ABFRACTIONS
THE ABSCESSED TOOTH
BUILDUPS-IMPROVING THE FIT OF A
CROWN
THE BUMPED FRONT TOOTH
BLEACHING
WHY TEETH WITH LARGE FILLINGS
OFTEN NEED CROWNS
COMPOSITE (TOOTH-COLORED) FILLINGS
IN BACK TEETH
THE CRACKED-TOOTH SYNDROME
FULL MOUTH SERIES OF X-RAYS
FRESHER BREATH
FLUORIDE TREATMENT
GINGIVITIS
GUM ABSCESS
PANOGRAPHIC X-RAY (PANOREX)
CLENCHING AND GRINDING HABITS
PERIODONTAL DISEASE
SCALING & ROOT-PLANING
SEALANTS
PULPOTOMY
VENEERS
WHY X-RAYS ARE NEEDED IN EXAMINING
TEETH
IMPACTED WISDOM TEETH
ABFRACTIONS
An ABFRACTION is a notched-out area on the root of a
tooth at the gumline. It is caused by toothbrush wear over a period of
time.....usually by vigorous brushing in certain areas or by the use of
a hard-bristled toothbrush. The hard enamel of the tooth is unaffected
while the softer root becomes worn, creating a notch at the gumline of
the tooth.
In the past it was believed that a change in toothbrushing
method prevented further notching of the tooth. Recent studies now
show that notching slowly increases over time even with corrected toothbrushing
habits. The reason is that all teeth flex very slightly at the gumline
with chewing and notched areas deepen due to this flexure. It occurs
slowly but can become very deep over time even to the point of affecting
and killing the nerve of the tooth.
For that reason it is recommended that deep areas of notching
be filled with a bonded tooth-colored filling to protect from further notching
and possible damage to the nerve of the tooth.
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THE ABSCESSED TOOTH
 The
center of a tooth is filled with blood vessels and nerves and is commonly
called the NERVE or the PULP of the tooth. When this NERVE becomes
infected ....usually from deep decay....pus begins to build up inside the
tooth and it may begin to hurt for no reason at all or wake a person up
at night; slight tapping on the tooth can cause pain. The tooth is said
to be ABSCESSING.
At this point there are 2 ways to treat the tooth-either
by pulling the tooth or having a root canal. There are several points
to consider for both treatments.
1. PULLING THE TOOTH - The long term consideration
for this is the space left. If the missing tooth is not replaced,
the teeth on either side of the space will tip and the opposing tooth will
supererupt making them harder to clean and therefore more prone to decay
and gum disease.
Replacing the missing tooth would require a cemented
bridge
or a removable partial denture.
2. ROOT CANAL TREATMENT - A tooth that has had a root
canal needs to be crowned to protect it from cracking.
With either decision, it may be necessary to first rid the
infection by taking an antibiotic for several days before any treatment
is done.
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BUILDUPS-IMPROVING THE FIT OF
A CROWN
 A tooth that
requires a crown most often
· has a sizable filling in it or
· has had a piece of the tooth to break away or
· has had a root canal which results in a portion
of the center of the tooth being hollowed out
In each of these situations, there is a varying amount of
solid tooth (or STUMP) left, on which to cement a crown. If part
of the STUMP is missing (as in the case of a broken tooth) or is riddled
with holes (as in the case of a sizable filling) or is hollowed out
(as in the case of a root canal) the remaining STUMP may not be sufficient
to hold on a cemented crown for very long.
A BUILDUP is a procedure of “building-up” the stump
with a strong bonded resin to give it strength and restore it to a size
that will retain a crown for the longest time possible. The BUILDUP
may sometimes require the use of pins on which the resin is bonded (this
occurs more often with broken teeth). In a few cases, a post is sunk
in the center of a tooth to aid in the placement of a buildup (this occurs
more often in a tooth with a root canal). The charge for a buildup
depends on the extent of the procedure .
If it appears that a buildup is necessary to provide the
best result possible with a crown, you will be informed. Sometimes
it is not always possible to predict the size of the STUMP until all of
the old filling is removed and the remaining STUMP inspected.
The additional time and expense of a buildup results in
a better-fitting and therefore longer-lasting crown.
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THE BUMPED FRONT TOOTH
Front teeth are often involved in injuries to the face.
