Periodontal (Gum) Disease
While you may think that some loss of teeth is inevitable with aging, it is actually possible for all of your teeth to last a lifetime. One of the ways you can achieve this goal is to avoid periodontal disease (“peri” – around; “odont” – tooth), which is caused by bacteria that attack the tissues around the teeth. Unfortunately, you may not even realize you have gum disease as the signs and symptoms are not always as apparent to you as they are to a dental professional.
Nearly all people who do not maintain good daily oral hygiene will develop gingivitis. If left untreated, this bacterial gum infection can progress from gingivitis (“gingival” – gum; “itis” – inflammation) to periodontitis, which results in bone loss around your teeth. As the bone tissue is lost, the gum tissues detach from the teeth and form little pockets that provide an even better place for bacteria to live — where your brush and floss can't reach. As periodontal disease advances leading to more bone loss, tooth loss can result. Part of this has to do with genetics, as periodontal disease tends to run in families. The good news is that periodontal disease can be controlled, even at more advanced stages.
Signs and Symptoms of Periodontal Disease
It's important to understand that you can have periodontal disease with no obvious symptoms, especially if you are a smoker (nicotine reduces blood supply preventing bleeding and swelling of the gum tissues). Still, there are some important things to look for:
Bleeding gums — Some people think that when their gums bleed, it simply means they're brushing too hard. While brushing too hard is bad for the gums, it should not cause bleeding. Any bleeding of the gums should be considered a warning sign of gum disease.
Bad breath — It's very easy for plaque to collect in the spaces between the teeth, creating the perfect living conditions for bacteria that produce odorous, sulfur-containing compounds, resulting in bad breath.
Redness or swelling of the gums — Inflammation of the gums is usually the first visible sign of periodontal disease.
Receding gums — If you notice that your teeth look longer than they used to, it may be that your gum tissue has receded (away from the enamel), exposing some of your tooth roots.
Sensitivity — If there is gum recession, the exposed roots may become sensitive to hot or cold.
Periodontal abscess — Bacteria can become enclosed in a periodontal pocket and the area will fill with pus, becoming swollen and painful.
Loose teeth — When periodontal disease results in bone loss, teeth can become loose or migrate. Tooth loss can result and may be accelerated if you are applying excessive biting forces from clenching or grinding your teeth.
All periodontal therapy starts with the evaluation of your oral hygiene techniques and instruction for improving them, followed by the mechanical removal of plaque and any calcified deposits (tartar or calculus) that are present on the root surfaces. This is accomplished with a cleaning technique known as scaling, root planing or debridement using hand instruments and/or ultrasonic (high frequency vibrational) instruments. Locally applied antimicrobial products or antibiotics might also be recommended during various parts of periodontal treatment to assist in healing and pocket-depth reduction, hopefully eliminating the need for periodontal surgery. Sometimes surgical procedures may be necessary to remove the deep pockets that form between inflamed gum tissue and teeth. There are many different types of surgery to handle a variety of problems. And many times, combinations of procedures are used to attempt to reduce the number of surgeries as well as the cost of treatment.
Periodontal Disease and Your Overall Health
Periodontal disease starts in your mouth but has actually been linked to more serious conditions, such as cardio-vascular disease (CVD), diabetes and preterm births. Research has suggested two plausible mechanisms for how gum disease and these other serious medical concerns could be related: moderate to severe periodontal disease increases the level of systemic (bodily) inflammation — a characteristic of all chronic inflammatory diseases. Also, the same bacterial strains that are commonly found in periodontal pockets surrounding diseased teeth have been found in blood vessel plaques of individuals with CVD. Therefore, it may be helpful to reduce periodontal inflammation to reduce systemic inflammation.
The best way to prevent periodontal disease is to brush and floss your teeth effectively every day. Regular dental checkups and professional cleanings every 3 or 4 or 6 months are also an important part of maintaining periodontal health; the instruments and techniques used in these cleanings can reach into areas that your toothbrush and floss can't.
It is also possible to detect early forms of gum disease by evaluating your gingival (gum) tissues, both visually and by examining their attachment levels to the teeth. And the health of your tooth-supporting bone can be assessed by taking dental radiographs (x-rays pictures).
There are other steps you can take: Eating right, reducing stress in your life, and giving up unhealthy habits like smoking will also help ensure that you keep your teeth for a lifetime.
