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Tooth Decay on the Root Surface

July 19, 2015 in Dentistry,Periodontal Treatment,White Fillings by mccarl_dental

Tooth decay on the root surface of teeth is also called root decay or root caries. It is an important dental problem that needs immediate treatment.

Root caries on lateral incisor, canine and first bicuspid

Root caries on lateral incisor, canine and first bicuspid

While many people are fortunate enough to have cavity resistant tooth enamel, few people have cavity resistant root surface. When gums recede below the enamel line of the tooth or pull away from the tooth, root surface is exposed. The root surface does not have a hard protective enamel covering like the crown of the tooth. This unprotected surface is very vulnerable to decay. Root caries do not occur unless the root of the tooth is exposed or there is loss of attachment of the gum to the tooth. An exposed root surface frequently becomes sensitive to hot, cold and sweet foods and drinks.

Causes of Gum Recession and Root Caries
Poor oral hygiene – not brushing teeth and flossing teeth daily
Brushing teeth too vigorously or using a hard bristle tooth brush
Age – as people age, their gums typically recede exposing root surfaces
Periodontal disease known as gum disease
Genetics – periodontal disease runs in families
Crooked teeth – misaligned teeth are more difficult to clean thoroughly and can make you more prone to gum disease
Smoking cigarettes or cigars, dipping, using chewing tobacco or any kind of tobacco use
Medication that causes dry mouth
Radiation treatment for head and neck cancer
Trauma to gums or teeth

Treatments for Receding Gums and Root Decay
The appropriate treatment of receding gums depends on the reason for recession and the extent and severity of the decay.

Use a soft bristle or electric toothbrush. Our dental hygienists teach dental patients how to brush teeth to clean tooth surfaces and gums thoroughly and prevent further gum recession. This will not repair existing damage but will hopefully prevent additional gum recession.

Excellent oral hygiene at home and routine cleaning by a dental hygienist and dental examinations.

If the gum recession is caused by periodontal disease, the patient will need periodontal treatment by a dental hygienist that usually starts with scaling and root planning. Plaque and tartar are removed from the surfaces of the root and teeth. Periodontal treatment can help gum tissues heal and reattach to the tooth surface.

If gum recession is advanced, a gum graft where the gum tissue has receded may be indicated. Grafts may help protect the root surface from sensitivity and decay.

Tooth colored fillings can repair this root caries before it becomes too advanced

Tooth colored fillings can repair this root caries before it becomes too advanced

Root caries on a lower molar

Root caries on a lower molar

If tooth decay or root caries are present, the patient will need to have the decay removed and replaced with a filling or crown. At McCarl Dental Group, we have not used amalgam fillings for more than 25 years. We use tooth colored composite filling material to fill a cavity after removing tooth decay.  Dental fillings should not be visible when you smile or talk.

Why Do We Measure Periodontal Pocket Depths?

September 22, 2011 in Dentistry,Periodontal Treatment by McCarl Dental Group

An important measure of periodontal (gum) health is the depth of the pocket around each tooth. The top of gum tissue does not attach directly to teeth. There is a space of pocket between the gum and the tooth before it attaches. This space or pocket deepens in the presence of gum disease. To monitor and evaluate gum health, the pocket depth must be measured, recorded, and monitored over time.

Many diseases are not obvious without testing. High blood pressure, high cholesterol, and high blood sugar levels must be measured in order to be evaluated. Similarly, periodontal disease needs to be measured by pocket depth around each tooth.

The pocket depths are compared to see if gum health is improving, maintaining, or getting worse. Gum disease is sometimes called “the sneak thief of teeth.” You may not know you have it until it is too late. People may assume their gums are fine because “they don’t hurt,” but if the pockets haven’t been measured, you can’t be for sure. The dentists and hygienists at McCarl Dental Group work to monitor these levels closely for each patient in our Greenbelt and Millersville, MD dental offices.

In a healthy mouth, a pocket can be anywhere from 1-3 millimeters deep. To measure a pocket we use a periodontal probe. The probe allows us to measure in millimeters from the top of the pocket to the bottom of the pocket. The bottom of the pocket is the area where the tissue is connected through ligaments to the root.
This measurement is taken very gently and causes no damage to the delicate gum tissue.