The center of a tooth is filled with blood vessels and nerves and is called
the NERVE or the PULP of the tooth. When this nerve is injured, as
from a blow to the tooth, it can die over a period of time. The tooth
doesn’t always abscess to indicate that the nerve has died but commonly
becomes a darker color than the adjacent teeth.
An injured front tooth may react in several ways over
time:
· It may abscess and become painful.
· A gumboil may form above the tooth on the gum.
This is an abscess in which the infection escapes at the site of the gumboil.
It is usually painless but needs to be treated in order not to become painful
in the future.
· The root may shorten over time to cause the tooth
to become loose. This is only found by taking periodic x-rays of
the injured tooth. This condition needs to be treated as early as possible
to prevent loss of the tooth
· The root may become thinner over time to cause
the tooth to break suddenly. This also is found only by taking periodic
x-rays of the injured tooth. This condition needs to be treated as
early as possible to prevent loss of the tooth. (over)
· A cyst may form around the tip of the root, destroying
bone and slowly enlarging. This is found only with periodic x-rays
and needs to be treated as early as possible.
For these reasons it is advisable to follow an injured front
tooth (or a tooth that is darker than adjacent teeth) with x-rays.
Comparing periodic x-rays is especially valuable in determining whether
suspected damage is occurring.
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BLEACHING
Bleaching is a very safe, effective, and long-lasting
way to lighten tooth color. The process involves wearing custom-made
clear plastic trays filled with a bleaching gel. The trays are worn for
30 minutes at a time, twice a day.
Results are noticeable in less than a week. The
entire process takes 2 weeks.
Teeth that have a yellow tint will lighten very nicely
while teeth that have a gray tint or have dark bands do not lighten appreciably.
Tooth-colored fillings and crowns do not lighten from bleaching.
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WHY TEETH WITH LARGE FILLINGS
OFTEN NEED CROWNS
Teeth with large fillings have been hollowed out - first
by decay and then by replacing the decay with fillings. Over time
the weakened remaining tooth builds up small fracture lines that become
larger and deeper. In addition, teeth become more brittle with age
which leads to more fracture lines.
This can cause a portion of the tooth to break off or
can cause a tooth to become sensitive to hot and cold or chewing pressure.
A crown is the only treatment to keep the cracks from
worsening. It acts like a belt to hold the tooth together.
The reason not to wait until a tooth breaks or becomes
sensitive is at that point the tooth may stay sensitive after it is crowned
(in some cases a root canal may be required to rid the sensitivity) or
pins, posts or even a second crown may be needed to hold the crown on the
broken tooth.
Cracks cannot be seen on x-rays and sometimes they are
very difficult to see on a tooth. They are many times identified
by sensitivity. Any tooth with a large filling in proportion to the
remaining tooth will build up crack lines over time and is best protected
with a crown.
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COMPOSITE (TOOTH-COLORED)
FILLINGS IN BACK TEETH
 
In the past, silver fillings rather than composite (tooth-colored)
fillings have been routinely used to restore back teeth because silver
fillings were more durable than composite fillings. However with
advancing technology, composite filling materials are now much stronger
than in the past…..in many cases they may actually outlast silver fillings.
Although composite fillings look better than silver fillings,
they require more time to place and to polish so the fee is higher.
In some instances where access to the tooth is difficult or the filling
is sizable, a silver filling remains the filling of choice.
In any case, if a composite filling is an appropriate
alternative to a silver filling you will be informed so you may choose.
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THE CRACKED-TOOTH SYNDROME
 Cracked-Tooth
Syndrome is identified more by symptoms than by actually seeing a crack
in a tooth (x-rays do not show cracks in teeth). The primary symptom is
pain on biting ….sensitivity to cold is also often reported. The pain from
biting occurs due to flexure of the crack when the tooth is put under a
load, as in chewing.
In almost every instance, the cracked tooth has a sizable
filling. A tooth with a large filling has been hollowed out - first by
decay and then by replacing the decay with a filling. Over time the
weakened remainder of the tooth builds up small fracture lines that become
larger and deeper. In addition, a tooth become more brittle with
age which leads to more fracture lines.
Success in treating a cracked tooth depends on the extent
of the crack. Most cracks (90%) do not extend to the nerve of the
tooth and are successfully treated with a crown. A crown acts like
a belt to hold the tooth together. In those cases in which the crack
extends to the nerve (9%), a root canal is often necessary to treat the
injured nerve. In a few cases (1%), the crack may extend through
the length of the tooth and extraction may be necessary.
