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At Central New England Endodontics and Implantology we love learning trivia and interesting facts about Thanksgiving! This year, Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants wanted to share some trivia that might help you feel a bit smarter at the holiday dinner table and help create some great conversation with friends and family.

The Turkey

There is no historical evidence that turkey was eaten at the first Thanksgiving dinner. It was a three-day party shared by the Wamponoag Indians and the pilgrims in 1621. Historians say they likely ate venison and seafood.

According to National Geographic, the dinner at the Plymouth colony was in October and included about 50 English colonists and 90 American Indian men. The first Thanksgiving dinner could have included corn, geese, and pumpkin.

Today, turkey is the meat of choice. According to the National Turkey Association, about 690 million pounds of turkey are consumed during Thanksgiving, or about 46 million turkeys.

The Side Dishes

The green bean casserole became popular about 50 years ago. Created by the Campbell Soup Company, it remains a popular side dish. According to Campbell’s, it was developed when the company was creating an annual holiday cookbook. The company now sells about $20 million worth of cream of mushroom soup each year, which is a major part of the recipe.

While there were likely plenty of cranberries for the pilgrims and Indians to enjoy, sugar was a luxury. What we know today as cranberry sauce was not around in those early Thanksgiving days. About 750 million pounds of cranberries are produced each year in the US, with about 30 percent consumed on Thanksgiving.

The Parade

Since Thanksgiving did not become a national holiday until Lincoln declared it in 1863, the annual parades were not yearly events until much later. The biggest parade that continues to draw crowds is the Macy's Thanksgiving Day Parade. Beginning in 1924 with about 400 employees, they marched from Convent Avenue to 145th Street in New York City. Famous for the huge hot-air balloons today, it was actually live animals borrowed from the Central Park Zoo that were the stars of the show then.

However you choose to spend your Thanksgiving holiday, we wish you a safe, happy and healthy holiday with those you love.

From the time you were small, you’ve been warned about the dangers of plaque. Why? Because:

• It’s an unappealing film that sticks to your teeth
• It causes cavities
• It causes gum disease

And really, do we need to know much more than this to motivate us to brush? But if you’re in a curious mood, you might be wondering just how this soft, fuzzy film accomplishes all that damage. Let’s take a closer look at the sticky problem of plaque.

How does plaque form?

We live with hundreds of species of oral bacteria, most of which are harmless, and some of which are actually beneficial. But when our oral ecosystem gets out of balance, problems can occur. For example, without regular and thorough brushing and flossing, we start to build up plaque.

Plaque starts forming within hours of your last brushing. And even though plaque fits the very definition of “seems to appear overnight,” this biofilm is actually a complex microbial community with several different stages of development.

• It starts with saliva.

Saliva is vital to our oral health, because it keeps us hydrated, washes away food particles, neutralizes acids in the mouth, and provides minerals which keep our enamel strong. Saliva also contains proteins, which help form a healthy, protective film on the tooth surface. This film is called a pellicle.

• Bacteria attach to the pellicle.

There are species of oral bacteria that are able to attach themselves to the pellicle film within hours of its formation. As they become more firmly attached, they begin to grow and divide to form colonies, and are known as the early colonizers of the plaque biofilm.

• A complex biofilm forms.

If you’ve skipped brushing for a few days (please don’t!), you’ll notice a fuzzy, sometimes discolored film on your enamel—that’s a thriving plaque community, and it only takes a matter of days to go from invisible to unpleasant.

If you’re not removing plaque regularly, it can harden further and become tartar. And once you have tartar buildup, you’ll need the care of a dental professional to remove it.

• What happens if we ignore plaque and tartar?

We get cavities and gum disease.

How does plaque cause cavities?

• The bacteria in plaque, like all organisms, need nutrients.

Our normal oral environment and the food in our everyday diets provide the nutrients plaque needs. Foods such as carbohydrates, starches, and sugars are most easily converted into acids, which is why we recommend that you enjoy them in moderation.

• The biofilm promotes acid production.

Within the plaque film, anaerobic bacteria (bacteria that don’t use oxygen) convert sugars and starches into acids. As the plaque film becomes denser, it blocks acid-neutralizing saliva and oxygen from reaching these bacteria close to the tooth’s surface, creating an ideal environment for the bacteria to produce their acid waste products.

• Acids attack enamel.

The sticky nature of plaque keeps these acids in contact with tooth enamel, where, over time, acids dissolve minerals in enamel, weakening the mineral structure of the tooth.

How does plaque cause gum disease?

• Bacteria cause inflammation and gingivitis.

The bacteria in plaque irritate the delicate tissue of the gums, which causes an inflammation response which can leave your gums swollen, red, bleeding, or tender. This early form of gum disease is gingivitis. Fortunately, good dental care and careful brushing and flossing can usually prevent and even eliminate gingivitis.

• Plaque and tartar can lead to periodontitis.

When plaque and tartar build up around and below the gum line, the gums pull away from the teeth, leaving pockets where bacteria collect, leading to infection as well as inflammation. Infections and constant inflammation not only harm gum tissue, they can destroy the bone supporting the teeth. This serious gum condition is periodontitis, and should be treated immediately to avoid further infection and even tooth loss.

How do we fight plaque?

From the time you were small, you’ve learned how to fight plaque:

• Brush at least twice a day for two minutes, and be sure to brush all of your tooth surfaces and around the gum line.
• Floss to remove plaque from between the teeth and near the gum line.
• See your dentist as recommended for a thorough professional cleaning.

