What is a pulpotomy

Question:

“I have a tooth where i would like to save the portion not damaged by bacteria.  i am only being presented an option of root canal. can i opt to have a pulpotomy — usually this is only for <16.
I would like to preserve my radicular pulp/ dentin. (not symptomatic)”

Answer:

Pulpotomies are usually just a temporary fix.  More often than not, once bacteria reaches the pulp tissue, there’s no sure sign of judging the extent of it’s invasion.

Pulpotomies are oftentimes performed on primary teeth, or in emergency situations on adult teeth to alleviate extreme pain.  If it is a primary tooth, then we would encourage you to pursue the pulpotomy option.  However, if this is a permanent tooth, and you elect to have the pulpotomy, there is a chance that symptoms will return later on (anywhere from 1 week later to 1 year later).

In a situation like yours, it’s best to remove the entire pulp tissue, thoroughly disinfect and sterilize the canals, and fill with a therapeutic material to ensure the bacteria will not return.  We encourage you to have a root canal, but in the end, the decision is entirely yours.  The article below will detail decay, pulptomies, pulpectomies, and full root canal treatment.  We hope this helps you in your decision.

What is Tooth Decay?

Tooth decay (also called caries or cavities), is a very common and preventable oral disease. Basically, it happens when naturally occurring bacteria in the mouth produce acids after interacting with food (especially carbohydrates) left on teeth. This eventually wears away teeth over time if not treated. The type of treatment necessary after bacteria have caused damage to teeth depends on the extent of the decay. These include:

• Dental filling (this involves removing the decay and replacing the lost tooth structure with amalgam or dental composite material).
• If the decay has been long-standing and has compromised an extensive amount of tooth structure, an extraction may be recommended. The missing tooth or teeth may be replaced by a dental implant, dental bridge or removable partial denture as necessary and recommended by a dentist.
• Tooth decay may be extensive enough to cause a dental.  A dental abscess is serious enough to warrant immediate treatment.
• If the decay has extended to the pulp, a root canal treatment may be necessary

What is Root Canal Treatment?

After a root canal therapy, a crown (also known as a cap) is usually placed over the tooth to protect it. This is necessary because the canal(s) have been cleaned and filled, and the tooth is more susceptible to fracture (it’s more brittle). The canals formerly contained the blood and nerve supply for the tooth, which nourished and maintained the tooth.

What is a Pulpotomy?

A pulpotomy is a type of root canal treatment procedure that is usually performed on primary teeth. It involves the removal of the tissue from the pulp chamber of tooth. Pulpotomies are necessary if the pulp has been violated, either by decay or a tooth fracture. Pulpotomies are different from the root canal treatment done on permanent (adult) teeth in that only a part of the pulp is removed. A pulpotomy procedure may be recommended for a few reasons, including:

• Pulpotomy in children may prevent unnecessary loss of teeth due to a possible infection (the procedure is therefore preventative).
• Pulpotomies may be recommended to save the tooth, hence the space needed for adult (permanent) teeth to erupt.
• A pulpotomy procedure may give a developing permanent tooth a chance to fully develop, after which a conventional root canal therapy is done. This is called apexogenesis.

The success of the procedure depends on the extent of the decay and the patient’s own immune system.

What is a Pulpectomy?

More often than not, if the aim is to prevent the early loss of baby teeth, all of the pulp may be removed from the tooth. This procedure is called a pulpectomy. A pulpectomy procedure may be recommended in the following instances:

• When a tooth has a deep decay.
• When a tooth is fractured, causing exposure of or damage to the pulp.
• Where there is large dental filling.

Whether or not the tooth is symptomatic is a part of assessment that a dentist uses to diagnose the tooth’s condition. If the tooth is asymptomatic with a large decay extending into the pulp, this may be a necrotic pulp (meaning the pulp tissue is dead). Pulp necrosis is one sign that a tooth will need a root canal treatment.

We hope that this was helpful!

Pain in tooth after root canal

Question:

“I have two root canals one on my upper left and the other on my upper right.  I have experienced episodes of pain in both since having the procedures done ~5 yrs ago. The most recent episode was a continuous sort of throbbing pain that persisted for three days before I decided to go to my dentist.  Each time one of these pain episodes occur my dentist takes x-rays and pokes around but is unable to provide an explanation and prescribes antibiotics.  A few days after taking the antibiotics the pain has dulled and goes away.  I no longer feel that this is an effective method in dealing with a persistent problem.  Antibiotics are discontinuing the pain, antibiotics attack and eliminate bacteria, so bacteria are a likely culprit to causing the pain.  Is a pain causing but not so severe bacterial infection able to be seen in an x-ray?  Should I request that my dentist remove the crown for a more thorough examination or is episodes of pain treated by antibiotics a part of the territory of living with a root canal? Lastly, am I supposed to even feel anything being that the pulp tissue is removed?”

