Posts for: March, 2016
Teeth can take a lot of force over a lifetime of biting and chewing, thanks to enamel, their outer layer made of the strongest substance in the human body. Unfortunately, they’re not invincible: it’s even possible for you to break or “fracture” a tooth while biting or chewing normally.
Although such a fracture might seem to occur out of the blue, it’s usually related to a condition known as cracked tooth syndrome. It usually occurs in three stages: in the first, miniscule cracks in the outer enamel known as craze lines develop. They’re not immediately dangerous since they only involve the enamel surface; but left untreated they could deepen and progress to the next stage, a larger crack that penetrates the tooth’s underlying dentin.
If allowed to grow, this crack in turn can lead to the third stage, a full fracture that could extend down to the root. A fracture can put the tooth in danger of loss, especially if its inner pulp becomes exposed. To avoid this worst case, it’s best to treat the tooth at the earliest stage possible when craze lines are just developing.
There is a difficulty, though, with detecting craze lines — they’re small, too small to detect normally with x-rays. We, therefore, rely on other methods such as using an instrument called an explorer to feel for cracks, having the patient bite on a stick or rubber pad to replicate pain symptoms or using fiber-optic lighting with special dye stains to highlight possible cracks. Endodontists, specialists in root canals, can use microscopic equipment that’s quite adept at detecting craze lines.
There are also some signs you can be on alert for that might indicate a craze line or crack. If you feel a short, sharp pain — a “wince” — when chewing and releasing food, you could have a crack that hasn’t yet affected the nerves. If a true fracture occurs, the pain will intensify and you may notice pieces of the tooth coming off. If the crack extends to the root, the pain will become greater and more chronic.
It’s important then that you see us for any recurring pain symptoms as soon as possible. If it’s a crack, the sooner it’s treated the better your tooth’s chances for survival.
If you would like more information on cracked tooth syndrome, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Tooth Syndrome.”
So you’re tearing up the dance floor at a friend’s wedding, when all of a sudden one of your pals lands an accidental blow to your face — chipping out part of your front tooth, which lands right on the floorboards! Meanwhile, your wife (who is nine months pregnant) is expecting you home in one piece, and you may have to pose for a picture with the baby at any moment. What will you do now?
Take a tip from Prince William of England. According to the British tabloid The Daily Mail, the future king found himself in just this situation in 2013. His solution: Pay a late-night visit to a discreet dentist and get it fixed up — then stay calm and carry on!
Actually, dental emergencies of this type are fairly common. While nobody at the palace is saying exactly what was done for the damaged tooth, there are several ways to remedy this dental dilemma.
If the broken part is relatively small, chances are the tooth can be repaired by bonding with composite resin. In this process, tooth-colored material is used to replace the damaged, chipped or discolored region. Composite resin is a super-strong mixture of plastic and glass components that not only looks quite natural, but bonds tightly to the natural tooth structure. Best of all, the bonding procedure can usually be accomplished in just one visit to the dental office — there’s no lab work involved. And while it won’t last forever, a bonded tooth should hold up well for at least several years with only routine dental care.
If a larger piece of the tooth is broken off and recovered, it is sometimes possible to reattach it via bonding. However, for more serious damage — like a severely fractured or broken tooth — a crown (cap) may be required. In this restoration process, the entire visible portion of the tooth may be capped with a sturdy covering made of porcelain, gold, or porcelain fused to a gold metal alloy.
A crown restoration is more involved than bonding. It begins with making a 3-D model of the damaged tooth and its neighbors. From this model, a tooth replica will be fabricated by a skilled technician; it will match the existing teeth closely and fit into the bite perfectly. Next, the damaged tooth will be prepared, and the crown will be securely attached to it. Crown restorations are strong, lifelike and permanent.
Was the future king “crowned” — or was his tooth bonded? We may never know for sure. But it’s good to know that even if we’ll never be royals, we still have several options for fixing a damaged tooth. If you would like more information, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Crowns and Bridgework.”
Most first-time root canal treatments achieve their purpose in saving an internally decayed tooth and extending its life to match those of the patient’s non-decayed teeth. Occasionally, though, a root canal-treated tooth may become re-infected by decay.
There are a number of reasons for this: the permanent crown meant to add further protection against decay may have been delayed, giving bacteria an opening to re-infect the tooth; it’s also possible the original seal for the pulp chamber and root canals after filling wasn’t sufficient to prevent bacterial contamination.
There‘s also another reason that’s very difficult to foresee — the presence of narrow, curved root canals in the tooth that can pose complications during the procedure. Some of these known as accessory or lateral canals branch off the main canals to create a complex network that’s difficult to detect during the initial procedure. If they’re not cleaned out and filled during the procedure any tissue trapped in them can remain infected and ultimately die. If these canals also open into the periodontal membrane at the attachment between the teeth and bone, the infection can spread there and become a periodontal (gum) infection that can trigger future tooth loss.
Fortunately, a reoccurrence of infection isn’t necessarily a death sentence for a tooth. A second root canal treatment can correct any problems encountered after the first treatment, especially complications from accessory canals. It may, though, require the advanced skills of an endodontist, a dental specialist in root canal problems. Endodontists use microscopic equipment to detect these smaller accessory canals, and then employ specialized techniques to fill and seal them.
If you encounter pain or other signs of re-infection for a tooth previously treated with a root canal procedure, contact us as soon as possible. The sooner we can examine and diagnose the problem, the better your tooth’s chances of survival by undergoing a second root canal treatment.
If you would like more information on tooth preservation through root canal treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Accessory Canals.”