Headaches and TMJ Pain
It is estimated that nearly 20 million people in the United States have TMJ related headaches. This is a huge number of people! Many of these people don’t even know their headaches are TMJ related. Medical doctors generally don’t know much about the TMJ and even many dentists struggle to effectively treat TMJ pain because it isn’t well understood and can present in many different ways.
Not all headaches are related to TMJ problems but enough are related that I believe anyone with chronic headaches should have a TMJ evaluation to rule it out before proceeding with any type of other treatment.
First let’s take a look at what types of headaches are commonly associated with or mistaken for TMJ pain.
- Tension headaches – These are the most common types of headaches. They present as a dull headache centered on the forehead, temple, or back of your neck. They aren’t terribly well understood but are thought to be a result of muscle tension, stress, tiredness, and many other factors.
- Sinus headaches – These are related to pressure in your sinuses. These can cause pain right over your cheekbones, between your eyes and upper nose, and also the lower middle portion of your forehead depending on which sinuses are involved.
- Cluster headaches – These are a pattern of severe headaches that cluster together in one time period. The headache is usually on one side of your head, causes severe pain, and last anywhere from 30 minutes to several hours. You’ll often have 1-4 headaches in a cluster. This is the one type of headache that affects more men than women.
- Migraine headaches – This is another type of severe headache that presents with severe pain in your temple area and front and back of your head on one side. They cause severe pain, light sensitivity, nausea, and sometimes vomiting. They usually are preceded by an “aura”, which is a specific feeling or visual sense that comes before the migraine starts. They usually last much longer than other headaches (many hours).
TMJ symptoms are extremely varied. They can include any of the following…
- Clicking and popping of the jaw joint
- Grating of the joint
- Difficulty opening or closing
- Limited opening
- Muscle pain around the jaw and TMJ
- Generalized facial pain
- Ear-ache
- Headaches ranging from dull aches to severe migraine types
Problems with the TMJ manifest in any of the different patterns that headaches come in. This is why it is so difficult to be sure exactly what is causing them.
Women are the most likely to suffer from TMJ related headaches and most start having them in early to middle adulthood. They also seek treatment for TMJ pain at a much higher rate than men. This is thought to be a result of changing hormone levels.
So what do you do if you are concerned that your headaches might TMJ related?
First, get checked out by your physician. Chronic headaches can be a sign of certain types of serious health conditions.
If they rule out anything major, start working on getting your TMJ healthy again. This includes…
- TMJ exercises
- TMJ splints
- Working on your posture
- Avoid chewing gum or other hard foods
- Warm compresses
You can see a TMJ specialist for treatment or you can try some at home methods. I tend to believe that most people should try at home treatment first before resorting to expensive professional treatment. Studies have shown that most TMJ pain can be managed with inexpensive, reversible, at home remedies. I have created very specific guides that cover everything from at home TMJ splints to exercises and postures to practice. If you’d like more information about these guides you can go here.
Oral Hygiene and Respiratory Illness
I talk a lot on here about how your oral health is closely related to your overall health. In elderly patients, one of the most important related illnesses is pneumonia. Aspiration pneumonia is a big problem in nursing homes and a lot of these cases can be prevented with improved oral hygiene.
Your mouth is host to a complex variety of different bacteria. With good oral health these bacteria are actually a good thing and don’t cause any major problems. When significant cavities or periodontal disease are present, the type of bacteria change over to a more unhealthy variety and the numbers of them increase significantly. With poor eating and swallowing, decreased immune function, and overall poorer health that is common in elderly patients, this bacteria can travel into the lungs and cause pneumonia. One study showed that residents in a nursing home who didn’t receive any special oral hygiene developed pneumonia at a rate of 20% over a two year period. The other group who received regular oral hygiene including cleanings to remove plaque and tartar only developed pneumonia at a rate of 11% over that same two year period. The study wasn’t anywhere near perfect, but several additional studies over the years have come to the same general conclusion… better oral hygiene reduces the rates of pneumonia in elderly patients significantly. Pneumonia has a significant financial cost as well as quality of life cost for elderly patients.
