Apicoectomy(endodontic surgery)

Generally, a root canal is all that is needed to save a tooth with an irreversibly injured pulp(nerve) from extraction. Occasionally, this non-surgical root canal procedure will not be sufficient to heal the tooth due to a persistent and/or recurrent infection. In this type of situation your dentist will evaluate and possibly recommend endodontic surgery or an apicoectomy. 

The tip of the tooth root is called the apex; “ectomy” at the end of a word implies removing something. Therefore, an apicoectomy is the surgical removal of the tip of the root of the problem tooth which also removes the infection. A root-end filling is placed to prevent reinfection of the existing root canal and the gum is sutured. After the removal of the root tip and infection the area will heal on it's own.

This surgical procedure is usually preformed by an oral surgeon using local anesthesia . It also has an exploratory nature and can be used to locate root fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this type of surgical procedure.

There are usually no restrictions after the procedure concerning driving or returning to work. If you have requested nitrous oxide (laughing gas) or IV sedation, you will receive special instructions at your consultation appointment about driving and recuperation after the procedure.

Following an apicoectomy, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. Application of ice on the affected side of the face off and on every 20 minutes after surgery for the first 24 hours will help minimize the swelling. To alleviate any discomfort, you will be instructed to take 2-4 ibuprofen (Advil or Motrin). Salt water or antiseptic rinses are also a good idea.

Stress and Oral Health

Recent research has shown that there is a link between stress and our physiologic health. The full extent of this connection is still being studied and more is discovered all the time. One of the ways that stressful conditions affect our bodies is through production of certain hormones. One such hormone is cortisol which is released in response to being anxious and/or depressed. It's primary functions are to increase blood sugar; suppress the immune system; and aid in fat, protein and carbohydrate metabolism. It also decreases bone formation. However  If the stress is persistent, the level of cortisol remains elevated as a compensatory mechanism and sustained elevated levels of cortisol can have a negative impact on many tissues including teeth and gums. This can lead to gum disease or periodontitis. There’s also evidence that stress and depression impair your immune system, making chronic infection throughout your body—including in your mouth—more likely. Certain sores in the mouth and bruxism(grinding or clenching of teeth) can also be a result of chronic stress.  In addition, hard times lead to bad habits which include less or no oral hygiene, smoking, drinking alcohol, and skipping necessary dental cleanings and check-ups.

The good news is that we are able to control our stress levels to some extent and in turn improve our overall health. We can change our outlook by realizing that some things are out of our control and for that reason not worth getting stressed out about. 

It is important to try and see life events as positive challenges rather than threats.

We can keep our bodies healthy by eating a nutritious, well-balanced diet, getting enough sleep and exercising on a regular basis. This will allow us to get in shape and also feel better by producing mood-boosting brain chemicals.

There are also many relaxation techniques including meditation, stretching and progressive muscle relaxation which involves a two-step process in which you systematically tense and relax different muscle groups in the body.

Procrastination

If there is one thing I am certain of from all my studies and twenty years of clinical private practice experience, it is the fact that avoiding the dentist and proper treatment will ALWAYS work against you! I have also learned through thousands of patient interviews that the two main reasons for avoiding the dentist are fear and finances. Now these may seem like fairly legitimate reasons, but in actuality they are not! 

The reason that some folks are fearful or "phobic" is usually because of an unpleasant experience that can be traced back to childhood or a long time ago. These experiences create a phobia that is completely irrational and baseless as seen in today's professional philosophies and technologically advanced practices. there have been many significant advances in the art and science of dentistry which make the vast majority of treatment modalities comfortable, safe and effective. I often hear "....if I knew it was that easy, I would have done it earlier."

On the other hand those who are concerned with finances should realize that the alternative is much more costly and unpleasant. Whether you have insurance or not, there are still financing options available that will allow you to get healthy. Often times those who come in regularly for check ups and cleanings have far fewer problems. Pathologies are a lot easier and less expensive to treat in their initial phases. By ignoring small problems you will most certainly inherit bigger ones! So in the long run procrastination will cost more and require more invasive and complex treatment.   

In general, the dental profession is more in tune with the individual needs of the patient and treatments are less uncomfortable and more affordable. You need to be honest with yourself and ask, are you putting off going to the dentist or are you finally going to start to become invested in your health?

Chemotherapy and Oral Care

You may be surprised that your dentist plays an important role in your cancer treatment. If you consult with your dentist before chemotherapy begins, you can help prevent serious mouth problems.
Chemotherapy is the use of specific drugs to treat cancer. These drugs kill cancer cells, but they may also harm normal cells, including cells in the mouth. Side effects include problems with your teeth and gums; the soft, moist lining of your mouth; and the glands that make saliva.
These drugs will basically diminish the immune response and therefor the patient becomes more susceptible to inflammation and/or infections. It is important to recognize and treat any oral pathology that may lead to an infection before the chemotherapy starts.
Also a loss in saliva will make the patient more vulnerable to tooth decay and gum disease. Saliva is a natural guard against plaque build up and bacteria. In it's absence oral bacteria tend to flourish which is why immaculate oral hygiene is essential during chemotherapy. A dentist can recommend ways to keep the oral environment moist. 
If the oral side effects are severe, the patient may not be able to keep up with their cancer treatment which is why it is important to consult with a dentist before any chemotherapy.

