Having a tooth pulled in adulthood is sometimes necessary.
Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:
Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.
If tooth decay or damage extends to the pulp -- the center of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canaltherapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.
If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.
Periodontal (Gum) Disease. If periodontal disease -- an infection of the tissues and bones that surround and support the teeth -- have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.
Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. In some instances, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleepthrough the procedure.
If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.
Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches -- usually self-dissolving -- to close the gum edges over the extraction site.
Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.
Although having a tooth pulled is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth pulled, let your dentist know your complete medical history, the medications and supplements you take, and if you have one of the following:
• Damaged or man-made heart valves
• Congenital heart defect
• Impaired immune system
• Liver disease (cirrhosis)
• Artificial joint, such as a hip replacement
• History of bacterial endocarditis
Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimize discomfort, reduce the risk of infection, and speed recovery.
• Take painkillers as prescribed.
• Bite firmly but gently on the gauze pad placed by your dentist to reduce bleeding and allow a clot to form in the tooth socket. Change gauze pads before they become soaked with blood. Otherwise, leave the pad in place for three to four hours after the extraction.
• Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time.
• Relax for at least 24 hours after the extraction. Limit activity for the next day or two.
• Avoid rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket.
• After 24 hours, rinse with your mouth with a solution made of 1/2 teaspoon salt and 8 ounces of warm water.
• Do not drink from a straw for the first 24 hours.
• Do not smoke, which can inhibit healing.
• Eat soft foods, such as soup, pudding, yogurt, or applesauce the day after the extraction. Gradually add solid foods to your diet as the extraction site heals.
• When lying down, prop your head with pillows. Lying flat may prolong bleeding.
• Continue to brush and floss your teeth, and brush your tongue, but be sure to avoid the extraction site. Doing so will help prevent infection.
It is normal to feel some pain after the anesthesia wears off. For 24 hours after having a tooth pulled, you should also expect some swelling and residual bleeding. However, if either bleeding or pain is still severe more than four hours after your tooth is pulled, you should call your dentist. You should also call your dentist if you experience any of the following:
• Signs of infection, including fever and chills
• Nausea or vomiting
• Redness, swelling, or excessive discharge from the affected area
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
The initial healing period usually takes about one to two weeks. New bone and gum tissue will grow into the gap. Over time, however, having a tooth (or teeth) missing can cause the remaining teeth to shift, affecting your bite and making it difficult to chew. For that reason, your dentist may advise replacing the missing tooth or teeth with an implant, fixed bridge, or denture.
Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their color, shape, size, or length.
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Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. You will need to discuss the best choice of veneer material for you with your dentist.
Veneers are routinely used to fix:
• Teeth that are discolored -- either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
• Teeth that are worn down
• Teeth that are chipped or broken
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
• Teeth with gaps between them (to close the space between these teeth)
Getting a dental veneer usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.
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This first step involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take X-rays and possibly make impressions of your mouth and teeth.
To prepare a tooth for a veneer, your dentist will remove about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 2-4 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed.
Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched -- which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.
Veneers offer the following advantages:
• They provide a natural tooth appearance.
• Gum tissue tolerates porcelain well.
• Porcelain veneers are stain resistant.
• The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter.
• Veneers offer a conservative approach to changing a tooth's color and shape; veneers generally don't require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative.
The downside to dental veneers include:
• The process is not reversible.
• Veneers are more costly than composite resin bonding.
• Veneers are usually not repairable should they chip or crack.
• Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
• Veneers may not exactly match the color of your other teeth. Also, the veneer's color cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
• Though not likely, veneers can dislodge and fall off. To minimize the chance of this occurring, do not bite your nails; chew on pencils, ice, or other hard objects; or otherwise put excessive pressure on your teeth.
• Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown.
• Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active gum disease), weakened teeth (as a result of decay, fracture, large dental fillings), or for those who have an inadequate amount of existing enamel on the tooth surface.
• Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.
Veneers generally last between 7 and 15 years. After this time, the veneers would need to be replaced.
Dental veneers do not require any special care. Continue to follow good oral hygiene practices, including brushing, flossing, and rinsing with an antiseptic mouthwash as you normally would.
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Even though porcelain veneers resist stains, your dentist may recommend that you avoid stain-causing foods and beverages (for example, coffee, tea, or red wine).
Yes, alternatives to veneers include bondings and crowns. Veneers offer a nice intermediate option. Veneers may be best suited for individuals who want to change the shape of their teeth more than just a little bit -- as is done with bonding -- but not enough to require a crown.