Answer:

To specifically address your question, if the problem is alleviated by antibiotics, that’s a sure sign that there is a bacterial re-contamination.  This can be caused by a number of reasons that are outlined in our older article, called Failed Root Canal.  However, it is not normal for you to be feeling pain 5 years after a root canal.  The purpose of a root canal is to completely remove the source of infection, thus removing the source of pain.  It sounds like there may have been a missed canal (lateral canal, or a small canal at the apex), or a leaky crown, but the bacteria has found some kind of way to reinvade and re-infect the area.  It may be best to visit an Endodontist to have him/her reassess your tooth.  The Endodontist specializes in only root canals and has the technology to more closely examine your tooth condition.  Below we have detailed information regarding root canals.

What is a Root Canal Treatment?

A root canal treatment (also called root canal therapy) is a procedure that is done in order to attempt to save a tooth, usually after it has become badly decayed or infected. If the affected tooth is not treated, the infection or decay will usually spread to the tissues surrounding the tooth, including the bone.

Does a root canal hurt?

In most cases, the procedure is not painful, though there may be some sensitivity afterwards. Most cases of discomfort are felt if there was pain before the procedure (it goes away as the tooth heals), or if there is any complication such as a missed canal. One of the wonderful things about a root canal treatment is that the source of the pain is removed, the canal(s) thoroughly cleaned and disinfected, and the canals filled to prevent re-invasion of bacteria. Many patients retain their root canal treated teeth for life.

It’s important to note too that in most cases where there is discomfort after, the source is not in the tooth itself but in the periodontal ligament (PDL) surrounding the tooth. The infection in the tooth often spreads to the PDL (and in some cases the bone), which by itself is the cause of much sensitivity and discomfort.

What to do after a root canal

The root canal procedure has a success rate ranging between 68-95%. It is a welcome procedure for patients who have the opportunity to try and save their tooth or teeth. After the procedure is completed, a few things to know and expect:

• If there was tooth pain or an infection before the procedure, you may have some sensitivity for a few days after. This is because the tooth is healing from the tooth inflammation that was present before. Your dentist will most likely prescribe NSAIDs for the pain and inflammation. Antibiotics are used to treat oral bacterial infections, in cases where a tooth or teeth may have developed an infection.
• Avoid chewing on the tooth being treated until a permanent crown is placed. This will help you to avoid damaging or re-contaminating the tooth.
• Ensure that you complete the procedure by having a crown (cap) placed over the tooth. This helps protect the tooth from being exposed again to bacteria, and provides structural support and protection for a tooth that is no longer as strong on its own.

Pain years after root canal

Though not very common, there can be root canal pain years later. Reasons for pain after a root canal procedure include:

• Tooth fracture.
• A failed dental restoration (usually a crown) that has allowed bacteria to invade the tooth, causing a re-infection.
• The material sealed inside the canal(s) break down, allowing bacteria to recontaminate the tooth.
• Missed canal – not all canals were located, cleansed, and sealed during the procedure

Failed root canal

After root canal pain, a dentist will re-examine the tooth including the crown to determine the condition of the tooth and what needs to be done. It is sometimes tricky to isolate the problem, but two common approaches to relieving the recurrence of inflammation and infection include:

• A root canal retreat. Re-treatment is sometimes successful, and involves thoroughly cleaning and refilling the canals.
• Endodontic surgery may be needed in other cases. The most common endodontic surgery used to attempt to treat this is an apicoectomy (also called root-end resection or root resection). Basically, the tip of the root and the infected tissue around the root tip are removed. A small filling may be placed at the root tip to seal the root canal.

In extreme circumstances, the tooth may be non-restorable and will need to be extracted. Comprehensive evaluation is necessary for diagnosis and treatment of each patient’s case. Depending on the extent of the infection, changes are sometimes seen on a dental radiograph (dental x-ray) that indicate the presence of an active infection.

We hope this information was helpful to you!