If you have a family member or friend who is in a nursing home, ask about their policy for oral hygiene. If the facility isn’t doing a good job, and you’re able to, consider assisting in dental hygiene. Elderly patients, especially those with dementia, really struggle with any type of adequate oral hygiene. If someone brushed their teeth with an electric toothbrush even for 30 seconds a day, it would go a long way towards improving their overall health.
The Facts About Dental Insurance
I’ve personally worked with most of the major dental insurance companies over my career. I’ve been an in network provider for many as well as being an out of network provider for others. In this time, I’ve come to really dislike these companies for many different reasons, the primary being that they interfere with your dentist’s ability to provide optimal care for you. Here are the real facts about dental “insurance”
- The main reason why dental insurance is so terrible, is because it isn’t really insurance at all. The point of most insurances is to protect you from a catastrophic event that would financially destroy you otherwise. In dentistry this is actually a pretty rare scenario. Most people need consistent dental care, and in those cases where you do need significant work, your insurance isn’t going to cover it. Think about dental insurance more as a discount plan than anything else.
- Dental insurance reimbursement for an in network dentist is somewhere between one half to three quarters of their actual fee. On average an in network dentist is going to have to use less expensive materials, use cheaper dental labs, and spend less time with each individual patient. This isn’t always the case but oftentimes is.
- Dental insurance maximums haven’t changed significantly for 30 years while premiums have continued to increase. Most plans max out at paying $1000-1500 per year. While this was great in 1980, at today’s prices, if a single teeth needs a root canal and crown, you’ve maxed out your plan.
- Dental insurance companies exist for one reason, to make money, and they do this very well. They don’t care about you and all their policies exist to limit expenses. Many top executives in these companies make over a million dollars a year.
- Dental insurance companies actively work to decrease usage of dental services. They most commonly do this through waiting periods on major work (which most people don’t know is in their plan until it is too late) and making providers do pre-determinations (which aren’t binding anyway). Neither of these things are in the best interest of your oral health.
- Dental insurance companies have arbitrary limits on what is covered and how often. These limits aren’t necessarily based on evidence of what is best for you.
- They deny payment for treatment on a consistent basis, even when there is clear evidence of it’s necessity. One of my most recent cases was on a patient who had a root canal on a back molar. The standard of care in dentistry is that these teeth need a build-up and crown as soon as possible after the root canal in order to prevent the tooth from breaking. Despite us sending in x-rays, pictures, and a description of what we did, they still denied the build-up saying it wasn’t necessary! These costs are directly passed on to patients.
- They ask for money back after paying. I had a patient who had oral cancer who needed a denture made. We received written authorization to go ahead with the denture which we made for the patient. 6 months later, they sent us a letter asking for the money back because they said they made an error in payment!
If you’ve got dental insurance, keep all this in mind. If your dentist recommends something outside of what your plan covers, there may be a good reason for it. Ask him or her about it and in most cases they’ll be happy to discuss why they are recommending it.
Veneers
Veneers are a type of dental restoration in which porcelain is bonded to the front surface of teeth in order to change their color or shape. When most people think of veneers, they think of celebrities who have changed relatively good looking teeth into bright white perfect teeth. While some cases of veneers do absolutely that, I’ve found that the majority of veneer cases I see are done to fix significant cosmetic issues. Let’s take a look at a couple of cases of veneers to see what they can do. Afterwards we’ll take a look at what actually goes into creating those veneers and some of the risks and benefits of this process.
Case #1: Yellow and brown staining from fluorosis
Before
After
Case #2: Significant spacing and staining from antibiotic use as a child
Before
Minimal removal of outer layer of enamel in preparation for veneers
After – This patient wanted a slightly more yellow appearance to match her other teeth.
So now that we’ve seen what veneers can do, let’s take a look at the actual process.
Getting Ready
Your dentist will usually take some photos and impressions of your teeth. The models of your teeth they’ll send to a dental lab to have them make a “wax-up” of what they would like the final veneers to look like. They can usually show this to you before you make the final decision to proceed with the veneers.