Costs of veneers vary depending on what part of the country you live in and on the extent of your procedure. Generally, veneers range in cost from $1,000 to $2,000 per tooth. The cost of veneers is not generally covered by insurance. To be certain, check with your specific dental insurance company.
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Despite improvements in dental care, millions of Americans suffer tooth loss -- mostly due to toothdecay, periodontal disease, or injury. For many years, the only treatment options available for people with missing teeth were bridges and dentures. But, today, dental implants are available.
Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.
There are many advantages to dental implants, including:
Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that teeth might slip.
Because they become part of you, implants eliminate the discomfort of removable dentures.
Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
Dental implants can give you back your smile and help you feel better about yourself.
Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
Implants are very durable and will last many years. With good care, many implants last a lifetime.
Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.
Success rates of dental implants vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care (see below), implants can last a lifetime.
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In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders -- such as diabetes or heart disease -- or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis. If you are considering implants, talk to your dentist to see if they are right for you.
In general, dental implants are not covered by dental insurance at this time. Coverage under your medical plan may be possible, depending on the insurance plan and/or cause of tooth loss. Detailed questions about your individual needs and how they relate to insurance should be discussed with your dentist and insurance provider.
The first step in the dental implant process is the development of an individualized treatment plan. The plan addresses your specific needs and is prepared by a team of professionals who are specially trained and experienced in oral surgery and restorative dentistry. This team approach provides coordinated care based on the implant option that is best for you.
Next, the tooth root implant, which is a small post made of titanium, is placed into the bone socket of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw. The healing process can take from six to 12 weeks.
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Once the implant has bonded to the jawbone, a small connector post -- called an abutment -- is attached to the post to securely hold the new tooth. To make the new tooth or teeth, your dentist makes impressions of your teeth, and creates a model of your bite (which captures all of your teeth, their type, and arrangement). The new tooth or teeth is based on this model. A replacement tooth, called a crown, is then attached to the abutment.
Instead of one or more individual crowns, some patients may have attachments placed on the implant that retain and support a removable denture.
Your dentist also will match the color of the new teeth to your natural teeth. Because the implant is secured within the jawbone, the replacement teeth look, feel, and function just like your own natural teeth.
Most people who have received dental implants say that there is very little discomfort involved in the procedure. Local anesthesia can be used during the procedure, and most patients report that implants involve less pain than a tooth extraction.
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After the dental implant, mild soreness can be treated with over-the-counter pain medications, such as Tylenol or Motrin.
Dental implants require the same care as real teeth, including brushing, flossing, rinsing with an antibacterial mouthwash, and regular dental check-ups.
To treat a cavity your dentist will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material was removed.
Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding).
First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill, air abrasion instrument, or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.
Next, your dentist will probe or test the area to determine if all the decay has been removed. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.
Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multilayering process is completed, the dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.
Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and materials called composite resin fillings. There is also a material that contains glass particles and is known as glass ionomer. This material is used in ways similar to the use of composite resin fillings.
The location and extent of the decay, cost of filling material, your insurancecoverage, and your dentist's recommendation assist in determining the type of filling best for you.
• Durability -- lasts at least 10 to 15 years and usually longer; doesn't corrode
• Strength -- can withstand chewing forces
• Aesthetics -- some patients find gold more pleasing to the eye than silver amalgam fillings.
• Expense -- gold cast fillings cost more than other materials; up to 10 times higher than cost of silver amalgam filings.
• Additional office visits -- requires at least two office visits to place
• Galvanic shock -- a gold filling placed immediately next to a silver amalgam filling may cause a sharp pain (galvanic shock) to occur. The interaction between the metals and saliva causes an electric current to occur. It's a rare occurrence, however.
• Aesthetics -- most patients dislike metal "colored" fillings and prefer fillings that match the rest of the tooth.
• Durability -- silver fillings last at least 10 to 15 years and usually outlasts composite (tooth-colored) fillings.
• Strength -- can withstand chewing forces
• Expense -- may be less expensive than composite fillings
• Poor aesthetics -- silver fillings don't match the color of natural teeth.
• Destruction of more tooth structure -- healthy parts of the tooth must often be removed to make a space large enough to hold the amalgam filling.
• Discoloration -- amalgam fillings can create a grayish hue to the surrounding tooth structure.
• Cracks and fractures -- although all teeth expand and contract in the presence of hot and cold liquids, which ultimately can cause the tooth to crack or fracture, amalgam material -- in comparison with other filling materials -- may experience a wider degree of expansion and contraction and lead to a higher incidence of cracks and fractures.
