Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”
Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.
Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:
A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.
If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.
Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.
Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.
Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.
If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”
Your tooth is in peril if its innermost layer, the pulp, becomes infected and inflamed. Deep tooth decay, repeated dental procedures or fractures can all expose the pulp and ultimately the roots to infection and lead to tooth loss.
But that scenario isn't inevitable — we can often save the tooth with a root canal treatment. By accessing the tooth's interior through a prepared hole, we're able to clean out the infected tissue in the pulp chamber and root canals, and fill the empty space with a special filling. We then cap the tooth with a custom crown to protect it from a re-infection.
Root canal treatments have a very high success rate — chances are good your tooth will survive for many years afterward. But there's a slight chance the tooth may become re-infected; in that case, a second root canal treatment may be in order.
In a few cases, though, a second root canal may not be advisable, and could even accelerate damage to the tooth. For example, if past dental work resulted in an extensive crown restoration, accessing the root canals the conventional way will require disassembling that restoration. This could weaken the tooth significantly.
We can approach the problem from a different route: instead of accessing the tooth's interior through the crown (the visible part of the tooth), we instead perform a surgical procedure called an apicoectomy, which accesses the tooth at the root end through the gums.
In this procedure we numb the area with local anesthesia and then make a small incision through the gums at the level of the affected root. After access, we remove any diseased tissue around the root and a few millimeters of the root tip itself. We then insert a small filling in its place to seal the canal and prevent further infection. In some cases we may also insert a graft to encourage bone growth and aid in healing.
Over time, the affected area will heal and return to normal function. Even if a traditional root canal treatment can't be used, an apicoectomy could be another option for saving your tooth.
If you would like more information on your options for preserving a problem tooth, 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 “Apicoectomy.”
As a new permanent tooth develops, the roots undergo a process of breakdown and growth. As older cells dissolve (a process called resorption), they’re replaced by newer cells laid down (deposition) as the jaw develops. Once the jaw development ends in early adulthood, root resorption normally stops. It’s a concern, then, if it continues.
Abnormal root resorption most often begins outside of the tooth and works its way in, beginning usually around the neck-like (or cervical) region of the tooth. Also known as external cervical resorption (ECR), the condition usually shows first as pink spots where the enamel is being undermined. As these spots continue to erode, they develop into cavity-like areas.
While its causes haven’t been fully confirmed, ECR has been linked to excessive pressure on teeth during orthodontic treatment, periodontal ligament trauma, teeth-grinding or other excessive force habits, and bleaching techniques performed inside a tooth. Fortunately, ECR is a rare occurrence, and most people who’ve had these problems won’t experience it.
When it does occur, though, it must be treated as quickly as possible because the damage can progress swiftly. Treatment depends on the size and location of the resorption: a small site can often be treated by surgically accessing the tooth through the gum tissue and removing the offending tissue cells. This is often followed with tooth-colored dental material that’s bonded to the tooth to replace lost structure.
A root canal treatment may be necessary if the damage has extended to the pulp, the tooth’s interior. However, there’s a point where the resorption becomes too extensive to save the tooth. In these cases, it may be necessary to remove the tooth and replace it with a dental implant or similar tooth restoration.
In its early stages, ECR may be difficult to detect, and even in cases where it’s been diagnosed more advanced diagnostics like a CBCT scanner may be needed to gauge the extent of damage. In any case, it’s important that you have your teeth examined on a regular basis, at least twice a year. In the rare chance you’ve developed ECR, the quicker it’s found and treatment begun, the better your chances of preserving the tooth.
Tooth decay is one of the most common diseases in the world, nearly as prevalent as the common cold. It’s also one of the two major dental diseases—the other being periodontal (gum) disease—most responsible for tooth and bone loss.
Tooth decay begins with high levels of acid, the byproduct of oral bacteria feeding on food remnants like sugar. Acid can erode tooth enamel, leading to a cavity that will require removal of decayed material around it and then a filling.
Sometimes, though, decay can spread deeper into the tooth reaching all the way to its core: the pulp with its bundle of nerves and blood vessels. From there it can travel through the root canals to the bone. The continuing damage could eventually lead to the loss of the infected tooth.
If decay reaches the tooth interior, the best course of action is usually a root canal treatment. In this procedure we access the pulp through the crown, the visible part of the tooth, to remove all of the diseased and dead tissue in the pulp chamber.
We then reshape it and the root canals to receive a filling. The filling is normally a substance called gutta percha that’s easily manipulated to conform to the shape of the root canals and pulp chamber. After filling we seal the access hole and later cap the tooth with a crown to protect it from re-infection.
Root canal treatments have literally saved millions of teeth. Unfortunately, they’ve gained an undeserved reputation for pain. But root canals don’t cause pain—they relieve the pain caused by tooth decay. More importantly, your tooth can gain a new lease on life.
But we’ll need to act promptly. If you experience any kind of tooth pain (even if it goes away) you should see us as soon as possible for an examination. Depending on the level of decay and the type of tooth involved, we may be able to perform the procedure in our office. Some cases, though, may have complications that require the skills, procedures and equipment of an endodontist, a specialist in root canal treatment.
So, don’t delay and allow tooth decay to go too far. Your tooth’s survival could hang in the balance.
If you would like more information on tooth decay treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Root Canal Treatment: What You Need to Know.”
When Entertainment Tonight host Nancy O’Dell set out to teach her young daughter Ashby how to brush her teeth, she knew the surest path to success would be to make it fun for the toddler.
“The best thing with kids is you have to make everything a game,” Nancy recently said in an interview with Dear Doctor TV. She bought Ashby a timer in the shape of a tooth that ticks for two minutes — the recommended amount of time that should be spent on brushing — and the little girl loved it. “She thought that was super fun, that she would turn the timer on and she would brush her teeth for that long,” Nancy said.
Ashby was also treated to a shopping trip for oral-hygiene supplies with Mom. “She got to go with me and choose the toothpaste that she wanted,” Nancy recalled. “They had some SpongeBob toothpaste that she really liked, so we made it into a fun activity.”
Seems like this savvy mom is on to something! Just because good oral hygiene is a must for your child’s health and dental development, that doesn’t mean it has to feel like a chore. Equally important to making oral-hygiene instruction fun is that it start as early as possible. It’s best to begin cleaning your child’s teeth as soon as they start to appear in infancy. Use a small, soft-bristled, child-sized brush or a clean, damp washcloth and just a thin smear of fluoride toothpaste, about the size of a grain of rice.
Once your child is old enough to hold the toothbrush and understand what the goal is, you can let him or her have a turn at brushing; but make sure you also take your turn, so that every tooth gets brushed — front, back and all chewing surfaces. After your child turns 3 and is capable of spitting out the toothpaste, you can increase the toothpaste amount to the size of a pea. Kids can usually take over the task of brushing by themselves around age 6, but may still need help with flossing.
Another great way to teach your children the best oral-hygiene practices is to model them yourself. If you brush and floss every day, and have regular cleanings and exams at the dental office, your child will come to understand what a normal, healthy and important routine this is. Ashby will certainly get this message from her mom.
“I’m very adamant about seeing the dentist regularly,” Nancy O’Dell said in her Dear Doctor interview. “I make sure that I go when I’m supposed to go.”
It’s no wonder that Nancy has such a beautiful, healthy-looking smile. And from the looks of things, her daughter is on track to have one, too. We would like to see every child get off to an equally good start!
If you have questions about your child’s oral health, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Taking the Stress Out of Dentistry for Kids” and “Top 10 Oral Health Tips for Children.”
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