Smiling with confidence makes you feel great. A beautiful smile is also an important social and professional asset. Yet there are many people who avoid showing their teeth in public or in photographs because they don't like what they see. If that describes you, then why not start the process of getting the smile you've always wanted with a smile makeover?
A smile makeover goes beyond simply responding to dental problems as they arise. It's a comprehensive smile-rejuvenation plan that's uniquely suited to your own facial features and aesthetic preferences. The results can be quite dramatic — both in terms of how your will look and how you will feel. These are the major steps involved:
Take a look. The makeover process is all about giving you the smile of your dreams. So take a good look at your smile and note what you like and don't like about it. Some questions you can ask yourself are:
Are your teeth as white as you'd like them to be?
Are any teeth chipped, cracked or worn?
Does your smile have a gummy appearance?
Do your teeth seem too large or small?
Do you like the alignment and spacing of your teeth
Are you self-conscious about crookedness or gaps?
Remember, beauty is in the eye of the beholder… and that's you! Some people want their smile to look “perfect” — and to them, that means completely straight, uniformly white teeth. Others like a slightly more natural look, and are not displeased by slight gaps or shade variations. There are lots of decisions to make, but don't worry — dentists are skilled at helping you sort it all out!
Share your thoughts. Communication is an extremely important part of the smile makeover process. At the first makeover consultation, it helps if you describe what you would like to change in as much detail as possible. Bring along pictures of smiles you like, or of how your own smile used to look. Your makeover dentist will have some thoughts to share with you as well because dentists are trained to look at smiles in terms of facial balance. In other words, a dentist will look not only at how the elements of a smile (teeth, lips and gums) relate to each other, but also how they blend in with the face as a whole.
Make a plan. An important part of planning a smile makeover is a comprehensive dental exam. Cosmetic dentistry offers an amazing array of lifelike tooth restorations and treatments; but first, any conditions in your mouth that may jeopardize a good result must be taken care of. If your teeth are discolored, for example, the reason must be determined. You may have an underlying dental disease that needs to be treated before whitening your teeth; otherwise, the whitening may not last. Likewise, if you often drink red wine or other beverages that stain, you might do better with porcelain veneers than bleaching treatments.
Try it out. A smile makeover is an investment that is meant to last. That's why many of the procedures performed are irreversible. So if you are contemplating some changes, it's a great idea to try them out before you fully commit to them. There are many ways to preview the results: computer imaging, 3-D models, and even placing temporary restorations on your teeth so you can see what the final results will look and feel like in your own mouth. This also allows a fine-tuning of the makeover plan.
A “trial smile” is a great way to eliminate unknowns in the makeover process. But when it's all done, there's still one thing you may not be prepared for: how great it feels to flash your new smile to the world!
Oral Hygiene for Kids
Teeth can last a lifetime if you take care of them right — and the best time to start is just as soon as they begin appearing. By establishing good oral hygiene routines for your children right from the start, you'll give them the best chance of keeping their teeth healthy — forever.
Tooth decay, the major cause of dental trouble that can eventually lead to tooth loss, is actually an infectious disease caused by bacteria. If it takes hold, it can form a cavity in the enamel and then progress deeper into the tooth — causing discomfort, difficulty eating and speaking, and a need for fillings or root canal treatment. The good news is that tooth decay (also called caries) is completely preventable.
The primary route to good dental health is plaque removal. Plaque is the sticky, whitish film that builds up on teeth in the absence of effective oral hygiene. Decay-causing bacteria thrive in plaque, where they break down any sugar that lingers in the mouth. In the process, they produce acid byproducts that erode teeth. This is how a cavity begins. What are the most effective techniques for plaque removal and decay prevention? That depends on the age of your child.
Babies can develop a form of tooth decay known as early childhood caries. This occurs when they are allowed to go to sleep with a bottle that's filled with anything but water. The sugars in formula, milk (even breast milk) and juice can pool around the teeth and feed decay-causing bacteria. When it comes to bedtime soothing, a pacifier or bottle filled with water is safer for developing teeth — that is, until about age 3. At that point, sucking habits should be gently discouraged to prevent orthodontic problems from developing later on.
Brush your baby's first teeth gently with a small, soft-bristled toothbrush, using just a thin smear of fluoride toothpaste, at least once a day at bedtime. Before a tooth is fully erupted, you can use a water-soaked gauze pad to clean around the tooth and gums.
