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!

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!

Dental pain after filling

Question:

About six months ago I went to the dentist and he did some kind of drilling.  After getting the drilling done, I couldn’t eat or drink anything! It hurt so bad. A month later the pain was basically gone.  It’s starting to come back again. But even worse. I don’t want to go threw anything painful, (filling, etc,.) I really hope this isn’t anything bad because the tooth mostly hurts on the top and whenever I drink cold milk or hot coffee. Or eat something hot or cold. I am totally scared of the dentist. I have got a filling before, they numbed me and stuff, but it still hurt! I DON’T WANT TO GET ANOTHER ONE  HELP ME!

Answer:

Reasons for a Filling or Crown

There are several reasons why dental drilling may be necessary. These include:

• Dental drilling to remove decay and then place a filling in that area
• Dental drilling to prepare a tooth or teeth for a cap (crown)
• Dental drilling to clean and fill the pulp if a tooth or teeth need root canal therapy

The description you gave sounds like a front tooth cavity. Sensitivity to cold sometimes indicates the beginning of tooth decay. There are two areas of a tooth that a dentist may have to go through when doing dental drilling in order to treat your front tooth cavity.

These are:

• Enamel -  which is the outside area, what you see when you look at your teeth
• Dentin – located directly below the enamel.  Dentin has holes in it with fluid located inside.  When this fluid is disturbed, it carries pain sensations to the pulp (the center of the tooth that has nerves and blood vessels).  This is what happens when teeth ache (or a single pain in tooth).

Tooth Sensitivity

Reasons that you may have a tooth sensitive to cold include:

• A tooth with a cavity/decay. The decay may go deep into the dentin and be the cause of your tooth sensitivity (caries/decay is usually the main culprit when teeth ache).

• A filling that has been placed in an area of deep decay.  If the amount of caries is extensive, the drilling necessary may be more than if there were less caries. This sometimes results in a tooth that is sensitive to cold, and may be prevented by having your dentist place a dental liner over the dentin before filling the tooth.

From the details of your question, your tooth pain that occurred after your filling may have been due to the fact that your front tooth cavity was deep and close to the pulp. Tooth pain after a filling is not at all uncommon, however prolonged tooth pain may be an indication that a liner may have helped. It would be a good idea to get a new radiograph (x-ray) of the tooth to see if there are other issues, and have it addressed from that point.

Also, do not hesitate to let your dentist know if the filling hurts during the procedure.  You should be completely anesthetized and should not feel anything.  You run the show, and you can stop if necessary.

Remember, don’t allow your dental fear to stop you from taking care of your oral health.

We hope this helps you!

I have tooth pain

Question:

Hi, I have been experiencing some weird tooth pain.  It comes as quickly as it goes and does not seem to last long( a few seconds) and has happened three times in the last 2 days.  It is not a throb pain, more a constant pain if that makes sense.  It feels like someone is touching ice cream to my tooth in the whole tooth but 10x worse, and is one of the worst pains I have ever experienced.  I am going to the dentist, I am just curious on your opinions.  Had a cavity filled in the tooth a couple months ago so not too sure why it would hurt all a sudden.  Thanks in advance.

Answer:

Thanks for submitting your question with us.  Now, the main piece of information that will determine the diagnosis of your tooth is:

Is the Pain provoked?

• Does the pain have a trigger point?  For instance, is it painful when you eat hot or cold food or drinks.
• Does the pain occur sporadically and unprovoked?  Does the pain come and goes as it pleases with no trigger point?  For example, the tooth becomes painful randomly throughout the day.
• Does the pain come when you bite down into food?  Or does the pain come when you open your mouth after biting down on food?

You’re probably wondering, why all the questions?  But believe it or not, answers to these simple questions can guide us down the right path to a correct diagnosis.  Let’s examine each answer:

Yes, the pain is provoked by eating cold/hot food or drink.