Preparation of the teeth and impression
At your veneer appointment your dentist will usually numb the teeth and then prepare them for veneers. In some cases, a significant amount of enamel must be removed from the front of the tooth while in other cases little to no enamel must be removed. A lot of this depends on your specific situation. In general, the cosmetic result can be greatly improved by removing at least a small portion of enamel (approximately 0.3 mm). They will take an impression of your prepared teeth and send this to a dental lab to have them make the final porcelain veneers.
Temporary veneers
Most times, your dentist will also place temporary veneers on your teeth as a trial run. This tells the dentist whether the bite is good and also gives you a chance to make sure you like the size and shape of them before the permanent ones are made and put in place. I personally like to have people wear them for 1-2 weeks before we have the dental lab start making the veneers. Once we make any adjustments to size or shape, we can take an impression and send this to the lab and they’ll duplicate this in the final porcelain veneers.
Final veneers
Once the final porcelain veneers are ready, your dentist will remove your temporary veneers and bond the porcelain ones in place. Depending on how sensitive your teeth are, they may need to numb you at this appointment as well.
Care and long term outlook
Veneers usually last 10-15 years. At this point your gum tissue will often have receded and you’ll see the (usually) stained interface between the veneer and the tooth. Most people like to get them replaced at that point for cosmetic reasons.
Another reason they fail is when they break or come off the tooth. I make a nightguard for all of my patients with veneers. This is a minimal expense that protects your very expensive investment. A nightguard minimizes this risk.
Frequently Asked Questions (FAQ) About Veneers
What are Lumineers?
Lumineers are a specific brand of veneer created by DenMat. They are marketed as no to minimal preparation veneers. I’ve personally found that the cosmetic results with Lumineers can be mixed, mostly because people want these veneers without any preparation of their teeth. This limits the ability of the veneer to effectively change the shape and color of the teeth adequately.
What is the difference between a crown and veneer and which is the best option?
A crown requires preparation of the entire tooth instead of just the front surface as a veneer does. A crown is usually the best option when a tooth is significantly worn or has a large cavity while a veneer is a better option when the tooth is structurally in pretty good shape but needs a cosmetic change.
Can I get a cavity around my veneer?
Yes, you most definitely can get a cavity around your veneer. In many cases you’ll need a new veneer or an entire crown on the tooth to fix this. Follow the usual rules of limiting intake of sugar and brushing and flossing regularly and you’ll reduce your risk of this significantly.
Are there any risks to having veneers?
Every time tooth is drilled on there is a chance that it will irritate the nerve enough for it to need a root canal. This is pretty unusual with veneers, especially those where the teeth are minimally prepared, but it is an important risk to understand.
Can all dentists do veneers?
Yes, all general dentists are qualified to do veneers. As with everything else in dentistry, some dentists are far more talented at this than others. One of the biggest differences can be in the quality of dental lab used. It takes a very skilled dental technician to make natural looking veneers.
How do I know if my dentist is any good at veneers?
Most dentists can show you examples of previous work they have done. Ask to see these and ask about their experience doing them. Anyone with decent experience should be able to discuss this freely with you.
Abfraction
Abfraction is a dental term for wedge shaped areas that sometimes form along the gumline of teeth over time, not related to cavities. It’s an extremely common occurence, especially in older patients, although I have seen it in young adults as well. Abfractions range from very minimal loss of tooth structure to very significant wedges that span nearly 1/3 the width of the tooth. I’ve seen some abfractions that extend nearly all the way into the nerve of the tooth, with just a thin layer of tooth structure covering the nerve. The picture shows a pretty advanced case with wear nearly into the space where the nerve is.
If you’re starting to notice areas like these along your teeth, you’re probably wondering why does it happen and what can you do to prevent it from progressing any further.
What causes abfractions?
The term abfraction has only been around since 1991. Abfractions have been around much longer than that but weren’t recognized specifically until then. As a result, not a whole lot of definitive research has been done to determine what exactly causes them to form. There are basically two schools of thought about their causes and the truth is likely that a combination of both forces as well as some other minor factors play into it.
