Patient Education

Root Canals

Root canal treatment is necessary when the pulp (soft tissue inside your teeth containing blood vessels, nerves and connective tissue) becomes inflamed or diseased. During root canal treatment, your dentists or endodontist (a dentist who specializes in treating the insides of teeth) removes the diseased pulp. The pulp chamber and root canals of the tooth are cleaned and sealed. If the infected pulp is not removed, pain and swelling can result, and your tooth may have to be removed.

Causes of an infected pulp could include:

• A deep cavity
• Repeated dental procedures
• A cracked or broken tooth
• Injury to the tooth (even if there’s not a visible crack or chip)

If you continue to care for your teeth and gums your restored tooth could last a lifetime. However, regular checkups are necessary; a tooth without its nerve can still develop cavities or gum disease. Most of the time, a root canal is a relatively simple procedure with little or no discomfort involving one to three visits. Best of all, is can save your tooth and your smile.

Dentures
Dentures are removable appliances that can replace missing teeth and help restore your smile. If you’ve lost all your natural teeth, whether from gum disease, tooth decay or injury, replacing missing teeth will benefit your appearance and your health. That’s because dentures make it easier to eat and speak better than you could without teeth – things that people often take for granted.

When you lose all of your teeth, facial muscles can sag, making you look older. Dentures can help fill out the appearance of your face and profile. They can be made to closely resemble your natural teeth so that your appearance does not change much. Dentures may even improve the look of your smile.

Types of dentures:

• Conventional . This full removable denture is made and placed in your mouth after the remaining teeth are removed and tissues have healed, which may take several months.
• Immediate . This removable denture is inserted on the same day that the remaining teeth are removed. Your dentist will take measurements and make models of your jaw during a preliminary visit. You don’t have to be without teeth during the healing period, but may need to have the denture relined or remade after your jaw has healed.
• Overdenture . Sometimes some of your teeth can be saved to preserve your jawbone and provide stability and support for the denture. An overdenture fits over a small number of remaining natural teeth after they have been prepared by your dentist. Implants can serve the same function, too.

New dentures may feel awkward for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place. It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should go away. Follow-up appointments with the dentist are generally needed after a denture is inserted so the fit can be checked and adjusted. If any problem persists, particularly irritation or soreness, be sure to consult your dentist.

Even if you wear full dentures, you still have to practice good dental hygiene. Brush your gums, tongue and roof of your mouth every morning with a soft bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque.

Like your teeth, your dentures should be brushed daily to remove food particles and plaque. Brushing also can help keep the teeth from staining.

• Rinse your dentures before brushing to remove any loose food or debris.
• Use a soft bristle toothbrush and non-abrasive cleanser to gently brush all the surfaces of the dentures so they don’t get scratched.
• When brushing, clean your mouth thoroughly –including your gums, cheeks, roof of your mouth and tongue to remove any plaque. This can help reduce the risk of oral irritation and bad breath.
• When you’re not wearing your dentures, put them in a safe place covered in water to keep them from warping.
• Occasionally, denture wearers may use adhesives. Adhesives come in many forms: creams, powders, pads/wafers, strips or liquids. If you use one of these products, read the instructions, and use them exactly as directed. Your dentist can recommend appropriate cleansers and adhesives; look for products with the ADA Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.

If you have any questions about your dentures, or if they stop fitting well or become damaged, contact your dentist. Be sure to schedule regular dental checkups, too. The dentist will examine your mouth to see if your dentures continue to fit properly.

Wisdom Teeth
Wisdom teeth, also referred to as third molars, get their name by being the last teeth to come in during young adulthood. As part of a dental visit, your dentist will examine you to determine if your wisdom teeth are healthy and properly positioned.

Every patient is unique, but in general, wisdom teeth may need to be removed when there is evidence of changes in the mouth such as:

• Pain
• Infection
• Cysts
• Tumors
• Damage to adjacent teeth
• Gum disease
• Tooth decay (if is not possible or desirable to restore the tooth)

You dentist or specialist may also recommend removal to prevent problems or for other reasons, such as when removal is part of an orthodontic, restorative or periodontal treatment plan.

In addition, the condition of your mouth changes over time. Wisdom teeth that are not removed should continue to be monitored, because the potential for developing problems later on still exists. As with many other health conditions, as people age, they are at greater risk for health problems and that includes potential problems with their wisdom teeth. Regular dental visits are important so that your dentist can evaluate not just your wisdom teeth but your overall oral health to help you prevent and manage dental disease and achieve optimal oral health.

Sealants
Dental sealants act as a barrier to prevent cavities. They are a plastic material usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often.

Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth. But toothbrush bristles cannot reach all the way into the depressions and grooves to extract food and plaque. Sealants protect these vulnerable areas by “sealing out” plaque and food.

Sealants are easy for your dentist to apply. The sealant is painted onto the tooth enamel, where it bonds directly to the tooth and hardens. The plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of back teeth. The sealant acts as a barrier, protecting enamel from plaque and acids. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and may last several years before a reapplication is needed. During your regular dental visits, your dentist will check the condition of the sealants and reapply as necessary.

The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. But adults can benefit from sealants as well.

Key ingredients in preventing tooth decay and maintaining a healthy mouth are:

• Brushing twice a day with an ADA-accepted fluoride toothpaste
• Cleaning between the teeth daily with floss or another interdental cleaner
• Eating a balanced diet and limiting snacks
• Visiting your dentist regularly

Ask your dentist about whether sealants can put extra power behind your prevention program.

Gum Disease
Here are some warning signs that can signal a problem:

• Gums that bleed easily
• Red, swollen tender gums
• Gums that have pulled away from the teeth
• Persistent bad breath or bad taste
• Permanent teeth that are loose or separating
• Any change in the way your teeth fit together when you bite
• Any change in the fit of partial dentures

Some factors increase the risk of developing gum disease. They are:

• Poor oral hygiene
• Smoking or chewing tobacco
• Genetics
• Crooked teeth that are hard to keep clean
• Pregnancy
• Diabetes
• Medications, including steroids, certain types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

Whitening
Everybody loves a bright white smile, and there are a variety of products and procedures available to help you improve the look of yours. Many people are satisfied with the sparkle they get from daily brushing and regular cleanings at your dentist’s office, but if you decide you would like to go beyond this to make your smile look brighter; you should investigate all of your whitening options.

Start by speaking with your dentist. He or she can tell you whether whitening procedures would be effective for you. Whiteners may not correct all types of discoloration. For example, yellow-ish hued teeth will probably bleach well, brownish-colored teeth may bleach less well, and grayish-hued teeth may not bleach well at all. If you have had bonding or tooth-colored fillings placed in your front teeth the whitener will not affect the color of these materials, and they will stand out in your newly whitened smile. You may want to investigate other options, like porcelain veneers or dental bonding.

If you are a candidate from whitening there are several ways to whiten your smile:

• In-office bleaching. This procedure is called chairside bleaching and usually requires only one visit. The dentist will apply either a protective gel to your gums or a rubber shield to protect the oral soft tissues. A bleaching agent is then applied to the teeth, and a special light may be used. Lasers have been used during tooth whitening procedures to enhance the action of the whitening agent.
• At-home bleaching. Peroxide – containing whiteners actually bleach the tooth enamel. They typically come in a gel and are placed in a mouth guard. Usage regimens vary. There are potential side effects, such as increased sensitivity or gum irritation. Speak with your dentist if you have any concerns.
• Whitening toothpastes. All toothpastes help remove surface stain through the action of mild abrasives. “Whitening” toothpastes in the ADA Seal of Acceptance program have special chemical or polishing agents that provide additional stain removal effectiveness. Unlike bleaches, these ADA Accepted products do not change the color of teeth because they can only remove stains on the surface.

Remember when selecting a whitener or any dental product, be sure to look for the ADA Seal of Acceptance – your assurance that they have met ADA standards of safety and effectiveness.

Veneers
Veneers are thin, custom-made shells crafted of tooth-colored materials designed to cover the front side of teeth. They are an option for correcting stained or chipped, decayed or crooked teeth. Veneers are made by a dental technician, usually in a dental lab, working from a model provided by your dentist. Placing veneers is usually an irreversible process, because it’s necessary to remove a small amount of enamel from your tooth to accommodate the shell. Your dentist may recommend that you avoid some foods and beverages that may stain or discolor your veneers such as coffee, tea or red wine. Sometimes a veneer might chip or fracture. But for many people the result are more than worth it.

Abscess
An abscessed tooth is an infection caused by tooth decay, periodontal disease or a cracked tooth. These problems can let bacteria enter the pulp (the soft tissue of a tooth that contains nerves, blood vessels and connective tissue) and can lead to pulp death. When pus builds up at the root tip in the jaw bone, it forms a pus-pocket called an abscess. If the abscess is not treated, it can lead to a serious infection in the jaw bone, teeth and surrounding tissues.

