Pericoronitis Treatment

Question:

If we decide to extract the recurrent pericoronitis tooth [should we] give antibiotic before the extraction or after the extraction of tooth?
ThankYou

Answer:

Pericoronitis, infection of the soft tissue typically around the crown of an impacted tooth, usually has a tendency to recur if the causative agent (the tooth) isn’t removed.  The tooth should not be removed until all signs and symptoms of the pericoronitis have been resolved.  If not, incidence of postoperative complications, specifically postoperative infection and dry socket, are highly increased.  However, some sources indicate that IF the pericoronitis is mild, and if the tooth can be easily removed, than an immediate extraction may be performed.  In the end, the recommendation is to treat the pericoronitis, then proceed with the extraction.

Hope this helps and good luck,

SaveMySmile Team

My root canal failed!

Question:

I had a root canal done and it abscessed. I haven’t got it finished all the way yet. Can I safely pull the tooth, and be done with it.

Answer:

Now before you think about pulling the tooth, let’s think about some other factors that will come into play down the road.  Once that tooth is gone, the tooth behind it and the tooth across from it (in the opposite jaw) will begin to slowly drift into the open space.  This will cause the other teeth to drift also, resulting in open spaces amongst your teeth.  You will eventually have to replace the space with either a bridge, implant, or partial denture which are all pretty costly.

Root canal procedures don’t have a 100% success rate, sometimes they do fail.  However, retreatment is always an option and definitely cheaper as compared to some of your other options.  Being that your procedure wasn’t finished, the pathway for bacteria wasn’t completely blocked meaning it had an opportunity to repopulate or wasn’t completely removed.

If would be best, in the long run, if you were to return to have the procedure completed or retreated.  Yea, it may be cheaper and easier to pull the tooth now, but believe us, you may regret this decision down the road.

Good luck with your decision,

SaveMySmile Team

Why are my gums receding?

Question:

Why does [the gum push down away from my tooth]? It looks like there won’t be support to my tooth if it [keeps] on happening. Is there any solution for it?

Answer:

It sounds like what you’re describing is a severe case of gingival recession.  Severe recession usually results from gingivitis or periodontitis.  Gingivitis is the inflammation of the gums around the tooth.  Periodontitis is similar to gingivitis, except it also includes loss of bone around the tooth and shrinkage of the gum tissues away from the tooth.

You want to try your best to preserve the tooth and its surrounding structures.  The gums (gingiva) usually shrink away from the teeth because bacteria have accumulated in areas around the tooth.  The bacteria cause our immune system to react in several ways to fight it off.  A combination of our immune system reactions and the harmful toxins released from the bacteria lead up to periodontitis (the gums shrinking away from the tooth).

The best way to treat this is to FLOSS EVERYDAY especially around this tooth and be sure to brush thoroughly all surfaces of your teeth.  If not, bacteria will continue to accumulate around your gumline and continue to add to your condition.

Is the tooth loose?  If so, you may need to visit your dentist for further evaluation.

Is there plaque or calculus around the tooth?  If yes, you will need a dental cleaning in order to effectively remove all of the bacteria from this area.

If the gum recession is severe, you can always visit your dentist for a periodontal graft to assist in replacing the tissue.

As a reminder, be sure to begin to take steps to treat this situation now.  If allowed to worsen, the tooth could eventually become loose and even fall out.  View our articles on Brushing and Flossing for more details on how to properly clean your teeth.

Good luck,

SaveMySmile Team

I have bad breath

Question:

I am suffering from bad breath for long time. Please give me suggestions.  Thank.

Answer:

Bad breath can come from many sources.  For starters, it comes from poor oral hygiene.  If you fail to brush after each meal and floss at least once a day, bacteria will begin to accumulate in your mouth, especially in those hard to reach areas.  This can include between the teeth or even on the back of the tongue.  Bacteria give off by-products that leave a stench.  Therefore the more bacteria you have in your mouth, the higher of a chance for bad breath.

Another reason could stem from your diet.  If you have a diet that’s low in carbohydrates, you are more likely to have bad breath.  Having a balanced diet that contains plenty of water is essential to great breath.

Some cures to bad breath include

• Occasionally chewing on sugar-free gum, that preferably contains Xylitol (see our article here), throughout the day
• Occasionally consuming sugar free mints throughout the day to stimulate salivary flow, thus cleansing the mouth of bacteria
• Maintaining good oral health (see our articles on Brushing and Flossing)
• Be sure to clean the tongue daily, with either a tongue scraper or the bristles of your toothbrush.