My teeth are loose

Question:

“Hello I am the age of 12 and I woke up to a loose premolar is there anything that i can do about it or will it fall out and never grow back?”

Answer:

Premolars are a part of our permanent set of teeth.  So, if you are sure that it’s a premolar that’s loose, and not one of your baby teeth (as baby teeth are significantly smaller than permanent teeth and can easily be mistaken for a premolar), then there is something else that is going on, and we highly recommend you visiting your dentist so that an x-ray can reveal the true culprit.

My tooth feels loose

Here are some reasons why teeth become loose:

• Periodontal disease. Localized aggressive periodontitis is less common form of periodontitis that may affect only a few teeth.
• Bruxism (habitual clenching or grinding of teeth, often especially at night). Many patients are night bruxers (grind their teeth while they sleep), and may not be aware of the habit.
• Trauma to teeth (resulting from sporting activities or other accident).
• Primary teeth (baby teeth) may become loose, as the new permanent teeth begin to erupt.
• Malocclusion
• Supernumerary teeth (extra teeth)

What is Malocclusion?

Let’s first define occlusion. Occlusion is simply the way the upper and lower teeth come together. Malocclusion means the upper and lower teeth aren’t in proper alignment (they don’t come together the way they should). Malocclusions are a big deal because extra pressure is sometimes placed on the bone surrounding the teeth. Malocclusion classification is divided into:

• Class 1 malocclusion
• Class 2 malocclusion (there’s also a class 2 division 1 malocclusion & a class 2 division 2 malocclusion)
• Class 3 malocclusion

What to do about Loose Teeth

The reason for the loose tooth must be found and treated, so proper diagnosis and treatment is necessary. This can only be done by a dentist (in your case, we recommend that your parents/guardians take you to see a pediatric dentist). General treatment options for loose teeth may include:

• Treating the periodontal disease.
• Allowing a primary (baby) tooth to naturally exfoliate (fall out).
• Orthodontic treatment.
• A night guard is sometimes prescribed to prevent grinding of teeth.
• Splinting teeth (joining them together) is sometimes recommended.

The treatment for each patient depends on the result of dental examination and diagnosis. Please recommend to your parents/guardians that you see a pediatric dentist (pedodontist) as soon as possible. The very best to you!

Pulpitis: Reversible pulpitis vs Irreversible pulpitis

Question:

“What procedure is done to fix reversible pulpitis”

Answer:

Causes of Tooth Pain

Whether it’s on and off, lingering or thumping, tooth pain is really uncomfortable and sometimes makes it hard to do anything else while the pain persists. Tooth pain causes are outlined in the article. Brushing at least twice a day and flossing daily, along with regular dental visits, are sure ways to prevent tooth decay (cavities). The modified bass technique is an effective brushing technique.

What is Pulpitis?

Pulpitis is an inflammation of the dental pulp. It’s primarily caused by bacteria that enter the pulp. The bacterial infection itself begins with tooth decay. Pulpitis may also be caused by any other type of injury to the pulp. Symptoms of pulpitis range from very mild to very severe. There are two types, and the pulpal diagnosis of each differs based of factors explained below.

What is Reversible Pulpitis?

This means that the tooth inflammation can be reversed, and the tooth symptoms relieved. The tooth therefore has a chance to heal and recover. The inflammation is usually secondary to decay, but may also be due to pulpal injury. Reversible pulpitis symptoms include:

• Tooth discomfort from contact with anything cold or another stimulus.
• Tooth symptoms that are relieved when cold or other stimulus is removed.
• Symptoms that gradually get better.
• Usually the discomfort experienced can be relieved by over the counter pain medications.

Treatment for Reversible Pulpitis

If a tooth has caries (tooth decay) and symptoms of reversible pulpitis, a dentist will remove the decay and replace the lost tooth structure with a dental filling. This reversible pulpitis treatment is usually sufficient to reverse the process. The symptoms normally improve over time, gradually disappearing.

What is Irreversible Pulpitis?

When the pulp tissue (nerve of the tooth) is damaged beyond recovery, this is known as irreversible pulpitis. The pulp will eventually die, and if the tooth isn’t treated soon enough, a tooth abscess (tooth infection) may occur.

A tooth vitality test is often done to confirm a diagnosis of irreversible pulpitis. The usual treatment of irreversible pulpitis is a root canal therapy. This is necessary in order to save the tooth. Irreversible pulpitis symptoms include:

• Spontaneous pain (pain that arises without any provocation). Tooth pain that wakes you up in the middle of the night is usually a sure sign of irreversible pulpitis.
• If the pain is brought on by a stimulus, it usually lingers even after the stimulus is removed.
• The symptoms generally get worse.
• Root canal treatment is usually necessary to treat the problem.