Then you have reversible pulpitis.  This means that you have slight inflammation of your pulp inside of your tooth.  This is caused by

• Bacteria/decay
• A recent deep filling without a protective base (Deep restorations need a protective layer underneath it to protect the tooth nerve/pulp)
• Recent deep cleaning

Reversible Pulpitis Treatment

Luckily, this can be easily treated by making a slight adjustment to the filling

No, the pain is not provoked by anything and occurs on its own

You may have irreversible pulpitis.  This means the pulp is damaged beyond repair.  This means that bacteria have leaked into your tooth nerve/pulp and are now irritating the tooth and needs to be removed to avoid serious infection.  Some signs of irreversible pulpitis include:

• Spontaneous, unprovoked pain
• On and off pain
• Continuous pain
• Pain lasts even after food/drink/or stimulus is removed
• Lying down or bending over produces pain

Irreversible Pulpitis Treatment

The treatment for irreversible pulpitis is a root canal treatment.

I feel pain when I bite down

Again, this indicates reversible pulpitis and can be treated by adjusting your filling.

I have pain when I open up after biting down

This indicates a fracture of the tooth.

Fractured Tooth Treatment

Treatment for this depends upon the extent of the fracture and can include anything from a new filling, or a root canal, or even an extraction.

For more information on tooth pain, check out our article here.

Also, see below for a descriptive chart of how to diagnose tooth pain.

We hope this helps and good luck,

Save My Smile Team

Is there an alternative to toothpaste?

Question:

I am going on a mission to Malawi, Africa.  We will be handing out toothbrushes to 1000 children.  Do you have any step by step posters to help illustrate how to brush your teeth? Also, what common products could they use when toothpaste is not available? Thank you any help would be appreciated.

Answer:

Feel free to check out our article on Brushing for a step-by-step guide on how to properly brush.  There is a graphic included with the article that illustrates the correct way to effectively brush.

Now, in response to a toothpaste alternative, let’s first discuss the purpose of brushing your teeth and the role of toothpaste (dentifrice).  The ultimate goal of brushing is to remove bacteria and debris (i.e. food debris) from the tooth surfaces.  We want to eliminate food, more specifically sugar, from our tooth surfaces so that bacteria won’t have the opportunity to grow and create harmful substances which could eventually damage our teeth.  This process of removing the above mentioned substances is accomplished with the toothbrush alone!  A toothpaste only adds to the experience of brushing our teeth.

A toothpaste is composed of several parts to enhance the toothbrushing experience and to encourage individuals to brush.  These parts include:

• Abrasive –used to more effectively clean the teeth.  For example an abrasive sponge is used to more effectively remove dirt and grime from a kitchen countertop.
• Detergents
• Flavoring agents – makes the toothpaste “taste good”.  The tolerable taste encourages individuals to brush more.
• Caries (cavity) preventive substance – some toothpastes contain Flouride or Triclosan.  These additional substances are used to strengthen the tooth enamel to aid in preventing cavities or gingivitis.

In a worst case scenario, if no toothpaste is available, baking powder can be used.  If this substance is not available, you can still effectively brush your teeth with just WATER!!  Remember, the goal is to remove bacteria and debris.  Toothpaste just adds to this process.

Hope these tips help out and good luck,

SaveMySmile Team

Cavity Basics

What is a cavity/tooth decay?

A cavity is an open pathway in the tooth which is caused by bacterial invasion.  In the dental world, it’s referred to as a carious lesion.  The severity of the cavity/carious lesion will determine which type of restoration is needed.

How would I know if I have a cavity?

If you experience pain in the tooth, more than likely it can be attributed to bacterial invasion/cavity.  However, keep in mind that tooth pain can be attributed to several other factors such as periodontal disease.  The best way to tell if you have a cavity is to visit the dentist.  Sometimes, cavities occur between our teeth, and the only way to determine its presence is on a radiograph/x-ray. 

What can be done to prevent cavities?

Brush, brush, and brush some more!!  If you brush 3 times a day, or even better, after each meal, you will remove food debris and other agents that act as magnets for bacteria.  If you are unable to brush that often, be sure to chew gum with Xylitol after your meals.  This will aid in remineralizing your enamel after a meal, thus making it stronger and more resistant to bacterial invasion.  Please see our article on gum with xylitol for more information.

Please see our article on cavity prevention for more information on maintaining a healthy mouth.