Make sure your child has his or her first dental visit by age 1. There, you can learn proper hygiene techniques; have your youngster examined for signs of early decay; and get a recommendation for fluoride supplements if needed.
Starting at age 3, you can begin teaching your child to brush with a children's toothbrush and no more than a pea-sized amount of fluoride toothpaste. But remember, children will need help with this important task until about age 6, when they have the fine motor skills to do an effective job themselves.
It's also extremely important to start encouraging healthy dietary habits at this time. Your child will have less plaque buildup and decay if you place limits on soda and sugary snack consumption. As a parent, you can model this behavior to instill it in your child. After all, monkey see, monkey do! Any sugary treats that are allowed should come at mealtimes, not in between. This will ensure your child is not creating favorable conditions for oral bacteria to grow around the clock.
At your child's regular, twice-yearly dental checkups and cleanings, topical fluoride can be applied to strengthen tooth enamel and make it more resistant to erosion and decay. If necessary, dental sealants can be applied to the back teeth (molars) to prevent food particles and bacteria from building up in the tiny grooves where a toothbrush can't reach.
At this point, your children have the primary responsibility for maintaining their day-to-day dental health — but you can continue to help them make good dietary and behavioral choices. These include drinking plenty of water and avoiding soda, sports drinks and energy drinks, all of which are highly acidic; avoiding tobacco and alcohol; and continuing to visit the dental office regularly for cleanings and exams. This is particularly important if your teen wears braces, which can make it more difficult to keep teeth clean.
Remember, it's never too soon to help your child develop good oral hygiene habits that will last a lifetime.
If you have never had a cavity, congratulations! If you have had one, you are not alone. About 78% of us have had at least one cavity by the time we reach age 17, according to a 2000 report by the U.S. Surgeon General. Fortunately there's a time-tested treatment for cavities: the dental filling.
Fillings do just what the name implies — seal a small hole in your tooth, i.e., a cavity, caused by decay. This prevents the decay (a bacteria-induced infection) from spreading further into your tooth and, if untreated, continue on to the sensitive inner pulp (nerve) tissue located in the root canal. Should that happen, you would need root canal treatment.
There are a variety of materials used to fill teeth these days, but the process of filling a tooth is similar regardless. The first step is a clinical exam of the tooth with x-rays, to determine the extent of the decay. Then the decayed area of the tooth is removed, usually with a handheld instrument such as a dental drill. Of course, your tooth will be anesthetized first, so you won't feel any discomfort. If you normally feel nervous about receiving numbing injections, it's possible that taking an anti-anxiety medication or using nitrous oxide can help you feel more relaxed. After removing the decay, the remaining tooth structure is roughened or “etched” with a mildly acidic solution; then translucent cement is applied to bond the tooth and the filling material together.
Types of Fillings
Composite — A popular choice for those who don't want their fillings to show, composite is a mixture of plastic and glass, which actually bonds to the rest of the tooth. Composites are more expensive than amalgam fillings, and the newer materials can hold up almost as long. Less drilling of the tooth is necessary when placing composite as compared to amalgam.
Porcelain — These high-tech dental ceramics are strong, lifelike, and don't stain as composites can. They are sometimes more expensive than composites because they may require the use of a dental laboratory or specialized computer-generated technology. While considered the most aesthetic filling, they can also, because of their relatively high glass content, be brittle.
Glass Ionomer — Made of acrylic and glass powders, these inexpensive, translucent fillings have the advantages of blending in pretty well with natural tooth color and releasing small amounts of fluoride to help prevent decay. They generally don't last as long as other restorative materials.
What to Expect After Getting Fillings
The numbness caused by your local anesthesia should wear off within a couple of hours. Until then, it's best to avoid drinking hot or cold liquids, and eating on the side of your mouth with the new filling. Some sensitivity to hot and cold is normal in the first couple of weeks after getting a tooth filled. If it persists beyond that, or you have any actual pain when biting, it could signal that an adjustment to your filling needs to be made. Continue to brush and floss as normal every day, and visit the dental office at least twice per year for your regular checkups and cleanings. And remember, tooth decay is a very preventable disease; with good oral hygiene and professional care, you can make your most recent cavity your last!
You've no doubt heard it said that an ounce of prevention is worth a pound of cure. In dentistry, you might say it's worth two pounds. Maybe even thousands of dollars. That's because dental problems can become exponentially more expensive — and painful — the longer they go unaddressed. Fortunately, modern dentistry has many easy and relatively inexpensive ways to make sure that today's minor annoyance does not turn into tomorrow's major headache.