We hope that you found this information helpful!

Pain after Root Canal

Question:

“I just had a root canal treatment in the top tooth, 5th from the middle. It’s been a month since the treatment, and I am having slight pain, it feels slightly loose.  What would you suggest for me to keep my tooth”

Answer:

What is Root Canal Treatment?

A root canal specifically refers to the space inside of the root of a tooth. A tooth may have one or more canals, just as they may have one or more roots.  Root canal treatment (also called root canal therapy or endodontic therapy) involves cleaning out the canal(s), disinfecting the canal(s) and then filling the canal(s).

Why do I need Root Canal Treatment?

Reasons why a root canal treatment may be recommended include:

• Tooth decay that has extended to the pulp
• Exposure of the pulp due to some trauma (this sometimes happens during rigorous sporting activities)
• A tooth that has become infected from decay (known as an abscessed tooth). Sometimes the infection may spread the bone surrounding the tooth.
• Internal resorption

Why does my root canal hurt?

There may be some sensitivity after the procedure, as the tooth heals. Pain after a root canal is not uncommon, though most patients may have no symptoms after treatment. In cases where there is associated pain, some reasons include:

• The associated pain is normal, as the inflammation slowly goes away and the tooth heals.
• There is an extra (much smaller) canal that may still need to be cleaned and filled. Teeth can be weird in this way (extra canals), and even the very best dentist can miss these hidden canals. This is usually corrected by the dentist or endodontist (a dentist who specializes in root canal treatment).
• The pain may actually be originating from the periodontal ligament surrounding the tooth.
• The root canal has failed, and a re-treat or endodontic surgery (also called root canal surgery) may be needed. If there is a dental infection at the root apex (tip), then an apicoectomy (which just means root tip removal) may be necessary.
• The tooth could have been fractures or perforated during the procedure.  Performing a root canal places a lot of pressure on the tooth.  Sometimes, if the tooth is weakened, it may fracture.  This could very well be the cause of your pain and looseness of the tooth.

Remember that each patient’s case is different, so diagnosing and treating depends on individual cases. Please see your dentist as soon as possible for evaluation to determine necessary treatment.

We hope this was helpful to you!

2,000 people received $1 million worth of dental

(Newsleader.com)–Around 200 dentist volunteered Friday and Saturday to provide dental care to hundreds of Missourians who otherwise might not have been able to obtain the care.

Some waited in line as long as 17 hours outside the Ozark Empire Fairgrounds in hopes of receiving the free dental services, hosted by the Missouri Mission of Mercy charity dental clinic.

“We couldn’t be happier with how things turned out — we hope to host similar events around the state in years to come,” said Darren Mahaffey, co-chair of the Missouri Mission of Mercy.

Read more here of the article here on News-leader.com

Tooth Trauma

Question:

“I am 13 yrs old. While playing my front upper incisors they broke in such a way the joint part broke giving “V”shape for the  front teeth.{small part only} please suggest what should be done to correct this ? Are dental caps[crowns] useful in this case.”

Answer:

Broken Front Teeth

Broken incisors are probably the most common complaint of a broken tooth after sporting activities. When teeth break as you’ve described, there’re three ways the fracture can occur (please read our Tooth Anatomy article for an understanding of tooth structure). This is referred to as an Ellis fracture.  Fractured teeth according to the Ellis classification are described as:

• A fracture involving only enamel (Ellis Class 1 fracture)
• A fracture involving enamel and dentin only (Ellis Class 2 fracture)
• A fracture involving enamel, dentin and pulp (Ellis Class 3 fracture)

Treatment for Broken Teeth

A dentist will need to examine your teeth and take dental x-rays to determine the extent of the damage and the necessary treatment. Your treatment will undoubtedly be based on your tooth fracture classification. Possible treatment options (depending on the extent of the fracture, also assuming that the teeth haven’t moved out of place) include:

• Restoring the teeth using dental composite ( a type of dental filling that has the same shade as normal teeth)
• Placing dental crowns (also called dental caps) over the teeth
• Doing a root canal treatment on the teeth (if the pulp is exposed), then placing dental crowns.