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FULL MOUTH SERIES OF X-RAYS
 A
Full Mouth Series of X-rays is the first step in a thorough dental examination.
We take this series of x-rays to find:
· cavities between the teeth
· worn out fillings and crowns
· tartar on the roots of teeth
· bone levels around teeth
· abscesses
We place 18 separate film packets in specific locations
to thoroughly evaluate your entire mouth. A lead apron protects the
rest of your body while taking x-rays of your mouth. Dental x-rays
use high speed film so the amount of radiation exposure is very low.
Even if you recently had x-rays taken of other parts of your body, a full
mouth series does not add to that exposure.
A Full Mouth Series is an important part of a thorough
dental examination. It gives us vital information we can’t get from
any other source.
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FRESHER BREATH
Forget what you’ve heard - most bad breath starts right
in the mouth. (Now obviously, if you’ve just eaten a pizza loaded
with garlic and onions you’ll have bad breath and, yes, this is coming
from your lungs as well as from your mouth. But this is temporary.
Chronic sinusitis, tonsillitis, chronic dry mouth and other medical conditions,
certain medications and a host of other factors can also cause bad breath.)
But in practically 90% of the cases, garden-variety chronic bad breath,
and even mediocre breath, are caused by a certain type of bacteria (anaerobes)
living in the crevices of the tongue, under the gums and in the nooks and
crannies on the teeth. These anaerobes give off waste products that
contain sulfur gases that cause the odor of bad breath.
There is no permanent cure for 90% of oral halitosis.
It requires long term management to minimize the numbers of the anaerobic
bacteria and to rid the accumulation of the sulfur gases.
Basically 3 steps are involved to do this:
1. First and most importantly is the elimination
of gum pockets and tooth decay. This of course is detected through
a thorough exam of the teeth and gums.
2. The second source of accumulation of anaerobic bacteria
is the TONGUE. The tongue is like a deep shag carpet where food and
bacteria collect. Toward the back of the tongue is especially prone
to accumulation. Use of a TONGUE SCRAPER aids in cleaning this hard-to-reach
area.
3. Thirdly, specific mouthrinses (Oxygene or BreathRx)
act to (1) kill bacteria and to (2) neutralize the odor of sulfur gases
by breaking the sulfur bond. Unlike commonly-used popular mouthwash
brands, these mouthrinses DO NOT CONTAIN ALCOHOL. Alcohol kills bacteria
but it also dries the mouth which leads to a greater re-accumulation of
anaerobic bacteria. Also. the commonly-used popular mouthwash brands
perfume the breath rather than neutralizing the sulfur gases.
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FLUORIDE TREATMENT
In some situations, we may recommend either:
1. Extra-strength fluoride toothpaste
OR
2. Custom-made fluoride trays to wear for a short time
daily.
Extra fluoride provides added protection against dental decay
and also may help reduce tooth sensitivity.
Extra-strength fluoride toothpaste has five times the
concentration of over-the-counter toothpaste. It is available in
our office or may be obtained at a pharmacy with a prescription.
Fluoride trays are custom fit to your teeth. Extra-strength
fluoride gel is placed in the trays and then worn for 5 minutes daily.
This method acts to squish the fluoride into hard-to-reach
areas of the teeth that may not otherwise
be accessible to clean thoroughly.
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GINGIVITIS
Gingivitis is an inflammation of the gums. It is
the REVERSIBLE early stage of periodontal (gum) disease. Seventy-five
percent of all adults may have some degree of gingivitis at some time during
their lifetime; it can also affect children. With gingivitis, the
gums become red, swollen and they bleed easily; it is usually painless.
Gingivitis can progress to periodontitis, a more serious form of gum disease,
which, if left untreated, can cause teeth to loosen and eventually need
to be extracted.
To control gingivitis, it is necessary to control plaque
on a regular basis. Plaque is a thin, colorless, sticky film that
forms on the teeth everyday. To remove this film from the teeth:
1. BRUSH at least twice a day, vibrating the
bristles into the gumline at a 45 degree angle.
2. FLOSS daily to remove plaque from places the toothbrush
cannot reach - between the teeth and under the gumline. With proper
home care, gingivitis can be controlled and prevented.
