Jim Erpenbach DDS

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Damage Control: Stopping Pulp Disease Early On

When tooth decay goes untreated, cavities form in the tooth’s hard outer enamel. These cavities are a gateway for bacteria to reach the rest of the tooth. When bacteria reach the inner living pulp of the tooth, the pulp becomes diseased and patients typically experience extreme pain and sensitivity, along with infection. Diseases that impact the dental pulp can lead to total tooth loss. There are treatments available to treat dental pulp disease, but some of these treatments may also lead to emergency extractions.

There are several types of pulp disease, medically known as pulpitis that infects the soft, sensitive living tissue called the pulp. These different types range from reversible or mild pulpits to dangerous infections caused by pulp exposure. All of these types are painful and cause serious infections or tooth loss.


Reversible pulpitis is a mild inflammation of this living tissue. Symptoms experienced by patients with a mild case of pulp disease include extreme sensitivity to hot and cold temperatures or when eating very sweet foods. If left untreated, a pus pocket can form within the tooth. This infection causes a fever for the patient and swelling of nearby tissues. Patients may be able to mitigate this type of pulpitis by practicing good oral hygiene, but most patients need to have to tooth treated professionally.

Irreversible pulpitis a more severe form of the condition that cannot be cured or reversed through stepping up oral hygiene practices. Patients with irreversible pulpitis experience severe pain that comes on quickly. Pulpitis spreads quickly through the gums and tissues of the mouth and may cause large facial abscesses in some individuals. Patients with this form of pulp disease are root canal candidates.

Root canals, also known as pulpectomies, go through the top of the tooth. Dentists gain access to the pulp by drilling through the enamel and then the dentin to reach the impacted, infected tissue. The dentist works to clean out diseased pulp tissue from the pulp chamber of tooth and root canals. After the dentist has removed the diseased tissue, the tooth is packed with cement and a rubber-like material for stabilization. Once the procedure is complete, a dental crown is placed over the tooth.

If the diseased tissue is not completely removed during the pulpectomy procedure, a bacterial infection develops.

"An infection after a root canal procedure typically means the patient is faced with losing their tooth," Dr. James Erpenbach said.

Erpenbach is says Knoxville, Tennessee dentist. 

While extracting an infected tooth is a benefit to patients suffering from an infected tooth, extractions have their own set of issues. When a patient loses a tooth, speech and chewing may be affected. Tooth loss leads to bone deterioration and bone loss in the jaw. 

"The goal of dentistry should be the preservation of the teeth, not restorations that risk the life of the tooth," Erpenbach said. 

This is a goal that Erpenbach keeps in mind when treating his patients. He practices biomimetic dentistry, a form of dentistry that focuses on the preservation of the teeth by neutralizing bacteria that cause decay. 

"Stopping decay where it starts is critical for tooth preservation," he said. 

After decay has been stopped, biomimetic dentists like Erpenbach use lifelike materials to seal the tooth off against future bacteria invaders.There are cases of pulp disease that occur as a result of dental fillings. Traditional dental fillings are unable to bond with the teeth like the biomimetic materials that Erpenbach uses. As a result, bacteria work their way under the filling and infect the tooth.

Biomimetic dentistry establishes a good foundation for the tooth, so that if for any reason the tooth break or restoration materials would fail, the inner, living pulp is protected. Failed biomimetic restorations are not really something that patients should worry about, says Erpenbach. 

"Biomimetic restorations have proven to last for many years – in contrast to traditional restorations that only have a few years expected life span," Erpenbach said.

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