Be proactive. If you have any questions, talk to your dentist about the best way to keep plaque at bay. And if deep cavities or damage to the roots or the bone surrounding them have put you at risk for tooth loss, call Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants at our Worcester office. Endodontists are specialists in saving teeth when the health of a tooth’s pulp or roots is compromised.

We’ve only brushed up on some plaque basics, because there is a lot more to discover about this complex biofilm. Happily, even with all there is to learn about plaque’s growth and development, it’s reassuring to know that getting rid of it is quite simple—with just a soft-bristled brush, some dental floss, and a few minutes of your time each day, you’re on the way to a healthy, happy, plaque-free smile.

Whether it’s a constant ache when you chew food or a sharp, jolting pain every time you bite down, if bite pain has you considering a permanent liquid diet, a trip to see Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants is definitely in order!

What causes bite pain? You might feel an ache because of a cavity, a loose filling, bruxism (grinding the teeth) or a malocclusion (bad bite). Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants will be able to help you get to the root of this type of tooth pain and provide treatment that will leave you smiling again.

But sometimes, pain is caused by damage or infection located in the inner chamber of the tooth. In this case, pain caused by biting or pressure on the tooth might indicate:

• Pulp Infection

The pulp of a tooth contains blood vessels, nerves, and connective tissue. Because it is composed of living tissue, pulp can be subject to injury, inflammation, and infection. If bacterial infection sets in, the pulp will need to be removed and the site cleaned, shaped, and filled. This is something that should not be postponed, because without treatment infection can spread to the surrounding bone and tissue.

• An Abscess

An abscess forms when pus collects into a pocket at the site of an infection. When tooth pulp suffers bacterial infection, the infection spreads through the interior of the tooth. An abscess can form at the tip of the root, or appear in the surrounding tissue. If the abscess finds a path to drain, you might feel some temporary relief, but treatment is essential. Unless the infected pulp is removed and the inner tooth cleaned, shaped, and filled, pain can not only recur, but the infection can spread to other parts of the body—sometimes with serious results. Endodontists are trained to treat infection in the tissues surrounding a compromised tooth.

• A Cracked or Injured Tooth

When a tooth suffers a significant crack or fracture, the pulp can become infected or damaged. An endodontist is trained to discover and diagnose cracks and fractures that might not appear on an X-ray. If the crack is treatable, there are a variety of procedures, including oral surgery, which can preserve a tooth even if some of the root area needs to be removed.

Of course, bite pain is not the only symptom of a damaged or infected inner tooth. Any redness, swelling, fever, or prolonged sensitivity to heat and cold are signs that your tooth should be examined as soon as possible.  If you are suffering from discomfort because the pulp of the tooth has been injured, endodontists like Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants are experts in treating your pain.

Whether the answer is a root canal or more complex oral surgery, Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants and our team have the training and experience to relieve pain, protect you from further infection, and save injured teeth.

If you are avoiding biting or chewing because of tooth pain, call our Worcester endodontic office. We can let you know how we can help give you back your happy—and healthy—smile.

If Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants and our team recommend an “apicoectomy” to save your tooth, you probably have a few questions about the procedure. Here are some of the basics you might discuss when you visit our Worcester office:

• What is an apicoectomy?

The tip of a root is also called its “apex.” An apicoectomy means the removal (“ectomy”) of the apex (“apico”) of the tooth. This is a surgical procedure performed by a specialist in the treatment of the inner tooth.

• Who performs apicoectomies?

Your endodontist is a specialist in tooth-saving surgical procedures. Endodontists like Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants diagnose and treat problems of the inner tooth and its surrounding tissue. They have two or more additional years of study in the field of endodontics, and have the experience, knowledge, skill, and specialized equipment needed to perform delicate endodontic surgeries.

• Why choose this procedure?

Usually, a root canal is all that you need to treat any damage or infection in your inner tooth. But when inflammation or infection returns at the tip of the root, or in the bone surrounding the tip, or a tooth can’t be treated with a conventional root canal, Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants may recommend an apicoectomy both to save your natural tooth and to prevent further infection or damage to the surrounding bone and teeth.

• How does the procedure work?

Often local anesthesia is all that is needed. (But if you have concerns, talk to us about your anesthesia and sedation options. We will have suggestions for you.) After the area is numb, an incision is made in the gum tissue to allow access to the root and any affected bone tissue.

Drs. Manzoli, Russo, Pauk, Desrosiers, Sahakyants will carefully remove a few millimeters from the tip of the tooth as well as any infected tissue from the area. Because the tip of the tooth is small, and cracks or extra canals in a root are often difficult to discover even with an X-ray, we might make use of microscopic technology to be sure there are no additional canals or large cracks or breaks in the root. Using specialized instruments, the end of the tooth will be cleaned and sealed.

Stitches or sutures will be used to close the incision, and will either dissolve on their own or might need to be removed on a follow-up visit. We will let you know just how to take care of the site after surgery.

In general, any pain or sensitivity after the procedure can be treated with over-the-counter anti-inflammatory pain relief such as ibuprofen. Follow post-op instructions carefully to reduce any swelling, and be sure to follow any dietary suggestions and restrictions. If pain or swelling are a problem, or if you have any other concerns, call our Worcester office.

Apicoectomies are a common procedure used by endodontists to save a compromised tooth.  If you have recurring or new pain or infection after a root canal, if you have an undetected extra canal, if there is a crown and post in place that would make it impractical to reach the root or pulp chamber area with conventional treatment, and if you want to preserve your natural tooth, an apicoectomy is an option well worth discussing.