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GUM ABSCESS
 A
GUM ABSCESS is an infection between the tooth and the gum. Symptoms
include soreness and swelling of the gum around the tooth. It occurs
in deep pocket areas around teeth that cannot be cleaned by flossing and
brushing. The result is an area in which food, plaque and germs can
create an infection. These pockets are usually found around teeth
with periodontal (gum) disease or around partially-erupted wisdom teeth.
A gum abscess is usually treated by flushing out the pocket
with hydrogen peroxide and then prescribing an antibiotic to clear away
the infection. This is very effective in clearing out infection but the
problem lies in the fact that the INFECTION WILL USUALLY RECUR unless the
pocket area is eliminated. This is accomplished by extracting the
partially erupted wisdom tooth or gum surgery or extraction of the periodontally-affected
tooth.
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PANOGRAPHIC X-RAY (PANOREX)
 Panographic
X-ray (or Panorex) is an x-ray of the entire jaw. It shows the jaw joints
and the sinuses as well as both upper and lower jaws and the teeth.
It is a screening tool to detect cystic areas in the jawbone and around
the roots of teeth. It also aids in visualizing impacted and developing
wisdom teeth.
The American Dental Association recommends having a panographic
x-ray every 3 to 5 years. At this office we request having a panographic
x-ray for first time examination visits and every 5 years thereafter.
If you have had a panographic x-ray within the last 5 years, we will
be happy to contact your previous dentist for a copy.
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CLENCHING AND GRINDING HABITS
 Clenching
and grinding of the teeth are extremely destructive dental habits.
Unlike normal chewing where the teeth are cushioned with portions of food,
clenching and grinding involve one tooth surface against another, leading
to the propagation of cracks in teeth and to wearing down of the chewing
sides of the teeth. With the accumulation of cracks, teeth may become sensitive
and portions of teeth may break off, leading to the necessity of
crowns. Over time, the wear may actually extend to the pulps of the teeth
thus requiring root canals or extractions.
Understandably, treatment of worn teeth can be both expensive
and involved so prevention of the clenching and grinding habit is obviously
desired. Since it is a habit, it is most often done unconsciously
and during sleep, making it extremely difficult to correct. However,
one way to lessen the destructive effects of the habit is by wearing a
cushioned splint, also known as a BITEGUARD, over the teeth. This
does not correct clenching and grinding but keeps the hard tooth surfaces
from contacting each other.
If you are aware of grinding, especially during
sleep, a nightguard would be wise to wear. On examination, if tooth
wear is evident, a biteguard might be suggested to lessen the long-term
damage of clenching and grinding.
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PERIODONTAL DISEASE
Periodontal Disease (also called gum disease or pyorrhea)
is the major cause of tooth looseness and tooth loss …it affects 3 out
of 4 persons.
The main cause of gum disease is PLAQUE which is a sticky
film of bacteria that constantly forms on the teeth. The bacteria
produce toxins (or poisons) that infect the gums….. making them red, swollen
and causing them to bleed easily. Over time, the gums begin to detach from
the tooth and form pockets that harbor more bacteria and cause the damage
to increase. As the damage progresses, the bone around the tooth
is destroyed, leading to looseness and eventual loss of the tooth.
A dental examination which discovers BLEEDING and POCKETING
of the gums indicates that periodontal disease is occurring. Unless
treated, the affected teeth can become loose and eventually be lost.
Treatment for periodontal disease is directed toward removing
plaque and calculus (hardened plaque) from the pockets around the tooth
and smoothing the root surfaces. This procedure is called scaling
and root planing. In most cases of early gum disease, this procedure
and proper daily cleaning are all that are required for a satisfactory
result. More advanced cases may require surgical treatment for deeper
pockets.
Keep in mind that treating gum disease is less costly
- and better for your health - than replacing teeth lost to untreated gum
disease.
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SCALING & ROOT-PLANING
Scaling and root planing is more extensive, detailed
and more involved than normal cleanings. The procedure serves to:
1. remove calluses of hardened plaque (calculus)
from the roots of the teeth and
2. smooth the roots to a glassy smoothness
This allows the inflamed gum to recover from the constant
irritation of the roughness and toxins of the calculus. It also acts
to hinder further plaque from adhering as quickly to the smoothed roots,
making daily plaque removal more effective.