Hope these tips help out and good luck,

SaveMySmile Team

Will my daughter’s baby tooth be replaced?

Question:

Sir, I would like to ask about my daughters tooth.  It is badly damage so the doctor told me to remove it. I want to know whether she will again get her permanent tooth back or not? She is completed 7yrs now. Please reply me soon. Thanks in advance.

Answer:

Around the age of 6, children begin to see their permanent teeth erupt.  Depending on which tooth is removed, more than likely it will be replaced with an adult tooth.  Below we have included a chart of eruption times of adult teeth.  The teeth are arranged starting with the central incisor at the midline and ending with the molar in the back of the mouth.

Upper Teeth
Tooth	Eruption Age
Central Incisor	7-8 yr
Lateral Incisor	8-9 yr
Canine	11-12 yr
First Premolar	10-11 yr
Second Premolar	10-12 yr
First Molar	6-7 yr
Second Molar	12-13 yr
Third Molar	17-21 yr

Lower Teeth
Tooth	Eruption Age
Central Incisor	6-7 yr
Lateral Incisor	7-8 yr
Canine	9-10 yr
First Premolar	10-12 yr
Second Premolar	11-12 yr
First Molar	6-7 yr
Second Molar	11-13 yr
Third Molar	17-21 yr

However, if a tooth is removed too early, it could influence the amount of space left for the adult tooth.  Ask your dentist if early removal of the tooth will influence the eruption of the adult dentition.  If so, the dentist is required to provide you with “space maintenance” options.  This means that when the adult tooth comes in, there will be enough room in the mouth to accommodate it.

Good luck with your decision,

SaveMySmile Team

Dental Implants Vs Bridges

Question:

My dentist recommended an Implant or a dental bridge.  She explained the options but I’m still confused.  What are the advantages and disadvantages of each option?

Answer:

Well let’s first describe what each option entails.  With an implant (usually a mini-screw, or blade, etc), the device is drilled directly through your bone.  Much like the root of a real tooth, it then supports a dental crown.  It looks and acts like a real tooth.

Advantages of this method include:

• esthetics (looks like a real tooth)
• Ability to easily clean it (floss, etc.)
• Looks and feels more natural

Disadvantages of this method include:

• Cost
• Implant failure (depends on location of implant but usually fairly low)

A bridge basically refers to a replacement tooth that is connected to two adjacent teeth.  Meaning, the tooth is attached to the adjoining teeth for support.  As a result, the two adjacent teeth must be crowned.

Advantages of this method include:

• Cost
• Somewhat esthetic (Not as esthetic as implants)

Disadvantages include:

• Somewhat difficult to clean
  • Because the tooth is connected to the two adjacent teeth.  It is hard to floss.  A proxy brush made be used to clean this area effectively
• Esthetics
  • As mentioned above, not as esthetic as implants
• You lose unnecessary tooth structure
  • Because the tooth needs two adjacent teeth for support, the two adjacent teeth must be crowned, causing unnecessary work on a normal tooth.

Good luck and we hope this helps with your decision!

SaveMySmile Team

Help! I have headaches after my extraction

Question:

I had an extraction about a week ago on tooth #17. Since the extraction, I have been having very bad headaches and ringing in my ears. What is causing this and how can I make it stop??

Answer:

Several problems can come into play when extracting a third molar.  Several key anatomical landmarks (including nerves, muscles, blood vessels, etc) in the area of the third molar make this extraction particularly more complicated then extraction of other teeth.  What you are describing sounds as if you might have damage to a nerve, specifically the auriculotemporal nerve (a branch of cranial nerve V3), during the extraction.  Usually, any issue with this nerve, can cause a tingling or irregular sensation in the areas of the jaw, ears, or even cause headaches.

The good news is that damage to the nerve usually heals.  However, this process can take anywhere from a few weeks to a few months, depending on the extent of damage to the nerve.  For now, continue to take the pain medication that the dentist probably prescribed you.  Make sure the pain medication is a NSAID like Ibuprofen.  If you need more, call your dentist for a refill or pick some up at your local store.  Also, placing a warm cloth or heating pad over the area can help decrease the pain.

If the problem doesn’t go away after a couple of more weeks, return to the dentist for further examination.

Hope this helps and good luck!

Because of trauma, my gum receded. Will it heal?

Question:

I got into a fight on New Years eve, and took a pretty good punch to the mouth. My gums were bruised, and the gum on my right front tooth receded so that part of the root is visible.

