Laser Endodontics LLC - Mary Ann Choby, DMD, MS

Did you know that the Commonwealth of Virginia amended a bill, early this year, in which it mandates that all prescriptions containing opioids be electronically transmitted? This amendment becomes effective July 1, 2020. The code of Virginia §54.1-3408.02 reads: “A. Consistent with federal law and in accordance with regulations promulgated by the Board, prescriptions may be transmitted to a pharmacy by electronic transmission or by facsimile machine and shall be treated as valid original prescriptions B. Any prescription for a controlled substance that contains opioids shall be issued as an electronic prescription.” This information was brought to our attention in a dental meeting in Texas. Virginia is joining several other states in the fight against drug overdose.  For the complete regulation visit: https://law.lis.virginia.gov/vacode/54.1-3408.02 /

The end of the year is upon us which means your dental benefits are about to expire. Most dental plans, but not all, expire on December 31st. If you have some dental work that needs to get done, do it! Save yourself some money by using your dental benefits. Don't wait until your tooth hurts: a small ache can result in a bigger course of treatment.  While we're on the subject of benefits, for those that have FSA: use it! Those benefits also expire. So don't forget to use it or you lose it. Take full advantage of your dental benefits today by visiting your dentist.

Happy Halloween!  We truly love our CT! Without it, we couldn't diagnosis a lot of our complex cases. Check out our recent complex case below.  Recently, a 31 year old called our office complaining of swelling. The swelling was located near tooth #19. She had this tooth Endodontically treated recently. Since then, she's been experiencing this swelling and discomfort.The 2-D image showed that there was a post in the tooth. Based on past experiences with other patients, it was decided a CT scan was the best course of action. The CT scan showed an area of low density on the mesial aspect of the distal root in the furcation. The low density parallels the post then extends apically. The CT shows the shape of the distal root as being a figure 8 shape. On the 2-D image, it is seen as being round, when in fact it was not. The dentin was thin in the furcation. There was a fracture line at the apical end of the post. The was loss of buccal bone that coordinates with the swelli

A 54 year old patient contacted our office regarding tooth #20. She was told that a retreat would solve the problem she was having. This tooth was treated 2-5 years prior to her visit with us. A fistula had recently developed so her dentist gave her an antibiotic. This fistula was causing the patient pressure and discomfort. After examining the 2-D image received by her general dentist, it was unclear was to what was going on. It was ultimately decided at a CT scan would provide us an answer. The CT scan showed that there was a post that was placed from the crown to the apex of the tooth. Upon closer observation, there were fracture lines at the apex. There was also bone loss on the cortical plate that was consistent with a fistula.  There were two options as to what to do. Option 1: an exploratory was possible along with an apicoectomy. However, the post was of a size that the strength on the dentinal wall was compromised. This would result in a limited long-term prognosi

A 28 year old male was seen in our office with swelling in the buccal of tooth #19. This swelling was causing him pressure and discomfort. He was taking antibiotics that temporary eased his discomfort. Tooth #19 was Endodontically treated a year ago by another dentist. It was unclear as to what was causing his swelling. A CT scan was acquired to determine the issue. The CT scan showed an area of low density in the furcation. This low density was absent an year ago when compared to the 2-D x-ray provided by his dentist. It was also unclear if the root resorption was evident at the time. The scan showed resorption on the distal of the mesial roots. It was also found on the mesial aspect of the distal root. This suggested that the cause of the resorption initiated from the furcation. We recommended the patient get a biopsy. We determined that the tooth may not be salvageable due to the pathology and resorption. A follow-up with the patient is pending.

A few months ago, a 63 year old male presented himself at our office with swelling on the buccal of tooth #19. The swelling was causing him pressure and pain. Tooth #19 was Endodontically treated years prior to his visit at a different office. The patient recently had his crown redone. It was highly suspected that there might be a fracture by both his general dentist and our office. The best course of action was to take a CT scan. It was observed that there was an area of low density at the apex of the distal root. The CT also showed three areas high density, posts. These posts appeared at the coronal aspect of the tooth. There was a suggestion of a lesion in the furcation, a possible fracture. It was determined that long-term prognosis was poor. An implant was recommended. We followed up with the patient and he had the tooth removed. This relived him of his discomfort. He's in the works of having an implant placed.