When a tooth has periodontal disease, this tissue becomes detached past 3mm deep. Under 3mm deep a pocket is considered healthy, while 4mm or deeper it is considered unhealthy. When connective tissue loss occurs, it is also a sign that there is bone loss. By our hygienists and dentists measuring the periodontal pockets regularly, we can monitor bone and tissue attachment levels. These measurements should be taken once or twice a year, or more often in patients with active or previous periodontal disease.

The recordings taken during periodontal probing are recorded onto a chart. There are 6 measurements taken for each tooth, 3 on the facial side and 3 on the tongue side. By monitoring the recordings against each other, the dentists and hygienists at our dental offices in Millersville and Greenbelt, MD are able to make sure no areas become progressively worse, or note improvement where treatment has occurred.

When several deep pockets are evident we will recommend scaling and root planing, or “deep cleaning.” The deep cleaning is more involved in that the focus is to remove the tartar from all pocket areas, since that is the bacteria’s “hiding place.”  Not even diligent brushing and flossing can remove the tartar from a deep pocket. If left alone, these infections can cause more bone loss and tissue detachment, resulting in tooth loss.

The Dentists at McCarl Dental Group in Millersville, MD and Greenbelt, MD, we believe in early intervention and prevention. By recording periodontal measurements at regular recall appointments, it can help us to detect small problems before they turn into large ones. We will work together with our patients to help them understand where these periodontal pockets are, and what we can do to help them heal. If you’re looking for a dentist in the Greenbelt or Millersville, MD area, please feel free to call and schedule an appointment. Greenbelt dental office –  301-474-4144; Millersville, Maryland dental office 410-987-8800. We’re available 6 days a week.   To learn more about periodontal charting and other dental topics, please visit the McCarl Dental website at

Diabetes and Gum Disease – The Low Down on High Blood Sugar

January 25, 2011 in Dental Hygiene,Dentistry,Periodontal Treatment by McCarl Dental Group

Each year about 800,000 new cases of diabetes are diagnosed.  Even more frightening- the Center for Disease Control reported a 70% increase in diabetes diagnosed in 30-39 year olds from 1990-1998.  In diabetics, the blood glucose level is higher than normal due to a lack of insulin.  Insulin is a hormone produced by the pancreas, the organ that breaks down sugar in our bodies.  Diabetics are typically unable to produce enough insulin or use the body’s natural insulin.  Heart disease, blindness, organ failure, and poor circulation are medical concerns associated with high glucose levels.  However, diabetes also increases the risk of gum disease, which can affect your overall health.

The first stage of gum disease is gingivitis.  Gingivitis occurs when normal bacteria in the mouth are not removed adequately. This causes the gums to become inflamed or swollen. Bacteria grow in plaque, a sticky film that everyone can remove with proper brushing and flossing.  If the plaque is not removed, it hardens into tartar (also known as calculus).  When teeth are not cleaned properly, gums start to bleed while brushing and flossing, a sign of gingivitis. Only a professional cleaning by your dental hygienist or dentist and can remove tartar or calculus.  The dentists and dental hygienists at McCarl Dental Group emphasize preventive oral hygiene. Every patient has unique oral health needs. Some people are more prone to plaque accumulation and need to have their teeth cleaned professionally by a dental hygienist more often than the usually recommended time interval of every six months.

If gingivitis is ignored, more severe gum disease called periodontitis may develop.  Periodontitis causes pockets to form between your teeth and gums.  The gums pull away from your teeth allowing more germs to enter.  The resulting infection may cause bone loss around your teeth which often leads to loose teeth and ultimately results in losing teeth. Missing teeth cause additional health problems.

Research indicates a strong correlation between gum disease and diabetes. Diabetics are more prone to bacterial infections and cannot fight bacterial infections as well as a patient with normal glucose levels.  Common symptoms of oral infections include swelling, pus, pain while chewing or general pain in the mouth, oral sensitivity to temperature and sweetness, and white or red patches within the mouth.

New, studies emphasize the importance of oral health and suggest that gum disease may actually contribute to diabetes.  Serious oral infections like periodontitis can cause unbalanced glucose levels which increase the risk factors for diabetes.

Preventing oral health problems in diabetics is first controlled by regulating diabetes.  Keep a healthy glucose level.  Secondly, brush and floss your teeth properly at least twice daily.  Finally, maintain regular check-ups with your dentist.  Make sure to keep your dentist and hygienist updated on your health condition, medications, and glucose levels.  Dental procedures are best performed when blood sugar is carefully controlled.  Diabetics are typically slower healers, so regulating diabetes allows for a faster healing time.  Remember to eat before heading to the dental office and stick to your normal meal plans afterwards in order to maintain regular blood sugar levels.  If you cannot chew well after the visit, plan an alternative way to sustain your calorie intake.  If you have any concerns about how your diabetes will affect your upcoming dental visit, please contact McCarl Dental Group serving Anne Arundel County and Prince Georges County Maryland to plan your strategy for a healthy smile.


