Cavities can best be described as holes in your teeth that are usually caused by tooth decay.  As we all know, tooth decay is influenced by what we eat, how we take care of our teeth, and the amount of fluoride in our toothpaste.  If your family has a history of tooth disease or teeth problems you may be susceptible to inheriting them.  Passing tooth problems down from generation to generation are not uncommon.

The key to the treatment of cavities is ultimately through preventing them from forming at all. Aside from maintaining regular routine visits with your dentist, there are several techniques that are crucial to the prevention of cavity development, starting with what you eat. Eating a lot of sweets and/or drinking sodas place you at a higher risk for cavity development.  Foods that are rich in sugar or starch are a favored food source for bacteria that thrive in plaque.  These bacteria produce acids that dissolve the enamel and dentin of teeth, eventually leading to more serious complications that will result in the need of a root canal and ultimately an extraction.  Consuming alternative foods such as apples and celery are not only good for your overall health but can actually reduce risk of cavity development, as they help to break away unwanted plaque and food debris.

Brushing and flossing after meals is one of the most recommended techniques in reducing cavity development, however many dentists will acknowledge that there are times when brushing and flossing are simply not feasible, such as during work or school.  When more thorough alternatives are not available or practical a step as simple as swishing a mouthful of water in your mouth after meals can greatly improve your chances of cavity reduction. Chewing sugar-free gum is yet another simple alternative method in removing plaque and unwanted food debris.

Another key contributor to cavity development is dry mouth.  While many may not realize it, saliva is incredibly significant in maintaining oral health and one of its central functions is cavity prevention.  Dry mouth is very common and is normally the result of medications, illness and/or radiation treatment.  Those who use tobacco products are especially prone to developing symptoms of dry mouth.  Using specialized oral products that aim to alleviate symptoms will help reduce cavity risk; however the most effective method is to limit provoking contributors to the best of your ability.

Visiting your dentist is the most effective measure in diagnosis of a cavity, however there several clues that can alert the presence of a cavity.  If a cavity develops it can change the color of the affected area.  If you notice a color change such as a blackened or whitened area in your tooth, or develop sensitivity to temperature changes such as when drinking ice water or hot tea or notice sensitivity to sweets you should make an appointment with your dentist immediately.

If left untreated the enamel of the tooth will start to degrade. After that the dentin and ultimately the pulp will be affected.  Once damaging acid has managed to eat away enough of the enamel below the surface, the surface will collapse, resulting in a cavity.  Without proper treatment the tooth will continue to degrade and the cavity will continue to spread until the entire tooth has been eaten away, diminishing protective enamel and exposing the tooth root – which can be very painful.

If you visit your dentist on a regular basis he/she can find cavities and fill them (usually) before they are too severe.  However, if left untreated cavities can become more serious and lead to an abscess.  An abscess infects the entire tooth down to the root tip and if left untreated can ultimately be fatal.  Leaving a cavity alone is damaging to both your health and your personal expense pocket, as the resulting root canal and crown to repair an abscess will cost much more than the initial cavity filling would have been.  Furthermore, if the tooth needs an extraction, the replacement cost will even further exceed the cost of the original filling.

Cavities can develop in the pits of chewing areas around the back teeth, between your teeth, or near the gum line, however no matter where they occur the easiest way to spot them is to visit your dentist.  Your dentist will be able to perform simple x-rays to diagnose the presence and severity of cavities and offer the most efficient treatment plan.  If caught in time the repair to the cavity will be minimally invasive and will prevent the further destruction of the affected tooth.

The early detection of cavities is crucial to the overall prognosis of your teeth; however the best treatment plan is to prevent cavities from forming all together.  Proper oral hygiene such as routine brushing and flossing are imperative to the prevention of cavities, and while there are several techniques to prevent cavities from forming in between dental visits, nothing can replace a routine check-up from your dentist.  Maintaining regular visits with your dentist is crucial in lowering cavity risk, and may lead to lower expenses to both your wallet and your health.

Your first line of defense should always be to arm yourself with the proper toothbrush and toothpaste.  Using a toothbrush with soft bristles allows you to remove unwanted food debris and plaque without causing unnecessary damage to your gums that may lead to sensitivity.  Try using a toothbrush with a smaller sized head to access hard to reach places such as back teeth and tight areas.  Visible signs of wear should alert you that it is time to replace your toothbrush since worn bristles can tear away and harm delicate gums.  Replacing your toothbrush every couple of months or after you have been sick is essential, as bristles can hold on to unhygienic germs and bacteria.

