By Carol Haddad, DMD
August 16, 2017
Category: Oral Health
Tags: oral cancer  
ThisYoungWomansCancerExperienceaTeachableMomentforallofus

With college, a full-time job and an upcoming wedding to plan, Brooke Vitense had the hectic life of an average young woman in her twenties. But a chance discovery one morning would completely upend her normal life.

That morning Brook noticed white spots on the underside of her tongue while brushing her teeth. Not long after, she pointed out the spots to her dentist during her regular dental checkup. He recommended having the spots biopsied, just to be safe. She needed a wisdom tooth removed, so she scheduled the biopsy with her oral surgeon to coincide with the tooth extraction.

She soon forgot about the biopsy — until her dentist contacted her about the results. The lesions were pre-cancerous: he recommended she have them and a portion of her tongue removed surgically as soon as possible.

She underwent the procedure, but that wasn't the end of her ordeal. The follow-up pathology report indicated cancerous cells in the tissue excised during the procedure. To ensure elimination of any remaining cancerous cells they would need to remove more of her tongue as well as the lymph nodes from her neck.

Brooke survived her cancer experience and has since resumed her life. Her story, though, highlights some important facts about oral cancer.

Oral cancer is life-threatening. Although cases of oral cancer are rarer than other types of malignancies, the survival rate is low (50%). This is because lesions or other abnormalities are often dismissed as simple sores. Like any cancer, the earlier it's detected and treated, the better the chances for survival.

Anyone of any age can develop oral cancer. While most cases occur in older adults, young and otherwise healthy people like Brooke are not immune. It's important for everyone to make healthy lifestyle choices (good oral hygiene and nutrition, moderate alcohol use and avoidance of tobacco) and see a dentist whenever you see an abnormal sore or spot in your mouth.

Regular dental checkups are crucial for early detection. Had Brooke not seen her dentist soon after discovering the spots on her tongue, her survivability could have been drastically lower. Regular dental visits (and cancer screenings if you're at high risk) could mean all the difference in the world.

If you would like more information on the signs and treatment of oral cancer, please contact us or schedule an appointment for a consultation. You can watch Brooke's interview by visiting How a Routine Dental Visit Saved My Life

FacialNervePaincanbeManagedwithEffectiveTreatment

Life would be harrowing if we had no ability to feel pain. Although experiencing it is unpleasant, pain's purpose is to alert us to something wrong in our body. Without pain diseases and other problems could worsen to the point of life-threatening.

But pain without a purpose — the nerves simply misfiring — can make life miserable. This can happen with the trigeminal nerves that exit the brain stem and end on each side of the face. Each nerve has three branches that serve the upper, middle and lower parts of the face and jaw.

When they don't work properly, trigeminal nerves can give rise to a disorder known as trigeminal neuralgia. Beginning often as an occasional twinge, they may escalate to several seconds of mild to excruciating pain occurring over weeks, months or even years. An episode may erupt from chewing, speaking or even lightly touching of the face.

We see this condition most often in people over fifty, particularly women. We don't know the exact cause, but there's strong suspicion that the nerve's protective sheath has been damaged, similar to what occurs with multiple sclerosis or other inflammatory conditions. Another possibility is a blood vessel putting pressure on the nerve and disrupting its normal operation. Such an impinged nerve might transmit pain signals at the slightest stimulation and then fail to “switch off” when the stimulation stops.

Although we can't cure trigeminal neuralgia, we can help you manage it and reduce discomfort during episodes. We'll first try conservative, less-invasive techniques, like signal-blocking medications or drugs that reduce abnormal firing.

If these aren't effective, we may then recommend a surgical solution. One such procedure is known as percutaneous treatment in which we insert a thin needle to selectively damage nerve fibers to prevent their firing. If we've determined an artery or vein has compressed the nerve, we might surgically relocate the vessel. These techniques can be quite effective but they do have possible side effects like numbness or hearing loss.

If you've experienced facial pain, don't continue to suffer. Visit us for a complete examination and learn about your options for pain relief. More than likely, there's a way to reduce your pain and improve your quality of life.

If you would like more information on facial pain, 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 “Trigeminal Neuralgia.”

AreYouintheKnowAboutDentalCrownsTakeourTrueorFalseQuiz

So, you're about to have a tooth capped with a crown. Do you know what you need to know before you undergo this common dental procedure?

Here's a short true or false quiz to test your knowledge of dental crowns.

All crowns are the same. False — while all crowns have the same basic design — a life-like prosthetic tooth fitted over and bonded or cemented to a natural tooth — their compositions can vary greatly. Early metal crowns consisted mainly of gold or silver and are still used today. Porcelain-fused-to-metal (PFM) crowns — a metal interior for strength overlaid by a porcelain exterior for appearance — became popular in the latter 20th Century. Although still widely used, PFMs have been largely surpassed by newer all-ceramic materials that are stronger than past versions.