Preventive dentistry describes all the procedures used to arrest tooth decay and other diseases in the earliest stages. The goal is to keep you as healthy as possible and maintain your natural teeth for life.
Preventive Dentistry Procedures
Preventive dentistry procedures range from the most basic services that have been used successfully for decades, to recent technological innovations. These procedures include:
Cleanings. This is where dental health starts. There's just no substitute for physically removing disease-causing dental plaque and calculus (tartar) from your teeth — especially in hard-to-reach areas near the gum line. That's why regular professional cleanings are so important to your health.
Dental Sealants. These invisible plastic coatings fill the tiny grooves in back teeth so they do not become havens for bacteria. They prevent cavities from forming and the need for fillings later on.
Fluoride. This mineral is readily incorporated into the teeth's mineral structure, thereby making them stronger and more decay-resistant. Fluoride can even reverse tiny cavities that are starting to form. If you are not getting enough from your toothpaste and drinking water, it can be applied directly to your teeth at the dental office.
Mouthguards. Athletic mouthguards are designed to absorb and distribute the forces of impact and minimize traumatic injury to both the hard and soft tissues of the mouth. In fact, an athlete is 60 times more likely to suffer harm to teeth when not wearing a mouthguard. The best ones are custom-made for you by your dentist.
Oral Cancer Screenings. Your best chance of surviving oral cancer — a disease that affects not only lifelong smokers but also young non-smokers — is early detection and treatment. Oral cancer screenings are a routine part of every regular dental exam.
Salivary Diagnostics. This is an exciting new development in the field of preventive dentistry. While it is in its infancy, it is already possible to detect the presence of certain diseases with a salvia test, and the technology is developing rapidly.
X-Rays. For around a century, dentists have been using x-rays to reveal signs of disease not visible to the naked eye. Now, with CAT scans, they have become three-dimensional and are an indispensable tool to diagnose tooth decay, gum disease, bone density, bone volume and tumors.
Your Role in Preventing Dental Disease
There's one more extremely important component of preventive dentistry: you. The procedures mentioned above can only be effective if you come in to the dental office to take advantage of them. Likewise, the importance of maintaining a good oral hygiene routine at home cannot be overstated. Daily effective brushing and flossing will go a long way toward removing the dental plaque responsible for dental disease, tooth loss, and the need for more complex dental treatment.
Bad Breath, or halitosis, is an embarrassing problem that affects millions. To combat it, many people use breath mints, chewing gum, sprays and mouthwashes. In fact, Americans spend billions of dollars each year on these products — even though they offer only a temporary fix. Getting rid of persistent foul odors on the breath in a lasting way requires a little detective work on the part of dental professionals.
Bad breath can affect anyone temporarily — think of “morning breath,” or the way your mouth smells after eating onions or drinking coffee. Some people, however, exhale noticeably unpleasant odors throughout the day, every day. That's when it is important to find the cause of the problem, so a lasting solution can be achieved.
Most often, bad breath originates in the mouth, from trapped food particles that are then processed by oral bacteria. The most common location for mouth-related bad breath is the back of the tongue, where large quantities of naturally occurring bacteria can thrive on food remnants, dead skin cells and post-nasal drip (mucus coming down your throat from the nose). The waste products of these bacteria include volatile sulfur compounds (VSCs), which have a smell resembling rotten eggs. Other places where bacteria and food particles can be trapped are between the teeth, beneath the gums, and in oral appliances or dentures. Poor oral hygiene sets the stage for these problems, as well as for tooth decay and gum disease, which can also cause foul odors.
It's possible for other health conditions and habits to affect your breath. Halitosis may occur in people who have a sinus or bronchial infection, an oral yeast infection (which can be caused by antibiotic use), or even a systemic (general body) disease such as diabetes, kidney failure or a liver malfunction. A chronically dry mouth (xerostomia), which is often a side effect of certain medications, and tobacco use can also contribute to this problem. Even stress, dieting and hormonal changes can affect your breath.
How Dentistry Can Help
Since bad breath most often originates in the mouth, the dental office is the best place to start in your quest for consistently better-smelling breath. After a thorough examination, any of the following might be recommended:
Oral hygiene instruction. It might be that you could benefit from a demonstration of how to brush and floss more effectively, or how to better clean your dentures. You can also be instructed on how to use a tongue scraper to clean the back of your tongue if necessary.