Selecting the proper toothpaste is another essential technique to promoting good oral hygiene.  There are a variety of toothpastes available that are specially designed for your own particular needs such as reduction of sensitivity, tarter control and prevention of gingivitis. If you are unsure of which type of toothpaste or toothbrush you should be using your dentist will be able to steer you in the right direction.

Maintaining a proper brushing routine is the first form of protection against cavities and gum disease.  However, even the most proficient brusher can not replace the benefits of regular check-ups and cleanings by your dentist.  A combination of regular dental visits and utilization of proper brushing techniques is your best means of achieving and maintaining good oral health.

For many years, different cultures have relied on herbs to help control toothache pain and provide temporary relief. Natural herbs such as cloves, calendula, tarragon, and yarrow can be used to help relieve toothache pain until you can get to the dentist.

For centuries Native Americans have applied the inner bark of the butternut tree to their gums to get relief from toothaches.  The butternut tree is found in North America, and is also the cousin of the black walnut tree.  Butternut trees are found along rivers in well drained soil, rich woods, and even in back yards.  Once the tree matures, it can reach heights of up to 60 feet, with the bark being light grey in color, and the leaves and the fruit resembling the black walnut tree.

Yarrow, another popular home remedy, can be found in Asia, Europe, and North America.  It normally grows wild in meadows, fields, and in open wood lands.  The root of yarrow has anesthetic properties and if applied to your tooth and gums it may help to temporarily alleviate pain.

Cloves are derived from evergreen trees that are native to tropical areas, however, in most households cloves can be found in the back of your ordinary spice closet. Medicinal properties are held within the dried flower bud of the clove tree. Applying clove oil directly to the source of pain often results in immediate alleviation of pain and discomfort.

Throughout the course of time, herbs have proven to be very effective with stopping toothache pain and were particularly of use in times predating the modern dental facilities that we have today.  You may find that using natural herbs are an excellent and affordable remedy to alleviate toothache pain.  However, a common toothache may be an indication of a more serious problem, and you should never rely on home remedies alone to diagnose or treat a true dental issue.  Always contact your dentist if you have any concerns or are experiencing any true discomfort in your teeth or gums.

Introduction

Removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy. Many people refer to pulp removal as “having a root canal.” Root canal treatments are quite common. In the United States, they save about 24 million teeth each year.

Why Would You Need Root Canal Treatment?
Root canal treatment is needed for two main reasons. The first is infection. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it reaches a root canal. This allows bacteria to infect the pulp. Antibiotics can’t get to infections inside teeth. The inflammation caused by the infection reduces the blood supply to the tooth. The reduced blood supply also keeps the pulp from healing.

The second reason for a root canal is damage to the pulp that can’t be fixed. Trauma or a fractured tooth can damage the pulp. So can a lot of restoration, such as several fillings placed in the same tooth over a period of time. Sometimes, common dental procedures, such as preparing a tooth for a crown, can hurt the pulp. Then the tooth might need a root canal.

When the pulp is inflamed but not infected, it may heal on its own. Your dentist may want see if this will happen before doing root canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection.

An infection in the pulp can affect the bone around the tooth. This can cause an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called gutta percha.

If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. They also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore an infected or injured tooth the infection can spread to other parts of your body.

Having root canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once a tooth is treated, it almost always will last the rest of your life.

Signs and Symptoms
If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

Your tooth might need a root canal if:

• It hurts when you bite down on it, touch it or push on it
• It is sensitive to heat
• It is sensitive to cold for more than a couple of seconds
• There is swelling near the tooth
• It is discolored (whether it hurts or not)
• It is broken

To determine whether your tooth needs root canal treatment, your dentist will often place hot or cold substances against the tooth. The purpose is to see if it is more or less sensitive than a normal tooth. He or she will examine the tissues around the tooth and gently tap on the tooth to test for symptoms.

You also will be given X-rays of the bone around the tooth. The X-rays may show a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root. If either of these is present, your dentist probably will recommend a root canal procedure.

Your dentist may need more information about the tooth. He or she may use an electric pulp tester. This hand-held device sends a small electric current through the tooth. It helps your dentist decide whether the pulp is alive. This test does not cause pain or a shock. You may feel a tingling sensation. It will stop when the tester is removed from the tooth.

An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support device.

