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!

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 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!

My tooth hurts when I eat hot or cold food or drinks

Question:

My tooth hurts whenever I eat hot or cold food or drinks.  If feels like a sharp pain, then it goes away.  What does this mean?

Answer:

This is a sure sign of reversible pulpitis.  The feeling that you are experiencing is caused by exposed dentin.  Remember that dentin is normally covered by enamel (see article on tooth anatomy), if for some reason a portion of dentin is left uncovered, you will usually feel sensations of short, sharp pain when exposed to hot or cold substances.  Exposed dentin can be caused by a cavity, a defective filling/restoration, or recent dental work.  The good news is that this problem can be fixed easily, the dentin just needs to be covered.  Your dentist will be able to give you a filling, simply fix your existing filling, or a pulp cap if necessary.  However, don’t wait too long.  Reversible pulpitis, if left untreated, can turn into irreversible pulpitis.  Unfortunately, irreversible pulpitis can only be treated with root canal therapy, which costs a lot more in the end.  So be sure to act now by visiting your dentist.

Good luck!

Teeth Grinding

Bruxism, or grinding of the teeth, is a fairly common condition that affects a majority of the adult population (estimates range up to 85%).  It usually occurs while sleeping and the individual is completely unaware that he or she is grinding his teeth.  Unfortunately, this bad habit can lead to a host of other dental problems.

How would I know if I grind my teeth?

• Teeth appear worn down or damaged
• Enamel has been worn down exposing a yellow layer (dentin)
• Experience headaches or migraines in the morning or right after waking up
• Frequent earaches
• Ringing in the ears, especially in the morning
• Sensitive teeth
• Have a loved one observe you in your sleep, grinding of the teeth will occur quite frequently throughout the night
• Facial Pain

What causes teeth grinding [bruxism]?

Causes of bruxism are still under investigation.  However, the most common causes are as follows:

• Stress
• Anxiety
• Alcohol
• Sleep disorders
• Malocclusion

How can I treat bruxism?

Effective treatment is still in the research phase.  The best way to prevent and control grinding of the teeth is to wear a nightguard.  This can be purchased over the counter or provided by your dentist.  Also, try to find ways to reduce the amount of stress in your life.  Activities such as deep breathing and yoga have found to be successful in reducing one’s stress level.

Please do not hesitate to visit the dentist if you suspect brusixm.  Grinding of the teeth can lead to several other dental problems including TMJ issues, the need for fillings, crowns, root canals, bridges, and even extractions.  Eventually, once the grinding becomes bad, the teeth can loosen and will need to be removed.  This is definitely not an issue to take lightly.

Have more questions?  Feel free to leave a commit or submit a question to be included in our FAQ’s.

Tooth Anatomy

The tooth is composed of 4 layers, the enamel, dentin, cementum, and dental pulp.

What is enamel?

Enamel is the hardest substance in the entire body.  It’s the outside layer of the tooth, completely covers the dentin, and is actually transparent in color.  That means the color of our teeth is due to dentin and not enamel.  However, enamel is comprised of enamel rods which can hold stain quite easily, including red wine, coffee, tea, and cigarettes.

What is enamel comprised of?

Enamel is comprised of 96% calcium hydroxyapatite and 4% organic material and water.  Bone is composed of 50% hydroxyapatite and 50% organic material including collagen, thus making enamel the hardest substance in the body.

If I chip or break enamel, will it repair on its own?

Unfortunatley, enamel does not contain any living cells.  Therefore, if chipped, it will not repair itself.  However, dentin can repair itself if damaged.

What is hydroxyapatite?

Hydroxyapatite is a storage form of calcium in the body.  99% of calcium in bone is stored as hydroxyapatite.  The chemical formula for hydroxyapatite is Ca₅(PO₄)₃OH.

What is dentin?

Dentin makes up the bulk of the tooth.  It completely surrounds the pulp, and is covered by enamel on the crown portion of the tooth, and by cementum on the root of the tooth.  Dentin is usually yellow in color and ultimately determines the color of the tooth, being that enamel is transparent.  Dentin is composed of dentinal tubules that communicate directly with the pulp.  This means that is bacteria reaches the dentin, usually some type of pain will be felt.  Dentin is composed of 65-70% calcium hydroxyapatite, 20-25% organic material, and 10% water.

What is cementum?

Cementum covers dentin on the root surface of the tooth.  Cementum connects the tooth to the periodontal ligaments and is therefore somewhat responsible for securing the tooth in the bone.  It is composed of 50% calcium hydroxyapatite and 50% organic material and water, the same consistency as bone.

What is pulp?

Pulp is the livelihood of the tooth.  Pulp supplies nutrients, blood, and nerves to the tooth.  This means that the pulp is responsible for keeping the dentin, cementum, and dentin strong.

Well what if my pulp is removed with a root canal?

Once bacteria reaches the pulp, depending on how extensive, it’s usually recommended to have the pulp removed.  This is because the pulp communicates directly with the rest of the body, and if harmful bacteria is present in your pulp, and it easily move to other areas of the body, including the brain!!  Please see the article on root canal for further information on this subject.