Professional dental cleaning. Food particles, bacteria and calcified deposits can become trapped where you can't reach them — but special dental instruments can. Regular professional cleanings are a great way to promote good oral health in general and good-smelling breath in particular.
Treatment of tooth decay. Bad breath may be caused by large, open cavities that need to be filled, or old, defective fillings that need to be repaired.
Treatment of gum disease. More advanced forms of gum disease cause the gums to separate from the teeth, forming pockets in which bacteria can thrive. If you have gum disease, you may need periodontal (gum) therapy, which can include a deep cleaning of the roots of your teeth, antibiotics, and, in advanced cases, periodontal surgery.
Treatment of infection. Infection that doesn't originate in your mouth needs to be treated by the appropriate medical professional. Whatever the cause of your bad breath, we are here to make sure you get the treatment you need.
Aging and Dental Health
Today, Americans are not only living longer — we're also retaining our natural teeth longer than ever before. But this rosy picture isn't free of thorns: Older adults tend to require increasingly complex dental treatments; are often more prone to contracting certain diseases; and sometimes find it challenging to keep up with daily oral health practices.
Yet maintaining good oral hygiene is critically important as we age. When problems occur in the mouth, they can cause difficulty chewing, swallowing, speaking and smiling — basic functions which can affect both physical and social well-being. It's possible that medications prescribed for other diseases can adversely affect a person's oral health; it's also possible that a decline in oral health can worsen existing maladies (such as diabetes), or even cause systemic (whole-body) inflammation. What other special dental issues do older people face — and what can be done about them?
Dental Concerns for Older Adults
If you think cavities are just for kids — think again! A recent study found that nearly one-third of people over 65 had untreated dental caries (cavities). In older people, these are found not only in the crown (chewing surface) of the tooth, but also in the root, which may become exposed due to gum recession. Regular dental checkups are the best way to find and treat dental caries; left untreated, they can cause pain, require more complex procedures, and eventually lead to lost teeth.
Gum disease is another major oral health issue faced by older people — and it's presently the leading cause of tooth loss in adults. The disease is caused by plaque bacteria, which thrive on the sticky biofilm that clings to the surface of teeth when they aren't properly cleaned. Poor-fitting dentures can make the problem worse, as can the presence of certain diseases (such as diabetes or cancer).
Sometimes, decreased mobility (due to arthritis or similar conditions) makes routine brushing and flossing more difficult. Special brushes with larger grips and floss holders can help make daily cleaning easier; additionally, therapeutic mouthrinses may be prescribed. In-office treatments can also be effective in bringing gum disease under control.
Oral cancer is a concern at any age, but it's 7 times more likely to show up in a person over 65 — and it causes more deaths in older Americans than skin cancer does. Early detection offers the best chance at controlling the disease, and improves survival rates significantly. A thorough screening for oral cancer should be a part of every older person's routine dental checkup.
Dry mouth (xerostomia) isn't just an annoyance — it can be harmful to your oral health. Aside from its lubricating qualities, saliva contains beneficial digestive enzymes, acid neutralizers, and bacteria-fighting agents. A number of factors may cause the body to produce less saliva than normal — but in older adults, this problem is often due to side effects from prescription or over-the-counter medications. If you're experiencing chronic dryness of the mouth, it's sometimes possible to change your medication, and/or use products designed to relieve these symptoms.
Oral Hygiene For Life
It was once commonly believed that dental problems and the loss of teeth were an inevitable consequence of aging. But here's the fact: Age itself isn't a risk factor for tooth loss; properly cared for, your teeth can last a lifetime. However, it's true that the mouth does change as you age. How can you give yourself the best chance of keeping your natural teeth? You guessed it: Maintain a regular practice of good oral hygiene!
Brush twice a day with a soft-bristled toothbrush — use one with a special grip, or an electric brush, if it helps. Clean in between your teeth with floss, or another type of interdental cleaner, at least once a day. If you wear dentures, regularly clean and care for them as instructed. Eat healthy foods and drink plenty of water. And don't forget to have regular dental exams so that little problems don't turn into major headaches!
Traumatic Dental Injuries
Traumatic dental injuries can occur in people of all ages and activity levels. The cause might be a car accident, a fall down the stairs, or an elbow to the face during a basketball game. As with most types of dental treatment, the primary goal when treating a traumatic dental injury is to save teeth at risk of being lost, and restore them to full function and normal appearance. In many cases, the difference between saving and losing a tooth depends on taking the proper action in the immediate aftermath of an injury. Here are some guidelines on how to prevent sports-related dental injuries and what to do after a dental injury occurs.
