Reasons to Smile

Dr. Sperbeck,
A recent discovery of cavities in my children prompts my asking:
would a root canal be necessary in a seven year old child?
should all cavities be filled, even small cavities in primary teeth?
is mercury in fillings acceptable for primary teeth which will be falling out within five years or so?
what can I do specifically so that we don’t have cavities like this again?

Thanks for any time you may be able to spend in addressing these questions.
–Laura

Dear Laura,
Let me try to answer your questions as listed.

1. Should root canals be appropriate for a 7 year old?
Root canals are use when the nerve of the tooth is damaged or dead. This will cause the leakage of toxins into the body. Usually an abscess is the result with a variety of consequences. Root canals for children fall into two catagories: for permanent teeth or baby teeth. if it is for a permanent tooth it is usually a very good idea. If it for a baby tooth, it depends on how much longer the tooth is needed before its eventual loss. Baby teeth serve many purposes: they are important in helping jaws develop and holding the place for the soon to be present permanent teeth. So whether the baby teeth should be root canaled the answer is maybe. Your dentist will be able to answer the pros and cons for treatment.

2. Should all cavities be filled?
Again, the answer is usually. If the tooth is not in hopeless condition and there is continued need for the tooth then the answer is yes. With a baby tooth I usually try to gauge the size of the cavity with the expected time for the loss of the tooth. If the cavity will not grow to big and cause nerve damage or affect the tooth next to it I will not repair it. I always inform the parent so they can be in on the decisions.

3. Should Mercury fillings be used?
Mercury fillings are also known as Amalgam fillings. The material is approximately 50% mercury and 50% silver. I do not believe it should be used for any reason. Mercury is very dangerous for children and women in the child bearing years. Once mercury enters and is absorbed in the body it is very difficult to remove, not to mention the expenses for removal. There are other materials that will restore the teeth as well with out the possibility of risk.

4. How to prevent cavities?
This is a great question. Prevention is where the battle should be fought. So your areas to concentrate on are:
A. Control diet. Everything that can cause cavities should be controlled. The list is numerous but the management is doable.
B. Good oral hygiene with toothbrush and floss. These are very inexpensive and have a huge bang for your buck.
C. The use of sealants. This wonderful tool is very under utilized.
D. Oral hygiene instruction from your dentist. Always ask the dentist or the hygienist for an evaluation at each visit because each hygiene appointment should be a learning time. Patients should clean their own teeth and the professionals should instruct.
E. Frequent hygiene appointments with a dental checkups each visit. This is the standard in our office. This allows for the aforementioned instruction and for the prompt discovery of problems early in the game.
F. X-rays routinly taken. The are invaluable to help in prevention of serious problems. If you can, have digital x-rays taken. Digital x-rays have a significant reduction in the exposure of the x-ray.

I hope this helps.

Regards,
Dr. Sperbeck

Well I can’t believe I am doing this, but it seems like a good idea to lead by example and share with you how I brush my teeth. Please bear with me.

My routine is preformed 2 times daily, once in the morning and once before bed. I am consistent six days a week, although it may vary depending on how tired I am.

The sequence is floss, then brush, then hydrofloss. Not very exciting, but very practical.

Flossing needs to be taught to you by a dental professional. I use the “wrap around the middle finger technique” that leaves the other fingers free to direct and control the floss. I will floss each side of a tooth ten times. Any floss will do, but I prefer the non-waxed floss because it gives me satisfaction when I hear it start to squeak. I like to floss first because I then use the brushing to remove the dislodged bacteria .

Brushing should take at least four minutes by the clock. How much day dreaming can you do looking at yourself for four minutes twice a day? I find an electric toothbrush to more efficient and I can very effectively brush in 2 minutes. I use a Rotodent because I think it is the best on the market.

Next is a tongue scraper. This helps with odor control.

Lastly I use a waterpik called a Hydofloss, also the best on the market. I add a couple cap-fulls of BreathRX to help me with odor control.

Total time: 4 minutes.

Best wishes,
Dr. Sperbeck

This is a true story told to me by a new patient named Stacey.

Stacey is originally from the East Coast and was given my name by a dentist who attended the Pankey Institute, an entity that teaches a sophisticated way to repair mouths.

Anyway back to my story. Stacey asked me how long a veneer should last. The answer is usually a long time. Some of the first ones I placed almost 25 years ago are still in the mouth and functioning well. Stacey, on the other hand, has had three replacements of her veneer in the last three years. This is obviously far too frequent, especially since she had had to pay each time. To make matters worse, these three replacements did not include the multiple times she had to have them re-cemented them. When I met Stacey today, she was missing her right front tooth. Obviously this was not a pretty sight and she was not happy. I asked her if she wanted to find out WHY and, to her credit, she decided to let us discover the problem and plan the cure.

So this is what we did…

I started with a complete exam. This told me Stacey’s mouth has three problems:

1. She has been grinding her teeth!
2. The way her bite hit was causing all the force of the bite to come down right on the veneers which caused them to break the cement junction!
3. Her teeth are significantly worn down. This changes the the forces and dynamics of her mouth accentuating the harmful forces.

After completing the exam, I placed a temporary bonding on the front teeth. Stacey was ecstatic and I thought, “not bad if I did not say so myself.”

I also made some molds of her teeth to make her a TMJ splint called a MAGO. This appliance is used to help diagnose the true jaw position called CR (Centric Occlusion) and then we can find true, neutral position. Finally, after discovering the CR and the neutral positions, we are ready for the full diagnosis and we can develop the PLAN.

In the meantime, I think the temporary bonding will last through this time, giving Stacey a temporary beautiful smile while we work to give her her permanent, stable one. I will keep you posted.

Dr. S