May 5, 2010 in Dentistry,Periodontal Treatment by McCarl Dental Group

Your oral health is connected to many other health conditions beyond your mouth. Sometimes the first sign of a disease shows up in your mouth. In other cases, infections in your mouth, such as gum disease, can cause problems in other areas of your body. Periodontal disease is a chronic bacterial infection of the gums, and the byproducts of oral bacteria can enter the bloodstream. When oral bacteria escapes into the bloodstream it increases inflammation throughout the body and can injure major organs. Chronic inflammation is recognized as a significant factor in aging and disease. Research links inflammatory periodontal diseases to systemic conditions.

Over 75 percent of Americans over the age of 35 have some form of gingivitis or gum disease.

Inflammation from periodontal disease is associated with a number of serious health problems including:

•    Heart disease
•    Diabetes
•    Dementia
•    Rheumatoid arthritis
•    Premature birth

Do you notice any of these signs of gum disease – bleeding gums (even when you brush); red, swollen or tender gums; loose teeth; persistent bad breath; or receding gums? Sometimes there are NO obvious signs of gum disease.

Dental plaque is a sticky film with bacteria that constantly forms on your teeth and gums. When plaque isn’t removed by daily brushing/flossing and routine dental hygiene cleanings, it not only causes tooth decay, but also leads to gum or periodontal disease. Gum disease ranges from simple gum inflammation, called gingivitis, to a more serious disease, called periodontitis, that causes gum tissue to pull away from the teeth and form pockets that are infected. Periodontitis can result in damage to the underlying bone supporting the teeth. The American Dental Association recommends prevention by proper diet, brushing, flossing and dental visits. If you have symptoms of gum disease, please call our Millersville Dental Office at 410-987-8800 or Greenbelt Office at 301-474-4144 to schedule an appointment!

Drs. Clayton, Jay and David McCarl of McCarl Dental Group,, are third-generation dentists with two dental offices in Greenbelt, Maryland and Shipley’s Choice Medical Park in Millersville adjacent to Severna Park fifteen minutes from  Annapolis. They are graduates of the University of Maryland Dental School and participate regularly in continuing education programs. Drs. McCarl are listed in America’s Top Dentists selected by the Consumers Research Council of America, Top Dentists as voted by Dental Specialists and Best Dentist in the Capital Reader’s Choice 2010 Poll.

For more information on the latest news in dentistry or the McCarl Dental Group, visit

This week’s winner of the worst reason for “Why I don’t floss my teeth”.

May 1, 2010 in Dental Hygiene,Dentistry,Periodontal Treatment by McCarl Dental Group

Every day we hear lots of creative (and sometimes lame) excuses for not flossing.

“The cat unraveled my floss.”

“I used it to hang my pictures.”

“I couldn’t find white thread and needed it to reattach a button.”

“Went fishing and used floss as fishing line.”

“Emergency shoe lace.”

“Ponytail holder.” Yada, yada, yada…

The excuse we hear most often is, “My gums bleed when I floss – it must be bad for me.

If this is your excuse, we have great news! Gums only bleed for a day or two when you start flossing daily. The reason for bleeding is that the gums are inflamed from food and plaque trapped between your teeth and gums. Once the plaque is removed, your gums will no longer be inflamed and will stop bleeding.  To keep your gums healthy, you must maintain regular brushing, flossing and routine professional cleaning to prevent build up of bacteria-harboring plaque and tartar.

At McCarl Dental Group, we give floss to every patient after their dental hygiene visits. If you have your teeth cleaned regularly according to your dentists’ recommendations, and run out of floss between visits, please come see us. We are happy to give you more floss!

According to Dr. Steven Offenbacher, professor of periodontology at UNC’s School of Dentistry and Dental Research, “Poor dental health is so prevalent that the number of lives saved by eliminating gum disease worldwide would definitely be in the hundreds of thousands.” The first sign of gum disease or gingivitis is red or swollen gums that bleed easily. If gingivitis progresses to periodontitis, the gums recede and pockets form between the gums and teeth, potentially leading to tooth loss.