Sports-Related Dental Injuries
Americans of all ages love playing sports — so much so that participation in high school sports has been increasing for 24 consecutive years, according to one survey. Yet to gain the very real benefits that sports offer, it's necessary to accept — and prepare for — the risk of injury.
Dental trauma accounts for a significant portion of all sports injuries, yet so many of these injuries are preventable. How? With a high-quality mouthguard. When you consider that the lifetime cost of replacing a permanent tooth has been estimated to exceed $20,000, a good mouthguard is one of the best investments you can make in sports equipment: It has been shown to reduce the risk of sports-related dental injury by 60 times.
The best kind of mouthguard is one that comes from your dentist's office. It's custom-made from a model of your own teeth, so it's strong, lightweight, and perfectly fitted. If you (or your child) are active in sports, ask about this indispensable piece of safety gear. And continue reading below to find out what to do in the case of specific types of dental injuries.
Knocked Out Teeth
If a permanent tooth has been knocked out of its socket (avulsed), immediate attention is required. First, recover the tooth — and if it's dirty, gently clean it off with water. Try not to touch the root portion of the tooth. Next, if possible, place the tooth back into its socket (making sure it is in the proper orientation), and apply gentle, sustained pressure to the area for five minutes. You can use a wad of wet tissue or gauze to help grasp and hold the tooth in place. Get emergency dental treatment as soon as possible afterward, and be sure to check whether a tetanus shot or booster is needed.
If it isn't possible to replant the tooth, have the patient hold it between his teeth and cheek, or place it into a plastic bag with the patient's saliva, or into a cup of cold milk. Control bleeding from the tooth socket by applying pressure to the area (use gauze if possible), and get the patient and the tooth to an emergency treatment center as soon as possible. Primary (baby) teeth, however, don't usually need to be replanted.
Partially Displaced Teeth
If teeth are driven into or pushed partially out of the jaw, or if they are out of alignment, the patient should see a dentist or oral surgeon within six hours of the accident. A careful examination of the mouth (plus x-rays if needed) should reveal the extent of the damage, and indicate what restorative treatments are likely to be required.
In addition to the teeth, dental injuries often involve damage to the gums, the tongue, and the inside of the mouth. When these soft-tissue injuries occur, it's best to take the following immediate actions, and then see a dentist as soon as possible: Wash and rinse the area with soap and water if possible, or remove debris and foreign material by hand. Bleeding can usually be controlled by applying direct, gentle pressure to gauze pads placed on the wound. If it can't be controlled after about 10 minutes, go to an emergency room.
Don't hesitate to call the dental office for more specific information about handling a traumatic dental injury.
Crowns and Bridgework
Dentistry is an art as well as a science; dental crowns offer a perfect example of this. A dental crown or “cap” is a covering that fits over a damaged, decayed or unattractive tooth. It can even replace a tooth entirely as part of dental bridgework.
A crown completely covers a tooth above the gum line. This is in contrast to a dental veneer, which only covers a tooth's front surface and needs natural tooth structure to support it. Therefore, if a tooth is missing a significant amount of structure above the gum line, a crown would be the restoration of choice.
Crowns strengthen damaged teeth, allowing them to function normally again. When crafted from today's high-tech porcelains (dental ceramics), crowns are virtually indistinguishable from natural teeth. They can even be designed to improve upon a tooth's original appearance.
There are other materials besides porcelain that we can use to make dental crowns, depending on what qualities are most important. For durability, cast gold can't be beat. However, this is not always the most aesthetic choice — especially towards the front of the mouth. Other possibilities include porcelain-fused-to-metal crowns (PFM), which have a metal interior for strength and a porcelain exterior for a more natural appearance, and all-porcelain crowns with zirconia, representing the strongest ceramic. We would be happy to discuss the pros and cons of these various options with you.
Crowning or capping a tooth will usually take two to three visits. At the first visit, your tooth is prepared to receive its new crown. First, it is shaped to fit inside the new covering. This will involve some drilling to give the tooth a uniform shape. The tooth and the surrounding area will be numbed beforehand. If there is very little tooth structure left to begin with, the tooth may have to be built up with filling material, rather than filed down, to support the crown.