The first factor is thought to be excessive force on the teeth from a “bad bite” or grinding. The abfractions form specifically in the area where the tooth is thought to move and flex. The theory is that all this pressure causes the tooth to flex so much that the tooth surface in that area starts to break down.
The second factor is thought to be excessive wear from toothbrushing. Hard toothbrushes, too much pressure, and highly abrasive toothpastes can all contribute to this. I saw one experiment where they took actual teeth (not in people’s mouths of course) and used a machine to aggressively brush them with abrasive toothpaste. Over time these teeth developed areas that looked exactly the same as abfractions do in the mouth.
It’s also thought that acid erosion in the mouth could cause this process to progress more rapidly.
My experience with patients over the years backs up the thought that there a lot of different factors at play. I’ve seen people who don’t have any wear from grinding at all but have developed significant abfractions. I’ve seen patients who do grind severely but don’t have any abfractions. I’ve seen patients who from all appearances, never brush their teeth, and definitely not with toothpaste, but still develop large abfractions. There isn’t one single factor that seems to tie them all together.
How can you prevent abfractions?
As we just discussed, we’re still not entirely sure what combination of factors causes abfractions to form. Your specific situation may lean more towards an abrasive process while for someone else it may be more related to excessive force on the teeth. It’s usually best to try and address both of these factors regardless.
- Reducing abrasive forces on the teeth
- Stay away from abrasive toothpastes. The biggest offenders are toothpastes that market themselves as having a whitening effect.
- Use a soft toothbrush. An electric toothbrush is even better. See our recommendations here.
- Brush gently, especially along the gumline.
- Don’t brush right after exposure to acidic foods or drinks… your enamel is temporarily weaker and needs about 30 minutes to remineralize before brushing
- Reducing excessive force on the teeth
- Wear a nightguard. This distributes and dissipates the force from grinding.
- Make sure you wear it every night.
- You can either have your dentist make one, order one from an online dental lab, or use our premium guide to fabricate a custom one at home.
- Reduce acid erosion of your teeth
- Avoid consistent exposure to acidic drinks, especially all types of soda
- Treat heartburn
- Don’t suck on lemons, limes, or sour candy
Is there any treatment for abfractions that have already developed?
If abfractions cause a tooth to become sensitive or pose a cosmetic problem you can have your dentist place a white composite filling to replace the missing tooth structure. Because the tooth surface is very smooth and often non-retentive, it can be more challenging to keep these fillings from coming out, especially if the forces that caused the abfraction are still present. These same forces will tend to break the bond of the filling material to the tooth surface over time.
Oral Cancer
How common is oral cancer?
Oral and pharyngeal (throat) cancers make up approximately 2% of all the cancers diagnosed in the United States. As of 2014, that was about 50,000 new cases each year. The most common type of oral cancer is known as squamous cell carcinoma with about 90% of the total cases.
What are the risk factors for oral cancer?
- Smoking tobacco
- Smokeless tobacco – Using smokeless can be better for preventing lung cancer but increases rates of oral cancer. Oral cancer usually appears where the tobacco is held in the mouth.
- Alcohol use – Increasing alcohol use is linked to higher rates of oral cancer
- Human Papilloma virus number 16 (HPV16) – This is a very common sexually transmitted disease. It causes anal, penile, cervical, and oral cancer. A vaccine is available for HPV now.
- A diet high in processed foods and low in fruits and vegetables is thought to be related.
- More commonly found in men, especially minorities
What is the long term prognosis?
The five year survival rate for oral cancer is 57% and hasn’t changed much over the years. The biggest challenge with oral cancer is that it is often discovered at a much later stage than other cancers, oftentimes after it has already spread to your lymph nodes or elsewhere in your body. The success rates of treatment are much lower for late stage cancers than early stage.
How is oral cancer detected?
Early stage oral cancer is most easily detected by your dentist at your routine visits. The most common locations for oral cancer are on the floor of your mouth, on the sides of your tongue, and between the cheek and gum tissue where smokeless tobacco is held. It usually starts as a non painful, red or white ulcerated area that looks similar to a canker sore or other type of injury to mouth. The biggest distinction is that areas of oral cancer will not go away whereas the other cases will almost always resolve within two weeks. If you have an area in your mouth that looks like this and doesn’t go away within two weeks, make sure to get it checked out.