A substance produced in the body called high-sensitivity C-reactive-protein or hs-CRP is suspected to play a role in the link between gum disease and heart disease. Inflammation from acute gum disease increases the amount of hs-CRP. The American Heart Association says hs-CRP is linked to an increased risk for heart attacks.

Here are a few pointers – just in case you have forgotten how to floss.
•    Hold an 18-inch piece of floss tightly between the thumbs and forefingers.

•    Guide the floss between the teeth, gently hugging the side of each tooth.

•    When the floss reaches the gum line, curve it into a C shape against the side of the tooth and slide it in between the gum and the tooth.

•    Move the floss away from the gum with up and down motions and repeat this method between all of your teeth. Don’t forget the back of your last tooth!


March 17, 2010 in Dentistry,Invisalign Orthodontics,Periodontal Treatment by McCarl Dental Group

Invisalign Orthodontics can correct a lot of different dental and orthodontic problems. The custom-made Invisalign aligners straighten teeth, create a beautiful smile and can have a positive impact on your health.

Please click to watch our video highlighting McCarl Dental Group Invisalign orthodontics patients who are delighted with their new healthy and beautiful smiles.

Patients featured in this video are from Annapolis Maryland, Crownsville, Crofton and Severna Park. Invisalign orthodontics straightened their teeth with virtually invisible aligners or trays in less than a year. Many of our McCarl dental patients choose to lighten their smile with professional teeth whitening gel during or after their Invisalign dental treatment.

Invisible Invisalign Orthodontics can solve problems caused by overly crowded teeth. When left untreated, overly crowded, missing and widely spaced teeth can prevent normal chewing and can also increase the likelihood of periodontal or gum disease.
A crossbite occurs when the upper and lower jaws are both misaligned and can cause wear of the teeth, gum disease, and bone loss.

An overbite occurs when the upper teeth bite over the lower teeth. An overbite can be caused by genetics, bad oral habits, or over development of the bone that supports the teeth. This orthodontic problem can lead to gum and periodontal problems, excessive wear on the lower teeth and can also cause painful jaw joint problems, Temporomandibular joint disorder or TMJ syndrome.

When the lower teeth protrude past the front teeth it is called an underbite. This can also be caused by missing upper teeth, but is usually caused by undergrowth of the upper jaw, overgrowth of the lower jaw. An underbite can also cause painful jaw and joint problems and can prevent the normal function of front teeth or molars which also leads to tooth wear.

While the cosmetic dental results are undeniable, Invisalign Orthodontics is much more than just a cosmetic dental procedure. Invisalign orthodontics is a custom-designed program that will treat your specific dental or orthodontic problems.

Invisalign Preferred Providers at McCarl Dental Group have achieved a high level of clinical training and experience in treating patients with the Invisalign system. The cost of Invisalign orthodontics is based on individual treatment programs. Also, be sure to speak with the patient advocates at McCarl Dental Group because dental insurance often covers correction of orthodontic problems.


January 21, 2010 in Dentistry,Invisalign Orthodontics,Periodontal Treatment by McCarl Dental Group

Straight teeth contribute to healthy teeth and gums. Crowded or crooked teeth are harder to brush and floss which makes them more prone to tooth decay, gum disease and other dental problems.  When teeth fit together with an ideal bite, it is less likely that they will have unusual wear from clenching and/or grinding. And, of course, there are the cosmetic benefits of a beautiful straight smile. Your teeth should make you look and feel great.


Invisalign Orthodontics are a great option for patients who would like to straighten teeth without the inconveniences associated with traditional metal braces. The clear Invisalign trays are almost invisible.  Our McCarl Dental patients really appreciate the ability to take the trays out of their mouth for eating and cleaning their teeth. In many cases, our patients’ smiles can go from “crooked to straight” in less than a year!

McCarl Dental Group is a Preferred Provider of Greenbelt, Millersville, Annapolis and Severna Park Invisalign Orthodontics. As always, our goal is to help you keep all of your teeth healthy and beautiful for life.

8601 Veterans Hwy, Suite 101, Millersville, MD 21108 USA
Dr. Clayton McCarl, Jr. Millersville, MD cosmetic, restorative, & preventive dentistry.
28 Ridge Road, Greenbelt, MD 20770 USA
Dr. Clayton McCarl, Jr. Greenbelt, MD cosmetic, restorative, & preventive dentistry. (301) 474-4144