My Blog

By Paul David Epstein, D.M.D. & Associates, P.C.
November 04, 2019
Category: Dental Procedures
TreatingaBabyToothwithInnerDecaycanbeComplicated-butStillNecessary

Even though a child’s primary (“baby”) teeth eventually give way, it’s still important to treat them if they become decayed. Primary teeth serve as guides for the emerging permanent teeth — if they’re lost prematurely, the permanent tooth may come in misaligned.

If the decay, however, affects the tooth’s inner pulp, it poses complications. A similarly decayed adult tooth would be treated with a root canal in which all the pulp tissue, including nerve fibers and blood vessels, are removed before filling and sealing. Primary teeth, however, are more dependent on these nerves and blood vessels, and conventional filling materials can impede the tooth’s natural loss process. It’s better to use more conservative treatments with primary teeth depending on the degree of decay and how much of the pulp may be affected.

If the decay is near or just at the pulp, it’s possible to use an indirect pulp treatment to remove as much of the softer decay as possible while leaving harder remnants in place: this will help keep the pulp from exposure. This is then followed with an antibacterial agent and a filling to seal the tooth.

If the pulp is partially exposed but doesn’t appear infected, a technique called direct pulp capping could be used to cover or “cap” the exposed pulp with filling material, which creates a protective barrier against decay. If decay in a portion of the pulp is present, a pulpotomy can be performed to remove the infected pulp portion. It’s important with a pulpotomy to minimize the spread of further infection by appropriately dressing the wound and sealing the tooth during and after the procedure.

A pulpectomy to completely remove pulp tissue may be necessary if in the worst case scenario the pulp is completely infected. While this closely resembles a traditional root canal treatment, we must use sealant material that can be absorbed by the body. Using other sealants could inhibit the natural process when the primary tooth’s roots begin to dissolve (resorb) to allow it to eventually give way.

These all may seem like extraordinary efforts to save a tooth with such a short lifespan. But by giving primary teeth a second chance, their permanent successors will have a better chance of future good health.

If you would like more information on treating decay in primary teeth, 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 “Root Canal Treatment for Children’s Teeth.”

By Paul David Epstein, D.M.D. & Associates, P.C.
October 25, 2019
Category: Oral Health
ModerateYourChildsJuiceDrinkingtoLowerToothDecayRisk

Along with daily brushing and flossing, limiting your child’s sugar consumption is an important way to prevent tooth decay. We all know the usual suspects: candy, sugar-added snacks and sodas. But there’s one category you may not at first think fits the profile—juices. But even natural juices with no added sugar can raise your child’s risk of tooth decay if they’re drinking too much.

Tooth decay is caused by certain strains of bacteria in the mouth, which produce acid. Sugar in any form (sucrose, fructose, maltose, etc.) is a primary food source for these bacteria. When there’s a ready food source, bacteria consume it and produce abnormally high levels of acid. This can cause the mineral content of tooth enamel to dissolve faster than saliva, which neutralizes acid, can reverse the tide.

Juices without added sugar still contain the natural sugar of the fruit from which they originate. The American Academy of Pediatrics conducted a study of the effect of these natural juice sugars on dental health. Their conclusion: it can have an effect, so the amount of juice consumed daily by a child should be restricted according to age.

They’ve since published guidelines to that effect:

  • Under age 1 (or any child with abnormal weight gain): no juice at all;
  • Ages 1-3: no more than 4 ounces a day;
  • Ages 4-6: no more than 6 ounces a day;
  • Ages 7-18: no more than 8 ounces (1 cup) a day.

Again, these are guidelines—you should also discuss the right limits for your individual child with your dentist or pediatrician. And if you’re wondering what kind of beverages pose less risk of tooth decay, you can look to low or non-fat milk. And, of course, don’t forget water—besides containing no sugar, nature’s hydrator has a neutral pH, so it won’t increase acidity in the mouth.

Tooth decay is one of the biggest health problems many kids face. But with good teeth-friendly habits, including restricting sugar intake in any of its many forms (including juices) you can go a long way in reducing their risk of this destructive disease.

If you would like more information on best dental care practices for children, please contact us or schedule an appointment for a consultation.

By Paul David Epstein, D.M.D. & Associates, P.C.
October 15, 2019
Category: Dental Procedures
Tags: teeth whitening  
WhatYouShouldKnowAboutaHomeTeethWhiteningKit

A relatively easy and inexpensive way to improve your smile is to whiten your teeth. In fact, you may even be able to do it yourself at home. Although there are differences between at-home and professional whitening, the former can still be effective.

That effectiveness, though, might be dependent on how well you understand what home whitening can do and what it can’t. So before you purchase your kit, here are a few things to know about DIY teeth whitening.

Home kits are safe—when used as directed. Although nothing in life is completely risk-free, home whitening kits are relatively safe. But only if you follow the directions: If you overuse the bleaching solution beyond its intended use, you could wind up with permanent damage to your tooth enamel that can be costly to treat.

Bleaching solutions are relatively mild. Nearly all home kits use carbamide peroxide, a form of hydrogen peroxide, as their bleaching agent. Home kits usually contain no more than 10% of this agent, much lower than professional solutions. Used as directed, this amount of bleaching agent poses little to no risk to dental or general health. On the other hand, the weaker home kit solution does limit the extent of brightness you can achieve compared to stronger professional treatments.

