My Blog

Posts for: February, 2015

By John G. Fisher, DMD
February 27, 2015
Category: Dental Procedures
Tags: root canal   dental injuries  
SevereDentalInjuriesMayRequireEndodonticTreatment

If you regularly participate in sports or other physical activity, you’re at a higher risk for dental injuries. While chipped teeth are the most common result of these injuries, a few may result in more serious trauma — dislodged, cracked or knocked out teeth. In these cases, the core of the tooth — the pulp — and the root may have been damaged. Saving the tooth may require endodontic treatment and possibly the expertise of a specialist in the field, an endodontist.

Endodontics, from the Greek words for “within” and “tooth,” is a specialty of dentistry that treats disease or damage affecting the inner parts of a tooth, particularly the pulp chamber, the root canals, and the root. While all dentists are trained in endodontic procedures, an endodontist has advanced training, experience and specialized equipment to address complex cases.

The type of endodontic treatment needed for an injured tooth will depend on the extent of damage. A mature, permanent tooth with pulp damage, for example, may require a root canal treatment. In this procedure the pulp chamber and root canals are thoroughly cleaned out, and then are filled with a special filling to prevent any future infection. Later the tooth should be crowned to permanently seal it. Although a general dentist may perform a root canal, more complex cases, such as a tooth with an extensive root canal network, may need to be performed by an endodontist using microscopic equipment.

A tooth that has undergone severe trauma, especially a knocked out tooth, will need extensive follow-up care by a general dentist and possibly an endodontist to improve its chances of long-term survival. Because of the severity, the tooth may lose viability and the body ultimately may begin to reject it. For this reason, the tooth should be monitored on a regular basis and may need further treatment from time to time, even up to five years after the injury.

One final word: if you participate in sports or exercise activity, you can significantly reduce your risk of dental injury with a mouthguard. There are various types, but the best protection is one custom designed to fit the specific contours of your mouth. We’ll be glad to advise you further on how to protect your teeth from injury.

If you would like more information on dental injury prevention and 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 “Trauma & Nerve Damage to Teeth.”


By John G. Fisher, DMD
February 19, 2015
Category: Dental Procedures
MarthaStewartSharesToothTouch-UpSecrets

Here’s a quick quiz: What recent activity did domestic guru Martha Stewart share via social media for the first time? Need a hint? Was she following the lead of other celebrities like rapper 50 Cent (AKA Curtis James Jackson III), actress Demi Moore and country music star LeAnn Rimes?

Give up? The answer is… she live-tweeted her visit to the dentist! Not only that, she also posted pictures of her mouth as she was undergoing an in-office whitening procedure.

Now, we understand that some might feel they don’t need to see close-ups of Stewart’s teeth under treatment. But we have to admire her for not trying to hide the fact that she’s had the same procedure that has benefited so many people, whether famous or not. Plus, her pictures actually provide a good illustration of how the treatment works.

In-office whitening treatments are the fastest way to brighten up your smile. In a single one-hour visit, your teeth can be lightened by three to eight shades — and that's a big difference! How can we achieve such dramatic results? When you’re under our direct supervision in an office setting, we can use the most concentrated bleach solutions safely and effectively. You can get similar results with custom-made trays and take-home lightening solutions we can prepare for you, but then the process will take longer.

If you look closely at her photos, you’ll see that Stewart’s lips, gums, and face are covered up to prevent any contact with the bleaching solution. She’s also wearing protective eyewear, which not only keeps chemicals away, but also guards her eyes against strong lights, which are sometimes used in conjunction with bleach. When we perform in-office whitening procedures, we use safeguards like these for all of our patients — not just celebrities!

We also perform a complete oral examination before starting any whitening procedure, to be sure you don’t have any underlying conditions that need to be treated before teeth whitening begins. That’s something you just can’t get from an over-the counter whitening product.

Teeth whitening is an effective and affordable way to give your smile a quick boost. But whether you decide to live-tweet your procedure — or keep your fans guessing about why your smile looks so good all of a sudden — that’s up to you.

If you would like more information about the teeth whitening, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Teeth Whitening” and “Important Teeth Whitening Questions Answered.”