Dental Resolutions

Here are some dental resolutions for the new year that will keep you healthy and problem free:

1- Brush twice a day for about 2 minutes at a time. Not 1 minute, 30 seconds or once a day. It really does take that long to clean the majority of all surfaces of the teeth in your mouth decently.
2- Floss once a day. Approximately 40% of your teeth are not being cleaned if you don't do it and a substantial percentage of cavities start in those areas.
3- Clean your tongue. I would say 95% of patients don't do this. A couple of quick swipes on the tongue is usually enough.
4- Reduce your intake of sugary foods. it will decrease the incidence of cavities, improve your blood sugar and health.
5- Drink more water, especially after staining drinks like coffee, tea and wine.
6- Regular maintenance appointments at least every 6 months. Seeing your Dentist/Hygienist for a checkup and cleaning is truly the dental version of the oil change. Prevention is always the best option.
7- Get things taken care of while they are small and don't procrastinate. Fairly minor issues easily become more severe if neglected. Dentistry operates on an exponential cost scale as things get more involved and complex. Getting a restoration that costs a few hundred dollars (and is usually covered by insurance) is much better for you and your finances than letting it turn into a multi-thousand dollar root canal/post&core/crown or implant.

I hope this is helpful and happy 2012!

Dental Anxiety and Phobia

Some people don't look forward to dental appointments but no more than they look forward to visits to other health care providers such as their physician. Most dental procedures when done right are reasonably comfortable. However, just being examined can make some people feel stressed. Most can live with having some anxiety about going to the dentist but for those with dental phobia, the thought of a dental visit is terrifying. They may be so frightened, in fact, that they'll do just about anything to avoid a dental appointment. 

People often use the words "anxiety" and "phobia" to mean the same thing, but they are different. A phobia is an intense, unreasonable fear of a specific activity, object or situation. Phobic patients will have exaggerated or unfounded worries or fears. Dental phobia is definitely a more serious condition than dental anxiety. People with dental phobia often put off routine care for years or even decades. To avoid it, they'll put up with gum infections, pain, or even broken and unsightly teeth.

Dental anxiety and phobia are extremely common. It has been estimated that 9% to 15% of Americans avoid seeing the dentist because of anxiety and fear. That's about 30 million to 40 million people. In a survey 36% of those who didn't see a dentist regularly said that fear was the main reason.

People develop dental anxieties and phobias for many different reasons. When researchers interview patients, however, a few common themes emerge:
Pain and/or discomfort — In a survey of people who had not seen a dentist for 12 months, 6% reported fear of pain as the main reason. This may be because their early dental visits happened before many of the advances in "pain-free" dentistry.
Helplessness and loss of control — Many people develop phobias about situations — such as flying in an airplane — in which they feel they have no control. When they're in the dental chair, they have to stay still. They may feel they can't see what's going on or predict what's going to hurt. It's common for people to feel helpless and out of control, which may trigger anxiety.
Embarrassment — The mouth is an intimate part of the body. People may feel ashamed or embarrassed to have a stranger looking inside. This may be a particular problem if they're self-conscious about how their teeth look. Dental treatments also require physical closeness. During a treatment, the hygienist or dentist's face may be just a few inches away. This can make people anxious and uncomfortable.
Negative past experiences — Anyone who has had pain or discomfort during previous dental procedures is likely to be more anxious the next time around.


There are several relaxation techniques and tools that you can utilize to help you maintain your comfort during dental visits. Many patients prefer a distraction during their visit such as listening to an ipod filled with their favorite music. Relaxation breathing or progressive muscle relaxation are techniques you may wish to try prior to beginning.
Your dentist should always explain the procedure to you in detail and make sure that you fully understand the procedures being preformed. An educated patient will always make a better patient. 
A signaling system is always useful if you feel you need a break. For most patients, being able to raise their hand and asking the dentist to stop is comforting and allows them to feel more in control of the situation.
Ultimately the most important part of overcoming dental fear is trust. Finding the right dentist who you are comfortable with and feel that you can trust will make the most difference in helping you relax during your visit.

Halloween & Healthy Teeth

Undoubtedly, candy will come home in classroom party goody bags and fall festival take-home treats. Add plain old trick-or-treating, and it’s no wonder a child’s excessive exposure to sugar can be a common result. It’s definitely a problem every parent faces and finding that balance between children being healthy and at the same time having fun and enjoying Halloween is a tough balancing act.

The process by which sugary snacks can cause cavities is as follows. Bacteria that live in a child's mouth feed on sugars and produce acids. These acids will demineralize or break down the tooth structure, resulting in decay. Generally speaking the longer the exposure to sugary materials, the more extensive the decay. The frequency of sugar consumption is much more critical than the amount.

Prevention starts with that well-known word that is easy to say but more difficult to implement: moderation. However moderation can be difficult to enforce when a full Halloween bag lurks on top of the refrigerator. But protecting your children’s teeth from the onslaught of sugar is another important consideration for parents. 
In the days following Halloween, it is recommended to ensure that your child eats a full plate of balanced and healthy foods before adding a sugary treat. Don’t buy Halloween candy too far in advance to avoid the temptation for children (and adults) to get a head start on the splurge. Try to ensure children eat a good, hearty meal before trick-or-treating so there will be less temptation to gorge on candy. Encourage kids to eat a set amount of candy in one sitting immediately followed by a thorough tooth-brushing, or at least a glass of water. Promote good oral health care habits year-round to your children by encouraging twice daily brushing with fluoridated toothpaste, flossing and getting regular dental checkups.