North Penn Endodontics

Fluoride: Nature’s Cavity Fighter

Fluoride Natures Cavity FighterNobody likes coming to the dentist to have a cavity filled! Many of our patients ask us how stop a cavity before it happens. Many people have heard of fluoride but wonder how it works and if it is safe. We wrote this blog to answer your questions about fluoride and to help you understand its benefits and how to use it effectively.

Fluoride occurs naturally in certain foods. You might be surprised to learn that it can be found in black teas and raisins, and in our water sources, such as lakes and rivers. And, because it provides such good protection from tooth decay, it has been added to dental products to help prevent cavities.

Fluoride works for both children and adults. It’s true! Before teeth even erupt through the gums, fluoride taken in from certain foods and supplements makes tooth enamel stronger and therefore more resistant to decay. After teeth erupt, brushing with fluoride toothpaste helps rebuild (remineralize) weakened tooth enamel, reversing early signs of cavity formation. In addition, the fluoride you consume becomes a part of your saliva, constantly bathing your teeth with tiny amounts of the cavity fighter. While it is critical for infants and children to be exposed to fluoride when primary and permanent teeth are forming, new research indicates that topical fluoride is just as important in fighting tooth decay for adults!

Use the correct amount of toothpaste to benefit your teeth. While all toothpaste removes plaque (a thin film of bacteria that can cause gum disease and tooth decay), only toothpaste with fluoride can prevent tooth decay by making teeth stronger. Make sure you’re using the correct amount of toothpaste with your children!

  • For very little ones, under 3 years of age, parents and caregivers should begin gently brushing teeth as soon as they come into the mouth with an amount of fluoridated toothpaste the size of a few grains of rice.
  • For children ages 3 to 6, a pea-size amount of toothpaste is best. Everyone should brush their teeth twice a day and make sure to supervise children to help instill good habits.

Some mouth rinses also contain fluoride. You may already be protecting your teeth with fluoride without even knowing it! However, mouth rinses should not be used with children under the age of 6, as they may not be able it use it appropriately. 

You may have fluoride in your water. Your community may have chosen water fluoridation (simply adding fluoride to drinking water) as a public health benefit. Water fluoridation is safe, effective, and healthy. The Center for Disease Control has noted water fluoridation as one of the ten best public health achievements of the 20th century.

For your best dental hygiene routine, ask us during your next visit about the right fluoride products for you and your family. Your oral health is our priority so we want to answer any questions that you have. Armed with the right information, your family can have healthy teeth for life. Contact our office to schedule your next visit! We can’t wait to see you soon!

Getting to the Root of An Apicoectomy

Beautiful golden transparent tooth with roots illustration. Healthy teeth care symbol.

Beautiful golden transparent tooth with roots illustration. Healthy teeth care symbol.

Just saying the word “Apicoectomy” is a mouthful! But don’t be put off by the name, it’s a simple and routine procedure that is effective in treating infections that may occur following root canal treatment.

What is an Apicoectomy? Teeth are held in place by roots that reach into your jawbone. The tip of the root is called the “apex” and this is where nerves and blood vessels enter your tooth. These nerves and vessels travel through a canal inside the root and into the crown, or visible part of your tooth. During root canal treatment, inflamed or infected tissue is removed from the canals. Canals are very complex, with many tiny branches, and occasionally infected debris remains in the tooth and prevents healing or causes re-infection. During an apicoectomy, the root tip, or apex, is removed, along with the infected tissue, and is replaced with a filling to reseal the end of the root.

Who needs an Apicoectomy? An apicoectomy is done only after a tooth has had at least one root canal. In many cases, a second root canal is considered before an apicoectomy. With advances in imaging, we can often detect infected canals that had not been appropriately treated in the past and treat them without the need for surgery. But if an infection persists, it is often near the root tip, and an apicoectomy is an important surgical procedure that can save your tooth from extraction.

What is the follow up? Most apicoectomies take 30 to 90 minutes, depending on which tooth it is and how complicated the root structure is. Your endodontist will use ultrasonic instruments and surgical microscopes to see the area clearly, which will increase the chances of success. The area may bruise and swell slightly in the area around the tooth. Follow up includes over the counter pain relievers or prescription medication. Stitches will be removed 2 to 7 days after the procedure, and full recovery can be expected within 2 weeks. While apicoectomy sounds complicated, most people report that the recovery is easier than that of the original root canal.