Symptoms of an abscess include :

• pain
• swelling
• redness in the gums
• bad taste in the mouth
• fever

An abscessed tooth can be treated with various treatments, depending on the severity of the infection. Here are some of the treatment methods a dentist may consider:

• antibiotics, to destroy the bacteria causing the infection
• drainage of the infection
• cleaning the space between the tooth and the gum if the cause is from gum disease
• root canal treatment if the abscess is caused by decay or a cracked tooth

Following good oral hygiene practices and routine dental exams will significantly reduce your risk of developing a tooth abscess. If your teeth experience trauma (become loosened or chipped), see your dentist as soon as possible.

Bridges
If you’re missing one or more teeth, you may notice a difference in chewing and speaking. Bridges can help restore your smile.

Sometimes called a fixed partial denture, a bridge replaces missing teeth with artificial teeth and literally “bridges” the gap where one or more teeth used to be. Bridges can be made from gold, alloys, porcelain or a combination of these materials and are attached to surrounding teeth for support. Unlike a removable bridge, which you can take out and clean, a fixed bridge can only be removed by a dentist.

An implant bridge attaches artificial teeth directly to the jaw or under the gum tissue. Depending on which type of bridge your dentist recommends, its success depends on the foundation. So it’s very important to keep your remaining teeth healthy and strong.

HPV and Oral Cancer
There is a growing body of research that shows an increasing incidence of human papillomavirus-associated cancer in the region of the oropharynx. The oropharynx includes the middle region of the throat, including the tonsils and base of the tongue.

Although the primary risk factors for head and neck cancers remain tobacco use and excessive alcohol consumption, HPV infection is now associated with some 10,000 cases of oropharyngeal cancer diagnosed each year in the United States, according to the Centers for Disease Control and Prevention. In April 2012, the CDC reported that oropharyngeal cancer is the second most diagnosed of cancers associated with HPV. HPV is commonly transmitted through sexual contact.

Not all types of HPV cause cancer, but 40 known strains of HPV can be transmitted through sexual contact.

According to the CDC, cancers of the head and neck are mostly caused by tobacco and alcohol, but recent studies show that about 60–70 percent of cancers of the oropharynx may be linked to HPV. Many of these may be caused by a combination of tobacco, alcohol, and HPV. Regular dental check-ups that include in examination of the entire head and neck can be beneficial in identifying cancerous and pre-cancerous signs and symptoms.

In its Statement on Human Papillomavirus and Squamous Cell Cancers of the Oropharynx, the ADA Council on Scientific Affairs noted that the FDA approved two HPV vaccines for the prevention of HPV-associated cancers of the cervical, vulvar, vaginal and anal mucosa; however, the vaccines may also be effective in the prevention of HPV-associated oropharyngeal cancers. More studies are needed to determine if vaccination aids in the prevention of HPV-associated oropharyngeal cancers. The ADA will continue to provide guidance to the dental profession and public about HPV-associated oropharyngeal cancer.

Talk to your dentist or physician if you experience any of these symptoms:

• persistent sore throat
• difficulty swallowing
• hoarseness
• ear pain
• enlarged lymph nodes

The following federal agencies can provide more information about HPV infection:

• National Institute of Allergy and Infectious Diseases
• Centers for Disease Control and Prevention

The CDC Advisory Committee on Immunization Practices recommends the HPV vaccine for women aged 9-26 years, and for males 11-21 years, to prevent cervical cancer.

There is no current recommendation of this vaccine to prevent other types of cancers.

Sensitive Teeth
Is the taste of ice cream or a sip of hot coffee sometimes a painful experience for you? Does brushing or flossing make you wince occasionally? If so, you may have sensitive teeth.

Possible causes include :

• Tooth decay (cavities)
• Fractured teeth
• Worn fillings
• Gum disease
• Worn tooth enamel
• Exposed tooth root

In healthy teeth, a layer of enamel protects the crowns of your teeth—the part above the gum line. Under the gum line a layer called cementum protects the tooth root. Underneath both the enamel and the cementum is dentin.
Dentin is less dense than enamel and cementum and contains microscopic tubules (small hollow tubes or canals). When dentin loses its protective covering of enamel or cementum these tubules allow heat and cold or acidic or sticky foods to reach the nerves and cells inside the tooth. Dentin may also be exposed when gums recede. The result can be hypersensitivity.