I am a smoker, so a few questions that have really been bothering me are:

Will it heal?
Will I require dental surgery?
Do I need to avoid smoking?
Will it get infected if I don’t take care of it?
What are the signs that the tooth is dying besides turning dark (which isnt happening….yet….)

Any help would be greatly appreciated, thanks.

Answer:

Well there are a couple of things to take into consideration when looking at your scenario.  For starters, is the tooth mobile?  This plays a HUGE role as to whether the tooth will “heal” or not.  If mobile, the tooth may need to have a splint attached by the dentist to immobilize the tooth so that healing can begin to occur.

We will answer your questions under the assumption that the tooth is not mobile.

Will it heal?

Yes and no.  Yes in that the periodontal ligaments (the fibers that attach the tooth to the socket and bone) have undergone extensive trauma and will begin to reattach so that the tooth can function normally.  No, in that the gums that have receded will not grow back over the exposed root without assistance from the dentist.  What will actually happen is that the pdl fibers will reattach on the remaining gingiva (gums).

Will I require dental surgery?

Yes.  You will need something referred to as periodontal plastic surgery (believe us, sounds much more complicated that what it actually is).  The dentist uses a free gingival graft or connective tissue graft to cover the area.  This means that he/she will remove some gum tissue from one part of your mouth, and place it over the area of recession in order to stimulate growth.

Do I need to avoid smoking?

Yes is an understatement!!  Smoking severely compromises the amount of blood supply to your gums.  Insufficient blood supply=delayed healing!

Will it get infected if I don’t take care of it?

Let’s consider the anatomy of teeth when looking at this question.  Unlike the crown of the tooth, which is covered by enamel, the root of the tooth is covered by a substance called cementum.  The composition of cementum is a little different than enamel, as it was made to function below the gums, and not actually in the mouth like enamel.  This means just continue to practice good oral hygiene, which means brushing after each meal and flossing once a day.  Be sure not to let food or any other debris accumulate in this area.

What are the signs that the tooth is dying besides turning dark?

This varies.  Some signs can include sharp pain, increased sensitivity, a long, dull, continuous pain, sensitivity to hot, cold, or when chewing, or, as you mentioned, color change.  Also, a tooth can undergo the process of necrosis (dying) with no signs or indications.  A dentist can run several tests to determine whether the pulp is still vital.

We hope these answers helped you out.  In a situation like this, it’s pretty hard to tell exactly what’s going on without running some tests and taking a look clinically.  But hopefully these answers can guide you down the right path.  It’ll be best to go to the dentist and have an x-ray taken of the tooth and a couple of diagnostic tests performed to determine the status of the tooth.  Don’t wait too long to visit the dentist, especially if the tooth is mobile.

Hope this helps and good luck!!

I’m afraid of the anesthetic

Question:

I’m afraid of the [anesthetic].  I’ve had a bad allergic reaction from another dentist mixing 2 [anesthetics].  How can i relax?

Answer:

Well first off, definitely explain this fear to the dentist during your visit.  If returning to the same dentist, he/she should have a note of this previous allergic reaction already recorded in your chart.  The dentist is responsible for using a different type of anesthetic next time to avoid the same mishap.  If going to a new dentist, make sure to note all of your allergies.  This can help the dentist provide you with the best possible care and minimize any risks of a reaction.

There are several things you can do in order to relax when going to the dentist.  They include:

• Relaxation techniques. Close your eyes and take 3 deep breaths very slowly.  Imagine a scene, say the beach for instance, that brings you peace.  Begin to slowly relax your body’s muscles, starting with rotating your head and relaxing your neck, and moving downward until you reach your feet.  This should ease anxiety and put you in a place of peace.
• Ask for sedation. The dentist can administer sedation, which will cause your body to relax.
• Bring music with you to the appointment. By listening to music, your body will feel at ease and will be able to relax easier.

See our article on Dental Phobia for more information on this topic.

Hope this helps and good luck.

Does flossing reduce bad breath?

Question:

Does flossing reduce bad breath?

Answer:

Yes it definitely plays a role in reducing bad breath.  Bad breath can be caused by a number of factors.  Some of these factors include decay in a tooth, bacteria or food debris trapped under the gum line or between teeth, plaque or calculus (tartar) accumulations, bacteria located on the tongue, bad oral hygiene habits, etc.  Flossing definitely needs to be incorporated into a daily routine, in addition to brushing after each meal, to better fight bad breath.  If you practice great oral hygiene habits and don’t have any decayed teeth or plaque, and yet still experience bad breath, maybe you should visit your dentist.  He/she may be able to identify a possible cause that could have been overlooked.

Good luck!

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