• Allergic reactions -- a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations.
The mercury contained in the amalgam releases low levels of mercury in the form of a vapor that can be inhaled and absorbed by the lungs. High levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys. Studies have found no link between the amalgam filinings and health problems and the FDA considers them safe for adults and children ages 6 and above.
• Aesthetics -- the shade/color of the composite fillings can be closely matched to the color of existing teeth. Composites are particularly well suited for use in front teeth or visible parts of teeth.
• Bonding to tooth structure -- composite fillings actually chemically bond to tooth structure, providing further support.
• Versatility -- in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth.
• Tooth-sparing preparation -- sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.
• Lack of durability -- composite fillings wear out sooner than amalgam fillings (lasting at least five years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgam fillings under the pressure of chewing and particularly if used for large cavities.
• Increased chair time -- because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgam fillings to place.
• Additional visits -- if composites are used for inlays or onlays, more than one office visit may be required.
• Chipping -- depending on location, composite materials can chip off the tooth.
• Expense -- composite fillings can cost up to twice the cost of amalgam fillings.
In addition to tooth-colored, composite resin fillings, two other tooth-colored fillings exist -- ceramics and glass ionomer.
These fillings are made most often of porcelain, are more resistant to staining than composite resin material but are also more abrasive. This material generally lasts more than 15 years and can cost as much as gold.
This is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts five years or less with costs comparable to composite resin. The newest ones have an even better lifespan and, when placed in appropriate areas. are equal to composites.
Most dental insurance plans cover the cost of the composite fillings up to the price of the silver filling, then the patient may have to pay the difference.
Indirect fillings are similar to composite or tooth-colored fillings except they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.
During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental lab that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while the restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.
There are two types of indirect fillings -- inlays and onlays.
• Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
• Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.
Inlays and onlays are more durable and last much longer than traditional fillings -- up to 30 years. They can be made of tooth-colored composite resin, porcelain, or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.
Another type of inlay and onlay -- direct inlays and onlays -- follow similar processes and procedures as the indirect, but the difference is that direct inlays and onlays are made in the dental office and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.
Temporary fillings are used under the following circumstances:
• For fillings that require more than one appointment -- for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
• Following a root canal
• To allow a tooth's nerve to "settle down" if the pulp became irritated
• If emergency dental treatment is needed (such as to address a toothache)
Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within a month. Be sure to contact your dentist to have a temporary filling replaced with a permanent one. If you don't, the tooth could become infected or you could have other complications.
Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgam fillings. Because these fillings contain the toxic substance mercury, some people think they are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis.
The American Dental Association (ADA), the FDA, and numerous public health agencies say there's no proof that dental fillings cause harm to consumers. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.
Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth.
In June 2008, the FDA said, "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses."
And there's more. "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner," according to the FDA.
The changes come in response to a lawsuit filed by consumer groups and individuals concerned about mercury exposure. To settle the suit, the FDA agreed to update its web site.
To maintain fillings, you should follow good oral hygiene -- visiting your dentist regularly for cleanings, brushing with a fluoride toothpaste, flossing and using an antibacterial mouthwash at least once daily. If your dentist suspects that a filling might be cracked or is "leaking" (when the sides of the filling don't fit tightly against the tooth, this allows debris and saliva to seep down between the filling and the tooth, which can lead to decay), he or she will take X-rays to assess the situation. If your tooth is extremely sensitive, if you feel a sharp edge, if you notice a crack in the filling, or if a piece of the filling is missing, call your dentist for an appointment.
Tooth sensitivity following placement of a filling is fairly common. A tooth may be sensitive to pressure, air, sweet foods, or temperature. Usually, the sensitivity resolves on its own within a few weeks. During this time, avoid those things that are causing the sensitivity. Pain relievers are generally not required.
Contact your dentist if the sensitivity does not subside within two to four weeks or if your tooth is extremely sensitive. He or she may recommend a desensitizing toothpaste, may apply a desensitizing agent to the tooth, or possibly suggest a root canal procedure.
Pain around the fillings can also occur. If you experience pain when you bite, the filling may be interfering with your bite. You will need to return to your dentist and have the filling reshaped. If you experience pain when your teeth touch, the pain is likely caused by the touching of two different metal surfaces (for example, the silver amalgam in a newly filled tooth and a gold crown on another tooth with which it touches). This pain should resolve on its own within a short period of time.
If the decay was very deep or close to the pulp of the tooth, you may experience a "toothache-type" pain. This "toothache" response may indicate this tissue is no longer healthy. If this is the case, root canal therapy may be required.