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SEALANTS
The first place decay occurs in permanent teeth is on
the chewing surface of back molars. This is due to deep grooves which
trap food and germs. A SEALANT is a plastic coating that is bonded
into these deep grooves to lessen the chance of decay developing.
A sealant is effective only if placed before any decay develops.
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PULPOTOMY
 Baby
Teeth are important for the proper alignment of erupting Permanent Teeth.
If a baby tooth is lost early (that is, pulled, due to extensive decay)
the space for the erupting permanent tooth is no longer held open fully,
and when the permanent tooth is ready to erupt it may not have enough room
to line up properly. The prevention of early loss of BABY MOLARS
is especially critical to the proper alignment of the erupting permanent
teeth.
For this reason, it is wise to try to retain the baby
molars even with extensive decay. In many cases, fillings are sufficient
to restore a decayed baby tooth. However, baby teeth have very large
nerves (called the PULP) and decay does not have to penetrate very deeply
before infecting this nerve.….requiring more than a simple filling to retain
the tooth. In these cases, a procedure called a PULPOTOMY is performed
to remove the infected pulp and place a medicine in the space to help suppress
further infection of the remaining pulp. This procedure is successful
about 90% of the time in preventing the entire pulp from becoming infected.
Due to the importance of BABY MOLARS, it is generally
wise to try and keep them until they are pushed out by their Permanent
Teeth replacements.
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VENEERS
Veneers can improve your smile. A veneer is a thin
shell of porcelain that is bonded to a tooth to improve its color and shape.
Generally a veneer only covers the front and top of a tooth.
Veneers can be used to:
· Close spaces between teeth
· Lengthen smaller or misshapen teeth
· Whiten stained or dark teeth
· Protect and restore teeth that are chipped and
worn
It takes 2 or more appointments to restore teeth with veneers.
On the first appointment we shape and roughen the teeth. From an
impression we make precise working models of the teeth. It’s on these
models that the veneers are crafted to exactly fit the teeth.
On the second appointment we use an adhesive to bond the
veneers to the teeth. A harmless high-intensity light hardens the
adhesive. The bond is extremely strong.
Veneers virtually become part of the teeth. You
can use them like you would your own teeth.
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WHY X-RAYS ARE NEEDED IN EXAMINING
TEETH
 A
tooth has FIVE SIDES that need to be checked for decay. In most cases
only three of these five sides can be examined by directly looking.
The other two sides are hidden from view due to another tooth in front
or behind.
X-RAYS help us determine if decay is occurring on these
hidden sides since decay shows up as a tiny shadow on the x-ray.
X-rays also give us other important information as:
· the condition of old fillings or crowns
below the gum
· the amount of bone supporting a tooth
· infection or cysts around the root of an injured,
decayed, or impacted tooth
· the shape and number of roots on a tooth
The amount of radiation from an x-ray is very slight.
It is only a fraction of what it was 10 to 15 years ago. This is
due to vast improvements in x-ray machines and also in x-ray film.
In fact, more radiation is absorbed from spending a day at the beach than
in having 18 x-rays taken.
For that reason, it is advisable to have periodic x-rays
taken at 1 1/2 to 2 year intervals to check for decay and other dental
conditions that could not otherwise be detected by visual examination alone.
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IMPACTED WISDOM TEETH
 In
adolescents, decisions regarding the removal of wisdom teeth are best made
around age 16 to 18. The wisdom teeth are usually developed sufficiently
to determine if there is room in the jaw for full eruption. If removal
is indicated, the procedure is better tolerated around this age for several
reasons…the roots of the teeth are seldom fully developed, the jawbone
is not as dense, and healing is much faster in teen years.
In persons over 30 years of age, impacted wisdom teeth
that are completely covered by bone and have not partially erupted into
the mouth generally produce no problems and should be left in place.
The impacted teeth should however be followed routinely for cystic or tumor
formation. Cysts or tumors do not cause pain but can become large
enough to cause damage if not detected early.
A PANOGRAPHIC X-RAY shows the full jaw. It aids
in determining if there is sufficient room for eruption in adolescents
as well as showing root shape and development if removal is necessary.
In adults, it can aid in detecting cystic changes around wisdom teeth
…especially when compared to previous panographic x-rays. For that
reason for impactions in adults, it is advisable to have a panographic
x-ray every 4 years.
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