Crowns can differ in their artistic quality. True — all crowns are designed to replicate a natural tooth's function — in other words, enable the tooth to effectively chew again. But a crown's appearance can be a different story, depending on how much attention to detail and artistry goes into it. The higher the individual craftsmanship, the more lifelike it will appear — and the more expensive it can be.

With digital milling equipment, dental labs are obsolete. False — although technology exists that allows dentists to produce their own crowns, the equipment is not yet in widespread use.  The vast majority of crowns are still produced by a trained technician in a dental laboratory. And just as you base your choice of a dentist on your confidence in and respect for them, dentists look for the same thing in a dental lab — good, reliable and consistent results.

Your insurance may not cover what your dentist recommends. True — dental insurance will typically pay for a basic, functional crown. Aesthetics — how it will look — is a secondary consideration. As a result, your policy may not cover the crown your dentist recommends to function properly and look attractive. A new crown, however, is a long-term investment in both your dental function and your smile. It may be well worth supplementing out of pocket your insurance benefit to get the crown that suits you on both counts.

If you would like more information on crown restorations, please contact us or schedule an appointment for a consultation.

By Carol Haddad, DMD
July 09, 2017
Category: Oral Health
Tags: canker sore  
YouDonthavetoSufferfromIrritatingCankerSores

We've all had them — tiny sores that pop up seemingly out of nowhere under the tongue or the inside of the cheek. They're named aphthous ulcers, but are more commonly known as canker sores. For some people, they can be a recurring irritation.

Round with a yellow-gray center surrounded by reddened skin, aphthous ulcers seem to coincide with periods of anxiety or stress, or as a result of some minor trauma. Many people will feel a tingling or painful sensation a few hours or days before the ulcers appear. Once they appear they usually persist for a week to ten days before finally drying and healing. In the meantime they can be painful, especially while eating or drinking.

One form known as recurrent aphthous stomatitis (RAS) affects about a quarter of the population with outbreaks of multiple ulcers that occur regularly. RAS ulcers are usually one centimeter or more in size — the larger the sore the more painful they tend to be.

There are ways to ease the discomfort of an ulcer outbreak and help hasten their healing. A number of over-the-counter products can be used in minor cases to numb the area temporarily and cover it to facilitate healing. We can also apply steroids or inject other medications for more severe cases. You may also find curbing your eating of certain foods like tomato sauce, citrus or spicy dishes can help.

For the most part aphthous ulcers aren't dangerous. In some situations, though, you should seek dental or medical evaluation: a sore that doesn't heal within two weeks; increases in severity, frequency or duration of ulcers; or when you don't seem to ever be without an ulcer in your mouth. We may need to perform tests, including tissue biopsy, to make sure there aren't any underlying systemic conditions causing the ulcers.

More than likely, though, you'll only need relief from the aggravation caused by aphthous ulcers. Among the many remedies, there's one right for you.

If you would like more information on aphthous ulcers or other mouth sores, 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 “Mouth Sores.”

AnswerstoCommonQuestionsAboutRootCanalTreatments

A root canal treatment is a commonly known but often misunderstood procedure. Contrary to popular belief, these treatments aren't painful — in fact, they often stop a toothache. More importantly, a “root canal” can give a tooth on the verge of loss another lease on life.

Still, if you've never experienced a root canal treatment before, you probably have questions. Here are the answers to a few of the most common.

Why do they call it a “root canal”? This is the popular shorthand term for a procedure that removes diseased tissue from a decay-infected pulp, the innermost part of a tooth and the actual root canals themselves. Root canals are the narrow, hollow channels that run from the tip of the root to the pulp and are also involved in the procedure.

Why do I need one? Once infected, the pulp's bundles of blood vessels, nerves and other tissues become diseased. This often results in a painful toothache that can also suddenly disappear once the nerves within the pulp die. But there's still a problem: If we don't clean out the diseased and dead pulp tissue, the infection could spread through the root canals to the bone and endanger the tooth's survival.

What happens during the procedure? After deadening the tooth and surrounding gums with local anesthesia, we enter the pulp through an access hole we create. Using special instruments we remove the diseased tissue and shape the root canals to seal them with a filling material called gutta percha. Sealing the access hole is then necessary to prevent re-infection. Later we'll cap the tooth with a porcelain crown to restore its appearance and add further protection against fracture or cracking of the tooth.

Who can perform a root canal treatment? In many cases a general dentist can perform the procedure. There are some complex situations, however, that require a root canal specialist with additional training, expertise and equipment to handle these more difficult cases. If your tooth is just such a case it's more than likely your general dentist will refer you to an endodontist to make sure you get the right kind of care to save it.

If you would like more information on root canal treatment, 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: What You Need to Know.”





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