Sometimes people experience what is known as referred pain -- pain or sensitivity in other teeth besides the one that received the filling. With this particular pain, there is likely nothing wrong with your teeth. The filled tooth is simply passing along "pain signals" it's receiving to other teeth. This pain should decrease on its own over 1 to 2 weeks.
Allergic reactions to silver fillings are rare. Fewer than 100 cases have ever been reported, according to the ADA. In these rare circumstances, mercury or one of the metals used in an amalgam restoration is thought to trigger the allergic response. Symptoms of amalgam allergy are similar to those experienced in a typical skin allergy and include skin rashes and itching. Patients who suffer amalgam allergies typically have a medical or family history of allergies to metals. Once an allergy is confirmed, another restorative material can be used.
Constant pressure from chewing, grinding, or clenching can cause dental fillings to wear away, chip, or crack. Although you may not be able to tell that a filling is wearing down, your dentist can identify weaknesses in them during a regular check-up.
If the seal between the tooth enamel and the filling breaks down, food particles and decay-causing bacteria can work their way under the filling. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscessed tooth.
If the filling is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown.
New fillings that fall out may be the result of improper cavity preparation, contamination before the filling is placed, or a fracture of the filling from bite or chewing trauma. Older restorations will generally be lost due to decay or fracturing of the remaining tooth.
If your gums rest too low or too high on your teeth and you are unhappy with your smile, you may be a candidate for gum contouringsurgery. Also called gum reshaping or tissue sculpting, this cosmetic dental procedure can even out an uneven gum line and give you a smile you can be proud of.
A number of things can cause your gums to be too low or too high. Gums that cover a large portion of your teeth can make your teeth look small. This may be the result of genetics, a particular health problem, or taking certain prescription drugs.
Gums that are too high and make your teeth appear long are often caused by gum recession, a condition in which gum tissue pulls back from a tooth and exposes the tooth's root. Not only can gum recession make your teeth look long, it can lead to serious dental problems such as decay and tooth loss. Gum recession may also be a sign of periodontal disease, the deterioration of the supporting structures of the teeth (gums and bone) .
Gum contouring alone is considered a cosmetic procedure. Most of the time it is not medically necessary. Most people have their gums reshaped to improve the appearance of their smile. However, some people undergo gum contouring surgery as part of other necessary periodontal procedures, such as crown lengthening, pocket reduction, and regenerative procedures.
Gum contouring procedures not considered cosmetic include adding gum tissue when recession has occurred and trimming overgrown tissue that has covered part of the tooth crown.
Many general dentists and periodontists (gum specialists) can perform the gum contouring procedure. Before having the procedure done, ask your dentist about his or her knowledge and experience with the process.
The cost of gum contouring depends on the extent of the work being done. Talk to your dentist about the cost based on your individual needs. Dental insurancedoes not typically cover gum contouring for cosmetic purposes.
Gum contouring surgery is performed in the dentist's office. Currently, dentists use scalpels, lasers, and radiosurgery to perform the gum contouring procedure. Ask your dentist which technique would be the most suitable for your situation.
Before surgery, your doctor should go over what he or she will be doing during the procedure. Often, dentists will use a pen and draw a line to mark the new gum line. That way, you can see exactly how much gum will be removed or how the gum line will be reshaped.
A local anesthetic may be applied to numb the area. Sometimes, bone at the front of the tooth's root must also be removed during gum contouring to get the best long-term results.
The day of surgery, you should rest and limit your activities. It may take a few days or weeks for your gums to heal completely. Your dentist will give you specific directions about what you need to do to aid the recovery process. Here are some general tips to get you through the recovery period:
• Ease pain by taking an over-the-counter pain reliever, such as Tylenol or Advil, as directed by your dentist. Do not take aspirin, which can cause bleeding.
• Eat soft, cool foods, such as eggs, pasta, yogurt, cottage cheese, soft vegetables, and ice cream, for the first few days after surgery. Avoid spicy foods and anything with seeds until your gums have healed completely.
• Follow your dentist's directions on when and how to brush your teeth during the healing process.
If you notice excessive swelling or bleeding, or if you have any concerns following the procedure, call your dentist.
No surgery is without risks. The risks associated with gum contouring include:
• Allergic reaction to the anesthetic (rare)
• Relapse of gum tissue
If you are unhappy with the way your teeth and gums look, talk to your dentist to see if gum contouring surgery is right for you. But remember, as with any cosmetic procedure, the end result depends on the skill of the doctor. Do not go to just anyone. Do your homework and make sure you are comfortable with the dentist's abilities. Ask the dentist what additional training he or she has had in cosmetic dentistry. Also, ask to see photos of the work he or she has done, and make sure you like what you see.
