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Posts for: February, 2020

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 Eric G. Piascik, DDS
February 14, 2020
Category: Dental Procedures
Tags: veneers  
VeneersMayNotBetheBestOptionforYourTeenagersTeeth

Just like adults, teenagers experience chipped, stained or disfigured teeth. And during a life stage where issues with appearance can be acutely painful, these defects call out for a solution.

And, there is one: porcelain veneers. These thin wafers of custom-made porcelain are bonded to the front of teeth to cover dental flaws. They’re one of the least invasive—and most affordable—methods for smile enhancement.

There is one caveat, though: The affected teeth will most likely need alteration. Veneers can look bulky when bonded directly to teeth, so we compensate for this by removing some of the surface enamel. This changes the tooth permanently, to the point that it will always require a veneer or some other form of restoration.

But although this may be a minor issue for an adult, it could pose a problem for a teenager. That’s because the pulp, the innermost layer of a tooth containing nerves and blood vessels, is larger in a younger adolescent tooth than in an older adult tooth. Because of its size, it’s closer to the tooth’s surface. During enamel reduction for veneers on a young tooth, this could lead to inadvertent nerve damage. If that happens, the tooth may need a root canal treatment to preserve it.

If the adolescent tooth needing a “facelift” has already been root canaled or sustained significant structural damage, then altering it for veneers may not be too concerning. Likewise, if the teeth are smaller than normal, the bulkiness of a veneer may actually improve appearance and not require alteration. We’ll need to examine a young patient first before making any recommendations.

There are also alternatives to veneers for improving smile appearance. Enamel staining could be enhanced temporarily with teeth whitening. Small chips can be repaired with bonded dental material, or in skilled hands be used to “build” a veneer one layer at a time with no enamel reduction. Although not as durable as regular veneers, these bonding techniques could buy time until the tooth is more mature for veneers.

Whichever path we take, there are effective ways to transform a teenager’s flawed tooth. And that can make for an even better smile.

If you would like more information on dental restorations for teenagers, 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 “Veneers for Teenagers.”


By Eric G. Piascik, DDS
February 04, 2020
Category: Oral Health
Tags: oral hygiene  
ImproveYourBrushingandFlossingTechniquesforaHealthierMouth

Five minutes a day: That’s all it takes to do something that could change your life. It may not seem like a lot of time, but it’s one of the most profound things you can do for your well-being.

So, what is this life-changing activity? Daily oral hygiene—good, old-fashioned brushing and flossing, just like your mom made you do. Along with regular dental visits, daily hygiene is crucial to keeping your teeth healthy. And healthy teeth are key to a healthy life.

Part of the magic is “showing up every day.” The main driver for tooth decay and periodontal (gum) disease is dental plaque, a thin film of bacteria and food particles that accumulates on teeth. Clearing away this daily buildup with brushing and flossing drastically reduces the likelihood of disease.

The real advantage, though, is in brushing and flossing effectively. Plaque can cling stubbornly to teeth, especially around the gum line and other hard to reach surfaces. What’s left behind interacts with saliva to form a hardened, calcified form called calculus (also known as tartar) that could increase your risk for disease. And it can’t be removed by brushing and flossing.

You can minimize calculus formation with proper brushing and flossing techniques. When brushing, for instance, use a circular motion and make sure you brush all tooth surfaces, including around the gum line (a thorough job takes about two minutes). And avoid aggressive brushing—you could damage your gums. Be gentle while you brush and let the toothpaste and brush bristles do the heavy lifting.

Don’t forget to floss to remove plaque from between teeth your brush can’t access. Wrap the ends of about 18 inches of floss thread around the middle finger of each hand. Using a combination of your index fingers and thumbs to maneuver it, work the floss between the teeth and then snug it to the tooth surface. Go up and down the sides of each tooth a few times until you hear a squeak (this only happens with unwaxed floss). Move then to the remaining teeth until you’re finished.

Focusing on these techniques will improve your ability to keep daily plaque accumulation low. And that means your teeth and gums have a better chance of staying disease-free and healthy.

If you would like more information on proper oral hygiene, 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 “Daily Oral Hygiene.”




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