Length of Treatment
Root canal treatment can be done in one or more visits. It depends on the situation. An uncomplicated root canal treatment often can be completed in one visit. Some teeth may be more difficult to treat because of where they are in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some teeth have curved root canals that are difficult to find. If you have an infection, you will visit the dentist several times so that he or she can make sure that the infection is gone.

Once the root canal treatment is finished, you will need to see your general dentist to have a crown or filling placed on the tooth. You are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of the crown is to prevent the tooth from breaking in the future.

Measuring and Cleaning the Root Canals
Measuring
First, your dentist or endodontist will numb the area around the tooth. You also may receive sedation, such as nitrous oxide. Your dentist also has other ways to reduce your anxiety. Before your first appointment, ask what is available.

The dentist will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some of the diseased pulp.

Then the root canals have to be measured. Your dentist needs to know how long the canals are to make sure the entire canal is cleaned. He or she also needs to know how much filling material to put in the cleaned canals.

To measure the root canals, dentists use X-rays or an electric device called an apex locator. For an X-ray, your dentist will place a file into the canal and then take an X-ray. An apex locator measures a root canal based on its resistance to a small electric current. Many dentists use both methods.

Cleaning
After the canals have been measured, your dentist or endodontist will use special tools to clean out all of the diseased pulp. Then the canal is cleaned with antiseptic. This helps treat and prevent infection. All the canals within a tooth must be cleaned. Teeth have different numbers of canals:

• The top front teeth have one canal.
• The bottom front teeth have one or two canals.
• The premolars have one or two canals.
• The molars have three or four canals.

The location and shape of the canals can vary quite a bit. Some endodontists look inside the tooth with a microscope to make sure all the canals have been cleaned out.

Once the canals have been thoroughly cleaned, the roots are filled. A temporary filling is then placed over the tooth. The top of the tooth should then be covered with a permanent filling or crown. The temporary filling you receive is not meant to last.

In most cases, the tooth will need a crown. A crown will help to restore the tooth’s strength and protect it from cracking. If a crown is indicated it should be placed soon after having root canal treatment.

The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

After Root Canal Treatment
As with most invasive medical or dental procedures, complications can occur. Here are some possibilities.

Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing. This causes swelling and pain.

Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it may be painful until it clears up.

A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and make a small hole in the side of the tooth. If saliva can get into the hole, it will have to be filled. Sometimes, the tooth has to be removed. If the hole is far enough under the gum that saliva can’t reach it, the hole may close on its own.

Finding root canals can be difficult. If all of the canals aren’t found and cleaned out, the tooth can stay infected. This also can happen if a canal isn’t measured correctly and pieces of infected or inflamed pulp are left near the bottom. In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that the dentist’s tools can’t reach.

The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the tooth. But if canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small cut is made in the gum so the dentist can get at the root of the tooth. The dentist shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.

Possible Complications
In most cases, you will not have any pain during a root canal procedure. Your dentist will numb your tooth and the surrounding area. Let your dentist know if you are feeling any pain during the root canal. Some people fear the numbing shots more than the root canal treatment itself. Today, numbing gels and modern injection systems have made injections virtually painless. If it does hurt when you are getting an injection, let your dentist know immediately. He or she can change the way the injection is given to avoid causing pain.

©2002-2009 Aetna, Inc. All rights reserved.
Reviewed by the faculty of Columbia University College of Dental Medicine

If you’re afraid of going to the dentist, you should know that there are ways to quell dental anxiety and make your dental care experience a lot more tolerable.

 

Not many people really like going to the dentist. But for some people, the thought of going to the dentist can bring on such a fear that they avoid getting the dental care they need. In fact, nearly half of adults skipped the dentist in 2009, according to the U.S. Centers for Disease Control and Prevention (CDC).

What Is Dental Anxiety?

Some people’s fear of going to the dentist or getting dental procedures done is so severe that they lose sleep at night and worry excessively about what might happen at the dentist’s office, says Kimberly Harms, DDS, consumer advisor and spokesperson for the American Dental Association, and a dentist in private practice in Farmington, Minn.

Dental anxiety is common, with up to 15 percent of Americans avoiding seeing a dentist due to fear.

Dr. Harms says that dental anxiety is more common in older people, who may have experienced dental care when technologies were not as advanced as they are today.

“Children today have very few negative dental experiences, so we tend to see fewer problems among younger people,” she says. But the older you are, the more likely you are to have had a dental procedure when anesthesia was less effective, or not used, and when dentists focused less on patient comfort.

