulp, where we’ll first remove all the dead and diseased tissue from the chamber. We’ll then disinfect the chamber and root canals with antiseptic and antibacterial solutions.

After some shaping, we’ll fill the chamber and canals, usually with gutta-percha that’s malleable when heated and can be compressed into and against the walls of the root canals to completely seal them. We’ll then seal the access hole.

You may have a few days of mild discomfort afterward, which can be managed generally with pain relievers like aspirin or ibuprofen. Later, we’ll permanently restore the tooth using filling to seal the root canal inside the tooth followed by a custom crown that’s fit over and bonded to the tooth. This will further minimize chances of a re-infection.

If we’ve recommended a root canal, then we think your tooth should be saved instead of extracted. The procedure will end the pain you’ve been suffering and give your tooth a new lease on life.

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 “A Step-By-Step Guide to Root Canal Treatment.”





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