An Update and A Lesson

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

Here we are, about to enter the holiday season already and I want to remind you that Spring Lake Dental Group remains committed to your safety in assisting in fighting this pandemic. My physician friends are starting to use the word “endemic” as they evaluate the results and recommendations from CDC but continue to use extreme vigilance when enforcing all of the protocols in preventing the spread of this deadly virus among our patient population. We are not there yet but encouraging the vaccination of our younger population is going to be key in gaining the upper hand in combating this pandemic. I hope to have a modified holiday celebration with my large family this year as we have not gathered formally for a year and a half. 

I would also like to remind you that the practice will be closed on Thursday, November 11, 2021 in honor of Veteran’s Day. As we are located in the center of the military universe here at Fort Bragg, I wanted my patients and employees/health care workers to have the ability to reflect on this occasion and to honor their service and sacrifice.  As is our custom, the reception room will have a Missing Man table erected in recognition of those veterans who are no longer among us.  From November 8-23, 2021, I invite you to bring in any pictures or mementos that honor any past service member and place them on the table to help drive home the message of their service to our great country.

Our training day this week was dedicated to learning more about vital pulp therapy. This is a term which describes treatment options on teeth that have deep carious lesions that involve or potentially involve the pulp of the tooth. Once decay decalcifies the tooth and penetrates the enamel, it is into dentin which is the protective layer over the pulp of the tooth. The pulp contains arteries, veins, lymphatics and nerve tissue that consist of the living parts of the tooth. The outer dentin is not very porous, but as you get close to the pulp, the dentin becomes microscopically much more porous. Therefore, any restorative materials that you place on deep or porous dentin are going to have a large affect on the vital pulp. Materials have been used in the past that have attempted to calm down pulpal tissue and stimulate a reparative dentin bridge over this area. But recent advancements have allowed us to achieve this result much more predictably.

When you have a carious exposure of the pulp, the traditional approaches have been to attempt a direct pulp cap with materials such as calcium hydroxide or to advance directly to a root canal. Root canals are expensive and deprive the tooth of vitality. Attempting vital pulp therapy is a conservative technique which has traditionally not resulted in a positive outcome. But newer materials that have been developed are allowing us to manage our patients with a much better chance or retaining a vital tooth that is asymptomatic. A bioactive trisilicate (Biotine by Septodent) has been shown to cover exposed pulps that are healthy and only reversibly symptomatic and keep the pulps healthy and vital. They also have been shown to stimulate the odontoblasts (dentin cells that produce new or reparative dentin) to lay down a reparative dentin bridge over this exposure. By using this technique, we can often avoid time consuming root canal therapy that usually also requires crown coverage of the tooth.