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!

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!

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

Steps on How to Care for Dental Braces Between Dental Visits

Many people wish for that perfectly straight smile and will go to any lengths to achieve it. Some wear metal braces for years and undergo several and somewhat painful treatments to finally get a better bite and smile. However, in order to reach your goals you need to take care of the dental braces in between dentist visits so that your time, money and pain are minimized.

Unfortunately, you can not eat just anything and everything you used to until you have your dental braces. Care for your orthodontic treatment by avoiding gooey, sugary and sticky food like gummy candy, raisins, hard bubble gum and the like. You may not notice it but small specks of hard food like popcorn or nuts and potato chips can lodge themselves in the nooks and crannies between your teeth and case complications.

Read more: http://www.weightlossdietinformation.com/how-to-care-for-dental-braces-between-visits.html

I have new spaces between my teeth after a cleaning

Question:

In June 2009 a dentist performed the advanced cleaning procedure they
identified as a full mouth debridement. The dentist also measured the
distance between the bottom of the enamel and the top of the gum. This was
painful as the measurement device pressed into what I assume was soft enamel
or dentin.

The reason for my concern and my question here follows. Before the cleaning,
my gums completely filled the gaps between my maxilla 7, 8, 9 and 10(top front teeth). After
the cleaning, between 9 and 10, a 1.5 millimeter gap exists. And, between 9
and 8, and between 8 and 7, a 0.5 mm gap exists. In other words it appears
that the dentist created gaps during the cleaning process. I definitely had
a lot of blood when I rinses after the cleaning. Did the dentist make a
mistake?

The dentist recommended that I come back for the second part of the cleaning
including having the undersides of my gums cleaned. Another dentist during
another previous appointment recommended the same. Based on the apparent
damage to my gums, I have ignored this. I have not had my teeth cleaning
since.

Answer:

Wow, your ability to relay the information in dental terminology is quite impressive

So first we will explain exactly what happened and then we will explain the reaction of your gums to the procedure.

Full Mouth Debridement

A full mouth debridement is an extensive cleaning procedure that involves cleaning the surfaces of your teeth including the tooth surfaces (root) located under the gums.  A dentist performs a periodontal probing to determine if a patient needs a debridement.  Based off of your information, it looks like the dentist recorded your probing depths, meaning he used a probe to measure the depths of the pockets around your teeth.  This information tells us whether or not your gums are inflamed, meaning that you are experiencing gingivitis (please see our article here for more information on gingivitis).

Signs of Gingivitis

It looks like you had inflammation of your gums.  The major factors in your situation that point us in this direction are the following:

• Bleeding during a cleaning or probing indicates inflammation of gums/gingivitis
• Shrinkage of the gums after the cleaning was performed indicates that the gums were inflamed and are now healing

Healing After Full Mouth Debridement

So now, the dentist performed the debridement and you see spaces that didn’t exist before.  Let’s explain fully why this occurred.

• There is a possibility that you had calculus deposits.  Calculus is a hardened buildup that can accumulate, over time, on teeth.  Sometimes, it appears as tooth structure, but is actually harmful to the teeth.  Calculus usually accumulates around the gumline.  If the dentist removed calculus, spaces can now appear in those newly cleaned areas.
• Your gums are now healing.  Before your gums were inflamed.  Gums become inflamed when there are bacteria, food deposits, plaque, or calculus that remains on the teeth near the gums.  The body’s defense system attempts to fight the foreign invaders resulting in inflammation and tenderness of the gums.  Some signs of inflammation include the following:
  • Red gums
  • Puffy gums
  • Gums that bleed when flossing

Healthy gums should appear coral pink (or slightly pigmented based on ethnicity), firm and tight.

So don’t worry, the dentist definitely didn’t mess up.  Your gums are now healing after the extensive cleaning was performed.  If the spaces in your teeth concern you, return to your dentist and he/she will be able to better assess the situation from this point.  More than likely, once the gums return to full health, the spaces will resolve.  Or, if you had periodontitis, meaning bone loss accompanied the gum inflammation, there are procedures the dentist can use to solve the problem.

Hope this helps and good luck,

Save My Smile Team

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!

Tooth Crown Pain

Question:

Help!!  The tooth under my crown is hurting.  What does this mean and what should I do?  I’ve only had this crown for one year!!

Answer:

Sorry to hear that your tooth is in pain.  This can mean a number of things.  Let’s take a look at the many reasons for pain under a tooth crown:

Carious lesion/cavity under your crown

Sometimes, bacteria are able to find its way under the margins of crowns if not cleaned properly (see article on brushing).  If this happens, it could result in a painful situation, especially if the tooth nerve still remains in the tooth.

Bacteria not completely removed while preparing tooth for crown

In order to prepare a tooth for a crown, alot of tooth structure must be removed.  However, sometimes bacteria may still remain on the tooth structure that cannot be visibly seen by the dentist.  If this occurs, pain will occur at a later time.

Crown not being correctly adjusted in mouth

It could be “too high”, which means your bite could be off, and may need to be reduced by the dentist.  It could also mean that the crown isn’t adjusted to tightly “hug” the tooth and seal off the margins.  If the margins aren’t tight and snug, bacteria could easily creep in and eventually cause tooth crown pain.

Be sure to visit the Dentist to fix the problem

Your best bet is to go to the dentist to evaluate your options.  First, make sure the dentist runs a couple of tests to ensure that the pain is indeed coming from that tooth.  Sometimes, pain in one area is projected to a nearby area, this phenomena is called referred pain and occurs quite frequently.  If the dentist identifies this tooth as the source of the pain, then you’ll have a couple of options.  The crown may just have to be readjusted, which will only take a few moments, or it may have to be removed and the situation assessed from there.  Depending on the extent of bacterial invasion, you may just need the crown re-prepped, a root canal, or even an extraction.  Also, depending on your dentist’s office polices, he/she may offer to re-do your crown for free.

Good luck!