If you are having any pain or swelling from a tooth that has had a root canal procedure, please don’t hesitate to call us! We can review your treatment options and answer any questions you may have. Fortunately, an apicoectomy is usually a permanent solution and should last for the life of your tooth!

HPV and Oral Cancer: The Connection

With cases of oral cancer, specifically oropharyngeal cancer (the back of the throat), on the rise among those under 40 years of age, we as oral health professionals are trying to get the word out about the various causes of oral cancer and the importance of early detection.

Oral cancer has historically been attributed at the highest rates to smokers. However, with smoking on the decrease, HPV is expected to take over the role as the biggest contributor to certain types of oral cancer (oropharyngeal) in the coming years.

Here are some answers to commonly asked questions about HPV and oral cancer:

  1. What is HPV? HPV (Human Papilloma Virus) is a very common sexually transmitted infection. Typically HPV goes away on its own without causing any health problems. In fact, most people don’t ever know that they have it, which is also one of the reasons that it spreads so easily. Even if you are not symptomatic, you can still spread HPV.
  2. How does HPV cause oral cancer? Occasionally, HPV does NOT go away on its own and causes problems down the road. There are specific types of cancer that HPV can lead to. For example, cervical cancer is almost always caused by HPV. Oropharyngeal cancer (the back of the throat, not the main oral cavity) is another type of cancer that can be caused by HPV.
  3. Why is oral cancer on the rise among younger people? Studies show that most cases of oral cancer among young people are caused by HPV. Therefore, as the incidence of the virus grows, so does the incidence of oral cancer.
  4. What can I do to protect myself? All girls and boys ages 11-12 years old should be vaccinated against HPV. The vaccine is also approved for other specific groups (check for more information). Those who are outside of the vaccination age group should practice safe sex.
  5. What about early detection do I need to know? As with many cancers, early detection is the key to a good prognosis. Self-examinations by you and regular examinations by us are the most important things you can do to protect yourself.

Please note that this information is intended to inform, not scare. Although oropharyngeal cancers are increasing in incidence, they are still a very small risk in our world. Be informed and be proactive!

Microsurgery: Better than Ever Before

Over the last 10-15 years, the field of endodontics has changed dramatically with considerable improvements in particular in the area of endodontic surgery! In fact, studies have shown that the traditional method of apicoectomy was fifty percent less successful than the current microsurgical success rate.

Why? The most important reason for the increased success rate has to do with the microsurgical materials and instruments themselves.

Here we offer a run-down of benefits of modern microsurgery over traditional apicoectomy methods:

  • Visual Enhancements – The microscope offers a more accurate visualization (both magnification and illumination) of infected canals and irregular anatomies, which leads to better identification and treatment.
  • Smaller Osteotomy – Better visualization and smaller instruments allows us to work within smaller osteotomies. This reduces the amount of bone that needs removing and therefore offers a quicker healing time and reduces the risk of tooth loss down the road.
  • Better Access to Difficult Areas: With microsurgery, we have enhanced access to narrow spaces and other difficult anatomical sites for irrigation.
  • Less Damage: Enhanced visualization allows us to avoid damaging nerves and the maxillary sinus.
  • Better Cleaning of the Apical Canal Space: Traditionally it has been very difficult to fully sterilize the apical canal space because it is very complex in its anatomy.
  • Enhanced Root-End Fillings: Ultrasonic tips are now specially designed to allow for preparation without reducing visibility – this results in a better seal of the filling.

All of these advancements help us save more teeth than we ever could before!

The Five Enemies of Tooth Enamel

It’s true: Enamel is the hardest substance in your body. However, it is not invincible! Our teeth are covered in enamel. It is the first line of defense against cavities and decay, the very substance that protects the interior, living parts of your tooth! No wonder it takes a beating! This all adds up to one fact: the better you take care of your tooth enamel, the longer you will get to keep your natural teeth! Fluoride is one way that we protect your tooth enamel, and even strengthen it. Fluoride has the ability to both protect your teeth from demineralization and re-mineralize it (strengthen the enamel).

