Another LOST TOOTH After a Root Canal Treatment

 So today I had to take out another tooth after the patient had a root canal treatment.

So many times patients come in and tell me how they had a root canal treatment and later had to have the tooth extracted as if this was caused by the root canal.  Sometimes root canals do fail and the tooth is lost but most of the time this is not the case.   The overwhelming amount of teeth that I extract after root canal treatment is because after the treatment the tooth was not restored properly.  That means that after the root canal a proper filling was not placed in the tooth and a crown was not placed on the tooth.

After root canal treatment the teeth are weakened and are prone to breakage and this happens a lot.  Unfortunately when this happens many times there is nothing left for us to do but extract the tooth.

So a little bit of friendly dental advice, get the crown after the root canal and protect your investment.

Doing dentistry in Hamilton Ontario

All the best

Dr. Ron Barzilay

https://thehamiltondentist.com/

www.rondentist.com

It's ok to pull that tooth Doc, I already stopped my Blood thinners!

Doc, it is OK to pull that tooth, I have already stopped my blood thinners!

WELL WHO ASKED YOU TO STOP YOUR BLOOD THINNERS?

Alot of patients coming into the office, are on blood thinners and have a lot of questions.  Some patients come into the office and are on blood thinners and already have the answers.

Most people who are taking blood thinners are taking them to prevent blood clots in their blood vessels that could end up moving and blocking major vessels or structures.  The ensuing loss of oxygen to the blocked structures could have major consequences for the patient, including death.

This is a concern in dentistry since almost every procedure we do may cause bleeding.  From fillings, to cleanings, to extractions, to periodontal surgery, to root canals and so on.  In dealing with the thousands of patients that we have here in our office we must always be careful with those patients who have bleeding tendencies. 

Bleeding tendencies can be subidivided into those patients who have natural bleeding disorders and those patients whose bleeding is caused by medication that they are taking to "thin" the blood.  In this blog I am talking about those patients taking blood thinners as those are the majority we see.
 Many patients are taking Warfarin type medications and many are taking Aspirin.  Those patients taking Warfarin medications can have a largely increased clotting time.  Those patients on Warfarin have a test done called INR (international normalized ratio).  This INR is a target goal for coagulation depending on the underlying condition so that a patients' dosage is adjusted to the target goal.  In most situations a dentist can still work without having the patient stop his medication.  This will depend on the patient specific factors such as the INR, patients overall health, expected bleeding and the length of the procedure.
Many patients are on low dose Aspirin.  This usually does not represent a problem and most dental procedures can go ahead without any change.
Patients on Heparin are usually in a hospital setting so that is really not an issue but today there is is LMWHs (low molecular weight heparin) which allows the use of Heparin type medication outside the hospital setting and this may require stopping a patients medication.

After all this, the question really is what should you the patient be doing?  The answer is very simple.  Speak to your dentist, he will have the answers and if he doesn't he will be in touch with your physicians to dicuss the proper treatment for your specific situation.  In most cases you will not have to ask your dentist as your dentist will be discussing it with you.  In consultation with your physician he will tell you wether you need to stop medication or continue.  Most important never do anything on your own. Stopping your medication even for a short time on your own may have a very negative affect.  No matter what you read on the internet or heard on Oprah.  Speak to your dentist, because every situation is different and there are no cookie cutter solutions.

All the best

Dr. Ron Barzilay

enjoying dentistry in Hamilton, Ontario Canada

www.rondentist.com

Is it time to have all my teeth out?

How many times has a patient come in and said, "Dr. I want all my teeth out!"
So many times I have said, YES you are right it is time to have them out and so many times I have said, NO it is not time.

How does a dentist decide whether  this patient needs or should have all their teeth out?
There are a number of issues we must look at before arriving at the decision.  Remember, once you take them out, you can't put them back.  Afterwards the patient may have to deal with other issues such as retention of a denture, gaginess and general discomfort.  And of course, even though a patient wants all his teeth out that doesn't mean that we have to do it.

The simpler cases are when the patients teeth are hopeless.  When, the teeth are so rotten or the teeth are moving so much that there is really no choice but to extract all of the patients teeth and make them dentures.  It starts to get complicated when those rotten teeth can be fixed and those receded gums can also be stabilized.  Then what?
A partial denture is better than a full denture because it is more stable in the mouth since it can use solid teeth as aids for stabilization.  Of course, no denture is the best, if we can just fix your teeth or create a fixed bridge.  Nothing to take out and of course the feel is the most natural.

So here we move into the grey area.  A patient comes into the practise and he has a fair number of teeth that are decayed and moving.  He has not brushed his teeth in a number of years.  When I ask him if we can fix his teeth will he start brushing them?  He answers NO.  Then the teeth are going to be lost no matter what and there is no point in wasting time trying to save these teeth because no matter what they will develop new problems again after we have done all the work to fix them.

A patient comes in with decay in his teeth, we fix all the teeth and then 6 months later the patient returns with large amounts of decay just as he had entered on the first day.  He now tells us that he has 5-6 Tim Horton's triple triples every day.  (That is triple sugar with the coffee)  He says he refuses to stop this as it is his one vice.  In this case we would also take the teeth out since the battle is lost before we even fired the first shot.

Sometimes a patient will come in who hasen't seen the dentist in 15 years, she may have 1-2 cavities and a lot of cleaning to do, but she is adamant that she needs all her teeth out.  Well of course we won't take her teeth out because she doesn't need it.  We will try to make the patient understand that their situation doesn't need such drastic measures and that they would be a lot happier with their own teeth.

All of these situations have happened to me and were dealt with as I have described.  Every case is different and requires a different response.  On the whole, keeping your teeth is better than extracting them, even keeping a few teeth is better than extracting them all but in some situations extracting all the teeth is the treatment of choice.   The black and white cases are easy to decide.  But through years of experience, through discussions with our patients of their needs and wants, we learn to make the proper and informed choices in the gray zone.

All the best

Don't forget to come visit us at  www.rondentist.com