Root Canals Are Complex Procedures

I have performed hundreds of root canals over the years. I can definitely admit they are complicated, detail-oriented procedures. That's because the internal anatomy of any tooth is like a maze. Think about the branches of a tree, and that's what the vital tissues of a root canal system look like. The image below is a micro-CT scan of the roots of a molar tooth. It illustrates the complexity of the root canal tissues. There are multiple microscopic openings (depicted with red dots) in the root canal that must be sealed.



The key to performing successful root canal therapy is cleaning, sterilizing, and sealing this intricate system from top to bottom. That way patients have the best odds of preventing reinfection or a recurrence of an abscess.

I still perform root canal therapy. But since 2010, I have decided to refer my patients with molar root canals to specialists who can successfully identify and treat these complex systems. I think it's important to give patients the best odds of success to maintain a molar tooth when a root canal is the treatment of choice. And just as importantly, the treatment time is significantly reduced when a specialist performs the procedure.

My Boy Turns Six!

August is a great kid. He has developed into a responsible, considerate, and wild comedian with some real independence. He's learning how to read, and recently asked me to read stories to him that don't have any pictures. He checks in with me every couple of minutes about which paragraph and word I am reading so he can keep up.


I'm sure we're like most parents, proud and observant of everything that our kids learn and practice. But as a dentist, I though a few observations about August's pediatric development and oral hygiene would be valuable to you.

Gus has really evolved his dental hygiene. My wife and I used to take charge of brushing and cleaning between his teeth twice a day, even when he battled us. That routine didn't stop until about 6 months ago. We had always allowed him to play with a toothbrush in the bathtub, and invited him to brush his own teeth. The concept of a dental home and habits are important to instill as early as possible. Being comfortable with a care provider usually starts with parent advocacy in the family home. Early introduction of pictures, concepts, and behaviors that occur for general medical and dental visits are easy to instill. A book, or playing doctor or dentist with your children matter. Props, costumes, toys, and even a toothbrush or stethoscope are all important ingredients in familiarizing kids prior to introducing the office setting. With that foundation, kids can transition to the dental home where the dentist, hygienist, and assistant can interact more comfortably to reinforce oral hygiene and prevention from the earloiest age possible.

I modeled toothbrushing as I sat next to the tub from about 10 months to 18 months before he really mirrored the simple techniques of getting to back and front teeth. Modeling is a great part of the growth process for any part of a child's development. But the fine motor skills to reproduce or mimic a modeled behavior like brushing don't emerge until about the first year.

Age 3 was another high point, where he was adamant about trying to do it on his own without our help. Which we allowed. But lke I tell parents: Encouraging independence and observing it are two different animals. There needs to be coaching and participation even from age 3.

We started with a non-electric brush, but made the move to an electric brush at about age 2. There was some flip-flopping with the type of brush. But generally, an electric brush is the best thing you can condition your kids to use from the get-go. There is so much more efficiency and effectiveness with an electric brush. They are cheap, and they are exponentially more successful at removing plaque.

So here we are, at 6 years old, a major developmental point for kids. Neural pathways are being solidified, and behavioral patterns are starting to become more apparent. Learning a personal healthcare skill or habit for a lifetime is a good thing to instill before age 6. At this point, kids have started to define their identity. And that includes how they identify with their personal health. Gus is not going to brush his teeth every day by himself without some prompting, but he is practicing the skills on his own with success. He knows it is important prevention, because we hear him discuss it now.

We're following the same path for his sister, Vivienne. And so far, it's a rerun. She's growing into health too.

We Love Our Town!

Did some bowling with other local dentists last month. The goal was to bring the dental community together to raise awareness and support for the hunger issue in our town. The event was called Bowling For Hunger. Hundreds of pounds of food flowed into the Stanwood Food Bank courtesy of the dental practices in Stanwood and Camano Island. I don;t have the final number, but we grossed over 1000 pounds on the event day, with more being provided after the event.

Our crew dressed up and arrived at Twin City Lanes, ready for fun. Here's some photos:



Our office manager, Laura, took home a trophy for the lowest score. To be fair, she was playing golf rules. But a trophy is a trophy. We display it proudly.