In addition to using toothpaste with fluoride and having fluoride treatments in our office, here are five ways that you can help to protect your tooth enamel:

  1. Avoid and rinse after acid: Fruit juices, sodas and acidic fruits soften the enamel in your mouth, and are very bad for your teeth. So if you do enjoy one of these treats, rinse after you are done with it. DON’T brush immediately, as your enamel will be vulnerable to breakage for the next hour.
  2. Don’t chew things that aren’t food! If you have a habit of chewing things like pencils, ice, popcorn kernels and, yes, fingernails, PLEASE STOP! Your teeth were designed to grind and chew up food, not ultra hard substances. Chewing these items can chip away at enamel and even fracture a tooth.
  3. Cut back on sugar: There are many reasons why you should reduce your sugar intake, and among the most important is for the health of your teeth! Sugar reacts with bacteria to create acid, and we know how bad that is for your tooth enamel!
  4. Don’t be a teeth grinder. If you grind while you sleep, you are damaging your teeth enamel. Ask us about solutions to stop grinding!
  5. Be gentle. In general, you should be gentle with your teeth, even when brushing. You may think that you need to brush hard to get all of the sugar bugs out of your mouth, but it’s not true. Hard brushing can lead to chipped enamel.

If you take care of your tooth enamel, it will take care of you!

Endodontic Retreatment: When Root Canals Fail

As with any dental or medical procedure, occasionally, endodontic treatment does not live up to its expected results and the root has to undergo retreatment. You may have noticed pain in the tooth or you may have no pain at all. Either way, with detailed imaging, we can see when root canal therapy has failed and when it is time for retreatment.

Why does it happen? Some of the most common reasons for a root canal to fail include:

  • Narrow canals: If your canals are too narrow or curved, this may have made it difficult for the original procedure to be performed thoroughly.
  • Inadequate Seal: After cleaning a root canal, we fill it with a restorative material. If that material doesn’t make a complete seal, reinfection is possible.
  • Complicated Anatomy: If your canals are shaped abnormally, the original treatment may have missed areas that needed cleaning.
  • Delayed Restoration: If there was a delay between the initial treatment and the placing of the crown or other restoration, reinfection may have occurred.
  • New Decay, Cracks or Fractures can introduce new infections into the root area.

Surgical vs. Non-Surgical Retreatment

Our first choice is always to save your natural tooth using the least invasive means possible. Natural teeth are far superior to their artificial counterparts when it comes to nutrition, lifestyle, aesthetics and the long-term health of your jaw.

During endodontic retreatment, we will need to essentially “reopen” your tooth to access the root area, removing the original restoration in the process. If your canals are too narrow or obstructed, we may need to perform an apicoectomy (surgical treatment) instead of a traditional, non-surgical root canal.

And, lastly, if neither of these methods presents a viable option to save your tooth, really our only other course of action is to remove the tooth. Since the removal of a tooth causes additional restoration work down the road, which can be more expensive, we always try to save the tooth first!

If you are experiencing pain in a tooth that previously underwent root canal therapy, give us a call! We can help you decide if retreatment is right for you!

It’s Alive! Your Tooth, That Is!

People often wonder, “How does a tooth get to the point of infection?”

It’s a common misconception that teeth are not alive. That belief leads to confusion about how teeth become infected. Because you can’t “feel” the part that you can see (the crown), many people think that their teeth are not alive. Yet, the opposite is true. Most of the material that makes up your teeth is, in fact, made of living cells. Since the material is alive, it makes a great hosting site for bacterial infections!

Similar to hair and fingernails, there is a part of your teeth that is not alive – it is the outermost part, called “enamel”. This is the hard, white part that you can see. It is made of calcium phosphate, a very hard mineral that is perfect for breaking down food when you eat. Underneath that enamel, however, is where all of the live action happens!

Starting on the outside and working our way in, we find dentin (alive), and then the pulp cavity and root canal, through which nerves and blood vessels flow.

Generally speaking, if the enamel is intact, bacteria cannot get through to the pulp to cause problems. However, if there is a crack in the outer part of the tooth due to injury or decay, this creates a pathway for bacteria to enter into the innermost part of the tooth (the pulp cavity and canal) causing infection of the living tissue.

That is when endodontic treatment becomes essential! The only way to remove the infected material is manually, by accessing the canal itself, irrigating and then filling, or closing off access, to the inside of the tooth again.

