Wednesday, October 8, 2014

What is a Deep Dental Cleaning?

I've read a bit recently online about dental cleanings. Many people are angry with their dentists. Many believe that their dentists are trying to scam their patients into getting unnecessary services. Many are angry that some insurance companies don't pay for deep cleanings. Seeing many of these comments prompted me to write about the differences between routine cleanings and deeper cleanings.

Take a look at the chart above.

You'll notice a progression of severity as we move from left to right. The top row demonstrates deeper gum pockets (measured with a probe in millimeters). When these pockets exceed 3 mm, it becomes increasingly difficult to access the deeper areas with a toothbrush and floss. In advanced cases, the probing depths can be 10 or more millimeters. When this occurs, even if the tooth itself is healthy, it will still be lost since there are inadequate amounts of bone to anchor the tooth in place.

The second row demonstrates the visible condition of the mouth. As you can see, a healthy mouth is exemplified by gums that are pink (as opposed to red or even purple). In addition, the gums do not bleed readily and are not tender. On the other hand, unhealthy gums will bleed readily and are very tender. When gums are chronically irritated, a loss of the gums and bone progresses much more rapidly as the disease process worsens.

The radiographs (X-rays) in the third row demonstrates what happens to the bone as the progression of periodontitis advances.

When a patient comes in for a "cleaning", either a routine cleaning or a deeper cleaning is indicated.

Routine Cleaning

In many cases we can get away with a simple cleaning. When we have a situation where the teeth are not severely stained, do not have deep pocketing and do not have subgingival (below the gumline) calculus (tartar), then a simple routine cleaning is all that is required. In these cases, the cleaning is for the most part above the gumline.

Deep Cleaning

When we run into a mouth that has bone loss, deep pockets and tartar that goes below the gumline, then cleaning well below the gumline is indicated to prevent the progression of periodontitis and potential tooth loss.

If we simply clean above the gumline with a "routine cleaning", two potential problems arise. One is that the causative factors of periodontitis are not removed and the patient's condition will worsen. A second less commonly known issue is the development of a periodontal abscess. This occurs because the gums at the neck of the teeth may heal and close off the pocketing. The pocket is still there, but now we don't have access to the deeper areas. The bacterial flora changes from primarily aerobic bacteria to anaerobic. These bacteria are much more pathogenic (disease causing) and so instead of actually helping the patient, we actually make things much worse for our patient.


So, in essence, when a routine cleaning is performed in a mouth that requires a deep cleaning, we are actually creating bigger problems. If you doubt the recommendations of your dentist, it's okay to get a second opinion.


Wednesday, October 1, 2014

Why Does My Tooth Hurt After A Root Canal?

In many cases, root canals are performed on teeth that are either dying or are already dead. Many of these teeth are incredibly painful. Root canals are performed to eliminate pain and infected tissue within the tooth. Fortunately, pain after having a root canal is uncommon. The literature shows that approximately 95% of the time there is little to no discomfort.

If you are one of the unfortunate few that does experience discomfort, there are several potential reasons why this could occur. The tooth is not the source of the discomfort after a root canal. It is the surrounding structures of the tooth that is the source of the pain. The tooth itself does not hurt because there are no longer any nerves within the tooth.

Here are some potential reasons why:

1. Inflammation

Inflammation may be present at the tip of the root. This may occur for a number of reasons. Once the inflammation is resolved, the discomfort will dissipate. NSAIDS such as Ibuprofen will usually resolve the inflammation.

Infected tooth. A root canal is indicated
2. Infection

When a root canal is performed, the inside of the tooth is completely cleaned out of any bacteria and diseased tissue. However, a root canal does not clean past the tip of the root. In order to remove any infection past the root tip, we rely on the immune system and antibiotics.

While the infection is still present, it is not uncommon for the bone surrounding the tooth to be tender. This is exacerbated whenever the tooth is pushed on or bitten into. A round of antibiotics will most often resolve the infection.

3. High bite

After a root canal is done, a temporary filling or temporary crown is placed. If too much material is placed, then a high bite can result. This will cause the opposing tooth to hit the treated tooth prematurely. The result is excessive force and pain on the tooth every time the teeth come together.


4. A fractured tooth

Sometimes a fracture can be incrediblydifficult to see even with high magnification. An x-ray most often will not reveal a fracture either.

When a tooth has a fracture that extends into the nerve or all the way through into the root, it will die. The treatment for a dead tooth is to remove the dead tissue within the tooth. The problem with a fractured tooth however is that no matter what is done, the tooth will eventually fail and the only thing we can do to correct the problem is to extract it.

5. Persistent infection

The goal of a root canal is simple…..remove all dead and infected tissue within the tooth and seal it so that it doesn't get recontaminated.

If the canal(s) is not cleaned thoroughly, then the root canal will eventually fail. Bacteria will remain within the tooth. Antibiotics will not be able to reach the site because there will no longer be a blood supply to the tooth to carry the antibiotic to the infected site.

Accessory canals can be difficult and sometimes impossible to clean and seal.

If you experience pain after a root canal is performed, call your dentist to determine why.