“Great strides have been made in focusing on making the patient comfortable,” says Harms.

How to Overcome Dental Anxiety

For people who have dental anxiety, the following strategies can help calm your fears:

• Communicate with your dentist. Harms says that the best thing you can do to get over your dental anxiety is to talk to your dentist about it. “A lot of patients don’t feel comfortable talking with their dentists on a one-on-one level,” she says. But remember that your dentist is a patient, too. In fact, Harms herself has dental anxiety that stems from her childhood dentist not using anesthesia when filling cavities. “If you are anxious about something,” she says, “come right out and talk to the dentist about it.”
• “Talk” with your hands. It can be difficult to speak when you have a mouth full of dental tools, so talk with your dentist before your procedure about how you will communicate should you have any discomfort or pain. Harms tells her patients to raise a hand if they feel any pain or sensation during a dental procedure. That way she can adjust the anesthesia and make sure the patient is comfortable.
• Get distracted. In Harms’ office, patients are provided with video glasses so that they can watch movies during dental procedures. Watching television, listening to the radio, or just letting your mind wander can help ease some of your anxiety.
• Consider medication. If you are having a dental procedure that requires anesthesia, rest assured that anesthesia is much more effective today than it was in the past. For some patients, a sedative or nitrous oxide can also help calm their nerves, says Harms.
• Take a break if you need it. Harms says that some patients need to take breaks during dental procedures, when anxiety builds up or they start to feel claustrophobic. If you feel like you need a break, let your dentist know.
• Ask about sedation dentistry. In some areas, there are dentists who practice sedation dentistry, which is where you get dental care under partial or full loss of consciousness. Harms says that most patients probably don’t need sedation dentistry, but for those whose dental anxiety is so severe that they refuse to get dental care any other way, it may be an option.

It could very well be that the unknown is what you fear, so don’t be afraid to ask questions before a procedure and make sure that your dentist does everything he or she can to make you feel comfortable during your visit. And getting regular dental care is vital to your oral health, so it’s well worth the effort.

Dental extractions are among the easiest and best ways to get relief from a toothache.  As the name implies, an extraction involves removing the tooth.  If your pulp has died or the tooth has become severely infected, extraction may be your only route.  Depending on the tooth, the dentist can do either a simple extraction or a more complicated extraction.

Simple extractions

These types of extractions, the simple extractions, are the most common in the world of dentistry.  Simple extractions, also known as pulling, don’t take long to complete.  The dentist will numb you before he starts, so you won’t feel anything.  Depending on the tooth, pulling it will normally take just a few minutes after you have been numbed with local anesthesia.  Once completed, the dentist will place gauze in your mouth to bite on and you will be free to go.

Complex extractions

As we all know, not all teeth can be pulled.  Sometimes, the tooth will be so decayed or broken off that the dentist will have nothing to grasp above the gum line.  In cases such as this, the dentist will need to perform a more complicated extraction, which involves getting the tooth out below the gum line, as he won’t be able to use the standard method of pulling and rocking.

Dental extractions are very common, and happen on a daily basis for dentists.    All types of extractions, even the most complex, will take time to heal.  As long as you take care of your extraction site, you’ll avoid common pitfalls such as dry sockets and other mishaps.  Once the procedure is over – you’ll eventually start to feel a lot better once you have had the tooth or teeth removed.

A tooth infection is also known as a tooth or root abscess. It is a pus-filled swelling. The infection is usually a result of tooth decay. The damage to your tooth is not caused by bacteria, but usually by certain dietary habits that are common in our modern industrial society.

Tooth With Infected Pulp

What Causes a Tooth Infection?

People will argue that bacteria is what causes a tooth infection, but in most cases, I do not believe that to be true.

An infection of the pulp within the tooth can only happen when foreign substances find their way into the tooth. When you eat food, and your tooth enamel is weak or breached due to tooth decay, then the food can penetrate deeply into the inner layers of the tooth. The food or other particles deep inside the tooth become an irritant. The body then creates a tooth infection to push out or collect the irritating substances. Another possible source of tooth infection is dead cells and tissues that are not cleaned away by the body. Every day our body gets rid of dead cells and cellular waste. If the body’s cleansing system is blocked, then it may be inhibited in its ability to remove toxins from inside the tooth or around the tooth. Imagine, for example, a stream that is dammed up; the water would stop flowing and it would stagnate. Likewise a tooth infection can be like a dam in the flow of blood vessels in or around the tooth.