The Many Faces of Tooth Pain

Here, we offer a guide to some common types of tooth pain and what that pain may be trying to tell you:

Sensitivity to hot and cold foods:

If the pain is short-lived, you probably do not have a serious problem, but more likely a loose filling or a small amount of gum recession that has resulted in root surface exposure. Use sensitive teeth toothpaste and a soft brush with an up and down motion. If this doesn’t help after a week or so, give us a call.

Heat sensitivity after an appointment:

Some types of dental work can inflame the pulp inside your teeth, causing sensitivity for several weeks. If it lasts longer than that, let us know.

Sharp pain when biting:

Sometimes sharp pain can be caused by a loose filling, other times it may signal that there is a crack in your tooth. Either of these scenarios requires evaluation by a professional, so please give us a call.

Pain/Sensitivity lasting longer than 30 seconds:

Often this means that the pulp (innermost part of your tooth) has been damaged. Without intervention, you may lose this tooth so it is important to call us to find out if you may need root canal treatment.

Frequent, dull aching in the jaw.

This can happen when excessive grinding of the teeth happens (bruxism), or it could even be a sign of a sinus headache or infection. Please call us for more information.

Severe pain, pressure or swelling of the gums:

This may mean that you have an abscessed, infected tooth that may have spread to other tissues in the mouth. This is a serious situation that requires an immediate call to our office for instructions.

What is an Apicoectomy?

“What is an Apicoectomy? Is it surgery? Is it painful? And why do I have to have one?” In our practice, we hear these question almost every day, so we thought we’d take a moment here to clarify what an apicoectomy actually is.

Word Origin:

To better explain what an apicoectomy is, let’s look first at the origin of the word. As is true with most medical terminology, the key to understanding this procedure lies within the origins of the word itself.

Your teeth are comprised of many parts, the main three being the crown (the part that you can see), the root canals (the long skinny parts that extend from the crown into the jaw) and the root tip, also called the “apex”, which comes from the Latin word meaning “tip” or “point”.

When a patient complains of infection or pain in a tooth that previously had root canal treatment, often it is because there is a problem in the apex area. So, during an “apicoectomy”, we remove (“ectomy”, from the Latin word excise) the apex (“apico”) along with any additional infected tissue that we find.

The Procedure:

Usually, local anesthesia is all we need to make you comfortable during the procedure, which takes about 30-90 minutes to complete. In fact, many patients have reported that the apicoectomy was even less painful than the original root canal treatment!


You may be sore or numb for a few days after the procedure, but usually over-the-counter anti-inflammatory drugs (NSAIDs) such as ibuprofen are all that is needed to control the pain. We will remove the stitches 2-7 days after the procedure, and most soreness and swelling will be gone by 14 days.

If you have any questions about apicoectomies or other procedures, please don’t hesitate to contact our office for more information!

Bringing Teeth Front and Center: Why Oral Hygiene is So Important

Fact: 75% of parents report that their children forget to brush their teeth from time to time.

Fact: 51 million school hours are lost annually due to kids with dental related illnesses.

Bringing-Teeth-Front-and-CenterWhen you combine these two facts, you would think that it is easy for the professional dental community to explain to kids and parents why oral hygiene is so important. Yet, we still have a long way to go when it comes to getting this message across properly!

Although the teeth are, without a doubt, part of the body, they have perhaps not been given the respect that they deserve during the childhood years.


It is understandable that, in times past, when a child was young, it seemed pointless to take care of their “baby” teeth, as they were going to fall out anyway.

>>Yet we now know that it is essential to take care of so-called baby teeth and even the gums before teeth erupt to ensure a life of good oral health.


As parents, we have all had those mornings and nights where asking our child to brush his or her teeth turned into a battle at best, and a tantrum at worst! So, understandably, we frequently backed down or even “forgot” to make them do it. >>But those moments of “forgetfulness” add up very quickly at this age and can cause decay that turns into cavities, abscesses and root damage in the near future.


If you are lucky, your teen will be more than willing to keep up on proper tooth brushing habits out of fear of teasing and other uncomfortable social situations. However this is not true for all teens.

>>This is the age where oral hygiene is even more important, catching any cavities before they turn into bigger problems. Also, if your teen has braces, they need extra care to keep the mouth in tiptop shape!

So please help us spread the word! Teeth are not a part of the body that can be ignored – they are the window to your body and overall health. The earlier that you set those good oral hygiene habits, the better oral health results you will see as your child grows up!