The Disastrous Beginnings
Taylor Loves Her Job!
Taylor, dental assistant at Dr. Porter's Fountain Hills dental office, talks about how much she loves her job. We pride ourselves on our ability to create a calm, welcoming environment for our patients. That being said, if our staff feels like Taylor does, our patients surely do too! Thanks for the glowing review, Taylor.
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John A. Porter DMD
Address: 17100 E. Shea Blvd. # 450
Fountain Hills, AZ 85268
Gum disease, or periodontal disease, is a very common malady effecting almost all adults over age 40. In fact other than the common cold it is the world’s most common affliction. And the most common cause of tooth loss. All mouths are “infected” with bacteria, commonly called “plaque”. To control the growth of plaque is why we brush our teeth. But no matter how well we brush our teeth plaque will be left behind. This left behind plaque will harden to become calculus, which can’t be removed by brushing alone.
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Left behind plaque hardens to become calculus.
What is Gum Disease?
Continued accumulation of calculus at the gum line and under the gum leads to the formation of “periodontal” pockets. As these pockets get deeper they become more difficult to clean and lead to progressive loss of tooth attachment. (gum tissue, cementum, and bone) Continued irritation by micro organisms in plaque and calculus lead to the formation of periodontal pockets. In the diagram captioned, ‘Periodontal Pocketing,’ note that not only are the gums inflamed and shrunken, but the bone that holds the tooth in place has been partially lost. Your dentist or hygienist will check the depth of your pockets to assess the severity of the disease. (periodontitis)
As periodontal disease continues untreated eventually the pockets reach the end or apex of the tooth. Up until this point the disease process has been painless. But at this point pain will be felt and the only alternative will be extraction. Teeth can become very mobile in the terminal stages of periodontal disease and can sometimes be pulled out with your fingers.
How to Avoid Periodontitis?
What you can do to help stop the progress of periodontal disease is to to improve oral hygiene and to make an effort to clean below the gum line. Vibrating your toothbrush bristles at a 45 degree angle under the gum line, and flossing under the gum line will help.
Periodontal disease is treated by scaling and root planing, that is, scraping calculus and debris from under the gum line. The is done by Dentists, Hygienists, and Periodontists (Dentists that specialize in treating gum disease) Other treatments include bone and tissue grafting, antibiotics injected under the gum line, and laser cleanings. Consult your Dentist to see what he or she recommends.
Avoid Periodontal Disease!
Regular visits to your dentist will help prevent periodontitis. Our new patient special, including X-Rays, an exam, and cleaning, is only $65. During this visit, Dr. Porter checks periodontal pocketing with a perio probe to identify any problem areas. Schedule an appointment with Dr. Porter today!
Why Replace Missing Teeth
No one will see it back there! So, why should I replace my missing back teeth?
Well, it turns out your dental health is highly correlated with whether or not you make the decision to replace your missing back teeth.
When a back tooth is removed it is kind of a “two for one” deal. Teeth that touch together, when you shut your mouth to chew, are “biting partners.” Like many partnerships, the loss of one partner affects the other. With no biting partner, the opposing tooth is not useful and chewing power is diminished. If the “back tooth” is a first molar, or a tooth ahead of the first molar, it will present as a “black hole” in your smile. No one wants their appearance to be swallowed by a black hole.
Teeth erupt until they hit something. Making sure teeth touch is the principle behind “teething” and the reason children’s teeth come in at the same time.
With nothing to touch, a superfluous tooth continues erupting. The resulting contact relationships (or lack thereof) of adjacent teeth allow for the formation of food traps.
The biting movement causes you teeth to move up and down a little bit. This process wears the contacts between them. However, over the course of your lifetime, your teeth stay together (usually). So, how does this happen?
There is a mechanism to move teeth forward (for molars) or backwards (for canines and premolars) to keep the contacts tight. With no tooth ahead of the last molar, it starts to move forward.
With the last molar tipped forward it becomes hard to clean the mesial. (the part of the tooth closest to the center of the mouth) Plaque and calculus accumulate at the gum line and cause periodontal pocketing. When this pocketing reaches the end of the root, abscesses (cavities filled with pus) form. This is painful and usually leads to extraction of the infected teeth.
With the posterior teeth gone the same process starts again on the more anterior teeth, with the premolars drifting distally (toward the back if the mouth).
The very word “Root Canal” is enough to strike terror into the heart of an otherwise compliant dental patient. So what are root canals and why are they often feared?
Figure 1 shows the anatomy of a tooth with enamel (the white external part of a tooth) and dentin (the yellow part of the tooth under the enamel) and blood vessels and nerves (pulp) inside the tooth. For a variety of reasons the pulp can become inflamed or necrotic (dead) and have to be removed. The process of removal of the pulp and filling the pulp chamber is called a “root canal”.
The process of doing a root canal is the process of removing the pulp (either alive or necrotic), and filling up the resulting space. Figure 2 shows the pulp being removed with an endodontic hand file. Generally pulp is removed first with hand files and then with rotary Nickel Titanium files.
The process of removing the pulp is frequently the most painful part of the root canal procedure. To be pain free it requires good anesthesia. Neither Nitrous Oxide (laughing gas) or IV Sedation (a needle in the arm) alone will give adequate anesthesia. Good block or Infiltration anesthesia or Intraosseous anesthesia is required for a pain free experience. Intraosseous anesthesia is the injection of local anesthesia directly into the bone surrounding the tooth, and nearly always gives a pain free result. A good question to ask your root canal doctor is whether or not he uses intraosseous anesthesia.
After the pulp is removed the empty space of the root canal system must be filled. The accepted filling material is called “Gutta Percha”. Usually the Gutta Percha filler is coated with a substance call “sealer” to fill in the gap between the GP Point and the canal walls, as illustrated in Figure 3.
After completion of the root canal process the tooth is “hollow”, and it is frequently recommended that the tooth have a crown (cap) to strengthen it. Sometimes it is also recommended that the canals be reinforced with metal “posts” to give the restored tooth more strength.
If all this sounds simple it really isnʼt. No discussion of root canals would be complete without mentioning the things that can go wrong. Figure 4 shows what is called an accessory (side) canal. Failure to fill these canals can result in root canal failure. Figure 5 shows a highly curved canal that could not be instrumented. Figure 6 shows a crack in the root of the tooth which frequently leads to root canal failure.
So, should root canals be done by a specialist (endodontist)? Although the probability of success in root canal treatment is the same (90%), endodontists have tools that most general dentists donʼt have. Such things as CT Scan Machines, Surgical Microscopes, and Gentle Wave cleaning systems. Sometimes these things can make a difference.