Foreign substances, such food in your mouth or dead tissues, can directly enter the once-protected tooth pulp tissues or the area right below the tooth root.

Tooth Infection Note: Please take care of yourself. Many tooth infections can be easily healed if one is in good health. But if you are in poor health, or have other serious health problems then you will need much more help than what is provided here. Avoiding a dentist is not recommended and this page is not a replacement for medical/dental advice.

What Happens to An Infected Tooth?

Through tooth decay, tooth cracks, or from dead tissue, the fluid flow of micronutrients within your tooth reverses. The tooth starts pulling debris from the mouth into the interior of the tooth. The interior of the tooth can then become inflamed from the unclean substance.

The body responds to this unclean substance by trying to remove the substance. Inflammation occurs. If the inflammation cannot trap the debris, then there is pus, a thin protein-rich fluid that the body uses to trap and contain foreign substances.

Imagine, for example, an infection that could occur from a cut on your arm. That would be similar to what is happening in your mouth.

Tooth abscess tip: Eat more butter. Unsalted butter will help reduce inflammation in your body.

Symptoms of a Tooth Infection

• Toothache
  • Severe, continuous pain
  • Gnawing or throbbing pain
  • Sharp or shooting pain
• Pain when chewing
• Sensitivity of the teeth to hot or cold
• Bitter taste in the mouth
• Breath odor
• Possible fever
• Swollen glands of the neck
• General discomfort, uneasiness, or ill feeling
• Swollen area of the upper or lower jaw — a very serious symptom

Types of Dental Infection

One type of infection is called a periapical abscess; it occurs from within the tooth pulp. This is what is shown above in the picture.

The other type of infection is a periodontal abscess, which occurs from the surrounding tissues and bones.

You can help get a better gauge on understanding which type of infection you have by observing the pain and inflammation response in your body. The periodontal abscess, which is a gum infection, is typically not effectively treated by a root canal since the infection would not likely be coming from within the middle of the tooth.

How To Heal A Tooth Infection Naturally

Healing an infection requires both internal and external treatments. Internally you can change your diet to remove toxic, infection-promoting foods. For the external treatment, you can help your body clean up the abscessed area with herbal remedies.

Tooth Abscess Healing Tip: Eat fewer grains. Grains will cause cavities if not properly prepared.

Herbal Remedies For Tooth Infection

Dietary Remedies For Tooth Infection

Details on Healing Tooth Abscess

Tooth Infection Tip: Avoid caffeine – Caffeine elevates blood sugar levels and has (some) effect on glucose metabolism, endocrine glands and the liver. This is not what your body needs when it has tooth pain or a tooth infection.

Antibiotics and Dental Infection

Amoxicillin is a common antibiotic prescribed for tooth infections. Amoxicillin tends to work best for treating an abscess, and dentists or doctors will claim that it is the only way to cure a tooth infection. My opinion is to avoid antibiotics at all costs unless it is an emergency. Dentist Hal Huggins in his book, “Uniformed Consent”, agrees with this theory stating that antibiotics used for dental infections will cause the bacteria to colonize elsewhere in a more serious location. Antibiotics work by poisoning the body. This forces the body to stop its pus removal activity. Because antibiotics are toxic, people develop a resistance to antibiotics working. Many people have written to me that antibiotics did not help their tooth infection. Meanwhile, they destroyed their intestinal probiotic bacteria by taking the antibiotics. Antibiotics do seem to get rid of infections in some cases. It would be interesting to see some scientific studies on antibiotics and their effectiveness both short and long term.

Gum Abscess or Periodontal Abscess

An abscess in your gums is a form of infection. A gum abscess is not caused by bacteria. Typical causes of gum abscess include anything that affects your body chemistry, particularly strong stimulating substances. These include: high fructose corn syrup, medications, illegal drugs, WHOLE wheat flour, synthetic sugars, or eating too many sweets. The remedy for the gum abscess is to remove these aggravating causes from your diet.

How do I know if my tooth is cracked?

Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and your dentist may have difficulty locating which tooth is causing the discomfort.

Why does a cracked tooth hurt?

To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

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How will my cracked tooth be treated?

There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Craze Lines

Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.

Fractured Cusp

When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.

Cracked Tooth

This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. A nontreatable tooth is shown in the graphic above.

Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

Split Tooth

A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.

Vertical Root Fracture

Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.

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After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations. S/he will advise you on how to keep your natural teeth and achieve optimum dental health.