By John G. Fisher, DMD
February 11, 2015
Category: Oral Health
Tags: gum disease   genetics  
GeneticsandyourGums

It is sometimes hard to believe all of the features and characteristics that we inherit from our parents. Whether you're tall, short, blue-eyed or blonde, you can usually attribute some of these features to your mother and father. Of course, the downside of genetics is that diseases and disorders are also linked to genes.

Well, you can add gum tissue to that list as well! Genetics actually determines whether you have what we call “thin” or “thick” gum tissue. How does this work? Well, the type of gum tissue you have relies heavily on the shape of your tooth, which indeed is genetically-coded. If you have a triangular tooth shape, you'll likely have thin gums. If you have a squarer tooth shape, you'll usually have thick gums.

So, what can you expect from each tissue type?

If you have a thin gum tissue type, you are more likely to have gum recession. Watch out for the following signs of gum recession:

  • Sensitivity to hot or cold, even without the presence of dental decay
  • If you have crowns on your teeth, you may see a dark gray line at the gum line from the metal casting beneath the crown
  • Small dark triangular spaces between teeth

On the other hand, if you have a thicker tissue type, your gums are more vulnerable to dental disease through a condition called “pocketing.” This happens when bacterial plaque causes your tissue to become inflamed, lose its attachment to the teeth and develop a pocket. Pocketing can result in bone loss, and, in worst-case scenarios, tooth loss.

It's important to note that while we use these terms to categorize different tissue types for treatment decisions, your tissue may also fall somewhere in between the two varieties.

So, how can you prevent gum disease? Daily oral hygiene is the best way to ensure proper care of your gums, no matter what type you have. Be sure to brush twice daily (use a soft toothbrush) and floss regularly at night. Floss gently until you hear a squeak, but watch out for your gum line. And of course, continue to visit us two times a year, so that we can assess whether you are in danger of developing gum disease.

If you would like more information about genetics and gum disease, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Genetics and Gum Tissue Types.”


By John G. Fisher, DMD
February 03, 2015
Category: Dental Procedures
Tags: orthodontics   retainers  
RetainersHelpyouProtectYourNewlyAlignedTeeth

Orthodontics can produce an amazing smile transformation. With today’s advanced appliances and techniques even the most difficult malocclusions (bad bites) can be overcome. All of this innovation, however, depends on one basic anatomical fact: though firmly set in the mouth, our teeth can still move.

Teeth are actually held in place by the periodontal ligament, a strong, elastic tissue that attaches to them through tiny collagen fibers on one side of the ligament and to the jawbone with similar fibers on the other side. When pressure is placed against a tooth, the bone on the opposite side of the force begins to dissolve (resorb), allowing the tooth to move. As it moves, new bone is built up behind the tooth, to stabilize it. Orthodontists take advantage of this natural mechanism through orthodontic hardware like braces that applies pressure in the desired direction of movement, while the ligament and bone do the rest.

There is, though, a downside to this process. The teeth, bone and gum tissues can contain a kind of “memory” for the former natural position of the teeth. Over time, the lower front teeth tend to take a gradual migratory movement back towards their original position. Also, as we age the lower front teeth may crowd each other as there is a genetic influence for teeth to move to the midline of the face, causing a pressure that allows the skinny lower front teeth to slip behind each other. As a result of both of these tendencies, corrected teeth may retreat from their new positions.

To stop these tendencies, we use an appliance known as a retainer after braces or other hardware is removed. As the name implies, this appliance “retains” the teeth in their new position. For structural “memory,” the retainer will keep the teeth in their new position until the impulse to return to the old one has faded, about eighteen months. Retainers can also slow or stop the natural genetic influence of movement, but it may mean wearing a retainer for an indefinite period, especially individuals who’ve undergone orthodontic treatment later in life.

The length of time you’ll need to wear a retainer after braces — and what type, whether a removable appliance or one permanently attached — will depend on a number of factors including the type of malocclusion, your individual mouth structure and age. We’ll recommend the best option that ensures the best chance of keeping your teeth in their new position.

If you would like more information on retainers after orthodontic 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 “Why Orthodontic Retainers?