Sensitive teeth can be treated. The type of treatment will depend on what is causing the sensitivity. Your dentist may suggest one of a variety of treatments:

• Desensitizing toothpaste. This contains compounds that help block transmission of sensation from the tooth surface to the nerve, and usually requires several applications before the sensitivity is reduced.
• Fluoride gel. An in-office technique which strengthens tooth enamel and reduces the transmission of sensations.
• A crown, inlay or bonding. These may be used to correct a flaw or decay that results in sensitivity.
• Surgical gum graft. If gum tissue has been lost from the root, this will protect the root and reduce sensitivity.
• Root canal. If sensitivity is severe and persistent and cannot be treated by other means, your dentist may recommend this treatment to eliminate the problem.

Proper oral hygiene is the key to preventing sensitive-tooth pain. Ask your dentist if you have any questions about your daily oral hygiene routine or concerns about tooth sensitivity.

Implants
If you are self-conscious because you have missing teeth, wear dentures that are uncomfortable or don't want to have good tooth structure removed to make a bridge, talk to your dentist to see if dental implants are an option for you.

Dental implants are a popular and effective way to replace missing teeth and are designed to blend in with your other teeth. They are an excellent long-term option for restoring your smile. In fact, the development and use of implants is one of the biggest advances in dentistry in the past 40 years. Dental implants are made up of titanium and other materials that are compatible with the human body. They are posts that are surgically placed in the upper or lower jaw, where they function as a sturdy anchor for replacement teeth.

Most patients find that a dental implant is secure, stable and a good replacement for their own tooth. There are generally three phases to getting an implant:

• First, the dentist surgically places the implant into the jawbone. Your dentist may recommend a diet of soft foods, cold foods and warm soup during the healing process.
• Next, the bone around the implant heals in a process called osseointegration. What makes an implant so strong is that the bone actually grows around it and holds it in place. Osseointegration means “combines with the bone” and takes time. Some patients might need to wait until the implant is completely integrated, up to several months, before replacement teeth can be attached to the implant. Other patients can have the implants and replacement teeth placed all in one visit.
• Finally, it’s time for the placement of the artificial tooth/teeth. For a single tooth implant, your dentist will customize a new tooth for you, called a dental crown. The crown will be based on size, shape, color and fit, and will be designed to blend in with your other teeth. If you are replacing more than a single tooth, custom-made bridges or dentures will be made to fit your mouth and your implants. (Note: The replacement teeth usually take some time to make. In the meantime, your dentist may give you a temporary crown, bridge or denture to help you eat and speak normally until the permanent replacement is ready.)

If you are interested in dental implants, it's a good idea to discuss it carefully with your dentist first. If you are in good general health this treatment may be an option for you. In fact, your health is more of a factor than your age. You may be medically evaluated by a physician before any implant surgery is scheduled.

Chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery. Patients with these issues may not be good candidates for implants. Using tobacco can also slow healing.

Crowns
If you want a smile that’s your crowning glory, you may need a crown to cover a tooth to help restore it to its normal shape and size. A crown can make your tooth stronger and improve its appearance.

A crown can help strengthen a tooth with a large filling when there isn’t enough tooth remaining to hold the filling. Crowns can also be used to attach bridges, protect a weak tooth from breaking or restore one that’s already broken. A crown is a good way to cover teeth that are discolored or badly shaped. It’s also used to cover a dental implant.

If your dentist recommends a crown, it is probably to correct one of these conditions. Your dentist’s primary concern, like yours, is helping you keep your teeth healthy and your smile bright.

Cracked Tooth Syndrome

What Is It?
Unlike teeth with obvious fractures, teeth with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome more often occurs in molars, usually lower molars, which absorb most of the forces of chewing.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth. Sometimes a person's normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

Teeth with large fillings or teeth that have undergone root canal treatment are weaker than other teeth and may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.

Symptoms
You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess, but the tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may become loose.

Many people with cracked tooth syndrome have symptoms for months, but it's often difficult to diagnose because the symptoms are not consistent.

Diagnosis
Diagnosis of cracked tooth syndrome is often difficult. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Your dentist also may take X-rays, although X-rays often do not show the crack.

Your dentist may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it.

Your dentist may shine a fiber-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Expected Duration
How long symptoms last depends somewhat on how quickly a cracked tooth can be diagnosed. Even then, treatment may not always completely relieve the symptoms.

Prevention
If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of cracked tooth syndrome.

Treatment
Treatments for cracked tooth syndrome do not always completely relieve the symptoms.

Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the center of the tooth, which contains the tooth's nerves).

If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. If a crack affects the pulp, you probably will need root canal treatment. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time.

In some severe cases, the tooth may need to be extracted . Some cracks extend into the root of the tooth under the bone and there's no way to fix the tooth. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or a bridge.

When To Call a Professional
If you experience pain upon biting or chewing, contact your dental office.

Prognosis
Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.