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What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

• Don’t chew on hard objects such as ice, unpopped popcorn kernels or pens.
• Don’t clench or grind your teeth.
• If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.
• Wear a mouthguard or protective mask when playing contact sports.

copyright American Association of Endodontists

http://www.aae.org/

What are Dental Crowns and Tooth Bridges?
Both crowns and most bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist.

How do Crowns Work?
A crown is used to entirely cover or “cap” a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.

Your dentist may recommend a crown to:

• Replace a large filling when there isn’t enough tooth remaining
• Protect a weak tooth from fracturing
• Restore a fractured tooth
• Attach a bridge
• Cover a dental implant
• Cover a discolored or poorly shaped tooth
• Cover a tooth that has had root canal treatment

How do Bridges Work?
A bridge may be recommended if you’re missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.

Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.

How are Crowns and Bridges Made?
Before either a crown or a bridge can be made, the tooth (or teeth) must be reduced in size so that the crown or bridge will fit over it properly. After reducing the tooth/teeth, your dentist will take an impression to provide an exact mold for the crown or bridge. If porcelain is to be used, your dentist will determine the correct shade for the crown or bridge to match the color of your existing teeth.

Using this impression, a dental lab then makes your crown or bridge, in the material your dentist specifies. A temporary crown or bridge will be put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.

How Long do Crowns and Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by Brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings.

To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.

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Crowns
Full porcelain fused to metal.	Full cast gold crown.

Bridges
Teeth around the space are prepared.	The bridge is mounted and adjusted for fit and comfort.	The bridge is cemented into position.

What Causes a Toothache?

Dentists recognize that an aching tooth can be an intimidating and frightening experience. I assure you that the dental profession takes a very gentle approach to make you comfortable once again. For most of our patients, the greatest amount of fear stems from a fear of the unknown. I hope that the information on this page helps reduce some anxiety, should you have any.

Most of us have experienced some type of toothache over the course of our lifetime, and the number of reasons for this discomfort are so great that I cannot expound on all of them here. Often, the first idea that comes to mind is, “Uh oh, I have a cavity.”

To understand the source of a toothache, it is first important to understand the anatomy of a tooth. Our teeth are living entities, complete with nerves and a blood supply to keep them healthy. Underneath the enamel of the crowns that we brush is another hard (but more yellow) mineral substance called dentin. Dentin is composed of thousands of microscopic pores which communicate with the nerves inside our teeth. When these “windows” are exposed, they produce sensitivity to heat, cold, sweets or other stimuli. Such pores are also prominent in the roots of our teeth since our roots do not have an outer enamel coating.

Cavities are certainly one way to expose the dentin of our teeth, essentially when bacteria tunnel holes through the enamel of our teeth. Fracturing enamel or losing an old filling may also expose the tubules which can cause discomfort. If you have gum recession, which exposes more of the roots of your teeth, there may be exposure for this reason and often painting a sealant on such teeth is all that is needed.

Our teeth may hurt for other reasons as well and include more extensive etiologies such as infection, trauma or mobility. We have all heard of a dental abscess and these occur when a tooth gets infected and builds up pressure around the root of a tooth. As with any infection in our body, it is very important to have this treated by a medical professional. Trauma comes in many sorts, including long term self-induced trauma such as bruxism, or grinding of your teeth. When we grind our teeth, we create forces which not only wear away the enamel on our teeth, but also can cause gum recession and irritate the tissues and ligaments around our teeth. There are several devices and treatments available which can alleviate these symptoms as well. Sometimes, mobile teeth can also cause irritation. Stabilizing these teeth (e.g., splinting to adjacent teeth) may be a treatment option. If you have impacted wisdom teeth, their “movement,” or eruption, may also be a cause.

Teeth are not the only sources of toothaches. If the ligaments or gums around your teeth are irritated, you may be interpreting this as a toothache as well. Such inflammation may be reduced by a dental cleaning and improved home dental hygiene. Even less obvious reasons for toothaches include causes of referred pain. This occurs when nerves in other parts of our body are irritated and our nervous system interprets this as a toothache. Rarely, heart disease or myocardial infraction can create a toothache in lower molars and must certainly be considered by the dentist if no other reasons for a toothache are apparent. Another example of referred pain is when a patient has an earache due to a cavity in a lower molar.

I hope that this information alleviates some anxiety you might be having about dental treatments. It is impossible to know the definitive causes of a toothache without a complete dental exam.

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