Sometimes when teeth fracture as you describe, there is tooth movement in the sockets, and a tooth or teeth may need to be moved back into placed using orthodontic treatment. Orthodontics involves moving teeth (and sometimes jaw movement also) to put teeth or jaws into proper position or alignment. Most people are familiar with orthodontic treatment from having or seeing other people with braces.

Please speak with you parents/guardians about seeing a pediatric dentist (a dentist who specializes in treating kids, including adolescents) or family general dentist as soon as possible. This is necessary so that you can be examined fully and the proper treatment given.

Good luck!

Circumvallate Papillae

What are circumvallate papillae?

The tongue is covered with fungiform, filiform, foliate, and circumvallate papillae (tastebuds).  The only difference between these different types of tastebuds is the shape and the exact taste that each respective type is responsible for.  For example, one type is responsible for the sour taste, while yet another is responsible for the sweet taste.  Also, combinations of the tastebuds produce certain taste.  The Circumvallate papillae are the tastebuds located all the way at the back of your tongue and are rather large.  They form a V-shape at the base of the tongue and can be seen by sticking your tongue out.

To view top posts regarding circumvallate papillae and the tongue’s anatomy, click here.

Temporary Crown Came Off

Question:

“My temporary crown came off during dinner tonight.  I purchased some OTC dental cement and used it to replace the temp. Holy Toledo! Talk about hurt!!! It’s been 1 hr (& 1 pain pill) ago & it’s still hurting! (it IS seated correctly as my bite is fine)
My dentist is several hours away so I cannot make several trips back & forth to get answers.  #1- does this pain mean I need a root canal? #2 if he seats the perm crown is it possible to do the root canal later on? Thanks for your help – I’m afraid it’s going to be a L-O-N-G night!”

Answer:

It’s likely that the extended exposure of your prepared tooth may have caused you some sensitivity and pain.  Your enamel has been removed in preparation for your crown and your dentin is exposed.  Dentin communicates directly with the pulp/nerve tissue.  This means when air, cold, or any other sensation hits your teeth, it will be interpreted as pain!  It doesn’t necessarily mean that you will need to have a root canal therapy. Your temporary crown may not be adequately sealed, thus causing a condition called reversible pulpitis.  It will easily go away once your tooth is properly protected.  Your dentist will be able to examine your tooth’s condition and determine what is necessary. We encourage you to get back to your dentist as soon as possible, where you can be provided with the appropriate professional services.

Let’s take a more detailed look at dental crowns and temporary dental crowns.  Also, look below for our chart on tooth pain interpretation.

Temporary Crown

A temporary crown is placed to protect a tooth or teeth that have been prepared to receive a permanent crown. The permanent crown is a ‘cap’ that is shaped like a tooth to restore a tooth or teeth to proper function, form and esthetics. The preparation of the tooth or teeth essentially involves removing some of the tooth structure so that the crown can fit comfortably on the tooth or teeth. Reasons you may need a crown include:

• The provide coverage and support for a tooth that has a large filling, with not much tooth structure left.
• To cover a dental implant.
• To restore a badly broken or worn down tooth.
• To protect a weakened tooth (for example after a root canal therapy).
• As part of a dental bridge.
• To restore desirable esthetics in discolored teeth or awkwardly shaped teeth.

Temporary Crown came off

If the permanent crown isn’t ready to be placed immediately after the preparation, a temporary crown is placed to protect the tooth. In the situation where your temporary crown came off, it is important to get it put back in place (as you did) as soon as possible. Even when there is a temporary crown loose, it needs to be re-seated. The main reasons:

• To protect the prepared tooth from fracture or other damage
• To prevent decay
• Maintaining coverage protects the tooth from sensitivity and pain due to exposed dentin

We hope this was helpful to you!

Save My Smile Team

Dental Care Evaluations by State

(Huffington Post)–Growing up, most of us learned how to brush our teeth and gums, and were instructed to do so at least twice a day, without exception — and for good reason. Beyond the obvious benefits of dental health, which include avoiding unsightly teeth stains and painful cavities, a healthy mouth has been increasingly linked to other health issues.

Just this summer, a study found a possible link between gum disease and an increased difficulty conceiving children, and periodontal disease has been linked to a host of heart problems — including coronary artery disease — as well as an increased chance of becoming diabetic. It seems fairly clear that oral health is something that we shouldn’t be neglecting. Unfortunately, a recent Gallup poll suggests that many Americans do just that.

Read more of the article here from Huffington Post

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