If you've recently been told by your dentist or gum doctor (periodontist) that you need a gum graft, don't panic. Gum surgery sounds worse than it is. A gum graft may be necessary to protect your teeth from the damaging effects of gum recession, or you may choose to have one to improve the appearance of your smile.
Gum recession is the process in which the tissue that surrounds the teeth pulls away from a tooth, exposing more of the tooth or the tooth's root. This can cause damage to supporting bone. Gum recession is a common dental problem; it affects 4% to 12% of adults and often goes unnoticed until it becomes more severe.
Many people don't even notice that their gums have receded, because it is a gradual process. However, over time, an exposed tooth root can not only look ugly, but can cause tooth sensitivity, especially when eating cold or hot foods. Eventually, gum recession, if not treated, can cause tooth loss. To repair the damage and prevent further dental problems, a gum tissue graft may be needed.
Here's what you can expect during and after a gum tissue graft procedure.
Three different types of gum tissue grafts are typically performed. Which type your dentist uses on you will depend on your specific needs. The graft procedures include:
This is the most common method used to treat root exposure. During the procedure, a flap of skin is cut at the roof of your mouth (palate) and tissue from under the flap, called subepithelial connective tissue, is removed and then stitched to the gum tissue surrounding the exposed root. After the connective tissue -- the graft -- has been removed from under the palatal flap, the flap is stitched back down.
Similar to a connective-tissue graft, free gingival grafts involve the use of tissue from the roof of the mouth. But instead of making a flap and removing tissue under the top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area being treated. This method is used most often in people who have thin gums to begin with and need additional tissue to enlarge the gums.
In this procedure, instead of taking tissue from the palate, it is grafted from gum around or near the tooth needing repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached. The gum is then pulled over or down to cover the exposed root and sewn into place. This procedure can only be done in people who have plenty of gum tissue near the tooth.
Some dentists and patients prefer to use graft material from a tissue bank instead of from the roof of the mouth. Sometimes, tissue-stimulating proteins are used to encourage your body's natural ability to grow bone and tissue. Your dentist can tell you which method will work best for you.
You will be able to go home following the procedure. However, if your dentist gives you a sedative to help you relax, you will need to make arrangements to have someone else drive you home.
Your dentist will give specific instructions regarding postoperative care, such as diet, physical activity, and medications. Do not floss or brush the gum line that was repaired until the area has healed. You will be asked to rinse your mouth with a special mouth rinse to help control plaque during the healing process, and you may be put on an antibiotic to reduce the risk of infection.
For a week or two following gum grafting, eat soft, cool foods, such as eggs, pasta, Jell-O, yogurt, cottage cheese, well-cooked vegetables, and ice cream.
The amount of pain you have after surgery depends on the type of gum graft performed. If no tissue is removed from your palate, you should have little to no discomfort. However, if tissue is removed from your palate, you may be uncomfortable for a few days following the procedure. The wound on the roof of your mouth has been described as feeling like a major pizza burn, but the good news is it tends to heal quickly. Over-the-counter anti-inflammatory medication or prescription pain medication can help keep you comfortable in the days following surgery.
While it may take a week or two for your mouth to fully heal, you should be able to return to work or normal activity the day after surgery.
Call your dentist if you experience any unusual symptoms following surgery, including:
• Bleeding that won't stop after applying pressure for 20 minutes
• More pain, swelling, and bruising than your dentist said to expect
Many dental insurance companies will pay a portion of the cost of gum grafts. If you don't have insurance, the cost of gum surgery will depend on how much work is being done. Talk to your dentist to learn about your payment options.
While gum tissue grafts are effective at repairing gum recession and preventing further damage, there is no guarantee that gum problems won't develop again in the future. However, with regular dental checkups and careful dental care at home, serious damage requiring surgery can be prevented. Other ways to prevent gum disease include:
• Brush your teeth twice a day with a fluoride toothpaste.
• Floss daily.
• Rinse once or twice a day with an antiseptic mouthwash
• Visit your dentist routinely for checkups and professional teeth cleaning and see your periodontist as needed.
• Eat a well balanced and healthy diet.
• Don't smoke.
A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.
"Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory -- to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
When a tooth's nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:
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A tooth's nerve and pulp can become irritated, inflamed, and infected due to deep decay, repeated dental procedures on a tooth, and/or large fillings, a crack or chip in the tooth, or trauma to the face.
A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.
The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.
Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.
An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.
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Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep out contaminants like saliva and food between appointments.
At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.
The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it to full function. Your dentist will discuss the need for any additional dental work with you.
Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling placed.
For the first few days following the completion of a root canal, the tooth may feel sensitive due to natural tissue inflammation, especially if there was pain or infection before the procedure. This sensitivity or discomfort usually can be controlled with over-the-counter pain medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Most patients can return to their normal activities the next day.
Until your root canal procedure is completely finished -- that is to say, the permanent filling is in place and/or the crown, it's wise to minimize chewing on the tooth under repair. This step will help avoid recontamination of the interior of the tooth and also may prevent a fragile tooth from breaking before the tooth can be fully restored.
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As far as oral health care is concerned, brush, floss, and use an antiseptic mouthwash as you regularly would and see your dentist at normally scheduled intervals.
Root canal treatment is highly successful; the procedure has more than a 95% success rate. Many teeth fixed with a root canal can last a lifetime.
Also, because the final step of the root canal procedure is application of a restoration such as a crown or a filling, it will not be obvious to onlookers that a root canal was performed.
Despite your dentist's best efforts to clean and seal a tooth, new infections might emerge after a root canal. Among the likely reasons for this include:
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The cost varies depending on how severe the problem is and the tooth affected. Many dental insurance policies at least partially cover endodontic treatment. A ballpark estimate for the root canal treatment itself (not including a dental restoration following the procedure) performed by a general dentist could range from $500 to $1,000 for an incisor and $800 to $1,500 for a molar. The fees charged by endodontists could be up to 50% higher.
Saving your natural teeth is the very best option, if possible. Your natural teeth allow you to eat a wide variety of foods necessary to maintain proper nutrition. The root canal procedure is the treatment of choice.
The only alternative to a root canal procedure is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting. These alternatives not only are more expensive than a root canal procedure but require more treatment time and additional procedures to adjacent teeth and supporting tissues.
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Since some of the reasons why the nerve of a tooth and its pulp become inflamed and infected are due to deep decay, repeated dental procedures on a tooth and/or large fillings, following good oral hygiene practices (brushing twice a day, flossing at least once a day, and scheduling regular dental visits) may reduce the need for a root canal procedure. Trauma resulting from a sports-related injury can be reduced by wearing a mouth guard.
Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or "impacted" between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.
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It's not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.
Dental implants are an option for tooth loss due to an accident or infection or as an alternative to bridges and dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.
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In some individuals, the upper and lower jaws fail to grow properly. This can cause difficulty in speaking, eating, swallowing, and breathing. While some of these problems -- like improper teeth alignment -- can be corrected with braces and other orthodontic appliances, more serious problems require oral surgery to move all or part of the upper jaw, lower jaw, or both, into a new position that is more balanced, functional, and healthy.
For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Oral surgery can also help long-term denture wearers. Supporting bone often deteriorates over time, resulting in dentures that no longer fit properly. In severe cases, an oral surgeon can add a bone graft to areas where little bone remains.
Dysfunction of the TMJ, the small joint in front of the ear where the skull and lower jaw meet, is a common source of headache and facial pain. Most patients with TMJ disorders can be successfully treated with a combination of oral medications, physical therapy, and splints. However, joint surgery is an option for advanced cases and when the diagnosis indicates a specific problem in the joint.
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Oral surgery is often used to repair fractured jaws and broken facial bones.
Oral surgeons can take a small sample of abnormal growth or tissue and then send it for laboratory testing for identification. Some lesions can be managed medically or can be removed by the oral surgeon.
Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. The result is a gap in the lip and/or a split or opening in the roof of the mouth. Oral surgeons work as part of a team of health care specialists to correct these problems through a series of treatments and surgical procedures over many years.
Pain and swelling in the face, neck, or jaws may indicate an infection. Infections in this area of the body can sometimes develop into life-threatening emergencies if not treated promptly and effectively. An oral surgeon can assist in diagnosing and treating this problem. Surgical treatment, if needed, may include cutting into and draining the infected area, as well as extracting any teeth that might be involved.
When conservative nonsurgical methods such as positive pressure air machines and dental splint appliances fail to alleviate this problem, surgery can be tried. Surgical procedures involve removing the soft tissues of the oropharynx (an area in the back portion of the mouth) or the lower jaw. Laser surgery is a newer treatment option.