For top results (or certain conditions), consider professional whitening. While you can obtain good results with a home whitening kit, professional whitening provides more precise brightness control and range, and may possibly last longer. That’s because your dentist has more advanced techniques and equipment, as well as stronger bleaching solutions. And, if your discoloration originates inside your teeth, a home kit won’t help—only a dentist can address that kind of discoloration.

Even if you decide to “go solo,” your dentist can still give you advice on what to look for in a home kit, as well as tips for the actual procedure. But whether you whiten at home or let your dentist do it, teeth whitening can take years off your smile and give you a more attractive look.

If you would like more information on teeth whitening, 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 “Tooth Whitening Safety Tips: Are Bleaching Products Safe?

By Paul David Epstein, D.M.D. & Associates, P.C.
October 05, 2019
Category: Oral Health
PopStarDemiLovatoPopsOutJayGlazersTooth

Singer and actor Demi Lovato has a new claim to fame: formidable martial artist. When she is not in the recording studio, on stage or in front of the camera, Lovato can often be found keeping in shape at Jay Glazer's Hollywood (California) gym. Glazer, who is best known as a sports journalist, also runs conditioning programs for professional athletes and celebrities based on mixed martial arts. On March 6, Glazer got more than he bargained for when 5'3" Lovato stepped into the ring and knocked out his front tooth.

Glazer reportedly used super glue to put his tooth back together. Not a good idea! While it may not be convenient to drop everything and get to the dental office, it takes an expert to safely treat a damaged tooth. If you glue a broken tooth, you risk having to undergo major work to correct your temporary fix—it's no easy task to "unglue" a tooth, and the chemicals in the glue may damage living tooth tissue as well as the surrounding gum and bone.

Would you know what to do in a dental emergency? Here are some guidelines:

  • If you chip a tooth, save the missing piece if possible. We may be able to reattach it.
  • If your tooth is cracked, rinse your mouth with warm water, but don't wiggle the tooth around or bite down on it. If it's bleeding, hold clean gauze to the area and call our office.
  • If your tooth is knocked loose or is pushed deeper into the socket, don't force the tooth back into position on your own. Immediate attention is very important.
  • If your tooth is knocked out, there's a chance it can be reattached. Pick up the tooth while being careful not to touch the root. Then rinse it off and have either someone place into its socket, or place it against the inside of your cheek or in a glass of milk. Please call the office immediately or go to a hospital.

What's the best thing to do in an emergency? Call us right away, and DON'T super glue your tooth! You can prevent worse problems by letting a professional handle any dental issues. And if you've been living with a chipped, broken or missing tooth, call us to schedule an appointment for a consultation—there are several perfectly safe ways to restore your smile. Meanwhile, if you practice martial arts to keep in shape, think twice before getting into the ring with Demi Lovato!

To learn more, read the Dear Doctor articles “Trauma & Nerve Damage to Teeth” and “Saving New Permanent Teeth After Injury.”

By Paul David Epstein, D.M.D. & Associates, P.C.
September 25, 2019
Category: Oral Health
Tags: tooth decay  
NewMinimallyInvasiveTechniquesareImprovingToothDecayTreatment

Although techniques and materials have changed, dentists still follow basic principles for treating tooth decay that date from the late 19th Century. And for good reason: They work. These principles first developed by Dr. G.V. Black—the "father of modern dentistry"—are widely credited with saving millions of teeth over the last century.

One of the most important of these treatment protocols is something known as "extension for prevention." In basic terms, it means a dentist removes not only decayed tooth structure but also healthy structure vulnerable to decay. But although effective in saving teeth, practicing this principle can result in loss of otherwise healthy tissue, which can weaken the tooth.

But with new advances in dentistry, decay treatment is getting an overhaul. While Dr. Black's time-tested protocols remain foundational, dentists are finding new ways to preserve more of the tooth structure in a concept known as minimally invasive dentistry (MID).

Better diagnostic tools. Because tooth decay can ultimately infect and damage the tooth's interior, roots and supporting bone, the best way to preserve more of the tooth structure is to treat it as early as possible. Now, new diagnostic tools like digital x-rays, microscopic magnification and optical scanning are helping dentists detect and treat decay earlier, thus reducing how much tissue is removed.

Better prevention methods. Oral hygiene and regular dental care are our basic weapons in the war with tooth decay. In addition, utilizing topical fluoride in combination with a milk-derived product called CPP-ACP dentists can get more of the cavity-fighting organic compound into the tooth enamel to strengthen it against acid attack.

Better treatment techniques. Using air abrasion (a fine particle spray that works like a miniature sandblaster) and lasers, dentists can now remove decayed structure with less harm to healthy tissue than with a traditional dental drill. And new, stronger dental fillings like those made with composite resins require less structural removal to accommodate them.

With these innovative approaches, dentists aren't just saving teeth, they're preserving more of their structure. And that can improve your overall dental health for the long-term.

If you would like more information on minimally invasive dentistry, 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 “Minimally Invasive Dentistry: When Less Care is More.”





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