After the tooth is prepared, impressions of your teeth are taken, either digitally or with reliable, putty-like impression materials, and sent to the dental laboratory. There, the impressions will be used to make models of your teeth for the creation of a crown. The models will serve as guides to the highly skilled lab technicians, who will ensure that your new crown is designed to enhance your smile and function well within your bite.
Before you leave the office, a temporary crown will be attached to your tooth to protect it until the permanent crown is ready. At the second visit, your permanent crown will be attached to your tooth with either a resin that hardens when exposed to a special light source, or a type of permanent cement.
Creating a Bridge
Crowns can also be used to create a lifelike replacement for a missing tooth. This is done with bridgework, which spans the space of the missing tooth and requires at least three crowns. Two of those crowns will be placed over healthy teeth on either side of the missing tooth; these healthy teeth are referred to as abutment teeth. The two crowned abutment teeth become supports for a third crown placed in between them; that third crown is referred to as a pontic. If more than one tooth is missing, more crowns will be needed to bridge the gap in between the abutment teeth.
The number of abutment teeth necessary to replace missing teeth is influenced by the number of missing teeth, the size and length of the abutment tooth roots, the amount of bone support each abutment tooth has, as well as where in the mouth the missing tooth is located. For example, if you have three missing teeth, four abutment teeth may be necessary, thereby creating a seven-tooth bridge. Engineering and designing of the bridge requires an understanding of how to replace teeth, as well as the biology of the supporting gum and bone tissue.
Caring for Your Crowns & Bridgework
Crowns and bridgework require the same conscientious care as your natural teeth. Be sure to brush and floss between all of your teeth — restored and natural — every day to reduce the buildup of dental plaque. When you have crowns, it is even more important to maintain your regular schedule of cleanings at the dental office. Avoid using your teeth as tools (to open packages, for example). If you have a grinding habit, wearing a nightguard would be a good idea to protect your teeth and your investment.
Same Day Crowns (CAD/CAM)
A tooth that has been structurally damaged by decay or trauma sometimes needs to be crowned or “capped” so that it can look good and function properly again. A crown is a durable covering that is custom-made to fit over the entire tooth from the gum line up. Crown fabrication traditionally takes place in a dental laboratory. But these days, there's a much more convenient alternative: same-day crowns made in the dental office.
Advanced dental technology known as Computer-Aided Design/Computer-Aided Manufacturing, or CAD/CAM, makes it possible to fabricate laboratory-grade crowns and other dental restorations in minutes. It's an amazing innovation when you consider that traditionally, crowns take two or three visits and just as many weeks of waiting. Now you can have a restored tooth without the wait.
Best of all, studies have shown that CAD/CAM tooth restorations are just as successful as crowns made with traditional materials and techniques. And the amazingly lifelike appearance of a same-day crown means that no one will know your tooth has been restored.
The process of crowning a tooth starts out the same way, whether it's a same-day crown or traditional crown: with “preparation” of the tooth. This involves removing any decay that's present, and shaping the tooth with a dental drill so that it will fit perfectly inside the crown. But the similarities end there.
If you were getting a traditional crown, the next step would be to take an impression (mold) of your teeth with a putty-like material, and use it to construct a model on which to create the crown. With a same-day crown, your teeth are simply given a light dusting of reflective powder and then a small scanning wand attached to a computer is used to take digital pictures inside your mouth. In seconds, the computer will generate a highly accurate 3D model of your teeth. But it gets even better.
With the help of the CAD/CAM software, your crown will be designed while you wait. The software can even be used to create a mirror-image twin of the same tooth on the other side of your mouth, for the most natural-looking result possible. Then a block of dental ceramic material is chosen in the shade that most closely matches your own teeth. The computer's digital design is transmitted to a milling machine that carves the crown from the ceramic block in about five minutes.
Once the crown's fit has been verified, and any necessary aesthetic enhancements have been made to the crown's surface (staining and glazing, for example), the crown will be bonded to your tooth. With a traditional crown, you would have to wear a temporary restoration for several weeks while the permanent crown was being fabricated at the lab. With a same-day crown, you walk out with the real thing.
Caring for Your Same-Day Crown
Crowned teeth require the same conscientious care as your natural teeth. Be sure to brush and floss between all of your teeth — restored and natural — every day to reduce the build-up of dental plaque. When you have crowns, it is even more important to maintain your regular schedule of professional cleanings at the dental office. Avoid using your teeth as tools (to open packages, for example). If you have a grinding habit, wearing a nightguard would be a good idea to protect your teeth and your investment. A well-cared-for same-day crown will last for years to come.