Due to the rising incidence of HPV16, the back of your tongue, the back of the throat, and on your tonsils have become more common and are usually more difficult to detect as they don’t tend to develop the same kind of tissue changes.
Later stage oral cancers are often found once they have spread to the lymph nodes of the neck and start to cause more symptoms such as the feeling of a mass in your mouth, throat, or neck, pain, or numbness.
When a concerning area presents, your dentist or physician will usually refer you to a surgeon to have a biopsy of the area done. This is the only sure way to tell what is happening. It is better to be safe than sorry. I have had several patients within the last couple of years who I had to send out for a biopsy for oral cancer that came back positive. They had treatment done and are still alive today thankfully.
What kind of treatments are used for oral cancer?
The most common treatments for oral cancer are a combination of radiation, surgery, and chemotherapy drugs.
What are the side effects of treatment for oral cancer?
The side effects of treatment for oral cancer can be very challenging to manage both before, during, and after treatment. You should have a dental evaluation prior to treatment to fix any dental problems and remove any teeth that are in bad shape. Having teeth removed after radiation can cause a condition known as osteoradionecrosis of the jaw which causes significant pain and damage to your jawbone.
During treatment you’ll likely develop mucositis, which is inflammation of the tissue inside of your mouth. The outer layer of tissue will slough off and you develop painful mouth sores. Most treatments for this only seek to treat the symptoms. Common options include pain medication and magic mouthwash mouthrinse.
Treatment often includes some amount of surgery ranging from removal of a small amount of tissue to removal of your entire jawbone. After healing they can do some amount of reconstruction but it can be extremely difficult and usually requires a team of specialists to complete.
After treatment the mucositis usually resolves but you are often left with an extremely dry mouth. Radiation to the head and neck area destroys all the cells that produce saliva. Dry mouth can be uncomfortable as well as significantly increasing your risk of developing cavities. This is best managed by drinking water throughout the day, dry mouth mouthrinses, brushing with a prescription strength fluoride toothpaste, using a fluoride containing mouthrinse, and watching your diet closely.
My Tongue Is Stained!
There are a lot of different things than can stain your tongue or change it’s color. Let’s take a look at the most common reasons and what you can do to help.
Smoking
Smoking is the most common reason for a stained tongue. The heat and chemicals in tobacco cause the papilla (little projections) on your tongue to elongate. This creates a lot more surface area where stain from the tobacco and other foods and drinks can get caught. It usually ends up taking on a brownish black appearance on the top of your tongue. Occasionally you’ll get a yellow or greenish color as well. Scraping and brushing will help some but you won’t be able to rid yourself of it until you stop smoking and allow your tongue to heal.
Thrush
Thrush is the overgrowth of a yeast known as candida albicans on your tongue. Thrush looks like a white covering on the top of your tongue that you can wipe off. It is usually the result of taking antibiotics or a weakened immune system. Check out our post on thrush for for more information on what you can do for it.
Foods and Drinks
The most common foods that cause a stained tongue are dark drinks like coffee and tea. Other types of food that have heavy amounts of food coloring tend to stain your tongue as well. Reducing how often you consume these foods or drinks and brushing your tongue consistently can help quite a bit here.
Glossitis
Allergies, low iron, and a dry mouth are all causes of glossitis (inflammation of your tongue). In these cases your tongue swells slightly, takes on a very smooth appearance, and generally turns a pale red color. Once you figure out what is causing it and treat it, it should go away.
Acid Reflux
Acid reflux can cause your tongue to take on a yellow tint. Treat the acid reflux with medications and diet changes and it should help.
Nutritional Deficiencies
Several B vitamin deficiencies can cause your tongue to take on a bright or dark red color as well as becoming very sore.
Causes of Tooth Discoloration
There are a lot of different reasons for tooth discoloration. Let’s take a look at the major ones…
Fluorosis (Brown)
When children are exposed to higher level of fluoride than recommended, the developing permanent teeth tend to take on a mottled brown appearance. This can range from very mild staining to very heavy depending on how high the levels of fluoride were. Excess fluoride can come from natural water sources (certain areas have naturally high levels of fluoride) or from swallowing too much toothpaste as a child. This is an example of a pretty mild case.