Patrick missed the top score by 1 pin. Here's some video of our ringer:

We Are Innovative

We have a lot of high-tech stuff in our practice. CAD-CAM crown systems, intraoral cameras, photosensitive cavity detection, lasers, and more. But every now and then we introduce something that just makes life easier without digital equipment or technological fuss.

Jeremy Legg, one of our registered dental hygienists, came up with an innovative answer to some basic hygiene instruments that patients need to reduce their risk for disease. He engineered a soft dental pick to insert into a brush handle. We needed a name, so I dubbed it the PerioSoft.



Several research studies have concluded that an inter-dental pick or instrument is as effective or more effective at removing oral plaque and bio-film as compared to dental floss. The shape of the soft picks is convex. which means that they can clean concave root surfaces of teeth more effectively. They are available from us or any drugstore.

Am I A Doctor or a Dentist?

I had the craziest call yesterday. The caller was angry that we would require a treatment consultation for a patient's gastric reflux disease and nutritional habits. "He's not a real doctor," she said. "Is he a nutritionist and a physician?" Yeah, yeah, I've seen "The Hangover." Don't worry. I'm sleeping at night.

The caller claims she filed a complaint with the Washington Dental Service, accusing me of violating privacy and treatment guidelines because I was practicing outside of my scope of dentistry and practicing medicine without a license. For a moment, let's forget about how this caller is a grandmother of 2 pediatric patients I saw for comprehensive examinations. And let's also forget about the fact that this caller was asking us to violate HIPAA regulations and disclosure laws. Let's stay focused on the issues of the kids for a moment, and what I feel must be clearly understood by patients and parents alike.

I sat with the mother of these kids prior to exam and talked about the reasons they were here. Mom was loking for a dentist who could perform sedation procedures for her anxious daughter. Mom was also concerned about visible cavities. So I led Mom through the decay risk assessment form that we issue to every patient who is at moderate or high risk for tooth decay. We discussed medical histories, nutirional habits, the scope and level of supervision for the dietary and oral hygiene habits of her teen and preteen kids. I heard what I think is pretty typical for a family: a little hands-on supervision with nutrition at home, kids are mostly self-managed away from the house at school. Hygiene supervision is self-directed. I also discovered some crucial information about the teenager--a history of mild to moderate episodic gastric reflux. So now it's time for the clinical exam.

I sit with the teenager and diagnose 16 teeth with first stage tooth decay or greater. This means there is likely a medical component to the cause of her decay. I also learn that there is a history of hay fever and the occasional need to medicate for it, along with the history of medicating the reflux. I drill down with the patient about her current symptoms of reflux, discovering some tipoffs to continued reflux. She has a few--occasional epigastric pain, morning cough and morning need to clear her throat with mucous discharge occasionally, a mild reddening of the upper airway tissues, routine late night eating. She also has a significant potential to improve her hygiene habits, and could reduce how much soda she consumes regularly.

Not only is it my obligation to treat tooth decay, it's also my duty to inform the parents of minors about the influence of medical conditions on their children's mouths. So Mom and I agree to schedule a consultation for executing a treatment plan to address GERD and tooth decay treatments for their teenager.

Let's understand why I am discussing any medical issues or nutritional issues. There are so many medical conditions that affect the mouth. Acid erosion and tooth decay are a real side effect of gastric reflux disease (also known as GERD). I have to be well informed about the clinical signs, symptoms, diagnosis, testing, and therapies, because GERD puts teeth directly in danger. I refer all my patients with this clinical presentation if they are not under the care of a physician for the conditions.

In my practice, we are experts in everything we become responsible for treating. We are one of the first healthcare facilities a patient will visit for a diagnosis of cardiovascular disease, sleep breathing disorders, diabetes, oral cancer, migraine headaches, the list goes on. I routinely train and acquire continuing education for these medical issues. We also team up with surgeons, gasteroenterologists, ENT, cardiologists, sleep medicine, internal medicine, and family physicians on a regular basis. I visit medical clinics and provide no-cost educational sessions for physicians to become better acquainted with the strong connections between medicine and dental health.

So, yeah, I know medicine. It's called oral medicine. And I've been practicing it since I became a dentist. Medical dentistry is now the recognized standard of care.