Root canal treatment — also called endodontics (“endo” – inside, “dont” – tooth) — is a set of specialized procedures designed to treat problems of the soft pulp (nerve) tissue inside the tooth. While some mistakenly think of it as an unusually painful treatment, in most cases the procedure is no more uncomfortable than getting a filling. It's actually one of the most effective ways of relieving some kinds of tooth pain.
A root canal procedure becomes necessary when infection or inflammation develops in the pulp tissue of the tooth. Pulp tissue consists of blood vessels, connective tissue and nerve cells — which explains why a problem here may cause you to feel intense pain. In time, the pain may go away... at least temporarily. Without treatment, however, the infection won't. It can lead to a dental abscess, and may even contribute to systemic problems in other parts of the body.
Root Canal Treatment Is Your Friend
We've all heard the gag: “I'd rather have a root canal...” This comedy line, comparing the procedure to something truly undesirable, may be funny — but putting off needed endodontic treatment is no joke. The idea that a root canal procedure invariably comes with complications and pain is a shopworn myth. It's certainly true that infection or inflammation in the tooth's pulp can be excruciatingly painful. But you should remember that having a root canal results in eliminating this acute pain and is not the cause of the pain.
Need another reason not to delay root canal treatment? How about this: A natural tooth that's saved via root canal treatment and restoration helps you avoid the problems that commonly occur when teeth must be removed. These include unwanted tooth migration or shifting, which can lead to difficulties in chewing; the need for bridgework or dental implants, which may be costly and complicated; and even the eventual loss of bone structure from the area of the missing tooth.
Root canal problems stem from infection and inflammation of the tooth's pulp tissue. One potential cause of infection is deep tooth decay. Untreated dental cavities eventually allow bacteria to work their way down to the center of the tooth, where they may infect the pulp tissue. Another path by which bacteria may come into contact with pulp is via chipped or cracked teeth. Any opening in the protective enamel coating has the potential to allow bacteria access to the tooth's pulp.
Trauma to the tooth — the kind that might result from a sports injury or automobile accident, for example — is also a major cause of pulp tissue damage. In this case, it's essential to seek treatment immediately, both to try and save the tooth, and to prevent future problems.
In some cases, extensive dental work itself may cause damage to the pulp tissue that will need to be treated via a root canal. Having multiple fillings or restorations on the same tooth increases the chances of this type of injury. Occasionally, common procedures like crown preparation or orthodontics may eventually lead to root canal problems.
What to Expect During Root Canal Therapy
If an examination shows that you do need root canal therapy, don't worry — it's one of the most routine and effective procedures in the arsenal of dental treatments and can often be accomplished in just one visit.
The root canal process generally begins the same way as a filling does, and with no greater discomfort: an anesthetic is administered to numb the tooth and the surrounding area. For many patients, the worst is already over.
Next, a small opening is made in the surface of the affected tooth to give access to the pulp chamber and root canals. Tiny instruments are used, sometimes with the aid of a microscope, to remove the dead and dying pulp tissue from inside these narrow passageways. The chamber and empty canals are then cleaned, disinfected, and prepared to receive a filling of inert, biocompatible material. Finally, adhesive cement is used to seal the opening in the tooth, preventing future infection.
Following root canal treatment, your tooth may feel some sensitivity or tenderness for a few days. Over-the-counter pain relievers like ibuprofen are generally effective in relieving discomfort, but prescription medications may also be given if needed. During this period, it may help to avoid biting hard on the affected tooth. All of these symptoms, however, should be temporary.
To further protect the tooth and restore it to full function, it's usually necessary to have a crown or other restoration placed on it. Restorations can take many forms, from traditional gold crowns to tooth replicas made of high-tech tooth-colored material. In any case, you will have made an investment in preserving your dental health for years to come.
Signs and Symptoms of Root Canal Problems
How do you know when you need a root canal? Sometimes, it's painfully obvious. If you feel constant and severe pain and pressure in your mouth, or noticeable swelling and extreme sensitivity in your gums, then it's clear you need an evaluation and treatment right away. Another telltale symptom of pulp tissue damage is sharp pain when you bite down on food. Lingering pain after eating hot or cold foods is also an indication of potential trouble. If you notice any of these symptoms, you need to have an examination as soon as possible.