Tetracycline staining (Gray)
Tetracycline staining occurs in permanent teeth as a result of certain antibiotics taken while the teeth were forming (most commonly tetracycline). It usually shows up as extremely dark staining on the permanent teeth oftentimes in horizontal lines. This used to be a pretty common occurrence, before the effects of tetracycline antibiotics on teeth were really known. Today, doctors generally don’t prescribe antibiotics that can cause permanent tooth discoloration. Treating tetracycline stained teeth can be challenging. The first option for treatment is the KOR Deep Bleaching System. This can only be done at a dentist’s office. It is the only whitening system that has proven effective at whitening tetracycline stained teeth. The second option is veneers to cover the stained teeth. Usually the dentist will need to remove about a 1/2 millimeter of tooth structure in order to make enough space for the veneers to block out the color from the tooth underneath.
Enamel hypoplasia (Brown)
Certain types of illnesses and high fevers during childhood can cause the permanent teeth to develop incorrectly. This can range from small isolated brown spots on the teeth to large, soft areas when the teeth come in. Sometimes treatment is needed but only your dentist can make this determination. If you do notice a permanent tooth that comes in not looking quite right, have it checked out as soon as you are able.
Trauma (Gray)
Trauma to a tooth, usually as a result of hard blow to the mouth or a fall, can cause several different things to happen. The most typical pattern is a graying of the tooth. This grayness is comparable to a bruise somewhere else on your body. With teeth, the bruising spreads into the underlying tooth structure and doesn’t go away with time. Some of these teeth will end up needing a root canal while others will be just fine. If you do end up getting a root canal, internal bleaching will sometimes be done to whiten the tooth. Without a root canal, the only option is to put a veneer or crown on the tooth.
Internal resorption (Pink)
Internal resorption is when the cells inside a tooth start to dissolve it from the inside out. This is often a result of trauma but sometimes can happen without any apparent cause. When the resorption has progressed significantly, the tooth will oftentimes turn pink. This is known as a pink tooth of mummery. A root canal done by an endodontist is usually the only option at this point. Sometimes teeth with internal resorption aren’t able to be saved, depending on how far it has progressed.
Baby teeth ready to come out (Pink)
Right before a baby tooth is ready to come out, sometimes it will turn pink. The remaining tooth has become very thin and you’re seeing the gum tissue through the tooth. No need to do anything here other than wait for the baby tooth to come out.
Decalcification (Chalky White)
Decalcification of the enamel of a tooth is the first step in a cavity forming. This shows up as a chalky whitish discoloration, usually right along the gumline but can also appear elsewhere. A lot of teenagers end up with these white areas around where the brackets for their braces were. It is almost always a result of excessive consumption of sugary and/or acidic drinks. If it progresses it will turn into a cavity. With a change in diet and better oral hygiene habits, the area can be remineralized and no treatment will be needed.
Cavities (Brown or Black)
Outright cavities on teeth are usually a brown or black color. They start off as areas of white decalcification, progress to light brown areas, and finally progress to a dark brown or black color. Occasionally, the outer layer of the tooth will stay intact and the cavity will continue to spread underneath. This shows up as a gray looking shadow. The only option in these cases is to have the cavities removed by a dentist and filled with a tooth colored material.
There are several other rare conditions that can cause changes in the color of the teeth. These include hyberbilirubinemia, osteogenesis imperfecta, and dentinogenesis imperfecta. These are pretty unusual and you’d likely have other health issues involved with them.
How Long Does Dental Work Last?
When most people have dental work done, they usually aren’t thinking ahead to what will happen when that filling, crown, or denture needs to be replaced or how they can extend it’s lifespan. They just want to get it over and get out of the dentist’s office! It is definitely something very important that you should think about! Let’s take a look at some different types of dental work, how long they last on average, and how you can maximize that lifespan.