Did you know that lasers were first used in the field of Endodontics in 1971?  We're known as the Endodontist in our area to use laser for our root canal treatments and surgeries. Though we still undergo the traditional method for root canal treatment, we use the laser right before we fill the canals. The laser is used to clean out the canals with sterile water and then it's used to dry out the canals to reduce bacterial count to a point of sterilization.  During our surgeries, we like to use the laser to create a flap in the gum area. We find that the laser  promotes faster healing and decreases post-operative pain.  In the recent issue of Decisions in Dentistry, Dr. Kazim Mirza writes about laser usage in Endodontics. He begins by writing that Endodontic treatment is highly successfully with a reported range of 82% to 97%. Dr. Mirza writes that research shows that disinfecting the canals with cleaning and irrigation increases the success rate of treatment. Dr. Mirza refe

We're truly dumbfounded with the amount of patients we treat in our office asking for opioids after treatment. Yes, we understand there will be discomfort! Patients will do and say anything to obtain them. Though we're very understanding of the situation, our goal is to inform patients that nonopioids work just as well or even better than opioids. Also, our goal doesn't only apply to patients but other doctors as well. In the past, we've had patients with opioid addictions. Most of the time, these patients are hard to work with because they won't consent to treatment unless we assure them they'd being get a prescription for opioids afterwards. We hate to see a patient leave our office in pain! In these cases, patients will argue until we come up with an agreement which is asking them to try nonopioids first, if pain escalates, we'll prescribe 6 tablets of opioids and no more. Majority of the time, they don't need them.   Unfortunately, there are som

Want to get rid our your smelly breath? Check out these tips from the  Mayo Clinic Health Letter. (Volume 37 Number 1 January 2019) Bad breath (halitosis) often stems from bacteria feeding on food particles in the mouth. Fend off bad breath by: Brushing your teeth  — Brush at least twice a day. Consider also brushing after meals. If brushing isn't convenient, swish with water or mouthwash, or chew sugarless gum, to rid your mouth of food particles. Cleaning your tongue  — Odor-causing bacteria thrive on the rough surface of the tongue, particularly at the back. Mucus from postnasal drip also can feed odor-causing bacteria. Use a toothbrush to brush your tongue, or use a tongue scraper. Gargling with mouthwash also may help. Flossing daily  — This removes food particles between your teeth. Drinking enough water or chewing sugarless gum  — Saliva and water wash away food particles that feed bad breath. Talk to your doctor if you have persistent dry mouth, as it can be caused

In the recent Mayo Clinic Health Letter , (Volume 37, Number 4) there was an interesting article on how tooth brushing reduces cardiovascular risks. The article states: Brushing your teeth twice daily is important for maintaining good oral hygiene. This daily routine can also benefit your heart. A study presented at the 2018 American Heart Association Scientific Sessions provides new evidence of this link. The study's 682 participants self-reported their tooth-brushing habits compared with the recommendation of twice a day for at least two minutes each time. Over an average of 28 months of follow-up, those who reported brushing their teeth less frequently and for a shorter duration had three times the risk of a first major cardiovascular event than did those who met the tooth-brushing guidelines. These cardiovascular events included heart attack, stroke, hospitalization for heart failure or dying of a cardiovascular cause. A separate study, published in the December 2018 i

Every year, after the craziness of the Holidays, our office participates in the annual OSHA & HIPAA training seminar hosted by Harris Biomedical. Thankfully, we don’t have to travel too far as it usually takes place in the Maggiano’s in Tysons Corner, literally a 5-minute drive from our office. Harris Biomedical has this seminar every year in the Tysons Corner area. Look out for their flyers in the mail around the beginning of the year. Check out their website for more information: http://harrisbiomedical.net/ . The four-hour seminar consisted of a two-hour session dedicated to OSHA and another two hours dedicated to HIPAA. Breakfast was included! For those who don’t know what OSHA or HIPAA means, here’s the breakdown. The Occupational Safety and Health Act, aka OSHA, are a collection of regulations that are managed and required in most states, Virginia being one of them, to guarantee employee safety and good health. OSHA, or referred in Virginia as VOSH, instructs empl

Happy New Year! May 2019 be full of good surprises and fun!