Fillings:
Fillings usually last around 2-10 years. The range on fillings is huge because there is an extreme amount of variation in how large the filling is, the type of filling material, and how much force they receive. I’ve seen some as old as 40-50 years old. I’ve also seen some fail within a year. Fillings fail for one of two main reasons. The first, and most common reason is that they develop decay around them. This is largely preventable. Maintain a good diet, avoid the intake of sugary drinks and foods, and brush and floss well. See our tips on dental health for more specifics on what you can do to prevent decay. The second reason for failure is either the filling or the tooth around it breaking. If you are a grinder, you can avoid some premature wear by wearing a nightguard. For everyone else, fillings wearing out is just a fact of life. Your mouth is one of the most difficult environments for anything to stand up to. That is why teeth are made out of the hardest material in the entire body. Filling materials still aren’t nearly as good as what you naturally have.
Crowns:
Crowns usually last about 10 years but I’ve seen ones that have lasted over 50 years and also a few that have failed within a couple of years! The main reason crowns need to be replaced is if the tooth develops a cavity under the crown. As with fillings this is largely preventable. Flossing around crowns is especially important. Crowns can also fail if they break. Newer materials are much stronger but can still break with the repeated wear and tear of being in your mouth over the years.
Root Canals
This is where it gets a little tricky. Studies have shown that success rates of root canals range from around 92-97% over about an eight year period. Root canals done by endodontists (root canal specialists) have significantly higher success rates than those done by general dentists. It’s about 90% for general dentists and 98% for endodontists. The other important factors in a root canal’s success are the state of the tooth prior to the root canal and having the final filling and/or crown done as soon as possible after the root canal is completed. Root canals usually fail by the tooth becoming reinfected and this has little to do with how well you take care of the tooth afterwards (but it can make the crown or filling in it fail faster).
Dental Implants
Studies have shown dental implant success rates from about 95-99% over varying time periods (anywhere from 2-16 years). Dental implants are the newest treatment option in dentistry and don’t have the same kind of long term studies as many other treatments do but what information we do have suggests that they are a very stable long term option for tooth replacement. The most common failure for a dental implant is when it develops an infection around the implant that destroys the bone in the area. This is known as peri-implantitis and is very similar to periodontal disease. You must take care of an implant just like a regular tooth. That includes brushing and more importantly, flossing around it regularly.
Partial Dentures (some teeth remaining):
The lifespan on partial dentures is difficult again because there is a huge variation in number of teeth remaining, materials, etc. On average we like to see at least 5-10 years before they need to be replaced. Some will need to be replaced or repaired before this and some will last significantly longer. The most important things you can do extend the lifespan is to take care of your other teeth. If you lose additional teeth due to decay or periodontal disease, you may need a new partial or even have to get a full denture.
Complete Dentures (no teeth remaining)
Most full dentures last at least 10 years before needing to be remade entirely. Sometimes you’ll need a reline or two during this time period as your gum tissue shrinks but the teeth generally hold up pretty well. If you have your natural teeth biting against a denture, the teeth will wear down significantly faster than if you have both bottom and top dentures.
Periodontal Disease and Pancreatic Cancer
It seems like every day that a new study comes out with another link between dental health and overall health. There is still a pretty big disconnect between dental and medical providers but hopefully that will continue to change as more and more evidence comes out.
The latest study to come out is from the Harvard School of Public Health. They followed 51,000 men over the course of 16 years. Of the 51,000 men, 216 of them developed pancreatic cancer. Pancreatic cancer, for those of you who aren’t aware, is one of the most deadly forms of cancer to be diagnosed with. The one year survival rate is approximately 20% and five year survival rate is around 6%. At this point pancreatic cancer is largely considered incurable. So back to the study. Researchers found that after controlling for other factors, pancreatic cancer risk was increased 63% for those with a history of periodontal disease vs those without a history of periodontal disease. This isn’t foolproof evidence that periodontal disease can contribute to a higher risk of pancreatic cancer, but it does add to a growing body of information that suggests that periodontal disease is involved in many long term health problems.
The next time you look at that floss and think “nah”, remember that 20 seconds of flossing a day will likely reduce your risk of a great many health problems long term.